The multidimensional roles and mechanisms of exercise intervention in pediatric oncology.

The importance of exercise interventions in pediatric oncology is steadily increasing. Their value lies not only in alleviating treatment-related adverse effects but also in supporting physiological recovery, psychological adjustment, and improvements in cognitive function. As research continues to reveal the effects of exercise on the tumor microenvironment, immune modulation, and energy metabolism, its role in pediatric cancer care is expanding from a rehabilitative adjunct to a comprehensive intervention with potential therapeutic relevance. Exercise can enhance tumor-related biological processes by improving blood flow and tissue oxygenation, increasing immune cell activity, mitigating immunosuppression, and modulating glucose utilization and fatty acid metabolism, thereby influencing the energy supply to tumor cells. At the clinical level, exercise strengthens skeletal muscle, improves cardiopulmonary function, increases physical reserves, and reduces long-term side effects such as fatigue and frailty. It also contributes to emotional stability, strengthens self-efficacy, and ameliorates cognitive impairments including attention and memory deficits. Moreover, exercise may exert synergistic effects with chemotherapy, radiotherapy, and immunotherapy by improving treatment tolerance and amplifying overall therapeutic benefit. Despite its potential, the implementation of exercise interventions remains challenged by limited resources, variability in adherence, and age-related differences. Future research should aim to develop personalized exercise prescription systems tailored to pediatric needs, supported by interdisciplinary teams and intelligent monitoring tools to enhance feasibility and scientific rigor. With continued advances in basic research and the accumulation of clinical evidence, exercise is expected to play an increasingly systematic and sustained role in pediatric cancer treatment, providing crucial support for improving rehabilitation quality and long-term health outcomes.