Dose-response relationship in exercise intervention for cancer patients: A meta-analysis based on the FACT-G scale
Abstract
Exercise has become an established component of supportive oncology care, yet the optimal dose required to improve patient-reported outcomes remains unclear. This meta-analysis examined the impact of exercise interventions on quality of life measured exclusively with the Functional Assessment of Cancer Therapy-General (FACT-G). A systematic search of Web of Science identified 61 records, of which 14 trials involving 1230 participants met eligibility criteria. The included studies encompassed diverse cancer populations and intervention formats, ranging from aerobic and resistance training to multimodal, yoga, and digitally supported programs. Despite heterogeneity, exercise was consistently safe and associated with either improvements or preservation of quality of life, with several trials reporting changes that exceeded the minimal clinically important difference. The clearest signal of benefit was observed in supervised programs delivering an accumulated dose of approximately 180 min per week over 8 to 16 weeks, where quality-of-life gains were most robust. Lower-dose programs of around 120 min per week yielded mixed results, while high-dose regimens of 270 min or more per week did not sustain superior benefits, suggesting an inverted-U dose–response trajectory. Importantly, exercise during active treatment frequently maintained quality of life in the face of therapeutic burden, whereas in survivorship larger absolute improvements were achieved. These findings support the integration of structured, supervised exercise into oncology care and reinforce the need for future precision trials to refine dose–response models and address sustainability of benefit.
Copyright (c) 2025 Author(s)
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
1. De Moor JS, Mariotto AB, Parry C, et al. Cancer survivors in the United States: Prevalence across the survivorship trajectory and implications for care. Cancer Epidemiology Biomarkers and Prevention. 2013; 22(4): 561-570. doi: 10.1158/1055-9965.EPI-12-1356
2. Winters-Stone KM, Medysky ME, Savin MA. Patient-reported and objectively measured physical function in older breast cancer survivors and cancer-free controls. Journal of Geriatric Oncology. 2019; 10(2): 311-316. doi: 10.1016/j.jgo.2018.10.006
3. Salvatore AL, Ahn SN, Jiang L, et al. National study of chronic disease self-management: 6-month and 12-month findings among cancer survivors and non-cancer survivors. Psycho-Oncology. 2015; 24(12): 1714-1722. doi: 10.1002/pon.3783
4. Sturgeon KM, Kok DE, Kleckner IR, et al. Updated systematic review of the effects of exercise on understudied health outcomes in cancer survivors. Cancer Medicine. 2023; 12(24): 22278-22292. doi: 10.1002/cam4.6753
5. Brown JC, Schmitz KH. The prescription or proscription of exercise in colorectal cancer care. Medicine and Science in Sports and Exercise. 2014; 46(12): 2202-2209. doi: 10.1249/MSS.0000000000000355
6. Schmitz KH, Campbell AM, Stuiver MM, et al. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA: A Cancer Journal for Clinicians. 2019; 69(6): 468-484. doi: 10.3322/caac.21579
7. Ormel HL, van der Schoot GGF, Sluiter WJ, et al. Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review. Psycho‐Oncology. 2018; 27(3): 713-724. doi: 10.1002/pon.4612
8. Smith AB, Cocks K, Parry D, Taylor M. Reporting of health-related quality of life (HRQOL) data in oncology trials: A comparison of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy-General (FACT-G). Quality of Life Research. 2014; 23(3): 971-976. doi: 10.1007/s11136-013-0534-2
9. Lewandowska A, Rudzki G, Lewandowski T, et al. Quality of life of cancer patients treated with chemotherapy. International Journal of Environmental Research and Public Health. 2020; 17(19): 1-16. doi: 10.3390/ijerph17196938
10. Silver Dunker K, Hopkins L, Kocollari A. The Impact of Religion and Spirituality on Quality of Life for Adult Oncology Patients. Journal of Nursing & Healthcare. 2017; 2(3): 1-4. doi: 10.33140/JNH/02/03/00007
