Exercise interventions and positive adaptation in childhood cancer survivors: Implications for school physical education

Advances in pediatric oncology have substantially improved survival rates, yet many childhood cancer survivors continue to face long-term physical, psychological, and educational challenges. Positive adaptation encompassing resilience, post-traumatic growth (PTG), quality of life (QoL), and psychosocial adjustment has emerged as a critical focus in survivorship care. Exercise interventions represent a promising strategy to promote adaptation, but their integration into school settings remains underexplored. This systematic review and meta-analysis, conducted in accordance with PRISMA 2020 guidelines, synthesized evidence from ten studies published between 2009 and 2023, spanning randomized controlled trials, quasi-experiments, and pilot programs. Interventions included aerobic, resistance, adventure-based, play-oriented, and technology-assisted formats, delivered in clinical, community, and home environments. Pooled findings demonstrated consistent benefits for QoL, muscular strength, and self-efficacy, with large-scale trials confirming sustained improvements up to 12 months. Evidence for PTG was mixed, with one small pilot reporting significant gains and another finding no change, underscoring the need for adequately powered studies. Fatigue outcomes varied by treatment stage: inpatient interventions-maintained stability during intensive therapy, while community-based adventure programs reduced fatigue in survivorship. Group-based and play-oriented approaches appeared particularly effective in fostering peer bonding and psychosocial growth. No studies directly embedded exercise into routine school physical education, highlighting a critical gap. Exercise interventions are safe, feasible, and multidimensional strategies that support physical recovery and psychosocial adaptation in childhood cancer survivors. Future research should prioritize school-based implementation and standardized evaluation to bridge clinical rehabilitation and educational reintegration.