Int J Sports Med 2009; 30(10): 703-712
DOI: 10.1055/s-0029-1225330

© Georg Thieme Verlag KG Stuttgart · New York

Resistance Training in Cancer Survivors: A Systematic Review

I. C. De Backer 1 , G. Schep 1 , F. J. Backx 2 , G. Vreugdenhil 3 , H. Kuipers 4
  • 1Maxima Medical Centre, Sports Medicine, Veldhoven, Netherlands
  • 2Department of Rehabilitation and Sports Medicine, University Medical Centre Utrecht, Utrecht, Netherlands
  • 3Maxima Medical Centre, Internal Medicine, Veldhoven, Netherlands
  • 4University Maastricht, Human Movement Sciences, Maastricht, Netherlands
Further Information

Publication History

accepted after revision April 28, 2009

Publication Date:
07 July 2009 (online)


This systematic review summarizes the research of previous studies that used resistance training in the post-treatment phase of cancer patients with a focus on methodological quality, training methods and physical outcome measures. We found twenty-four studies (10 RCTs, 4 controlled clinical trials and 10 uncontrolled trials) that met all inclusion criteria. The studies were of moderate methodological quality. The majority of studies involved breast cancer patients (54%), followed by prostate cancer patients (13%). Most studies used a combination of resistance and aerobic training, which was mostly supervised. Resistance training involved large muscle groups, with 1–3 sets of 8–12 repetitions. The duration of the resistance training programs varied from 3–24 weeks, with a training frequency of 1–5 sessions per week. The training intensity ranged from 25% to 85% of the one-repetition maximum. Overall, positive training effects were observed for cardiopulmonary and muscle function, with significant increases in peak oxygen uptake (range: 6–39%), and in the one-repetition maximum (range: 11–110%). In general, there were no effects of training on body composition, endocrine and immune function, and haematological variables. No adverse effects of the resistance training were reported. Based upon these results, we recommend to incorporate resistance training in cancer rehabilitation programmes.


