Chiu, H.Y., Huang, H.C., Chen, P.Y., Hou, W.H., & Tsai, P.S. (2015). Walking improves sleep in individuals with cancer: A meta-analysis of randomized, controlled trials. Oncology Nursing Forum, 42, E54–E62.
DOI Link
Purpose
Search Strategy
Literature Evaluated
Sample Characteristics
- FINAL NUMBER STUDIES INCLUDED = 9
- TOTAL PATIENTS INCLUDED IN REVIEW = 599
- SAMPLE RANGE ACROSS STUDIES: Not provided
Phase of Care and Clinical Applications
PHASE OF CARE: Multiple phases of care
Results
Overall, the effect size for walking on sleep disturbance was -0.52 (Hedges' g: 95%; CI -0.79, -0.25). There was significant overall heterogeneity among the studies. Multiple subgroup analyses were conducted to explore factors that may contribute to the heterogeneity. The effect size was not associated with age, gender, the duration of the intervention, or adherence rate. An analysis demonstrated no evidence of publication bias. Studies were done before, during, or after treatment for cancer, and the overall effect sizes did not differ according to the timing of the intervention. All studies used walking of moderate intensity, and most studies were done in women with breast cancer. Some studies included additional exercise interventions such as strength training, and some also included psychoeducational interventions.
Conclusions
Walking exercise appears to improve sleep in patients with cancer.
Limitations
There was a relatively small number of studies included with high heterogeneity. Twelve studies were excluded because they did not report sufficient data to compute an effect size or they did not use a self-reported sleep outcome. These excluded studies, which have been summarized in other PEP® summaries, did not demonstrate the effectiveness of exercise. This suggests that effectiveness may be overestimated in this analysis.
Nursing Implications
This analysis provides some support for moderate intensity walking exercise to improve sleep. The findings need to be viewed with caution because of the high heterogeneity of the studies and the contrary findings that were excluded from this analysis. However, walking is a safe activity for patients, and it can be suggested to patients as an approach that may improve sleep. It also could be incorporated into multicomponent approaches to address sleep-wake disturbances.