Summary of findings for the main comparison. Exercise compared with control for women receiving adjuvant therapy for breast cancer.
| Exercise compared with control for women receiving adjuvant therapy for breast cancer | ||||
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Population: women receiving adjuvant therapy (chemo‐ or radiotherapy or both) for breast cancer Settings: supervised or home based Intervention: aerobic or resistance exercise or a combination of both Comparison: control intervention (usual care or intervention that was not exercise, such as stretching) | ||||
| Outcomes | Relative effects* (95% CI) | No of Participants (studies) | Quality of the evidence (GRADE) | Comments |
| Exercise vs control | ||||
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Physical fitness assessed with: 6‐ or 12‐minute walk test, peak oxygen uptake, and other scales (follow‐up: 18 weeks to 6 months) |
The mean physical fitness in the intervention group was 0.42 standard deviations higher (0.25 to 0.59 higher) | 1310 (15 RCTs) |
⊕⊕⊕⊝ moderate1 | SMD 0.42 (95% CI 0.25 to 0.59) |
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Fatigue assessed with: FACIT‐F scale, (revised) Piper Fatigue Scale, Multidimensional Fatigue Inventory and other scales (follow‐up: 18 weeks to 6 months) |
The mean fatigue in the intervention group was 0.28 standard deviations lower (0.41 lower to 0.16 lower) | 1698 (19 RCTs) |
⊕⊕⊕⊝ moderate2 | SMD ‐0.28 (95% CI ‐0.41 to ‐0.16) |
|
Cancer‐specific quality of life assessed with: FACT‐G, EORTC QLQ‐C30 and other scales (follow‐up: 12 weeks to 6 months) |
The mean cancer‐specific quality of life in the intervention group was 0.12 standard deviations higher (0.00 to 0.25 higher) | 1012 (12 RCTs) |
⊕⊕⊕⊝ moderate3 | SMD 0.12 (95% CI 0.00 to 0.25) |
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Health‐related quality of life assessed with EQ‐5D visual analogue scale (higher scores indicate higher quality of life, score range from 0 to 100) MID: 7 points (follow‐up: end of intervention) |
The mean health‐related quality of life in the intervention group was 1.10 points higher (5.28 lower to 7.48 higher) | 68 (1 RCT) |
⊕⊕⊝⊝ low4,5 | MD 1.10 (95% CI ‐5.28 to 7.48) |
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Cancer site‐specific quality of life assessed with: FACT‐B (higher scores indicate better quality of life, score range from 0 to 144) MID: 7 to 8 points (follow‐up: end of intervention) |
The mean cancer site‐specific quality of life in the intervention group was 4.24 points higher (1.81 lower to 10.29 points higher) | 262 (4 RCTs) |
⊕⊕⊝⊝ low6,7 | MD 4.24 (95% CI ‐1.81 to 10.29) |
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Depression assessed with: BDI, CES‐D (follow‐up: 6 months) |
The mean depression in the intervention group was 0.15 standard deviations lower (0.30 lower to 0.01 higher) | 674 (5 RCTs) |
⊕⊕⊕⊝ moderate8 | SMD ‐0.15 (95% CI ‐0.30 to 0.01) |
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Cognitive function assessed with: Trail Making Test (less time in seconds needed for completing the test means less cognitive dysfunction) (follow‐up: end of intervention) |
The mean time needed for completing the test in the intervention group was 11.55 seconds less (22.06 seconds less to 1.05 seconds less) | 213 (2 RCTs) |
⊕⊕⊝⊝ low9,10 | MD ‐11.55 (95% CI ‐22.06 to ‐1.05) |
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Lymphoedema assessed with: volumetric arm measurements and bioimpedance spectroscopy (follow‐up: 8 weeks) |
Assumed risk11:
85 per 1000
Corresponding risk: 60 per 1000 (30 to 123) |
436 (2 RCTs) |
⊕⊕⊝⊝ low12,13 | RR 0.71 (95% CI 0.35 to 1.45) |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). BDI: Beck Depression Inventory; CES‐D: Center for Epidemiological Studies‐Depression Scale; CI: confidence interval; FACIT‐F: Functional Assessment of Chronic Illness Therapy‐Fatigue Scale; FACT‐B: Functional Assessment of Cancer Therapy‐Breast; FACT‐G: Functional Assessment of Cancer Therapy‐General; MD: mean difference; MID: minimally important difference; RCT: randomised controlled trial; RR: risk ratio; SMD: standardised mean difference | ||||
| GRADE Working Group grades of evidence High quality: Further research is very unlikely to change our confidence in the estimate of effect. Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low quality: We are very uncertain about the estimate. | ||||
1Lack of blinding, low adherence and high or unclear contamination, several randomisation and many allocation concealment procedures were unclear, therefore we downgraded by one level. 2Lack of blinding, low adherence and high or unclear amount of contamination, many allocation concealment procedures were unclear, therefore we downgraded by one level. 3Lack of blinding, low adherence and high or unclear amount of contamination, and a high rate of incomplete outcome data, therefore we downgraded by one level. 4Lack of blinding, low adherence and high amount of contamination, high rate of incomplete outcome data, and group similarity at baseline was at high risk, therefore we downgraded by one level. 5Small number of participants and null effect and appreciable benefit included in the confidence interval for the mean difference: imprecision, therefore we further downgraded by one level. 6Lack of blinding, low adherence, a high or unclear amount of contamination in three of four trials in the meta‐analysis, two of four allocation concealment procedures were unclear, therefore we downgraded by one level. 7Small number of participants, wide confidence intervals for two of the four trials, and null effect and appreciable benefit included in the confidence interval for the mean difference: imprecision, therefore we further downgraded by one level. 8Lack of blinding, low adherence and unclear or high contamination, two published studies could not contribute to the meta‐analysis, and in one of those there were no changes in the depression scores in any of the groups, therefore we downgraded by one level. 9Lack of blinding, low and unclear adherence and unclear contamination, group similarity at baseline for one study was at high risk of bias, therefore we downgraded by one level. 10Small number of participants: imprecision, therefore we further downgraded by one level. 11Assumed risk based on the mean control group risk in the included studies. 12Lack of blinding, low adherence and unclear or high contamination, one of two allocation procedures was unclear, group similarity at baseline was at high risk of bias for one study, therefore we downgraded by one level. 13Small number of participants and null effect and appreciable harm and benefit included in the confidence interval for the risk ratio: imprecision, therefore we further downgraded by one level.