Physical activity interventions and health-related quality of life in women with breast cancer: A systematic literature review of the World Cancer Research Fund/American Institute of Cancer Research


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Dagfinn Aune1, Georgios Markozannes1, Leila Abar1, Katia Balducci1, Margarita Cariolou1, Neesha Nanu1, Ana Rita Vieira1, Steven Clinton2, Edward L Giovannucci2, Marc J Gunter3, Alan Jackson4, Ellen Kampman2, Viv Lund2, Anne McTiernan5, Kate Allen6, Nigel Brockton7, Helen Crocker6, Daphne Katsikioti6, Deirdre McGinley-Gieser7, Panagiota Mitrou6, Martin Wiseman6, Galina Velikova2, Wendy Demark-Wahnefried8, Teresa Norat1, Konstantinos K Tsilidis1, Doris S.M. Chan1
1Imperial College London, 2Other, 3International Agency for Research on Cancer (IARC), 4University of Southampton, 5Fred Hutchinson Cancer Research Center, 6World Cancer Research Fund International, 7American Institute for Cancer Research, 8University of Alabama at Birmingham



Physical activity has been associated with improved health-related quality of life (HRQoL) in women diagnosed with breast cancer. Questions remain regarding the impact of its different aspects, such as exercise type (aerobic, resistance, aerobic and resistance, yoga, other), frequency, duration, intensity, mode (group-based/individual-based/mixed) and timing (during/after treatment) on various HRQoL measures. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) in breast cancer survivors.


PubMed and CENTRAL were searched up to August 2019, supplemented by hand searches. We assessed the evidence of randomization to physical activity versus control arms on global HRQoL and its physical, emotional, and mental health domains. The Functional Assessment of Cancer Therapy (FACT) General/Breast (FACT-G/-B), the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (EORTC-QLQ-C30) and the short form-36 (SF-36) were employed to measure HRQoL. We estimated weighted mean differences (WMD) and weighted mean change differences using random-effects models.


Seventy-eight RCTs, mostly on cancer stages I-III, were included. Median duration of intervention across studies was 12 weeks (range: 3-52 weeks). Aerobic exercise and aerobic-resistance combination were the most studied interventions. Randomization to physical activity resulted in higher global HRQoL as assessed by FACT-B (WMD=5.94, 95% confidence interval: 2.64-9.24; n=12 studies), FACT-G (WMD=4.53, 1.94-7.13; n=18), EORTC-QLQ-C30 (WMD=6.59, 2.61-10.58; n=18) and general health perceptions assessed by SF-36 (WMD=3.72, 0.74-6.70; n=9). Randomization to physical activity also resulted in improved physical function (FACT-G, EORTC-QLQ-C30, and SF-36), emotional function (FACT-G and EORTC-QLQ-C30), mental health and mental component summary score (SF-36), but the effect sizes were relatively weaker for emotional and mental domains. The combination of aerobic and resistance exercise showed stronger beneficial effects compared to other activity domains. Effects were more pronounced in group-based interventions compared to other modes.


This first WCRF/AICR review of HRQoL in breast cancer survivors showed that physical activity may improve overall HRQoL, physical and emotional functioning, and mental health. Although these results are encouraging, further interventional research could focus on carefully constructed attention control groups, blinding of assessors and incorporation of objective measures such as physical and cognitive performance in addition to patient reported outcomes.

Impact statement