Follow-up effects of exercise-based interventions on physical performance in cancer survivors: a systematic review and meta-analysis

PURPOSE: Physical performance impairments are common in cancer survivors and can limit daily activities, quality of life, and long-term health. Although structured exercise programs have proven beneficial for improving physical performance, maintenance of these benefits is unclear. This study aimed to systematically evaluate whether improvements in physical performance are maintained following structured exercise oncology interventions. METHODS: A systematic search was conducted for randomized controlled trials (RCTs) published between January 1990 and March 2025. Eligible trials engaged adult cancer survivors in structured exercise interventions and reported objective measures of cardiorespiratory fitness, muscular strength, and/or walking capacity at the end of the intervention and ≥ 3 months after program completion. Data were pooled using random-effects meta-analyses with weighted mean differences (WMD) used to summarize effects. RESULTS: Twenty-four RCTs (2289 participants; mean follow-up post-intervention = 8 months) were included. Exercise significantly improved cardiorespiratory fitness at post-intervention (WMD = + 1.76 ml/kg/min; p = 0.008); however, improvements were attenuated at follow-up (WMD = + 1.24 ml/kg/min; p = 0.130). Similarly, upper and lower body strength improved post-intervention (WMD = + 3.35 kg; p = 0.001; WMD = + 12.7 kg; p = 0.045), but effects diminished at follow-up (WMD = + 1.80 kg; p = 0.081; WMD = + 10.0 kg; p = 0.093). In contrast, walking capacity increased post-intervention (WMD = + 40.3 m; p = 0.002) and remained elevated at follow-up (WMD = + 49.4 m; p = 0.006). Certainty of evidence ranged from very low to low across outcomes, primarily due to risk of bias, inconsistency, and imprecision in effect estimates. CONCLUSIONS: Structured exercise interventions were found to produce short-term improvements in physical performance among cancer survivors. Although gains in cardiorespiratory fitness and muscular strength appeared to persist at follow-up, they were attenuated compared with post-intervention and supported by very low certainty evidence. In contrast, walking capacity demonstrated sustained improvements at follow-up, though the certainty of evidence remained low. Future work is needed to identify longer-term effects (> 12 months) and develop strategies to better maintain improved physical performance. IMPLICATIONS FOR CANCER SURVIVORS: While exercise programs can improve physical performance, these benefits may not persist without ongoing support. Cancer survivors should be encouraged to continue self-directed exercise after program completion, and exercise programs should incorporate strategies to maintain longer-term improvements in physical performance.