OBJECTIVE: The primary purpose of this study is to structure the available evidence relating to physical exercise programs and their impact on patients' cardiovascular system during the convalescence for breast cancer.
METHODS: We searched six English databases and four Chinese databases from inception to May 19, 2021. Two reviewers independently screened literature, extracted data. They assessed the risk of bias according to the eligibility criteria, and the Cochrane Collaboration RevMan 5.3.0 version software and STATA 15.0 software were used for this meta-analysis. This study has been registered in the International Prospective Register of Systematic Reviews (CRD42021226319).
RESULTS: In total, 3483 articles were screened and data from 11 randomized controlled trials (RCTs) involving 666 breast cancer patients were used in this meta-analysis. The results showed that exercise could decrease systolic blood pressure (SBP) (P = 0.006), diastolic blood pressure (DBP) (P = 0.0003), triglycerides (TG) levels (P < 0.00001), body mass index (BMI) (P = 0.009). Results also showed that exercise could significantly increase peak oxygen uptake (VO2peak) (P = 0.009), maximal oxygen consumption (VO2max) (P = 0.01), and High-density leptin cholesterol (HDL-C) levels (P < 0.0001). However, compared with the control group, there was no significant changes of mean arterial pressure (MAP), peak heart rate (HRpeak), and peak respiratory exchange ratio (PERpeak) (P > 0.05).
CONCLUSIONS: Physical exercise could improve the cardiovascular system function associated with decreased the levels of SBP, DBP, TG, and increased the levels of VO2peak, VO2max, and HDL-C in breast cancer patients. These findings reveal that exercise may be a promising means for cardiovascular nursing.
BACKGROUND: Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend.
OBJECTIVES: To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2).
SEARCH METHODS: We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts.
SELECTION CRITERIA: We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss.
DATA COLLECTION AND ANALYSIS: Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available.
MAIN RESULTS: We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality.
AUTHORS' CONCLUSIONS: Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.
BACKGROUND: Effects of exercise interventions on patients with breast cancer (BC) have shown benefits regardless of the measured variables, although the type of exercise and its duration during adjuvant therapy are unclear.
OBJECTIVE: We investigated the effects of exercise interventions on each measurement, physical fitness, quality of life (QL), fatigue, depression, anxiety, and body compositions and found effective exercise interventions during adjuvant therapy for BC.
METHODS: Twenty-nine studies were found by searching the databases of MEDLINE and EMBASE from January 2000 to February 2018. Randomized controlled trials that investigated the effects of exercise on physical and psychological outcomes in BC patients during adjuvant therapy were selected in this meta-analysis. The size of the effect for each variable from the selected studies considered the method of measurement and was calculated using the standardized mean difference statistic.
RESULTS: A total of 2989 BC patients were included. Exercise interventions had positive outcomes in physical fitness, handgrip strength, QL, fatigue, depression, anxiety, self-esteem, % body fat, and body mass index. Exercise interventions were an average of 150 minutes, 3 times per week, for 17 weeks and consisted of moderate to vigorous (~60% of VO2peak), aerobic, resistance, or combined exercises.
CONCLUSIONS: Interventions that involve moderate to vigorous exercise 150 minutes for 3 times per week and in any modality may provide a better outcome for BC patients during adjuvant therapy.
IMPLICATIONS FOR PRACTICE: Empowering BC patients to implement these exercise interventions could not only improve their health and QL, but also reduce fatigue, depression, and anxiety during adjuvant therapy.
BACKGROUND: Exercise is recognised as an adjunct therapy for breast cancer patients; however, little is known about the resistance training dose-response. We conducted a systematic review and meta-regression to examine the resistance training dose-response (i.e., volume and intensity) in breast cancer patients undergoing primary treatment.
METHODS: Searches in MEDLINE, CINAHL, and SPORTDiscus were conducted for studies published up to November 2019. Experimental studies that evaluated resistance-based exercise interventions in women with breast cancer undergoing primary treatment were included. Information about resistance training components, average change and change per week, as well as standardised mean difference were extracted, and used for meta-regression analysis. Outcome measures were upper and lower body muscle strength and body composition.
RESULTS: 10 trials were included in the systematic review and 4 trials in the dose-response analysis. Resistance training weekly prescribed volume was inversely associated with increases in upper and lower body muscle strength (r2 = 98.1-100%; p = 0.009), although there was no relationship between resistance training intensity and strength gains. There was insufficient data for the dose-response analysis of body mass index, percent body fat, and lean mass.
