Exercise Therapy and Cognitive Behavioural Therapy for Fatigue in Female Cancer Patients in Singapore

Inclusion Criteria: Primary cohort (N=90): 1. Female 2. ≥21 years of age 3. Stage I-III breast cancer regardless of hormone receptor status or human epidermal growth factor receptor 2 (HER2) status 4. Completed surgery 5. Completed adjuvant chemotherapy, if indicated 6. Reported fatigue (One-item fatigue scale score ≥ 4) 7. Ability to read and communicate in English 8. Willing to provide informed consent for the study participation Exploratory cohort (N=10): 1. Female 2. ≥21 years of age 3. Stage IV breast cancer regardless of hormone receptor status or human epidermal growth factor receptor 2 (HER2) status 4. Completed surgery 5. Currently receiving systemic therapy (e.g. endocrine therapy, chemotherapy, targeted therapy or immunotherapy) 6. Reported fatigue (One-item fatigue scale score ≥ 4) 7. Ability to read and communicate in English 8. Willing to provide informed consent for the study participation Exclusion Criteria for both cohorts: 1. Pregnant or lactating 2. Presence of dementia or major psychiatric disease 3. Deemed medically unsuitable by medical team for low to moderate intensity exercise 4. Unable or unwilling for tele-counselling sessions 5. Uncontrolled pain or undiagnosed pain 6. Low blood counts: Hb \<8.0, Platelet \<50K, ANC \<1 7. Electrolyte imbalances: K \<3.0, Na \<130 8. Cardiovascular diseases, including but not limited to: LVEF \<35%, uncontrolled arrhythmias, severe coronary artery disease, severe valvular heart disease, uncontrolled hypertension etc. not cleared by a cardiologist 9. Active infection 10. Currently engaged in moderate to vigorous physical activity