Zhang, L.L., Wang, S.Z., Chen, H.L., & Yuan, A.Z. (2016). Tai chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: A randomized controlled trial. Journal of Pain and Symptom Management, 51, 504–511. 

To assess the effectiveness of Tai Chi in managing cancer-related fatigue

Patients were randomized to the Tai Chi or low-impact exercise groups. Tai Chi was taught by instructors in the community and via DVD. Patients were enrolled during hospitalization for chemotherapy. Sessions were conducted for 12 days during each course of chemotherapy every other day across four courses of treatment. Study assessments were conducted prior to the first and third courses of chemotherapy and at the end of the fourth course.

• N = 91
• MEAN AGE = Not reported. Forty-four percent were aged over 60 years.
• MALES: 74.7%, FEMALES: 25.3%
• KEY DISEASE CHARACTERISTICS: All had lung cancer; the majority had stage III or IV disease.
• OTHER KEY SAMPLE CHARACTERISTICS: The majority had sixth grade or less of education.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: China

• PHASE OF CARE: Active antitumor treatment

• Randomized, active, controlled trial

• Multidimensional Fatigue Inventory-Short Form (MFI-SF)

Fatigue scores increased in all patients. At six weeks, general and physical fatigue subscale scores were lower in the Tai Chi group (p < 0.05). Vigor scale scores were higher in the Tai Chi group (p < 0.05). These scores were also better in the Tai Chi group at 12 weeks (p < 0.05). No other differences existed between groups. 

Tai Chi was beneficial for patients with lung cancer to reduce treatment-related fatigue while undergoing chemotherapy.

• Small sample (< 100)
• Risk of bias (no blinding)
• Questionable protocol fidelity
• Subject withdrawals ≥ 10%  
• Whether exercise and Tai Chi sessions were done with instructors or self-managed in the home is unclear. Similarly, whether sessions were done in individual or group settings is unclear.
• Compliance with sessions was not evaluated.

The findings suggest that Tai Chi can be an effective intervention to combat fatigue during cancer treatment with chemotherapy. Exercise has been shown to be an effective intervention, and patients who did Tai Chi experienced less fatigue than those doing low-impact exercise. This study had multiple limitations, so the strength of this finding is limited. Additional research is warranted to provide strong support for this intervention.