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Meta-Analysis
. 2024 Mar 8:12:e17053.
doi: 10.7717/peerj.17053. eCollection 2024.

Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis

Rachita Gururaj  1 , Stephen Rajan Samuel  2   3 , K Vijaya Kumar  2 , Ravishankar Nagaraja  4 , Justin W L Keogh  2   5   6
Affiliations
Meta-Analysis

Effect of exercise based interventions on sleep and circadian rhythm in cancer survivors-a systematic review and meta-analysis

Rachita Gururaj et al. PeerJ. .

Abstract

Background: Disrupted circadian rhythm commonly reported in cancer survivors is closely associated with cancer related fatigue, sleep disturbances and compromised quality of life. As more cancer survivors request non-pharmacological treatment strategies for the management of their chronic sleep-related symptoms, there is a need for meta-analyses of various interventions such as exercise on sleep and circadian rhythm disturbances.

Methods: A search for RCT's was conducted in April 2020 and updated in July 2023 using relevant keywords for cancer, sleep, circadian rhythm and exercise interventions on PubMed, Scopus, Web of Science, PEDro and CINAHL.

Results: Thirty-six studies were included for qualitative analysis and 26, for meta-analysis. Thirty-five studies analyzed sleep outcomes, while five analyzed circadian rhythm. RCT's studying the effect of aerobic exercise, resistance exercise, combined aerobic and resistance exercise, physical activity, yoga, or tai chi were included. Meta-analysis results showed significant exercise-related improvements on sleep quality assessed by Pittsburgh Sleep Quality index (PSQI) (SMD = -0.50 [-0.87, -0.13], p = 0.008), wake after sleep onset (WASO) (SMD = -0.29 [-0.53, -0.05], p = 0.02) and circadian rhythm, assessed by salivary cortisol levels (MD = -0.09 (95% CI [-0.13 to -0.06]) mg/dL, p < 0.001). Results of the meta-analysis indicated that exercise had no significant effect on sleep efficiency, sleep onset latency, total sleep time and circadian rhythm assessed by accelerometry values.

Conclusion: While some sleep and circadian rhythm outcomes (PSQI, WASO and salivary cortisol) exhibited significant improvements, it is still somewhat unclear what exercise prescriptions would optimize different sleep and circadian rhythm outcomes across a variety of groups of cancer survivors.

Implication: As exercise does not exacerbate cancer-related circadian rhythm and sleep disturbances, and may actually produce some significant benefits, this meta-analysis provides further evidence for cancer survivors to perform regular exercise.

Keywords: Carcinoma; Circadian Rhythm; Endurance training; Exercise; Sleep disturbance; Strength training; Tai chi; Yoga.

PubMed Disclaimer

Conflict of interest statement

Justin Keogh is an Academic Editor for PeerJ.

Figures

Figure 1
Figure 1. PRISMA flowchart summarizing the article selection process of the review.
Figure 2
Figure 2. The effects of various interventions vs usual care on sleep efficiency as assessed by accelerometry in cancer survivors.
Figure 3
Figure 3. The effect of various interventions vs usual care on sleep onset latency as assessed by accelerometry in cancer survivors.
Figure 4
Figure 4. The effect of various interventions vs usual care on wake after sleep onset (WASO) as assessed by accelerometry in cancer survivors.
Figure 5
Figure 5. The effect of various interventions vs usual care on total sleep time (TST) as assessed by accelerometry in cancer survivors.
Figure 6
Figure 6. The effect of various interventions vs usual care on sleep quality as assessed by PSQI in cancer survivors.
Figure 7
Figure 7. The effect of yoga vs usual care on circadian rhythm as assessed by salivary cortisol levels in cancer survivors.
Figure 8
Figure 8. The effect of aerobic training interventions vs usual care on sleep quality as assessed by GSDS in cancer survivors.
Figure 9
Figure 9. The effect of aerobic training vs usual care on circadian rhythm as assessed by accelerometry values (r24, MESOR) in cancer survivors.
See this image and copyright information in PMC

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