CONCLUSION: Low volume resistance training might be a suitable exercise recommendation for breast cancer patients undergoing primary treatment producing superior benefits for muscle strength compared to higher volume training, regardless of the training intensity. Low volume resistance training may provide a conservative and appropriate approach for breast cancer patients, allowing gradual progression and modification throughout the exercise program.
BACKGROUND: Physical exercise may be beneficial to breast cancer (BC) survivors. Here, we systematically summarized the effects of aerobic exercise in BC survivors. We conducted a systematic review of randomized controlled trials (RCTs).
METHODS: We searched PubMed, Web of knowledge, Scopus, Cochrane Central, Virtual Health Library and PEDRO databases for relevant RCTs, comparing aerobic exercise with usual care among BC survivors. Data were extracted and evidence was synthesized narratively.
RESULTS: Twelve studies were included in this systematic review. Studies reported that aerobic exercise can significantly improve the quality of life in BC survivors. Moreover, aerobic exercise alleviated the symptoms of depression and anxiety. However, current evidence from the included studies showed that there was no significant benefit for aerobic exercise in terms of weight loss.
CONCLUSION: Our study suggests that aerobic exercise is beneficial to BC survivors.
CLINICAL RELEVANCE: Aerobic exercise should be recommended in the therapeutic and rehabilitative regimens of BC survivors.<br />.
PURPOSE: Randomized clinical trials are inconclusive regarding the role of physical exercise in anthropometric measurements, quality of life, and survival in breast cancer patients. Our aim was to conduct a systematic review and meta-analysis to assess the effects of physical exercise on these outcomes in women who went through curative treatment of early-stage breast cancer.
METHODS: Pubmed, Embase, Cochrane Library were searched for randomized clinical trial comparing physical exercise (counseling or structured programs with supervised/individualized exercise sessions) with usual care in women that went through for breast cancer treatment. Primary outcomes were overall survival and disease-free survival, while secondary outcomes were weight loss, body mass index, waist-hip ratio, percentage of body fat, and quality of life.
RESULTS: We found 60 randomized clinical trials, only one of them showed mortality data; the HR for mortality was 0.45 (95% CI 0.21-0.97) for the intervention group when compared to the control group. Physical exercise was associated with weight reduction (- 1.36 kg, 95% CI - 2.51 to - 0.21, p = 0.02), lower body mass index (- 0.89 kg/m
CONCLUSIONS: The articles found had heterogeneous types of intervention, but they showed significant effects on anthropometric measures and quality of life. Among them, only one study had mortality as outcome and it showed physical exercise as a protective intervention. Despite these findings, publication bias and poor methodological quality were presented. Physical exercise should be advised for breast cancer survivors since it has no adverse effects and can improve anthropometrics measures and quality of life. PROSPERO registry: CRD42014008743.
ANTECEDENTES: Las pacientes con diagnóstico de cáncer de mama pueden presentar enfermedades a corto y a largo plazo, así como resultados fisiológicos y psicosociales adversos relacionados con el tratamiento. Estos resultados pueden repercutir negativamente en el pronóstico, la calidad de vida relacionada con la salud (CdVRS), y la función psicosocial y física. La actividad física puede ayudar a mejorar el pronóstico y puede aliviar los efectos adversos del tratamiento adyuvante.
OBJETIVOS: Evaluar los efectos de las intervenciones de actividad física después del tratamiento adyuvante para las pacientes con cáncer de mama.
MÉTODOS DE BÚSQUEDA: Se hicieron búsquedas en el registro especializado del Grupo Cochrane de Cáncer de Mama (Cochrane Breast Cancer Group (CBCG) Specialised Registry), Registro Cochrane Central de Ensayos Controlados (Cochrane Central Register of Controlled Trials) (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, y en la World Health Organization (WHO) International Clinical Trials Registry Platform, el 18 septiembre 2015. También se hicieron búsquedas en OpenGrey y en las Healthcare Management Information Consortium databases.
CRITERIOS DE SELECCIÓN: Se buscaron los ensayos aleatorios y cuasialeatorios que compararan intervenciones de actividad física versus control (p.ej. atención habitual o estándar, ninguna actividad física, ningún ejercicio, atención control, placebo) después del tratamiento adyuvante (es decir, después de finalizar la quimioterapia o la radioterapia, pero no la terapia hormonal) en pacientes con cáncer de mama.
OBTENCIÓN Y ANÁLISIS DE LOS DATOS: Dos autores de la revisión, de forma independiente, seleccionaron los estudios, evaluaron el riesgo de sesgo y extrajeron los datos. Cuando fue necesario, se estableció contacto con los autores de los ensayos para pedir información adicional. Se calculó el tamaño general del efecto con los intervalos de confianza (IC) del 95% para cada resultado y se utilizó GRADE para evaluar la calidad de la evidencia para los resultados más importantes.
