. Author manuscript; available in PMC: 2018 Sep 1.

Published in final edited form as: PM R. 2017 Sep;9(9 Suppl 2):S347–S384. doi: 10.1016/j.pmrj.2017.07.074

Table 2.

Synopsis of Findings

Reference	Review characteristics	Participants	Intervention	Comparison	Outcomes
Babatunde O. et al.^* 2016¹⁶	2 intervention trials 5 observational studies Evaluating physical activity levels. AMSTAR Score 6/11	Endometrial cancer survivors with cross sectional, self-report.	Self-report of PA Intensity Moderate Duration 150 minutes/week at least 30 min day Session Frequency 5 days/week Complemented with computer technology/accelerometer and intervention with computer-based or mobile app	Cross sectional and single arm intervention (one with baseline data from prospective lifestyle intervention trials)	Increased physical activity contributes to improved QOL Higher BMI correlated with lower QOL.
Bergenthal, N. et al 2014⁴⁰	9 RCT’s Evaluating the efficacy, safety or feasibility of aerobic physical exercise. Moderate selection bias. High bias in patient-reported outcomes. AMSTAR Score 9/11	n = 818 adults with hematological cancers including; ALL, AML, malignant lymphoma, and multiple myeloma.	AT programs mostly walking programs. Duration and Intensity: Variable	No exercise intervention or ‘usual care’.	Quality of Life outcomes: Significant improvements but small effect size (SMD 0.26; 95% CI 0.03 to 0.49; P = 0.03). Physical functioning: Significant improvements but small effect size (SMD 0.33; 95% CI 0.13 to 0.52; P = 0.0009) Depression: Significant improvements but small effect size (SMD 0.25; 95% CI −0.00 to 0.50; P = 0.05) Anxiety: No significant changes Fatigue: Significant improvement but small effect size (SMD 0.24; 95% CI 0.08 to 0.40; P = 0.003) Physical Performance: Individual trials demonstrated significant improvements favoring exercise intervention vs none, however results could not be pooled. Serious Adverse Events: No significant difference in events between exercise intervention vs none. (RR 1.44; 95% CI 0.96 to 2.18; P = 0.06)
Bourke, L. et al. 2013³¹	14 RCTs Cochrane review AMSTAR Score 10/11 Low selection and reporting bias. Moderate attrition bias.	n = 648 Various cancer types including breast, colorectal, prostate and others.	AT with or without RT RT alone Only “6 trials would meet current recommendations for aerobic exercise” Questionnaires or exercise log reported 2 – 5 times/week	Control group with the same type of cancer ^* standard care did include physiotherapy in at least one trial	Aerobic exercise tolerance improved at 8 –12 weeks’ post intervention with large effect size. (SMD 0.73, 95% CI 0.51–0.95) and at 6 months with large effect size. (SMD 0.84, 95% CI 0.45–0.94)
Bradt J. et al.^* 2014⁵²	1 quasi-experimental RCT 1 RCT ^* Cochrane review AMSTAR Score 9/11	n= 68 Women with breast cancer within 5 years of treatment	Dance/movement therapy	Wait-list control group	Body Image No significant effect Individual studies reviewed trend towards significance in QOL and fatigue, but no pooled effects analyzed. No effect on shoulder ROM and arm circumference, but large variability was reported in these measures.
Buffart, L. et al. 2017³⁶	34 RCTs AMSTAR Score 9/11	n = 4,519 Various types of cancers including; Breast, male GU, hematologic, GI, GYN, respiratory, and other. Post completion of active cancer treatment.	AT and RT exercise programs. Supervised and unsupervised exercise programs. Session Frequency 2 – 5x/week	Control groups varied; usual care, wait-list, attention.	QOL Significantly improved with small effect size. (0.15, 95% CI 0.10; 0.20) Physical Function Signifiantly improved with exercise but with small effect size. (0.18, 95% CI 0.13; 0.23) Effects of supervised exercise twice as large as unsupervised exercise. Suggested that impact of attention from physiotherapist, better equipment, more challenging prescriptions, or better adherence from supervised programs needed further investigation. No significant effect on BMI. Studies may not adequately measure and reflect adiposity.
Capozzi, L.C. et al.^* 2016³⁷	16 observational studies 8 experimental trials Moderate selection bias. Low to moderate outcomes reporting bias. AMSTAR score 8/11	Various cancers of the head and neck including: Hypopharynx, Larynx, Oropharynx, Lip, Oral Cavity, Tonsil, Salivary glands, Nasopharynx, Nasal cavity, Paranasal sinus, and middle ear. During and after cancer treatment.	RT, Hydrotherapy, Walking, Walking + exercise. Exercise frequency was highly variable Intensity Moderate to vigorous Duration was highly variable Supervised and unsupervised trials.	4 trials with control groups of usual care. Remaining trials with no control comparison group.	Significant improvement in lean body mass, strength, physical function, QOL, fatigue management. ^*75% of patients reported “possibly” or “definitely” interested in physical activity counseling.
