Moving More
Moving your body reduces your risk of cancer, promotes health and survival after a diagnosis, and can reduce some side effects of treatment. Finding an activity that is fun will increase both your motivation and your enjoyment.
How can Moving More help you? What the research says
How does Moving More impact your cancer outcomes, affect your quality of life, or impact your body terrain? We present the evidence.
For information and guidance on adding physical activity to your life, see these pages:
We strongly emphasize that Moving More by itself will not prevent, cure or control cancer or prevent recurrence. Like every other therapy or approach included on this website, Moving More is one component of an individualized integrative plan rather than a stand-alone therapy.
We summarize the clinical evidence for each medical benefit here. We begin with our assessment of the strength of evidence within each category, followed by a brief summary of individual studies or reviews of several studies. In assessing the strength of evidence, we consider the study design, number of participants, and the size of the treatment effect (how much outcomes changed with treatment).
Our assessments of evidence for each medical benefit fall into one of these categories:
- Strong evidence: consistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results
- Good evidence: significant effects in one large or several mid-sized and well-designed clinical studies ( randomized controlled trialsa study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects with an appropriate placebo or other strong comparison control or observational studies that control for confounds)
- Modest evidence: significant effects in at least three small but well-designed randomized controlled trials (RCTs), or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies), or several small studies aggregated into a meta-analysis
- Preliminary evidence: significant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect
- Weak evidence: one or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects
- Insufficient evidence: preclinical evidence only OR clinical studies with such poor or unclear methodology that no conclusion can be drawn OR conflicting findings across clinical studies with no preponderance of evidence in one direction; conflicting evidence occurs when studies find conflicting effects (positive effect vs no effect or negative effect) with the same treatment and the same general study population (same cancer type, for example)
Learn more about how we research and rate therapies and practices in How We Rate Therapies ›
Improving treatment outcomes
Is Moving More linked to improved survival? Is it linked to less cancer growth or metastasis? Does it enhance the anticancer action of other treatments or therapies? We present the evidence.
The relationship between activity and survival becomes complex as people have more advanced disease or illness. People who are very ill may not be able to move much at all, but we wouldn’t conclude that more activity would delay death. However, evidence shows that even with advanced cancer, increasing activity within your limits is linked to better survival.
Similarly, pushing yourself to high levels of activity during treatment may not be wise. Guidelines encourage you to be as active as available given your situation. Follow your doctor’s recommendations, and also listen to your body’s need for rest.
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds (this is the CancerChoices definition; other researchers and studies may define this differently) of moderately better survival among people with higher activity levels after diagnosis
Modest evidenceat least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis found no effect (this is the CancerChoices definition; other researchers and studies may define this differently) of possibly better chemotherapy completion rates, but no evidenceoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. of improved response rate or survival among people with cancer participating in aerobic exercise during chemotherapy
Physical activity after diagnosis: good evidence of moderately better survival with higher activity levels
- 24% lower mortality among people with cancer and survivors participating in exercise or physical activity interventions compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 8 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects of low quality1Morishita S, Hamaue Y, Fukushima T, Tanaka T, Fu JB, Nakano J. Effect of exercise on mortality and recurrence in patients with cancer: a systematic review and meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420917462.
- 22% lower mortality among people with cancer with the highest levels of physical activity compared to other people in a review of 71 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies2Li T, Wei S et al. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. British Journal of Sports Medicine. 2016 Mar;50(6):339-45.
- 28% lower cancer-specific mortality among people with increased leisure-time physical activity after cancer diagnosis compared to those who remained inactive in a very large observational study3Cannioto RA, Dighe S et al. Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes Control. 2019 Jan;30(1):1-12.
- More than double the mortality among people with cancer with the slowest walking pace compared to the fastest in a very large observational study4Salerno EA, Saint-Maurice PF et al. Ambulatory function and mortality among cancer survivors in the NIH-AARP Diet and Health Study. Cancer Epidemiology, Biomarkers & Prevention. 2021 Mar 4.
During chemotherapy: modest evidence of possibly better chemotherapy completion rates, but no evidence of improved response rate or survival among people with cancer participating in aerobic exercise during chemotherapy
- Possibly better chemotherapy completion rates, but no evidence of improved response rate or survival among people with cancer participating in aerobic exercise (walking, jogging, or cycling) during chemotherapy in a subset of trials reviewed in a meta-analysis of 33 RCTs5Cave J, Paschalis A et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Supportive Care in Cancer. 2018 Oct;26(10):3337-3351.
- Better chemotherapy completion rates without causing lymphedema or significant adverse events among people with breast cancer participating in exercise compared to controls in a mid-sized RCT6Courneya KS, Segal RJ et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007 Oct 1;25(28):4396-404.
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better survival among people with more physical activity
Higher activity levels: preliminary evidence of better survival among people with more physical activity
- Better survival (lower risk of earlier mortality) among people with advanced cancer with higher levels of physical activity compared to other people only in observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies but not RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 11 studies;7Takemura N, Chan SL, Smith R, Cheung DST, Lin CC. The effects of physical activity on overall survival among advanced cancer patients: a systematic review and meta-analysis. BMC Cancer. 2021 Mar 7;21(1):242. the researchers suggest that increasing physical activity only after a diagnosis of advanced cancer may be too late to reap benefits
Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of moderately better survival among people with higher activity levels compared to low levels
Good evidence of moderately better survival among people increasing their activity levels after diagnosis
Preliminary evidence of better cancer-specific survival among people with any level of physical activity after a breast cancer diagnosis
More physical activity compared to less physical activity: strong evidence of moderately better survival among people with higher activity levels compared to low levels
- 28% lower cancer-specific mortality among people with moderate amounts of physical activity (300-500 minutes per week) after diagnosis compared to low levels (and greater gains with moderate-intensity physical activity) in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 24 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies8Lee J. A meta-analysis of the association between physical activity and breast cancer mortality. Cancer Nursing. 2019 Jul/Aug;42(4):271-285.
- 37-41% lower cancer-specific mortality among people with breast cancer with the highest levels of physical activity after diagnosis compared to the lowest in large and very large meta-analyses9Spei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: a systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019 Apr;44:144-152; Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncologica. 2015 May;54(5):635-54. and in pooled analyses10Friedenreich CM, Neilson HK, Farris MS, Courneya KS. Physical activity and cancer outcomes: a precision medicine approach. Clinical Cancer Research. 2016 Oct 1;22(19):4766-4775. of observational studies
- 25% lower cancer-specific mortality among people with breast cancer achieving at least 10 MET-hours per week (3 hours of brisk walking) compared to less activity in a large pooled analysis of 4 observational studies11Beasley JM, Kwan ML Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Research and Treatment. 2012 Jan;131(2):637-43.
- 17–19% lower cancer-specific mortality among people with moderate and high levels of physical activity after diagnosis compared to low levels, with more benefit among overweight women than women with normal weight and among postmenopausal women than premenopausal women, in a large meta-analysis of 16 observational studies12Zhong S, Jiang T et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. European Journal of Epidemiology. 2014 Jun;29(6):391-404.
- 22% increased breast cancer mortality among breast cancer survivors with very low physical activity compared to the average mortality in a pooled analysis of observational studies13Nelson SH, Marinac CR et al. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Research and Treatment. 2016 Feb;155(3):551-7.
Increasing activity after diagnosis: good evidence of moderately better survival among people increasing their activity levels after diagnosis
- 24% decreased total mortality among breast cancer survivors with each 10 metabolic equivalent task-hour/week increase in physical activity after diagnosis (equivalent to current recommendations of 150 min/week of at least moderate intensity activity) in a large meta-analysis of 23 observational studies14Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Annals of Oncology. 2014 Jul;25(7):1293-1311.
- 55% lower mortality among people with breast cancer participating in an exercise intervention compared to usual care in a mid-sized RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects15Hayes SC, Steele ML et al. Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials. Breast Cancer Research and Treatment. 2018 Jan;167(2):505-514.
- 34% lower cancer-specific mortality among people with breast cancer with increased physical activity after diagnosis in a review of 6 observational studies16Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
Any activity after diagnosis: preliminary evidence of better cancer-specific survival among people with any level of physical activity after a breast cancer diagnosis
- Lower cancer-related and overall mortality among people with breast cancer participating in physical activity after diagnosis compared to no activity in a systematic review of 6 observational studies17Ballard-Barbash R, Friedenreich CM et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. Journal of the National Cancer Institute. 2012 Jun 6;104(11):815-40.
Strong evidence of moderately better survival among people participating in more physical activity
Strong evidence of moderately better survival among people who increased their physical activity after diagnosis
Modest evidence of moderately higher mortality among people with high levels of sedentarycharacterized by much sitting and little physical exercise time
More physical activity compared to less physical activity: strong evidence of moderately better survival among people with more physical activity
- 28% decreased total mortality among people with colorectal cancer with each 10 metabolic equivalent task-hour/week increase in physical activity after diagnosis (equivalent to current recommendations of 150 min/week of at least moderate intensity activity) in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 23 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies18Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Annals of Oncology. 2014 Jul;25(7):1293-1311.
- 36% lower cancer-specific mortality among people with colorectal cancer with the highest levels of physical activity compared to the lowest levels after diagnosis in a meta-analysis of 18 observational studies19Qiu S, Jiang C, Zhou L. Physical activity and mortality in patients with colorectal cancer: a meta-analysis of prospective cohort studies. European Journal of Cancer Prevention. 2020 Jan;29(1):15-26.
- 30–38% lower cancer-specific mortality among people with colorectal cancer with higher levels of physical activity compared to other people in a review20Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
Increasing activity after diagnosis: strong evidence of moderately better survival among people who increased their physical activity after diagnosis
- 39% lower total mortality among people with colorectal cancer who increased their physical activity by any level after diagnosis compared to other people in a large meta-analysis of 23 observational studies21Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Annals of Oncology. 2014 Jul;25(7):1293-1311.
- 30% lower mortality among people who increased their level of activity compared to other people in a meta-analysis of 7 observational studies22Otto SJ, Korfage IJ et al. Association of change in physical activity and body weight with quality of life and mortality in colorectal cancer: a systematic review and meta-analysis. Supportive Care in Cancer. 2015 May;23(5):1237-50.
Sedentary time: modest evidence of moderately higher mortality among people with high levels of sedentary time
- 22% higher cancer-specific mortality among people with colorectal cancer with higher sedentary behavior in a meta-analysis of 33 observational studies of low quality23Swain CTV, Nguyen NH et al. Postdiagnosis sedentary behavior and health outcomes in cancer survivors: a systematic review and meta-analysis. Cancer. 2020 Feb 15;126(4):861-869.
Good evidence of better survival among people with higher physical activity after a lymphoma diagnosis
Modest evidence of better survival among people participating in physical activity before diagnosis
- 26% lower cancer-specific mortality at 3 years among people with lymphoma who met the American Cancer Society recommendations for physical activity, and 51% lower mortality among those who increased levels of physical activity after diagnosis compared with those whose activity levels remained stable in a large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study24Pophali PA, Ip A et al. The association of physical activity before and after lymphoma diagnosis with survival outcomes. American Journal of Hematology. 2018 Dec;93(12):1543-1550.
- 19% lower cancer-specific mortality among people with lymphoma with the highest adult lifetime levels of physical activity at baseline (within 9 months of diagnosis) compared with the lowest levels in a large observational study25Pophali P, Larson MC et al. The level of physical activity before and after lymphoma diagnosis impacts overall and lymphoma-specific survival. Blood. 2017 Dec 8;130 supplement 1: 914.
Strong evidence of improved survival and reduced disease progression among people with prostate cancer with higher levels of physical activity after diagnosis
No evidenceoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. of a change in prostate-specific antigen (PSA) among men with prostate cancer participating in resistance exercise in a combined analysis of studies
More physical activity compared to less physical activity: strong evidence of improved survival and reduced disease progression among people with prostate cancer with higher levels of physical activity after diagnosis
- 31–37% lower cancer-specific mortality among men with prostate cancer with the highest levels of physical activity after diagnosis compared to the lowest in a pooled analysis26Friedenreich CM, Neilson HK, Farris MS, Courneya KS. Physical activity and cancer outcomes: a precision medicine approach. Clinical Cancer Research. 2016 Oct 1;22(19):4766-4775. and a separate meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 72 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies27Benke IN, Leitzmann MF, Behrens G, Schmid D. Physical activity in relation to risk of prostate cancer: a systematic review and meta-analysis. Annals of Oncology. 2018 May 1;29(5):1154-1179.
- 30% lower risk of cancer-specific mortality and 57% lower rate of disease progression among men with prostate cancer with 3 hours per week of moderate intensity physical activity compared to less activity in a review of 2 observational studies28Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- 38% lower risk of cancer-specific mortality and 23% lower risk of progression among people with prostate cancer with higher levels of physical activity compared to lower levels in a review of observational studies29Brown JC, Ligibel JA. The role of physical activity in oncology care. Journal of the National Cancer Institute. Monographs. 2017 Nov 1;2017(52).
Change in PSA: no evidence of a change in PSA among men with prostate cancer participating in resistance exercise in a combined analysis of studies
- No change in PSA among men with prostate cancer participating in resistance exercise in a meta-analysis of 23 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects30Lopez P, Taaffe DR, Newton RU, Galvão DA. Resistance exercise dosage in men with prostate cancer: systematic review, meta-analysis, and meta-regression. Medicine and Science in Sports and Exercise. 2021 Mar 1;53(3):459-469.
Good evidence of better survival among people with colorectal cancer practicing healthy lifestyle behaviors
Good evidence of lower risk of lethal prostate cancer, but not overall prostate cancer, over 27 years among people with high genetic risk following a healthy lifestyle of a healthy weight, vigorous physical activity, not smoking, and a healthy diet
Preliminary evidence of decreasing PSA levels among men with early stage prostate cancer combining a low-fat, vegetarian diet with physical activity, group support and stress management
Good evidence of lower risk of lethal prostate cancer, but not overall prostate cancer, among people with high genetic risk following a healthy lifestyle of a healthy weight, vigorous physical activity, not smoking, and a healthy diet
Preliminary evidence of better survival and lower risk of relapse among people with breast cancer combining diet and exercise
Preliminary evidence of better survival among people with colorectal cancer following diet and physical activity guidelines
Moving More and Eating Well
Body weight
Preliminary evidence of more of a decrease in body weight and both visceral and subcutaneous fat among people with type 2 diabetes eating a vegetarian diet and also participating in exercise
Weak evidence of better markers of body mass index and cardiorespiratory fitness among people with breast cancer participating in an intervention of nutrition and exercise
- More of a decrease in body weight and both visceral and subcutaneous fat among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding exercise for an additional 12 weeks in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects31Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
- Better markers of body mass index and cardiorespiratory fitness among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design32Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
High blood sugar and insulin resistance
Preliminary evidence of better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet and participating in exercise
Weak evidence of lower markers of glycemic imbalance among men with prostate cancer participating in a diet and an exercise program
Weak evidence of better markers of insulin growth factor among men participating in a diet and exercise program
Weak evidence of better markers of blood sugar and insulin among people participating in both diet and exercise
- Better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding physical exercise for an additional 12 weeks in a small RCT33Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
- No change in insulin resistance and metabolic syndrome related to androgen deprivation therapy (ADT), but weak trends toward lower markers of high blood sugar in men with prostate cancer and without diabetes treated with metformin, a low-glycemic-index diet and an exercise program compared to controls receiving only ADT in a small RCT34Nobes JP, Langley SE, Klopper T, Russell-Jones D, Laing RW. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU International. 2012 May;109(10):1495-502.
- Better markers of insulin growth factor and less serum-stimulated LNCaP cell growth among men participating in a diet and exercise program compared to baseline in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study35Ngo TH, Barnard RJ, Tymchuk CN, Cohen P, Aronson WJ. Effect of diet and exercise on serum insulin, IGF-I, and IGFBP-1 levels and growth of LNCaP cells in vitro (United States). Cancer Causes & Control. 2002;13(10):929–935.
- Better markers of blood sugar (glycemia) and insulin resistance among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial36Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
- Lower insulin and insulin-like growth factor-I (IGF-I) and higher IGF binding protein-1 among overweight/obese, postmenopausal women―whether on hormone treatment or not―following a low-fat, high-fiber diet and attending daily exercise classes for 2 weeks in an uncontrolled trial37Barnard RJ, Gonzalez JH, Liva ME, Ngo TH. Effects of a low-fat, high-fiber diet and exercise program on breast cancer risk factors in vivo and tumor cell growth and apoptosis in vitro. Nutrition and Cancer. 2006;55(1):28-34.
Hormone imbalance
Modest evidence of more benefits with breast cancer-related sex hormones among healthy postmenopausal women combining and exercise
Preliminary evidence of higher levels of adiponectin (important for regulating blood glucose, insulin sensitivity, and lipid metabolism) and lower levels of leptin (which inhibits hunger) among people with type 2 diabetes eating a vegetarian diet and participating in exercise
- Benefits with breast cancer-related sex hormones among healthy, physically inactive postmenopausal women participating in either reduced caloric intake alone or exercise alone, but the broadest benefits came from combining both diet and exercise in a meta-analysis of 6 RCTs38de Roon M, May AM et al. Effect of exercise and/or reduced calorie dietary interventions on breast cancer-related endogenous sex hormones in healthy postmenopausal women. Breast Cancer Research. 2018 Aug 2;20(1):81.
- Better markers of testosterone among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial39Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
- Lower serum estradiol levels among overweight/obese, postmenopausal women―whether on hormone treatment or not―following a low-fat, high-fiber diet and attending daily exercise classes for 2 weeks in an uncontrolled trial40Barnard RJ, Gonzalez JH, Liva ME, Ngo TH. Effects of a low-fat, high-fiber diet and exercise program on breast cancer risk factors in vivo and tumor cell growth and apoptosis in vitro. Nutrition and Cancer. 2006;55(1):28-34.
- Higher levels of adiponectin and lower levels of leptin among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding exercise for an additional 12 weeks in a small RCT41Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
Inflammation: weak evidence of better markers of inflammation among people with breast cancer participating in an intervention of nutrition and exercise
- Better markers of inflammation among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial42Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
Optimizing your body terrain
Does Moving More promote an environment within your body that is less supportive of cancer development, growth or spread? We present the evidence.
Several imbalances in your body terrainthe internal conditions of your body, including nutritional status, fitness, blood sugar balance, hormone balance, inflammation, and more can make your body more supportive of cancer. Resolving terrain imbalances can decrease your risk of cancer or recurrence, promote healing and wellness, and improve survival.
Find health professionals who specialize in managing body terrain ›
Strong evidence of less body fat and more lean body mass among people with cancer participating in exercise without regard to cancer treatment phase
- Less body fat among people with colorectal cancer participating in exercise compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 19 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects, 17 of which were high quality43Singh B, Hayes SC et al. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. International Journal of Behavioral Nutrition and Physical Activity. 2020 Sep 24;17(1):122.
- Lower body weight, lower body mass index, and lower percentage of body fat among women with early breast cancer participating in physical exercise compared to controls in a meta-analysis of 60 RCTs44Soares Falcetta F, de Araújo Vianna Träsel H et al. Effects of physical exercise after treatment of early breast cancer: systematic review and meta-analysis. Breast Cancer Research and Treatment. 2018 Aug;170(3):455-476.
- Better fat mass and lean mass with no change in body mass index among men with prostate cancer participating in resistance exercise compared to controls in a meta-analysis of 21 RCTs45Lopez P, Taaffe DR, Newton RU, Galvão DA. Resistance exercise dosage in men with prostate cancer: systematic review, meta-analysis, and meta-regression. Medicine and Science in Sports and Exercise. 2021 Mar 1;53(3):459-469.
- Better body mass index (BMI) among women with gynecological cancer participating in interventions with an exercise component compared to controls in a meta-analysis of 7 RCTs46Lin KY, Frawley HC, Denehy L, Feil D, Granger CL. Exercise interventions for patients with gynaecological cancer: a systematic review and meta-analysis. Physiotherapy. 2016 Dec;102(4):309-319.
- A larger reduction in fat mass and better lean mass among people with cancer across all stages of therapy and aftercare participating in both moderate-intensity and high-intensity interval training compared to usual care in a meta-analysis of 12 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial47Mugele H, Freitag N et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. Journal of Cancer Survivorship. 2019 Apr;13(2):205-223.
- Lower body fat percentage, more lean mass and trunk fat mass, plus a weak trend toward lower whole-body fat mass, among men with prostate cancer participating in resistance exercise compared to controls in a pooled analysis of 32 intervention studies48Keilani M, Hasenoehrl T et al. Effects of resistance exercise in prostate cancer patients: a meta-analysis. Supportive Care in Cancer. 2017 Sep;25(9):2953-2968.
