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Introduction: Therapeutic exercise has an important role in the population living with cancer as it improves function and quality of life and reduces the symptoms of cancer treatment. There is little clinical evidence on the effects of hypopressive exercise in women with gynecological cancer. Objective: Evaluate the effects of 4 weeks of hypopressive exercise associated with muscle strength training and aerobic exercises on fatigue, urinary incontinence symptoms, sexual function, and quality of life in women treated for gynecological cancer compared to a group that will perform conventional training. Methods: This randomized, single-blinded clinical trial study is set in the Clinical Research Laboratory, Department of Kinesiotherapy, at a Chilean University. Patients will be randomly assigned to an experimental group of hypopressive exercises associated with muscle strength training and aerobic exercises or a control group of muscle strength training and aerobic exercises. Twelve tele-rehabilitation sessions will be performed. Women over 18 years of age with gynecologic cancer who have been prescribed radiotherapy or chemotherapy will participate. Fatigue, quality of life, urinary incontinence symptoms, and sexual function will be assessed before and after the intervention. Expected results: The results of this clinical trial have important implications for specific treatment for the cancer population and generate new techniques in the practice of oncology-specialized kinesiologists. Hypopressive exercise is expected to reduce incontinence symptoms due to neuromuscular activation of the pelvic floor muscles. However, more studies are needed to confirm the beneficial effects of hypopressive exercises in face-to-face or remote rehabilitation.

Introducción: El ejercicio terapéutico juega un rol importante en la población con cáncer, ya que mejora la función, la calidad de vida y reduce los síntomas del tratamiento contra el cáncer. Hay poca evidencia clínica sobre los efectos del ejercicio hipopresivo en mujeres con cáncer ginecológico. Objetivo: Evaluar los efectos de cuatro semanas de ejercicio hipopresivo asociado con entrenamiento de fuerza muscular y ejercicios aeróbicos sobre la fatiga, los síntomas de incontinencia urinaria, la función sexual y la calidad de vida en mujeres tratadas por cáncer ginecológico, en comparación con un grupo que realizará entrenamiento convencional. Métodos: El escenario para este estudio de ensayo clínico aleatorizado y simple ciego es el Laboratorio de Investigación Clínica, Departamento de Kinesiología, en una Universidad Chilena. Las pacientes serán asignadas aleatoriamente a un grupo experimental de ejercicios hipopresivos asociados con entrenamiento de fuerza muscular y ejercicios aeróbicos, o a un grupo de control de entrenamiento de fuerza muscular y ejercicios aeróbicos. Se realizarán doce sesiones de telerehabilitación. Participarán mujeres mayores de 18 años con cáncer ginecológico a quienes se les haya indicado radioterapia o quimioterapia. Se evaluarán la fatiga, la calidad de vida, los síntomas de incontinencia urinaria y la función sexual antes y después de la intervención. Resultados: esperados Los resultados de este ensayo clínico tienen importantes implicaciones en términos del tratamiento específico para la población con cáncer y generan nuevas técnicas en la práctica de kinesiólogos especializados en oncología. Se espera que el ejercicio hipopresivo reduzca los síntomas de incontinencia debido a la activación neuromuscular de los músculos del suelo pélvico. Sin embargo, se necesitan más estudios para confirmar los efectos beneficiosos de los ejercicios hipopresivos, ya sea en rehabilitación presencial o a distancia.

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OBJECTIVES: Transcranial direct current stimulation (tDCS) combined with aerobic exercise (tDCS-AE) effectively reduces fatigue in patients with fibromyalgia. However, no study has assessed this method in systemic lupus erythematosus (SLE) patients with significant fatigue. Therefore, we evaluated the safety and efficacy of tDCS-AE for significant fatigue symptoms in adult female SLE patients. METHODS: This randomised, sham-controlled, double-blind study included 25 patients with SLE in remission or low disease activity (SLEDAI-2K £4) and with significant fatigue [≥36 points on the Fatigue Severity Scale (FSS) or ≥38 points on the Modified Fatigue Scale (MFIS)]. The patients received sham or tDCS for five consecutive days. The anode and cathode were positioned at M1 and Fp2, respectively (international 10-20 EEG system). tDCS was applied at an intensity of 2mA, and density of 0.057mA/cm2 in the tDCS-AE group. Both groups underwent combined low-intensity treadmill exercise. FSS, MFIS, pain visual analogue scale, physical activity, and sleep quality were evaluated at baseline and on days 7, 30, and 60. Adherence and safety were assessed using a standardised questionnaire. RESULTS: Improvement in fatigue levels was observed in both groups. However, a sustained reduction in fatigue levels on days 30 and 60 occurred only with tDCS-AEs (p<0.05). No significant differences were observed in pain level, sleep quality, or physical activity. No disease flares occurred and the adverse effects were mild and transient. Finally, the patient's adherence to the treatment was satisfactory. CONCLUSIONS: Despite isolated AEs, there was an improvement in fatigue, however, only tDCS-AE maintained significant and sustained improvement.

