Home-based exercise interventions incorporating cardiac rehabilitation principles for people with cancer: a systematic review and meta-analysis

Background: People with cancer are at increased cardiovascular risk due to treatment-related cardiotoxicity and shared risk factors. Exercise-based cardiac rehabilitation (exCR) may mitigate these risks, but access to center-based programs is limited. This systematic review and meta-analysis evaluated the effectiveness, safety, and adherence of home-based exCR in oncology populations. Methods: Six databases were searched in January 2025 for randomized controlled trials (RCTs) of home-based exCR in adults with cancer. Eligible interventions included structured aerobic and/or resistance exercise consistent with established CR guidelines. Primary outcomes were cardiorespiratory fitness (CRF), health-related quality of life (HRQoL), adherence, and safety. Random-effects meta-analyses used standardized mean differences (SMDs). Results: Nine RCTs (632 participants) were included. Home-based exCR improved CRF (SMD 0.42; 95% CI 0.09–0.75; I²=62%) and HRQoL (SMD 0.63; 95% CI 0.05–1.22; I²=84%). TESTEX scores indicated generally good methodological and reporting quality (mean 10/15; range 7–13). Adherence exceeded 75% in most studies reporting this outcome, and dropout was 15.2%. Adverse-event reporting was inconsistent; no clear safety signal emerged, but evidence was insufficient for firm conclusions. Strength and fatigue findings were inconsistent. Conclusions: Home-based exCR appears feasible and may improve CRF and HRQoL in people with cancer, offering an accessible alternative or complement to center-based rehabilitation. Incomplete adverse-event reporting limits safety conclusions. Future studies should evaluate full, multi-component CR models in oncology.