Objective: The effectiveness of exercise in addressing sleep disturbance and improving survival outcomes among advanced cancer survivors remains inconsistent. To evaluate and synthesize the effectiveness of exercise on sleep disturbance and survival in advanced cancer survivors.

Materials and Methods: Databases of the Cochrane Library, PubMed, PsycINFO, CINAHL, EMBASE, and China National Knowledge Infrastructure (CNKI) were searched. A total of 12 randomized controlled trials (RCTs) were included. A total of 12 RCTs with 1313 participants of advanced cancer survivors were included. Outcomes were assessed using the revised Cochrane risk-of-bias tool in RevMan. A random-effects model was used, and the results are presented as summary standardized mean differences (SMDs) with their 95% confidence intervals (CIs). To explore sources of heterogeneity, a meta-regression was conducted using Stata 15.0.

Results: Meta-analysis revealed a significant inverse association between exercise levels and subjective sleep quality (SMD = -0.42, 95% CI: -0.70 to -0.13). Meta-regression identified a significant moderating effect of gender proportion on exercise’s impact on sleep disturbance (95% CI: 0.36 to 1.32, p = 0.002). Subgroup analysis indicated that exercise significantly reduced sleep disturbance, specifically in cohorts with ≤50% female participation (SMD = -0.63, 95% CI: -0.92 to -0.34). Conversely, pooled data showed no significant effect of exercise interventions on overall survival in advanced cancer survivors.

Conclusions: Long-term exercise should help improve sleep, especially for male patients with advanced cancer. The impact of exercise intervention on survival should be assessed not only at advanced stages of cancer, but also from early exercise habits. More evidence is needed from randomized trials of exercise interventions on survival in advanced cancer survivors.