Carvahlo, A.P. et al. 2012⁵³	3 controlled trials Low selection, attrition and reporting bias. ^* Cochrane review AMSTAR score 9/11	n = 104 Head and neck cancer survivors (primarily oropharynx) with shoulder dysfunction Range 2 – 180 months post-surgery	PRE with ROM and stretching. Frequency Average 3x/week Program Duration 12 weeks Intensity Variable	Control groups with “standard care,” some of which included shoulder ROM exercises (but not progressive)	Progressive resistive training was more effective than standard physiotherapy for restoring shoulder function however effect is small. (−6.26, 95% CI −12.2;−0.31)
Cheema, B. et al. 2008³³	5 RCT 4 uncontrolled trials 1 non-randomized intervention trial AMSTAR score 5/11	Women only, during or after chemotherapy and radiation, Variable disease stage Variable extent of surgery No males	Various AT and RT programs with PRE. Duration 8 – 24 weeks Supervision 6 trials with complete supervision 3 with partial supervision 1 with no supervision. Progressive resistive exercise was referred to but parameters were not defined.	“Non-exercise” control group	PRE significantly improved: endurance, strength, flexibility, lean mass, cardiorespiratory fitness, immune system, mood, self-esteem. Large effect size seen with change in grip strength. Moderate effect size with peak power and VO2 improvements. Chemotherapy dose tolerance significantly improved. Immune Function: Increased % T-helper lymphocytes. Increased total activated CD-4 cells. Increased lymphocyte proliferation. Improved IFN gamma to IL-6 ratio. Increased circulating IGF-II.
Cheifetz, O. et al.^* 2010⁵⁵	10 trials focusing on the role of exercise in lymphedema High selection and outcomes measurement bias. AMSTAR score: 4/11	Breast cancer	Early physiotherapy RT Primarily supervised exercise programs. Frequency or duration not defined.	“Non-intervention” group	Exercise is beneficial and safe for secondary lymphedema. Post-operative rehabilitation improves shoulder ROM. Supervised PRE does not worsen lymphedema.
Chipperfield, K. et al.^* 2014¹⁵	4 interventional trials 2 pilot studies 1 cross-sectional survey High selection and outcomes reporting bias. AMSTAR score 6/11	Prostate cancer patients during ADT administration.	Variable RT and AT programs 1 cross-sectional of PA Program Duration 12 weeks - 6 months. Intensity Most trials moderate intensity Most trials supervised intervention.	Two pilot studies and one cross-sectional without a control group “considerable variability in sample sizes”	Significant improvement in QOL. Inconclusive findings regarding impact on cognitive changes, depression, and anxiety. ^* only 45% of reported PA met guideline standards.
Cramer, H. et al. 2017⁶⁶	24 RCTs of yoga interventions ^* Cochrane review Moderate attrition and reporting bias. AMSTAR score 9/11	n = 2,166 Breast cancer patients. During or after cancer treatment.	Program duration Range of 6 sessions to 6 months. Session Frequency 1 – 3 x week Session Duration 20 – 120 min	Wait list controls. One trial with exercise intervention control	Significant improvements in: QOL with small effect size (SMD = 0.22, 95% CI 0.04; 0.40) Fatigue with medium effect size (SMD = −0.48, 95% CI − 0.75; − 0.40) Sleep disturbance with small effect size (SMD = − 0.25, 95% CI −0.40; − 0.09) Depression with very small effect size (SMD = −0.13, 95% CI −0.31; 0.05) Anxiety with medium effect size (SMD = − 0.53, 95% CI −1.10; 0.04)
Cramer, H. et al 2014²⁰	5 RCTs AMSTAR score 7/11	n = 238 Colorectal cancer patients from 3 – 60 months post cancer treatment	AT Intensity Low vs Moderate Duration 2 –16 weeks 3 trials with supervision 2 trials home-based	Usual care or different exercise program One trial with attention control with phone calls at same interval as program interventions.	Significant short-term improvement of overall physical fitness. (SMD = 0.59, 95% CI 0.25; 0.93, P < 0.01) No evidence for significant effects on QOL or fatigue biomarkers. Inflammatory profile Significantly improved with moderate exercise. Greater DNA damage noted with moderate exercise.
Cramp, F. et al. 2012²¹	56 controlled trials on cancer-related fatigue High detection bias ^* Cochrane review AMSTAR score 9/11	n = 4,068 Various types of cancer with the majority including breast cancer. During and after completion of cancer treatment.	AT Frequency and duration Variable Mode Walking or cycling	Usual care or wait-list. At least two trials controlled with psychotherapy interventions.	Significant improvement in cancer-related fatigue with AT but with small effect size. (SMD = −0.27, 95% CI −0.37; −0.17)
D’Souza, V. et al.^* 2016³⁸	8 studies reviewing 2 studies reviewed use of PA 5 trials included but were not limited to RCTs. AMSTAR score 7/11	Various types of cancers	Physical activity, various modes,	Variable	Body composition Significant reduction in BMI Endurance Significant increase in peak O2 consumption and peak power. Fatigue Significantly less with greater levels of reported PA. QOL Improved with greater levels of PA.
Davies, N.J. et al.^* 2011⁶⁴	Review of studies with varied methodology including: 4 RCTs with biomarker of recurrence as outcome 4 Prospective cohort studies 2 Cross-sectional studies 3 Systematic reviews/meta-analysis Significant heterogeneity in included studies. High risk of selection bias. AMSTAR: 3/11	Breast, prostate, and colorectal cancer patients both during and after completion of cancer treatment	Observational Studies: Self-reported physical activity RCTs: 1 Moderate intensity AT 2 AT + RT Program Duration: 12–36 weeks	For observational studies & systematic reviews: Active PA group compared to inactive/lowest PA group; For RCTs: Exercise vs usual care	Physical Activity Participation Improved survival and reduced risk of recurrence, mostly based on observational studies; Threshold of moderate intensity may be necessary to achieve positive impact on survival. Dose response improved with longer or more intense exercise.
