Yoga and resistance exercise of significant benefit in cancer-related fatigue

A meta-analysis comparing several types of guideline-recommended exercises finds that only yoga and resistance exercise are of significant benefit in alleviating cancer-related fatigue (CRF) in cancer survivors.

CRF is reported in >80 percent of cancer survivors. [https://www.cancer.gov/about-cancer/treatment/side-effects/fatigue – accessed on 18 April 2025] It is a type of physical, emotional, and cognitive exhaustion or tiredness in cancer patients that is persistent, distressing, and subjective, and cannot be entirely relieved by rest or sleep. [J Natl Compr Canc Netw 2015;13:1012-1039] Multiple studies have demonstrated that exercise interventions, psychosocial and mind–body interventions, including yoga, Tai Chi, and Qigong, are effective in reducing fatigue during and after cancer treatment. [Cochrane Database Syst Rev 2012;11:CD006145; Psychol Bull 2008;134:700-741] Although the benefits of various exercise programmes are well documented and widely recognized, their relative effectiveness in mitigating CRF remains largely unclear.

A network meta-analysis of 33 randomized clinical trials (RCTs) examining the effects of aerobic exercise, resistance exercise, stretching exercise, combined aerobic and resistance exercise, yoga, Qigong, or Tai Chi on CRF in various cancer types was carried out. Overall, seven RCTs evaluating yoga, five examining resistance exercise, nine on aerobic exercise, four on Qigong, four on stretching, three on Tai Chi, and six on combined aerobic and resistance exercise were identified. Some of these RCTs included more than one type of exercise and used different interventions in the experimental and control groups. [Cancer Med 2025;14:e70816]

In terms of relief of CRF, both resistance exercise (standardized mean difference [SMD], -1.72) and yoga (SMD, -1.27) reduced the fatigue severity significantly better than standard care, whereas pooled analysis results did not identify a statistically significant decrease in fatigue severity score with aerobic exercise (SMD, -0.23), Qigong (SMD, 0.21), Tai Chi (SMD, 1.49), stretching exercise (SMD, 0.35), or aerobic and resistance exercise (SMD, 2.18).

“Among physical exercises, resistance exercise showed better effectiveness than stretching exercise [SMD, -2.09], while adding aerobic exercise to resistance exercise did not generate higher improvement compared with resistance exercise alone [SMD, 3.92]. Among mind–body interventions, yoga proved best compared with Tai Chi [SMD, -2.77] and Qigong [SMD, -1.49],” reported the researchers.

Metabolic changes, such as significantly lower concentrations of tryptophan and valine have been reported in patients with CRF vs those without, thus, altered metabolism could be one of the mediators of CRF. [Cell Rep 2020;33:108554] At the same time, a plasma metabolic profiling study found that resistance exercise was associated with a higher level of metabolites related to the TCA cycle (eg, lactate, pyruvate and malate) and decreased levels of succinate vs endurance exercise, suggesting better energy use with resistance exercise. In addition, resistance exercise may alter lipid, carbohydrate and amino acid metabolism, thereby increasing anaerobic metabolic capacity, which could explain resulting fatigue resistance. [Metabolites 2023;13:694]

According to post hoc analysis, for patients <55 years of age, both resistance exercise (SMD, -1.75) and yoga (SMD, -1.66) significantly reduced fatigue severity vs standard care. On the other hand, for cancer survivors >55 years of age, only yoga and none of the other exercises showed statistically significant improvement in CRF (SMD, -1.27). “Compared with physical exercise such as aerobic exercise, mind–body interventions are less intense and often accompanied by meditation along with relaxing deep breathing. For older cancer survivors, mind–body interventions might be a better choice due to greater feasibility and compliance,” suggested the researchers. [Curr Oncol Rep 2014;16:417]