Exercise interventions for health-related quality of life, fatigue, depression, and anxiety in colorectal cancer survivors: a systematic review and network meta-analysis.

[BACKGROUND] Colorectal cancer survivors frequently experience persistent fatigue, psychological distress, and reduced health-related quality of life (HRQoL) after treatment. Exercise is increasingly recognized as an effective nonpharmacologic intervention, but the comparative efficacy of different modalities remains uncertain. This study aimed to evaluate and rank the effects of exercise interventions on HRQoL, fatigue, depression, and anxiety in colorectal cancer survivors through a systematic review and network meta-analysis.

[METHODS] Five databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Google Scholar) were searched from inception to October 30, 2025. Eligible randomized controlled trials included adult colorectal cancer survivors receiving structured exercise interventions-such as aerobic exercise (AE), resistance training (RT), combined AE plus RT (AE + RT), yoga, qigong, tai chi, or multicomponent programs-compared with usual care or alternative exercise modalities. Primary outcomes were HRQoL, fatigue, depression, and anxiety assessed after the intervention. Standardized mean differences (SMDs) and 95% CIs were pooled using random-effects models, and comparative rankings were estimated using the surface under the cumulative ranking curve (SUCRA).

[RESULTS] A total of 22 trials (n = 1676) met the inclusion criteria. Overall, exercise significantly improved HRQoL (SMD, 0.48; 95% CI, 0.28-0.67) and reduced fatigue (SMD, -0.44; 95% CI, -0.70 to -0.19), depression (SMD, -0.29; 95% CI, -0.48 to -0.10), and anxiety (SMD, -0.29; 95% CI, -0.42 to -0.15). Subgroup analyses indicated greater effects with supervised or tele-supervised, moderate-intensity programs (3-5.9 metabolic equivalents of task) in 30- to 60-min sessions, 3 to 4 times weekly for 9 to 23 weeks. Network meta-analysis ranked RT highest for improving HRQoL (SUCRA, 91.8%), and AE + RT most effective for reducing fatigue, depression, and anxiety (SUCRA, 81.7%-82.4%).

[CONCLUSION] Exercise significantly enhances HRQoL and psychological well-being in colorectal cancer survivors, with optimal benefits observed from moderate-intensity, supervised, or tele-supervised programs. AE + RT seems the most effective for symptom relief, whereas RT provides the greatest gains in global quality of life.