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

Abstract

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.

Keywords: advanced-stage cancer; aerobic exercise; exercise interventions; network meta-analysis; quality of life (QoL); randomized controlled trials (RCTs).

Figure 1

Flow diagram depicting the study selection process in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines.

Figure 2

Network illustrating the comparative effects of different exercise interventions on quality of life in advanced-stage cancer patients. The size of each node and the thickness of each connecting line reflect the number of trials contributing to each intervention and comparison.

Figure 3

Forest plot illustrates the standard mean difference (SMD) in quality-of-life improvements between exercise intervention and control groups. The plot highlights the variability in effect sizes across the groups, showcasing the comparative effectiveness of various exercise interventions on participants’ quality of life.

Figure 4

Forest plot showing the risk differences (RDs) in dropout rates between various exercise interventions and control groups among patients with advanced-stage cancer. Confidence intervals overlapping zero indicate no statistically significant differences in attrition.