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds (this is the CancerChoices definition; other researchers and studies may define this differently) of better insulin balance among people with cancer as a whole participating in physical activity
Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of some better markers of insulin balance and insulin-like growth factor (IGF) among people with breast cancer with higher levels of physical activity
Strong evidence of better insulin balance among people with colorectal cancer with higher levels of physical activity
Cancer as a whole: good evidence of better insulin balance among people participating in physical activity
- Better levels of insulin, insulin resistance, and glucose, with insulin levels improving throughout the intervention among those with higher baseline insulin levels, among cancer survivors with a physical activity intervention compared to control conditions in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects49Wang Y, Jin B et al. The effects of exercise on insulin, glucose, IGF-axis and CRP in cancer survivors: meta-analysis and meta-regression of randomised controlled trials. European Journal of Cancer Care (England). 2020 Jan;29(1):e13186.
- A consistent trend toward lower levels of insulin and insulin-related pathways among cancer survivors who had completed treatment with exercise compared to controls in a review of 15 trials including 12 RCTs50McDermott LA, Murphy MH, McNeilly AM, Rankin JP, Gracey JH. Biological markers as an outcome measure of exercise in cancer rehabilitation: a systematic review. Journal of Cancer Research and Therapeutics. 2018 Jan-Mar;14(2):267-277.
Breast cancer: strong evidence of some better markers of insulin balance and insulin-like growth factor (IGF) among people with breast cancer with higher levels of physical activity
- Lower levels of serum insulin, IGF, and insulin resistance among women with breast cancer with physical activity in a meta-analysis of 12 RCTs51Han JK, Kim G. Role of physical exercise in modulating the insulin-like growth factor system for improving breast cancer outcomes: a meta-analysis. Experimental Gerontology. 2021 Sep;152:111435.
- Lower levels of insulin and related IGF markers, but not other markers of blood sugar, among people with breast cancer with physical activity in a meta-analysis of 11 RCTs52Kang XY, Xu QY et al. The effects of physical activity on physiological markers in breast cancer survivors: a meta-analysis. Medicine (Baltimore). 2020 May;99(20):e20231.
- Lower fasting insulin levels, especially when participants lost weight, among people with breast cancer with exercise compared to controls in a meta-analysis of 18 RCTs53Kang DW, Lee J et al. Effects of exercise on insulin, IGF axis, adipocytokines, and inflammatory markers in breast cancer survivors: a systematic review and meta-analysis. Cancer Epidemiology, Biomarkers & Prevention. 2017 Mar;26(3):355-365.
- Better serum metabolic markers among inactive women with newly diagnosed breast cancer with an exercise intervention compared to a mind-body intervention comparison group in a small randomized comparison trial54Ligibel JA, Dillon D et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the Pre-Operative Health and Body (PreHAB) study. Clinical Cancer Research. 2019 Sep 1;25(17):5398-5406.
Colorectal cancer: strong evidence of better insulin balance among people with colorectal cancer with higher levels of physical activity
- Lower fasting insulin levels and insulin resistance among people with colorectal cancer who have completed treatment and who participated in an exercise intervention compared to their usual lifestyle in a meta-analysis of 20 RCTs55Gao R, Yu T et al. Exercise intervention for post-treatment colorectal cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2020 Dec;14(6):878-893.
Changes in hormone levels seen in the studies here may not be beneficial in every situation. Your oncology team needs to determine whether any changes would be favorable for your condition.
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of better levels of leptin among people with or at high risk of breast cancer, but only among people with body mass index above 25
Modest evidencesignificant effects in at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower cortisol levels (a marker of stress) among people with major depressive disorder participating in exercise
Leptin levels: preliminary evidence of better levels of leptin among people with or at high risk of breast cancer, but only among people with body mass index above 25
- Better levels of serum leptin among people with breast cancer, and also with overweight or obesity, participating in an exercise intervention compared to controls in mid-sized and small RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects56Dieli-Conwright CM, Courneya KS et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: a randomized controlled trial. Journal of Clinical Oncology. 2018 Mar 20;36(9):875-883; Kim TH, Chang JS et al. Effects of exercise training on circulating levels of Dickkpof-1 and secreted frizzled-related protein-1 in breast cancer survivors: a pilot single-blind randomized controlled trial. PLoS One. 2017 Feb 8;12(2):e0171771.
- No change in serum leptin levels among people with breast cancer participating in physical activity compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 11 RCTs57Kang XY, Xu QY et al. The effects of physical activity on physiological markers in breast cancer survivors: a meta-analysis. Medicine (Baltimore). 2020 May;99(20):e20231.
Cortisol levels
Modest evidence of lower cortisol levels (a marker of stress) among people with major depressive disorder participating in exercise
Modest evidence of lower cortisol levels among students in grade school through higher education participating in mind–body physical activity
- Lower cortisol levels among people with major depressive disorder participating in exercise compared to controls in a meta-analysis of 5 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial58Beserra AHN, Kameda P et al. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends in Psychiatry and Psychotherapy. 2018 Oct-Dec;40(4):360-368.
- Lower cortisol levels, with stronger effects in older students compared to younger ones, among students in grade school through higher education participating in mind–body physical activity compared to controls in a meta-analysis of 26 studies59Strehli I, Burns RD et al. Mind–body physical activity interventions and stress-related physiological markers in educational settings: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2020 Dec 30;18(1):224.
Increased immune system activation is not always beneficial, so your oncology team needs to determine whether immune activation would be favorable in your situation.
Preliminary evidence of higher immune activation among previously inactive women with breast cancer participating in an exercise intervention
Weak evidence of short-term higher markers of immune function among people with cancer performing a single 10-minute exercise session
- Higher markers of immune activation (upregulation of pathways related to inflammation and immunity) among inactive women with newly diagnosed breast cancer participating in an exercise intervention compared to a mind-body intervention comparison group in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects60Ligibel JA, Dillon D et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the Pre-Operative Health and Body (PreHAB) study. Clinical Cancer Research. 2019 Sep 1;25(17):5398-5406.
- Changes in markers of immune function (higher proportions of total NK cells and CD56+CD16+ NK cells, higher proportion of CD8+ T cells and lower proportion of CD4+ T cells) immediately after exercise, decreasing back to baseline after 30 minutes, among people with lymphoma performing a single 10-minute session on a bicycle ergometer at moderate exercise intensity compared to baseline in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design61Koivula T, Lempiäinen S et al. Acute exercise mobilizes CD8+ cytotoxic T cells and NK cells in lymphoma patients. Frontiers in Physiology. 2023 Jan 11;13:1078512.
- Higher markers of immune function (leukocytes, CD8+ T cells, CD19+ B cells, CD56+CD16+ NK cells, and CD14+CD16+ monocytes) immediately after exercise among people with newly diagnosed breast cancer performing a single 10-minute session compared to baseline in a small uncontrolled trial62Koivula T, Lempiäinen S et al. The effect of acute exercise on circulating immune cells in newly diagnosed breast cancer patients. Scientific Reports. 2023 Apr 21;13(1):6561.
Preliminary (conflicting) evidence of lower inflammation among people with cancer participating in physical activity
- Better levels of a marker of inflammation among people with cancer participating in physical activity compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects63Wang Y, Jin B et al. The effects of exercise on insulin, glucose, IGF-axis and CRP in cancer survivors: meta-analysis and meta-regression of randomised controlled trials. European Journal of Cancer Care (England). 2020 Jan;29(1):e13186.
- Lower levels of pro-inflammatory markers and a weak trend toward decreased anti-inflammatory markers among people with cancer exercising, with the greatest effects in combined aerobic and resistance training and among people with breast or prostate cancer, in a meta-analysis of 27 RCTs64Khosravi N, Stoner L, Farajivafa V, Hanson ED. Exercise training, circulating cytokine levels and immune function in cancer survivors: a meta-analysis. Brain, Behavior, and Immunity. 2019 Oct;81:92-104.
- A weak trend toward lower markers of inflammation among people with breast cancer participating in exercise compared to controls in a meta-analysis of 18 RCTs65Kang DW, Lee J et al. Effects of exercise on insulin, IGF axis, adipocytokines, and inflammatory markers in breast cancer survivors: a systematic review and meta-analysis. Cancer Epidemiology, Biomarkers & Prevention. 2017 Mar;26(3):355-365.
- No significant change in markers of inflammation among people with breast cancer participating in physical activity compared to controls in a meta-analysis of 11 RCTs66Kang XY, Xu QY et al. The effects of physical activity on physiological markers in breast cancer survivors: a meta-analysis. Medicine (Baltimore). 2020 May;99(20):e20231.
- Better markers of inflammation and immunity among inactive women with newly diagnosed breast cancer participating in an exercise intervention compared to a mind-body intervention comparison group in a small RCT67Ligibel JA, Dillon D et al. Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: results from the Pre-Operative Health and Body (PreHAB) study. Clinical Cancer Research. 2019 Sep 1;25(17):5398-5406.
Good evidence of lower markers of oxidative stressoxidation is a process in which molecules combine with oxygen or lose electrons; losing an electron creates unstable free radicals that can damage cells, causing illness and aging among people exercising
- Lower markers of pro-oxidant activity and higher antioxidant capacity among people exercising compared with controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 19 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects68de Sousa CV, Sales MM, Rosa TS, Lewis JE, de Andrade RV, Simões HG. The antioxidant effect of exercise: a systematic review and meta-analysis. Sports Medicine. 2017 Feb;47(2):277-293.
Modest evidence of healthier microbiota among healthy people with higher levels of physical activity
- Increased abundance of beneficial bacteria including butyrate-producing bacteria, and butyrate concentration in athletes and active people compared to other people in a review of 17 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies69Aya V, Flórez A, Perez L, Ramírez JD. Association between physical activity and changes in intestinal microbiota composition: a systematic review. PLoS One. 2021 Feb 25;16(2):e0247039.
Why this matters: beneficial bacteria in your gut are needed to process and create essential nutrients by fermenting dietary fiber and producing butyrate. These processes provide energy to colon cells and promote protective immune system effects. As a result, adequate dietary fiber is essential for a healthy interaction among the gut microbiome, colon cells, and immunity,70Block KI, Block PB, Gyllenhaal C. Integrative treatment for colorectal cancer: a comprehensive approach. Journal of Alternative and Complementary Medicine. 2018;24(9-10):890–901. and lower levels of butyrate-producing bacteria are associated with the presence of colorectal cancer.71Purcell RV, Pearson J et al. Colonization with enterotoxigenic Bacteroides fragilis is associated with early-stage colorectal neoplasia. PLoS One. 2017;12(2):e0171602.
Modest evidence of higher risk of low vitamin D levels among people with low levels of physical activity
- Higher risk of low vitamin D levels among people with low levels of physical activity compared to high levels in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies72Xu J, Yuan X et al. Association of circulating 25-hydroxyvitamin D levels with colorectal cancer: an updated meta-analysis. Journal of Nutritional Science and Vitaminology (Tokyo). 2018;64(6):432-444.
See why vitamin D levels are important in cancer in Vitamin D ›
Preliminary evidence of more of a decrease in body weight and both visceral and subcutaneous fat among people with type 2 diabetes eating a vegetarian diet and also participating in exercise
Weak evidence of better markers of body mass index and cardiorespiratory fitness among people with breast cancer participating in an intervention of nutrition and exercise
Preliminary evidence of better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet and participating in physical exercise
Weak evidence of lower markers of glycemic imbalance among men with prostate cancer participating in a diet and an exercise program
Weak evidence of better markers of insulin growth factor among men participating in a diet and exercise program
Weak evidence of better markers of blood sugar and insulin among people participating in both diet and exercise
Modest evidence of more benefits with breast cancer-related sex hormones among healthy, physically inactive postmenopausal women combining diet and exercise
Preliminary evidence of higher levels of adiponectin (important for regulating blood glucose, insulin sensitivity, and lipid metabolism) and lower levels of leptin (which inhibits hunger) among people with type 2 diabetes eating a vegetarian diet and participating in exercise
Weak evidence of better markers of inflammation among people with breast cancer participating in an intervention of nutrition and exercise
Moving More and Eating Well
Body weight
Preliminary evidence of more of a decrease in body weight and both visceral and subcutaneous fat among people with type 2 diabetes eating a vegetarian diet and also participating in exercise
Weak evidence of better markers of body mass index and cardiorespiratory fitness among people with breast cancer participating in an intervention of nutrition and exercise
- More of a decrease in body weight and both visceral and subcutaneous fat among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding exercise for an additional 12 weeks in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects73Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
- Better markers of body mass index and cardiorespiratory fitness among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design74Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
High blood sugar and insulin resistance
Preliminary evidence of better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet and participating in exercise
Weak evidence of lower markers of glycemic imbalance among men with prostate cancer participating in a diet and an exercise program
Weak evidence of better markers of insulin growth factor among men participating in a diet and exercise program
Weak evidence of better markers of blood sugar and insulin among people participating in both diet and exercise
- Better insulin sensitivity and higher incidence of reduced diabetes medication among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding physical exercise for an additional 12 weeks in a small RCT75Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
- No change in insulin resistance and metabolic syndrome related to androgen deprivation therapy (ADT), but weak trends toward lower markers of high blood sugar in men with prostate cancer and without diabetes treated with metformin, a low-glycemic-index diet and an exercise program compared to controls receiving only ADT in a small RCT76Nobes JP, Langley SE, Klopper T, Russell-Jones D, Laing RW. A prospective, randomized pilot study evaluating the effects of metformin and lifestyle intervention on patients with prostate cancer receiving androgen deprivation therapy. BJU International. 2012 May;109(10):1495-502.
- Better markers of insulin growth factor and less serum-stimulated LNCaP cell growth among men participating in a diet and exercise program compared to baseline in a small observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study77Ngo TH, Barnard RJ, Tymchuk CN, Cohen P, Aronson WJ. Effect of diet and exercise on serum insulin, IGF-I, and IGFBP-1 levels and growth of LNCaP cells in vitro (United States). Cancer Causes & Control. 2002;13(10):929–935.
- Better markers of blood sugar (glycemia) and insulin resistance among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial78Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
- Lower insulin and insulin-like growth factor-I (IGF-I) and higher IGF binding protein-1 among overweight/obese, postmenopausal women―whether on hormone treatment or not―following a low-fat, high-fiber diet and attending daily exercise classes for 2 weeks in an uncontrolled trial79Barnard RJ, Gonzalez JH, Liva ME, Ngo TH. Effects of a low-fat, high-fiber diet and exercise program on breast cancer risk factors in vivo and tumor cell growth and apoptosis in vitro. Nutrition and Cancer. 2006;55(1):28-34.
Hormone imbalance
Modest evidence of more benefits with breast cancer-related sex hormones among healthy postmenopausal women combining and exercise
Preliminary evidence of higher levels of adiponectin (important for regulating blood glucose, insulin sensitivity, and lipid metabolism) and lower levels of leptin (which inhibits hunger) among people with type 2 diabetes eating a vegetarian diet and participating in exercise
- Benefits with breast cancer-related sex hormones among healthy, physically inactive postmenopausal women participating in either reduced caloric intake alone or exercise alone, but the broadest benefits came from combining both diet and exercise in a meta-analysis of 6 RCTs80de Roon M, May AM et al. Effect of exercise and/or reduced calorie dietary interventions on breast cancer-related endogenous sex hormones in healthy postmenopausal women. Breast Cancer Research. 2018 Aug 2;20(1):81.
- Better markers of testosterone among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial81Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
- Lower serum estradiol levels among overweight/obese, postmenopausal women―whether on hormone treatment or not―following a low-fat, high-fiber diet and attending daily exercise classes for 2 weeks in an uncontrolled trial82Barnard RJ, Gonzalez JH, Liva ME, Ngo TH. Effects of a low-fat, high-fiber diet and exercise program on breast cancer risk factors in vivo and tumor cell growth and apoptosis in vitro. Nutrition and Cancer. 2006;55(1):28-34.
- Higher levels of adiponectin and lower levels of leptin among people with type 2 diabetes eating a vegetarian diet for 12 weeks compared to a conventional diabetic diet, with even greater differences after adding exercise for an additional 12 weeks in a small RCT83Kahleova H, Matoulek M et al. Vegetarian diet improves insulin resistance and oxidative stress markers more than conventional diet in subjects with type 2 diabetes. Diabetic Medicine. 2011 May;28(5):549-59.
Inflammation: weak evidence of better markers of inflammation among people with breast cancer participating in an intervention of nutrition and exercise
- Better markers of inflammation among people with breast cancer participating in a 3-month lifestyle intervention of nutrition and exercise in a small uncontrolled trial84Natalucci V, Marini CF et al. Effects of a home-based lifestyle intervention program on cardiometabolic health in breast cancer survivors during the COVID-19 lockdown. Journal of Clinical Medicine. 2021 Jun 17;10(12):2678.
Managing side effects and promoting wellness
Is Moving More linked to fewer or less severe side effects or symptoms? Is it linked to less toxicity from cancer treatment? Does it support your quality of life or promote general well-being? We present the evidence.
Modest evidence of less toxicity during chemotherapy among people with cancer participating in exercise
- Less chemotherapy toxicity, but no evidence of less suppression of bone marrow activity (myelosuppression), among people with cancer participating in aerobic exercise (walking, jogging, or cycling) during chemotherapy compared to controls in a subset of trials reviewed in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 33 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects85Cave J, Paschalis A et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Supportive Care in Cancer. 2018 Oct;26(10):3337-3351.
Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of a small improvement in anxiety among people participating in exercise without regard to treatment phase
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds (this is the CancerChoices definition; other researchers and studies may define this differently) of slightly less anxiety among people participating in exercise during chemotherapy, radiotherapy, adjuvant therapytreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation, or hormone therapy
Strong evidence of small to moderate improvement in anxiety among people participating in exercise after cancer treatment
No evidence of an effectoverall, one or more studies did not demonstrate that a treatment or intervention led to an expected outcome; this does not always mean that there is no effect in clinical practice, but that the studies may have been underpowered (too few participants) or poorly designed. Larger, well-designed studies provide more confidence in making assessments. on anxiety among adults with advanced cancer participating in exercise in a combined analysis of studies
Without regard to treatment phase: strong evidence of a small improvement in anxiety among people participating in exercise
- Less anxiety among people with lung cancer participating in exercise, with no higher risk of an adverse event, compared to usual care in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 32 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects86Singh B, Spence R, Steele ML, Hayes S, Toohey K. Exercise for individuals with lung cancer: a systematic review and meta-analysis of adverse events, feasibility, and effectiveness. Seminars in Oncology Nursing. 2020 Oct;36(5):151076.
- Slightly less anxiety among people with cancer participating in an online physical activity or diet intervention compared to controls in a meta-analysis of 24 RCTs87Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Less anxiety among women diagnosed with stage 2+ breast cancer participating in exercise compared to controls in a meta-analysis of RCTs88Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- No impact on anxiety among people with non-advanced colorectal cancer participating in physical activity interventions compared to controls in a meta-analysis of 16 RCTs89McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
- Fewer symptoms of anxiety among people with lung cancer participating in exercise interventions compared to controls in a meta-analysis of 8 RCTs90Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
- Less anxiety among people with lung cancer participating in home-based exercise compared to controls in a meta-analysis of 7 RCTs91Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- No difference in anxiety among adults with blood cancers (mostly leukemia, lymphoma, and multiple myeloma) doing aerobic exercise compared to no intervention or usual care in meta-analysis of 6 RCTs with very low certainty evidence92Knips L, Bergenthal N et al. Aerobic physical exercise for adult patients with haematological malignancies. Cochrane Database of Systematic Reviews. 2019 Jan 31;1(1):CD009075.
- Lower anxiety among people with cancer participating in exercise compared to controls in a meta-analysis of 40 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial93Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
During treatment: good evidence of slightly less anxiety among people participating in exercise during adjuvant therapy, chemotherapy, radiotherapy, or hormone therapy
- Slightly less anxiety during adjuvant therapy among people with breast cancer participating in exercise compared to controls in a meta-analysis of 29 RCTs94Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Small improvements in anxiety among people undergoing chemotherapy, radiotherapy, or hormone therapy and participating in exercise compared to controls in a review of 6 RCTs95Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Lower anxiety among people with breast cancer participating in aerobic exercise training for the duration of their chemotherapy compared to controls in a mid-sized RCT96Courneya KS, Segal RJ et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology, Biomarkers & Prevention. 2007 Dec;16(12):2572-8.
After treatment: strong evidence of small to moderate improvement in anxiety among people participating in exercise
- Small-to-moderate improvements in anxiety after adjuvant therapy among women with breast cancer participating in exercise compared to controls in a meta-analysis of 63 controlled trials97Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database of Systematic Reviews. 2018 Jan 29;1(1):CD011292.
