This document summarizes recent advances in exercise interventions for managing fatigue in patients with gynecologic cancer. It reviews 3 studies that investigated the effects of different types of exercise on fatigue. A randomized controlled trial found that a 12-week resistance exercise program significantly improved quality of life and reduced fatigue in patients with gynecologic cancer compared to a control group. Another study found that relaxation breathing exercises conducted 4 times daily for 30 minutes significantly reduced fatigue in women receiving chemotherapy, more so than exercises conducted 2 times daily. A systematic review concluded that resistance, aerobic, flexibility, and breathing exercises can all help alleviate fatigue in this patient population, but noted limited evidence and called for additional research.

1. RECENT ADVANCES IN EXERCI
INTERVENTION FOR FATIGUE
MANAGEMENT IN PATIENTS WI
GYNAECOLOGIC CANCER
MUSKAN RASTOGI
222139001
MPT(OBG)-GYNAECOLOGICAL PHYSIOTHERAPY

2. Contents
2
1.Introduction
2.Need for recent advance
3.Search strategy
4.Inclusion criteria
5.Exclusion criteria
6.Total included articles
7.Clinical implication
8.Future Scope
9.References

3. INTRODUCTION
• Gynaecological cancer is an umbrella term for cancer of women’s
reproductive organs, which includes ovarian, endometrial(corpus uteri),
vaginal, vulval and cervical cancer(cervix uteri).
• Globally, 1.4 million females were estimated to be newly diagnosed with
gynaecological cancers in 2020, with 6.8 lakh deaths.
(CDC National Centre for Health Statistics, Jan 2022)
3

4. • In India, 2 lakh new gynecological cancer cases were
diagnosed in 2020, and 1.2 lakh deaths occurred among
females. Every 1 in 30 Indian women develops gynecological
cancer in their lifetime, and one in 48 women dies from it.
(Sung H et al. 2021)
• Among Indian females, cancer was observed mainly in the age
group of 35–64 years, which is also the most productive age
group.
(ICMR-NCDIR, Bengaluru, India
2020)
4

5. 5

6. • Most epidemiological studies indicate that the fatigue caused by
cancer and its treatment occurs more pervasively, persistently, and
profoundly than any other symptom.
(Mendoza et al.
1999)
• For patients with gynecological cancer, cancer-related fatigue
(CRF) has been well documented as an adverse event by clinicians
in clinical trials of new drugs and during standard intraperitoneal
chemotherapy.
(Wang & Woodruff
2015)
6

7. • In a qualitative examination of ovarian cancer patients, CRF
emerged as the most common symptom, with 93% of patients
reporting its presence.
• Additionally, the validation study for the MD Anderson
Symptom Inventory ovarian cancer module revealed that 20%
of patients experienced severe fatigue.
(Wang & Woodruff 2015)
7

8. • In the past, cancer patients were encouraged to rest if they felt
fatigued. Physical exercise has been suggested as helpful in
reducing the fatigue associated with cancer by counteracting the
tumors and toxic therapy’s adverse effects on the capacity for
physical performance.
• However, the benefits of exercise on fatigue were explicitly
observed for people with breast cancer and prostate cancer.
(Kessels and Ellen et. Al. 2018)
8

9. NEED FOR RECENT ADVANCE
9
• Studies have proven that exercise is an effective tool for reducing cancer-
related fatigue.
• However, these investigations have been restricted to groups of
individuals affected by breast and prostate cancer.
• The appropriate exercise type and dosage for gynaecological cancer
patients to alleviate fatigue remains uncertain.
• Hence, this RA aims to gain insight into the efficacy of each exercise
intervention given to gynecological cancer patients to reduce fatigue
levels.

