By Ahmed Yakdhan Saleh, Abdulkareem Shareef,
Ashok Kumar Bishoyi, S. Renuka Jyothi, Rajashree Panigrahi, et al
Oncology Reviews: 12 September 2025 DOI 10.3389/or.2025.1645505
Summary: At Cancer Fitness, Jay K. Harness, MD, FACS
This internationally created publication provides a comprehensive evaluation of personalized exercise programming as an emerging, evidence-based therapeutic component across the cancer care continuum. Backed by extensive randomized trials, meta-analyses, and implementation research, the review reinforces that exercise is not merely supportive care—it is a clinically meaningful, modifiable intervention capable of improving physiological function, reducing treatment-related toxicity, enhancing psychological wellbeing, and potentially influencing survival outcomes. Personalizing exercise plans, rather than relying on generic prescriptions, is presented as a critical next step to optimize safety and effectiveness for diverse cancer populations.
Why Exercise Matters Clinically
Cancer treatments—including surgery, chemotherapy, radiation, and immunotherapy—carry profound physiological and functional consequences, such as sarcopenia, reduced cardiorespiratory fitness, fatigue, neuropathy, inflammation, and metabolic dysregulation. The publication highlights robust data showing that structured aerobic and resistance exercise can mitigate many of these sequelae. Meta-analyses encompassing dozens of trials consistently demonstrate reductions in cancer-related fatigue, improvements in VO₂ peak, muscle strength, mobility, glycemic control, inflammatory biomarkers, and health-related quality of life.
Of clinical relevance, higher fitness and muscle strength levels are correlated with substantial reductions (31–46%) in all-cause mortality among cancer survivors. These findings elevate exercise from an optional adjunct to a therapy with measurable prognostic significance.
The Need for Personalization
The central thesis of the publication is that one-size-fits-all exercise prescriptions are inadequate given the wide heterogeneity among cancer patients. Key drivers of variation include:
- Tumor type and stage: Patients with early-stage disease tolerate moderate aerobic training well, whereas those with advanced disease or bone metastases may require modified or non–weight-bearing approaches.
- Treatment modality: Chemotherapy cycles can acutely decrease VO₂ peak; radiation may exacerbate lymphedema; immunotherapy may cause myositis—each requiring tailored intensity and timing.
- Baseline fitness and comorbidities: Sedentary patients with heart disease, diabetes, or arthritis have distinct risk profiles and may need graded progression.
- Socioeconomic and structural context: Rural residence, low income, limited digital literacy, and lack of trained professionals significantly affect access.
For physicians, these findings underscore the importance of individualized assessment before exercise prescription. Standard components include fatigue evaluation, cardiopulmonary testing (e.g., 6MWT, VO₂ peak), strength metrics, mobility assessments, and screening for contraindications.
Current Approaches Supporting Personalization
The publication outlines several frameworks and real-world models:
- Risk-Stratification and Baseline Evaluation:
Prospective trials in lung cancer patients using cardio-pulmonary testing and inflammatory biomarkers showed that personalized prescriptions improved 6MWT, VO₂ trends, muscle content, lung capacity, and strength—without adverse events. - Professional Guidelines (ACSM, ESSA, NCCN):
All recommend combining aerobic and resistance exercise (e.g., 150 min/week moderate intensity + 2 resistance sessions). Many emphasize cardiac screening, functional assessment, and tailoring based on symptoms and treatment. - Multidisciplinary Delivery Models:
Integrating exercise physiologists, oncologists, PTs, psychologists, and dietitians—such as through lifestyle medicine clinics or telehealth-supported fitness care managers—supports whole-person care and improves adherence and outcomes.
Digital Tools Enhancing Personalization
Wearables, mobile apps, and AI-enabled platforms allow real-time monitoring of steps, heart rate variability, sleep, and symptom patterns. These tools can detect clinical deterioration before it manifests, personalize intensity, enhance engagement, and improve adherence. Telehealth programs achieve comparable functional gains to in-person interventions and reduce travel burden—an important consideration for rural and mobility-limited patients.
Implementation Barriers and Equity Considerations
Despite strong evidence, the uptake of exercise oncology remains low. Major barriers include:
- Patient-level: fatigue, pain, fear of harm, lack of motivation, low self-efficacy.
- Clinician-level: limited time, safety concerns, lack of standardized referral pathways.
- System level: inadequate staffing, absence of structured exercise pathways, lack of reimbursement.
The authors emphasize the need for equity-driven approaches, including community-based programs, opt-out referral systems, device-loaning initiatives, culturally tailored materials, and policy reforms mandating reimbursement for exercise oncology services.
Clinical Importance to Physicians and Patients
For physicians, the evidence supports integrating personalized exercise as a routine component of cancer treatment and survivorship care. This includes proactive referrals, baseline functional evaluations, and collaboration with trained exercise professionals.
For patients, personalized exercise offers a safe, adaptable strategy to improve strength, stamina, mood, independence, and overall quality of life—while also potentially improving treatment completion and long-term outcomes.Reference: Oncology Reviews: 12 September 2025 DOI 10.3389/or.2025.1645505
