Physical exercise for functional capacity, blood immune function, fatigue, and quality of life in high-risk prostate cancer patients during radiotherapy: a prospective, randomized clinical study. Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Exercise reduces daily fatigue in women with breast cancer receiving chemotherapy. Fatigue mediates the effects of exercise on quality of life Effects of Exercise on Biobehavioral Outcomes of Fatigue During Cancer Treatment Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: A randomized controlled trial. Effect of Exercise on Markers of Inflammation in Breast Cancer Survivors: The Yale Exercise and Survivorship Study Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: A randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue Effects of Scheduled Exercise on Cancer-Related Fatigue in Women with Early Breast Cancer Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Biobehavioral factors mediate exercise effects on fatigue in breast cancer survivors. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment. Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial The effect of a multidimensional exercise intervention on physical capacity, well-being and quality of life in cancer patients undergoing chemotherapy
BACKGROUND During radiotherapy ( RT ) , prostate cancer ( PCa ) patients may report cancer related fatigue ( CRF ) , which impairs functional capacity , psychological status , and quality of life ( QoL ) . RT can induce cytokine responses that could play a role in mediating radiation toxicity by increasing inflammation . While it is known that physical exercise plays an important anti-inflammatory role in healthy adults , its specific anti-inflammatory effects in PCa patients with CRF have not yet been determined . AIM Previous studies have shown that physical exercise in cancer patients undergoing RT improves cardiac fitness , muscle strength , and QoL , however it is still unknown how physical exercise affects inflammation and its specific consequences in PCa patients . Therefore , the purpose of this trial was to examine the effect of supervised physical exercise on inflammatory blood markers , as well as the relationship of these parameters with functional capacity , fatigue , and QoL in high-risk PCa patients undergoing RT .  DESIGN This was a prospect i ve , two-arm r and omized controlled clinical trial . SETTING The study was performed in our out patients center . POPULATION Fifty-four high-risk PCa men were r and omly allocated to two groups prior to undergoing RT . METHODS Twenty-seven patients performed supervised , moderate-intensity physical exercise ( exercise group ; EG )  and the other 27 formed a control group that carried out normal daily physical activity ( usual group ; UG ) . The following parameters were assessed before and after RT : functional capacity , changes in blood count variables and production of pro-inflammatory cytokines ( interleukin [IL]-1β , IL-6 , tumor necrosis factor [TNF]-α ) , fatigue , and QoL ( using FACT-F score and EORTC question naires ) . RESULTS No significant differences existed between the study groups at baseline assessment . After RT , there was a significant improvement in functional capacity ( P<0.05 ) and a decrease in pro-inflammatory cytokine levels ( P>0.05 ) and fatigue ( P<0.05 ) in the EG compared to the UG . Fatigue level was significantly higher in the UG ( F[2.126 ] ; P<0.05 ) after RT than before . Physical exercise had no effect on the correlation between inflammatory blood markers and functional capacity and fatigue scores provided by study participants . CONCLUSIONS Regular , moderate-intensity physical exercise improves functional capacity , decreases the production of inflammatory markers and fatigue , and has a positive influence on QoL in high-risk PCa patients during RT . CLINICAL REHABILITATION IMPACT This is one of the first studies to examine the effects of supervised exercise training on pro-inflammatory cytokine levels during RT in PCa patients by measuring functional capacity , fatigue , and PURPOSE / OBJECTIVES To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments . DESIGN Pretest and post-test quasiexperimental . SETTING Outpatient oncology rehabilitation center . SAMPLE 96 breast cancer survivors undergoing various clinical treatments . METHODS Subjects were divided into four groups based on the specific type of clinical treatment : surgery alone ( n = 22 ) ; surgery and chemotherapy ( n = 30 ) ; surgery and radiation ( n = 17 ) ; and surgery , chemotherapy , and radiation ( n = 27 ) . Following a comprehensive screening and medical examination , cardiovascular endurance , pulmonary function , and fatigue were assessed , leading to the development of an individualized exercise prescription and a six-month exercise intervention . Repeated- measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups . MAIN RESEARCH VARIABLES Systolic and diastolic blood pressure , resting heart rate , forced vital capacity , forced expiratory volume , predicted oxygen consumption , time on treadmill , and fatigue . FINDINGS Cardiopulmonary function ( predicted maximal oxygen consumption and time on treadmill ) significantly increased in all groups after exercise training . In addition , resting heart rate and forced vital capacity significantly improved in those receiving surgery , chemotherapy , and radiation . Psychologically , the exercise intervention result ed in significant reductions in behavioral , affective , sensory , cognitive and mood , and total fatigue scale scores in all three groups who received treatment with surgery . The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral , affective , and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores . CONCLUSIONS The results suggest that moderate intensity , individualized , prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type . Moreover , cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention . IMPLICATION S FOR NURSING Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments . Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy Purpose : Fatigue is a common side effect of cancer treatment that impacts quality of life .  Exercise is one approach suggested to improve fatigue . The purpose of this study was to explore the relationship of exercise to fatigue and quality of life . Methods : Thirty-one subjects with breast cancer were enrolled prior to beginning chemotherapy and 27 completed the study . All baseline measures were obtained before the first chemotherapy treatment . Subjects were instructed on a home-based , 8-week exercise program . Results : Women who adopted the exercise program ( 60 % ) showed significant increases in functional ability and less weight gain . Exploratory , stepwise multiple regression analyses suggested that the maximum effect of exercise on quality of life outcomes may be mediated by fatigue . Conclusions : The low-to-moderate intensity , home-based exercise program was feasible for some women with breast cancer receiving chemotherapy .  The results suggest that exercise may affect quality of life and that this effect may be mediated by the effects of exercise on fatigue . Better retention of functional ability and better weight control are additional possible benefits of exposing breast cancer patients to increased exercise . A r and omized , controlled clinical trial is needed to establish confidence in these observed relationships Cancer treatment is associated with decreased hemoglobin ( Hb ) concentration and aerobic fitness ( VO2 max ) , which may contribute to cancer-related fatigue ( CRF ) and decreased quality of life ( QoL ) .  Endurance exercise may attenuate CRF and improve QoL , but the mechanisms have not been thoroughly investigated . Objectives . To ( a ) determine the feasibility of conducting an exercise intervention among women receiving treatment for breast cancer ; ( b ) examine the effects of exercise on Hb and VO2 max and determine their association with changes in CRF and QoL ; and ( c ) investigate changes in selected inflammatory markers . Methods . Fourteen women receiving chemotherapy for Stages I – II breast cancer were r and omly assigned to exercise ( n = 7 ) or usual care ( n = 7 ) . Women in the exercise group performed supervised , individualized treadmill exercise 2–3 times/week for the duration of chemotherapy ( 9–12 weeks ) . Data were collected 4 times over 15–16 weeks . Results . Recruitment rate was 45.7 % . Sixteen women consented and 14 completed the trial , for a retention rate of 87.5 % . Adherence to exercise protocol was 95–97 % , and completion of data collection was 87.5–100 % . Exercise was well tolerated . VO2 max was maintained at prechemotherapy levels in exercisers but declined in the usual-care group ( p < .05 ) . Hb decreased ( p < .001 ) in all participants as they progressed through chemotherapy . Exercise did not have significant effects on CRF or QoL. Changes in inflammatory markers favored the exercise group . Conclusions . Exercise during chemotherapy may protect against chemotherapy-induced decline in VO2 max but not Hb concentration Multiple exercise interventions have shown beneficial effects on fatigue and quality of life ( QoL ) in cancer patients , but various psychosocial interventions as well . It is unclear to what extent the observed effects of exercise interventions are based on physical adaptations or rather on psychosocial factors associated with supervised , group-based programs . It needs to be determined which aspects of exercise programs are truly effective . Therefore , we aim ed to investigate whether resistance exercise during chemotherapy provides benefits on fatigue and QoL beyond potential psychosocial effects of group-based interventions . One-hundred-one breast cancer patients starting chemotherapy  were r and omly assigned to resistance exercise ( EX ) or a relaxation control ( RC ) group . Both interventions were supervised , group-based , 2/week over 12 weeks . The primary endpoint fatigue was assessed with a 20-item multidimensional question naire , QoL with the EORTC QLQ-C30/BR23 . Analyses of covariance for individual changes from baseline to Week 13 were calculated . In RC , total and physical fatigue worsened during chemotherapy , whereas EX showed no such impairments ( between-group p = 0.098 and 0.052 overall , and p = 0.038 and 0.034 among patients without severe baseline depression ) . Differences regarding affective or cognitive fatigue were not significant . Benefits of EX were also seen to affect role and social function . Effect sizes were between 0.43 and 0.48 . Explorative analyses indicated significant effect modification by thyroxin use ( p-interaction = 0.044 ) . In conclusion , resistance exercise appeared to mitigate physical fatigue and maintain QoL during chemotherapy beyond psychosocial effects inherent to supervised group-based setting s. Thus , resistance exercise could be an integral part of supportive care for breast cancer patients