Table 2.

Summary of included studies investigating the effects of an exercise intervention on sleep disturbances. Abbreviations: CG, Control Group; IG, Intervention Group.

Study	Participants	Study Design and Follow-up	Exercise Protocol	CIPN measures	Outcomes
Cheville et al. (2013)	Stage IV lung or colorectal cancer patients (44% undergoing chemotherapy) (N = 66) IG: N = 33 CG: N = 33	RCT, outcomes measured at baseline and after 8-week intervention	Type: home-based incremental walking and resistance training (2 sets of 5 exercises, one upper body and one lower body) Frequency: 4 strength and 4 walking sessions/week (total 8 weeks) Intensity: Resistance: use of band that required moderate force but maintained control Aerobic: walking briskly at pace of 1 mile in 20 min Time: strength based on repetitions, walking duration not explicitly stated	Objective: None Subjective: patient-reported scale to assess sleep quality (0–11), Functional Assessment of Cancer Therapy (FACT)-fatigue subscale (0–52)	Following the intervention, IG reported significantly better sleep quality (p = 0.05) and less fatigue (p = 0.02) than CG. There were significant differences between IG and CG in mean changes in sleep scores (+1.46 vs. –0.10, p = 0.002) and fatigue scores (+4.46 vs. –0.79, p = 0.03) across the intervention, favoring IG.
Courneya et al. (2014)	Breast cancer patients, ongoing chemotherapy (N = 301) Standard dose of aerobic exercise (STAN): N = 96 Higher dose of aerobic exercise (HIGH): N = 101 Combined dose of aerobic and resistance exercise (COMB): N = 104	RCT, outcomes measured at baseline, 2x during chemotherapy, 1x post-chemotherapy	Type: at-home aerobic or combined aerobic plus resistance training (2 sets of 10–12 reps of nine different exercises) Frequency: 3 days/week (Total duration based on duration of chemotherapy) Intensity: Aerobic: “vigorous” Resistance: 60–75% of estimated 1RM Time: STAN: 25–30 min/session HIGH: 50–60 min/session COMB: 25–30 min of aerobic exercise and 30–35 min of strength training	Objective: none Subjective: Pittsburg Sleep Quality Index (PSQI) (global sleep quality scale 0–21, individual components scale 0–3)	Compared to STAN, HIGH reported significantly better global sleep quality (p = 0.039; Cohen’s d = 0.22), subjective sleep quality (p = 0.028; d = 0.26), and sleep latency (p = 0.049; d = 0.18) following intervention. Compared to STAN, COMB reported borderline significantly better global sleep quality (p = 0.085; d = 0.19) and sleep duration (p = 0.051; d = 0.22), significantly better sleep efficiency (p = 0.040; d = 0.24), and significantly lower proportion of poor sleepers (p = 0.045; d = 0.20) following intervention. Compared to COMB, HIGH reported significantly better sleep latency (p = 0.040; d = 0.20) following the intervention.
Courneya et al. (2012)	Lymphoma patients (45% undergoing chemotherapy) (N = 122) IG: N = 60 CG: N = 62	RCT, outcomes measured at baseline and after 12-week exercise intervention	Type: supervised cycle ergometer Frequency: 3 sessions/week (total 12 weeks) Intensity: began at 60% of peak oxygen consumption (VO2peak) and was increased by 5% each week to reach 75% by the 4th week Time: began at 15–20 min per session, increased by 5 min per week to reach 40–45 min by the 9th week	Objective: none Subjective: Pittsburg Sleep Quality Index (PSQI)	No significant difference between IG and CG in change in global sleep quality (–0.64, p = 0.16; d = -0.19) or any component scores. Borderline significant reduction in percentage of poor sleepers favoring IG (–14.2, p = 0.086; d = -0.27). In planned subgroup analysis, exercise resulted in improved global sleep quality in patients currently receiving chemotherapy (p = 0.013; d = -0.50), but not in off-treatment patients (p = 0.72).
