The effect of exercise on cancer-related pain: A systematic review with meta-analysis

Abstract

Aims: To evaluate the effect of exercise interventions on cancer-related pain among people with cancer.

Methods: An electronic search was undertaken for exercise studies measuring pain in people with cancer that were published up to September 2021. All stages of screening and data extraction were conducted independently by two researchers. The Cochrane risk-of-bias tool for randomised trials (RoB 2) was used to assess study risk of bias and overall quality of the evidence was assessed using the GRADE approach. Meta-analyses were performed to evaluate the effect of exercise on pain and pain-associated symptoms. Planned subgroup analyses were performed to assess the potential for effect modification on exercise-related (mode, intervention duration, degree of supervision), and patient-related (type of pain, cancer type, stage of treatment) features. The protocol for this review was prospectively registered on PROSPERO (CRD42021266826).

Results: Sixty studies, with a total of 4908 participants, were included in this review. Most studies were conducted in women with breast cancer (n = 28 studies), followed by prostate cancer (n = 7 studies). The meta-analysis of exercise compared to non-exercise or usual care groups at the last follow-up revealed a reduction in pain favouring the exercise group (standardised mean difference (SMD) −0.43; 95% confidence interval (CI): −0.60, −0.27), as well as for intensity of neuropathic symptoms (SMD −0.53; 95% CI: −0.98, −0.08) and for pain interference (SMD −0.38; 95% CI: −0.66, −0.10). For most of the subgroup analyses (96%), the direction of the exercise effect was consistent and favoured exercise, with effect sizes ranging from small to large (effect size range: −0.01 to −1.36).

Conclusions: Findings support the use of exercise therapy to manage cancer-related pain for the wider cancer population, irrespective of exercise mode, length of intervention, degree of supervision, stage of cancer treatment, or type of pain.