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The Effectiveness of Exercise Interventions for Improving Health-Related Quality of Life From Diagnosis Through Active Cancer Treatment

Shiraz I. Mishra

Roberta W. Scherer

Claire Snyder

Paula Geigle

Carolyn Gotay

quality of life, health status, anxiety, depression, fatigue, exercise, survivors, yoga, resistance training, physical activity
ONF 2015, 42(1), E33-E53. DOI: 10.1188/15.ONF.E33-E53

Purpose/Objectives: To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among adults scheduled to, or actively undergoing, cancer treatment.

Data Sources: 11 electronic databases were searched through November 2011. In addition, the authors searched PubMed's related article feature, trial registries, and reference lists of included trials and related reviews.

Data Synthesis: 56 trials with 4,826 participants met the inclusion criteria. At 12 weeks, people exposed to exercise interventions had greater improvement in overall HRQOL, physical functioning, role functioning, social functioning, and fatigue. Improvement in HRQOL was associated with moderate-to-vigorous intensity exercise interventions.

Conclusions: Exercise can be a useful tool for managing HRQOL and HRQOL domains for people scheduled to, or actively undergoing, cancer treatment. More methodologically rigorous trials are needed to examine the attributes of exercise programs most effective for improving HRQOL.

Implications for Nursing: Evidence from this review supports the incorporation of exercise programs of moderate-to-vigorous intensity for the management of HRQOL among people scheduled to, or actively undergoing, cancer treatment into clinical guidelines through the Oncology Nursing Society's Putting Evidence Into Practice resources.

