Meta-analysis of the use of Chinese martial arts training for alleviating cancer-related fatigue in cancer survivors

Abstract

Cancer was the second leading cause of death worldwide in 2018 according to WHO. The disease burden continues to grow and has tremendous impacts on families and healthcare systems. Cancer-related fatigue is one of the most distressing symptoms experienced by cancer patients and has adverse impacts on the patients' quality of life and functioning. Both pharmacological and non-pharmacological interventions could be adopted to tackle cancer-related fatigue. Among non-pharmacological interventions, exercise training is recommended by various authorities, such as the American College of Sports Medicine and the National Comprehensive Cancer Network, to manage cancer-related fatigue. In particular, resistance training with moderate-intensity exercise has been proven to be the most effective intervention for alleviating cancer-related fatigue. Chinese martial art that includes moderate-intensity physical training with a strong mind–body component is believed to offer mental well-being and stress reduction benefits in addition to the benefits of traditional resistance training, thus potentially enhancing the overall quality of life of cancer patients. This systematic review and meta-analysis aimed to identify the effectiveness of Chinese martial arts training in reducing cancer-related fatigue in cancer patients. Sixteen randomised controlled trials (RCTs) with 1365 cancer patients were included in this systematic review and meta-analysis. All of the included studies had implemented either Tai Chi or Baduanjin as the martial arts training intervention. The results of the meta-analysis showed that the overall effects of the trainings were not significant (standardised mean difference [SMD]: −0.23, 95% confidence interval [CI]: −0.57 to 0.11, p = 0.19). In the sub-group analysis, martial arts training administered over a shorter intervention period (less than 12 weeks) was found to yield a significant medium-to-large pooled effect size on the reduction of cancer-related fatigue (SMD: −0.77, 95% CI: −1.54 to −0.01, p = 0.05).