Cancer Related Fatigue

12 September 2019

Of all the side effects of cancer treatment, some expected, some unexpected, cancer related fatigue is the most common and the most debilitating.

What is cancer related fatigue?

Cancer related fatigue (CRF) is a persistent lack of energy that is not significantly improved by sleep, and is not due to over exertion. CRF feels different to a tiredness you might feel at the end of a long day that is restored with a good nights' sleep. CRF can make it difficult to cope with the demands of normal daily activity, often leading to people being less active in their day to day lives. This in turn can create a deconditioning effect where people feel weaker and more fatigued it's a vicious cycle!

CRF can take many forms, including:

Generalised weakness or feelings of heaviness
Reduced ability to concentrate and perceived lack of short term memory
Reduce motivation or interest in engaging in usual activities
Difficultly sleeping
Fatigue that is not relieved by sleep
Difficulty completing daily tasks due to fatigue

What causes cancer related fatigue?

There are often multiple contributing factors to someone experiencing cancer related fatigue, and some of these are listed below:

Cancer
Hypothyroidism
Depression
Anxiety/stress
Poor nutrition
Sedentary behaviour
Treatments
Poor sleep
Anaemia (low red blood cell count)
Medication

I'm already tired! How can exercise help me feel less fatigued?

Exercise is now recommended as a part of every cancer treatment plan. Research has found it has no harmful effects on patients with cancer and has shown that those who exercise regularly experience less cancer related fatigue.

Exercise increases strength, flexibility, and cardiovascular fitness. The easier it is to move, the less fatiguing moving is. Exercise maintains bone health and elevates mood. Exercise also helps to control body weight and reduces cancer reoccurrence.

In 2009 Courneya (2) compared 12 weeks of aerobic training to usual care in 122 lymphoma patients. The exercise group showed better physical functioning, fatigue levels, quality of life, happiness, lower depression levels and improved cardiovascular fitness and lean body mass.

In 2011 a meta-analysis was performed on 44 (RCT) studies looking at exercise and cancer related fatigue. The outcomes of 3,254 participants found that moderate resistance exercise reduced cancer related fatigue more than light resistance exercise or low to moderate aerobic exercise. (3)

In another meta-analysis performed on 56 studies in 2012 Cramp found that aerobic exercise was the more beneficial form of exercise for cancer related fatigue.

How do I get started?

This may seem overwhelming. It is important to start low and progress slowly, especially if you have never exercised before. Everyone's Cancer Related Fatigue experience is different, but there are some general ideas you can follow. For an individual exercise program that takes into account your own history, cancer, treatment, your response, any other problems you may have, and for an assessment of your current level of fitness and condition, please see an Exercise Physiologist with a special interest in cancer.

Depending on your fatigue and fitness levels, your exercise program might start with exercising lying down, or might include a walk to the letter box and back each day, going further as you improve.

Remember, doing something is better than nothing. Exercise is one way you can take back control of your body and improve your mood. It is important to seek specialist advice from an Exercise Physiologist in order to ensure you are performing the safest exercises for you.

References

1. Bower JE. Cancer-related fatigue--mechanisms, risk factors, and treatments. Nature reviews Clinical oncology. 2014;11(10):597-609.

2. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, Friedenreich CM, et al. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2009;27(27):4605-12.

3. Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT. Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology. 2011;20(1):123-33.