Testing the cognitive–affective self-regulation pathway: How exercise shapes cancer-related fatigue

Cancer-related fatigue (CRF) is a psychologically shaped symptom that often persists after cancer treatment, yet the mechanisms through which exercise alleviates CRF remain insufficiently understood. Guided by the Cognitive–Affective Self-Regulation Pathway (CASRP), this study examined whether exercise influences CRF through survivors’ perceived capability to exercise (self-efficacy) and their emotional and functional well-being (quality of life; QoL). A sample of 320 cancer survivors from Jiangxi Province, China, completed validated measures of exercise behavior, self-efficacy, QoL, and CRF. Given the cross-sectional design, the findings should be interpreted as theoretically informed associations rather than definitive causal effects. Structural equation modeling demonstrated that exercise was associated with lower CRF largely through psychosocial processes: self-efficacy and QoL each mediated the exercise–fatigue relationship, and a sequential pathway—exercise → self-efficacy → QoL → CRF—provided strong support for the CASRP mechanism. Indirect effects accounted for most of the total association, suggesting that exercise may operate as a psychological activator rather than solely as a physical intervention. These findings highlight the centrality of cognitive reappraisal and affective–functional adaptation in survivors’ fatigue experiences and underscore the value of integrating self-efficacy enhancement and QoL-focused components into exercise-based survivorship care.