Clinical Review | Gerontology
Exercise Interventions Found to Alleviate Depression and Anxiety in Older Cancer Patients
Time to read: 05:10
Time to listen: 11:08
Published on MedED: 12 February 2025
Originally Published: 04 February 2025
Source: JAMA Network Open
Type of article: Clinical Research Summary
MedED Catalogue Reference: MCCS014
Category: Gerontology
Cross-reference: Oncology
Keywords: mental health, depression, anxiety, oncology, physical health, exercise science
Originally Published in JAMA Network Open, 4 February 2025. This is a summary of the clinical study and in no way represents the original research. Unless otherwise indicated, all work contained here is implicitly referenced to the original author and trial. Links to all original material can be found at the end of this summary. Access the Disclaimer
Key Take Aways
1. This systematic review and meta-analysis found that exercise was significantly linked to reduced depression and anxiety and improved health-related quality of life (HRQOL) in older adults with cancer.
2. Notably, mind-body exercises such as yoga and tai chi showed the most profound benefits.
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Study Context | Objectives | Study Design | Findings | Discussion| Limitations | Conclusion | Original Research | Funding | References
Cancer remains a major global health challenge, with cases projected to rise from 19.96 million in 2022 to over 35 million by 2050.¹ The disease predominantly affects older adults, with two-thirds of new diagnoses occurring in individuals aged 60 and above.¹,²
Beyond its physical toll, cancer is closely linked to mental health challenges. Up to 35% of patients are diagnosed with psychiatric disorders, and psychological distress significantly increases the risk of suicide—nearly four times higher than in the general population. Additionally, distress can impair immune function, increasing the risk of cancer recurrence and mortality.3
Exercise therapy, which extends beyond routine physical activity, has shown promise in alleviating cancer-related symptoms, reducing depression, anxiety, fatigue, and treatment side effects..3
A recent large-scale South African study, published in January 2025, examined the physical activity levels of 28,248 patients with stage 1 cancer enrolled in an oncology program. Researchers categorized physical activity in the 12 months before diagnosis as : no activity, low activity (<60 minutes per week), and moderate-to-high activity (≥60 minutes per week). Key outcomes measured included time to progression, overall survival, and all-cause mortality.4
Findings revealed that physically active patients had lower rates of cancer progression and all-cause mortality, reinforcing the potential benefits of exercise.
In the study under review here, the authors conducted a meta-analysis of randomized clinical trials to explore the role of exercise in alleviating mental distress and enhancing quality of life in older cancer patients, comparing mind-body exercises with conventional exercise approaches.
To determine if exercise interventions are associated with improvements in psychological outcomes among older adults with cancer.
This protocol was registered on PROSPERO (CRD42023394964).
Eligible studies were those that analysed depression, anxiety, or HRQOL, with control groups receiving usual care. Data were screened and extracted independently by two authors.
Random-effects meta-analyses and meta-regressions were performed following PRISMA guidelines. Standardized mean difference (SMD) was used to quantify the association of exercise interventions.
The analysis included 1,929 participants across various cancer types, with prostate cancer being the most studied.
Exercise interventions varied in intensity, duration, and format, with both conventional (e.g., resistance and aerobic training) and mind-body exercises (e.g., yoga and tai chi) examined.
The following findings were recorded:
Notably, mind-body exercises showed the most profound effect (SMD = -0.89; 95% CI, -1.51 to -0.27), surpassing conventional exercise methods. Additionally, longer exercise interventions (12 weeks or more) proved more effective in alleviating depressive symptoms. Age, cancer type, and other intervention characteristics did not appear to influence the extent of improvement.
More Than Just Physical Gains
Among 26 studies (1,866 participants), exercise interventions were found to significantly improve HRQOL (SMD = 0.63; 95% CI, 0.10-1.17).
The Bigger Picture: Social and Demographic Influences
This systematic review and meta-analysis found that exercise was significantly linked to reduced depression and anxiety and improved health-related quality of life (HRQOL) in older adults with cancer.
