The American Cancer Society (ACS) estimates that 618,120 Americans will die from cancer in 2025, averaging 1,700 deaths per day.1 While conventional cancer treatments like surgery, chemotherapy, radiation and immunotherapy remain the standard approach, these methods focus exclusively on eliminating cancer cells. These interventions also come with significant side effects, which further impact survival and quality of life.
Despite this, far less attention has been given to the broader factors that influence survival, particularly the body’s overall resilience and ability to self-heal. Now, a systematic review with meta-analysis published in January 2025 in the British Journal of Sports Medicine2 is bringing renewed focus to a vital yet often overlooked factor in cancer outcomes — physical fitness.
How Do Muscle Strength and Cardio Workouts Lower Cancer Death Risk?
Physical fitness and strength training are well-documented strategies for lowering the risk of developing various types of cancer. “That’s fairly well established now,” said Kristin Campbell, a physical therapist and researcher with the Canadian Cancer Society, in an interview with Global News.3
“But this new study adds to this. We look at physical activity and how much those things are really important after your cancer diagnosis, not just to manage symptoms, but how it might really impact cancer outcomes.”
• The study assessed the impact of fitness levels on cancer survival — The featured review4 analyzed 42 studies involving 46,694 cancer patients across different cancer types and stages.
The goal was to examine the relationship between physical fitness, measured through muscle strength and cardiorespiratory endurance, and mortality risk in people diagnosed with cancer. They also looked at whether these associations varied based on the type and stage of cancer.
• Higher muscle strength and cardiovascular fitness significantly reduced mortality risk — The findings showed that those with higher muscle strength or cardiovascular fitness had between a 31% and 46% lower risk of all-cause mortality.
• Each increase in fitness level provided additional protection — Every unit increase in muscle strength reduced the risk of death by an additional 11%, while unit increases in cardiovascular fitness lowered cancer-specific mortality risk by 18%.
• Even advanced-stage cancer patients benefited from improved fitness — Those with higher fitness levels was associated with an 8% to 46% reduced risk of all-cause mortality. Those with lung and digestive cancers saw a 19% to 41% reduction in their risk of death. The researchers concluded:
“High muscle strength and CRF (cardiorespiratory fitness) were significantly associated with a lower risk of all-cause mortality. In addition, increases in CRF were associated with a reduced risk of cancer-specific mortality. These fitness components were especially predictive in patients with advanced cancer stages as well as in lung and digestive cancers.
This highlights the importance of assessing fitness measures for predicting mortality in cancer patients. Given these findings, tailored exercise prescriptions to improve muscle strength and CRF in patients with cancer may contribute to reducing cancer-related mortality.”5
This research confirms previous findings and strengthens the growing evidence that physical fitness both improves quality of life and has a direct impact on survival rates, even for patients with aggressive or late-stage cancers. For example:
• In 2020, a systematic review and meta-analysis published in JNCI Cancer Spectrum6 examined the association between pre- and post-diagnosis physical activity and survival outcomes across multiple cancer types. The study concluded that higher levels of physical activity, both before and after diagnosis, were associated with improved survival rates for 11 types of cancer, including reductions in cancer-specific and all-cause mortality.
• Another 2020 meta-analysis published in Cancer Epidemiology, Biomarkers and Prevention7 found that even light-intensity physical activities, such as leisurely walking, were associated with a reduced risk of cancer mortality.
Previous Studies on the Role of Exercise in Cancer Prevention
Beyond improving cancer outcomes, regular physical activity has been consistently linked to a reduced risk of developing various types of cancer in the first place. For example, a 2021 review published in the British Medical Bulletin8 found that physical activity is associated with a lower risk of developing multiple cancer types, including breast, prostate, colorectal, bladder and uterine cancer.
• Exercise reduces the risk of multiple cancers — The data suggest that individuals who engage in moderate-intensity exercise for at least three to four hours per week reduce their overall cancer risk by approximately 10% to 20%. The mechanisms behind exercise’s protective effect against cancer are well-documented. Regular physical activity helps regulate insulin levels, reduce chronic inflammation and enhance immune function.
• Hormone-sensitive cancers are particularly impacted by exercise — The study highlights that exercise lowers serum estrogen levels, which plays a role in reducing hormone-sensitive cancers such as breast and ovarian cancer. Exercise also upregulates tumor-suppressing genes, supports DNA repair pathways and improves your body’s ability to eliminate damaged cells before they become cancerous.9
• Physical activity mitigates side effects of cancer treatment — Chemotherapy and radiation weaken your immune system, cause fatigue and lead to weight gain or muscle loss.10 Physical activity counteracts these effects by enhancing cardiovascular health, preserving muscle mass and reducing inflammation.11
Exercise programs have also been shown to improve the quality of life in cancer patients by alleviating depression, cognitive impairment and treatment-related fatigue.12
The data is clear — staying physically active is one of the effective lifestyle strategies for reducing cancer risk and improving survival outcomes. Unfortunately, despite growing evidence, implementation remains inconsistent across healthcare systems.
Does Walking Improve Cancer Outcomes and Overall Health?
