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Physical activity improves fatigue and muscle strength in pediatric cancer patients based on a meta-analysis of 24 studiesDoes moving more help young cancer patients feel better and fight fatigue?

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Key Takeaway
Consider physical activity to improve fatigue and muscle strength in pediatric cancer patients, noting limited safety data.

This systematic review and meta-analysis assessed the impact of physical activity (PA) on children and adolescents with cancer. The analysis pooled data from 24 studies, comprising 9 focused on children, 5 on adolescents, and 10 including both groups. The primary outcomes examined included quality of life, exercise capacity, and cognitive function, with secondary outcomes covering social function, body composition, and safety.

Significant improvements were identified for several specific indicators. Fatigue showed a standardized mean difference (SMD) of 0.66, while muscle strength improved with an SMD of 1.77. Trunk muscle strength demonstrated the largest effect size with an SMD of 4.20. Other significant improvements included PA behavior (SMD = 1.04), PA levels (SMD = 0.97), six-minute walk test (SMD = 0.62), cognitive function (SMD = 0.32), executive function (SMD = 0.47), and social function (SMD = 0.23).

In contrast, no significant effects were found for quality of life scales, upper and lower body muscle strength, balance, flexibility, athletic performance, peak oxygen uptake, depressive symptoms, bone density, BMI, fat percentage, NK cells, or inflammatory factors. Regarding safety, adverse events, serious adverse events, discontinuations, and tolerability were not reported in the included studies.

The evidence regarding the association between PA and adverse effects in this population remains limited. While the practice relevance suggests PA can improve health-related outcomes and potentially reduce disease burden, the lack of reported safety data and the observational nature of the evidence necessitate cautious interpretation. Clinicians should consider these results as supportive but not definitive proof of benefit or harm.

Imagine a young person fighting cancer who feels too tired to play or focus in school. A new look at the science suggests that getting moving can change that story. Researchers combined data from 24 different studies involving children and adolescents with cancer to see if physical activity helps. The answer is a clear yes for several key areas of life.

The study showed that active kids and teens felt less fatigued and had stronger muscles, especially in their trunks. They also walked further in tests and showed better signs of thinking clearly and managing their emotions. Social connections improved, too, as these young people felt more able to engage with friends and family.

But the news is not perfect. The review found no significant changes in overall quality of life scores, body composition like BMI or fat percentage, or balance. It also did not boost athletic performance or peak oxygen levels. The researchers noted that while the benefits for fatigue and strength are strong, we still need more information about whether exercise causes any side effects in this specific group.

The bottom line is that moving more can help reduce the burden of disease by improving how these patients feel physically and mentally. It is a safe and effective way to tackle specific problems like tiredness, but it does not fix everything. We must be honest about what the data shows: movement helps, but it is just one part of a larger journey.

What this means for you:
Physical activity reduces fatigue and builds strength in young cancer patients, but does not change overall quality of life scores.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedMar 2026
View Original Abstract ↓
BackgroundAlthough treatment-related adverse effects in children and adolescents with cancer are likely multifactorial, insufficient physical activity (PA) is a major contributor. However, evidence on the association between PA and adverse effects in these population remains limited. We aimed to estimate the effects of PA on health-related outcomes (HrO).MethodsWe searched nine databases from inception to August 5, 2025, for randomized controlled trials evaluating the effects of PA on HrO in children and adolescents with cancer. Data extraction followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting guideline. Independent reviewers extracted study data, and a random-effects model was used to pool results. Two reviewers independently extracted data, assessed the risk of bias, and evaluated the quality of evidence. The primary outcomes included quality of life (QoL), exercise capacity, and cognitive function indicators, while secondary outcomes encompassed social function and body composition indicators, as well as PA intervention acceptability and safety.ResultsThe search identified 3,037 studies, only 24 met the eligibility criteria, including nine articles on children, five on adolescents, and ten on both groups. For primary outcomes, PA significantly improved fatigue (SMD = 0.66), muscle strength (SMD = 1.77), trunk muscle strength (SMD = 4.20), PA behaviour (SMD = 1.04), PA levels (SMD = 0.97), six-minute walk test (SMD = 0.62), cognitive function (SMD = 0.32), and executive function (SMD = 0.47); however, PA had no significant effect on QoL, the QoL scale, upper and lower body muscle strength, balance, flexibility, athletic performance, peak oxygen uptake, and depressive symptoms. Regarding secondary outcomes, PA significantly improved social function (SMD = 0.23) but had no significant effect on bone density, BMI, fat percentage, NK cells, or inflammatory factors. Additionally, moderator analysis showed that PA conditions and participant traits significantly affected the outcomes.ConclusionsIn children and adolescents with cancer, PA can improve HrO, ultimately helping to reduce the disease burden.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/view/CRD420251018626, identifier CRD420251018626.
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