An umbrella review was published in the British Journal of Sports Medicine (2025), synthesizes findings from 80 meta-analyses comprising 485 unique associations based on randomized controlled trials (RCTs) to evaluate the impact of exercise on health outcomes in people with cancer.
Objective
The study aimed to comprehensively assess the effects of various exercise interventions on a wide array of health outcomes among individuals with cancer, and to rate the strength of the evidence using AMSTAR and GRADE criteria.
Key Findings
- Overall Effects: 260 of the 485 associations (53.6%) were statistically significant. Of these, 81 (16.7%) were supported by high-certainty evidence and 152 (31.3%) by moderate-certainty evidence.
- Types of Exercise Studied: Included aerobic exercise (AE), resistance exercise (RE), high-intensity interval training (HIIT), and mind–body exercises (e.g., yoga, Tai Chi, Qigong).
- Cancer Types Covered: Breast cancer was the most studied, followed by lung, prostate, digestive system, and hematologic malignancies.
Health Outcome Domains and Effects
1. Cancer-Related Adverse Effects
- Cognitive Impairment, Cardiotoxicity, CIPN: Exercise alleviated symptoms with moderate to high-certainty evidence.
- Postoperative Outcomes: Preoperative exercise reduced complications, length of stay, and mortality in lung cancer patients.
2. Body Composition and Biomarkers
- BMI and Fat Mass: Exercise reduced body fat and improved lean mass; results varied by cancer type and exercise modality.
- Biomarkers: Exercise decreased levels of insulin, IGF-1, IGFBP-1, and CRP—linked to cancer progression and inflammation.
3. Sleep, Psychological Well-Being, and QoL
- Sleep Quality: Yoga and combined exercise reduced insomnia and improved sleep in advanced-stage cancer.
- Depression and Anxiety: Mind–body exercises (e.g., Qigong, yoga) effectively reduced psychological distress.
- Quality of Life (QoL): Exercise improved both general and cancer-specific QoL, especially in breast and colorectal cancer patients.
4. Physiological and Social Function
- Fatigue and Physical Function: Exercise, including HIIT and resistance training, alleviated cancer-related fatigue and improved physical capacity (e.g., VO₂ peak).
- Muscular Strength: Weight training significantly enhanced upper and lower body strength.
- Social Reintegration: Exercise improved social function and return-to-work rates.
Strengths
- Largest and most comprehensive synthesis of RCT-based meta-analyses on exercise and cancer to date.
- Use of rigorous methodological tools (AMSTAR, GRADE).
- Inclusion of diverse cancer types, exercise interventions, and outcome domains.
Limitations
- Substantial heterogeneity across studies in population, intervention type, and outcome measures.
- Many included studies had small sample sizes.
- Limited data for rarer cancers and advanced stages.
Conclusion
Exercise is a highly effective, evidence-based adjunct to cancer care, reducing adverse effects of treatment, improving physical and psychological well-being, and enhancing overall quality of life. Mind–body modalities deserve greater integration into cancer care guidelines. Further, high-quality, cancer-specific RCTs are needed to refine recommendations and personalize exercise prescriptions.
Reference: Bai X-L, et al. Br J Sports Med 2025;0:1–11. doi:10.1136/bjsports-2024-109392
