McMillan, E.M., & Newhouse, I.J. (2011). Exercise is an effective treatment modality for reducing cancer-related fatigue and improving physical capacity in cancer patients and survivors: A meta-analysis. Applied Physiology, Nutrition, and Metabolism = Physiologie Appliquee, Nutrition Et Metabolisme, 36, 892–903.

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To determine if exercise interventions can effectively mitigate cancer-related fatigue (CRF)

Search Strategy


KEYWORDS: exercise, physical activity, exercise therapy, exercise training, aerobic exercise, resistance exercise, physical training, exercise prescription, cancer, oncology, malignancy, neoplasm cancer treatment, chemotherapy, radiotherapy, hormonal therapy, fatigue, CRF, QOL, depression


  • Experimental, quasi-experimental, or pre-post design
  • Data reported and available for meta-analysis
  • Inclusion of exercise intervention to measure effects on CRF
  • Control groups received care as usual with no prescribed physical activity


  • Interventions and measures focusing only on range of motion

Literature Evaluated

TOTAL REFERENCES RETRIEVED = 948 articles initially identified

EVALUATION METHOD: No quality scoring of retrieved studies was described.

Sample Characteristics

FINAL NUMBER STUDIES INCLUDED = 16 studies included in meta-analysis

SAMPLE RANGE ACROSS STUDIES, TOTAL PATIENTS INCLUDED IN REVIEW: Study sample sizes ranged from 22–242; 1,426 patients in treatment and control groups

KEY SAMPLE CHARACTERISTICS: Subjects were at various phases in cancer treatment, with some in active treatment of various modes and others post-treatment. Eight trials were in patients with breast cancer. Other studies included prostate cancer, mixed disease types, and acute myelogenous leukemia.


Overall effect of exercise on CRF showed a small but significant effect size with overall reduction in CRF ( SMD = 0.28, 95% CI 0.17–0.38, p <.001).

Subgroup analysis of exercise mode:

  • Aerobic exercise had a small but significant positive effect (SMD = 0.25, 95% CI 0.12–0.38, p < .001)
  • Resistance training had a small and insignificant effect (SMD =1.66, 95% CI 0.41–3.73, p > .05)
  • Mixed aerobic and resistance exercise had a small and insignificant positive effect (SMD = 0.22, p > .05)

Interventions provided in a supervised setting (15 trials) significantly reduced CRF (SMD = 0.29, 95% CI 0.17–0.46, p < .001).

Unsupervised exercise showed a positive trend but no significant difference with exercise.

Effects in phase of treatment:

  • Exercise caused a moderate and significant reduction in CRF when provided after completion of treatment (SMD = .31, 95% CI 0.6–14.03, p < .001).
  • Exercise during treatment also resulted in reduced CRF (SMD = 0.24, 95% CI .12–.36, p < .001).

Effects in patients with cancer other than breast cancer:

  • Subgroup analysis in trials with those patients with cancer other than breast cancer (four trials) showed that exercise significantly reduced CRF (SMD = 0.17, 95% CI .01–0.34, p < .05).

Exercise intervention produced improvement in aerobic fitness and musculoskeletal fitness (p < .001).


Findings from meta-analysis provide strong support for the positive effect of exercise on CRF. Effect sizes are small.

Findings suggest that various modes of exercise show a trend toward a positive impact on CRF in patients with breast cancer, as well as patients with other types of cancer.

There may be differences in effect based on mode of exercise.

Findings suggest positive effects in supervised and unsupervised exercise programs, but only those that were supervised demonstrated statistical significance in this study. It is unclear if this represents a real difference in effectiveness, or the fact that there were only four studies of unsupervised exercise included.

Nursing Implications

Findings support the use of exercise to reduce CRF during and after completion of cancer treatment. Subgroup analyses in this study begin to provide additional useful information regarding the modes and types of exercise interventions that may be most effective. Further research comparing effectiveness of various approaches is warranted.

Effect sizes of exercise are small, suggesting that studies that include patients with very low fatigue or interventions to prevent fatigue may not readily show significant changes.

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