RESULTADOS PRINCIPALES: Se incluyeron 63 ensayos que asignaron al azar a 5761 mujeres a una intervención de actividad física (n = 3239) o a control (n = 2524). La duración de las intervenciones varió de cuatro a 24 meses, y la mayoría duró ocho o 12 semanas (37 estudios). Veintiocho estudios incluyeron ejercicios aeróbicos solamente, 21 ejercicios aeróbicos y entrenamiento de resistencia, y siete utilizaron entrenamiento de resistencia solamente. Treinta estudios describieron el grupo de comparación como atención habitual o estándar, ninguna intervención o control. La quinta parte de los estudios informó al menos un desgaste del 20% en la intervención y una adherencia promedio a la actividad física de aproximadamente 77%.No hubo datos disponibles de los efectos de la actividad física sobre la mortalidad relacionada con el cáncer de mama y la mortalidad por todas las causas, ni sobre la recidiva del cáncer de mama. El análisis de los valores al seguimiento inmediatamente después de la intervención y el cambio en las puntuaciones desde el inicio hasta el final de la intervención mostraron que las intervenciones de actividad física dieron lugar a mejoras significativas pequeñas a moderadas en la CdVRS (diferencia de medias estandarizada [DME] 0,39; IC del 95%: 0,21 a 0,57; 22 estudios, 1996 mujeres; DME 0,78; IC del 95%: 0,39 a 1,17; 14 estudios, 1459 mujeres, respectivamente; evidencia de baja calidad), la función emocional (DME 0,21; IC del 95%: 0,10 a 0,32; 26 estudios, 2102 mujeres, evidencia de calidad moderada; DME 0,31; IC del 95%: 0,09 a 0,53; 15 estudios, 1579 mujeres, respectivamente; evidencia de baja calidad), la función física observada (DME 0,33; IC del 95%: 0,18 a 0,49; 25 estudios, 2129 mujeres; DME 0,60; IC del 95%: 0,23 a 0,97; 13 estudios, 1433 mujeres, respectivamente; evidencia de calidad moderada), la ansiedad (DME -0,57; IC del 95%: -0,95 a -0,19; siete estudios, 326 mujeres; DME -0,37; IC del 95%: -0,63 a -0,12; cuatro estudios, 235 mujeres, respectivamente; evidencia de baja calidad), y el estado cardiorrespiratorio (DME 0,44; IC del 95%: 0,30 a 0,58; 23 estudios, 1265 mujeres, evidencia de calidad moderada; DME 0,83; IC del 95%: 0,40 a 1,27; nueve estudios, 863 mujeres, respectivamente; evidencia de muy baja calidad).Los investigadores informaron pocos eventos adversos leves.Las mejorías pequeñas con las intervenciones de actividad física se mantuvieron a los tres meses o más después de la intervención para la fatiga (DME -0,43; IC del 95%: -0,60 a -0,26; DME -0,47; IC del 95%: -0,84 a -0,11; respectivamente), el estado cardiorrespiratorio (DME 0,36; IC del 95%: 0,03 a 0,69; DME 0,42; IC del 95%: 0,05 a 0,79; respectivamente) y la actividad física autoinformada (DME 0,44; IC del 95%: 0,17 a 0,72; DME 0,51; IC del 95%: 0,08 a 0,93; respectivamente), para los valores al seguimiento y el cambio a partir de las puntuaciones iniciales.Sin embargo, la evidencia de heterogeneidad entre los ensayos se debió a la variación en los componentes de la intervención (es decir, la modalidad, la frecuencia, la intensidad, la duración de la intervención y las sesiones) y las medidas utilizadas para evaluar los resultados. Todos los ensayos examinados tuvieron alto riesgo de sesgo de realización y en su mayoría también tuvieron alto riesgo de sesgo de detección, desgaste y selección. Al considerar los problemas ya mencionados, se determinó que la evidencia fue de calidad muy baja, baja o moderada.
CONCLUSIONES DE LOS AUTORES: No fue posible establecer conclusiones con respecto a la mortalidad relacionada con el cáncer de mama y la mortalidad por todas las causas, ni sobre la recidiva del cáncer de mama. Sin embargo, las intervenciones de actividad física pueden tener efectos beneficiosos pequeños a moderados sobre la CdVRS y la función emocional o física percibida, así como sobre la función social, la ansiedad, el estado cardiorrespiratorio y la actividad física autoinformada y medida objetivamente. Los resultados positivos presentados en la presente revisión se deben interpretar con precaución debido a la calidad muy baja a moderada de la evidencia, la heterogeneidad de las intervenciones y las medidas de resultado, la imprecisión de algunas estimaciones y el riesgo de sesgo en muchos ensayos. Se requieren estudios futuros con bajo riesgo de sesgo para determinar la combinación óptima de las modalidades, las frecuencias, las intensidades y las duraciones de la actividad física necesarias para mejorar resultados específicos en las pacientes que han recibido tratamiento adyuvante.
