Table 1.

Characteristics of trials included in the analysis.

Source*	Intervention	Trial design	Sample size (I/C) a , dropout (I/C) a	Age (I/C) a (year)	Arms (course)	Participant characteristics	Race	Outcome measurement tool	Primary outcome result
Crew et al. (37)	MA	Sham-controlled	43 (23/20), 5 (3/2)	58 (44–77)/57 (37–77)	TA/SA (30 min twice weekly, 6 wk)	Postmenopausal Stage I–III breast cancer Estrogen receptor-positive, progesterone receptor-positive, or both AI for 3 months Pain score on the BPI-SF of ≥3 points	White (39%), Hispanic (55%), Black (3%), Asian (3%)	BPI-SF WOMAC M-SACRAH FACT-G	Positive
(US)		2-arm
Oh et al. (38)	EA	Sham-controlled	32 (16/16), 3 (2/1)	<45 14 (93%) and ≥45 1 (7%)/<45 12 (86%) and ≥45 2 (14%)	TA/SA (30 min twice weekly, 6 wk)	Postmenopausal Stage I–IIIa breast cancer Estrogen receptor-positive, progesterone receptor-positive, or both AI for 6 months Pain score on the BPI-SF of points	Caucasian (86%), Others (14%)	BPI-SF WOMAC FACT-G Blood analysis: CRP, ESR	Positive
(Australia)		2-arm
Mao et al. (27)	EA	Sham-controlled	67 (22/22/23), 8 (3/3/2)	57.5 ± 10.1/60.9 ± 6.5/60.6 ± 8.2	TA/SA/WLC (twice a week for 2 wk; then weekly for 6 wk)	Stage I–III breast cancer AI for 3 months Joint pain ≥3 months Numerical rating scale ≥4 points At least15 days with pain in the preceding 30 days	White (72%), Others (28%)	BPI WOMAC DASH PPT Fatigue: BFI Sleep: PSQI Anxiety: HADS Depression: HADS-Depression	Positive c
(US) b		3-arm
Bao et al. (29)	MA	Sham-controlled	51 (25/26), 4 (2/2)	61 (44–82)/61(45–85)	TA/SA (8 weekly for 8 wk)	Postmenopausal Stage I–III breast cancer AI for 1 month Baseline HAQ-DI score ≥3 and/or pain using a 100-point VAS ≥20 Have not received acupuncture treatment in the past 12 months	Caucasian (72%), African American (19%), Other (9%)	HAQ-DI VAS β-endorphin; estradiol; Proinflammatory cytokines: IL-1, -6, -8, -10, -12, -17, IFN-γ, TNF-α Menopausal symptoms: NSABP Hot Flash: HFRDI Sleep: PSQI Depression: CESD Anxiety:HADS-A, Quality of life: Euro Qol	Negative
(US) b		2-arm
Hershman et al. (30)	MA	Sham-controlled	226 (110/59/57), 20 (9/5/6)	60.8 (34.1–80.6)/57.0 (40.6–77.5)/60.6 (27.1–76.0)	TA/SA/WLC (twice a week for 6 wk; then weekly for 6 wk)	Postmenopausal or premenopausal with gonadotropin-releasing hormone agonist Stages I–III breast cancer Estrogen receptor-positive, progesterone receptor-positive, or both AI ≥ 1 month to continue for at least 1 additional year Zubrod performance 0–1 Pain score on the BPI-SF of ≥3 points	White (85%), Black (4.4%), Asian (6.6%), Pacific Islander (0.4%), American Indian (0.4%), others (3.2%)	BPI WOMAC PROMIS PI-SF M-SACRAH FACT-ES	Positive c
(US)		3-arm
Baker et al. (31)	EX (Low-frequency, low-magnitude vibrative)	Open label-controlled	31 (14/17), 0	61.6 ± 9.2/61.6 ± 7.8	EX/WLC (20 min of vibration, 3 weekly for 12 wk)	Breast cancer (stage unknown) Taking any bone-altering medications or supplements Able to stand unassisted for sustained periods of time (i.e., 20 min)	Australian (100%)	WOMAC FACT–Fatigue subscale Bone Resorption and Formation: NTx/Cr, P1NP Body Composition and Bone Mineral Density Physical Functioning	Negative
(Australia)		2-arm
Paulo et al. (32)	EX (resistance training followed by aerobic training)	Open label-controlled	36 (18/18), 7 (3/4)	63.2 ± 7.1/66.6 ± 9.6	EX/CG (3 weekly for 36 months)	Aged between 50 and 80 years Stage I–III breast cancer AI for breast cancer No muscle and bone damage	Brazilians (100%)	SF36 EORTC QLQ-C30 EORTC QLQ-BR23	Positive
(Brazil)		2-arm
Baglia et al. (33)	EX (strength-training and aerobic exercise)	Open label-controlled	121 (61/60), 38 (16/22)	62 ± 7/60.5 ± 7	EX/CG (2 weekly for 12 months)	Postmenopausal women, HR-positive, stage I–III BC diagnosed 0.5–4 years prior to enrolment AI for 6 months Arthralgias for ≥2 months, with BPI-SF score≥3/10 4.Pre-existing joint pain allowed if worsened after AI Physically inactive: baseline <90 min exercise/week, no strength training	Non-Hispanic White (85%)	FACT FACT-G FACT-B SF-36 FACIT-Fatigue	Positive
							Hispanic (3%)
							African American (9%)
							Asian/Pacific Islander (2%)
							American Indian (1%)
(US)		2-arm
Nyrop et al. (34)	EX (Walk)	Open label-controlled	62 (31/31), 9 (7/2)	63.3 ± 6.9/64.4 ± 9.7	EX/WLC (150 min weekly for 6 wk)	Age >21 years Stage 0–III breast cancer AI for 4 weeks Pain score on the BPI-SF of ≥3 points Exercising ≤150 min per week	Caucasian (74%), Others (26%)	VAS WOMAC FACT‐G RAI ASE OEE SEPA	Positive
(US)		2-arm
Fields et al. (35)	EX (Nordic walking)	Open label-controlled	40 (20/20), 0	60 ± 8/66 ± 7	EX/CG (once a week for 6 wk, then four times a week for 6 wk)	Breast cancer (stage unknown) AI for breast cancer Reporting joint symptoms over preceding 12 months	Caucasian (100%)	BPI-SF PSEQ CES-D SF-36	Positive
(UK)		2-arm
Irwin et al. (36)	EX (strength-training and aerobic exercise)	Open label-controlled	121 (61/60), 38 (16/22)	62 ± 7/60.5 ± 7	EX/CG (2 weekly for 12 months)	Postmenopausal women, HR-positive, stage I–III BC diagnosed 0.5–4 years prior to enrolment AI for 6 months Arthralgias for ≥2 months, with BPI-SF score≥3/10 Pre-existing joint pain allowed if worsened after AI Physically inactive: baseline <90 min exercise/week, no strength training	Non-Hispanic White (85%)	BPI WOMAC DASH Grip strength	Positive
							Hispanic (3%)
							African American (9%)
							Asian/Pacific Islander (2%)
							American Indian (1%)
(US)		2-arm

