Physical activity and testicular cancer survivorship health-related quality of life: a scoping review

Introduction

Materials and methods

Review procedures and data abstraction

Three articles were ultimately included in this scoping review (see Figure 1). Relevant data, including type of intervention, research setting, behavioral change outcomes, and health outcomes, were extracted from each study and summarized. Due to the heterogeneity in study design and outcome measures, coupled with the lower numbers of identified qualifying articles, a systematic review or meta-analysis was not appropriate for this research topic.

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Figure 1.

PRISMA flowchart.

A total of four reviewers conducted the primary searching and screening for relevant literature. Each reviewer had their criteria for search strategy parameters and appropriate databases to search through. Peer conferencing techniques were employed to discuss search findings and to decide on a final qualified batch of articles.

Results

Figure 1 demonstrates the process for identification of included studies. Of the three studies that focused on the relationship between PA’s possible benefits among TC survivors, one was a feasibility study, ²⁵ one was a randomized controlled trial (RCT), ¹⁸ and one was a descriptive study ²³ (see Table 1).

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Table 1.

Selected study overview.

Reference	Design	Sample	Primary findings	Limitations
Effects of HIIT on fatigue and quality of life in testicular cancer survivors 21	Prospective, two-armed randomized control trial (phase II)	n = 63	HIIT training is still a statistically significant intervention for cancer related fatigue in TC survivors’ post-intervention. HIIT training has grander effects on those who did not partake in physical activity previously, had high testosterone, clinical fatigue, and lower fitness ability.	HIIT training showed no improvement for anxiety, stress, depression, or sleep quality (psychosocial outcomes). No significant effects on physical functioning, bodily pain, role-emotional or in their physical component score post intervention.
Psychological needs satisfaction, self-rated health and the mediating role of exercise among testicular cancer survivors 25	Cross-Sectional with convenience sampling	n = 135	Physical activity satisfied the physiological need for autonomy, competence, and exercise.	Only 66% (n = 76) of participants stuck with their weekly exercise guidelines. Bivariate correlations indicated that covariates (age, cancer stage, and time since cancer diagnosis) were not significantly correlated with study variables. Self-rated mental health was significantly positively related to satisfaction of the needs for competence and relatedness but unrelated to autonomy and exercise. Utilized a convenience study and self-reported questionnaire.
Feasibility of a physical activity intervention during and shortly after chemotherapy for testicular cancer 27	A single, institutional one-armed intervention study	n = 12	The intent to engage in physical activity was noted to be during the tail end of chemotherapy treatment and/or once treatment has ended.	With a small sample size, very few participants carried out the physical activity guidelines although it is important to note that these patients were still undergoing chemotherapy during the time of these PA assignments. Therefore, treatment related barriers were present. Gradually, all the participants were unable to keep up with the weekly guidelines. The researchers and labs were asynchronous in their collaborative efforts resulting in the inability to fully commit to this study.

HIIT, high-intensity interval training; TC, testicular cancer.

In the RCT, ¹⁸ 63 TC survivors in Canada were randomly assigned to 12 weeks of supervised HIIT (35 participants) or usual care (28 participants). Men between the ages of 18 and 80 with a confirmed history of TC and confirmation of post-surgery and treatment were eligible. Exclusion criteria included the inability to complete the first two stages of the aerobic exercise test, the presence of any uncontrolled cardiovascular condition, the presence of any psychiatric condition, or the regular performance of vigorous-intensity aerobic exercise.

HIIT participants attended three supervised sessions per week each approximately 35 min in length. ¹⁸ Usual care participants were asked to maintain their baseline exercise levels. Baseline characteristics included an average participant age of 43.7 years. 92.1% had a single orchidectomy and 36.5% received chemotherapy. Participants self-reported an average of 105 exercise min/week. Post-intervention results showed significantly improved self-reported cancer-related fatigue in the HIIT group (p = 0.003) and self-esteem (p = 0.029) but not depression, anxiety, stress, or sleep quality. In the HIIT group, there was also significant improvement in participants’ mental component score (p = 0.034), vitality (p = 0.001), social functioning (p = 0.011), general health (p = 0.016), and role-physical (p = 0.048), and mental health (p = 0.054). Of note, there were no significant changes in physical functioning, bodily pain, role-emotional, or physical component score. At 3-month follow-up, HIIT maintained its significant effect on cancer related fatigue (p = 0.031) and vitality (p = 0.015). Yet, there were no other significant between-group differences for any other psychosocial or quality of life outcomes at 3-month follow-up.