11. Hall CC, Cook J, Maddocks M, et al. Combined exercise and nutritional rehabilitation in outpatients with incurable cancer: a systematic review. Supportive Care in Cancer. 2019; 27(7): 2371-2384. doi: 10.1007/s00520-019-04749-6
12. Shao W, Zhang H, Qi H, Zhang Y. The effects of exercise on body composition of prostate cancer patients receiving androgen deprivation therapy: An update systematic review and meta-analysis. PLoS One. 2022; 17(2): e0263918. doi: 10.1371/journal.pone.0263918
13. Gu Z, Yang C, Tang L, Wu H. Interaction of anxiety and hypertension on quality of life among patients with gynecological cancer: a cross-sectional study. BMC Psychiatry. 2023; 23(1): 26. doi: 10.1186/s12888-023-04521-5
14. Wilailak S, Lertkhachonsuk A, Lohacharoenvanich N, et al. Quality of life in gynecologic cancer survivors compared to healthy check-up women. Journal of Gynecologic Oncology. 2011; 22(2): 103-109. doi: 10.3802/jgo.2011.22.2.103
15. Mahakwe G, Johnson E, Karlsson K, Nilsson S. A systematic review of self-report instruments for the measurement of anxiety in hospitalized children with cancer. International Journal of Environmental Research and Public Health. 2021; 18(4): 1-20. doi: 10.3390/ijerph18041911
16. Gerritsen JKW, Vincent AJPE. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine. 2016; 50(13): 796-803. doi: 10.1136/bjsports-2015-094787
17. Meneses-Echávez JF, González-Jiménez E, Ramírez-Vélez R. Effects of supervised exercise on cancer-related fatigue in breast cancer survivors: A systematic review and meta-analysis. BMC Cancer. 2015; 15(1): 77. doi: 10.1186/s12885-015-1069-4
18. Schumacher O, Luo H, Taaffe DR, et al. Effects of Exercise During Radiation Therapy on Physical Function and Treatment-Related Side Effects in Men with Prostate Cancer: A Systematic Review and Meta-Analysis. International Journal of Radiation Oncology*Biology*Physics. 2021; 111(3): 716-731. doi: 10.1016/j.ijrobp.2021.06.034
19. Marshall TF, Andzel W, Spaccarotella K. The Effects of Exercise on Perceived Barriers and Benefits of Exercise by Cancer Survivors Post Treatment. Journal of Basic & Applied Sciences. 2016; 12: 445-453. doi: 10.6000/1927-5129.2016.12.69
20. Kampshoff CS, Chinapaw MJM, Brug J, et al. Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: Results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study. BMC Medicine. 2015; 13(1): 275. doi: 10.1186/s12916-015-0513-2
21. Wu C, Zheng Y, Duan Y, et al. Nonpharmacological interventions for cancer‐related fatigue: a systematic review and Bayesian network meta‐analysis. Worldviews on Evidence‐Based Nursing. 2019; 16(2): 102-110. doi: 10.1111/wvn.12352
22. Mikkelsen MK, Nielsen DL, Vinther A, Lund CM, Jarden M. Attitudes towards physical activity and exercise in older patients with advanced cancer during oncological treatment – A qualitative interview study. European Journal of Oncology Nursing. 2019; 41: 16-23. doi: 10.1016/j.ejon.2019.04.005
23. Capozzi LC, Daun JT, Francis GJ, et al. Feasibility and Implementation of an Oncology Rehabilitation Triage Clinic: Assessing Rehabilitation, Exercise Need, and Triage Pathways within the Alberta Cancer Exercise–Neuro-Oncology Study. Current Oncology. 2023; 30(7): 6220-6245. doi: 10.3390/curroncol30070461
24. Flannery MK, Morin J, O’Malley K, et al. Team Survivors: Preliminary Analysis of an Innovative Intervention to Promote Physical Activity in Survivors of Childhood Cancer and Hematopoietic Stem Cell Transplant. Children. 2025; 12(4): 399. doi: 10.3390/children12040399
25. Frankinouille R, Vanhoutte G, Stassijns G, et al. Evaluation of a supervised physical activity programme for cancer survivors: From treatment to triathlon. Journal of Rehabilitation Medicine-Clinical Communications. 2020; 3(1): 1000030. doi: 10.2340/20030711-1000030
26. Ismail A, Dora YM, Hidajat T. Consumer Decision Making Model Process but as Independent Factors: And Its Influence on Purchasing Behavior. Available online: https://www.preprints.org/manuscript/202402.1188?utm_source=researchgate.net&utm_medium=article (accessed on 1 December 2025).
