The study selection process is presented in Fig. 1. A total of 6490 records were identified; 5179 remained after de-duplication. After title and abstract screening, 114 articles were identified for full-text review. Of those, 14 studies were deemed eligible and were included in full data extraction for this review.
This review included 14 papers [47,48,49,50,51,52,53,54,55,56,57,58,59,60]. A further eight related papers were referenced to provide more detail when unable to find information in the primary paper (e.g. protocol papers) [61,62,63,64,65,66,67,68]. One study was a three-arm randomized controlled trial (RCT)  with the remaining 13 studies being two-arm RCTs. One study was described as a pilot  and seven as feasibility [47, 48, 50, 54, 55, 58, 60] RCTs. Seven studies took place in the USA [49, 50, 55, 56, 59, 60], two in Canada [47, 51] and one each in China , Japan , Korea , Sweden  and UK . Five studies recruited patients with prostate cancer only [47, 48, 55, 57, 60], one each recruited bladder , lung  and breast cancer only , with the remaining recruiting a mixed sample of cancer types [49, 50, 53, 54, 56, 59].
Risk of bias assessment
Full results from the assessment can be found in Figs. 2 and 3. Based on assessments from two reviewers, no studies received overall risk of bias judgements of low, ten were judged to have some concerns and four had high risk of bias. Twelve studies were low [47,48,49,50,51, 53, 54, 56,57,58,59,60] and two some concerns [52, 55] for allocation; ten were low [47, 49, 52,53,54, 56,57,58,59,60], two some concerns [48, 50] and two high [51, 55] for intervention deviations; nine rated low [47,48,49,50, 52,53,54, 56, 59], three some concerns [55, 57, 60] and two high [51, 58] for missing data; one ranked low  and 13 some concerns [47,48,49,50,51, 53,54,55,56,57,58,59,60] for outcome measurement; and finally, 11 rated low [47,48,49,50,51,52,53,54,55,56,57], two some concerns [58, 59] and one high  for selective reporting.
Most interventions focused on PA behaviour only [47, 51,52,53,54,55, 57,58,59,60] and three on both nutrition and activity behaviour [48, 49, 56]. One study reported improving nutrition as its main objective; however, this was a gardening intervention which could also be considered activity . The studies ranged in duration from 7 days to 1 year, six studies [48,49,50, 56, 58] collected follow-up measures beyond post-study though only three studies reported this data in the included articles [48, 49, 58]. Intervention settings included hospital [52,53,54,55, 58], community [57, 59, 60], home [49, 50, 56] or a mixture of settings [47, 48, 51]. Detailed characteristics of the included studies can be found in Table 1.
Activity intervention characteristics
Eight studies included some specific form of aerobic activity [47, 48, 51, 52, 54,55,56, 58], five had traditional-style strength training (e.g. lifting weights or using resistance bands) [47, 48, 56, 58, 60] and five included specific training to build balance and/or functional strength [51, 52, 57,58,59]. Seven interventions included at least one supervised individual session [47, 52,53,54,55, 57, 60], seven had home-based activities [47,48,49,50,51, 53, 56] and four were group-based classes or training sessions [47, 48, 58, 59]. Home-based interventions were delivered using DVD , booklets/binders [48,49,50, 53, 56] and four included visits or telephone calls to check-in and determine progress [47, 49, 50, 56]. Six home-based studies included personalized advice on activity [47,48,49, 51, 55, 56].
Nutrition intervention characteristics
One study provided participants with all supplies and guidance on growing their own vegetables at home and had role models in the form of a Master Gardener to teach and assist . One other study provided portion-control tableware to assist eating habits and included tailored nutrition advice as compared to national guidelines . One study had personalized comparisons to general information regarding standard nutrition guidelines . One study had a series of “healthy eating” seminars and a nutrition advice pack .
Theoretical intervention characteristics
Three studies explicitly stated they used a theory to develop study materials including social cognitive theory [49, 50, 56], transtheoretical model  and social ecological model . Other studies included information regarding habit formation , autonomy , self-efficacy  and action/coping planning [47, 50]. Aside from those studies with group-based session, to increase social support, one study formally included spouses or partners in the intervention  and one had a private Facebook group for study participants . Detailed descriptions of the interventions included can be found in Table 2.
