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The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

  • Justin C. Brown ,

    brownjus@mail.med.upenn.edu

    Affiliations Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America, Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America

  • Tania B. Huedo-Medina,

    Affiliation Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America

  • Linda S. Pescatello,

    Affiliation Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America

  • Stacey M. Ryan,

    Affiliation Department of Physical Therapy, M.D. Anderson Cancer Center, Houston, Texas, United States of America

  • Shannon M. Pescatello,

    Affiliation Department of Psychology, Western New England College, Springfield, Massachusetts, United States of America

  • Emily Moker,

    Affiliation Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America

  • Jessica M. LaCroix,

    Affiliation Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America

  • Rebecca A. Ferrer,

    Affiliation Biobehavioral and Psychological Sciences, National Cancer Institute, Rockville, Maryland, United States of America

  • Blair T. Johnson

    Affiliation Center for Health, Intervention and Prevention, University of Connecticut, Storrs, Connecticut, United States of America

The Efficacy of Exercise in Reducing Depressive Symptoms among Cancer Survivors: A Meta-Analysis

  • Justin C. Brown, 
  • Tania B. Huedo-Medina, 
  • Linda S. Pescatello, 
  • Stacey M. Ryan, 
  • Shannon M. Pescatello, 
  • Emily Moker, 
  • Jessica M. LaCroix, 
  • Rebecca A. Ferrer, 
  • Blair T. Johnson
PLOS
x

Abstract

Introduction

The purpose of this meta-analysis was to examine the efficacy of exercise to reduce depressive symptoms among cancer survivors. In addition, we examined the extent to which exercise dose and clinical characteristics of cancer survivors influence the relationship between exercise and reductions in depressive symptoms.

Methods

We conducted a systematic search identifying randomized controlled trials of exercise interventions among adult cancer survivors, examining depressive symptoms as an outcome. We calculated effect sizes for each study and performed weighted multiple regression moderator analysis.

Results

We identified 40 exercise interventions including 2,929 cancer survivors. Diverse groups of cancer survivors were examined in seven exercise interventions; breast cancer survivors were examined in 26; prostate cancer, leukemia, and lymphoma were examined in two; and colorectal cancer in one. Cancer survivors who completed an exercise intervention reduced depression more than controls, d+ = −0.13 (95% CI: −0.26, −0.01). Increases in weekly volume of aerobic exercise reduced depressive symptoms in dose-response fashion (β = −0.24, p = 0.03), a pattern evident only in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = −0.26, p = 0.01) and when cancer survivors were between 47–62 yr (β = 0.27, p = 0.01).

Conclusion

Exercise training provides a small overall reduction in depressive symptoms among cancer survivors but one that increased in dose-response fashion with weekly volume of aerobic exercise in high quality trials. Depressive symptoms were reduced to the greatest degree among breast cancer survivors, among cancer survivors aged between 47–62 yr, or when exercise sessions were supervised.

Introduction

There are over 12 million cancer survivors in the US [1]. Nearly 100% of all cancer survivors experience psychological and physical symptoms and side effects related to cancer or cancer treatment [2]. Cancer survivors may experience fear of death, disease relapse, and body image changes [3] that can contribute to the depressive symptoms experienced by up to 60% of cancer survivors [4] compared to 7% of the general US population [5]. Depression is associated with chemotherapy noncompliance [6], [7] and reduced 5 yr survival rates [8], [9]. Therefore, appropriate management of depressive symptoms among cancer survivors is of clinical importance. Exercise is an effective non-pharmacological therapy to reduce depressive symptoms among those living with depression [10], with a moderate standardized mean reduction when compared to those who do not exercise. Exercise provides similar or larger reductions in depressive symptoms in an array of clinical populations including those living with chronic obstructive pulmonary disease [11], human immunodeficiency virus [12], and coronary artery disease [13].

Accumulating evidence suggests exercise training after diagnosis of cancer may improve functional capacity, muscular strength, quality of life, and reduce cancer-related fatigue [14][16], but the efficacy of exercise to reduce depressive symptoms is inconsistent [2]. Some studies have demonstrated moderate to large reductions in depressive symptoms as the result of exercise [17], [18], whereas others observe no such reductions [19], [20]. Although a previous meta-analysis quantified the heterogeneity of exercise interventions to reduce depressive symptoms among cancer survivors and reported a moderate to large amount of heterogeneity (I2 = 55%–76%), it did not examine moderator variables that could explain the variability in results [16].

Therefore, this meta-analysis examined the efficacy of exercise to reduce depressive symptoms among cancer survivors, confirming a previous meta-analysis [16], and attempted to identify exercise prescription and clinical factors associated with the greatest reductions in depressive symptoms. Identification of characteristics moderating the magnitude of reduction in depressive symptoms may aid clinicians in prescribing tailored exercise interventions to manage depressive symptoms among cancer survivors.

Methods

Inclusion Criteria

Studies were identified on a priori criteria that included: (1) a randomized controlled design comparing an exercise intervention with a control group (i.e., no exercise program prescribed and instructions to maintain current activity levels or no exercise related information); (2) report of depression outcomes; and (3) adults diagnosed with any type of cancer, regardless of stage of diagnosis or type or stage of treatment. Exercise interventions occurring in any setting, with or without supervision, were eligible.

Systematic Search

The databases PubMed, PsycINFO, CINAHL Plus, SPORTSdiscus, OregonPDF in Health and Performance, and ProQuest Theses and Dissertations were searched through Nov 18, 2010. We searched all databases using a Boolean search strategy [i.e., (cancer OR neoplas* OR tumor OR chemo* OR radiat* OR malign* OR carciniom*) AND (depress* OR anxiety OR anxious OR worried OR scared OR nervous OR cognitive OR biofeedback OR relaxation OR social support OR mind-body) AND (exercise OR physical activity OR aerobic OR cardiovascular OR resistance OR strength OR muscular OR flexibility OR walking OR program OR interval OR sport OR fitness OR performance OR movement OR stretching OR tai chi OR yoga OR dance OR body OR composition)]. Journals focusing on cancer survivorship (Journal of Clinical Oncology, Breast Cancer Research and Treatment, Journal of Cancer Survivorship, Oncology Nursing Forum), and the reference lists of included studies were also searched for additional reports.