  • 1 Ahmed RL, Thomas W, Yee D, Schmitz KH. Randomized controlled trial of weight training and lymphedema in breast cancer survivors.  J Clin Oncol. 2006;  24 2765-2772
  • 2 Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, Guyatt GH, Harbour RT, Haugh MC, Henry D, Hill S, Jaeschke R, Leng G, Liberati A, Magrini N, Mason J, Middleton P, Mrukowicz J, O’Connell D, Oxman AD, Phillips B, Schunemann HJ, Edejer TT, Varonen H, Vist GE, Williams Jr JW, Zaza S. Grading quality of evidence and strength of recommendations.  BMJ. 2004;  328 1490-1498
  • 3 Berglund G, Bolund C, Gustavsson UL, Sjoden PO. Starting again – a comparison study of a group rehabilitation program for cancer patients.  Acta Oncol. 1993;  32 15-21
  • 4 Cheema B, Gaul CA, Lane K, Fiatarone Singh MA. Progressive resistance training in breast cancer: a systematic review of clinical trials.  Breast Cancer Res Treat. 2008;  109 9-26
  • 5 Cheema BS, Gaul CA. Full-body exercise training improves fitness and quality of life in survivors of breast cancer.  J Strength Cond Res. 2006;  20 14-21
  • 6 Conn VS, Hafdahl AR, Porock DC, McDaniel R, Nielsen PJ. A meta-analysis of exercise interventions among people treated for cancer.  Support Care Cancer. 2006;  14 699-712
  • 7 Courneya KS. Exercise in cancer survivors: an overview of research.  Med Sci Sports Exerc. 2003;  35 1846-1852
  • 8 Courneya KS, Friedenreich CM. Physical exercise and quality of life following cancer diagnosis: a literature review.  Ann Behav Med. 1999;  21 171-179
  • 9 Courneya KS, Friedenreich CM, Quinney HA, Fields AL, Jones LW, Fairey AS. Predictors of adherence and contamination in a randomized trial of exercise in colorectal cancer survivors.  Psychooncology. 2004;  13 857-866
  • 10 Courneya KS, Segal RJ, Reid RD, Jones LW, Malone SC, Venner PM, Parliament MB, Scott CG, Quinney HA, Wells GA. Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors.  J Clin Epidemiol. 2004;  57 571-579
  • 11 Culos-Reed SN, Robinson JL, Lau H, O’Connor K, Keats MR. Benefits of a physical activity intervention for men with prostate cancer.  J Sport Exerc Psychol. 2007;  29 118-127
  • 12 De Backer IC, van Breda E, Vreugdenhil A, Nijziel MR, Kester AD, Schep G. High-intensity strength training improves quality of life in cancer survivors.  Acta Oncol. 2007;  46 1143-1151
  • 13 De Backer IC, Vreugdenhil G, Nijziel MR, Kester AD, van Breda E, Schep G. Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life.  Br J Cancer. 2008;  99 30-36
  • 14 de Jong N, Courtens AM, bu-Saad HH, Schouten HC. Fatigue in patients with breast cancer receiving adjuvant chemotherapy: a review of the literature.  Cancer Nurs. 2002;  25 283-297
  • 15 de Paleville DT, Topp RV, Swank AM. Effects of aerobic training prior to and during chemotherapy in a breast cancer patient: a case study.  J Strength Cond Res. 2007;  21 635-637
  • 16 Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM. Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer.  J Clin Oncol. 2005;  23 5814-5830
  • 17 Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas.  Cancer. 2000;  88 674-684
  • 18 Schwartz S, Wesel N, Voigt A, Thiel E. Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment.  Ann Oncol. 2008;  19 1495-1499
  • 19 Galvao DA, Newton RU. Review of exercise intervention studies in cancer patients.  J Clin Oncol. 2005;  23 899-909
  • 20 Galvao DA, Nosaka K, Taaffe DR, Peake J, Spry N, Suzuki K, Yamaya K, McGuigan MR, Kristjanson LJ, Newton RU. . Endocrine and immune responses to resistance training in prostate cancer patients.  Prostate Cancer Prostatic Dis. 2008;  11 160-165
  • 21 Galvao DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, Suzuki K, Yamaya K, Newton RU. Resistance training and reduction of treatment side effects in prostate cancer patients.  Med Sci Sports Exerc. 2006;  38 2045-2052
  • 22 Ganz PA. A teachable moment for oncologists: cancer survivors, 10 million strong and growing!.  J Clin Oncol 2005. 23 5458-5460
  • 23 Hayes SC, Davies PS, Parker TW, Bashford J, Green A. Role of a mixed type, moderate intensity exercise programme after peripheral blood stem cell transplantation.  Br J Sports Med. 2004;  38 304-309
  • 24 Hayes SC, Rowbottom D, Davies PS, Parker TW, Bashford J. Immunological changes after cancer treatment and participation in an exercise program.  Med Sci Sports Exerc. 2003;  35 2-9
  • 25 Heim ME, Malsburg ML, Niklas A. Randomized controlled trial of a structured training program in breast cancer patients with tumor-related chronic fatigue.  Onkologie. 2007;  30 429-434
  • 26 Herrero F, San Juan AF, Fleck SJ, Balmer J, Perez M, Canete S, Earnest CP, Foster C, Lucia A. Combined aerobic and resistance training in breast cancer survivors: A randomized, controlled pilot trial.  Int J Sports Med. 2006;  27 573-580
  • 27 Humpel N, Iverson DC. Review and critique of the quality of exercise recommendations for cancer patients and survivors.  Support Care Cancer. 2005;  13 493-502
