Exercise and pathologic complete response to cancer treatment: a systematic review and meta-analysis
In brief
Exercise during neoadjuvant chemotherapy does not increase complete response rates
A meta-analysis of eight randomized trials (504 patients with breast, esophageal, gastric or rectal cancer) found no overall improvement in pathologic complete response when exercise was added to neoadjuvant chemotherapy (risk ratio ~1.08, not statistically significant). Exploratory data hint at a possible benefit in hormone-receptor-positive/HER2-negative breast cancer, but the evidence is limited and uncertain.
- Journal
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Q1)
- Published
- 9 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Nuno Dias Rato, Catarina Garcia, Diogo Pinto, Helena Guedes, Ana Joaquim, Sofia Viamonte, et al.
- PMID
- 42714641
- DOI
- 10.1007/s00520-026-11156-1
Why clinicians should know about it
- Picked for Pathology and Forensic Medicine (top studies of the week, 13 September 2026): High-quality evidence in a top journal
Abstract
PURPOSE: Neoadjuvant chemotherapy (NACT) is a commonly recommended approach for treating several cancers, and improving patients' outcomes to this therapy is important. This systematic review and meta-analysis assessed the impact of exercise on pathologic complete response (pCR), a key short-term marker of treatment efficacy, in patients with solid tumors receiving NACT. METHODS: Four electronic databases were searched for randomized controlled trials with physical exercise during NACT as an intervention published until May 2025. Risk of bias was assessed using Cochrane RoB 2.0 and the TESTEX scale. A random-effect meta-analysis using the inverse variance method synthesized the results. Heterogeneity was assessed using I2 and chi2 statistics. Risk ratio estimated the effect size. RESULTS: Eight studies involving 504 patients with breast, esophageal, gastric, or rectal cancer were included in the final analysis. Exercise interventions consisted of aerobic and resistance exercise. Overall, there were no significant differences between exercise and control groups in the rate of pCR to NACT (pooled risk ratio: 1.08 (95% CI: 0.82 to 1.43) Z = 0.56, p = 0.58). However, meta-regression data from breast cancer (BC) studies (4 studies, 367 participants) suggest exercise may be associated with enhanced tumor response to NACT in HR + /HER2- subtypes (regression coefficient: 0.83 (95% CI: -0.00 to 1.67), p = 0.05). CONCLUSION: Exercise during NACT did not improve pCR across cancer types. Exploratory meta-regression findings suggest a possible benefit of exercise in BC patients with the HR + /HER2- subtype. These results should be interpreted with caution due to the small number of studies and low certainty of the evidence.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.