Schuler, M.K., Hentschel, L., Kisel, W., Kramer, M., Lenz, F., Hornemann, B., . . . Kroschinsky, F. (2016). Impact of different exercise programs on severe fatigue in patients undergoing anticancer treatment-A randomized controlled trial. Journal of Pain and Symptom Management, 53, 57–66. 

DOI Link

Study Purpose

To compare partially supervised, structured exercise to standard of care for patients with advanced cancer. The primary outcome was general fatigue.

Intervention Characteristics/Basic Study Process

Patients were randomized into three groups. Group A received treatment as usual; participants in group B were taught a structured, individual sports program; and group C received additional ambulatory physiotherapeutical supervision. Exercises were defined based on expert consensus with physical therapists and physicians. Included as “possible exercises” into a catalog and a patient information sheet. For groups B and C, a physical therapist selected applicable exercises from this catalog. Patients were instructed to complete three sessions of endurance and two sessions of strength each week for 20-30 minutes per session. Patients were contacted at weeks 4 and 8, during which groups B and C could ask specific questions and adherence was encouraged. Patients were then followed up with in person at 12 and 24 weeks.

Sample Characteristics

  • N = 43   
  • AGE = 52.38 years (consented group) 
  • MALES: 58%, FEMALES: 42%
  • CURRENT TREATMENT: Chemotherapy, radiation 
  • KEY DISEASE CHARACTERISTICS: Curative and palliative treatment
  • OTHER KEY SAMPLE CHARACTERISTICS: Hematologic, brain, gastrointestinal, lung, head and neck, testicle, and breast cancer, as well as sarcoma


  • SITE: Single site   
  • SETTING TYPE: Inpatient    
  • LOCATION: University Hospital Carl Gustav Carus, Dresden

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment

Study Design

Randomized, controlled trial into three groups

Measurement Instruments/Methods

  • Multidimensional Fatigue Inventory-14 
  • 6-minute walk test (6MWT)
  • International Physical Activity Questionnaire Short-Form


No difference in general fatigue was observed. Significant difference was found with mental fatigue (p = 0.03). Over time, all groups experienced an increase in fitness, with group C experiencing the most improvement.


No effects on fatigue were seen.


  • Small sample (< 100)
  • Risk of bias (no blinding)
  • Risk of bias (sample characteristics)


Nursing Implications

This study did not find any effect of interventions. The study was underpowered to identify significant differences between groups.