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    Adamsen, L., Quist, M., Andersen, C., Moller, T., Herrstedt, J., Kronborg, D., … Rorth, M. (2009). Effect of a multimodal high intensity exercise intervention in cancer patients undergoing chemotherapy: randomised controlled trial. BMJ, 339, b3410.
    American Cancer Society. (2014). Cancer facts and figures, 2014. Atlanta, GA: Author.
    American College of Sports Medicine. (1998). Position stand: The recommended quantity and quality of exercise for developing and maintaining cardiorespiratory and muscular fitness, and flexibility in healthy adults. Medicine and Science in Sports and Medicine, 30, 975-991.
    American College of Sports Medicine. (2005). ACSM's guidelines for exercise testing and prescription (7th ed.). Philadelphia, PA: Lippincott Williams and Wilkins.
    Arbane, G., Jackson, D., Tropman, D., & Garrod, R. (2009). An early exercise intervention prevents quadriceps weakness after thoracotomy for non-small cell lung cancer: randomized controlled trial. Thorax, 64(Suppl. IV), A20-A21.
    Aziz, N. M. (2007). Cancer survivorship research: state of knowledge, challenges and opportunities [Review]. Acta Oncologica, 46, 417-432. doi:10.1080/02841860701367878
    Aziz, N. M., & Rowland, J. H. (2003). Trends and advances in cancer survivorship research: Challenge and opportunity [Review]. Seminars in Radiation Oncology, 13, 248-266. doi:10.1016/S1053-4296(03)00024-9
    Banerjee, B., Vadiraj, H. S., Ram, A., Rao, R., Jayapal, M., Gopinath, K. S., … Prakash Hande, M. (2007). Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integrated Cancer Therapies, 6, 242-250. doi:10.1177/1534735407306214
    Battaglini, C. L., Mihalik, J. P., Bottaro, M., Dennehy, C., Petschauer, M. A., Hairston, L. S., & Shields, E. W. (2008). Effect of exercise on the caloric intake of breast cancer patients undergoing treatment. Brazilian Journal of Medical Biology Research, 41, 709-715.
    Blanchard, C. M., Denniston, M. M., Baker, F., Ainsworth, S. R., Courneya, K. S., Hann, D. M., … Kennedy, J. S. (2003). Do adults change their lifestyle behaviors after a cancer diagnosis? American Journal of Health Behaviors, 27, 246-256.
    Bourke, L., Doll, H., Crank, H., Daley, A., Rosario, D., & Saxton, J. M. (2011). Lifestyle intervention in men with advanced prostate cancer receiving androgen suppression therapy: A feasibility study. Cancer Epidemiology Biomarkers and Prevention, 20, 647-657. doi:10.1158/1055-9965.EPI-10-1143
    Brown, P., Clark, M. M., Atherton, P., Huschka, M., Sloan, J. A., Gamble, G., … Rummans, T. A. (2006). Will improvement in quality of life (QOL) impact fatigue in patients receiving radiation therapy for advanced cancer? American Journal of Clinical Oncology, 29, 52-58.
    Brownson, R. C., Colditz, G. A., & Proctor, E. K. (Eds.). (2012). Dissemination and implementation research in health: Translating science to practice. New York, NY: Oxford University Press.
    Cadmus, L. A., Salovey, P., Yu, H., Chung, G., Kasl, S., & Irwin, M. L. (2009). Exercise and quality of life during and after treatment for breast cancer: Results of two randomized controlled trials. Psycho-Oncology, 18, 343-352. doi:10.1002/pon.1525
    Caldwell, M. G. (2009). The effects of an endurance exercise regimen on cancer-related fatigue and physical performance in women with breast cancer [Doctoral dissertation]. Louisiana State University Health Sciences Center School of Nursing.
    Campbell, A., Mutrie, N., White, F., McGuire, F., & Kearney, N. (2005). A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. European Journal of Oncology Nursing, 9, 56-63. doi:10.1016/j.ejon.2004.03.007
    Cella, D., Riley, W., Stone, A., Rothrock, N., Reeve, B., Yount, S., … Hays, R. (2010). The Patient-Reported Outcomes Measurement Information System (PROMIS) developed and tested its first wave of adult self-reported health outcome item banks: 2005-2008. Journal of Clinical Epidemiology, 63, 1179-1194. doi:10.1016/j.jclinepi.2010.04.011
