Exercise is often recommended for cancer patients. However, for advanced cancer palliative care patients, it is unclear whether exercise, as a lifestyle intervention, is beneficial for palliative outcomes. To examine randomized controlled trials assessing the effectiveness of lifestyle exercise interventions on palliative outcomes in patients with advanced stage cancer. Systematic review and descriptive evidence synthesis. Pubmed/Medline, Embase, CINAHL, PsychInfo, and Web of Science were systematically searched from inception to 2022. Two reviewers identified articles and removed duplicates. Next two reviewers independently screened titles and abstracts and then assessed full-texts articles for eligibility. Finally, all six reviewers examined full-text articles for eligibility and conducted the evidence synthesis. Eight randomized controlled trials were included. Studies were heterogeneous making direct comparisons challenging, but were grouped along three categories: aerobic, resistance, or resistance-aerobic exercises. One of three aerobic studies had positive quality-of-life outcomes. Fatigue improved in one aerobic and one combination resistance-aerobic study. Most resistance-aerobic studies and one aerobic study showed improved physical function. All resistance studies showed improvement in at least one outcome. Across all studies, ill health was the most common reason for participant dropout. The most commonly used assessment tools were: Functional Assessment of Cancer Therapy: Fatigue, European Organization for Research and Treatment of Cancer Quality-of-life Questionnaire Core 30, and accelerometer. Current randomized controlled trials regarding effects of exercise interventions on palliative outcomes for advanced cancer patients show great variability. While studies show promise, no generalizable conclusions can be made. Further research is needed.