Home-based, telehealth, and hybrid exercise interventions for adults undergoing or recovering from hematopoietic stem cell transplantation: a systematic review of randomized controlled trials.

Introduction

Hematopoietic stem cell transplantation (HSCT) serves as a potentially life-saving, curative, or life-prolonging intervention for numerous hematologic malignancies. Each year, approximately 70,000 HSCT procedures are conducted globally ( 1 ). The incidence of patients receiving HSCT has experienced a notable rise over recent decades ( 2 ). Despite the treatment's capacity to extend life expectancy, this is often accompanied by co-morbidities such as graft-vs.-host disease, infections, and oral mucositis, which result in years lived with disabilities as well as transplant-related mortality ( 3 , 4 ). In addition, many patients undergoing HSCT procedures have adverse effects from the treatment, which include reduced physical functioning, reduced quality of life (QoL), and fatigue ( 5 – 7 ).

Growing evidence has emphasized the essential role of exercise in both the prevention and management of cancer ( 8 ). Targeted physical activity programs, including aerobic, resistance, and multimodal exercise interventions, have shown significant improvements in enhancing physical function, QoL, and alleviating cancer-related fatigue across various patient demographics, including those who have undergone HSCT ( 9 , 10 ).

However, various hindrances often restrict patients from accessing extensive cancer rehabilitation programs. These hindrances may include socioeconomic factors, transportation problems, work commitments, financial issues, and time limitations, which often restrict patients from maintaining regular face-to-face physical activity-based interventions ( 11 ). This demonstrates the need for recent, accessible, and engaging rehabilitation programs to effectively overcome the participation hindrances ( 12 ).

Telemedicine has surfaced as a viable approach for providing specialized care from a distance ( 13 ). Through the use of electronic communication technology, telemedicine has the potential to improve access to post-HSCT care, reduce the burden of frequent in-person visits, and facilitate ongoing patient monitoring, even in the presence of unstable clinical conditions ( 14 ). While telemedicine has tremendous potential in the delivery of care for HSCT patients, its use, efficacy, and impact have not been adequately assessed. Albeit a recent scoping review mapped available evidence ( 11 ), no systematic review has synthesized the effects of home-based or telehealth exercise interventions specifically in HSCT populations. This review aims to evaluate the effectiveness, feasibility, and safety of such interventions based on randomized controlled studies.

Methods

Study design

This systematic review was conducted with the guidance of the PRISMA 2020 reporting guideline ( 15 ). The systematic review protocol has been registered prospectively in the International Prospective Register of Systematic Reviews (PROSPERO; registration number: CRD420251245892). The main objective of this systematic review was to synthesize evidence from randomized controlled trials (RCTs) that examined the impact of structured exercise, including aerobic, resistance, balance, and multimodal training, on functional, physical, and psychological outcomes in adult patients who were undergoing HSCT. Only studies that examined the impact of post-transplant, pre-transplant, or peri-transplant exercise interventions were included.

The conduct of the review was broadly consistent with the registered PROSPERO protocol. Minor clarifications were made during manuscript preparation. First, hybrid interventions were considered eligible when they included a substantial home-based or telehealth-supported exercise component and were not delivered exclusively as centre-based rehabilitation. Second, reference lists of included studies and relevant reviews were checked to maximize search sensitivity. Third, outcomes were narratively organized according to the domains reported across the included trials; however, all outcomes were consistent with those prespecified in PROSPERO. No changes were made to the target population, randomized study design eligibility, or overall narrative synthesis approach.

Search strategy

A comprehensive literature search was carried out in PubMed, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials (CENTRAL) from the inception of the databases until November 2025. A combination of controlled vocabulary (MeSH terms) and keywords was used in the literature search. A comprehensive search strategy combining controlled vocabulary (MeSH terms) and free-text terms was used to identify relevant studies. The search included terms related to telehealth, rehabilitation, and hematopoietic stem cell transplantation. Broad terms (e.g., “rehab*”, “therap*”, and “home-based”) were intentionally used to maximize sensitivity and capture a wide range of exercise-based interventions, including different modalities such as walking. The full search strategies for all databases are provided in the Supplementary Material . The search strategy was adapted for the other databases. In addition, the reference lists of included studies and relevant systematic reviews were manually searched to identify additional eligible trials. Detailed search strategies for all databases are provided in the Supplementary Material . Screening and duplicate removal were performed using Rayyan systematic review software to facilitate study selection.

