Feasibility of an exercise intervention for chemotherapy-related fatigue in patients with gynecologic cancer: a randomized controlled trial with multidimensional assessment

Abstract

Although exercise interventions have shown benefits in several cancer populations, evidence during chemotherapy for gynecologic cancers remains limited. This randomized controlled trial evaluated the feasibility and efficacy of a home-based exercise intervention for cancer-related fatigue, quality of life, and physical function in patients undergoing chemotherapy for gynecologic cancers. A total of 110 patients with cervical, endometrial, or ovarian cancer were randomized 1:1 to an exercise or control group during paclitaxel–carboplatin chemotherapy. The home-based intervention comprised 30 min of moderate-intensity walking and squat exercises three times weekly. Participants attended rehabilitation visits every 3 weeks for feedback on safety, appropriate technique, and adherence. Control participants received standard care without exercise instructions but recorded their daily activity. The primary endpoint was change in fatigue measured using the Functional Assessment of Chronic Illness Therapy–Fatigue (FACIT-F) subscale. Secondary endpoints included other patient-reported outcomes, physical function, body composition, and adverse events. Fifty-one and 55 patients in the exercise and control groups, respectively, were evaluable. No significant difference in FACIT-F change was observed (LS mean difference: 1.8; 95% CI: − 1.3 to 4.9). Exercise adherence was 76% in the exercise group; 71% of the controls voluntarily exercised at similar levels. Patients with prior exercise habits were more likely to meet exercise criteria (81% vs. 65%; p = 0.07). The exercise group showed better preservation of quadriceps strength; CT revealed reduced psoas muscle mass and increased visceral fat in both groups. Grade ≥ 2 nausea and myalgia were less frequent in the exercise group. Although the intervention did not significantly improve fatigue, it was safe, feasible, and associated with preserved lower limb strength and fewer non-hematologic toxicities. High adherence in both groups suggests that exercise during chemotherapy is achievable and well accepted, reflecting strong motivation to remain active, which may also have contributed to control-group contamination and reduced between-group differences. Future studies should refine exercise protocols through digital monitoring and combined nutritional strategies while identifying patient subgroups most likely to benefit during active cancer treatment. Registered with the Japan Registry of Clinical Trials (jRCT; registration number: jRCT1031200069; date: July 16, 2020).