Kampshoff, C.S., Chinapaw, M.J., Brug, J., Twisk, J.W., Schep, G., Nijziel, M.R., . . . Buffart, L.M. (2015). Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: Results of the Resistance and Endurance Exercise After ChemoTherapy (REACT) study. BMC Medicine, 13, 275-015-0513-2. 

DOI Link

Study Purpose

To evaluate the effectiveness of a high-intensity (HI) and low-to-moderate–intensity (LMI) resistance and endurance exercise program compared with a wait-list control (WLC) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment, including chemotherapy

Intervention Characteristics/Basic Study Process

Exercise sessions were given twice per week for 12 weeks. Both exercise programs included six resistance exercises targeting large muscle groups with a frequency of two sets of 10 repetitions. The workload per exercise was defined by an indirect one-repetition maximum (1-RM) measurement. HI–resistance exercises started in the first week at 70% of 1-RM and gradually increased to 85% of 1-RM in week 12, whereas LMI–resistance exercises started at 40% of 1-RM and gradually increased to 55% of 1-RM. Every four weeks (weeks 5 and 9), the physiotherapist conducted the indirect 1-RM test and adjusted the workload accordingly.

Sample Characteristics

  • N = 277  
  • MEAN AGE = 50s
  • MALES: 18%, FEMALES: 82%
  • KEY DISEASE CHARACTERISTICS: Patients with lymphoma and breast, ovarian, colon, cervix, and testis cancer from stage I to Stage IV
  • OTHER KEY SAMPLE CHARACTERISTICS: Patients who completed primary cancer treatment


  • SITE: Single site    
  • SETTING TYPE: Not specified    
  • LOCATION: Patients recruited from nine Dutch hospitals

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment
  • APPLICATIONS: Elder care, palliative care 

Study Design

  • Randomized, controlled trials including three study arms: HI exercise, LMI exercise, and WLC
  • Double-blinded study

Measurement Instruments/Methods

  • Cardiorespiratory fitness was measured during a maximal exercise test on an electronically braked cycle ergometer.
  • Upper body muscle strength was assessed using a Jamar hand-grip dynamometer.
  • Fatigue was assessed using the Multidimensional Fatigue Inventory (MFI).
  • Health-related quality of life (HRQOL) was measured using the European Organization Research and Treatment of Cancer Core Quality of Life (EORTC QLQ-C30)


The HI (β = 2.2, 95% confidence interval [CI] [1.2, 3.1]) and LMI (β = 1.3, 95% CI [0.3, 2.3]) groups showed significantly larger improvements in peak VO2 compared to the WLC group. Improvement in peak VO2 was larger for the HI group than the LMI group (β = 0.9, 95% CI [−0.1, 1.9]), but the difference was not statistically significant (p = 0.08). Relative improvements in peak VO2 were 20% and 15% for the HI and LMI groups, respectively, which is in line with the relative improvements in healthy adults after a 12-week exercise program. No significant intervention effects were found for grip strength and 30-second chair-stand tests. Compared to the WLC group, both the HI and LMI groups showed significant improvements in general fatigue (HI: β = −1.3, 95% CI [−2.2, −0.4] and LMI: β = −1.1, 95% CI [−2, −0.2]), physical fatigue (HI: β = −2, 95% CI [−2.9, −1.1] and LMI: β = −1.4, 95% CI [−2.3, −0.5]), and reduced activity (HI: β = −1.1, 95% CI [−1.9, −0.2] and LMI: β = −1.2, 95% CI [−2.1, −0.3]), with no significant differences between both interventions. The HI group showed a beneficial effect on motivation compared to the LMI group (β = −0.8, 95% CI [−1.5, −0.03]) and WLC group (β = −1.2, 95% CI [−1.9, −0.4]), with no significant differences between the LMI and WLC groups. Furthermore, the HI group showed a significant reduction in mental fatigue compared to the WLC group (β = −0.9, 95% CI [−1.7, −0.2]). The effects on peak VO2 were modified by age (HI: βinteraction = −0.2, 95% CI [−0.3, −0.1], p = 0 and LMI: βinteraction = −0.1, 95% CI [−0.2, −0.01], p = 0.03), indicating larger effects for younger participants. No significant interaction effects for gender or diagnosis were found for physical fitness or fatigue.


Supervised HI exercise can be safely recommended to cancer survivors shortly after their completion of cancer treatment. HI and LMI exercise were equally beneficial in counteracting general and physical fatigue.

Nursing Implications

Advising patients to exercise or referring them to exercise specialists to exercise under supervision is beneficial when possible.