De Backer, I.C. et al.^* 2009²⁶	24 trials post chemotherapy 10 RCTs 4 Controlled intervention trials 10 Uncontrolled trials High risk of attrition and outcomes reporting bias. AMSTAR Score: 7/11	All trials post-chemotherapy 13 Breast 3 Prostate 6 various types of cancer 1 post-stem cell transplant	RT with or without additional AT. RT was mostly machine based; total body program. Frequency 2 – 3 days/week Program Duration 3 – 24 weeks (median =12 weeks) Intensity Moderate to vigorous Detailed reporting of exercise parameters of included studies.	Not reported	Body composition No effect of resistance exercise on adiposity. Trend towards significance in improved lean body mass. Cardiopulmonary Function Increased Muscle function Improved muscle strength and muscle endurance. Lymphedema Exercise at any level had no impact on swelling. Immune Function No significant impact from exercise. Endocrine Function Decrease in insulin family proteins. Hematologic Function No influence on hemoglobin levels.
Egan, M.Y. et al.^* 2013⁴²	Exercise interventions post cancer treatment only 13 systematic reviews 6 RCTs AMSTAR Score: 6/11	Various types of cancers	Mixed AT and RT PA Supervised settings	Low levels of PA or no PA or Usual care	Physical Function Moderate improvements in overall function. Fatigue Significant improvements Depression Small effect trending towards positive impact.
Fong, D.T. et al. 2012²⁴	34 RCTs Evaluating the effects of PA after cancer treatment. AMSTAR Score: 9/11	22 trials breast cancer. 3 trials colorectal cancer 1 trial endometrial cancer. 8 trials including various cancer types. Average age 55 years (range = 39 – 74 years)	27 trials AT 6 trials AT + RT Duration Average 13 weeks (range = 3 – 60 weeks) Intensity 11 trials: moderate 2 trials: vigorous	Sedentary comparisons or assigned no exercise	Physiological markers: Significant reduction in insulin-like growth factor-I (95% CI −23.3 to −0.5; P = 0.04) No effect on insulin, glucose, and homeostatic model assessment. Body composition: Slightly reduced BMI (−0.4, 95% CI, −0.6 to −0.2; P<0.01) and body weight (−1.1kg, 95% CI, −1.6 to − 0.6kg; P<0.001) No effect on waist: hip ratio Physical functions: Significant increase in peak oxygen consumption (2.2mL/kg/min, 1.0 to 3.4; P<0.01) peak power output (21W, 13.0 to 29.1; P<0.01) distance walked in six minutes (29m, 4 to 55; P = 0.03) bench press weight (6kg, 4 to 8; P<0.01) leg press weight (19kg, 9 to 28; P<0.01) right hand grip strength (3.5 kg, 0.3 to 6.7; P= 0.03) Psychological outcomes: Reduced depression using Beck depression inventory (−4.1, −6.5 to −1.8; P<0.01) Reduced fatigue using Piper Fatigue scale (−1.0, −1.8 to − 1.0: P=0.03) Quality of Life outcomes: Significant improvement on SF-36 physical function, social function, and mental health functions.
Fontein, D.B. et al.^* 2013⁶³	14 Prospective observational studies 2 RCTs 2 Retrospective case control studies AMSTAR Score 7/11	Breast cancer only	Self-report levels of PA	Inactive or low self-reported PA	Cancer specific survival and all-cause mortality: 36%–67% decrease in rate of disease-specific mortality of highest PA levels vs. lowest PA levels. Significant benefit on all-cause mortality in the highest PA group ranging from 14%–56% decrease compared to low PA.
Fu, M.R. et al.^* 2014⁶⁰	9 RCTs 2 Uncontrolled trials 3 systematic reviews AMSTAR Score: 5/11	Various types of cancers	“Full body exercise” not characterized. Some reported use of resistance training.	Not described	Full Body Exercise Does not worsen lymphedema and may improve shoulder mobility. Resistive Training Safe if progressive, starting with low intensity.
Granger, C.L. et al.^* 2011²⁷	9 Case series 2 RCTs 3 Cohort studies AMSTAR: 11/11	Non-small cell lung cancer at any phase of treatment.	All studies included aerobic 54% added RT 31% added stretching Intensity Moderate to vigorous Program Duration 4–12 weeks Session Frequency 2–7 days/week	Not described	Pre-operative Exercise Improvements in 6-minute walk distance post treatment. No change in HRQOL. Post-operative Exercise Improvement in 6MWD but only small significance as compared to usual care. Conflicting evidence for HRQOL between trials.
Guinan, E.M. et al.^* 2013²⁸	7 RCTs 2 non-randomized trials Moderate attrition bias AMSTAR Score: 8/11	Early stage, post-adjuvant treatment breast cancer survivors	7 trials AT with or without RT 1 trail RT only Intensity Moderate to vigorous Program Duration 8–36 weeks	Non-exercise control group	Body Composition Mixed findings for impact on % body fat, BMI, and waist and hip circumferences. Insulin Resistance Markers No effect on insulin or FBG Decreased levels of IGF-1. Mixed results for IGF II or IGFBP3 levels.
Hackshaw-McGeagh et al. 2015⁴⁴	4 RCTs with exercise only 6 RCTs with Exercise + Diet AMSTAR: 10/11	Prostate cancer survivors at various stages of disease and phases of treatment.	AT + RT 1 trial RT only 3 aerobic only Program Duration 13 – 104 weeks	Non-exercise control group in most studies.	No impact from exercise on disease progression markers, e.g., PSA, testosterone.