10. SEARCH STRATEGY
DATABASES
• EMBASE - 7
• SCOPUS- 19
• PUBMED – 11
• GOOGLE SCHOLAR- 15
• Total Results - 42
• Removal of duplicates- 36
• Title and abstract screening- 3
Keywords used- “exercise,” “gynecologic cancer,” “Fatigue” “ovarian” “vulval,”
“endometrial” “cervical” “aerobic exercise,” “breathing exercise,” “resistance
exercise”
Boolean operators- “AND” and “OR”
Timeline- 2018 to 2023
10

11. INCLUSION CRITERIA
11
1. Participants diagnosed/ undergoing chemotherapy for any type of
Gynecologic Cancers.
2. Exercise intervention specific to gynecologic cancer patients.
3. Exercise given at any stage of diagnosis or treatment.
4. Studies published in the English language.
5. Studies with the highest level of evidence
6. Studies performed on human subjects

12. EXCLUSION CRITERIA
• Studies in languages other than English.
• Full-text articles not available, Case series, Case reports.
12

13. Recent
Advances

14. Articles Included
Title Level of
Evidence
PEDro
score
The effect of resistance exercise on quality of life and fatigue in patients with
gynecological cancer
1b 8/11
Effect of Relaxation Breathing Exercise on Fatigue for Women with Gynecological
Cancer Receiving Chemotherapy
1b 9/11
Exercise Interventions to Manage Fatigue in Women With Gynecologic Cancer: A
Systematic Review
1a
14

15. TURKISH JOURNAL OF SPORTS MEDICINE
2022;57(1):44-50

16. • AIM
To investigate the effect of resistance exercises on quality of life
and fatigue in patients with gynecological cancer.
• PARTICIPANTS
160 endometrial, cervical, or ovarian cancer patients participated in
the study. Participants were divided into two groups the exercise
and control groups, with 80 individuals in each group.
Single centred randomized controlled trial
16

17. • OUTCOME MEASURES TAKEN
Primary outcome measurements.
Functional Assessment of Cancer Therapy-General
Functional Assessment of Chronic Illness Therapy-Fatigue
Secondary outcome measurements.
Body mass index (BMI)
Body fat ratio
Hand grip strength
Hip and back extensor group muscle strength
17

18. • INTERVENTION (EXERCISE GROUP)
12 weeks of intervention were given. (1-2 sets x 8-12 repetitions for 2
days/week)
Exercises for the upper extremity:
• Abduction, extension, and external rotation of the shoulder against
resistance,
• Horizontal adduction and protraction against resistance,
• Flexion of the elbow against resistance.
Exercises for the lower extremity :
• Flexion-extension of the hip against resistance,
• Abduction and adduction of the hip against resistance,
• Flexion and extension of the knee against resistance,
• Flexion and extension of the ankle against resistance.
• A total of five different levels of resistance bands were used. The
patients were asked to choose the resistance band so that they would
perform the last repetitions with a compelling effort. The participants
18

19. • INTERVENTION (CONTROL GROUP)
Usual oncological care.
(intervention not defined)
19

20. • RESULTS
At the end of the study, significant improvements were observed in the
quality of life (p<0.001) and fatigue (p<0.001), as well as body
composition and strength values (p<0.001) in the exercise group
compared to the control group.
The levels of change in the values were more significant in the
exercise group (p<0.001). A significant correlation was found between
the changes in physical parameters (body fat ratio, BMI) and the
changes in quality of life and fatigue levels (p<0.001)
• CONCLUSION
Resistance exercises could significantly reduce cancer-related fatigue
and improve quality of life in patients with gynecological cancer. It can
be concluded that resistance exercises can contribute to the treatment
process and the patient’s quality of life
20

21. EGYPTIAN JOURNAL OF HEALTHCARE, 2020

22. • AIM
To evaluate the effect of relaxation breathing exercises on fatigue for
women with gynecological cancer receiving chemotherapy.
• PARTICIPANTS
Simple random sample were recruited to participate in this study.
Subjects: Subjects of this study included 183 women
Inclusion criteria: Women who had gynaecological cancer, received
chemotherapy in the inpatient units, endured cancer-related fatigue,
alert, and knew writing and reading.
Exclusion criteria: Women with chronic medical conditions such as
diabetes mellitus, heart disease, and chronic kidney disease were
excluded from the study because fatigue experience can be affected by
these conditions.

