Cardiovascular training versus resistance training for fatigue in people with cancer

Background With prevalence estimates between 50% and 90% of people with cancer, cancer‐related fatigue is one of the most common morbidities related to cancer and its treatment. Exercise is beneficial for the treatment of cancer‐related fatigue. However, the efficacy of different types of exercise (i.e. cardiovascular training and resistance training) have not yet been investigated systematically and compared directly in a meta‐analysis. Objectives To compare the benefits and harms of cardiovascular training versus resistance training for treatment or prevention of cancer‐related fatigue in people with cancer. Search methods We searched CENTRAL, MEDLINE, Embase, and five other databases in January 2023. We searched ClinicalTrials.gov and the International Clinical Trials Registry Platform for ongoing trials. We integrated results from update searches of previously published Cochrane reviews. In total, our searches included trials from inception to October 2023. Selection criteria We included randomised controlled trials investigating cardiovascular training compared with resistance training, with exercise as the main component. We included studies on adults with cancer (aged 18 years and older), with or without a diagnosis of cancer‐related fatigue, for any type of cancer and any type of cancer treatment, with the intervention starting before, during, or after treatment. We included trials evaluating at least one of our primary outcomes (cancer‐related fatigue or quality of life). We excluded combined cardiovascular and resistance interventions, yoga, and mindfulness‐based interventions. Our primary outcomes were cancer‐related fatigue and quality of life. Our secondary outcomes were adverse events, anxiety, and depression. Data collection and analysis We used standard Cochrane methodology. For analyses, we pooled results within the same period of outcome assessment (i.e. short term (up to and including 12 weeks' follow‐up), medium term (more than 12 weeks' to less than six months' follow‐up), and long term (six months' follow‐up or longer)). We assessed risk of bias using the Cochrane RoB 1 tool, and certainty of the evidence using GRADE. Main results We included six studies with 447 participants with prostate, breast, or lung cancer who received radiotherapy or chemotherapy, had surgery, or a combination of these. All studies had a high risk of bias due to lack of blinding. Three studies had an additional high risk of bias domain; one study for attrition