Eligibility criteria

Eligibility criteria were informed by the PICOS criteria. The target population included adult participants 18 years or older with autologous or allogeneic HSCT, regardless of the type of cancer, disease status, or treatment period. Eligible intervention included structured exercise, which could be aerobic, strength, balance, or multimodal training, conducted in supervised, unsupervised, home-based, or telehealth settings, conducted before, during, or after HSCT. The comparator could be usual care, standard treatment, delayed intervention, or education control. The primary outcomes were physical function and physical fitness, including functional capacity, physical performance, muscle strength, gait-related measures, the 6-minute walk test, peak oxygen uptake, Short Physical Performance Battery, and sit-to-stand performance, as well as fatigue assessed using validated patient-reported measures. Secondary outcomes included QoL, psychological outcomes, physical activity, feasibility, adherence, retention, safety, and adverse events. Pilot and feasibility randomized controlled trials were also included; however, these studies were interpreted with caution as they are not primarily designed to assess effectiveness.

Data extraction

Data extraction was performed independently by two reviewers using a standardized form to ensure consistency and minimize bias. Any disagreements were resolved through discussion. Variables extracted included the following: author, year of publication, country, sample size, demographics of the participants (age, sex, BMI, cancer type), transplant type and conditioning intensity, intervention details (type, frequency, duration, intensity, timing, and mode of delivery), details of the comparator, outcome measures, follow-up periods, adherence, retention and withdrawal, and details of the procedures for monitoring the safety of the participants.

Risk of bias assessment

Methodological quality of the included studies was independently assessed by two reviewers using the Cochrane Risk of Bias 2 tool ( 16 ). These domains included the following: randomization process, deviations from the intended interventions, completeness of outcome data, the validity and reliability of the outcome measures, and the selective reporting of the outcomes. These domains were assessed as being at low risk of bias, some concerns, or a high risk of bias.

Data synthesis was conducted narratively. Findings were summarized according to intervention type, timing relative to HSCT, delivery mode, and outcome domain. A meta-analysis was not performed because of the limited number of included studies and substantial clinical and methodological heterogeneity, including differences in transplant type, intervention timing, exercise content, supervision level, outcome measures, and follow-up duration.

Risk of bias due to missing results was considered as part of the assessment of selective reporting within the RoB 2 framework. Formal assessment of publication bias using funnel plots was not performed because fewer than 10 studies were included and the review was synthesized narratively. Therefore, publication bias could not be reliably assessed statistically.

Results

Study selection and included trials

The systematic search yielded 1,228 records, and 26 full text articles were screened, with 7 RCTs included ( Figure 1 ). The trials represented a total of 542 adults with hematological malignancies ( 17 – 23 ). Cancer populations were heterogeneous. Sample sizes ranged between 20 and 139 participants (Mean:77). The primary focus across these trials includes evaluation of physical performance, strength, QoL, fatigue, and psychological well-being, with adherence rates typically exceeding 80%. All included studies were randomized controlled trials, including pilot and feasibility RCTs.

Type of exercise intervention

The interventions were predominantly multimodal, consisting of combinations of aerobic and resistance training. Specific components included endurance exercise such as walking or cycling, resistance training using simple equipment, and combined programs adapted to patients' functional status. One study also included additional components such as mindfulness-based stress management and motivational support ( 20 ). Intervention intensity ranged from moderate to high, and session duration varied from 20 to 60 min, performed 2 to 7 times per week. In six studies, exercise prescriptions were adjusted according to clinical status and safety considerations ( 18 – 23 ). Three studies used supervised telehealth interventions ( 19 – 21 ), whereas four used unsupervised home-based interventions ( 17 , 18 , 22 , 23 ) ( Table 1 ). Detailed FITT characteristics of the exercise interventions, including frequency, intensity, session and program duration, exercise type, and delivery/supervision mode, are summarized in Table 2 .

Timing relative to HSCT

The timing of interventions varied substantially across studies. Pre-transplant prehabilitation initiated 2 to 8 weeks before HSCT admission was evaluated in five studies ( 17 , 18 , 21 – 23 ). Peri-transplant or early post-transplant interventions, initiated during hospitalization or soon after discharge, were reported in four studies ( 18 – 21 ). Two studies also included longer-term follow-up assessments at 6 or 12 months to evaluate maintenance of effects ( 18 , 20 ).

Telehealth and home-based delivery mode

Four studies ( 18 – 21 ) used telehealth-supported interventions, most commonly in supervised formats delivered via videoconferencing or remote monitoring platforms. Several studies also incorporated unsupervised home-based components supported by written materials, telecoaching, or symptom-guided progression. Across studies, these delivery models were generally feasible, with high adherence and low rates of serious adverse events.