Harder, H. et al.^* 2012⁴⁹	18 RCTs Moderate bias in randomization, attrition, and blinding. AMSTAR Score: 8/11	Breast cancer survivors at various phases of treatment and with stages of disease	Yoga Program Duration 4 – 36 weeks (most were between 4–12 weeks) Program Frequency 1–2 sessions per week + home practice	Education only Rehabilitation intervention Wait-list control	Psychological/symptom distress: Significantly reduced depression (ES: 0.24 to 0.33) anxiety (ES: 0.31) and negative affect (ES: 0.59 to 0.84) HRQOL: Significantly improved function scales: Social well-being (ES: 0.22) physical functioning (ES: 0.44) and emotional function (ES: 0.71) Significantly improved symptom or single-item symptom measures were 0.47 or below (insomnia and appetite loss). Fatigue (ES: .33–1.5)
Keogh, J.W. et al.^* 2011³⁰	12 intervention trials AMSTAR Score: 7/11	Prostate cancer survivors	RT, AT or RT + AT Intensity Moderate to vigorous Frequency 2 – 5 days/week, Program Duration 8 – 25 weeks	Not described	Resistance Training: Grade A evidence for improves fatigue, QOL and muscle endurance; Grade C for body composition impact, muscle strength and general function. Aerobic Training: Grade B evidence for aerobic endurance, sit to stand time, fatigue, QOL; Grade C evidence for body composition and strength. Resistance + Aerobic Training: Grade B evidence for muscle mass, muscle strength & endurance, walk speed, QOL Grade C evidence for aerobic endurance, and fatigue.
Kwan, M.L. et al.^* 2011²⁹	13 RCTs 2 Case series 4 Cohort studies AMSTAR Scores: 7/11	Breast cancer survivors	RT or RT + AT Intensity Low to moderate Frequency 2–3 days/week Program Duration Up to 39 weeks; Also included physiotherapy directed programs	Usual care	Resistive Training is safe and does not increase risk of lymphedema in breast cancer. Aerobic + Resistive Training trends towards positive but results are inconclusive due to limited studies.
Larkin, D. et al. 2014⁴³	5 interventional trials AMSTAR Score: 9/11	Prostate cancer survivors on androgen depravation therapy (ADT) and/or radiation therapy	Mix of RT, AT, and RT + AT. Program Duration 8 – 16 weeks	Not described	Significant effect of exercise on reducing fatigue.
Lof, M. et al^*. 2012⁵¹	9 RCTs AMSTAR Score: 3/11	Breast cancer survivors mostly early stage	Tai chi, AT, AT + RT Intensity Moderate Session Duration 30 – 60 minutes Frequency 3 – 5 days/week Program Duration 8 – 36 weeks	Usual care or support group	No conclusive evidence for positive effect on insulin axis proteins or interleukins.
McNeely, M. et al. 2006³⁵	14 RCTs High risk of blinding bias in methodology and reporting. AMSTAR Score: 9/11	n = 717 Women with a history of breast cancer stage 0 – III. Surgery ± adjuvant treatment.	Mixed AT + RT and AT alone.	Placebo, controlled comparison, or standard care.	QOL Significant improvement using FACT-B (6.62, 95% CI 1.21 to 33.64) Endurance Significant improvement in peak oxygen consumption. Body composition Non-significant reduction in body weight and BMI. Fatigue Significant improvement with exercise after active treatment with moderate effect size. (SMD 0.46, 95% CI 0.23 to 0.70) but not significant during active treatment (SMD 0.28, 95% CI −0.02 to 0.57)
McNeely, M. et al 2010⁵⁶	24 RCTs evaluating interventions for breast cancer-related upper limb dysfunction. ^* Cochrane Review AMSTAR score: 10/11	n = 2132 Women with breast cancer receiving therapeutic exercise for upper limb recover after breast cancer treatment.	Targeted upper limb exercises, AT, RT, and mixed AT + RT. Supervised vs unsupervised exercise. Timing: Early post-surgical exercise and delayed exercise during cancer treatment.	Usual care control group	Early versus Delayed Post-Operative Upper Limb Exercise Significant increase in return to ROM post-operatively with early exercise. (WMD 10.6; 95% CI, 4.51 to 16.6) Significant increase in wound drainage volume (SMD 0.31, 95% CI, 0.13 to 0.49) and in duration of drain placement (WMD 1.15, 95% CI, 0.65 to 1.65) with early exercise. Supervised vs unsupervised exercise Significant improvement with physical therapy supervised exercise in shoulder ROM post-operatively (WMD 12.92, 95% CI, 0.69 to 25.16) in shoulder function following intervention (SMD:0.77; 95% CI, 0.33 to 1.21) and at 6 months follow up (SMD: 0.75; 95% CI: 0.32 to 1.19)
