Effect of combined lifestyle intervention on cardiometabolic risk in cancer survivors: A systematic review and meta-analysis of randomized controlled trials

Purpose Unhealthy lifestyle behaviors are significant and adjustable contributors to cardiometabolic abnormalities among cancer survivors. Combined lifestyle interventions (CLIs), addressing multiple behaviors simultaneously, may offer superior cardioprotective effects. This systematic review and meta-analysis synthesized evidence on existing CLIs and evaluated their effectiveness in reducing cardiometabolic risk. Methods A comprehensive search was performed in PubMed, Web of Science, EMBASE, CINAHL, the Cochrane Library, CNKI, Wanfang, SinoMed, and Yiigle until December 3, 2025, following the PRISMA checklist. Standardized mean difference (SMD) and 95% confidence intervals (95% CI) were estimated using random-effects models. Heterogeneity and publication bias were also assessed. Results Of the 7649 articles screened, 25 met criteria, and 21 were included in meta-analysis. Interventions primarily focused on diet and exercise, with several also incorporating psychological support, alcohol abstinence, or weight management. Studies mainly targeted breast and prostate cancer survivors, with varied cardiometabolic outcomes. CLIs demonstrated greater improvements in body mass index (n = 16, SMD = −0.27, 95% CI = −0.38 to −0.15, P < 0.001), fasting blood glucose (n = 12, SMD = −0.29, 95% CI = −0.54 to −0.04, P = 0.021), low-density lipoprotein (n = 8, SMD = −0.15, 95% CI = −0.30 to −0.01, P = 0.039), diastolic blood pressure (n = 10, SMD = −0.12, 95% CI = −0.20 to −0.04, P = 0.003), and triglycerides (n = 10, SMD = −0.26, 95% CI = −0.43 to −0.08, P = 0.004). Subgroup analyses showed limited differences across intervention types, except for effects on fasting blood glucose levels. Conclusions CLIs are associated with modest but statistically significant improvements in cardiometabolic risk management among cancer survivors. Further studies may prioritize more consistent frameworks for defining CLIs, while incorporating digital health technologies and evidence-based behavior change strategies to enhance intervention effectiveness and sustainability. Review registration Registered on PROSPERO (CRD420251013007).