Those survivors with a more sedentary lifestyle, lower fitness, higher testosterone, and clinical fatigue at baseline had a greater effect overall compared to other participants regarding cancer-related fatigue. Primary limitations of this study included smaller sample size, attrition at 3-months, self-reporting nature of the study, and between-condition baseline heterogeneity of clinical fatigue. Other reported limitations included the recruitment of TC survivors without specific psychosocial or HRQoL deficits and the lack of an attention control comparison group.

The feasibility study’s ²⁵ goal was to determine patient recruitment, compliance, and adherence to a PA intervention with consideration for variables such as self-perceived feelings of inefficacy, external obligations, preference of intensity and refusal to participate, and other comorbidities that the survivors suffer from, such as other ongoing cancer diagnoses and treatment. This study highlighted the expected positive relationship between PA and improvement in HRQoL for TC survivors. They noted that patients during and post-chemotherapy were experiencing a reduction in well-being and a sharp increase in their fatigue. ²⁵

The small sample size (nine completed the entirety of the study) restricts the generalizability of the results, as a larger cohort would provide a more comprehensive understanding of the intervention’s effectiveness across diverse populations. Furthermore, the reliance on self-reported measures for assessing PA and quality of life may introduce bias, as participants could overestimate their engagement in PA or the perceived benefits they experienced. The short duration of the study, which was during and 3 months after chemotherapy, limited the ability to assess the long-term impacts on participants’ health and quality of life, underscoring the need for future studies with extended observation periods.

The cross-sectional design ²³ sought to uncover, based on the psychological needs theory, whether satisfaction of psychological needs was directly associated with increased self-reported health, and if this relationship was mediated by PA in TC survivors. A self-reported questionnaire served as the study’s primary data collection tool. The sample size was 135 TC survivors with a mean age of 32.45. Satisfaction of psychological needs was positively correlated with both self-reported physical and mental health. Exercise was a mediator in self-reported physical health.

This study was primarily limited in its analysis where causal mechanisms could not be derived due to the lack of temporal classification and properly defined comparison groups. Improved reliability and validity analyses are needed to ensure more robust data quality. This design ²³ indicated significant relationships between PA and improved psychosocial outcomes among TC survivors, including the need for autonomy and exercise.

All studies indicated the negative effects of chemotherapy during treatment, which include statistically significant increases in fatigue, BMI, and poor mental health in the expressions of depression, anxiety, and stress.^2,4,9

Discussion

The aim of this scoping review was to explore the literature on PA interventions among TC survivors and determine the depth and breadth of existing research in this area. While several studies have explored the role of exercise and/or PA in cancer patients, few studies have explored the role of PA in TC survivors. The few studies that exist provided encouraging preliminary evidence on the potential role PA can play in improving TC survivors HRQoL and highlighted a degree of interest in these types of interventions from TC survivors ²⁵ paving the way for future studies in this area.

The selected studies from our scoping review indicated that depression, anxiety, and stress improved, ¹⁸ there was a general willingness to want to exercise more among survivors,^18,23,25 and that nearly 70% of a reported sample were meeting recommended PA guidelines. ²³ This mirrors what the broader literature suggests are the benefits for PA and cancer survivorship outcomes, specifically, HRQoL. In addition to that, short HIIT exercises that are incorporated in the lifestyle of survivors have also shown remarkable improvements in the physical, mental, and social functioning components in the QoL. ⁹ The studies enlarge the need for an appropriate longitudinal intervention, with several fitness providers and clinicians to draw a clear connection between the effects of PA and the wide span of their innumerable benefits to TC survivors.

Regarding exercise guidelines for cancer survivors, guidance from exercise oncology experts states the need for “exercise prescription” from healthcare workers and fitness professionals when designing and delivering exercise (i.e., PA) programs to adequately address the needs, preferences, and abilities of people with cancer. ²⁸ By implementing PA interventions after cancer treatment, cancer survivors can experience reductions in fatigue, anxiety, and depression, and improvements in physical function, quality of life, with less impact on lymphedema. ²⁸ It is worth noting that these recommendations from the American College of Sports Medicine and other partner organizations—such as the American Cancer Society and the National Cancer Institute—specifically address exercise/PA for prevention, treatment, and recovery from breast, colon, and prostate cancer, and do not speak to TC survivors, specifically.

