van Weert, E., May, A. M., Korstjens, I., Post, W. J., van der Schans, C. P., van den Borne, B., Mesters, I., . . . Hoekstra-Weebers, J. E. (2010). Cancer-related fatigue and rehabilitation: a randomized controlled multicenter trial comparing physical training combined with cognitive-behavioral therapy with physical training only and with no intervention. Physical Therapy, 90, 1413–1425.

To determine the effect of a combined rehabilitation program (physical training [PT] and cognitive-behavioral training [CBT]) and PT alone on cancer-related fatigue (CRF) compared with a control group receiving no intervention.

Two groups of cancer survivors were randomly assigned to 12 weeks of PT or to 12 weeks of PT plus CBT. The control group was not randomized. PT included aerobic training combined with progressive resistance exercise (twice weekly for two hours). CBT included self-management skills based on problem-solving (once weekly for two hours). In the analysis, fatigue scores were also compared to a general Dutch population of similar age.

• The sample was comprised of 147 patients (44% male, 56% female).   
• Mean age was 46 years.
• Breast cancer was predominant in all three groups.
• Patients were cancer survivors one to two years posttreatment.

• Multisite  
• Four rehabilitation centers in The Netherlands

The study was a randomized, controlled trial.

Multidimensional Fatigue Inventory (MFI) was used preintervention (Cronbach α range 0.73–0.83) and postintervention (Cronbach α range 0.84–0.88) to measure five domains:  general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue.

Levels of fatigue significantly decreased in all domains in all groups (p < 0.05; effect size across domains range –0.38 to –1.36), except in mental fatigue in the control group. No significant differences were found in decline of fatigue between the intervention groups. Patients completed 82.4% of PT and CBT sessions and 83.5% of PT sessions. In the post hoc analysis, patients with lower educational levels reported less decline in physical fatigue, reduced motivation, and reduced activation.

PT combined with CBT was equally effective in reducing fatigue, suggesting that CBT had no benefit beyond PT. Patients in the control group also showed a significant decline in fatigue, suggesting that time alone is also effective related to fatigue reduction.

• The study lacked an appropriate control group.
• There was an overrepresentation of patients with breast cancer.
• The study lacked a group receiving CBT only.
• The study duration was limited (12 weeks). 

The study supported the effectiveness of PT in the treatment of CRF.