Exercise, Psychological Therapy Help Ease Cancer-Related Fatigue Better Than Medicine

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Fatigue is hard to describe. You feel like you don't have any energy and are tired all the time. But there's not a specific cause, such as doing errands all day, working out, or other exertion. When you're tired from exertion, if you get enough sleep that night, you usually feel better the next day. With fatigue, you feel generally tired all the time and lose interest in people and the things you normally like to do.

Fatigue is the most common side effect of breast cancer treatment. Some doctors estimate that 9 out of 10 people experience some fatigue during treatment. Fatigue from treatment can appear suddenly and can be overwhelming. Rest doesn't ease fatigue, and it can last for months after treatment ends.

Symptoms of fatigue include:

  • lack of energy
  • sleeping more
  • not wanting to do normal activities or being unable to do them
  • paying less attention to personal appearance
  • feeling tired even after sleeping
  • trouble thinking or concentrating
  • trouble finding words or speaking

Almost every treatment for breast cancer can cause fatigue, and many pain medicines, such as codeine and morphine, also can cause fatigue.

A study has found that exercise and psychological therapy are much better than medicines at reducing cancer-related fatigue.

The research was published online on March 2, 2017 by JAMA Oncology. Read the abstract of “Comparison of Pharmaceutical, Psychological, and Exercise Treatments for Cancer-Related Fatigue: A Meta-analysis.”

This study was a meta-analysis. A meta-analysis combines and analyzes the results of a number of earlier studies. In this case, results from 113 studies looking at treatments for cancer-related fatigue were analyzed. In this meta-analysis, all the studies analyzed were randomized clinical trials, the gold standard for evaluating effective treatments.

More than 11,500 people were in the studies; 78% of them were women and nearly half were women being treated for breast cancer. All the people in the studies were experiencing cancer-related fatigue. The studies were published between Jan. 1, 1999 and May 31, 2016 and looked at four treatments for fatigue caused by cancer and its treatments:

  • exercise
  • psychological therapy
  • a combination of exercise and psychological therapy
  • medicine

The researchers found that exercise eased cancer-related fatigue the most. It didn’t matter if the exercise was aerobic, such as walking, jogging, dancing, hiking, etc., or anaerobic, such as weight lifting, sprinting, interval training, or jumping.

Psychological therapy, such as therapy that educates a person about the causes of fatigue, changes behavior, or changes the way a person thinks about his or her circumstances also improved fatigue.

A combination of exercise and psychological therapy had mixed results and the best way to combine these two to make them effective wasn’t clear.

Finally, the researchers found that medicines to treat cancer-related fatigue, such as Provigil (chemical name: modafinil), which is used to treat excessive sleepiness caused by narcolepsy, and Ritalin (chemical name: methylphenidate), which is used to treat attention deficit hyperactivity disorder (ADHD), don’t work.

"If a cancer patient is having trouble with fatigue, rather than looking for extra cups of coffee, a nap, or a pharmaceutical solution, consider a 15-minute walk," said Karen Mustian, Ph.D., MPH, associate professor at the University of Rochester Medical Center. "It’s a really simple concept but it’s very hard for patients and the medical community to wrap their heads around it because these interventions have not been front-and-center in the past. Our research gives clinicians a valuable asset to alleviate cancer-related fatigue.

"The literature bears out that these drugs don't work very well although they are continually prescribed," Mustian continued. "Cancer patients already take a lot of medications and they all come with risks and side effects. So any time you can subtract a pharmaceutical from the picture it usually benefits patients."

If you’re having fatigue from breast cancer treatment, you may want to talk to your doctor about this study. Ask how much and how often you can exercise, as well as if there are types of exercise you should avoid. If you’ve never exercised before, it can help to think of exercise as another important part of your overall treatment plan that helps you recover and stay healthy. You also can ask around and see if any breast cancer support groups near you have organized exercise classes. If you can't find an exercise class through a breast cancer group, consider joining another exercise class or start walking with a friend. There's a good chance that exercising with other people will give you the motivation and support to make regular exercise part of your recovery. Find the right exercise routine for YOU and then do your best to stick with it! It can make a difference, today and tomorrow.

In the Breastcancer.org Exercise section, you can learn about:

  • the benefits of exercise
  • types of exercise
  • when you can and can't exercise during treatment
  • tips on finding a trainer


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