Exercise During Chemotherapy in Colorectal Cancer: A Systematic Review

Abstract : This study investigates the effects of structured exercise on treatment tolerance, physical function, and frailty-related outcomes in adults with colorectal cancer (CRC) receiving chemotherapy, with separate appraisal for older patients to evaluate its potential to support safe and effective treatment delivery. Using a Systematic Review methodology, this study synthesized research published between January 2021 and March 2026 from PubMed, Taylor & Francis Online, and SAGE Journals searched (1 May–1 June 2026). Data were analyzed using a narrative synthesis approach, focusing on tolerance, function, fatigue, frailty, quality of life, adherence, and safety, with bias assessed via RoB 2 and ROBINS-I. The findings indicate that of 701 studies screened, 7 reports (5 cohorts) were eligible, with no serious exercise-related adverse events. A geriatric intervention with supervised physiotherapy showed higher chemotherapy completion than usual care (45% vs 28%, p=0.037), though not isolated from concurrent nutritional therapy and medication review. Unsupervised home-based resistance training did not improve relative dose intensity, while function improved most consistently with supervised or progressive resistance programs. Unlike previous review studies, this research integrates tolerance, function, frailty, and safety outcomes into a unified narrative framework specific to the CRC chemotherapy population. The study concludes that structured exercise appears feasible and may preserve physical function, though its independent contribution to treatment tolerance remains undetermined and frailty-specific evidence is limited to one geriatric cohort. Additionally, further research is required to compare exercise delivery models using adequately powered trials and standardized frailty/tolerance measures.