Home-based, telehealth, and hybrid exercise interventions for adults undergoing or recovering from hematopoietic stem cell transplantation: a systematic review of randomized controlled trials

Background Hematopoietic stem cell transplantation (HSCT) is associated with substantial treatment-related morbidity, including reduced physical function, fatigue, and impaired quality of life. Home-based and telehealth-supported exercise may improve access to rehabilitation in this population, but randomized evidence remains limited. Objective To systematically review randomized controlled trials evaluating the effectiveness, feasibility, and safety of structured exercise interventions delivered in home-based, telehealth, or hybrid formats for adults undergoing or recovering from HSCT. Methods A systematic search of PubMed, Scopus, Web of Science, and Cochrane CENTRAL was conducted from database inception to November 2025. Randomized controlled trials involving adults undergoing autologous or allogeneic HSCT were included if they evaluated structured exercise performed before, during, or after transplantation. Primary outcomes included physical function and physical fitness, including functional capacity, physical performance, muscle strength, gait-related measures, and fatigue. Secondary outcomes included quality of life, psychological outcomes, physical activity, feasibility, adherence, retention, safety, and adverse events. Results Seven randomized controlled trials involving 542 adults were included. Interventions varied in timing, content, and delivery mode, and included aerobic, resistance, balance, or multimodal exercise delivered in unsupervised home-based, supervised telehealth, or hybrid formats. Across studies, the most consistent trend of improvement was observed in functional capacity and physical performance, particularly in outcomes such as the 6-minute walk test, gait-related measures, and sit-to-stand performance. Findings for muscle strength, fatigue, and quality of life were less consistent. Adherence was generally high in studies reporting it, often exceeding 80%, and serious exercise-related adverse events were uncommon. Conclusions Structured exercise delivered in home-based, telehealth, or hybrid settings appears feasible and generally safe for adults undergoing or recovering from HSCT. Based on the limited randomized evidence available, the most consistent trend of improvement was observed in functional capacity and physical performance, whereas broader patient-reported outcomes remain less certain. Larger, methodologically robust trials are needed to clarify optimal timing, intervention design, and effects on quality of life, fatigue, and other patient-centered outcomes. Systematic Review Registration identifier PROSPERO CRD420251245892.