Effect of exercise based prehabilitation on postoperative pain inbreast cancer patients: a systematic review with meta-analysi

Abstract
Background Postoperative pain is a common complication following breast cancer surgery, adversely influencing recovery and quality of life. Exercise-based prehabilitation, initiated before surgery to enhance physical readiness, has shown benefits in other surgical settings. However, its specific impact on postoperative pain in breast cancer patients remains unclear.
Methods This systematic review and meta-analysis evaluated the effectiveness of exercise-based prehabilitation in reducing postoperative pain in women undergoing breast cancer surgery. Following PRISMA guidelines, a comprehensive search was conducted in PubMed, Scopus, and Web of Science up to June 2025 (search conducted prior to submission). Eligible studies were randomized controlled trials (RCTs) comparing exercise-based prehabilitation with usual care or educational interventions. The primary outcome was pain at one month post-surgery. Risk of bias was assessed using the Cochrane RoB 2 tool, and methodological quality via the TESTEX scale.
Results Six RCTs (n=519) were included in the qualitative synthesis, and three (n=157) in the meta-analysis. Interventions varied in duration (1–9 weeks), modality (aerobic, resistance, mobility, stretching), and supervision. Pain was measured using tools such as VAS, NPRS, EORTC QLQ-C30 and SPADI. Meta-analysis showed a small, non-significant effect (SMD = -0.24; 95% CI: -0.55 to 0.08; p=0.14). Heterogeneity was statistically low (I² = 0%; 95% CI: 0% to 79%), although this estimate was based on only three studies and should not be interpreted as evidence of true consistency across trials.
Conclusions Exercise-based prehabilitation was reported as safe and feasible in the included studies, with a possible but non-significant benefit in reducing postoperative pain. Given the low certainty of evidence, further high-quality RCTs are needed to clarify its role in breast cancer surgical care.