Exercise effects on symptoms of depression and anxiety vary by patient, clinical, and intervention characteristics in cancer survivors: Results from pooled analyses of individual participant data of 26 RCTs
Publication date
2025-07-01
Authors
Kenkhuis, Marlou-Floor
Doorenbos, Meike
Mast, Isa H
Aaronson, Neil K
van Beurden, Marc
Bohus, Martin
Courneya, Kerry S
Daley, Amanda J
Galvão, Daniel A
Goedendorp, Martine M
Editors
Advisors
Supervisors
Document Type
Article
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Abstract
PURPOSE: This study aimed to investigate whether socio-demographic, clinical, and intervention-related variables moderate the effects of exercise on depression and anxiety symptoms in cancer survivors. METHODS: Data from 26 RCTs in the POLARIS database were analyzed using a one-step individual participant data (IPD) meta-analytic approach with linear mixed models to assess exercise effects on depression and anxiety symptoms (z-scores). Interaction terms were added to these models to explore moderators. Results are presented as betas (corresponding to Cohen's d effect size). RESULTS: Albeit statistically significant, exercise demonstrated negligible effects on symptoms of depression (β = - 0.11; 95% CI = - 0.16; - 0.06) and anxiety (β = - 0.07; 95% CI = - 0.12; - 0.02) compared to controls. The effects of exercise interventions on depressive symptoms were larger for patients who were not living with a partner (β = - 0.23; 95% CI = - 0.35; - 0.11), had a low/medium education level (β = - 0.14; 95% CI = - 0.21; - 0.07), and who had moderate-to-severe symptoms of depression at baseline (β = - 0.30; 95% CI = - 0.43; - 0.16). Patients with moderate-to-severe symptoms of depression at baseline combined with those not living with a partner or a low/medium education level yielded the largest effect size through exercise (β = - 0.61; 95% CI = - 0.89; - 0.33 and β = - 0.37; 95% CI = - 0.57; - 0.17, respectively). Effects on anxiety symptoms were larger for patients with moderate-to-severe symptoms of anxiety at baseline (β = - 0.17; 95% CI = - 0.32; - 0.01) compared to those with no-to-mild symptoms. Sex, age, cancer type, BMI, and intervention-related variables did not moderate the exercise effects. CONCLUSION: The findings of this study highlight the heterogeneous response to exercise interventions across various patient subgroups. Patients with moderate-to-severe anxiety or depression, those with a low/medium education, and those not living together with a partner may particularly benefit.
Keywords
Adult, Anxiety/therapy, Cancer Survivors/psychology, Depression/therapy, Exercise Therapy/methods, Exercise/psychology, Female, Humans, Male, Middle Aged, Neoplasms/psychology, Randomized Controlled Trials as Topic, Survivors/psychology, Journal Article, Meta-Analysis
Citation
Kenkhuis, M-F, Doorenbos, M, Mast, I H, Aaronson, N K, van Beurden, M, Bohus, M, Courneya, K S, Daley, A J, Galvão, D A, Goedendorp, M M, van Harten, W H, Hayes, S C, Hiensch, A E, Irwin, M L, Kersten, M J, Knoop, H, May, A M, McConnachie, A, van Mechelen, W, Mutrie, N, Newton, R U, Nollet, F, Oldenburg, H S, Schmidt, M E, Schmitz, K H, Schulz, K-H, Sonke, G S, Steindorf, K, Stuiver, M M, Taaffe, D R, Thorsen, L, Velthuis, M J, Wiskemann, J, Mesters, I, Ulrich, C M, van Vulpen, J K, Custers, J A E & Buffart, L M 2025, 'Exercise effects on symptoms of depression and anxiety vary by patient, clinical, and intervention characteristics in cancer survivors : Results from pooled analyses of individual participant data of 26 RCTs', Supportive Care in Cancer, vol. 33, no. 7, 647. https://doi.org/10.1007/s00520-025-09646-9