Physical Activity Interventions Using Digital Health Interventions for Cancer-Related Fatigue in People With a History of Cancer: Scoping Review
Clinical Snapshot
PICO Framework
| P — Population | Adults with a history of cancer (any type, any stage, any treatment phase) |
| I — Intervention | Digital health interventions (DHIs) delivering physical activity programs — including mobile apps, wearable devices, web-based platforms, videoconferencing, exergaming, and augmented reality |
| C — Comparator | Control groups (usual care, waitlist, or active comparators); direct comparisons with in-person exercise programs were scarce |
| O — Outcomes | Cancer-related fatigue (CRF) as a primary outcome, measured by varied self-report and objective tools; secondary outcomes included intervention characteristics, DHI modality classification, and sustainability of effect |
Bottom Line
This well-structured scoping review maps the emerging landscape of digital health-based physical activity interventions for cancer-related fatigue (CRF) across 33 studies and 3,443 participants. The headline finding — that 56% of interventions demonstrated statistically significant CRF reductions — is encouraging but must be interpreted cautiously. The review does not pool effect sizes or apply GRADE certainty ratings, and no formal risk of bias assessment was conducted. The evidence is heavily concentrated in breast cancer populations, limiting generalisability. Wearable device-based interventions and programs exceeding 12 weeks appear most promising, but these are narrative observations rather than quantitative conclusions. Long-term efficacy data are almost entirely absent. For Australian clinicians, digital exercise delivery aligns with existing telehealth infrastructure and COSA exercise oncology guidelines, and Medicare-funded allied health pathways support implementation. However, before recommending specific digital platforms, clinicians should seek evidence of TGA regulatory compliance for any app or device used therapeutically. This review is best understood as a roadmap for future research priorities — standardised fatigue measurement, diverse cancer populations, longer follow-up, and system-level integration — rather than a definitive evidence base for practice change.
Key Findings
P Value: Not pooled; individual study significance reported narratively
Effect Size: 18 of 32 interventions (56%) demonstrated statistically significant between-group CRF reductions; wearable device-based interventions showed the highest proportion of significant improvement; interventions lasting >12 weeks appeared more effective than shorter programs
Primary Outcome: Cancer-related fatigue (CRF) reduction in adults with a history of cancer receiving digital health-based physical activity interventions
Nnt Or Sensitivity: NNT not calculable from scoping review data; no sensitivity/specificity or hazard ratio data reported; 56% of interventions showed significant CRF benefit at immediate post-intervention assessment
Confidence Interval: Not reported — no meta-analytic pooling performed; scoping review design
Clinical Application
Digital delivery addresses known barriers to exercise participation (geographic, temporal, physical access limitations). Mobile apps and wearable devices are the most commonly studied modalities and are widely available. However, digital literacy, device access, data privacy, and healthcare system integration remain practical barriers. Most interventions were classified as ESF tier C, indicating they have not yet been evaluated for system-level scalability or workflow integration. Cancer-related fatigue is a recognised clinical priority in Australian oncology. Exercise oncology is supported by Cancer Australia and endorsed by COSA (Clinical Oncology Society of Australia), which recommends exercise as standard of care for people with cancer. Exercise physiologists are Medicare-rebatable under Chronic Disease Management plans (GP Management Plan + Team Care Arrangement), providing a funding pathway for supervised digital exercise programs. Wearable devices and telehealth-delivered exercise programs align with Australia's expanding telehealth infrastructure post-COVID-19. The TGA regulates digital health tools as Software as a Medical Device (SaMD) under the Therapeutic Goods Act 1989, and clinicians should verify regulatory status of specific apps before recommending them. The RACGP supports exercise prescription in cancer survivorship care. PBS listing is not directly relevant to exercise interventions, though allied health referral pathways under Medicare are applicable. The breast cancer population dominance in this review is relevant given Australia's high breast cancer incidence (the most commonly diagnosed cancer in Australian women). Adults with a history of any cancer type experiencing cancer-related fatigue; current evidence is most applicable to breast cancer survivors given population dominance in included studies; applicability to other cancer types, advanced disease, or active treatment phases requires further research
Abstract
BACKGROUND: Although exercise has been proven effective in alleviating cancer-related fatigue (CRF), traditional face-to-face programs may not be accessible due to physical, temporal, or geographical barriers. Digital health interventions (DHIs) offer scalable alternatives for promoting physical activity; however, evidence synthesizing DHI-based physical activity interventions specifically targeting CRF and their intervention characteristics remains limited. OBJECTIVE: This scoping review aimed to map the types of digital health-based physical activity interventions for managing CRF, to summarize the key characteristics of DHI modalities and CRF outcomes, and to identify knowledge gaps for future research. METHODS: A systematic literature search was conducted across 4 databases (PubMed, EMBASE, Cochrane, and PsycINFO) up to December 2025. Inclusion criteria comprised experimental studies involving adults with a history of cancer, digital exercise interventions, a control group, and fatigue outcomes. Screening and data extraction followed the Joanna Briggs Institute Manual for Evidence Synthesis and PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review) standards. The protocol was registered in PROSPERO (International Prospective Register of Systematic Reviews; CRD42022304285). Interventions were classified using the Evidence Standards Framework (ESF). RESULTS: Thirty-three studies comprising 3443 participants were included, representing 32 interventions. Most were randomized controlled trials (n=30, 91%). Interventions were delivered primarily via mobile apps (11/32, 34%) and wearable devices (8/32, 25%), followed by web-based platforms, videoconferencing, exergaming, and augmented reality. Eighteen interventions (reported in 19 studies) demonstrated statistically significant between-group CRF reductions, predominantly at immediate postintervention assessments. Evidence for sustained benefit beyond 12 months was limited, and only one study evaluated ultra-long-term outcomes, which did not demonstrate maintained improvement. Populations with breast cancer accounted for the largest proportion of participants. Fatigue measurement tools varied substantially, potentially contributing to heterogeneity in effect estimates. Most interventions were classified as ESF tier C, indicating a predominant focus on clinical outcome improvement rather than individual-level self-management and system-level implementation. Wearable device-based interventions showed the highest proportion of significant CRF improvement, whereas mobile app-based interventions reported both significant and nonsignificant results. DHIs lasting more than 12 weeks appeared to be associated with more effective CRF outcomes compared to shorter programs. Direct comparisons between in-person and digital delivery were scarce. CONCLUSIONS: Digital health-based physical activity interventions can reduce CRF in people with a history of cancer, with wearable device and longer-duration interventions showing the most favorable outcomes. However, the current evidence is concentrated in populations with breast cancer, and system-level integration remains unexplored. Future research should prioritize diverse populations with cancer, longer follow-up periods, standardized fatigue measurement, and systematic examination of specific intervention components that contribute to CRF reduction. Ultimately, advancing from individual efficacy trials toward scalable, workflow-integrated digital solutions will be key to sustainable CRF management across diverse oncology settings.
References
- 1.Kim, Y., Bae, K. R., Sung, J. H., Ko, Y. H., & Kim, S. (2026). Physical activity interventions using digital health interventions for cancer-related fatigue in people with a history of cancer: Scoping review. Journal of Medical Internet Research. https://doi.org/10.1016/j.critrevonc.2024.104602
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