多模态运动干预对癌症患者癌因性疲乏和生活质量影响的Meta分析

Meta-Analysis of the Effects of Multimodal Exercise Interventions on Cancer-Related Fatigue and Quality of Life in Cancer Patients

摘要: 背景：癌因性疲乏是癌症患者最常见的伴随症状之一，严重影响患者的生活质量和治疗依从性。多模态运动(结合有氧运动与抗阻训练等多种运动模式)作为一种非药物干预手段，其对癌因性疲乏的改善效果尚存在争议，且近年来新增多项随机对照试验。目的：系统评价多模态运动干预对癌症患者癌因性疲乏及生活质量的改善效果。并分别按年龄、癌症类型和偏倚风险等级进行亚组分析，探索异质性的潜在来源。方法：计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国知网(CNKI)和万方数据库(WanFang Data)，检索时限为建库至2026年2月。纳入关于多模态运动干预改善癌症患者疲乏的随机对照试验，由两名研究者独立进行文献筛选、数据提取和偏倚风险评估。采用Stata 16.0和RevMan 5.4软件进行Meta分析。结局指标包括癌因性疲乏评分和生活质量评分，效应量采用标准化均数差及其95%置信区间表示。采用亚组分析比较不同年龄组(<65岁vs ≥65岁)、不同癌症类型(乳腺癌vs多种癌症类型)以及不同偏倚风险等级(中等风险vs低风险)之间的效应差异。结果：共纳入13项随机对照试验，包括1509例癌症患者。Meta分析结果显示：① 疲乏改善：多模态运动干预可显著降低癌症患者的疲乏水平，合并效应量为[SMD = −0.96, 95% CI (−1.41, −0.51), P < 0.01]，研究间存在高度异质性(I² = 93.8%)。② 生活质量改善：多模态运动干预可显著提升患者的生活质量，合并效应量为[SMD = 1.04, 95% CI (0.86, 1.22), P < 0.01]，研究间存在中度异质性(I² = 61.1%)。亚组分析显示：① 年龄亚组：≥65岁患者疲乏改善效果(SMD = −1.29)优于<65岁患者(SMD = −0.59)；② 癌症类型亚组：乳腺癌患者(SMD = −0.66)从干预中获益显著，而多种癌症类型混合患者(SMD = 0.09)效果无统计学意义；③ 偏倚风险亚组：中等风险研究的合并效应量(SMD = −0.96)与总体效应量一致。敏感性分析显示结果稳健。Egger检验未发现明显发表偏倚(t = 0.22, P = 0.829)。结论：当前证据表明，多模态运动干预可有效改善癌症患者的癌因性疲乏症状并提升生活质量。亚组分析提示，该干预在老年患者和乳腺癌患者中效果更为显著，而癌症类型是影响干预效果的重要因素。受纳入研究数量和质量的限制，上述结论仍需更多高质量、大样本的随机对照试验加以验证。

Abstract: Background: Cancer-related fatigue (CRF) is one of the most prevalent and distressing symptoms experienced by cancer patients, severely impairing their quality of life and treatment compliance. Multimodal exercise, defined as a combination of aerobic and resistance training, has emerged as a promising non-pharmacological intervention. However, its efficacy remains controversial, and recent years have seen the publication of multiple new randomized controlled trials (RCTs). Objective: To systematically evaluate the effects of multimodal exercise interventions on CRF and quality of life (QOL) in cancer patients. Additionally, we will explore potential sources of heterogeneity through subgroup analyses based on age, cancer type, and risk of bias. Methods: A systematic search was conducted across PubMed, Embase, Cochrane Library, Web of Science, CNKI, and WanFang Data from inception to February 2026. RCTs investigating multimodal exercise interventions for cancer-related fatigue were eligible for inclusion. Two reviewers independently performed literature screening, data extraction, and risk of bias assessment using the RoB 2.0 tool. Meta-analysis was performed using Stata 16.0 and RevMan 5.4 software. Outcomes included CRF scores and QOL scores, with effect sizes expressed as standardized mean differences (SMD) and 95% confidence intervals (CI). Subgroup analyses were conducted to compare effects between different age groups (<65 vs. ≥65 years), cancer types (breast cancer vs. mixed cancers), and risk of bias levels (moderate vs. low). Results: Thirteen RCTs comprising 1509 cancer patients were included. The main analysis for CRF included 11 RCTs, excluding Steindorf (2014) which examined pure resistance training, and Li Chunyan (2024) which involved non-cancer populations. Meta-analysis showed that multimodal exercise significantly reduced CRF (SMD = −0.96, 95% CI: −1.41 to −0.51, P < 0.01), with high heterogeneity (I² = 93.8%). For QOL, multimodal exercise significantly improved outcomes (SMD = 1.04, 95% CI: 0.86 to 1.22, P < 0.01), with moderate heterogeneity (I² = 61.1%). Subgroup analysis revealed that: ① Age: Patients aged ≥ 65 years benefited more (SMD = −1.29) than those <65 years (SMD = −0.59); ② Cancer Type: Breast cancer patients showed significant improvement (SMD = −0.66), whereas patients with mixed cancer types showed no statistically significant effect (SMD = 0.09); ③ Risk of Bias: The effect size of moderate-risk studies (SMD = −0.96) aligned with the overall estimate. Sensitivity analysis confirmed robust results. Egger’s test indicated no significant publication bias (t = 0.22, P = 0.829). Conclusions: Current evidence suggests that multimodal exercise effectively alleviates CRF and enhances QOL in cancer patients. Subgroup analyses indicate that elderly patients and breast cancer patients derive the most benefit, highlighting cancer type as a key moderator of intervention effects. Due to limitations in the number and quality of included studies, these findings require further validation through large-scale, high-quality RCTs.