Molecular, cellular, biochemical, and rehabilitative insights into exercise interventions for gynecological cancer prevention and survivorship: a narrative review

Abstract This review paper investigated existing literature on the relationship between physical activity, exercise, and gynecological cancers, focusing on ovarian, endometrial, and cervical cancers. Epidemiological studies consistently demonstrate an inverse association between physical activity levels and the risk of developing gynecological cancers, as well as improved survival outcomes among cancer survivors engaging in regular exercise. Mechanistic insights suggest that physical activity and exercise may modulate key pathways involved in carcinogenesis, tumor progression, and treatment response, offering promising avenues for preventive and adjunctive therapeutic interventions. However, despite a growing body of research in exercise oncology, there is a lack of disease-specific synthesis addressing how exercise can be tailored to the distinct pathophysiological, treatment-related, and psychosocial challenges of gynecological cancers. Current guidelines often generalize exercise recommendations across all cancer types, overlooking the unique symptom burdens, such as pelvic floor dysfunction, sarcopenia, and menopausal symptoms, specific to gynecologic malignancies. This review addresses this gap by examining the evidence base for exercise in ovarian, endometrial, and cervical cancers, with an emphasis on mechanistic, clinical, and rehabilitative dimensions. By integrating epidemiological findings with preclinical and intervention data, this work aims to establish a gynecologic-specific framework for exercise prescription. This review underscores the importance of multidisciplinary research efforts to optimize lifestyle interventions, inform evidence-based guidelines, and improve outcomes for individuals affected by gynecological cancers.