Advancements in cancer research, treatment protocols, and supportive care interventions have contributed to an increasing population of adolescent and young adult cancer survivors (AYA-CS). Impaired cardiorespiratory fitness is a key modifiable risk factor in AYA-CS, linked to several conditions, in particular cardiovascular disease. This scoping review describes and synthesizes previously published data that has documented the cardiorespiratory fitness in AYA-CS. Secondary objectives were to synthesize the assessment methodologies used to measure cardiorespiratory fitness and to explore whether exercise interventions improve AYA-CS fitness. CINAHL, EMBASE, MEDLINE, and SPORTDiscus were systematically searched from [28/02/2025]. Original articles that assessed cardiorespiratory fitness in AYA-CS (aged between 15 and 39 at the time of cancer diagnosis and had completed treatment) were eligible. A total of 3049 articles were identified from the database search. After screening, 10 studies were included, representing 494 participants (59.7% female). AYA-CS exhibit markedly reduced cardiorespiratory fitness with peak oxygen uptake values 20–47% below healthy controls when measured via cardiopulmonary exercise test. There was wide variability in both the measures used to assess cardiorespiratory fitness and the types and mode of prescribed exercise interventions. Exercise interventions were primarily individualized and aerobic, demonstrating good feasibility and high acceptability among AYA-CS. This scoping review highlights that AYA-CS experience persistent impairments in cardiorespiratory fitness post-treatment. Future research is required to standardize fitness assessment measures, establishing cardiorespiratory fitness norms to help guide clinical interventions and the development of targeted interventions aimed at improving fitness and health outcomes.
JanssenSHM, van der GraafWTA, van der MeerDJ, et al.Adolescent and young adult (AYA) cancer survivorship practices: An overview. Cancers (Basel), 2021; 13(19):4847.
2.
GuptaS, HarperA, RuanY, et al.International trends in the incidence of cancer among adolescents and young adults. J Natl Cancer Inst, 2020; 112(11):1105–1117.
3.
Australian Institute of Health and Welfare. Cancer in adolescents and young adults in Australia 2023, catalogue number CAN 151, 2023, Australian Goverment.
4.
BakerKS, et al.Adolescent and Young Adult Cancer Survivors: Late Effects of Treatment, in Cancer in Adolescents and Young Adults. BleyerA, et al., (Eds). 2017, Springer International Publishing: Cham. pp. 687–710.
5.
TaiE, BuchananN, TownsendJ, et al.Health status of adolescent and young adult cancer survivors. Cancer, 2012; 118(19):4884–4891.
6.
ChaoC, XuL, BhatiaS, et al.Cardiovascular disease risk profiles in survivors of adolescent and young adult (AYA) cancer: The Kaiser Permanente AYA Cancer Survivors Study. J Clin Oncol, 2016; 34(14):1626–1633.
7.
ChaoC, BhatiaS, XuL, et al.Chronic comorbidities among survivors of adolescent and young adult cancer. J Clin Oncol, 2020; 38(27):3161–3174.
8.
LeeJS, DuBoisSG, CocciaPF, et al.Increased risk of second malignant neoplasms in adolescents and young adults with cancer. Cancer, 2016; 122(1):116–123.
WangL, WangF, ChenL, et al.Long-term cardiovascular disease mortality among 160 834 5-year survivors of adolescent and young adult cancer: An American population-based cohort study. Eur Heart J, 2021; 42(1):101–109.
11.
WangZ, FanZ, YangL, et al.Higher risk of cardiovascular mortality than cancer mortality among long-term cancer survivors. Front Cardiovasc Med, 2023; 10:1014400.
12.
BaassiriMJ and MulrooneyDA. At the heart of adolescent and young adult cancer survivorship. J Clin Oncol, 2016; 34(14):1570–1572.
13.
MulrooneyDA, YeazelMW, KawashimaT, et al.Cardiac outcomes in a cohort of adult survivors of childhood and adolescent cancer: Retrospective analysis of the Childhood Cancer Survivor Study cohort. BMJ, 2009; 339:b4606.
14.
BerkmanAM, AndersenCR, RothME, et al.Cardiovascular disease in adolescent and young adult cancer survivors: Impact of sociodemographic and modifiable risk factors. Cancer, 2023; 129(3):450–460.
