Supportive Care in Cancer

, Volume 27, Issue 5, pp 1601–1612 | Cite as

Group-based exercise interventions for increasing physical activity in cancer survivors: a systematic review of face-to-face randomized and non-randomized trials

  • Heather J. LeachEmail author
  • Scherezade K. Mama
  • Samantha M. Harden
Review Article



To increase physical activity (PA), interventions based on group dynamics may be superior to interventions that target aggregates of people but do not have formal strategies to enhance cohesion. This review examined the extent to which group dynamics processes have been integrated within exercise and/or PA interventions in cancer survivors, and explored the implementation and effectiveness of these interventions for increasing PA.


A systematic review was conducted of English articles published January 2005–March 13, 2017 using the electronic databases PsycINFO, CINAHL, and PubMed Medline (National Library of Medicine). Studies in adult cancer survivors that had a controlled or uncontrolled experimental design, included face-to-face exercise, had a group-based component, and reported PA pre- and post-intervention were included. Self-reported PA effect sizes were estimated for pre- to post-intervention, separately for studies that implemented ≥ 1 group dynamics strategy versus none.


Twenty-three studies were reviewed, 34.8% (n = 8) included ≥ 1 group dynamics strategy (M = 1.6 ± 0.7, range = 1–3). Most interventions were delivered in a healthcare or rehabilitation setting by an exercise professional, and face-to-face exercise dose ranged from 72.0–6000.0 min. PA effect size ranged from 0.3–1.2 for studies that implemented ≥ 1 group dynamics strategy versus 0.4–2.4 for those with none. Studies reviewed lacked detailed examples of group dynamics strategies, and none measured group cohesion.


The additional benefit of group dynamics–based interventions for increasing PA in cancer survivors remains unclear. More research is needed to enhance the generalizability of face-to-face exercise interventions, and determine how to maximize the potential of including group dynamics strategies.


