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Ejercicios para mujeres que reciben tratamiento adyuvante para el cáncer de mama

Information

DOI:
https://doi.org/10.1002/14651858.CD005001.pub3Copy DOI
Database:
  1. Cochrane Database of Systematic Reviews
Version published:
  1. 21 September 2016see what's new
Type:
  1. Intervention
Stage:
  1. Review
Cochrane Editorial Group:
  1. Cochrane Breast Cancer Group

Copyright:
  1. Copyright © 2016 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.

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Authors

  • Anna C Furmaniak

    Correspondence to: Department of Psychosomatic Medicine and Psychotherapy, Klinikum Rechts der Isar, Technische Universität München, Munich, Germany

    [email protected]

    Department of Psychosomatic Medicine and Psychotherapy, University of Bonn, Bonn, Germany

  • Matthias Menig

    Federal Office of Public Health FOPH, Health and Accident Insurance Directorate, Bern, Switzerland

  • Martina H Markes

    Department Non‐Drug Interventions, Institute for Quality and Efficiency in Health Care (IQWiG), Köln, Germany

Contributions of authors

ACF: handsearching and screening search results, study selection, data extraction, contacted experts for unpublished trials and trial investigators for additional data, methodological assessments, quantitative and qualitative synthesis of included studies, reporting.

MM: screening search results, study selection, methodological assessments, contributed to consensus finding when disagreement in study selection, data extraction or methodological assessments persisted between the other two review authors (ACF, MHM), quantitative and qualitative synthesis of included studies, manuscript review.

MHM: handsearching and screening search results, study selection, data extraction, methodological assessments, contributed to consensus finding when disagreement in study selection or methodological assessments persisted between the other two review authors (ACF, MM), quantitative and qualitative synthesis of included studies, reporting.

Declarations of interest

ACF, MM, MHM: None known.

Acknowledgements

We would like to thank Melina Wilson, who rendered assistance in her role as Managing Editor of the Cochrane Breast Cancer Group and the Editorial Base of the Cochrane Breast Cancer Group. Moreover, we would like to thank the referees who provided valuable feedback during the peer review process and the authors of primary trials for additional information about their trials. Anke Schulz rendered support in statistics for this update version of the review. Juyoung Byun from the Korean Branch of the Australasian Cochrane Centre assisted with one Korean language publication. We also thank Karl‐Ludwig Resch for obtaining several dissertations and for help with data extraction and 'Risk of bias' assessment of one trial.

Version history

Published

Title

Stage

Authors

Version

2016 Sep 21

Exercise for women receiving adjuvant therapy for breast cancer

Review

Anna C Furmaniak, Matthias Menig, Martina H Markes

https://doi.org/10.1002/14651858.CD005001.pub3

2006 Oct 18

Exercise for women receiving adjuvant therapy for breast cancer

Review

Martina Markes, Thomas Brockow, Karl‐Ludwig Resch

https://doi.org/10.1002/14651858.CD005001.pub2

2004 Oct 18

Exercises for women receiving adjuvant therapy for breast cancer

Protocol

Martina Markes, Thomas Brockow, Karl‐Ludwig Resch

https://doi.org/10.1002/14651858.CD005001

Differences between protocol and review

We included only randomised controlled trials in this updated version of the review, as opposed to the original version of the review, in which we also included controlled trials without a randomisation procedure. This was due to the increasing number of randomised trials.

We excluded hormonal therapy only as adjuvant therapy in this version of the review as we did not consider the side effects of hormonal therapy comparable in their severity to chemo‐ or radiotherapy or both. We did not include biological outcomes like immune function measured with T‐cells in this version of the review, as the focus of the review is on directly participant‐relevant outcomes. The same applied to morphological outcomes (changes in body weight or body composition).

We classified outcomes into primary and secondary outcomes in this version of the review.

We did not include data for outcomes assessed with subscales of questionnaires (for example physical functioning subscale of the SF‐36 or vitality subscale of the SF‐36, nausea item of the SCL‐90) in this version of the review.

We also assessed the quality of evidence for the main outcomes using the GRADE methodology and developed a 'Summary of findings' table. This ensures that the review complies with new Cochrane methodological standards.

