Kozik, T.M., Hickman, M.C., Schmidt, S., Connolly, T.F., Paustenbach, K., Vosti, P., & Bhattacharyya, M. (2018). An exercise program to improve depression and sleep disorders in oncology patients: The SAD study. European Journal of Oncology Nursing, 37, 19–22.

To evaluate the effect of a structured supervised outpatient exercise program on insomnia and depression in patients with cancer.

Patients were referred by their oncologist office to the program. Participants were consented, administered two instruments before and after, and then participated in a 90-minute structured, supervised exercise program two days per week. The exercise consisted of a warm-up, cardiovascular circuit training, strength training, and cool down. The program was for 10 weeks.

• N = 75 
• MEAN AGE: 59 years (SD = 10)
• MALES: 23.1%  
• FEMALES: 59.7%
• CURRENT TREATMENT: Combination of radiation therapy and chemotherapy 
• KEY DISEASE CHARACTERISTICS: Currently on treatment for any type of cancer
• OTHER KEY SAMPLE CHARACTERISTICS: Older than age 18, excluded if within 8 weeks of surgery, within 6 months of treatment, cognitive issues excluded

• SITE: Multi-site   
• SETTING TYPE: Outpatient    
• LOCATION: 40-facility Catholic healthcare system in Stockton, California

PHASE OF CARE: Active anti-tumor treatment

• Descriptive observational study
• Patients consented and enrolled

• Insomnia measured with Athens Insomnia scale (AIS)
• Depression measured with Zung Self-Rating Depression Scale (ZSDS)
• Both tests administered on the first and last day of the 10-week program

75 patients were enrolled and 40 completed the 10-week program. The study demonstrated a significant improvement in insomnia. Baseline scores (mean = 9.5; SD = 3.7) compared to final scores (mean = 6.3; SD = 3.5) showed (t = 4.468; p = 0.01). The significance level of 0.05 is over the 90%. The depression scores were also seen as significantly different from baseline (mean = 37.4; SD = 9.7) and final scores (mean = 33; SD = 9.7) (t = 2.427; p = 0.01). The significance of 0.05 is about 80%. The study team also evaluated those who did not complete the program and there was no difference. Depression scores at baseline were higher for those who did not complete the program.

This study showed improvement in depression and insomnia in patients with cancer who participated in a structured, supervised exercise program.

• Small sample (< 100)
• Baseline sample/group differences of import        
• Risk of bias (no control group)
• Risk of bias (no blinding)
• Risk of bias (no random assignment)
• Findings not generalizable
• Subject withdrawals ≥ 10%

Nurses should assess patients for insomnia and depression and provide appropriate referrals to structured exercise programs. The cost is low and many cancer centers have existing exercise programs for fatigue which could be combined with the mental health benefits. Nurses could encourage and participate in development of these programs with their healthcare and community fitness centers where none currently exist.