Risk of bias assessment

The risk-of-bias assessment showed a heterogeneous methodological profile across the included trials. Wood et al. ( 17 ) was judged as low risk of bias. Ma et al. ( 20 ), Wiskemann et al. ( 18 ), Coleman et al. ( 23 ), and Lee et al. ( 19 ) were judged as having some concerns, mainly related to issues in the randomization process (Potiaumpai et al., McCourt et al.), deviations from intended interventions (Lee et al.), and reporting issues (Wiskemann et al.) ( Figure 2 ). Potiaumpai et al. ( 22 ) and McCourt et al. ( 21 ) were judged as high risk of bias, particularly because of concerns related to randomization, missing outcome data, and reporting. Overall, the methodological limitations of several studies should be considered when interpreting the findings.

Effect of exercise interventions on key outcomes

Muscle strength

Muscle strength was assessed in six studies ( 17 – 22 ), most commonly using handgrip dynamometry and sit-to-stand-based measures. Overall, the evidence suggests that exercise may help preserve or improve some aspects of muscle performance, although the findings were not consistent across all studies. For example, Ma et al. reported no significant between-group differences in handgrip strength despite improvements in functional capacity. Studies such as Wiskemann et al. ( 18 ) and McCourt et al. ( 21 ) suggest that hospitalization, treatment burden, and transplant-related symptoms may partly explain why improvements in strength outcomes were less consistent than improvements in functional capacity ( 18 , 21 ).

QoL

QoL was assessed in several studies using instruments such as FACT-BMT, EORTC QLQ-C30, SF-36, and distress-related measures ( 18 , 20 , 21 , 23 ). Overall, exercise interventions appeared to attenuate decline or support recovery in quality-of-life-related outcomes, although findings were not uniform across studies. Ma et al. ( 20 ) did not identify significant between-group differences in QoL, whereas McCourt et al. ( 21 ) and Coleman et al. ( 23 ) suggested favorable trends in selected patient-reported outcomes.

Physical activity level

Three studies assessed physical activity using step counts or self-report measures such as the International Physical Activity Questionnaire ( 18 , 20 , 21 ). Overall, exercise interventions appeared to support maintenance or improvement in physical activity levels, although the evidence remained limited and inconsistent. Two studies ( 18 , 20 ) reported favorable changes, whereas hospitalization and treatment-related symptoms may have contributed to reductions in activity in others.

Physical capacity

Physical capacity was examined in six studies, most commonly using the 6-minute walk test and peak oxygen uptake ( 17 , 18 , 20 – 23 ). Across studies, exercise interventions generally showed the most consistent positive signal in this outcome domain. Ma et al. reported significant improvements in 6minute walk distance, whereas Wood et al. found no statistically significant between-group differences in VO2peak or 6MWD, likely reflecting the limited evaluable sample ( 17 ). Coleman et al. ( 23 ) suggested that exercise may attenuate decline in walking performance during intensive treatment, rather than produce large absolute gains ( 23 ). Taken together, the findings suggest a possible favorable effect of exercise on physical capacity, although the magnitude of benefit varies by intervention and study context.

Psychological well-being and fatigue

Two studies assessed psychological well-being using measures such as DASS or POMS ( 18 , 20 ), and four studies evaluated fatigue. Overall, the findings suggest that exercise may help reduce fatigue and improve aspects of psychological well-being, although the results were not fully consistent across studies. Wiskemann et al. reported favorable effects on fatigue and global distress, while McCourt et al. suggested that better adherence to exercise was associated with improved fatigue and QoL ( 18 , 21 ). However, the small sample sizes and heterogeneity of measures limit firm conclusions in this domain.

Adherence and safety

Adherence was generally high in the studies that reported it ( 18 – 21 , 23 ), often exceeding 80%, and exercise-related adverse events were rare. Safety monitoring typically included symptom review, perceived exertion, progression rules, and medical clearance procedures. These findings support the feasibility and tolerability of structured exercise in HSCT populations when appropriate monitoring and individualized adaptation are applied.

Discussion

This systematic review synthesized randomized evidence on structured exercise interventions delivered in home-based, telehealth, or hybrid formats for adults undergoing or recovering from HSCT. However, the heterogeneity across studies, small sample sizes, and the presence of studies with some concerns or high risk of bias limit the strength of these findings and preclude firm conclusions regarding effectiveness. Overall, the available evidence suggests that these interventions are feasible and generally safe, with the most consistent trend of improvement observed in functional capacity and physical performance. This pattern is broadly concordant with the wider HSCT exercise literature, in which exercise more reliably improves functional recovery than broader patient-reported outcomes, especially when trials are small and interventions are heterogeneous ( 11 , 24 – 26 ). However, direct comparability across studies was limited by substantial clinical and methodological heterogeneity, including differences in transplant type, intervention timing, exercise characteristics, supervision level, outcome measures, and follow-up duration.