Keywords

MeSH

PICOs

Population
Intervention
Comparison
Outcome

The PICO model is widely used and taught in evidence-based health care as a strategy for formulating questions and search strategies and for characterizing clinical studies or meta-analyses. PICO stands for four different potential components of a clinical question: Patient, Population or Problem; Intervention; Comparison; Outcome.

See more on using PICO in the Cochrane Handbook.

Study flow diagram.
Figures and Tables -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figures and Tables -
Figure 2

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Forest plot of comparison: 1 Exercise versus control, outcome: 1.1 Physical fitness.
Figures and Tables -
Figure 3

Forest plot of comparison: 1 Exercise versus control, outcome: 1.1 Physical fitness.

Forest plot of comparison: 1 Exercise versus control, outcome: 1.2 Fatigue.
Figures and Tables -
Figure 4

Forest plot of comparison: 1 Exercise versus control, outcome: 1.2 Fatigue.

Forest plot of comparison: 1 Exercise versus control, outcome: 1.3 Cancer‐specific quality of life.
Figures and Tables -
Figure 5

Forest plot of comparison: 1 Exercise versus control, outcome: 1.3 Cancer‐specific quality of life.

Forest plot of comparison: 1 Exercise versus control, outcome: 1.6 Depression.
Figures and Tables -
Figure 6

Forest plot of comparison: 1 Exercise versus control, outcome: 1.6 Depression.

Comparison 1 Exercise versus control, Outcome 1 Physical fitness.
Figures and Tables -
Analysis 1.1

Comparison 1 Exercise versus control, Outcome 1 Physical fitness.

Comparison 1 Exercise versus control, Outcome 2 Fatigue.
Figures and Tables -
Analysis 1.2

Comparison 1 Exercise versus control, Outcome 2 Fatigue.

Comparison 1 Exercise versus control, Outcome 3 Cancer‐specific quality of life.
Figures and Tables -
Analysis 1.3

Comparison 1 Exercise versus control, Outcome 3 Cancer‐specific quality of life.

Comparison 1 Exercise versus control, Outcome 4 Health‐related quality of life.
Figures and Tables -
Analysis 1.4

Comparison 1 Exercise versus control, Outcome 4 Health‐related quality of life.

Comparison 1 Exercise versus control, Outcome 5 Cancer site‐specific quality of life.
Figures and Tables -
Analysis 1.5

Comparison 1 Exercise versus control, Outcome 5 Cancer site‐specific quality of life.

Comparison 1 Exercise versus control, Outcome 6 Depression.
Figures and Tables -
Analysis 1.6

Comparison 1 Exercise versus control, Outcome 6 Depression.

Comparison 1 Exercise versus control, Outcome 7 Cognitive function.
Figures and Tables -
Analysis 1.7

Comparison 1 Exercise versus control, Outcome 7 Cognitive function.

Comparison 1 Exercise versus control, Outcome 8 Strength.
Figures and Tables -
Analysis 1.8

Comparison 1 Exercise versus control, Outcome 8 Strength.

Comparison 1 Exercise versus control, Outcome 9 Subjective upper body function.
Figures and Tables -
Analysis 1.9

Comparison 1 Exercise versus control, Outcome 9 Subjective upper body function.

Comparison 1 Exercise versus control, Outcome 10 Shoulder mobility.
Figures and Tables -
Analysis 1.10

Comparison 1 Exercise versus control, Outcome 10 Shoulder mobility.

Comparison 1 Exercise versus control, Outcome 11 Arm morbidity.
Figures and Tables -
Analysis 1.11

Comparison 1 Exercise versus control, Outcome 11 Arm morbidity.

Comparison 1 Exercise versus control, Outcome 12 Anxiety.
Figures and Tables -
Analysis 1.12

Comparison 1 Exercise versus control, Outcome 12 Anxiety.

Comparison 1 Exercise versus control, Outcome 13 Mood disturbances.
Figures and Tables -
Analysis 1.13

Comparison 1 Exercise versus control, Outcome 13 Mood disturbances.

Comparison 1 Exercise versus control, Outcome 14 Hospital Anxiety and Depression Scale.
Figures and Tables -
Analysis 1.14

Comparison 1 Exercise versus control, Outcome 14 Hospital Anxiety and Depression Scale.

