J Breast Cancer.  2020 Apr;23(2):205-217. 10.4048/jbc.2020.23.e22.

Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program

  • 1Department of Nursing, College of Health. Welfare and Education, Tongmyong University, Busan, Korea
  • 2Department of Sports Industry Studies, Yonsei University, Seoul, Korea
  • 3College of Nursing, Yonsei University, Seoul, Korea
  • 4Biobehavioral Center, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
  • 5Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea


This study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS).
BCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale.
In this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points.
The BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.


Breast neoplasms; Cytokines; Exercise; Fatigue
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