Network meta-analysis shows exercise interventions improve cognitive function in breast cancer patients

INTRODUCTION: Cognitive impairment, often termed "chemobrain," significantly impacts the quality of life in breast cancer survivors. While exercise is a recommended intervention, the relative efficacy of different exercise modalities remains unclear. This study aims to compare and rank the effects of various exercise types on cognitive function in breast cancer patients through a network meta-analysis (NMA). METHODS: We conducted a systematic review of randomized controlled trials from six databases published up to January 2026. Methodological quality followed Cochrane guidelines, with data analyzed using Review Manager 5.3 and Stata 16.0. Evidence certainty was assessed via GRADE methodology. RESULTS: Nineteen RCTs involving 1440 participants were included. NMA results indicated that mind-body exercise (MBE) [SMD = 0.68, 95% CI: 0.30 to 1.06] and aerobic exercise (AE) [SMD = 0.40, 95% CI: 0.10 to 0.71] significantly improved self-reported cognitive function. SUCRA rankings identified MBE as the most effective intervention (88.4%), followed by multi-component exercise (ME) (69.2%) and aerobic exercise (AE) (55.5%). Subgroup analysis suggested that Yoga and Baduanjin were the primary contributors to the efficacy of MBE. Regarding cognitive domains, exercise significantly enhanced executive function [SMD = -0.35, 95% CI: -0.56 to -0.13, P = 0.002] and reduced cognitive fatigue [SMD = -0.22, 95% CI: -0.41 to -0.03, P = 0.02], whereas no significant effect was found for memory function [SMD = 0.11, 95% CI: -0.63 to 0.84, P = 0.77]. CONCLUSIONS: MBE and AE are effective interventions for mitigating cognitive decline in breast cancer patients, with MBE showing the highest probability of being the optimal intervention. Future research should prioritize large-scale, head-to-head trials to refine these rankings and explore objective cognitive assessments.