A commentary on “A novel approach to cancer rehabilitation: assessing the influence of exercise intervention on postoperative recovery and survival rates”

Dear Editor, We read with great interest the recent article titled “A novel approach to cancer rehabilitation: assessing the influence of exercise intervention on postoperative recovery and survival rates”[1] published in the International Journal of Surgery. This article investigates how exercise intervention affects cancer patients’ postoperative recovery and survival rates. Exercise therapy before and after surgery has been shown to significantly improve patients’ physical capabilities, reduce postoperative complications, shorten hospital stays, and enhance overall quality of life. However, future research must address a number of important challenges. First, there are insufficient individualized criteria for exercise prescriptions. Although existing literature emphasizes the importance of developing individualized exercise regimens, it fails to provide a clear and actionable set of specific criteria. There is a lack of stratified or quantified guidance on how to dynamically adjust exercise types, intensity, frequency, and duration based on factors such as cancer type, stage, treatment phase (e.g. chemotherapy cycles, radiotherapy site), patient physical baseline, complications (e.g. bone metastases, lymphedema), and age[2]. For instance, current research remains vague regarding how core training for patients undergoing abdominal surgery with stoma should be performed safely while mitigating risks. This results in clinical practice where “individualization” still largely relies on the experiential judgment of rehabilitation physicians, lacking a standardized framework based on evidence-based medicine. Consequently, this affects the reproducibility of intervention protocols and the stability of therapeutic outcomes. Second, the article lacks an in-depth exploration of the mechanisms integrating psychological intervention with exercise[3]. While it acknowledges the impact of psychological factors (e.g. anxiety, depression) on rehabilitation and mentions that exercise can improve psychological states, it provides insufficient elaboration on the critical pathway of “how exercise influences physiological rehabilitation outcomes through psychological mechanisms.” For instance, the neuroendocrine mechanisms by which exercise alleviates anxiety (e.g. reducing cortisol levels and modulating the hypothalamic-pituitary–adrenal axis) are not systematically explained, nor is it clarified how these effects translate into faster wound healing, enhanced immune function, or improved treatment adherence. Psychological rehabilitation and exercise interventions are discussed in parallel rather than being deeply integrated. The article fails to adequately explore specific models for integrating structured psychological interventions (e.g. cognitive behavioral therapy, mindfulness-based stress reduction) with exercise regimens, either temporally or content-wise, to achieve synergistic effects. Third, the literature review on special populations and complex conditions remains insufficient. The covered cancer types are predominantly common malignancies (e.g. breast cancer, colorectal cancer, and lung cancer), while evidence on the safety and efficacy of exercise rehabilitation for low-incidence or poor-prognosis cancers (e.g. pancreatic cancer, biliary tract cancer, glioblastoma) and patients with special complex conditions (e.g. advanced age, multiple metastases, severe treatment-related adverse effects such as severe peripheral neuropathy, refractory cancer-related fatigue) is virtually nonexistent. The recommendations in Table 1 (page 9) remain overly generalized. For these populations, there is a lack of targeted research on which exercises are absolutely contraindicated, which exercises require close monitoring, and how to establish an extremely low but effective exercise threshold. This results in an overly conservative approach in clinical practice for patients who most urgently need rehabilitation support. In conclusion, this study systematically reviews the positive impact of exercise intervention on postoperative cancer rehabilitation, yet reveals several limitations in the depth and precision of clinical translation. Future research should focus on strengthening long-term efficacy evidence while developing refined, stratified clinical decision support tools, exploring integrated intervention programs based on the biopsychosocial model, and actively leveraging digital technologies to establish sustainable multidisciplinary collaborative implementation frameworks. These efforts will ultimately realize the true value of exercise rehabilitation in the comprehensive management of cancer throughout its entire lifecycle. All of this is related to the Transparency in the Reporting of Artificial Intelligence (TITAN) guideline, which mandates openness in artificial intelligence reporting[4].