Comparison 1 Exercise versus control, Outcome 15 Self esteem.
Figures and Tables -
Analysis 1.15

Comparison 1 Exercise versus control, Outcome 15 Self esteem.

Comparison 1 Exercise versus control, Outcome 16 Physical activity.
Figures and Tables -
Analysis 1.16

Comparison 1 Exercise versus control, Outcome 16 Physical activity.

Comparison 1 Exercise versus control, Outcome 17 Neuropathic pain.
Figures and Tables -
Analysis 1.17

Comparison 1 Exercise versus control, Outcome 17 Neuropathic pain.

Comparison 1 Exercise versus control, Outcome 18 Neuropathy symptoms.
Figures and Tables -
Analysis 1.18

Comparison 1 Exercise versus control, Outcome 18 Neuropathy symptoms.

Comparison 1 Exercise versus control, Outcome 19 Endocrine symptoms.
Figures and Tables -
Analysis 1.19

Comparison 1 Exercise versus control, Outcome 19 Endocrine symptoms.

Comparison 1 Exercise versus control, Outcome 20 Gait and balance.
Figures and Tables -
Analysis 1.20

Comparison 1 Exercise versus control, Outcome 20 Gait and balance.

Comparison 1 Exercise versus control, Outcome 21 Lymphoedema incidence.
Figures and Tables -
Analysis 1.21

Comparison 1 Exercise versus control, Outcome 21 Lymphoedema incidence.

Comparison 2 Exercise versus control follow‐up, Outcome 1 Physical fitness.
Figures and Tables -
Analysis 2.1

Comparison 2 Exercise versus control follow‐up, Outcome 1 Physical fitness.

Comparison 2 Exercise versus control follow‐up, Outcome 2 Fatigue.
Figures and Tables -
Analysis 2.2

Comparison 2 Exercise versus control follow‐up, Outcome 2 Fatigue.

Comparison 2 Exercise versus control follow‐up, Outcome 3 Cancer‐specific quality of life.
Figures and Tables -
Analysis 2.3

Comparison 2 Exercise versus control follow‐up, Outcome 3 Cancer‐specific quality of life.

Comparison 2 Exercise versus control follow‐up, Outcome 4 Depression.
Figures and Tables -
Analysis 2.4

Comparison 2 Exercise versus control follow‐up, Outcome 4 Depression.

Comparison 2 Exercise versus control follow‐up, Outcome 5 Strength.
Figures and Tables -
Analysis 2.5

Comparison 2 Exercise versus control follow‐up, Outcome 5 Strength.

Comparison 2 Exercise versus control follow‐up, Outcome 6 Physical activity.
Figures and Tables -
Analysis 2.6

Comparison 2 Exercise versus control follow‐up, Outcome 6 Physical activity.

Comparison 2 Exercise versus control follow‐up, Outcome 7 Anxiety.
Figures and Tables -
Analysis 2.7

Comparison 2 Exercise versus control follow‐up, Outcome 7 Anxiety.

Comparison 2 Exercise versus control follow‐up, Outcome 8 Self esteem.
Figures and Tables -
Analysis 2.8

Comparison 2 Exercise versus control follow‐up, Outcome 8 Self esteem.

Comparison 2 Exercise versus control follow‐up, Outcome 9 Endocrine symptoms.
Figures and Tables -
Analysis 2.9

Comparison 2 Exercise versus control follow‐up, Outcome 9 Endocrine symptoms.

Comparison 2 Exercise versus control follow‐up, Outcome 10 Neuropathy symptoms.
Figures and Tables -
Analysis 2.10

Comparison 2 Exercise versus control follow‐up, Outcome 10 Neuropathy symptoms.

Comparison 2 Exercise versus control follow‐up, Outcome 11 Gait and balance.
Figures and Tables -
Analysis 2.11

Comparison 2 Exercise versus control follow‐up, Outcome 11 Gait and balance.

Comparison 2 Exercise versus control follow‐up, Outcome 12 Lymphoedema incidence.
Figures and Tables -
Analysis 2.12

Comparison 2 Exercise versus control follow‐up, Outcome 12 Lymphoedema incidence.

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

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

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)

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)

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)

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)

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)

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)

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.