- Small to moderate improvement in anxiety among people with cancer participating in exercise after treatment compared to controls in a meta-analysis of 66 controlled trials of high quality98Speck R, Courneya K, Masse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010 Jun; 4(2):87-100.
- Less anxiety after completing primary treatment among people with cancer participating in exercise interventions for 12 weeks compared to controls in a meta-analysis of 40 controlled trials99Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncology Nursing Forum. 2014 Nov 1;41(6):E326-42.
- Small improvements in anxiety among people participating in exercise after treatment compared tothose not exercising in a review of 6 RCTs100Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
Advanced disease: no evidence of an effect on anxiety among adults with advanced cancer participating in exercise in a combined analysis of studies
- No change in anxiety among adults with advanced lung cancer participating in exercise training compared to controls in a pooled analysis of 6 RCTs101Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
Strong evidence of more lean body mass among people with cancer participating in resistance training without regard to treatment phase
Strong evidence of increased lean body mass and less body fat or obesity among people receiving neoadjuvanttherapy used before a main treatment, such as chemotherapy, radiation therapy, and hormone therapy before surgery or adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation chemotherapy, radiotherapy, or hormone therapy, including androgen deprivation therapy, when participating in exercise
Without regard to treatment phase: strong evidence of more lean body mass among people with cancer participating in resistance training
- More lean body mass among people with cancer participating in resistance training: gain of 0.51 kg compared to a loss of 0.59 kg in controls in a meta-analysis of 34 RCTs102Koeppel M, Mathis K, Schmitz KH, Wiskemann J. Muscle hypertrophy in cancer patients and survivors via strength training. A meta-analysis and meta-regression. Critical Reviews in Oncology/Hematology. 2021 Jul;163:103371.
During treatment: strong evidence of increased lean body mass and less body fat or obesity during neoadjuvant or adjuvant chemotherapy, radiotherapy, or hormone therapy, including androgen deprivation therapy, among people participating in exercise
- Slight increases in lean body tissue, along with less body fat among people with cancer participating in exercise during chemotherapy, radiotherapy, or hormone therapy or after treatment compared to controls in a review of 5 RCTs103Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Increased lean body mass and decreased body fat among people with cancer undergoing neoadjuvant or adjuvant therapy participating in resistance exercise compared to controls in a meta-analysis of 14 controlled trials104Padilha CS, Marinello PC et al. Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: a meta-analysis. Journal of Cancer Survivorship. 2017 Jun;11(3):339-349.
- Less obesity related to androgen deprivation therapy (ADT) among men with prostate cancer receiving ADT and participating in exercise compared to controls in a meta-analysis of 14 RCTs and 1 controlled trial105Yunfeng G, Weiyang H, Xueyang H, Yilong H, Xin G. Exercise overcome adverse effects among prostate cancer patients receiving androgen deprivation therapy: an update meta-analysis. Medicine (Baltimore). 2017 Jul;96(27):e7368.
- Better muscle strength immediately after chemotherapy among people with cancer participating in a 24-week exercise intervention started during chemotherapy compared to starting after chemotherapy in a mid-sized RCT106van der Schoot GGF, Hormel HL et al. Optimal timing of a physical exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. Journal of the American College of Cardiology: CardioOncology. 2022.
- Improved muscle mass among people with rectal cancer undergoing neoadjuvant chemoradiotherapy in preparation for surgery and participating in a 13-17-week telephone-guided graduated walking program compared to standard care in a small RCT107Moug SJ, Barry SJE et al. Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial. Techniques in Coloproctology. 2020 Sep;24(9):959-964.
- A small reduction in waist size, and no change in weight or body mass index during treatment with androgen-deprivation therapy (leuprorelin acetate) among people with locally advanced, relapsed, or metastatic prostate cancer participating in weekly or biweekly supervised group aerobic and resistance training exercise for 10-18 weeks (16 exercise sessions in total) compared to baseline in a large uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design;108Schumacher O, Galvão DA et al. Nationwide industry-led community exercise program for men with locally advanced, relapsed, or metastatic prostate cancer on androgen-deprivation therapy. JCO Oncology Practice. 2022 Aug;18(8):e1334-e1341. weight gain is often a side effect of ADT, and so the lack of a change in weight is a positive finding
- More muscle mass among people with rectal cancer undergoing neoadjuvant chemoradiotherapy in preparation for surgery and participating in a 13-17-week telephone-guided graduated walking program compared to standard care in a small RCT109Moug SJ, Barry SJE et al. Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial. Techniques in Coloproctology. 2020 Sep;24(9):959-964.
Preliminary (conflicting) evidence of better bone mineral density among people with cancer participating in exercise
- No change in bone mineral density among men with nonmetastatic prostate cancer initiating or continuing androgen deprivation therapy (ADT) participating in exercise compared to usual care in a meta-analysis of 27 randomized trials and 2 systematic reviews of trials110Alibhai SMH, Zukotynski K et al. Bone health and bone-targeted therapies for nonmetastatic prostate cancer: a systematic review and meta-analysis. Annals of Internal Medicine. 2017 Sep 5;167(5):341-350.
- Better bone mineral density only at the lumbar spine among people with cancer participating in at least 6 months of combined resistance and impact exercise in a meta-analysis of 12 RCTs111Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporosis International. 2018 Feb;29(2):287-303.
- Less bone loss only at the femoral neck and not at the lumbar spine, and only among premenopausal women with early breast cancer, participating in at least 12 months of exercise in a meta-analysis of RCTs of 7 RCTs112Fornusek CP, Kilbreath SL. Exercise for improving bone health in women treated for stages I-III breast cancer: a systematic review and meta-analyses. Journal of Cancer Survivorship. 2017 Oct;11(5):525-541.
- Weak trends toward better density at the lumbar spine and femoral neck but not total hip among people with cancer participating in exercise in a meta-analysis of 6 RCTs113Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporosis International. 2018 Feb;29(2):287-303.
- Better bone mineral density among women treated for early-stage breast cancer participating in 1 year of football (soccer) fitness compared to controls in a small RCT114Uth J, Fristrup B et al. One year of Football Fitness improves L1–L4 BMD, postural balance, and muscle strength in women treated for breast cancer. Scandinavian Journal of Medicine & Science in Sports. 2021 Jul;31(7):1545-1557.
Strong evidence of less breathlessness among people participating in aerobic, resistance, or both types of exercise without regard to treatment phase
Good evidence of less breathlessness among people with most advanced cancer types participating in physical activity
No evidence of an effect on breathlessness among people with advanced lung cancer participating in exercise in a combined analysis of studies
Good evidence of less breathlessness among people participating in exercise training before or after lung resection surgery
Without regard to treatment phase: strong evidence of less breathlessness among people participating in aerobic, resistance, or both types of exercise
- Less breathlessness among people with cancer participating in exercise interventions (aerobic, resistance, or both) compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects115Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
Advanced cancer
Good evidence of less breathlessness among people with most advanced cancer types participating in physical activity
No evidence of an effect on breathlessness among people with advanced lung cancer participating in exercise in a combined analysis of studies
- Less breathlessness among people with advanced cancer participating in exercise training compared to controls in a meta-analysis of 15 RCTs116Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- No evidence of an effect on breathlessness among people with advanced lung cancer participating in exercise in a meta-analysis of 6 RCTs117Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
With lung resection: good evidence of less breathlessness among people participating in exercise training before or after lung resection surgery
- Substantially lower breathlessness scores among people undergoing resection of non–small cell lung cancer participating in exercise training before surgery compared to controls in a meta-analysis of 15 studies including 8 RCTs118Ni HJ, Pudasaini B et al. Exercise training for patients pre- and postsurgically treated for non-small cell lung cancer: a systematic review and meta-analysis. Integrative Cancer Therapies. 2017 Mar;16(1):63-73.
- Less breathlessness among people participating in exercise training after lung resection compared to controls in a meta-analysis of 8 RCTs with very low quality evidence119Cavalheri V, Burtin C et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2019 Jun 17;6(6):CD009955.
Therapies and practices that improve cardiovascular health and reduce the decline in cardiovascular function from some treatments deserve special attention from people with cancer.
Good evidence of less treatment-associated decline and better cardiovascular outcomes among people with cancer participating in exercise
Strong evidence of better cardiovascular fitness or function among people with breast cancer participating in exercise
Weak evidence of lower systolic and diastolic blood pressure and better cardiorespiratory fitness during treatment with androgen-deprivation therapy among people with locally advanced, relapsed, or metastatic prostate cancer participating in group aerobic and resistance training exercise
Preliminary evidence of less decline in cardiovascular function among people with breast cancer undergoing adjuvant treatment, and in particular among those receiving chemotherapy, with exercise training
Good evidence of less treatment-associated decline and better cardiovascular outcomes among people with cancer participating in exercise
- Less treatment-associated decline and better cardiovascular outcomes among people with cancer participating in exercise in a review of review articles120Zimmerman A, Planek MIC et al. Exercise, cancer and cardiovascular disease: what should clinicians advise? Cardiovascular Endocrinology & Metabolism. 2020 Sep 3;10(2):62-71.
Strong evidence of better cardiovascular fitness or function among people with breast cancer participating in exercise
- Small-to-moderate improvements in cardiorespiratory fitness after adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation therapy among women with breast cancer participating in exercise compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 63 randomized and quasi-randomized trials121Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database of Systematic Reviews. 2018 Jan 29;1(1):CD011292.
- Better cardiorespiratory fitness among people with breast cancer receiving hormone therapy, tamoxifen, or aromatase inhibitors participating in aerobic plus resistance exercise or walking compared to controls in a meta-analysis of 11 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial122Boing L, Vieira MCS, Moratelli J, Bergmann A, Guimarães ACA. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy—a systematic review and meta-analysis. Maturitas. 2020 Nov;141:71-81.
- Lower decreases in a measure of cardiorespiratory fitness (VO2peak) immediately after chemotherapy among people with cancer participating in a 24-week exercise intervention started during chemotherapy compared to starting after chemotherapy in a mid-sized RCT123van der Schoot GGF, Hormel HL et al. Optimal timing of a physical exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. Journal of the American College of Cardiology: CardioOncology. 2022.
- Lower risk of cardiovascular events across 8 years among people with breast cancer getting at least 2.5 MET-hours/week of exercise (45 minutes of brisk walking) before diagnosis compared to less exercise in a large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study124Okwuosa TM, Ray RM et al. Pre-diagnosis exercise and cardiovascular events in primary breast cancer: Women’s Health Initiative. JACC CardioOncology. 2019 Sep 24;1(1):41-50.
Weak evidence of lower systolic and diastolic blood pressure and better cardiorespiratory fitness during treatment with androgen-deprivation therapy among people with locally advanced, relapsed, or metastatic prostate cancer participating in group aerobic and resistance training exercise
- Lower systolic and diastolic blood pressure and better cardiorespiratory fitness during treatment with androgen-deprivation therapy (leuprorelin acetate) among people with locally advanced, relapsed, or metastatic prostate cancer participating in weekly or biweekly supervised group aerobic and resistance training exercise for 10-18 weeks (16 exercise sessions in total) compared to baseline in a large uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design125Schumacher O, Galvão DA et al. Nationwide industry-led community exercise program for men with locally advanced, relapsed, or metastatic prostate cancer on androgen-deprivation therapy. JCO Oncology Practice. 2022 Aug;18(8):e1334-e1341.
Preliminary evidence of less decline in cardiovascular function among people with breast cancer undergoing adjuvant treatment, and in particular among those receiving chemotherapy, participating in exercise training
- Less decline in cardiovascular function among people with breast cancer undergoing adjuvant treatment, and in particular among those receiving chemotherapy, participating in exercise training compared to usual care in a mid-sized RCT126Thune I, Husøy A et al. Cardiovascular function and the effect of exercise training during adjuvant breast cancer treatment. Results from The EBBA-II trial. Presentation at the San Antonio Breast Cancer Symposium (SABCS) 2018. December 7, 2018.
No evidence of an effect of exercise on appetite among people with cancer in combined analyses of studies
- No evidence of an effect on appetite among people with lung cancer participating in home-based exercise compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 14 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial including 7 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects127Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- No impact on loss of appetite among people with cancer participating in exercise interventions compared to controls in a meta-analysis of 10 RCTs128Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
Modest evidence of better cognitive scores among people with breast cancer participating in exercise
Preliminary evidence of better cognitive scores among people with grades 2–3 brain cancer (glioma) participating in an exercise program
Breast cancer: modest evidence of better cognitive scores among people with breast cancer participating in exercise
- Better cognitive scores—comparable to matched cancer-free controls—among people with stage 1–3C breast cancer meeting national physical activity guidelines before chemotherapy compared to those not meeting the guidelines in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study129Salerno EA, Culakova E et al. Physical activity patterns and relationships with cognitive function in patients with breast cancer before, during, and after chemotherapy in a prospective, nationwide study. Journal of Clinical Oncology. 2021 Oct 10;39(29):3283-3292.
- Better self-reported cognition among people with stage 1–3C breast cancer meeting national physical activity guidelines throughout chemotherapy compared to those not meeting the guidelines in a mid-sized observational study130Salerno EA, Culakova E et al. Physical activity patterns and relationships with cognitive function in patients with breast cancer before, during, and after chemotherapy in a prospective, nationwide study. Journal of Clinical Oncology. 2021 Oct 10;39(29):3283-3292.
Brain cancer: preliminary evidence of better cognitive scores among people with grades 2–3 brain cancer (glioma) participating in an exercise program
- Small to medium improvements on measures of attention, information processing speed, verbal memory, and executive function, but not sustained selective attention, among people with grades 2–3 glioma participating in a 6-month program of home-based, remotely coached exercise, with moderate to vigorous intensity for 20-45 minutes, 3 times per week compared to an active control group in a small RCTrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects131Gehring K, Stuiver MM et al. A pilot randomized controlled trial of exercise to improve cognitive performance in patients with stable glioma: a proof of concept. Neuro-Oncology. 2020 Jan 11;22(1):103-115.
Strong evidence of less depression among people with cancer participating in exercise without regard to treatment phase
Preliminary (conflicting) evidence of less depression among people participating in exercise during cancer treatment
Good evidence of less depression among people participating in exercise after cancer treatment
No evidence of an effect on depression among adults with advanced lung cancer participating in exercise training in a combined analysis of studies
Without regard to treatment phase: strong evidence of less depression among people with cancer participating in exercise
- Less depression among people with lung cancer participating in exercise, with no higher risk of an adverse event, compared to usual care in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 32 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects132Singh B, Spence R, Steele ML, Hayes S, Toohey K. Exercise for individuals with lung cancer: a systematic review and meta-analysis of adverse events, feasibility, and effectiveness. Seminars in Oncology Nursing. 2020 Oct;36(5):151076.
- Slightly less depression among people with cancer participating in an online physical activity or diet intervention compared to controls in a meta-analysis of 24 RCTs133Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Less depression among people with colorectal cancer participating in exercise compared to usual care in a meta-analysis of 19 RCTs134Singh B, Hayes SC et al. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. International Journal of Behavioral Nutrition and Physical Activity. 2020 Sep 24;17(1):122.
- No impact on depression among people with non-advanced colorectal cancer participating in physical activity interventions compared to no intervention or usual care in a meta-analysis of 16 RCTs135McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
- Fewer symptoms of depression among people with lung cancer participating in exercise interventions compared to controls in a meta-analysis of 8 RCTs136Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
- Less depression among women diagnosed with stage 2+ breast cancer participating in exercise compared to controls in a meta-analysis of RCTs137Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- Slightly better depression among people with lymphoma participating in an exercise intervention compared to controls in a meta-analysis of 6 RCTs138Liu L, He X, Feng L. Exercise on quality of life and cancer-related fatigue for lymphoma survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2019 Nov;27(11):4069-4082.
- Better mood among women with breast cancer participating in pilates compared to controls in a meta-analysis of 4 RCTs139Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2018 Dec;41:130-140.
- Lower levels of depression 5 years after participating in a supervised exercise program among women with early stage breast cancer with higher levels of activity compared to lower levels in a mid-sized RCT;140Mutrie N, Campbell A, Barry S, Hefferon K, et al. Five-year follow-up of participants in a randomized controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment. Are there lasting effects? Journal of Cancer Survivorship. 2012; Jul 27. women who had participated in the program also reported higher levels of leisure physical activity and more positive moods than controls
- Less depression among people with lung cancer participating in home-based exercise in a meta-analysis of 14 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial including 7 RCTs141Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Fewer symptoms of depression among people with lung cancer participating in exercise compared to standard care in a meta-analysis of RCTs142Hsieh CC, Hsiao FH. The effects of supportive care interventions on depressive symptoms among patients with lung cancer: a metaanalysis of randomized controlled studies. Palliative & Supportive Care. 2017 Dec;15(6):710-723.
During treatment: preliminary (conflicting) evidence of less depression among people participating in exercise
- Little or no evidence of an effect on depression among women undergoing adjuvant treatment for breast cancer participating in exercise compared to controls in a meta-analysis of 32 RCTs143Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews. 2016 Sep 21;9(9):CD005001.
- Less depression during adjuvant therapy among people with breast cancer participating in exercise compared to controls in a meta-analysis of 29 RCTs144Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Less depression among people with cancer undergoing chemotherapy participating in exercise compared to controls in a meta-analysis of 10 RCTs145Zeng J, Wu J, Tang C, Xu N, Lu L. Effects of exercise during or postchemotherapy in cancer patients: a systematic review and meta-analysis. Worldviews on Evidence-Based Nursing. 2019 Apr;16(2):92-101.
- No impact on depression among people receiving chemotherapy, radiotherapy, or hormone therapy and participating in physical activity compared to controls in a review of 8 RCTs146Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Less depression during chemotherapy among people with lung cancer participating in exercise compared to controls in a meta-analysis of 6 RCTs147Lee J. Physiologic and psychologic adaptation to exercise interventions in lung cancer patients undergoing chemotherapy: a systematic review and meta-analysis of randomized controlled trials. Supportive Care in Cancer. 2021 Jun;29(6):2863-2873.
- Less depression among people with cancers other than breast cancer who exercised during treatment, but no evidence of an effect among people with breast cancer compared to controls in a pooled analysis of 40 controlled trials148Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Fewer symptoms of depression, but only among those with clinical levels of depressive symptoms at baseline, among people with breast cancer who initiated chemotherapy and participated in exercise compared to controls in a mid-sized RCT149Courneya KS, McKenzie DC et al. A multicenter randomized trial of the effects of exercise dose and type on psychosocial distress in breast cancer patients undergoing chemotherapy. Cancer Epidemiology, Biomarkers & Prevention. 2014 May;23(5):857-64.
After treatment: good evidence of less depression among people participating in exercise
- Moderately less depression among people with cancer participating in exercise-based rehabilitation compared to usual care in a systematic review of 17 RCTs150Dennett AM, Sarkies M et al. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. Journal of Physiotherapy. 2021 Jan;67(1):12-26.
- Less depression after treatment among people participating in exercise compared to controls in a review of 8 RCTs151Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Less depression among people with cancers other than breast cancer who exercised after treatment, but no evidence of an effect among people with breast cancer compared to controls in a pooled analysis of 40 controlled trials152Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Less depression after surgery and a first cycle of adjuvant chemotherapy among women with ovarian cancer participating in exercise and cognitive behavioral therapy compared to usual care in a small RCT153Zhang Q, Li F, Zhang H, Yu X, Cong Y. Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial. International Journal of Nursing Studies. 2018 Feb;78:52-60.
Advanced cancer: no evidence of an effect on depression among adults with advanced lung cancer participating in exercise training in a combined analysis of studies
- No change in depression among adults with advanced lung cancer participating in exercise training compared to controls in a pooled analysis of 6 RCTs154Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
Good evidence of less cancer-related fatigue among people participating in exercise without regard to treatment phase
Strong evidence of less cancer-related fatigue during treatment among people participating in exercise
Strong evidence of less cancer-related fatigue among people participating in exercise after treatment
Insufficient (conflicting) evidence of an impact on fatigue among people with advanced cancer participating in exercise
Without regard to treatment phase: good evidence of less cancer-related fatigue among people participating in exercise
- Uncertainty whether exercise is linked to less cancer-related fatigue, but good evidence that it does not increase fatigue in a systematic review of previous systematic reviews with meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study155Kelley GA, Kelley KS. Exercise and cancer-related fatigue in adults: a systematic review of previous systematic reviews with meta-analyses. BMC Cancer. 2017 Oct 23;17(1):693.
