{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:27:01Z","timestamp":1787030821443,"version":"build-2736575974"},"update-to":[{"DOI":"10.12688\/f1000research.112667.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000}}],"reference-count":44,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns5:p>Background: Cardiotoxicity is a major long-term complication of anti-cancer drugs such as anthracycline and androgen deprivation therapy (ADT). These drugs also impact the quality of life, reduced functional capacity, and life expectancy. Exercise attenuates the cardiotoxic effects of anticancer treatments via antioxidant effects, as indicated by a growing body of evidence. Methods: Studies for this review were retrieved from databases PubMed, SCOPUS, EMBASE, COCHRANE, and Web of Science and were restricted only to clinical trials. Study results were screened and synchronized to Mendeley. Studies that met the eligibility criteria were extracted into the spreadsheet, summarizing information regarding the site and cancer stages, adjuvant therapy, various exercise interventions, and outcome measures. Risk of bias quality analysis was done in accordance with the National Heart Lung Blood Institute. Results: In this systematic review, 9021 articles were screened. After the exclusion criteria, seven articles were included for qualitative analysis. Outcome measures analyzed were measures of cardiotoxicity such as left ventricular ejection fraction (LVEF), cardiac biomarkers, and global longitudinal strain. Conclusion: Although a structured exercise protocol including aerobic and resistance training has been found to improve, the functional capacity is an indirect measure of cardiotoxicity. There is a lack of data on improvements in direct measurements of cardiotoxicity, such as LVEF and cardiac biomarkers. A lack of evidence from direct measurements of cardiotoxicity regarding the effects of exercise underscores the need for further research.<\/ns5:p>","DOI":"10.12688\/f1000research.112667.2","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T08:49:05Z","timestamp":1785142145000},"page":"497","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of exercise training on cardiotoxicity in cancer survivors. A systematic review"],"prefix":"10.12688","volume":"11","author":[{"given":"Ravindra","family":"Reddy C","sequence":"first","affiliation":[{"name":"Department of Physiotherapy, Kasturba Medical College, Mangalore Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5636-2620","authenticated-orcid":false,"given":"Stephen","family":"Samuel","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Kasturba Medical College, Mangalore Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0642-7155","authenticated-orcid":false,"given":"Vijay Pratap","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Kasturba Medical College, Mangalore Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sourjya","family":"Banerjee","sequence":"additional","affiliation":[{"name":"Department of Radiotherapy and Oncology, Kasturba Medical College, Mangalore Manipal Manipal Academy of Higher Education"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2560","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"363-385","DOI":"10.3322\/caac.21565","article-title":"Cancer treatment and survivorship statistics.","volume":"69","author":"K Miller","year":"2019 2019 Sep 1 cited 2021 May 11","journal-title":"CA Cancer J Clin."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1182-1186","DOI":"10.1126\/science.aaw4892","article-title":"Science and health for all children with cancer.","volume":"363","author":"C Lam","year":"2019","journal-title":"Science. American Association for the Advancement of Science."},{"key":"ref3","doi-asserted-by":"publisher","first-page":"7-30","DOI":"10.3322\/caac.21590","article-title":"Cancer statistics.","volume":"70","author":"R Siegel","year":"2020 2020 Jan cited 2021 May 11","journal-title":"CA Cancer J Clin."},{"key":"ref5","doi-asserted-by":"publisher","first-page":"216-227","DOI":"10.1016\/j.jtho.2020.11.002","article-title":"Cardiac Toxicity of Thoracic Radiotherapy: Existing Evidence and Future Directions.","volume":"16","author":"K Banfill","year":"2021","journal-title":"J Thorac Oncol. Elsevier Inc."