27. Winstead-Fry P, Schultz A. Psychometric analysis of the Functional Assessment of Cancer Therapy-General (FACT-G) scale in a rural sample. Cancer: Interdisciplinary International Journal of the American Cancer Society. 1997; 79(12): 2446-2452. doi: 10.1002/(SICI)1097-0142(19970615)79:12<2446::AID-CNCR23>3.0.CO;2-Q
28. Cramer H, Lauche R, Klose P, et al. A systematic review and meta-analysis of exercise interventions for colorectal cancer patients. European Journal of Cancer Care. 2014; 23(1): 3-14. doi: 10.1111/ecc.12093
29. Temel JS, Greer JA, Muzikansky A, et al. Early palliative care for patients with metastatic non–small-cell lung cancer. New England Journal of Medicine. 2010; 363(8): 733-742. doi: 10.1056/NEJMoa1000678
30. Shinall MC, Martin SF, Karlekar M, et al. Effects of Specialist Palliative Care for Patients Undergoing Major Abdominal Surgery for Cancer: A Randomized Clinical Trial. JAMA Surgery. 2023; 158(7): 747-755. doi: 10.1001/jamasurg.2023.1396
31. Koh D, Song S, Moon SE, et al. Adherence to the american cancer society guidelines for cancer survivors and health-related quality of life among breast cancer survivors. Nutrients. 2019; 11(12): 2924. doi: 10.3390/nu11122924
32. Boyle T, Vallance JK, Buman MP, Lynch BM. Reallocating time to sleep, sedentary time, or physical activity: Associations with waist circumference and body mass index in breast cancer survivors. Cancer Epidemiology Biomarkers and Prevention. 2017; 26(2): 254-260. doi: 10.1158/1055-9965.EPI-16-0545
33. Horsboel TA, De Thurah A, Nielsen B, Nielsen CV. Factors associated with work outcome for survivors from haematological malignancies - A systematic literature review. European Journal of Cancer Care. 2012; 21(4): 424-435. doi: 10.1111/j.1365-2354.2012.01348.x
34. Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. Journal of Clinical Oncology. 2022; 40(22): 2491-2507. doi: 10.1200/JCO.22.00687
35. Welch WA, Ehlers D, Gavin KL, et al. Effects of reallocating sedentary time with physical activity on quality of life indicators in breast cancer survivors. Psycho-Oncology. 2019; 28(7): 1430-1437. doi: 10.1002/pon.5091
36. Witlox L, Hiensch AE, Velthuis MJ, et al. Four-year effects of exercise on fatigue and physical activity in patients with cancer. BMC Medicine. 2018; 16(1): 86. doi: 10.1186/s12916-018-1075-x
37. Coughlin SS, Yoo W, Whitehead MS, Smith SA. Advancing breast cancer survivorship among African-American women. Breast Cancer Research and Treatment. 2015; 153(2): 253-261. doi: 10.1007/s10549-015-3548-3
38. Coughlin SS, Caplan L, Stone R, Stewart J. A review of home-based physical activity interventions for breast cancer survivors. Current Cancer Reports. 2019; 1(1): 6-12. doi: 10.25082/CCR.2019.01.002
39. Vuille-Lessard É, Berzigotti A. Exercise Interventions for Cirrhosis. Current Treatment Options in Gastroenterology. 2022; 20(3): 336-350. doi: 10.1007/s11938-022-00393-y
40. Makarm WK, Sharaf DM, Zaghlol RS. Impact of home exercise program on self-efficacy and quality of life among primary knee osteoarthritis patients: a randomized controlled clinical study. Egyptian Rheumatology and Rehabilitation. 2021; 48(1): 28. doi: 10.1186/s43166-021-00073-2
41. Arora NK, Donath L, Owen PJ, et al. DOSage of Exercise for chronic low back pain disorders (DOSE): Protocol for a systematic review with dose-response network meta-analysis. BMJ Open Sport & Exercise Medicine. 2024; 10(3): e002108. doi: 10.1136/bmjsem-2024-002108
42. Courneya KS, Mckenzie DC, Mackey JR, et al. Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy. British Journal of Cancer. 2014; 111(9): 1718-1725. doi: 10.1038/bjc.2014.466
43. Dubé JJ, Allison KF, Rousson V, et al. Exercise dose and insulin sensitivity: Relevance for diabetes prevention. Medicine and Science in Sports and Exercise. 2012; 44(5): 793-799. doi: 10.1249/MSS.0b013e31823f679f
44. Wang H, Xu S, Aku Yi, et al. Physical Activity, Psychopathologies, and Self-Injurious Behaviors in Youths: Which Type and How Much Is Sufficient? Available online: https://www.researchsquare.com/article/rs-4127644/v1 (accessed on 1 December 2025).