One plausible explanation is that functional outcomes such as the 6-minute walk test, gait speed, chair stand performance, or the Short Physical Performance Battery may be more responsive to short-term exercise exposure than global quality-of-life or fatigue scales. In HSCT populations, QoL and fatigue are influenced by multiple concurrent factors, including conditioning toxicity, infection risk, graft vs.-host disease, nutritional compromise, sleep disturbance, and prolonged physical deconditioning. As a result, functional outcomes may respond earlier than broader patient-reported outcomes. This interpretation is consistent with previous meta-analytic data showing favorable exercise effects on lower-limb strength, functional capacity, fatigue, and QoL, but less consistent effects on cardiorespiratory fitness, upper-limb strength, and psychosocial outcomes ( 24 , 25 ). In addition, the presence of studies with some concerns and high risk of bias further limits the strength of the conclusions and suggests that the findings should be interpreted with caution. It is important to note that several included studies were pilot or feasibility trials, which are typically not powered to detect effectiveness outcomes. Therefore, their findings should be interpreted primarily in terms of feasibility and acceptability rather than definitive efficacy.

The timing of intervention is also likely to be a major source of heterogeneity. The studies included in our review covered pre-transplant prehabilitation, peri-transplant or hybrid models, and post-transplant survivorship interventions. These phases should not be interpreted as clinically equivalent. Pretransplant exercise may optimize physiological reserve before an expected decline, whereas posttransplant exercise more often aims to reverse deconditioning, frailty, and reduced activity levels. Peri-transplant programs may help attenuate decline across the full transplant trajectory. Earlier meta-analysis suggested that exercise initiated before transplantation may yield more favorable effects on upper- and lower-limb strength, fatigue, and QoL than exercise started only after transplant ( 24 ). This view is also supported by individual studies included in our review, such as prehabilitation-focused designs and peri-transplant hybrid interventions ( 17 , 21 , 22 ).

A key contribution of the present review is its focus on home-based and telehealth-supported delivery. This is particularly relevant in HSCT care, where patients frequently face barriers to repeated participation in center-based rehabilitation, including immunosuppression, travel burden, fatigue, scheduling demands, and the need for close symptom monitoring. This broader relevance is also supported by a recent randomized trial in lymphoma survivors, in which telehealth-supported home-based rehabilitation showed no statistically significant 12-month differences vs. matched centre-based rehabilitation for cardiorespiratory fitness and most secondary outcomes; however, these findings were not interpreted as proof of equivalence or non-inferiority ( 27 ). Recent telemedicine-focused evidence suggests that remotely supported exercise interventions are generally feasible, acceptable, and safe, although the field remains dominated by small prospective and feasibility-oriented studies ( 11 ). Across these studies, telemedicine-facilitated exercise was associated with improvements in VO2peak, 6 min walk distance, handgrip strength, and sit-to-stand performance, while also helping overcome access barriers ( 11 , 15 ). Our findings are therefore clinically meaningful because they support the continued development of remote and hybrid rehabilitation models in HSCT rather than reliance on exclusively face-to-face formats ( 11 , 15 , 31 ).

Safety requires equally careful interpretation. In our review, adherence was frequently high and serious exercise-related adverse events were uncommon, but exercise in HSCT should not be framed as a simple yes-or-no issue. Rather, safe prescription requires individualized adaptation according to transplant phase, blood counts, infection status, symptom burden, and overall clinical stability. Recent evidence in hematologic cancer rehabilitation suggests a shift away from absolute contraindications based solely on laboratory values toward adaptation of exercise and activities of daily living according to the full clinical picture ( 28 – 30 ). In the scoping review of safe blood count thresholds, platelet-related decisions increasingly favored modification rather than blanket cessation, hemoglobin thresholds more often guided adaptation or temporary restriction, and neutropenia primarily required infection-control precautions rather than automatic exercise prohibition ( 28 , 29 ). This supports a practical model of HSCT rehabilitation based on symptom-guided progression, monitoring of exertion and vital signs, and flexible supervision intensity ( 28 – 31 ).

