Effects of Tai Chi versus Aerobic Exercise on Sleep for Patients with Late-Stage Lung Cancer: A Multicentered Three-Arm Randomized Controlled Trial

Abstract

<p>​​​​​​​<strong>Background:</strong> Sleep disturbances are common in advanced lung cancer patients, worsening physical and psychological symptoms, and reducing quality of life and survival.</p><p><strong>Objective:</strong> To evaluate the efficacy of aerobic exercise (AE) and Tai Chi (TC) on sleep quality, physical and psychological outcomes, and survival in advanced lung cancer patients.</p><p><strong>Design, Setting, and Participants:</strong> This assessor-blind, randomized trial involved 226 patients across three public hospitals in Hong Kong from 2018 to 2022. Patients were randomized 1:1:1 into AE, TC, or control groups. Interventions: For 16 weeks, the AE group had two monthly 60-minute supervised group sessions and home exercises; the TC group attended 60-minute group sessions twice weekly, while the control group received physical activity guidelines.</p><p><strong>Outcomes and Measures:</strong> Primary outcome was subjective sleep quality. Secondary outcomes included objective sleep measures, anxiety, depression, fatigue, quality of life, physical function, circadian rhythm, and one-year survival. Assessments occurred at baseline (T0), 16 weeks (T1), and one year (T2).</p><p><strong>Results:</strong> Of the 226 participants (46.0% male), the mean age was 61.41 (8.73) years. Compared to control group, AE and TC groups showed significant improvements in subjective sleep quality, psychological distress, physical function, step count, and circadian rhythm from T0 to T1 and T2. TC demonstrated greater sleep improvement than AE at T1 and T2, and significantly improved survival compared to control.</p><p><strong>Conclusions:</strong> AE and TC enhanced sleep, psychological distress, physical function, and circadian rhythm, with TC showing greater sleep and survival benefits. Both exercises, especially TC, can be integrated into lung cancer survivorship care.</p>