Meta-Analysis

. 2025 Jul 1;33(7):647.

doi: 10.1007/s00520-025-09646-9.

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

Marlou-Floor Kenkhuis¹, Meike Doorenbos¹, Isa H Mast¹, Neil K Aaronson², Marc van Beurden³, Martin Bohus^{4

5

6}, Kerry S Courneya⁷, Amanda J Daley⁸, Daniel A Galvão⁹, Martine M Goedendorp¹⁰, Wim H van Harten^{2

11}, Sandi C Hayes¹², Anouk E Hiensch¹³, Melinda L Irwin¹⁴, Marie José Kersten¹⁵, Hans Knoop¹⁶, Anne M May¹³, Alex McConnachie¹⁷, Willem van Mechelen^{18

19

20

21}, Nanette Mutrie²², Robert U Newton^{9

23}, Frans Nollet^{24

25}, Hester S Oldenburg³, Martina E Schmidt²⁶, Kathryn H Schmitz²⁷, Karl-Heinz Schulz²⁸, Gabe S Sonke³, Karen Steindorf²⁶, Martijn M Stuiver², Dennis R Taaffe⁹, Lene Thorsen^{29

30}, Miranda J Velthuis³¹, Joachim Wiskemann³², Ilse Mesters³³, Cornelia M Ulrich³⁴, Jonna K van Vulpen³⁵, Jose A E Custers³⁶, Laurien M Buffart³⁷

Affiliations

¹ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
² Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
³ Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁴ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
⁵ Heidelberg University, Heidelberg, Germany.
⁶ Faculty of Health, University of Antwerp, Antwerp, Belgium.
⁷ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.
⁸ Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁹ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
¹⁰ Department of Psychology, University of Groningen, Groningen, Netherlands.
¹¹ University of Twente, Enschede, The Netherlands.
¹² School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Mackay, QLD, Australia.
¹³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁴ Yale School of Public Health, New Haven, CT, USA.
¹⁵ Department of Hematology, Cancer Center Amsterdam and LYMMCARE, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
¹⁶ Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
¹⁸ Department of Public and Occupational Health, Amsterdam University Medical Centers, Location VU University, Amsterdam, The Netherlands.
¹⁹ Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
²⁰ Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²¹ School of Public Health, Physiotherapy and Sports Science, UCD, University College Dublin, Dublin, Ireland.
²² Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
²³ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
²⁴ Department of Rehabilitation Medicine, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
²⁵ Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
²⁶ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and University Medical Center, Heidelberg, Germany.
²⁷ University of Pittsburgh, Pittsburgh, PA, USA.
²⁸ Competence Center for Sports- and Exercise Medicine (Athleticum) and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁹ National Advisory Unit On Late Effects After Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
³⁰ Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
³¹ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
³² Department of Medical Oncology, Heidelberg University Clinic and National Center for Tumor Diseases (NCT) Heidelberg, a Partnership Between German Cancer Research Center and University Medical Center, Heidelberg, Germany.
³³ Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
³⁴ Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Utah, Salt Lake City, USA.
³⁵ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁶ Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁷ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands. laurien.buffart@radboudumc.nl.

PMID: 40591016
PMCID: PMC12213934
DOI: 10.1007/s00520-025-09646-9

Meta-Analysis

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

Marlou-Floor Kenkhuis et al. Support Care Cancer. 2025.

. 2025 Jul 1;33(7):647.

doi: 10.1007/s00520-025-09646-9.

Authors

Affiliations

¹ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands.
² Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
³ Netherlands Cancer Institute/Antoni Van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
⁴ Institute of Psychiatric and Psychosomatic Psychotherapy, Central Institute of Mental Health, Mannheim, Germany.
⁵ Heidelberg University, Heidelberg, Germany.
⁶ Faculty of Health, University of Antwerp, Antwerp, Belgium.
⁷ Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Canada.
⁸ Centre for Lifestyle Medicine and Behaviour (CLiMB), The School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
⁹ Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
¹⁰ Department of Psychology, University of Groningen, Groningen, Netherlands.
¹¹ University of Twente, Enschede, The Netherlands.
¹² School of Public Health, Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Mackay, QLD, Australia.
¹³ Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁴ Yale School of Public Health, New Haven, CT, USA.
¹⁵ Department of Hematology, Cancer Center Amsterdam and LYMMCARE, Amsterdam University Medical Centers, Amsterdam, The Netherlands.
¹⁶ Department of Medical Psychology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
¹⁷ Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, UK.
¹⁸ Department of Public and Occupational Health, Amsterdam University Medical Centers, Location VU University, Amsterdam, The Netherlands.
¹⁹ Faculty of Health and Behavioural Sciences, School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Australia.
²⁰ Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
²¹ School of Public Health, Physiotherapy and Sports Science, UCD, University College Dublin, Dublin, Ireland.
²² Physical Activity for Health Research Center, University of Edinburgh, Edinburgh, UK.
²³ School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
²⁴ Department of Rehabilitation Medicine, UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
²⁵ Amsterdam Movement Sciences, Rehabilitation & Development, Amsterdam, The Netherlands.
²⁶ Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg, a partnership between DKFZ and University Medical Center, Heidelberg, Germany.
²⁷ University of Pittsburgh, Pittsburgh, PA, USA.
²⁸ Competence Center for Sports- and Exercise Medicine (Athleticum) and Institute for Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
²⁹ National Advisory Unit On Late Effects After Cancer Treatment, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
³⁰ Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
³¹ Netherlands Comprehensive Cancer Organisation (IKNL), Utrecht, The Netherlands.
³² Department of Medical Oncology, Heidelberg University Clinic and National Center for Tumor Diseases (NCT) Heidelberg, a Partnership Between German Cancer Research Center and University Medical Center, Heidelberg, Germany.
³³ Department of Epidemiology, Maastricht University, Maastricht, The Netherlands.
³⁴ Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Utah, Salt Lake City, USA.
³⁵ Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
³⁶ Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.
³⁷ Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands. laurien.buffart@radboudumc.nl.

PMID: 40591016
PMCID: PMC12213934
DOI: 10.1007/s00520-025-09646-9

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: Anxiety; Cancer survivors; Depression; Distress; Exercise; Moderators.

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Conflict of interest statement

Declarations. Ethics approval: All studies included in this IPD obtained approval from their respective local ethics committees. POLARIS is registered in the Prospective Register of Systemic Reviews (PROSPERO) under reference number CRD 42013003805. Consent to participate: Informed consent was obtained from all individual participants included in the studies. Competing interests: The authors declare no competing interests.

References

1. Sung H et al (2021) Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249 - PubMed
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1. Mitchell AJ et al (2011) Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies. Lancet Oncol 12(2):160–174 - PubMed
1. Wang X et al (2020) Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Mol Psychiatry 25(12):3186–3197 - PMC - PubMed
1. Brown JC et al (2012) The efficacy of exercise in reducing depressive symptoms among cancer survivors: a meta-analysis. PLoS ONE 7(1):e30955 - PMC - PubMed

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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

Affiliations

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

Authors

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Conflict of interest statement

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