背景：疲憊是乳癌婦女普遍且困擾的症狀，研究證據顯示運動介入是有效的緩解疲憊策略，但在治療或治療後不同階段較適合的運動方案尚未釐清，值得深入探討。
目的：透過系統性文獻回顧及網絡統合分析法，找出治療或治療後階段乳癌婦女的較佳緩解疲憊運動類型，並依據個案、運動及研究因素分析提出運動建議執行方案，作為緩解疲憊決策之參考。
方法：在MEDLINE (via Ovid)、Embase (via Elsevier)、CINAHL（EBSCOhost）Cochrane（CINHAL）之四個資料庫，搜尋2018年10月以前的隨機對照性試驗研究，使用RevMan與STATA進行資料處理及分析。
結果：本網路統合分析共納入65篇文獻，結果顯示乳癌治療階段，緩解疲憊效果最佳排序前三名之運動類型依序為：瑜珈（standardized mean difference, SMD = .59, 95%CI [0.27, 0.90]）、監督者有氧合併抗阻力（SMD = .43, 95%CI [0.13, 0.73]），及居家有氧運動（SMD = .43, 95%CI [0.11, 0.75]），具有小至中度效果量；治療後階段緩解疲憊效果最佳排序前三名之運動類型依序為：有氧合併瑜珈（SMD = 1.98, 95%CI [0.96, 3.01]）、瑜珈（SMD = .63, 95%CI [0.30, 0.96]），及監督者有氧合併抗阻力運動（SMD = .61, 95%CI [0.28, 0.94]），具有中至高度效果量。在乳癌治療階段，瑜珈的運動方案在個案因素中，可以建議平均年齡50歲左右者執行，對早期及晚期乳癌皆有緩解疲憊效果；運動因素之建議為輕度瑜珈活動，每次50-60分鐘，每週2-4次；瑜珈研究因素中之高誤差風險對結果具潛在影響。在乳癌治療後階段，瑜珈合併有氧運動的個案因素建議於早期乳癌，平均年齡48歲左右執行；運動因素中，運動設計建議每星期3次、每次30分鐘的監督者有氧運動及30分鐘的瑜珈運動；有氧合併瑜珈研究因素中之高誤差風險對結果同樣具潛在影響。並且本研究也發現在治療階段，瑜珈對東方國家似乎有較好的緩解疲憊效果，建議後續研究探討。
結論：治療或治療後階段較佳緩解疲憊之運動方案不同，乳癌治療階段以瑜珈、監督者有氧合併抗阻力，及居家有氧運動；治療後階段以有氧合併瑜珈、瑜珈，及監督者有氧合併抗阻力運動，為最佳的運動類型。健康照護者應據此研究結果，提供臨床照護中的運動方案建議。

SUMMARY
Fatigue is one of the most common symptoms of women with breast cancer. Although evidences suggested that exercise is the most effective strategy on reducing fatigue, the proper exercise program in different therapy periods were still unclear.
The aim of this network meta-analysis was to identify the better exercise type in relieve fatigue among women with breast cancer in different treatment period (Treatment phase and after treatment phase), and to propose the best effective exercise programs according to subject factors, exercise factors, and research factors in these periods. Studies with RCTs deign published before 2018 were collected from the databases of MEDLINE, Embase, CINAHL, and Cochrane. Data were managed and analyzed by using RevMan and STATA software. Sixty-five studies were included. During the breast cancer treatment, yoga had the highest ranked effect on reducing fatigue, following the supervised aerobic resistance, and home aerobic were in the third. All had small-to-moderate effect size. After breast cancer treatment, aerobic combine yoga was the highest ranked effect on reduced fatigue, following the yoga, and supervised aerobic resistance were the third. All had moderate-to-large effect size. The study results provided clinical providers precision exercise strategies for women with breast cancer.

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