Background
Methods
Protocol and objective
Search methods
Ethics proclamations
Selection criteria
Data extraction and quality assessment
Outcome measures
Data synthesis
Results
Characteristics of the studies included
Study | Random allocation | Concealed allocation | Groups similar at baseline | Participant blinding | Therapist blinding | Assessor blinding | <15% dropouts | Intention to treat analysis | Between-group difference reported | Point estimate and variability reported | Total (0 to 10) |
---|---|---|---|---|---|---|---|---|---|---|---|
Campbell et al. 2005 [38] | Y | N | Y | N | N | N | Y | N | Y | Y | 5 |
Cantarero et al. 2013 [39] | Y | Y | Y | N | N | Y | Y | N | Y | Y | 7 |
Courneya et al. 2003 [40] | Y | N | Y | N | N | Y | Y | Y | Y | Y | 7 |
Ergun et al. 2013 [41] | Y | N | Y | N | N | Y | Y | N | Y | Y | 6 |
Milne et al. 2008 [42] | Y | Y | Y | N | N | N | Y | Y | Y | Y | 7 |
Mutrie et al. 2007 [43] | Y | Y | Y | N | N | Y | Y | Y | Y | Y | 8 |
Saarto et al. 2012 [44] | Y | N | Y | N | N | N | Y | N | Y | Y | 5 |
Segal et al. 2001 [45] | Y | N | Y | N | N | N | N | Y | Y | Y | 5 |
Winters et al. 2012 [46] | Y | Y | Y | N | N | Y | N | Y | Y | Y | 7 |
Characteristics of breast cancer survivors
Study | Design | Breast cancer description | Participants* | Intervention** | Outcome measures |
---|---|---|---|---|---|
Campbell et al. 2005 [38] | RCT | Early stage (I-II) Breast cancer | Characteristics of cancer treatment = Chemotherapy, radiotherapy and combination. | Exp = Aerobic exercise and resistance training | FACT-G, FACT-B, SWLS, PFS, SPAQ, 12-minute walk test |
N = 22 | Length = 12 weeks. | ||||
Female = 22 | Duration = 20 min/session | ||||
Exp (n = 12) | Frequency = 2 session/week | ||||
Age (yr) = 48 (10) | Intensity = 60%-75% | ||||
Age (yr) = 47 (5) | Con = Conventional care | ||||
Cantarero et al. 2013 [39] | RCT | Breast cancer (stages I-IIIA) | Characteristics of cancer treatment = Chemotherapy radiotherapy and combination. | Exp = Aerobic exercise and resistance training | PFS, The Spanish version of the Profile of |
Length = 8 weeks | |||||
N = 61 | Duration = 60 min/session | Mood States, The “multiple sit-to-stand test”, The trunk curl static endurance test | |||
Female = 61 | Frequency = 3 session/week | ||||
Exp (n = 32) | Intensity = 60%-75% | ||||
Age (yr) = 49 (7) | Con = Conventional care | ||||
Con (n = 29) | |||||
Age (yr) = 47 (8) | |||||
Courneya et al. 2003 [40] | RCT | Early stage Breast cancer | Characteristics of cancer treatment = Chemotherapy – Radiotherapy | Exp = Aerobic exercise | FACT- G, FACT-B, FACT-F |
N = 52 | Length = 15 weeks | ||||
Female = 52 | Duration = 35 min/session | ||||
Exp (n = 24) | Frequency = 3 session/week | ||||
Age (yr) = 59 (5) | Intensity = 70%-75% | ||||
Con (n = 28) | Con = Conventional care | ||||
Age (yr) = 58 (6) | |||||
Ergun et al. 2013 [41] | RCT | Breast cancer (stages I-IIIA) | Characteristics of cancer treatment = Chemotherapy, radiotherapy, mastectomy, axillary dissection and sentinel lymph node biopsy | Exp = Aerobic exercise and resistance training. | EORTC QLQ-C30, BFI, BDI, ELISA kit, RayBio Human |
N = 60 | Length = 12 weeks | ||||
Female = 60 | Duration = 45 min/session | Cytokine Antibody Array 3 | |||
Exp (n = 20) | Frequency = 3 session/week | ||||
Age (yr) = 49.65 (8.25) | Intensity = 60%-80% | ||||
Home-based exercise (n = 20) | Con = Home-based exercise (brisk walking for 30 min/day for 3 days/week) + education programme | ||||
Age (yr) = 55.05 (6.85) | Education group = patient information booklet that also included lymphedema-specific exercises | ||||
Education group (n = 20) | |||||
Age (yr) = 55.30 (10.37) | |||||
Milne et al. 2008 [42] | RCT | Early stage Breast cancer | Characteristics of cancer treatment = Chemotherapy – Radiotherapy | Exp = Aerobic exercise, resistance training and stretching. | FACT-B, SCFS, rPARQ, Aerobic Power Index |