  • 28 Hutnick NA, Williams NI, Kraemer WJ, Orsega-Smith E, Dixon RH, Bleznak AD, Mastro AM. Exercise and lymphocyte activation following chemotherapy for breast cancer.  Med Sci Sports Exerc. 2005;  37 1827-1835
  • 29 Irwin ML, Ainsworth BE. Physical activity interventions following cancer diagnosis: methodologic challenges to delivery and assessment.  Cancer Invest. 2004;  22 30-50
  • 30 Jones LW, Demark-Wahnefried W. Diet, exercise, and complementary therapies after primary treatment for cancer.  Lancet Oncol. 2006;  7 1017-1026
  • 31 Knobf MT, Musanti R, Dorward J. Exercise and quality of life outcomes in patients with cancer.  Semin Oncol Nurs. 2007;  23 285-296
  • 32 Kolden GG, Strauman TJ, Ward A, Kuta J, Woods TE, Schneider KL, Heerey E, Sanborn L, Burt C, Millbrandt L, Kalin NH, Stewart JA, Mullen B. A pilot study of group exercise training (GET) for women with primary breast cancer: feasibility and health benefits.  Psychooncology. 2002;  11 447-456
  • 33 Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription.  Med Sci Sports Exerc. 2004;  36 674-688
  • 34 Lane K, Jespersen D, McKenzie DC. The effect of a whole body exercise programme and dragon boat training on arm volume and arm circumference in women treated for breast cancer.  Eur J Cancer Care (Engl). 2005;  14 353-358
  • 35 Lee RC, Wang Z, Heo M, Ross R, Janssen I, Heymsfield SB. Total-body skeletal muscle mass: development and cross-validation of anthropometric prediction models.  Am J Clin Nutr. 2000;  72 796-803
  • 36 Ligibel JA, Campbell N, Partridge A, Chen WY, Salinardi T, Chen H, Adloff K, Keshaviah A, Winer EP. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors.  J Clin Oncol. 2008;  26 907-912
  • 37 Lucia A, Earnest C, Perez M. Cancer-related fatigue: can exercise physiology assist oncologists?.  Lancet Oncol. 2003;  4 616-625
  • 38 Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials.  Phys Ther. 2003;  83 713-721
  • 39 Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer.  Cochrane Database Syst Rev. 2006;  CD005001
  • 40 May AM, van WE, Korstjens I, Hoekstra-Weebers JE, van der Schans CP, Zonderland ML, Mesters I, van den BB, Ros WD. Improved physical fitness of cancer survivors: a randomised controlled trial comparing physical training with physical and cognitive-behavioural training.  Acta Oncol. 2008;  47 825-834
  • 41 McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study.  J Clin Oncol. 2003;  21 463-466
  • 42 McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis.  CMAJ. 2006;  175 34-41
  • 43 McNeely ML, Parliament MB, Seikaly H, Jha N, Magee DJ, Haykowsky MJ, Courneya KS. Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial.  Cancer. 2008;  113 214-222
  • 44 McTiernan A. Physical activity after cancer: physiologic outcomes.  Cancer Invest. 2004;  22 68-81
  • 45 Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial.  Breast Cancer Res Treat. 2008;  108 279-288
  • 46 Nieman DC, Cook VD, Henson DA, Suttles J, Rejeski WJ, Ribisl PM, Fagoaga OR, Nehlsen-Cannarella SL. Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients.  Int J Sports Med. 1995;  16 334-337
  • 47 Ohira T, Schmitz KH, Ahmed RL, Yee D. Effects of weight training on quality of life in recent breast cancer survivors: the Weight Training for Breast Cancer Survivors (WTBS) study.  Cancer. 2006;  106 2076-2083
  • 48 Ott CD, Lindsey AM, Waltman NL, Gross GJ, Twiss JJ, Berg K, Brisco PL, Henricksen S. Facilitative strategies, psychological factors, and strength/weight training behaviors at risk for osteoporosis.  Orthop Nurs. 2004;  23 45-52
  • 49 Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins.  Cancer Epidemiol Biomarkers Prev. 2005;  14 1672-1680
  • 50 Schmitz KH, Holtzman J, Courneya KS, Masse LC, Duval S, Kane R. Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis.  Cancer Epidemiol Biomarkers Prev. 2005;  14 1588-1595
  • 51 Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Cancer treatment-induced alterations in muscular fitness and quality of life: the role of exercise training.  Ann Oncol. 2007;  18 1957-1962
  • 52 Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment.  Cancer. 2007;  110 918-925
  • 53 Schwartz AL. Cancer. In Durstine JL, Moore GE, (eds.) ACSM's Exercise Management for Persons with Chronic Diseases and Disabilities.  Champaign, Human Kinetics. 2003;  166-173
  • 54 Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, Slovenic D’Angelo ME, Wells GA. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer.  J Clin Oncol. 2003;  21 1653-1659
  • 55 Steultjens EM, Dekker J, Bouter LM, van de Nes JC, Cup EH, van den Ende CH. Occupational therapy for stroke patients: a systematic review.  Stroke. 2003;  34 676-687
  • 56 Turner J, Hayes S, Reul-Hirche H. Improving the physical status and quality of life of women treated for breast cancer: a pilot study of a structured exercise intervention.  J Surg Oncol. 2004;  86 141-146


I. C. De BackerMSc 

Maxima Medical Centre

Sports Medicine

De Run 4600

5500MB Veldhoven


Phone: +0031/40/88 88 620

Fax: +0031/40/88 88 584