- Less cancer-related fatigue among people participating in resistance exercise or aerobic exercise compared to controls in a meta-analysis of 182 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects156Wu C, Zheng Y et al. Nonpharmacological Interventions for cancer-related fatigue: a systematic review and Bayesian network meta-analysis. Worldviews on Evidence-Based Nursing. 2019 Apr;16(2):102-110.
- Less severity of fatigue among people with cancer participating in aerobic, neuromotor, resistance and combination exercises—with smaller effects with resistance exercises—compared to controls in a meta-analysis of 170 RCTs157Oberoi S, Robinson PD et al. Physical activity reduces fatigue in patients with cancer and hematopoietic stem cell transplant recipients: a systematic review and meta-analysis of randomized trials. Critical Reviews in Oncology/Hematology. 2018 Feb;122:52-59.
- Less cancer-related fatigue among people participating in a supervised intervention of either aerobic or resistance training compared to controls in a meta-analysis of 9 RCTs of high quality158Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: a systematic review and meta-analysis. BMC Cancer. 2015 Feb 21;15:77.
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently toward less fatigue among people with cancer participating in an online physical activity or diet intervention compared to controls in a meta-analysis of 24 RCTs159Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Less fatigue among people with colorectal cancer participating in exercise compared to controls in a meta-analysis of 19 RCTs160Singh B, Hayes SC et al. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. International Journal of Behavioral Nutrition and Physical Activity. 2020 Sep 24;17(1):122.
- Less fatigue among people with non-advanced colorectal cancer participating in physical activity interventions compared to no intervention or usual care in a meta-analysis of 16 RCTs161McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
- Less fatigue among people with cancer participating in exercise interventions compared to controls in a meta-analysis of 10 RCTs162Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
- Moderate benefit for cognitive, physical, and general dimensions of cancer-related fatigue among women with breast cancer participating in exercise compared to controls in a meta-analysis of 11 RCTs163Vannorsdall TD, Straub E et al. Interventions for multidimensional aspects of breast cancer-related fatigue: a meta-analytic review. Supportive Care in Cancer. 2021 Apr;29(4):1753-1764.
- Less fatigue among people with lung cancer participating in exercise interventions compared to controls in a meta-analysis of 8 RCTs164Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
- Slightly better fatigue among people with lymphoma participating in an exercise intervention compared to controls in a meta-analysis of 6 RCTs165Liu L, He X, Feng L. Exercise on quality of life and cancer-related fatigue for lymphoma survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2019 Nov;27(11):4069-4082.
- A weak trend toward less fatigue among people with colorectal cancer (but without cancer-related fatigue) participating in exercise compared to controls in a meta-analysis of 5 RCTs, but no consistent results in 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies;166Brandenbarg D, Korsten JHWM, Berger MY, Berendsen AJ. The effect of physical activity on fatigue among survivors of colorectal cancer: a systematic review and meta-analysis. Supportive Care in Cancer. 2018 Feb;26(2):393-403. our note: a large effect of less fatigue would not be expected among people who were not experiencing fatigue
- “Moderately strong effects in tumor-associated fatigue syndrome” among people participating in physical activity compared to others in a review of selected articles, with a focus on guidelines, expert opinions, and recommendations from professional societies167Tewes M, Baumann F, Teufel M, Ostgathe C. Symptoms during outpatient cancer treatment and options for their management. Deutsches Ärzteblatt International. 2021 Apr 30;118(17):291–7.
- Less fatigue among women diagnosed with stage 2+ breast cancer participating in exercise compared to controls in a meta-analysis of RCTs168Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- Less cancer-related fatigue among people with lung cancer participating in home-based exercise conpared to controls in a meta-analysis of 14 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial including 7 RCTs169Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Less fatigue after 3 but not after 6 months among people with pancreatic cancer participating in resistance training (either home-based or supervised training) compared to usual care in a small RCT170Steindorf K, Clauss D et al. Quality of life, fatigue, and sleep problems in pancreatic cancer patients—a randomized trial on the effects of exercise. Deutsches Ärzteblatt International. 2019 Jul 8;116(27-28):471-478.
- Less cancer-related fatigue among people with testicular cancer participating in 12 weeks of high-intensity interval training compared to usual care, with greater improvements in survivors with an inactive lifestyle, lower fitness, higher testosterone, and clinical fatigue at baseline in a small RCT171Adams SC, DeLorey DS et al. Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors. British Journal of Cancer. 2018 May;118(10):1313-1321.
During treatment: strong evidence of less cancer-related fatigue during treatment among people participating in exercise
- Less cancer-related fatigue during primary treatment among people with cancer participating in either exercise, psychological, or exercise plus psychological interventions, but marginal improvement with pharmaceutical interventions compared to controls in a meta-analysis of 113 RCTs of high quality172Mustian KM, Alfano CM et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncology. 2017 Jul 1;3(7):961-968.
- Less cancer-related fatigue during adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation cancer therapy among people participating in exercise compared to controls in a meta-analysis of 56 RCTs173Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev. 2012 Nov 14;11(11):CD006145.
- Substantially less cancer-related fatigue during cancer treatment among people participating in relaxation exercise, or with combined aerobic and resistance training—more improvement than with either aerobic or resistance training alone—compared to usual care in a meta-analysis of 12 RCTs174Hilfiker R, Meichtry A et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. British Journal of Sports Medicine. 2018;52(10):651-658.
- No evidence of an effect on fatigue among people participating in exercise during chemotherapy, radiotherapy, or hormone therapy compared to controls in a review of 15 RCTs175Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Less fatigue during multimodal cancer treatment, including surgery, among people participating in exercise compared to usual care in a meta-analysis of 11 RCTs providing low- or moderate-certainty evidence176Loughney LA, West MA, Kemp GJ, Grocott MP, Jack S. Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database of Systematic Reviews. 2018 Dec 11;12(12):CD012280.
- “Strong evidence of at least modest effects of exercise on cancer-related fatigue” during breast cancer treatment in a meta-analysis and review177Ehlers DK, DuBois K, Salerno EA. The effects of exercise on cancer-related fatigue in breast cancer patients during primary treatment: a meta-analysis and systematic review. Expert Review of Anticancer Therapy. 2020 Oct;20(10):865-877.
- Slightly less fatigue among women undergoing adjuvant treatment for breast cancer participating in physical exercise compared to controls in a meta-analysis of 32 RCTs178Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews. 2016 Sep 21;9(9):CD005001.
- Less fatigue among people with breast cancer participating in exercise during adjuvant therapy compared to controls in meta-analyses of 29 RCTs179Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125; Lipsett A, Barrett S, Haruna F, Mustian K, O’Donovan A. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: a systematic review and meta-analysis. Breast. 2017 Apr;32:144-155.
- Less fatigue immediately after chemotherapy among people with cancer participating in a 24-week exercise intervention started during chemotherapy compared to starting after chemotherapy in a mid-sized RCT180van der Schoot GGF, Hormel HL et al. Optimal timing of a physical exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. Journal of the American College of Cardiology: CardioOncology. 2022.
- Less fatigue among men with prostate cancer receiving androgen deprivation therapy participating in either resistance exercise training or aerobic exercise training compared to controls in a meta-analysis of 14 RCTs and 1 controlled trial181Yunfeng G, Weiyang H, Xueyang H, Yilong H, Xin G. Exercise overcome adverse effects among prostate cancer patients receiving androgen deprivation therapy: an update meta-analysis. Medicine (Baltimore). 2017 Jul;96(27):e7368.
- Less cancer-related fatigue among people with prostate cancer receiving androgen deprivation therapy participating in exercise interventions compared to controls in a meta-analysis of 10 RCTs182Yang B, Wang J. Effects of exercise on cancer-related fatigue and quality of life in prostate cancer patients undergoing androgen deprivation therapy: a meta-analysis of randomized clinical trials. Chinese Medical Sciences Journal. 2017 Apr 10;32(1):13-21.
- A weak trend toward less fatigue during induction chemotherapy among adults with acute leukemia participating in a 4-week mixed-modality supervised exercise program (4 times a week, twice a day) compared to controls in a small RCT183Bryant AL, Deal AM et al. The effects of exercise on patient-reported outcomes and performance-based physical function in adults with acute leukemia undergoing induction therapy: Exercise and Quality of Life in Acute Leukemia (EQUAL). Integrative Cancer Therapies. 2018 Jun;17(2):263-270.
After treatment: strong evidence of less cancer-related fatigue among people participating in exercise after treatment
- Less cancer-related fatigue after primary treatment among people with cancer participating in either exercise, psychological, or exercise plus psychological interventions, but marginal improvement with pharmaceutical interventions, compared to controls in a meta-analysis of 113 RCTs of high quality184Mustian KM, Alfano CM et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncology. 2017 Jul 1;3(7):961-968.
- Moderately less fatigue among people with cancer participating in exercise after treatment compared to controls in a meta-analysis of 66 controlled trials of high quality185Speck R, Courneya K, Masse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010 Jun; 4(2):87-100.
- Less cancer-related fatigue among people participating in exercise after adjuvant cancer therapy compared to controls in a meta-analysis of 56 RCTs186Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews. 2012 Nov 14;11(11):CD006145.
- Less fatigue after completing primary treatment among people with cancer participating in exercise interventions for 12 weeks compared to controls in a meta-analysis of 40 controlled trials187Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncology Nursing Forum. 2014 Nov 1;41(6):E326-42.
- Moderately less fatigue after treatment among people participating in relaxation exercise, or with combined aerobic and resistance training—greater than with either aerobic or resistance training alone—compared to usual care in a meta-analysis of 12 RCTs188Hilfiker R, Meichtry A et al. Exercise and other non-pharmaceutical interventions for cancer-related fatigue in patients during or after cancer treatment: a systematic review incorporating an indirect-comparisons meta-analysis. British Journal of Sports Medicine. 2018;52(10):651-658.
- Moderately less fatigue among people participating in exercise after treatment compared to controls in a review of 14 RCTs189Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Less fatigue among people with breast cancer participating in exercise interventions compared to controls, with slightly higher improvements in fatigue when the patients received the intervention after adjuvant breast cancer treatment in a meta-analysis of 25 RCTs190Juvet LK, Thune I et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: a meta-analysis. Breast. 2017 Jun;33:166-177.
- Less behavioral fatigue and cognitive fatigue after surgery and a first cycle of adjuvant chemotherapy among women with ovarian cancer participating in exercise and cognitive behavioral therapy compared to usual care in a small RCT191Zhang Q, Li F, Zhang H, Yu X, Cong Y. Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial. International Journal of Nursing Studies. 2018 Feb;78:52-60.
Advanced cancer: insufficient (conflicting) evidence of an impact on fatigue among people with advanced cancer participating in exercise
- No change in fatigue among people with metastatic cancers participating in exercise compared to controls in a meta-analysis of 16 RCTs192Nadler MB, Desnoyers A, Langelier DM, Amir E. The effect of exercise on quality of life, fatigue, physical function, and safety in advanced solid tumor cancers: a meta-analysis of randomized control trials. Journal of Pain and Symptom Manage. 2019 Nov;58(5):899-908.e7.
- Less fatigue among people with advanced cancer participating in exercise compared to controls in a meta-analysis of 15 RCTs193Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- No change in fatigue among adults with advanced lung cancer participating in exercise training compared to controls in a pooled analysis of 6 RCTs194Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
No evidence of an impact of exercise on nausea and vomiting, constipation, or diarrhea in a combined analysis of studies
- No change in nausea and vomiting, constipation, or diarrhea among people with cancer participating in exercise interventions compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects195Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
Strong evidence of less lymphedema among people doing either aerobic and resistance exercise
No evidence of benefit for breast cancer-related lymphedema among people participating in aquatic exercise in a combined analysis of studies
Aerobic and resistance exercise: strong evidence of less lymphedema and swelling among people with breast cancer participating in either aerobic or resistance exercise
- Less swelling from breast cancer-related lymphedema in the acute-intensive phase and as maintenance among people participating in both aerobic and resistance exercise in a review of reviews, systematic reviews, and meta-analysesa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study196Marchica P, D’Arpa S et al. Integrated treatment of breast cancer-related lymphedema: a descriptive review of the state of the art. Anticancer Research. 2021 Jul;41(7):3233-3246.
- Less breast cancer-related lymphedema with resistance exercise in a meta-analysis of 5 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and 1 controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial197Hasenoehrl T, Palma S et al. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Supportive Care in Cancer. 2020 Aug;28(8):3593-3603.
- Less lymphedema among women with breast cancer with Nordic walking in a meta-analysis of 4 RCTs and 5 quasi-experimental studies198Sánchez-Lastra MA, Torres J, Martínez-Lemos I, Ayán C. Nordic walking for women with breast cancer: a systematic review. European Journal of Cancer Care (Engl). 2019 Aug 6:e13130.
Aquatic exercise: no evidence of benefit for breast cancer-related lymphedema among people participating in aquatic exercise in a combined analysis of studies
- No benefit for breast cancer-related lymphedema among people participating in aquatic exercise in a meta-analysis of 4 RCTs of moderate quality199Yeung W, Semciw AI. Aquatic therapy for people with lymphedema: a systematic review and meta-analysis. Lymphatic Research and Biology. 2018 Feb;16(1):9-19.
Good evidence of better balance, nerve conduction velocity, quality of life, and neuropathy-induced symptoms, and quicker movement initiation among people with peripheral neuropathydamage to the peripheral nerves outside the brain and spinal cord participating in exercise interventions
- Better balance, nerve conduction velocity, quality of life, and neuropathy-induced symptoms, and quicker movement initiation among people with peripheral neuropathy, including chemotherapy-induced peripheral neuropathy (CIPN), participating in exercise interventions in a meta-analysis of RCTs of moderate to high quality200Streckmann F, Balke M et al. Exercise and neuropathy: systematic review with meta-analysis. Sports Med. 2022 May;52(5):1043-1065.
Good evidence of less pain among people with many types of cancer, but not lung cancer, participating in exercise without regard to treatment phase
Good evidence of less pain during cancer treatment except insufficient evidence regarding aromatase inhibitor-associated joint pain
Preliminary evidence of less pain among women recovering after breast cancer surgery participating in 12 months of physical activity
Without regard to treatment phase: good evidence of less pain among people with many types of cancer, but not lung cancer, participating in exercise
- Less pain among people with cancer participating in exercise interventions compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects201Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
- Less pain among people with head and neck cancer participating in progressive resistance training compared to conventional treatment in a meta-analysis of 7 RCTs with moderate-certainty evidence202Almeida KAM, Rocha AP, Carvas N, Pinto ACPN. Rehabilitation interventions for shoulder dysfunction in patients with head and neck cancer: systematic review and meta-analysis. Physical Therapy. 2020 Oct 30;100(11):1997-2008.
- No evidence of an effect on pain among people with lung cancer participating in home-based exercise in a meta-analysis of 14 controlled triala study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial, including 7 RCTs203Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Less pain among women with breast cancer participating in pilates compared to controls in a meta-analysis of 4 RCTs204Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2018 Dec;41:130-140.
- Less pain among women with endometrial cancer after participating in a 6-month, telephone-based physical activity intervention compared to baseline in a mid-sized uncontrolled trial205Robertson MC, Lyons EJ et al. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health and Quality of Life Outcomes. 2019 May 27;17(1):91.
During treatment
Good evidence of less pain during cancer treatment among people participating in exercise
Insufficient evidence of less aromatase inhibitor-associated joint pain among people participating in exercise
Insufficient evidence regarding aromatase inhibitor-associated joint pain
- Less pain during hormone therapy among people with breast cancer participating in aerobic plus resistance exercise compared to walking activity in a meta-analysis of 11 controlled trials206Boing L, Vieira MCS, Moratelli J, Bergmann A, Guimarães ACA. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy—a systematic review and meta-analysis. Maturitas. 2020 Nov;141:71-81.
- Less pain and stiffness while taking aromatase inhibitors among people with breast cancer participating in exercise compared to controls in a meta-analysis of 9 RCTs and quasi-experimental studies207Lu G, Zheng J, Zhang L. The effect of exercise on aromatase inhibitor-induced musculoskeletal symptoms in breast cancer survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2020 Apr;28(4):1587-1596.
- No evidence of an effect on aromatase inhibitor-associated joint pain (arthralgia) among postmenopausal female breast cancer survivors (excluding those with metastatic cancer) participating in exercise compared to controls in a meta-analysis of 15 intervention studies208Yang GS, Kim HJ et al. Interventions for the treatment of aromatase inhibitor-associated arthralgia in breast cancer survivors: a systematic review and meta-analysis. Cancer Nursing. 2017 Jul/Aug;40(4):E26-E41.
- No evidence of an effect on aromatase inhibitor-associated joint pain or stiffness among women with stage 1 to 3 hormone receptor-positive breast cancer with aromatase inhibitor‐induced musculoskeletal symptoms participating in exercise in a meta-analysis of 6 RCTs209Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database of Systematic Reviews. 2020 Jan 29;1(1):CD012988.
- Less pain during chemotherapy among people with lung cancer participating in exercise compared to controls in a meta-analysis of 6 RCTs210Lee J. Physiologic and psychologic adaptation to exercise interventions in lung cancer patients undergoing chemotherapy: a systematic review and meta-analysis of randomized controlled trials. Supportive Care in Cancer. 2021 Jun;29(6):2863-2873.
- Somewhat less shoulder pain and disability, and better range of motion and strength among people with shoulder dysfunction due to treatment of head and neck cancer and participating in progressive resistance training in a meta-analysis of 3 RCTs of low to moderate quality211Carvalho AP, Vital FM, Soares BG. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer. Cochrane Database of Systematic Reviews. 2012 Apr 18;(4):CD008693.
After treatment: preliminary evidence of less pain among women recovering after breast cancer surgery participating in 12 months of physical activity
- Lower pain intensity after 12 months among women recovering after breast cancer surgery with a physiotherapy-led exercise program of stretching, strengthening, physical activity, and behavioral change techniques to support adherence to exercise compared to usual care, and without increases in complications, lymphedema, or adverse events in a midi-sized RCT212Bruce J, Mazuquin B et al; Prevention of Shoulder Problems Trial (PROSPER) Study Group. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021 Nov 10;375:e066542.
Good evidence of better quality of life, fitness, and strength among people with cancer participating in exercise without regard to treatment phase
Good evidence of better fitness, strength, and quality of life among people participating in exercise during treatment, except not among people with shoulder dysfunction due to treatment for head and neck cancer
Good evidence of better strength, fitness, and quality of life among people participating in exercise after treatment
Preliminary (conflicting) evidence of better quality of life, strength, and physical function among people with advanced cancers participating in exercise
Without regard to treatment phase
Good evidence of better quality of life, fitness, and strength among people with cancer participating in exercise without regard to treatment phase
Cancer as a whole: good evidence of at least slightly better quality of life and better physical fitness among people participating in exercise
- Slightly improved quality of life among people with cancer participating in an online physical activity or diet intervention compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 24 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects213Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Better physical fitness and quality of life among people participating in high-intensity interval training compared to usual care, and comparable to moderate-intensity interval training, across all stages of cancer therapy and aftercare in a meta-analysis of 12 controlled studiesa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial214Mugele H, Freitag N et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. Journal of Cancer Survivorship. 2019 Apr;13(2):205-223.
Breast cancer: good evidence of better fitness, strength, range of motion, and quality of life among people with breast cancer participating in exercise
- Better shoulder range of motion, fitness, self-reported upper extremity function, functional status, and quality of life among women with breast cancer participating in pilates compared to controls, and results similar to other exercise programs in a meta-analysis of 5 RCTs and 2 uncontrolled studiesa study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design215Pinto-Carral A, Molina AJ, de Pedro Á, Ayán C. Pilates for women with breast cancer: a systematic review and meta-analysis. Complementary Therapies in Medicine. 2018 Dec;41:130-140.
- Better fitness, strength, and quality of life among women diagnosed with stage 2+ breast cancer participating in exercise compared to controls in a meta-analysis of RCTs216Singh B, Spence RR et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Archives of Physical Medicine and Rehabilitation. 2018 Dec;99(12):2621-2636.
- Better muscular strength in the upper and lower limbs among people with breast cancer participating in resistance exercise compared to controls in a meta-analysis of 6 controlled studies of exercise interventions217Hasenoehrl T, Palma S et al. Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis. Supportive Care in Cancer. 2020 Aug;28(8):3593-3603.
- Better physical fitness and less disability among women with breast cancer participating in Nordic walking compared to controls in a meta-analysis of 4 RCTs and 5 quasi-experimental studies218Sánchez-Lastra MA, Torres J, Martínez-Lemos I, Ayán C. Nordic walking for women with breast cancer: a systematic review. European Journal of Cancer Care (Engl). 2019 Aug 6:e13130.
