Structured exercise interventions and survival outcomes in patients with cancer: systematic review and meta-analysis of randomised controlled trials.

Abstract

Structured exercise is widely recommended in oncology care to improve quality of life and physical function, but its definitive role as a therapeutic intervention to prolong survival remains uncertain. This study aimed to quantify the association between structured exercise interventions and survival related outcomes in patients with cancer. Systematic review and meta-analysis. PubMed, Embase, Cochrane CENTRAL, Web of Science, Scopus and ClinicalTrials.gov covering reports from database inception to 20 December 2025. Randomised controlled trials (RCTs) of structured exercise interventions in adults with confirmed cancer, reporting survival or pathological outcomes. 21 RCTs were included in the meta-analysis. Structured exercise was associated with significant improvements in overall survival (HR 0.77; 95% CI 0.65 to 0.92; 11 RCTs, n=3828), disease-free survival (HR 0.83; 95% CI 0.72 to 0.95; 7 RCTs, n=5077), reduced all cause mortality (RR 0.82; 95% CI 0.70 to 0.97; 13 RCTs, n=5492) and reduced cancer specific mortality (RR 0.74; 95% CI 0.57 to 0.96; 6 RCTs, n=2048), but not with progression-free survival or pathological complete response. Certainty of evidence, assessed using Grading of Recommendations, Assessment, Development and Evaluation (GRADE), was rated as moderate for overall survival, disease-free survival and cancer specific and all cause mortality. Further exploratory analyses indicated a more pronounced benefit among participants with higher adherence, those who underwent aerobic exercise and those with early stage disease. These results support consideration of structured exercise as an effective adjuvant therapy in oncological care, with potential survival and recurrence benefits that extend beyond its traditional role in improving quality of life. PROSPERO CRD420251245153.