Mishra, S.I., Scherer, R.W., Snyder, C., Geigle, P., & Gotay, C. (2014). Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncology Nursing Forum, 41, E326–E342. 

DOI Link


PURPOSE: To evaluate the effectiveness of exercise interventions on several domains of health-related quality of life

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: MEDLINE, CENTRAL, EMBASE, CINAHL, psycINFO, PEDRO, LILACS SIGLE, SportDiscus, OTSeeker, and Sociological Abstracts from inception to October 2011
KEYWORDS: Not provided
INCLUSION CRITERIA: Randomized, controlled trials or controlled trials; adult cancer survivors; compared exercise interventions to usual care or another nonxercise intervention
EXCLUSION CRITERIA: Patients in hospice; terminally ill patients; patients receiving active treatment

Literature Evaluated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane handbook method for risk of bias assessment

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 40 in systematic review (33 in meta-analysis)
  • KEY SAMPLE CHARACTERISTICS: Multiple tumor types

Phase of Care and Clinical Applications

PHASE OF CARE: Late effects and survivorship


Studies included those with interventions such as yoga, tai chi, and qigong, as well as more traditional exercises. Moderate to vigorous exercise was associated with positive effects on quality of life (SMD = 0.29, 95% CI = 0, 0.58), but no effect was seen for mild to moderate level exercise. These findings did not differ by type of cancer. Anxiety was reduced in all studies by 12 weeks, but this was not observed at longer follow-up periods. At 12 weeks, more vigorous exercise showed no overall effect on anxiety with pooled data. However, a significant effect was seen with mild to moderate exercise (SMD = -0.26, 95% CI = -0.02,-0.51). For fatigue, there were significant positive effects at 12 weeks and between three and six months, but not at six months


The findings of this review show the benefits of various types of exercise on anxiety, fatigue, and quality of life among cancer survivors. Results varied by exercise intensity and at various time points in patient follow-up. This suggests that benefits exist mainly in the short-term up to six months.


Most studies showed a moderate to high risk of bias. All types of exercise were combined with various mind/body interventions, which would affect the results of the meta-analysis. It is not clear that these various types of interventions are truly equivalent types of interventions. The methods of measurement for the studies included were not provided, and differences in measurement would affect the meta-analysis. The search result volumes differed in two areas of this report. The differences reported by exercise intensity are confusing. It is not clear how more vigorous exercise improved quality of life while less vigorous exercise only affected anxiety.

Nursing Implications

Overall findings confirm other findings that exercise is beneficial for patients with cancer at various phases of care. This particular analysis was aimed at cancer survivors who completed initial treatment. It is of interest that the benefits of interventions appear to wane around the six-month timeframe. It is not clear if the interventions were done in a group setting for some time period or if social interaction could have influenced the findings that long-term effects were not generally seen if group exercise activity had ceased. Future research in this area should incorporate data to facilitate our understanding of the longevity of effects and mechanisms to maintain improvements long-term.

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