Efficacy of Exercise Therapy on Cardiorespiratory Fitness in Patients With Cancer: A Systematic Review and Meta-Analysis
Open accessAbstract
Purpose: To evaluate the effects of exercise therapy on cardiorespiratory fitness (CRF) in randomized controlled trials (RCTs) among patients with adult-onset cancer. Secondary objectives were to evaluate treatment effect modifiers, safety, and fidelity. Methods: A systematic search of PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, and the Cochrane Library was conducted to identify RCTs that compared exercise therapy to a nonexercise control group. The primary end point was change in CRF as evaluated by peak oxygen consumption (VO 2peak; in mL O 2 × kg−1 × min−1) from baseline to postintervention. Subgroup analyses evaluated whether treatment effects differed as a function of exercise prescription (ie, modality, schedule, length, supervision), study characteristics (ie, intervention timing, primary cancer site), and publication year. Safety was defined as report of any adverse event (AE); fidelity was evaluated by rates of attendance, adherence, and loss to follow-up. Results: Forty-eight unique RCTs that represented 3,632 patients (mean standard deviation age, 55 ± 7.5 years; 68% women); 1,990 (55%) and 1,642 (45%) allocated to exercise therapy and control/usual care groups, respectively, were evaluated. Exercise therapy was associated with a significant increase in CRF (+2.80 mL O 2 × kg−1 × min−1) compared with no change (+0.02 mL O 2 × kg−1 × min−1) in the control group (weighted mean differences, +2.13 mL O 2 × kg−1 × min−1; 95% CI, 1.58 to 2.67; I 2, 20.6; P < .001). No statistical significant differences were observed on the basis of any treatment effect modifiers. Thirty trials (63%) monitored AEs; a total of 44 AEs were reported. The mean standard deviation loss to follow-up, attendance, and adherence rates were 11% ± 13%, 84% ± 12%, and 88% ± 32%, respectively. Conclusion: Exercise therapy is an effective adjunctive therapy to improve CRF in patients with cancer. Our findings support the recommendation of exercise therapy for patients with adult-onset cancer.
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Research supports that cancer survivors can respond positively to exercise training by improving cardiorespiratory fitness, muscular strength and endurance, and body composition.
“Research to date supports the potential of cancer survivors to respond positively to an exercise training stimulus by improving individual components of physical fitness, including cardiorespiratory fitness (i.e., VO2peak)(86), muscular strength and endurance(87, 88), body composition(89).”
From Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) · cites this paper as [86]
Randomized trials of aerobic exercise during adjuvant chemotherapy show preservation or improvement in cardiorespiratory fitness, especially in those with low initial values, while others report better improvement in those with higher initial values.
“Randomized trials of aerobic exercise during adjuvant chemotherapy demonstrate a preservation of, or an improvement in, cardiorespiratory fitness, especially in those with low initial values(86), while others report better improvement in those with higher initial values(91).”
From Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) · cites this paper as [86]
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MethodAmerican College of Sports Medicine Roundtable on Exercise Guidelines for Cancer Survivors
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BackgroundExercise therapy and cardiovascular toxicity in cancer
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- Authors
- Scott, J. M., Zabor, E. C., Schwitzer, E., Koelwyn, G. J., Adams, S. C., Nilsen, T. S., Moskowitz, C. S., Matsoukas, K., Iyengar, N. M., Dang, C. T., & Jones, L. W.
- Affiliations
- Memorial Sloan Kettering Cancer Center (US)
- Corresponding author
- Scott, Jessica M.
- ORCID
- Venue
- Journal of Clinical Oncology
- Published
- 2018-08-01
- Volume
- 36
- Issue
- 22
- Pages
- 2297-2305
- ISSN
- 0732-183X (ISSN-L)
- 1527-7755
- PMC
- PMC6804903
- OpenAlex
- W2808328174
- Semantic Scholar
- 98a5a09b20b17a872fdc2e0b82e1f82f5fb0096f
- Cited by
- 345
- References
- 9
- Citations by year
- 2026: 27 · 2025: 43 · 2024: 49 · 2023: 56 · 2022: 58 · 2021: 46 · 2020: 39 · 2019: 23 · 2018: 4
- FWCI
- 2.93
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Clinical Oncology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Cancer Institute (P30CA008748)
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Health Sciences › Medicine › Physiology › Physical Activity and Health
- Keywords
- exercise therapy, cardiorespiratory fitness, cancer patients, peak oxygen uptake, exercise adherence, exercise safety, adjunctive therapy, exercise prescription, treatment effect modifiers
- MeSH terms
- Cardiorespiratory Fitness, Exercise Therapy, Humans, Neoplasms, Randomized Controlled Trials as Topic
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