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Objetivo: analizar el efecto de la reflexología podal sobre la fatiga en pacientes en hemodiálisis, combinando los resultados de estudios independientes sobre este tema. Método: estudio de metaanálisis. Se realizó una búsqueda bibliográfica en siete bases de datos. La calidad metodológica de los estudios incluidos se evaluó mediante las herramientas propuestas por el Joanna Briggs Institute. Para el metaanálisis se utilizó el programa Comprehensive Meta-Analysis v3. Resultados: en el metaanálisis se incluyeron ocho estudios. El resultado de la diferencia de medias estandarizada del metaanálisis = 1,580 (Intervalo de Confianza de 95% = 1,075 - 2,085 p = 0,000). El resultado del análisis de subgrupos realizado sobre la base de la diferencia de medias estandarizada en el número de sesiones de reflexología podal = 1,478 (Intervalo de Confianza de 95% = 1,210 - 1,747, p = 0,000). Conclusión: se concluyó que la reflexología podal puede utilizarse para reducir la fatiga en pacientes en hemodiálisis. En los estudios investigados no se proporcionó información sobre los posibles efectos secundarios y negativos de la reflexología podal.

Objective: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. Method: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. Results: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). Conclusion: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology.

Objetivo: analisar o efeito da reflexologia podal sobre a fadiga em pacientes em hemodiálise, combinando os resultados de estudos independentes sobre este assunto. Método: estudo de metanálise. Foi realizada uma pesquisa bibliográfica em sete bases de dados. A qualidade metodológica dos estudos incluídos foi avaliada por meio de ferramentas propostas pelo Joanna Briggs Institute. Para a metanálise, foi utilizado o Comprehensive Meta-Analysis v3. Resultados: oito estudos foram incluídos na metanálise. O resultado da diferença média padronizada da metanálise = 1,580 (Intervalo de Confiança de 95% = 1,075 - 2,085 p = 0,000). O resultado da análise de subgrupo realizada com base na diferença média padronizada do número de sessões de reflexologia podal = 1,478 (Intervalo de Confiança de 95% = 1,210 - 1,747, p = 0,000). Conclusão: a reflexologia podal pode ser utilizada para reduzir a fadiga em pacientes em hemodiálise. Não foram fornecidas informações nos estudos investigados sobre os possíveis efeitos colaterais e negativos da reflexologia podal.

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OBJECTIVE: this meta-analysis study analyzed the effect of foot reflexology on fatigue in hemodialysis patients by combining the results of independent studies on this subject. METHOD: meta-analysis study. A literature search was conducted in seven databases. The methodological quality of the included studies was assessed using tools proposed by the Joanna Briggs Institute. Comprehensive Meta-Analysis v3 was used for meta-analysis. RESULTS: eight studies were included in the meta-analysis. The result of the meta-analysis standardized mean difference = 1.580 (95% Confidence Interval = 1.075 - 2.085 p = 0.000). The result of the subgroup analysis performed based on the number of foot reflexology sessions standardized mean difference = 1,478 (95% Confidence Interval = 1,210 - 1,747, p = 0.000). CONCLUSION: it was concluded that foot reflexology can be used to reduce fatigue in hemodialysis patients. No information was provided in the investigated studies about the possible side effects and negative effects of foot reflexology. (1) This study found that foot reflexology reduced fatigue levels. (2) The 10-session foot reflexology was the most effective. (3) This study will guide nurses and health workers. (4) Reflexology is one of the non-pharmacological methods used to relieve fatigue.

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PURPOSE: This clinical trial aimed to evaluate the influence of Mat Pilates and time on the change in fatigue scores in women with breast cancer undergoing adjuvant radiotherapy (RT). Additionally, assess the adherence and adverse effects of Mat Pilates sessions and the association of the level of physical activity with severe fatigue symptoms. METHODS: One hundred fifty-six patients with non-metastatic breast cancer were randomized to usual care or supervised Mat Pilates exercise. Fatigue and physical activity level were measured at baseline, end of RT, 30 days, 3 and 6 months after RT. The generalized estimating equation (GEE) with intention to treat was applied. RESULTS: A significant difference in the fatigue mean between the end of RT and the baseline was found in patients of both groups. There was no adverse effect with the practice of Mat Pilates, and it was analyzed the reduction of the symptom pain after the end of RT in women of intervention group compared to the control. There was no significant effect on fatigue between the groups. Patients with severe fatigue after 3 and 6 months of RT reported a significantly lower level of physical activity in the last periods. CONCLUSION: Fatigue levels increased at the end of RT but returned to baseline values after 6 months. A lower level of physical activity was associated with severe fatigue symptoms. Mat Pilates was safe for these women and reduced the symptom pain after treatment, but it did not successfully reduce fatigue during adjuvant RT. REGISTRATION: NCT03333993. November 7, 2017.  https://clinicaltrials.gov/ct2/show/NCT03333993?term=breast+cancer&cond=pilates&draw=2&rank=1 .

