Comparison of the intervention effects of different Tai Chi training intensities on fatigue-insomnia-depression triad in cancer patients: A bibliometric analysis review
Abstract
This study used a dual method of bibliometric analysis and clinical evidence integration to systematically explore the intervention effect of different training intensities of Tai Chi on fatigue-insomnia-depression triad (FSD) in cancer patients and the current status of research. By analyzing 41 high-intensity literatures from 2004 to 2024 in the Web of Science database, an intensity stratification model based on the ACSM standard was constructed (low intensity <3 MET, medium intensity 4-6 MET, high intensity > 7 MET). The study confirmed that the standardized mean difference (SMD) of moderate-intensity Tai Chi on FSD triad was 0.57, significantly better than low intensity (SMD = 0.22), and its mechanism was related to the reconstruction of HPA axis function (recovery to 89% of healthy controls) and a 39.6%–43.2% decrease in inflammatory factors IL-6/TNF-α; however, high-intensity training may weaken the benefits of sleep (PSQI score increased). There are key gaps in current research, such as 78.3% of the intensity was not quantified and the evidence for critically ill patients (ECOG ≥ 2) accounted for only 5.3%. The study finally proposed to construct a “movement-intention” dual-axis classification framework, and suggested conducting a multi-center intensity-stratified RCT and integrating biomarker monitoring to provide evidence-based decision support for Tai Chi’s precise intervention in FSD.
Copyright (c) 2026 Yu Sun, Jiaqi Qian, Wei Hui
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. He X, Ng MSN, Choi KC, et al. Effects of a 16-week dance intervention on the symptom cluster of fatigue-sleep disturbance-depression and quality of life among patients with breast cancer undergoing adjuvant chemotherapy: A randomized controlled trial. International Journal of Nursing Studies. 2022; 133: 104317. doi: 10.1016/j.ijnurstu.2022.104317
2. Ho S Y, Rohan K J, Parent J, et al. A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. Journal of Pain and Symptom Management, 2015, 49(4): 707–715. doi: 10.1016/j.jpainsymman.2014.09.009
3. Zhang Q, Li F, Zhang H, et al. Effects of nurse-led home-based exercise and cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial. International Journal of Nursing Studies. 2018; 78: 52–60. doi: 10.1016/j.ijnurstu.2017.08.010
4. Irwin MR, Olmstead R, Breen EC, et al. Tai Chi, cellular inflammation, and transcriptome dynamics in breast cancer survivors with insomnia: A randomized controlled trial. Journal of the National Cancer Institute Monographs. 2014; 2014(50): 295–301. doi: 10.1093/jncimonographs/lgu028
5. Tomlinson D, Diorio C, Beyene J, Sung L. Effect of exercise on cancer-related fatigue: A meta-analysis. American Journal of Physical Medicine & Rehabilitation. 2014; 93(8): 675–686. doi: 10.1097/PHM.0000000000000083
6. Grégoire C, Faymonville ME, Vanhaudenhuyse A, et al. Effects of an intervention combining self-care and self-hypnosis on fatigue and associated symptoms in post-treatment cancer patients: A randomized controlled trial. Psychooncology. 2020; 29(7): 1165–1173. doi: 10.1002/pon.5395
7. Chen HM, Tsai CM, Wu YC, et al. Randomized controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. British Journal of Cancer 2015; 112(3): 438–445. doi: 10.1038/bjc.2014.612
8. Bower JE, Garet D, Sternlieb B, et al. Yoga for persistent fatigue in breast cancer survivors: A randomized controlled trial. Cancer. 2012; 118(15): 3766–3775. doi: 10.1002/cncr.26702
9. Loh KP, Zittel J, Kadambi S, et al. Elucidating the associations between sleep disturbance and depression, fatigue, and pain in older adults with cancer. Journal of Geriatric Oncology. 2018; 9(5): 464–468. doi: 10.1016/j.jgo.2018.02.006