},{"key":"ref6","doi-asserted-by":"publisher","first-page":"65-76","DOI":"10.1159\/000510573","article-title":"Modern Radiotherapy and Risk of Cardiotoxicity.","volume":"65","author":"E Koutroumpakis","year":"2020","journal-title":"Chemotherapy. S. Karger AG."},{"key":"ref8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.3389\/fped.2020.00123","article-title":"Subclinical Cardiac Dysfunction in Childhood Cancer Survivors on 10-Years Follow-Up Correlates With Cumulative Anthracycline Dose and Is Best Detected by Cardiopulmonary Exercise Testing, Circulating Serum Biomarker, Speckle Tracking Echocardiography, and Tissue Doppler Imaging.","volume":"8","author":"C Wolf","year":"2020 Mar","journal-title":"Front Pediatr."},{"key":"ref9","doi-asserted-by":"publisher","first-page":"181-192","DOI":"10.1007\/978-3-030-43032-0_15","author":"A Bhagat","year":"2020","journal-title":"Advances in Experimental Medicine and Biology."},{"key":"ref10","doi-asserted-by":"publisher","first-page":"186-200","DOI":"10.1016\/j.critrevonc.2018.03.014","article-title":"Cardiotoxic effects of chemotherapy: A review of both cytotoxic and molecular targeted oncology therapies and their effect on the cardiovascular system.","volume":"126","author":"H Babiker","year":"2018","journal-title":"Critical Reviews in Oncology\/Hematology."},{"key":"ref11","doi-asserted-by":"publisher","first-page":"315-23","DOI":"10.2459\/JCM.0000000000000667","article-title":"Chemotherapy-induced cardiotoxicity: new insights into mechanisms, monitoring, and prevention.","volume":"19","author":"C Dessalvi","year":"2018 Jul 1","journal-title":"J Cardiovasc Med."},{"key":"ref12","doi-asserted-by":"publisher","first-page":"64-9","DOI":"10.15420\/ecr.2017:17:2","article-title":"Cardio-oncology: A focus on cardiotoxicity.","volume":"13","author":"A Koutsoukis","year":"2018 Jun 1","journal-title":"Eur Cardiol Rev."},{"key":"ref13","doi-asserted-by":"crossref","first-page":"911-39","DOI":"10.1016\/j.echo.2014.07.012","article-title":"Expert consensus for multimodality imaging evaluation of adult patients during and after cancer therapy: A report from the American society of echocardiography and the European association of cardiovascular imaging.","volume":"27","author":"J Plana","year":"2014 cited 2021 May 11","journal-title":"J Am Soc Echocardiogr."},{"key":"ref14","doi-asserted-by":"publisher","first-page":"1981-8","DOI":"10.1161\/CIRCULATIONAHA.114.013777","article-title":"Early detection of anthracycline cardiotoxicity and improvement with heart failure therapy.","volume":"131","author":"D Cardinale","year":"2015 Jun 2","journal-title":"Circulation."},{"key":"ref15","doi-asserted-by":"publisher","first-page":"596-603","DOI":"10.1161\/CIRCIMAGING.112.973321","article-title":"Assessment of echocardiography and biomarkers for the extended prediction of cardiotoxicity in patients treated with anthracyclines, taxanes, and trastuzumab.","volume":"5","author":"H Sawaya","year":"2012","journal-title":"Circ: Cardiovasc Imaging."},{"key":"ref16","doi-asserted-by":"publisher","first-page":"130-137","DOI":"10.1093\/eurjhf\/hfr165","article-title":"Detection, monitoring, and management of trastuzumab-induced left ventricular dysfunction: An actual challenge.","volume":"14","author":"C Tocchetti","year":"2012","journal-title":"Eur J Heart Fail."},{"key":"ref17","doi-asserted-by":"publisher","first-page":"105-118","DOI":"10.2217\/fca.12.73","article-title":"Using cardiac biomarkers and treating cardiotoxicity in cancer.","volume":"9","author":"A Colombo","year":"2013","journal-title":"Future Cardiology."},{"key":"ref18","doi-asserted-by":"publisher","first-page":"325-332","DOI":"10.1007\/s00059-011-3453-4","article-title":"Assessment of cardiotoxicity with cardiac biomarkers in cancer patients.","volume":"36","author":"D Cardinale","year":"2011","journal-title":"Herz."