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Objective: To analyze the influence of exergaming (EXE) quality of life, cancer-related fatigue (CRF), electromyography, and strength and endurance muscle in a randomized crossover trial. Methods: We conducted a single-blinded, randomized, and crossover trial, which included 38 cancer volunteers undergoing chemotherapy (Age = 60.07 ± 12.10 years; body mass index = 26.79 ± 5.33 kg/m2). All volunteers were randomized into two intervention moments: EXE and without intervention (WI) and after 1-month washout period of crossing of the evaluated moments. The intervention was performed on an EXE protocol using Xbox 360 Kinect®, with the game "Your Shape Fitness Evolved 2012" two to three times per week for 20 sessions. All volunteers were assessed the CRF and quality-of-life levels through the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire, the median frequency (MDF) by surface electromyography, maximal voluntary isometric contraction (MVIC), and the muscle endurance time at 80% MVIC of the dorsiflexors and plantar flexors using dynamometer. Results: In the comparison between EXE and WI moments, were observed increase in the scores for quality of life (P < 0.001), subscale fatigue (P < 0.001), in the MDF values of right lateral gastrocnemius muscles: P = 0.017, muscle endurance time (left dorsiflexion [LDF]: P < 0.001; right dorsiflexion [RDF]: P < 0.001; left plantar flexion [LPF]: P < 0.001; RPF: P = 0.039), and muscle strength (LDF: P < 0.001; RDF: P < 0.001; LPF: P = 0.002). Conclusion: The crossover study, the EXE protocol promoted improvement in cancer-related fatigue (CRF) and quality of life, increased MVIC, endurance time, and MDF values of the dorsiflexor and plantar flexor muscles of cancer volunteers undergoing chemotherapy.

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OBJECTIVE: To assess the effect of physical therapy on cancer-related fatigue (CRF) during cytotoxic anticancer treatment. METHODS: Systematic review with meta-analysis of randomized clinical trials published from 2010 to 2021 (EMBASE, MEDLINE, PEDro; SciELO, and LILACS). Studies assessing the effect of supervised physical therapy (IG) for the management of CRF on adults undergoing anticancer treatment compared with a control group (CG) covering usual care or any uncontrolled practice, such as recommendations about exercise and health education, were included in this review. RESULTS: A total of 22 studies were included in the SR and 21 in the meta-analysis, resulting in 1.992 individuals (CG = 973 and IG = 1.019). There was a reduction in general fatigue [SMD = - 0.69; 95%CI (- 1.15, - 0.22) p < 0.01; I2 = 87%; NNT = 3], with greater weight attributed to combined exercise (44%). Physical fatigue also reduced [SMD = - 0.76; 95%CI (- 1.13, - 0.39) p < 0.01; I2 = 90%; NNT = 2], with greater weight for resistance exercise (50%) and greater effect with combined exercise [SMD = - 1.90; 95%CI (- 3.04, - 0.76) p < 0.01; I 2 = 96%]. There was reduction in general fatigue with moderate intensity (74%) [SMD = - 0.89; 95%CI (- 1.61, - 0.17) p < 0.02; I2 = 90%] and physical fatigue [SMD = - 1.00; 95%CI (- 1.54, - 0.46) p < 0.01; I2 = 92%], while high intensity reduced only general fatigue [SMD = - 0.35; 95%CI (- 0.51, - 0.20) p < 0.01; I2 = 0%]. The number of overall and weekly sessions has been shown to contribute to the reduction of CRF. CONCLUSION: Physical rehabilitation with moderate intensity promoted greater relief of general and physical fatigue. Even after controlling for high heterogeneity, the quality of evidence, summarized in GRADE, was considered moderate for general fatigue and low for physical fatigue.