Meneses-Echavez, J.F. et al 2015²⁵	9 RTCs examining impact of exercise on CRF AMSTAR Score: 9/11	n = 772 Various types of cancer during adjuvant cancer treatment. Average time since diagnosis 8.2 months (SD ± 10.7) Adults mean age 55.5 years (SD ± 7.2)	Supervised, multi-modal exercise interventions including AT, RT, and stretching for CRF.	Controls with no intervention	61.3 % adherence rate Significant improvement in CRF (SMD = −0.23; 95% CI −0.37 to −0.09, P = 0.001) Gains maintained at average 12 weeks, 24 weeks, and 6 months. Subsets AT + RT + stretching experienced significant reduction in CRF (P = 0.001) RT alone no significant improvement in CRF levels (P = 0.30)
Meneses-Echavez, J. F., et al. 2016⁶¹	9 trials Evaluating inflammatory mediators in breast cancer patients. AMSTAR Score: 9/11	n = 478 (253 exercise/225 control) Age mean 54 ± 4 (range 49 – 56) Breast Cancer stage 0 – IIIb Majority of patients were postmenopaus al.	AT +/− RT, yoga, Tai-chi Program Duration Mean 19 weeks (±13 weeks) Frequency Mean 3 (± 1) sessions/week Session Duration 69 (± 34) minutes	No exercise or ‘usual care’	Inflammatory Markers Interleukin 6 Significant reduction in concentration (WMD −0.55 pg/ml, 95% CI −1.02 to − 0.09) Tumor Necrosis Factor α Significant reduction in concentration (WMD −0.64 pg/ml, 95% CI - −1.21 to − 0.06) Interleukin 8 Significant reduction in concentration (WMD −0.49 pg/ml, 95% CI −0.89 to − 0.09) Interleukin 2 Significant reduction in concentration (WMD 1.03 pg/ml, 95% CI 0.04 to 1.67) CRP No significant effect Interleukin 10 No significant effect
Mishra, S.I. et al. 2012³²	56 RCTs or quasi-randomized trials evaluating the effectiveness of exercise on HRQOL and HRQOL domains. ^* Cochrane Review AMSTAR Score: 9/11	n = 4826 Various types of cancers both during and after active cancer treatment.	Mode: Walking, cycling, RT, strength training, mixed AT + RT, yoga, and Qigong	Controls with no exercise intervention, or education only as an intervention.	HRQOL Overall improvement with exercise from baseline to 12 week follow up (SMD = 0.33, 95% CI 0.12; 0.55) Improvement at 12 weeks in Physical functioning (SMD = 0.69, 95% CI 0.16; 1.22) Role function (SMD = 0.48, 95% CI 0.07; 0.9) Social function Improvement at 6 months in physical functioning Fatigue: Significant difference in fatigue levels favoring the exercise group at 12 weeks. Subset Disease State: Breast Cancer Significant reduction in anxiety as compared to other cancer types. Cancers other than breast Greater reduction in depression, fatigue, sleep disturbance as compared to breast cancer. Greater improvement in HRQOL, emotional wellbeing, physical functioning and role function as compared to breast cancer. Subset Exercise Intensity: Greater improvements in HRQOL and physical functioning, and significant reductions in fatigue, anxiety, and sleep disturbance with moderate or vigorous exercise versus mild or none.
Mustian, K.M. et al. 2017³⁹	113 trials comparing exercise, psychological, and pharmaceutical interventions to treat cancer-related fatigue AMSTAR Score: 11/11	n = 11,525 Various types of cancer. 78 % female 22 % male Mean age 54 years (range, 35 – 72 years)	AT, RT, and mixed AT + RT. Program Duration Average 43 sessions (range = 1 – 364) over 14 weeks (range = 1 – 60 weeks) Session Duration Average 60 minutes (range = 16 – 150)	68 % used standard care, no intervention or wait-list control. 31% used placebo, time attention or education control.	Significant moderate improvement in CRF from pre to post treatment with exercise intervention (WES, 0.30; 95% CI, 0.25 – 0.36, P<0.001) and with psychological intervention (WES, 0.27; 95% CI, 0.21 – 0.33; P < 0.001) and with exercise + psychological intervention (WES, 0.26; 95% CI, 0.13 – 0.38; P < 0.001) Exercise, psychological, exercise + psychological interventions were superior to pharmaceutical interventions in improving CRF.
Otto, S.J. et al. 2015⁶²	7 observational studies examining self-reported levels of PA and impact on QOL and survival. AMSTAR Score: 10/11	n = 4487 colorectal cancer patients (2089 examining QOL end points and 2398 examining survival end points) Self-reported change in physical activity during cancer treatment.	Patient self-reported recall regarding levels of physical activity pre-diagnosis, during treatment, and post-treatment. Variety of Patient Reported Outcomes Measures used to quantify level of PA. Assessment time points varied among trials.	None	QOL Increasing levels of PA during or post treatment associated with improved QOL (SMD = 0.74 (CI = 0.66–0.82)) Survival Increasing physical activity levels post diagnosis improved survival. (HR = 0.70 95% CI, 0.55; 0.85) ^* Weight gain did not affect disease-related mortality.