},{"key":"ref19","doi-asserted-by":"publisher","first-page":"383-393","DOI":"10.1016\/j.soncn.2016.09.002","article-title":"Exercise Recommendations for the Management of Symptoms Clusters Resulting From Cancer and Cancer Treatments.","volume":"32","author":"K Mustian","year":"2016","journal-title":"Seminars in Oncology Nursing. W.B. Saunders."},{"key":"ref20","doi-asserted-by":"publisher","first-page":"81","DOI":"10.17925\/OHR.2012.08.2.81","article-title":"Exercise Recommendations for Cancer-Related Fatigue, Cognitive Impairment, Sleep Problems, Depression, Pain, Anxiety, and Physical Dysfunction\u2014A Review.","volume":"08","author":"K Mustian","year":"2012 cited 2021 May 11;0802:81","journal-title":"Oncol Hematol Rev."},{"key":"ref21","doi-asserted-by":"publisher","first-page":"176-181","DOI":"10.1249\/JSR.0b013e3181ae98f3","article-title":"Effects of exercise on quality of life and prognosis in cancer survivors.","volume":"8","author":"A Speed-Andrews","year":"2009","journal-title":"Current Sports Medicine Reports."},{"key":"ref22","doi-asserted-by":"crossref","first-page":"2375-90","DOI":"10.1249\/MSS.0000000000002116","article-title":"Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable.","volume":"51","author":"K Campbell","year":"2019 Nov 1","journal-title":"Medicine and Science in Sports and Exercise."},{"key":"ref23","first-page":"1409-26","article-title":"No Title.","author":"K Schmitz","year":"Jul, 2010","journal-title":"Medicine and Science in Sports and Exercise Med Sci Sports Exerc."},{"key":"ref24","doi-asserted-by":"publisher","DOI":"10.1007\/s11864-020-00752-w","volume":"21","author":"C Tong","year":"2020","journal-title":"Curr Treat Options Oncol."},{"key":"ref25","doi-asserted-by":"publisher","first-page":"1176-1191","DOI":"10.1161\/CIRCULATIONAHA.117.024671","article-title":"Exercise therapy and cardiovascular toxicity in cancer.","volume":"137","author":"J Scott","year":"2018","journal-title":"Circulation."},{"key":"ref26","doi-asserted-by":"publisher","first-page":"28-37","DOI":"10.17925\/OHR.2018.14.1.28","article-title":"Exercise for Toxicity Management in Cancer\u2014A Narrative Review.","volume":"14","author":"I Kleckner","year":"2018","journal-title":"Oncol Hematol Rev."},{"key":"ref27","doi-asserted-by":"publisher","first-page":"H213-H222","DOI":"10.1152\/ajpheart.00646.2016","article-title":"Aerobic exercise in anthracycline-induced cardiotoxicity: A systematic review of current evidence and future directions.","volume":"312","author":"J Chen","year":"2017","journal-title":"Am J Physiol - Hear Circ Physiol."},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.17605\/OSF.IO\/Q4YZM","article-title":"Effects of exercise training on cardiotoxicity in cancer survivors.","author":"S Samuel","year":"2022, April 5"},{"key":"ref30","doi-asserted-by":"crossref","first-page":"1573-1581","DOI":"10.1249\/MSS.0000000000001970","article-title":"Persistent Impairment in Cardiopulmonary Fitness after Breast Cancer Chemotherapy.","volume":"51","author":"S Foulkes","year":"2019 Aug 1 cited 2020 Nov 29","journal-title":"Med Sci Sports Exerc."},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.3390\/jcm9051379","article-title":"The Preventive Role of Regular Physical Training in Ventricular Remodeling, Serum Cardiac Markers, and Exercise Performance Changes in Breast Cancer in Women Undergoing Trastuzumab Therapy-An REH-HER Study.","volume":"9","author":"K Hojan","year":"2020 May","journal-title":"J Clin Med."},{"key":"ref32","doi-asserted-by":"publisher","first-page":"305-315","DOI":"10.1177\/2047487318811181","article-title":"Exercise as a diagnostic and therapeutic tool for the prevention of cardiovascular dysfunction in breast cancer patients.","volume":"26","author":"E Howden","year":"2019 Feb 1","journal-title":"Eur J Prev Cardiol."},{"key":"ref33","doi-asserted-by":"publisher","first-page":"719-29","DOI":"10.1007\/s10549-017-4554-4","article-title":"The effect of an aerobic exercise bout 24 h prior to each doxorubicin treatment for breast cancer on markers of cardiotoxicity and treatment symptoms: A.","volume":"167","author":"A Kirkham","year":"2018 Nov 6","journal-title":"Breast Cancer Res Treat."