Coding and Reliability

We estimated the intensity of exercise using the compendium of metabolic equivalent units (METs), where 1 MET represents sitting quietly (3.5 ml O2·kg-1·min-1) and <3 METs, 3 to <6 METs, and ≥6 METs represent low, moderate, and vigorous intensity exercise, respectively [21]. We calculated the weekly volume of aerobic exercise as the product of minutes of daily exercise and frequency of exercise sessions per week (min·wk−1). We used the Physiotherapy Evidence Database scale (PEDro) to gauge methodological quality of the trials in terms of internal validity and statistical reporting [22]. Four independent, trained raters extracted information related to the study with high inter-rater reliability, mean Cohen's κ = 0.90, for categorical variables, and mean intra-class correlation r = 0.94 for continuous variables.

Study Outcome and Effect Size Calculation

The studies assessed depressive symptoms among cancer survivors as a continuous outcome variable assessed as a component of a comprehensive psychological questionnaire with a depression subscale [23] or a questionnaire solely assessing depression levels [24][27]. To assess baseline levels of depressive symptoms on a common metric across depression questionnaires, we used a 0–100 scale, where ‘0’ implies absolutely no depressive symptoms, and ‘100’ implies the highest level of symptoms possible on a given scale. We used the standardized mean difference effect size (d) to quantify the difference in depression from baseline to follow-up between the exercise and control groups, correcting for small sample size bias [28], [29]. The effect size d denotes the difference between the mean depression values of the control and exercise groups, divided by the pooled standard deviation [30]; the sign of d values was set to be negative when the exercise group reduced depression more than the control group. The standardized d value can be interpreted as −0.20, −0.50, and −0.80, represent small, medium, and large reductions in depressive symptoms, respectively [31]. When trials included more than one exercise group (e.g., aerobic exercise and resistance exercise), we calculated multiple effect sizes. Sensitivity analysis examined the influence of a single study on the overall mean effect size of all trials by iteratively removing a single study and then re-estimating the overall mean effect with 95% confidence intervals [32]. We present overall mean effect sizes (d+) as both, fixed- and random-effects estimates.

We used Stata 11.1 (StataCorp, College Station, TX) with macros developed for meta-analysis [33] to perform all statistical analyses. Begg's test [34] (z = −1.67, p = 0.10), Egger's test [35] (t = −0.12, p = 0.90), and the trim-and-fill method [36] identified no asymmetries in the effect size distribution suggestive of publication bias. Potential heterogeneity or between-study variance was calculated as Q and I2 (and 95% CI) [37], [38]. The Q statistic follows an approximate χ2 distribution with k-1 degrees of freedom, where k is the number of studies included in the meta-analysis [38]. The Q statistic can be standardized to I2 with values ranging from 0% (homogeneity) to 100% (heterogeneity). To explain variance of depressive symptom reduction—the relation between study-level characteristics and the magnitude of the depression reduction effect size (d+)—a modified, weighted least squares regression was used with weights equal to the inverse variance of each exercise intervention effect size (viz., fixed-effects meta-regression). The underlying assumptions of meta-regression are similar to that of ordinary least-squares regression, including independence of errors, homoscedasticity of variance, and normally distributed variables [28], [33], [39], [40]. Statistically significant bivariate regression analyses were integrated into a multiple-moderator fixed effects regression to determine which variables could explain unique between study variance. To reduce multicollinearity in multiple meta-regression models, all continuous variables were zero centered based on their means; categorical variables were contrast coded (−1/+1). Beta-values (β) appear in standardized form in order to quantify the amount of variability in ds associated with each moderator of interest. All meta-regression model estimated effect sizes are depicted using the moving constant technique, entering multiple predictor variables simultaneously [41]. Two-sided statistical significance was p<0.05.

Results

Methodological Characteristics

Qualifying for inclusion in the meta-analysis were 37 relevant randomized controlled exercise interventions [17][20], [42][74] (N = 2,929) with a total of 40 comparisons (k = 40) of exercise versus control conditions (Figure 1). Thirty-four studies provided one effect size, and three provided two effect sizes [20], [44], [52]. Exercise interventions were published in 2006±4.2 (range: 1994–2010) with most studies (70%) conducted in North America. The mean PEDro score of the exercise interventions was 7.0±1.0 suggesting relatively high methodological quality [22]. A minority of studies (20%) reported that they implemented at least one theory of behavior change (Table 1). Studies assessed depression using the Center for Epidemiologic Studies-Depression questionnaire (40%) [25], Profile of Mood States (23%) [23], the Beck Depression Inventory (18%) [24], Hospital Anxiety and Depression Scale (12%) [26], or Symptom Assessment Scale (7%) [27].

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Figure 1. Flow diagram of exercise intervention identification and selection.

https://doi.org/10.1371/journal.pone.0030955.g001

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Table 1. Descriptive characteristics of included studies, subjects and exercise interventions by type of cancer (means ± SD, n(%), k(%) where noted).

https://doi.org/10.1371/journal.pone.0030955.t001

Cancer Survivor Characteristics

Cancer survivors participating in the exercise trials averaged 51.3±6.5 yr (range: 39–70). The majority of cancer survivors participating in the exercise interventions were white, non-Hispanic (n = 2,255; 77%), and women (n = 2,548; 87%) with a time since cancer diagnosis of 25.3±19.6 months (range: 2.8–73.0). Exercise interventions were more common during curative therapy with 29 of the 40 exercise interventions (73%) occurring during treatment (i.e., chemotherapy or radiation treatment). Trials most often examined breast cancer survivors (k = 24) [17], [20], [48][69]. Two trials each focused on prostate cancer [19], [70], leukemia [72], [73], and lymphoma [18], [74] survivors, and only one trial examined colorectal cancer survivors [71]. The remaining 6 trials examined survivors with diverse types of cancer diagnoses [42][47]. At baseline, the standardized metric of depressive symptoms was 34.2±26.9 and ranged from 3.49 to 81.5.

Exercise Intervention Characteristics

The mean length of the exercise interventions was 13.2±11.7 wk with an average of 3.0±2.5 sessions per week lasting 49.1±27.1 min·session−1. Average weekly volume of all exercise was 129.4±64.9 min·wk−1. Exercise modalities included walking (k = 16; 40%), stationary cycling (k = 5; 13%), weight machines (k = 2; 5%), resistance bands (k = 3; 8%), and yoga (k = 8; 20%). In addition, flexibility exercises were prescribed in 50% of the exercise interventions. The absolute intensity of exercise was 3.9±1.3 METs indicating they were of low (i.e., <3 METs) to moderate (i.e., ≥3 to <6 METs) intensity. A majority of exercise interventions (60%) was supervised. Table S1 summarizes methodological characteristics of the included trials.

