Meneses-Echavez, J.F., Gonzalez-Jimenez, E., & Ramirez-Velez, R. (2015). Supervised exercise reduces cancer-related fatigue: A systematic review. Journal of Physiotherapy, 61, 3–9. 

DOI Link


STUDY PURPOSE: To determine if supervised activity reduces cancer-related fatigue
TYPE OF STUDY: Systematic review and meta-analysis

Search Strategy

DATABASES USED: Pubmed, Central, EMbase, and Ovid
KEYWORDS: (randomized controlled trial OR controlled clinical trial OR randomized OR trial OR ‘‘clinical trials as topic’’) AND (cancerORneoplasm*ORtumour*ORtumor*ORcarcino* OR leukaemi* OR leukemi*) AND (physical activity OR exercise OR aerobic OR resistance OR strength OR flexibility OR stretching) AND (fatigue)”].
  • Randomized, controlled trials
  • Participants: Patients with any type of cancer without restriction to a particular stage of diagnosis or treatment
  • Intervention: Supervised physical activity interventions (i.e., aerobic, resistance, stretching)
  • Outcome measures: Cancer-related fatigue (primary outcome), physical wellbeing, and functional wellbeing
  • Comparisons: Supervised physical activity versus conventional care
EXCLUSION CRITERIA: Any article that did not meet the above criteria

Literature Evaluated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: This systematic review was conducted according to the Cochrane Handbook for Systematic Reviews of Interventions, analyzed using Review Manager Software version 5.2, and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Relevant data were extracted independently from the eligible trials by two reviewers using a standard form, and the third author arbitrated in cases of disagreement. The assessment of risk of bias showed a mean PEDro score of 6.5 (SD = 1.1), indicating consistent methodologic quality and a low risk of most biases except blinding.

Sample Characteristics

  • SAMPLE RANGE ACROSS STUDIES: 22–500 patients
  • KEY SAMPLE CHARACTERISTICS: Mean age = 47–66 years; 78% female; breast cancer most common diagnosis; chemotherapy most common treatment


Phase of Care and Clinical Applications



The interventions had a mean duration of 17 weeks (SD = 12) with an average of three sessions (SD = 1) per week. The mean session duration was 45 minutes (SD = 29). The interventions included aerobic exercise (i.e., walking, stationary cycling) in all trials, resistance training in six trials (55%), and stretching/flexibility exercises in four trials (36%). Training intensity varied considerably among studies, ranging from 50%–90% of maximum heart rates. All studies reported pre-exercise screening before high intensity physical training. The overall meta-analysis showed that supervised physical activity had a favorable effect on cancer-related fatigue when compared to conventional care. The final analysis of the results revealed that supervised physical activity interventions were effective in the management of cancer-related fatigue for all types of cancer. The favorable effect was no longer significant at the six-month follow-up. However, more participants in the intervention group continued to exercise.


This study provides additional support for exercise in management of cancer-related fatigue during active treatment, in this case supervised activity. It reinforces the role of physiotherapy in the management of cancer-related fatigue.


Publication bias may have been present, but it was not possible to test for it because of the small number of included studies. Heterogeneity was present in most of the meta-analyses. This may be because of the range of sample sizes, the diverse exercise regimens (in terms of length, duration, and intensity) evaluated, and the wide variety in outcome measurement tools used in the included studies

Nursing Implications

Nurses can continue to recommend exercise as an intervention for cancer-related fatigue. However, additional research is still needed on the type, frequency, intensity, and duration of exercise.

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