The Effects of Exercise on Fatigue, Quality of Life, and Psychological Function for Men with Prostate Cancer: Systematic Review and Meta-analyses

Context: Conflicting data exists on the role of exercise interventions in patients with prostate cancer (PCa) regarding quality of life (QOL) endpoints. Objective: To evaluate the effects of exercise interventions on fatigue, QOL, depression, and anxiety in PCa patients. Evidence acquisition: We searched seven major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and Scopus) for randomized control trials (RCTs) of supervised exercise interventions for men with PCa from database inception to October 2015. For meta-analyses, studies required standardized fatigue, QOL, or mood-related scales with standard-care control groups. The effect size was measured in terms of mean difference (MD) with 95% confidence interval (CI) for continuous outcomes using a random-effects model. Statistical heterogeneity between studies was assessed using the Cochrane Q test and I-2 statistic. Evidence synthesis: We selected 13 RCTs enrolling 1057 PCa patients (mean age 69.4 +/- 2.1 yr) undergoing exercise interventions, of which eight studies involving 675 patients qualified for meta-analyses. The study duration varied from 4 wk to 6 mo. A 12-16-wk exercise intervention significantly improved fatigue symptoms (MD 4.83, 95% CI 3.24-6.43; p < 0.00001) as assessed according to the Functional Assessment of Cancer Therapy (FACT)-Fatigue scale. Fatigue remained improved at 6 mo (MD 3.60, 95% CI 2.80-5.12; p < 0.00001). Furthermore, exercise interventions improved QOL measured using the FACT-General (MD 3.93, 95% CI 1.37-5.92; p = 0.003) and FACT-Prostate (MD 3.85, 95% CI 1.25-6.46; p = 0.04) scales. The pooled data did not reveal a significant improvement in depression or anxiety. Conclusions: Combined evidence from RCTs shows improvement in QOL and fatigue according to FACT scales. No significant differences in depression or anxiety were observed. Patient summary: Exercise improves fatigue and quality-of-life outcomes in patients with prostate cancer. Further studies are necessary to identify patient-specific exercise regimens to optimize these benefits. (C) 2016 European Association of Urology. Published by Elsevier B.V. All rights reserved.