A systematic review and meta-analysis of the effects of walking training on cardiorespiratory fitness in cancer patients
Source: PubMed Central Open Access, NCBI / U.S. National Library of Medicine
Objective Walking is a simple and accessible form of aerobic exercise that may improve cardiorespiratory fitness (CRF) in cancer patients; however, its independent effects remain unclear. This systematic review and meta-analysis aimed to evaluate the effects of walking training on CRF, fatigue, dyspnea, safety, and adherence in adult cancer patients. Methods A systematic search was conducted in 4 databases—Web of Science, Embase, PubMed, and Cochrane Library Database—covering the period from the inception of each database through November 28, 2025. The inclusion criteria were randomized controlled trials (RCTs) evaluating walking interventions for cancer patients. Priority was given to meta-analyses of outcome measures using a random-effects model. If the statistical heterogeneity is less than 40%, a fixed-effects model is used. Results 11 randomized controlled trials involving 649 participants were included. Compared with standard care or no intervention, walking training was associated with statistically significant improvements in the two outcomes: peak oxygen uptake (VOpeak) (SMD = 0.56; 95% CI: [0.06, 1.06]; I² = 75%; τ²=0.28; P = 0.03) and fatigue (SMD = −0.45; 95% CI: [−0.71, −0.18]; I² = 32%; τ²=0; P = 0.001). In contrast, no statistically significant effects were observed for maximal oxygen uptake (VOmax) (SMD = 0.20;95% CI: [−0.15, 0.54]; I² = 0%; P = 0.26), 6-Minute Walk Distance (6MWD) (MD = 53.97;95% CI: [−23.00, 130.93]; I² = 80%; τ²=2538;P = 0.17), and dyspnea
Abstract
Objective Walking is a simple and accessible form of aerobic exercise that may improve cardiorespiratory fitness (CRF) in cancer patients; however, its independent effects remain unclear. This systematic review and meta-analysis aimed to evaluate the effects of walking training on CRF, fatigue, dyspnea, safety, and adherence in adult cancer patients. Methods A systematic search was conducted in 4 databases—Web of Science, Embase, PubMed, and Cochrane Library Database—covering the period from the inception of each database through November 28, 2025. The inclusion criteria were randomized controlled trials (RCTs) evaluating walking interventions for cancer patients. Priority was given to meta-analyses of outcome measures using a random-effects model. If the statistical heterogeneity is less than 40%, a fixed-effects model is used. Results 11 randomized controlled trials involving 649 participants were included. Compared with standard care or no intervention, walking training was associated with statistically significant improvements in the two outcomes: peak oxygen uptake (VOpeak) (SMD = 0.56; 95% CI: [0.06, 1.06]; I² = 75%; τ²=0.28; P = 0.03) and fatigue (SMD = −0.45; 95% CI: [−0.71, −0.18]; I² = 32%; τ²=0; P = 0.001). In contrast, no statistically significant effects were observed for maximal oxygen uptake (VOmax) (SMD = 0.20;95% CI: [−0.15, 0.54]; I² = 0%; P = 0.26), 6-Minute Walk Distance (6MWD) (MD = 53.97;95% CI: [−23.00, 130.93]; I² = 80%; τ²=2538;P = 0.17), and dyspnea (SMD = −0.18, 95% CI: [−0.47, 0.11]; I² = 0%; P = 0.23). No serious intervention-related adverse events were reported, and adherence rates ranged from 67% to 94%. Conclusion Current evidence suggests that walking training may improve VOpeak and reduce fatigue in cancer patients, while demonstrating acceptable short-term safety and adherence. However, these findings should be interpreted cautiously because the certainty of evidence remains low. Larger, high-quality randomized controlled trials with standardized intervention protocols and longer follow-up periods are needed to confirm these findings. This study conducted a systematic literature search in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Prior to the search, the study protocol was prospectively registered on the international systematic review registry platform (PROSPERO, registration number: CRD420251140743) to ensure the scientific rigor and methodological soundness of this study. Systematic review registration , identifier CRD420251140743.