Pan, Y. et al 2015⁴⁸	16 RCTs AMSTAR Score: 6/11	n = 538 yoga/493 control Breast cancer patients Stage 0–III. +/− Hormonal therapy	Supervised, guided yoga interventions. Program Duration Average 3 weeks to 6 months. Session Frequency Average 1 – 3 session(s)/week Session Duration Average 60 – 90 minutes. Yoga interventions included: Integrated yoga program Iyengar Modified yoga Restorative Mindfulness Viniyoga Hatha Yoga Sutras	Waitlisted control group	Depression: Significant improvement for yoga cohort. (SMD: −0.17, 95% CI: −0.32 to −0.01; P=0.00) Anxiety: Significant reduction for yoga cohort. (SMD: −0.98, 95% CI: −1.38 to −0.57; P<0.00) Physical Well-being No significant improvement for yoga cohort. (SMD: 0.23, 95% CI: −0.04, 0.52; P = 0.10) Overall Health-related Quality of Life Significant improvement for yoga cohort. (SMD: 0.85, 95% CI: 0.37, 1.34; P = 0.001) Fatigue No significant reduction in yoga cohort. (SMD: −0.22, 95% CI: −0.53, −0.09; P = 0.17) Sleep Quality No significant improvement in yoga cohort (SMD: −0.19, 95% CI: −0.39, 0.00; P=0.05) Gastrointestinal symptoms Significant improvement in yoga cohort (SMD: −0.09, 95% CI: −0.64, 0.46; P=0.74) Duration of Intervention Significantly improved effects with yoga program duration of > 3 months. (SMD: 0.40, 95% CI: 0.00, 0.79; P=0.04)
Schmid, D. et al. 2014⁵⁹	23 prospective longitudinal studies 16 studies breast cancer 7 studies colorectal cancer AMSTAR Score: 9/11	n = 49,095 Breast and colorectal cancer patients self-reported levels of physical activity pre-diagnosis, during cancer treatment, and post diagnosis.	Patient self-reported level of physical activity converted to METS. Used pooled RRs to compare high vs. low categories of PA at each time point. Duration/Intensity Estimated at 150 minutes of moderate physical activity per week.		Breast Cancer Survivors: High vs Low PA pre-diagnosis Associated with decreased risk of total mortality (RR = 0.77: 95% CI= 0.69–0.88) and decreased risk of disease mortality (RR = 0.77): 95% CI= 0.66–0.90) Each 5, 10, or 15 MET-h/week increase from pre-diagnosis PA level was associated with 7%, 13%, or 19% reduced mortality. High vs Low PA post-diagnosis Associated with decreased risk of total mortality (RR = 0.52: 95% CI = 0.42 – 0.64) and decreased risk of disease mortality (RR = 0.72; 95% CI = 0.60 – 0.85) Each 5, 10, or 15 MET-h/week increase in post-diagnosis PA levels was associated with 13%, 24%, or 34% reduced mortality. Colorectal Cancer Survivors: High vs Low PA pre-diagnosis Associated with decreased risk of total mortality (RR = 0.74; 95% CI = 0.63 –0.86) and decreased risk of disease mortality (RR = 0.75; 95% CI = 0.62 – 0.91) Each 5, 10, or 15 MET-h/week increase in pre-diagnosis PA levels was associated with 7%, 14%, or 20% reduction in total mortality. High vs Low PA post-diagnosis Associated with strong risk reduction for total mortality (RR = 0.58; 95% CI = 0.48 – 0.70) and colorectal cancer mortality (RR = 0.61; 95% CI = 0.40 – 0.92) Each 5, 10, or 15 MET-h/week increase in post-diagnosis PA levels was associated with a 15%, 28%, or 38% lower risk of mortality.
Scott, D.A. et al 2013⁵⁷	12 RCT’s AMSTAR Score: 4/11	n = 1669 Various types of cancers. All participants had completed primary cancer treatments.	Multidimensional rehabilitation program (MDRP): Inclusive of a physical (exercise, dietary regime) and psychosocial (counseling, cognitive behavior therapy) component carried out on 2 or more occasions. Individual supervised Group supervised Unsupervised	No intervention or lower-level intensity program, or different mode of administration.	Significant improvement in the SF-36 physical health component score (Mean Difference = 2.22 (95% CI 0.12 to 4.31, P = 0.04)) MDRP most successful when focusing on one behavior area (exercise or stress management) rather than focusing on several different behaviors at the same time. Significant improvements noted in supervised vs unsupervised settings, but the type of provider delivering services had no impact on improvements. Maximum benefit to MDRP was noted by 6 months.
Sebio Garcia, R. et al. 2016³⁴	21 controlled trials evaluating the impact of pre-operative exercise interventions. AMSTAR Score: 8/11	n = 1189 (595 intervention/594 controls) Lung cancer Stage I – IIIA during adjuvant or neoadjuvant treatment. 62 % male Average age 64.8 years (±5.28)/64.3 years (± 6.3)	Outpatient-based exercise programs. AT, RT, or mixed AT + RT with or without breathing or incentive spirometry intervention. Duration Average 4 weeks (range = 1 week to 10 weeks) Intensity Moderate to Vigorous	No exercise	Pulmonary Function: Significant increase post operatively in FEV1 (SMD = 0.27, 95% CI 0.11, 0.42) and in FVC (SMD = 0.38, 95% CI 0.14, 0.63). Trend towards significance in VO2peak. Improvement noted but pooled effects were not possible. Functional Recovery: Significant reduction in post-operative hospital length of stay (mean difference = − 4.83, 95% CI −5.90, −3.67) Significant reduction in post-operative complications (RR = 0.45, 95% CI 0.28, 0.73) HRQOL: No significant improvements. Breathing Exercises: No evidence to support that adding breathing exercises or incentive spirometry provides additional benefit.