The Influence of Exercise on Depressive Symptoms

Exercise provided a small overall reduction in depressive symptoms compared to standard care among all types of cancer [d+ = −0.13 (95% CI: −0.26, −0.01)]. Subgroup analysis by cancer type revealed significant reductions in depressive symptoms among breast cancer survivors [d+ = −0.17 (95% CI: −0.32, −0.02)], but no significant difference in depressive symptoms among prostate, leukemia, lymphoma, and colorectal cancer survivors (Table 2). Figure 2 depicts the fixed-effects mean reduction in depressive symptoms, stratified by type of cancer. Collectively, the 40 effect sizes lacked homogeneity [I2 = 55% (95% CI: 35–68), p<0.001], as did the analysis when restricted to breast cancer survivors [I2 = 59% (95% CI: 37–73), p<0.001; Table 2].

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Table 2. Weighted mean effect of exercise modulating depressive symptoms by type of cancer.

https://doi.org/10.1371/journal.pone.0030955.t002

Moderators of the Influence of Exercise on Depressive Symptoms

Three moderators explained unique variance relating to the efficacy of exercise to reduce depressive symptoms when entered in a multiple meta-analysis regression model. Weekly volume of aerobic exercise reduced depression in dose-response fashion (β = −0.24, p = 0.03), a pattern that was only evident in higher quality trials. Exercise reduced depressive symptoms most when exercise sessions were supervised (β = −0.26, p = 0.01) and cancer survivors were between 47–62 yr [(β = 0.27, p = 0.01); Table 3]. These three moderators together explained 35% of the variance in depression reduction resulting from exercise; yet, variability beyond that expected by sampling error alone remained unexplained.

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Table 3. Characteristics related to depressive symptoms change for all cancer survivors.

https://doi.org/10.1371/journal.pone.0030955.t003

In our bivariate analyses (Table S2), three other features related to the magnitude of exercise-induced reduction of depressive symptoms: explicit use of theory in intervention development, the percentage of non-Hispanic Whites in the sample, and time since cancer diagnosis. Interventions were more successful in reducing depressive symptoms when they used psychological theory, sampled greater percentages of non-Hispanic Whites, and were more proximal to the date of cancer diagnosis. Still, none of these moderators explained significant variability in combined moderator analysis, suggesting that their influence is explained by the variables in the combined moderator model (viz., supervision, volume of exercise, methodological quality, and age; see Table 3). Standardized baseline depressive symptom scores were not associated with depressive symptom improvements resulting from exercise (p = 0.71).

Discussion

This review found that exercise provided a small overall reduction in depressive symptoms among cancer survivors, d+ = −0.13 (95% CI: −0.26, −0.01), but the amount of change varied widely across studies. Our analysis revealed exercise reduced depressive symptoms among breast cancer survivors, d+ = −0.17 (95% CI: −0.32, −0.02), a pattern that confirms previous reports in the literature [2], [75], [76]. We observed non-significant exercise-related reductions in depressive symptoms among prostate, colorectal, leukemia, and lymphoma survivors, but the lack of statistical significance among these types may be due in part to the small numbers of included studies and subsequent lowered statistical power to detect effects (Table 2). Of note, in bivariate analyses a model related to type of cancer revealed no difference (results not shown), suggesting that the depression-reducing effects of exercise may generalize to other types of cancer.

Studies included in our analysis implemented an array of depression measures to indicate whether one may suffer from depression. The questionnaires used to assess depression varied with respect to content of questions, scoring, and cut-points used for clinical judgment, making the comparability of depression at baseline between trials difficult, and making the clinical generalizability of the current results more difficult. Therefore, we chose to focus our discussion on the standardized mean difference effect size, and the statistical interpretation of the association between exercise and depressive symptoms, rather than clinical significance.

We attempted to elucidate the exercise dose and clinical characteristics moderating the overall reduction of depressive symptoms among cancer survivors. To date, one meta-analysis has examined moderator variables associated with improvements in depressive symptoms among cancer survivors [76]. This previous meta-analysis examined individual moderators of depressive symptoms [76], whereas our meta-analysis examined multiple moderators simultaneously. Aerobic exercise reduced depressive symptoms in dose-response fashion such that as weekly minutes of aerobic exercise increased, so did reductions in depressive symptoms, a finding observed only in higher quality trials (Table 3). In higher quality trials, the amount of depressive symptom reduction reached large magnitude for those with 3 hours per week of aerobic exercise.

Since the overall mean reduction in depressive symptoms was small in magnitude, it is plausible that only the methodologically rigorous studies were able to detect such an effect in depressive symptom reduction. These trends are consistent with evidence suggesting exercise reduces depressive symptoms in dose-response fashion among populations with depression [77] and among cancer survivors [76]. Consistent with our findings, the American College of Sports Medicine consensus statement on exercise and cancer survivorship suggests all cancer survivors should strive to achieve a large volume of aerobic exercise of ≥150 min·wk−1 to maximize the health benefits [2]. Moreover, accumulating large volumes of aerobic exercise should be progressive, increasing duration and frequency of exercise over weeks or months of exercise training as the course of the disease process allow and functional capacity improves [2], [78], [79].

Our results showed that cancer survivors engaging in supervised exercise experienced less depressive symptoms than those who engaged in unsupervised exercise. Similar patterns have appeared in prior meta-analyses addressing the effects of exercise on quality of life [14], fatigue reduction [80], and depressive symptoms [76] among cancer survivors. Moreover, Spence et al., and Whitehead et al., found breast and colon cancer survivors prefer supervised exercise training over unsupervised exercise [81], [82].

We found exercise reduced depressive symptoms more among cancer survivors between 47–62 yr than those younger than 47 yr and older than 62 yr. Because previous studies reported higher levels of psychosocial stress, including depressive symptoms, among younger cancer survivors [83], [84], we hypothesized it would be younger cancer survivors who would experience the greatest reductions in depressive symptoms attributable to exercise. It is unclear why cancer survivors younger than 47 yr did not experience significant exercise-induced reductions in depressive symptoms, on average (Table 3). One possibility is that the average weekly aerobic exercise volume performed (∼130 min·wk−1) was not a large enough dose of exercise to reduce depressive symptoms among cancer survivors younger than 47 yr. The fact that no significant reduction in depressive symptoms among cancer survivors older than 62 yr appeared may be due in part to a floor effect [10]. That is, older cancer survivors report less depressive symptoms at baseline [85], and may show smaller exercise-induced improvements in depressive symptoms compared to those who are middle-aged.

