Evaluating the role of exercise in modulating immunity and immunotherapy outcomes in cancer: A systematic review.

Abstract

2646 Background: Immunotherapy has become a key cancer treatment, improving survival and reducing side effects. However, its effectiveness can be influenced by immune system function, overall health, and treatment-related side effects. Exercise, known for its health benefits, may also modulate immune responses and enhance immunotherapy outcomes. Despite promising evidence, the impact of exercise on immune function and cancer treatment remains insufficiently understood. This review aims to assess the role of exercise in modulating immunity and improving immunotherapy outcomes in cancer patients. Methods: A systematic review was conducted following PRISMA guidelines, with a comprehensive search of PubMed, Cochrane Library, EMBASE, and ClinicalTrials.gov for studies published from 2010 to 2025. Eligible studies included randomized controlled trials (RCTs), non-randomized trials, pilot studies, and systematic reviews investigating exercise interventions on immune function and immunotherapy in cancer. Key outcomes included changes in immune markers, immune function, and quality of life. Data were extracted and analyzed using standardized protocols. Results: Eight studies, involving 1,172 cancer patients across various types (lymphoma, CLL, melanoma, NSCLC, breast, ovarian, prostate), were included. Exercise modalities studied included aerobic exercise, resistance training, cycling, yoga, and mind-body practices like qigong. Findings consistently showed positive effects of exercise on immune function and treatment outcomes. Two studies reported that exercise mobilized T cells and NK cells, enhancing immune responses. Another two demonstrated improved efficacy of immunotherapeutic agents such as rituximab. Additionally, three studies indicated that exercise improved physical fitness, body composition, and overall quality of life. Conclusions: This review provides evidence that exercise may enhance immune responses and improve outcomes in cancer immunotherapy. While exercise appears to be a beneficial adjunctive therapy, the optimal type, intensity, and duration remain unclear. Further large-scale, high-quality trials are needed to define effective exercise regimens and explore their impact on immunotherapy across various cancer types. The study is registered in PROSPERO: CRD42024627822.