Physical activity Intervention studies Group structure Cancer survivor 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Aarons GA, Sklar M, Mustanski B, Benbow N, Brown CH (2017) “Scaling-out” evidence-based interventions to new populations or new health care delivery systems. Implement Sci 12:111CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    American Cancer Society (2016) Cancer treatment & survivorship: facts & figures 2016–2017. In: Editor (ed)^(eds) Book Cancer treatment & survivorship: facts & figures 2016–2017, CityGoogle Scholar
  3. 3.
    Barber FD (2012) Social support and physical activity engagement by cancer survivors. Clin J Oncol Nurs 16:E84–E98CrossRefPubMedGoogle Scholar
  4. 4.
    Basen-Engquist K, Alfano CM, Maitin-Shepard M, Thomson CA, Schmitz KH, Pinto BM, Stein K, Zucker DS, Syrjala KL, Fallon E, Doyle C, Demark-Wahnefried W (2017) Agenda for translating physical activity, nutrition, and weight management interventions for cancer survivors into clinical and community practice. Obesity (Silver Spring) 25(Suppl 2):S9–S22CrossRefGoogle Scholar
  5. 5.
    Beauchamp MR, Carron AV, McCutcheon S, Harper O (2007) Older adults’ preferences for exercising alone versus in groups: considering contextual congruence. Ann Behav Med 33:200–206CrossRefPubMedGoogle Scholar
  6. 6.
    Bloom JR, Stewart SL, D’Onofrio CN, Luce J, Banks PJ (2008) Addressing the needs of young breast cancer survivors at the 5 year milestone: can a short-term, low intensity intervention produce change? J Cancer Surviv 2:190–204CrossRefPubMedGoogle Scholar
  7. 7.
    Broderick JM, Guinan E, Kennedy MJ, Hollywood D, Courneya KS, Culos-Reed SN, Bennett K, DM OD, Hussey J (2013) Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial. J Cancer Surviv 7:551–562CrossRefPubMedGoogle Scholar
  8. 8.
    Broderick JM, Ryan J, O’Donnell DM, Hussey J (2014) A guide to assessing physical activity using accelerometry in cancer patients. Support Care Cancer 22:1121–1130CrossRefPubMedGoogle Scholar
  9. 9.
    Bruun DM, Krustrup P, Hornstrup T, Uth J, Brasso K, Rorth M, Christensen JF, Midtgaard J (2014) “All boys and men can play football”: a qualitative investigation of recreational football in prostate cancer patients. Scand J Med Sci Sports 24(Suppl 1):113–121CrossRefPubMedGoogle Scholar
  10. 10.
    Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, May AM, Galvao DA, Chinapaw MJ, Steindorf K, Irwin ML, Stuiver MM, Hayes S, Griffith KA, Lucia A, Mesters I, van Weert E, Knoop H, Goedendorp MM, Mutrie N, Daley AJ, McConnachie A, Bohus M, Thorsen L, Schulz KH, Short CE, James EL, Plotnikoff RC, Arbane G, Schmidt ME, Potthoff K, van Beurden M, Oldenburg HS, Sonke GS, van Harten WH, Garrod R, Schmitz KH, Winters-Stone KM, Velthuis MJ, Taaffe DR, van Mechelen W, Kersten MJ, Nollet F, Wenzel J, Wiskemann J, Verdonck-de Leeuw IM, Brug J (2017) Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev 52:91–104CrossRefPubMedGoogle Scholar
  11. 11.
    Burke SM, Carron AV, Eys MA, Ntoumanis N, Estabrooks PA (2006) Group versus individual approach? A meta-analysis of the effectiveness of interventions to promote physical activity. Sport & Exercise Psychology Review 2:13–29Google Scholar
  12. 12.
    Carron AV, Spink KS (1993) Team building in an exercise setting. Sport Psychol 7:8–18CrossRefGoogle Scholar
  13. 13.
    Carron AV, Hausenblas HA, Mack D (1996) Social influence and exercise: a meta-analysis. J Sport Exerc Psychol 18:1–16CrossRefGoogle Scholar
  14. 14.
    Carter CL, Onicescu G, Cartmell KB, Sterba KR, Tomsic J, Alberg AJ (2012) The comparative effectiveness of a team-based versus group-based physical activity intervention for cancer survivors. Support Care Cancer 20:1699–1707CrossRefPubMedGoogle Scholar
  15. 15.
    Casla S, Hojman P, Cubedo R, Calvo I, Sampedro J, Barakat R (2014) Integrative exercise and lifestyle intervention increases leisure-time activity in breast cancer patients. Integr Cancer Ther 13:493–501CrossRefPubMedGoogle Scholar
  16. 16.
