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; Meike Doorenbos; Isa H Mast; Neil K Aaronson; Marc van Beurden; Martin Bohus; Kerry S Courneya; Amanda J Daley; Daniel A Galvão; Martine M Goedendorp; Wim H van Harten; Sandi C Hayes; Anouk E Hiensch; Melinda L Irwin; Marie José Kersten; Hans Knoop; Anne M May; Alex McConnachie; Willem van Mechelen; Nanette Mutrie; Robert U Newton; Frans Nollet; Hester S Oldenburg; Martina E Schmidt; Kathryn H Schmitz; Karl-Heinz Schulz; Gabe S Sonke; Karen Steindorf; Martijn M Stuiver; Dennis R Taaffe; Lene Thorsen; Miranda J Velthuis; Joachim Wiskemann; Ilse Mesters; Cornelia M Ulrich; Jonna K van Vulpen; Jose A E Custers; Laurien M Buffart

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 Kenkhuis
, Meike Doorenbos
, Isa H Mast
, Neil K Aaronson
, Marc van Beurden
, Martin Bohus
, Kerry S Courneya
, Amanda J Daley
, Daniel A Galvão
, Martine M Goedendorp
, Wim H van Harten
, Sandi C Hayes
, Anouk E Hiensch
, Melinda L Irwin
, Marie José Kersten
, Hans Knoop
, Anne M May
, Alex McConnachie
, Willem van Mechelen
, Nanette Mutrie

Robert U Newton, Frans Nollet, Hester S Oldenburg, Martina E Schmidt, Kathryn H Schmitz, Karl-Heinz Schulz, Gabe S Sonke, Karen Steindorf, Martijn M Stuiver, Dennis R Taaffe, Lene Thorsen, Miranda J Velthuis, Joachim Wiskemann, Ilse Mesters, Cornelia M Ulrich, Jonna K van Vulpen, Jose A E Custers, Laurien M Buffart^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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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.

Original language	English
Article number	647
Journal	Supportive Care in Cancer
Volume	33
Issue number	7
DOIs	https://doi.org/10.1007/s00520-025-09646-9
Publication status	Published - 1 Jul 2025

Keywords

Adult
Anxiety/therapy
Cancer Survivors/psychology
Depression/therapy
Exercise Therapy/methods
Exercise/psychology
Female
Humans
Male
Middle Aged
Neoplasms/psychology
Randomized Controlled Trials as Topic
Survivors/psychology

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Kenkhuis, M.-F., Doorenbos, M., Mast, I. H., Aaronson, N. K., van Beurden, M., Bohus, M., Courneya, K. S., Daley, A. J., Galvão, D. A., Goedendorp, M. M., van Harten, W. H., Hayes, S. C., Hiensch, A. E., Irwin, M. L., Kersten, M. J., Knoop, H., May, A. M., McConnachie, A., van Mechelen, W., ... Buffart, L. M. (2025). 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. Supportive Care in Cancer, 33(7), Article 647. https://doi.org/10.1007/s00520-025-09646-9

@article{bedf629967a9467eb32859952cbf7279,

title = "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",

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 = "Adult, Anxiety/therapy, Cancer Survivors/psychology, Depression/therapy, Exercise Therapy/methods, Exercise/psychology, Female, Humans, Male, Middle Aged, Neoplasms/psychology, Randomized Controlled Trials as Topic, Survivors/psychology",

author = "Marlou-Floor Kenkhuis and Meike Doorenbos and Mast, \{Isa H\} and Aaronson, \{Neil K\} and \{van Beurden\}, Marc and Martin Bohus and Courneya, \{Kerry S\} and Daley, \{Amanda J\} and Galv{\~a}o, \{Daniel A\} and Goedendorp, \{Martine M\} and \{van Harten\}, \{Wim H\} and Hayes, \{Sandi C\} and Hiensch, \{Anouk E\} and Irwin, \{Melinda L\} and Kersten, \{Marie Jos{\'e}\} and Hans Knoop and May, \{Anne M\} and Alex McConnachie and \{van Mechelen\}, Willem and Nanette Mutrie and Newton, \{Robert U\} and Frans Nollet and Oldenburg, \{Hester S\} and Schmidt, \{Martina E\} and Schmitz, \{Kathryn H\} and Karl-Heinz Schulz and Sonke, \{Gabe S\} and Karen Steindorf and Stuiver, \{Martijn M\} and Taaffe, \{Dennis R\} and Lene Thorsen and Velthuis, \{Miranda J\} and Joachim Wiskemann and Ilse Mesters and Ulrich, \{Cornelia M\} and \{van Vulpen\}, \{Jonna K\} and Custers, \{Jose A E\} and Buffart, \{Laurien M\}",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2025.",

