Evidence-Based Exercise Recommendations to Improve Mental Wellbeing in Women with Breast Cancer during Active Treatment: A Systematic Review and Meta-Analysis

Abstract

Breast cancer was the most common cancer in women worldwide. The aims of the current systematic review and meta-analysis are: (i) to systematically examine the effects of exercise interventions on mental wellbeing; (ii) to examine the specific effect of the type of supervised exercise and its intensity, volume and frequency on mental wellbeing; and (iii) to explore which interventions are most effective in mental wellbeing among women with breast cancer during active treatment. An electronic literature search was performed using MEDLINE (via PubMed), Embase (Ovid), and Web of Science, we identified 175 full-text articles. The 57 publications included data from 6988 participants, age ranging from 18 to 78 years (weighted mean: 50.85 years). Compared with the control conditions, exercise training programs were associated with significant reductions in anxiety (d = −0.22, I2 = 53.0%), depression (d = −0.24, I2 = 66.6%), and fatigue (d = −0.47, I2 = 69.8%), as well as increases in body image (d = 0.27, I2 = 69.2%) and quality of life (overall, d = 0.46, I2 = 71.6%; emotional function, d = 0.33, I2 = 65.7%; and FACT-B, d = 0.60, I2 = 76.2%). There were a variety of frequencies, intensities, and durations of supervised exercise programs reported in the included meta-analytic approach. In addition, we found that concomitant concurrent training, at moderate-to-vigorous intensity, and with a volume ≥50 min/week had benefits on a number of health outcomes, such as fatigue, depression, and quality of life measure by the FACT-B instrument. These findings have important implications for healthcare providers and multidisciplinary teams involved in mental health management in cancer patients during active treatment.

Physical Therapies for Psychosomatic Symptoms and Quality of Life Induced by Aromatase Inhibitors in Breast Cancer Patients: A Systematic Review and Meta-Analysis

“…Several potential mechanisms might interpret the benefits of exercise in cancer patients. First, exercise helps promote body composition and psychological benefits through maintaining cardiovascular function and metabolic parameters ( 57 ). Second, exercise elevates emotional experiences by the neural factors and neurotransmitter systems, such as the endocannabinoid system ( 58 ).…”

Connecting breast cancer survivors for exercise: protocol for a two-arm randomized controlled trial

“…While exercise is known to be safe for BCS when performed correctly [ 14 , 15 ], minor injuries have the potential to occur in any exercise intervention. To enhance participant safety in this study, all participants will be cleared to exercise prior to enrollment using the PAR-Q+/ePARmed-X+, [ 72 ] with physician clearance as needed.…”

“…Exercise is well-established as a safe and feasible means of improving health and wellbeing through all phases of breast cancer survivorship, including for individuals living with metastatic disease [ 5 – 13 ]. There is long-standing evidence from randomized controlled trials (RCTs) involving breast cancer survivors (BCS) that exercise improves physical, mental, and social health indicators linked specifically to HRQOL; and that exercise is associated with reduced risk of cancer recurrence, cancer-specific mortality, and all-cause mortality [ 5 – 15 ]. Cancer exercise guidelines recommend that BCS engage in a minimum of 90–150 min of at least moderate intensity exercise per week and resistance training at least two times per week [ 16 – 18 ]; however, the majority of BCS do not meet these guidelines [ 19 – 22 ].…”

Effects of exercise interventions on cancer-related fatigue in breast cancer patients: An overview of systematic reviews

“…A total of 252 RCTs were included and analyzed across the 29 reviews with a CCA of 3%, indicating a slight overlap. Sixteen reviews [23,24,[36][37][38][39][40][41][42][43][44][45][46][47][48][49] explored the effects of exercise therapy on CRF by including studies with different types of exercise, including aerobic exercise, yoga, resistance exercise, and Pilates. For the other 13 reviews, six [50][51][52][53][54][55] focused on yoga, ve[56-60] on aerobic exercise, and two[61, 62] on tai chi.…”

“…Routine methods of care and/or health education without any active exercise components were commonly utilized as the study comparisons. Seventeen reviews [23,24,36,37,39,43,44,46,[50][51][52][53][54][56][57][58], 61] used the Cochrane risk of bias (RoB) criteria. Other reviews were assessed using the Quality Assessment of Controlled Intervention Studies[38], the Norwegian Knowledge Centre for the Health Services (NOKC) Handbook for Systematic Reviews, [41] Homemade Standard [42] ,the Revised Risk-of-Bias Tool for Randomized Trials (RoB 2.0) [55], Jadad Scores [59],the Newcastle-Ottawa Scale (NOS)[60], the Physiotherapy Evidence Databases (PEDro) Scale [40,45,62]and the Joanna Briggs Institute-Critical Appraisal for Randomized Controlled Trials (JBI-MAStARI) tool [47], respectively.…”