Comparative Efficacy of Various Exercise Types on Psychophysiological Outcomes in Colorectal Cancer Survivors: A Network Meta-Analysis

Abstract

Purpose: This network meta-analysis aimed to evaluate and rank the comparative efficacy of aerobic training (AT), resistance training (RT), combined AT and RT (CT), and high-intensity interval training (HIIT) primarily on body weight and secondarily on body mass index (BMI), fat-free mass, fasting glucose, fasting insulin, handgrip strength, physical activity, cardiorespiratory fitness, fatigue, quality of life, anxiety, depression, and exercise adherence in colorectal cancer (CRC) survivors.

Methods: MEDLINE/PubMed, Scopus, Web of Science, CENTRAL, and MedRxiv were searched for randomized controlled trials (RCTs) from inception up to July 1, 2025. RCTs published in English comparing exercise to controls (CON) or to another exercise type in CRC patients after colon resection surgery were qualified.

Results: Thirty-two studies involving 2001 CRC survivors (51.3/48.7 male-female ratio; mean ± standard deviation: age, 58.0 ± 10.2 years; BMI, 27.1 ± 3.9 kg·m -2 ) were included. HIIT and CT were more effective than CON in improving cardiorespiratory fitness and fasting insulin, respectively. No exercise type was identified as being more efficacious than CON in improving any other outcome measures. Nevertheless, HIIT had the highest probability of being the best exercise intervention for improving body weight, physical activity, cardiorespiratory fitness, and quality of life. AT had the highest likelihood of reducing BMI, fasting glucose, and anxiety. CT had the highest probability of improving fasting insulin, fatigue, depression, and exercise adherence, while RT showed the highest probability of being the most effective exercise type in increasing handgrip strength and fat-free mass.

Conclusions: The current evidence indicates few confirmed benefits of exercise in CRC survivors, suggesting which types of exercise are most promising for a given psychophysiological outcome and may inform further large-scale RCTs of high methodological quality.

Keywords: AEROBIC EXERCISE; CONCURRENT TRAINING; HIGH-INTENSITY INTERVAL TRAINING; NEOPLASM; RESISTANCE TRAINING.