Effects of Exercise on Cancer-related Fatigue and Quality of Life in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Meta-analysis of Randomized Clinical Trials

doi:10.24920/J1001-9242.2007.002

Abstract

Objective To gain insight on how exercise affects the outcomes of prostate cancer patients treated with androgen deprivation therapy, specifically cancer-related fatigue (CRF) and quality of life (QoL).Methods Systematic searches for randomized clinical trials (RCTs) evaluating the effects of exercise on CRF and QoL of prostate cancer patients receiving androgen deprivation therapy were carried out to identify the eligible studies from EMBASE, PubMed and Cochrane library. Related data were extracted from eligible studies and then subjected to Reviewer Manage 5.3 for analysis. Standardized mean differences (SMD) and its 95% confidence interval (CI) were calculated.Results In all, 10 RCTs involving 841 prostate cancer patients (448 of whom exercised and 393 did not) were included in this study. With respect to CRF, there was good consistency among different studies, and it was remarkably reduced in the exercise group (SMD=-0.32, 95% CI: -0.45 to -0.18, P<0.00001, n=784). In regards to QoL, there was also good consistency among different studies, and it was also improved significantly in the exercise group (SMD=0.21, 95% CI: 0.08 to 0.34, P=0.002, n=841).Conclusion Exercise both reduced CRF and improved QoL in prostate cancer patients receiving androgen deprivation therapy.

Key words: exercise, cancer related fatigue, prostate cancer, androgen deprivation therapy, meta-analysis

Yang Bo, Wang Jiansheng. Effects of Exercise on Cancer-related Fatigue and Quality of Life in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: A Meta-analysis of Randomized Clinical Trials[J].Chinese Medical Sciences Journal, 2017, 32(1): 13-21.

Figures/Tables 5

Figure 1.

Table 1

Characteristics of included studie"

Studies	Sample size	Mean age^§ (yrs)	ADT status	Exercise interventions	Control interventions	Outcome measures	Follow-up
Bourke et al¹⁸	Exercise: 25 Control: 25	71.3±6.4 72.2±7.7	≥6 months ADT	12-week lifestyle intervention combined with supervised and self-directed exercise with dietary advice	Usual care	Fatigue [FACT-F] QoL [FACT-P]	12 weeks
Bourke et al¹⁹	Exercise: 43 Control: 43	71±6 71±8	≥6 months ADT	12-week lifestyle intervention consisting of aerobic and resistance exercise with parallel dietary advice	Usual care	Fatigue [FACT-F] QoL [FACT-P]	12 weeks
Buffart et al²⁰	Exercise: 29 Control: 28	69.7±7.3 70.1±7.3	≥2 months ADT	12-week lifestyle intervention consisting of aerobic and resistance exercise (program of chest press, seated row, shoulder press, triceps extension, leg press, leg extension, leg curl, and abdominal crunch)	Usual care	Fatigue [EORTC, QLQ-C30] QoL [SF-36]	12 weeks
Cormie et al²¹	Exercise: 32 Control: 31	69.6±6.5 67.1±7.5	≥3 months ADT	Twice weekly exercise sessions for 3 months consisting of an aerobic and resistance exercise program with parallel dietary advice	Usual care	Fatigue [FACT-F] QoL [SF-36]	3 months
Culos-Reed et al¹¹	Exercise: 53 Control: 476	67.2±8.8 68.0±8.4	≥6 months ADT	16-week supervised and unsupervised program of walking, stretching, light resistance and core strengthening	Usual care	Fatigue [FSS] QoL [EORTC-QOLC-30]	16 weeks
Galvão et al²²	Exercise: 29 Control: 28	69.5±7.3 70.1±7.3	≥2 months ADT, Continuing for subsequent 6 months	12-week combined progressive resistance and aerobic training	Usual care	QoL [SF-36]	12 weeks
Studies	Sample size	Mean age^§ (yrs)	ADT status	Exercise interventions	Control interventions	Outcome measures	Follow-up
O’Neill et al²³	Exercise: 47 Control: 47	69.7±6.8 69.9±7.0	≥6 months ADT	Walk at a brisk pace for at least 30 minutes per day, five or more days per week in line with UK physical activity guidelines for 6 months, and consume a diet commensurate with UK healthy eating guidelines	Usual care	Fatigue [FSS] QoL [FACT-P]
Segal et al²⁴	Exercise: 82 Control: 73	68.2±7.9 67.7±7.5	≥3 months ADT	12-week program of 9 strength training exercises carried out under supervision 3 times per week	Usual care	Fatigue [FACT-F] QoL [FACT-P]	12 weeks
Segal et al²⁵	Resistance exercise: 40 Aerobic exercise: 40 Control: 41	66.4±7.6 66.2±6.8 65.3±7.6	≥16 weeks ADT	Resistance exercise: 24-week program of three sessions per week performing two sets of 8-12 repetitions of 10 different exercises Aerobic exercise: 24-week program of three sessions per week with a cycle ergometer, treadmill, or elliptical trainer, beginning at 50% to 60% of the predetermined peak oxygen consumption (VO_2peak) for weeks 1 to 4, progressing to 70%-75% for weeks 5 to 24	Usual care	Fatigue [FACT-F] QoL [FACT-G]	24 weeks
Nilsen et al²⁶	Exercise: 28 Control: 30	66 (range, 54-76) 66 (range, 54-76)	2-6 months after the initiation of neo-adjuvant ADT, followed by 9-36 months adjuvant ADT	16-week program of 9 strength training exercises carried out under supervision 3 times per week	Usual care	Fatigue [EORTC-QOLC-30] QoL [EORTC-QOLC-30]	16 weeks

Table 1

Figure 2.

Figure 3.

Table 3

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Omitting study	CRF (fixed model)
Omitting study	SMD (95% CI), P heterogeneity, I², n	SMD (95% CI), P heterogeneity, I², n
Bourke et al¹⁸	-0.28 (-0.42 to -0.14), 0.32, 14%, 734	0.20 (0.07 to 0.34), 0.53, 0, 791
Bourke et al¹⁹	-0.31 (-0.45 to -0.16), 0.09, 41%, 698	0.18 (0.04 to 0.32), 0.68, 0, 755
Buffart et al²⁰	-0.27 (-0.41 to -0.13), 0.48, 0, 727	0.19 (0.05 to 0.33), 0.63, 0, 784
Cormie et al²¹	-0.32 (-0.46 to -0.17), 0.09, 42%, 721	0.24 (0.1 to 0.38), 0.81, 0, 778
Culos-Reed et al¹¹	-0.33 (-0.48 to -0.18), 0.09, 41%, 684	0.20 (0.06 to 0.34), 0.51, 0, 741
Galvão et al²²	-	0.19 (0.05 to 0.33), 0.63, 0, 784
O’Neill et al²³	-0.32 (-1.47 to -0.17), 0.09, 42%, 690	0.23 (0.09 to 0.37), 0.60, 0, 747
Segal et al²⁴	-0.36 (-0.51 to -0.21), 0.14, 34%, 629	0.22 (0.07 to 0.36), 0.51, 0, 686
Segal et al²⁵	-0.32 (-0.48 to -0.17), 0.06, 49%, 663	0.22 (0.07 to 0.36), 0.41, 2%, 720
Nilsen et al²⁶	-0.34 (-0.49 to -0.20), 0.15, 33%, 726	0.22 (0.08 to 0.36), 0.55, 0, 783

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