The trajectory of recovery after HSCT is another important consideration. Recovery is often prolonged and incomplete, and short intervention periods may underestimate the potential value of exercise. In a recent longitudinal study of allo-HSCT recipients, handgrip strength and 6-minute walk performance recovered to pre-transplant levels by one year, whereas muscle mass did not fully recover and several quality-of-life domains remained below population norms ( 32 ). These data help explain why some trials show preservation of function, attenuation of decline, or faster recovery rather than large short-term gains across all domains. In HSCT populations, exercise may therefore be important not only for producing improvement, but also for limiting deterioration and accelerating return toward baseline ( 32 , 33 ).

Older studies from the broader HSCT rehabilitation literature also provide useful context for interpreting our findings. Pilot and early post-transplant studies suggested that individualized or home-based aerobic exercise could improve fatigue, aerobic fitness, and physical well-being, even though many of these designs lacked a control group ( 34 , 35 ). Similarly, randomized inpatient or peri-transplant studies demonstrated that structured walking or multimodal supervised exercise could improve functional status, muscle strength, aerobic capacity, and selected aspects of physical or emotional well-being, with stronger signals often seen in less fit patients or those with lower baseline function ( 36 , 37 ). Together, these studies reinforce the idea that the strongest and earliest benefits of exercise in HSCT are often seen in functional recovery rather than in broader psychosocial endpoints.

The clinical implications of our review are therefore practical. First, structured exercise in HSCT does not need to rely exclusively on center-based delivery. Simple home-based prescriptions, supervised telehealth sessions, and hybrid models appear workable across different phases of care. Second, patient selection and tailoring are likely critical. Frail survivors, deconditioned patients, and those with poorer baseline functional capacity may derive substantial benefit, but may also require closer monitoring and more individualized progression ( 15 , 36 ). Third, multimodal rehabilitation approaches that integrate exercise with education, behavioral support, and where appropriate nutritional support may be especially relevant in this population, given the interaction between functional decline, symptom burden, and prolonged recovery ( 33 , 38 ).

Future research should move beyond small proof-of-concept trials toward adequately powered multicenter randomized studies that distinguish more clearly between pre-transplant, peri-transplant, and post-transplant rehabilitation models. Greater consistency is needed in intervention reporting, progression rules, safety monitoring, adherence metrics, and clinically relevant core outcomes. Separate analyses for autologous and allogeneic populations, as well as frail or high-risk subgroups, would also improve interpretability ( 39 ). Based on the limited randomized evidence available, the present review suggests that structured exercise may represent a promising supportive care strategy in HSCT, particularly for preserving or restoring functional capacity; however, stronger evidence is needed before firm conclusions can be drawn regarding broader patient-centered outcomes ( 11 , 24 – 26 , 32 ).

Limitations

This review has several limitations. Only seven randomized trials were included, and several were pilot or feasibility studies with small sample sizes. In addition, the restriction to English-language publications and the exclusion of grey literature may have introduced selection bias. The studies differed substantially in transplant type, disease characteristics, intervention timing, supervision level, and outcomes assessed. In addition, some interventions were multimodal, which limits attribution of effects to exercise alone. Finally, although the review focused on home-based and telehealth-supported exercise, some included studies also involved hybrid or partly supervised delivery models, which should be acknowledged when interpreting the findings.

Conclusion

Structured exercise interventions delivered in home-based, telehealth, or hybrid settings appear feasible and generally safe for adults undergoing or recovering from HSCT. Based on the limited randomized evidence available, the most consistent trend of improvement was observed in functional capacity and physical performance, whereas effects on QoL, fatigue, and muscle strength were less consistent. These findings should be interpreted cautiously because of the small number of trials, heterogeneity of interventions and outcomes, and methodological concerns in several studies. Larger, methodologically robust trials with clearer reporting of timing, safety, adherence, and patient-centered outcomes are needed.

Edited by: Ashraf S Gorgey , Hunter Holmes McGuire VA Medical Center, United States

Reviewed by: Raquel Carbonera , Santa Casa de Misericórdia de Porto Alegre, Brazil

Ulas Ar , Yuksek Ihtisas Training and Research Hospital, Türkiye

Author contributions

ME: Data curation, Formal analysis, Investigation, Writing – original draft, Writing – review & editing. HA: Data curation, Formal analysis, Investigation, Writing – review & editing. MM: Data curation, Formal analysis, Investigation, Writing – review & editing. EA: Conceptualization, Supervision, Writing – review & editing. LB: Conceptualization, Methodology, Supervision, Writing – original draft, Writing – review & editing.

Conflict of interest

The author(s) declared that this work was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

The author LB declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision.