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BACKGROUND: and purpose: Fatigue is among the most common persistent symptoms following post-acute sequelae of Sars-COV-2 infection (PASC). The current study investigated the potential therapeutic effects of High-Definition transcranial Direct Current Stimulation (HD-tDCS) associated with rehabilitation program for the management of PASC-related fatigue. METHODS: Seventy patients with PASC-related fatigue were randomized to receive 3 mA or sham HD-tDCS targeting the left primary motor cortex (M1) for 30 min paired with a rehabilitation program. Each patient underwent 10 sessions (2 sessions/week) over five weeks. Fatigue was measured as the primary outcome before and after the intervention using the Modified Fatigue Impact Scale (MFIS). Pain level, anxiety severity and quality of life were secondary outcomes assessed, respectively, through the McGill Questionnaire, Hamilton Anxiety Rating Scale (HAM-A) and WHOQOL. RESULTS: Active HD-tDCS resulted in significantly greater reduction in fatigue compared to sham HD-tDCS (mean group MFIS reduction of 22.11 points vs 10.34 points). Distinct effects of HD-tDCS were observed in fatigue domains with greater effect on cognitive (mean group difference 8.29 points; effect size 1.1; 95% CI 3.56-13.01; P < .0001) and psychosocial domains (mean group difference 2.37 points; effect size 1.2; 95% CI 1.34-3.40; P < .0001), with no significant difference between the groups in the physical subscale (mean group difference 0.71 points; effect size 0.1; 95% CI 4.47-5.90; P = .09). Compared to sham, the active HD-tDCS group also had a significant reduction in anxiety (mean group difference 4.88; effect size 0.9; 95% CI 1.93-7.84; P < .0001) and improvement in quality of life (mean group difference 14.80; effect size 0.7; 95% CI 7.87-21.73; P < .0001). There was no significant difference in pain (mean group difference -0.74; no effect size; 95% CI 3.66-5.14; P = .09). CONCLUSION: An intervention with M1 targeted HD-tDCS paired with a rehabilitation program was effective in reducing fatigue and anxiety, while improving quality of life in people with PASC.

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BACKGROUND: Resistance training (RT) has become an important topic for the treatment of fibromyalgia (FM); however, there are still controversies regarding its ability to significantly improve physical symptoms and a lack of adequate recommendations for evidence-based practice. AIM: The aim of this study is to analyze the effects of RT on the physical symptoms of patients with FM through a systematic review with meta-analysis. METHODS: We conducted a systematic review of randomized controlled trials in June 2022, according to PRISMA recommendations. The searches were carried out on the databases PubMed, Embase, Science Direct, Web of Science, PEDro, CINAHL, SciELO, and Google Scholar for gray literature, and the protocol was recorded in PROSPERO. Studies that evaluated patients with FM undergoing an RT program lasting more than 2 weeks and that analyzed physical health were selected. To carry out the meta-analysis, the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions were followed. RESULTS: In total, 13 studies were included for qualitative analysis and nine for meta-analysis. Regarding meta-analysis, a favorable improvement was found for pain ([MD = - 10.22 (95% CI: - 18.86 to - 1.58; I2: 64%; P for heterogeneity: 0.003)]; very low quality of evidence {QoE}), fatigue ([SMD = - 0.39 (95% CI: - 0.61 to - 0.17; I2: 0%; P = 0.91)]; moderate QoE), and muscle strength ([SMD = 0.94 (95% CI: 0.02 to 1.85; I2: 93%; for heterogeneity: < 0.0001)]; very low QoE) and improvement in functional capacity ([MD = 18.75 (95% CI: 4.27 to 33.22; I2: 39%; P = 0.19)]; low QoE), in the general comparison. CONCLUSION: RT was effective in reducing pain and fatigue and increasing strength and functional capacity; however, due to the quality of the evidence, more studies are needed.

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OBJECTIVE: This study's objective was to compare the best long-term treatment, mandibular advancement device (MAD) or continuous positive airway pressure (CPAP), for patients with mild obstructive sleep apnea (OSA) in improving excessive daytime sleepiness, fatigue, mood, sustained attention, and quality of life. METHODS: This study was a single-blind, parallel, randomized clinical trial with controls. The sample was composed of individuals between 18 and 65 years of age with a body mass index of < 35 kg/m2 and apnea/hypopnea index above five and less than 15. Participants were submitted to physical examination, polysomnography, and the following questionnaires: Pittsburgh Sleep Quality Index, Berlin Questionnaire, Epworth Sleepiness Scale, Stanford Sleepiness Scale, Karolinska Sleepiness Scale, Modified Fatigue Impact Scale, Functional Outcomes of Sleep Questionnaire, Beck Anxiety Inventory, and Beck Depression Inventory. They were also presented with the following tests: maintenance of wakefulness test and psychomotor vigilance task. RESULTS: Of 79 patients, 25 were in the MAD group, 31 in the CPAP group, and 23 in the control group. Polysomnographic parameters were best normalized with CPAP compared with MAD. Fatigue was improved in the MAD and CPAP groups, with no difference between these treatments. Quality of life was also improved with both treatments, but CPAP was superior to MAD. Daytime sleepiness, mood, and sustained attention showed no difference with the interventions. Greater adherence was obtained with MAD patients than with CPAP measured by hours of use. CONCLUSIONS: Treatment with CPAP was better at normalizing polysomnographic parameters and improving quality of life in patients with mild OSA. Both treatments improved fatigue with no difference between the two treatments. Neither treatment improved daytime sleepiness, mood or sustained attention. CLINICAL TRIALS DATABASE: NTC01461486.

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