Although studies have reported an increase in BMI for TC survivors, it is important to distinguish that this is caused by body toxicity after cisplatin chemotherapy leading to a cascade of comorbidities such as: hypertension, compensated reduction in Leydig function, decreased bone mass density, and cardiovascular disease. ²⁹ These aliments leave TC survivors at high risk for mental illness and fatigue, which may be eventually linked to adverse body weight fluctuation. ³⁰ This distinction is important for oncologists and TC patients to be informed about, as it highlights the current absence and need for post chemotherapy treatment research on TC survivors and the role PA intervention can play in optimizing their health. This information is particularly important for this population, as studies have also shown how TC survivors are at an increased risk for increases in annual BMI gains compared to the normal population. ²⁹

Our goal for conducting this scoping review was to map the landscape of a what research exists in the broader literature concerning TC and PA. However, some potential limitations of this study include a certain lack of depth in our analysis. Although some thoughts were given on the limitations of the selected studies, comments were not comprehensive, nor systematic. Furthermore, our chosen studies were few in number, had varying rigor, and slightly different methodologies, which prevents us from offering strong, evidence-informed recommendations and establishing best practices.

Despite the dearth of literature pertaining to PA interventions for TC survivors, there are still several key takeaways that can help inform future research. First, studies are needed incorporating larger sample sizes, with stronger study designs to examine causal mechanisms (i.e., wait-list control group or delayed treatment), and more robust and longer PA protocols (e.g., accelerometers or wrist-worn devices for weeks/months). Second, future interventions may need to consider feasibility of protocols and programming logistics, PA dose, and potential interactive feedback or counseling to increase adherence to the intervention. Specifically, previous studies have shown that distance to the facility (i.e., location where exercise/PA will take place) can act as a barrier to engaging in PA programming ³⁰ ; thus, adopting a community-based model where the PA “prescription” takes place near the patients’ home (e.g., community center, recreational facility) may be one strategy worth adopting in a future trial, especially when trying to assist hard-to-reach populations such as TC survivors living in rural locations.

Finally, tailoring the PA intervention, including the use of counseling and/or peer coaches, has shown a degree of success in previous smaller trials. ²⁵ Although adopting this approach makes it more difficult to generalize appropriate dose and mode of PA for TC survivors and is resource-intensive, there is an opportunity here to leverage technology applications and consumer wearables. Incorporating the use of smart-phone-based applications that can be paired with consumer wearable fitness trackers (e.g., Fitbit) may allow for a more streamlined approach that can unite groups of users (i.e., increase social capacity), allow intervention personnel to monitor PA adherence to guidelines based on real-time data, and provide individualized tailored feedback to multiple users, all from a remote central location.

The findings of this scoping review highlight the emerging but still limited body of research on the relationship between PA and HRQoL among TC survivors. While existing studies suggest that PA—particularly structured interventions like HIIT—can improve cancer-related fatigue, mental well-being, and certain HRQoL components, the breadth of research remains constrained by small sample sizes, methodological limitations, and inconsistent adherence among participants. Notably, PA interventions appear to offer benefits beyond physical health, potentially addressing psychological concerns such as stress, self-esteem, and overall mental health. However, adherence challenges, particularly in long-term engagement beyond structured interventions, underscore the need for sustainable, scalable exercise strategies tailored to the unique needs of TC survivors.

Given the significant morbidity burden associated with TC survivorship—including CIPN, fatigue, and psychological distress—further research is warranted to explore optimized PA interventions. Future studies should incorporate diverse survivor populations, longitudinal designs, and alternative exercise modalities beyond HIIT to determine the most effective and accessible approaches. Additionally, addressing behavioral barriers to exercise engagement through targeted interventions could enhance adherence and long-term benefits. Ultimately, expanding the evidence base in this area will be essential for informing clinical recommendations and developing personalized survivorship care plans that integrate PA as a cornerstone for improving TC survivors’ overall quality of life.

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