    Chandwani, K. D., Thornton, B., Perkins, G. H., Arun, B., Raghuram, N. V., Nagendra, H. R., … Cohen, L. (2010). Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. Journal of Social and Integrative Oncology, 8, 43-55.
    Chang, P. H., Lai, Y. H., Shun, S. C., Lin, L. Y., Chen, M. L., Yang, Y., … Cheng, S. Y. (2008). Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: A randomized controlled trial. Journal of Pain and Symptom Management, 35, 524-534. doi:10.1016/j.jpainsymman.2007.06.013
    Cheville, A. L., Girardi, J., Clark, M. M., Rummans, T. A., Pittelkow, T., Brown, P., … Gamble, G. (2010). Therapeutic exercise during outpatient radiation therapy for advanced cancer: Feasibility and impact on physical well-being. American Journal of Physical Medicine and Rehabilitation, 89, 611-619. doi:10.1097/PHM.0b013e3181d3e782
    Cohen, L., Warneke, C., Fouladi, R. T., Rodriguez, M. A., & Chaoul-Reich, A. (2004). Psychological adjustment and sleep quality in a randomized trial of the effects of a Tibetan yoga intervention in patients with lymphoma. Cancer, 100, 2253-2260. doi:10.1002/cncr.20236
    Courneya, K. S., & Friedenreich, C. M. (2007). Physical activity and cancer control. Seminars in Oncology Nursing, 23, 242-252. doi:10.1016/j.soncn.2007.08.002
    Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357-374. doi:10.1002/pon.658
    Courneya, K. S., Jones, L. W., Peddle, C. J., Sellar, C. M., Reiman, T., Joy, A. A., … Mackey, J. R. (2008). Effects of aerobic exercise training in anemic cancer patients receiving darbepoetin alfa: a randomized controlled trial. Oncologist, 13, 1012-1020. doi:10.1634/theoncologist.2008-0017
    Courneya, K. S., Segal, R. J., Mackey, J. R., Gelmon, K., Reid, R. D., Friedenreich, C. M., … McKenzie, D. C. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. Journal of Clinical Oncology, 25, 4396-4404. doi:10.1200/JCO.2006.08.2024
    Courneya, K. S., Sellar, C. M., Stevinson, C., McNeely, M. L., Peddle, C. J., Friedenreich, C. M., … Reiman, T. (2009). Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. Journal of Clinical Oncology, 27, 4605-4612. doi:10.1200/JCO.2008.20.0634
    Craft, L. L., Vaniterson, E. H., Helenowski, I. B., Rademaker, A. W., & Courneya, K. S. (2012). Exercise effects on depressive symptoms in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiology Biomarkers and Prevention, 21, 3-19. doi:10.1158/1055-9965.EPI-11-0634
    Cramp, F., & Byron-Daniel, J. (2012). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 11, CD006145. doi:10.1002/14651858.CD006145.pub3
    Cramp, F., & Daniel, J. (2008). Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews, 2, CD006145. doi:10.1002/14651858.CD006145.pub2
    Cramp, F., James, A., & Lambert, J. (2010). The effects of resistance training on quality of life in cancer: A systematic literature review and meta-analysis. Supportive Care in Cancer, 18, 1367-1376. doi:10.1007/s00520-010-0904-z
    Creswell, J. W. (2014). Research design: Qualitative, quantitative, and mixed method approaches (4th ed.). Thousand Oaks, CA: Sage.
    Crowley, S. A. (2003). The effect of a structured exercise program on fatigue, strength, endurance, physical self-efficacy, and functional wellness in women with early stage breast cancer [Doctoral dissertation]. University of Michigan.
    Culos-Reed, S. N., Robinson, J. W., Lau, H., Stephenson, L., Keats, M., Norris, S., … Faris, P. (2010). Physical activity for men receiving androgen deprivation therapy for prostate cancer: Benefits from a 16-week intervention. Supportive Care in Cancer, 18, 591-599. doi:10.1007/s00520-009-0694-3
    Danhauer, S. C., Mihalko, S. L., Russell, G. B., Campbell, C. R., Felder, L., Daley, K., & Levine, E. A. (2009). Restorative yoga for women with breast cancer: Findings from a randomized pilot study. Psycho-Oncology, 18, 360-368. doi:10.1002/pon.1503
    de Oliveira, M. M., Souza, G. A., Miranda, M. S., Okubo, M. A., Amaral, M. T., Silva, M. P., & Gurgel, M. S. (2010). [Upper limbs exercises during radiotherapy for breast cancer and quality of life]. Revista Brasileira de Ginecologia e Obstetricia, 32, 133-138.
