New Findings Strengthens Case for Exercise Therapy in Cancer Care

Is it possible that older patients with cancer who experience anxiety and/or depression can alleviate these symptoms and improve their health-related quality of life (HRQOL) through exercise interventions? The answer is yes, according to a systematic review and meta-analysis published in JAMA Network Open, which found a significant correlation between implementing exercise therapies and mental health improvements.¹ 

As February 4 marks World Cancer Day, paying extra mind to patients’ mental health remains a pertinent concern in oncology.

In this study, significantly reduced levels of depression were observed in patient groups who undertook exercise programs, with the authors noting that forms of mind-body exercise were more strongly tied to decreased depression levels compared with resistance or aerobic training. | image credit: Yelloone - stock.adobe.com

Exercise regimens offer a wealth of benefits for patients with cancer; the present authors point to previous studies not only indicating the impact of physical activity on mental health outcomes but also its influence on inflammation, tumor regression, and angiogenesis.²

One of the main drawbacks to pharmacological therapies, they add, are the risks they carry for certain drug interactions or adverse effects. Cognitive behavioral therapies have also been explored; however, associated stigma may prevent patients from seeking out the mental health support they need. Therefore, the potential upside of exercise therapies warrants further investigation.¹

To continue exploring the link between exercise and mental health in patients with cancer, researchers collected information from 27 randomized clinical trials (RCTs), which included 1929 patients. Data were sourced from Cochrane, Embase, PsycINFO and PubMed from the time their databases were established until November 5, 2024. Interventions that included strength-, resistance, and/or aerobic-related physical activity, as well as mind-body therapies such as tai chi, yoga, and others, were eligible for consideration. Furthermore, included studies featured populations aged 60 years, with patients having any sort of cancer diagnosis, no matter the presence of comorbidities.

Of the 27 analyzed RCTs, 26 recorded HRQOL data, and depression and anxiety were evaluated in 12 and 9 studies, respectfully. The most prevalent form of cancer in these RCTs was prostate cancer (n = 15 studies), followed by a mix of cancer types (n = 4 studies), lung cancer (n = 3 studies), breast cancer (n = 2 studies), and bladder, colorectal, and head and neck cancers (n = 1 study each). The Functional Assessment of Cancer Therapy, Hospital Anxiety and Depression Scale, and the Brief Symptom Inventory were utilized to measure HRQOL, anxiety, and depression outcomes, respectfully.

A total of 826 patients were included throughout the 12 depression RCTs. Significantly reduced levels of depression were observed in patient groups who undertook exercise programs (standardized mean difference [SMD], −0.53; 95% CI, −0.79 to −0.28). The Hospital Anxiety and Depression scale further confirmed this association (SMD, −0.69; 95% CI, −1.23 to −0.15). The authors noted that forms of mind-body exercise were more strongly tied to decreased depression levels (SMD, −0.89; 95%CI, −1.51 to −0.27) compared with resistance or aerobic training (SMD, −0.39; 95%CI,−0.64 to−0.13). Longer durations of exercise had a larger impact on depression severity compared with shorter durations; age did not have a significant impact.

There were 685 patients included in the anxiety studies, which also revealed a significant association between exercise and decreases in anxiety (SMD, −0.39; 95% CI, −0.66 to −0.12). Mind-body exercises, again, had the greatest influence on these outcomes compared with conventional forms of exercise. No significant associations were found relating to age, cancer type, exercise duration, etc.

Lastly, 1866 patients were included in studies pertaining to HRQOL. In a continuing trend, exercise was found to significantly benefit patients’ HRQOL (SMD = 0.63; 95% CI, 0.10-1.17), with participants younger than 70 years exhibiting the greatest benefits vs those older than 70 years (SMD, 0.91; 95% CI, 0.11-1.71).

Considering their findings, the authors concludes, “Health care professionals and policymakers should focus more on implementing exercise interventions to improve mental health outcomes in this vulnerable population.”

References

1. Soong RY, Low CH, Ong V, et al. Exercise interventions for depression, anxiety, and quality of life in older adults with cancer: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(2):e2457859. doi:10.1001/jamanetworkopen.2024.57859

2. Hojman P, Geh lJ, Christensen JF, Pedersen BK. Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metab. 2018;27(1):10-21. doi:10.1016/j.cmet.2017.09.015