15.
FerioliM, ZauliG, MartelliAM, et al.Impact of physical exercise in cancer survivors during and after antineoplastic treatments. Oncotarget, 2018; 9(17):14005–14034.
16.
CarretierJ, BoyleH, DuvalS, et al.A review of health behaviors in childhood and adolescent cancer survivors: Toward prevention of second primary cancer. J Adolesc Young Adult Oncol, 2016; 5(2):78–90.
17.
BerkmanAM and LakoskiSG. A review of cardiorespiratory fitness in adolescent and young adult survivors of childhood cancer: Factors that affect its decline and opportunities for intervention. J Adolesc Young Adult Oncol, 2016; 5(1):8–15.
18.
CarnethonMR, GiddingSS, NehgmeR, et al.Cardiorespiratory fitness in young adulthood and the development of cardiovascular disease risk factors. JAMA, 2003; 290(23):3092–3100.
19.
SchmidD and LeitzmannMF. Cardiorespiratory fitness as predictor of cancer mortality: A systematic review and meta-analysis. Ann Oncol, 2015; 26(2):272–278.
20.
ImbodenMT, HarberMP, WhaleyMH, et al.Cardiorespiratory fitness and mortality in healthy men and women. J Am Coll Cardiol, 2018; 72(19):2283–2292.
21.
CormieP, AdamsD, AtkinsonM, et al.; Clinical Oncology Society of Australia Exercise and Cancer Group. Exercise as part of routine cancer care. Lancet Oncol, 2018; 19(9):e432.
22.
FullerJT, HartlandMC, MaloneyLT, et al.Therapeutic effects of aerobic and resistance exercises for cancer survivors: A systematic review of meta-analyses of clinical trials. Br J Sports Med, 2018; 52(20):1311.
23.
CormieP, ZopfEM, ZhangX, et al.The impact of exercise on cancer mortality, recurrence, and treatment-related adverse effects. Epidemiol Rev, 2017; 39(1):71–92.
24.
PatelAV, FriedenreichCM, MooreSC, et al.American College of Sports Medicine roundtable report on physical activity, sedentary behavior, and cancer prevention and control. Med Sci Sports Exerc, 2019; 51(11):2391–2402.
25.
HayesSC, NewtonRU, SpenceRR, et al.The exercise and sports science Australia position statement: Exercise medicine in cancer management. J Sci Med Sport, 2019; 22(11):1175–1199.
26.
VasilopoulouM, AsimakopoulouZ, VelissariJ, et al.Interventions about physical activity and diet and their impact on adolescent and young adult cancer survivors: A Prisma systematic review. Support Care Cancer, 2024; 32(6):342.
27.
AdesPA and TothMJ. Accelerated decline of aerobic fitness with healthy aging. Circulation, 2005; 112(5):624–626.
28.
LetnesJM, NesBM and WisløffU. Age-related decline in peak oxygen uptake: Cross-sectional vs. longitudinal findings. A review. Int J Cardiol Cardiovasc Risk Prev, 2023; 16:200171.
29.
MunsieC, et al.The benefit of physical activity in adolescent and young adult cancer patients during and after treatment: A systematic review. J Adolesc Young Adult Oncol, 2019.
30.
CaruM, LevesqueA, RaoP, et al.A scoping review to map the evidence of physical activity interventions in post-treatment adolescent and young adult cancer survivors. Crit Rev Oncol Hematol, 2022; 171:103620.
31.
CaruM, WurzA, BrunetJ, et al.; North American Consortium on Exercise in AYAs Diagnosed with Cancer. Physical activity and physical fitness assessments in adolescents and young adults diagnosed with cancer: A scoping review. Support Care Cancer, 2023; 31(10):569.
32.
PetersMDJ, GodfreyCM, KhalilH, et al.Guidance for conducting systematic scoping reviews. Int J Evid Based Healthc, 2015; 13(3):141–146.
33.
TriccoAC, LillieE, ZarinW, et al.PRISMA extension for scoping reviews (PRISMA-ScR): Checklist and explanation. Ann Intern Med, 2018; 169(7):467–473.
34.
