Finding the right time to initiate exercise rehabilitation following a cancer diagnosis: A systematic review and meta-analysis.
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OBJECTIVE: To determine the effect of earlier vs. later initiation of exercise rehabilitation on patient and health service outcomes in individuals with cancer. DATA SOURCES: CINAHL, Embase, MEDLINE and PubMed were searched until October 2025. STUDY SELECTION/ELIGIBILITY CRITERIA: Randomised controlled trials including adults and/or children with cancer that compared exercise rehabilitation initiated at different times were eligible. The primary outcome was physical activity. Secondary outcomes included cardiorespiratory fitness, walking capacity, fatigue and quality of life; and health service outcomes such as hospital length of stay. DATA EXTRACTION AND DATA SYNTHESIS: Outcome data were extracted, and the methodological quality assessed using PEDro. Clinically homogenous data were combined in meta-analyses; overall quality of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations approach. RESULTS: Fifteen trials involving 1270 participants most commonly with breast (n = 6), colorectal (n = 3) and haematological (n = 3) cancers were included. There was low to moderate certainty evidence demonstrating similar improvements in physical activity (SMD -0.03, 95% CI -0.60 to 0.54), fitness (SMD 0.17, 95% CI -0.14 to 0.48), walking capacity (SMD 0.78, 95% CI -0.6 to 0.54), fatigue (SMD -0.11, 95% CI -0.55 to 0.33) and quality of life (SMD 0.17, 95% CI -0.17 to 0.50) when comparing earlier to later initiation. No differences were found in hospital length of stay (MD 0 days, 95% CI -0.9 to 0.9). CONCLUSION: People with cancer can achieve comparable health benefits, regardless of when exercise rehabilitation is initiated. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO Registration Number CRD42024518878. CONTRIBUTION OF PAPER.