Fong, D.Y., Ho, J.W., Hui, B.P., Lee, A.M., Macfarlane, D.J., Leung, S.S., . . . Cheng, K.K. (2012). Physical activity for cancer survivors: Meta-analysis of randomised controlled trials. BMJ, 344, e70.

DOI Link


STUDY PURPOSE: To evaluate the evidence regarding the effects of physical activity in cancer survivors

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: Medline, CINAHL, and Google Scholar
KEYWORDS: Detailed keywords provided including multiple terms for cancer, treatment type, and exercise and activity
INCLUSION CRITERIA: Randomized, controlled trials; adult patients; patients who completed initial cancer treatment; assessed effects of physical activity

Literature Evaluated

TOTAL REFERENCES RETRIEVED: 1,892 (387 identified through sources other than the search)
EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Study quality was assessed using a checklist from the Scottish Intercollegiate Guidelines Network.

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 54 in qualitative review and 34 in meta-analysis
  • SAMPLE RANGE ACROSS STUDIES: Median sample size was 93 patients
  • KEY SAMPLE CHARACTERISTICS: Various tumor types with the most common being breast, colorectal, and endometrial; mean age was 55 years (range = 39–74 years)

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship


The median duration of the exercise intervention was 13 weeks (range = 3–60). A meta-analysis of results for body mass index, body weight, and other physiologic measures was reported. A meta-analysis was completed for three studies regarding effect on fatigue, and slightly reduced fatigue was demonstrated using the Piper Fatigue Scale (p = 0.03). However, sample sizes were small in these studies. A meta-analysis of effects on depression included four studies and showed reduced depression using the Beck Depression Inventory (p < 0.01). Three of the four studies had relatively small sample sizes. Quality of life outcomes showed improved Short Form-36 physical functioning scores (p = 0.01) and mental health scores (p = 0.01). The authors noted substantially different results based on the measurement scales used in the included studies.


This analysis supports the effectiveness of exercise in general on cancer-related fatigue and depression.


It was suggested that the intensity of the exercise could affect results, and intensity was not consistently reported in the studies included. The mean duration of the intervention was as high as 13 weeks and as low as three weeks. The relatively short duration limits the ability to assess long-term outcomes. Most studies were completed in patients with breast cancer. There were very few studies in the analysis, and it was surprising that more studies were not found for inclusion. The studies of fatigue and depression included in this meta-analysis had relatively small sample sizes.

Nursing Implications

This report adds to the already large body of evidence demonstrating that exercise can improve fatigue and depression outcomes in cancer survivors. Current evidence, however, involves relatively short-term interventions and assessments. For long-term benefits, it is generally believed that physical activity needs to be incorporated into everyday life. Nursing interventions and future research should consider the examination of approaches to address this need for ongoing behavior change. Most exercise studies continue to involve women with breast cancer. Although there is some evidence in other groups, it is limited. Continued research to examine exercise's effects in more varied patients would be beneficial.

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