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

Appendices

Appendix 1. CENTRAL

#1 MeSH descriptor: [Breast Neoplasms] explode all trees
#2 breast near cancer
#3 breast near neoplasm*
#4 breast near carcinoma*
#5 breast near tumour*
#6 breast near tumor*
#7 #1 or #2 or #3 or #4 or #5 or #6
#8 MeSH descriptor: [Exercise] explode all trees
#9 MeSH descriptor: [Exercise Movement Techniques] explode all trees
#10 MeSH descriptor: [Physical Education and Training] explode all trees
#11 MeSH descriptor: [Exercise Therapy] explode all trees
#12 MeSH descriptor: [Physical Fitness] explode all trees
#13 exercise or exercise movement technique or exercise therapy or physical education or physical fitness or weight or training or strengthening endurance
#14 #8 or #9 or #10 or #11 or #12 or #13
#15 #7 and #14

Appendix 2. MEDLINE search strategy (via OvidSP)

# ▲

Searches

1

randomized controlled trial.pt.

2

controlled clinical trial.pt.

3

randomized.ab.

4

placebo.ab.

5

Clinical Trials as Topic/

6

randomly.ab.

7

trial.ti.

8

(crossover or cross‐over).tw.

9

Pragmatic Clinical Trials as Topic/

10

pragmatic clinical trial.pt.

11

or/1‐10

12

exp Breast Neoplasms/

13

(breast adj6 cancer$).mp.

14

(breast adj6 neoplasm$).mp.

15

(breast adj6 carcinoma$).mp.

16

(breast adj6 tumour$).mp.

17

(breast adj6 tumor$).mp.

18

12 or 13 or 14 or 15 or 16 or 17

19

exp Exercise/

20

exp Exercise Movement Techniques/

21

exp Exercise Therapy/

22

exercise.mp.

23

exp "Physical Education and Training"/

24

physical‐education‐and‐training.mp.

25

exp Physical Fitness/

26

physical fitness.mp.

27

Physical Exertion/

28

exertion.mp.

29

exp Sports/

30

sport$.mp.

31

physical activity.mp.

32

physical activities.mp.

33

exp Walking/

34

walking.ti,ab.

35

exp Jogging/

36

jogging.ti,ab.

37

exp Swimming/

38

swimming.ti,ab.

39

exp Bicycling/

40

bicycling.ti,ab.

41

cycling.ti,ab.

42

weight.ti,ab.

43

training.ti,ab.

44

muscle.ti,ab.

45

strengthening.ti,ab.

46

endurance.ti,ab.

47

19 or 20 or 21 or 22 or 23 or 24 or 25 or 26 or 27 or 28 or 29 or 30 or 31 or 32 or 33 or 34 or 35 or 36 or 37 or 38 or 39 or 40 or 41 or 42 or 43 or 44 or 45 or 46

48

adjuvant therapy.mp.

49

chemotherapy.mp. or exp Drug Therapy/

50

radiotherapy.mp. or exp Radiotherapy/

51

hormonal therapy.mp.

52

48 or 49 or 50 or 51

53

11 and 18 and 47 and 52

54

Animals/ not Humans/

55

53 not 54

Appendix 3. EMBASE search strategy (via Embase.com)

  1. 'breast cancer'/exp OR 'breast cancer'

  2. 'breast carcinoma'/exp

  3. 'breast neoplasm'

  4. 'breast tumour'

  5. 'breast tumor'/exp

  6. #1 OR #2 OR #3 OR #4 OR #5

  7. 'exercise'/exp

  8. exercise*

  9. 'exercise movement techniques'/exp OR 'exercise movement techniques'

  10. 'physical education training'

  11. 'physical education'/exp OR 'physical education'

  12. 'physical training'/exp OR 'physical training'

  13. 'physical fitness'/exp OR 'physical fitness'

  14. 'exercise therapy'/exp OR 'exercise therapy'

  15. 'exertion'/exp OR exertion

  16. 'sports'/exp OR sports

  17. 'walking'/exp OR walking

  18. 'jogging'/exp OR jogging

  19. 'swimming'/exp OR swimming

  20. 'cycling'/exp OR cycling

  21. 'bicycling'/exp OR bicycling

  22. 'endurance'/exp OR endurance

  23. 'weight'/exp OR weight

  24. 'training'/exp OR training

  25. 'muscle'/exp OR muscle

  26. strengthening

  27. 'endurance'/exp OR endurance

  28. #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14 OR #15 OR #16 OR #17 OR #18 OR #19 OR #20 OR #21 OR #22 OR #23 OR #24 OR#25 OR #26 OR #27