23. 23

24. • OUTCOME MEASURES TAKEN
PFS- PIPER FATIGUE SCALE
WOMEN’S DIARY NOTES
• INTERVENTION
7-day intervention
Subjects of the two times relaxation breathing exercise group were taught how to perform a
3-step relaxation breathing exercise.
Step1.Preliminary exercise: In which women sit on the bed in a comfortable position and
focus their attention on the lower abdomen.
Step2.Relaxation breathing: This step focuses on performing relaxation breathing exercises
through which the women relax and inhale deep breath and exhale them loudly.
Step 3. Ending Exercise: In this step the exercise instruction was to extend both arms and
legs and keep their minds clear. Each participant exercises twice; once in the morning/8 am
and the other in the afternoon/8 pm
Four-time relaxation breathing exercise group received the same care as 2 times group
except that they were instructed to perform RBE four times instead. This group were
instructed on 3-step relaxation breathing exercises 4 times daily for 30 minutes each time, at
this time;(morning/8 am, midday/12 pm, afternoon/4pmandnight/8 pm) for seven days.
24

25. Results:
• There was a highly significant difference in fatigue scores between
intervention and control. Also, fatigue scores were statistically
significantly reduced between two weeks and four weeks groups.
• There was also a considerable difference concerning four fatigue
domains between intervention and control groups.
• Moreover, there was a significant difference in mean fatigue score
concerning daily activities on the seventh day of the study among
interventions (two times group). At the same time, there was a high
significance difference between the four times groups and the control
group.
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27. 27

28. 28

29. 29

30. Conclusion:
• Relaxation breathing exercise is a cost-effective, non-invasive, easy,
and safe practice to alleviate cancer related-fatigue, mainly when
conducted four times daily.
• Moreover, relaxation breathing exercise positively improves the
performance of daily activities and associated symptoms of
chemotherapy.
30

31. ONCOLOGY NURSING FORUM,2019

32. 32
AIM and PROBLEM IDENTIFICATION: Fatigue has a negative impact on the quality of life of
patients with cancer. This review aims to evaluate studies on the effectiveness of exercise
interventions in reducing fatigue in women with gynecologic cancer.
LITERATURE SEARCH: The review was conducted according to the PRISMA guidelines using the
CINAHL, MEDLINE, EMBASE, PsycINFO, and Cochrane Library databases. The Critical Appraisal
Skills Programme was used for quality assessment.
DATA EVALUATION: Five studies met the inclusion criteria: three randomized controlled trials and
two single-arm trials.
CONCLUSION: Evidence suggests that exercise interventions significantly reduce fatigue in women
with gynecologic cancer. However, the current evidence is limited. Additional studies are required to
address the dose-dependent outcomes of exercise interventions on fatigue in women with
gynecologic cancer.

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37. CLINICAL IMPLICATION
• Relaxation breathing exercises improve all four domains of
fatigue.{Repetition of four is more effective than two times for
30 minutes daily}
• Resistance exercise can be given as 1-2 sets x 8-12
repetitions for 2 days/week with the help of resistance
bands.
• Superiority of any exercise intervention is not established.
• Resistance, aerobic, flexibility, and breathing exercises
alleviate fatigue in patients with gynecological cancer, hence,
they should be a part of the exercise protocol to relieve fatigue.
37

38. FUTURE SCOPE
• Standardized parameters for all the types of exercise to reduce
fatigue in gynecologic cancer patients.
• Effect of application of exercise intervention on fatigue within
the different types of gyanecologic cancer should be studied.
38

39. REFERENCES
• Mendoza TR, Wang XS, Cleeland CS, Morrissey M, Johnson
BA, Wendt JK, Huber SL. The rapid assessment of fatigue
severity in cancer patients: use of the Brief Fatigue Inventory.
Cancer. 1999 Mar 1;85(5):1186-96.
• Wang XS, Woodruff JF. Cancer-related and treatment-related
fatigue. Gynecologic oncology. 2015 Mar 1;136(3):446-52.
• Kessels, Ellen et al. “The effect of exercise on cancer-related fatigue in
cancer survivors: a systematic review and meta-analysis.” Neuropsychiatric
disease and treatment vol. 14 479-494. 9 Feb. 2018,
doi:10.2147/NDT.S150464
39

40. Thank you