45. McGarrah RW, Slentz CA, Kraus WE. The effect of vigorous-versus moderate-intensity aerobic exercise on insulin action. Current Cardiology Reports. 2016; 18(12): 117. doi: 10.1007/s11886-016-0797-7
46. Haley JS, Hibler EA, Zhou S, et al. Dose-dependent effect of aerobic exercise on inflammatory biomarkers in a randomized controlled trial of women at high risk of breast cancer. Cancer. 2020; 126(2): 329-336. doi: 10.1002/cncr.32530
47. Gunadi JW, Welliangan AS, Soetadji RS, et al. The role of autophagy modulated by exercise in cancer cachexia. Life. 2021; 11(8): 781. doi: 10.3390/life11080781
48. Cheville AL, Kollasch J, Vandenberg J, et al. A home-based exercise program to improve function, fatigue, and sleep quality in patients with stage iv lung and colorectal cancer: A randomized controlled trial. Journal of Pain and Symptom Management. 2013; 45(5): 811-821. doi: 10.1016/j.jpainsymman.2012.05.006
49. Clark MM, Rummans TA, Atherton PJ, et al. Randomized controlled trial of maintaining quality of life during radiotherapy for advanced cancer. Cancer. 2013; 119(4): 880-887. doi: 10.1002/cncr.27776
50. Murtezani A, Ibraimi Z, Bakalli A, et al. The effect of aerobic exercise on quality of life among breast cancer survivors: A randomized controlled trial. Journal of Cancer Research and Therapeutics. 2014; 10(3): 658-664. doi: 10.4103/0973-1482.137985
51. Foley MP, Barnes VA, Hasson SM. Effects of a community-based multimodal exercise program on physical function and quality of life in cancer survivors: A pilot study. Physiotherapy Theory and Practice. 2015; 31(5): 303-312. doi: 10.3109/09593985.2015.1004390
52. Hagstrom AD, Marshall PWM, Lonsdale C, et al. Resistance training improves fatigue and quality of life in previously sedentary breast cancer survivors: a randomised controlled trial. European Journal of Cancer Care. 2016; 25(5): 784-794. doi: 10.1111/ecc.12422
53. Ng AV, Cybulski AN, Engel AA, et al. Triathlon training for women breast cancer survivors: feasibility and initial efficacy. Supportive Care in Cancer. 2017; 25(5): 1465-1473. doi: 10.1007/s00520-016-3531-5
54. Furzer BJ, Ackland TR, Wallman KE, et al. A randomised controlled trial comparing the effects of a 12-week supervised exercise versus usual care on outcomes in haematological cancer patients. Supportive Care in Cancer. 2016; 24(4): 1697-1707. doi: 10.1007/s00520-015-2955-7
55. Park SH, Tish Knobf M, Jeon S. Endocrine Therapy–Related Symptoms and Quality of Life in Female Cancer Survivors in the Yale Fitness Intervention Trial. Journal of Nursing Scholarship. 2019; 51(3): 317-325. doi: 10.1111/jnu.12471
56. Li L, Ma G, Si Z, et al. Clinical Study on Improving Quality of Life for Cancer Patients with Cachexia Syndrome Using Nutrition Support and Resistance Exercise (Chinese). Chinese General Practice. 2019; 22(3): 319-323. doi: 10.12114/j.issn.1007-9572.2018.00.339
57. Quist M, Langer SW, Lillelund C, et al. Effects of an exercise intervention for patients with advanced inoperable lung cancer undergoing chemotherapy: A randomized clinical trial. Lung Cancer. 2020; 145: 76-82. doi: 10.1016/j.lungcan.2020.05.003
58. Yamada PM, Teranishi-Hashimoto C, Bantum EO. Paired exercise has superior effects on psychosocial health compared to individual exercise in female cancer patients. Supportive Care in Cancer. 2021; 29(11): 6305-6314. doi: 10.1007/s00520-021-06209-6
59. Kaushik D, Shah PK, Mukherjee N, et al. Effects of yoga in men with prostate cancer on quality of life and immune response: a pilot randomized controlled trial. Prostate Cancer and Prostatic Diseases. 2022; 25(3): 531-538. doi: 10.1038/s41391-021-00470-w
60. Johnson MN. The Effect of Physical Therapy Intervention on Fatigue, Balance, Depression and Quality of Life in Clients Following Medical Treatment for Cancer: A Pilot Study [PhD thesis]. University of North Dakota; 2023.
61. Shachar SS, Heiling H, Muss HB, et al. Physical Activity Intervention in Patients with Metastatic Breast Cancer During Active Treatment: Quality of Life and Function. The Oncologist. 2023; 28(1): 84-e70. doi: 10.1093/oncolo/oyac232
