Comparative effects of different types of physical activity on health-related quality of life in breast cancer survivors: A systematic review, network meta-analysis, and meta-regression.

ABSTRACT

Background: Physical activity is associated with improved health-related quality of life (HRQoL) in breast cancer survivors (BCS); however, no studies have assessed optimal physical activity. Objective: We aimed to investigate the optimal types of physical activity for improving HRQoL in patients with BCS during and after cancer treatment. Methods: A comprehensive search was conducted in Medline, Embase, Web of Science, and Cochrane Library from inception to November 2023. We included randomized controlled trials (RCTs) reporting the effects of different physical activities on HRQoL in BCS. Two independent reviewers assessed the risk of bias using the Cochrane risk of bias tool for randomized trials (version 2.0). A network meta-analysis approach based on a frequentist framework was used to rank the effectiveness of different physical activities. Results: A total of 66 RCTs with 6464 participants were included. For all BCS, aerobic combined with resistance exercise (CE) (standardized mean difference [SMD] = 0.71; 95 % confidence interval [CI] 0.40 to 1.10; P-score = 0.75; Grade moderate) was the most effective physical activity to improve HRQoL. For participants in treatment, resistance exercise (RE) (SMD = 0.68; 95 % CI 0.35 to 1.10; P-score = 0.84; Grade moderate) was the most effective. However, after treatment, CE (SMD = 0.77; 95 % CI 0.28 to 1.26; P-score = 0.74; Grade very low) remained the most effective way to improve HRQoL in BCS. In addition, the regression analysis did not find any sources of heterogeneity. Conclusions: The findings of this study suggest that all physical activities improved HRQoL in BCS compared to the control group. CE may have the best effect on all survivors and post-treatment survivors, whereas RE has the best effect during treatment. In addition, the quality of the included studies was low, and there was some risk of bias, which may affect the interpretation of the findings.