The release of monoamine neurotransmitters (i.e., serotonin, dopamine, and norepinephrine) and endorphins during aerobic exercise has provided preliminary mechanistic support for the use of aerobic exercise to reduce and manage depressive symptoms [86], [87] and avoids common side-effects associated with anti-depressant medications [88], [89]. Interestingly, running distance is associated with improved neurological function; increasing neurotropic factors in the brain and improving mood [90]. Nonetheless, these hypotheses are limited in explaining the complex physiological and psychosocial etiologies of depressive symptoms [87]. Studies in the current meta-analysis rarely included physiological measures, impeding clear tests of such hypotheses. Continued research is necessary to examine mechanisms underpinning the reduction of depressive symptoms in response to exercise.

Limitations

The major limitation of this meta-analysis is that depressive symptoms were a secondary outcome in almost all exercise interventions. As such, cancer survivors in the exercise trials that we meta-analyzed were not recruited based on depression levels; moreover, they may have exhibited few depressive symptoms at baseline. Nonetheless, our analysis suggests exercise is efficacious to improve depressive symptoms among cancer survivors. Our analysis may underestimate the efficacy of exercise to reduce depressive symptoms among cancer survivors with higher levels of depression or those with a diagnosis of depression. Furthermore, our analysis and interpretation of our findings have focused on the statistical associations, not the clinical implications of exercise and the experience of depressive symptoms.

Despite our intention to include all types of cancer of any race, 26 of the 40 effect sizes (65%) targeted white, non-Hispanic, breast cancer survivors exclusively, which has been a limitation of previous meta-analyses examining a variety of health-related outcomes among cancer survivors [14][16]. Additionally, the number of exercise interventions among breast cancer survivors limits the generalizability of our findings to other types of cancer, even though there was no significant difference in reduction of depressive symptoms attributable to type of cancer. These limitations should provide an impetus for researchers to continue investigating the effects of exercise among other ethnic groups and underrepresented cancer types.

Despite an overall rating of high methodological quality (7.0±1.0 of 11), we noted some consistent methodological weaknesses throughout the literature, such as inclusion of small sample sizes, inconsistent criteria with respect to study entry eligibility and baseline depressive symptoms levels, poor reporting of adverse events, and failure to follow intent-to-treat analytic strategies. Indeed, the dose-response pattern of exercise to the reduction of depression symptoms materialized most clearly only in the studies with the highest methodological quality.

Conclusion

In closing, we confirmed that exercise provides a small overall reduction in depressive symptoms among cancer survivors. Depressive symptom reduction occurred in dose-response fashion with weekly volume of aerobic exercise, with high-quality trials documenting large changes for cancer survivors accruing larger weekly volumes of aerobic exercise. Larger reductions in depressive symptoms also occurred with supervised exercise, and among cancer survivors 47–62 yr. Cancer survivors should strive to avoid physical inactivity; discuss the safety and feasibility of exercising with their medical care provider to optimize depressive symptoms management; and eventually aim to achieve larger weekly volumes of aerobic exercise if possible, complimented with resistance training twice-weekly, and flexibility activity on days of non-exercise [2]. Furthermore, clinicians now have evidence to advocate the potential benefit of aerobic exercise as a modality to manage depressive symptoms among cancer survivors.

Supporting Information

Table S1.

Clinical, exercise, and methodological characteristics of included studies.

https://doi.org/10.1371/journal.pone.0030955.s001

(DOCX)

Table S2.

Bivariate moderator intervention characteristics related to depressive symptoms reduction for all cancer survivors.

https://doi.org/10.1371/journal.pone.0030955.s002

(DOCX)

Acknowledgments

We thank the anonymous reviewers and Robert D. Siegel, M.D., Gray Cancer Center of Hartford Hospital, for their valuable feedback on prior versions of this article.

Author Contributions

Conceived and designed the experiments: JCB TBH-M BTJ RAF LSP. Performed the experiments: JCB TBH-M BTJ SMR SMP EM JML RAF LSP. Analyzed the data: JCB TBH-M BTJ. Contributed reagents/materials/analysis tools: JCB TBH-M BTJ SMR SMP EM JML RAF LSP. Wrote the paper: JCB TBH-M BTJ SMR SMP EM JML RAF LSP.