Shneerson, C. et al. 2013⁴⁶	5 RCTs Evaluating the effect of yoga 4/5 studies had high risk for selection and outcome reporting bias. AMSTAR score 7/11	n = 66 Breast cancer, after completion of active treatment. Age range 50–63	Yoga programs 3 trials of hatha 1 trial restorative 1 trial Iyengar) Program Duration 7 weeks - 6 months Frequency At least twice a week Session Duration 1 – 1.5 hours	All RCTs, with waitlist controls	Very small effect sizes overall. QOL Improved in only 1 study vs controls Emotional subscale of FACT-B improved in only 1 study (ES 0.51, 95 % CI 0.18 – 0.84) for overall QOL at 3 months, no difference at 6 months. Physical QOL no difference at 3 months. Mental QOL better than controls at 3 months (ES 0.46, 95% CI 0.14 – 0.77)
Singh, F. et al.^* 2013⁵⁸	18 controlled trials evaluating prehabilitation or pre-operative exercise programs. (10 RCT’s) AMSTAR Score: 7/11	n = 966 Lung, prostate, Abdominal & GI cancers receiving exercise training or intervention prior to surgery. Age range 54.1 years (± 8.53) to 71.1 years (± 6.3)	AT, RT, and mixed forms AT + RT +/− muscle re-education exercises. Supervised and unsupervised programs. Timing of intervention prior to surgery Median 21 days (range = 7 – 52 days) Frequency 5 – 7 x/week Intensity Aerobic: Range 40% – 80% max capacity. Resistance: 60 % to 80 % 1RM Or Repetitions as a proxy for intensity Session Duration 15 minutes to up to 3 hours/session.	Education-only or No intervention or Different training program	Functional walking capacity: Trend towards significance, only 2 studies showed significance. Pooled effects not calculated. Cardiorespiratory fitness: Significant increases (8% to 32%) Pooled effects not calculated. Quality of Life: Mixed results. Significant variability in measurement tools prevented pooled calculations. 3/5 studies measuring QOL showed no improvement. Rate of Return to Continence: Trend towards significance, study heterogeneity prevented pooled calculations. Length of Hospital Stay: Significant improvements noted, pooled calculations not possible.
Smits, A. et al.^* 2015⁶⁵	8 controlled trials (3 RCTs) AMSTAR score 7/11	n = 413 Endometrial and Ovarian cancers. Following completion of active cancer treatment.	Predominately walking, and unspecified physical activity home-based program. Program Duration 4 weeks to 6 months Frequency 5x/week Session Duration 30 minutes	Mixed controlled and single-arm trials. Comparisons not specified.	Endurance 12-min walk and aerobic capacity improved at 3 and 6 months post intervention. Strength Improved at 6 months. QOL No improvement noted at 3 or 6 months.
Speck, R. et al 2010¹⁷	82 studies 66/82 ‘high quality’ controlled studies included in meta-analysis. AMSTAR score 7/11	n = 6838 Breast (83%), colon, lung, ovarian, leukemia, lymphoma, prostate, sarcoma, stomach, testicular, and other cancer types. 40% during active cancer treatment. 60% post treatment.	80% had combined exercise AT+RT programs. Mode was primarily AT. Intensity Not specified. Assessed frequency during vs. after treatment. Program Duration Most interventions > 5 weeks Session Frequency Average 3 – 5x/week.	All studies included comparison groups but were unspecified.	Exercise during active cancer treatment Significant WMES improvement in Overall physical activity level (0.38, p = 0.001) Aerobic fitness (0.33, p = 0.009) Upper body strength (0.39, p = 0.005) Lower body strength (0.24, p= 0.006) Body weight (−0.25, p = 0.05) Body fat percentage (−0.25, p = 0.04) Functional quality of life (0.28, p = 0.04) Positive mood (0.39, p = 0.002) Anxiety (−0.21, p = 0.02) Self-esteem (0.25, p = 0.02) No significant adverse effects were reported (e.g. blood counts) Exercise after completion of cancer treatment Significant WMES improvement in Physical activity level (0.38, p < 0.0001) Aerobic fitness (0.32, p = 0.03) Upper body strength (0.99, p<0.0001) Lower body strength, (0.90, p = 0.024) Body weight (−0.18, p = 0.004) Body fat percentage (−0.18, p = 0.006) BMI (−0.14, p = 0.002) Overall quality of life (0.29, p = 0.03) Breast cancer-specific concerns (0.62, p = 0.003) Perception of physical condition (0.57, p = 0.04) Mood disturbance (−0.39, p = 0.04) Confusion (−0.57, p = 0.05) Body image (−0.26, p = 0.03) Fatigue (−0.54, p = 0.003), General symptoms and side effects (−0.30, p = 0.03) IGF-1 (−0.31, p = 0.03)
Spence, R.R. et al.^* 2010¹⁸	10 studies (4 RCTs, 3 controlled non-randomized, 2 intervention, non-controlled, 1 single group design) AMSTAR score 8/11	n = 483 4 trials included breast cancer only. 3 trials included mostly breast cancer. 2 trials included only colorectal cancer. Age range 16 – 71 years	AT and RT Program Duration 2 – 26 weeks Intensity Moderate Frequency 3x/week during ‘rehab period’ up to 12 months after adjuvant treatment	Current activity Stretching 3 trials with no comparison group.	Physical Function and Endurance Significantly improved VO2peak and strength. Fatigue Reduced Physiological Biomarkers Trend towards improvement but somewhat mixed. Improvements immune cell function, lower reported neutropenia, lower inflammatory markers. Modest improvements in body composition.
Steel, J. et al.^* 2014²²	2 studies Both trials in hospital-based settings immediately after surgery. AMSTAR score 8/11	n = 58 GI cancers primarily stomach and colorectal.	Arm and leg cycling exercises. Intensity Moderate Frequency 5x/week Program Duration 2 weeks Session Duration 40 minutes	Lower intensity exercise or no exercise controls.	Immune function Significant improvement in NK cell activity. Lower antagonist/cytokine ratio at end of program vs controls. ^* Initially exercise induced a decrease in NK cell activity.