},{"key":"ref34","doi-asserted-by":"publisher","first-page":"263-270","DOI":"10.1016\/j.ijcard.2017.07.037","article-title":"Protective effects of acute exercise prior to doxorubicin on cardiac function of breast cancer patients: A proof-of-concept RCT.","volume":"245","author":"A Kirkham","year":"2017","journal-title":"Int J Cardiol."},{"key":"ref35","doi-asserted-by":"publisher","first-page":"4963-4967","DOI":"10.1158\/1078-0432.CCR-09-0628","article-title":"Adjuvant Trastuzumab Induces Ventricular Remodeling Despite Aerobic Exercise Training.","volume":"15","author":"M Haykowsky","year":"2009 Aug","journal-title":"Clin Cancer Res."},{"key":"ref36","first-page":"1125-1129","article-title":"Effect of anthracycline combined with aerobic exercise on the treatment of breast cancer.","volume":"31","author":"Z Ma","year":"2018 May","journal-title":"Pak J Pharm Sci."},{"key":"ref38","article-title":"Cardiotoxicity of Anticancer Treatments: Epidemiology, Detection, and Management CONTINUING MEDICAL EDUCATION ACCREDITATION AND DESIGNATION STATEMENT."},{"key":"ref39","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCHEARTFAILURE.115.002661","article-title":"Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 1: Definitions, Pathophysiology, Risk Factors, and Imaging.","volume":"9","author":"M Bloom","year":"2016 Jan 1 cited 2021 Jun 13","journal-title":"Circ Hear Fail."},{"key":"ref40","doi-asserted-by":"publisher","first-page":"2329-2336","DOI":"10.1016\/j.jacc.2007.02.055","article-title":"A Meta-Analysis of the Effect of Exercise Training on Left Ventricular Remodeling in Heart Failure Patients. The Benefit Depends on the Type of Training Performed.","volume":"49","author":"M Haykowsky","year":"2007","journal-title":"J Am Coll Cardiol."},{"key":"ref41","doi-asserted-by":"publisher","first-page":"1007-1018","DOI":"10.1001\/jamacardio.2019.2952","article-title":"Assessment of Prognostic Value of Left Ventricular Global Longitudinal Strain for Early Prediction of Chemotherapy-Induced Cardiotoxicity: A Systematic Review and Meta-analysis.","volume":"4","author":"E Oikonomou","year":"2019","journal-title":"JAMA Cardiology."},{"key":"ref42","doi-asserted-by":"crossref","first-page":"310-6","DOI":"10.1111\/j.1475-097X.2012.01128.x","article-title":"Changes in global longitudinal strain during rest and exercise in patients treated with cardiac resynchronization therapy.","volume":"32","author":"C Valzania","year":"2012 Jul cited 2021 Jun 15","journal-title":"Clin Physiol Funct Imaging."},{"key":"ref43","doi-asserted-by":"publisher","first-page":"431-450","DOI":"10.1007\/s12265-020-10042-3","article-title":"The Role of Biomarkers in Cardio-Oncology.","volume":"13","author":"K Ananthan","year":"2020","journal-title":"J Cardiovasc Transl Res."},{"key":"ref44","doi-asserted-by":"publisher","first-page":"99-125","DOI":"10.1152\/physrev.00029.2014","article-title":"Are there deleterious cardiac effects of acute and chronic endurance exercise?.","volume":"96","author":"T Eijsvogels","year":"2016","journal-title":"Physiol. Rev."},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1170-1175","DOI":"10.1016\/S0735-1097(99)00339-3","article-title":"Neuroendocrine activation in heart failure is modified by endurance exercise training.","volume":"34","author":"R Braith","year":"1999","journal-title":"J Am Coll Cardiol."},{"key":"ref46","doi-asserted-by":"crossref","first-page":"134-41","DOI":"10.1016\/j.ijcard.2018.02.076","article-title":"High intensity interval training versus moderate intensity continuous training on exercise capacity and quality of life in patients with heart failure with reduced ejection fraction: A systematic review and meta-analysis.","volume":"261","author":"M Gomes Neto","year":"2018 Jun 15 cited 2021 Jun 19","journal-title":"Int J Cardiol."},{"key":"ref47","doi-asserted-by":"publisher","first-page":"97-104","DOI":"10.1634\/theoncologist.2017-0255","article-title":"Sarcopenia Is Associated with Quality of Life and Depression in Patients with Advanced Cancer.","volume":"23","author":"R Nipp","year":"2018 Jan","journal-title":"Oncologist."},{"key":"ref48","doi-asserted-by":"publisher","first-page":"8075-8077","DOI":"10.7314\/APJCP.2015.16.18.8075","volume":"16","author":"J Chindapasirt","year":"2016","journal-title":"Asian Pac J Cancer Prev."