Kuchinski, A. M., Reading, M., & Lash, A. A. (2009). Treatment-related fatigue and exercise in patients with cancer: a systematic review. Medsurg Nursing, 18, 174–180.

To determine if patients receiving treatment for cancer experienced less treatment-related fatigue if they participated in a regular committed exercise regimen, compared to those who did not exercise regularly.

Databases searched were CINAHL, MEDLINE, Ovid, and ProQuest between January 2000 and October 2006.

Search keywords were fatigue, cancer, and exercise.

Studies were included in the review if

• The date range was January 2000 to October 2006
• The participants were 18 years or older
• They were written in the English language
• They were published in peer-reviewed nursing and healthcare journals
• They were quantitative or qualitative studies.

Two unpublished doctoral dissertations were also included.

Initially, 400 articles addressing the topics of fatigue, cancer, and exercise were found. When the inclusion criteria were applied, 10 studies were included. Levels of evidence presented were established using the Priority Symptom Management (PRISM) system developed by the Oncology Nursing Society.  No meta-analysis was performed due to differing definitions and methods of measurement of fatigue across studies.  All studies demonstrated strong levels of evidence of PRISM level I or II. Brief summaries of study design, exercise regimen, outcomes, limitations, level of evidence, and study recommendations were provided. Studies were identified within two major categories: home-based exercise interventions and out-of-home exercise interventions.

• There were 523 total participants across 10 studies.
• Sample sizes of studies ranged from 12 to 108 participants.

The majority of studies (eight of 10) used home-based exercise interventions.

Eight of the studies had findings that supported exercise during treatment to reduce fatigue.  In the two studies that did not show differences in fatigue, one had a very small sample size and one showed poor patient adherence to the exercise regimen.

Exercise was generally well tolerated by participants, and there were no adverse events associated with exercise.

Components of the regimens that were found to be beneficial were

• Ease of treatment (home-based, use of own equipment, etc.)
• Interest in treatment (allowing patients to choose an aerobic activity of interest to them, such as biking, walking, swimming, etc.)
• Inclusion of a daily diary to record frequency and intensity of exercise, as well as other symptoms
• Design of a program based upon a physician’s assessment of individual abilities
• Participation in a group exercise program provided support and increased motivation.

Theoretical foundations of studies were reviewed. These included

• Transtheoretical Model
• Roy’s Adaptation Theory
• Adherence
• Multidimensional conceptual framework interrelating psychosocial and physiologic dimensions of fatigue.

The evidence suggested that an individualized exercise program should be included in the treatment of patients receiving chemotherapy and/or radiation therapy. Studies have not shown any adverse effects, such as increased fatigue or falls, as a result of exercise. Studies retrieved were limited to four types of cancer: multiple myeloma, breast, lung, and prostate. Studies reviewed encompassed both early and late stages of disease.

Common limitations found among the studies reviewed included

• Lack of a universal definition of fatigue
• Lack of a universal instrument or method to measure fatigue and evaluate the effectiveness of interventions.

Use of common definitions and methods of measurement of outcome variables is needed to further advance this area of study. Evidence supports the inclusion of scheduled exercise in the care plan of patients undergoing cancer treatment. It was noted that approximately 50% of healthy Americans have been shown to have difficulty initiating and maintaining an exercise program for more than three months. This suggests that individuals with cancer are likely to need professional support to begin and maintain an exercise program. Nurses’ awareness of the role of exercise can enable better education that benefits patients.