Effects of different resistance training programs on quality of life and fatigue in cancer patients: a network meta-analysis

Abstract

To systematically evaluate, via network meta-analysis, the effects of different resistance training intensities on quality of life and cancer-related fatigue in cancer patients, and to identify the optimal exercise regimen. A systematic search of PubMed, Embase, the Cochrane Library, and Web of Science was conducted from database inception to January 13, 2026. Randomized controlled trials comparing different resistance training protocols—stratified by intensity (low, moderate, high) and frequency (twice or three times per week)—on quality of life and fatigue in cancer patients were included. Two reviewers independently screened studies, extracted data, and assessed risk of bias. Traditional and network meta-analyses were performed using Stata 17.0, with the standardized mean difference (SMD) and its 95% confidence interval (CI) as the effect measure. Sources of heterogeneity were explored through subgroup analysis, and the surface under the cumulative ranking curve (SUCRA) was used to rank the interventions. Twenty-one studies involving 1,655 patients were included. Traditional meta-analysis showed that resistance training significantly improved quality of life (SMD = 0.20, 95% CI: 0.05 to 0.34) and reduced fatigue (SMD = − 0.34, 95% CI: −0.57 to − 0.11) compared with the control group. Subgroup analysis indicated that moderate-intensity, low-frequency (MI-LF) resistance training led to more significant improvements in quality of life and fatigue in patients with breast or gastrointestinal cancer, and that the significant benefits for different outcome measures also depended on the specific assessment instruments used. Network meta-analysis revealed that MI-LF training ranked highest for improving quality of life, with a SUCRA value of 71.1% (SMD = 0.27, 95% CI: 0.10 to 0.45); it also ranked highest for reducing fatigue, with a SUCRA value of 78.1% (SMD = − 0.65, 95% CI: −1.26 to − 0.03). Resistance training effectively improves quality of life and alleviates fatigue in cancer patients. Among the examined regimens, MI-LF training had the highest probability of being a relatively more favorable option for both outcomes. However, given that SUCRA values reflect only the relative ranking probabilities of interventions, their clinical application warrants caution, and individualized exercise prescriptions should be formulated based on patients’ specific conditions.