    Clifford BK, Mizrahi D, Sandler CX, Barry BK, Simar D, Wakefield CE, Goldstein D (2018) Barriers and facilitators of exercise experienced by cancer survivors: a mixed methods systematic review. Support Care Cancer 26:685–700CrossRefPubMedGoogle Scholar
  17. 17.
    Collins LM, Chakraborty B, Murphy SA, Strecher V (2009) Comparison of a phased experimental approach and a single randomized clinical trial for developing multicomponent behavioral interventions. Clin Trials 6:5–15CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Collins LM, Nahum-Shani I, Almirall D (2014) Optimization of behavioral dynamic treatment regimens based on the sequential, multiple assignment, randomized trial (SMART). Clin Trials 11:426–434CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Culos-Reed SN, Shields C, Brawley LR (2005) Breast cancer survivors involved in vigorous team physical activity: psychosocial correlates of maintenance participation. Psychooncology 14:594–605CrossRefPubMedGoogle Scholar
  20. 20.
    Culos-Reed SN, Robinson JL, Lau H, O’Connor K, Keats MR (2007) Benefits of a physical activity intervention for men with prostate cancer. J Sport Exerc Psychol 29:118–127CrossRefPubMedGoogle Scholar
  21. 21.
    Culos-Reed SN, Robinson JW, Lau H, Stephenson L, Keats M, Norris S, Kline G, Faris P (2010) Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention. Support Care Cancer 18:591–599CrossRefPubMedGoogle Scholar
  22. 22.
    Curran GM, Bauer M, Mittman B, Pyne JM, Stetler C (2012) Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 50:217–226CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Cuthbert CA, King-Shier K, Ruether D, Tapp DM, Culos-Reed SN (2017) What is the state of the science on physical activity interventions for family caregivers? A systematic review and RE-AIM evaluation. J Phys Act Health 14:578–595CrossRefPubMedGoogle Scholar
  24. 24.
    Dishman RK, Buckworth J (1996) Increasing physical activity: a quantitative synthesis. Med Sci Sports Exerc 28:706–719CrossRefPubMedGoogle Scholar
  25. 25.
    Emslie C, Whyte F, Campbell A, Mutrie N, Lee L, Ritchie D, Kearney N (2007) I wouldn’t have been interested in just sitting round a table talking about cancer’; exploring the experiences of women with breast cancer in a group exercise trial. Health Educ Res 22:827–838CrossRefPubMedGoogle Scholar
  26. 26.
    Estabrooks PA (2007) Group integration intervention in exercise. Theory, practice and future directions. In: Beauchamp MR, Eys MA (eds) Group dynamics in exercise and sport psychology. Routledge, New York, pp 141–156Google Scholar
  27. 27.
    Estabrooks PA, Smith-Ray RL, Almeida FA, Hill J, Gonzales M, Schreiner P, Van Den Berg R (2011) Move more: translating an efficacious group dynamics physical activity intervention into effective clinical practice. Int J Sport Exerc Psychol 9:4–18CrossRefGoogle Scholar
  28. 28.
    Estabrooks PA, Smith-Ray RL, Dzewaltowski DA, Dowdy D, Lattimore D, Rheaume C, Ory MG, Bazzarre T, Griffin SF, Wilcox S (2011) Sustainability of evidence-based community-based physical activity programs for older adults: lessons from active for life. Transl Behav Med 1:208–215CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Estabrooks PA, Harden SM, Burke SM (2012) Group dynamics in physical activity promotion: what works? Soc Personal Psychol Compass 6:18–40CrossRefGoogle Scholar
  30. 30.
    Estabrooks PA, Harden SM, Johnson SB, Pardo KA (2014) Group integration interventions in exercise: theory, practice, and future directions. In: Beauchamp MR, Eys MA (eds) Group dynamics in exercise and sport psychology. Routledge, New YorkGoogle Scholar
  31. 31.
    Eys M, Kim J (2017) Team building and group cohesion in the context of sport and performance psychology. In: Editor (ed)^(eds) Book Team building and group cohesion in the context of sport and performance psychology. Oxford University Press, CityGoogle Scholar
  32. 32.
