Effect of different delivery modalities of physical activity promotion interventions in cancer survivors: a systematic review and network meta-analysis

Abstract Background Physical activity (PA) promotion interventions are delivered via different modalities for cancer survivors, yet the optimal delivery modality (e.g., PA counselling, supervised exercise training) remains unknown. The aim of this study is to compare the effects of various delivery modalities on short-term (3-month) and long-term (6-month) PA of cancer survivors. Methods This was a systematic review and network meta-analysis. Four electronic databases were searched: PubMed, ScienceDirect, Web of Science, and EBSCOhost through February 2026. Randomized controlled trials that tested interventions aimed at promoting PA among post-treatment cancer survivors and reported moderate-to-vigorous PA (MVPA; min/week) and/or total PA in time-based metabolic equivalent of task (MET) units were eligible. Interventions were categorized according to their delivery modalities. Standardized mean differences (SMDs) were estimated using network meta-analysis with random effects, and interventions were ranked using the surface under the cumulative ranking curve (SUCRA). Risk of bias in the included studies was assessed using the revised Cochrane risk-of-bias tool. Results A total of 55 studies (3,908 randomized participants) were included. At 3 months, significant improvements in MVPA compared with control were observed for PA counselling plus tracking aids (SMD = 0.90, 95%CI: 0.62, 1.18), PA counselling (SMD = 0.85, 95%CI: 0.38, 1.31), and PA counselling plus supervised exercise training (SMD = 0.70, 95%CI: 0.33, 1.08). These interventions also ranked highest by SUCRA. At 6 months, supervised exercise training (SMD = 0.81, 95%CI: 0.17, 1.45), PA counselling plus tracking aids (SMD = 0.45, 95%CI: 0.26, 0.64), PA counselling plus supervised exercise training (SMD = 0.42, 95%CI: 0.10, 0.75), and PA counselling (SMD = 0.34, 95%CI: 0.06, 0.62) were significantly better than control, with supervised exercise training ranking first. For MET-min/week, only PA counselling was significantly better than control at 3 months; no significant differences were found at 6 months. Notably, certainty of evidence at 6 months was very low for all comparisons. Conclusions PA counselling, alone or combined with tracking aids, ranked among the most effective approaches for increasing MVPA and MET-min/week at 3 months. PA counselling-based modalities should be prioritized in survivorship care. Future research should evaluate longer-term maintenance, optimal component combinations, and cost-effectiveness. Trial registration PROSPERO CRD42024535225.