The effects of physical exercise in the palliative care phase for people with advanced cancer: a systematic review with meta-analysis

Purpose The purpose of this systematic review with meta-analysis was to evaluate the safety, feasibility and effectiveness of exercise in the palliative care phase for people with advanced cancer. Methods Electronic databases were searched for exercise randomised controlled trials involving individuals with incurable cancer that were published prior to April 14, 2021. Meta-analyses were performed to evaluate the effects of exercise on health outcomes. Subgroup effects for exercise mode, supervision, intervention duration and cancer diagnosis were assessed. Results Twenty-two trials involving interventions ranging between 2 weeks and 6 months were included. Interventions comprised of aerobic ( n = 3), resistance ( n = 4), mixed-mode ( n = 14) and other exercise ( n = 1) modalities. Cancer types consisted of lung ( n = 6), breast ( n = 3), prostate ( n = 2), multiple myeloma ( n = 1) and mixed cancer types ( n = 10). Meta-analysis of 20 RCTs involving 1840 participants showed no difference in the risk of a grade 2–4 adverse event between exercise and usual care ( n = 110 adverse events (exercise: n = 66 events; usual care: n = 44 events), RD = − 0.01 (91% CI = − 0.01, 0.02); p = 0.24). Overall median recruitment, retention and adherence rates were 56%, 80% and 69%, respectively. Meta-analysis of health outcomes showed effects in favour of exercise for quality of life, fatigue, aerobic fitness and lower-body strength (SMD range = 0.27–0.48, all p < 0.05). Conclusions Participants who engaged in exercise experienced an increase in quality of life, fitness and strength and a decrease in fatigue. Implications for Cancer Survivors Physical activity programs were found to be safe and feasible for people with advanced cancer in the palliative care phase.