Beyond Fatigue: Psychological Benefits of Exercise in Cancer

It is well established that adapted physical activity (APA) reduces cancer-related fatigue, with high levels of evidence across nearly all types of cancer. But how can we encourage long-term engagement in this practice? Beyond the physical benefits, Marion Barrault-Couchouron, psychologist and psychotherapist, Bergonié Cancer Institute, Bordeaux, and Charlène Goetgheluck Villaron, PhD, associate professor, Management Sport Cancer Laboratory, Faculty of Sport Sciences, Aix-Marseille University, Marseille, France, proposed highlighting its psychological and relational benefits during a dedicated session at the 17th National Congress on Supportive Care in Oncology, held in Lille, France, from October 14 to 16, 2026.“Telling someone who is extremely tried to move is counterintuitive. There are many misconceptions that need to be addressed,” Goetgheluck Villaron emphasized in her opening remarks. The researcher also proposed reversing the hierarchy of goals associated with physical activity in oncology: While oncology traditionally focuses on physical variables, we sometimes forget that it also provides psychological benefits.With mental health recognized as a major national priority, this goal should be prioritized. For some people, engaging in physical activity may be a first step toward setting physical goals. Exercise therapy should therefore be prescribed and monitored using psychosocial measures, such as anxiety and body image, alongside physical outcomes. Neither set of benefits should automatically take precedence; the balance should reflect each person’s needs and preferences, she said.How Does APA Improve Psychological Well-Being?Research suggests that APA may reduce anxiety in women with breast cancer by improving body image, with a smaller benefit for depression. These effects appear more pronounced among patients who live alone, have an intermediate level of education, or have moderate depression at baseline — factors that could help identify patients who may benefit from APA. Studies also suggest that gentle exercise, once considered too low-intensity to be effective, can provide physiologic benefits, particularly for anxiety.Goetgheluck Villaron discussed the dragon boat programs launched in the 1990s, which brought women together to paddle, fostering a sense of belonging, peer connection, and empowerment. She also presented the results of research she and her team conducted to understand the factors behind this effectiveness. For example, among women in the very early stages of posttreatment for breast cancer who were invited to participate in an adapted water polo program: Although the sport is demanding, nearly 90% of the scheduled sessions were attended. The activity helped them transition from being patients to being athletes. Because the activity was challenging, it strengthened their sense of self-efficacy, and the group aspect was also beneficial for them. In another initiative, physical activity instructors worked with patients in prehabilitation rooms before stem cell transplantation, wearing sports attire and bringing exercise equipment to the bedside. The approach brought a sense of sport into the hospital room and helped ease patients’ feelings of isolation, the researcher said. Across these examples, patients become active participants in their own health rather than passive recipients of care. A study is now underway to examine how the relationship between physical activity instructors and patients may influence engagement.What Approach Should Be Taken?Although some patients volunteer that they are fatigued, about three quarters do not mention it unless asked, said Barrault-Couchouron. Many consider fatigue an expected consequence of illness. She said it should therefore be screened for routinely as part of care, for example with a visual analog scale assessing fatigue over the previous 7 days. A score above 4 of 10 should prompt a comprehensive assessment of its physical, emotional, and cognitive dimensions.The specialist identifies three types of factors to be assessed:Preexisting risk factors, such as a history of fatigue, mood or sleep disorders, a sedentary lifestyle, being overweight, etc.Triggering factors related to the illness and treatments — toxicity, pain, and comorbiditiesMaintaining factors that can be addressed: misconceptions about rest, catastrophizing, symptom focus, low self-efficacy, deconditioning due to prolonged rest and avoidance of activity, and sleep disordersIn addition to physical activity, other approaches may be helpful:Cognitive-behavioral therapies, which help deconstruct misconceptions — such as the idea that rest is restorative — by focusing on cognitive restructuring and planning rewarding activitiesMindfulness programs, Tai Chi, or Qigong, which help shift attention away from physical sensations, making perceptions less catastrophic and reducing emotional reactivityPsychoeducationLimited pharmacologic options, depending on the clinical contextFinally, for cognitive fatigue, the recommendations are less clear, but screening must remain systematic: If the complaint persists, patients should be referred for a neuropsychological evaluation, followed by psychoeducation, cognitive remediation, and likely physical activity.AFSOS published recommendations on Physical Activity and Cancer in 2024.This story was translated from Univadis France, part of the Medscape Professional Network.