Physiotherapy programme reduces fatigue in patients with advanced cancer receiving palliative care: randomized controlled trial.

The short version

This randomized trial with 60 adults tested whether a short course of physiotherapy could ease cancer-related fatigue in people with advanced cancer who were receiving palliative (comfort-focused) rather than curative care -- a group rarely included in fatigue research even though fatigue is one of their most common and distressing symptoms, often dismissed as an inevitable part of advanced illness rather than something physiotherapy could actually help treat. Conducted at a palliative care unit and hospice in Poland, the study split participants evenly into a physiotherapy group and a no-exercise control group, with everyone continuing their usual medications. The physiotherapy group did six 30-minute sessions over two weeks, combining gentle active arm-and-leg exercises with myofascial release (a hands-on technique that eases tight connective tissue) and proprioceptive neuromuscular facilitation, or PNF (stretching-and-contracting patterns that improve movement and reduce stiffness). Fatigue and its impact on daily life were measured with the Brief Fatigue Inventory, while nine common symptoms -- including pain, mood and appetite -- were tracked with the Edmonton Symptom Assessment Scale. By day 8, the physiotherapy group already showed significantly less fatigue than the control group, and by day 12 their fatigue scores had dropped from about 6.4 to 4.4 out of 10 (p<0.01) across every fatigue measure, while the control group barely changed on most items. The therapy group also reported significantly less pain, depression, anxiety and drowsiness, and better appetite and overall well-being (all p<0.01) -- benefits the control group did not show over the same two weeks. Nearly all physiotherapy patients (26 of 29 evaluated) rated the program positively on a satisfaction scale, and not a single patient rated it negatively, suggesting the approach was both effective and well tolerated even in a population that is frail and seriously ill, which many clinicians would have assumed could not handle any exercise at all. These results suggest that even patients in palliative care, who are often assumed too frail for exercise, can safely benefit from a brief, well-tailored physiotherapy program that reduces fatigue and improves overall comfort. The study's small size, single location, lack of blinding, and short two-week follow-up mean the findings need confirmation in larger, longer trials, and a chance imbalance in gender between the two groups (more women ended up in the control group) is a limitation worth noting, though it did not appear to affect the fatigue results.

Key findings

• In this 60-patient randomized trial, a 2-week physiotherapy programme combining active exercise, myofascial release, and PNF (a stretching-and-contracting technique) significantly reduced cancer-related fatigue in patients with advanced cancer receiving palliative care.
• Fatigue scores dropped from about 6.4 to 4.4 out of 10 in the physiotherapy group after 12 days, while the no-exercise control group showed little change.
• Beyond fatigue, the physiotherapy group also reported significantly less pain, depression, anxiety and drowsiness, and better appetite and overall well-being.
• Nearly all patients who received the physiotherapy program (26 of 29) rated it positively, showing that even people in palliative care can safely tolerate and enjoy structured, gentle exercise.
• The trial was small, conducted at one site, and could not blind participants or the treating therapist, and randomization happened to place more women in the control group, so larger studies are needed to confirm these findings.

Common questions