*Sources of funding for the included studies are provided in the Supplement 1 .

^aI/C, data of Intervention group/data of control group(s);

^bDifferent outcomes were reported in separate publications; the data were merged.

^cPrimary results of comparisons (experimental intervention vs. sham control(s) and experimental intervention vs. waitlist control) were both positive.

NM, no mention; EA, electroacupuncture; MA, manual acupuncture; AI, aromatase inhibitor; TA, true acupuncture group; SA, sham acupuncture group; WLC, waitlist control; EX, exercise; CG, control group; BPI-SF, Brief Pain Inventory–Short Form; WOMAC, Western Ontario and McMaster Universities Osteoarthritis Index; M-SACRAH, Modified Score for the Assessment and Quantification of Chronic Rheumatoid Affections of the Hands; FACT-G, Functional Assessment of Cancer Therapy–General; BFI, Brief Fatigue Inventory; PSQI, Pittsburgh Sleep Quality Index; HADS, Hospital Anxiety and Depression Scale; HAD-DI, The Health Assessment Questionnaire—the disability index; NSABP, National Surgical Adjuvant Breast and Bowel Project; HADS-A, Hospital Anxiety and Depression Scale—the anxiety subscale; PROMIS PI-SF, The PROMIS Pain Impact-Short Form; CES-D, Center for Epidemiological Studies Depression; PSEQ, Pain Self-Efficacy Questionnaire; DASH, The Disabilities of the Arm, Shoulder, and Hand questionnaire; PPT, The Physical Performance Test; BMI, body mass index; %FM, percent body fat; LBM, lean body mass; BMD, bone mineral density; FSI, Fatigue Symptom Inventory; AUSCAN, Australian/Canadian Hand Osteoarthritis Index; HFRDIS, Hot Flash Related Daily Interference Scale; EORTC QLQ-C30, European Organization for Research and Treatment of Cancer questionnaire entitled “Quality of life Questionnaire version 3.0; EORTC QLQ-BR23, European Organization for Research and Treatment of breast cancer module; FACT-ES, Functional Assessment of Cancer Therapy—the endocrine subscale; FACT-B, Functional Assessment of Cancer Therapy–Breast cancer; FACIT-Fatigue, Functional Assessment of Chronic illness Therapy–Fatigue; SF-36, the MOS item short from health survey; VAS, visual analog scale; RAI, rheumatology attitudes index; ASE, arthritis self‐efficacy scale; OEE, outcome expectations from exercise; SEPA, self-efficacy for physical activity.