IRELAND Trial: A Translational Biomarker and Exercise Study During Neoadjuvant Breast Cancer Therapy

The goal of this clinical trial is to learn whether a physiotherapy-led exercise programme delivered during treatment before surgery (neoadjuvant therapy) for breast cancer can improve physical fitness, quality of life, and how well people cope with treatment. The study will also investigate whether blood and tumour markers, including microRNAs (small molecules that help regulate gene activity), together with information about the participant and the cancer itself (clinical information), can help predict how well patients respond to treatment. The main questions this study aims to answer are: * Does a structured physiotherapy-led exercise programme improve physical fitness, muscle strength, quality of life, and the ability to complete treatment? * Can blood and tumour markers, together with clinical information, help predict which patients will have the best response to treatment? Researchers will compare participants who receive the physiotherapy-led exercise programme with participants who receive standard care to determine whether the exercise programme improves physical and patient-reported outcomes. Participants will: * Receive standard treatment before surgery for breast cancer. * Be randomly assigned to either a 14-week physiotherapy-led personalised exercise programme or standard care. * Provide blood and tumour tissue samples for research. * Complete physical assessments and questionnaires about their symptoms, physical function, and quality of life during treatment. * Be followed throughout treatment, surgery, and follow-up to assess treatment response and other health outcomes.