Generative AI statement

The author(s) declared that generative AI was used in the creation of this manuscript. Generative artificial intelligence was used for language polishing and editorial improvement of the manuscript text. All scientific content, interpretation, and conclusions are the sole responsibility of the authors, who reviewed and verified the final manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

Publisher's note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Supplementary material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fresc.2026.1846935/full#supplementary-material

References

1. Niederwieser D Baldomero H Szer J Gratwohl M Aljurf M Atsuta Y Hematopoietic stem cell transplantation activity worldwide in 2012 and a SWOT analysis of the worldwide network for blood and marrow transplantation group including the global survey . Bone Marrow Transplant . ( 2016 ) 51 ( 6 ): 778 – 85 . 10.1038/bmt.2016.18 26901703 PMC4889523

2. Gratwohl A Pasquini MC Aljurf M Atsuta Y Baldomero H Foeken L One million haemopoietic stem-cell transplants: a retrospective observational study . Lancet Haematol . ( 2015 ) 2 ( 3 ): e91 – e100 . 10.1016/S2352-3026(15)00028-9 26687803

3. Bhatia S . Long-term health impacts of hematopoietic stem cell transplantation inform recommendations for follow-up . Expert Rev Hematol . ( 2011 ) 4 ( 4 ): 437 – 54 . 10.1586/ehm.11.39 21801135 PMC3163085

4. Chaudhry HM Bruce AJ Wolf RC Litzow MR Hogan WJ Patnaik MS The incidence and severity of oral mucositis among allogeneic hematopoietic stem cell transplantation patients: a systematic review . Biol Blood Marrow Transplant . ( 2016 ) 22 ( 4 ): 605 – 16 . 10.1016/j.bbmt.2015.09.014 26409924

5. Persoon S Kersten MJ Buffart LM Vander Slagmolen G Baars JW Visser O Health-related physical fitness in patients with multiple myeloma or lymphoma recently treated with autologous stem cell transplantation . J Sci Med Sport . ( 2017 ) 20 ( 2 ): 116 – 22 . 10.1016/j.jsams.2016.01.006 26971299

6. Cheon J Lee YJ Jo JC Kweon K Koh S Min YJ Late complications and quality of life assessment for survivors receiving allogeneic hematopoietic stem cell transplantation . Support Care Cancer . ( 2020 ) 29 ( 2 ): 975 – 86 . 10.1007/s00520-020-05572-0 32556712

7. Smeland KB Loge JH Aass HCD Aspelin T Bersvendsen H Bolstad N Chronic fatigue is highly prevalent in survivors of autologous stem cell transplantation and associated with IL-6, neuroticism, cardiorespiratory fitness, and obesity . Bone Marrow Transplant . ( 2019 ) 54 ( 4 ): 607 – 10 . 10.1038/s41409-018-0342-y 30262906

8. Schmitz KH Courneya KS Matthews C Demark-Wahnefried W Galvão DA Pinto BM American college of sports medicine roundtable on exercise guidelines for cancer survivors . Med Sci Sports Exerc . ( 2010 ) 42 ( 7 ): 1409 – 26 . 10.1249/MSS.0b013e3181e0c112 20559064

9. Bourgeois A Horrill TC Mollison A Lambert LK Stajduhar KI . Barriers to cancer treatment and care for people experiencing structural vulnerability: a secondary analysis of ethnographic data . Int J Equity Health . ( 2023 ) 22 ( 1 ): 58 . 10.1186/s12939-023-01860-3 36998035 PMC10064679

10. Jiang C Yabroff KR Deng L Wang Q Perimbeti S Shapiro CL Self-reported transportation barriers to health care among us cancer survivors . JAMA Oncol . ( 2022 ) 8 ( 5 ): 775 – 8 . 10.1001/jamaoncol.2022.0143 35323841 PMC8949758

11. Gonçalves Leite Rocco P Mahony Reategui-Rivera C Finkelstein J . Telemedicine-supported exercise interventions in hematopoietic stem cell transplantation: a scoping review . Int J Gen Med . ( 2025 ) 18 : 4251 – 65 . 10.2147/IJGM.S526025 40786951 PMC12335289

12. Eid M Alkerdasy H Hilmy A Sameh A Ashraf A . Effectiveness of virtual reality–based exercise rehabilitation for enhancing functional outcomes and quality of life in adult cancer survivors: a systematic review of randomized controlled trials . J Cancer Surviv . ( 2025 ), 1 – 12 . 10.1007/s11764-025-01923-0 41298970

