- Design
- Systematic review and meta-analysis of randomised trials
- Population
- 7 trials, 513 women receiving anthracyclines and/or anti-HER2 therapy
- Primary outcome
- Change in LVEF and global longitudinal strain
- Effect
- LVEF MD 0.07 (95% CI −1.38 to 1.52); GLS MD −0.10 (−0.79 to 0.58)
A meta-analysis identified seven randomised trials, 513 women with breast cancer, testing structured exercise during anthracycline or anti-HER2 treatment. Most trials had some concerns or high risk of bias, and only two could be pooled.
Over about four months of anthracycline treatment, exercise made no measurable difference to ejection fraction (mean difference 0.07 points, 95% CI −1.38 to 1.52) or global longitudinal strain (−0.10, −0.79 to 0.58). Biomarker data were too varied to combine, and no trial reported cardiac events, survival or heart failure with preserved ejection fraction.
The point is not that exercise is useless. It has other well-established benefits during cancer treatment. It is that it should not replace cardio-oncology monitoring on the assumption that it protects the heart.
- Encourage exercise during chemotherapy for its general benefits, not as cardioprotection
- Keep baseline and serial cardiac imaging as indicated for anthracycline and anti-HER2 therapy
- Do not reduce cardiac surveillance because a patient is exercising
- Manage blood pressure, lipids and glucose as part of cardio-oncology care
Why it matters
It questions a widely assumed cardioprotective effect that may be influencing monitoring decisions.
Don't overread it
Absence of evidence here reflects sparse, low-quality trials, not proof that exercise has no cardiac effect.
The statistics, in plain English
A difference of 0.07 percentage points in ejection fraction is effectively zero, and the interval allows a small benefit or a small harm. With only two poolable trials, the evidence is thin.
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