Effectiveness of home-based exercise interventions on cardiorespiratory fitness and cancer treatment-related cardiovascular toxicity in cancer survivors exposed to cardiotoxic therapies: a systematic review and meta-analysis of randomized controlled trials

To evaluate the effectiveness of home-based exercise (HBE) interventions on cardiorespiratory fitness and cancer treatment-related cardiovascular toxicity (CTR-CVT) in cancer survivors. A comprehensive search of seven electronic databases was conducted for randomized controlled trials (RCTs) published from January 2000 to October 2025. The participants were cancer survivors who had received cardiotoxic therapies. The interventions were structured HBE programmes. Eligible studies were those that reported on any outcomes related to CTR-CVT. The primary outcomes included direct cardiotoxicity parameters (e.g., left ventricular ejection fraction [LVEF] and global longitudinal strain [GLS]) and cardiac biomarkers (e.g., troponins and B-type natriuretic peptide); clinical cardiovascular events (e.g., heart failure and arrhythmias); cardiorespiratory fitness (e.g., peak oxygen uptake [VO2 peak]); and (d) functional capacity (e.g., the six-minute walk test [6MWT]). Two researchers independently performed the study selection, data extraction, and methodological quality assessment. Meta-analyses were conducted using R software. Ten RCTs involving 851 participants were included. The meta-analysis demonstrated that the HBE interventions significantly improved VO2 peak (MD = 2.35 mL/kg/min, 95% CI: 1.26 to 3.43, p < 0.001), which indicated improved cardiorespiratory fitness. Subgroup analysis found larger effects for longer-duration interventions (24 to 52 weeks), mHealth use, and cancer Stage III/IV. Evidence on direct cardiotoxicity parameters and biomarkers was limited, as only one study assessed these outcomes. No significant improvements were found in the 6MWT or health-related quality of life (HRQoL). While HBE improved cardiorespiratory fitness (VO2 peak) and mitigated functional decline in cancer survivors, its ability to prevent CTR-CVT was unproven. Future adequately powered trials should incorporate direct cardiotoxicity assessments to establish true cardioprotective efficacy and implementation studies to optimise real-world delivery. not applicable.