Objective: To review the evidence that personalised physical activity is a feasible and acceptable means of significantly improving quality of life (QoL) and cancer related fatigue (CRF) in childhood cancer. Methods: Seven databases/registers were searched for studies evaluating exercise interventions in paediatric cancer (2013-2023). Studies included patients ages 3-25 years, with any cancer type, undergoing exercise interventions during active treatment. Thirteen studies (551 participants) were included. Primary outcome measures analysed were CRF and QoL. Results: Three of eight studies (N=105) measuring CRF revealed significant reduction in total fatigue score (p=0.001, 0.01, 0.026). All others demonstrated a non-significant reduction in CRF in the intervention group (mean -5.7 (±8.82 pooled SD)). One of ten papers (N=99) measuring QoL reported significant improvement (p=0.014), with non-significant favourable outcomes (mean change +3.47) in all remaining studies. No adverse events were reported. Conclusion: Physical activity is a feasible way to improve CRF and QoL in children undergoing cancer treatment.