OBJECTIVE: To systematically evaluate the safety, feasibility and effect of exercise among women with stage II+ breast cancer.
DATA SOURCES: CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, Science Direct and SPORTDiscus were searched for articles published prior to March 1, 2017.
STUDY SELECTION: Randomised, controlled, exercise trials involving at least 50% of women diagnosed with stage II+ breast cancer were included.
DATA EXTRACTION: Risk of bias was assessed and adverse event severity was classified using the Common Terminology Criteria. Feasibility was evaluated by computing median (range) recruitment, withdrawal and adherence rates. Meta-analyses were performed to evaluate exercise safety and effects on health outcomes only. The influence of intervention characteristics (mode, supervision, duration and timing) on exercise outcomes were also explored.
DATA SYNTHESIS: There were no differences in adverse events between exercise and usual care (risk difference: <0.01 [95% CI: -0.01, 0.01]), p=0.38). Median recruitment rate was 56% (1%-96%), withdrawal rate was 10% (0%-41%) and adherence rate was 82% (44%-99%). Safety and feasibility outcomes were similar, irrespective of exercise mode, supervision, duration, or timing. Effects of exercise for quality of life, fitness, fatigue, strength, anxiety, depression, body mass index and waist circumference compared with usual care were significant (standardised mean difference range: 0.17-0.77, p<0.05).
CONCLUSION: The findings support the safety, feasibility and effects of exercise for those with stage II+ breast cancer, suggesting that national and international exercise guidelines appear generalizable to women with local, regional and distant breast cancer.
BACKGROUND: Obesity and weight gain have been associated with poor disease-specific and health-related outcomes in women with breast cancer.
OBJECTIVES: This review aimed to evaluate the effectiveness of weight gain prevention interventions among women with breast cancer.
METHODS: Completed and ongoing trials evaluating a behaviourally based dietary intervention with or without physical activity and with a focus on weight gain prevention during treatment for breast cancer were reviewed. Weight change and body composition data were extracted. Within-group weight change of ±1 kg and between-group (intervention versus control) weight difference of ≥2 kg were defined as successful weight gain prevention.
RESULTS: Five completed trials (seven intervention arms) and five ongoing trials were identified. Completed trials exclusively recruited premenopausal or premenopausal and postmenopausal women. Within-group weight gain was prevented in two intervention arms, two arms achieved weight loss and three arms reported weight gain. Of the five comparisons with control groups, two reported significant differences in weight change between groups. Ongoing trials will provide further evidence on longer-term outcomes, cost-effectiveness and blood markers.
CONCLUSION: This small but growing number of studies provides preliminary and promising evidence that weight gain can be prevented in women with breast cancer undergoing chemotherapy.
The primary purpose of this study is to structure the available evidence relating to physical exercise programs and their impact on patients' cardiovascular system during the convalescence for breast cancer.
METHODS:
We searched six English databases and four Chinese databases from inception to May 19, 2021. Two reviewers independently screened literature, extracted data. They assessed the risk of bias according to the eligibility criteria, and the Cochrane Collaboration RevMan 5.3.0 version software and STATA 15.0 software were used for this meta-analysis. This study has been registered in the International Prospective Register of Systematic Reviews (CRD42021226319).
RESULTS:
In total, 3483 articles were screened and data from 11 randomized controlled trials (RCTs) involving 666 breast cancer patients were used in this meta-analysis. The results showed that exercise could decrease systolic blood pressure (SBP) (P = 0.006), diastolic blood pressure (DBP) (P = 0.0003), triglycerides (TG) levels (P < 0.00001), body mass index (BMI) (P = 0.009). Results also showed that exercise could significantly increase peak oxygen uptake (VO2peak) (P = 0.009), maximal oxygen consumption (VO2max) (P = 0.01), and High-density leptin cholesterol (HDL-C) levels (P < 0.0001). However, compared with the control group, there was no significant changes of mean arterial pressure (MAP), peak heart rate (HRpeak), and peak respiratory exchange ratio (PERpeak) (P > 0.05).
CONCLUSIONS:
Physical exercise could improve the cardiovascular system function associated with decreased the levels of SBP, DBP, TG, and increased the levels of VO2peak, VO2max, and HDL-C in breast cancer patients. These findings reveal that exercise may be a promising means for cardiovascular nursing.
