EXERCISE ONCOLOGY AND LIFESTYLE MEDICINE: PHYSICAL ACTIVITY AS AN ADJUNCT IN CANCER PREVENTION AND SURVIVORSHIP CARE
Abstract
Background: Cancer is a leading cause of mortality worldwide, with over 19.3 million new cases diagnosed annually. Despite advances in oncological treatment, growing evidence demonstrates that physical activity plays a clinically significant role across the entire cancer continuum—from primary prevention to peri-treatment management and long-term survivorship. Exercise oncology has emerged as a critical discipline within lifestyle medicine. Objective: To synthesize current evidence on the role of physical activity as a therapeutic and preventive adjunct in cancer care, encompassing cancer prevention, prehabilitation, peri-treatment exercise, survivorship, and the underlying molecular mechanisms. Methods: A narrative review of peer-reviewed literature was conducted using PubMed, Scopus, and Google Scholar. Key terms included 'exercise oncology,' 'physical activity cancer prevention,' 'cancer survivorship exercise,' 'myokines cancer,' and 'exercise prehabilitation.' Priority was given to randomized controlled trials, systematic reviews, meta-analyses, and landmark studies published from 2010 to 2026. Results: Physical activity reduces the risk of at least 13 types of cancer. The landmark CHALLENGE Trial (NEJM, 2025) demonstrated that a 3-year structured exercise program after adjuvant chemotherapy for colon cancer reduced disease-free survival events by 28% (HR 0.72) and improved overall survival. Exercise during and after cancer treatment improves cardiorespiratory fitness, reduces cancer-related fatigue, alleviates depression and anxiety, prevents sarcopenia, and enhances quality of life. Mechanistically, exercise induces anti-tumor myokines (CXCL1, irisin, SPARC, IL-10), remodels the tumor immune microenvironment, and modulates systemic inflammatory pathways. Conclusion: Physical activity should be considered a core therapeutic modality in oncological care, integrated across prevention, prehabilitation, active treatment, and survivorship. Clinicians should adopt an Assess–Advise–Refer model, prescribing individualized exercise programs using FITT principles with cancer-specific modifications.
Keywords
Full Text:
PDFReferences
World Health Organization. Global cancer statistics 2022. GLOBOCAN. Geneva: WHO; 2022. https://doi.org/10.3322/caac.21834
Siegel RL, Kratzer TB, Giaquinto AN, Sung H, Jemal A. Cancer statistics, 2025. CA Cancer J Clin. 2025;75(1):10-45. https://doi.org/10.3322/caac.21871
Guthold R, Stevens GA, Riley LM, Bull FC. Worldwide trends in insufficient physical activity from 2001 to 2016: a pooled analysis of 358 population-based data sources with 1.9 million participants. Lancet Glob Health. 2018;6(10):e1077-e1086. doi:10.1016/S2214-109X(18)30357-7. https://doi.org/10.1016/S2214-109X(18)30357-7
Lee IM, Shiroma EJ, Lobelo F, Puska P, Blair SN, Katzmarzyk PT; Lancet Physical Activity Series Working Group. Effect of physical inactivity on major non-communicable diseases worldwide: an analysis of burden of disease and life expectancy. Lancet. 2012;380(9838):219-229. https://doi.org/10.1016/S0140-6736(12)61031-9
Hundal J, Peshin S, Ghazanfar R, Hayes S, Mansfield S, Sirotin N, et al. Implementing lifestyle medicine in cancer survivorship: a narrative review of global models. Am J Lifestyle Med. 2025. https://doi.org/10.1177/15598276251359525
Moore SC, Lee IM, Weiderpass E, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816-825. https://doi.org/10.1001/jamainternmed.2016.1548
Friedenreich CM, Ryder-Burbidge C, McNeil J. Physical activity, obesity and sedentary behavior in cancer etiology: epidemiology, biology and opportunities for prevention. Cancer Causes Control. 2021;32(8):803-816. https://doi.org/10.1002/1878-0261.12772
Patel AV, Friedenreich CM, Moore SC, et al. American Society of Clinical Oncology statement on exercise and cancer prevention and treatment. J Clin Oncol. 2019;37(10):876-882. doi:10.1200/JCO.18.02323.
Biswas A, Oh PI, Faulkner GE, et al. Sedentary time and its association with risk for disease incidence, mortality, and hospitalization in adults: a systematic review and meta-analysis. Ann Intern Med. 2015;162(2):123-132. https://doi.org/10.7326/m14-1651
Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. J Clin Oncol. 2022;40(22):2491-2507. https://doi.org/10.1200/JCO.22.00687
Courneya KS, Booth CM, Gill S, et al. Structured exercise after adjuvant chemotherapy for colon cancer: the CHALLENGE randomized controlled trial. N Engl J Med. 2025;393(1):13-25. https://doi.org/10.1056/nejmoa2502760
ASCO. Movement is medicine: structured exercise program may lower risk of cancer recurrence and death for some colon cancer survivors. ASCO News Release. 2025 Jun 1. https://www.asco.org/about-asco/press-center/news-releases/movement-medicine-structured-exercise-program-challenge.
