Effects of physical exercise in patients undergoing haematopoietic stem cell transplantation: systematic review and meta-analysis

Abstract

Purpose To evaluate the effects of physical exercise on key clinical outcomes (such as quality of life (QoL), aerobic capacity, fatigue, and muscle strength) in patients undergoing haematopoietic stem cell transplantation. Methods PRISMA systematic review and meta-analysis from inception to April 2025. PubMed, Embase, Cochrane Library, Web of Science and Scopus databases were searched for eligible studies. Methodological quality and risk of bias were evalu- ated with the Pedro scale and the Risk-Of-Bias Tool for randomized trials (ROB2.0) respectively. Results An initial search retrieved 5217 articles. Finally, 20 studies were included in the qualitative synthesis and 7 in the meta-analysis. Exercise showed a small, non-significant effect on QoL (SMD = 0.23; p = 0.072), and a significant moderate effect on functional capacity (SMD = 0.43; p = 0.002). No significant effects were found on fatigue (SMD = − 0.05; p = 0.819) or handgrip strength (SMD = 0.21; p = 0.201), although a large and significant effect was observed for lower limb strength (SMD = 1.48; p < 0.001). Meta-regression analyses indicated that longer intervention duration was significantly associated with greater improvements in fatigue. Conclusions Physical exercise improves functional capacity and lower limb strength in transplant patients, while effects on quality of life and fatigue are less consistent. Longer interventions are associated with greater improvements in fatigue. These results support the implementation of prolonged exercise programmes to optimize post-transplant recovery.