Evidence summary (Updated 2022)
A small reduction was observed in body weight in 1 meta-analysis in which both aerobic and resistance exercise was included (16 RCTs). A slight reduction in body fat percentage was seen in the same meta-analyses for breast cancer (10 RCTs)(1). This study only looked at post treatment. A further systematic review looked at 15 RCTs – 6 studies looked at patients undergoing active treatment and 9 studies post treatment(2). A small improvement in body composition was observed for resistance exercise interventions.
In a recent review of the evidence 20 reviews were shown to have a definite positive effect on body composition(3–22) .
Two considered the intervention as prehabilitation/ before treatment for the cancer(9,14). Two of 20 studies reported an improvement seen during the treatment stage(13,16). Eight of 20 reported on interventions during and post treatment(3,4,6,10,11,17,20,22). Three studies reported on improved body composition with PA interventions following cancer treatment(12,15,19). Four of 20 did not specify the treatment stage of the interventions(5,7,8,18).
While 7 reported on multiple cancer types(5–8,12,19,20), including lung, breast, colorectal, pancreatic, testicular, lymphoma, melanoma, vaginal, cervical, ovarian and bladder, and endometrial. Several reported on a single cancer only; improved body composition with the physical activity intervention group was seen in breast cancer(3,4,15–18), prostate(21,22), pancreatic(9), brain(10), gastrointestinal(14), head and neck(11,13) cancer patients.
When considering the intervention type studies considered multiple or combination physical activity/exercise interventions(3,4,22,5,8,10,11,14–16,21). Combined aerobic and anaerobic activities were evaluated(7,9,13,17). Other individual interventions shown to be effective included HIIT(20), Pilates, and aerobic(12) exercises. Physical activity delivered by exer-gaming was also found to have a positive effect on body composition in cancer patients(6).
Interventions of any frequency, intensity and duration were included in several the studies. Improvements in body composition were seen in moderate intensity and moderate-vigorous(11,16) intensity interventions. Rossi et al assessed aerobic interventions through the use of behaviour change(19) . Several interventions also looked at combination exercise and nutrition interventions and found a positive outcome on body composition(13,23).
Quality of evidence
Grade B – Moderate
Strength of recommendation
2 – Weak
Physical activity appears to have an overall benefit in body composition. The evidence suggests that this is predominantly in patients who undergo resistance-based exercises both during and post treatment in its analysis. There is marked heterogeneity in interventions and outcome measures.
- Fong DY. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 344:70.
- Focht BC. Resistance exercise interventions during and following cancer treatment: a systematic review. J Support Oncol. 11(2):45–60.
- Singh B, Spence RR, Steele ML, Sandler CX, Peake JM, Hayes SC. A Systematic Review and Meta-Analysis of the Safety, Feasibility, and Effect of Exercise in Women With Stage II+ Breast Cancer. Arch Phys Med Rehabil [Internet]. 2018 Dec 1 [cited 2022 Oct 10];99(12):2621–36. Available from: https://pubmed.ncbi.nlm.nih.gov/29730319/
- Shaikh H, Bradhurst P, Ma LX, Tan SY, Egger SJ, Vardy JL. Body weight management in overweight and obese breast cancer survivors. Cochrane database Syst Rev [Internet]. 2020 Dec 11 [cited 2022 Oct 12];12(12). Available from: https://pubmed.ncbi.nlm.nih.gov/33305350/
- Koeppel M, Mathis K, Schmitz KH, Wiskemann J. Muscle hypertrophy in cancer patients and survivors via strength training. A meta-analysis and meta-regression. Crit Rev Oncol Hematol [Internet]. 2021 Jul 1 [cited 2022 Oct 12];163. Available from: https://pubmed.ncbi.nlm.nih.gov/34062243/
- Tough D, Robinson J, Gowling S, Raby P, Dixon J, Harrison SL. The feasibility, acceptability and outcomes of exergaming among individuals with cancer: a systematic review. BMC Cancer [Internet]. 2018 Nov 21 [cited 2022 Oct 10];18(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30463615/
- Heywood R, McCarthy AL, Skinner TL. Efficacy of Exercise Interventions in Patients With Advanced Cancer: A Systematic Review. Arch Phys Med Rehabil [Internet]. 2018 Dec 1 [cited 2022 Oct 10];99(12):2595–620. Available from: https://pubmed.ncbi.nlm.nih.gov/29738745/
