Individualisation of Exercise Prescription in Cancer: A Systematic Review and Meta-Analysis

The importance of prescribing individualised exercise programs for all people with cancer has been echoed across the literature. However, there is a notable gap in our understanding of how exercise individualisation is applied in oncology research, what the common individualisation practises of exercise prescription for people with cancer are, and the effects of these practises on common symptoms such as fatigue.

The aims of this systematic review and meta-analysis were to elucidate the individualisation prescription methods employed in exercise oncology research, determine whether current studies employ best-practice autoregulatory prescription for people with and following treatment for cancer, and conduct subgroup analyses to determine the influence of exercise individualisation methodology on fatigue severity.

A systematic literature search was conducted in PubMed, EMBASE, CINAHL, and Web of Science databases. Studies written in English stating they prescribed any form of 'individualised' exercise for people ≥ 18 years with a histologically confirmed diagnosis of cancer were included in this review. Pooled meta-analysis and subgroup meta-analysis were performed using a random-effects model.

Sixty-three studies involving 4472 participants were included. The rationale underpinning why exercise was individualised was predominantly based on objective reasons (41%). Most commonly, exercise was individualised pre-session, and inter-session (25%) via modulation of the exercise prescription, whereby exercise prescriptions were adapted in various heterogenous ways (22%). Autoregulation was only explicitly reported in two (3%) studies. Individualising exercise using subjective reasoning was significantly associated with reduced fatigue severity (SMD = - 0.355, 95% CI - 0.631 to - 0.079; p = 0.0116). Timing exercise individualisation inter-session had a moderate and significant pooled effect on reducing fatigue severity (SMD = - 0.616, 95% CI - 0.962 to - 0.271; p = 0.0005).

This review highlights most exercise oncology studies individualise exercise at baseline only, with this being broadly reported via modulation of the exercise prescription, which may not meet the needs of people with cancer, given their often-fluctuating symptoms and clinical status. Fatigue severity may be reduced by individualising exercise prescription using subjective assessments and by timing the individualisation between sessions.

The original protocol was registered with the Open Science Framework on 28 April 2022 ( https://osf.io/d6tkv/ ).