10. Kruse JL, Strouse TB. Sick and tired: mood, fatigue, and inflammation in cancer. Current Psychiatry Reports. 2015; 17(3): 72. doi: 10.1007/s11920-015-0555-3
11. Maccora J, Garland SN, Ftanou M, et al. The SleepCaRe trial: rationale and design of a randomized controlled trial of cognitive behavioral and bright light therapy for insomnia and fatigue in women with breast cancer receiving chemotherapy. Contemporary Clinical Trials. 2022; 120: 106877. doi: 10.1016/j.cct.2022.106877
12. Wong WM, Chan DNS, He X, et al. Effectiveness of pharmacological and nonpharmacological interventions for managing the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients undergoing chemotherapy. Cancer Nursing. 2023; 46(2): E70–E80. doi: 10.1097/NCC.0000000000001048
13. Arring NM, Barton DL, Brooks T, et al. Integrative therapies for cancer-related fatigue. The Cancer Journal. 2019; 25(5): 349–356. doi: 10.1097/PPO.0000000000000396
14. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from an international multidisciplinary roundtable. Medicine and Science in Sports and Exercise. 2019; 51(11): 2375–2390. doi: 10.1249/MSS.0000000000002116
15. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Physical Therapy, Sports Therapy and Rehabilitation. 2010; 42(7): 1409–1426. doi: 10.1249/MSS.0b013e3181e0c112
16. McNeely ML, Campbell KL, Rowe BH, et al. Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. CMAJ. 2006; 175(1): 34–41. doi: 10.1503/cmaj.051073
17. Müller F, Wijayanto F, Abrahams H, et al. Potential mechanisms of the fatigue-reducing effect of cognitive behavioral therapy in cancer survivors: three randomized controlled trials. Psychooncology. 2021; 30(9): 1476–1484. doi: 10.1002/pon.5710
18. Jain S, Boyd C, Fiorentino L, et al. Are there efficacious treatments for treating the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients? A rapid evidence assessment of the literature (REAL©). Breast Cancer: Targets and Therapy. 2015; 7: 267–291. doi: 10.2147/BCTT.S25014
19. Larkey LK, Roe DJ, Weihs KL, et al. Randomized controlled trial of Qigong/Tai Chi Easy on cancer-related fatigue in breast cancer survivors. Annals of Behavioral Medicine. 2014; 49(2): 165–176. doi: 10.1007/s12160-014-9645-4
20. Kiecolt-Glaser JK, Bennett JM, Andridge R, et al. Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: A randomized controlled trial. Journal of Clinical oncology. 2014; 32(10): 1040–1049. doi: 10.1200/JCO.2013.51.8860
21. Bower JE, Irwin MR. Mind-body therapies and control of inflammatory biology: A descriptive review. Brain, Rehavior, and Immunity. 2016; 51: 1–11. doi: 10.1016/j.bbi.2015.06.012
22. Yao LQ, Kwok SWH, Tan JY, et al. The effect of an evidence-based Tai Chi intervention on the fatigue-sleep disturbance-depression symptom cluster in breast cancer patients: A preliminary randomized controlled trial. European Journal of Oncology Nursing. 2022; 61: 102202. doi: 10.1016/j.ejon.2022.102202
23. Mustian KM, Sprod LK, Janelsins MC, et al. Multicenter, randomized controlled trial of yoga for sleep quality among cancer survivors. Journal of Clinical Oncology. 2013; 31(26): 3233–3241. doi: 10.1200/JCO.2012.43.7707
24. Takemura N, Cheung DST, Fong DYT, et al. Impact of adherence to exercise interventions on effectiveness in improving sleep in advanced lung cancer patients: a comparison between aerobic exercise and Tai Chi. Palliat Support Care. 2023; 22(6): 1676–1684. doi: 10.1017/S1478951523000962
25. Carlson LE, Bultz BD. Mind-body interventions in oncology. Current Treatment Options in Oncology. 2008; 9(2–3): 127–134. doi: 10.1007/s11864-008-0064-2
26. Yao LQ, Tan JY, Turner C, et al. Feasibility and potential effects of Tai Chi for the fatigue-sleep disturbance-depression symptom cluster in patients with breast cancer: protocol of a preliminary randomized controlled trial. BMJ Open. 2021; 11(8): e048115. doi: 10.1136/bmjopen-2020-048115
