Structured exercise may help people with cancer live longer and have more time free of disease, finds a synthesis of the available evidence, published online in the British Journal of Sports Medicine.
The survival and recurrence risk benefits were strongest in early stage disease, in those who did aerobic exercise or aerobic exercise plus strength training, and in those who managed to keep up their exercise routines, the findings indicate.
Their analysis prompts the researchers to conclude that incorporating the therapeutic potential of exercise into cancer care merits consideration.
Cancer comes back in between 20%–40% of patients, even after standard curative surgery and chemotherapy, point out the researchers.
While structured exercise is widely recommended to ease fatigue and improve physical functioning and quality of life, its potential to prolong survival and stave off disease recurrence remains a subject of debate, they add.
In a bid to strengthen the evidence base, the researchers scoured research databases for randomised controlled clinical trials published up to the end of 2025 and reporting on survival and disease recurrence in adults with confirmed cancer who were given structured exercise programmes as part of their care.
From an initial haul of 123 studies, 21 clinical trials from North America, Europe, Australia, and Asia, involving a total of 8449 participants (88% women), met the eligibility criteria.
The average age of participants was 54 (range 47–76), and the average monitoring period was 64 months (range 2–99 months). The most common type of cancer studied was that of the breast followed by those of the bowel and pancreas.
Pooled data analysis of the results showed that structured exercise was associated with significant improvements in overall survival.
Those who exercised as part of their care were 23% less likely to die and 17% less likely to have a recurrence before death than those who didn't exercise. Separate analyses showed that they were also 18% less likely to die from any cause, and 26% less likely to die from their cancer.
But there was no clear evidence that structured exercise prolonged the time before patients' cancer worsened or increased the likelihood that no invasive cancer remained after standard treatment.
An exploratory analysis showed that the associations were stronger among participants who completed at least 70% of their exercise programme.
Overall survival estimates favoured aerobic exercise alone and programmes combining aerobic exercise and strength training. No clear association was found for strength training alone, but this finding was based only on one trial, involving 129 participants, note the researchers
"Aerobic exercise drives systemic cardiovascular conditioning, immune cell mobilisation, and normalisation of tumour perfusion, mechanisms directly relevant to systemic tumour control," explain the researchers.
There are plausible biological explanations for the beneficial effects of exercise on cancer survival and risk of recurrence, they suggest.
Exercise may boost the body's immune system response to cancer and improve blood flow within tumours, potentially helping treatment to work better. It may also lower circulating levels of sex specific hormones and increase glucose uptake by muscles, leaving less available to fuel cancer cells, they highlight. And it may help cells repair DNA damage, potentially limiting changes that can make tumours more aggressive, they add.
The researchers acknowledge various limitations to their findings, including the migration of participants in comparison groups to healthier behaviours; considerable variations in the type, duration, and intensity of the included exercise interventions; and a predominance of evidence from breast cancer trials, with relatively little evidence on advanced stage disease.
Nevertheless, they conclude: "Our meta-analysis provides direct, quantified evidence suggesting that the benefits of structured exercise may extend beyond supportive care to outcomes traditionally associated with therapeutic interventions, while underscoring that observed effects are context dependent and sensitive to trial design, conduct, and feasibility."
They add: "On the strength of this evidence, clinicians can reasonably recommend structured exercise as part of oncological care, while recognising that important questions remain and that ongoing trials will continue to refine its optimal application."
