Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses

P Bernard; J Savard; K Steindorf; M G Sweegers; K S Courneya; R U Newton; N K Aaronson; P B Jacobsen; A M May; D A Galvao; M J Chinapaw; M M Stuiver; K A Griffith; I Mesters; H Knoop; M M Goedendorp; M Bohus; L Thorsen; M E Schmidt; C M Ulrich; G S Sonke; W van Harten; K M Winters-Stone; M J Velthuis; D R Taaffe; W van Mechelen; M J Kersten; F Nollet; J Wenzel; J Wiskemann; I M Verdonck-de Leeuw; J Brug; L M Buffart

doi:10.1016/j.jpsychores.2019.109746

Effects and moderators of exercise on sleep in adults with cancer: Individual patient data and aggregated meta-analyses

J Psychosom Res. 2019 Sep:124:109746. doi: 10.1016/j.jpsychores.2019.109746. Epub 2019 Jun 23.

Authors

P Bernard¹, J Savard², K Steindorf³, M G Sweegers⁴, K S Courneya⁵, R U Newton⁶, N K Aaronson⁷, P B Jacobsen⁸, A M May⁹, D A Galvao⁶, M J Chinapaw¹⁰, M M Stuiver¹¹, K A Griffith¹², I Mesters¹³, H Knoop¹⁴, M M Goedendorp¹⁵, M Bohus¹⁶, L Thorsen¹⁷, M E Schmidt³, C M Ulrich¹⁸, G S Sonke¹⁹, W van Harten²⁰, K M Winters-Stone²¹, M J Velthuis²², D R Taaffe⁶, W van Mechelen¹⁰, M J Kersten²³, F Nollet²⁴, J Wenzel²⁵, J Wiskemann²⁶, I M Verdonck-de Leeuw²⁷, J Brug²⁸, L M Buffart²⁹

Affiliations

¹ Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada; Physical Activity Sciences Department, Université du Québec à Montréal, Montréal, Quebec, Canada; Research centre, University Institute of Mental Health at Montreal, Montréal, Quebec, Canada. Electronic address: bernard.paquito@uqam.ca.
² Université Laval Cancer Research Center, Québec, Québec, Canada; School of Psychology, Université Laval, Québec, Québec, Canada; CHU de Québec - Université Laval Research Center, Québec, Québec, Canada.
³ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Disease (NCT), Heidelberg, Germany.
⁴ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
⁵ Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada.
⁶ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
⁷ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
⁸ Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
⁹ Department of Clinical Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁰ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
¹¹ Department of Physiotherapy, Netherlands Cancer Institute, Amsterdam, The Netherlands.
¹² School of Nursing, University of Maryland, Baltimore, USA.
¹³ Department of Epidemiology, Maastricht University, The Netherlands.
¹⁴ Amsterdam UMC, University of Amsterdam, Department of Medical Psychology, Amsterdam, The Netherlands.
¹⁵ Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany.
¹⁶ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Heidelberg t University, Mannheim, Germany; Faculty of Health, University of Antwerp, Belgium.
¹⁷ National Advisory Unit on Late Effects after Cancer, Department of Oncology, Oslo University Hospital, Oslo, Norway.
¹⁸ Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA.
¹⁹ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Population Science, Moffitt Cancer Center and Research Institute, Tampa, FL, USA.
²⁰ Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Huntsman Cancer Institute and University of Utah, Department of Population Health Sciences, Salt Lake City, USA.
²¹ Oregon Health & Science University, Portland, USA.
²² Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
²³ Amsterdam UMC, University of Amsterdam, Department of Hematology, Amsterdam, The Netherlands.
²⁴ Amsterdam UMC, University of Amsterdam, Department of Rehabilitation Medicine, Amsterdam Movement Sciences, Amsterdam, The Netherlands.
²⁵ Johns Hopkins School of Nursing, Johns Hopkins School of Medicine, Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA.
²⁶ Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany.
²⁷ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Otolaryngology-Head and Neck Surgery, The Netherlands; Department of Clinical Psychology, Vrije Universiteit Amsterdam, The Netherlands.
²⁸ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; National Institute for Public Health and the Environment, Bilthoven, The Netherlands.
²⁹ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam, The Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam, The Netherlands.

PMID: 31443811
DOI: 10.1016/j.jpsychores.2019.109746

Abstract

Objectives: To evaluate the effects of exercise interventions on sleep disturbances and sleep quality in patients with mixed cancer diagnoses, and identify demographic, clinical, and intervention-related moderators of these effects.

Methods: Individual patient data (IPD) and aggregated meta-analyses of randomized controlled trials (RCTs). Using data from the Predicting OptimaL cAncer RehabIlitation and Supportive care project, IPD of 2173 adults (mean age = 54.8) with cancer from 17 RCTs were analyzed. A complementary systematic search was conducted (until November 2018) to study the overall effects and test the representativeness of analyzed IPD. Effect sizes of exercise effects on self-reported sleep outcomes were calculated for all included RCTs. Linear mixed-effect models were used to evaluate the effects of exercise on post-intervention outcome values, adjusting for baseline values. Moderator effects were studied by testing interactions for demographic, clinical and intervention-related characteristics.

Results: For all 27 eligible RCTs from the updated search, exercise interventions significantly decreased sleep disturbances in adults with cancer (g = -0.09, 95% CI [-0.16; -0.02]). No significant effect was obtained for sleep quality. RCTs included in IPD analyses constituted a representative sample of the published literature. The intervention effects on sleep disturbances were not significantly moderated by any demographic, clinical, or intervention-related factor, nor by sleep disturbances.

Conclusions: This meta-analysis provides some evidence that, compared to control conditions, exercise interventions may improve sleep disturbances, but not sleep quality, in cancer patients, although this effect is of a small magnitude. Among the investigated variables, none was found to significantly moderate the effect of exercise interventions on sleep disturbances.

Keywords: Cancer; Physical activity; Treatment, sleep.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Review

MeSH terms

Adult
Exercise*
Humans
Neoplasms / physiopathology*
Quality of Life
Sleep / physiology*
Sleep Wake Disorders