The study highlighted that mind-body exercises, such as walking meditation, were more effective than conventional exercises like aerobic or resistance training in reducing anxiety and depression levels.
The benefits of exercise are likely due to mechanisms including the release of neurotransmitters that stimulate brain-derived neurotrophic factor, enhancing mood control and neurogenesis, as well as improving sleep quality, which has a reciprocal relationship with mental health.
Furthermore, longer interventions, particularly those lasting at least 12 weeks, were found to be more effective in reducing depression. This aligns with previous findings suggesting that sustained exercise, especially of moderate intensity, has significant psychological benefits for cancer survivors.
Clinical Note
Interpreting the Evidence: Bias and Limitations
A risk of bias assessment determined that 10 studies carried a low risk, 15 had potential concerns, and two were classified as high-risk. Some publication bias was detected, though the overall findings remain robust.
Limitations
This study faced several limitations. There was significant heterogeneity in measuring and defining confounding variables such as education, income, marital status, and social support, which are well-studied globally across different age groups and cancer types. Additionally, variations in the duration, frequency, and supervision of interventions prevented the statistical pooling of these variables, leading to the adoption of a synthesis without a meta-analysis approach.
The diverse health statuses and treatments of participants introduced variability, potentially affecting the generalizability of findings. Furthermore, controls did not receive equal attention as exercise groups, making it difficult to determine if observed effects were due to exercise or attention.
Conclusion
This systematic review and meta-analysis reinforce the importance of exercise as a key intervention, demonstrating significant improvements in depression, anxiety, and HRQOL among older adults with cancer. Notably, mind-body exercises such as yoga and tai chi showed the most profound benefits.
Given these findings, healthcare professionals and policymakers should prioritize the integration of structured exercise programs into cancer care. By doing so, they can help mitigate the psychosocial burdens of cancer and enhance the overall well-being of this vulnerable population.
Importance of this study for South Africa
In South Africa, cancer poses a significant health challenge, with the National Cancer Registry reporting a lifetime risk of 1 in 8 for females and 1 in 6 for males. The median age at death due to cancer is 62 for females and 64 for males, indicating a substantial impact on the elderly population. Regular physical activity has been shown to reduce cancer progression and mortality rates.5
These findings suggest that incorporating exercise interventions could be a vital strategy to improve health outcomes for South Africa's ageing cancer population.
Access the Study
Soong, R. Y., Low, C. E., Ong, V., Sim, I., Lee, C., Lee, F., Chew, L., Yau, C. E., Lee, A. R. Y. B., & Chen, M. Z. (2025). Exercise Interventions for Depression, Anxiety, and Quality of Life in Older Adults With Cancer: A Systematic Review and Meta-Analysis. JAMA network open, 8(2), e2457859. https://doi.org/10.1001/jamanetworkopen.2024.57859
Conflict of Interest, Funding and Support
Role of the Funder/Sponsor
No information available
Conflict of Interest Disclosures
Full declaration available online
Funding/Support
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References
2. KPMG. When cancer grows old: assessing the socio-economic burden of cancer and ageing and the policies required. Published February 2022. Accessed December 23, 2024. https://assets.kpmg.com/content/dam/kpmg/sg/pdf/2022/02/socio-economic-burden-of-cancer-and-ageing.pdf
3. Low CE, Yau CE, Tan RY, et al. Association of depression with all-cause and cancer-specific mortality in older adults with cancer: systematic review, meta-analysis, and meta-regression. J Geriatr Oncol. 2024;15(4):101700. doi:10.1016/j.jgo.2023.101700
4. Mabena, N., Rugbeer, N., Lehmann, S., Torres, G., et al (2025). Association between recorded physical activity and cancer progression or mortality in individuals diagnosed with cancer in South Africa. British journal of sports medicine, bjsports-2024-108813. Advance online publication. https://doi.org/10.1136/bjsports-2024-108813
5. 30 March 2023 | StatsticsSA.gov |Cancer report – A look at the latest findings
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