Design

A scoping review design has been selected to capture the broad and emerging evidence in this field. This approach allows for a comprehensive mapping of digital exercise interventions, providing an overview of their key characteristics and identifying gaps in the literature.

PCC framework

The Population, Concept and Context framework recommended in the JBI Manual for Evidence Synthesis [12] was used to identify the following key concepts:

• Population: People with breast cancer
• Concept: Pre- and/ or rehabilitation programs with a focus on exercise
• Context: Digital intervention

Eligibility criteria

Results of a rapid review by the authors identified limited evidence on surgical interventions alone. Therefore, the search was broadened to include all treatment interventions incorporating an exercise component, to better reflect the complexity of cancer rehabilitation and the emerging range of digital interventions. Given that patients often experience both physical and psychological challenges affecting their wellbeing and quality of life [16], many interventions adopt a multimodal approach. Based on this, the following eligibility criteria have been defined.

Studies will be included if they meet the following criteria:

Inclusion criteria:

• Adults with a diagnosis of breast cancer at any stage of the treatment or survivorship pathway
• Studies involving mixed cancer populations will be included only if breast cancer–specific data can be extracted separately
• Prehabilitation or rehabilitation resources
• Interventions aimed at improving physical functioning and mobility
• Must include exercise component
• Interventions must be digital or online (home-based), including (but not limited to) mobile applications, web-based platforms, online videos, virtual or telehealth programmes, or digital interventions supported by wearables
• Interventions must be delivered digitally to support independent or self-managed rehabilitation
• RCT’s, cohort studies, mixed-methods, qualitative studies, feasibility studies, and quasi-experimental studies
• Protocols that are relevant but do not yet have published results
• Peer-reviewed articles in English
• No restrictions on publication date

Studies will be excluded if they meet the following criteria:

Exclusion criteria:

• Studies including other types of cancer without separate data on breast cancer
• Studies that do not include an exercise component
• Studies focused exclusively on palliative care
• Studies focused on breast cancer prevention or preventing reoccurrence of breast cancer
  • Weight loss or weight management resources
  • Walking only interventions
• Fully supervised, in-person programmes (non-digital interventions)
• Scoping and systematic reviews
• Opinion pieces, editorials, and conference abstracts

Search strategy

The search strategy was developed in consultation with the research team and subject librarian, and guided by the PCC framework, focusing on three key concepts: breast cancer, exercise, and digital approaches. Trial searches were conducted in each database to refine the use of subject headings, keywords, Boolean operators, and wildcards, ensuring a comprehensive search.

Tables 1–4 present our planned search strategy for each individual database. The subject headings and keywords within each concept will be combined using OR, and the overall concepts with AND, to capture articles addressing all three areas.

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Table 1. Search strategy for Medline ALL (Ovid).

https://doi.org/10.1371/journal.pone.0350300.t001

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Table 2. Search strategy for Embase (Ovid).

https://doi.org/10.1371/journal.pone.0350300.t002

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Table 3. Search strategy for CINAHL (EBSCOhost).

https://doi.org/10.1371/journal.pone.0350300.t003

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Table 4. Search strategy for Web of Science (Clarivate).

https://doi.org/10.1371/journal.pone.0350300.t004

Information Sources

The following databases will be searched to uncover relevant literature: Medline ALL, Embase, CINAHL, and Web of Science. Trial registration sites (ClinicalTrials.gov, ISRCTN registry and EU Clinical Trials Register) will also be explored to ensure we include any relevant upcoming trials that meet eligibility criteria. In addition, citation searches will further help identify any relevant grey literature that may be missed. Reference lists from excluded reviews on the same topic will be individually searched to identify additional primary sources. Any additional findings will subsequently be added to the screening process of this review.

Data collection, extraction and analysis

An initial screening of titles and abstracts will be conducted by one reviewer to remove clearly irrelevant studies. All potentially eligible records will then be independently screened at the full-text level by two reviewers. Disagreements will be resolved through discussion or by consulting a third reviewer until consensus is reached.

All search results will be imported to Covidence [17] for management and tracking of the screening process. The study selection process will be documented using a PRISMA flow diagram [15]. Included studies will be exported to EndNote (version 21.5, Clarivate Analytics [18] to support citation management and facilitate reference checking.

To accurately synthesise the available evidence, data will be extracted using a tailored charting template from Covidence and summarised in a spreadsheet. To enhance accuracy and rigour, the modified extraction template will be reviewed by the research team and refined as needed to ensure all relevant data are captured prior to full data extraction. This iterative process will help ensure clarity and consistency throughout.

Extracted data will include: general study information (e.g., author, publication year, country), study aims, design, duration, funding source, and any reported conflicts of interest. Participant information will include eligibility criteria, recruitment method, sample size, age, gender, ethnicity, breast cancer type, and cancer treatments received.

Intervention‑related data will include the delivery mode, exercise components, prescribed intensity, frequency and duration, additional treatments, setting, required equipment, and any multimodal components. We will also extract information on intervention development processes, such as whether co‑design or stakeholder involvement was used, or note where these details are absent. With respect to outcomes, we will extract primary and secondary outcomes as defined by each study; the physical functioning domains assessed (e.g., range of motion, strength, mobility, daily functioning); the measurement tools used; whether these tools are validated; and, where available, whether they have been validated specifically in breast cancer populations. Measurement timepoints and any reported usability or acceptability data will also be recorded. Missing or unspecified data will be documented.

In this scoping review, appraisal refers to the comprehensive mapping and characterisation of intervention features as outlined above, rather than an assessment of methodological quality or risk of bias. Consistent with scoping review methodology, no formal critical appraisal of study quality will be conducted. To help summarise all of the findings a narrative synthesis of the collected data and results will follow. Patterns and themes will be identified to summarise the range and scope of existing digital exercise rehabilitation interventions for breast cancer patients. Where applicable, gaps in the literature and areas for future research will be highlighted.