PateR, OriaM, PillsburyL. and Health-related fitness measures for youth: Cardiorespiratory endurance, in Fitness measures and health outcomes in youth., 2012, National Academies Press. (US).
35.
FlegJL, PiñaIL, BaladyGJ, et al.Assessment of functional capacity in clinical and research applications. Circulation, 2000; 102(13):1591–1597.
36.
MarlowN, HastingsK, and HanssonJ. Exercise and Sports Science Australia’s Outcome Measures for Exercise Physiologists: Ensuring Evidence-Based Practice. 2014: Exercise & Sports Science Australia.
37.
CloseAG, DreyzinA, MillerKD, et al.Adolescent and young adult oncology—past, present, and future. CA Cancer J Clin, 2019; 69(6):485–496.
38.
OsbornM, LittleC, BoweringS, et al.Youth cancer services in Australia: Development and implementation. International Perspectives on AYAO, Part 3. J Adolesc Young Adult Oncol, 2013; 2(3):118–124.
39.
BleyerA. Adolescent and young adult (AYA) oncology: The first A. Pediatr Hematol Oncol, 2007; 24(5):325–336.
40.
AlbrittonK, BarrR, and BleyerA. The adolescence of young adult oncology. Semin Oncol, 2009; 36(5):478–488.
41.
KetterlTG, BallardS, BradfordMC, et al.Feasibility and acceptability of a home-based resistance training intervention in adolescent and young adult hematopoietic cell transplant survivors. Pediatr Blood Cancer, 2021; 68(11):e29206.
42.
BerkmanAM, and LakoskiSG. Treatment, behavioral, and psychosocial components of cardiovascular disease risk among survivors of childhood and young adult cancer. J Am Heart Assoc, 2015; 4(4):e001891.
43.
AspenesST, NilsenTIL, SkaugE-A, et al.Peak oxygen uptake and cardiovascular risk factors in 4631 healthy women and men. Med Sci Sports Exerc, 2011; 43(8):1465–1473.
44.
AntwiGO, JayawardeneW, LohrmannDK, et al.Physical activity and fitness among pediatric cancer survivors: A meta-analysis of observational studies. Support Care Cancer, 2019; 27(9):3183–3194.
45.
MurnaneA, MesinovicJ, KissN, et al.Fitness, body composition, and health behaviors in long-term survivors of adolescent and young adult cancers. J Adolesc Young Adult Oncol, 2025; 14(5):401–411.
46.
WeinkaufK, FyfeE, HewittD, et al.Cardiorespiratory fitness in childhood cancer survivors: A systematic review and meta-analysis. Eur J Prev Cardiol, 2024:zwae317.
47.
ATS Committee on Proficiency Standards for Clinical Pulmonary Function Laboratories. ATS statement: Guidelines for the six-minute walk test. Am J Respir Crit Care Med, 2002; 166(1):111–117.
48.
HutchinsonMJ, KouwijzerI, de GrootS, et al.Comparison of two Borg exertion scales for monitoring exercise intensity in able-bodied participants, and those with paraplegia and tetraplegia. Spinal Cord, 2021; 59(11):1162–1169.
49.
El-JawahriA, PidalaJ, InamotoY, et al.Impact of age on quality of life, functional status, and survival in patients with chronic graft-versus-host disease. Biol Blood Marrow Transplant, 2014; 20(9):1341–1348.
50.
JohansenSH, WisløffT, EdvardsenE, et al.Effects of systemic anticancer treatment on cardiorespiratory fitness. JACC: CardioOncology, 2025; 7(2):96–106.
51.
MurnaneA, GoughK, ThompsonK, et al.Adolescents and young adult cancer survivors: Exercise habits, quality of life and physical activity preferences. Support Care Cancer, 2015; 23(2):501–510.
52.
ThorsenL, SkovlundE, StrømmeSB, et al.Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. J Clin Oncol, 2005; 23(10):2378–2388.
53.
AtkinsonM, MurnaneA, GoddardT, et al.A randomized controlled trial of a structured exercise intervention after the completion of acute cancer treatment in adolescents and young adults. Pediatr Blood Cancer, 2021; 68(1):e28751.
54.
RabinC, PintoB, and FavaJ. Randomized trial of a physical activity and meditation intervention for young adult cancer survivors. J Adolesc Young Adult Oncol, 2016; 5(1):41–47.
