March 02, 2017
3 min read

Exercise may reduce cancer-related fatigue during, after treatment

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Exercise and psychological interventions provide greater benefit to patients than pharmaceutical drugs for reducing cancer-related fatigue, according to results of a meta-analysis.

“Exercise doses are low to moderate and work well in people who have historically been sedentary,” Karen Mustian, PhD, MPH, associate professor in the department of surgery at University of Rochester Medical Center, told HemOnc Today. “You don't have to be an athlete or fitness buff to do them or benefit. Exercise works during treatments like chemotherapy, radiation and hormone therapy, as well as after they are complete.”

Karen Mustian

The four most commonly recommended treatments for cancer-related fatigue are exercise, psychological interventions, a combination of the two, and pharmaceutical intervention. However, no prior study applied meta-analytic methods to compare the efficacy of all the treatments.

Thus, Mustian and colleagues evaluated clinical outcomes from 113 unique randomized trials published between January 1999 and May 2016 that included adults with cancer. The researchers sought to compare the mean weight effect size (WES) of the common treatments and to identify variables associated with treatment effectiveness.

The Physiotherapy Evidence-Based Database scale showed the studies were of good quality and free of publication bias (mean scale score, 8.2; range, 5-12).

In total, the studies included 11,525 patients (mean age, 54 years; range, 35-72; 78% women). Fifty-three of the studies (46.9%) focused on women with breast cancer.

The mean sample size was 102 (standard deviation [SD], 95.5) at baseline, with a mean 47 patients (SD, 47.3) in the control groups and 57 (SD, 49) in the intervention groups.

Seventy-seven studies used standard cancer care control interventions, no intervention or waitlist control, whereas 36 studies used a placebo, time, attention or an education control. The mean duration of interventions was 14 weeks (range, 1-60).

Pharmaceutical interventions included paroxetine hydrochloride (n = 2), modafinil or armodafinil (n = 4), methylphenidate hydrochloride or dexmethylphenidate (n = 5), or methylprednisolone (n = 1). Studies of exercise evaluated aerobic modes (n = 36), anaerobic (n = 13) and aerobic plus anaerobic modes (n = 20), and psychological studies tested cognitive behavior method (n = 19), psychoeducational method (n = 14), and an eclectic method (n = 1); ten studies evaluated a combination of exercise plus psychosocial intervention.

Significant improvement in cancer-related fatigue was observed across all 113 studies (WES = 0.33; 95% CI, 0.24-0.43). The use of exercise alone showed the largest improvement in cancer-related fatigue (WES = 0.3; 95% CI, 0.25-0.36) during and after cancer treatment.

The use of psychological interventions (WES = 0.27; 95% CI, 0.21-0.33) and combined exercise and psychological interventions (WES = 0.26; 95% CI, 0.13-0.38) also showed improved cancer-related fatigue.

Pharmaceutical interventions did not improve cancer-related fatigue (WES = 0.09; 95% CI, 0-0.19).

“The literature bears out that these drugs don’t work very well, although they are continually prescribed,” Mustian said in a press release. “Cancer patients already take a lot of medications, and they all come with risks and side effects, so any time you can subtract a pharmaceutical from the picture it usually benefits patients.”

Further analysis showed the following variables were associated with intervention effectiveness: cancer stage, treatment status at baseline, experimental treatment format, primary delivery mode of experimental treatment, psychological mode, type of control condition, use of intention-to-treat analysis and fatigue scale used (WES range, –0.91 to 0.99). Further, the effectiveness of exercise and psychological interventions was not attributable to time, attention and education, and more specific interventions could be effective for treating patients with cancer-related fatigue at different points of treatment (WES range, 0.09-0.22). For example, exercise may be the most effective treatment for patients undergoing primary treatment, whereas exercise plus psychological interventions may be most effective for survivors who have completed primary treatment.

“Exercise and psychological treatments should be prescribed as first-line therapy for cancer-related fatigue,” Mustian said. “The pharmaceutical agents we have tested thus far are not as effective for treating this toxicity.” – by Melinda Stevens

For more information:

Karen Mustian, PhD, MPH , can be reached at Wilmot Cancer Institute, Department of Surgery, University of Rochester Medical Center, 265 Crittend Blvd., Room 2215, Rochester, NY 14642; email:

Disclosure: The researchers report no relevant financial disclosures.