References

  1. 1. Jemal A, Bray F, Center MM, Ferlay J, Ward E, et al. (2011) Global cancer statistics. CA Cancer J Clin 61(2): 69–90.A. JemalF. BrayMM CenterJ. FerlayE. Ward2011Global cancer statistics.CA Cancer J Clin6126990
  2. 2. Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, et al. (2010) American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7): 1409–1426.KH SchmitzKS CourneyaC. MatthewsW. Demark-WahnefriedDA Galvao2010American college of sports medicine roundtable on exercise guidelines for cancer survivors.Med Sci Sports Exerc42714091426
  3. 3. Reich M, Lesur A, Perdrizet-Chevallier C (2008) Depression, quality of life and breast cancer: A review of the literature. Breast Cancer Res Treat 110(1): 9–17.M. ReichA. LesurC. Perdrizet-Chevallier2008Depression, quality of life and breast cancer: A review of the literature.Breast Cancer Res Treat1101917
  4. 4. Newport DJ, Nemeroff CB (1998) Assessment and treatment of depression in the cancer patient. J Psychosom Res 45(3): 215–237.DJ NewportCB Nemeroff1998Assessment and treatment of depression in the cancer patient.J Psychosom Res453215237
  5. 5. Kessler RC, Chiu WT, Demler O, Merikangas KR, Walters EE (2005) Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 62(6): 617–627.RC KesslerWT ChiuO. DemlerKR MerikangasEE Walters2005Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the national comorbidity survey replication.Arch Gen Psychiatry626617627
  6. 6. Lebovits AH, Strain JJ, Schleifer SJ, Tanaka JS, Bhardwaj S, et al. (1990) Patient noncompliance with self-administered chemotherapy. Cancer 65(1): 17–22.AH LebovitsJJ StrainSJ SchleiferJS TanakaS. Bhardwaj1990Patient noncompliance with self-administered chemotherapy.Cancer6511722
  7. 7. Gilbar O, De-Nour AK (1989) Adjustment to illness and dropout of chemotherapy. J Psychosom Res 33(1): 1–5.O. GilbarAK De-Nour1989Adjustment to illness and dropout of chemotherapy.J Psychosom Res33115
  8. 8. Watson M, Haviland JS, Greer S, Davidson J, Bliss JM (1999) Influence of psychological response on survival in breast cancer: A population-based cohort study. Lancet 354(9187): 1331–1336.M. WatsonJS HavilandS. GreerJ. DavidsonJM Bliss1999Influence of psychological response on survival in breast cancer: A population-based cohort study.Lancet354918713311336
  9. 9. Pasquini M, Biondi M (2007) Depression in cancer patients: A critical review. Clin Pract Epidemiol Ment Health 3: 2.M. PasquiniM. Biondi2007Depression in cancer patients: A critical review.Clin Pract Epidemiol Ment Health32
  10. 10. Conn VS (2010) Depressive symptom outcomes of physical activity interventions: Meta-analysis findings. Ann Behav Med 39(2): 128–138.VS Conn2010Depressive symptom outcomes of physical activity interventions: Meta-analysis findings.Ann Behav Med392128138
  11. 11. Coventry PA, Hind D (2007) Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis. J Psychosom Res 63(5): 551–565.PA CoventryD. Hind2007Comprehensive pulmonary rehabilitation for anxiety and depression in adults with chronic obstructive pulmonary disease: Systematic review and meta-analysis.J Psychosom Res635551565
  12. 12. O'Brien K, Nixon S, Tynan AM, Glazier R (2010) Aerobic exercise interventions for adults living with HIV/AIDS. Cochrane Database Syst Rev (8)(8): CD001796.K. O'BrienS. NixonAM TynanR. Glazier2010Aerobic exercise interventions for adults living with HIV/AIDS.Cochrane Database Syst Rev(8)8CD001796
  13. 13. Clark AM, Haykowsky M, Kryworuchko J, MacClure T, Scott J, et al. (2010) A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease. Eur J Cardiovasc Prev Rehabil 17(3): 261–270.AM ClarkM. HaykowskyJ. KryworuchkoT. MacClureJ. Scott2010A meta-analysis of randomized control trials of home-based secondary prevention programs for coronary artery disease.Eur J Cardiovasc Prev Rehabil173261270
  14. 14. Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS (2011) Exercise interventions for cancer survivors: A meta-analysis of quality of life outcomes. Ann Behav Med 41(1): 32–47.RA FerrerTB Huedo-MedinaBT JohnsonS. RyanLS Pescatello2011Exercise interventions for cancer survivors: A meta-analysis of quality of life outcomes.Ann Behav Med4113247
  15. 15. Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, et al. (2011) Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: A meta-analysis. Cancer Epidemiol Biomarkers Prev 20(1): 123–133.JC BrownTB Huedo-MedinaLS PescatelloSM PescatelloRA Ferrer2011Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: A meta-analysis.Cancer Epidemiol Biomarkers Prev201123133
  16. 16. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. J Cancer Surviv 4(2): 87–100.RM SpeckKS CourneyaLC MasseS. DuvalKH Schmitz2010An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis.J Cancer Surviv4287100
  17. 17. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, et al. (2007) Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25(13): 1713–1721.AJ DaleyH. CrankJM SaxtonN. MutrieR. Coleman2007Randomized trial of exercise therapy in women treated for breast cancer.J Clin Oncol251317131721
  18. 18. Courneya KS, Sellar CM, Stevinson C, McNeely ML, Peddle CJ, et al. (2009) Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. J Clin Oncol 27(27): 4605–4612.KS CourneyaCM SellarC. StevinsonML McNeelyCJ Peddle2009Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients.J Clin Oncol272746054612
  19. 19. Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, et al. (2010) Physical activity for men receiving androgen deprivation therapy for prostate cancer: Benefits from a 16-week intervention. Support Care Cancer 18(5): 591–599.SN Culos-ReedJW RobinsonH. LauL. StephensonM. Keats2010Physical activity for men receiving androgen deprivation therapy for prostate cancer: Benefits from a 16-week intervention.Support Care Cancer185591599
  20. 20. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, et al. (2007) Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. J Clin Oncol 25(28): 4396–4404.KS CourneyaRJ SegalJR MackeyK. GelmonRD Reid2007Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial.J Clin Oncol252843964404
  21. 21. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, et al. (2000) Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl): S498–504.BE AinsworthWL HaskellMC WhittML IrwinAM Swartz2000Compendium of physical activities: An update of activity codes and MET intensities.Med Sci Sports Exerc329 SupplS498504
  22. 22. Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M (2003) Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther 83(8): 713–721.CG MaherC. SherringtonRD HerbertAM MoseleyM. Elkins2003Reliability of the PEDro scale for rating quality of randomized controlled trials.Phys Ther838713721
  23. 23. Reddon JR, Marceau R, Holden RR (1985) A confirmatory evaluation of the profile of mood states: Convergent and discriminant item validity. Journal of Psychopathology and Behavioral Assessment 7(3): 243–259.JR ReddonR. MarceauRR Holden1985A confirmatory evaluation of the profile of mood states: Convergent and discriminant item validity.Journal of Psychopathology and Behavioral Assessment73243259
