在化疗初期的患者中，进行运动治疗以提高心肺适能（CRF）的最佳时机尚不清楚。研究了在乳腺癌患者中化疗期间、化疗后或化疗期间和化疗后进行运动治疗的效果。采用平行组随机试验设计，将158名刚开始接受（新）辅助化疗的女性患者分配到接受（1:1比例）：常规治疗或三个运动方案中的一个-同时（仅在化疗期间）、串行（仅在化疗后）或同时和串行（连续）（每组n = 39/40）。运动包括每周三次跑步机步行，20-50分钟，达到峰值氧气摄取量（VO2peak）的55%-100%，连续进行约16（同时，串行）或约32周（持续）。在治疗前（基线）、化疗后立即和化疗后约16周评估VO2peak。在意图分析中，化疗期间进行的运动与常规治疗和化疗后进行的串行运动和常规治疗之间的VO2peak变化的主要终点之间没有差异[总体差异，-0.88 mL O2·kg-1·min-1;95%置信区间（CI）：-3.36，1.59，P = 0.48]。在次要分析中，大约等于其他方案长度两倍的持续性运动治疗耐受性良好，是唯一与基线至干预后VO2peak显著改善相关的策略（1.74 mL O2·kg-1·min-1，P < 0.001）。相对于常规治疗，同时和串行运动疗法在初发乳腺癌女性中的CRF改善之间没有统计学差异。约32周连续运动治疗的良好耐受性和CRF益处值得在更大的试验中进一步评估。©作者（们）2023。由牛津大学出版社代表欧洲心脏病学学会出版。保留所有权利。如需权限，请发送电子邮件至：journals.permissions@oup.com。

The most appropriate timing of exercise therapy to improve cardiorespiratory fitness (CRF) among patients initiating chemotherapy is not known. The effects of exercise therapy administered during, following, or during and following chemotherapy were examined in patients with breast cancer.Using a parallel-group randomized trial design, 158 inactive women with breast cancer initiating (neo)adjuvant chemotherapy were allocated to receive (1:1 ratio): usual care or one of three exercise regimens-concurrent (during chemotherapy only), sequential (after chemotherapy only), or concurrent and sequential (continuous) (n = 39/40 per group). Exercise consisted of treadmill walking three sessions/week, 20-50 min at 55%-100% of peak oxygen consumption (VO2peak) for ≈16 (concurrent, sequential) or ≈32 (continuous) consecutive weeks. VO2peak was evaluated at baseline (pre-treatment), immediately post-chemotherapy, and ≈16 weeks after chemotherapy. In intention-to-treat analysis, there was no difference in the primary endpoint of VO2peak change between concurrent exercise and usual care during chemotherapy vs. VO2peak change between sequential exercise and usual care after chemotherapy [overall difference, -0.88 mL O2·kg-1·min-1; 95% confidence interval (CI): -3.36, 1.59, P = 0.48]. In secondary analysis, continuous exercise, approximately equal to twice the length of the other regimens, was well-tolerated and the only strategy associated with significant improvements in VO2peak from baseline to post-intervention (1.74 mL O2·kg-1·min-1, P < 0.001).There was no statistical difference in CRF improvement between concurrent vs. sequential exercise therapy relative to usual care in women with primary breast cancer. The promising tolerability and CRF benefit of ≈32 weeks of continuous exercise therapy warrant further evaluation in larger trials.© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.