American Academy of Nursing

View all recommendations from this society

Released April 23, 2015

Don’t neglect to advise patients with cancer to get physical activity and exercise during and after treatment to manage fatigue and other symptoms.

During treatment for cancer, up to 99% of patients will have fatigue and many individuals continue to experience persistent fatigue for years after completion of treatment. It is the natural tendency for people to try to get more rest when feeling fatigued and health care providers have traditionally been educated about the importance of getting rest and avoiding strenuous activity when ill. In contrast to these traditional views, resistance and aerobic exercise have been shown to be safe, feasible and effective in reducing symptoms of fatigue during multiple phases of cancer care. Exercise has also been shown to have a positive effect on symptoms of anxiety and depression. Current professional guidelines recommend 150 minutes of moderate-level exercise such as fast-walking, cycling or swimming per week along with 2-3 strength training sessions per week, unless specifically contraindicated.


These items are provided solely for informational purposes and are not intended as a substitute for consultation with a health professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician or nurse.

How The List Was Created

The American Academy of Nursing has convened a workgroup of member fellows who are leaders of professional nursing organizations representing a broad range of clinical expertise, practice settings and patient populations. The workgroup collaboratively identifies nursing/interdisciplinary interventions commonly used in clinical practice that do not contribute to improved patient outcomes or provide high value. An extensive literature search and review of practice guidelines is conducted for each new proposed recommendation for the list. The supporting evidence is then reviewed by the respective nursing organization(s) with the most relevant expertise to each recommendation. The Academy workgroup fellows narrow the recommendations through consensus, based on established criteria. The final recommendations are presented to the American Academy of Nursing’s Board of Directors for approval to be added to the Choosing Wisely list created by the Academy.

The American Academy of Nursing’s conflict of interests and disclosures policy can be found at www.AANnet.org.

Sources

Bower JE, Bak K, Berger A, Breitbart W, Escalante CP, Ganz PA, Schnipper HH, Lacchetti C, Ligibel JA, Lyman GH, Ogaily MS, Pirl WF, Jacobsen PB; American Society of Clinical Oncology. Screening, assessment, and management of fatigue in adult survivors of cancer: an American Society of Clinical Oncology clinical practice guideline adaptation. J Clin Oncol. 2014 Jun 10;32(17):1840-50.

Fulcher CD, Kim HJ, Smith PR, Sherner TL. Putting evidence into practice: evidence based interventions for depression. Clin J Oncol Nurs. 2014 Dec;18 Suppl:26-37.

Mitchell SA, Hoffman AJ, Clark JC, DeGennaro RM, Poirier P, Robinson CB, Weisbrod BL. Putting evidence into practice: an update of evidence-based interventions for cancer-related fatigue during and following treatment. Clin J Oncol Nurs. 2014 Dec;18 Suppl:38-58.

NCCN clinical practice guidelines in oncology: cancer-related fatigue [v.1.2014]. Fort Washington (PA): National Comprehensive Cancer Network; 2014.

Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvão DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, von Gruenigen VE, Schwartz AL; American College of Sports Medicine. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010 Jul;42(7):1409-26.

Fatigue [Internet]. Pittsburgh (PA): Oncology Nursing ; 2015 [cited 2015 Apr 6]. Available from: https://www.ons.org/practice-resources/pep/fatigue.