For many cancer patients, the idea of exercising, especially during or after treatment, feels overwhelming. However, improving fitness doesn’t require extreme workouts. Even small, gradual increases in physical activity will yield significant benefits.
• Simple movements make a meaningful difference — Campbell explains that something as simple as taking daily walks or performing body-weight exercises, such as standing up from a chair multiple times, makes a meaningful difference in both strength and overall fitness.
The key is progressive adaptation, starting at a manageable level and slowly increasing intensity as your body adjusts. Over time, even modest efforts enhance resilience, combat fatigue and improve overall well-being.13
• Higher step counts reduce cancer mortality risk — A 2022 study published in JAMA Internal Medicine14 found that increasing daily step count, especially up to 10,000 steps per day, was linked to a lower risk of dying from cancer and other major diseases.
Even smaller increases made a difference, with an extra 2,000 steps per day reducing cancer mortality risk. Walking at a brisker pace provided even greater benefits, which shows that both the amount and intensity of movement matter.
• Walking is one of the most accessible and effective forms of exercise — If you’ve been following my articles, you know that walking is one of my recommended physical activities, as I believe it’s an easily accessible and effective form of exercise.
In my previous interview with Dr. James O’Keefe, a cardiologist with the Mid-America Heart Institute at St. Louis Hospital in Kansas City, he emphasized that for every 1,000 steps you take on average per day, your risk of mortality decreases by 10% to 15%. He also noted that walking improves your all-cause survival rate about two times better than vigorous exercise.15
• Walking supports longevity and mitochondrial health — Backing this up, a study16 published in JAMA Network Open revealed that even a modest amount of walking significantly boosts longevity. Other research published in GeroScience17 found that walking helps create new mitochondria and boost their function, which lowers your risk for any condition related to mitochondrial dysfunction, which includes cancer.
Hence, integrating walking into your daily routines and promoting walking-based physical activities is a highly effective strategy for promoting healthy aging and improving overall health outcomes in all populations. To learn more about the benefits of walking, read “Don’t Underestimate the Power of a Good Walk.”
The Sweet Spot for Walking and Strength Training
O’Keefe and three other coauthors published a meta-analysis18 in the March-April 2023 issue of Missouri Medicine, the journal of the Missouri State Medical Association, which revealed the “Goldilocks dose” for different exercises. I view this study as a landmark paper that radically changed my views on exercise.
• Walking provides continuous benefits with no upper limit — One of their findings is that when it comes to moderate exercise, which includes walking (loosely defined as exercising to the point where you’re slightly winded but can still carry on a conversation), more is better as it cannot be overdone. But how many steps a day should you aim for? In our interview, O’Keefe stated:
“Clearly, more is better. You get the big gains going from sedentary lifestyles — 2,000 to 3,000 steps a day — up to 7,000 or 8,000. [Here] you have this very steep reduction in mortality, improvement in survival. It continues to about 12,000 steps a day. Most of the studies show that it plateaus at 12,000.”
This means the generally recommended 10,000 steps per day for optimal health is a good goal.
• Strength training follows a J-shaped curve — As for strength training, O’Keefe’s analysis revealed that more is not always better. While moderate exercise like walking can be done in high volumes without negative effects, strength training follows a J-shaped curve, meaning the benefits increase up to a point, but beyond that, they start to decline.
• The optimal strength training “sweet spot” — The ideal amount for strength training appears to be around 40 to 60 minutes per week, ideally spread out across two to three sessions. Beyond that, the longevity benefits begin to diminish.
Once you get to 130 to 140 minutes of strength training per week, your longevity benefit becomes the same as if you weren’t doing anything, which is nothing short of shocking. If you train for three to four hours a week, you actually end up with worse long-term survival than people who don’t strength-train.
• Excessive weightlifting can cause long-term harm — While walking or light activity has no upper limit for benefits, excessive weightlifting places too much strain on the body, leading to issues like increased cardiovascular stress, higher risk of atrial fibrillation and accelerated arterial calcification.
• Prioritize moderate exercise over excessive strength training — The take-home message here is that 20 minutes of strength training twice a week on non-consecutive days, or 40 minutes once a week is the sweet spot. You also don’t want your exercise regimen to center around strength training. It should be an add-on, as you get far greater benefits simply from walking, or any other moderate exercise.
To learn more about how much you should exercise, read my article “Nailing the Sweet Spots for Exercise Volume.”
Frequently Asked Questions (FAQs) About Exercise and Cancer Survival
Q: Can exercise reduce the risk of dying from cancer?
A: Yes, studies show that people with higher muscle strength and cardiovascular fitness have up to a 46% lower risk of death from cancer.
Q: How does exercise help cancer patients?
A: Exercise strengthens the immune system, lowers inflammation, regulates insulin and helps maintain muscle mass — all of which improve survival and recovery during and after treatment.
Q: What’s the best type of exercise for cancer survival?
A: Walking and moderate strength training provide the greatest benefits. Aim for 10,000 to 12,000 steps per day and 40 to 60 minutes of strength training per week.
Q: Is walking enough to improve cancer outcomes?
A: Yes, walking as little as 2,000 extra steps per day reduces cancer mortality risk. Walking also improves mitochondrial function, which is essential for energy production and disease prevention.