  24. 24. Salkind MR (1969) Beck depression inventory in general practice. J R Coll Gen Pract 18(88): 267–271.MR Salkind1969Beck depression inventory in general practice.J R Coll Gen Pract1888267271
  25. 25. Kohout FJ, Berkman LF, Evans DA, Cornoni-Huntley J (1993) Two shorter forms of the CES-D (center for epidemiological studies depression) depression symptoms index. J Aging Health 5(2): 179–193.FJ KohoutLF BerkmanDA EvansJ. Cornoni-Huntley1993Two shorter forms of the CES-D (center for epidemiological studies depression) depression symptoms index.J Aging Health52179193
  26. 26. Zigmond AS, Snaith RP (1983) The hospital anxiety and depression scale. Acta Psychiatr Scand 67(6): 361–370.AS ZigmondRP Snaith1983The hospital anxiety and depression scale.Acta Psychiatr Scand676361370
  27. 27. Sutherland HJ, Walker P, Till JE (1988) The development of a method for determining oncology patients' emotional distress using linear analogue scales. Cancer Nurs 11(5): 303–308.HJ SutherlandP. WalkerJE Till1988The development of a method for determining oncology patients' emotional distress using linear analogue scales.Cancer Nurs115303308
  28. 28. Hedges LV, Olkin I (1985) Statistical methods for meta-analysis. Orlando, FL: Academic Press Inc. 369 p.LV HedgesI. Olkin1985Statistical methods for meta-analysisOrlando, FLAcademic Press Inc369
  29. 29. Becker BJ (1988) Synthesizing standardized mean-change measures. Br J Math Stat Psychol 41(2): 257–278.BJ Becker1988Synthesizing standardized mean-change measures.Br J Math Stat Psychol412257278
  30. 30. Morris SB, DeShon RP (2002) Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs. Psychol Methods 7(1): 105–125.SB MorrisRP DeShon2002Combining effect size estimates in meta-analysis with repeated measures and independent-groups designs.Psychol Methods71105125
  31. 31. Cohen J (1998) Statistical power analysis for the behavioral sciences. New York, NY: Erlbaum. J. Cohen1998Statistical power analysis for the behavioral sciencesNew York, NYErlbaum
  32. 32. Becker BJ (2000) Handbook of applied multivariate statistics and mathematical modeling. San Diego, CA: Academic Press. pp. 499–525.BJ Becker2000Handbook of applied multivariate statistics and mathematical modelingSan Diego, CAAcademic Press499525
  33. 33. Lipsey MW, Wilson DB (2001) Practical meta-analysis. Thousand Oaks, CA: SAGE. 247 p.MW LipseyDB Wilson2001Practical meta-analysisThousand Oaks, CASAGE247
  34. 34. Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50(4): 1088–1101.CB BeggM. Mazumdar1994Operating characteristics of a rank correlation test for publication bias.Biometrics50410881101
  35. 35. Egger M, Smith GD, Schneider M, Minder C (1997) Bias in meta-analysis detected by a simple, graphical test. Br Med J 315(7109): 629–634.M. EggerGD SmithM. SchneiderC. Minder1997Bias in meta-analysis detected by a simple, graphical test.Br Med J3157109629634
  36. 36. Duval S, Tweedie R (2000) A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis. Journal of the American Statistical Association 95(449): 89–98.S. DuvalR. Tweedie2000A nonparametric “trim and fill” method of accounting for publication bias in meta-analysis.Journal of the American Statistical Association954498998
  37. 37. Higgins JP, Thompson SG (2002) Quantifying heterogeneity in a meta-analysis. Stat Med 21(11): 1539–1558.JP HigginsSG Thompson2002Quantifying heterogeneity in a meta-analysis.Stat Med211115391558
  38. 38. Huedo-Medina TB, Sanchez-Meca J, Marin-Martinez F, Botella J (2006) Assessing heterogeneity in meta-analysis: Q statistic or I2 index? Psychol Methods 11(2): 193–206.TB Huedo-MedinaJ. Sanchez-MecaF. Marin-MartinezJ. Botella2006Assessing heterogeneity in meta-analysis: Q statistic or I2 index?Psychol Methods112193206
  39. 39. Harbord RM, Higgins JPT (2008) Meta-regression in stata. The Stata Journal (8): 493–519.RM HarbordJPT Higgins2008Meta-regression in stata.The Stata Journal8493519
  40. 40. Thompson SG, Higgins JP (2002) How should meta-regression analyses be undertaken and interpreted? Stat Med 21(11): 1559–1573.SG ThompsonJP Higgins2002How should meta-regression analyses be undertaken and interpreted?Stat Med211115591573
  41. 41. Johnson BT, Huedo-Medina TB (2011) Depicting estimates using the intercept in meta-regression models:The moving constant technique. Research Syn Method. BT JohnsonTB Huedo-Medina2011Depicting estimates using the intercept in meta-regression models:The moving constant technique.Research Syn Method
  42. 42. Burnham TR, Wilcox A (2002) Effects of exercise on physiological and psychological variables in cancer survivors. Med Sci Sports Exerc 34(12): 1863–1867.TR BurnhamA. Wilcox2002Effects of exercise on physiological and psychological variables in cancer survivors.Med Sci Sports Exerc341218631867
  43. 43. Dimeo FC, Stieglitz RD, Novelli-Fischer U, Fetscher S, Keul J (1999) Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85(10): 2273–2277.FC DimeoRD StieglitzU. Novelli-FischerS. FetscherJ. Keul1999Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy.Cancer851022732277
  44. 44. Dodd MJ, Cho MH, Miaskowski C, Painter PL, Paul SM, et al. (2010) A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nurs 33(4): 245–257.MJ DoddMH ChoC. MiaskowskiPL PainterSM Paul2010A randomized controlled trial of home-based exercise for cancer-related fatigue in women during and after chemotherapy with or without radiation therapy.Cancer Nurs334245257
  45. 45. Berglund G, Bolund C, Gustafsson UL, Sjoden PO (1994) One-year follow-up of the ‘starting again’ group rehabilitation programme for cancer patients. Eur J Cancer 30A(12): 1744–1751.G. BerglundC. BolundUL GustafssonPO Sjoden1994One-year follow-up of the ‘starting again’ group rehabilitation programme for cancer patients.Eur J Cancer30A1217441751
  46. 46. Courneya KS, Friedenreich CM, Sela RA, Quinney HA, Rhodes RE, et al. (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes. Psychooncology 12(4): 357–374.KS CourneyaCM FriedenreichRA SelaHA QuinneyRE Rhodes2003The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: Physical fitness and quality of life outcomes.Psychooncology124357374
  47. 47. Thorsen L, Skovlund E, Stromme SB, Hornslien K, Dahl AA, et al. (2005) Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. J Clin Oncol 23(10): 2378–2388.L. ThorsenE. SkovlundSB StrommeK. HornslienAA Dahl2005Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy.J Clin Oncol231023782388
  48. 48. Culos-Reed SN, Carlson LE, Daroux LM, Hately-Aldous S (2006) A pilot study of yoga for breast cancer survivors: Physical and psychological benefits. Psychooncology 15(10): 891–897.SN Culos-ReedLE CarlsonLM DarouxS. Hately-Aldous2006A pilot study of yoga for breast cancer survivors: Physical and psychological benefits.Psychooncology1510891897
