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Physical activity for cancer survivors: meta-analysis of randomised controlled trials

BMJ 2012; 344 doi: (Published 31 January 2012) Cite this as: BMJ 2012;344:e70
  1. Daniel Y T Fong, assistant professor1,
  2. Judy W C Ho, consultant surgeon2,
  3. Bryant P H Hui, research assistant3,
  4. Antoinette M Lee, assistant professor4,
  5. Duncan J Macfarlane, associate professor5,
  6. Sharron S K Leung, assistant professor1,
  7. Ester Cerin, associate professor5,
  8. Wynnie Y Y Chan, public health nutritionist6,
  9. Ivy P F Leung, dietitian7,
  10. Sharon H S Lam, part time lecturer (nutritional science)8,
  11. Aliki J Taylor, honorary senior clinical research fellow9,
  12. Kar-keung Cheng, professor9
  1. 1School of Nursing, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, China
  2. 2Division of Colorectal Surgery, Department of Surgery, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong
  3. 3Department of Applied Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong
  4. 4Department of Psychiatry, Li Ka Shing Faculty of Medicine, University of Hong Kong, Queen Mary Hospital, Pokfulam, Hong Kong
  5. 5Institute of Human Performance, University of Hong Kong, Pokfulam, Hong Kong
  6. 6College of Life Sciences and Technology, Dietetics, Food and Nutritional Sciences, School of Professional and Continuing Education, University of Hong Kong, Pokfulam, Hong Kong
  7. 7Department of Dietetics, Queen Elizabeth Hospital, Kowloon, Hong Kong
  8. 8College of International Education (CIE), Hong Kong Baptist University, Shek Mun, Shatin, Hong Kong
  9. 9Department of Public Health, Epidemiology and Biostatistics, University of Birmingham, Public Health Building, Edgbaston, Birmingham B15 2TT, United Kingdom
  1. Correspondence to: J W C Ho, Division of Colorectal Surgery, Department of Surgery, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR, China judyho{at}
  • Accepted 8 November 2011


Objective To systematically evaluate the effects of physical activity in adult patients after completion of main treatment related to cancer.

Design Meta-analysis of randomised controlled trials with data extraction and quality assessment performed independently by two researchers.

Data sources Pubmed, CINAHL, and Google Scholar from the earliest possible year to September 2011. References from meta-analyses and reviews.

Study selection Randomised controlled trials that assessed the effects of physical activity in adults who had completed their main cancer treatment, except hormonal treatment.

Results There were 34 randomised controlled trials, of which 22 (65%) focused on patients with breast cancer, and 48 outcomes in our meta-analysis. Twenty two studies assessed aerobic exercise, and four also included resistance or strength training. The median duration of physical activity was 13 weeks (range 3-60 weeks). Most control groups were considered sedentary or were assigned no exercise. Based on studies on patients with breast cancer, physical activity was associated with improvements in insulin-like growth factor-I, bench press, leg press, fatigue, depression, and quality of life. When we combined studies on different types of cancer, we found significant improvements in body mass index (BMI), body weight, peak oxygen consumption, peak power output, distance walked in six minutes, right handgrip strength, and quality of life. Sources of study heterogeneity included age, study quality, study size, and type and duration of physical activity. Publication bias did not alter our conclusions.

Conclusions Physical activity has positive effects on physiology, body composition, physical functions, psychological outcomes, and quality of life in patients after treatment for breast cancer. When patients with cancer other than breast cancer were also included, physical activity was associated with reduced BMI and body weight, increased peak oxygen consumption and peak power output, and improved quality of life.


  • Contributors: JWCH and DYTF contributed equally to the study. JWCH, DYTF, EC, WYYC, AJT, SHSL, IPFL, and KC conceived and designed the study. DYTF, JWCH, BPHH, DJM, and SHSL searched the literature. DYTF, JWCH, and BPHH reviewed the literature and extracted data. DYTF and BPHH performed the meta-analysis. DYTF, JWCH, and AML analysed and interpreted the data. DYTF, JWCH, and BPHH drafted the manuscript. DJM, EC, AML, SSKL, WYYC, AJT, SHSL, IPFL, and KC critically revised the manuscript for important intellectual content. All authors approved the final version of the manuscript. JWCH, DJM, AML, SSKL, AJT, and KC obtained funding. JWCH and KC supervised the study. JWCH is guarantor.

  • Funding: This study was supported by the World Cancer Research Fund International, World Cancer Research Fund UK, and World Cancer Research Fund Hong Kong (grant No 2009/02). The funding body had no input in study design and the collection, analysis, and interpretation of data and the writing of the article and the decision to submit it for publication. All authors are independent from the funding body.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at (available on request from the corresponding author) and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: No additional data available.

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