PURPOSE: Radiation therapy for breast cancer often causes side effects like cancer-related fatigue, depression, and sleep disorders, impacting health-related quality of life, psychosocial aspects, and physical function. Exercise therapy is commonly used to manage cancer-related fatigue, but its effectiveness remains uncertain due to varying patient conditions and adherence. This systematic review aims to assess exercise interventions during radiotherapy for their effects on physiological and psychological side effects in breast cancer patients, clarifying efficacy and exploring different intervention types. METHODS: Randomized controlled trials were searched in PubMed, EBSCO, Scopus, Web of Science, and the Cochrane Library up to April 24, 2024. Trials included breast cancer patients undergoing exercise therapy (e.g., running, yoga, Qi Gong, resistance training). Primary outcomes were cancer-related fatigue levels and quality of life
secondary outcomes included sleep quality and depressive symptoms. RESULTS: Sixteen trials with 1373 stage 0 to III breast cancer patients were analyzed. The results indicate that exercise during radiation therapy has a significant positive impact on reducing cancer-related fatigue compared to the control group (SMD = -0.29, 95% CL: -0.56 to -0.02, P = 0.032), subgroup analysis showed that compared to treadmill exercise, Tai Chi, and resistance training with equipment, yoga is more effective in improving cancer-related fatigue in breast cancer patients. Regarding improvement in quality of life (SMD = 0.29, 95 % CI: -0.08 to 0.66, P = 0.121), sleep quality (SMD: -0.27, 95 % CI: -0.62 to 0.07, P = 0.116), and depression (SMD: -0.01, 95 % CI: -0.35 to 0.34, P = 0.977), the three groups did not show significant statistical differences, but they demonstrated beneficial effects in alleviation, which require further studies for confirmation. CONCLUSION: Exercise therapy can effectively alleviate cancer-related fatigue in breast cancer patients, with yoga being the most recommended form of exercise. Exercise therapy shows potential for improving quality of life, sleep, and depressive symptoms, necessitating more clinical studies for validation.