Characterising Pragmatic Exercise Interventions to Reduce Cognitive Impairment in Cancer Survivors: A Scoping Review Protocol


  • Nikolas Joy Jelicic Dalhousie University
  • Jodi Langley Dalhousie University
  • Shelley McKibbon Dalhousie University
  • Scott Grandy Dalhousie University
  • Daniel Santa Mina University of Toronto
  • Stephanie Snow Dalhousie University
  • Mary MacNeil Dalhousie University
  • Nicole Culos Reed
  • Margaret McNeely
  • Melanie Keats Dalhousie University & Nova Scotia Health



Objective: The objective of this scoping review is to identify the characteristics of pragmatic exercise interventions aimed at reducing cognitive impairment in cancer survivors, and their effectiveness in reducing this impairment and maintaining high adherence. Introduction: Cognitive impairment (CI) is a particularly troublesome side effect of cancer treatment that has been suggested to decrease following exercise interventions. Most existing research consists of randomized control trials, which often lack external validity. Pragmatic interventions fill this gap. However, some pragmatic trials that provide real-world evidence struggle to maintain strong participant adherence. Thus, examining characteristics of pragmatic interventions with high levels of adherence may be beneficial in improving overall adherence in future pragmatic trials on this topic. Inclusion criteria: This review will examine literature with cancer survivors who are partaking in pragmatic exercise programs. Specifically, literature exploring the effects of pragmatic exercise interventions in decreasing cancer survivors‘ CI will be examined, with no limits to intervention frequency, intensity, time, or type. “Cancer survivor” will be defined as any individual with a cancer diagnosis, at any point along the survivorship continuum. Methods: A comprehensive search strategy was developed in accordance with JBI methodology to retrieve relevant sources. Databases to be reviewed from inception to present will include CINAHL, MEDLINE, Embase, SPORTDiscus, Scopus, and PsycInfo. Two independent screeners will examine titles and abstracts as well as full texts of relevant sources. The results of the search and the study inclusion process will be reported in full in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) flow diagram. The results will be presented narratively, using appropriate tables and figures.

Author Biographies

Nikolas Joy Jelicic, Dalhousie University

School of Health and Human Performance, BSc

Jodi Langley, Dalhousie University

Faculty of Health, PhD

Shelley McKibbon, Dalhousie University

Kellogg Health Science Library, MSc

Scott Grandy, Dalhousie University

School of Health and Human Performance, PhD

Daniel Santa Mina, University of Toronto

Faculty of Kinesiology and Physical Education, PhD

Stephanie Snow, Dalhousie University

Department of Medicine, Division of Medical Oncology,  MD

Mary MacNeil, Dalhousie University

Department of Medicine, Division of Medical Oncology, MD

Melanie Keats, Dalhousie University & Nova Scotia Health

School of Health and Human Performance & Division of Medical Oncology, PhD


Boykoff, N., Moieni, M., & Subramanian, S. K. (2009). Confronting chemobrain: An in-depth look at survivors‘ reports of impact on work, social networks, and health care response. Journal of Cancer Survivorship: Research and Practice, 3(4), 223–232.

Buffart, L. M., Newton, R. U., Chinapaw, M. J., Taaffe, D. R., Spry, N. A., Denham, J. W., Joseph, D. J., Lamb, D. S., Brug, J., & Galvão, D. A. (2015). The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long-term survivors of prostate cancer. Cancer, 121(16), 2821–2830.

Campbell, K. L., Zadravec, K., Bland, K. A., Chesley, E., Wolf, F., & Janelsins, M. C. (2020). The effect of exercise on cancer-related cognitive impairment and applications for physical therapy: Systemic review of randomized controlled trials. Physical Therapy, 100(3), 523–542.

Canadian Agency for Drugs and Technologies in Health. (2019, April). Grey matters: A practical tool for searching health-related grey literature.

Canadian Cancer Statistics Advisory Committee. (2019). Canadian cancer statistics 2019. Canadian Cancer Society.

Caspersen, C. J., Powell, K. E., & Christenson, G. M. (1985). Physical activity, exercise, and physical fitness: Definitions and distinctions for health-related research. Public Health Reports, 100(2), 126–131.

Courneya, K. S., Friedenreich, C. M., Sela, R. A., Quinney, H. A., Rhodes, R. E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (GROUP-HOPE) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12(4), 357–374.

Cuesta-Vargas, A. I., Garcà­a-Romero, J. C., Arroyo-Morales, M., Diego-Acosta, à. M., & Daly, D. J. (2011). Exercise, manual therapy, and education with or without high-intensity deep-water running for nonspecific chronic low back pain: A pragmatic randomized controlled trial. American Journal of Physical Medicine & Rehabilitation, 90(7), 526–538.

Frost, M. H., Suman, V. J., Rummans, T. A., Dose, A. M., Taylor, M., Novotny, P., Johnson, R., & Evans, R. E. (2000). Physical, psychological and social well-being of women with breast cancer: The influence of disease phase. Psycho-Oncology, 9(3), 221–231.<221::AID- PON456>3.0.CO;2-T

Hacker, E. D., Larson, J., Kujath, A., Peace, D., Rondelli, D., & Gaston, L. (2011). Strength training following hematopoietic stem cell transplantation. Cancer Nursing, 34(3), 238–249.

Henderson, F. M. E., Cross, A. J., & Baraniak, A. R. (2019). ‘A new normal with chemobrain‘: Experiences of the impact of chemotherapy-related cognitive deficits in long-term breast cancer survivors. Health Psychology Open, 6(1), Article 2055102919832234.

