Tang, M. F., Liou, T. H., & Lin, C. C. (2010). Improving sleep quality for cancer patients: benefits of a home-based exercise intervention. Supportive Care in Cancer, 18, 1329–1339.

To determine the effect of a home-based walking exercise program on the sleep quality and quality of life (QOL) of cancer patients and to determine if enhanced sleep quality was associated with improvement in QOL over time.

Patients were recruited from oncology outpatient clinics in two university-based medical centers and were allocated to either usual care (n = 35) or a home-based walking exercise intervention for eight weeks (n = 36). The exercise intervention involved brisk walking for 30 minutes three times per week in the evening before supper, with a five-minute warm-up and five-minute cool-down. Questionnaires were delivered in interview format.

• The sample was comprised of 71 patients (24% male, 76% female).
• Mean age was 51.80 years (standard deviation = 12.13 years).
• Cancer sites included breast (n = 39), gastrointestinal (n = 11), nasopharyngeal (n = 7), lung (n = 4), and other (n = 10).
• Of the patients, 74% were married, 32% were working, and 30% were receiving cancer treatment.
• Mean time since diagnosis was 3.84 years.

• Multisite
• Outpatient
• Hospital in Taipei, Taiwan

Patients were undergoing the active treatment phase of care.

The study was a randomized, controlled trial.

• Pittsburgh Sleep Quality Index (PSQI), Taiwanese version
• Medical Outcomes Study Short Form-36 (MOS-SF), Taiwanese version
• Borg rating of perceived exertion (RPE) scale     
• Walking exercise log

Patients in the exercise group reported significant improvements in sleep quality (p < 0.01) at one and two months, and the mental health dimension of QOL; no change was reported in the control group. Physical components of QOL were also improved in the exercise group (p < 0.0001). Among patients who exercised, enhanced sleep quality also corresponded with reduced bodily pain and improvements over time in the mental health dimension of QOL.

A home-based walking exercise program can be easily incorporated into care for cancer patients who are suffering from sleep disturbances and may benefit sleep quality and aspects of QOL.

• The study had a small sample size, with less than 100 patients.
• Confounders of sleep (environment, light exposure, and social factors) were not controlled.
• Only subjective sleep data were collected.
• The objective measure of physical activity was not collected, and additional physical activity, apart from the walking intervention, was not measured.
• The short follow-up did not provide information about whether patients continued adherence to the walking program, and the benefits.  

A home-based exercise program appears promising for improving sleep quality and QOL for cancer patients that can easily be incorporated into care, but further study is warranted with more objective measures and measurement of potential confounding variables.