Anthracyclines are chemotherapeutic agents frequently used in breast cancer (BC) treatment. Although it improves disease-free and overall survival, the use of anthracyclines is associated with a cumulative risk of cardiac toxicity. Preventive strategies to optimize cardiac health are needed and exercise is proposed as a potential non-pharmacological approach for counteracting anthracycline-related cardiotoxicity (ARC). Most of the data on the effects of exercise to reduce ACT are from animal studies, with only a few studies in a limited number of patients indicating beneficial effects. To better understand the effectiveness of exercise in the mitigation of ARC, clinical, real-world trials claim require a larger sample size and more accurate and valuable clinical biomarkers. In this study, we intend to include a large sample and investigate cardiac function through serial measures of biomarkers and imaging techniques. This protocol describes a two-arm, prospective, randomized controlled trial that will explore the cardioprotective effect of a structured exercise program in women with BC undergoing anthracycline-containing chemotherapy (ACT). Ninety adult women with early BC and recommended to receive ACT will be randomly assigned (1:1) to an intervention group or a control group. Patients allocated to the intervention group will perform a supervised exercise program three times per week, consisting of a combination of aerobic and resistance training with progressive intensity and volume, during the time period they receive ACT. The control group will receive standard BC care. Primary outcomes related to cardiac (dys)function will be circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, resting left ventricular (LV) longitudinal strain, and resting LV ejection fraction. Secondary outcomes will include the assessment of resting blood pressure, resting heart rate (HR), resting HR variability (HRV), recovery HR, physical function outcomes, self-reported physical activity level, health-related quality of life, and fatigue. Data will be obtained at baseline (t0), after the end of anthracycline-treatment (t2), and 3 months after t2 (t3). Additionally, NT-proBNP will be measured 1–24 h prior to each anthracycline-treatment cycle (t1). The implementation of the present study design, using novel clinical biomarkers, will determine the effect of structured exercise interventions at mitigating ARC, with the overall aim of finding means to further improve BC care. ISRCTN, ISRCTN32617901 . Registered on 24 October 2018. Last updated on 11 January 2019.

Background/Objectives: Cancer patients undergoing chemotherapy often face challenges that reduce their physical function and quality of life. Technological resources offer innovative solutions for physical rehabilitation, but the extent of their application in this context remains unclear. This scoping review aims to explore and map the various technological tools used to support physical rehabilitation in cancer patients during chemotherapy, focusing on their potential to improve outcomes and enhance patient care. Methods: A scoping review was conducted following the Joanna Briggs Institute (JBI) guidelines and the PRISMA-ScR framework. Comprehensive searches were performed in the MEDLINE, CINAHL, Scopus, SPORTDiscus, and COCHRANE databases. The included studies focused on the technological resources used in physical rehabilitation for cancer patients undergoing chemotherapy. Data extraction followed the World Health Organization’s “Classification of Digital Health Interventions v1.0” to categorize the technologies. Results: A total of 32 studies met the inclusion criteria. The most commonly used technologies included wearable devices (16 studies), web-based platforms and telerehabilitation systems (7 studies), mHealth applications (6 studies), virtual reality (2 studies), and exergaming (3 studies). These tools were designed to enhance physical function, manage treatment-related symptoms, and improve overall quality of life. Wearable devices were particularly effective for monitoring physical activity, while web-based platforms and mHealth applications supported remote rehabilitation and patient engagement. Conclusions: Technological resources offer significant opportunities for personalized rehabilitation interventions in cancer patients undergoing chemotherapy. However, further research is needed to evaluate the long-term effectiveness, cost-efficiency, and clinical integration of these tools to ensure broader accessibility and sustainable impact.

The aim of this systematic review and meta-analysis is to systematically collect, evaluate, and critically synthesize research findings on the effects of physical exercise on chemotherapy-induced peripheral neuropathy (CIPN). The Joanna Briggs Institute (JBI) methodology for systematic reviews was adopted for this study. We searched the Medline®, CINAHL, SportDiscus, and Scopus databases to identify relevant articles published from inception to March 2024. This review was reported in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Twelve studies met the inclusion criteria, totaling 928 participants. Interventions ranged from aerobic and resistance exercises to balance and strength training. A range of physical exercise interventions was explored, including brisk walking, endurance training, weight exercises, and resistance bands, as well as combined programs of aerobics, resistance, and balance training, all tailored to improve symptoms and quality of life in patients with chemotherapy-induced peripheral neuropathy. The meta-analysis focused on five studies that used the FACT/GOG-Ntx scale indicated a standardized mean difference of 0.50 (95% CI: 0.26, 0.74), favoring exercise, reflecting significant improvements in neuropathy symptoms. The heterogeneity among the studies was low (I² = 2%), suggesting consistency in the beneficial effects of exercise. From the results analyzed, the descriptive analysis of the 12 included studies shows promising outcomes not only related to individuals' perceptions of CIPN severity but also in terms of physical functioning, balance, ADL (Activities of Daily Living) performance, pain, and quality of life. The findings support the integration of structured exercise programs into oncological treatment plans.

