Project HERO: Health Empowerment & Recovery Outcomes

This study will establish the efficacy of a 12-week Body Mind Training (BMT) for reductions in fatigue (the study's primary outcome). Secondary patient-reported outcomes include quality of life changes (e.g., changes in sleep and perceived psychological distress), changes in the biomarkers of inflammation, including genome-wide transcriptional factors, and expression of fatigue-related genes. Post-award, the target sample size was revised to (n=166) with NCI permission.

There are over 9 million cancer survivors who are 55 years of age or older. Cancer survivors in this age group have unique challenges coping with the late and long-term effects of having had a cancer diagnosis and treatment, coupled with age-related declines and comorbidities. This may influence their ability to engage in lifestyle interventions because of slower post-treatment recovery, increased functional limitations, and other quality of life (QOL) impairments. Fatigue is common, under-recognized, undertreated, and correlated with impairments in psychological distress, social and functional well-being, and health-related QOL in cancer survivors. For male cancer survivors suffering from fatigue, Tai Chi and Qigong (TCQ) may be more appealing because it is not overly physically exertive and is safe for people 55 years of age or older. In this study, we referred to the intervention groups as follows: TCQ intervention was referred to as body-mind training (BMT), and the exercise intensity-matched condition was referred to as body training (BT). This was done to help reduce bias by minimizing participants' expectations or perceived differences between the groups.

• Body Mind Training (BMT) (Behavioral): Participants will practice BMT under the instruction of a BMT instructor. There will be 24 sessions. Each session will last 60 minutes and will occur twice a week for 12 weeks. Each session will include both light physical exercise and mind training. Sessions will be supplemented with home-based practice using an instructional DVD and handouts. Participants will be instructed to practice at least 30 minutes a day (at least 3 days per week) throughout the intervention and post-intervention period.
• Body Training (BT): (Behavioral): Participants will practice BT under the instruction of a BT instructor. There will be 24 sessions. Each session will last 60 minutes and will occur twice a week for 12 weeks. Sessions will be supplemented with home-based practice using an instructional DVD and handouts. Participants will be instructed to practice at least 30 minutes a day (at least 3 days per week) throughout the intervention and post-intervention period.
• Usual Care (UC) (Behavioral): Participants in the usual care arm will receive care as normal and will not attend classes but will complete the same assessments as participants in the BMT and BT classes.

Primary outcomes

• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale [Baseline, 6 weeks, 1 week post-intervention, 3 months, 12 months post-intervention]: 13-item self-report scale assessing fatigue and its impact on daily activities during the past 7 days; higher scores indicate less fatigue (range 0-52).
• Change in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale [Baseline, 6 weeks, 1 week post-intervention, 3 months, 12 months post-intervention]: 13-item self-report scale assessing fatigue and its impact on daily activities during the past 7 days; higher scores indicate less fatigue (range 0-52). Mean difference between Baseline and timepoint.

Sex: Male, ages: 55 Years to any

Inclusion Criteria:

* Age ≥ 55 years
* Previous diagnosis of local, regional, or metastatic cancer. If treated for cancer, prostate cancer therapy completed, 3+ months. If on ADT/ hormone manipulation, must be for 4 or more months
* Previous diagnosis of small intestine, thyroid, oral, non-muscle invasive bladder, kidney/renal, lung, colon, rectum, soft tissue, or other cancer
* Meet study criteria for fatigue: Medical Health Outcome Study Short Form Vitality/Fatigue subscale (SF-36 Vitality scale-4 items; 5 Likert scale) using a fatigue cut-off value of ≤13; or the Patient-Reported Outcomes Measurement Information System Fatigue scale (PROMIS Fatigue scale) using a cut-off value of ≥9
* Live within 75 miles of New Brunswick or Newark
* Inactive (<150 minutes of vigorous exercise/week within the past 3 months)
* Has transportation to attend on-site classes and assessments

Exclusion Criteria:

* Patient Health Questionnaire PHQ-9 Score >12
* Indication of suicidality from PHQ-9 reports that he has several or more days of "thoughts that you would be better off dead, or of hurting yourself."
* Karnofsky performance status score of 50 or below
* Current regular practice within the past year (2-3 times a week over a period of two months that is not interrupted) of BMT or other complementary and alternative medicine that shares similar principles of BMT.
* Inability to speak and read English proficiently
* Unable to understand informed consent
* Current health conditions that may interfere with the intervention: respiratory, cardiovascular, or neurological problems unless released by a physician
* Medical conditions or activities that can cause severe fatigue: Severe hearing loss that would cause difficulty following an instructor in a group setting, chronic fatigue syndrome, current major depression, alcohol use disorder, shift work
* Prostate cancer that has metastasized to the liver, brain, or lungs
* Currently receiving chemotherapy with VePesid, Cytoxan, Enzalutamide (XTANDI®), intravenous chemotherapy or radionucleotides (Strontium-89, Samarium (Quadramet®), Radium-223 (Xofigo®)), or other therapy (as confirmed by study team)
* Unwilling to be randomized to study arms and/or commit to 12 weeks of classes and assessments
* Have had a diagnosis of another cancer, unless:

  * Non-melanoma skin cancer or
  * Completed treatment AND cancer-free for 5 or more years.

We will not include any of the following special populations:

* Adults unable to consent
* Individuals who are not yet adults (infants, children, teenagers)
* Pregnant women
* Prisoners

Participant flow

Outcome results

• Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale (Primary), Mean, score on a scale: Usual Care (UC/Control) 37.8 +/- 1.9; Body Training (BT/Exercise Intensity-Matched Control) 36.7 +/- 1.4; Body-Mind Training (BMT/Tai Chi Qigong) 38.7 +/- 1.4
• Change in Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-Fatigue) Scale (Primary), Mean, score on a scale: Usual Care (UC/Control) 1.33 (-0.84 to 3.50); Body Training (BT/Exercise Intensity-Matched Control) 2.72 (0.95 to 4.48); Body-Mind Training (BMT/Tai Chi Qigong) 1.24 (-0.36 to 2.84)

Adverse events

Time frame: Time of enrollment to study completion, an average of 12 months

• Results publication: Tundealao S, Irwin MR, Cole S, Blair CK, Lu SE, Saraiya B, Kim IY, Guest DD, Lin Y, An J, Arana-Chicas E, Chen C, Handorf E, Stroup A, Kang Y, Arap W, Kinney AY. Biological correlates of cancer-related fatigue in older male cancer survivors. Transl Psychiatry. 2026 Jul 17. doi: 10.1038/s41398-026-04274-1. Online ahead of print. PMID 42469198
• Results publication: Kinney AY, An J, Lin Y, Tundealao S, Saraiya B, Lu SE, Guest DD, Harding EM, Amorim F, Heidt E, Arana-Chicas E, Chen C, Boyce T, Kim IY, Arap W, Blair CK, Irwin MR. Project HERO: a randomized trial of Tai Chi qigong versus intensity-matched exercise and usual care for fatigue in older male cancer survivors. BMC Complement Med Ther. 2025 Jul 4;25(1):239. doi: 10.1186/s12906-025-04988-7. PMID 40616105

• Study Protocol (PDF, 2025-10-01)
• Statistical Analysis Plan (PDF, 2025-10-25)
• Informed Consent Form (PDF, 2022-10-06)

• Anita Y Kinney, PhD, RN, Principal investigator, Rutgers, The State University of New Jersey
• Michael R. Irwin, MD, Principal investigator, University of California, Los Angeles