A randomized trial of aerobic exercise and sleep quality in lymphoma patients receiving chemotherapy or no treatments

Background: Patients with lymphoma experience sleep problems that may be managed with aerobic exercise but no previous study has examined this issue. Methods: We randomized 122 patients with lymphoma to usual care (n ¼ 62) or 12 weeks of supervised aerobic exercise training (AET; n ¼ 60). Our primary sleep endpoint was global sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). Secondary endpoints were the PSQI component scores. Planned subgroup analyses were also conducted. Results: Intention-to-treat analyses indicated that AET resulted in a nonsignificant (P ¼ 0.16) improvement in global sleep quality compared with usual care [mean group difference¼ 0.64; 95% confidence interval (CI), 1.56 to þ0.27]. In planned subgroup analyses, statistically significant or borderline significant interactions were identified for type of lymphoma (Pinteraction ¼ 0.006), current treatment status (Pinteraction ¼ 0.036), time since diagnosis (Pinteraction ¼ 0.010), body mass index (Pinteraction ¼ 0.075), and baseline sleep quality (Pinteraction ¼ 0.041). Specifically, AET improved global sleep quality in patients with lymphoma who had indolent non–Hodgkin lymphoma (P ¼ 0.001), were receiving chemotherapy (P ¼ 0.013), were <2 years post-diagnosis (P ¼ 0.005), were obese (P ¼ 0.025), and were poor sleepers at baseline (P ¼ 0.007). Conclusions: AET did not significantly improve sleep quality in this heterogeneous sample of patients with lymphoma; however, clinically identifiable subgroups appeared to benefit. Future exercise trials targeting these responsive subgroups are needed to confirm these findings. Impact: If replicated in larger and more focused trials, aerobic exercise may be an attractive option to manage sleep dysfunction in patients with cancer because of its favorable safety profile and other documented health benefits.