Colorectal cancer: strong evidence of better quality of life, fitness and strength among people participating in exercise
- Better quality of life, aerobic fitness, and upper-body strength among people with colorectal cancer participating in exercise compared to controls in a meta-analysis of 19 RCTs219Singh B, Hayes SC et al. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. International Journal of Behavioral Nutrition and Physical Activity. 2020 Sep 24;17(1):122.
- Better health‐related quality of life among people with non-advanced colorectal cancer participating in physical activity interventions compared to no intervention or usual care in a meta-analysis of 16 RCTs220McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database of Systematic Reviews. 2020 May 3;5(5):CD012864.
- Higher overall quality of life scores among people with colorectal cancer increasing their physical activity compared to others in a meta-analysis of 7 observational studies221Otto SJ, Korfage IJ et al. Association of change in physical activity and body weight with quality of life and mortality in colorectal cancer: a systematic review and meta-analysis. Supportive Care in Cancer. 2015 May;23(5):1237-50.
Gynecological cancer: modest evidence of better quality of life and less limitation due to poor health among people participating in physical activity
- Better quality of life among people with cervical cancer participating in pelvic floor muscle training with counseling and yoga or core exercises compared to controls in a review of 5 RCTs and 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies222Brennen R, Lin KY, Denehy L, Frawley HC. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review. Physical Therapy. 2020 Aug 12;100(8):1357-1371.
- Better general health and less limitation due to physical health among women with endometrial cancer participating in a 6-month, telephone-based physical activity intervention compared to baseline in a mid-sized uncontrolled trial223Robertson MC, Lyons EJ et al. Change in physical activity and quality of life in endometrial cancer survivors receiving a physical activity intervention. Health and Quality of Life Outcomes. 2019 May 27;17(1):91.
Head and neck cancer: modest evidence of less dysfunction among people participating in resistance training
- Less dysfunction among people with head and neck cancer participating in progressive resistance training compared to conventional treatment in a meta-analysis of 7 RCTs with moderate-certainty evidence224Almeida KAM, Rocha AP, Carvas N, Pinto ACPN. Rehabilitation interventions for shoulder dysfunction in patients with head and neck cancer: systematic review and meta-analysis. Physical Therapy. 2020 Oct 30;100(11):1997-2008.
Lung cancer: strong evidence of better quality of life, aerobic fitness, and strength among people participating in exercise
- Better quality of life, aerobic fitness, upper-body strength, and lower-body strength among people with lung cancer participating in exercise, with no higher risk of an adverse event, compared to usual care in a meta-analysis of 32 RCTs225Singh B, Spence R, Steele ML, Hayes S, Toohey K. Exercise for individuals with lung cancer: a systematic review and meta-analysis of adverse events, feasibility, and effectiveness. Seminars in Oncology Nursing. 2020 Oct;36(5):151076.
- Better exercise capacity and muscle strength among people with lung cancer participating in exercise interventions after surgery compared to others in an overview of systematic reviews of high/moderate-quality evidence226Zhou W, Woo S, Larson JL. Effects of perioperative exercise interventions on lung cancer patients: an overview of systematic reviews. Journal of Clinical Nursing. 2020 Dec;29(23-24):4482-4504.
- Better quality of life among people with lung cancer participating in home-based exercise compared to controls in a meta-analysis of 14 controlled trials including 7 RCTs227Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Moderately better quality of life among people with lung cancer participating in exercise interventions compared to controls in a meta-analysis of 8 RCTs228Zhou L, Chen Q, Zhang J. Effect of exercise on fatigue in patients with lung cancer: a systematic review and meta-analysis of randomized trials. Journal of Palliative Medicine. 2021 Jun;24(6):932-943.
Lymphoma: modest evidence of better quality of life among people participating in exercise
- Slightly better quality of life among people with lymphoma participating in an exercise intervention in a meta-analysis of 6 RCTs229Liu L, He X, Feng L. Exercise on quality of life and cancer-related fatigue for lymphoma survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2019 Nov;27(11):4069-4082.
Pancreatic cancer: preliminary evidence of short-term better physical functioning and quality of life among people participating in resistance training
- Better physical functioning and quality of life among people with pancreatic cancer after 3 but not after 6 months of participating in resistance training (either home-based or supervised training) compared to usual care in a small RCT230Steindorf K, Clauss D et al. Quality of life, fatigue, and sleep problems in pancreatic cancer patients—a randomized trial on the effects of exercise. Deutsches Ärzteblatt International. 2019 Jul 8;116(27-28):471-478.
Prostate cancer: strong evidence of better fitness, strength, and function among people participating in exercise
- Better functional capacity and fitness outcomes among men with prostate cancer participating in exercise compared to controls in a meta-analysis of 21 RCTs231Lopez P, Taaffe DR, Newton RU, Galvão DA. Resistance exercise dosage in men with prostate cancer: systematic review, meta-analysis, and meta-regression. Medicine and Science in Sports and Exercise. 2021 Mar 1;53(3):459-469.
- Greater upper- and lower-body muscle strength and walk time among men with prostate cancer participating in resistance exercise in a pooled analysis of 32 intervention studies232Keilani M, Hasenoehrl T et al. Effects of resistance exercise in prostate cancer patients: a meta-analysis. Supportive Care in Cancer. 2017 Sep;25(9):2953-2968.
Testicular cancer: preliminary evidence of better quality of life and vitality among people participating in exercise
- Better quality of life and vitality among people with testicular cancer participating in 12 weeks of high-intensity interval training compared to usual care, with greater improvements in survivors with an inactive lifestyle, lower fitness, higher testosterone, and clinical fatigue at baseline in a small RCT233Adams SC, DeLorey DS et al. Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors. British Journal of Cancer. 2018 May;118(10):1313-1321.
During treatment
Good evidence of better fitness, strength, and quality of life among people participating in exercise during treatment, except not among people with shoulder dysfunction due to treatment for head and neck cancer
Cancer as a whole
Good evidence of better fitness and quality of life among people participating in exercise during chemotherapy
Preliminary evidence of better fitness, strength, and quality of life among people participating in exercise during other treatments or cancer treatment as a whole
- Maintained or even improved fitness, improved quality of life, and earlier return to work among people with cancer participating in aerobic exercise (walking, jogging, or cycling) during chemotherapy, with adverse events “mild and self-limiting”, compared to controls in a meta-analysis of 33 RCTs234Cave J, Paschalis A et al. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Supportive Care in Cancer. 2018 Oct;26(10):3337-3351.
- Better quality of life among people with cancer who exercised during treatment compared to controls in a pooled analysis of 40 controlled trials235Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Small increases in fitness and muscle strength, but no impact on quality of life among people participating in exercise during chemotherapy, radiotherapy, or hormone therapy compared to controls in a review of 5 RCTs236Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Little or no difference on physical fitness or health-related quality of life among people undergoing multimodal cancer treatment including surgery and also participating in exercise compared to usual care in a meta-analysis of 11 RCTs providing low- or moderate-certainty evidence237Loughney LA, West MA, Kemp GJ, Grocott MP, Jack S. Exercise interventions for people undergoing multimodal cancer treatment that includes surgery. Cochrane Database of Systematic Reviews. 2018 Dec 11;12(12):CD012280.
- Increased lower-limb muscular strength among people with cancer undergoing neoadjuvanttherapy used before a main treatment, such as chemotherapy, radiation therapy, and hormone therapy before surgery or adjuvant therapy and participating in resistance exercise compared to controls in a meta-analysis of 14 controlled trials238Padilha CS, Marinello PC et al. Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: a meta-analysis. Journal of Cancer Survivorship. 2017 Jun;11(3):339-349.
- Better health-related quality of life immediately after chemotherapy among people with cancer participating in a 24-week exercise intervention started during chemotherapy compared to starting after chemotherapy in a mid-sized RCT239van der Schoot GGF, Hormel HL et al. Optimal timing of a physical exercise intervention to improve cardiorespiratory fitness: during or after chemotherapy. Journal of the American College of Cardiology: CardioOncology. 2022.
Breast cancer
Strong evidence of better fitness, shoulder mobility, strength, and quality of life, and less disability among people participating in exercise during treatment
No evidence of an effect on grip strength, health‐related quality of life or cancer‐specific quality of life among women with breast cancer with aromatase inhibitor‐induced musculoskeletal symptoms participating in exercise
- Better physical fitness and quality of life among people with breast cancer participating in exercise during adjuvant treatment applied after initial treatment for cancer, especially to suppress secondary tumor formation therapy compared to controls in a meta-analysis of 29 RCTs240Lee J, Lee MG. Effects of exercise interventions on breast cancer patients during adjuvant therapy: a systematic review and meta-analysis of randomized controlled trials. Cancer Nursing. 2020 Mar/Apr;43(2):115-125.
- Better physical fitness and a weak trend toward better quality of life among women undergoing adjuvant treatment for breast cancer participating in physical exercise compared to controls in a meta-analysis of 32 RCTs241Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews. 2016 Sep 21;9(9):CD005001.
- Better quality of life among people with breast cancer taking aromatase inhibitors and participating in exercise compared to controls in a meta-analysis of 9 RCTs and quasi-experimental studies242Lu G, Zheng J, Zhang L. The effect of exercise on aromatase inhibitor-induced musculoskeletal symptoms in breast cancer survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2020 Apr;28(4):1587-1596.
- Better shoulder mobility without an increased risk of lymphedema among people with breast cancer participating in exercise compared to controls during chemotherapy, radiotherapy, or hormone therapy in a review of 6 RCTs243Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
- Slightly better increases in upper and lower body muscle strength among women with breast cancer undergoing primary treatment participating in a lower weekly volume of resistance training compared to a higher volume, but no relationship with exercise intensity, in a meta-analysis of 10 experimental trials;244Lopez P, Galvão DA et al. Resistance training in breast cancer patients undergoing primary treatment: a systematic review and meta-regression of exercise dosage. Breast Cancer. 2021 Jan;28(1):16-24. our interpretation: a lower weekly volume of exercise is at least as good as a higher volume in building strength over time
- Better leg muscle strength, and postural balance in women treated for early-stage breast cancer participating in 1 year of football (soccer) fitness compared to controls in a small RCT245Uth J, Fristrup B et al. One year of Football Fitness improves L1–L4 BMD, postural balance, and muscle strength in women treated for breast cancer. Scandinavian Journal of Medicine & Science in Sports. 2021 Jul;31(7):1545-1557.
- No evidence of an effect on grip strength, health‐related quality of life or cancer‐specific quality of life among women with stage 1 to 3 hormone receptor-positive breast cancer with aromatase inhibitor‐induced musculoskeletal symptoms participating in exercise in a meta-analysis of 6 RCTs246Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database of Systematic Reviews. 2020 Jan 29;1(1):CD012988.
Head and neck cancer: no evidence of an effect on quality of life among people with shoulder dysfunction due to treatment participating in progressive resistance training in a combined analysis of studies
- No significant change in quality of life among people with shoulder dysfunction due to treatment of head and neck cancer participating in progressive resistance training in a meta-analysis of 3 RCTs of low to moderate quality247Carvalho AP, Vital FM, Soares BG. Exercise interventions for shoulder dysfunction in patients treated for head and neck cancer. Cochrane Database of Systematic Reviews. 2012 Apr 18;(4):CD008693.
Lung cancer: modest evidence of better strength and quality of life during chemotherapy among people participating in exercise
- Better strength and quality of life during chemotherapy among people with lung cancer participating in exercise compared to controls in a meta-analysis of 6 RCTs248Lee J. Physiologic and psychologic adaptation to exercise interventions in lung cancer patients undergoing chemotherapy: a systematic review and meta-analysis of randomized controlled trials. Supportive Care in Cancer. 2021 Jun;29(6):2863-2873.
Prostate cancer
Strong evidence of better quality of life during androgen deprivation therapy among people participating in exercise
Preliminary evidence of better fitness during androgen deprivation therapy among people participating in exercise
- Better quality of life among men with prostate cancer receiving androgen deprivation therapy and participating in either resistance exercise training or aerobic exercise training compared to controls in a meta-analysis of 11 RCTs249Ying M, Zhao R, Jiang D, Gu S, Li M. Lifestyle interventions to alleviate side effects on prostate cancer patients receiving androgen deprivation therapy: a meta-analysis. Japanese Journal of Clinical Oncology. 2018 Sep 1;48(9):827-834.
- Better quality of life among men with prostate cancer receiving androgen deprivation therapy and participating in exercise interventions compared to controls in a meta-analysis of 10 RCTs250Yang B, Wang J. Effects of exercise on cancer-related fatigue and quality of life in prostate cancer patients undergoing androgen deprivation therapy: a meta-analysis of randomized clinical trials. Chinese Medical Sciences Journal. 2017 Apr 10;32(1):13-21.
- Better quality of life, upper body fitness, and lower body fitness among men with prostate cancer receiving androgen deprivation therapy with a 12-week resistance exercise program compared to no intervention in a mid-sized RCT251Segal RJ, Reid RD et al. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. Journal of Clinical Oncology. 2003 May 1;21(9):1653-9.
- Better muscle strength during treatment with androgen-deprivation therapy (leuprorelin acetate) among people with locally advanced, relapsed, or metastatic prostate cancer participating in weekly or biweekly supervised group aerobic and resistance training exercise for 10-18 weeks (16 exercise sessions in total) compared to baseline in a large uncontrolled trial252Schumacher O, Galvão DA et al. Nationwide industry-led community exercise program for men with locally advanced, relapsed, or metastatic prostate cancer on androgen-deprivation therapy. JCO Oncology Practice. 2022 Aug;18(8):e1334-e1341.
After treatment
Good evidence of better strength, fitness, and quality of life among people participating in exercise after treatment
Cancer as a whole: strong evidence of better strength, fitness, and quality of life among people participating in exercise after treatment
- A small to moderate positive effect on upper and lower body strength and functional quality of life among people with cancer participating in exercise after treatment compared to controls in a meta-analysis of 66 controlled trials of high quality253Speck R, Courneya K, Masse L, Duval S, Schmitz K. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Journal of Cancer Survivorship. 2010 Jun; 4(2):87-100.
- Improved muscle strength among people with cancer participating in exercise-based rehabilitation compared to usual care in a systematic review of 82 RCTs254Dennett AM, Sarkies M et al. Multidisciplinary, exercise-based oncology rehabilitation programs improve patient outcomes but their effects on healthcare service-level outcomes remain uncertain: a systematic review. Journal of Physiotherapy. 2021 Jan;67(1):12-26.
- Better quality of life among people with cancer who exercised after treatment compared to controls in a pooled analysis of 40 controlled trials255Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Better health-related quality of life, emotional well-being, and social functioning after completing primary treatment among people with cancer participating in exercise interventions for 12 weeks compared to controls in a meta-analysis of 40 controlled trials256Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncology Nursing Forum. 2014 Nov 1;41(6):E326-42.
- Small increases in quality of life and fitness but large increases in strength among people participating in exercise after cancer treatment compared to controls in a review of 14 RCTs257Campbell A, Foster J, Stevinson C, Cavill N. The importance of physical activity for people living with and beyond cancer. Macmillan Cancer Support. 2017.
Breast cancer: strong evidence of better function and quality of life, and less disability among people participating in exercise after treatment
- Small increase in physical functioning among people with breast cancer participating in exercise interventions compared to controls, with slightly higher improvements in physical functioning when the patients received the intervention after adjuvant breast cancer treatment, in a meta-analysis of 25 RCTs258Juvet LK, Thune I et al. The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: a meta-analysis. Breast. 2017 Jun;33:166-177.
- Better physical functioning scores and overall quality of life among women with breast cancer participating in exercise after radiotherapy compared to controls in a meta-analysis of 13 RCTs259Shen Q, Yang H. Impact of post-radiotherapy exercise on women with breast cancer: a systematic review and meta-analysis of randomized controlled trials. Journal of Rehabilitation Medicine. 2020 Oct 16;52(10):jrm00112.
- Small-to-moderate improvements in perceived physical function and health-related quality of life among women with breast cancer after adjuvant therapy and participating in exercise compared to controls in a meta-analysis of 63 randomized and quasi-randomized trials260Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database of Systematic Reviews. 2018 Jan 29;1(1):CD011292.
- Better upper limb function and fewer arm disability symptoms among women recovering after breast cancer surgery participating in a physiotherapy-led exercise program of stretching, strengthening, physical activity, and behavioral change techniques to support adherence to exercise compared to usual care, and without increases in complications, lymphedema, or adverse events in a midi-sized RCT261Bruce J, Mazuquin B et al; Prevention of Shoulder Problems Trial (PROSPER) Study Group. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021 Nov 10;375:e066542.
Lung cancer: modest evidence of better quality of life among people participating in exercise after lung resection
- Better physical component of health-related quality of life among people with non-small cell lung cancer treated with lung resection and participating in exercise training compared to controls in a meta-analysis of 8 RCTs of moderate quality262Cavalheri V, Burtin C et al. Exercise training undertaken by people within 12 months of lung resection for non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2019 Jun 17;6(6):CD009955.
Prostate cancer: modest evidence of better quality of life and ability to control urination after surgery among people participating in pelvic floor muscle training
- Better quality of life and ability to control urination at three months after surgery among people participating in pelvic floor muscle training among men with newly diagnosed, adult-onset prostate cancer in a meta-analysis of 18 RCTs263Treanor C, Kyaw T, Donnelly M. An international review and meta-analysis of prehabilitation compared to usual care for cancer patients. Journal of Cancer Survivorship. 2018 Feb;12(1):64-73.
Advanced cancer
Preliminary (conflicting) evidence of better quality of life, strength, and physical function among people with advanced cancers participating in exercise
- Better physical function and quality of life among people with advanced cancer participating in exercise compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 15 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects264Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
- No significant change in quality of life among people with metastatic cancers participating in exercise compared to controls in a meta-analysis of 16 RCTs265Nadler MB, Desnoyers A, Langelier DM, Amir E. The effect of exercise on quality of life, fatigue, physical function, and safety in advanced solid tumor cancers: a meta-analysis of randomized control trials. Journal of Pain and Symptom Manage. 2019 Nov;58(5):899-908.e7.
- Better disease-specific global health-related quality of life but no change in physical functioning among adults with advanced lung cancer participating in exercise training compared to controls in a pooled analysis of 6 RCTs266Peddle-McIntyre CJ, Singh F et al. Exercise training for advanced lung cancer. Cochrane Database of Systematic Reviews. 2019 Feb 11;2(2):CD012685.
- Greater strength and better quality of life among people with advanced cancer participating in supervised physical rehabilitation programs compared to controls or baseline in a meta-analysis of 11 studies including both controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial and uncontrolled trialsa study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design267Yang J, Choi M et al. Supervised physical rehabilitation in the treatment of patients with advanced cancer: a systematic review and meta-analysis. Journal of Korean Medical Science. 2020 Jul 27;35(29):e242.
Modest evidence of better sexuality among people participating in exercise
Modest evidence of better sexual function among women with cervical cancer participating in pelvic floor muscle training as part of a package of interventions
Modest evidence of better sexual function during androgen deprivation therapy (ADT) among people with prostate cancer participating in exercise
Preliminary evidence of greater sexual activity but no impact on sexual function among people with prostate cancer participating in exercise
Cancer as a whole
Modest evidence of better sexuality among people participating in exercise
- Better sexuality scores among people with cancer who exercised either during or after treatment compared to controls in a pooled analysis of 40 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial268Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
Gynecological cancer
Modest evidence of better sexual function among women with cervical cancer participating in pelvic floor muscle training as part of a package of interventions
- Better sexual function among survivors of cervical cancer participating in pelvic floor muscle training with counseling and yoga or core exercises compared to controls in a review of 5 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects and 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies269Brennen R, Lin KY, Denehy L, Frawley HC. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review. Physical Therapy. 2020 Aug 12;100(8):1357-1371.
Prostate cancer
Modest evidence of better sexual function during androgen deprivation therapy (ADT) among people with prostate cancer participating in exercise
Preliminary evidence of greater sexual activity but no impact on sexual function among people with prostate cancer participating in exercise
- Better sexual function among men with prostate cancer receiving ADT participating in either resistance exercise training or aerobic exercise training compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 14 RCTs and 1 controlled trial270Yunfeng G, Weiyang H, Xueyang H, Yilong H, Xin G. Exercise overcome adverse effects among prostate cancer patients receiving androgen deprivation therapy: an update meta-analysis. Medicine (Baltimore). 2017 Jul;96(27):e7368.
- Greater sexual activity but not better sexual function among people with prostate cancer participating in a 12-week exercise program of 4 sessions per week compared to controls in a small RCT271Mardani A, Pedram Razi S, Mazaheri R, Haghani S, Vaismoradi M. Effect of the exercise programme on the quality of life of prostate cancer survivors: a randomized controlled trial. International Journal of Nursing Practice. 2021 Apr;27(2):e12883.
