Table 2. The technical characteristics of included studies in the current systematic review.

Reference	Sample size	Cancer type	Gender	Method (exercise name, duration, intensity, sets, reps).	Timing of intervention	Duration of the study	Immunity and quality of life parameter or immune component examined	Results	Conclusion
Perez-Tejada et al. (2021)	57 EX = 29 Co = 28	Prostate	Male	Patients undergo combined progressive AE & RT.	More than 2 MO after starting with androgen deprivation therapy	12 W	General health; QLQ-C30 and C-RP	Significant improvement in QOL: pre-EX: 66.0 ± 23.1, post-EX: 71.4 ± 17.5, P-value = 0.02.	Improve well-being and overall QOL of patients. The CRP significantly decreased following EX.
				RT included (upper- and lower-body 8 EX, 2-4 sets, 12-6RM) & AE (Progressive cycling and walking 2/w) 15–20 M, 65–80%				CRP: pre-EX: 2.7 ± 3.2, post-EX: 1.8 ± 1.1, P-value = 0.008
				HR peak and 11-13 RPE
Lanser et al. (2020)	54 EX = 27 CO = 27	Prostate	Male	The intervention group undergoes AE for 30 M and 15 M of RT (sets of 8 reps at 70% to 75% of their estimated 1RM). Both EX was about 50 to 55 M at 65–70% VO2M for 5/D/W. The CO group revised only usual care.	EX started one W before radiotherapy	8 W	TNF- α, pro-inflammatory cytokines (interleukin IL-1 β, IL-6) F, and QOL	Significantly decreased pro-inflammatory cytokine levels: IL-6: pre-EX: 43461.35 ± 1824.8, post-EX: 907.5 + 2460.7, TNF- α: pre-EX: 50.01 ± 20.63, post-EX: 61.74 + 39.12, and IL-1 β: pre-EX: 98.57 ± 180.12, post-EX: 96.72 ± 134.03, P-value = < 0.05.	Improves inflammatory markers (by decreasing their levels), decreases F, and improves QOL in high-risk PC patients after radiation therapy.
								Decreased F: pre-EX: 42.7 ± 2.1, post-EX: 43.9 ± 5.0, P-value = < 0.05
								Improved QOL: pre-EX: 70.7 ± 2.1, post-EX: 72.3 ± 6.3, P-value = < 0.05
Ferlay et al. (2020)	66 EX = 35 CO = 31	Prostate	Male	The intervention groups undergo AE; 5/S/W for 8W and 3/D/W for the next 10 MO for 30 M.	During and after radiotherapy and androgen deprivation therapy	12-M0	Inflammatory factors, FACT-G score, and QLQ-C30	Improve all the aspects of QOL: pre-EX: 70.7 ± 2.1, post-EX: 65.91 ± 4.8, P-value = 0.001.	EX improved QOL and reduce pro-inflammatory cytokine levels in patients with PC undergoing radiotherapy and androgen deprivation therapy.
				& RT; (2 sets of 8 reps at 70% to 75% for 25 M of their estimated 1RM). Both EX was about 65 to 70 M. with 65% to 70% VO2M. After radiation therapy, the intervention group did the same program, 3/W, but 1.5 H/D for 40 M of AE & 35M of RT. with 70% to 80% of heart rate reserve. The CO received only usual care				F: Pre: 42.7 ± 2.1, Post: 39.8 ± 3.7, p-value = 0.001.
								No significant difference in IL- 1: pre-EX:106.6 ± 226.6, post-EX: 150.6 ± 1933.8, P-value = 0.18, and TNF- α levels: Pre-EX: 32.8 + 161.1, Post-EX: 84.6 ± 262.7, P-value = 0.71
								Significant difference in IL ¬ 6: Pre-EX: 3158.1 ± 1675.2 and Post-EX: 150.6 ± 1933.8, P-value = < 0.001.
Hasham, Ahmed & Zeshan (2020)	67	Head and neck, Breast, Hematologic =, Non-small cell lung Small cell lung, Colorectal, Prostate, Liverbile duct , Esophageal Central nervous system, Skin, Unknown primary, Urogenital, Hodgkin lymphoma	Male and female	67 patients engaged in Rehab program for 8 W at the hospital gym 2D/W under the direction of an Occupational Therapist	After anticancer therapy	8w	Esas, CRP, F and QOL	A significant relationship between normal serum CRP and program completion, pre-EX: 3.15 ± 2.97, post-EX: 3.68 ± 3.23, P-value = 0.02.	Patients with different advanced types of cancers showed considerable improvements in functioning and QOL across several categories. The study concluded that an average amount of C-RP could indicate program completion.
								Significant improvement in QOL: pre-EX: 4.85 ± 2.62, post-EX: 3.89 ± 2.41, P-value = 0.01.
								F: pre-EX: 4.89 ± 2.6, post-EX: 3.81 ± 2.26, P-value = 0.001.
Condello et al. (2016)	38 EX = 19 CO = 19	Prostate and breast	Male and female	AE: (walking) increasing with 5–20% of steps at 3–5 RPE & RT: 11 EX, increasing towards 4 sets 15 reps: Low to moderate intensity. Patients were engaged in daily EX.	Following primary diagnosis, starting radiotherapy of at least 6 W	4W	PSQI scores, IL-6, and sTNF-R	Improvement in sleep quality: pre-EX: 7.06 ± 4.26, post-EX: 6.00 ± 3.87, P-value = 0.37.	Changes in sleep measurements and inflammatory markers were not associated with the intervention group. The relationship was found between TNF- α and subjective sleep quality as well as TNF- α sleep delay, patients had a better subjective sleep quality, and sleep efficiency was linked with higher levels of sTNF-R and IL-6p, respectively.
								IL-6: pre-EX: 1.08 (range 0.06–2.98), post-EX: 1.38 (range 0.29–6.41) were increased, P-value = 0.31. While sTNF-R was decreased: pre-EX: 760.62 (range 448.64–1,476.21), post-EX: 680.52 (range 361.68–1,319.53). P-value = 0.59.
