Evidence summary (Updated 2022)
Meta-analysis demonstrated slight improvement in depression in all cancers, however no clear effect on depression was seen in a systematic review on breast cancer.(1,2)
2 RCTs and a systematic review have demonstrated no clear change in anxiety levels in studies for all cancer types and breast cancer respectively.(1,3)
Improved sleep quality was demonstrated from meta-analysis involving walking interventions.(4)
No improvement in quality of life was demonstrated in meta-analysis and systematic reviews for breast or prostate cancer, however for head and neck cancers there was control or improvement.(1,5,6)
In a recent review of the evidence 19 reviews were shown to have a definite positive effect on symptoms of depression.(7–25)
Three of 19 studies reported an improvement seen during the treatment stage.(9,19,25) Nine of 19 reported on interventions during and post treatment.(7,10–12,14,15,18,20,21) Four of 19 studies reported on improved depression symptoms with PA interventions following cancer treatment.(13,16,23,24) Three of 19 did not specify the treatment stage of the interventions.(8,17,22)
While 7 reported on multiple cancer types(9–11,14–17), several reported on a single cancer only; improved depressive symptoms with the physical activity intervention group was seen in breast cancer(7,8,18–26), and lung cancer(12,13) patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions.(7,8,10,16,21,23–25) Combined aerobic and anaerobic activities were evaluated.(12,13,15,19) Other interventions shown to be effective included Pilates(18), Aerobic exercises(9,20,22), mind-body activities(11,17) such as Tai Chi(26), Yoga, Qigong, and dance(17). Physical activity delivered by exer-gaming(14) was also found to have a positive effect on anxiety symptoms in cancer patients.
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in depression were seen in moderate(9,20) intensity and moderate-vigorous(19) intensity interventions.
Quality of evidence
B – Moderate quality
Strength of recommendation
1 – Strong
Depression has been shown to have slight improvement. Further moderate to high quality evidence supports using physical activity to improve depressive symptoms in cancer patients. However, the evidence has high heterogeneity, but good data exists in general population to support a strong recommendation.
- Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev. 9:5001.
- Craft LL. Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. 21(1):3–19.
- Mishra SI. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database Syst Rev. 2012(8):7566.
- Chiu HY. Walking improves sleep in individuals with cancer: a meta-analysis of randomized, controlled trials. Oncol Nurs Forum. 42(2):54–62.
- Gardner JR, Livingston PM, Fraser SF. Effects of exercise on treatment-related adverse effects for patients with prostate cancer receiving androgen-deprivation therapy: a systematic review. J Clin Oncol. 32(4):335–46.
- Capozzi LC. The impact of physical activity on health-related fitness and quality of life for patients with head and neck cancer: a systematic review. Br J Sport Med. 50(6):325–38.
- Singh B, Spence RR, Steele ML, Sandler CX, Peake JM, Hayes SC. A Systematic Review and Meta-Analysis of the Safety, Feasibility, and Effect of Exercise in Women With Stage II+ Breast Cancer. Arch Phys Med Rehabil [Internet]. 2018 Dec 1 [cited 2022 Oct 10];99(12):2621–36. Available from: https://pubmed.ncbi.nlm.nih.gov/29730319/
- SHEN Q, YANG H. Impact of post-radiotherapy exercise on women with breast cancer: A systematic review and meta-analysis of randomized controlled trials. J Rehabil Med [Internet]. 2020 Oct 1 [cited 2022 Oct 10];52(10). Available from: https://pubmed.ncbi.nlm.nih.gov/32940714/
- Cave J, Paschalis A, Huang CY, West M, Copson E, Jack S, et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Support Care Cancer [Internet]. 2018 Oct 1 [cited 2022 Oct 10];26(10):3337–51. Available from: https://pubmed.ncbi.nlm.nih.gov/29936624/
- Zeng J, Wu J, Tang C, Xu N, Lu L. Effects of Exercise During or Postchemotherapy in Cancer Patients: A Systematic Review and Meta-Analysis. Worldviews evidence-based Nurs [Internet]. 2019 Apr 1 [cited 2022 Oct 10];16(2):92–101. Available from: https://pubmed.ncbi.nlm.nih.gov/30854763/
