Chen, H.M., Tsai, C.M., Wu, Y.C., Lin, K.C., & Lin, C.C. (2016). Effect of walking on circadian rhythms and sleep quality of patients with lung cancer: A randomised controlled trial. British Journal of Cancer, 115, 1304–1312.

To assess the effects of a 12-week walking program on improving subjective and objective sleep quality and rest-activity rhythms in patients with lung cancer

Home-based walking exercise at moderate intensity and weekly exercise counseling were provided. Participants were given detailed instruction according to a manual for the exercise program, including determination of intensity, pulse monitoring, rating perceived exertion, prevention of injury, and conditions requiring termination of the exercise program. Weekly exercise-related phone counseling was provided to reinforce teaching and encourage continued participation. The usual care control group was given typical services and asked to maintain normal activity and not perform additional exercise. Exercise counseling was offered to the usual care group at the end of the study. An actigraph was worn by patients to collect data continuously for 72 hours.

• N = 111, 89 assessed at six months
• MEAN AGE = 63.6 years
• AGE RANGE = 37–83 years
• MALES: 44.1%, FEMALES: 55.9%
• CURRENT TREATMENT: Combination radiation and chemotherapy, other
• KEY DISEASE CHARACTERISTICS: All had surgery for lung cancer, and most were receiving radiation and chemotherapy. Most had stage I disease.
• OTHER KEY SAMPLE CHARACTERISTICS: Eighty-two percent were married. Patients were an average of 454 days since diagnosis.

• SITE: Single-site   
• SETTING TYPE: Home    
• LOCATION: Taiwan

PHASE OF CARE: Multiple phases of care

Randomized, controlled trial

• Pittsburgh Sleep Quality Index (PSQI)
• Actigraphy for evaluation of rest activity parameters, sleep parameters, and physical activity

Overall participants completed 58.2% of all planned exercise sessions. The usual care group showed a higher mean amount of moderate physical activity at all time points when measured (37–46 minutes per day compared to 38–10 minutes per day at three and six months). No significant difference over time was reported between groups. The walking exercise group had improved PSQI scores over time compared to the usual care group (p = 0.001). No differences between groups in objective measures of sleep quality existed, except that total sleep time at six months was higher in the exercise group (p = 0.023).

Sleep quality measures showed improvement in the study group compared to the controls; however, given that the average amount of moderate intensity exercise was higher in the control group, the impact of walking exercise versus counseling is unclear.

• Small sample (< 100)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Measurement/methods not well described
• Subject withdrawals ≥ 10%
• It was stated that baseline minutes of moderate activity differed significantly between study groups; however, data were not provided, and the direction of difference is unknown.

The effect of exercise on sleep quality in patients with insomnia remains unclear from this study. Although measures showed improvement in the walking exercise group compared to the controls, the amount of moderate intensity exercise was actually higher in the control group. This does not point to the impact of exercise on differences seen in this study.