# Assessing the Impact of Exercise on Quality of Life in Advanced-Stage Cancer Patients: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

## TL;DR

This study finds that all types of exercise improve quality of life for advanced-stage cancer patients, with aerobic exercise possibly offering a slight edge, but no type is clearly better than the others.

## Contribution

The study provides a network meta-analysis comparing aerobic, strength, and combined exercise for quality of life in advanced-stage cancer patients.

## Key findings

- Aerobic exercise showed the greatest improvement in quality of life, but the difference was not statistically significant.
- Dropout rates were similar across all exercise types, indicating good tolerability.
- No single exercise modality was found to be significantly superior to the others.

## Abstract

This study investigates which type of exercise—aerobic, strength training, or a combination of both—is most effective in improving quality of life (QoL) among patients with advanced-stage cancer. By analyzing data from 11 randomized controlled trials, we found that aerobic exercise may offer a slight advantage in improving QoL, though differences between exercise types were not statistically significant. Importantly, dropout rates were similar across all exercise groups, suggesting that each modality is generally well tolerated. These findings may help clinicians and patients tailor exercise plans according to individual preferences and needs.

Background/Objectives This systematic review and network meta-analysis aimed to determine the most effective therapeutic exercise modality for improving quality of life (QoL) in patients with advanced-stage cancer. Specifically, the study compared the effects of aerobic training, strength training, and combined aerobic and strength training on QoL outcomes. Methods A systematic literature search was conducted in PubMed, Embase, Cochrane Reviews, and the Cochrane Central Register of Controlled Trials up to 24 February 2023. The review adhered to PRISMA guidelines. Included studies were randomized controlled trials (RCTs) involving adult patients with advanced-stage cancers (e.g., pancreatic, colorectal, lung, breast, prostate, gastrointestinal, gynecological, hematological, head and neck, melanoma, or cancers with bone metastases). The primary outcome was post-intervention QoL, while the secondary outcome assessed was the dropout rate across exercise modalities. Results Aerobic training demonstrated the greatest improvement in QoL with a standardized mean difference (SMD) of 0.30 (95% CI: 0.00 to 0.61), followed by strength training (SMD = 0.13; 95% CI: −0.41 to 0.66) and combined training (SMD = 0.07; 95% CI: −0.11 to 0.24). However, none of the interventions showed statistically significant superiority. Dropout rates were comparable across all exercise modalities and control groups, suggesting strong adherence and feasibility of these interventions in advanced cancer populations. Conclusions While all exercise modalities were associated with improved QoL in patients with advanced-stage cancer, no single intervention emerged as significantly superior. Aerobic exercise may offer a slight advantage, although this effect was not statistically significant. These results highlight the importance of individualized exercise prescriptions based on patient preference, functional status, and treatment context. Further research is warranted to identify patient subgroups that may benefit most from specific exercise interventions and to explore QoL subdomains such as fatigue, emotional well-being, and physical functioning.