    Ferrer RA, Huedo-Medina TB, Johnson BT, Ryan S, Pescatello LS (2011) Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes. Ann Behav Med 41:32–47CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Floyd A, Moyer A (2009) Group vs. individual exercise interventions for women with breast cancer: a meta-analysis. Health Psychol Rev 4:22–41CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Harden SM, Burke SM, Haile AM, Estabrooks PA (2015) Generalizing the findings from group dynamics-based physical activity research to practice settings: what do we know? Eval Health Prof 38:3–14CrossRefPubMedGoogle Scholar
  35. 35.
    Harden SM, McEwan D, Sylvester BD, Kaulius M, Ruissen G, Burke SM, Estabrooks PA, Beauchamp MR (2015) Understanding for whom, under what conditions, and how group-based physical activity interventions are successful: a realist review. BMC Public Health 15:958CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Higgins JPT, Green S (2011) Cochrane handbook for systematic reviews of interventions version 5.1.0. In: Editor (ed)^(eds) Book Cochrane handbook for systematic reviews of interventions version 5.1.0, CityGoogle Scholar
  37. 37.
    Hyland KA, Jacobs JM, Lennes IT, Pirl WF, Park ER (2018) Are cancer survivors following the national comprehensive cancer network health behavior guidelines? An assessment of patients attending a cancer survivorship clinic. J Psychosoc Oncol 36:64–81CrossRefPubMedPubMedCentralGoogle Scholar
  38. 38.
    Jankowski CM, Ory MG, Friedman DB, Dwyer A, Birken SA, Risendal B (2014) Searching for maintenance in exercise interventions for cancer survivors. J Cancer Surviv 8:697–706CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Kampshoff CS, Jansen F, van Mechelen W, May AM, Brug J, Chinapaw MJ, Buffart LM (2014) Determinants of exercise adherence and maintenance among cancer survivors: a systematic review. Int J Behav Nutr Phys Act 11:80CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    Lewin K (1939) Experiments in social space Harvard. Educ Rev 9:21–32Google Scholar
  41. 41.
    Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, Deng Y, Chen Q, Wei S, Nie S, Liu L (2016) The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med 50:339–345CrossRefPubMedGoogle Scholar
  42. 42.
    May AM, Duivenvoorden HJ, Korstjens I, van Weert E, Hoekstra-Weebers JE, van den Borne B, Mesters I, van der Schans CP, Ros WJ (2008) The effect of group cohesion on rehabilitation outcome in cancer survivors. Psychooncology 17:917–925CrossRefPubMedGoogle Scholar
  43. 43.
    Midtgaard J, Tveteras A, Rorth M, Stelter R, Adamsen L (2006) The impact of supervised exercise intervention on short-term postprogram leisure time physical activity level in cancer patients undergoing chemotherapy: 1- and 3-month follow-up on the body & cancer project. Palliat Support Care 4:25–35CrossRefPubMedGoogle Scholar
  44. 44.
    Miller KD, Siegel RL, Lin CC, Mariotto AB, Kramer JL, Rowland JH, Stein KD, Alteri R, Jemal A (2016) Cancer treatment and survivorship statistics, 2016. CA Cancer J Clin 66:271–289CrossRefPubMedGoogle Scholar
  45. 45.
    National Cancer Institute (2017) Annual report to the nation 2017: special section: survival. In: Editor (ed)^(eds) Book Annual report to the nation 2017: special section: survival, CityGoogle Scholar
  46. 46.
    Pellegrini CA, Hoffman SA, Collins LM, Spring B (2014) Optimization of remotely delivered intensive lifestyle treatment for obesity using the Multiphase Optimization Strategy: Opt-IN study protocol. Contemp Clin Trials 38:251–259CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Phillips SM, Alfano CM, Perna FM, Glasgow RE (2014) Accelerating translation of physical activity and cancer survivorship research into practice: recommendations for a more integrated and collaborative approach. Cancer Epidemiol Biomark Prev 23:687–699CrossRefGoogle Scholar
  48. 48.
    Rejeski WJ, Brawley LR, Ambrosius WT, Brubaker PH, Focht BC, Foy CG, Fox LD (2003) Older adults with chronic disease: benefits of group-mediated counseling in the promotion of physically active lifestyles. Health Psychol 22:414–423CrossRefPubMedGoogle Scholar
  49. 49.
    Rogers LQ, Hopkins-Price P, Vicari S, Pamenter R, Courneya KS, Markwell S, Verhulst S, Hoelzer K, Naritoku C, Jones L, Dunnington G, Lanzotti V, Wynstra J, Shah L, Edson B, Graff A, Lowy M (2009) A randomized trial to increase physical activity in breast cancer survivors. Med Sci Sports Exerc 41:935–946CrossRefPubMedGoogle Scholar
