Exercise Helps Counter Cancer-Linked Fatigue

Whether from the disease itself or the treatment, cancer can be exhausting, but a new review says there are ways to beat back cancer-related fatigue.

The review included a look at 113 past studies that included more than 11,000 adult cancer patients. The researchers found that exercise and/or behavioral and educational therapy seemed to be more effective than prescription drugs for dealing with fatigue.

"Exercise and psychological treatment, and the combination of these two interventions, work the best for treating cancer-related fatigue -- better than any pharmaceuticals we have tested," noted study lead author Karen Mustian. She's an associate professor with the University of Rochester Medical Center's Wilmot Cancer Institute in Rochester, N.Y.

The upshot, said Mustian, is that doctors should consider exercise and psychological interventions as the "first-line therapy" instead of more medications when it comes to tackling cancer-related fatigue.

The study team noted that cancer-related fatigue is a very common problem among cancer patients, both during and following treatment.

The American Cancer Society describes the phenomenon as distinct from routine tiredness. Even if you get rest, you're still tired. Your arms and legs may feel heavy. You may feel too tired to do even the simplest tasks, such as eating a meal, according to the ACS.

Beyond affecting overall quality of life, cancer-related fatigue can also interfere with a patient's ability to continue cancer treatment itself. That may result in a poorer prognosis and, in some cases, a reduced chance for long-term survival, the study authors said.

For the study, Mustian and colleagues looked at cancer-related fatigue triggered by the onset of cancer itself, rather than as a side effect of treatment.

Almost half of the patients included in the review were women battling breast cancer. Ten studies focused solely on male patients. In all, almost 80 percent of study participants were women. Their average age was 54.

The analysis excluded studies that looked at so-called complementary therapies, with an exception made for alternative exercise treatments, such as yoga or tai chi.

In addition, the research team didn't include studies that had assessed drug treatments involving erythropoietin medications (such as epoetin alpha, brand names Procrit and Epogen). These drugs are designed to stimulate red blood cell production, and are "used primarily for treating anemia and are not recommended as a stand-alone treatment for [cancer-related fatigue] due to adverse effects," the study authors stated.

Studies included looked at the impact of four different treatment approaches: exercise alone (including aerobic, such as walking or swimming or anaerobic, such as weight-lifting); mental health interventions aimed at providing information and/or helping patients understand and adapt to their current situation; a combination of both exercise and psychological treatment; and prescription drugs, including stimulant medications (such as modafinil, brand name Provigil) and ADHD meds (such as methylphenidate, brand name Ritalin).

All four interventions led to improvement in fatigue. But the researchers found that exercise therapy led to the best outcomes.

But psychological therapies produced similarly positive results, as did treatments that integrated exercise with mental health efforts.

The team concluded that when it came to controlling cancer-related fatigue, the exercise and/or psychological therapy approaches appeared to outperform prescription drugs.

Colleen Doyle is managing director of nutrition and physical activity for the ACS. She said exercise has many benefits, not just helping to ease fatigue.

"But because many people undergoing treatment do experience fatigue, it's nice to know that there is something an individual can do to help reduce that fatigue and gain some of the many other benefits of exercise [both during and after treatment]: reduced stress, less anxiety, [and] benefits to physical functioning," Doyle said.

But can the typical cancer patient actually handle an exercise regime? Mustian says yes.

"These are not your elite athletes or fitness buffs," she said. Almost all of the studies focused on people who had been sedentary and were placed on a low-to-moderate intensity exercise regimen, involving activities such as yoga or resistance training.

"So they are normal people who were not regular exercisers, and who were able to complete these interventions and have relief from their fatigue," Mustian said.

Doyle said that for patients who weren't previously active, it's important to start slowly.

"Our recommendation for survivors is essentially avoid inactivity as best you can. There will be days when you feel like not doing much of anything, and that's okay, but strive to do something. Even if it is gentle stretching exercises, or a five-minute walk down the block," she advised.

Mustian stressed that relatively few studies looked at combining exercise and psychological therapy.

"So it is not as clear what the best way to combine them would be," she noted. The researchers said more studies need to be done to explore the ideal way to integrate exercise and psychological interventions.

The study was published March 2 in JAMA Oncology.