    Dimeo, F. C., Stieglitz, R. D., Novelli-Fischer, U., Fetscher, S., & Keul, J. (1999). Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer, 85, 2273-2277.
    DiSipio, T., Rye, S., Newton, M., Guy, L., Spathonis, K., Eakin, E., & Hayes, S. (2009). Exercise for health: A breast cancer recovery program—Quality of life benefits. Asia-Pacific Journal of Clinical Oncology, 5(Suppl. 2), A232.
    Dominique, L., Gilles, D., Annelie, A., Madan, B., Pierre, D., & Ginette, M. (2010). Impact of the yoga Bali method on quality of life and depressive symptoms among women diagnosed with breast cancer undergoing chemotherapy. Psycho-Oncology, 19(Suppl. 2), S136-S140.
    Donnelly, C. M., Blaney, J. M., Lowe-Strong, A., Rankin, J. P., Campbell, A., McCrum-Gardner, E., & Gracey, J. H. (2011). A randomised controlled trial testing the feasibility and efficacy of a physical activity behavioural change intervention in managing fatigue with gynaecological cancer survivors. Gynecolgical Oncology, 122, 618-624. doi:10.1016/j.ygyno.2011.05.029
    Duijts, S. F., Faber, M. M., Oldenburg, H. S., van Beurden, M., & Aaronson, N. K. (2011). Effectiveness of behavioral techniques and physical exercise on psychosocial functioning and health-related quality of life in breast cancer patients and survivors—A meta-analysis. Psycho-Oncology, 20, 115-126. doi:10.1002/pon.1728
    Ferrer, R. A., Huedo-Medina, T. B., Johnson, B. T., Ryan, S., & Pescatello, L. S. (2011). Exercise interventions for cancer survivors: A meta-analysis of quality of life outcomes. Annals of Behavioral Medicine, 41, 32-47. doi:10.1007/s12160-010-9225-1
    Galvao, D. A., Taaffe, D. R., Spry, N., Joseph, D., & Newton, R. U. (2010). Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: A randomized controlled trial. Journal of Clinical Oncology, 28, 340-347. doi:10.1200/JCO.2009.23.2488
    Ganz, P. A., Kwan, L., Stanton, A. L., Krupnick, J. L., Rowland, J. H., Meyerowitz, B. E., … Belin, T. R. (2004). Quality of life at the end of primary treatment of breast cancer: First results from the moving beyond cancer randomized trial. Journal of the National Cancer Institute, 96, 376-387.
    Glasgow, R. E. (2013). What does it mean to be pragmatic? Pragmatic methods, measures, and models to facilitate research translation. Health Education Behavior, 40, 257-265.
    Glasgow, R. E., Magid, D. J., Beck, A., Ritzwoller, D., & Estabrooks, P. A. (2005). Practical clinical trials for translating research to practice: Design and measurement recommendations. Medical Care, 43, 551-557.
    Gomes, A., Fernandes, E. L., Carvalho, M. P., & Fabricio, V. C. (2011). Effectiveness of a brief exercise orientation program on breast cancer induced fatigue. European Journal of Cancer, 47(Suppl. 1), S238-S239.
    Griffith, K., Wenzel, J., Shang, J., Thompson, C., Stewart, K., & Mock, V. (2009). Impact of a walking intervention on cardiorespiratory fitness, self-reported physical function, and pain in patients undergoing treatment for solid tumors. Cancer, 115, 4874-4884. doi:10.1002/cncr.24551
    Hacker, E. D., Larson, J., Kujath, A., Peace, D., Rondelli, D., & Gaston, L. (2011). Strength training following hematopoietic stem cell transplantation. Cancer Nursing, 34, 238-249. doi:10.1097/NCC.0b013e3181fb3686
    Haddad, R., Chandwani, K., Perkins, G., Spelman, A., Johnson, K., Fortier, A., … Cohen, L. (2011). Randomized controlled trial of yoga for women with breast cancer undergoing radiotherapy. Psychosomatic Medicine, 73, A119-A120.
    Headley, J. A., Ownby, K. K., & John, L. D. (2004). The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncology Nursing Forum, 31, 977-983. doi:10.1188/04.ONF.977-983
    Higgins, J. P. T., Altman, D. G., & Sterne, J. A. C. (2001). Chapter 8: Assessing risk of bias in included studies. In J. P. T. Higgins & S. Green (Eds.), Cochrane handbook for systematic reviews of interventions [v.5.1.0]. Retrieved from
    Hwang, J. H., Chang, H. J., Shim, Y. H., Park, W. H., Park, W., Huh, S. J., & Yang, J. H. (2008). Effects of supervised exercise therapy in patients receiving radiotherapy for breast cancer. Yonsei Medical Journal, 49, 443-450. doi:10.3349/ymj.2008.49.3.443
