Dose–response effects of aerobic exercise intensity on anxiety, sleep, and well-being in cancer survivors: A multi-arm randomized controlled trial
Abstract
Cancer survivors frequently experience psychological challenges including anxiety, sleep disturbances, and diminished well-being, with anxiety affecting 18%–40% and sleep disruptions impacting 30%–50% of survivors will post-treatment. While exercise is recognized as beneficial for this population, the optimal intensity remains unclear. This study investigated the dose-response relationship between aerobic exercise intensity and psychological outcomes through a randomized controlled trial with 160 cancer survivors assigned to high-intensity interval training (HIIT), moderate-intensity continuous training (MICT), low-intensity exercise (LIE), or usual care control for 12 weeks with 3-month follow-up. The HIIT group demonstrated significantly greater improvements in anxiety (mean reduction: 10.4 points, 95% CI: −12.3 to −8.5), sleep quality (mean improvement: 4.1 points, 95% CI: −4.8 to −3.4), and quality of life (mean increase: 14.9 points, 95% CI: 12.5 to 17.3) compared to MICT, LIE, and control groups. Regression analyses revealed an intensity-dependent pattern, with each 10% increase in exercise intensity associated with an additional reduction of 1.8 points in anxiety scores. Age and BMI significantly moderated these effects, with younger participants showing stronger associations. All exercise protocols demonstrated good safety profiles and adherence rates (HIIT: 82.3%, MICT: 85.1%, LIE: 86.7%). This research provides evidence that higher-intensity exercise protocols may optimize psychological health outcomes in cancer survivors when appropriately supervised and individualized.
Copyright (c) 2026 Haoyang Ling, Sheng Guo, Zhixin Zeng, Yu Zhou
This work is licensed under a Creative Commons Attribution 4.0 International License.
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