Courneya, K. S., & Friedenreich, C. M. (1999). Physical exercise and quality of life following cancer diagnosis: a literature review. Annals of Behavioral Medicine, 21, 171–179.

Search Strategy

Databases searched were MEDLINE, CANCERLIT, CINAHL, HERACLES, PsycINFO, and SPORTDiscus through 1997. Studies restricted solely to movement therapy and/or stretching/flexibility exercises for rehabilitation of range of motion were excluded. Studies were also excluded if they presented insufficient detail to allow for critical review.

Literature Evaluated

Eighteen intervention studies (10 quasiexperimental and eight experimental designs) of physical exercise designed to improve cardiovascular and/or muscular fitness were included.

Outcomes were fatigue, health-related quality of life, symptom distress, immune function, physical exercise capacity (maximal oxygen consumption), and other physical performance measures.

Treatment evaluated cycle ergometer (eight studies), walking either alone or in combination with some other exercise mode (six studies), resistance training (one study), and unspecified (three studies).

Length of the intervention was 12 weeks or less in 14 studies, between four and six months in three studies, and one year in one study. Exercise was supervised (13 studies), unsupervised home-based (three studies), and partially supervised (two studies).

Sample Characteristics

  • The sample sizes ranged from eight to 70 participants.
  • Most of the studies were conducted in patients with or survivors of breast cancer or those who were predominantly stage I and II.
  • A few studies evaluated exercise in patients with leukemia following allogeneic stem cell transplantation and in patients with solid tumors following autologous stem cell transplantation.
  • Single studies were found for survivors of head and neck, colorectal, and childhood cancer.


The reviewed studies indicated promising effects on both physiological and psychological outcomes. Three studies reported a significant reduction in fatigue. Although effect sizes could not be summarized across studies due to the diversity of outcomes with small numbers of effect sizes, the effects appeared to be robust and clinically significant.


  • Small convenience samples were used.
  • The study design lacked appropriate control groups.
  • The range of cancer sites was restricted. 
  • The intervention period was short (the exercise treatment lasted 12 weeks or less in most studies).

Nursing Implications

Additional studies are needed to examine the effect of exercise, specifically on the endpoint of fatigue.

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