undergoing chemotherapy Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR Background International evidence -based guidelines recommend physical exercise to form part of st and ard care for all cancer survivors . However , at present , the optimum exercise intensity is unclear . Therefore , we aim ed to evaluate the effectiveness of a high intensity ( HI ) and low-to-moderate intensity ( LMI ) resistance and endurance exercise program compared with a wait list control ( WLC ) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment , including chemotherapy . Methods Overall , 277 cancer survivors were r and omized to 12 weeks of  HI exercise ( n = 91 ) , LMI exercise ( n = 95 ) , or WLC ( n = 91 ) . Both interventions were identical with respect to exercise type , duration and frequency , and only differed in intensity . Measurements were performed at baseline ( 4–6 weeks after primary treatment ) and post-intervention . The primary outcomes were cardiorespiratory fitness ( peakVO2 ) , muscle strength ( grip strength and 30-second chair-st and test ) , and self-reported fatigue ( Multidimensional Fatigue Inventory ; MFI ) . Secondary outcomes included health-related quality of life , physical activity , daily functioning , body composition , mood , and sleep disturbances . Multilevel linear regression analyses were performed to estimate intervention effects using an intention-to-treat principle . Results In the HI and LMI groups , 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions , respectively ( P = 0.53 ) . HI ( β = 2.2 ; 95 % CI , 1.2–3.1 ) and LMI ( β = 1.3 ; 95 % CI , 0.3–2.3 ) exercise showed significantly larger improvements in peakVO2 compared to WLC . Improvements in peakVO2 were larger for HI than LMI exercise ( β = 0.9 ; 95 % CI , −0.1 to 1.9 ) , but the difference was not statistically significant ( P = 0.08 ) . No intervention effects were found for grip strength and the 30-second chair-st and test . HI and LMI exercise significantly reduced general and physical fatigue and reduced activity ( MFI subscales ) compared to WLC , with no significant differences between both interventions . Finally , compared to WLC , we found benefits in global quality of life and anxiety after HI exercise , improved physical functioning after HI and LMI exercise , and less problems at work after LMI exercise . Conclusions Shortly after completion of cancer treatment , both HI and LMI exercise were safe and effective . There may be a dose – response relationship between exercise intensity and peakVO2 , favoring HI exercise . HI and LMI exercise were equally effective in reducing general and physical fatigue . Trial registration This study was registered at the Netherl and s Trial Register [ NTR2153 ] on the 5th of January 2010 Background Cancer-related fatigue ( CRF ) is one of the most common and distressing side effects of cancer and its treatment . During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life ( QoL ) . Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being , effective treatment methods are scarce . Physical activity for breast cancer patients has been reported to decrease fatigue , to improve emotional well-being and to increase physical strength . The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise , however , are poorly understood . In the BEST trial we aim to assess the effects of resistance training on fatigue , QoL and physical fitness as well as on molecular , immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy . Methods / design The BEST study is a prospect i ve r and omized , controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy .  To determine the effect of exercise itself beyond potential psychosocial group effects , patients in the control group perform a group-based progressive muscle relaxation training . Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy . Main exclusion criteria are acute infectious diseases , severe neurological , musculosceletal or cardiorespiratory disorders . The primary endpoint is cancer-related fatigue ; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood , saliva and urine . In addition , QoL , depression , physical performance and cognitive capacity will be assessed . Discussion The BEST study is the first r and omized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy . Based on the analysis of physiological , immunological and inflammatory parameters it will contribute to a better underst and ing of the physiological and psychosocial effects and the biological mechanisms of resistance training . The ultimate goal is the implementation of optimized intervention programs to reduce fatigue , improve quality of life and potentially the prognosis after breast cancer . Trial registration Clinical Trials.gov Background Preliminary studies suggest that physical exercise interventions can improve physical fitness , fatigue and quality of life in cancer patients after completion of chemotherapy . Additional research is needed to rigorously test the effects of exercise programmes among cancer patients and to determine optimal training intensity accordingly . The present paper presents the design of a r and omized controlled trial evaluating the effectiveness and cost-effectiveness of a high intensity exercise programme compared to a low-to-moderate intensity exercise programme and a waiting list control group on physical fitness and fatigue as primary outcomes . Methods After baseline measurements , cancer patients who completed chemotherapy  are r and omly assigned