Exercise during adjuvant breast-cancer chemotherapy

Evidence label: Supportive randomized evidence with regimen and delivery caveats · Clinical goal: preserve fitness and reduce fatigue during adjuvant chemotherapy

Evidence at a glance

Population: 230 people scheduled for adjuvant breast-cancer chemotherapy in the PACES trial.
Interventions: a low-intensity home activity program or a supervised moderate-to-high-intensity aerobic-plus-resistance program, each compared with usual care.
Result: the supervised program best preserved fitness and reduced fatigue; a separate 39-person infusion-cycling trial did not improve fatigue or global quality of life.

What was studied

PACES randomized 230 participants among Onco-Move, OnTrack and usual care during adjuvant chemotherapy. OnTrack combined supervised resistance and aerobic exercise at moderate-to-high intensity; Onco-Move emphasized lower-intensity home activity. A 2026 single-blind trial separately tested 20 minutes of low-intensity cycling during infusions 2 through 6 in 39 women.

What the evidence shows

PACES supports supervised combined training for physical fitness and fatigue during chemotherapy, with some favorable treatment-completion and symptom findings. The abstract does not provide every effect estimate, so unsupported numeric details are not reproduced here.

In the smaller infusion trial, fatigue and overall quality of life did not differ between groups. A reported change in perceived alopecia severity was exploratory and does not show that exercise prevents chemotherapy hair loss. Neither trial tested cancer control.

Limits and uncertainty

Exercise type, supervision and dose differed substantially. PACES full-text numeric extraction was not available in this appraisal, while the infusion study was small and analyzed 39 completers. These results should not be merged into one precise effect size.

Safety and practical context

Blood counts, infection, cardiotoxic treatment, neuropathy, falls, ports and symptom peaks can change what is safe from cycle to cycle. Fever, chest pain, fainting, new severe breathlessness or suspected thrombosis requires medical assessment rather than exercise progression.

Questions for the care team

Should my plan change on infusion days or when blood counts are low?
Would supervised aerobic-plus-resistance training be available through oncology rehabilitation?
Which symptoms mean I should pause and contact the treatment team?

Sources

Literature searched: October 22, 2026 · Record appraised: October 22, 2026

Educational evidence summary, not personal medical advice. Research regimens describe what was studied; they are not personal prescribing instructions and should not replace cancer treatment or individualized supportive care.