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

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

Author information

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.

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

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