to either a 12-week high intensity exercise programme or a low-to-moderate intensity exercise programme . Next , patients from both groups are r and omly assigned to immediate training or a waiting list ( i.e. waiting list control group ) . After 12 weeks , patients of the waiting list control group start with the exercise programme they have been allocated to . Both interventions consist of equal bouts of resistance and endurance interval exercises with the same frequency and duration , but differ in training intensity . Additionally , patients of both exercise programmes are counselled to improve compliance and achieve and maintain an active lifestyle , tailored to their individual preferences and capabilities . Measurements will be performed at baseline ( t = 0 ) , 12 weeks after r and omization ( t = 1 ) , and 64 weeks after r and omization ( t = 2 ) . The primary outcome measures are cardiorespiratory fitness and muscle strength assessed by means of objective performance indicators , and self-reported fatigue . Secondary outcome measures include health-related quality of life , self-reported physical activity , daily functioning , body composition , mood and sleep disturbances , and return to work . In addition , compliance and satisfaction with the interventions will be evaluated . Potential moderation by pre- and post-illness lifestyle , health and exercise-related attitudes , beliefs and motivation will also be assessed . Finally , the cost-effectiveness of both exercise interventions will be evaluated . Discussion This r and omized controlled trial will be a rigorous test of effects of exercise programmes for cancer patients after chemotherapy , aim ing to contribute to evidence -based practice in cancer rehabilitation programmes . Trial registration This study is registered at the Netherl and s Trial Register ( NTR2153 While physical activity during cancer treatment is found beneficial for breast cancer patients , evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms . This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy  , on cancer-related fatigue , physical fitness , and activity level .  Sixty-seven women were r and omized to an exercise intervention group ( n = 33 , performed strength training 3x/week and 30 minutes brisk walking/day ) and a control group ( n = 34 , performed their regular physical activity level ) . Data collection was performed at baseline , at completion of chemotherapy ( Post1 ) , and 6-month postchemotherapy ( Post2 ) . Exercise levels were slightly higher in the scheduled exercise group than in the control group . In both groups , cancer-related fatigue increased at Post1 but returned to baseline at Post2 . Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2 . Significant differences between intervention and control groups were not found . The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy , although one can not rule out that results reflect diminishing treatment side effects over time BACKGROUND Exercise has been reported to decrease cancer-related fatigue  and to increase quality of life ( QoL ) in various breast cancer ( BC ) population s. However , studies investigating exercise during radiotherapy or resistance training are scarce . We conducted a r and omized , controlled trial ( BEST study ) to assess the efficacy of 12-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention . PATIENTS AND METHODS One hundred sixty patients with BC stage 0-III were r and omly assigned to a 12-week progressive resistance training ( 2 times/week ) or a 12-week relaxation control ( RC , 2 times/week ) . Both interventions were group-based . The primary end point fatigue was assessed with a 20-item multidimensional question naire , QoL with EORTC question naires . Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week 13 . RESULTS Adherence to the intervention program as well as the completion rate ( 97 % ) for the primary outcome variable fatigue was high . In intention-to-treat analyses for the N = 155 patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = 0.044 ) , especially for the subscale physical fatigue [ MD = -0.8 ; 95 % confidence interval -1.5 to -0.2 , P = 0.013 ] , but not for affective ( P = 0.91 ) or cognitive fatigue ( P = 0.65 ) . For QoL , significantly larger improvements regarding the role function ( P = 0.035 ) and pain ( P = 0.040 ) were noted among exercisers compared with RCs . Future perspective improved significantly stronger in the RC group compared with the EX group ( P = 0.047 ) . CONCLUSIONS The 12-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL  in BC patients during adjuvant radiotherapy . As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinical ly relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher . TRIAL REGISTRATION Clinical Trials.gov NCT01468766 PURPOSE This study aim ed to examine mediators of fatigue response to an exercise intervention for breast cancer survivors in a pilot r and omized controlled trial . METHODS Postmenopausal breast cancer survivors ( n = 46 ; ≤stage 2 ) , off primary treatment , and reporting fatigue and /or sleep dysfunction were r and omized to a 3-month exercise intervention ( 160 min·wk of moderate-intensity aerobic walking , twice weekly resistance training with resistance b and s ) or control group . Six discussion group sessions provided behavioral support to improve adherence . Fatigue , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , sleep dysfunction , and psychosocial factors were assessed at baseline