Midtgaard, J., Stage, M., Møller, T., Andersen, C., Quist, M., Rörth, M., . . . Adamsen, L. (2011). Exercise may reduce depression but not anxiety in self-referred cancer patients undergoing chemotherapy. Post-hoc analysis of data from the 'Body & Cancer' trial. Acta Oncologica, 50, 660–669.

To investigate the effect of a six-week intervention program including exercise, relaxation, massage, and body awareness training on anxiety and depression in patients undergoing chemotherapy

Patients were randomly assigned to the intervention group or a wait list control group. Patients in the intervention participated in group supervised exercise sessions for six weeks. Sessions involved fitness training on stationary bicycles of 10.5 metabolic equivalents (MET) and heavy resistance training. Warm up and cool down exercises and stretching were also done. All patients received usual care. Control group patients were not restrained from increasing physical activity and participating in available supportive care activities. Data on depression and anxiety were obtained at baseline and were repeated at week 6.

• The study reported on a sample of 209 patients.
• Mean patient age was 47.5 years, with a range of 20–65 years.
• The sample was 75% female and 25% male.
• Patients had a variety of tumor types; the most frequent were breast and bowel cancers.
• Most patients (71%) were married or living together in a relationship.
• About 17% had a usual activity level of “sedentary” at baseline, and 34% had baseline activity levels of regular physical exercise of at least three hours per week or more.
• Baseline HADS anxiety scores ranged from 0 to 19, and baseline HADS depression scores ranged from 0 to 14; 23.4% were identified as moderate for anxiety, and 11.5% were suspicious or definite cases of depression.

• Multisite
• Outpatient setting
• Denmark

Patients were undergoing the active treatment phase of care.

The study design was post-hoc analysis of data from a randomized controlled trial.

Hospital Anxiety and Depression Scale (HADS)

The intervention group depression score declined a mean of 0.7 points, compared to a decline of 0.24 points on average in the control group (p = 0.015). Patients defined by HADS as borderline or definite cases of depression (n = 24, HADS score ≥ 8) had a mean reduction of –2.53 points, while controls declined an average of 0.25 points (p = 0.021). There were no significant changes or differences between groups in anxiety scores either in the whole sample or in the subgroup defined as baseline borderline or moderate anxiety. Adherence to the exercise sessions was 73.1%.

Exercise may be helpful to reduce depression in patients receiving cancer chemotherapy. No effect on anxiety was observed.

• The study did not have an appropriate control group.
• There was no attentional control.
• Intervention participants worked in groups and had the opportunity for group discussion, etc., so it is unclear what aspects of this multicomponent program contributed to effects seen.
• There is no information about the activity level of control patients.
• No information is provided regarding the use of any medications for anxiety or depression.
• In the overall intervention group, mean score changes were below those identified as clinically relevant for HADs.
• Only 24 patients had baseline scores indicating probable depression, so analysis showing an effect for the intervention was only in a very small group.

Findings suggest that the intervention tested here, including exercise, group support, massage, and body awareness interventions, may be helpful to combat depression, but may not be helpful for anxiety. However, clinically relevant effects were only seen for depression in those patients who had clinically relevant levels of depression scores at baseline. This suggests that such a program may not be useful to prevent depression, but may be helpful in the situation of actual depression. Screening for depression may be useful to identify those individual patients who are most likely to benefit from this type of approach. Further research is needed to test whether combinations of pharmacotherapy, exercise, and psychotherapy are better than separate approaches to manage anxiety and depression.