Schmitz KH, Courneya KS, Matthews C, et al.; American College of Sports Medicine. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409-1426. https://doi.org/10.1249/mss.0b013e3181e0c112
Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Med Sci Sports Exerc. 2019;51(11):2375-2390. https://doi.org/10.1249/mss.0000000000002116
Soong RY, Low CE, Ong V, et al. Exercise interventions for depression, anxiety, and quality of life in older adults with cancer: a systematic review and meta-analysis. JAMA Netw Open. 2025;8(2):e2457859. https://doi.org/10.1001/jamanetworkopen.2024.57859
Brown JC, Ligibel JA. Exercise medicine for cancer survivors. Ann Intern Med. 2024;177(3):374-382. doi:10.7326/M23-1579.
Toohey K, Pumpa KL, Arnolda L, et al. A pilot study examining the effects of low-volume high-intensity interval training and continuous low to moderate intensity training on quality of life, functional capacity and cardiovascular risk factors in cancer survivors. PeerJ. 2016;4:e1613. https://doi.org/10.7717/peerj.2613
Patsou ED, Alexias GD, Anagnostopoulos FG, Karamouzis MV. Effects of physical exercise on depressive symptoms during breast cancer treatment: a meta-analysis of randomised control trials. ESMO Open. 2017;2(6):e000interruption. https://doi.org/10.1136/esmoopen-2017-000271
Christensen JF, Simonsen C, Hojman P. Exercise training in cancer control and treatment. Compr Physiol. 2019;9(1):165-205. https://doi.org/10.1002/cphy.c180016
Demark-Wahnefried W, Colditz GA, Rock CL, et al. Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY) randomized controlled trial. J Clin Oncol. 2015;33(12):1340-1346. https://doi.org/10.1007/s10549-015-3627-5
Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J. A systematic review of exercise systematic reviews in the cancer literature (2005-2017). PM R. 2017;9(9S2):S347-S384. https://doi.org/10.1016/j.pmrj.2017.07.074
NCCN. NCCN guidelines insights: survivorship, version 2.2025. J Natl Compr Canc Netw. 2025;23(6):208-217. https://doi.org/10.6004/jnccn.2024.0062
Carli F, Silver JK, Feldman LS, et al. Surgical prehabilitation in patients with cancer: state-of-the-science and recommendations for future research from a panel of subject matter experts. Phys Med Rehabil Clin N Am. 2017;28(1):49-64. https://doi.org/10.1016/j.pmr.2016.09.002
Carretti G, Tognaccini A, et al. Kinesiological insights into exercise prescription within oncological prehabilitation: current knowledge and future perspectives. Front Sports Act Living. 2025;7:1715484. https://doi.org/10.3389/fspor.2025.1715484
Santa Mina D, Clarke H, Ritvo P, et al. Effect of total-body prehabilitation on postoperative outcomes: a systematic review and meta-analysis. Physiotherapy. 2014;100(3):196-207. https://doi.org/10.1016/j.physio.2013.08.008
Minnella EM, Awasthi R, Loiselle SE, Agnihotram RV, Ferri LE, Carli F. Effect of exercise and nutrition prehabilitation on functional capacity in esophagogastric cancer surgery: a randomized clinical trial. JAMA Surg. 2018;153(12):1081-1089. https://doi.org/10.1001/jamasurg.2018.1645
Pedersen BK, Febbraio MA. Muscles, exercise and obesity: skeletal muscle as a secretory organ. Nat Rev Endocrinol. 2012;8(8):457-465. https://doi.org/10.1038/nrendo.2012.49
Hojman P, Gehl J, Christensen JF, Pedersen BK. Molecular mechanisms linking exercise to cancer prevention and treatment. Cell Metab. 2018;27(1):10-21. https://doi.org/10.1016/j.cmet.2017.09.015
Bettariga F, Taaffe DR, Crespo-Garcia C, et al. A single bout of resistance or high-intensity interval training increases anti-cancer myokines and suppresses cancer cell growth in vitro in survivors of breast cancer. Breast Cancer Res Treat. 2025;213:171-180. https://doi.org/10.1007/s10549-025-07772-w
Zhang XN, Liang ZD, Li MD. Comparison of different exercise modalities on chronic inflammation and immune function in cancer survivors: a systematic review with network, dose-response, and Bayesian meta-analyses. Support Care Cancer. 2025;33(12):1158. https://doi.org/10.1007/s00520-025-09971-z
Chen J, Li Y, Wang L, Liu Q. The molecular mechanisms of exercise in cancer prevention and management. Eur J Cancer Prev. 2025. https://doi.org/10.1097/cej.0000000000000989
Corrêa R, de Almeida CV, da Fonseca V, Tabak BM. Influence of physical exercise on health improvement in older adult cancer patients: a systematic review. Front Public Health. 2025;13:1525021. https://doi.org/10.3389/fpubh.2025.1525021