Albrecht & Taylor (2012)	43, EX= 22 CO=21	Thyroid cancer	Male and female	Patents were asked to perform AE (walking, 3–5 D/W for at least 150 M/W), RT (upper body EX for 2/W for more than 2 sets/ times) & flexibility EX (5 M before and after AE and RT).	During taking thyroid hormone medicine	12 W	HADS-A, EORTC QLQ-C30, NKCA and NKCC	Anxiety: pre-EX: 13.86 ± 3.31, post-EX: 11.32 ± 2.59, and F: pre-EX: 4.48 ± 1.46, post-EX: 3.52 ± 1.74 were significantly decrease, P-value = 0.001.	In thyroid cancer patients, a home-based EX program is beneficial in lowering F and anxiety, enhancing QOL, and boosting immunological function. A home-based EX program can be implemented for cancer patients.
				30–40 M of EX were considered appropriate.				Improvement in QOL: pre-EX: 70.51 ± 12.33, post-EX: 82.73 ± 10.49, P-value = 0.001.
								NKCA cytotoxicity: pre-EX:11.09 ± 7.71, post-EX: 14.46 ± 8.28, and NKCC cell: pre-EX: 10.93 ± 5.05, post-EX: 12.65 ± 5.86, in the intervention group were significantly increased, P-value = 0.004.
Shephard (2017)	60	Breast	Female	Patients were divided into three groups: 1—supervised EX group (AE + RT + education programme, n = 20); performed 45 M/D for 3 D/W under the direction of a professional doctor. 2—Home EX group (AE + education programme, n = 20); performed brisk walking for 30 M/D for 3 A/W. Groups 1 and 2 undergo 12 W of EX. 3—education programme (n = 20) followed up for 12 W.	Following breast cancer treatments.	12 W	IL-8, TNF- α, ENA-78, EORTC QLQ-C30, BFI and BDI.	Post-treatment IL-8: pre-EX: 10.37 ± 3.60, post-EX: 7.76 ± 3.10, and ENA-78: pre-EX: l9.64 ± 3.81, post-EX: 7.34 ± 5.29, and TNF- α: pre-EX: 13.01 ± 6.72, post-EX: 11.60 ± 4.71 levels were significantly decreased in the home EX group P-value = 0.03. BDI: pre-EX: 7.75 ± 6.69, post-EX: 4.70 ± 4.10, and BFI: pre-EX: 3.44 ± 2.23, post-EX: 2.86 ± 2.02, and QOL: pre-EX: 80.35 ± 11.22, post-EX: 85.67 ± 8.07, were significantly decreased following the EX, P-value = 0.004.	EX-induced changes in angiogenesis and apoptosis-related molecules imply that these parameters may be affected by EX. Patients with breast cancer who have completed their treatments have improved their QOL and reduced their depression.
Higgins et al. (2014)	64 EX = 32 CO = 32	Malignant with the indication haematopoietic	Male and female	EX group undergo aerobic endurance training 2/D on a bicycle ergometer 10–20 M during hospitalization & activities of daily living include walking on the hospital’s corridor every D (except weekend). CO group undergoes 20 M/D under the professional therapist at all times.	Undergoing haematopoietic stem cell transplantation	Approximately 6 W	EORTC QLQ-C30, haematological parameters (leucocytes, plts, Hb)	All haematological measures show significant declines in the intervention group: leucocytes: pre-EX: 6.7 ± 6.1, post-EX: 4.0 ± 1.6, Plts: pre-EX: 157.8 ± 98.1, post-EX: 83.6 ± 69.5, and Hb: pre-EX: 10.8 ± 2.2, post-EX: 9.4 ± 1.4, P-value = 0.001. Significant differences in favour of the EX-group concerning the QOL: pre-EX: 75.8 ± 21.8, post-EX: 61.6 ± 22.7, P-value = 0.006.	EX might have some favourable impacts on the patient’s physiological, psychological, and psychosocial levels during the full duration of the Hematopoietic stem cell transplant. During the EX-period, the majority of the patients were found to have steady neutrophil engraftment. Patients who underwent hematopoietic stem cell transplantation were not exposed to any additional risks, and on the contrary, the training program appeared to have aided in the patient’s recovery process.
Courneya & Friedenreich (1999)	20 EX = 10 CO = 10	Non-metastatic cancer		EX group undergo combined AE and RT. AE was 20 to 40 M (+5 M of warm-up and 5 M cool-down with 50% to 75%) intensity of estimated heart rate reserve (VO2M) & RT intensity was from 1 set of 12–15 reps to 2–3 sets of 10–15 RM. Patients participated 3/S/W, with 2/S under the supervision of the EX-physiologists. While the CO performed 2/S/W of supervised static stretching 30–45/M/S	During chemotherapy	12W	Inflammatory profile pro-inflammatory cytokines (IL-6 and IL-1 β), anti-inflammatory cytokines (IL-10, IL-1ra, and IL-15), and CRP. FACIT-F and PASE questionnaire	The intervention group showed no deterioration of the inflammatory profile and cancer-related F following the intervention, IL-1 β: pre-EX: 0.9 (0.4–1.1), post-EX: 1 (0.4–1.6), IL-10: pre-EX: 1.7 (0.5–9.2), post-EX: 8.2 (4.5–16.4), IL-15: pre-EX: 2.0 (1.8–4.6), post-EX: 2.5 (1.8–6.6), and IL-6: pre-EX: 0.7 (0.2–3.7), post-EX: 0.5 (0.1–3.3). P-value = 0.40. A decline in the CRP: pre-EX: 4.7 (3.8–5.8), post-EX: 3.1 (2.0–8.1) was observed in the intervention group. associations reaching significance were observed for the delay in D post-intervention in IL-1 β, IL-15, and leptin. A lower IL-6/IL-10 ratio: pre-EX: 0.47 (0.3–0.67), post-EX: 0.73 (0.18–3.2) in the intervention group was also found, P-value = 0.03. There was a trend for a significant increase of 4 points on the FACIT-F scale in the intervention group scores following the EX, P-value = 0.10.	The study concluded that, in breast cancer patients undergoing chemotherapy, no rise in pro-inflammatory markers was shown, EX had a favourable effect on cancer-related F and pain. EX might be a positive factor to improve QOL and decreased F. For cancer patients in the early stages of therapy, combined EX training appears to have a beneficial effect on cancer-related F without altering the fasting systemic pro-inflammatory profile.

