Effects of activity pacing-related interventions on cancer-related fatigue and classification of behavior change techniques: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Non-significant overall; significant in chemotherapy subgroup

• Effect Size: SMD = -0.36 (overall); SMD = -0.58 (chemotherapy subgroup)

• Primary Outcome: Cancer-related fatigue severity

• Nnt Or Sensitivity: Moderate effect size in chemotherapy patients (Cohen's d ≈ 0.6)

• Confidence Interval: 95% CI: -0.73 to 0.00 (overall); 95% CI: -0.87 to -0.29 (chemotherapy)

Clinical Application

Activity pacing interventions appear feasible but require structured implementation with goal setting and social support Relevant to Australian cancer care pathways; could complement existing Cancer Council support programs and align with COSA guidelines for supportive care Cancer patients receiving chemotherapy, particularly those with breast cancer

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 (I2 = 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.

References

1. 1.Shimizu, Y., Tsuji, K., Hanai, A., & Hosokawa, M. (2026). Effects of activity pacing-related interventions on cancer-related fatigue and classification of behavior change techniques: A systematic review and meta-analysis. Supportive Care in Cancer. https://doi.org/10.12688/wellcomeopenres.19363.2