27. Chen Y, Zuo X, Tang Y, et al. The effects of Tai Chi and Baduanjin on breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Frontiers in Oncology. 2024; 14: 1434087. doi: 10.3389/fonc.2024.1434087
28. Zhang LL, Wang SZ, Chen HL, Yuan AZ. Tai Chi exercise for cancer-related fatigue in patients with lung cancer undergoing chemotherapy: A randomized controlled trial. Journal of Pain and Symptom Management. 2016; 51(3): 504–511. doi: 10.1016/j.jpainsymman.2015.11.020
29. Salinas-Ríos K, García López AJ. Bibliometrics, a useful tool within the field of research. Journal of Basic and Applied Psychology Research. 2022; 3(6): 9–16. doi: 10.29057/jbapr.v3i6.6829
30. Donthu N, Kumar S, Mukherjee D, Pandey N, Lim WM. How to conduct a bibliometric analysis: an overview and guidelines. Journal of business research. 2021; 133: 285–296. doi: 10.1016/j.jbusres.2021.04.070
31. Husebø A, Husebø T. Quality of life and breast cancer: how can mind-body exercise therapies help? An overview study. Sports (Basel). 2017; 5(4): 79. doi: 10.3390/sports5040079
32. Berger AM, Mooney K, Alvarez-Perez A, et al. Cancer-related fatigue, version 2.2015. Journal of the National Comprehensive Cancer Network. 2015; 13(8): 1012–1039. doi: 10.6004/jnccn.2015.0122
33. Serra MC, Ryan AS, Ortmeyer HK, Addison O, Goldberg AP. Resistance training reduces inflammation and fatigue and improves physical function in older breast cancer survivors. Menopause. 2018; 25(2): 211–216. doi: 10.1097/GME.0000000000000969
34. Brown JC, Huedo-Medina TB, Pescatello LS, et al. The efficacy of exercise in reducing depressive symptoms among cancer survivors: A meta-analysis. PLOS ONE. 2012; 7(1): e30955. doi: 10.1371/journal.pone.0030955
35. Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews. 2016; (9): CD005001. doi: 10.1002/14651858.CD005001.pub2
36. Takemura N, Cheung DST, Fong DYT, et al. Effectiveness of aerobic exercise and Tai Chi interventions on sleep quality in patients with advanced lung cancer. JAMA oncology. 2024; 10(2): 176. doi: 10.1001/jamaoncol.2023.5248
37. Murley B, Haas B, Hermanns M, Gilbert C. Influence of Tai Chi on self-efficacy, quality of life, and fatigue among patients with cancer receiving chemotherapy: A pilot study brief. Journal of Holistic Nursing. 2019; 37(4): 354–363. doi: 10.1177/0898010119867557
38. Wayne PM, Lee MS, Novakowski J, et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: A systematic review and meta-analysis. Journal of Cancer Survivorship. 2017; 12(2): 256–267. doi: 10.1007/s11764-017-0665-5
39. Geng L, Duan Y, Li X, et al. Comparative efficacy of mind-body exercise for depression in breast cancer survivors: A systematic review and network meta-analysis. Worldviews on Evidence‐Based Nursing. 2023; 20(6): 593–609. doi: 10.1111/wvn.12669
40. Liu L, Tan H, Yu S, et al. The effectiveness of Tai Chi in breast cancer patients: A systematic review and meta-analysis. Complementary Therapies in Clinical Practice. 2020; 38: 101078. doi: 10.1016/j.ctcp.2019.101078
41. Mustian KM, Katula JA, Gill DL, et al. Tai Chi Chuan, health-related quality of life and self-esteem: A randomized trial with breast cancer survivors. Support Care Cancer. 2004; 12(12): 871–876. doi: 10.1007/s00520-004-0682-6
42. Kinney AY, Blair CK, Guest DD, et al. Biobehavioral effects of Tai Chi Qigong in men with prostate cancer: study design of a three-arm randomized clinical trial. Contemporary Clinical Trials Communications. 2019; 16: 100431. doi: 10.1016/j.conctc.2019.100431
43. Galantino ML, Callens ML, Cardena GJ, et al. Tai Chi for well-being of breast cancer survivors with aromatase inhibitor-associated arthralgias: A feasibility study. Altern Ther Health Med. 2013; 19(6): 38–44.
