- Design
- Systematic review and meta-analysis of randomised trials
- Population
- 15 trials, 1,041 adults with lung cancer
- Primary outcome
- Depressive symptom scores
- Effect
- Hedges' g -0.75 (95% CI -1.18 to -0.32); I² 87%; prediction interval -2.27 to 0.76
This meta-analysis pooled 15 randomised trials with 1,041 adults with lung cancer comparing structured exercise with usual care or another rehabilitation approach.
Exercise reduced depressive symptom scores (Hedges' g -0.75, 95% CI -1.18 to -0.32), but heterogeneity was very high (I² 87%) and the prediction interval crossed zero. Removing two influential studies shrank the effect to -0.49 and removed the heterogeneity. Certainty was rated very low.
Exercise is already part of good supportive care for other reasons. This analysis does not show it treats major depression, and patients with significant depression still need assessment and treatment in their own right.
- Encourage structured exercise within the patient's capacity during and after lung cancer treatment.
- Screen for depression and treat it; do not rely on exercise alone.
- Refer to pulmonary or cancer rehabilitation where available.
- Tailor exercise to breathlessness, anaemia and bone metastases.
Why it matters
It supports exercise as a low-risk addition to care, while showing how uncertain the size of its mood benefit is.
Don't overread it
Very low certainty evidence; it does not show exercise treats major depressive disorder.
The statistics, in plain English
A Hedges' g of -0.75 is a moderate to large effect on paper. But when studies disagree this much, the prediction interval, which crosses zero, is a better guide to what a new setting might see: anything from a large benefit to none.
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