Physical exercise in brain tumor patients: a systematic review

Background Brain tumors – both primary and metastatic – are a leading cause of mortality and disability among cancer patients. For patients with cancer, physical exercise has proven effective in the management of multiple cancer- and treatment-related symptoms. However, the benefits of physical exercise have been understudied in patients with a brain tumor diagnosis. Methods We systematically reviewed the literature on physical exercise interventions in patients with brain tumors. A systematic search of PubMed and the Cochrane Library was conducted up to December 2025 following PRISMA guidelines. Studies were screened according to predefined inclusion and exclusion criteria, and data were extracted using a structured approach. Study quality and level of evidence were assessed using the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence, and risk of bias was evaluated using the Cochrane Risk of Bias 2 (RoB 2) tool for randomized controlled trials (RCT) and Risk Of Bias in Non-randomized Studies of Interventions (ROBINS -I) for non-randomized studies. Results were synthesized descriptively. Results Thirty-one studies (23 clinical trials, 4 observational studies, 2 qualitative analyses, 1 case report and 1 case study) met inclusion criteria and were synthesized descriptively to accommodate for the heterogeneity of study designs and recorded outcomes. Brain tumor patients were able to participate in aerobic, strength training, mixed (aerobic + strength), yoga and balance exercise interventions, and the findings suggest potential improvements in physical and cognitive function as well as quality of life. Adverse events reported were rare and consistent with exercise-related adverse events reported for individuals without cancer. Conclusions The available literature suggests the feasibility and overall safety of physical exercise in brain tumor patients although evidence of clinical effectiveness remains preliminary. The majority of findings are based on structured intervention studies, and broader applicability remains to be determined due to the limited evidence available. The high risk of bias noted in most studies, as well as their generally small sample sizes and diversity of exercise interventions studied, highlight the need for larger prospective clinical trials to determine clinical effectiveness and inform the design of exercise guidelines for brain tumor patients. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251111272 , identifier CRD420251111272.