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 13 reviews were shown to have a definite positive effect on well-being outcomes.(7–19) One of these studies was a Cochrane review by McGettigan et al who found that physical activity had a positive effect on the HR-QoL (Health related Quality of Life) for up to a 6 month follow-up period (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence).(18)
One of 13 studies reported an improvement seen before the treatment stage/ prehabilitation before surgery.(17) Three of 13 studies reported an improvement seen during the treatment stage.(7,13,18) Two of 13 reported on interventions during and post treatment.(11,16) Four of 13 studies reported on improved depression symptoms with PA interventions following cancer treatment.(12,14,15,19) Two of 13 did not specify the treatment stage of the interventions.(8,9)
While 5 reported on multiple cancer types(9,13,14,16), these included any combination of the following; breast, colon, ovarian, stomach, prostate or haematological and with bone metastases(10). Several reported on a single cancer only; improved well-being outcomes with the physical activity intervention group was seen in breast(7,8,12), gastrointestinal(15,17–19), and brain(11) cancer patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions.(10–12,16,17) Combined aerobic and anaerobic activities were mostly evaluated. (7,9,14,15,18,19) Aerobic exercise interventions were shown to be effective.(8,13)
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in well-being were seen in moderate(13) intensity and moderate-vigorous(7,11,14) intensity interventions.
Quality of evidence
B – Moderate quality.
Strength of recommendation
2 – weak recommendation.
Meta-analyses reported an improved quality of life for cancer of all types, and a further meta-analyses showed a small increase in quality of life .(3,20) No change in quality of life was seen in meta-analysis in lung cancer after resection and colorectal cancer survivors.(21,22) Slight reductions in depression were demonstrated in a meta-analysis.(2)
In a recent review of the evidence 13 reviews were shown to have a definite positive effect on well-being outcomes.(7–19) One of these studies was a Cochrane review by McGettigan et al who found that physical activity had a positive effect on the HR-QoL (Health related Quality of Life) for up to a 6 month follow-up period (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence).(18) Four of 13 studies reported on improved depression symptoms with PA interventions following cancer treatment.(12,14,15,19)
Quality of evidence
B – Moderate quality
Strength of recommendation
2 – Weak recommendation.
Improvements have been seen in QoL outcomes, mental health outcomes and sleep quality. The evidence is mostly moderate in quality. There is high heterogeneity in both interventions and outcome measure. Overall patients would expect an improvement in quality of life with benefits outweighing risks. Quality of life has been grouped together and not divided into different aspects. Quality of life evidence does not exist for post-surgical resection patients in lung cancer, and patients post treatment for colorectal cancer.
- 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.
- 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/
- 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/
- 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/
- Weller S, Hart NH, Bolam KA, Mansfield S, Santa Mina D, Winters-Stone KM, et al. Exercise for individuals with bone metastases: A systematic review. Crit Rev Oncol Hematol [Internet]. 2021 Oct 1 [cited 2022 Oct 10];166. Available from: https://pubmed.ncbi.nlm.nih.gov/34358650/
- Sandler CX, Matsuyama M, Jones TL, Bashford J, Langbecker D, Hayes SC. Physical activity and exercise in adults diagnosed with primary brain cancer: a systematic review. J Neurooncol [Internet]. 2021 May 1 [cited 2022 Oct 10];153(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33907968/
- 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/
- 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/
- 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/
- Lund CM, Dolin TG, Mikkelsen MK, Juhl CB, Vinther A, Nielsen DL. Effect of Exercise on Physical Function and Psychological Well-being in Older Patients With Colorectal Cancer Receiving Chemotherapy-A Systematic Review. Clin Colorectal Cancer [Internet]. 2020 Dec 1 [cited 2022 Oct 10];19(4):e243–57. Available from: https://pubmed.ncbi.nlm.nih.gov/32828706/
- Machado P, Pimenta S, Oliveiros B, Ferreira JP, Martins RA, Cruz J. Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis. Cancers (Basel) [Internet]. 2021 Oct 1 [cited 2022 Oct 10];13(19). Available from: https://pubmed.ncbi.nlm.nih.gov/34638459/
- Piraux E, Reychler G, de Noordhout LM, Forget P, Deswysen Y, Caty G. What are the impact and the optimal design of a physical prehabilitation program in patients with esophagogastric cancer awaiting surgery? A systematic review. BMC Sport Sci Med Rehabil [Internet]. 2021 Dec 1 [cited 2022 Oct 10];13(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33766107/
- McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane database Syst Rev [Internet]. 2020 May 3 [cited 2022 Oct 10];5(5). Available from: https://pubmed.ncbi.nlm.nih.gov/32361988/
- Mbous YP, Patel J, Kelly KM. A systematic review and meta-analysis of physical activity interventions among colorectal cancer survivors. Transl Behav Med [Internet]. 2020 Oct 1 [cited 2022 Oct 10];10(5):1134–43. Available from: https://pubmed.ncbi.nlm.nih.gov/33044539/
- Fong DY. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 344:70.
- Cramer H. A systematic review and meta-analysis of exercise interventions for colorectal cancer patients. Eur J Cancer Care (Engl. 23(1):3–14.
- Cavalheri V. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database Syst Rev. 2013(7):9955.