This review aims to summarize the recommendations endorsed by scientific societies regarding physical activity for patients with cancer. A systematic search was conducted to identify guidelines endorsed by scientific societies and published in the last 15 years dedicated to physical activity for cancer patients. The AGREE II instrument was used to assess the methodological quality of the guidelines. Results are presented as qualitative synthesis. A total of 11 guidelines met the inclusion criteria. Seven were considered high quality, scoring ≥60% in the AGREE II tool. All the guidelines recommended to include aerobic and resistance training as types of activities. Regarding the physical activity dosage, most suggested a generic 150minutes/week of moderate-intensity activity plus resistance training twice a week. Three guidelines reported instructions for exercise prescription, including frequency, intensity, and duration of training sessions. Six guidelines reported exercise testing/medical clearance instructions, 9 provided considerations regarding adaptation/precautions, and 7 detailed the specialists for referral. Four guidelines considered motivational aspects related to physical activity and cancer. Although important steps have been made in the more recent recommendations, effort is needed to produce high-quality research in the exercise-oncology field, with the ultimate aim of developing more tailored guidelines.

Exercise before surgery, as part of prehabilitation, aiming to enhance patients' functional and physiological capacity, has become widespread, necessitating an in-depth understanding. A systematic search was conducted on Pubmed, Cochrane, and Scopus to examine the effect of exercise as prehabilitation, alone or in combination with other interventions, in patients with cancer. Interventional studies applying a single-arm, randomized controlled, or nonrandomized design were included. A total of 96 studies were included, and categorized according to cancer types, i.e., gynecological, breast, urological, gastrointestinal and lung cancer. For each cancer site, the effect of exercise, on physical fitness parameters and postoperative outcomes, including length of hospital stay and postoperative complications, was reported. Exercise as prehabilitation may have an important role in improving physical fitness, postoperative outcomes, and accelerating recovery, especially in certain types of malignancies.

Purpose Cardiovascular diseases are a leading cause of non-cancer mortality among patients with cancer, with cardiac autonomic dysfunction identified as a significant predictor of future cardiovascular conditions. Despite the importance of autonomic dysfunction as a prognostic marker being well-established in healthy individuals and other chronic conditions, its role in patients with cancer remains underexplored. This narrative review aims to synthesize existing literature on the role of cardiac autonomic dysfunction in patients with cancer and explore the potential of physical exercise as a non-pharmacological intervention to modulate the autonomic nervous system positively. Methods This review examines methods for assessing cardiac autonomic dysfunction, the factors contributing to its dysregulation, and the prognostic role of heart rate variability. It also analyzes current evidence on the effectiveness of various physical exercise modalities, including aerobic, resistance training, and mind-body interventions, in modulating autonomic function. Results Patients with cancer are exposed to disease-related, lifestyle, and physiological factors that impair autonomic regulation. This dysfunction is associated with worse outcomes, such as increased mortality and disease progression. Preliminary evidence suggests that physical exercise, particularly a combination of aerobic and resistance training, as well as yoga, may improve heart rate variability and mitigate sympathovagal imbalance in patients. Conclusion While research on the effects of physical exercise on autonomic modulation in cancer patients is still limited, early findings show promise. Further studies are needed to fully understand the mechanisms through which exercise improves cardiac autonomic function and its long-term benefits in oncology, positioning this as a novel area of research.

Whereas an exercise intervention effectively improves patients’ quality of life, little information is available about the contribution of each physical fitness component. This study aims to explore the association between physical fitness components and the quality-of-life domain in patients with cancer. Between September 2021 and August 2023, 160 patients with mixed cancer types visiting the Oncology Unit were selected on a consecutive basis according to selection criteria. They underwent a comprehensive baseline assessment including the six-minute walking test, the handgrip strength test, the isometric leg press test, the back scratch, sit and reach tests, their waist–hip ratio, and their body mass index. The European Organization for Research and Treatment of Cancer Quality of Life and Core Questionnaire was used to measure the quality of life. The sample size was based on the use of regression models to study associations between clinical characteristics and fitness outcomes. All of the analyses were performed using the SPSS v.25 statistical package. Patients had a mean age of 58 years, 68% were female, 42% were affected by breast cancer, and all were receiving anticancer treatments. Higher functional capacity was associated with better global health status (p < 0.0001) and physical (p < 0.0001), role (p < 0.0001), emotional (p = 0.026), and social function (p = 0.016) and inversely linked with fatigue (p = 0.001). Lower-limb flexibility was significantly associated with all of the domains except for role and social functions. The waist–hip ratio was inversely associated with physical function (p < 0.0001) and positively related to fatigue (p = 0.037). Exercise programs aiming to improve the quality of life in cancer should be addressed to optimize these fitness components.

Purpose: Exercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities. Methods: Forty-seven patients with breast cancer (stage I -IV) participated in a 12 -week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program , the home -based program, or the group -based program . Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health -related skills and quality of life. Results: Out of 47 recruited patients, 24 chose the home -based program, 19 the personal training program, and four the group -based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home -based programs, and 100% for group -based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality -of -life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected. Conclusions: An exercise prescription based on a patient -preferred delivery modality showed high feasibility in women with breast cancer.

Purpose: Physical activity is associated with a lower mortality and recurrence risk in cancer, yet the underlying mechanisms remain unclear. This study aimed to evaluate the effects of running sessions on the tumorigenic potential of prostate cancer cells using a 3D in vitro model. Methods: Fifteen healthy males completed two outdoor running sessions (5 km and 10 km), interspersed by 1 month of wash-out time. Blood samples were collected before (PRE), immediately after (POST), and 3 h after (POST-3 h) sessions. Human serum (HS) samples were used to stimulate LNCaP and PC3 cell lines in 3D in vitro culture technique. The spheroid formation ability was quantified after 21 days of incubation, using GelCount. Results: In both prostate cancer cell lines, a reduction in spheroid number was shown, by both running sessions and in all timepoints considered (LNCaP cells: 5 km: − 23.8%; 10 km: − 5.6% POST HS; 5 km: − 37.8%; 10 km: − 34.8% POST-3 h HS; PC3 cells: 5 km: − 14%; 10 km: − 15.9% POST HS; 5 km: − 14.2%; 10 km: − 13% POST-3 h HS). The spheroid volume was reduced by 42.6% (5 km) and 51.1% (10 km) with POST-3 h HS, in LNCaP cells; no significant reduction was observed in PC3 cells. No differences were found between the running sessions, while higher muscle mass, cardiorespiratory fitness and age were associated with greater reductions in spheroid number and volume, especially in LNCaP cells. Conclusion: Running sessions reduce prostate cancer cell spheroid formation, especially in participants with higher physical fitness. Shorter running distances showed comparable effects to longer ones, highlighting practical implications for real-world exercise prescriptions in oncology.