Objective This study assesses the impact of varying adherence to American College of Sports Medicine (ACSM) guidelines on quality of life and symptom burden in lung cancer patients. Methods A systematic search was performed across PubMed, Embase, Web of Science, and Cochrane Library to identify RCTs of exercise in lung cancer. Interventions were classified by adherence to ACSM guidelines for subsequent subgroup analyses. Meta-analyses used random-effects models to pool standardized mean differences (SMDs) and 95% confidence intervals (CIs). Study quality was assessed using the revised Cochrane Risk of Bias tool for randomized trials (RoB 2), and publication bias was evaluated using Begg’s and Egger’s tests. Results A total of 32 studies were analyzed, of which 18 demonstrated high adherence to the ACSM guidelines. Meta-analysis demonstrated that exercise interventions significantly improved quality of life (SMD = 0.44, 95% CI: 0.18, 0.70, p 0.001), with a greater effect in the high-adherence group compared with the low or uncertain adherence group (SMD = 0.75 vs. 0.20, p = 0.03). Exercise also significantly alleviated fatigue (SMD = −0.50, 95% CI: −0.81, −0.20, p = 0.001), with more pronounced improvements in the high-adherence group (SMD = −0.77 vs. −0.11, p = 0.004). In addition, exercise significantly reduced anxiety (SMD = −0.63, 95% CI: −1.00, −0.26, p 0.001) and depression (SMD = −0.67, 95% CI: −0.97, −0.38, p 0.001); however, no significant differences were observed between adherence subgroups. Pain was also relieved (SMD = −0.81, 95% CI: −1.49, −0.12, p = 0.02), with a greater effect in the high-adherence group (SMD = −1.46 vs. 0.02, p = 0.01). Overall evidence shows no clear sleep improvement (SMD = −0.12, 95% CI: −0.37, 0.12, p = 0.32), despite borderline significance in the high-adherence subgroup ( p = 0.05) and near-significant subgroup differences ( p = 0.06). Conclusions Exercise interventions with high adherence to the ACSM guidelines may be more effective in improving quality of life, fatigue, and pain. However, improvements in anxiety and depression do not appear to be dependent on adherence. No significant improvement was observed in sleep quality. Further large-scale studies are warranted. Systematic Review Registration https://www.crd.york.ac.uk/prospero/ , identifier CRD420251249211.
Guo et al. (Wed,) studied this question.