    International Society for Quality of Life Research. (2013). What is health-related quality of life research? Retrieved from
    Jarden, M., Baadsgaard, M. T., Hovgaard, D. J., Boesen, E., & Adamsen, L. (2009). A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT. Bone Marrow Transplantation, 43, 725-737.
    Lee, M. K., Son, B. H., Hwang, S. Y., Han, W., Yang, J. H., Lee, S., & Yun, Y. H. (2007). Factors affecting health-related quality of life in women with recurrent breast cancer in Korea. Quality of Life Research, 16, 559-569. doi:10.1007/s11136-006-9144-6
    Lobb, R., & Colditz, G. A. (2013). Implementation science and its application to population health. Annual Reviews in Public Health, 34, 235-251. doi:10.1146/annurev-publhealth-031912-114444
    McNeely, M. L., Campbell, K. L., Rowe, B. H., Klassen, T. P., Mackey, J. R., & Courneya, K. S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis. CMAJ, 175, 34-41. doi:10.1503/cmaj.051073
    Mishra, S. I., Scherer, R. W., Geigle, P. M., Berlanstein, D. R., Topaloglu, O., Gotay, C. C., & Snyder, C. (2012). Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews, 8, CD007566. doi:10.1002/14651858.CD007566.pub2
    Mishra, S. I., Scherer, R. W., Snyder, C., Geigle, P. M., Berlanstein, D. R., & Topaloglu, O. (2012). Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database of Systematic Reviews, 8, CD008465. doi:10.1002/14651858.CD008465.pub2
    Moadel, A. B., Shah, C., Wylie-Rosett, J., Harris, M. S., Patel, S. R., Hall, C. B., & Sparano, J. A. (2007). Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. Journal of Clinical Oncology, 25, 4387-4395. doi:10.1200/JCO.2006.06.6027
    Mock, V., Burke, M. B., Sheehan, P., Creaton, E. M., Winningham, M. L., McKenney-Tedder, S., … Liebman, M. (1994). A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 21, 899-907.
    Mock, V., Dow, K. H., Meares, C. J., Grimm, P. M., Dienemann, J. A., Haisfield-Wolfe, M. E., … Gage, I. (1997). Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum, 24, 991-1000.
    Mock, V., Frangakis, C., Davidson, N. E., Ropka, M. E., Pickett, M., Poniatowski, B., … McCorkle, R. (2005). Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. Psycho-Oncology, 14, 464-477. doi:10.1002/pon.863
    Mock, V., Pickett, M., Ropka, M. E., Muscari Lin, E., Stewart, K. J., Rhodes, V., … McCorkle, R. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 9, 119-127.
    Monga, U., Garber, S. L., Thornby, J., Vallbona, C., Kerrigan, A. J., Monga, T. N., & Zimmermann, K. P. (2007). Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Archives of Physical Medicine and Rehabilitation, 88, 1416-1422. doi:S0003-9993(07)01448-7
    Moros, M. T., Ruidiaz, M., Caballero, A., Serrano, E., Martinez, V., & Tres, A. (2010). [Effects of an exercise training program on the quality of life of women with breast cancer on chemotherapy]. Revista Medica de Chile, 138, 715-722.
    Mustian, K. M., Peppone, L., Darling, T. V., Palesh, O., Heckler, C. E., & Morrow, G. R. (2009). A 4-week home-based aerobic and resistance exercise program during radiation therapy: A pilot randomized clinical trial. Journal of Supportive Oncology, 7, 158-167.
    Mutrie, N., Campbell, A. M., Whyte, F., McConnachie, A., Emslie, C., Lee, L., … Ritchie, D. (2007). Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ, 334, 517. doi:10.1136/bmj.39094.648553.AE
    National Cancer Institute. (2014). Patient Reported Outcomes Measurement Information System (PROMIS). Retrieved from
    Oh, B., Butow, P., Mullan, B., & Clarke, S. (2008). Medical qigong for cancer patients: Pilot study of impact on quality of life, side effects of treatment and inflammation. American Journal of Chinese Medicine, 36, 459-472.
    Oh, B., Butow, P., Mullan, B., Clarke, S., Beale, P., Pavlakis, N., … Rosenthal, D. (2010). Impact of medical qigong on quality of life, fatigue, mood and inflammation in cancer patients: A randomized controlled trial. Annals of Oncology, 21, 608-614. doi:10.1093/annonc/mdp479
