Exercise & Diet Interventions Enhance Fat-Free Mass and Reduce Fatigue in Ovarian Cancer Patients

by Ella

Recent research published in the British Journal of Cancer reveals that exercise and dietary interventions significantly improve fat-free mass (FFM), physical functioning, and reduce fatigue in patients with ovarian cancer (OC). However, these benefits were observed equally in both the experimental and control groups.

Impact of Ovarian Cancer Treatment

Standard treatment for OC typically includes cytoreductive surgery followed by six cycles of neoadjuvant or adjuvant chemotherapy. This rigorous treatment often leads to a variety of physical and psychosocial challenges, including severe fatigue, diminished physical functioning, and malnutrition. These issues collectively degrade patients’ health-related quality of life (HRQoL).


Study Rationale and Methodology

Previous studies have demonstrated the efficacy of dietary and exercise interventions in enhancing body composition, HRQoL, physical fitness, and fatigue in cancer patients. However, these studies primarily involved breast cancer patients receiving curative treatment, leaving uncertainty about the applicability of these findings to OC patients, who have distinct treatment regimens and disease trajectories.


To address this gap, researchers conducted a two-arm multicenter randomized controlled trial. The trial compared the effects of usual OC care alone with usual care plus a combined dietary and exercise intervention. Participants were recruited from three gynecological cancer centers and affiliated hospitals in the Netherlands between 2018 and 2022. Eligible participants were over 18 years old, had primary epithelial OC, and were scheduled for (neo)adjuvant chemotherapy.


Intervention Details

Participants were randomized into two groups: a control group receiving standard care and an intervention group receiving additional dietary and exercise support. The intervention commenced with the first 3-week cycle of chemotherapy and continued until the last cycle, spanning the entire chemotherapy treatment period.


Exercise Program

The exercise regimen included two 1-hour sessions per week. These sessions incorporated moderate- to high-intensity aerobic and resistance exercises designed to maintain and improve physical fitness and body composition.

Dietary Counseling

Dietary counseling was provided by oncology-specialized dietitians. Each session, lasting 30 to 45 minutes, occurred every three weeks, either in the hospital or over the phone. The counseling was personalized based on each patient’s nutritional needs, body composition, and dietary intake, focusing on preventing weight loss and ensuring adequate nutritional intake.

Study Outcomes and Measurements

The primary outcomes assessed were physical functioning, body composition (specifically FFM), and fatigue. FFM was measured using bioelectrical impedance analysis, while fatigue and physical functioning were evaluated through patient questionnaires. Measurements were taken at three time points: baseline before randomization (T0), after the final chemotherapy cycle (T1), and 12 weeks post-T1 (T2).


Out of 257 eligible patients, 81 (31.5%) participated in the trial. The average age of participants was 59 years. Approximately 60% of the participants had undergone primary surgery followed by adjuvant chemotherapy, and 42.7% had a high education level.

Both groups showed significant improvements in FFM and physical functioning and reductions in general fatigue over time. However, there were no significant differences between the intervention and control groups regarding these outcomes at T1 and T2. Specifically:

At T1, no significant differences were found in FFM (β, –0.5; 95% CI, –3.2 to 2.1), physical function (β, 1.4; 95% CI, –5.4 to 8.3), or fatigue (β, 0.7; 95% CI, –2.3 to 2.1).

At T2, similarly, no significant differences were observed in FFM (β, –0.9; 95% CI, –3.5 to 1.8), physical functioning (β, –1.6; 95% CI, –8.7 to 5.5), or fatigue (β, –0.1; 95% CI, –2.3 to 2.1).

The authors noted, “Both groups exhibited enhancements in body composition, physical functioning, and fatigue levels during chemotherapy. Hence, the intervention group did not demonstrate additional benefits when compared to the control group, although the wide confidence intervals suggest that some individuals may have derived greater benefits than others.”

Study Limitations and Future Directions

The researchers acknowledged several limitations, including the study’s demographic, which was limited to patients from the Netherlands, potentially affecting the generalizability of the findings to other populations. They highlighted the need for tailored research and interventions specific to the unique characteristics and needs of OC patients.


The study underscores the value of exercise and dietary interventions in improving the health outcomes of OC patients during chemotherapy. Despite the lack of significant differences between the intervention and control groups, both sets of patients experienced notable improvements. This highlights the broader benefits of such interventions in cancer care. Future research should focus on refining these interventions and exploring their applicability across diverse cancer types and populations to enhance HRQoL and treatment outcomes for all cancer patients.



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