Abstract
Purpose Physical activity may play a supportive role in cancer survivorship. However, evidence on the association between post-diagnosis physical activity and mortality among women with gynecological cancer remains limited and inconsistent. Methods We conducted a systematic review of the literature published between 1949 and January 2026. Eligible observational studies were identified, and random-effects meta-analyses were performed to estimate pooled hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between post-diagnosis physical activity and all-cause mortality among women diagnosed with gynecological cancer. Results A total of ten eligible studies on endometrial, ovarian, and cervical cancer were included, collectively reporting 3,867 deaths. High levels of post-diagnosis physical activity, compared with low levels, were associated with lower mortality (HR: 0.65; 95% CI 0.54–0.78). This inverse relationship was evident in both endometrial and ovarian cancer survivors (endometrial cancer: HR: 0.60; 95% CI 0.43–0.83; ovarian cancer: HR: 0.71; 95% CI 0.58–0.86). Medium levels of physical activity tended to be inversely associated with mortality (HR: 0.88; 95% CI 0.76–1.02). Conclusion Higher levels of physical activity after a gynecological cancer diagnosis were associated with improved survival. The results suggest that physical activity may represent a modifiable lifestyle factor with the potential to improve long-term outcomes among gynecological cancer survivors. Implications for cancer survivors This supports the potential value of integrating physical activity into survivorship care, although further high-quality prospective studies are needed to strengthen causal inference.