Fatigue interference emerged as the central symptom in contemporaneous networks and fatigue consistently served as the dominant node driving subsequent sleep disturbances and quality of life outcomes across the 12-week Simplified Sitting Badunjin intervention period in advanced cancer patients.
Key Findings
Results
Fatigue interference was the central symptom in contemporaneous networks for both intervention and control groups across early and mid intervention stages.
In the intervention group, fatigue interference had EI values of 1.249 at T1 and 2.610 at T2
In the control group, fatigue interference had EI values of 1.462 at T1 and 1.950 at T2
This finding held across both groups regardless of whether participants received the SSBDJ intervention
16 dimensions across 3 constructs (fatigue, sleep disturbances, and quality of life) were included in the symptom network
Results
SSBDJ intervention was strongly negatively associated with both fatigue severity and fatigue interference in the early and mid phases of the intervention.
At T0→T1, SSBDJ was associated with fatigue severity (β = -0.497) and fatigue interference (β = -0.504)
At T1→T2, SSBDJ was associated with fatigue severity (β = -0.210) and fatigue interference (β = -0.256)
These associations were identified using cross-lagged panel network (CLPN) analysis
The stronger associations were observed in the earlier transition period (T0→T1) compared to the mid-intervention period (T1→T2)
Results
Fatigue consistently served as the central node with the highest out-expected influence across the 12-week intervention period, independently influencing sleep disturbances and quality of life.
Fatigue demonstrated the highest out-expected influence (out-EI) across the entire 12-week intervention period
At the mid-stage of intervention (T2→T3), fatigue's impact on sleep disturbances and quality of life tended to exert independent influence, with an out-EI of r = 2.641
This suggests fatigue operated as a driver rather than a downstream symptom during this phase
The finding was identified through longitudinal cross-lagged panel network analysis with 175 participants
Results
Fatigue remained a dominant predictor of sleep disturbances and quality of life even after the SSBDJ intervention had concluded.
During the post-intervention follow-up period (T3→T4), fatigue maintained an out-predictability of r = 1.993
Data were collected at 4 weeks after the end of intervention (T4) to capture these post-intervention effects
This suggests the influence of fatigue on other symptoms persisted beyond the active intervention period
This was a secondary analysis of a randomized controlled trial with 175 participants included in the network analysis
Methods
The study employed contemporaneous networks and cross-lagged panel network analysis to examine symptom interactions at five time points across 16 symptom dimensions.
Data were collected at baseline (T0), 4 weeks (T1), 8 weeks (T2), 12 weeks (T3) of intervention, and 4 weeks post-intervention (T4)
A total of 175 participants with advanced cancer were included in the network analysis
The 16 dimensions included: fatigue severity, fatigue interference, sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, daytime dysfunction, physical discomfort, food related concerns, healthcare concerns, support, negative emotions, existential distress, sense of alienation, and value of life
This was a secondary analysis of a randomized controlled trial comparing SSBDJ intervention to a control group
What This Means
This research suggests that a gentle seated exercise practice called Simplified Sitting Badunjin (SSBDJ), adapted for people who cannot stand, can meaningfully reduce fatigue in patients with advanced cancer. Using a sophisticated statistical method called network analysis, the researchers tracked how fatigue, sleep problems, and quality of life interacted with each other and with the exercise program over 12 weeks plus a 4-week follow-up period. Among 175 patients, they found that fatigue — specifically how much it interfered with daily life — was the most central and connected symptom in the network, meaning it had the greatest influence on other symptoms.
This research suggests that SSBDJ had its strongest effect on reducing fatigue in the first four weeks of the program, and this effect continued through weeks four to eight, though somewhat less strongly. Importantly, the analysis revealed that fatigue did not just respond to the intervention — it also actively drove worsening sleep and reduced quality of life in the middle and later stages of the study period, and this influence persisted even after the exercise program ended. This means fatigue appeared to be a key 'hub' symptom that, when left unaddressed, could pull other symptoms down with it.
The practical implication of this research is that targeting fatigue early and aggressively may be especially important in managing the broader symptom burden for advanced cancer patients. The findings support the use of mind-body exercises like SSBDJ as a non-drug approach to symptom management, and suggest that the first four weeks of such a program may be the critical window for intervention. The network approach used here may help clinicians better understand which symptoms to prioritize when designing individualized care plans for this population.
Zheng J, Zou H, Lu Y, Chen L, Zheng M, Zhu Z, et al.. (2026). Mechanisms of simplified sitting Badunjin effects on symptom burden: a network-based cross-lagged analysis in advanced cancer patients.. Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer. https://doi.org/10.1007/s00520-026-10410-w