Courneya, K.S., McKenzie, D.C., Gelmon, K., Mackey, J.R., Reid, R.D., Yasui, Y., . . . Segal, R.J. (2014). A multicenter randomized trial of the effects of exercise dose and type on psychosocial distress in breast cancer patients undergoing chemotherapy. Cancer Epidemiology, Biomarkers and Prevention, 23, 857–864. 

To examine the effects of exercise dose and type on psychosocial distress in patients with breast cancer receiving chemotherapy

Patients were computer-stratified by center and protocol and randomly assigned in a 1:1:1 ratio to standard (STAN), combination (COMB), or high-volume (HIGH). Participants exercised for the duration of their chemotherapy schedules. STAN treatment followed the Physical Activity Guidelines for Americans. The guidelines recommend a minimum of 75 minutes per week of vigorous aerobic exercise over three days per week. HIGH followed double the minimum guidelines of 150 minutes per week, and COMB followed the STAN guideline with the addition of a standard strength training program for three days per week. Exercise was supervised, and attendance, duration, and the intensity of aerobic exercise, weight, sets, and repetitions of strength training were recorded.

• N = 301  
• AGE RANGE = 45–55 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: Breast cancer stages I–III initiating adjuvant chemotherapy

• SITE: Multi-site    
• SETTING TYPE: Multiple settings    
• LOCATION: Canada

• PHASE OF CARE: Active antitumor treatment

Randomized trial

• Short version of Center for Epidemiological Studies-Depression Scale (CES-D)
• Short form of the Spielberger State-Trait Anxiety Inventory (STAI)
• Perceived Stress Scale (PSS)
• Rosenberg Self-Esteem Scale (RSES)

There were no significant differences in managing depressive symptoms with HIGH and COMB exercises compared to the STAN exercise. COMB and HIGH exercises were effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline. There were no differences between the groups in anxiety scores.

Compared to standard exercise, higher volumes of exercise did not improve depressive symptoms, but it was effective in managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline.

• Risk of bias (no blinding)

Depression is the most common psychological symptom in patients with cancer. Oncology nurses should encourage patients to perform standard aerobic exercise to improve depressive symptoms. Exercise also has been shown to be beneficial for anxiety and fatigue.