To assess the effects of a group class physical exercise program on health-related quality of life (HRQOL), physical fitness and activity, and safety in early breast cancer women after treatment, a double-phase trial [16-week control phase (CP) followed by a 16-week intervention phase (IP)] was designed. Outcomes were evaluated at baseline (T1), 8 (T2) and 16 (T3) weeks (CP), and 24 (T4) and 32 (T5) weeks (IP). The primary endpoint was global health status. Out of 82 enrolled patients, 37 completed the IP. Global health status decreased (-10,1; 95% CI -19.8 to -0.4; p = 0.040) during the CP and stabilized during the IP. Physical and sexual functioning increased during the IP (p = 0.008; p = 0.017), while cardiorespiratory fitness increased in the CP (p = 0.004). Upper limb strength and lower limb functionality increased during both phases [CP: p < 0.0001, p = 0.001 (surgical and nonsurgical arm), p = 0.028; IP: p < 0.0001, p = 0.002, p = 0.009]. Body mass index decreased in the IP (p = 0.026). Waist circumference increased in the CP (p = 0.001) and decreased in the IP (p = 0.010); sedentary behaviours and moderate and vigorous physical activity did not change. Adherence to 70% of the sessions was reported in 54% of patients. No serious adverse events related to the intervention were reported. In conclusion, the physical exercise program was able to prevent the decline in global health status and to improve other domains of HRQOL and physical fitness. As physical exercise is not the standard of care in many countries, the implementation of group class programs might be an option.

To aggregate, interpret, and synthesize findings from qualitative studies on patients' experiences with chemotherapy-induced peripheral neuropathy (CIPN). A qualitative metasynthesis was conducted following the thematic synthesis approach of Thomas & Harden. A systematic literature search was performed in MEDLINE, CINAHL, Psychology and Behavioral Sciences Collection, and Scopus, including studies published up to December 2024. Two researchers independently conducted the screening and data extraction. They also independently evaluated the quality of the included studies. The data from these studies were then thematically analyzed and synthesized using Dorothea Orem's model. Eighteen studies were included. Four main categories were identified: (1) Physical and Functional Impact of CIPN, (2) Emotional and Psychological Impact, (3) Coping Strategies and Self-management, and (4) Support and Barriers to Health. The findings revealed distinct self-care deficits related to functional limitations, emotional distress, and coping challenges. Utilizing Orem's Nursing Theory of Self-Care Deficit, these deficits were mapped onto different levels of nursing intervention, ranging from compensatory support to educational and self-management strategies, emphasizing an action-oriented approach in patient care. This metasynthesis highlights the complex and multidimensional effects of peripheral neuropathy on the lives of cancer patients. Applying Orem's model underscores the critical role of nurses in addressing healthcare system gaps, functional impairments, and long-term adaptation challenges to enhance supportive care for individuals suffering from CIPN.

Background: we conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the efficacy of exercise training on cardiac function and circulating biomarkers outcomes among women with breast cancer (BC) receiving anthracycline or trastuzumab-containing therapy. Methods: PubMed, EMBASE, Cochrane Library, Web of Science and Scopus were searched. The primary outcome was change on left ventricular ejection fraction (LVEF). Secondary outcomes included diastolic function, strain imaging and circulating biomarkers. Results: Four RCTs were included, of those three were conducted during anthracycline and one during trastuzumab, involving 161 patients. All trials provided absolute change in LVEF (%) after a short to medium-term of treatment exposure (≤6 months). Pooled data revealed no differences in LVEF in the exercise group versus control [mean difference (MD): 2.07%; 95% CI: −0.17 to 4.34]. Similar results were observed by pooling data from the three RCTs conducted during anthracycline. Data from trials that implemented interventions with ≥36 exercise sessions (n = 3) showed a significant effect in preventing LVEF decline favoring the exercise (MD: 3.25%; 95% CI: 1.20 to 5.31). No significant changes were observed on secondary outcomes. Conclusions: exercise appears to have a beneficial effect in mitigating LVEF decline and this effect was significant for interventions with ≥36 exercise sessions.