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Effects of exercise-based prehabilitation programs on sleep in patients with cancer undergoing surgery: a systematic

Manuel Fernandez-Escabias¹, Benito Miron², Marta Flor-Alemany³

¹Department of Physiology, Faculty of Medicine, Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.

European Journal of Surgical Oncology : the Journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology

|December 23, 2025

Abstract

Objective:

This meta-analysis aimed to determine the effects of exercise-based prehabilitation programs on sleep in patients with cancer undergoing surgery.

Data Sources:

A systematic search was conducted in MEDLINE (via PubMed) and Web of Science from inception to April 2024.

Study Selection:

After eligibility assessment, 170 articles met the criteria for review. Ultimately, 11 randomized and non-randomized controlled studies, as well as 9 uncontrolled before-and-after studies, were included.

Outcome Measures:

Subjective sleep outcomes included changes in the insomnia dimension of the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale and the Insomnia Severity Index. Objective sleep outcomes included total sleep duration, sleep efficiency, sleep onset latency and wake after sleep onset.

Results:

The meta-analysis of controlled studies showed that exercise-based prehabilitation programs did not show statistically significant improvements in any of the assessed sleep outcomes (P > 0.05). In uncontrolled before-and-after analyses, a small but statistically significant reduction in insomnia symptoms was observed (d = -0.18; P < 0.001). Greater enhancements in insomnia symptoms were found in only-exercise programs involving moderate-intensity concurrent training conducted at home.

Conclusions:

Our findings suggest that exercise-based prehabilitation programs may lead to modest improvements in sleep-related outcomes among patients with cancer undergoing surgery. In particular, concurrent and home-based interventions appear most promising for reducing insomnia symptoms in the preoperative context.

Prospero:

CRD42024507613.

Keywords:

Lifestyle Nutrition Operation Preoperative Psychology Training

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