Henshall CL., Allin L., & Aveyard H. (2018). A systematic review and narrative synthesis to explore the effectiveness of exercise-based interventions in improving fatigue, dyspnea, and depression in lung cancer survivors. Cancer Nursing, 42, 295-306.

• STUDY PURPOSE: Examine evidence on the effects of exercise interventions on fatigue, dyspnea, and depression.
• TYPE OF STUDY: Meta analysis and systematic review

• DATABASES USED: Using PRISMA guidelines, the databases CINAHL, MEDLINE, Embase, and Cochrane were accessed
• YEARS INCLUDED: 2000 to 2017
• INCLUSION CRITERIA: Lung cancer survivors, depression, fatigue, and dyspnea. 
• EXCLUSION CRITERIA: Patients undergoing therapy, duplicate studies, and participants aged 18 years or older, not primary research; fatigue, depression, and fatigue not outcome measures

• TOTAL REFERENCES: N = 852
• EVALUATION METHOD AND COMMENTS ON LITERATURE: Three researchers reviewed looking for dyspnea, fatigue, and depression as primary measures, looking for pre- and post-testing.

• STUDIES INCLUDED: 10  
• TOTAL PATIENTS INCLUDED: 516
• SAMPLE RANGE ACROSS STUDIES: 10 to 162.
• KEY SAMPLE CHARACTERISTICS: 58% were post-treatment for lung cancer

• PHASE OF CARE: Late effects and survivorship     
• APPLICATIONS: Elder care, palliative care 

Dimeo et al. (2004): After three weeks of exercises and relaxation, no significant results were noted for dyspnea, but were significant for fatigue (p = 0.67 and 0.54)

Glattki et al. (2012): In a study with pulmonary rehab measured using modified research council (MRC), the dyspnea scale was significant (p = 0.007, 0.26, SD = 0.61) for improvement in dyspnea.

Peddle-McIntyre et al. (2012): The MRC dyspnea scale was measured after 10 weeks and was not significant (pre = 1.6, SD = 0.6; post = 1.4, SD = 0.8).

Riesenberg and Lubbe (2010): The study showed significant improvements in dyspnea after four weeks of QLQ testing (p < 0.001) and also for fatigue (mean difference = -13.7).

Spruit et al. (2006): Using the BORG scale, no significant difference was found (p = 0.2969)

Overall, six studies reported statistically significant reductions in fatigue, two reported significant improvement in dyspnea, and one had significant reduction in depression.

Although there were some studies that showed that exercise interventions could possibly be effective for relief of symptoms such as dyspnea, the results were mixed, and there are unclear variations between programs and high dropout rates, so no recommendations can be made based on this particular analysis.

• Limited number of studies included
• Mostly low quality/high risk of bias studies

Nurses should be aware that there is the possibility that exercise may benefit some patients, and there is little risk of harm, but nurses should be aware that it is unclear what patients or what programs would be of benefit; therefore, no recommendations can be made at this time.