Evaluating the safety and cardiac impact of resistance training in anthracycline-treated patients: a systematic review

Abstract

Anthracycline chemotherapy is commonly used to treat cancer in both adult and pediatric patients. While effective, anthracycline treatment is associated with a high risk of cardiotoxicity, often manifesting as a decline in left ventricular function, resulting in long term cardiovascular complications. Aerobic exercise has been studied extensively for its cardioprotective benefits in patients with anthracycline-induced cardiac dysfunction; however, the role of resistance training remains unexplored and controversial due to historical concerns regarding safety. This systematic review examined the existing literature on the effects and safety of resistance training in pediatric and adult cancer patients treated with anthracyclines. A two-part screening process was completed in Covidence (2025), starting with the screening of titles and abstracts, followed by the full-text screening. Eight studies, all incorporating AR-T were reviewed. The findings suggest that AR-T is safe and well-tolerated, with no evidence indicating that resistance training exacerbates cardiac dysfunction. No studies included exclusively pediatric or adolescent patients, limiting the generalizability of the findings to these populations. Randomized controlled trials focused solely on resistance training are needed to inform future clinical guidelines.