Effects of exercise-based interventions on cancer-related cognitive impairment: A systematic review and network meta-analysis.

OBJECTIVE: To assess the short-term (immediately post-intervention) and long-term (post-intervention follow-up) effects of exercise-based interventions and to compare the effects of different exercise modality for improving subjective and objective cognitive function. DATA SOURCES: A comprehensive literature search was conducted in PubMed, Scopus, Embase, Web of Science, and the Cochrane Library. STUDY SELECTION: Randomized controlled trials evaluating exercise-based interventions for cognitive outcomes in adult cancer patients were included. DATA EXTRACTION: Pairwise and network meta-analyses were conducted to estimate the standardized mean difference (SMD) with 95% confidence interval (CI). The Surface Under the Cumulative Ranking Curve (SUCRA) was used to estimate the intervention ranking probability. DATA SYNTHESIS: Twenty-seven studies (28 articles, 2,809 participants) were included. Exercise-based interventions significantly improved short- and long-term subjective cognitive function (SMD: 0.44, 95% CI: 0.27 to 0.61; SMD: 0.37, 95% CI: 0.16 to 0.57), executive function (SMD: -0.28, 95% CI: -0.43 to -0.14; SMD: -0.32, 95% CI: -0.56 to -0.08), working memory (SMD: 0.27, 95% CI: 0.14 to 0.41; SMD: 0.31, 95% CI: 0.06 to 0.55), and processing speed (SMD: -0.16, 95% CI: -0.31 to -0.01; SMD: -0.31, 95% CI: -0.55 to -0.07). In the short term, combined exercise and non-exercise intervention had the highest SUCRA ranking for subjective cognitive function (SUCRA: 93.50%), resistance exercise for executive function (SUCRA: 81.60%), multicomponent exercise for working memory (SUCRA: 77.74%), and mind-body exercise for processing speed (SUCRA: 78.39%). In the long term, aerobic exercise ranked highest for subjective cognitive function (SUCRA: 83.81%) and multicomponent exercise ranked first for executive function (SUCRA: 75.22%), working memory (SUCRA: 86.35%), and processing speed (SUCRA: 77.39%). CONCLUSION: Exercise-based interventions provide short- and long-term benefits across subjective and objective cognitive domains in cancer patients, with varying probabilistic advantages by exercise modality. No single modality demonstrated superiority across all outcomes. Further studies are warranted given the low to moderate certainty of evidence.