Introduction
Methods
Protocol and registration
Eligibility criteria
Information sources and search strategy
Medline/Pubmed | CINAHL/PsycINFO | |
---|---|---|
Colorectal cancer | “Colorectal Neoplasms”[Mesh] OR Colorectal cancer[tiab] OR colorectal neoplasm*[tiab] OR colon cancer[tiab] OR rectal cancer[tiab] OR colon neoplasm*[tiab] OR rectal neoplasm*[tiab] OR bowel cancer[tiab] OR gastrointestinal cancer[tiab] OR gastrointestinal neoplasm*[tiab] OR cancer [tiab] | (MH “Colorectal Neoplasms+”) OR (MH “Colonic Neoplasms+”) OR TX (“colorectal cancer”) OR TX (“colon cancer”) OR TX (“rectal cancer”) |
Physical activity | “Exercise”[Mesh] OR Exercise*[tiab] OR physical activit*[tiab] OR walk*[tiab] OR jog*[tiab] OR run*[tiab] OR move*[tiab] OR active lifestyle*[tiab] OR sport*[tiab] OR lifestyle intervention*[tiab] OR resistance training [tiab] OR sedentary behavior [tiab] | (MH “Exercise+”) OR TX (“exercise”) OR (MH “Recovery, Exercise”) OR (MH “Aerobic Exercises+”) OR (MH “Resistance Training”) OR (MH “Therapeutic Exercise+”) OR (MH “Aquatic Exercises”) OR (MH “Anaerobic Exercises”) OR (MH “Exercise Intensity”) OR (MH “Sports Nutritional Sciences”) OR (MH “Physical Activity”) OR (MH “Activity Therapy (Iowa NIC)”) OR (MH “Physical Activity (Omaha)”) OR (MH “Activity and Exercise Enhancement (Iowa NIC)+”) OR (MH “Physical Endurance+”) OR (MH “Physical Performance”) OR (MH “Physical Fitness+”) OR TX (“Physical activity”) OR (MH “Life Style Changes”) OR (MH “Life Style, Sedentary”) OR TX (“Lifestyle”) OR ((DE “Physical Activity” OR DE “Actigraphy” OR DE “Exercise” OR DE “Physical Fitness”) OR (DE “Exercise” OR DE “Aerobic Exercise” OR DE “Weightlifting” OR DE “Yoga”)) OR (DE “Activity Level”) |
Fatigue | “Fatigue”[Mesh]) OR “Questionnaires”[Mesh]) OR “Quality of Life”[Mesh] OR Questionnaire*[tiab] OR HRQOL[tiab] OR fatigue[tiab] OR quality of life[tiab] OR qol[tiab] OR daily activit*[tiab] OR performance[tiab] OR function*[tiab] OR health related quality of life [tiab] OR tiredness [tiab] OR FACT-F OR BFI OR FFIS OR CFS OR FSI OR MFI OR MFSI-SF OR EORTS QLQ-C30 OR CRDFS OR MAF OR FSS OR FIB | (MH “Fatigue+”) OR TX (“Fatigue”) OR (MH “Cancer Fatigue”) OR (MH “Mental Fatigue”)OR (MH “Quality of Life+”) OR TX (“HRQoL”) OR TX (“QoL”) OR TX(“Quality of Life”) OR TX (“Health Related Quality of Life”) or TX (“tiredness”) OR TX (“performance”) OR (DE “Fatigue”) OR (DE “Quality of Life” OR DE “Quality of Work Life”) |
Data collection
Statistical analysis for meta-analysis of randomized controlled trials
Risk of bias assessment
Results
Selection of articles
Randomized controlled trials
Patients
Study | Treatment | Age; % female | Time since treatment | Sample size; dropouts | In- and exclusion criteria | Intervention (I) and control (C) | Primary outcome | Fatigue questionnaire | Timing of measurements |
---|---|---|---|---|---|---|---|---|---|
Bourke et al. | S | 69 (52–80)*; 33% female | 6–24 months |
n = 18 (I: 9, C: 9); Dropout: 6% (n = 1) | Inclusion: Histologically confirmed colon cancer (Dukes A-C) resected 6–24 months previously. Exclusion: (1) Participation in regular physical activity (30 min/3× a week). (2) Karnofsky rating < 80. (3) Unstable angina (4). Uncontrolled hypertension. (5) Recent myocardial infarction. (6) Pacemaker | I: 12 weeks at home and supervised. First 6 weeks: 2 group sessions with 30 min aerobic at 55–85% of age predicted max HR and 2–4 set of 8–12 reps of resistance. Final 6 weeks: 1 supervised session, 2 sessions at home. Dietary seminars with focus on healthy eating C: Care as usual | Exercise behavior (Godin Leisure Score Index) | FACT-F | 12 weeks |
Courneya et al. | S, S + RT, S + CT, S + RT + CT | 60.32 ± 10,42; 42% female | < 3 months |
n = 102 (I: 33, C: 69); Dropout: 9% (n = 9) | Inclusion: (1) Surgery for CRC in past 3 months. (2) Recovery from surgery as indicated by physician. (3) Ability to understand and provide written info and IC in English. (4) Passed the revised Physical Activity Readiness Questionnaire (rPAR-Q) Exclusion: Contraindications as determined by submaximal cardiorespiratory fitness test | I: 16 weeks home-based personalized exercise program that took into account their baseline fitness test results, exercise history, performance status, adjuvant therapy, and personal preferences. Focuses on improving wellbeing by cardiovascular and flexibility exercises. Participants were allowed to choose the mode of exercise preferred (e.g., swimming, cycling), otherwise walking. Goal: 3–5 times/week for 20–30 min at 65–75% of predicted HR max. Weekly telephone calls to monitor. C: Asked not to initiate structured physical activity | Quality of Life (FACT-C) | FACT-F | 16 weeks |
