Home-based exercise programmes improved fitness and quality of life in people with cancer

Design

Systematic review and random-effects meta-analysis of randomised controlled trials

Population

632 adults with cancer in nine randomised trials of home-based exercise

Primary outcome

Cardiorespiratory fitness, health-related quality of life, adherence and safety

Effect

Fitness SMD 0.42 (95% CI 0.09 to 0.75); quality of life SMD 0.63 (95% CI 0.05 to 1.22); dropout 15.2%

This meta-analysis pooled nine randomised trials with 632 adults with cancer who followed structured home-based aerobic and/or resistance exercise programmes based on cardiac rehabilitation principles. Primary outcomes were cardiorespiratory fitness, health-related quality of life, adherence and safety.

Home-based exercise improved fitness (standardised mean difference 0.42, 95% CI 0.09 to 0.75; I-squared 62%) and quality of life (0.63, 0.05 to 1.22; I-squared 84%). Reporting and methods quality were generally good. Adherence exceeded 75% in most studies that reported it, and dropout was 15.2%. Adverse event reporting was inconsistent, and the authors found no clear safety signal but call the evidence insufficient for firm safety conclusions. Findings on strength and fatigue were inconsistent.

The heterogeneity was high, so the size of benefit differs between programmes and populations, and intervals are wide. Exercise should be started with the oncology team's agreement and adapted to blood counts, bone disease and symptoms. A home-based format is attractive where access to supervised centres is limited.

• Consider recommending a structured, graded home exercise plan for patients who are medically stable, after discussing with the oncology team.
• Combine aerobic and resistance elements and build up slowly.
• Check for contraindications first: low counts, bone metastases, recent surgery, unstable symptoms.
• Agree a simple log and a review at each visit to support adherence.
• Arrange supervised sessions where available for patients with higher risk.

Why it matters

It offers a low-cost way to reach patients who cannot attend centre-based rehabilitation.

Don't overread it

Safety reporting was incomplete and heterogeneity was high, so firm conclusions on safety and on the size of benefit are not possible.

The statistics, in plain English

A standardised mean difference of 0.42 is a small-to-moderate improvement in fitness, and 0.63 is moderate for quality of life. High heterogeneity (84% for quality of life) means trials disagreed, and the lower confidence limit near 0.05 means a small benefit cannot be ruled out.

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