Physical activity interventions using digital health interventions on cancer-related fatigue in cancer survivors: scoping review.

Abstract

Cancer-related fatigue (CRF) is one of the most common and persistent symptoms experienced by cancer survivors. Exercise has been proven effective in alleviating CRF, yet traditional face-to-face programs may not be accessible due to physical, temporal, or geographical barriers. Digital health interventions (DHIs) offer scalable alternatives for delivering physical activity interventions; however, evidence synthesizing DHI-based physical activity interventions specifically targeting CRF and their intervention characteristics remains limited. This scoping review aimed to map the types of digital health-based physical activity interventions for managing CRF, to summarize the key characteristics of DHIs modalities and CRF outcomes, and identify knowledge gaps for future research. A systematic literature search was conducted across four databases (PubMed, EMBASE, Cochrane, PsycINFO) up to December 2025. Inclusion criteria comprised experimental studies involving adult cancer survivors, digital exercise interventions, a control group, and fatigue outcomes. Screening and data extraction followed NECA guidance and PRISMA-ScR standards. The protocol was registered in PROSPERO (CRD42022304285). Interventions were classified using the Evidence Standards Framework. Thirty-three studies comprising 3,443 participants were included, representing 32 interventions. Most studies were randomized controlled trials (91%). Interventions were delivered primarily via mobile applications (34%) and wearable devices (25%), followed by web-based platforms, videoconferencing, exergaming, and augmented reality. Eighteen interventions (reported in 19 studies) demonstrated statistically significant between-group reductions in CRF, predominantly at immediate post-intervention 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. Breast cancer populations accounted for the largest proportion of participants. Fatigue measurement tools varied substantially, most commonly using the Multidimensional Fatigue Inventory, FACIT-based scales, and the EORTC QLQ-C30 fatigue subscale, potentially contributing to heterogeneity in effect estimates. Most interventions were classified as Evidence Standards Framework 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 application-based interventions reported both significant and non-significant 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. Digital health-based physical activity interventions can reduce CRF in cancer survivors, with wearable device and longer-duration interventions showing the most favorable outcomes. However, the current evidence was concentrated in breast cancer populations, and system-level integration remains unexplored. Future research should prioritize diverse cancer populations, 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.