Beneficial Exercises for Cancer-Related Fatigue among Women with Breast Cancer: A Systematic Review and Network Meta-Analysis

SIMPLE SUMMARY: In this study, the aim of conducting the network meta-analysis (NMA) was to explore the efficacy of different exercises and their respective ranks in the context of reducing cancer-related fatigue (CRF) in women with breast cancer (BC) during the inter-treatment and post-treatment periods. We found that yoga, resistance exercise, and aerobic resistance were the top three recommended exercise modes for the purposes of reducing CRF during the inter-treatment period among women with BC; moreover, Qigong ranked last in terms of efficacy. Yoga, aerobic yoga, and aerobic resistance were the top three exercise options that should be performed in order to relieve CRF during the post-treatment period; conversely, relaxation ranked last in this respect. Aerobic plus resistance, resistance exercise, and yoga were conducted via using a supervisor, as well as short-time sessions. Objective measures are recommended in order to examine the causal relationship of vigorous exercise or yoga on physical functions. This was performed in order to obtain clarity in respect to the optimal therapeutic management strategies that will best aid with the reduction in CRF among women with BC. ABSTRACT: Context: Cancer-related fatigue (CRF) is the most common cause of physical powerlessness in women with breast cancer (BC). The practice of continuous effective exercise is beneficial with respect to reducing CRF. Objective: To explore exercise efficacy and respective ranks with respect to reducing CRF in women with BC within the inter-treatment and post-treatment periods. Methods: Throughout this systematic review and network meta-analysis, articles published from 2000 to March 2022 were included. Article searches were conducted on the MEDLINE, Embase, CINAHL, and CENTRAL databases. Adult women with BC and different exercise programs were compared with those involved in regular care as a control during or after treatment. In addition, randomized controlled trials (RCT) were also included. A risk-of-bias assessment, with the revised Cochrane risk-of-bias tool regarding RCT and probability-based ranking, was established based on the surface under the cumulative rank (SUCRA) method via network meta-analysis. Results: a total of 5747 women with BC followed seven exercise interventions. Yoga (SMD = −0.54, 95% CI [−0.86, −0.22]) was ranked first (94.5%), with significant effects in respect of mitigating CRF, followed by resistance exercise (66.2%), and aerobic resistance (63.3%), while Qigong ranked last (22.2%) among the 36 RCT in inter-treatment. Aerobic resistance exercise (SMD = −0.52, 95% CI [−0.98, −0.07]) induced significant effects in respect of mitigating CRF in the 38 RCTs in the post-treatment period. Yoga, aerobic yoga, and aerobic resistance exercise ranked as the top three (75.5%, 75.0%, and 72.4%, respectively), whereas relaxation ranked last (38.8%) in the post-treatment period. Conclusion: Yoga, aerobic resistance, and aerobic yoga are recommended for the purposes of inter- and post-treatment exercise to reduce CRF in women with BC by enhancing their physical resilience and long-term quality of life.