Stricker, C. T., Drake, D., Hoyer, K. A., & Mock, V. (2004). Evidence-based practice for fatigue management in adults with cancer: exercise as an intervention. Oncology Nursing Forum, 31, 963–976.

Databases searched were MEDLINE, CINAHL, and Database of Abstracts of Reviews of Effects (DARE) through October 2003.  Proceedings of the annual meetings of the American Society of Clinical Oncology, American College of Sports Medicine, and Oncology Nursing Society were also searched.

Twenty experimental studies (nine randomized, clinical trials and 11 quasiexperimental studies) were included.  The outcome was fatigue. Treatment evaluated physical activity or group or individual exercise.

• Sample sizes ranged from nine to 11 participants.
• Participants were adults.
• Participants had breast cancer, mixed solid tumors, or hematologic malignancies; were receiving active treatment, including stem cell transplantation, radiation, or chemotherapy; were receiving or palliative care; or were long-term survivors.

There is strong evidence to support the effectiveness of home-based exercise programs performed by middle-aged women undergoing adjuvant chemotherapy or radiation therapy for nonmetastatic breast cancer and some evidence that exercise may be equally beneficial in other cancer populations, including individuals with solid tumors and hematologic malignancies and cancer survivors.  Based on current evidence, low-intensity exercise individualized to patient comfort is the only type of exercise that can be considered safe for patients in palliative care settings. Evidence supports the efficacy of aerobic laboratory-based interval training in individuals receiving peripheral blood stem cell transplantation.

All studies had some design limitations, including

• Small sample sizes
• No random assignment
• No control groups
• Failure to control for anemia levels, intensity of chemotherapy, and the timing of the fatigue measurement in relationship to chemotherapy treatments.