The impact of exercise interventions before, during, and following neoadjuvant therapies for locally advanced rectal cancer: a critical review
DOI:
https://doi.org/10.2340/1651-226X.2026.44930Keywords:
exercise, physical activity, neoadjuvant chemoradiotherapy, rectal cancer, locally advanced rectal cancer, feasibilityAbstract
Background and purpose: Neoadjuvant chemoradiotherapy (NACRT) and radiotherapy (NART) are standard treatments for locally advanced rectal cancer (LARC). However, their associated toxicities negatively affect patients’ quality of life (QoL), prompting growing interest in exercise as a supportive intervention. This critical narrative review synthesised evidence on exercise interventions delivered before, during, or after NACRT/NART, with a focus on feasibility, safety, functional, psychosocial, and emerging oncological outcomes.
Materials and methods: A systematic literature search was conducted across MEDLINE, CINAHL Ultimate, and SPORTDiscus (2010–2025). Prospective studies evaluating exercise-based interventions in patients with LARC receiving NACRT or NART were included. Studies were selected using the Participants, Exposure, and Outcome framework, and methodological quality was appraised using Critical Appraisal Skills Programme checklists. Data were synthesised narratively in accordance with PRISMA reporting standards.
Results: Sixteen studies met the inclusion criteria. Interventions varied in type, intensity, supervision, and timing. Of these, nine studies (n = 226) were analysed quantitatively.
Feasibility outcomes varied widely across studies: Eligibility (27.1–100%), recruitment (27.5–90.0%), attendance (74.0–96.0%), attrition (0–100%). No serious adverse events were reported. Consistent improvements were observed cardiorespiratory fitness, strength, fatigue, QoL. Limited evidence suggested a potential association between post-NACRT exercise and tumour regression; however, some of these findings were not powered for oncological endpoints.
Interpretation: Exercise is a feasible and safe adjunct to treatment in LARC. Further research should explore oncological outcomes and improve representation across demographics.
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