Physical Activity and Functional Rehabilitation in Lower Limb Soft Tissue Sarcoma Survivors

Lower-extremity soft tissue sarcomas (STSs) are rare malignancies for which advances in multimodal treatment have substantially improved survival; however, many survivors experience persistent functional impairments related to surgery, radiotherapy, and systemic therapy. Treatment-related sequelae commonly include muscle weakness, altered biomechanics, neuropathic pain, reduced joint mobility, and gait abnormalities, which may significantly affect physical function, participation, and quality of life. Rehabilitation and structured physical activity, therefore, represent critical components of survivorship care, yet sarcoma-specific evidence remains limited and heterogeneous. This review, therefore, synthesizes current evidence and provides practical rehabilitation guidance for clinicians managing survivors of lower-limb STS. Available evidence supports the feasibility and safety of resistance training, aerobic exercise, and multimodal rehabilitation programs when interventions are individualized and appropriately supervised. Emerging approaches, including prehabilitation, telerehabilitation, and aquatic therapy, demonstrate potential benefits but are supported by limited sarcoma-specific data. Rehabilitation protocols should be tailored according to surgical procedures, reconstruction type, neurovascular involvement, and treatment-related complications, with attention to safety considerations such as skeletal fragility, neuropathy, and lymphedema. Despite growing interest in exercise oncology for sarcoma populations, substantial gaps remain regarding optimal training parameters, long-term outcomes, and implementation strategies. High-quality prospective studies and standardized outcome measures are needed to establish evidence-based rehabilitation guidelines and improve functional recovery and quality of life among survivors of lower-extremity STS. • Lower-extremity soft tissue sarcoma survivors experience persistent functional impairments from surgery, radiotherapy, and systemic therapy that significantly affect quality of life. • Resistance training, aerobic exercise, and multimodal rehabilitation may be feasible and safe when individualized and appropriately supervised in this population. • Prehabilitation, telerehabilitation, and aquatic therapy show promise but remain supported by limited sarcoma-specific evidence. • Rehabilitation protocols must be tailored to surgical procedures, reconstruction type, neurovascular involvement, and treatment-related complications. • High-quality prospective studies and standardized outcome measures are needed to establish evidence-based rehabilitation guidelines for lower-limb STS survivors.