13. Batalik L Chamradova K Winnige P Dosbaba F Batalikova K Vlazna D Effect of exercise-based cancer rehabilitation via telehealth: a systematic review and meta-analysis . BMC Cancer . ( 2024 ) 24 ( 1 ): 600 . 10.1186/s12885-024-12348-w 38760805 PMC11100177

14. Echefu G Batalik L Lukan A Shah R Nain P Guha A The digital revolution in medicine: applications in cardio-oncology . Curr Treat Options Cardiovasc Med . ( 2025 ) 27 ( 1 ): 2 . 10.1007/s11936024-01059-x 39610711 PMC11600984

15. Page MJ McKenzie JE Bossuyt PM Boutron I Hoffmann TC Mulrow CD The PRISMA 2020 statement: an updated guideline for reporting systematic reviews . Br Med J . ( 2021 ) 29 : n71 . 10.1136/bmj.n71 PMC8005924 33782057

16. Sterne JA Savović J Page MJ Elbers RG Blencowe NS Boutron I Rob 2: a revised tool for assessing risk of bias in randomised trials . Br Med J . ( 2019 ) 366 : l4898 . 10.1136/bmj.l4898 31462531

17. Wood WA Weaver M Smith-Ryan AE Hanson ED Shea TC Battaglini CL . Lessons learned from a pilot randomized clinical trial of home-based exercise prescription before allogeneic hematopoietic cell transplantation . Support Care Cancer . ( 2020 ) 28 ( 11 ): 5291 – 8 . 10.1007/s00520-020-05369-1 32112353 PMC7483208

18. Wiskemann J Dreger P Schwerdtfeger R Bondong A Huber G Kleindienst N Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation . Blood . ( 2011 ) 117 ( 9 ): 2604 – 13 . 10.1182/blood-2010-09-306308 21190995

19. Lee K Shamunee J Lindenfeld L Ross E Hageman L Sedrak MS Feasibility of implementing a supervised telehealth exercise intervention in frail survivors of hematopoietic cell transplantation: a pilot randomized trial . BMC cancer . ( 2023 ) 23 ( 1 ): 390 . 10.1186/s12885-023-10884-5 37127595 PMC10150529

20. Ma DD Liu Z Au K Tran M Artuz CM Greenwood M Randomized controlled trial of a virtually delivered exercise and stress management program to improve physical performance of hematopoietic cell transplant survivors . J Clin Oncol . ( 2025 ) 43 ( 8 ): 949 – 59 . 10.1200/JCO.24.00333 39591546 PMC11895824

21. McCourt O Fisher A Ramdharry G Land J Roberts AL Rabin N Exercise prehabilitation for people with myeloma undergoing autologous stem cell transplantation: results from PERCEPT pilot randomised controlled trial . Acta Oncol (Madr) . ( 2023 ) 62 ( 7 ): 696 – 705 . 10.1080/0284186X.2023.2178326 36794394

22. Potiaumpai M Caru M Mineishi S Naik S Zemel BS Schmitz KH . IMPROVE-BMT: a pilot randomized controlled trial of prehabilitation exercise for adult hematopoietic stem cell transplant recipients . J Clin Med . ( 2024 ) 13 ( 7 ): 2052 . 10.3390/jcm13072052 38610816 PMC11012812

23. Coleman EA Coon SK Kennedy RL Lockhart KD Stewart CB Anaissie EJ Effects of exercise in combination with epoetin alfa during high-dose chemotherapy and autologous peripheral blood stem cell transplantation for multiple myeloma . Oncol Nurs Forum . ( 2009 ) 35 ( 3 ): E53 . 10.1188/08.ONF.E53-E61 PMC2447545 18467280

24. Liang Y Zhou M Wang F Wu Z . Exercise for physical fitness, fatigue and quality of life of patients undergoing hematopoietic stem cell transplantation: a meta-analysis of randomized controlled trials . Jpn J Clin Oncol . ( 2018 ) 48 ( 12 ): 1046 – 57 . 10.1093/jjco/hyy144 30277514

25. Martín-Sánchez C Polo-Ferrero L Baile-González M Marcos-Asensio S Fernández-Rodríguez EJ Méndez-Sánchez R Effects of physical exercise in patients undergoing haematopoietic stem cell transplantation: systematic review and metaanalysis . Support Care Cancer . ( 2025 ) 33 : 1160 . 10.1007/s00520-025-10194-5 41329197 PMC12672829

