New Evidence Shows Exercise Could Ease Key Symptoms of Ovarian Cancer

Exercise may offer meaningful benefits for patients with ovarian cancer, particularly by improving quality of life and sleep, although its effects on fatigue and body composition remain uncertain, according to a new systematic review and meta-analysis.¹ The findings, drawn from randomized controlled trials (RCTs) published through April 2025, highlight the promise of exercise as a supportive care strategy and the ongoing need for more rigorous research in this population.

Ovarian cancer is the deadliest gynecologic malignancy.² The burden of treatment often leaves patients struggling with poor quality of life, disrupted sleep, and changes in body composition.¹ Although exercise has been shown to improve these outcomes in patients with other cancer types, evidence specific to ovarian cancer has historically been limited and inconsistent. To address this gap, researchers conducted a systematic literature search across major databases, including PubMed, Embase, Web of Science, and the Cochrane Library, and identified 9 RCTs enrolling 767 patients for inclusion in their analysis.

The studies varied widely in design, intervention type, and reporting quality. Although most trials showed low risk of bias in straightforward domains such as outcome measurement and data completeness, several had methodological weaknesses. Issues such as unclear random sequence generation, inadequate allocation concealment, deviations from intended interventions, and inconsistent blinding were common. These limitations contributed to substantial heterogeneity in several of the pooled analyses.

Despite these challenges, the meta-analysis found that exercise yielded moderate, statistically significant improvements in overall quality of life. Across 6 trials, exercise interventions were associated with a standardized mean difference (SMD) of 0.59 (95% CI, 0.41–0.77). However, heterogeneity for this outcome was extremely high (I² = 98%), driven in part by 1 outlier study. When that trial was removed in a sensitivity analysis, the effect size remained positive (SMD, 0.25), and heterogeneity fell sharply, suggesting the overall conclusion is robust even under more conservative assumptions.

Sleep quality also improved significantly among patients assigned to exercise interventions. Three trials using the Pittsburgh Sleep Quality Index demonstrated consistent benefits, with no observed heterogeneity (I² = 0%). The pooled SMD of –0.56 (95% CI, –0.93 to –0.18) indicates that exercise meaningfully reduced sleep disturbance. Because sleep outcomes are less influenced by placebo effects than more subjective measures, the authors note that this consistency may point to a physiological mechanism. Exercise is known to regulate circadian rhythms, modulate autonomic activity, increase melatonin production, and reduce chronic inflammation, all factors that can promote better sleep.

In contrast, the effects of exercise on body mass index (BMI) and fatigue were inconclusive. Three studies that reported BMI outcomes showed no significant changes, and although heterogeneity was high (I² = 72%), sensitivity analyses did not meaningfully alter the findings. Fatigue, evaluated in 3 trials using the Multidimensional Fatigue Inventory, also showed no significant reduction. The authors suggest that the complex, multifactorial nature of cancer-related fatigue, shaped by inflammation, anemia, neuropathy, mood, and treatment burden, may limit the impact of exercise alone. Differences in baseline fatigue levels, adherence to exercise programs, and intervention intensity likely contributed to the mixed results.

The review provides encouraging evidence that exercise can play a beneficial role in improving quality of life and sleep among patients with ovarian cancer. However, the small number of available trials, combined with methodological variability and moderate to high heterogeneity in key outcomes, underscores the need for more rigorously designed research. Future studies, the authors conclude, should incorporate better randomization procedures, clearer intervention reporting, and individualized exercise programs tailored to the unique needs of ovarian cancer patients.

References

1. Wang Y, Zhou C. Effect of exercise intervention on quality of life, sleep quality, and BMI in patients with ovarian cancer: a systematic review and meta-analysis. Medicine. 2025;104(50):e46272. doi:10.1097/MD.0000000000046272

2. Webb PM, Jordan SJ. Global epidemiology of epithelial ovarian cancer. Nat Rev Clin Oncol. 2024;21:389–400. doi:10.1038/s41571-024-00881-3