    Raghavendra, R. M., Nagarathna, R., Nagendra, H. R., Gopinath, K. S., Srinath, B. S., Ravi, B. D., … Nalini, R. (2007). Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. European Journal of Cancer Care, 16, 462-474. doi:10.1111/j.1365-2354.2006.00739.x
    Riley, W. T., Glasgow, R. E., Etheredge, L., & Abernethy, A. P. (2013). Rapid, responsive, relevant (R3) research: A call for a rapid learning health research enterprise. Clinical Translational Medicine, 2, 10.
    Rogers, L. Q., Hopkins-Price, P., Vicari, S., Markwell, S., Pamenter, R., Courneya, K. S., … Verhulst, S. (2009). Physical activity and health outcomes three months after completing a physical activity behavior change intervention: persistent and delayed effects. Cancer Epidemiology Biomarkers and Prevention, 18, 1410-1418. doi:10.1158/1055-9965.EPI-08-1045
    Segal, R. J., Evans, W., Johnson, D., Smith, J., Colletta, S., Gayton, J., … Reid, R. (2001). Structured exercise improves physical functioning in women with stages I and II breast cancer: Results of a randomized controlled trial. Journal of Clinical Oncology, 19, 657-665.
    Segal, R. J., Reid, R. D., Courneya, K. S., Malone, S. C., Parliament, M. B., Scott, C. G., … Wells, G. A. (2003). Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology, 21, 1653-1659.
    Segal, R. J., Reid, R. D., Courneya, K. S., Sigal, R. J., Kenny, G. P., Prud'Homme, D. G., … Slovinec D'Angelo, M. E. (2009). Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Journal of Clinical Oncology, 27, 344-351. doi:10.1200/JCO.2007.15.4963
    Speck, R. M., Courneya, K. S., Masse, L. C., Duval, S., & Schmitz, K. H. (2010). An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Journal of Cancer Survivorship, 4, 87-100. doi:10.1007/s11764-009-0110-5
    Stange, K. C., Breslau, E. S., Dietrich, A. J., & Glasgow, R. E. (2012). State-of-the-art and future directions in multilevel interventions across the cancer control continuum. Journal of the National Cancer Institute. Monographs, 44, 20-31. doi:10.1093/jncimonographs/lgs006
    Stevinson, C., Lawlor, D. A., & Fox, K. R. (2004). Exercise interventions for cancer patients: systematic review of controlled trials. Cancer Causes and Control, 15, 1035-1056.
    Tang, M. F., Liou, T. H., & Lin, C. C. (2010). Improving sleep quality for cancer patients: Benefits of a home-based exercise intervention. Supportive Care in Cancer, 18, 1329-1339. doi:10.1007/s00520-009-0757-5
    Targ, E. F., & Levine, E. G. (2002). The efficacy of a mind-body-spirit group for women with breast cancer: a randomized controlled trial. General Hospital Psychiatry, 24, 238-248.
    Tunis, S. R., Stryer, D. B., & Clancy, C. M. (2003). Practical clinical trials: increasing the value of clinical research for decision making in clinical and health policy. JAMA, 290, 1624-1632.
    Vadiraja, H. S., Rao, R. M., Hongasandra, N. R., Nagarathna, R., Rekha, M., Vanitha, N., … Rao, N. (2009). Effects of yoga on symptom management in breast cancer patients: A randomized controlled trial International Journal of Yoga, 2, 73-79.
    Wang, Y. J. (2010). Effects of a six-week home-based walking program on Taiwanese women newly diagnosed with early stage breast cancer [Doctoral dissertation]. State University of New York at Buffalo.
    Warburton, D. E., Nicol, C. W., & Bredin, S. S. (2006). Health benefits of physical activity: the evidence. CMAJ, 174, 801-809. doi:10.1503/cmaj.051351
    Windsor, P. M., Nicol, K. F., & Potter, J. (2004). A randomized, controlled trial of aerobic exercise for treatment-related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma. Cancer, 101, 550-557. doi:10.1002/cncr.20378
    Wiskemann, J., Dreger, P., Schwerdtfeger, R., Bondong, A., Huber, G., Kleindienst, N., … Bohus, M. (2011). Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Blood, 117, 2604-2613. doi:blood-2010-09-306308
    Yang, C. Y., Tsai, J. C., Huang, Y. C., & Lin, C. C. (2011). Effects of a home-based walking program on perceived symptom and mood status in postoperative breast cancer women receiving adjuvant chemotherapy. Journal of Advanced Nursing, 67, 158-168. doi:10.1111/j.1365-2648.2010.05492.x