N = 58 | Length = 12 weeks. | ||||
Female = 58 | Duration = 30 min/ses. | ||||
Exp (n = 29) | Frequency = 3 ses/wk. | ||||
Age (yr) = 55.2 (8.4) | Intensity = about 75%. | ||||
Con (n = 29) | Con = Delayed exercise group | ||||
Age (yr) = 55.1 (8.0) | (DEG) completed the exercise program from 13 to 24 weeks. | ||||
Mutrie et al. 2007 [43] | RCT | Early stage Breast cancer | Characteristics of cancer treatment = Chemotherapy – Radiotherapy and combination | Exp = Aerobic exercise and resistance training. | FACT-G, FACT-B, FACT-F, BDI, PANAS, SPAQ Leisure time, BMI, 12 minute walk test |
N = 174 | Length = 12 weeks. | ||||
Female = 174 | Duration = 45 min/ses. | ||||
Exp (n = 82) | Frequency = 2 ses/wk. | ||||
Age (yr) = 51.3 (10.3) | Intensity = 50%-75%. | ||||
Con (n = 92) | Con = Conventional care. | ||||
Age (yr) = 51.8 (8.7) | |||||
Saarto et al. 2012 [44] | RCT | Early stage Breast cancer | Characteristics of cancer treatment = Chemotherapy – Radiotherapy | Exp = Aerobic exercise | EORTC QLQ-C30, FACIT-F, RBDI, WHQ |
N = 500 | Length = 48 weeks. | ||||
Female = 500 | Duration = 60 min/ses. | ||||
Exp (n = 263) | Frequency = 1 ses/wk. | ||||
Age (yr) = 52.3 (36–68) | Intensity = 86%-92%. | ||||
Con (n = 237) | Con = Encourage to maintain their previous level of physical activity and exercise habits. | ||||
Age (yr) = 52.4 (35–68) | |||||
Segal et al. 2001 [45] | RCT | Early stage Breast cancer | Characteristics of cancer treatment = Chemotherapy | Exp = Aerobic exercise | FACT-G, FACT-B, MOS SF-36 |
N = 123 | Length = 26 weeks. | ||||
Female = 123 | Duration = No reported. | ||||
Exp (n = 42) | Frequency = 3 ses/wk. | ||||
Age (yr) = 51.4 (8.7) | Intensity = 50%-60%. | ||||
Con (n = 41) | Con = Conventional care. | ||||
Age (yr) = 50.3 (8.7) | Self-Directed Exercise Group = 5 times per week progressive walking at 50% to 60% maximal predicted oxygen uptake. | ||||
Self-Directed Exercise | |||||
Group (n = 40) | |||||
Age (yr) = 51.0 (8.7) | |||||
Winters et al. 2012 [46] | RCT | Breast cancer (stagesI-IIIA) | Characteristics of cancer treatment = Chemotherapy – Radiotherapy | Exp = Resistance training | SCFS, 1-RM, PPB, Hand grip dynamometry |
N = 106 | Length = 1 year. | ||||
Female = 106 | Duration = 60 min/ses. | ||||
Exp (n = 52) | Frequency = 2 ses/wk. | ||||
Age (yr) = 62.3 (6.7) | Intensity = 60%-80%. | ||||
Con (n = 54) | Con = Stretching placebo program. | ||||
Age (yr) = 62.6 (6.7) |
Characteristics of supervised exercise interventions
Adverse effects
Pooled effects estimates for outcome measures
Cancer-related fatigue (CRF)
Meta-regression: heterogeneity and dose–response interaction
Publication bias
Effects of supervised exercise on CRF based on cancer treatment stage
Outcome | Effect size random effects model –SMD* (95%CI) | Statistical heterogeneity (I
2
) |
---|---|---|
Primary outcome (CRF)
| ||
Supervised aerobic exercise | −0.51, 95%CI [−0.81, −021], (P = 0.001) † | 75% |
Supervised resistance training | −0.41, 95%CI [−0.76, −0.05], (P = 0.02) † | 64% |
Supervised exercise during active anti-cancer treatment | −0.66, 95%CI [−1.08, −0.23], (P = 0.002) † | 78.6% |
Supervised exercise after anti-cancer treatment | −0.25, 95%CI [−0.55, 0.05], (P = 0.10) | 85.8% |
Secondary outcomes
| ||
Depression | −0.23, 95%CI [−0.55, 0.09], (P = 0.16) | 69% |
Body mass index | −0.14, 95%CI [−0.38, 0.11], (P = 0.28) | 0% |
Physical activity level | 1.10, 95%CI [−0.41, 2.62], (P = 0.15) | 85% |
Health-related quality of life
| ||
Physical wellbeing | 0.63, 95%CI [0.08, 1.18], (P = 0.02) † | 89% |
Functional wellbeing | 0.60, 95%CI [0.08, 1.11], (P = 0.02) † | 89% |
Social wellbeing | 0.08, 95%CI [−0.11, 0.27], (P = 0.24) | 28% |
Emotional wellbeing | 0.30, 95%CI [−0.05, 0.65], (P = 0.09) | 76% |