TABLE 5.

Description of the included interventional studies on exercise and psychological interventions for breast cancer survivors

Study	Study design	Studies included	Major findings	Recommended intervention design
Duijts et al., 2011	Systematic review and meta‐analysis	56 RCTs	Physical exercise interventions had statistically significant effects on depression (p = .016) and body image (p = .007). Psychosocial interventions, mainly behavioural techniques such as cognitive therapy and mind–body relaxation techniques, had a small positive effect on body image (p = .051).	An intervention combining both physical exercise and behavioural techniques is suggested to afford stronger effects.
Fong et al., 2012	Systematic review and meta‐analysis	34 RCTs	Physical activity showed positive effects on breast cancer survivors' body composition by decreasing their body weight, which in turn improved their body image.	A combination of aerobic and resistance training that leads to a higher intensity of training is recommended for larger effects.
Hall‐Alston, 2015	Literature review	34	Exercise is required for the reconditioning of breast cancer survivors' body image and is effective in ensuring a healthy lifestyle by decreasing the adverse effects of breast cancer and its treatments.	Patient‐centred, tailor‐made exercise programmes that include regular aerobic exercise, resistance training or specialty exercise such as yoga, Tai chi and Pilates are recommended. Home‐based, community‐based and one‐on‐one exercise sessions are recommended as they showed the highest patient adherence. Nurse practitioners should be involved to facilitate coordination between the multidisciplinary team and the survivors, their family and their caregivers to achieve the best results.
Lewis‐Smith et al., 2018	Systematic review	21	Psychotherapy, psychoeducation, and physical activity delivered at different treatment stages significantly improved body image at post‐test (ds = 0.15–0.43), but these effects were not sustained at follow‐ups (from 3 weeks to 9 months).	Future evaluative studies on exercise and psychosocial interventions to improve breast cancer survivors' body image are recommended to use empirically supported theories, approaches that only address body image, psychotherapeutic interventions with a narrow disease‐focused approach, follow‐up evaluations and robust methodology. Delivery in the format of a multi‐session, face‐to‐face group is recommended. An exercise programme involving aerobic, weight‐lifting, relaxation and physiotherapeutic exercises delivered as bi‐weekly sessions for 10 weeks led by a fitness instructor, physiotherapist or sports therapist is recommended.
Matthews et al., 2017	Systematic review and meta‐analysis	32	Psychosocial interventions had a small effect on body image (Hedges' g = 0.40); cognitive behavioural therapy and support group interventions were particularly effective at improving body image.	No intervention designs were recommended.