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. 2012 Aug 15;2012(8):CD008465. doi: 10.1002/14651858.CD008465.pub2

Courneya 2009.

Study characteristics
Methods Study design: RCT
Number randomized: 122; 60 to an exercise group and 62 to the control group
Study start and stop dates: 2005 to 2008
Length of intervention: 12 weeks
Length of follow‐up: 6 months
Participants Type cancer, n (%): lymphoma

  • exercise group: NHL indolent, 25 (41.7%); NHL aggressive, 24 (40.0%); HL, 11 (18.3%)

  • control group: NHL indolent, 27 (43.5%); NHL aggressive, 24 (38.7%); HL, 11 (17.7%)


Stage, n (%):

  • exercise group: Stage I, 11 (18.3%); Stage II, 8 (13.3%); Stage III, 9 (15.0%); Stage IV, 15 (25.0%)

  • control group: Stage I, 7 (11.3%); Stage II, 15 (24.2%); Stage III, 8 (12.9%); Stage IV, 13 (21.0%)


Time since cancer diagnosis, mean (SD) months since diagnosis:

  • exercise group: 25.3 (31.5) months

  • control group: 33.0 (39.0) months


Time in active treatment: not reported, but some participants still being actively treated.
Inclusion criteria:

  • English speaking

  • ≥ 18 years old

  • histologically confirmed HL or NHL

  • receiving chemotherapy or no treatment. Patients receiving chemotherapy may have started treatment before enrolment but needed to have at least 8 weeks of planned treatment remaining


Eligibility criterion related to interest or ability, or both, to exercise:

  • none


Exclusion criteria:

  • uncontrolled hypertension

  • cardiac illness

  • residence > 80 km from facility

  • not approved by their oncologist


Gender, n (%):

  • exercise group: male, 37 (61.7%)

  • control group: male, 35 (56.5%)


Current age, mean (range) years:

  • exercise group: 52.8 (18 to 77) years

  • control group: 53.5 (18 to 80) years


Age at cancer diagnosis: not reported
Ethnicity/race: not reported
Education level, completed university, n (%):

  • exercise group: 31 (51.7%)

  • control group: 32 (51.6%)


SES, income > USD60,000 per year, n (%):

  • exercise group: 34 (63.0%)

  • control group: 39 (62.9%)


Employment status, employed, n (%):

  • exercise group: 22 (36.7%)

  • control group: 32 (51.6%)


Comorbidities, n (%):

  • exercise group: arthritis, 24 (40.0%); hypercholesteremia, 18 (30.0%); hypertension, 14 (23.3%)

  • control group: arthritis, 14 (22.6%); hypercholesteremia, 18 (29.0%); hypertension, 21 (33.9%)


Past exercise history, baseline exerciser, n (%):

  • exercise group: 12 (20.0%)

  • control group: 23 (37.1%)


On hormone therapy: not reported
Current chemotherapy, n (%):

  • exercise group: 28 (46.7%)

  • control group: 26 (41.9%)


Other characteristics, n (%):

  • exercise group: overweight, 27 (45.0%); obese, 16 (26.7%); current smoker, 4 (6.7%)

  • control group: overweight, 20 (32.3%); obese, 17 (27.4%); current smoker, 9 (14.5%)


Other characteristics, mean (SD):

  • exercise group: BMI, 27.4 (4.5) kg/m2; weight (SD), 81.8 (14.8) kg

  • control group: BMI, 26.7 (5.4) kg/m2; weight (SD), 78.5 (17.1) kg
Interventions 60 participants assigned to the exercise group, including:

  • exercise on an upright or recumbent cycle ergometer (Life Fitness, Schiller Park, IL) for 12 weeks

  • 1 session per week of interval training above the ventilatory threshold in week 7

  • 1 session of VO2 peak interval training in week 9


Type exercise (aerobic/anaerobic): aerobic
Intensity of experimental exercise intervention: started at 60% of peak power output (VO2 peak) and increased by 5% each week to 75% by the fourth week
Frequency: 3 times per week
Duration of individual sessions: 15 to 20 minutes for first 4 weeks, increased by 5 minutes per week to 40 to 45 minutes in the ninth week
Duration of exercise program: 12 weeks
Total number of exercise sessions: 36 sessions
Format: group
Facility: facility
Professionally led by an exercise physiologist
62 participants assigned to the control group, including:

  • request not to increase exercise above baseline levels

  • offer of 4 weeks supervised exercise at end of the study


Adherence: attended a mean of 28/36 (77.8%) and a median of 33/36 (91.7%) supervised sessions. Duration and intensity were met during 27.8/28 (99.0%) and 25.4/28 (90.7%) supervised sessions, respectively.

  • 45/60 (75%) participants attended ≥ 66% of sessions

  • 3/60 (65%) participants attended ≥ 80% of sessions

  • 21/60 (35%) participants attended 100% of sessions


Contamination of control group: the mean change in vigorous exercise from baseline: ‐4 minutes

  • 49/62 (79%) participants reported no regular vigorous exercise during intervention

  • 13/62 (21%) participants reported regular vigorous exercise during intervention
Outcomes Primary outcome: patient‐rated physical functioning, assessed using the TOI‐An from the FACT‐An scale
Secondary QoL outcomes included:

  • total FACT‐An

  • FACT‐Fatigue subscale

  • happiness, assessed by the Happiness scale

  • depression, assessed by the CES‐D

  • anxiety, assessed by the SF STAI

  • lymphoma symptoms, assessed by the lymphoma scale of the FACT

  • general health by the single item on the MOS SF‐12


Outcomes were measured at baseline, 12 weeks, and 6 months:

  • exercise group: n = 60 at baseline, n = 57 at 12 weeks, n = 55 at 6 months

  • control group: n = 62 at baseline, n = 60 at 12 weeks, n = 55 at 6 months


Subgroup analyses: major disease type, current treatment status (on chemotherapy versus not), patient preference, age, sex, marital status, disease stage at entry, general health, BMI
Adverse events: 3 adverse events related to exercise (back, hip, knee)
Notes Country: Canada
Funding: Lance Armstrong Foundation; Canada Research Chairs Program; Alberta Heritage Foundation for Medical Research; NCIC; and by the CCS and the NCIC/CCS Sociobehavioral Cancer Research Network
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk "computer‐generated sequence"
Allocation concealment (selection bias) Low risk  "The allocation sequence was generated independently and concealed in opaque envelopes from the study coordinator who assigned participants to groups."
Blinding of participants and personnel (performance bias)
All outcomes High risk Owing to the nature of the intervention, it was not possible to conceal allocation to the intervention from the participants
Blinding of outcome assessment (detection bias)
All outcomes High risk "Outcomes assessors were not always blinded to group assignment but were trained in standardizing testing procedures."
Incomplete outcome data (attrition bias)
All outcomes High risk Although stated ITT analyses, missing data were not accounted for. In exercise group, 3 participants did not complete QoL measures postintervention and 3 at 6 months
In control group, 2 participants did not complete QoL measures postintervention, and 5 at 6 months
Selective reporting (reporting bias) Low risk There appears to be no selective reporting of outcomes
Other bias Low risk The trial appears to be free of other problems that could put it at a high risk of bias