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A Systematic Review and Narrative Synthesis to Explore the Effectiveness of Exercise-Based Interventions in Improving Fatigue, Dyspnea, and Depression in Lung Cancer Survivors

Henshall, Catherine L., PhD; Allin, Lizzie; Aveyard, Helen, PhD

doi: 10.1097/NCC.0000000000000605
Article: PDF Only

Background Lung cancer survival rates are increasing; however, lung cancer survivors' mental and physical well-being can suffer from experiencing symptoms of fatigue, dyspnea, and depression. Exercise can improve these symptoms. However, no studies have examined the effects of different exercise interventions on these symptoms.

Objective This review aims to examine the evidence on the effects of exercise interventions on fatigue, dyspnea, and depression in lung cancer survivors.

Methods PRISMA guidelines were followed. CINAHL, MEDLINE, EMBASE, and Cochrane databases were searched between 2000 and May 2017. Gray literature was searched. All identified studies were screened for inclusion. Quantitative data were narratively synthesized.

Results From 852 records retrieved and screened, 10 full-text articles were included. Seven studies had a high risk of bias, 2 had an unclear risk, and 1 study had a low risk, limiting the robustness of findings. Exercise interventions included pulmonary rehabilitation, aerobic exercise, resistance training, exercise and balance programs, and medical qigong. Six studies reported statistically significant reductions in fatigue; 2 reported significant improvements in dyspnea, and one a significant reduction in depression postintervention.

Conclusions Exercise interventions may be effective and are unlikely to cause harm for lung cancer survivors. However, evidence quality is limited. More rigorous study designs are required to provide guidance about which interventions may help lung cancer survivors self-manage these symptoms.

Implications for Practice Health professionals should provide comprehensive, customized exercise screening and treatment plans to lung cancer survivors to complement their lifestyle needs and ensure appropriate recommendations aimed at improving symptom control are communicated to them.

Author Affiliations: OxINMAHR, Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, United Kingdom.

The authors have no conflicts of interest to disclose.

Correspondence: Catherine L. Henshall, PhD, OxINMAHR, Oxford Brookes University, Faculty of Health & Life Sciences, The Colonnade, Gipsy Lane, Headington, Oxford OX3 0BP, United Kingdom (

Accepted for publication February 16, 2018.

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