School of Nursing, Putian University, 1133 Xueyuan Middle Road, Putian, Fujian, China.
College of Nursing and Midwifery, Charles Darwin University, Brisbane Centre, 410 Ann Street, Brisbane, QLD, Australia.
Support Care Cancer. 2022 Dec;30(12):10421-10440. doi: 10.1007/s00520-022-07389-5. Epub 2022 Nov 3.
OBJECTIVE: This overview of systematic reviews aims to critically appraise and consolidate evidence from current systematic reviews (SRs)/meta-analyses on the effects of exercise interventions on cancer-related fatigue (CRF) in breast cancer patients. METHODS: SRs/meta-analyses that explored the effects of exercise interventions on CRF in breast cancer patients compared with the routine methods of treatment and care were retrieved from nine databases. The methodological quality of the included SRs was appraised using A MeaSurement Tool to Assess systematic Reviews II (AMSTAR II). The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to calculate the grading of outcomes in the included SRs. The exercise type, frequency, duration, and inclusion/absence of supervision were further evaluated with subgroup analyses. The Stata 16.0 software was utilized for data analysis. RESULTS: Twenty-nine reviews were included. The overall methodological quality and level of evidence of the included reviews were unsatisfactory, with only three reviews rated as high methodological quality and no review identified as high-quality evidence. Moderate certainty evidence indicated that exercise could improve fatigue in breast cancer patients (SMD = - 0.40 [95%CI - 0.58, - 0.22]; P = 0.0001). Subgroup analysis based on the types of exercise showed that yoga (SMD = - 0.30 [95%CI - 0.56, - 0.05]; I = 28.7%) and aerobic exercise (SMD = - 0.29 [95%CI - 0.56, - 0.02]; I = 16%) had a significantly better effect on CRF in breast cancer patients; exercising for over 6 months (SMD = - 0.88 [95%CI - 1.59, - 0.17]; I = 42.7%; P = 0.0001), three times per week (SMD = - 0.77 [95%CI - 1.04, - 0.05]; I = 0%; P = 0.0001), and for 30 to 60 min per session (SMD = - 0.81 [95%CI - 1.15, - 0.47]; I = 42.3%; P = 0.0001) can contribute to a moderate improvement of CRF. Supervised exercise (SMD = - 0.48 [95%CI - 0.77, - 0.18]; I = 87%; P = 0.001) was shown to relieve CRF. CONCLUSION: Exercise played a favorable role in alleviating CRF in breast cancer. Yoga was recommended as a promising exercise modality for CRF management in the majority of the included studies. Exercising for at least three times per week with 30 to 60 min per session could be recommended as a suitable dosage for achieving improvement in CRF. Supervised exercise was found to be more effective in alleviating CRF than unsupervised exercise. More rigorously designed clinical studies are needed to specify the exact exercise type, duration, frequency, and intensity to have an optimal effect on CRF in breast cancer patients. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: CRD42020219866.
目的:本系统综述旨在批判性地评价和综合当前系统综述(SR)/荟萃分析关于运动干预对乳腺癌患者癌因性疲乏(CRF)影响的证据。
方法:从九个数据库中检索了探索运动干预对乳腺癌患者 CRF 影响的 SR/荟萃分析,这些干预措施与常规治疗和护理方法进行了比较。使用评估系统评价的测量工具 II(AMSTAR II)评估纳入 SR 的方法学质量。使用推荐评估、制定与评价(GRADE)对纳入 SR 中的结局进行分级。进一步进行了亚组分析,评估了运动类型、频率、持续时间以及是否有监督。使用 Stata 16.0 软件进行数据分析。
结果:共纳入 29 篇综述。纳入综述的整体方法学质量和证据水平均不理想,仅有 3 篇被评为高质量,且没有一篇被评为高质量证据。中等确定性证据表明,运动可以改善乳腺癌患者的疲乏(SMD=-0.40 [95%CI-0.58, -0.22];P=0.0001)。基于运动类型的亚组分析表明,瑜伽(SMD=-0.30 [95%CI-0.56, -0.05];I=28.7%)和有氧运动(SMD=-0.29 [95%CI-0.56, -0.02];I=16%)对乳腺癌患者的 CRF 有更显著的改善效果;运动时间超过 6 个月(SMD=-0.88 [95%CI-1.59, -0.17];I=42.7%;P=0.0001)、每周 3 次(SMD=-0.77 [95%CI-1.04, -0.05];I=0%;P=0.0001)和每次 30-60 分钟(SMD=-0.81 [95%CI-1.15, -0.47];I=42.3%;P=0.0001)有助于中度改善 CRF。有监督的运动(SMD=-0.48 [95%CI-0.77, -0.18];I=87%;P=0.001)可缓解 CRF。
结论:运动对缓解乳腺癌患者的 CRF 有积极作用。瑜伽被推荐为大多数纳入研究中管理 CRF 的一种有前途的运动方式。每周至少运动 3 次,每次 30-60 分钟,可以作为改善 CRF 的合适剂量。有监督的运动比无监督的运动更能有效地缓解 CRF。需要更严格设计的临床试验来明确确切的运动类型、持续时间、频率和强度,以对乳腺癌患者的 CRF 产生最佳效果。
试验注册:ClinicalTrials.gov 标识符:CRD42020219866。
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