Ligibel et al. (2016)	Metastatic breast cancer patients (42% undergoing chemotherapy) (N = 101) IG: N = 48 CG: N = 53	RCT, outcomes measured at baseline and after 16-week intervention	Type: home based aerobic exercise Frequency: not specified (total 16 weeks) Intensity: “moderate” Time: 150 min/week	Objective: none Subjective: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTQLQ C-30), insomnia subscale	No significant differences between IG and CG in changes in global quality of life (7.0, p = 0.17), fatigue (-5.4, p = 0.63), or insomnia (-3.7, p = 0.22).
Schmidt et al. (2015)	Breast cancer patients, ongoing chemotherapy (N = 81) Endurance group: N = 29 Resistance group: N = 24 CG: N = 28	RCT, outcomes measured at baseline and after 12-week intervention	Type: supervised indoor bike or resistance training (10 strength exercises) Frequency: twice weekly (total 12 weeks) Intensity: Endurance: RPE of 11–14 Resistance: 50% hypothetical 1RM for 20 reps of each exercise Time: 60-minute sessions	Objective: none Subjective: European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTQLQ C-30) version 3 BR23 with insomnia subscale, Multidimensional Fatigue Inventory 20 questions (MFI-20)	RT showed significant improvement in QOL (p = 0.011), ET borderline improvement (p = 0.09), and CG no significant change (p = 0.80). There were no significant changes in insomnia or fatigue for either RT or ET groups, as well as the control group.
Tang et al. (2010)	Cancer patients with varying cancer types (14% undergoing chemotherapy) (N = 71) IG: N = 36) CG: N = 35	RCT, outcomes measured at baseline and after 8-week intervention	Type: home-based walking Frequency: 3 days/week (total 8 weeks) Intensity: RPE of 11–13 Time: 30 min each day	Objective: none Subjective: Taiwanese version of the Pittsburg Sleep Quality Index, Medical Outcomes Study Short Form-36 to measure QOL	IG reported significant improvements in sleep quality (p < 0.01) and the mental health dimension of quality of life (p < 0.01) In the IG, improved sleep quality was associated with reduced bodily pain (p = 0.04) and improved mental health over time (p < 0.01)
Wang et al. (2011)	Early stage breast cancer patients, ongoing chemotherapy (N = 72) IG: N = 35 CG: N = 37	RCT, outcomes measured at 24 h prior to surgery (T0), 24 h prior to the first chemotherapy cycle (T1), day of expected nadir (T2), and end of 6-week intervention (T3)	Type: home-based walking (along with strategies to improve self-efficacy) Frequency: 3–5 sessions/week (total 6 weeks) Intensity: HRmax of 40–60% Time: 30 min per session	Objective: none Subjective: PSQI, FACT-G version 4 for QOL, FACIT-F fatigue scale	Subjects in exercise group had significantly better quality of life (p < 0.001 & p = 0.011) and less sleep disturbances (p < 0.001 & p = 0.006) over time (p values indicate linear growth rate and quadratic growth rate, respectively) Exercise group had less fatigue than the control group after the intervention period (p = 0.003)
Wenzel et al. (2013)	Prostate, breast, and other solid tumor cancer patients (35% undergoing chemotherapy, others undergoing other cancer treatments) (N = 138) IG: N = 68 CG: N = 58	RCT, outcomes measured at baseline and after each individual’s treatment regimen (ranging from 5 to 35 weeks)	Type: home-based walking Frequency: 5 days/week (total weeks dependent on cancer treatment) Intensity: “brisk” Time: 20–30 min sessions	Objective: none Subjective: PSQI, modified Piper Fatigue Scale (PFS)	Sleep quality for both groups was not statistically different No significant difference in fatigue between groups Regardless of randomization, patients who engaged in more aerobic exercise reported less fatigue (p = 0.035).