The Effect of Mild Exercise in the Chemotherapy Room on the Anxiety Level of Cancer Patients: A Prospective Observational Paired Cohort Study

Abstract

Background/Objectives: Cancer represents a significant health challenge, with high mortality and morbidity rates. Its diagnosis often triggers chronic stress, adversely affecting patient outcomes. Exercise has emerged as complementary therapy, enhancing treatment adherence and mitigating the side effects of chemotherapy. This study examines the effects of mild exercise during chemotherapy on patient anxiety. Methods: This prospective paired cohort study was conducted in the General Oncology Hospital of Kifisia "Agioi Anargyroi" in Athens, Greece. Adult cancer patients undergoing chemotherapy participated, excluding those with cognitive, hearing, or motor impairments, those who experienced side effects, or those who declined consent. Anxiety was measured before and after a 20-minute exercise routine performed during chemotherapy, using the Greek-translated State-Trait Anxiety Inventory (STAI). The exercise regimen included warm-up, full-body stretching, and cool-down exercises. Pre- and post-exercise scores were analyzed using the Wilcoxon signed-rank test. Results: Forty-five patients (20 women, 25 men; mean age 69.02 ± 10.62 years) with various cancer backgrounds participated. Pre-intervention anxiety levels were in the borderline "moderate" range, dropping post-exercise to the "low" range. Mean STAI scores decreased from 37.73 ± 13.33 to 32.00 ± 14.22 (p < 0.0001), with a medium-large effect size (Cohen's d for paired samples = -0.646). No significant correlation was found between age and anxiety scores. Discussion: This study found a significant short-term reduction in anxiety, suggesting that incorporating mild exercise during chemotherapy may help in alleviating patient stress. The medium-to-large effect size supports the potential for meaningful short-term benefits. Conclusions: Incorporating mild exercise during chemotherapy may help reduce anxiety and psychological burden. These findings underscore the need for more comprehensive research in larger, more diverse populations to better understand the benefits of incorporating mild exercise during chemotherapy.

Keywords: anxiety; chemotherapy; exercise therapies.

Figure 1

Warm up exercise. (I-1a) Starting position; (I-1b) dorsiflexion; (I-1c) plantar flexion; (I-2a) mid-range knee extension; (I-2b) full knee extension and isometric contraction; (I-3) knee lift.

Figure 2

Main Exercise 1. (II-1a) Starting position for torso rotation; (II-1b) right rotation; (II-1c) left rotation; (II-2a) starting position for hand gripping; (II-2b) final position of hand gripping; (II-3a) forearm supination; (II-3b) forearm pronation.

Figure 3

Main Exercise 2. (II-4a) Starting position of elbow flexion; (II-4b) mid-range of elbow flexion; (II-4c) end-range of elbow flexion; (II-5a) starting position of shoulder flexion; (II-5b) mid-position of shoulder flexion; (II-5c) final position of shoulder flexion; (II-6a) starting position of shoulder abduction; (II-6b) mid-position of shoulder abduction; (II-6c) final position of shoulder abduction.

Figure 4

Main Exercise 3. (II-7a) Starting position; (II-7b) left small on-the-spot step; (II-7c) right small on-the-spot step; (II-8a) left high-knee step; (II-8b) right high-knee step; (II-9a) left leg lunge; (II-9b) right leg lunge.

Figure 5

Cool-Down. (III-1a) Starting position for torso bend; (III-1b) right torso bend; (III-1c) left torso bend; (III-2a) starting position for standing lateral torso bends with arms raised; (III-2b) right standing lateral bend with arms raised; (III-2c) left standing lateral bend with arms raised; (III-3) overhead arm stretch; (III-4a) right seated hamstring stretch; (III-4b) left seated hamstring stretch; (III-5a) starting position for deep breath; (III-5b) deep inhale; (III-5c) exhale through the mouth.

Figure 6

Patient recruitment flow chart. Notably, most eligible patients refused participation due to fear of injury or fatigue.

Figure 7

Y-1 Form of STAI-State questionnaire answers before and after exercise. The median is symbolized by a continuous horizontal line, quartiles by dotted horizontal lines.

Figure 8

Spearman’s rho correlation analysis. Cells show Spearman’s rho values, representing the strength and direction of a monotonic association between variables (−1 to +1). Blue = positive correlation, red = negative correlation, white = no correlation; color intensity reflects strength of association.