Influence of Exercise Management for Frail Elderly Cancer Patients on Chemotherapy Tolerance and Complications: A Systematic Review and Meta-Analysis

Elderly frail cancer patients face reduced chemotherapy tolerance and higher complications. Exercise intervention shows promise, but evidence remains limited. To evaluate exercise management's impact on chemotherapy tolerance and complications in this population via systematic review and meta-analysis. Randomized controlled trials (RCTs) were retrieved from databases including PubMed and Embase from inception to July 2025. Elderly cancer patients aged ≥65 years with frailty (per standard diagnostic criteria) undergoing chemotherapy were included, comparing exercise intervention with conventional care. The Cochrane ROB 2.0 tool was used for quality assessment, and RevMan 5.4 software was employed for meta-analysis. Effect sizes were expressed as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). 18 RCTs (1655 patients) showed exercise significantly reduced complication rates (OR = 0.41, P = 0.01), severe complications (OR = 0.39, P = 0.003), improved 12-minute walking distance (MD = 45.64, P = 0.02), decreased fatigue (MD=-0.80, P = 0.002), and improved quality of life (MD=-6.11, P < 0.001). No effects on Comprehensive Complication Index or readmission rates (P > 0.05). Exercise management is a safe and effective non-pharmacological intervention that reduces chemotherapy complication risks, improves functional status, and enhances quality of life in elderly frail cancer patients. It is recommended as a supportive therapy during chemotherapy, prioritizing comprehensive exercise programs (aerobic plus resistance training), administered 3-5 times weekly for 30-60 minutes over 8-12 weeks. Individualized protocols should be developed by multidisciplinary teams (oncology, rehabilitation, and geriatrics) with dynamic tolerance assessment.