and 3 months . RESULTS The exercise intervention effect sizes for fatigue were as follows : fatigue intensity d = 0.30 ( P = 0.34 ) , interference d = -0.38 ( P = 0.22 ) , and general fatigue d = -0.49 ( P = 0.13 ) . Using the Freedman-Schatzkin difference-in-coefficients tests , increase in fatigue intensity was significantly mediated by interleukin 6 ( IL-6 ) ( 82 % ) , IL-10 ( 94 % ) , IL-6/IL-10 ( 49 % ) , and tumor necrosis factor-α (TNF-α):IL-10 ( 78 % ) with reduced sleep dysfunction increasing the relationship between intervention and fatigue intensity rather than mediating intervention effects ( -88 % ) . Decrease in fatigue interference was mediated by sleep dysfunction ( 35 % ) , whereas IL-10 and pro-anti-inflammatory cytokine ratios increased the relationship between intervention and interference ( -25 % to -40 % ) . The reduction in general fatigue was significantly mediated by minutes of physical activity ( 76 % ) , sleep dysfunction ( 45 % ) , and physical activity enjoyment ( 40 % ) , with IL-10 ( -40 % ) and IL-6/IL-10 ( -11 % ) increasing the intervention-fatigue relationship . In the intervention group , higher baseline fatigue , anxiety , depression , and perceived exercise barrier interference predicted a greater decline in fatigue interference and /or general fatigue during the intervention . CONCLUSIONS Biobehavioral factors mediated and enhanced intervention effects on fatigue , whereas psychosocial factors predicted fatigue response . Further study is warranted to confirm our results and to improve underst and ing of relationships that mediate and strengthen the intervention-fatigue association BACKGROUND Fatigue is a relevant problem of cancer patients during and after treatment . Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy . However , there is a lack of information about the effects of this intervention on persistent cancer-related fatigue . Therefore , we assessed the effects of an exercise program on cancer-related fatigue after treatment . PATIENTS AND METHODS A consecutive series of 32 cancer patients with mild to severe persistent fatigue [ scores on the Brief Fatigue Inventory ( BFI ) > 25 ] participated in a 3-week exercise program consisting of endurance ( 30 min walking on a treadmill ) and resistance/coordination exercises for the major muscle groups .  Fatigue , mood , and anxiety were assessed with question naires and physical performance with a stress test before and after the program . RESULTS At the end of the program , we observed a significant increase of physical performance ( workload at the anaerobic threshold pre 61 + /- 26 W , post 78 + /- 31 W , P < 0.0001 ) and reduction of global fatigue ( Functional Assessment of Cancer Therapy : pre 45.7 + /- 13.4 , post 52.6 + /- 12.4 , P < 0.0001 ; BFI : pre 37.9 + /- 18.3 , post 31.2 + /-17.1 , P < 0.001 ) . However , no significant improvement of cognitive fatigue or reduction of anxiety was observed . CONCLUSIONS A 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment . However , this intervention does not affect depression , anxiety , or cognitive fatigue This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register The aim of the present study was to investigate the impact of a multidimensional exercise intervention focusing on physical capacity ; one-repetition maximum ( 1RM ) and maximum oxygen uptake ( VO2Max ) , activity level , general well-being and quality of life in cancer patients undergoing chemotherapy .  The intervention comprised resistance and fitness training , massage , relaxation and body-awareness training .  Eighty-two cancer patients , with or without evidence of residual disease , were included : 66 patients with 13 different types of solid tumours and 16 patients with 6 types of haematological malignancies . The patients trained in mixed groups for 9 h weekly for 6 weeks . Physical capacity , physical activity level and psychosocial well-being as measured by the Medical Outcomes Study 36-item Short-Form Health Survey and the European Organization for Research and Treatment of Cancer Quality of Life Question naire C30 were assessed pre- and post-intervention . Highly significant increases were achieved in muscular strength ( p<0.001 ) , physical fitness ( p<0.001 ) and physical activity levels ( p<0.001 ) . The patients reported significant reduction in treatment-related symptoms , i.e. , fatigue ( p=0.006 ) and pain ( p=0.03 ) . Highly significant improvements were observed in physical functioning ( p<0.001 ) and role functioning ( p<0.001 ) . Even patients with advanced disease were able to improve their results after 6 weeks . It is concluded that a multidimensional exercise intervention , including resistance training , may be beneficial for cancer patients undergoing chemotherapy . This study indicates significant clinical meaningful improvements . The exact role of the intervention has to be defined in a r and omized controlled design . A clinical ly controlled trial including 250 patients is currently being carried out
A significant negative association was found between aerobic exercise intensity and fatigue reduction .
A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance .
No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes .
Rates of adherence were typically high and few adverse events were reported .
Exercise is safe , reduces fatigue and increases endurance in cancer survivors .
QUESTION Is there a dose-response effect of exercise on inflammation , fatigue and activity in cancer survivors ?