Notes.

EX

exercise

CO

control

MO

Month

RT

Resistance training

AE

Aerobic exercise

W

Weeks

M

Minute

VO2M

Maximal heart rate

S

Session

H

Hour

D

Day

The Edmonton Symptom assessment system = RM

Repetition maximum

RPE

Rating of perceived

FACT-F

Functional Assessment of Cancer Therapy–Fatigue

FACT-G

Functional Assessment of Cancer Therapy-General

EORTC QLQ-C30

European Organization for the Research and Treatment of Cancer Quality of Life Questionnaire

HADS-A

Hospital Anxiety-Depression Scale-Anxiety

NKCA

natural killer cell activity

NKC

natural killer cell

ENA-78

epithelial neutrophil activating protein 78

VEGF

vascular endothelial growth factor

GRO

growth related oncogene alpha

RANTES

regulated upon activation, normal T-cell expressed, and secreted

ANG

angiogenin

PDGF

platelet derived growth factor

TRO

thrombopoetin

MCP 1

monocyte chemotactic protein-1

MCP2

monocyte chemotactic protein-2

MCP3

monocyte chemotactic protein-3

BFI

the brief fatigue inventory

BDI

Beck Depression Inventory

CRP

C-reactive protein

TNF- α

tumour necrosis factor alpha

F

fatigue

Esas

the Edmonton Symptom Assessment System