- Weller S, Hart NH, Bolam KA, Mansfield S, Santa Mina D, Winters-Stone KM, et al. Exercise for individuals with bone metastases: A systematic review. Crit Rev Oncol Hematol [Internet]. 2021 Oct 1 [cited 2022 Oct 10];166. Available from: https://pubmed.ncbi.nlm.nih.gov/34358650/
- Bundred JR, Kamarajah SK, Hammond JS, Wilson CH, Prentis J, Pandanaboyana S. Prehabilitation prior to surgery for pancreatic cancer: A systematic review. Pancreatology [Internet]. 2020 Sep 1 [cited 2022 Oct 12];20(6):1243–50. Available from: https://pubmed.ncbi.nlm.nih.gov/32826168/
- Sandler CX, Matsuyama M, Jones TL, Bashford J, Langbecker D, Hayes SC. Physical activity and exercise in adults diagnosed with primary brain cancer: a systematic review. J Neurooncol [Internet]. 2021 May 1 [cited 2022 Oct 10];153(1). Available from: https://pubmed.ncbi.nlm.nih.gov/33907968/
- Lynch PT, Horani S, Lee R, Sumer BD, Lee SC, Mayo HG, et al. Effectiveness of physical activity interventions in improving objective and patient-reported outcomes in head and neck cancer survivors: A systematic review. Oral Oncol [Internet]. 2021 Jun 1 [cited 2022 Oct 12];117. Available from: https://pubmed.ncbi.nlm.nih.gov/33901767/
- Toohey K, Pumpa K, McKune A, Cooke J, Semple S. High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes. J Cancer Res Clin Oncol [Internet]. 2018 Jan 1 [cited 2022 Oct 12];144(1). Available from: https://pubmed.ncbi.nlm.nih.gov/29210001/
- Bye A, Sandmael JA, Stene GB, Thorsen L, Balstad TR, Solheim TS, et al. Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis. Nutrients [Internet]. 2020 Nov 1 [cited 2022 Oct 13];12(11):1–26. Available from: https://pubmed.ncbi.nlm.nih.gov/33105699/
- Vermillion SA, James A, Dorrell RD, Brubaker P, Mihalko SL, Hill AR, et al. Preoperative exercise therapy for gastrointestinal cancer patients: a systematic review. Syst Rev [Internet]. 2018 Jul 24 [cited 2022 Oct 13];7(1). Available from: https://pubmed.ncbi.nlm.nih.gov/30041694/
- Soares Falcetta F, de Araújo Vianna Träsel H, de Almeida FK, Rangel Ribeiro Falcetta M, Falavigna M, Dornelles Rosa D. Effects of physical exercise after treatment of early breast cancer: systematic review and meta-analysis. Breast Cancer Res Treat [Internet]. 2018 Aug 1 [cited 2022 Oct 12];170(3):455–76. Available from: https://pubmed.ncbi.nlm.nih.gov/29654416/
- Lee 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 Nurs [Internet]. 2020 Mar 1 [cited 2022 Oct 10];43(2):115–25. Available from: https://pubmed.ncbi.nlm.nih.gov/30601270/
- Schutz S, Aidar FJ, Souza RLM, dos Santos JL, Voltarelli FA, Vieira Junior RC, et al. Different Methods of Physical Training Applied to Women Breast Cancer Survivors: A Systematic Review. Front Physiol [Internet]. 2021 Apr 14 [cited 2022 Oct 12];12. Available from: https://pubmed.ncbi.nlm.nih.gov/33935799/
- Raji Lahiji M, Vafa S, de Souza RJ, Zarrati M, Sajadian A, Razmpoosh E, et al. Effect of Dietary-Based Lifestyle Modification Approaches on Anthropometric Indices and Dietary Intake Parameters in Women with Breast Cancer: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Adv Nutr [Internet]. 2022 May 31 [cited 2022 Oct 12];13(5). Available from: https://pubmed.ncbi.nlm.nih.gov/35641019/
- Rossi A, Friel C, Carter L, Garber CE. Effects of Theory-Based Behavioral Interventions on Physical Activity Among Overweight and Obese Female Cancer Survivors: A Systematic Review of Randomized Controlled Trials. Integr Cancer Ther [Internet]. 2018 Jun 1 [cited 2022 Oct 10];17(2):226–36. Available from: https://pubmed.ncbi.nlm.nih.gov/29076388/
- Mugele H, Freitag N, Wilhelmi J, Yang Y, Cheng S, Bloch W, et al. High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis. J Cancer Surviv [Internet]. 2019 Apr 15 [cited 2022 Oct 10];13(2):205–23. Available from: https://pubmed.ncbi.nlm.nih.gov/30806875/
- Lopez P, Taaffe DR, Newton RU, Galvão DA. Resistance Exercise Dosage in Men with Prostate Cancer: Systematic Review, Meta-analysis, and Meta-regression. Med Sci Sports Exerc [Internet]. 2021 Mar 1 [cited 2022 Oct 11];53(3):459–69. Available from: https://pubmed.ncbi.nlm.nih.gov/32890199/
- Zdravkovic A, Hasenöhrl T, Palma S, Crevenna R. Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020. Wien Klin Wochenschr [Internet]. 2020 Aug 1 [cited 2022 Oct 11];132(15–16):452–63. Available from: https://pubmed.ncbi.nlm.nih.gov/32681360/
- Hall CC, Cook J, Maddocks M, Skipworth RJE, Fallon M, Laird BJ. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Support Care Cancer [Internet]. 2019 [cited 2022 Oct 10];27(7). Available from: https://pubmed.ncbi.nlm.nih.gov/30944994/