Ergun, M., Eyigor, S., Karaca, B., Kisim, A., & Uslu, R. (2013). Effects of exercise on angiogenesis and apoptosis-related molecules, quality of life, fatigue and depression in breast cancer patients. European Journal of Cancer Care, 22, 626–637.

DOI Link

Study Purpose

Evaluate moderate intensity exercise programs for patients with breast cancer and their effect on several immune indicators as well as on fatigue, depression, and quality of life

Intervention Characteristics/Basic Study Process

Lab was obtained at week 0 and 12 and analyzed. Quality of life, fatigue, and depression were evaluated before and after the exercise program using tools mentioned. Patients were assigned to one of three groups. All were provided education. Group one did supervised exercise consisting of 45 minutes per day three times per week and brisk walking for 30 minutes per day three times per week. Group two did brisk walking for 30 minutes per day three times per week. Group three received education only. Patients wrote down their progress, and groups two and three were interviewed over the phone once a week. Arm circumference was measured to control for lymphedema at zero, one, two, and three months.

Sample Characteristics

  • N = 58
  • AGE: 18–65 years
  • MALES: 0%, FEMALES: 100%
  • KEY DISEASE CHARACTERISTICS: Breast cancer, completed surgery, radiation, chemotherapy, post-menopausal, had not smoked in past year, absence of physical condition that would hinder exercise, cognitive capacity
  • OTHER KEY SAMPLE CHARACTERISTICS: Patient demographics, age at diagnosis, type of operation, time after diagnosis, axillary dissection, sentinel lymph node biopsy, operation side, number of chemotherapy cycles, number of radiation treatments, body mass index


  • SITE: Single site    
  • SETTING TYPE: Outpatient    
  • LOCATION: Outpatient clinic for oncology and support unit of Ege University Tulay Aktas Oncology Hospital

Phase of Care and Clinical Applications

PHASE OF CARE: Transition phase after active treatment

Study Design

Prospective, randomized controlled study

Measurement Instruments/Methods

  • European Organisation for Research and Treatment of Cancer Quality of Life C30
  • Brief Fatigue Inventory (BFI)
  • Beck Depression Inventory (BDI)


Demographics were similar among the three groups. Exercise groups had a statistically significant decrease in some of the biomarkers, while the education group had a statistically significant increase in monocyte chemoattractant protein 1 levels. Functional score and global health score in both exercise groups increased.  Depression score was reduced in the supervised exercise group (p < .05). However, no significant differences were seen between groups after the intervention.


Significant changes in biomarkers were found at the end of 12 weeks, and improvements were seen in quality of life and depression in the supervised  and unsupervised exercise groups.


  • Small sample (< 100)
  • Findings not generalizable
  • Intervention expensive, impractical, or training needs
  • 12-week exercise program often is difficult for individuals
  • Unclear if the home walking group adhered to the exercise program

Nursing Implications

Nurses encouraging patients with breast cancer to stay physically active and adopt a moderate exercise program is important to improve quality of life and help with symptoms of depression.