The Role of Physical Activity in Oral Cancer Recovery:A Systematic Review.

IMPORTANCE: Physical activity (PA) is a cornerstone in cancer rehabilitation, yet evidence in oral cancer remains limited and heterogeneous, despite the significant functional impairments and morbidity associated with treatment. OBJECTIVE: This systematic review synthesizes evidence on PA in people living with or beyond oral cancer (PLWBOC), focusing on its association with recovery-related outcomes across the cancer care continuum. DATA SOURCES: A comprehensive systematic search was conducted in 9 databases (PubMed, Embase, CENTRAL, CINAHL, Web of Science, Scopus, PEDro, ClinicalTrials.gov and the International Clinical Trials Registry Platform (ICTRP)) on October 26, 2024. The review followed PRISMA 2020 and SwiM guidelines and was registered with PROSPERO (CRD42024591662). STUDY SELECTION: Eligible studies included randomized controlled trials (RCTs), quasi-experimental designs, and observational studies examining the associations between postoperative PA and recovery-related outcomes in PLWBOC. DATA EXTRACTION AND SYNTHESIS: Two reviewers independently extracted data on PA characteristics, outcomes, and study quality using a standardized form. Risk of bias was assessed using the Revised Cochrane Risk of Bias tool for randomized trials (RoB 2) for RCTs and Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) for non-randomized studies, visualized with Risk-of-bias Visualization tool (ROBVIS). Twenty-four studies met the inclusion criteria, which encompassed RCTs, pilot trials, and cohort studies. MAIN OUTCOME(S) AND MEASURE(S): Primary outcomes include physical function, fatigue, health-related quality of life (HRQoL), and treatment-related morbidity. RESULTS: PA consisted of resistance training, aerobic exercise, and multimodal programs combining PA with education or behavioral support. PA was associated with improved functional performance, reduced fatigue, and moderate HRQoL gains. Resistance training increased lean body mass and strength. Early-phase and 12 to 24 week programs showed prominent effects. Supervised, individualized programs yielded higher adherence rates and better functional outcomes. Nonetheless, heterogeneity in protocols, outcome measures, and study quality limited comparability and precluded meta-analysis. CONCLUSIONS AND RELEVANCE: PA-supervised, multimodal, and early-initiated-offers promising benefits for PLWBOC. Future research should prioritize RCTs, standardized outcome measures, extended follow-up, and digital outreach to establish tailored exercise guidelines for this populations.