  49. 49. Rausch SM (2007) Evaluating the psychosocial effects of two interventions, tai chi and spiritual growth groups, in women with breast cancer. SM Rausch2007Evaluating the psychosocial effects of two interventions, tai chi and spiritual growth groups, in women with breast cancer.PhD Dissertation. PhD Dissertation.
  50. 50. Ohira T, Schmitz KH, Ahmed RL, Yee D (2006) Effects of weight training on quality of life in recent breast cancer survivors: The weight training for breast cancer survivors (WTBS) study. Cancer 106(9): 2076–2083.T. OhiraKH SchmitzRL AhmedD. Yee2006Effects of weight training on quality of life in recent breast cancer survivors: The weight training for breast cancer survivors (WTBS) study.Cancer106920762083
  51. 51. Perna FM, Craft L, Freund KM, Skrinar G, Stone M, et al. (2010) The effect of a cognitive behavioral exercise intervention on clinical depression in a multiethnic sample of women with breast cancer: A randomized controlled trial. International Journal of Sport and Exercise Psychology 8(1): 36–47.FM PernaL. CraftKM FreundG. SkrinarM. Stone2010The effect of a cognitive behavioral exercise intervention on clinical depression in a multiethnic sample of women with breast cancer: A randomized controlled trial.International Journal of Sport and Exercise Psychology813647
  52. 52. Lee SA, Kang JY, Kim YD, An AR, Kim SW, et al. (2010) Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: A randomized controlled pilot trial. Clin Rehabil 24(7): 600–613.SA LeeJY KangYD KimAR AnSW Kim2010Effects of a scapula-oriented shoulder exercise programme on upper limb dysfunction in breast cancer survivors: A randomized controlled pilot trial.Clin Rehabil247600613
  53. 53. Demark-Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, et al. (2008) Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clin Breast Cancer 8(1): 70–79.W. Demark-WahnefriedLD CaseK. BlackwellPK MarcomW. Kraus2008Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy.Clin Breast Cancer817079
  54. 54. Targ EF, Levine EG (2002) The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial. Gen Hosp Psychiatry 24(4): 238–248.EF TargEG Levine2002The efficacy of a mind-body-spirit group for women with breast cancer: A randomized controlled trial.Gen Hosp Psychiatry244238248
  55. 55. Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, et al. (2007) Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ 334(7592): 517.N. MutrieAM CampbellF. WhyteA. McConnachieC. Emslie2007Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial.BMJ3347592517
  56. 56. Latka RN, Alvarez-Reeves M, Cadmus L, Irwin ML (2009) Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: The yale exercise and survivorship study. J Cancer Surviv 3(3): 148–157.RN LatkaM. Alvarez-ReevesL. CadmusML Irwin2009Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: The yale exercise and survivorship study.J Cancer Surviv33148157
  57. 57. Patel SR (2004) The effects of yoga on mood disturbance and pain in an underserved breast cancer population. SR Patel2004The effects of yoga on mood disturbance and pain in an underserved breast cancer population.PhD Dissertation. PhD Dissertation.
  58. 58. Vadiraja HS, Raghavendra RM, Nagarathna R, Nagendra HR, Rekha M, et al. (2009) Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial. Integr Cancer Ther 8(1): 37–46.HS VadirajaRM RaghavendraR. NagarathnaHR NagendraM. Rekha2009Effects of a yoga program on cortisol rhythm and mood states in early breast cancer patients undergoing adjuvant radiotherapy: A randomized controlled trial.Integr Cancer Ther813746
  59. 59. McClure MK, McClure RJ, Day R, Brufsky AM (2010) Randomized controlled trial of the breast cancer recovery program for women with breast cancer-related lymphedema. Am J Occup Ther 64(1): 59–72.MK McClureRJ McClureR. DayAM Brufsky2010Randomized controlled trial of the breast cancer recovery program for women with breast cancer-related lymphedema.Am J Occup Ther6415972
  60. 60. Pinto BM, Clark MM, Maruyama NC, Feder SI (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12(2): 118–126.BM PintoMM ClarkNC MaruyamaSI Feder2003Psychological and fitness changes associated with exercise participation among women with breast cancer.Psychooncology122118126
  61. 61. Mock V, Dow KH, Meares CJ, Grimm PM, Dienemann JA, et al. (1997) Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncol Nurs Forum 24(6): 991–1000.V. MockKH DowCJ MearesPM GrimmJA Dienemann1997Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer.Oncol Nurs Forum2469911000
  62. 62. Danhauer SC, Mihalko SL, Russell GB, Campbell CR, Felder L, et al. (2009) Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psychooncology 18(4): 360–368.SC DanhauerSL MihalkoGB RussellCR CampbellL. Felder2009Restorative yoga for women with breast cancer: Findings from a randomized pilot study.Psychooncology184360368
  63. 63. Cadmus LA, Salovey P, Yu H, Chung G, Kasl S, et al. (2009) Exercise and quality of life during and after treatment for breast cancer: Results of two randomized controlled trials. Psychooncology 18(4): 343–352.LA CadmusP. SaloveyH. YuG. ChungS. Kasl2009Exercise and quality of life during and after treatment for breast cancer: Results of two randomized controlled trials.Psychooncology184343352
  64. 64. Drouin JS, Armstrong H, Krause S, Orr J, Birk TJ, et al. (2005) Effects of aerobic exercise training on peak aerobic capacity, fatigue, and psyhchological factors during radiation for breast cancer. Rehabilitation Oncology 1(23): 11–17.JS DrouinH. ArmstrongS. KrauseJ. OrrTJ Birk2005Effects of aerobic exercise training on peak aerobic capacity, fatigue, and psyhchological factors during radiation for breast cancer.Rehabilitation Oncology1231117
  65. 65. Chandwani KD, Thornton B, Perkins GH, Arun B, Raghuram NV, et al. (2010) Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol 8(2): 43–55.KD ChandwaniB. ThorntonGH PerkinsB. ArunNV Raghuram2010Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer.J Soc Integr Oncol824355
  66. 66. Vito NL (2007) The effects of a yoga intervention on physical and psychological functioning for breast cancer survivors. NL Vito2007The effects of a yoga intervention on physical and psychological functioning for breast cancer survivors.PhD Dissertation. PhD Dissertation.
  67. 67. Payne JK, Held J, Thorpe J, Shaw H (2008) Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Oncol Nurs Forum 35(4): 635–642.JK PayneJ. HeldJ. ThorpeH. Shaw2008Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy.Oncol Nurs Forum354635642
  68. 68. Mock V, Burke MB, Sheehan P, Creaton EM, Winningham ML, et al. (1994) A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncol Nurs Forum 21(5): 899–907; discussion 908.V. MockMB BurkeP. SheehanEM CreatonML Winningham1994A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy.Oncol Nurs Forum215899907; discussion 908
  69. 69. Eyigor S, Karapolat H, Yesil H, Uslu R, Durmaz B (2010) Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: A randomized controlled study. Eur J Phys Rehabil Med 46(4): 481–487.S. EyigorH. KarapolatH. YesilR. UsluB. Durmaz2010Effects of pilates exercises on functional capacity, flexibility, fatigue, depression and quality of life in female breast cancer patients: A randomized controlled study.Eur J Phys Rehabil Med464481487