Strong evidence of less sleep disruption and better sleep without regard to treatment among people with cancer participating in exercise
Strong evidence of better sleep among people with cancer participating in exercise, especially aerobic exercise, during treatment
Strong evidence of better sleep among people with cancer participating in exercise after treatment
Good evidence of less insomnia among people with advanced cancer participating in exercise
Without regard to treatment phase: strong evidence of less sleep disruption and better sleep among people participating in exercise
- Better sleep among people with lung cancer participating in exercise, with no higher risk of an adverse event, compared to usual care in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 32 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects272Singh B, Spence R, Steele ML, Hayes S, Toohey K. Exercise for individuals with lung cancer: a systematic review and meta-analysis of adverse events, feasibility, and effectiveness. Seminars in Oncology Nursing. 2020 Oct;36(5):151076.
- Better sleep among people with colorectal cancer participating in exercise compared to controls in a meta-analysis of 19 RCTs273Singh B, Hayes SC et al. Exercise and colorectal cancer: a systematic review and meta-analysis of exercise safety, feasibility and effectiveness. International Journal of Behavioral Nutrition and Physical Activity. 2020 Sep 24;17(1):122.
- Less sleep disturbance but no change in sleep quality among people with cancer participating in exercise compared to controls in a large meta-analysis of 27 RCTs274Bernard P, Savard J et al. Effects and moderators of exercise on sleep in adults with cancer: individual patient data and aggregated meta-analyses. Journal of Psychosomatic Research. 2019 Sep;124:109746.
- Less sleep disturbance among people with cancer participating in moderate-intensity walking compared to yoga in a meta-analysis of 25 RCTs275Tang MF, Chiu HY et al. Walking is more effective than yoga at reducing sleep disturbance in cancer patients: a systematic review and meta-analysis of randomized controlled trials. Sleep Medicine Reviews. 2019 Oct;47:1-8.
- Less insomnia among people with cancer participating in exercise interventions compared to controls in a meta-analysis of 10 RCTs276Nakano J, Hashizume K et al. Effects of aerobic and resistance exercises on physical symptoms in cancer patients: a meta-analysis. Integrative Cancer Therapies. 2018 Dec;17(4):1048-1058.
- Better sleep quality, but no evidence of an effect on other sleep scores, among people with breast cancer participating in a physical activity intervention compared to usual care in a meta-analysis of 6 RCTs277Yang H, Yang Z, Pan H, Zhou Q. Effects of physical activity on sleep problems in breast cancer survivors: a meta-analysis. Supportive Care in Cancer. 2021 Jul;29(7):4023-4032.
- Less insomnia among people with lung cancer participating in home-based exercise compared to controls in a meta-analysis of 14 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial including 7 RCTs278Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
- Slightly better sleep quality among people with lymphoma participating in an exercise intervention compared to controls in a meta-analysis of 6 RCTs279Liu L, He X, Feng L. Exercise on quality of life and cancer-related fatigue for lymphoma survivors: a systematic review and meta-analysis. Supportive Care in Cancer. 2019 Nov;27(11):4069-4082.
- Less sleep impairment among people with breast or colorectal cancer participating in a 12-week multi-component physical activity module including integrated Fitbit tracking compared to controls in a small RCT280Rastogi S, Tevaarwerk AJ et al. Effect of a technology-supported physical activity intervention on health-related quality of life, sleep, and processes of behavior change in cancer survivors: a randomized controlled trial. Psycho-Oncology. 2020 Nov;29(11):1917-1926.
- Fewer sleep problems among people with pancreatic cancer after 3 but not after 6 months of resistance training (either home-based or supervised training) compared to usual care in a small RCT281Steindorf K, Clauss D et al. Quality of life, fatigue, and sleep problems in pancreatic cancer patients—a randomized trial on the effects of exercise. Deutsches Ärzteblatt International. 2019 Jul 8;116(27-28):471-478.
During treatment: strong evidence of better sleep among people participating in exercise, especially aerobic exercise during treatment
- Better sleep scores among people with breast cancer participating in physical activity during treatment in a meta-analysis of 22 RCTs282Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Research and Treatment. 2019 Jul;176(1):1-15.
- Less sleep disturbance among people with cancer exercising during treatment in a pooled analysis of 40 controlled trials283Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Moderate to large effects with aerobic exercise, but small positive effects with exercise overall, on sleep quality among people with cancer during treatment compared to controls in a meta-analysis of intervention trials284Fang YY, Hung CT, Chan JC, Huang SM, Lee YH. Meta-analysis: exercise intervention for sleep problems in cancer patients. European Journal of Cancer Care (Engl). 2019 Sep;28(5):e13131.
After treatment: strong evidence of better sleep among people participating in exercise after treatment
- Better sleep scores among people with breast cancer participating in physical activity compared to controls after treatment in a meta-analysis of 22 RCTs285Kreutz C, Schmidt ME, Steindorf K. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Research and Treatment. 2019 Jul;176(1):1-15.
- Less sleep disturbance among people with cancer exercising compared to controls after treatment in a pooled analysis of 40 controlled trials286Mishra SI, Scherer RW et al. Exercise interventions on health-related quality of life for cancer survivors. Cochrane Database of Systematic Reviews. 2012 Aug 15;2012(8):CD007566.
- Less sleep disturbance among people with lung cancer enrolled with a support partner in an exercise or rehabilitation program compared to controls, but only during active interventions and not persisting after completion in a meta-analysis of 22 clinical studies287Papadopoulos D, Papadoudis A, Kiagia M, Syrigos K. Nonpharmacologic interventions for improving sleep disturbances in patients with lung cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2018 May;55(5):1364-1381.e5.
- Moderate to large effects with aerobic exercise, but small positive effects with exercise overall, on sleep quality among people with cancer exercising after treatment compared to controls in a meta-analysis of intervention trials288Fang YY, Hung CT, Chan JC, Huang SM, Lee YH. Meta-analysis: exercise intervention for sleep problems in cancer patients. European Journal of Cancer Care (Engl). 2019 Sep;28(5):e13131.
- Better sleep duration and sleep quality, with less sleep dysfunction and daytime dysfunction after surgery and completing a first cycle of adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation chemotherapy among women with ovarian cancer participating in exercise and cognitive behavioral therapy compared to usual care in a small RCT289Zhang Q, Li F, Zhang H, Yu X, Cong Y. Effects of nurse-led home-based exercise & cognitive behavioral therapy on reducing cancer-related fatigue in patients with ovarian cancer during and after chemotherapy: a randomized controlled trial. International Journal of Nursing Studies. 2018 Feb;78:52-60.
Advanced cancer: good evidence of less insomnia among people with advanced cancer participating in exercise
- Less insomnia among people with advanced cancer participating in exercise in a meta-analysis of 15 RCTs290Chen YJ, Li XX et al. Exercise training for improving patient-reported outcomes in patients with advanced-stage cancer: a systematic review and meta-analysis. Journal of Pain and Symptom Management. 2020 Mar;59(3):734-749.e10.
Good evidence of more rapid recovery from surgery, shorter hospital stays, and substantially fewer complications from surgery among people participating in exercise training before surgery
No evidence of an effect on coughing among people with lung cancer participating in exercise in a combined analysis of studies
Surgery outcomes
Exercise before surgery: good evidence of more rapid recovery from surgery, shorter hospital stays, and substantially fewer complications from surgery among people participating in exercise training before surgery
- Shorter hospital stays (almost five days on average), 67% fewer complications after surgery, better physical health scores, and better exercise capacity among people undergoing resection of non–small cell lung cancer who participated in exercise training before surgery compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 15 studies, including 8 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects291Ni HJ, Pudasaini B et al. Exercise training for patients pre- and postsurgically treated for non-small cell lung cancer: a systematic review and meta-analysis. Integrative Cancer Therapies. 2017 Mar;16(1):63-73.
- Shorter hospital stays (more than four days shorter on average), 67% lower risk of developing a postoperative lung complication, and fewer days needing a surgical site drainage tube (intercostal catheter) among people undergoing surgical resection for early stage non-small cell lung cancer who participated in exercise before surgery compared to controls in a pooled analysis of 5 RCTs292Cavalheri V, Granger C. Preoperative exercise training for patients with non-small cell lung cancer. Cochrane Database of Systematic Reviews. 2017 Jun 7;6(6):CD012020.
- Shorter hospital stays (small to moderate effect size) with surgery not specific to cancer among people participating in exercise before surgery compared to controls in a meta-analysis of 21 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial and uncontrolled trialsa study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design of moderate to poor quality293Santa Mina D, Clarke H et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014 Sep;100(3):196-207.
- Improved muscle mass among people with rectal cancer undergoing neoadjuvanttherapy used before a main treatment, such as chemotherapy, radiation therapy, and hormone therapy before surgery chemoradiotherapy in preparation for surgery and participating in a 13-17-week telephone-guided graduated walking program compared to standard care in a small RCT294Moug SJ, Barry SJE et al. Does prehabilitation modify muscle mass in patients with rectal cancer undergoing neoadjuvant therapy? A subanalysis from the REx randomised controlled trial. Techniques in Coloproctology. 2020 Sep;24(9):959-964.
Cough: no evidence of an effect on coughing among people with lung cancer participating in exercise in a combined analysis of studies
- No evidence of an effect on coughing among people with lung cancer participating in home-based exercise in a meta-analysis of 14 controlled trials including 7 RCTs295Yang M, Liu L et al. Effects of home-based exercise on exercise capacity, symptoms, and quality of life in patients with lung cancer: a meta-analysis. European Journal of Oncology Nursing. 2020 Dec;49:101836.
Modest evidence of benefit, including among those with anxiety and stress-related disorders
Good evidence of lower heart rates and blood pressure among students, and especially adolescents and young adults, participating in mind-body physical activity such as yoga, tai chi, or qigong
Modest evidence of higher cognitive scores among adults spending more time in physical activity
Good evidence of fewer or less severe symptoms among people with a diagnosis of major depressive disorder or with depressive symptoms participating in exercise
Modest evidence of fewer symptoms among people with symptoms of constipation participating in exercise
No evidence of an effect of exercise on frequency or intensity of hot flashes among perimenopausal or postmenopausal women participating in exercise in a combined analysis of studies
Preliminary evidence of less reduction in the number of hot flashes among sedentary women with vasomotor symptoms participating in exercise compared to estrogen therapy
Good evidence of less pain among people participating in physical activity
Preliminary evidence of less pain after surgery among people participating in total-body exercise before surgery
Good evidence of small and moderate improvements in physical function and reported quality of life among people with chronic pain participating in physical activity
Modest evidence of lower physical markers of stress among people participating in exercise or movement
Anxiety: modest evidence of less anxiety among people participating in physical activity, including people with anxiety and stress-related disorders
- Lower anxiety among healthy older adults participating in physical activity in a review of 8 RCTs296Mochcovitch MD, Deslandes AC, Freire RC, Garcia RF, Nardi AE. The effects of regular physical activity on anxiety symptoms in healthy older adults: a systematic review. Revista Brasileira de Psiquiatria. 2016 Jul-Sep;38(3):255-61.
- Fewer symptoms of anxiety among overweight or obese women with a lifestyle intervention of physical activity and/or diet in a meta-analysis of 5 RCTs297van Dammen L, Wekker V et al. A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: the effects on symptoms of depression and anxiety. Obesity Reviews. 2018 Dec;19(12):1679-1687.
- Fewer anxiety symptoms, with less improvement among those with physical or mental health conditions compared to healthy volunteers, with resistance exercise training in a meta-analysis of 16 RCTs298Gordon BR, McDowell CP, Lyons M, Herring MP. The effects of resistance exercise training on anxiety: a meta-analysis and meta-regression analysis of randomized controlled trials. Sports Medicine. 2017 Dec;47(12):2521-2532.
- Fewer anxiety symptoms among people with anxiety and stress-related disorders in a meta-analysis of 6 RCTs299Stubbs B, Vancampfort D et al. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatry Research. 2017 Mar;249:102-108.
Cardiovascular symptoms: good evidence of lower heart rates and blood pressure among students, and especially adolescents and young adults, participating in mind-body physical activity such as yoga, tai chi, or qigong
- Lower heart rates and blood pressure among students, and especially adolescents and young adults, participating in mind-body physical activity such as yoga, tai chi, or qigong compared to controls in a meta-analysis of 26 controlled studies, of which 10 were good quality300Strehli I, Burns RD, Bai Y, Ziegenfuss DH, Block ME, Brusseau TA. Mind-body physical activity interventions and stress-related physiological markers in educational settings: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2020 Dec 30;18(1):224.
Cognitive difficulties: modest evidence of higher cognitive scores among adults spending more time in physical activity
- Higher cognitive scores among people in their mid 40s spending more time in moderate and vigorous physical activity compared to little time in a large observational study301Mitchell JJ, Blodgett JM et al. Exploring the associations of daily movement behaviours and mid-life cognition: a compositional analysis of the 1970 British Cohort Study. Journal of Epidemiology & Community Health. 2023 Jan 23:jech-2022-219829.
- Higher cognition at age 69 among people participating in physical activity at least once a month throughout adulthood compared to no activity in a large observational study302James SN, Chiou YJ et al. Timing of physical activity across adulthood on later-life cognition: 30 years follow-up in the 1946 British birth cohort. Journal of Neurology, Neurosurgery, and Psychiatry. 2023 Feb 21:jnnp-2022-329955.
Depression: good evidence of fewer or less severe symptoms among people with a diagnosis of major depressive disorder or with depressive symptoms participating in exercise
- Moderately to substantially fewer or less severe symptoms among people with a diagnosis of major depressive disorder or with depressive symptoms participating in exercise, especially supervised exercise interventions, compared to non-exercising controls in a meta-analysis of 41 RCTs303Heissel A, Heinen D et al. Exercise as medicine for depressive symptoms? A systematic review and meta-analysis with meta-regression. British Journal of Sports Medicine. 2023 Feb 1:bjsports-2022-106282.
Gastrointestinal symptoms: modest evidence of fewer symptoms among people with symptoms of constipation participating in exercise
- Fewer symptoms among people with symptoms of constipation participating in exercise, especially aerobic exercise such as qigong or walking, compared to controls in a meta-analysis of 10 RCTs of low quality304Gao R, Tao Y et al. Exercise therapy in patients with constipation: a systematic review and meta-analysis of randomized controlled trials. Scandinavian Journal of Gastroenterology. 2019 Feb;54(2):169-177.
Hot flashes
No evidence of an effect of exercise on frequency or intensity of hot flashes among perimenopausal or postmenopausal women participating in exercise in a combined analysis of studies
Preliminary evidence of less reduction in the number of hot flashes among sedentary women with vasomotor symptoms participating in exercise compared to estrogen therapy
- No evidence of an effect of exercise on frequency or intensity of hot flashes (vasomotor symptoms) among perimenopausal or postmenopausal women participating in exercise compared to no active treatment (3 RCTs) or yoga 2 (RCTs) in meta-analyses305Daley A, Stokes-Lampard H, Thomas A, MacArthur C. Exercise for vasomotor menopausal symptoms. Cochrane Database of Systematic Reviews. 2014 Nov 28;(11):CD006108.
- Less reduction in the number of hot flashes among sedentary women with vasomotor symptoms participating in exercise for 24 weeks compared to estrogen therapy in a small RCT306Lindh-Astrand L, Nedstrand E, Wyon Y, Hammar M. Vasomotor symptoms and quality of life in previously sedentary postmenopausal women randomised to physical activity or estrogen therapy. Maturitas. 2004 Jun 15;48(2):97-105.
Pain not specific to cancer: good evidence of less pain among people participating in physical activity
- Lower pain severity in general (not specific to cancer) among people participating in physical activity in a large review of reviews of 381 RCTs307Geneen LJ, Moore RA et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017 Apr 24;4(4):CD011279.
- Better measures of physical function and less pain among overweight and obese older adults with knee pain and osteoarthritis participating in a diet and exercise intervention compared to a healthy lifestyle control group in a mid-sized RCT308Messier SP, Loeser RF et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis & Rheumatism. 2004;50(5):1501–1510.
Pain with surgery: preliminary evidence of less pain after surgery among people participating in total-body exercise before surgery
- Less pain after surgery among people participating in total-body exercise before surgery in a meta-analysis of both controlled and uncontrolled trials of poor to moderate quality309Santa Mina D, Clarke H et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014 Sep;100(3):196-207.
Physical function and reported quality of life: good evidence of small and moderate improvements in physical function and reported quality of life among people with chronic pain participating in physical activity
- Generally small and moderate improvements in physical function and reported quality of life among people with chronic pain participating in physical activity in a large review of reviews of RCTs310Geneen LJ, Moore RA et al. Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. Cochrane Database of Systematic Reviews. 2017 Apr 24;4(4):CD011279.
Stress: modest evidence of lower physical markers of stress among people participating in exercise or movement
- Lower cortisol levels, a marker of stress, among people with major depressive disorder participating in exercise compared to controls in a meta-analysis of 5 controlled trialsa study design in which people are assigned to either an experimental group or a control group to compare the outcomes from different treatment; assignment is not random, and so this is not as strong a study design as a randomized controlled trial, but still stronger than an uncontrolled trial311Beserra AHN, Kameda P, Deslandes AC, Schuch FB, Laks J, Moraes HS. Can physical exercise modulate cortisol level in subjects with depression? A systematic review and meta-analysis. Trends in Psychiatry and Psychotherapy. 2018 Oct-Dec;40(4):360-368.
Good evidence of slightly less anxiety among people with cancer participating in a combined intervention of diet and physical activity
Preliminary evidence of less depression among women with early breast cancer participating in an intervention of both diet and exercise
Preliminary evidence of less fatigue among women with early breast cancer participating in an intervention of both diet and exercise
Modest evidence of much better physical function among people with head and neck cancer participating in an intervention of nutrition and exercise
Good evidence of slightly improved quality of life among people with cancer participating in both better diet and physical activity
Preliminary evidence of better measures of physical function and less pain among overweight and obese older adults with knee pain and osteoarthritis participating in a diet and exercise intervention
Modest evidence of less depression and anxiety among overweight or obese women participating in an intervention of physical activity and/or diet
Modest evidence of better sexual function and health-related quality of life among people with cervical cancer participating in pelvic floor muscle training with counseling and yoga or core exercises
Weak evidence of less stress urinary incontinence, less pelvic pain, and better pelvic floor strength after prostatectomy among people with stress urinary incontinence treated with an individualized program of exercise for underactive pelvic floor dysfunction (PFD), relaxation for overactive PFD, or a combination treatment for mixed-type PFD
Moving More and Eating Well
Anxiety: good evidence of slightly less anxiety among people with cancer participating in a combined intervention of diet and physical activity
- Slightly less anxiety among people with cancer participating in an online, combined intervention of diet and physical activity in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 24 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects312Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Less anxiety among women with early breast cancer participating in an intervention of both diet and exercise compared to controls in a mid-sized RCT313Carayol M, Ninot G et al. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial. BMC Cancer. 2019 Jul 25;19(1):737.
Depression: preliminary evidence of less depression among women with early breast cancer participating in an intervention of both diet and exercise
- Less depression among women with early breast cancer participating in an intervention of both diet and exercise compared to controls in a mid-sized RCT314Carayol M, Ninot G et al. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial. BMC Cancer. 2019 Jul 25;19(1):737.
Fatigue: preliminary evidence of less fatigue among women with early breast cancer participating in an intervention of both diet and exercise
- Less fatigue among women with early breast cancer participating in an intervention of both diet and exercise compared to controls in a mid-sized RCT315Carayol M, Ninot G et al. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial. BMC Cancer. 2019 Jul 25;19(1):737.
Physical function and quality of life
Modest evidence of much better physical function among people with head and neck cancer participating in an intervention of nutrition and exercise
Good evidence of slightly improved quality of life among people with cancer participating in both better diet and physical activity
- Substantially improved physical function among people with head and neck cancer undergoing radiotherapy treatment who participated in an intervention of nutrition and in some cases exercise compared to controls in a meta-analysis of 13 RCTs316Bye A, Sandmael JA et al. Exercise and nutrition interventions in patients with head and neck cancer during curative treatment: a systematic review and meta-analysis. Nutrients. 2020 Oct 22;12(11):3233.
- Slightly improved quality of life among people with cancer participating in an online physical activity and diet intervention compared to controls in a meta-analysis of 24 RCTs317Furness K, Sarkies MN, Huggins CE, Croagh D, Haines TP. Impact of the method of delivering electronic health behavior change interventions in survivors of cancer on engagement, health behaviors, and health outcomes: systematic review and meta-analysis. Journal of Medical Internet Research. 2020 Jun 23;22(6):e16112.
