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Objective·To assess the cardiopulmonary exercise capacity in patients with breast cancer after neoadjuvant chemotherapy in the early stage and explore possible factors leading to the reduced functional tolerance in those patients. Methods·Fifty-two consecutive patients suffering from breast cancer and receiving neoadjuvant chemotherapy were included and completed cardiopulmonary exercise testing (CPET), laboratory tests, electrocardiograph and echocardiography after 1 cycle of chemotherapy in the Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine from September, 2020 to May, 2021. Fifty-two healthy age-, gender- and body mass index (BMI)-matched volunteers were enrolled and received CPET as the control group. The general conditions, hematological biomarkers, electrocardiogram and echocardiography of the subjects in the two groups were collected and recorded. Results·Compared to the control group, the group of patients receiving neoadjuvant chemotherapy had reduced peak VO2 [(18.22±3.48) mL/(min·kg) vs (22.80±3.13) mL/(min·kg), P=0.000], anaerobic threshold [(12.09±2.35) mL/(min·kg) vs (14.93±2.60) mL/(min·kg), P=0.000] and oxygen pulse [(7.67±1.45) mL/beat vs (8.87±1.29) mL/beat), P=0.000]. On multivariable regression analysis, BMI was independently associated with peak VO2 (β = - 0.528, P=0.047) of patients in the early stage of neoadjuvant chemotherapy. Conclusion·Decreased cardiopulmonary function could be detected in the early stage of neoadjuvant chemotherapy on patients with breast cancer via CPET. High BMI can be an independent predictor of the reduced peak VO2 . Maintaining BMI at normal level by losing weight may help to improve patients' cardiopulmonary function and long-term cardiovascular prognosis. [ABSTRACT FROM AUTHOR]