}],"container-title":["F1000Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/f1000research.com\/articles\/11-497\/v2\/xml","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-497\/v2\/pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/f1000research.com\/articles\/11-497\/v2\/iparadigms","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:44:15Z","timestamp":1787028255000},"score":1,"resource":{"primary":{"URL":"https:\/\/f1000research.com\/articles\/11-497\/v2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,27]]},"references-count":44,"URL":"https:\/\/doi.org\/10.12688\/f1000research.112667.2","relation":{"has-version":[{"id-type":"doi","id":"10.12688\/f1000research.112667.1","asserted-by":"subject"}],"has-review":[{"id-type":"doi","id":"10.5256\/f1000research.199218.r505310","asserted-by":"subject"},{"id-type":"doi","id":"10.5256\/f1000research.199218.r505310","asserted-by":"object"}]},"ISSN":["2046-1402"],"issn-type":[{"value":"2046-1402","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,27]]},"assertion":[{"value":"Indexed","URL":"https:\/\/f1000research.com\/articles\/11-497\/v2#article-reports","order":0,"name":"referee-status","label":"Referee status","group":{"name":"current-referee-status","label":"Current Referee Status"}},{"value":"10.5256\/f1000research.124396.r140895, Sharon F. Kramer, Faculty of Health, School of Nursing and Midwifery, Deakin University, Geelong, Vic, 01 Jul 2022, version 1, 3 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-497\/v1#referee-response-140895","order":0,"name":"referee-response-140895","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Stephen Samuel<\/b>; \n<i>Posted: 22 Apr 2026<\/i>; 1)The rationale for the review is clearly stated. The background is missing some details regarding definitions of the main concepts addressed in this review, for example cardiotoxicity and details about how this is measured (this information is reported in the discussion and could be moved to the background and methods) and exercise and what is the potential underlying mechanisms of exercise on cardiotoxicity.  \n<b>Response:<\/b> Dear reviewer, Thank you for your comments, the description about cardiotoxicity and its measures was already mentioned in the introduction in 6\n<sup>th<\/sup> line of 3\n<sup>rd<\/sup> paragraph. . We have also updated the mechanism of how exercise works in the 9\n<sup>th<\/sup> line of the 5th paragraph.   2.Methods:  Several sections are missing in the methods.  \n<b>Response:&nbsp;<\/b>Dear reviewer, thank you for your comments. We have made significant changes in the methods section.  What criteria are used regarding study design? i.e., randomized controlled trail, non-randomised controlled trials, pre-post studies?  \n<b>Response:&nbsp;<\/b>Dear reviewer, thanks for your comments. We have added the criteria and it is updated in the method section under inclusion criteria. What was the process of screening title and abstract? Dear reviewer, thanks for your comments. We have added the screening details in the method section. &nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;  What comparisons were of interest? i.e., exercise A vs exercise B, exercise vs no exercise, etc.  \n<b>Response:&nbsp;<\/b>Dear reviewer, thanks for your comments. We are focused on how exercise can help the risk of cardiotoxicity;so any kind of exercise is considered, the comparison was not in our scope of review, as there is lot of variation in study designs. we are unable to do comparison.&nbsp;  I suggest providing more background about why these tools were developed as I was not aware of these tools and maybe other readers might not be either. For example, it is not clear that there are several tools that were developed for different study types. Specify which tools were used.   \n<b>Response:<\/b>&nbsp;Dear reviewer, the NHLBI(national heart lung and blood institute) has its different study tools for varied study designs. The details are available and updated in the risk of bias section.  