- Better quality of life among women with early breast cancer participating in an intervention of both diet and exercise compared to controls in a mid-sized RCT318Carayol M, Ninot G et al. Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial. BMC Cancer. 2019 Jul 25;19(1):737.
Symptoms not specific to cancer
Preliminary evidence of better measures of physical function and less pain among overweight and obese older adults with knee pain and osteoarthritis participating in a diet and exercise intervention
Modest evidence of less depression and anxiety among women with overweight or obesity participating in an intervention of physical activity and/or diet
- Better measures of physical function and less pain among overweight and obese older adults with knee pain and osteoarthritis participating in a diet and exercise intervention compared to a healthy lifestyle control group in a mid-sized RCT319Messier SP, Loeser RF et al. Exercise and dietary weight loss in overweight and obese older adults with knee osteoarthritis: the Arthritis, Diet, and Activity Promotion Trial. Arthritis & Rheumatism. 2004;50(5):1501–1510.
- Fewer symptoms of depression and anxiety among overweight or obese women participating in a lifestyle intervention of physical activity and/or diet in a meta-analysis of 5 RCTs320van Dammen L, Wekker V et al. A systematic review and meta-analysis of lifestyle interventions in women of reproductive age with overweight or obesity: the effects on symptoms of depression and anxiety. Obesity Reviews. 2018 Dec;19(12):1679-1687.
Muscle training with counseling and yoga or core exercises: modest evidence of better sexual function and health-related quality of life among people with cervical cancer participating in pelvic floor muscle training with counseling and yoga or core exercises
- Better sexual function and health-related quality of life among people with cervical cancer participating in pelvic floor muscle training with counseling and yoga or core exercises compared to controls in a systematic review of 5 RCTs and 2 retrospective cohort studies321Brennen R, Lin KY, Denehy L, Frawley HC. The effect of pelvic floor muscle interventions on pelvic floor dysfunction after gynecological cancer treatment: a systematic review. Physical Therapy. 2020 Aug 12;100(8):1357-1371.
Pelvic floor exercise and relaxation: weak evidence of less stress urinary incontinence, less pelvic pain, and better pelvic floor strength after prostatectomy among people with stress urinary incontinence treated with an individualized program of exercise for underactive pelvic floor dysfunction (PFD), relaxation for overactive PFD, or a combination treatment for mixed-type PFD
- Less stress urinary incontinence, less pelvic pain, and better pelvic floor strength after prostatectomy among people with stress urinary incontinence treated with an individualized program of exercise for underactive pelvic floor dysfunction (PFD), relaxation for overactive PFD, or a combination treatment for mixed-type PFD compared to baseline in a mid-sized uncontrolled triala study in which a therapy is used, but without a comparison group against which to judge outcomes; an uncontrolled trial is considered a weak study design322Scott KM, Gosai E et al. Individualized pelvic physical therapy for the treatment of post-prostatectomy stress urinary incontinence and pelvic pain. International Urology and Nephrology. 2020 Apr;52(4):655-659.
Reducing cancer risk
Is Moving More linked to lower risks of developing cancer or of recurrence? We present the evidence.
Modest evidencesignificant effects in at least three small but well-designed RCTs, or one or more well-designed, mid-sized clinical studies of reasonably good quality (RCTs or observational studies), or several small studies aggregated into a meta-analysis (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of recurrence among people participating in exercise
Strong evidenceconsistent, significant effects in several large (or at least one very large) well designed clinical studies or at least two meta-analyses of clinical studies of moderate or better quality (or one large meta-analysis) finding similar results (this is the CancerChoices definition; other researchers and studies may define this differently) of a lower risk of a cancer diagnosis among people with higher levels of physical activity
Preliminary evidencesignificant effects in small or poorly designed clinical studies OR conflicting results in adequate studies but a preponderance of evidence of an effect (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of metastatic cancer among people participating in high-intensity exercise
Strong evidence of lower cancer mortality among people without cancer at baseline and who had the highest levels of physical activity
Recurrence: modest evidence of lower risk of recurrence among people participating in exercise
- 48% lower risk of recurrence among people with cancer participating in exercise compared to controls in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 8 RCTsrandomized controlled trial, a study design in which people are randomly assigned to either an experimental group or a control group to compare the outcomes from different treatments; an RCT is considered a strong design for determining a therapy’s effects323Morishita S, Hamaue Y, Fukushima T, Tanaka T, Fu JB, Nakano J. Effect of exercise on mortality and recurrence in patients with cancer: a systematic review and meta-analysis. Integrative Cancer Therapies. 2020 Jan-Dec;19:1534735420917462.
Cancer diagnosis: strong evidence of lower risk of cancer among people with higher levels of physical activity
- Lower risk of cancer at 7 sites—colon, breast, endometrial, lung, esophagus, pancreas, and central nervous system (meningioma)—among people with higher levels of physical activity compared to other people in an umbrella review of systematic reviews324Rezende LFM, Sá TH et al. Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases. British Journal of Sports Medicine. 2018 Jul;52(13):826-833.
- 26% lower risk of cancer as a whole among healthy community-dwelling adults aged 70 years or older practicing “a simple home strength exercise program (SHEP)” compared to placebo and control exercise in a large RCT; even greater reductions were found when SHEP was combined with vitamin D (44% lower risk), omega-3 fatty acids (48% lower risk), or both vitamin D and omega-3s (61% lower risk) 325Bischoff-Ferrari HA, Willett WC et al. Combined vitamin D, omega-3 fatty acids, and a simple home exercise program may reduce cancer risk among active adults aged 70 and older: a randomized clinical trial. Frontiers in Aging. 2022 Apr 25;3.
- Lower incidence of total cancer among people without cancer at baseline doing muscle-strengthening exercises (up to 130 minutes per week) in a very large meta-analysis of observational studies with evidence rated as very low quality326Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
- Lower risk of future cancer among people participating in physical activity compared to other people in a very large observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study327Lau ES, Paniagua SM et al. Cardiovascular risk factors are associated with future cancer. Journal of the American College of Cardiology: CardioOncology. 2021 Mar, 3 (1) 48–58.
- 73% lower risk of metastatic cancer but only modestly lower risk of cancer in low metastatic stages among people participating in high-intensity exercise compared with inactive people in a large observational study328Sheinboim D, Parikh S et al. An exercise-induced metabolic shield in distant organs blocks cancer progression and metastatic dissemination. Cancer Research. 2022 Nov 15;82(22):4164-4178.
- Lower risk of cardiovascular disease, which is associated with future cancer, among people participating in physical activity compared to other people in a very large observational study329Lau ES, Paniagua SM et al. Cardiovascular risk factors are associated with future cancer. Journal of the American College of Cardiology: CardioOncology. 2021 Mar, 3 (1) 48–58.
Cancer mortality: strong evidence of lower cancer mortality among people without cancer at baseline and who had the highest levels of physical activity
- 20% lower cancer mortality among people without cancer at baseline and who had the highest levels of physical activity before diagnosis compared to the lowest, and 15% lower risk with any amount of regular physical activity compared to non/occasional physical activity in a large meta-analysis of 32 observational studies330Li Y, Gu M et al. Association between physical activity and all cancer mortality: dose-response meta-analysis of cohort studies. International Journal of Cancer. 2016 Feb 15;138(4):818-32.
- Increased cancer mortality among people without cancer at baseline who have the most sitting time, and especially who are the least active compared to others, in meta-analyses of 8 and 47 observational studies331Ekelund U, Brown WJ et al. Do the associations of sedentary behaviour with cardiovascular disease mortality and cancer mortality differ by physical activity level? A systematic review and harmonised meta-analysis of data from 850 060 participants. British Journal of Sports Medicine. 2019 Jul;53(14):886-894; Biswas A, Oh PI, Faulkner GE, Bajaj RR, Silver MA, Mitchell MS, Alter DA. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Annals of Internal Medicine. 2015 Jan 20;162(2):123-32.
- 25% lower risk of cancer mortality among people without cancer at baseline and commuting by bicycle, but not other types of active commuting, compared to other people in a very large meta-analysis of 23 observational studies332Dinu M, Pagliai G, Macchi C, Sofi F. Active commuting and multiple health outcomes: a systematic review and meta-analysis. Sports Medicine. 2019 Mar;49(3):437-452.
- Lower total cancer mortality among people without cancer at baseline participating in muscle-strengthening exercise, and 28% lower total cancer mortality with combined muscle-strengthening and aerobic exercise compared to other people in a very large meta-analysis of 12 observational studies333Nascimento W, Ferrari G et al. Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies. International Journal of Behavioral Nutrition and Physical Activity. 2021 May 29;18(1):69.
- Slightly lower cancer mortality among people without cancer at baseline doing muscle-strengthening exercises (up to 130 minutes per week) in a very large meta-analysis of observational studies with evidence rated as very low quality334Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
- 28% lower cancer mortality among people without cancer at baseline doing both muscle-strengthening and aerobic activities in a very large meta-analysis of observational studies with evidence rated as very low quality335Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
- 9% lower cancer mortality among people without cancer at baseline replacing sedentary time by 30 minutes per day of light-intensity physical activity compared to other people in a meta-analysis of 5 observational studies336Qiu S, Cai X et al. Objectively-measured light-intensity physical activity and risk of cancer mortality: a meta-analysis of prospective cohort studies. Cancer Epidemiology, Biomarkers & Prevention. 2020 May;29(5):1067-1073.
- 14–36% lower cancer-related mortality among adults without cancer at baseline participating in higher amounts of leisure-time physical activity compared with those who were consistently inactive throughout adulthood in 2 very large observational studies337Saint-Maurice PF, Coughlan D et al. Association of leisure-time physical activity across the adult life course with all-cause and cause-specific mortality. JAMA Network Open. 2019 Mar 1;2(3):e190355; Cannioto RA, Dighe S et al. Habitual recreational physical activity is associated with significantly improved survival in cancer patients: evidence from the Roswell Park Data Bank and BioRepository. Cancer Causes Control. 2019 Jan;30(1):1-12.
- Moderately lower risk of cancer mortality among people without cancer at baseline participating in brief bursts of vigorous intermittent lifestyle physical activity for several minutes a day compared to no vigorous activity in a very large observational study338Stamatakis E, Ahmadi MN et al. Association of wearable device-measured vigorous intermittent lifestyle physical activity with mortality. Nature Medicine. 2022 Dec;28(12):2521-2529.
Weak evidenceone or more case studies, supported by animal evidence OR small treatment effects of limited clinical significance OR studies with no controls OR weak trends of effects (this is the CancerChoices definition; other researchers and studies may define this differently) of lower risk of bladder cancer among people doing muscle-strengthening exercises
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward lower risk of bladder cancer among people doing muscle-strengthening exercises compared to other people in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies of low quality339Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
Modest evidence of slightly lower risk of recurrence among people participating in higher levels of physical exercise
Strong evidence of a slightly lower risk of a breast cancer diagnosis among people participating in more physical activity
Strong evidence of a higher risk of breast cancer among people with more sitting time
Good evidencesignificant effects in one large or several mid-sized and well-designed clinical studies (RCTs with an appropriate placebo or other strong comparison control or observational studies that control for confounds (this is the CancerChoices definition; other researchers and studies may define this differently) of lower breast cancer mortality among people without cancer at baseline participating in higher levels of physical activity
Recurrence
Modest evidence of slightly lower risk of recurrence among people participating in higher levels of physical exercise
- A weak trend toward lower risk of recurrence among people with breast cancer with the highest levels of physical activity after diagnosis compared to the lowest in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 10 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies340Spei ME, Samoli E et al. Physical activity in breast cancer survivors: a systematic review and meta-analysis on overall and breast cancer survival. Breast. 2019 Apr;44:144-152. and pooled analyses of 4 observational studies341Beasley JM, Kwan ML, Chen WY et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Research and Treatment. 2012 Jan;131(2):637-43; World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed September 9, 2021.
- Moderately lower risk of recurrence or progression among people with higher levels of physical activity after diagnosis compared to low levels in a pooled analysis of 6 observational studies of low quality342Friedenreich CM, Neilson HK, Farris MS, Courneya KS. Physical activity and cancer outcomes: a precision medicine approach. Clinical Cancer Research. 2016 Oct 1;22(19):4766-4775.
Cancer diagnosis
Physical activity: strong evidence of a slightly lower risk of a breast cancer diagnosis among people participating in more physical activity
- 13% lower risk of breast cancer among people participating in physical activity compared to other people in an umbrella review of systematic reviews343Rezende LFM, Sá TH et al. Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases. British Journal of Sports Medicine. 2018 Jul;52(13):826-833.
- Lower risk of breast cancer among women with greater overall physical activity, greater vigorous activity, and lower sedentary time compared to other women in a very large study employing Mendelian randomizationa method of using measured variation in genes of known function to examine the causal effect of a modifiable exposure on disease in observational studies344Dixon-Suen SC, Lewis SJ et al. Physical activity, sedentary time and breast cancer risk: a Mendelian randomisation study. British Journal of Sports Medicine. Published Online First: 06 September 2022.
- Lower risk of breast cancer among people participating in physical activity compared to other people, with similar impacts in both premenopausal and postmenopausal women, and with slightly greater benefit from high-intensitya level that gets you moving fast enough or strenuously enough to burn off more than six times as much energy per minute as you do when you are sitting quietly; examples include jogging at 6 mph, bicycling 14-16 mph, or playing basketball physical activity compared to low-intensity exercise in a very large meta-analysis of 139 observational studies345Hardefeldt PJ, Penninkilampi R, Edirimanne S, Eslick GD. Physical activity and weight loss reduce the risk of breast cancer: a meta-analysis of 139 prospective and retrospective studies. Clinical Breast Cancer. 2018 Aug;18(4):e601-e612.
- 16% lower risk of breast cancer among people participating in physical activity—and further benefits with more vigorous activity—compared to other people, with the effect stronger among postmenopausal women than premenopausal in a large meta-analysis of 126 observational studies346Chan DSM, Abar L et al. World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes & Control. 2019 Nov;30(11):1183-1200.
- 2–3% lower risk of breast cancer with each 10 MET-hours (180 minutes of brisk walking) per week, with greater benefit among premenopausal women compared to postmenopausal in a large meta-analysis of 38 observational studies347Chen X, Wang Q, Zhang Y, Xie Q, Tan X. Physical activity and risk of breast cancer: a meta-analysis of 38 cohort studies in 45 study reports. Value in Health. 2019 Jan;22(1):104-128.
- 20% lower risk of premenopausal breast cancer and 21% lower risk of postmenopausal breast cancer among people participating in higher levels of moderate-vigorous recreational activity compared to lower levels in a meta-analysis of 101 observational studies348Neilson HK, Farris MS et al. Moderate-vigorous recreational physical activity and breast cancer risk, stratified by menopause status: a systematic review and meta-analysis. Menopause. 2017 Mar;24(3):322-344.
- 6–10% lower risk of breast cancer among people participating in 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to no activity in a large meta-analysis of 9 observational studies349Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- 11–13% lower risk of premenopausal breast cancer among people with the highest levels of physical activity compared to the lowest in a meta-analysis of 6 observational studies350World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed September 9, 2021.
- Lower risk of breast cancer among people with higher levels of exercise compared to lower levels, even among women at higher genetic risk of breast cancer in a very large observational study351Al Ajmi K, Lophatananon A, Mekli K, Ollier W, Muir KR. Association of nongenetic factors with breast cancer risk in genetically predisposed groups of women in the UK Biobank Cohort. JAMA Network Open. 2020;3(4):e203760.
- 12.2% higher risk of developing breast cancer among postmenopausal white women genetically predisposed to breast cancer with no regular physical activity compared to higher levels of activity in a large observational study352Al Ajmi K, Lophatananon A, Mekli K, Ollier W, Muir KR. Association of nongenetic factors with breast cancer risk in genetically predisposed groups of women in the UK Biobank Cohort. JAMA Network Open. 2020;3(4):e203760.
Sedentary time: strong evidence of a higher risk of breast cancer among people with more sitting time
- Higher risk of breast cancer among people who spend more time sitting compared to other people, with the effect stronger among postmenopausal women than premenopausal in a large meta-analysis of 126 observational studies353Chan DSM, Abar L et al. World Cancer Research Fund International: Continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes & Control. 2019 Nov;30(11):1183-1200.
- 15.5% higher risk of breast cancer with sedentary work compared to other types of work in a meta-analysis of 31 observational studies354Lee J, Lee J, Lee DW, Kim HR, Kang MY. Sedentary work and breast cancer risk: a systematic review and meta-analysis. Journal of Occupational Health. 2021 Jan;63(1):e12239.
Breast cancer mortality
Good evidence of lower breast cancer mortality among people without cancer at baseline participating in higher levels of physical activity
- 27% lower breast cancer-specific mortality among people without cancer at baseline and with high lifetime recreational physical activity levels, and 16% lower mortality with more recent recreational physical activity before diagnosis, compared to low/no lifetime recreational physical activity in a very large meta-analysis of 22 observational studies355Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta Oncologica. 2015 May;54(5):635-54.
- 17–19% lower cancer-specific mortality among people without cancer at baseline with moderate and high levels of physical activity before diagnosis compared to low levels, with more benefit among overweight women than normal weight women and among postmenopausal women than premenopausal women in a large meta-analysis of 16 observational studies356Zhong S, Jiang T et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. European Journal of Epidemiology. 2014 Jun;29(6):391-404.
Preliminary evidence of moderately to substantially lower risk of recurrence of colon cancer with higher levels of exercise after diagnosis
Strong evidence of lower risk of colon cancer among people with higher levels of physical activity
Preliminary (conflicting) evidence of lower risk of rectal cancer among people with higher levels of physical activity
Strong evidence of higher risk of colon cancer or neoplasia among people with more sedentary (sitting) time
Recurrence
Preliminary evidence of moderately to substantially lower risk of recurrence of colon cancer among people with higher levels of exercise after diagnosis
- About half the risk of colorectal cancer recurrence among people with stage 3 colon cancer having completed adjuvanttreatment applied after initial treatment for cancer, especially to suppress secondary tumor formation chemotherapy performing 18 MET-hours (about 5½ hours of brisk walking) per week compared to less than 3 MET-hours (less than an hour of brisk walking) in a mid-sized observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods study357Meyerhardt JA, Heseltine D et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Journal of Clinical Oncology. 2006 Aug 1;24(22):3535-41.
Cancer diagnosis
Physical activity: strong evidence of lower risk of colon cancer among people with higher levels of physical activity
- 19% lower risk of colon cancer among people with higher levels of recreational physical activity compared to other people in an umbrella review of systematic reviews358Rezende LFM, Sá TH et al. Physical activity and cancer: an umbrella review of the literature including 22 major anatomical sites and 770 000 cancer cases. British Journal of Sports Medicine. 2018 Jul;52(13):826-833.
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward lower risk of colon cancer among people doing muscle-strengthening exercises compared to other people in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 2 observational studies of low quality359Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
- 8–14% lower risk of colon cancer among men performing 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to no physical activity in a large meta-analysis of 9 observational studies360Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- 19% lower risk of colon cancer and 12% lower risk of rectal cancer among people with the highest levels of physical activity compared to the lowest in a meta-analysis of 47 observational studies361Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13.
- Lower risk of colorectal cancer among people with a first-degree family history of colorectal cancer or with higher body mass index (BMI) participating in the highest level of physical activity compared to the lowest in a meta-analysis of 18 observational studies362Shaw E, Farris MS et al. Effects of physical activity on colorectal cancer risk among family history and body mass index subgroups: a systematic review and meta-analysis. BMC Cancer. 2018 Jan 11;18(1):71.
- 23–24% lower risk of colon cancer but no lower risk of rectal cancer among people participating in physical activity compared to other people in a meta-analysis of 30 observational studies363Robsahm TE, Aagnes B et al. Body mass index, physical activity, and colorectal cancer by anatomical subsites: a systematic review and meta-analysis of cohort studies. European Journal of Cancer Prevention. 2013 Nov;22(6):492-505.
- 16–20% lower risk of colon cancer among people with the highest levels of physical activity compared to the lowest in a meta-analysis of 29 observational studies364World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed September 9, 2021.
- 15–34% (depending on the type of physical activity) lower risk of colon cancer and 12–13% lower risk of rectal cancer among people participating in physical activity, and 44% greater risk of colon cancer and 2% greater risk of rectal cancer with occupational sitting (sedentary behavior) in a meta-analysis of 38 observational studies365Mahmood S, MacInnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. International Journal of Epidemiology. 2017 Dec 1;46(6):1797-1813.
