Effectiveness and Implementation of Physical Activity Interventions for Rural Breast Cancer Survivors: A Systematic Review.

Physical activity is recommended for breast cancer survivors to improve physical function, reduce treatment-related symptoms, and enhance quality of life. However, survivors living in rural areas often face barriers to participating in exercise programs due to geographic isolation, limited access to rehabilitation services, and fewer community resources. Although various exercise interventions have been developed for cancer survivors, evidence regarding their effectiveness and implementation in rural populations remains limited. This systematic review examined the effectiveness and feasibility of physical activity interventions for breast cancer survivors living in rural or non-urban settings. A systematic review was conducted in accordance with a predefined protocol. Electronic databases were searched to identify studies evaluating structured physical activity or rehabilitation programs for adult breast cancer survivors residing in rural areas. Eligible study designs included randomized controlled trials, quasi-experimental studies, and observational studies. Two reviewers independently screened studies, extracted data, and assessed methodological quality. Outcomes included physical function, physical activity levels, health-related quality of life, fatigue, adherence, and feasibility. Findings were synthesized narratively due to heterogeneity in study designs and outcome measures. Seven studies met the inclusion criteria. Interventions included telephone-based counseling, tele-exercise programs, lifestyle interventions, and community-based physical activity initiatives. Most studies reported improvements in physical activity participation, physical performance, lifestyle behaviors, or quality of life. Several interventions demonstrated measurable benefits, including increased physical activity levels and improvements in functional outcomes. Remote delivery approaches, such as telephone or telehealth programs, were frequently used to address geographic barriers. Risk-of-bias assessment indicated generally low to moderate methodological quality across the included studies. Physical activity interventions appear to be feasible and beneficial for breast cancer survivors living in rural areas. Remote and community-based delivery approaches may help overcome access barriers and support participation in exercise programs. Future research should explore sustainable, community-engaged models that promote long-term physical activity and improve quality of life among rural cancer survivors.