Van Dijck, S. et al.^* 2016 ²³	13 RCTs AMSTAR score 4/11	n = 2,180 Breast cancer patients during and after cancer treatment.	AT Program Duration 1 – 12 months Unspecified duration, intensity, and frequency Primarily unsupervised (as part of ‘physical self-management’ program)	Usual physical activity, usual care or written materials	During cancer treatment QOL was modestly improved or no change was identified. Fatigue modestly improved. Physical function improved. After cancer treatment Consistent improvement in QOL. No significant difference for fatigue levels Mixed results on endurance measures (6MWD, VO2peak)
van Vulpen, J.K. et al. 2016⁴¹	5 RCTs (784 patients) High risk of performance and attention bias. AMSTAR score 8/11	n = 784 Breast cancer patients during adjuvant cancer treatment. (defined as either chemotherapy or radiation therapy) Mean age 50 – 56 years	RT and AT Session Frequency 2 – 5x/week Session Duration 30 – 60 minutes Intensity AT: Moderate RT: > 60 % of 1RM Supervised	Usual care or sham	Fatigue Small to medium effect sizes (ES 0.20–0.50) for general fatigue and physical fatigue improvements vs controls during chemotherapy. No significant effect on cognitive fatigue Supervised programs had larger effect sizes than unsupervised.
Visser, W. et al.^* 2014⁵⁴	5 studies (2 prospective cohort, 2 retrospective cohort, 1 case control) AMSTAR score 7/11	n = 321 Rectal cancer Mean age 55 – 67 years	Pelvic floor and core muscle training Program Duration 7 – 15 sessions Supervised	2 trials pre-post comparison. 3 trials compared to no rehabilitation.	QOL Significantly improved Improved incontinence and pelvic floor muscle function.
Winters Stone, K. M. et al.^* 2010¹⁹	8 studies investigating impact of exercise on bone density. (5 RCT, 5 uncontrolled intervention) AMSTAR score 9/11	n = 567 7 trials breast 1 trial prostate During survivorship period. Mean age range 48 – 55 years.	50% AT 50% RT Program Duration 12 – 52 weeks Session Frequency 2 – 7x/week Intensity Predominately moderate 50% supervised 50% unsupervised	Usual care or drug therapy without exercise	Most exercise groups maintained BMD while controls experienced decline in levels of BMD. Modest increase in BMD in some exercise groups. Trend towards positive improvement in BMD with exercise.
Zhu G. et al. 2016⁴⁶	33 RCTs Moderate allocation and reporting bias. AMSTAR 7/11	n = 2,659 Breast cancer survivors	AT with or without RT, Tai-chi, yoga Frequency and duration not reported	Usual care, wait-list, brief supportive therapy	Significant improvement in QOL (I² = 0% P = 0.006, 95% CI: 0.11, 0.62) General health (I² = 95%, P = 0.02, 95% CI: 0.70, 8.48) Emotional well-being (I² = 2%, P = 0.0006, 95% CI: 0.12, 0.43) Social well-being (I² = 0%, P = 0.01, 95% CI: 0.19, 1.69) No significant improvement in fatigue. Muscle strength significantly improved. (I²= 48%, P = 0.0009, 95% CI: 1.76, 6.78) BMI significantly improved (I² = 0%, P = 0.00001, 95% CI: −1.09, −0.47) Significant reduction in Insulin (I² = 95%, P = 0.05, 95% CI: −13.64, 0.06) and Insulin-like growth factor binding protein (IGFBP)-1 (I² = 46%, P = 0.00001, 95% CI: −4.40, −1.91)
Zimmer, P. et al^* 2016⁴⁷	14 studies (6 RTCs, 1 non-randomized, 2 prospective non-controlled, 1 case series, 1 observational study, 3 cross sectional studies) AMSTAR score 7/11	Mostly breast and some prostate cancer survivors.	11 trials yoga of various forms 1 trial AT 1 trial RT 1 trial tai chi Program Duration 4 weeks - 6 months Session Frequency 1 – 3x/week Session Duration 60 – 90 minutes	Most with no comparison group. 2 trials with usual care comparison.	Cognitive Function Significant improvement with yoga. Significant improvement with other exercise types (AT, RT, and tai chi) Inflammatory Markers Profile improved in both yoga and other exercise groups.

Table Abbreviations: 6MWD- 6 minute walk distance, ALL – Acute leukocytic leukemia, AML – Acute myeloid leukemia, AT – Aerobic training, BMD – Bone mineral density, BMI – Body mass index, CI – Confidence interval, CRC – colorectal cancer, CRF – Cancer-related fatigue, ES – Effect size, FEV – Forced expiratory volume, FVC – Forced vital capacity, GI – Gastrointestinal, HR – Hazzard ratio, IFN – Interferon IGF-BP3 – Insulin-like growth factor binding protein 3, ILGF-I – Insulin-like growth factor I, ILGF- II – Insulin-like growth factor II, HRQOL – Health related quality of life, MET – Metabolic equivalent of task, MDRP – multidimensional rehabilitation program, PA – Physical activity, PRE – progressive resistive training, PSA- Prostate-specific antigen, QOL- Quality of life, RCT – Randomized controlled trial, ROM – Range of motion, RR – Risk ratio, RT – Resistance training, SD – Standard deviation, SF-36 – Short form 36, SMD – Standard mean difference, VO2max – Maximal oxygen consumption, WES – Weighted effect size, XRT – Radiation therapy.

Effect size calculations not provided in the review