Is Resistance Training an Effective Treatment for Fatigue in People With Cancer?

Does resistance training improve cancer-related fatigue and quality of life before, during, or after cancer treatments?

Studies of up to 12 weeks' duration show that resistance training during cancer treatment decreases cancer-related fatigue compared with no training. It is unclear whether this training improves quality of life, and there is insufficient evidence to determine whether risks are associated with resistance training.¹ (Strength of Recommendation: B, inconsistent or limited-quality patient-oriented evidence.)

Cancer-related fatigue manifests as prolonged intense exhaustion affecting physical and mental health secondary to the diagnosis of cancer and the subsequent effects of cancer treatment.^1,2 It is not simply tiredness relieved by rest or relaxation. In the United States, there were approximately 1.8 million new cancer cases reported in 2022, making the recognition of cancer-related fatigue important to family medicine physicians.³ The primary objective by the authors of this Cochrane review was to determine whether the incorporation of resistance training before, during, or after the cancer treatment regimen mitigates cancer-related fatigue or its subsequent effects (eg, quality of life, unwanted or harmful effects, depression, anxiety).

This Cochrane review included 21 randomized controlled trials (RCTs) with a total of 2,221 participants (ages 45–72 years) diagnosed with various types of cancer.¹ The data encompass resistance training conducted during (14 studies) or after (seven studies) cancer treatment. The size of the training and control groups ranged from 20 to 82 participants. Ten studies exclusively involved participants who identified as female, with eight studies focused on breast cancer; one on endometrial cancer; and one on endometrial, cervical, or ovarian cancers. Six studies included patients who identified as male or female, and one included patients with varying malignancies (eg, hematologic cancers, nasopharyngeal carcinoma, lung cancer, pancreatic cancer, breast cancer).

To be included, training programs had to be structured, involve at least five sessions with a face-to-face component, and have more than 20 participants; studies not meeting these criteria were excluded.¹ The resistance-training methods included use of body weight, free weights, workout machines, and resistance bands. No studies examined the effects of resistance-training programs that began before the initiation of cancer treatment. The baseline fitness level of patients included in these studies was not described.

The authors used the Functional Assessment of Chronic Illness Therapy–Fatigue scale and correlated the timing of resistance training to the timing of cancer treatment.¹ Risk of bias and evidence certainty were evaluated using Cochrane's bias risk tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) system, respectively.⁴

Studies of up to 12 weeks' duration demonstrated that resistance training performed during cancer treatment resulted in decreased cancer-related fatigue compared with no training (mean difference on Functional Assessment of Chronic Illness Therapy–Fatigue scale = 3.90; 95% CI, 1.30–6.51; scale from 0 to 52 with higher values meaning better outcome; minimal important difference = 3; 12 RCTs; n = 1,120; moderate-certainty evidence).¹

Studies of up to 12 weeks' duration demonstrated resistance training improved quality of life compared with no training, yet this was not considered clinically meaningful (based on 12 RCTs; n = 1,117; low-certainty evidence).¹