Add a section to the methods about the outcomes of interest including: timing of outcome measurement of interest (post intervention and FU), how these outcomes are\/should be measures, and how the outcome measure should be interpreted higher value is greater toxicity? (Some of the details are reported in discussion and could be moved to methods section).  \n<b>Response:<\/b>Dear reviewer, thank you for your comments. The measures of cardiotoxicity (outcomes) have been already explained in the introduction. Regarding the interpretation, which is greater toxicity, there is no standardized set value for this. Only if there is critical changes seen in cardiotoxicity outcomes (LVEF, GLS, cardiac biomarkers) from baseline to follow up time period, the studies have considered toxicity. &nbsp;  Although no meta-analyses were performed, the methods still need a section about how the data was summarized\/synthesized. Please provide information about how the results were structured by study design, by population, by outcome.&nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp; &nbsp;&nbsp;  \n<b>Response:&nbsp;<\/b>Dear reviewer, thank you for your comment. The data of the included articles were summarised and added to the Excel sheet. This information has been mentioned under the data extraction heading of the method section  3. Results  The main results regarding toxicity are reported in the discussion and should be moved to the results section. I suggest restructuring or adding a table with just the results outcomes and consider how this could be structured (see suggestions above by study design, outcome or population).  \n<b>Response:&nbsp;<\/b>Dear reviewer, thank you for your comment. We have mentioned the main results considering the cardiotoxicity in the result section under the 3\n<sup>rd<\/sup> paragraph. All the articles retrieved and the data of the included studies is reported in the table under the results section. So the discussion part is more focused on exercise effects and cardiotoxicity outcomes.","URL":"https:\/\/f1000research.com\/articles\/11-497\/v2#referee-comment-16012","order":1,"name":"referee-comment-16012","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.124396.r180450, Quentin Jacquinot, University of Franche-Comt\u00e9, Besan\u00e7on, 12 Jul 2023, version 1, 3 approved with reservations","URL":"https:\/\/f1000research.com\/articles\/11-497\/v1#referee-response-180450","order":2,"name":"referee-response-180450","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"<b>Stephen Samuel<\/b>; \n<i>Posted: 22 Apr 2026<\/i>;  Harmonize the writing. For example: Capitalize the first only or capitalize first letter for each word. Write the meaning of MET in full. Add &quot;of Task&quot;.  \n<b>Reply:<\/b> Dear reviewer, thank you for your comment. The changes have been made.(Abbreviations are corrected.  \n<b>Introduction section (page 3)<\/b>  &nbsp;Add a reference for the first sentence. &nbsp; Change the order of the sentences in the writing of the first paragraphs of the introduction for more logic. For example: Start with the incidence (ref 1 and 2), then the notion of mortality (ref 3) then the sentences of references 4-6 and finally the first two sentences of the introduction and the reference. &nbsp; Weight your comments regarding the sentence &quot;This training can be implemented before, during, and after cancer treatments,19\u201323 thus nullifying the cardiotoxic effects&quot;. Modify &quot;can be&quot; by &quot;could be&quot; and &quot;nullifying&quot; by a less &quot;strong&quot; term because it contradicts the results of your article. &nbsp; Regarding VO\n<sub>2<\/sub>, specify that it is an &quot;indirect&quot; reflection of cardiotoxicity.  \n<b>Response: <\/b>Dear reviewer, thank you for your comment, the necessary changes have been made in the introduction.  \n<b>Methods section<\/b>  Cite reference 28 (See Underlying data) earlier and in each subsections of the method section because currently it comes too late, whereas these informations are important.  \n<b>Response: Dear<\/b> reviewer, thank you for your comment, the reference section is updated with the necessary changes.  \n<b><i>subsection &quot; Search strategy and selection criteria&quot;<\/i><\/b>  Add the words MESH for all categories (intervention, cardiotoxicity, etc...) as done for neoplasm and cancer survivors.  \n<b>Response: Dear<\/b> reviewer, thank you for your comment. The mesh terms are updated.  \n<b><i>subsection &quot;Inclusion criteria&quot;<\/i><\/b>  Specify the type of study design (RCT, observational, etc.)  \n<b>Response: Dear<\/b> reviewer, thank you for your comment(inclusion criteria is refined and type of study design are added )  \n<b><i>subsection &quot;Exclusion criteria&quot;<\/i><\/b>  Specify that pre-clinical studies are excluded. &nbsp; Why Nordic walking is excluded whereas selected studies offered unsupervised walking or the treadmill (cf : Supervised treadmill walking, unsupervised home-based walking in results section)?  \n<b>Response: Dear<\/b> reviewer, thank you for your comment. The necessary changes have been made. &nbsp;We acknowledge that it could be a part of interventions, but Nordic walking requires skilled walking and the use of a pole, which has more heterogeneity.  \n<b>Results section<\/b>  \n<b><i>Subsection &quot;Characteristics of the studies&quot;<\/i><\/b>  Maybe add the flowchart in the body text and not in the supplementary data? &nbsp; In the first sentence put the number in brackets like this: PubMed (n=6). &nbsp; Add &quot;&reg;&quot; to Thera band&reg; as it's a brand or change by &quot;resistance bands&quot;. \u200b In table 2: Write in the &quot;results&quot; column &quot;usual&quot; and &quot;training&quot; at the top and not only in the first line. This will make it possible to harmonize the wording to facilitate reading on the 2 pages. &nbsp; Same comment: Harmonize the wording of the &quot;outcomes measures&quot; column because sometimes it writes echo* - sometimes echography in full then sometimes no information on the method (as for Katarzyna et al). &nbsp; Same comment for the &quot;outcomes measure&quot; column: Sometimes there are deadlines, sometimes not. You must harmonize the wording and be more rigorous in the wording and organization of the paragraphs so that they are written in the same way for all the studies. &nbsp; Last sentence of the result part, please add the reference of the study.   \n<b>Response: Dear<\/b> reviewer, the flow chart was added in the body text at first ,but as per the journal instruction its been added as supplementary material.  \n<b>Response:&nbsp;<\/b>Dear reviewer in Table 2 , the necessary changes have been made in outcome measures column.  \n<b>Response:&nbsp;<\/b>Dear reviewer, the reference has been updated to the last sentence of the results part.  \n<b>Discussion section<\/b>  First sentence of the discussion part, please add a reference. &nbsp; Specify within the limits that the data presented relates only to breast cancer.   \n<b>Response:&nbsp;<\/b>Dear reviewer, thanks for your comment. The first sentence of the discussion part is referenced with 37 and updated.  \n<b>Response:&nbsp;<\/b>Dear reviewer, thanks for your comment. I have added the necessary changes to the discussion part( limited to breast cancer).","URL":"https:\/\/f1000research.com\/articles\/11-497\/v2#referee-comment-16013","order":3,"name":"referee-comment-16013","label":"Referee Comment","group":{"name":"article-reports","label":"Article Reports"}},{"value":"10.5256\/f1000research.199218.r505310, Sheetal Kalra, School of Physiotherapy, Delhi Pharmaceutical Sciences and Research University, New Delhi, Delhi, 18 Aug 2026, version 2, indexed","URL":"https:\/\/f1000research.com\/articles\/11-497\/v2#referee-response-505310","order":4,"name":"referee-response-505310","label":"Referee Report","group":{"name":"article-reports","label":"Article Reports"}},{"value":"The author(s) declared that no grants were involved in supporting this work","order":5,"name":"grant-information","label":"Grant Information"},{"value":"This is an open access article distributed under the terms of the Creative Commons Attribution Licence, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.","order":0,"name":"copyright-info","label":"Copyright"}]}}