Tomlinson, D., Diorio, C., Beyene, J., & Sung, L. (2014). Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine and Rehabilitation, 93, 675–686. 

DOI Link


STUDY PURPOSE: To determine whether exercise reduces fatigue compared to usual care or a nonexercise control intervention in patients with cancer
TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Ovid MEDLINE, EMBASE, PsycINFO, The Cochrane Central Register of Controlled Trials, and CINAHL
KEYWORDS: Fatigue, neoplasm, and exercise therapy
INCLUSION CRITERIA: Random assignment to intervention or control; diagnosed with cancer; in active treatment or follow-up; and fatigue as primary or secondary outcome
EXCLUSION CRITERIA: No random assignment; treatment arm not one of the interventions; no control arm or used as intervention; participants not diagnosed with cancer; fatigue not reported; duplicate publication; publication not in English; or publication was conference session or thesis

Literature Evaluated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Studies were reviewed by two people independently, and included studies were agreed upon by both using the Jadad scale. 

Sample Characteristics

  • TOTAL PATIENTS INCLUDED IN REVIEW = 5,367 (2,740 in intervention, 2,627 control groups)
  • KEY SAMPLE CHARACTERISTICS: 19% aerobic, 26% walking, 12.5% yoga, 31% mixed-exercise, 63% supervised, 36% home-based, 63% mixed malignancy, 26% solid tumor, 11% hematologic; and most patients off treatment

Phase of Care and Clinical Applications

PHASE OF CARE: Multiple phases of care


There was a moderate effect on fatigue, sleep disturbance, and depression with exercise in the intervention groups (p < 0.001) compared to the control group. The benefits of exercise did not differ by type of exercise intervention (P = 0.85 for interaction). However, the effect of exercise on fatigue reduction may differ by underlying malignancy type with a stronger effect in solid tumors versus hematologic and mixed-malignancy types (P = 0.01 for interaction). There was a stronger effect on depression in females (p = 0.03). Patients with solid tumors seemed to experience a greater benefit.


Exercise can have an effect on fatigue despite the type of exercise and phase of care when delivered.


The clinical effect of what is considered a significant reduction in Functional Assessment of Cancer Therapy - Fatigue was questioned. The terms physical activity and exercise were used interchangeably, and the meaning of structured exercise was not well-explained.

Nursing Implications

Patients may be given several options for kinds of exercise to improve fatigue based on their preference while still receiving the benefit of improved fatigue.

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