Cramer et al. | S, RT, CT | 68.3 ± 6.7; 38.9% female | 2–48 months |
n = 54 (I: 27; C: 27); Dropout: 20% (n = 11) | Inclusion: (1) At least 18 years old. (2) Surgically treated for histologically confirmed non-metastatic CRC (stage I–III). (3) 2–48 months post-surgery Exclusion: (1) Physical disability precluding even light yoga activity. (2) Further active oncological diseases. (3) Diagnosed and pharmacologically treated psychiatric disorder except cancer-related depression. (4) Pregnancy. (5) Breastfeeding. (6) Regular yoga practice within 12 month prior to start study | I: 10 weeks of weekly 90-min classes of traditional hatha yoga. Led by classified hatha yoga instructors with longstanding experience. Participants were encouraged to practice yoga at home. C: Waitlist: offered program after 22 weeks | Quality of Life (FACT-C) | FACT-F | 10 weeks 22 weeks |
Hawkes et al. | S, RT, CT | 66.4 ± 10,1; 46% female | < 12 months |
n = 410 (I: 205, C: 205); Dropout: 21% (n = 88) | Inclusion: (1) > = 18 years, residing in Queensland. (2) Histologically confirmed diagnosis of CRC within previous 12 months. (3) Understand and provide IC. (4) A telephone Exclusion: (1) Metastatic disease. (2) Medical conditions limiting adherence to an unsupervised PA program. (3) < one poor health behavior | I: 6 months: 11 telephone interviews, a participant handbook, a pedometer, motivational postcard prompts. Based on Acceptance Commitment Therapy. Telephone session addressed: cancer experience, CRC-related symptoms, ACT components in relation to lifestyle behaviors and strategies to improve health behaviors. Experienced health coaches. Participants were encouraged to achieve 10,000 steps per day and monitor their steps. C: Care as usual | Quality of Life (SF-36) | FACT-F | 6 months 12 months |
Pinto et al. | S, RT, CT | 57.3 ± 9.7; 57% female | < 5 years |
n = 46 (I: 20, C: 26); Dropout: 7% (n = 3) | Inclusion: (1) > = 18 years. (2) Completed primary and adjuvant treatments for colon or rectal cancer. (3) < = 5 years since treatment. (4) Able to read and speak English. (4) Consent for medical chart review. (5) Able to walk unassisted. (5) Sedentary over past 6 months. (6) Access to telephone Exclusion: (1) Prior history of cancer. (2) Medical or current psychiatric illness | I: 3 months: Participants received in-person instructions on how to exercise at moderate levels. Were given home exercise logs and a pedometer to wear during exercise. Goals: 10 min on at least 2 days/week, goals gradually increased to 30 min on at least 5 days/week. Weekly call to monitor and counseling (personalized goal-setting) C: Weekly calls to monitor symptoms. Received CRC survivorship tip sheets | Physical activity (7-day Physical Activity Recall) | FACT-F | 3 months 6 months 12 months |
Study | Baseline characteristics | Fatigue outcome (FACT-F score), mean (SD) | ||||||||
---|---|---|---|---|---|---|---|---|---|---|
Intervention | Control | Intervention | Control | |||||||
Bourke et al. | Age, mean (SD) | 67.9 | (5.7) | 70.3 | (8.7) | Baseline | 43 | (7) | 42 | (9) |
% female | 44.4 | 22.2 | 12 weeks | 48 | (4) | 43 | (6) | |||
Time since treatment (months) | 16.4 | 16.7 | ||||||||
Courneya et al. | Age, mean (SD) | 59.92 | (10.73) | 61.13 | (9.93) | Baseline | 38.9a
| (10.1) | 40.1a
| (10.8) |
% female | 45.2 | 35.5 | 16 weeks | 39.3a
| (10.9) | 39.9a
| (10.8) | |||
Time since treatment (days) | 74.65 | (34.02) | 71.65 | (18.08) | ||||||
Moderate exercise (min/week)c
| 68.87 | (97.57) | 77.98 | (137.01) | ||||||
Cramer et al. | Age, mean (SD) | 68.70 | (9.13) | 67.81 | (10.37) | Baseline | 42.70 | (9.19) | 40.13 | (7.72) |
% female | 37.0 | 40.7 | 10 weeks | 43.02 | (6.52) | 40.45 | (8.04) | |||
Time since treatment (months) | 21.41 | (11.51) | 24.11 | (14.59) | 22 weeks | 43.12 | (7.28) | 40.10 | (9.46) | |
Hawkes et al. | Age, mean (SD) | 64.9 | (10.8) | 67.8 | (9.2) | Baseline | 38.5 | (10.7) | 39.7 | (9.9) |
% female | 48.3 | 43.9 | 6 months | 42.1 | (7.8) | 41.9 | (8.0) | |||
Time since diagnosis (months) | 6.0 | (2.3) | 6.3 | (2.5) | 12 months | 42.4 | (8.8) | 42.6 | (7.7) | |
MVPA (min/week)d
| 58.9 | (132.9) | 52.0 | (112.5) | ||||||
Pinto et al. | Age, mean (SD) | 59.5 | (11.2) | 55.6 | (8.24) | Baseline | 40.7 | (8.7) | 37.9 | (10.6) |
% female | 60 | 54 | 3 monthsb
| 42.2 | (5.8) | 41.9 | (5.7) | |||
Time since diagnosis (years) | 3.14 | (1.62) | 2.88 | (1.67) | 6 monthsb
| 43.3 | (5.0) | 40.1 | (5.8) | |
PA recall (min/week)e
| 37.6 | (72.5) | 28.7 | (31.5) | 12 monthsb
| 42.3 | (5.0) | 41.8 | (5.6) |