Systematic review finds activity pacing may improve cancer-related fatigue during chemotherapy

Photo by Stephen Phillips - Hostreviews.co.uk / Unsplash

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer Published May 16, 2026 Medically reviewed May 16, 2026 Study authors: Shimizu Yoichi, Tsuji Katsunori, Hanai Akiko, Hosokawa Mai PubMed ↗ DOI ↗ By Dr. Julia Lee, PhD · Oncology, Genomics & Drug Development

Key Takeaway

Consider activity pacing for cancer-related fatigue during chemotherapy, but evidence certainty is extremely low.

This systematic review and meta-analysis evaluated the effect of activity pacing-related interventions on cancer-related fatigue (CRF). The analysis included 5 studies with 617 participants, comparing activity pacing interventions to controls. The primary outcome was CRF.

Overall, the pooled effect was small and not statistically significant (SMD = -0.36; 95% CI: -0.73 to 0.00), indicating a trend toward improvement but with uncertainty. In a subgroup of patients undergoing chemotherapy (3 studies, 197 participants with breast cancer), a moderate and statistically significant effect was observed (SMD = -0.58; 95% CI: -0.87 to -0.29).

The authors note substantial heterogeneity (I² = 66%) and rate the certainty of the evidence as extremely low. Adverse events, tolerability, and long-term outcomes were not reported. Limitations include low evidence certainty and limited generalizability beyond chemotherapy patients.

Clinically, activity pacing may offer some benefit for CRF, particularly during chemotherapy, but the evidence is weak and should be interpreted cautiously. Further high-quality research is needed.

Study Details

Study typeMeta analysis

Sample sizen = 617

EvidenceLevel 1

PublishedMay 2026

PMID42141128

View Original Abstract ↓

PURPOSE: Although physical activity is recommended for managing cancer-related fatigue (CRF), activity pacing (AP) and energy conservation are also implemented to balance activity and rest. This systematic review assessed the effectiveness of AP-related interventions and behavior change techniques (BCTs) employed in AP-related interventions for CRF management. METHODS: We searched PubMed, CINAHL, CENTRAL, and Ichu-shi databases for articles published up to February 28, 2026. After assessing the risk of bias, we performed meta-analyses for quantitative synthesis. We also identified and classified BCTs using data from the Behavior Change Technique Taxonomy version 1. RESULTS: Among the 1257 identified studies, 10 (7 randomized controlled trials [RCTs] and 3 non-RCTs) met the inclusion criteria. The effect size was small but not significant (standardized mean differences [SMD] = - 0.36; 95% confidence intervals [CI]: - 0.73 to 0.00; 5 studies; 617 participants), with substantial heterogeneity (I = 66%). Compared with controls, the intervention showed a moderate, statistically significant effect in the subgroup of patients undergoing chemotherapy (SMD = - 0.58; 95% CI: - 0.87 to - 0.29; three studies; 197 participants with breast cancer). The primary BCTs used in AP-related interventions were "goal setting," "social support," and "graded tasks." CONCLUSION: AP-related interventions may provide some benefit in improving CRF, particularly during chemotherapy. However, the certainty of the current evidence is extremely low. Although these interventions represent useful approaches, further RCTs are needed, and digitization of AP-related intervention programs incorporating effective BCTs may be beneficial.