Holzner, B., Kemmler, G., Kopp, M., Moschen, R., Schweigkofler, H., Dünser, M., Margreiter, R., Fleischhacker, W. W., & Sperner-Unterweger, B. (2001). Quality of life in breast cancer patients—Not enough attention for long-term survivors? Psychosomatics, 42(2), 117–123.

Joly, F., Giffard, B., Rigal, O., De Ruiter, M. B., Small, B. J., Dubois, M., LeFel, J., Schagen, S. B., Ahles, T. A., Wefel, J. S., Vardy, J. L., Pancré, V., Lange, M., & Castel, H. (2015). Impact of cancer and its treatments on cognitive function: Advances in research from the Paris International Cognition and Cancer Task Force Symposium and update since 2012. Journal of Pain and Symptom Management, 50(6), 830–841.

Martin, E., Bulsara, C., Battaglini, C., Hands, B., & Naumann, F. L. (2015). Breast and prostate cancer survivor responses to group exercise and supportive group psychotherapy. Journal of Psychosocial Oncology, 33(6), 620–634.

Mitchell, T., & Turton, P. (2011). ‘Chemobrain‘: Concentration and memory effects in people receiving chemotherapy – a descriptive phenomenological study. European Journal of Cancer Care, 20(4), 539–548.

Myers, J. S., Erickson, K. I., Sereika, S. M., & Bender, C. M. (2018). Exercise as an intervention to mitigate decreased cognitive function from cancer and cancer treatment: An integrative review. Cancer Nursing, 41(4), 327–343. 000000549

National Cancer Institute. (n.d.). Survivorship. In NCI dictionary of cancer terms.

Patsopoulos, N. A. (2011). A pragmatic view on pragmatic trials. Dialogues in Clinical Neuroscience, 13(2), 217–224. 3.2/npatsopoulos

Peters, M. D. J., Godfrey, C., McInerney, P., Munn, Z., Tricco, A. C., & Khalil, H. (2020). Chapter 11: Scoping reviews. In E. Aromataris & Z. Munn (Eds.), JBI manual for evidence synthesis. JBI.

Piper, C. (2019). System for the Unified Management, Assessment, and Review of Information (SUMARI). Journal of the Medical Library Association, 107(4), 634–636.

Recklitis, C. J., & Syrjala, K. L. (2017). Provision of integrated psychosocial services for cancer survivors post-treatment. The Lancet Oncology, 18(1), e39–e50. 2045(16)30659-3

Saarto, T., Penttinen, H. M., Sievänen, H., Kellokumpu-Lehtinen, P.-L., Hakamies- Blomqvist, L., Nikander, R., Huovinen, R., Luoto, R., Kautiainen, H., Järvenpää, S., Idman, I., Utriainen, M., Vehmanen, L., Jääskeläinen, A.-S., Elme, A., Ruohola, J., Palva, T., Vertio, H., Rautalahti, M., ”¦ Luoma, M.-L. (2012). Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Research, 32(9), 3875–3884.

Salerno, E. A., Rowland, K., Kramer, A. F., & McAuley, E. (2019). Acute aerobic exercise effects on cognitive function in breast cancer survivors: A randomized crossover trial. BMC Cancer, 19, Article 371. 019-5589-1

Schmidt, J. E., Beckjord, E., Bovbjerg, D. H., Low, C. A., Posluszny, D. M., Lowery, A. E., Dew, M. A., Nutt, S., Arvey, S. R., & Rechis, R. (2016). Prevalence of perceived cognitive dysfunction in survivors of a wide range of cancers: Results from the 2010 LIVESTRONG survey. Journal of Cancer Survivorship: Research and Practice, 10(2), 302–311.

Schmidt, M. E., Wiskemann, J., Armbrust, P., Schneeweiss, A., Ulrich, C. M., & Steindorf, K. (2015). Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: A randomized controlled trial. International Journal of Cancer, 137(2), 471–480.

Schneider, C. M., Hsieh, C. C., Sprod, L. K., Carter, S. D., & Hayward, R. (2007). Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integrative Cancer Therapies, 6(3), 235–241. https://doi. org/10.1177/15347354073 05871

Selamat, M. H., Loh, S. Y., Mackenzie, L., & Vardy, J. (2014). Chemobrain experienced by breast cancer survivors: A meta-ethnography study investigating research and care implications. PLOS ONE, 9(9), Article e108002. 108002

Statistics Canada. (2018, June 27). Leading causes of death, total population, by age group. en/tv.action?pid=1310039401

Tomlin, G., & Borgetto, B. (2011). Research Pyramid: A new evidence-based practice model for occupational therapy. The American Journal of Occupational Therapy, 65(2), 189–196.

Treweek, S., & Zwarenstein, M. (2009). Making trials matter: Pragmatic and explanatory trials and the problem of applicability. Trials, 10, Article 37.

Tricco, A. C., Lillie, E., Zarin, W., O‘Brien, K. K., Colquhoun, H., Levac, D., Moher, D., Peters, M. D. J., Horsley, T., Weeks, L., Hempel, S., Akl, E. A., Chang, C., McGowan, J., Stewart, L., Hartling, L., Aldcroft, A., Wilson, M. G., Garritty, C., ”¦ Straus, S. E. (2018). PRISMA extension for Scoping Reviews (PRISMA-ScR): Checklist and explanation. Annals of Internal Medicine, 169(7), 467–473.