Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract · 2025
Comparative effectiveness of exercise modalities on psychological outcomes and quality of life in digestive system cancer survivors: a systematic review and network meta-analysis.
СтатьяСистематический обзорМетаанализСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Li Jiaqi, Zhang Qian, Ning Wei, Wang Zhenzi
Аннотация
BACKGROUND: Survivors of digestive system cancers frequently experience depression, anxiety, fatigue, and impaired health-related quality of life (HRQoL). Exercise has emerged as a promising adjunctive therapy. However, the optimal modality and prescription remain unclear. This study aimed to evaluate the effects of exercise on psychological outcomes and HRQoL, to rank the relative efficacy of different modalities, and to identify optimal exercise characteristics through subgroup analyses.
METHODS: PubMed, Embase, CENTRAL, Web of Science, and Google Scholar were searched until August 31, 2025, for randomized controlled trials (RCTs) of exercise interventions in adult survivors of digestive system cancers. Eligible comparators included usual care, no intervention, or alternative exercise. The primary outcomes were HRQoL, fatigue, depression, and anxiety, which were measured using validated instruments. The standardized mean differences (SMDs) with 95% CIs were used as effect estimates. Pairwise meta-analyses were performed with random-effects models, and Bayesian network meta-analysis was used to compare exercise modalities. Subgroup analyses were used to examine moderators, including cancer type, exercise intensity, frequency, session duration, and intervention length.
RESULTS: A total of 38 RCTs that involved 3255 participants were included. The exercise group significantly had improved HRQoL (SMD, 0.43 [95% CI, 0.27-0.59]) and reduced fatigue (SMD, -0.52 [95% CI, -0.72 to -0.32]), depression (SMD, -0.37 [95% CI, -0.58 to -0.15]), and anxiety (SMD, -0.33 [95% CI, -0.44 to -0.21]) compared with the control group. Network meta-analysis indicated that mind-body exercise (such as yoga or tai chi) was most effective for HRQoL (SMD, 0.68 [95% CI, 0.22-1.14]) and depression (SMD, -0.55 [95% CI, -0.95 to -0.16]), resistance training for fatigue (SMD, -0.79 [95% CI, -1.35 to -0.23]), and combined training (CT) for anxiety (SMD, -0.38 [95% CI, -0.53 to -0.23]). Subgroup analyses showed that moderate-intensity, moderate-frequency, and medium-to-long interventions produced the most consistent benefits.
CONCLUSION: Exercise interventions significantly improved HRQoL and reduced depression, anxiety, and fatigue in survivors of digestive system cancers. Mind-body exercise (eg, yoga or tai chi) demonstrated the greatest benefits for HRQoL and depression, resistance training best alleviated fatigue, and CT reduced anxiety. Moderate-intensity, sustained programs achieved the most consistent benefits, supporting individualized exercise prescriptions in survivorship care.
METHODS: PubMed, Embase, CENTRAL, Web of Science, and Google Scholar were searched until August 31, 2025, for randomized controlled trials (RCTs) of exercise interventions in adult survivors of digestive system cancers. Eligible comparators included usual care, no intervention, or alternative exercise. The primary outcomes were HRQoL, fatigue, depression, and anxiety, which were measured using validated instruments. The standardized mean differences (SMDs) with 95% CIs were used as effect estimates. Pairwise meta-analyses were performed with random-effects models, and Bayesian network meta-analysis was used to compare exercise modalities. Subgroup analyses were used to examine moderators, including cancer type, exercise intensity, frequency, session duration, and intervention length.
RESULTS: A total of 38 RCTs that involved 3255 participants were included. The exercise group significantly had improved HRQoL (SMD, 0.43 [95% CI, 0.27-0.59]) and reduced fatigue (SMD, -0.52 [95% CI, -0.72 to -0.32]), depression (SMD, -0.37 [95% CI, -0.58 to -0.15]), and anxiety (SMD, -0.33 [95% CI, -0.44 to -0.21]) compared with the control group. Network meta-analysis indicated that mind-body exercise (such as yoga or tai chi) was most effective for HRQoL (SMD, 0.68 [95% CI, 0.22-1.14]) and depression (SMD, -0.55 [95% CI, -0.95 to -0.16]), resistance training for fatigue (SMD, -0.79 [95% CI, -1.35 to -0.23]), and combined training (CT) for anxiety (SMD, -0.38 [95% CI, -0.53 to -0.23]). Subgroup analyses showed that moderate-intensity, moderate-frequency, and medium-to-long interventions produced the most consistent benefits.
CONCLUSION: Exercise interventions significantly improved HRQoL and reduced depression, anxiety, and fatigue in survivors of digestive system cancers. Mind-body exercise (eg, yoga or tai chi) demonstrated the greatest benefits for HRQoL and depression, resistance training best alleviated fatigue, and CT reduced anxiety. Moderate-intensity, sustained programs achieved the most consistent benefits, supporting individualized exercise prescriptions in survivorship care.