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Physical exercise during neoadjuvant chemotherapy does not significantly improve pathologic complete response in solid tumorsExercise and chemotherapy results for several types of cancer

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Key Takeaway
Note that exercise during neoadjuvant chemotherapy did not significantly improve pathologic complete response across solid tumors.

This meta-analysis evaluated the impact of aerobic and resistance exercise on pathologic complete response (pCR) in 504 patients with solid tumors, including breast, esophageal, gastric, and rectal cancers, undergoing neoadjuvant chemotherapy (NACT). The primary analysis found no significant difference in pCR between the exercise and control groups (Risk ratio: 1.08; 95% CI: 0.82 to 1.43; p = 0.58).

A meta-regression for the specific subset of patients with HR+ / HER2- breast cancer suggested that exercise might be associated with enhanced tumor response (regression coefficient: 0.83; 95% CI: -0.00 to 1.67; p = 0.05). However, the authors note that this finding is exploratory and should be interpreted with caution.

The evidence is characterized by low certainty due to the small number of included studies. Clinical application is limited as exercise did not demonstrate a clear improvement in pCR across the broader range of cancer types studied. The potential benefit in the specific breast cancer subtype remains preliminary and lacks sufficient evidence for standard clinical recommendation.

How this fits prior evidence

This meta-analysis addresses a gap in evidence regarding the role of physical exercise during neoadjuvant chemotherapy for solid tumors. While previous evidence noted that physical frailty is a risk factor for pneumonia after esophagectomy, this study specifically evaluates the impact of exercise on pathologic complete response. The finding of no significant difference in pCR across cancer types suggests that exercise does not currently offer a measurable improvement in primary treatment response for these specific solid tumors.

When facing a cancer diagnosis, patients often look for every possible way to improve their treatment. One common question is whether adding physical exercise to chemotherapy can help shrink tumors more effectively. Researchers looked at data from 504 patients with solid tumors, including breast, esophageal, gastric, and rectal cancers, to find out.

The analysis found that for most patients, adding aerobic or resistance exercise did not significantly change the rate of pathologic complete response. This is the measure of how well chemotherapy clears the tumor. However, the data did show a potential trend for a specific type of breast cancer, but the evidence for this is not very strong.

It is important to keep these findings in perspective. Because the study relied on a small number of reports, the overall certainty of the evidence is low. While the data suggests a possible link for some breast cancer patients, it is not enough to confirm a clear benefit for everyone. Patients should talk to their doctors about how exercise fits into their specific care plan.

What this means for you:
Exercise did not show a significant overall impact on tumor shrinkage across the different cancer types studied.

Common questions

Does exercise help shrink tumors during chemotherapy?

The study found no significant difference in tumor shrinkage between patients who exercised and those who did not across most cancer types. While there was a potential trend for a specific type of breast cancer, the evidence is currently not strong enough to confirm a clear benefit for all patients.

What types of cancer were included in this study?

The study looked at patients with solid tumors, specifically those with breast, esophageal, gastric, or rectal cancer. It focused on how these patients responded to neoadjuvant chemotherapy, which is chemotherapy given before primary treatment like surgery.

Is the evidence for exercise in breast cancer patients reliable?

The evidence is currently of low certainty because the study relied on a small number of reports. While some data suggested a possible increase in response for one specific breast cancer subtype, these results should be interpreted with caution.

Study Details

Study typeMeta analysis
Sample sizen = 504
EvidenceLevel 1
PublishedSep 2026
View Original 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 I and chi 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.
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