Figures and Tables -
Summary of findings for the main comparison. Exercise compared with control for women receiving adjuvant therapy for breast cancer
Comparison 1. Exercise versus control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Physical fitness Show forest plot

20

1310

Std. Mean Difference (IV, Random, 95% CI)

0.42 [0.25, 0.59]

2 Fatigue Show forest plot

22

1698

Std. Mean Difference (IV, Random, 95% CI)

‐0.28 [‐0.41, ‐0.16]

3 Cancer‐specific quality of life Show forest plot

13

1012

Std. Mean Difference (IV, Random, 95% CI)

0.12 [‐0.00, 0.25]

4 Health‐related quality of life Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

5 Cancer site‐specific quality of life Show forest plot

4

262

Mean Difference (IV, Random, 95% CI)

4.24 [‐1.81, 10.29]

6 Depression Show forest plot

6

674

Std. Mean Difference (IV, Random, 95% CI)

‐0.15 [‐0.30, 0.01]

7 Cognitive function Show forest plot

2

213

Mean Difference (IV, Random, 95% CI)

‐11.55 [‐22.06, ‐1.05]

8 Strength Show forest plot

13

912

Std. Mean Difference (IV, Random, 95% CI)

0.27 [0.04, 0.50]

9 Subjective upper body function Show forest plot

3

231

Mean Difference (IV, Random, 95% CI)

‐0.52 [‐4.45, 3.41]

10 Shoulder mobility Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

11 Arm morbidity Show forest plot

3

240

Mean Difference (IV, Random, 95% CI)

1.11 [‐4.07, 6.29]

12 Anxiety Show forest plot

3

331

Mean Difference (IV, Random, 95% CI)

‐1.45 [‐4.36, 1.46]

13 Mood disturbances Show forest plot

3

111

Std. Mean Difference (IV, Random, 95% CI)

‐1.00 [‐1.40, ‐0.60]

14 Hospital Anxiety and Depression Scale Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

15 Self esteem Show forest plot

4

323

Mean Difference (IV, Random, 95% CI)

1.69 [‐0.01, 3.39]

16 Physical activity Show forest plot

8

549

Std. Mean Difference (IV, Random, 95% CI)

0.29 [0.12, 0.47]

17 Neuropathic pain Show forest plot

2

130

Mean Difference (IV, Random, 95% CI)

3.64 [‐1.32, 8.60]

18 Neuropathy symptoms Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

19 Endocrine symptoms Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

20 Gait and balance Show forest plot

3

122

Std. Mean Difference (IV, Random, 95% CI)

0.10 [‐0.25, 0.46]

21 Lymphoedema incidence Show forest plot

4

436

Risk Ratio (M‐H, Random, 95% CI)

0.71 [0.35, 1.45]

Figures and Tables -
Comparison 1. Exercise versus control
Comparison 2. Exercise versus control follow‐up

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Physical fitness Show forest plot

6

612

Std. Mean Difference (IV, Random, 95% CI)

0.26 [‐0.06, 0.57]

2 Fatigue Show forest plot

8

814

Std. Mean Difference (IV, Random, 95% CI)

‐0.21 [‐0.35, ‐0.07]

3 Cancer‐specific quality of life Show forest plot

6

583

Std. Mean Difference (IV, Random, 95% CI)

0.18 [0.01, 0.35]

4 Depression Show forest plot

3

378

Std. Mean Difference (IV, Random, 95% CI)

‐0.27 [‐0.48, ‐0.06]

5 Strength Show forest plot

4

386

Std. Mean Difference (IV, Random, 95% CI)

‐0.00 [‐0.30, 0.30]

6 Physical activity Show forest plot

3

261

Std. Mean Difference (IV, Random, 95% CI)

0.28 [‐0.05, 0.61]

7 Anxiety Show forest plot

2

201

Mean Difference (IV, Random, 95% CI)

‐3.61 [‐7.24, 0.03]

8 Self esteem Show forest plot

2

201

Mean Difference (IV, Random, 95% CI)

1.20 [‐0.41, 2.81]

9 Endocrine symptoms Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

10 Neuropathy symptoms Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

11 Gait and balance Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Totals not selected

12 Lymphoedema incidence Show forest plot

2

194

Risk Ratio (M‐H, Random, 95% CI)

0.79 [0.37, 1.69]

Figures and Tables -
Comparison 2. Exercise versus control follow‐up