Steindorf, K., Schmidt, M.E., Klassen, O., Ulrich, C.M., Oelmann, J., Habermann, N., . . . Potthoff, K. (2014). Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: Results on cancer-related fatigue and quality of life. Annals of Oncology, 25, 2237–2243. 

DOI Link

Study Purpose

To evaluate the efficacy of resistance training to treat fatigue

Intervention Characteristics/Basic Study Process

Patients were randomly assigned to 12 weeks of resistance training or to an attention control group who received group-based muscle relaxation programs. Study assessments were done at baseline, at week 7 after radiotherapy, and at week 13. The progressive exercise intervention was comprised of eight different machine-based resistance exercises (three sets of 8–12 repetitions at 60%–80% of one repetition maximum).

Sample Characteristics

  • N = 155  
  • MEAN AGE = 56 years (range = 29–75 years)
  • FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer stages I–III; received lumpectomy or mastectomy and scheduled for radiotherapy; majority did not receive chemotherapy; study occurred an average of 67 days after surgery
  • OTHER KEY SAMPLE CHARACTERISTICS: Age ≥ 18 years; body mass index ≥ 18 kg/m2


  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Germany

Phase of Care and Clinical Applications

  • PHASE OF CARE: Active antitumor treatment

Study Design

Single, blinded, randomized, controlled trial

Measurement Instruments/Methods

  • Fatigue was assessed with the Fatigue Assessment Questionnaire (FAQ), a 20-item self-assessment questionnaire validated for a German-speaking population. 
  • Center for Epidemiologic Studies Depression Scale (CES-D)
  • Quality of life was assessed with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30 BR23) for breast cancer.
  • Trail Making Test (TMT)


The median number of attendance for the intervention/placebo group was 19 out of a total of  24, and adherence was similar for both groups. The total cancer-related fatigue decreased significantly in the exercise group while in the control group, there was no significant change. Correspondingly, the primary ITT analysis showed significant differences between both intervention groups (P = 0.044) with a moderate effect size (ES = 0.25)(supplementary figure S1, available at the Annals of Oncology online). Considering the different fatigue dimensions, the effect was significant regarding physical fatigue (P = 0.013, ES = 0.33) but not for the affective (P = 0.91, ES = 0.01) or the cognitive (P = 0.65, ES = 0.07) dimension.


Resistance exercise was safe, feasible, and efficacious in improving cancer-related fatigue and components of quality of life in patients with breast cancer during adjuvant radiotherapy. The observed physiologic effects of resistance exercise were over and above the psychosocial benefits associated with group-based supervised programs. 


  • Other limitations/explanation: Patients were blinded, but investigators were not.

Nursing Implications

This study adds to the already extensive evidence supporting that exercise improves fatigue. This study showed this to be the case for patients receiving radiation therapy treatment and demonstrated that group interaction and attention alone were not responsible for the changes seen by including an attention control group in the study design. Nurses should recommend that patients participate in exercise to combat fatigue during cancer treatment.