Evidence summary (Updated 2022)
Improved sleep quality was demonstrated from a meta-analysis that involved walking interventions(1). A further two systematic reviews demonstrated equivocal evidence on sleep quality in 1 review and likely showing benefit in the second review – however the conclusion being that there is likely benefit(2,3). A meta-analyses demonstrated no significant effect on sleep measures.
In a recent review of the evidence 15 reviews were shown to have a definite positive effect on sleep quality(4–19).
Seven of 15 reported on interventions during and post treatment (5,6,9,12,15–18). Three studies reported on improved sleep quality with PA interventions following cancer treatment(4,7,19). Five of 15 did not specify the treatment stage of the interventions(8,10,11,13,14).
While 10 reviews reported on multiple cancer types(8–11,14,16–19), including advanced stages(13). Several reviews reported on a single cancer only; improved sleep quality with the physical activity intervention group was seen in breast(4,5,15) and lung(6,7) cancer patients.
When considering the intervention type, studies considered multiple or combination physical activity/exercise interventions(7,11,12,15,17). Combined aerobic and anaerobic activities were evaluated(4,6,8,13,18,19). Other interventions shown to be effective included HIIT(9), aerobic exercises(5), mind-body activities(10) such as dance, yoga, Tai Chi(16), and Qigong(14).
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in sleep quality were seen in moderate(5) and moderate-vigorous(13,19) intensity interventions.
Quality of evidence
Grade B – Moderate
Strength of recommendation
2 – weak
The studies are highly heterogenous, but the evidence base is growing in number and quality. More rigorous RCTs are needed, however it is likely that physical activity would be beneficial to patients to improve sleep quality
- Chiu HY. Walking improves sleep in individuals with cancer: a meta-analysis of randomized, controlled trials. Oncol Nurs Forum. 42(2):54–62.
- Matthews E. Sleep-Wake Disturbance: A Systematic Review of Evidence-Based Interventions for Management in Patients With Cancer. Clin J Oncol Nurs. 22(1):37–52.
- Mercier J, Savard J, Bernard P. Exercise interventions to improve sleep in cancer patients: A systematic review and meta-analysis. Sleep Med Rev. 36:43–56.
- Yang H, Yang Z, Pan H, Zhou Q. Effects of physical activity on sleep problems in breast cancer survivors: a meta-analysis. Support Care Cancer [Internet]. 2021 Jul 1 [cited 2022 Oct 13];29(7):4023–32. Available from: https://pubmed.ncbi.nlm.nih.gov/33403402/
- 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/
- 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/
- Heywood R, McCarthy AL, Skinner TL. Efficacy of Exercise Interventions in Patients With Advanced Cancer: A Systematic Review. Arch Phys Med Rehabil [Internet]. 2018 Dec 1 [cited 2022 Oct 10];99(12):2595–620. Available from: https://pubmed.ncbi.nlm.nih.gov/29738745/
- Lavín-Pérez AM, Collado-Mateo D, Mayo X, Liguori G, Humphreys L, Copeland RJ, et al. Effects of high-intensity training on the quality of life of cancer patients and survivors: a systematic review with meta-analysis. Sci Rep [Internet]. 2021 Dec 1 [cited 2022 Oct 12];11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34301995/
- 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/
- Takemura N, Cheung DST, Smith R, Deng W, Ho KY, Lin J, et al. Effectiveness of aerobic exercise and mind-body exercise in cancer patients with poor sleep quality: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev [Internet]. 2020 Oct 1 [cited 2022 Oct 8];53. Available from: https://pubmed.ncbi.nlm.nih.gov/32505970/
- 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).
- De Lazzari N, Niels T, Tewes M, Götte M. A Systematic Review of the Safety, Feasibility and Benefits of Exercise for Patients with Advanced Cancer. Cancers (Basel) [Internet]. 2021 Sep 1 [cited 2022 Oct 14];13(17). Available from: https://pubmed.ncbi.nlm.nih.gov/34503288/
- Kuo CC, Wang CC, Chang WL, Liao TC, Chen PE, Tung TH. Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials. Evid Based Complement Alternat Med [Internet]. 2021 [cited 2022 Oct 13];2021. Available from: https://pubmed.ncbi.nlm.nih.gov/33880125/
- Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind–body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Res Treat. 2019 Jul 15;176(1).
- Yang L, Winters-Stone K, Rana B, Cao C, Carlson LE, Courneya KS, et al. Tai Chi for cancer survivors: A systematic review toward consensus-based guidelines. Cancer Med [Internet]. 2021 Nov 1 [cited 2022 Oct 13];10(21):7447–56. Available from: https://pubmed.ncbi.nlm.nih.gov/34533284/
- Tang MF, Chiu HY, Xu X, Kwok JY, Cheung DST, Chen CY, et al. Walking is more effective than yoga at reducing sleep disturbance in cancer patients: A systematic review and meta-analysis of randomized controlled trials. Sleep Med Rev [Internet]. 2019 Oct 1 [cited 2022 Oct 14];47:1–8. Available from: https://pubmed.ncbi.nlm.nih.gov/31207341/
- Nakano J, Hashizume K, Fukushima T, Ueno K, Matsuura E, Ikio Y, et al. Effects of Aerobic and Resistance Exercises on Physical Symptoms in Cancer Patients: A Meta-analysis. Integr Cancer Ther [Internet]. 2018 Dec 1 [cited 2022 Oct 13];17(4):1048–58. Available from: https://pubmed.ncbi.nlm.nih.gov/30352523/
- Chen Y jing, Li X xia, Ma H kun, Zhang X, Wang B wei, Guo T tao, et al. Exercise Training for Improving Patient-Reported Outcomes in Patients With Advanced-Stage Cancer: A Systematic Review and Meta-Analysis. J Pain Symptom Manage [Internet]. 2020 Mar 1 [cited 2022 Oct 10];59(3):734-749.e10. Available from: https://pubmed.ncbi.nlm.nih.gov/31546002/