Exercise interventions remodel the aging microenvironment to improve prognosis in older patients with cancer.

Cancer in older adults has become a significant public health challenge, with increasing incidence and limited efficacy of conventional treatments due to aging-related biological changes, such as chronic inflammation, immune decline, metabolic dysfunction, and cellular senescence. These alterations create a pro-tumor environment, weakening antitumor capacity and reducing treatment sensitivity. Exercise medicine has emerged as a promising systemic intervention, regulating multiple physiological systems, including metabolism, immunity, skeletal muscle, and inflammation. Through these effects, exercise reshapes the aging-driven tumor-susceptible environment, potentially improving treatment tolerability and clinical outcomes. This review explores how exercise alleviates aging-associated phenotypes like metabolic decline, chronic inflammation, immune dysfunction, and sarcopenia, enhancing tumor suppression and boosting the efficacy of chemotherapy, radiotherapy, and immunotherapy. It also discusses strategies for precision exercise interventions, such as individualized prescriptions based on aging biomarkers, comprehensive risk assessments, safety management, multidisciplinary collaboration, and digital monitoring technologies. This review highlights the importance of integrating exercise into geriatric oncology care and outlines future research directions to improve the clinical management of cancer in older adults.