BACKGROUND: Cancer-related fatigue (CRF) is the most common and distressing symptom in breast cancer survivors. Approximately 40% to 80% of cancer patients undergoing active treatment suffer from CRF. Exercise improves overall quality of life and CRF; however, the specific effects of the training modalities are not well understood. METHODS: This study aimed to determine the pooled effects of supervised exercise interventions on CRF in breast cancer survivors. We searched PubMed/Medline, Embase, Scopus, CENTRAL and CINAHL databases between December 2013 and January 2014 without language restrictions. Risk of bias and methodological quality were evaluated using the PEDro score. Pooled effects were calculated with a random-effects model according to the der Simonian and Laird method. Heterogeneity was evaluated with the I2 test. RESULTS: Nine high-quality studies (n = 1,156) were finally included. Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors (SMD -0.51, 95% CI -0.81 to -0.21), with high statistical heterogeneity (p = 0.001; I2 = 75%). Similar effects were found for resistance training on CRF (SMD -0.41, 95% CI -0.76 to -0.05; p = 0.02; I2 = 64%). Meta-regression analysis revealed that exercise volume parameters are closely related with the effect estimates on CRF. Egger's test suggested moderate evidence of publication bias (p = 0.04). CONCLUSIONS: Supervised exercise reduces CRF and must be implemented in breast cancer rehabilitation settings. High-volume exercises are safe and effective in improving CRF and overall quality of life in women with breast cancer. Further research is encouraged. TRIAL REGISTRATION: CRD42014007223.

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