26. Takekiyo T Morishita S . Effect of rehabilitation in patients undergoing hematopoietic stem cell transplantation . Fukushima J Med Sci . ( 2023 ) 69 ( 2 ): 73 – 83 . 10.5387/fms.2022-33 37164764 PMC10480509

27. Batalik L Su JJ Liska D Rutkowski S Felsoci M Chamradova K Twelve-month outcomes of telehealth-supported home-based versus centre-based cardio-oncology rehabilitation in lymphoma survivors: a randomized controlled trial . Arch Rehabil Res Clin Transl . ( 2026 ): 100621 . 10.1016/j.arrct.2026.100621

28. Gorzelitz JS Bouji N Stout NL . Program barriers and facilitators in virtual cancer exercise implementation: a qualitative analysis . Transl J Am Coll Sports Med . ( 2022 ) 7 ( 3 ): e000199 . 10.1249/TJX.0000000000000199 35601444 PMC9119660

29. Houston JL Boyd KP Gittings PM Cavalheri V . What are safe hemoglobin, neutrophil and platelet counts for people with hematological malignancies to participate in exercise and activities of daily living: a scoping review . Support Care Cancer . ( 2025 ) 33 : 605 . 10.1007/s00520-025-09612-5 40542825 PMC12182480

30. Yen MS Wu LM Feng YH Chen MD . Developing a feasible exercise program for patients undergoing hematopoietic stem cell transplantation: an action research approach . Eur J Oncol Nurs . ( 2026 ) 81 : 103164 . 10.1016/j.ejon.2026.103164 41818950

31. Denehy L Abo S Swain C Short CE Kiss N Khot A Rehabilitation after bone marrow transplant compared with usual care to improve patient outcomes (REBOOT): protocol for a randomised controlled trial . BMC Cancer . ( 2025 ) 25 : 532 . 10.1186/s12885-025-13898-3 40122792 PMC11931774

32. Takekiyo T Utsunomiya A Nara S Nakashima N Okamura T Tokunaga M Recovery of physical function, muscle mass, and quality of life in patients undergoing allogeneic hematopoietic stem cell transplantation . Blood Cell Ther . ( 2024 ) 7 ( 3 ): 64 – 73 . 39263619 10.31547/bct-2023-034 PMC11384126

33. Abo S Ritchie D Denehy L Panek-Hudson Y Irving L Granger CL . A hospital and homebased exercise program to address functional decline in people following allogeneic stem cell transplantation . Support Care Cancer . ( 2018 ) 26 ( 5 ): 1727 – 36 . 10.1007/s00520-017-4016-x 29243166

34. Wilson RW Jacobsen PB Fields KK . Pilot study of a home-based aerobic exercise program for sedentary cancer survivors treated with hematopoietic stem cell transplantation . Bone Marrow Transplant . ( 2005 ) 35 ( 7 ): 721 – 7 . 10.1038/sj.bmt.1704815 15696182

35. Carlson LE Smith D Russell J Fibich C Whittaker T . Individualized exercise program for the treatment of severe fatigue in patients after allogeneic hematopoietic stem-cell transplant: a pilot study . Bone Marrow Transplant . ( 2006 ) 37 ( 10 ): 945 – 54 . 10.1038/sj.bmt.1705343 16565742

36. DeFor TE Burns LJ Gold EMA Weisdorf DJ . A randomized trial of the effect of a walking regimen on the functional status of 100 adult allogeneic donor hematopoietic cell transplant patients . Biol Blood Marrow Transplant . ( 2007 ) 13 ( 8 ): 948 – 55 . 10.1016/j.bbmt.2007.04.008 17640599

37. Jarden M Baadsgaard MT Hovgaard DJ Boesen E Adamsen L . A randomized trial on the effect of a multimodal intervention on physical capacity, functional performance and quality of life in adult patients undergoing allogeneic SCT . Bone Marrow Transplant . ( 2009 ) 43 ( 9 ): 725 – 37 . 10.1038/bmt.2009.27 19234513

38. Rupnik E Skerget M Sever M Zupan IP Ogrinec M Ursic B Feasibility and safety of exercise training and nutritional support prior to haematopoietic stem cell transplantation in patients with haematologic malignancies . BMC Cancer . ( 2020 ) 20 : 1142 . 10.1186/s12885020-07637-z 33234112 PMC7687740

39. Su JJ Winnige P Chamradova K Dosbaba F Batalikova K Lin R Feasibility, safety, and adherence of home-based exercise interventions in people diagnosed with cancer: a systematic review . J Cancer Surviv. ( 2025 ), 1 – 22 . 10.1007/s11764-025-01778-5 40119984