Effects of physical activity in pediatric acute lymphoblastic leukemia after oncologic treatment A systematic review

Abstract

Acute lymphoblastic leukaemia (ALL) is the most common paediatric malignancy. Although survival rates have improved, children and survivors frequently experience long-term impairments in aerobic capacity, muscle strength, functional mobility, and health-related quality of life (HRQoL). Objective: To systematically synthesize evidence regarding the effects of structured physical activity and exercise programs in paediatric patients with ALL after oncologic treatment or during late phases of therapy. A systematic review was conducted following PRISMA 2020 and the PICO framework. PubMed, PEDro, and SciELO were searched (September–December 2025). Randomized controlled trials (RCTs), non-randomized trials, and pre–post studies in participants <15 years with ALL were included if the intervention was described and outcomes included physical function, biological markers, and/or HRQoL. Methodological quality was assessed using the McMaster tool. Six studies met eligibility criteria. Most interventions were multicomponent (aerobic + resistance ± flexibility), lasting 12–16 weeks, 2–5 sessions/week. Exercise improved aerobic capacity (VO₂ outcomes), functional mobility (TUG, TUDS, 9-min walk), and selected strength outcomes. HRQoL results were inconsistent and often non-significant. Biological outcomes were heterogeneous, including stable oxygen pressure, no clear effects on bone mineral density, and improvements in haematological parameters in one study. Structured exercise appears feasible and may improve physical fitness outcomes in paediatric ALL, but evidence remains limited by heterogeneity in interventions and outcomes. Larger standardized trials are required.