year = "2025",

month = jul,

day = "1",

doi = "10.1007/s00520-025-09646-9",

language = "English",

volume = "33",

journal = "Supportive Care in Cancer",

issn = "0941-4355",

publisher = "Springer Science and Business Media Deutschland GmbH",

number = "7",

}

Kenkhuis, M-F, Doorenbos, M, Mast, IH, Aaronson, NK, van Beurden, M, Bohus, M, Courneya, KS, Daley, AJ, Galvão, DA, Goedendorp, MM, van Harten, WH, Hayes, SC, Hiensch, AE, Irwin, ML, Kersten, MJ, Knoop, H, May, AM, McConnachie, A, van Mechelen, W, Mutrie, N, Newton, RU, Nollet, F, Oldenburg, HS, Schmidt, ME, Schmitz, KH, Schulz, K-H, Sonke, GS, Steindorf, K, Stuiver, MM, Taaffe, DR, Thorsen, L, Velthuis, MJ, Wiskemann, J, Mesters, I, Ulrich, CM, van Vulpen, JK, Custers, JAE & Buffart, LM 2025, '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', Supportive Care in Cancer, vol. 33, no. 7, 647. https://doi.org/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. / Kenkhuis, Marlou-Floor; Doorenbos, Meike; Mast, Isa H et al.
In: Supportive Care in Cancer, Vol. 33, No. 7, 647, 01.07.2025.

Research output: Contribution to journal › Article › Academic › peer-review

TY - JOUR

T1 - Exercise effects on symptoms of depression and anxiety vary by patient, clinical, and intervention characteristics in cancer survivors

T2 - Results from pooled analyses of individual participant data of 26 RCTs

AU - Kenkhuis, Marlou-Floor

AU - Doorenbos, Meike

AU - Mast, Isa H

AU - Aaronson, Neil K

AU - van Beurden, Marc

AU - Bohus, Martin

AU - Courneya, Kerry S

AU - Daley, Amanda J

AU - Galvão, Daniel A

AU - Goedendorp, Martine M

AU - van Harten, Wim H

AU - Hayes, Sandi C

AU - Hiensch, Anouk E

AU - Irwin, Melinda L

AU - Kersten, Marie José

AU - Knoop, Hans

AU - May, Anne M

AU - McConnachie, Alex

AU - van Mechelen, Willem

AU - Mutrie, Nanette

AU - Newton, Robert U

AU - Nollet, Frans

AU - Oldenburg, Hester S

AU - Schmidt, Martina E

AU - Schmitz, Kathryn H

AU - Schulz, Karl-Heinz

AU - Sonke, Gabe S

AU - Steindorf, Karen

AU - Stuiver, Martijn M

AU - Taaffe, Dennis R

AU - Thorsen, Lene

AU - Velthuis, Miranda J

AU - Wiskemann, Joachim

AU - Mesters, Ilse

AU - Ulrich, Cornelia M

AU - van Vulpen, Jonna K

AU - Custers, Jose A E

AU - Buffart, Laurien M

PY - 2025/7/1

Y1 - 2025/7/1

N2 - 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.

AB - 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.

KW - Adult

KW - Anxiety/therapy

KW - Cancer Survivors/psychology

KW - Depression/therapy

KW - Exercise Therapy/methods

KW - Exercise/psychology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Neoplasms/psychology

KW - Randomized Controlled Trials as Topic

KW - Survivors/psychology

U2 - 10.1007/s00520-025-09646-9

DO - 10.1007/s00520-025-09646-9

M3 - Article

C2 - 40591016

SN - 0941-4355

VL - 33

JO - Supportive Care in Cancer

JF - Supportive Care in Cancer

IS - 7

M1 - 647

ER -