Spahn, G., Choi, K.E., Kennemann, C., Ludtke, R., Franken, U., Langhorst, J., . . . Dobos, G.J. (2013). Can a multimodal mind-body program enhance the treatment effects of physical activity in breast cancer survivors with chronic tumor-associated fatigue? A randomized controlled trial. Integrative Cancer Therapies, 12, 291–300. 

To evaluate a multimodal mind-body program (MMMT) compared to walking effect on fatigue in women with stage I–IIIA breast cancer

Participants in the intervention group underwent six hours of training in meditation, whole-food cooking, naturopathic strategies, and mindfulness by a multidisciplinary team. A sports therapist supervised a walking program in weeks 1, 3, and 10. Participants were encouraged to walk at home three times per week for 30 minutes. Participants in the control group also underwent a sports therapist-supervised walking program in weeks 1, 3, and 10. They also were encouraged to walk at home three times per week for 30 minutes.

• N = 55   
• AGE: Control mean: 55.3 years; MMMT mean: 58.1 years
• MALES: 0%, FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Average time first diagnosis: 39.7 months control, 61.9 months MMMT; stage I disease: 48% control, 30% MMMT; stage II disease: 44% control, 56.7% MMMT; stage IIIA disease: 0% control, 6.7% MMMT
• OTHER KEY SAMPLE CHARACTERISTICS: 20% smokers in MMMT group, 0 in control; mean fatigue in last month: MMMT 6.5, control 6.7

• SITE: Single site 
• SETTING TYPE: Outpatient 
• LOCATION: University of Duisburg-Essen, Germany

• PHASE OF CARE: Late effects and survivorship

• RCT

• German Fatigue Assessment Questionnaire with visual analog scale
• European Organization for Research and Treatment of Cancer EORTC QLQ-30
• Multidimensional Fatigue Inventory (MFI)
• Hospital Anxiety and Depression Scale (HADS)
• Menopausal Rating Scale

Unusual fatigue in the last week and last month was improved in both groups with no group differences. Anxiety in the MMMT group was improved compared to the control group (p = .043) during treatment but was not maintained in follow-up (p = .422). Both groups showed overall anxiety improvement. Reported pain between groups was improved in MMMT at follow-up compared to control (p = .031).  Menopausal symptoms decreased in both groups. No significant side effects were seen.

A home-based exercise program showed improvement in reported fatigue. The addition of a mind-body component showed no additional benefit.

• Small sample (< 100)
• Risk of bias (no control group)
• Unintended interventions or applicable interventions not described that would influence results
• Key sample group differences that could influence results
• Questionable protocol fidelity
• Subject withdrawals ≥ 10%

Home-based exercise is a reasonable and safe option for patients experiencing cancer-related fatigue.