The effect of exercise on fatigue associated with cancer

Cramp F, Daniel J

Published Online:

November 10, 2010

Fatigue is now recognised as a side-effect of cancer and its treatment. In the past people with cancer were encouraged to rest if they felt fatigued. It is important that individuals with cancer receive appropriate support and advice to help them cope with any adverse-effects. Physical exercise has been suggested as helpful in reducing the fatigue that is associated with cancer. A number of studies have been carried out to investigate the effects of exercise both during and after treatment. The current review was carried out to evaluate the effect of physical exercise on fatigue related to cancer. Twenty-eight studies were included in the review. Results suggest that physical exercise can help to reduce fatigue both during and after treatment for cancer. However, the evidence is not sufficient to demonstrate the best type or intensity of exercise for reducing the symptom of fatigue.

Abstract (click to read)

Background:

Cancer-related fatigue is now recognised as an important symptom associated with cancer and its treatment. A number of studies have investigated the effects of physical activity in reducing cancer-related fatigue with no definitive conclusions regarding its effectiveness.

Objectives:

To evaluate the effect of exercise on cancer-related fatigue both during and after cancer treatment.

Search strategy:

The Cochrane Controlled Trials Register (CENTRAL/CCTR), MEDLINE (1966 to July 2007), EMBASE (1980 to July 2007), CINAHL (1982 to July 2007), British Nursing Index (January 1984 to July 2007), AMED (1985 to July 2007), SIGLE (1980 to July 2007), and Dissertation Abstracts International (1861 to July 2007) were all searched using key words. Reference lists off all studies identified for inclusion and relevant reviews were also searched. In addition, relevant journals were hand searched and experts in the field of cancer-related fatigue were contacted.

Selection criteria:

Randomised controlled trials (RCTs) that investigated the effect of exercise on cancer-related fatigue in adults were included.

Data collection and analysis:

Two review authors independently assessed the methodological quality of studies and extracted data based upon predefined criteria. Where data were available meta-analyses were performed for fatigue using a random-effects model.

Main results:

Twenty-eight studies were identified for inclusion (n = 2083 participants), with the majority carried out on participants with breast cancer (n = 16 studies; n = 1172 participants). A meta-analysis of all fatigue data, incorporating 22 comparisons provided data for 920 participants who received an exercise intervention and 742 control participants. At the end of the intervention period exercise was statistically more effective than the control intervention (SMD -0.23, 95% Confidence Interval (CIs) -0.33 to -0.13).

Authors' conclusions:

Exercise can be regarded as beneficial for individuals with cancer-related fatigue during and post cancer therapy. Further research is required to determine the optimal type, intensity and timing of an exercise intervention.

This record should be cited as:

Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews 2008, Issue 2. Art. No.: CD006145. DOI: 10.1002/14651858.CD006145.pub2

Assessed as up to date:

February 10, 2008

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Primary Review Group:

Pain, Palliative and Supportive Care Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

Is exercise effective for the management of cancer-related fatigue in adults?

Bottom line:

In adults, physical exercise can help to reduce fatigue both during and after treatment for cancer. However, the evidence is not sufficient to demonstrate the best type or intensity of exercise for reducing the symptoms of fatigue. Therefore, exercise should be considered as one component of the management strategy for fatigue that may include a range of other interventions and education.

Caveat:

The review incorporates a diverse range of studies with small numbers in several studies. There is also a considerable degree of clinical heterogeneity between studies in terms of adjuvant therapy, mode and intensity of exercise, and stage and type of cancer.

Context:

Fatigue is now recognised as a side effect of cancer and its treatment, affecting 70–100% of cancer patients.¹ In the past, people with cancer were encouraged to rest if they felt fatigued, but physical exercise might be a more appropriate response. Exercise has been demonstrated to be effective in reducing fatigue and improving the exercise tolerance of healthy individuals and individuals with chronic diseases.² 1. Mock V. Cancer 2001;92:1699-1707. 2. Mock V et al. Psychooncology 2005;14:464-477.

Cochrane Systematic Review:

Cramp F, Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Reviews 2008, Issue 1. Art. No.: CD006145. DOI:10.1002/14651858.CD006145.pub2. This review contains 28 trials involving 2083 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Cancer > Palliative and supportive care > Symptomatic relief

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

The effect of exercise on fatigue associated with cancer

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