- Wayne PM, Lee MS, Novakowski J, Osypiuk K, Ligibel J, Carlson LE, et al. Tai Chi and Qigong for cancer-related symptoms and quality of life: a systematic review and meta-analysis. J Cancer Surviv [Internet]. 2018 Apr 1 [cited 2022 Oct 10];12(2):256–67. Available from: https://pubmed.ncbi.nlm.nih.gov/29222705/
- Singh B, Spence R, Steele ML, Hayes S, Toohey K. Exercise for Individuals With Lung Cancer: A Systematic Review and Meta-Analysis of Adverse Events, Feasibility, and Effectiveness. Semin Oncol Nurs [Internet]. 2020 Oct 1 [cited 2022 Oct 10];36(5). Available from: https://pubmed.ncbi.nlm.nih.gov/33008682/
- Yang M, Liu L, Gan C e., Qiu L hong, Jiang X juan, He X ting, et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: A meta-analysis. Eur J Oncol Nurs [Internet]. 2020 Dec 1 [cited 2022 Oct 10];49. Available from: https://pubmed.ncbi.nlm.nih.gov/33120218/
- Tough D, Robinson J, Gowling S, Raby P, Dixon J, Harrison SL. The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review. BMC Cancer [Internet]. 2018 Nov 21 [cited 2022 Oct 10];18(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30463615/
- Fuller JT, Hartland MC, Maloney LT, Davison K. Therapeutic effects of aerobic and resistance exercises for cancer survivors: a systematic review of meta-analyses of clinical trials. Br J Sports Med [Internet]. 2018 Oct 1 [cited 2022 Oct 10];52(20):1311. Available from: https://pubmed.ncbi.nlm.nih.gov/29549149/
- Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer [Internet]. 2019 [cited 2022 Oct 10];27(7). Available from: https://pubmed.ncbi.nlm.nih.gov/30944994/
- Duan L, Xu Y, Li M. Effects of Mind-Body Exercise in Cancer Survivors: A Systematic Review and Meta-Analysis. Evid Based Complement Alternat Med [Internet]. 2020 [cited 2022 Sep 2];2020. Available from: https://pubmed.ncbi.nlm.nih.gov/32952591/
- Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: A systematic review and meta-analysis. Complement Ther Med [Internet]. 2018 Dec 1 [cited 2022 Oct 10];41:130–40. Available from: https://pubmed.ncbi.nlm.nih.gov/30477829/
- Lee J, Lee MG. Effects of Exercise Interventions on Breast Cancer Patients During Adjuvant Therapy: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Cancer Nurs [Internet]. 2020 Mar 1 [cited 2022 Oct 10];43(2):115–25. Available from: https://pubmed.ncbi.nlm.nih.gov/30601270/
- Bekhet AH, Abdalla AR, Ismail HM, Genena DM, Osman NA, El Khatib A, et al. Benefits of Aerobic Exercise for Breast Cancer Survivors: A Systematic Review of Randomized Controlled Trials. Asian Pac J Cancer Prev [Internet]. 2019 [cited 2022 Oct 10];20(11):3197–209. Available from: https://pubmed.ncbi.nlm.nih.gov/31759342/
- Olsson Möller U, Beck I, Rydén L, Malmström M. A comprehensive approach to rehabilitation interventions following breast cancer treatment – A systematic review of systematic reviews. BMC Cancer. 2019 May 20;19(1).
- Abdin S, Lavallée JF, Faulkner J, Husted M. A systematic review of the effectiveness of physical activity interventions in adults with breast cancer by physical activity type and mode of participation. Psychooncology [Internet]. 2019 Jul 1 [cited 2022 Oct 10];28(7):1381–93. Available from: https://pubmed.ncbi.nlm.nih.gov/31041830/
- Baumann FT, Reike A, Reimer V, Schumann M, Hallek M, Taaffe DR, et al. Effects of physical exercise on breast cancer-related secondary lymphedema: a systematic review. Breast Cancer Res Treat [Internet]. 2018 Jul 1 [cited 2022 Oct 10];170(1). Available from: https://pubmed.ncbi.nlm.nih.gov/29470804/
- Del-Rosal-Jurado A, Romero-Galisteo R, Trinidad-Fernández M, González-Sánchez M, Cuesta-Vargas AI, Ruiz-Muñoz M. Therapeutic Physical Exercise Post-Treatment in Breast Cancer: A Systematic Review of Clinical Practice Guidelines. J Clin Med [Internet]. 2020 Apr 1 [cited 2022 Oct 10];9(4). Available from: https://pubmed.ncbi.nlm.nih.gov/32344683/
- Ramírez‐vélez R, Zambom‐ferraresi F, García‐hermoso A, Kievisiene J, Rauckiene‐michealsson A, Agostinis‐sobrinho C. Evidence-Based Exercise Recommendations to Improve Mental Wellbeing in Women with Breast Cancer During Active Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) [Internet]. 2021 Jan 2 [cited 2022 Oct 10];13(2):1–27. Available from: https://pubmed.ncbi.nlm.nih.gov/33445739/
- Luo XC, Liu J, Fu J, Yin HY, Shen L, Liu ML, et al. Effect of Tai Chi Chuan in Breast Cancer Patients: A Systematic Review and Meta-Analysis. Front Oncol [Internet]. 2020 Apr 23 [cited 2022 Oct 10];10. Available from: https://pubmed.ncbi.nlm.nih.gov/32391277/