Exercise interventions in cancer-related cognitive impairment: an umbrella review

Purpose The aim of this umbrella review is to assess the effectiveness of exercise interventions in preventing and managing cancer-related cognitive impairment among cancer survivors, providing an evidence-based foundation for clinical practice. Methods The umbrella review was pre-registered on PROSPERO. It included systematic reviews that assessed any exercise interventions aimed at improving cognition in cancer patients. The overview adhered to gold-standard guidelines and recommendations. We utilized AMSTAR 2 to evaluate the quality of the literature and to synthesize the consistency of the evidence in order to formulate recommendations. Results Based on 28 systematic reviews, four subtypes of exercise interventions were identified. High-quality evidence consistently demonstrates that aerobic exercise significantly improves performance on specific neuropsychological tests. The Hopkins Verbal Learning Test (HVLT) shows a score improvement ( SMD = 0.65, 95% CI : 0.42, 0.88); The Trail Making Test Part A (TMT-A) shows a reduction ( SMD = -0.61, 95% CI : -0.92, -0.30). Mind-body exercises also have notable effects on alleviating subjective cognitive complaints, indicated by an improvement in the FACT-Cog score ( SMD = 0.82, 95% CI : 0.49, 1.15). However, the evidence for objective cognitive improvement is limited and inconsistent. Combined training presents preliminary evidence of synergistic effects in enhancing global cognitive function, with an average effect across multiple cognitive domains ( SMD = 0.45, 95% CI : 0.20, 0.70). Currently, resistance training lacks robust, high-quality evidence, and more studies are needed to determine its effects on specific objective cognitive domains. Conclusions This review highlights exercise intervention as a key non-pharmacological approach for managing Cancer-Related Cognitive Impairment (CRCI). Urgent priorities for future research include: 1. Conducting high-quality randomized controlled trials (RCTs) to validate exercise tolerability in patients undergoing active treatment. 2. Developing multimodal assessment frameworks that integrate neuroimaging and blood-based biomarkers. 3. Establishing personalized exercise guidelines tailored to specific cancer types and treatment phases. Additionally, future studies should focus on clarifying the biological mechanisms that underpin the cognitive improvements associated with exercise. This will help create a stronger evidence base for precision exercise prescription.