The Effect of Exercise and Nutrition on Muscle Wasting and Fatigue in Cancer
Patients: A Review of Literature
Savanna Bryson, Kylee Drury, Nikki Ichiho, Emma Smith, Taya Darrington, Lilly Teeples, SN
INTRODUCTION
Background:
• Fatigue is one of the most common side effects of cancer. This
can be related to radiation, chemotherapy, or even the disease
itself (Patel et al., 2017). The effect fatigue takes on the body
can diminish the patient's quality of life. This happens by fatigues
negative impact on the patient's energy level, strength, range of
motion, and ability to complete activities of daily living. Exercise
is known to improve all aspects of health for all patients.
However, detailed exercise programs have not been established
as a mainstay of treatment for patients with cancer-related
fatigue and muscle wasting.
• Although there is data suggesting a positive correlation between
exercise and fatigue, a literature review is needed to assess the
effects that exercise has on fatigue in cancer patients (An et al.,
2019).
• Exercise programs are not a common form of therapy
for cancer patients but could be beneficial in the
prevention of muscle wasting and fatigue.
Clinical Question:
In cancer patients with muscle wasting, what is the effect of
adjunctive exercise on slowing the progression of muscle wasting
and fatigue compared to nutritional interventions alone?
METHODOLOGY
- An integrative methodology literature review was conducted
• Databases: CINAHL, Medline
• Search terms: cachexia AND "cancer patient*" AND exercise
• Other: cachexia AND "cancer patients" AND physical activity
”effect of exercise” AND “Cancer patients” and cachexia
• Date range: 2011-2022
• Boolean Operators: AND/OR
• Inclusion criteria: English language, primary research, quantitative studies
• Exclusion criteria: QI studies, non-English language, Pharmacologic
interventions, Qualitative studies
Faculty Mentor: Julie Chew, PhD
Department of Nursing, College of Health Sciences
RESULTS
• Research shows a correlation between physical activity and a decrease in
cancer-related fatigue or muscle wasting.
• Participating in physical activity may improve quality of life and ability to
do ADLs in cancer patients.
• Exercise was shown to improve lean body mass and
decrease postural sway as compared to those who did not
participate in physical activity (Stuecher et al., 2019).
• An addition of nutritional supplementation with the physical activity may
be required to have the desired effect.
• One experimental trial had patients consume at least half a
unit of the protein-rich ONS (corresponding to 9-10 grams
of protein and 150-200 kcal) after each training session and a
minimum of 3 nutritional counseling sessions (Ballmer et al.,
2019).
• There is evidence physical activity before and after diagnosis, even in low
moderation, can present decreased mortality rates in those with many
different types of cancer (Cannioto et al., 2019).
• Another study showed home-based aerobic exercise
has the potential to improve functional capacity, postural stability, and
body composition (Stuecher et al., 2019).
• The aim was to complete 150 min of moderate
intensity walking per week.
• Results of one study show a decrease in fatigue with aerobic
exercises during a 6-week program following chemotherapy and/or
radiotherapy (Patel et al., 2017).
• Cancer-related fatigue was measured with the brief fatigue
inventory (BFI) which is patient-report instrument with
established reliability and validity commonly used in studies
of CRF
• The QOL was assessed using the functional assessment of
cancer therapy-general (FACT-G)
DISCUSSION
• Implications
• Research data suggests exercise interventions may
be effective in improving physical performance and
quality of life, reducing cancer-related fatigue, and
decreasing mortality
• Nutritional interventions may be effective in
increasing protein and caloric intake
• Strengths
• Multiple articles reviewed discussed the use of
physical activity in therapy for cancer patients.
• Limitations
• Large variety of other variables including type of
cancer, progression of disease, and adjunctive
therapies used. Additionally, the findings were not
statistically significant due to the small sample sizes.
• Future Recommendations
• Additional research on larger sample sizes is needed
to direct healthcare providers to form a
comprehensive plan of care for patients with muscle
wasting and fatigue.
• In-patient exercise programs may need to be further
studied to assess the benefits of exercise during
hospitalization.
REFERENCES
- An, K.-Y., In Yang, H., Kang, D.-W., Courneya, K. S., & Jeon, J. Y. (2020). Development process of an evidence-
based exercise program for post-operative colorectal cancer patients. Supportive Care in Cancer, 28(2), 755–
765.
- Ballmer, P. E., Uster, A., Ruehlin, M., Imoberdorf, R., & Pless, M. (2019). Effects of nutrition and physical
exercise intervention in palliative cancer patients: A randomized controlled trial. Clinical Nutrition (Edinburgh,
Scotland), 38(1), 476.
- Cannioto, R. A., Dighe, S., Mahoney, M. C., Moysich, K. B., Sen, A., Hulme, K., McCann, S. E., & Amrosone,
C. B. (2018). Habitual recreational physical activity is associated with significantly improved survival in ‘
cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes & Control,
30, 1–12.
- Furzer, B. J., Ackland, T. R., Wallman, K. E., Petterson, A. S., Gordon, S. M., Wright, K. E., & Joske, D. J. (2015). A
randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on
outcomes in haematological cancer patients. Supportive Care in Cancer, 24(4), 1697–1707.
- Oldervoll, L. M., Loge, J. H., Lydersen, S., Paltiel, H., Asp, M. B., Nygaard, U. V., Oredalen, E., Frantzen, T. L.,
Lesteberg, I., Amundsen, L., Hjermstad, M. J., Haugen, D. F., Paulsen, Ø., & Kaasa, S. (2011). Physical exercise for
cancer patients with advanced disease: a randomized controlled trial. The Oncologist, 16(11), 1649–1657.
- Patel, J. G., & Bhise, A. R. (2017). Effect of aerobic exercise on cancer-related fatigue. Indian Journal of
Palliative Care, 23(4), 355–361.
- Stuecher, K., Vogt, L., Niederer, D., Banzer, W., Schmidt, K., Bolling, C., & Dignaß, A. (2019). Exercise improves
functional capacity and lean body mass in patients with gastrointestinal cancer during chemotherapy: a single-
blind RCT. Supportive Care in Cancer, 27(6), 2159–2169.
- Uster, A., Ruefenacht, U., Ruehlin, M., Pless, M., Siano, M., Haefner, M., Imoberdorf, R., & Ballmer, P. E. (2013).
Influence of a nutritional intervention on dietary intake and quality of life in cancer patients: A randomized
controlled trial. Nutrition, 29(11/12), 1342–1349.
- Wallengren, O., Lundholm, K., & Bosaeus, I. (2013). Diagnostic criteria of cancer cachexia: relation to quality of
life, exercise capacity and survival in unselected palliative care patients. Supportive Care in Cancer, 21(6), 1569–
1577.