Structured exercise and cardiac outcomes during anthracycline or anti-HER2 therapy in breast cancer: systematic review and meta-analysis of randomized trials
In brief
Seven trials find no clear cardiac protection from exercise during breast cancer therapy
Across seven trials involving 513 women, exercise showed no clear advantage over usual care in preserving heart pumping function or strain during chemotherapy. Only two trials could be pooled, and the evidence was low-certainty with wide uncertainty; studies did not report cardiovascular events or survival, so whether exercise prevents clinically important heart problems remains unknown.
- Journal
- Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer (Q1)
- Published
- 2 October 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Raúl Cobreros-Mielgo, Jesús Seco-Calvo, Diego Fernández-Lázaro
- PMID
- 42825938
- DOI
- 10.1007/s00520-026-11287-5
Why clinicians should know about it
- Picked for Radiation Oncology (top studies of the week, 4 October 2026): Not applicable to radiation oncology
- Picked for Surgical Oncology (top studies of the week, 4 October 2026): High-quality evidence in a top journal
- Picked for Biochemistry (medical) (top studies of the week, 4 October 2026): Exercise impact on cardiac outcomes during anthracycline therapy
- Picked for Rehabilitation (top studies of the week, 4 October 2026): High-quality evidence in a top journal
Abstract
PURPOSE: To evaluate whether structured exercise, compared with usual care, preserves left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and cardiac biomarkers in women with breast cancer receiving anthracyclines and/or anti-HER2 therapy. METHODS: We performed a systematic review and meta-analysis of randomized controlled trials. Risk of bias was assessed with the revised Cochrane risk-of-bias tool for randomized trials (RoB 2), and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. When clinically and methodologically comparable, effects were pooled as net differences in change (ΔEG - ΔCG) using random-effects models. The primary synthesis was restricted to the baseline-to-end-of-anthracycline-treatment window (~ 4 months). RESULTS: Seven trials (9 reports; n = 513) were included. Most trials had some concerns or high risk of bias. Quantitative synthesis was feasible in only two trials. No between-group differences were observed for LVEF (MD 0.07, 95% CI - 1.38 to 1.52; I2 = 28.2%) or GLS (MD - 0.10, 95% CI - 0.79 to 0.58; I2 = 0%). Confidence intervals were wide and compatible with benefit, no effect, or harm. Biomarker data were too heterogeneous for meta-analysis. Comparative clinical cardiovascular-event and survival outcomes and formal assessments of heart failure with preserved ejection fraction (HFpEF) were not reported. CONCLUSION: Current randomized evidence is sparse, heterogeneous, and of low certainty. Available data do not confirm a consistent cardioprotective effect of exercise on LVEF or GLS and do not permit conclusions about clinical cardiovascular events, survival, or HFpEF.
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.