  50. 50.
    Rogers LQ, Courneya KS, Anton PM, Hopkins-Price P, Verhulst S, Vicari SK, Robbs RS, Mocharnuk R, McAuley E (2015) Effects of the BEAT Cancer physical activity behavior change intervention on physical activity, aerobic fitness, and quality of life in breast cancer survivors: a multicenter randomized controlled trial. Breast Cancer Res Treat 149:109–119CrossRefPubMedGoogle Scholar
  51. 51.
    Ross Zahavich AN, Robinson JA, Paskevich D, Culos-Reed SN (2013) Examining a therapeutic yoga program for prostate cancer survivors. Integr Cancer Ther 12:113–125CrossRefPubMedGoogle Scholar
  52. 52.
    Saarto T, Penttinen HM, Sievanen H, Kellokumpu-Lehtinen PL, Hakamies-Blomqvist L, Nikander R, Huovinen R, Luoto R, Kautiainen H, Jarvenpaa S, Idman I, Utriainen M, Vehmanen L, Jaaskelainen AS, Elme A, Ruohola J, Palva T, Vertio H, Rautalahti M, Fogelholm M, Blomqvist C, Luoma ML (2012) Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Res 32:3875–3884PubMedGoogle Scholar
  53. 53.
    Schlechter CR, Rosenkranz RR, Guagliano JM, Dzewaltowski DA (2016) A systematic review of children’s dietary interventions with parents as change agents: application of the RE-AIM framework. Prev Med 91:233–243CrossRefPubMedGoogle Scholar
  54. 54.
    Schmid D, Leitzmann MF (2014) Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol 25:1293–1311CrossRefPubMedGoogle Scholar
  55. 55.
    Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K (2015) Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Cancer 137:471–480CrossRefPubMedGoogle Scholar
  56. 56.
    Smith SG, Chagpar AB (2010) Adherence to physical activity guidelines in breast cancer survivors. Am Surg 76:962–965PubMedGoogle Scholar
  57. 57.
    Spark LC, Reeves MM, Fjeldsoe BS, Eakin EG (2013) Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes. J Cancer Surviv 7:74–82CrossRefPubMedGoogle Scholar
  58. 58.
    Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4:87–100CrossRefPubMedGoogle Scholar
  59. 59.
    Spector D, Battaglini C, Alsobrooks A, Owen J, Groff D (2012) Do breast cancer survivors increase their physical activity and enhance their health-related quality of life after attending community-based wellness workshops? J Cancer Educ 27:353–361CrossRefPubMedGoogle Scholar
  60. 60.
    Stolley MR, Sharp LK, Oh A, Schiffer L (2009) A weight loss intervention for African American breast cancer survivors, 2006. Prev Chronic Dis 6:A22PubMedGoogle Scholar
  61. 61.
    Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J (2017) A systematic review of exercise systematic reviews in the cancer literature (2005-2017). PM R 9:S347–S384CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Suh EE, Kim H, Kang J, Kim H, Park KO, Jeong BL, Park SM, Jeong SY, Park KJ, Lee K, Jekal M (2013) Outcomes of a culturally responsive health promotion program for elderly Korean survivors of gastrointestinal cancers: a randomized controlled trial. Geriatr Nurs 34:445–452CrossRefPubMedGoogle Scholar
  63. 63.
    Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Brug J, Buffart LM (2018) Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 52:505–513CrossRefPubMedGoogle Scholar
  64. 64.
    Wurz A, St-Aubin A, Brunet J (2015) Breast cancer survivors’ barriers and motives for participating in a group-based physical activity program offered in the community. Support Care Cancer 23:2407–2416CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Heather J. Leach
    • 1
    • 2
    Email author
  • Scherezade K. Mama
    • 3
  • Samantha M. Harden
    • 4
  1. 1.Department of Health and Exercise ScienceColorado State UniversityFort CollinsUSA
  2. 2.Department of Community and Behavioral HealthColorado School of Public Health at Colorado State UniversityFort CollinsUSA
  3. 3.Department of KinesiologyThe Pennsylvania State UniversityState CollegeUSA
  4. 4.Department of Human Nutrition, Foods, and ExerciseVirginia TechBlacksburgUSA

Personalised recommendations