Aerobic and resistance exercise training for cardiorespiratory fitness, quality of life, and physical function in people living with and beyond cancer: a systematic review and meta-analysis

Exercise is recommended for all people living with and beyond cancer, but most meta-analyses conflate aerobic and resistance training and rarely evaluate efficacy against minimal clinically important difference (MCID) thresholds. We compared the effects of aerobic, resistance, and combined exercise training versus usual care on cardiorespiratory fitness, quality of life, and physical function in adults with cancer. We searched MEDLINE, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials from inception to 1 November 2025. Parallel-group randomized controlled trials (RCTs) of structured aerobic, resistance, or combined exercise versus usual care in adults with cancer were eligible. Primary outcomes were peak oxygen uptake (VO 2 peak) and quality of life. Random-effects meta-analyses with Hartung-Knapp-Sidik-Jonkman adjustment were performed by exercise modality and follow-up window; certainty of evidence was rated using GRADE. 89 RCTs involving 6,571 participants were included. Compared with usual care, combined aerobic and resistance training improved cardiorespiratory fitness (VO 2 peak) at 3, 6, and 12 months (MD 2.9, 95% CI 1.9 to 3.9; 4.5, 95% CI 2.3 to 6.6; and 4.2, 95% CI 0.1 to 8.3 mL·kg⁻¹·min⁻¹, respectively), exceeding MCID thresholds. Combined training also improved quality of life at 3 months (MD 7.0, 95% CI 4.2 to 10.2 points) and 6-minute walk distance at 3 months (MD 52, 95% CI 33 to 71 m). Aerobic training alone improved VO 2 peak at 3 months (MD 3.6, 95% CI 0.9 to 6.3 mL·kg⁻¹·min⁻¹), while resistance training alone improved quality of life at 3 months (MD 6.3, 95% CI 1.1 to 11.3 points). Combined training also improved lower-body muscle strength and reduced body fat percentage at 6 months. Safety data from 86 trials showed that serious adverse events were rare and did not differ between groups. Structured exercise was associated with clinically meaningful improvements in cardiorespiratory fitness, quality of life, and physical function versus usual care, most consistently with combined aerobic and resistance training; longer-term effects varied by outcome, and superiority over single-modality exercise remains unclear. Exercise should be individually prescribed and progressively adjusted. PROSPERO CRD420251087789.