Physical activity reduces all-cause mortality in patients with cancer: a systematic review and meta-analysis of randomized controlled trials

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Introduction Growing evidence suggests that physical activity (PA) may improve survival in patients with cancer. However, causal evidence from randomized controlled trials (RCTs) remains limited. This systematic review and meta -analysis aims to evaluate the effect of PA on all-cause mortality in patients with cancer based on RCTs evidence. Methods MEDLINE and CENTRAL were searched without language restrictions up to November 30, 2025. Eligibility criteria included RCTs of PA interventions reporting mortality outcomes in adult cancer patients. The risk of bias in included studies was assessed using the Cochrane Risk of Bias tool for randomized trials (RoB 2), and the quality of the studies was checked with GRADE, by two independent reviewers. Pooled hazard ratios (HRs) were calculated using inverse-variance common-effects models. The study protocol is available at PROSPERO (registration number CRD42023486651). Results Thirteen RCTs involving 3282 patients with cancer were included. PA reduced all-cause mortality risk by 26% compared to no PA (pooled HR 0.74, 95% CI 0.63 to 0.87, p < 0.001, with moderate quality of evidence), with non-significant heterogeneity (p = 0.21). Subgroup analyses showed consistent effects regardless of intervention duration (≥6 weeks: HR = 0.74; 95% CI: 0.63–0.87; <6 weeks: HR = 0.73; 95% CI: 0.43–1.22; p interaction = 0.93) or hormone dependent status of cancer (non-hormonally dependent: HR = 0.75; 95% CI: 0.63–0.91; hormonally dependent: HR = 0.71; 95% CI: 0.50–1; p interaction = 0.75). Overall, the risk of bias was moderate. Conclusions This meta -analysis of RCTs provides causal evidence that PA improves survival in cancer patients, reducing all-cause mortality by 26% (moderate quality of evidence). The results suggest that, in addition to its well-established supportive care benefits, PA should also be recommended as a part of comprehensive disease management in oncology.

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