Courneya, K.S., Sellar, C.M., Trinh, L., Forbes, C.C., Stevinson, C., McNeely, M.L., . . . Reiman, T. (2012). A randomized trial of aerobic exercise and sleep quality in lymphoma patients receiving chemotherapy or no treatments. Cancer Epidemiology Biomarkers & Prevention, 21, 887–894.

To test the hypothesis that aerobic exercise would be better than usual care for improving sleep quality, and to examine potential moderators of intervention effects

Patients were stratified by lymphoma type and whether the patient was receiving chemotherapy and then randomized to receive the exercise intervention or usual care. The intervention consisted of supervised aerobic sessions three days per week for 12 weeks. Prescriptions for unsupervised exercise were provided for patients who were unable or unwilling to attend supervised sessions, and these sessions were not counted in adherence evaluation. Usual care patients were asked to not change baseline exercise habits and were offered supervised exercise after final study assessments.

• N = 117
• AGE: 32.5% were younger than 50 years, and the rest were older than 50 years. No other age information is provided.
• MALES: 59%, FEMALES: 41%
• KEY DISEASE CHARACTERISTICS: All had non-Hodgkin lymphoma, 54.7% were off treatment, and 45.3% were in active treatment.  
• OTHER KEY SAMPLE CHARACTERISTICS: At baseline, 71.8% were not meeting recommended activity guidelines. At baseline, overall, 47% were poor sleepers. The prevalence of poor sleepers was higher in the intervention group (57.9% compared to 36.7%, p = .021).

• SITE: Not stated/unknown  
• SETTING TYPE: Outpatient  
• LOCATION: Canada

• PHASE OF CARE: Multiple phases of care

• RCT

• Pittsburgh Sleep Quality Index

Aerobic exercise resulted in a small (d = -0.19) but not significant improvement in global sleep quality. In the intervention group, the exercise program improved global sleep quality in patients receiving chemotherapy (p = .013), but not for those who were off therapy. Exercise improved global sleep quality in those who were poor sleepers at baseline (p = .007), but not in those who were good sleepers at baseline.  Analysis further showed that positive effects of exercise were seen in patients with shorter time since diagnosis, patients who were obese, and patients who had less aggressive disease.

Aerobic exercise did not significantly improve sleep quality in this study of patients with lymphoma. Exercise appeared to have some benefits for sleep quality in individuals who were in active treatment.

• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Key sample group differences that could influence results
• Other limitations/explanation: Findings showed that those with poor sleep quality had a greater effect with aerobic exercise, and, at baseline, more poor sleepers were in the intervention group. This suggests that actual effects may be even lower for exercise than shown here. No statement is provided of how many patients did not participate in the supervised exercise sessions and how this was handled in overall analysis of group differences.

Findings show that overall, participation in aerobic exercise does not improve overall sleep quality in patients with lymphoma. Some benefit may exist for patients during chemotherapy treatment and for individuals who have baseline poor sleep quality. For these types of patients, nurses should consider suggesting aerobic exercise or providing exercise prescriptions.