Effectiveness of physical exercise on quality of life in women with breast cancer undergoing chemotherapy: a network meta-analysis.

BACKGROUND: Breast cancer is the most prevalent cancer among women worldwide and poses significant challenges because of its high incidence and treatment-related sequelae. Although the benefits of physical exercise across treatment phases are well documented, evidence specifically assessing its effects during chemotherapy remains limited. OBJECTIVE: To evaluate the effectiveness of different types of physical exercise in improving overall health-related quality of life (HRQoL) in women with breast cancer undergoing chemotherapy. METHODS: A network meta-analysis (NMA) of randomized controlled trials (RCTs) was conducted to compare the impact of various exercise modalities on HRQoL during chemotherapy. Literature searches were conducted through August 2025. The risk of bias was assessed using the Cochrane RoB 2.0 tool, and the evidence quality was rated using GRADE. Pairwise and NMA were conducted via random effects models. Surface under the cumulative ranking curve (SUCRA) values were calculated to rank the interventions. RESULTS: Eighteen RCTs with 1539 participants were included. Compared with the control interventions, the combined and endurance-based exercise interventions had greater effect sizes (ES = 0.41; 95 % CI, 0.15-0.68 for both). These programs significantly improved overall HRQoL in women undergoing chemotherapy. CONCLUSIONS: Physical exercise during chemotherapy effectively enhances HRQoL in women with breast cancer. Combined and endurance interventions are the most beneficial. IMPLICATIONS FOR PRACTICE: Findings support the use of structured, supervised exercise, especially combined or endurance-based exercise, in routine care. Programs with relaxation components (eg, yoga) are particularly effective for addressing stress and anxiety. Tailored interventions may optimize adherence and therapeutic outcomes. PROSPERO REGISTRATION: CRD42024555581.