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

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. Umbrella review of meta-analyses. PubMed, Embase, Cochrane and Web of Science databases were searched from their inception to 23 July 2024. Meta-analyses of randomised controlled trials that investigated the associations between exercise and health outcomes among people with cancer. 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. Exercise reduces adverse events and enhances well-being through a range of health outcomes in people with cancer.