Cancer-related fatigue is the most common and severe symptom of cancer and cancer treatment. Prevalence ranges between 50 to 90% and is associated with decreased quality of life. This systematic review aimed to estimate the effects of cardiovascular training compared to no training on fatigue and quality of life in people with cancer.

Articles were included if they were randomised controlled trials evaluating cardiovascular training in people with cancer, study samples had 20 or more per group, had at least 80% of participants aged 18 years or older with any diagnosed type and stage of cancer and any type of anti-cancer therapy; intervention was at least five sessions of structured cardiovascular exercise (i.e. aerobic training) with face-face instruction (either in person or via video). The comparator was no intervention, a minimally active intervention (e.g. progressive muscle relaxation) or usual care. Eight databases (including Cochrane Central Register of Controlled Trials, Medline and PEDro), two clinical trial registries and citation tracking were searched between 2003 and 2023. Primary outcomes were cancer-related fatigue using MFI, FACT-F or FBI and quality of life using EORTC QLQ-C30 or FACT-G. At least two reviewers independently determined eligibility, extracted data and assessed risk of bias. Disagreements were resolved through arbitration by a third reviewer. Treatment effects were quantified by calculating mean differences (MD) or standardised mean differences (SMD), both with 95% confidence intervals. The overall certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Twenty-three trials (2,135 participants) were included. The most frequent cancer diagnosis was breast cancer (57%), followed by lung (7%) and prostate (6%) cancers, ranging from Stages I to IV. Excluding studies of breast, prostate and testicular cancer, the proportion of females ranged from 27% to 100%, and the mean age ranged from 44 to 66 years. Ten trials initiated cardiovascular training during anti-cancer therapy, 13 after completing anti-cancer therapy and none before commencing anti-cancer therapy. There was a large range of exercise prescription, though the most common was individual, supervised sessions involving cycling and walking at moderate-high intensity (range low-moderate to high intensity) for three times per week (range one to five times), with a training duration of eight to 12 weeks (range three to 26 weeks).

During anti-cancer therapy, there was moderate-certainty evidence that cardiovascular training reduces cancer-related fatigue slightly in the short-term, up to 12 weeks post-intervention (6 studies, 593 participants; SMD -0.27, 95%CI -0.43 to -0.11); and has little to no difference in quality of life (6 studies, 612 participants; SMD -0.17, 95%CI -0.33 to -0.01). In the medium-term (12 to 26 weeks) and long-term (26 weeks+) post-intervention, there was very low-certainty evidence that cardiovascular training had an effect on cancer-related fatigue (1 study, 62 participants; MD 2.67, 95% CI -2.58 to 7.92; and 2 studies, 230 participants; SMD -0.04, 95% CI -0.33 to 0.22, respectively) and quality of life (1 study, 62 participants; MD 6.79, 95% CI -4.39 to 17.97; and 2 studies, 230 participants; SMD -0.08, 95% CI -0.34 to 0.18, respectively).

After anti-cancer therapy, there was very low-certainty evidence that cardiovascular training had an effect on cancer-related fatigue (6 studies, 497 participants; SMD -0.37, 95% CI -0.73 to 0.00) and quality of life (8 studies, 642 participants; SMD -0.27, 95% CI -0.54 to 0.01). In the long-term post-intervention (26 weeks+), there was very low-certainty evidence cardiovascular training had an effect on cancer-related fatigue after anti-cancer therapy (2 studies, 262 participants; SMD -0.43, 95C%CI -0.93 to 0.07) and quality of life (1 study, 201 participants; MD 3.10, 95%CI -1.12 to 7.32).

Cardiovascular training during anti-cancer therapy slightly reduces short-term cancer-related fatigue and has little to no effect on short-term quality of life (moderate-certainty evidence); whereas the effects on medium- and long-term fatigue and quality of life are uncertain. The effects of cardiovascular training after anti-cancer therapy on short- and long-term fatigue and quality of life are uncertain.

Wagner C, Ernst M, Cryns N, Oeser A, Messer S, Wender A, Wiskemann J, Baumann FT, Monsef I, Bröckelmann PJ, Holtkamp U, Scherer RW, Mishra S and Skoetz N. Cardiovascular training for fatigue in people with cancer. Cochrane Database of Systematic Reviews. 2025: Issue 2, Art No: CD015517; doi: 10.1002/14651858.CD015517.

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