Structured exercise training significantly improves cardiorespiratory fitness, quality of life, and physical function for adults diagnosed with cancer, according to a systematic review and meta-analysis published in BMC Cancer.
Reviewing Randomized Controlled Trials for Cancer Participants
The systematic review evaluated 89 randomized controlled trials involving 6,571 adult cancer participants. Researchers searched MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception through 1 November 2025.
In contrast, another review focusing specifically on metastatic breast cancer examined 11 randomized controlled trials with 656 participants contributing to cancer-related fatigue analysis, drawing from seven electronic databases spanning from 2000 to September 2026, while a separate review analyzed 26 randomized controlled trials involving 1,731 people with colorectal cancer.
Clinically meaningful gains emerged most consistently when participants engaged in combined aerobic and resistance exercise programs. Peak oxygen uptake (VO2peak) and quality of life served as the primary outcomes, which were synthesized using random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustments by exercise modality and follow-up duration, with evidence certainty evaluated using the GRADE framework.
Measured Fitness and Quality of Life Gains
Pooled results demonstrated that combined aerobic and resistance training improved cardiorespiratory measured as VO2peak compared with usual care at three months with a mean difference of 2.9 mL per kilogram per minute, at six months with a mean difference of 4.5 mL per kilogram per minute, and at 12 months with a mean difference of 4.2 mL per kilogram per minute.
These outcomes consistently surpassed minimal clinically important difference thresholds. For patients with metastatic breast cancer, exercise interventions significantly reduced cancer-related fatigue with an SMD of 0.44 and improved overall quality of life across eight studies involving 517 participants with an SMD of 0.29.
Combined training also produced improvements at 3 months in quality of life (MD 7.0 points, 95% CI 4.2 to 10.2) and 6-minute walk distance (MD 52 m, 95% CI 33 to 71 m), as well as increased lower-body muscle strength and reduced body fat percentage at 6 months.
For CRF-related secondary outcomes, significant reductions were observed in emotional fatigue [SMD = −0.47, 95% CI (−0.68, −0.26), p < 0.00001], fatigue interference [SMD = −0.87, 95% CI (−1.35, −0.40), p = 0.0003], and physical fatigue [SMD = −0.84, 95% CI (−1.05, −0.63), p < 0.00001]. Interventions lasting ≤12 weeks significantly reduced CRF [SMD = 0.55, 95% CI (0.12, 0.97), p = 0.01; I² = 65%], whereas the pooled effect for interventions lasting >12 weeks did not reach statistical significance [SMD = 0.22, 95% CI (−0.05, 0.49), p = 0.10; I² = 16%]. Programs during active treatment showed the weakest effects.
Aerobic and Resistance Training Yield Measurable Benefits
Single modalities also yielded measurable benefits. For single modalities, aerobic training alone improved VO2peak at 3 months (MD 3.6 mL·kg⁻¹·min⁻¹, 95% CI 0.9 to 6.3), whereas resistance training alone improved quality of life at 3 months (MD 6.3 points, 95% CI 1.1 to 11.3).
Safety data compiled from 86 trials indicated that serious adverse events were rare and did not differ significantly between exercise groups and usual care. The authors concluded that exercise interventions should be individually prescribed and progressively adjusted for individuals living with and beyond cancer.