55.
SchneiderCM, RepkaCP, BrownJM, et al.Demonstration of the need for cardiovascular and pulmonary normative data for cancer survivors. Int J Sports Med, 2014; 35(13):1134–1137.
56.
MurnaneA, ThompsonK, MancusoSG, et al.Exploring the effect of exercise physiology intervention among adolescent and young adults diagnosed with cancer. Rehabilitation Oncology, 2019; 37(2):55–63.
57.
SmithA, MurnaneA, ThompsonK, et al.ReActivate—A goal-orientated rehabilitation program for adolescent and young adult cancer survivors. Rehabilitation Oncology, 2019; 37(4):153–159.
58.
HaukenMA, HolsenI, FismenE, et al.Working toward a good life as a cancer survivor: A longitudinal study on positive health outcomes of a rehabilitation program for young adult cancer survivors. Cancer Nurs, 2015; 38(1):3–15.
59.
MurnaneA, KissN, FraserSF, et al.Health-related quality of life, fatigue and health behaviours in Australian adolescent and young adult cancer survivors. Pediatr Blood Cancer, 2021; 68(10):e29243.
60.
PughG, HoughR, GravestockH, et al.The health behaviour status of teenage and young adult cancer patients and survivors in the United Kingdom. Support Care Cancer, 2020; 28(2):767–777.
61.
PillsburyL, OriaM, PateR. and Fitness measures and health outcomes in youth. 2013.
62.
GonzalesTI, WestgateK, StrainT, et al.Cardiorespiratory fitness assessment using risk-stratified exercise testing and dose-response relationships with disease outcomes. Sci Rep, 2021; 11(1):15315.
63.
NoonanV, and DeanE. Submaximal exercise testing: Clinical application and interpretation. Phys Ther, 2000; 80(8):782–807.
64.
SartorF, VernilloG, de MorreeHM, et al.Estimation of maximal oxygen uptake via submaximal exercise testing in sports, clinical, and home settings. Sports Med, 2013; 43(9):865–873.
65.
ReedJL, CotieLM, ColeCA, et al.Submaximal exercise testing in cardiovascular rehabilitation settings (BEST Study). Front Physiol, 2019; 10:1517.
66.
MizrahiD, FardellJE, CohnRJ, et al.The 6-minute walk test is a good predictor of cardiorespiratory fitness in childhood cancer survivors when access to comprehensive testing is limited. Int J Cancer, 2020; 147(3):847–855.
67.
VerdicchioC, FreeneN, HollingsM, et al.A clinical guide for assessment and prescription of exercise and physical activity in cardiac rehabilitation. A CSANZ position statement. Heart Lung Circ, 2023; 32(9):1035–1048.
68.
SpenceRR, SandlerCX, JonesTL, et al.Practical suggestions for harms reporting in exercise oncology: The exercise harms reporting method (ExHaRM). BMJ Open, 2022; 12(12):e067998.
69.
SladeSC, DionneCE, UnderwoodM, et al.Consensus on exercise reporting template (CERT): Explanation and elaboration statement. Br J Sports Med, 2016; 50(23):1428–1437.
70.
HoffmannTC, GlasziouPP, BoutronI, et al.Better reporting of interventions: Template for intervention description and replication (TIDieR) checklist and guide. BMJ, 2014; 348:g1687.
71.
FilipovicMG, LuediMM. Cardiovascular biomarkers: Current status and future directions. Cells, 2023; 12(22):2647.
72.
WilsonRL, ChristopherCN, YangEH, et al.Incorporating exercise training into cardio-oncology care: Current evidence and opportunities: JACC: CardioOncology state-of-the-art review. JACC CardioOncol, 2023; 5(5):553–569.
73.
WootenSV, WangF, RothME, et al.Early skeletal muscle loss in adolescent and young adult cancer patients treated with anthracycline chemotherapy. Cancer Med, 2023; 12(22):20798–20809.
74.
GartlehnerG, AffengruberL, TitscherV, et al.Single-reviewer abstract screening missed 13 percent of relevant studies: A crowd-based, randomized controlled trial. J Clin Epidemiol, 2020; 121:20–28.
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