- 23% lower risk of any new, uncontrolled growth of colorectal cells (neoplasia) and 27% lower risk of advanced colorectal neoplasia among people with the highest levels of physical activity compared to the lowest in a large meta-analysis of 32 observational studies366Wang J, Huang L et al. Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies. British Journal of Sports Medicine. 2020 May;54(10):582-591.
Sedentary time: strong evidence of higher risk of colon cancer or neoplasia among people with more sedentary time
- 44% greater risk of colon cancer and 2% greater risk of rectal cancer among people with occupational sitting (sedentary behavior) compared to other people in a meta-analysis of 38 observational studies367Mahmood S, MacInnis RJ, English DR, Karahalios A, Lynch BM. Domain-specific physical activity and sedentary behaviour in relation to colon and rectal cancer risk: a systematic review and meta-analysis. International Journal of Epidemiology. 2017 Dec 1;46(6):1797-1813.
- Higher risk of any new, uncontrolled growth of colorectal cells (neoplasia) among people with more sedentary time compared to other people in a large meta-analysis of 32 observational studies368Wang J, Huang L et al. Physically active individuals have a 23% lower risk of any colorectal neoplasia and a 27% lower risk of advanced colorectal neoplasia than their non-active counterparts: systematic review and meta-analysis of observational studies. British Journal of Sports Medicine. 2020 May;54(10):582-591.
Strong evidence of lower risk of esophageal adenocarcinomas among people participating in physical activity as a whole, but not in occupational physical activity
Good evidence of lower risk of gallbladder cancer with higher levels of physical activity
Strong evidence of lower risk of liver cancer among people with higher levels of physical activity
Good evidence of lower risk of mortality from liver cancer among people without cancer at baseline participating in higher levels of physical activity
Strong evidence of lower risk of stomach cancer among people with higher levels of physical activity
Esophageal cancer diagnosis: strong evidence of lower risk of esophageal adenocarcinomas with physical activity as a whole, but not occupational physical activity
- Lower risk of esophageal adenocarcinomas among people participating in physical activity compared to other people in a review of 100 meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies369Castro C, Peleteiro B, Lunet N. Modifiable factors and esophageal cancer: a systematic review of published meta-analyses. Journal of Gastroenterology. 2018 Jan;53(1):37-51.
- 21% Lower risk of esophageal adenocarcinomas among people participating in physical activity compared to other people in a meta-analysis of 24 observational studies370Behrens G, Jochem C et al. The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis. European Journal of Epidemiology. 2014 Mar;29(3):151-70.
- No reduced risk of esophageal cancer among people participating in higher levels of occupational physical activity compared to others in an umbrella review of low-quality evidence from observational studies371Cillekens B, Lang M et al. How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies. British Journal of Sports Medicine. 2020 Dec;54(24):1474-1481.
Gallbladder cancer diagnosis: good evidence of lower risk of gallbladder cancer with higher levels of physical activity
- 21% lower risk of gallbladder cancer among people participating in the highest levels of physical activity compared to the lowest in a meta-analysis of 47 observational studies372Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13.
Liver cancer diagnosis: strong evidence of lower risk of liver cancer among people with higher levels of physical activity
- 26–27% lower risk of liver cancer among people participating in the highest levels of physical activity compared to the lowest, with greater benefit with higher intensitya level that gets you moving fast enough or strenuously enough to burn off more than six times as much energy per minute as you do when you are sitting quietly; examples include jogging at 6 mph, bicycling 14-16 mph, or playing basketballhigher intensity physical activity, in meta-analyses of 47 and 10 observational studies373Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13; Lee J. Associations between physical activity and liver cancer risks and mortality: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2020 Dec 1;17(23):8943.
- 18–27% lower risk of liver cancer among people performing 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to less activity in a large meta-analysis of 9 observational studies374Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- Estimated 20% or more lower risk of liver cancer among people with high levels of physical activity compared to low levels in a large meta-analysis of 14 observational studies375Baumeister SE, Leitzmann MF, Linseisen J, Schlesinger S. Physical activity and the risk of liver cancer: a systematic review and meta-analysis of prospective studies and a bias analysis. Journal of the National Cancer Institute. 2019 Nov 1;111(11):1142-1151.
- 25% lower risk of liver cancer among people participating in overall daily physical activity compared to other people, but only a weak overall trend toward less risk with increased leisure-time physical activity—a stronger trend among people who have never smoked—in a meta-analysis of 5 observational studies376Lin ZZ, Xu YC, Liu CX, Lu XL, Wen FY. Physical activity and liver cancer risk: a systematic review and meta-analyses. Clinical Journal of Sport Medicine. 2021 Jan;31(1):86-90.
Liver cancer mortality: good evidence of lower risk of mortality from liver cancer among people without cancer at baseline participating in higher levels of physical activity
- 25% lower risk of cancer-specific mortality with 3 or more hours of physical activity per week compared with less than 2 hours a week in a meta-analysis of 10 observational studies377Lee J. Associations between physical activity and liver cancer risks and mortality: a systematic review and meta-analysis. International Journal of Environmental Research and Public Health. 2020 Dec 1;17(23):8943.
Stomach cancer risk: strong evidence of lower risk of stomach cancer among people with higher levels of physical activity
- 19% lower risk of stomach cancer among people participating in physical activity compared to other people in a very large meta-analysis of 10 observational studies378Psaltopoulou T, Ntanasis-Stathopoulos I et al. Physical activity and gastric cancer risk: a systematic review and meta-analysis. Clinical Journal of Sport Medicine. 2016 Nov;26(6):445-464.
- 17% lower risk of gastric cardia adenocarcinoma and 28% lower risk of gastric non-cardia adenocarcinoma among people participating in physical activity compared to other people in a large meta-analysis of 24 observational studies379Behrens G, Jochem C et al. The association between physical activity and gastroesophageal cancer: systematic review and meta-analysis. European Journal of Epidemiology. 2014 Mar;29(3):151-70.
- 17% lower risk of stomach cancer among people participating in the highest levels of physical activity compared to the lowest in a very large meta-analysis of 47 observational studies380Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13.
- A weak trend toward lower risk of stomach cancer among people participating in at least 60 minutes of moderate- to vigorous-intensity physical activity per day, or 300 minutes per week, compared to less activity in a very large meta-analysis of 232 observational studies381Poorolajal J, Moradi L, Mohammadi Y, Cheraghi Z, Gohari-Ensaf F. Risk factors for stomach cancer: a systematic review and meta-analysis. Epidemiology and Health. 2020;42:e2020004.
Good evidence of lower risk of endometrial cancer among people with higher levels of physical activity
- 10–18% lower risk of endometrial cancer among people performing 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to less activity in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 9 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies382Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- 21–27% lower risk of endometrial cancer among people with the highest levels of physical activity compared to the lowest in a meta-analysis of 9 observational studies383World Cancer Research Fund, American Institute for Cancer Research. Physical activity and the risk of cancer. 2018. Viewed September 9, 2021.
- 19–23% lower risk of endometrial cancer among people with higher levels of occupational physical activity compared to the least in reviews of moderate quality384Cillekens B, Lang M et al. How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies. British Journal of Sports Medicine. 2020 Dec;54(24):1474-1481.
Good evidence of lower risk of oropharyngeal cancer among people with higher levels of physical activity
- 27% lower risk of oropharyngeal cancer among people with the highest levels of physical activity compared to the lowest in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 47 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies385Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13.
Strong evidence of lower risk of kidney cancer among people with higher levels of physical activity
- 11–17% lower risk of kidney cancer among people achieving 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to less activity in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 9 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies386Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- 26% lower incidence of kidney cancer among people participating in muscle-strengthening exercise compared to other people in a meta-analysis of 9 observational studies387Nascimento W, Ferrari G et al. Muscle-strengthening activities and cancer incidence and mortality: a systematic review and meta-analysis of observational studies. International Journal of Behavioral Nutrition and Physical Activity. 2021 May 29;18(1):69.
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward lower risk of kidney cancer among people with higher levels of occupational physical activity compared to other people in a meta-analysis of 17 observational studies388Cillekens B, Lang M et al. How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies. British Journal of Sports Medicine. 2020 Dec;54(24):1474-1481.
- A weak trend toward lower risk of kidney cancer among people doing muscle-strengthening exercises compared to other people in a very large meta-analysis of 2 observational studies of low quality389Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
Modest evidence of lower risk of lung cancer among current and former smokers with higher levels of physical activity
Insufficient evidence of an effect on lung cancer risk among nonsmokers with higher levels of physical activity
Modest evidence of higher risk of lung cancer among men with high levels of occupational activity
Modest evidence of lower risk of lung cancer among males who smoked and who had moderate and moderate or high cardiorespiratory fitness compared to low fitness
Physical activity:
Modest evidence of lower risk of lung cancer among current and former smokers with higher levels of physical activity
Insufficient evidence of an effect on lung cancer risk among nonsmokers with higher levels of physical activity
Modest evidence of higher risk of lung cancer among men with high levels of occupational activity
- Lower risk of lung cancer overall, but evidence varies by smoking status: 20% lower risk of lung cancer among current smokers and 32% lower risk among former smokers, but no difference among people who have never smoked, among people with high levels of physical activity compared to low levels in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 25 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies390Schmid D, Ricci C, Behrens G, Leitzmann MF. Does smoking influence the physical activity and lung cancer relation? A systematic review and meta-analysis. European Journal of Epidemiology. 2016 Dec;31(12):1173-1190.
- 15% higher risk of lung cancer among men who engage in high levels of occupational physical activity compared to those engaging in low level or sedentary occupational physical activity, but no association among women in a large meta-analysis of 8 observational studies391Rana B, Hu L et al. Occupational physical activity and lung cancer risk: a systematic review and meta-analysis. Sports Medicine. 2020 Sep;50(9):1637-1651. Our note: the researchers controlled for smoking status but do not report if they controlled for exposure to secondhand smoke.
- Slightly lower risk of lung cancer among people doing muscle-strengthening exercises compared to other people in a very large meta-analysis of 2 observational studies of low quality392Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
Cardiovascular fitness: modest evidence of lower risk of lung cancer among males who smoked and who had moderate and moderate or high cardiorespiratory fitness compared to low fitness
- 77% lower risk of lung cancer among male former smokers with high cardiovascular fitness and 51% lower risk among those with moderate cardiovascular fitness compared to low fitness in a large observational study393Vainshelboim B, Lima RM, Kokkinos P, Myers J. Cardiorespiratory fitness, lung cancer incidence, and cancer mortality in male smokers. American Journal of Preventive Medicine. 2019 Nov;57(5):659-666.
Cancer mortality: modest evidence of lower lung cancer mortality among men who smoked and did not not have cancer at baseline and who had moderate and high cardiorespiratory fitness
- 84–85% lower lung cancer mortality among males who smoked and did not not have cancer at baseline and who had moderate and high cardiorespiratory fitness compared to low fitness in a large observational study394Vainshelboim B, Lima RM, Kokkinos P, Myers J. Cardiorespiratory fitness, lung cancer incidence, and cancer mortality in male smokers. American Journal of Preventive Medicine. 2019 Nov;57(5):659-666.
Good evidence of lower risk of lymphoma among people with higher levels of physical activity
- 11–18% lower risk of non-Hodgkin lymphoma among women achieving 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to less activity in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 9 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies395Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
- 1% lower risk for each 3 MET-hours (about 1 hour of brisk walking) per week, for an 11% lower risk with the highest levels of physical activity compared to the lowest in a meta-analysis of 18 observational studies396Davies GA, Strader C, Chibbar R, Papatheodorou S, Dmytriw AA. The relationship between physical activity and lymphoma: a systematic review and meta analysis. BMC Cancer. 2020 Oct 6;20(1):962.
Weak evidence of lower risk of melanoma among people with higher levels of physical activity compared to low levels, but only if exposure to UV radiation is not increased with activity
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward lower risk of melanoma among people with higher levels of physical activity compared to low levels, but only if exposure to UV radiation is not increased with activity in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 8 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies397Behrens G, Niedermaier T, Berneburg M, Schmid D, Leitzmann MF. Physical activity, cardiorespiratory fitness and risk of cutaneous malignant melanoma: systematic review and meta-analysis. PLoS One. 2018 Oct 31;13(10):e0206087.
Good evidence of lower risk of myeloma among people with higher levels of physical activity
- 14–19% lower risk of myeloma among people achieving 7.5 to 15 MET-hours (135–270 minutes of brisk walking) per week compared to less activity in a large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 9 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies398Matthews CE, Moore SC et al. Amount and intensity of leisure-time physical activity and lower cancer risk. Journal of Clinical Oncology. 2019 Dec 26:JCO1902407.
Good evidence of lower risk of ovarian cancer among people with higher levels of physical activity and less sitting time
- Lower risk of ovarian cancer among people achieving at least 2 hours of moderate physical activity per week and less than 3 hours of sitting time per day compared to other people in a meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 34 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies399Lee J. Physical activity, sitting time, and the risk of ovarian cancer: a brief research report employing a meta-analysis of existing. Health Care Women International. 2019 Apr;40(4):433-458.
- 29% higher risk of ovarian cancer among people with the highest levels of sitting time (sedentary behavior) compared to the lowest levels in a meta-analysis of 7 observational studies400Biller VS, Leitzmann MF et al. Sedentary behaviour in relation to ovarian cancer risk: a systematic review and meta-analysis. European Journal of Epidemiology. 2021 Aug;36(8):769-780.
Strong evidence of lower risk of pancreatic cancer among people with higher levels of overall physical activity
Preliminary evidence of lower risk of pancreatic cancer among people with recreational activity
Weak evidence of a slightly higher risk of pancreatic cancer among people doing muscle-strengthening exercises
- 27% lower risk of pancreatic cancer among people with the highest levels of physical activity compared to the lowest in a very large meta-analysisa statistical analysis that combines the results of two or more research studies; the results of smaller research studies addressing the same or similar questions can be analyzed as though they are one bigger, more powerful study of 47 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies401Xie F, You Y et al. Association between physical activity and digestive-system cancer: an updated systematic review and meta-analysis. Journal of Sport and Health Science. 2021 Jan;10(1):4-13.
- 11% lower risk of pancreatic cancer, with more benefits among those under age 50, among people participating in leisure-time physical activity compared to other people in a meta-analysis of 26 observational studies402Farris MS, Mosli MH, McFadden AA, Friedenreich CM, Brenner DR. The association between leisure time physical activity and pancreatic cancer risk in adults: a systematic review and meta-analysis. Cancer Epidemiology, Biomarkers & Prevention. 2015 Oct;24(10):1462-73.
- 25% lower risk of pancreatic cancer among people with higher levels of occupational physical activity (3 studies) compared to other people, but only a weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) for lower risk with leisure-time physical activity (14 studies) in a review of observational studies403Bao Y, Michaud DS. Physical activity and pancreatic cancer risk: a systematic review. Cancer Epidemiology, Biomarkers & Prevention. 2008 Oct;17(10):2671-82.
- A weak trend toward higher risk of pancreatic cancer among people doing muscle-strengthening exercises compared to other people in a very large meta-analysis of 2 observational studies of low quality404Momma H, Kawakami R, Honda T, Sawada SS. Muscle-strengthening activities are associated with lower risk and mortality in major non-communicable diseases: a systematic review and meta-analysis of cohort studies. British Journal of Sports Medicine. 2022 Feb 28:bjsports-2021-105061.
Weak evidence of a lower risk of prostate cancer recurrence among men with the highest levels of physical activity
Preliminary evidence of lower risk of prostate cancer among people with higher levels of physical activity
Recurrence
Weak evidence of a lower risk of prostate cancer recurrence among men with the highest levels of physical activity
- A weak trendan apparent change due to a therapy, close to but not achieving full statistical significance (this is the CancerChoices definition; other researchers and studies may define this differently) toward a lower risk of prostate cancer recurrence among men with the highest levels of physical activity after diagnosis compared to the lowest in a pooled analysis of 2 observationala type of study in which individuals are observed or certain outcomes are measured, but no attempt is made to affect the outcome (for example, no treatment is given); an example is a study that records people’s diets, but doesn’t try to alter their diets, and looks for patterns of disease or other outcomes related to different foods studies405Friedenreich CM, Neilson HK, Farris MS, Courneya KS. Physical activity and cancer outcomes: a precision medicine approach. Clinical Cancer Research. 2016 Oct 1;22(19):4766-4775.
Cancer risk
Preliminary evidence of lower risk among people with higher levels of physical activity
- 14% lower risk of prostate cancer among people with the highest levels of occupational physical activity compared to the lowest, but only over 10 years or more, in 17 reviews of moderate or better quality406Cillekens B, Lang M et al. How does occupational physical activity influence health? An umbrella review of 23 health outcomes across 158 observational studies. British Journal of Sports Medicine. 2020 Dec;54(24):1474-1481.
- No clear indication of a link between physical activity and prostate cancer risk, with considerable variability among study outcomes, in a review of 85 studies407Shephard RJ. Physical activity and prostate cancer: an updated review. Sports Medicine. 2017 Jun;47(6):1055-1073.
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Authors
Ms. Hepp is a researcher and communicator who has been writing and editing educational content on varied health topics for more than 20 years. She serves as lead researcher, program manager, and writer for CancerChoices. Her graduate work in research and cognitive psychology, her master’s degree in instructional design, and her certificate in web design have all guided her in writing and presenting information for a wide variety of audiences and uses. Nancy’s service as faculty development coordinator in the Department of Family Medicine at Wright State University also provided experience in medical research, plus insights into medical education and medical care from the professional’s perspective.
Laura Pole is senior clinical consultant for CancerChoices. Laura is an oncology clinical nurse specialist who has been providing integrative oncology clinical care, navigation, consultation, and education services for over 40 years. She is the co-creator and co-coordinator of the Integrative Oncology Navigation Training at Smith Center for Healing and the Arts in Washington, DC. Laura also manages the “Media Watch Cancer News That You Can Use” listserv for Smith Center/Commonweal. In her role as a palliative care educator and consultant, Laura has served as statewide Respecting Choices Faculty for the Virginia POST (Physician Orders for Scope of Treatment) Collaborative as well as provided statewide professional education on palliative and end-of-life care for the Virginia Association for Hospices and Palliative Care.
For CancerChoices, Laura curates content and research, networks with clinical and organizational partners, brings awareness and education of integrative oncology at professional and patient conferences and programs, and translates research into information relevant to the patient experience as well as clinical practice.
Laura sees her work with CancerChoices as a perfect alignment of all her passions, knowledge and skills in integrative oncology care. She is honored to serve you.
Reviewers
Dr. Schettler is science director of the Collaborative on Health and the Environment and the Science and Environmental Health Network and author of The Ecology of Breast Cancer. He has worked extensively with community groups and non-governmental organizations throughout the US and internationally, addressing many aspects of human health and the environment. He has served on advisory committees of the US EPA and National Academy of Sciences. He is co-author of Generations at Risk: Reproductive Health and the Environment, which examines reproductive and developmental health effects of exposure to a variety of environmental toxicants. He is also co-author of In Harm’s Way: Toxic Threats to Child Development, which discusses the impact of environmental exposures on neurological development in children, and Environmental Threats to Healthy Aging: With a Closer Look at Alzheimer’ and Parkinson’s Diseases.
Dr. You is a physician specializing in maternal-fetal medicine (MFM) with a specific interest in cancer in the context of pregnancy. She completed a postdoctoral fellowship in health services research with a focus in health literacy and received a Master of Public Health.
Andrew Jackson, ND, serves as a CancerChoices research associate. As a naturopathic physician practicing in Kirkland, Washington, he teaches critical evaluation of the medical literture at Bastyr University in Kenmore, Washington. His great appreciation of scientific inquiry and the scientific process has led him to view research with a critical eye.
Last update: May 26, 2023
Last full literature review: September 2021
CancerChoices provides information about integrative in cancer care, a patient-centered approach combining the best of conventional care, self care and evidence-informed complementary care in an integrated plan cancer care. We review complementaryin cancer care, complementary care involves the use of therapies intended to enhance or add to standard conventional treatments; examples include supplements, mind-body approaches such as yoga or psychosocial therapy, and acupuncture therapies and self-care lifestyle actions and behaviors that may impact cancer outcomes; examples include eating health-promoting foods, limiting alcohol, increasing physical activity, and managing stress practices to help patients and professionals explore and integrate the best combination of conventionalthe cancer care offered by conventionally trained physicians and most hospitals; examples are chemotherapy, surgery, and radiotherapy and complementary therapies and practices for each person.
Our staff have no financial conflicts of interest to declare. We receive no funds from any manufacturers or retailers gaining financial profit by promoting or discouraging therapies mentioned on this site.
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