44. Irwin MR, Olmstead R, Carrillo C, et al. Tai Chi Chih compared with cognitive behavioral therapy for the treatment of insomnia in survivors of breast cancer: A randomized, partially blinded, noninferiority trial. Journal of Clinical Oncology. 2017; 35(23): 2656–2665. doi: 10.1200/JCO.2016.71.0285
45. Li W, You F, Wang Q, et al. Effects of Tai Chi Chuan training on the quality of life and psychological well-being in female patients with breast cancer: A systematic review of randomized controlled trials. Frontiers in Oncology. 2023; 13: 1143674. doi: 10.3389/fonc.2023.1143674
46. Cheng D, Wang X, Hu J, et al. Effect of Tai Chi and resistance training on cancer-related fatigue and quality of life in middle-aged and elderly cancer patients. Chinese Journal of Integrative Medicine. 2021; 27(4): 265–272. doi: 10.1007/s11655-021-3278-9
47. Peoples AR, Garland SN, Pigeon WR, et al. Cognitive behavioral therapy for insomnia reduces depression in cancer survivors. Journal of Clinical Sleep Medicine. 2019; 15(1): 129–137. doi: 10.5664/jcsm.7586
48. Spahrkäs SS, Looijmans A, Sanderman R, Hagedoorn M. How does the Untire app alleviate cancer-related fatigue? A longitudinal mediation analysis. Psychooncology. 2022; 31(6): 970–977. doi: 10.1002/pon.5886
49. Stan DL, Collins NM, Olsen MM, et al. The evolution of mindfulness-based physical interventions in breast cancer survivors. Evid Based Complement Alternat Med. 2012; 2012: 758641. doi: 10.1155/2012/758641
50. Jasim N, Balakrishnan D, Zhang H, et al. Effects and mechanisms of Tai Chi on mild cognitive impairment and early-stage dementia: A scoping review. Systematic Reviews. 2023; 12: 2358. doi: 10.1186/s13643-023-02358-3
51. Liao M. Global research dynamics in Tai Chi and insomnia: A bibliometric study from 2006 to 2025. Front Psychiatry. 2025; 16: 1669378. doi: 10.3389/fpsyt.2025.1669378
52. Zou H, Lin X, Duan T, et al. Simple sitting Baduanjin mind-body exercise: randomized controlled trial protocol for advanced cancer patients with the fatigue-sleep disturbance symptom cluster. BMC Complementary Medicine and Therapies. 2024; 24(1): 4652. doi: 10.1186/s12906-024-04652-6
53. Ahmad T, Ornos EDB, Ahmad S, et al. Global research mapping of psycho-oncology between 1980 and 2021: a bibliometric analysis. Frontiers in Psychology. 2022; 13: 947669. doi: 10.3389/fpsyg.2022.947669
54. Fox S, Lynch J, D’Alton P, Carr A. Psycho-oncology: A bibliometric review of the 100 most-cited articles. Healthcare (Basel). 2021; 9(8): 1008. doi: 10.3390/healthcare9081008
55. Shubina I. Scientific publication patterns of systematic reviews on psychosocial interventions improving well-being: bibliometric analysis. Interactive Journal of Medical Research. 2022; 11(2): e41456. doi: 10.2196/41456
56. Singh VK, Singh P, Karmakar M, et al. The journal coverage of Web of Science, Scopus and Dimensions: A comparative analysis. Scientometrics. 2021; 126: 5113–5142. doi: 10.1007/s11192-021-03948-5
57. Zeng Y, Luo T, Xie H, et al. Health benefits of Qigong or Tai Chi for cancer patients: A systematic review and meta-analyses. Complementary Therapies in Medicine. 2014; 22(1): 173–186. doi: 10.1016/j.ctim.2013.11.010
58. Reid-Arndt SA, Matsuda S, Cox CR. Tai Chi effects on neuropsychological, emotional, and physical functioning following cancer treatment: A pilot study. Complementary Therapies in Clinical Practice. 2012; 18(1): 26–30. doi: 10.1016/j.ctcp.2011.02.005