  70. 70. Monga U, Garber SL, Thornby J, Vallbona C, Kerrigan AJ, et al. (2007) Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Arch Phys Med Rehabil 88(11): 1416–1422.U. MongaSL GarberJ. ThornbyC. VallbonaAJ Kerrigan2007Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy.Arch Phys Med Rehabil881114161422
  71. 71. Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, et al. (2003) A randomized trial of exercise and quality of life in colorectal cancer survivors. European Journal of Cancer Care 12(4): 347–357.KS CourneyaCM FriedenreichHA QuinneyAL FieldsLW Jones2003A randomized trial of exercise and quality of life in colorectal cancer survivors.European Journal of Cancer Care124347357
  72. 72. Jarden M, Nelausen K, Hovgaard D, Boesen E, Adamsen L (2009) The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: A randomized controlled trial. J Pain Symptom Manage 38(2): 174–190.M. JardenK. NelausenD. HovgaardE. BoesenL. Adamsen2009The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: A randomized controlled trial.J Pain Symptom Manage382174190
  73. 73. Chang PH, Lai YH, Shun SC, Lin LY, Chen ML, et al. (2008) Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: A randomized controlled trial. J Pain Symptom Manage 35(5): 524–534.PH ChangYH LaiSC ShunLY LinML Chen2008Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: A randomized controlled trial.J Pain Symptom Manage355524534
  74. 74. Cohen L, Warneke C, Fouladi RT, Rodriguez MA, Chaoul-Reich A (2004) Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma. Cancer 100(10): 2253–2260.L. CohenC. WarnekeRT FouladiMA RodriguezA. Chaoul-Reich2004Psychological adjustment and sleep quality in a randomized trial of the effects of a tibetan yoga intervention in patients with lymphoma.Cancer1001022532260
  75. 75. Duijts SF, Faber MM, Oldenburg HS, van Beurden M, Aaronson NK (2011) Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors-a meta-analysis. Psychooncology 20(2): 115–126.SF DuijtsMM FaberHS OldenburgM. van BeurdenNK Aaronson2011Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors-a meta-analysis.Psychooncology202115126
  76. 76. Craft L, Vaniterson EH, Helenowski IB, Rademaker A, Courneya KS (2011) Exercise effects on depressive symptoms in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiol Biomarkers Prev. L. CraftEH VanitersonIB HelenowskiA. RademakerKS Courneya2011Exercise effects on depressive symptoms in cancer survivors: A systematic review and meta-analysis.Cancer Epidemiol Biomarkers Prev
  77. 77. Dunn AL, Trivedi MH, Kampert JB, Clark CG, Chambliss HO (2005) Exercise treatment for depression: Efficacy and dose response. Am J Prev Med 28(1): 1–8.AL DunnMH TrivediJB KampertCG ClarkHO Chambliss2005Exercise treatment for depression: Efficacy and dose response.Am J Prev Med28118
  78. 78. Jones LW, Eves ND, Peppercorn J (2010) Pre-exercise screening and prescription guidelines for cancer patients. Lancet Oncol 11(10): 914–916.LW JonesND EvesJ. Peppercorn2010Pre-exercise screening and prescription guidelines for cancer patients.Lancet Oncol1110914916
  79. 79. Thompson WR, Gordon NF, Pescatello LS, editors. (2010) ACSM's guidelines for exercise testing and prescription. Philadelphia, PA: Lippincott, Williams & Wilkins. WR ThompsonNF GordonLS Pescatello2010ACSM's guidelines for exercise testing and prescriptionPhiladelphia, PALippincott, Williams & Wilkins
  80. 80. Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM (2010) The effect of physical exercise on cancer-related fatigue during cancer treatment: A meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 22(3): 208–221.MJ VelthuisSC Agasi-IdenburgG. AufdemkampeHM Wittink2010The effect of physical exercise on cancer-related fatigue during cancer treatment: A meta-analysis of randomised controlled trials.Clin Oncol (R Coll Radiol)223208221
  81. 81. Spence RR, Heesch KC, Brown WJ (2011) Colorectal cancer survivors' exercise experiences and preferences: Qualitative findings from an exercise rehabilitation programme immediately after chemotherapy. Eur J Cancer Care (Engl) 20(2): 257–266.RR SpenceKC HeeschWJ Brown2011Colorectal cancer survivors' exercise experiences and preferences: Qualitative findings from an exercise rehabilitation programme immediately after chemotherapy.Eur J Cancer Care (Engl)202257266
  82. 82. Whitehead S, Lavelle K (2009) Older breast cancer survivors' views and preferences for physical activity. Qual Health Res 19(7): 894–906.S. WhiteheadK. Lavelle2009Older breast cancer survivors' views and preferences for physical activity.Qual Health Res197894906
  83. 83. Mor V, Allen S, Malin M (1994) The psychosocial impact of cancer on older versus younger patients and their families. Cancer 74(7 Suppl): 2118–2127.V. MorS. AllenM. Malin1994The psychosocial impact of cancer on older versus younger patients and their families.Cancer747 Suppl21182127
  84. 84. Mao JJ, Armstrong K, Bowman MA, Xie SX, Kadakia R, et al. (2007) Symptom burden among cancer survivors: Impact of age and comorbidity. J Am Board Fam Med 20(5): 434–443.JJ MaoK. ArmstrongMA BowmanSX XieR. Kadakia2007Symptom burden among cancer survivors: Impact of age and comorbidity.J Am Board Fam Med205434443
  85. 85. Holland JC, Andersen B, Breitbart WS, Compas B, Dudley MM, et al. (2010) Distress management. J Natl Compr Canc Netw 8(4): 448–485.JC HollandB. AndersenWS BreitbartB. CompasMM Dudley2010Distress management.J Natl Compr Canc Netw84448485
  86. 86. Brosse AL, Sheets ES, Lett HS, Blumenthal JA (2002) Exercise and the treatment of clinical depression in adults: Recent findings and future directions. Sports Med 32(12): 741–760.AL BrosseES SheetsHS LettJA Blumenthal2002Exercise and the treatment of clinical depression in adults: Recent findings and future directions.Sports Med3212741760
  87. 87. North TC, McCullagh P, Tran ZV (1990) Effect of exercise on depression. Exerc Sport Sci Rev 18: 379–415.TC NorthP. McCullaghZV Tran1990Effect of exercise on depression.Exerc Sport Sci Rev18379415
  88. 88. Papakostas GI (2008) Tolerability of modern antidepressants. J Clin Psychiatry 69: Suppl E18–13.GI Papakostas2008Tolerability of modern antidepressants.J Clin Psychiatry69Suppl E1813
  89. 89. Kelly CM, Juurlink DN, Gomes T, Duong-Hua M, Pritchard KI, et al. (2010) Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population based cohort study. BMJ 340: c693.CM KellyDN JuurlinkT. GomesM. Duong-HuaKI Pritchard2010Selective serotonin reuptake inhibitors and breast cancer mortality in women receiving tamoxifen: A population based cohort study.BMJ340c693
  90. 90. Greenwood BN, Fleshner M (2011) Exercise, stress resistance, and central serotonergic systems. Exerc Sport Sci Rev 39(3): 140–149.BN GreenwoodM. Fleshner2011Exercise, stress resistance, and central serotonergic systems.Exerc Sport Sci Rev393140149