Impact of exercise on health outcomes in people with cancer: an umbrella review of systematic reviews and meta-analyses of randomised controlled trials

OBJECTIVE: To examine the comprehensive health impacts of exercise on people with cancer by systematically summarising existing evidence and assessing the strength and reliability of the associations. DESIGN: Umbrella review of meta-analyses. DATA SOURCE: PubMed, Embase, Cochrane and Web of Science databases were searched from their inception to 23 July 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Meta-analyses of randomised controlled trials that investigated the associations between exercise and health outcomes among people with cancer. RESULTS: This umbrella review identified 485 associations from 80 articles, all evaluated as moderate to high quality using A Measurement Tool to Assess Systematic Reviews (AMSTAR). Two hundred and sixty (53.6%) associations were statistically significant (p<0.05), 81/485 (16.7%) were supported by high-certainty evidence according to the Grading of Recommendations Assessment, Development, and Evaluation criteria. Compared with usual care or no exercise, moderate- to high-certainty evidence supported the view that exercise significantly mitigates adverse events associated with cancer and its treatments (eg, cardiac toxicity, chemotherapy-induced peripheral neuropathy, cognitive impairment and dyspnoea). Exercise also modulates body composition and biomarkers (eg, insulin, insulin-like growth factor-1, insulin-like growth factor-binding protein-1 and C-reactive protein) in people with cancer, and enhances sleep quality, psychological well-being, physiological functioning and social interaction, while improving overall quality of life. CONCLUSION: Exercise reduces adverse events and enhances well-being through a range of health outcomes in people with cancer.