Exercise therapy in cancer prevention and treatment

Leading oncology agencies endorse exercise as a supportive-care adjunct to mitigate acute and late effects of cancer treatment. A parallel corollary line of investigation in 'exercise oncology' has emerged examining whether exercise benefit extends beyond symptom control to therapeutic outcomes. In this Review, we synthesize the current evidence for exercise as an anticancer strategy. In the cancer prevention and post-diagnosis settings in turn, we first review the epidemiological evidence linking exercise with primary cancer risk and disease outcomes after diagnosis. We then summarize data from key clinical trials evaluating the efficacy of structured exercise therapy on clinical end points and on blood-based and tissue-based biomarkers in individuals with or at risk of cancer. Modification of an individual's exposure to exercise can alter the host macroenvironment, leading to changes in distant tissue and/or tumour microenvironments. Such adaptations might alter the efficacy of conventional cancer therapies, and the newest developments in this rapidly expanding field are also reviewed herein. Finally, we outline a translational framework to facilitate continued development of exercise as an anticancer therapeutic modality and a path towards precision exercise oncology.