Introduction People with metastatic cancers experience fatigue, decreased physical function (PF), and poor quality of life (QoL). Exercise improves these symptoms in the curative setting, but the efficacy and safety in patients with metastatic cancer is uncertain. Methods Studies were identified from 3 prior systematic reviews and updated using a PubMed search. Included studies were randomized trials of moderate/high intensity aerobic exercise or resistance training intervention versus control in patients with metastatic solid cancers. The mean and standard deviation (SD) for validated outcomes (QoL, PF, and fatigue) were extracted for intervention and control groups at baseline and post-intervention. The effect of exercise was evaluated as the pooled change between baseline and postintervention. Groups were compared using the Mann Whitney test. Results Twenty-one trials met inclusion criteria and 7 were excluded due to incomplete data. Among patients with mean baseline scores, exercise was not associated with significant change in fatigue, PF or QoL. In those with baseline scores 2 SD below mean, there was clinical improvement in PF (0.44 vs 8.5) and avoidance of decline in 6-minute walk test (-29.75 vs -0.38m), without statistical significance. There was a statistical improvement in sit-tostand (STS) at the mean and 2 SD below the mean (2.5 vs 6.5, p=0.029) for both groups. There were no differences in falls, fractures, or pain. Conclusions In patients with metastatic solid cancers, exercise interventions are associated with clinically meaningful improvements in PF, and statistically improved STS scores in patients with baseline score at themean or lower.