Study feasibility was stated as the primary outcome for seven studies [47, 48, 50, 54, 55, 58, 60], of which six were deemed feasible based on recruitment, retention, adherence, and compliance rates [47, 48, 50, 54, 55, 60]. Though attendance and compliance rates were high, one study was deemed not feasible due to the large number of dropouts owing to the more severe illness of bladder cancer patients . Change in activity or diet behaviour was a primary outcome for two studies [48, 49] and five focused on physical [52, 56,57,58] or cognitive functioning . Seven found significant improvements in the primary outcome [48,49,50, 52, 54, 56, 57] while one found no significant group difference , though this was a feasibility trial. Further details can be found in Table 3.
To measure QoL, five studies used the Medical Outcomes Study’s Short-Form 36 (SF-36) [50, 56,57,58, 60], five used all or part of the general Functional Assessment of Cancer Therapy (FACT-G) [47, 48, 51, 53, 54] and one used the European Organization for Research and Treatment of Cancer QoL Questionnaire 30 (EORTC-QLQ-30) . Six used cancer-specific measures including the FACT-Prostate [47,48,49, 55], FACT-Breast [49, 51] and the EORTC Lung Cancer supplement . Six studies assessed symptom specific QoL including fatigue [47, 48, 51, 55, 59], anxiety and mood  and side effect burden . Six studies reported significant intervention group improvements [48, 55,56,57,58,59] and six reported no significant group difference in one or more QoL measure [48, 49, 51, 52, 54, 60]. Two studies reported significant negative intervention difference in QoL [47, 50]. There was no difference in effectiveness between studies that reported using theory/psychosocial components to guide the interventions versus those reporting no theory. Three studies using theory reported significant group differences in QoL measures [47, 50, 56]; however, two of these were favouring the non-intervention group [47, 50]. Both theory-based and non-theory-based studies had within group improvements in both quality of life and physical outcomes. Select QoL results are described below; full details can be found in Tables 3 and 4.
Quality of life
Participants in a home- or group-based activity programme reported poorer general and cancer-specific QoL than those in a 1:1 personal training group . Participants that received a home-based personalized activity and nutrition intervention reported similar improvements in general QoL to an attention control group receiving general information at study end which was maintained at follow-up . A wait-list control group showed more positive improvement in scores for pain, physical role and overall mental health compared to those receiving a gardening intervention . Both the home-based and group session-based participants in an exercise intervention for women diagnosed with breast cancer improved their overall and breast cancer-specific QoL . No differences were observed between groups on global or lung cancer-specific QoL in those participating in a prehabilitation intervention versus usual care . In a group of mixed cancer patients undergoing chemotherapy, between group differences favouring the intervention were noted among those having poorer social and emotional well-being at baseline measures compared to the wait-list control . No between-group or within-group differences were found for QoL in speed feedback therapy group versus usual care . Those receiving a supervised activity programme had significant between-group improvements in overall and prostate cancer-specific QoL compared to those receiving usual care . While both groups in a home-based activity and nutrition intervention versus wait-list control had declines in overall QoL throughout the study period, the intervention group had significantly smaller declines than the control group . Physical and mental composite scores of the SF-36 returned to preoperative levels in participants in a functional exercise intervention when compared to those in a usual care group . In an exercise study among people with bladder cancer, only the role-physical domain scores improved significantly in the intervention group compared to usual care; all other scores had no differences . No differences were found between exercise and control groups in men with prostate cancer, but among spouses also participating, there was a non-significant increase in partners’ mental health scores .
Fatigue and other side effects
Men starting or currently on androgen deprivation therapy (ADT) reported a similar change in fatigue among three groups receiving an activity programme . Participants that received a combination of supervised and home-based activity reported more improvement in fatigue than control groups after the study period which was maintained at follow-up . An activity and nutrition intervention found improvement in depression scores in both the tailored versus non-tailored groups .
In a study comparing the same programme either home or group based, there were non-significant improvements in fatigue in both groups . Participants receiving a low- to moderate-intensity home-based activity programme, with poorer anxiety and mood at baseline, had significant improvements compared to the control group . Men with prostate cancer participating in aerobic exercise before radiotherapy reported significantly better fatigue scores than those in usual care . Those participating in a yoga intervention reported significantly lower cancer-related fatigue and global side effect burden than the wait-list control group .