A common side effect of managing head and neck cancer is trismus, which devastates patients' quality of life. The purpose of this study was to investigate prophylactic exercise interventions for preventing trismus and difficulty in mouth opening in head and neck cancer. Five databases were searched for randomized controlled trials. Network meta-analysis was performed with risk ratio (RR) or mean difference (MD) with 95% confidence interval (CI). This study finally included 11 randomized controlled trials (n = 805). Trismus risk in patients who received exercise with phone call follow up (E plus P) was significantly lower than those received usual care (RR 0.42; 95% CI 0.29 to 0.61) and exercise alone (RR 0.33; 95% CI 0.18 to 6.22). Mouth opening in usual care was significantly lower than in the tri-integrated strategy group (MD 15.22; 95% CI 8.88 to 21.56). Exercise is recommended for preserving mouth opening distance in patients with head and neck cancer. Tri-integrated strategies could be an effective method for preventing trismus.

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