## 4 Discussion  
This systematic review and meta-analysis was conducted to determine the effectiveness of supervised therapeutic exercise on fatigue in oncology patients with breast or prostate cancer. A total of 25 interventions from 19 randomized controlled trials were included, all demonstrating a positive effect of therapeutic exercise on fatigue in cancer patients. Although the magnitude of the effect falls within the range considered small by conventional standards, its clinical relevance is notable given that cancer-related fatigue is a highly prevalent, debilitating symptom that is difficult to manage pharmacologically. These results support the inclusion of therapeutic exercise as a safe and effective strategy to reduce fatigue, with the potential to improve quality of life, functional capacity, and recovery after cancer treatment. The consistency observed across studies also suggests that these programs can be flexibly adapted to different clinical profiles without compromising effectiveness. These findings align with those reported in previous studies [37; 38; 46]. The improvements observed may be explained by exercise's protective effect against the decline in maximal oxygen uptake, which may help alleviate cancer-related fatigue [55]. In addition, physical training promotes progressive improvements in exercise tolerance and muscle strength, which may delay fatigue onset. Another relevant mechanism is the anti-inflammatory effect of physical activity, which, together with its cognitive benefits, could help counteract some treatment-related side effects, including fatigue [69]. These benefits are further enhanced by professional supervision, which helps patients overcome common barriers such as a lack of knowledge about exercise benefits or perceiving fatigue as a limitation. Supervision by trained professionals improves understanding  
Figure 5: Funnel Plot. \begin{table}
\begin{tabular}{c c c} \hline
**Exercise vs. Control Group** & **Coefficient** & \(p\)**-Value** \\ \hline  & 0.284 & 0.672 \\ \hline \end{tabular}
\end{table} 
Table 9: Publication bias by [PERSON]’s test. of exercise utility, thereby increasing adherence and intervention effectiveness [36]. Importantly, no serious adverse events or clinical complications directly attributable to the supervised exercise programs were reported. This finding, consistent with prior systematic reviews [24], reinforces the favorable risk-benefit profile of exercise prescription in cancer patients. The absence of major adverse effects strongly supports the integration of these non-pharmacological strategies into personalized care plans. Beyond its direct impact on patients' daily functioning, cancer-related fatigue has been commonly associated with lower treatment adherence, reduced quality of life, and worse clinical outcomes [17]. [PERSON] et al. [23] also demonstrated that fatigue is one of the most debilitating symptoms in cancer patients, significantly affecting overall health status and functional capacity, particularly in advanced or palliative stages. Moreover, persistent fatigue may reduce patients' ability to complete chemotherapy, radiotherapy, or hormonal therapy regimens, thereby compromising therapeutic efficacy and survival. [PERSON] et al. [70] reported that modifiable lifestyle factors such as physical inactivity, poor diet, and obesity accounted for over 18% of cancer cases in the U.S. in 2014. Altogether, these data support the clinical importance of interventions targeting fatigue and related behaviors, as improvements may not only enhance patient well-being but also promote better adherence, treatment tolerance, and long-term clinical outcomes. Subgroup analyses by exercise type showed that all supervised modalities were effective in reducing cancer-related fatigue, with statistically significant effect sizes. Combined aerobic and resistance training showed the largest effect size, although with considerable heterogeneity, suggesting variability in how these interventions are implemented.