59. Sprod LK, Janelsins MC, Palesh OG, et al. Health-related quality of life and biomarkers in breast cancer survivors participating in Tai Chi Chuan. Journal of Cancer Survivorship. 2011; 6(2): 146–154. doi: 10.1007/s11764-011-0205-7
60. Carlson LE, Ismaila N, Addington EL, et al. Integrative oncology care of symptoms of anxiety and depression in adults with cancer: Society for Integrative Oncology–ASCO guideline. Journal of Clinical Oncology. 2023; 41(28): 4562–4591. doi: 10.1200/JCO.23.00857
61. Wang X, Li P, Pan C, et al. The effect of mind-body therapies on insomnia: A systematic review and meta-analysis. Evid Based Complement Alternat Med. 2019; 2019: 9359807. doi: 10.1155/2019/9359807
62. Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: A systematic review and meta-analysis. Breast Cancer Research and Treatment. 2019; 176(1): 1–15. doi: 10.1007/s10549-019-05217-9
63. McQuade JL, Prinsloo S, Chang DZ, et al. Qigong/Tai Chi for sleep and fatigue in prostate cancer patients undergoing radiotherapy: A randomized controlled trial. Psychooncology. 2016; 26(11): 1936–1943. doi: 10.1002/pon.4256
64. Luo XC, Liu J, Fu J, et al. Effect of Tai Chi Chuan in breast cancer patients: A systematic review and meta-analysis. Frontiers in Oncology. 2020; 10: 607. doi: 10.3389/fonc.2020.00607
65. Larkey LK, Roe DJ, Smith L, Millstine D. Exploratory outcome assessment of Qigong/Tai Chi Easy on breast cancer survivors. Complementary Therapies in Medicine. 2016; 29: 196–203. doi: 10.1016/j.ctim.2016.10.006
66. Song S, Yu J, Ruan Y, et al. Ameliorative effects of Tai Chi on cancer-related fatigue: A meta-analysis of randomized controlled trials. Support Care Cancer. 2018; 26(7): 2091–2102. doi: 10.1007/s00520-018-4136-y
67. Cheung DST, Takemura N, Lam TC, et al. Feasibility of aerobic exercise and Tai Chi interventions in advanced lung cancer patients: A randomized controlled trial. Integrative Cancer Therapies. 2021; 20: 15347354211033352. doi: 10.1177/15347354211033352
68. Xiang Y, Lu L, Chen X, et al. Does Tai Chi relieve fatigue? A systematic review and meta-analysis of randomized controlled trials. PLOS ONE. 2017; 12(4): e0174872. doi: 10.1371/journal.pone.0174872
69. Ni X, Chan RJ, Yates P, et al. The effects of Tai Chi on quality of life of cancer survivors: a systematic review and meta-analysis. Support Care Cancer. 2019;27(10):3701–3716. doi: 10.1007/s00520-019-04911-0
70. Larkey LK, Huberty J, Pedersen M, et al. Qigong/Tai Chi Easy for fatigue in breast cancer survivors: rationale and design of a randomized clinical trial. Contemporary Clinical Trials. 2016; 50: 222–228. doi: 10.1016/j.cct.2016.08.002
71. Deleemans JM, Mather H, Spiropoulos A, et al. Recent progress in mind-body therapies in cancer care. Current Oncology Reports. 2023; 25(4): 293–307. doi: 10.1007/s11912-023-01373-w
72. Garland SN, Mahon K, Irwin MR. Integrative approaches for sleep health in cancer survivors. The Cancer Journal. 2019; 25(5): 337–342. doi: 10.1097/PPO.0000000000000398
73. Liu C, Qin M, Zheng X, et al. Intervention effect of mind-body exercise on relieving cancer-related fatigue in breast cancer patients: a meta-analysis. Evid Based Complement Alternat Med. 2021; 2021: 9980940. doi: 10.1155/2021/9980940
