Puetz, T. W., & Herring, M. P. (2012). Differential effects of exercise on cancer-related fatigue during and following treatment: a meta-analysis. American Journal of Preventive Medicine, 43, e1–e24.

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To review systematically randomized, controlled trials (RCTs) examining the effects of exercise interventions on cancer-related fatigue in patients during and following treatment to determine the extent to which the effect is differentiated across the time course of treatment and recovery.

Search Strategy

Databases searched were Google Scholar, MEDLINE, PsycINFO, PubMed, and Web of Science.
Search keywords were cancer, exercise, fatigue, physical activity, and randomized controlled trial.
Studies were included in the review if they reported
  • Cancer patients currently undergoing treatment
  • Randomization to either exercise training or a nonexercise comparison
  • A cancer-related fatigue outcome measured before and during and/or after exercise training.
Studies were excluded if they compared exercise only with an active therapy, examined the effect of acute exercise on cancer-related fatigue, and/or used education or promotion to increase physical activity but the intervention did not show increased activity.

Literature Evaluated

In total, 434 records were screened, and 325 were excluded.  One hundred nine RCTs were screened further, with 23 excluded due to no primary data being available.  Eighty-six studies were assessed for eligibility, and 16 were excluded. 

The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Authors extracted data independently and resolved discrepancies via consensus judgment.

Sample Characteristics

  • The final number of studies included was 70.
  • In total, 4881 patients were included; 3235 were undergoing treatment and 1646 were posttreatment.
  • Key sample characteristics varied because results were captured during and after treatment investigations.

Phase of Care and Clinical Applications

Patients were undergoing multiple phases of care.


Exercise significantly reduced cancer-related fatigue during and after treatment.  During treatment, patients with lower baseline fatigue scores and higher exercise adherence achieved the greatest improvements.  Following treatment, cancer-related fatigue improvement was largest in trials with longer durations between treatment completion and exercise initiation, trials with shorter exercise program lengths, and trials with wait-list comparisons.


Exercise reduces cancer-related fatigue in patients during and after cancer treatment. Exercise is palliative in patients during treatment and recuperative posttreatment.


  • Many studies did not report adequate information about the exercise intervention or appropriateness of comparisons and underreported adherence levels, medication use, and cancer sites.  
  • The authors did not use a validated cancer-related fatigue outcome measure in 10% of the trials.

Nursing Implications

The study provided evidence for prescribing exercise during and following cancer treatment and recognized the differential effects of exercise on cancer-related fatigue when prescribing exercise.

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