Gannon NP, Vaughan RA, Garcia-Smith R, Bisoffi M, Trujillo KA. Effects of the exercise-inducible myokine irisin on malignant and non-malignant breast epithelial cell behavior in vitro. Int J Cancer. 2015;136(4):E197-E202. https://doi.org/10.1002/ijc.29142
Bettariga F, Galvao DA, Taaffe DR, et al. Association of muscle strength and cardiorespiratory fitness with all-cause and cancer-specific mortality in patients diagnosed with cancer: a systematic review with meta-analysis. Br J Sports Med. 2025;59:722-732. https://doi.org/10.1136/bjsports-2024-108671
Whellan DJ, O'Connor CM, Lee KL, et al. Heart failure and a controlled trial investigating outcomes of exercise training (HF-ACTION): design and rationale. Am Heart J. 2007;153(2):201-211. https://doi.org/10.1016/j.ahj.2006.11.007
Scott JM, Zabor EC, Schwitzer E, et al. Efficacy of exercise therapy on cardiorespiratory fitness in patients with cancer: a systematic review and meta-analysis. J Clin Oncol. 2018;36(22):2297-2305. https://doi.org/10.1200/jco.2017.77.5809
Schmitt J, Lindner N, Reuss-Borst M, Holmberg HC, Sperlich B. A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial. Physiol Rep. 2016;4(3):e12693. https://doi.org/10.14814/phy2.12693
Awick EA, Phillips SM, Lloyd GR, McAuley E. Physical activity, self-efficacy and self-esteem in breast cancer survivors: a panel model. Psychooncology. 2017;26(10):1625-1631. https://doi.org/10.1002/pon.4180
Watson G, Coyne Z, Houlihan E, Leonard G. Exercise oncology: an emerging discipline in the cancer care continuum. Postgrad Med. 2022;134(1):26-36. https://doi.org/10.1080/00325481.2021.2009683
Blaney JM, Lowe-Strong A, Rankin-Watt J, Campbell A, Gracey JH. Cancer survivors' exercise barriers, facilitators and preferences in the context of fatigue, quality of life and physical activity participation: a questionnaire-survey. Psychooncology. 2013;22(1):186-194. https://doi.org/10.1002/pon.2072
Zhang F, Bang D, Visperas CA, Tun MH, Tay SS. Feasibility, user acceptance, and outcomes of using a cancer prehabilitation app for exercise: pilot cohort study. JMIR Form Res. 2025;9:e64427. https://doi.org/10.2196/64427
Phillips SM, Awick EA, Conroy DE, Pellegrini CA, Mailey EL, McAuley E. Objectively measured physical activity and sedentary behavior and quality of life indicators in survivors of breast cancer. Cancer. 2015;121(22):4044-4052. https://doi.org/10.1002/cncr.29620
Humpel N, Iverson DC. Review and critique of the quality of exercise recommendations for cancer patients and survivors. Support Care Cancer. 2005;13(7):493-502. https://doi.org/10.1007/s00520-005-0811-x
Bower JE. Cancer-related fatigue–mechanisms, risk factors, and treatments. Nat Rev Clin Oncol. 2014;11(10):597-609. https://doi.org/10.1038/nrclinonc.2014.127
Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961-968. https://doi.org/10.1001/jamaoncol.2016.6914
Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity for women with breast cancer after adjuvant therapy. Cochrane Database Syst Rev. 2018;1(1):CD011292. https://doi.org/10.1002/14651858.cd011292.pub2
Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncol Nurs Forum. 2014;41(6):E326-E342. https://doi.org/10.1188/14.onf.e326-e342
Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, et al. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res. 2018;20(1):124. https://doi.org/10.1186/s13058-018-1051-6
DOI: http://dx.doi.org/10.46827/ejphs.v9i1.256
Refbacks
- There are currently no refbacks.
Copyright (c) 2026 Phemyaphat Singto
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright © 2019 - 2026. European Journal of Public Health Studies (ISSN 2668-1056/ISSN-L 2668-1056) is a registered trademark of Open Access Publishing Group. All rights reserved.
This journal is a serial publication uniquely identified by an International Standard Serial Number (ISSN) serial number certificate issued by Romanian National Library. All the research works are uniquely identified by a CrossRef DOI digital object identifier supplied by indexing and repository platforms. All the research works published on this journal are meeting the Open Access Publishing requirements and standards formulated by Budapest Open Access Initiative (2002), the Bethesda Statement on Open Access Publishing (2003) and Berlin Declaration on Open Access to Knowledge in the Sciences and Humanities (2003) and can be freely accessed, shared, modified, distributed and used in educational, commercial and non-commercial purposes under a Creative Commons Attribution 4.0 International License. Copyrights of the published research works are retained by authors.
