Current evidence on traditional Chinese exercises for cancer-related fatigue: a quantitative synthesis of randomized controlled trials

IntroductionCancer-related fatigue (CRF) is the most frequent and debilitating symptom faced by cancer patients. Traditional Chinese exercises (TCEs) combine the characteristics of physical activities and psychosocial interventions for treating CRF. However, the effectiveness of TCEs on CRF management remains controversial. This systematic review was conducted to summarize the current evidence of TCEs on the management of CRF.MethodsRandomized controlled trials (RCTs) were identified in eight databases (PubMed, Embase, CENTRAL, AMED, Science Direct, Thomson Reuters Web of Science, PsyclNFO, and ALT HealthWatch). Adult cancer patients receiving TCEs combined either with or without other treatments were eligible for inclusion. TCEs were limited to widely used modalities including Tai Chi, Qigong, Baduanjin, Wuqinxi, Yijinjing, and Liuzijue. The primary outcome was CRF. Risk of bias for each of the included studies was judged based on the quality assessment method as recommended by the 2011 Cochrane Handbook. Review Manager 5.3 (RevMan 5.3) was employed to generate pooled estimates of effect size. Random-effects modelling was used to calculate pooled weighted mean differences (WMDs) or standardized mean differences (SMDs) with corresponding 95% confidence intervals (CIs). Because trial results were presented as either change scores from baseline to follow-up or only final values, meta-analyses were completed for both types of measures.ResultsNine studies with 703 patients were included. Methodological limitations were identified in the analyzed studies. When measured as the change scores at the short-term follow-up, the pooled results suggested that TCEs had a significant positive effect on CRF (SMD 1.03; 95% CI [0.61, 1.44]; P < 0.00001). Data synthesis was also performed for studies using follow-up values only, and the results indicated that TCEs failed to improve CRF, both at short-term (SMD ⿿0.00; 95% CI [⿿0.42, 0.41]; P = 0.99) and long-term follow-up (SMD 0.05; 95% CI [⿿0.26, 0.35]; P = 0.77).ConclusionsThe study findings suggest that the evidence on the effectiveness of TCEs for CRF management is inconclusive. Due to the small number of included studies and their methodological limitations, further well-designed RCTs with sufficient intervention durations and follow-up periods are needed to provide more reliable evidence.