Effects of traditional Chinese exercise on cancer-related sleep disturbance: current evidence and directions for future research and practice

Introduction: Sleep disturbance is one of the major symptoms experienced by cancer patients. Up to 75% of patients had experienced sleep disturbance. Traditional Chinese exercise (TCE) is widely utilised by cancer patients to relieve sleep disturbance. In the past decade, the number of studies on TCE for cancer-related sleep disturbance (CRSD) has been increasing. However, relevant research evidence has not been systematically summarised.

Objective: This systematic review aimed to summarise and critically assess the effects of TCE on sleep disturbance in cancer patients.

Methods: A systematic search was performed in the eleven databases from their inception to July 2019. Randomised controlled trials (RCTs) assessing the effects of TCE on CRSD were included. The primary outcome was the change in cancer-related sleep quality as measured by questionnaires. The secondary outcome was adverse events related to TCE intervention. The Cochrane risk of bias criteria was used to evaluate the methodological quality of all the included articles. Descriptive analysis was used to narratively summarise the study’s findings.

Results: Ten published studies and three ongoing clinical trials were included. TCE has a significantly better effect on sleep disturbance than the usual care. However, contradictory findings were reported in three studies, in which TCE was compared with other exercises. Only one trial compared true TCE with a sham intervention. The true TCE group was not significantly better than the sham group in managing sleep disturbance. In addition, no statistically significant difference can be found between the TCE group and cognitive behaviour therapy for insomnia (CBT-I) group in terms of sleep disturbance management, although the result trend favoured the TCE group.

Conclusion: The results indicated TCE could be an effective approach for the improvement of CRSD. However, the research evidence is inconclusive given the limited quantity and methodological quality of the included studies. Rigorously designed large-scale, sham-controlled RCTs are warranted to further explore the role of TCE in the management of CRSD.