Exercise Interventions to Improve Depression, Anxiety and Health-Related Quality of Life in Older Adults with Cancer: A Systematic Review and Meta-Analysis of Randomised Control Trials

Background: Older adults aged 60 years and above account for two-thirds of newly diagnosed cancer cases and are susceptible to poor mental well-being following their diagnoses. In this paper, we analysed the significance of exercise therapy in improving psychological outcomes–depression, anxiety and health-related quality-of-life (HRQOL)–among older adults with cancer. Methods: This PRISMA-adherent systematic review involved searching PubMed, MedLine, Embase, and PsycINFO databases for randomised controlled trials (RCTs) that examined the effectiveness of community-based exercise interventions on improving depression, anxiety, and HRQOL among older adults with cancer. Random-effects meta-analyses and meta-regressions were used for analysis. Results: 12 RCTs were included in this study. Meta-analyses observed significant reduction in levels of depression (SMD=-0.67, 95%CI: -1.04;-0.29) and anxiety (SMD=-0.52, 95%CI: -0.89;-0.16), but statistically insignificant outcomes on overall HRQOL (SMD=0.60, 95%CI: -0.30;1.50). Mind- body exercise interventions (Tai Chi, Yoga, Qigong) improved depression (SMD=-0.91, 95%CI: -1.56;-0.27) and anxiety levels (SMD=-0.77, 95%CI: -1.54;-0.01) compared to conventional exercise interventions. Exercise interventions that progressively increased in intensity were also found to significantly reduce depression severity (SMD=-0.60, 95%CI: -1.15; -0.05) compared to non-progressive exercise interventions. Subgroup analyses revealed variations in the improvement of psychological outcomes across age groups, countries of study, and frequencies and duration of exercise interventions. Conclusion: Community-based exercise interventions can improve depression and anxiety in older adults with cancer. Improvements were more significant for mind-body interventions and physical activity that progressively increased in intensity. The prescription of supervised community-based exercise interventions in older adults with cancer is encouraged, given the expected positive psychological outcomes. Funding: No funding was required for this study. Declaration of Interest: The authors have no conflicts of interest to disclose.