  29. 'adjuvant therapy'/exp OR 'adjuvant therapy'

  30. 'chemotherapy'/exp OR chemotherapy

  31. 'radiotherapy'/exp OR radiotherapy

  32. hormonal AND ('therapy'/exp OR therapy)

  33. #29 OR #30 OR #31 OR #32

  34. random* OR factorial* OR crossover* OR cross NEXT/1 over* OR placebo* OR (doubl* AND blind*) OR (singl* AND blind*) OR assign*OR allocat* OR volunteer* OR 'crossover procedure'/exp OR 'double blind procedure'/exp OR 'randomized controlled trial'/exp OR'single blind procedure'/exp

  35. #6 AND #28 AND #33 AND #34

  36. #35 NOT ([animals]/lim NOT [humans]/lim)

  37. #36 AND [embase]/lim

Appendix 4. WHO ICTRP search strategies

Basic Searches:

1.     Exercise for women receiving adjuvant therapy for breast cancer

2.     Breast cancer AND exercise 

Advanced Searches:

1.       Title: Exercise for women receiving adjuvant therapy for breast cancer

Recruitment Status: ALL

2.       Condition: breast cancer

Intervention: exercise

Recruitment Status: ALL

3.       Condition: breast cancer

Intervention: exercise% OR exercise therap% OR physical education

Recruitment Status: ALL

Appendix 5. ClinicalTrials.gov search strategies

Basic Searches:

1.     Exercise for women receiving adjuvant therapy for breast cancer

2.     Breast cancer AND exercise

Advanced Searches:

1.       Title: Exercise for women receiving adjuvant therapy for breast cancer

Recruitment: All studies

Study Results: All studies

Study Type: All studies

Gender: All Studies

2.       Condition: breast cancer

Intervention: exercise OR exercises OR exercise therapy OR exercise therapies OR exercise movement technique OR exercise movement techniques OR physical education OR physical training OR physical fitness OR physical activity OR physical activities

Recruitment: All studies

Study Results: All studies

Study Type: All studies

Gender: All Studies

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Figure 6

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

Comparison 1 Exercise versus control, Outcome 1 Physical fitness.
Figuras y tablas -
Analysis 1.1

Comparison 1 Exercise versus control, Outcome 1 Physical fitness.

Comparison 1 Exercise versus control, Outcome 2 Fatigue.
Figuras y tablas -
Analysis 1.2

Comparison 1 Exercise versus control, Outcome 2 Fatigue.

Comparison 1 Exercise versus control, Outcome 3 Cancer‐specific quality of life.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Analysis 1.5

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

Comparison 1 Exercise versus control, Outcome 6 Depression.
Figuras y tablas -
Analysis 1.6

Comparison 1 Exercise versus control, Outcome 6 Depression.

Comparison 1 Exercise versus control, Outcome 7 Cognitive function.
Figuras y tablas -
Analysis 1.7

Comparison 1 Exercise versus control, Outcome 7 Cognitive function.

Comparison 1 Exercise versus control, Outcome 8 Strength.
Figuras y tablas -
Analysis 1.8

Comparison 1 Exercise versus control, Outcome 8 Strength.

Comparison 1 Exercise versus control, Outcome 9 Subjective upper body function.
Figuras y tablas -
Analysis 1.9

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

Comparison 1 Exercise versus control, Outcome 10 Shoulder mobility.
Figuras y tablas -
Analysis 1.10

Comparison 1 Exercise versus control, Outcome 10 Shoulder mobility.

Comparison 1 Exercise versus control, Outcome 11 Arm morbidity.
Figuras y tablas -
Analysis 1.11

Comparison 1 Exercise versus control, Outcome 11 Arm morbidity.

Comparison 1 Exercise versus control, Outcome 12 Anxiety.
Figuras y tablas -
Analysis 1.12

Comparison 1 Exercise versus control, Outcome 12 Anxiety.

Comparison 1 Exercise versus control, Outcome 13 Mood disturbances.
Figuras y tablas -
Analysis 1.13

Comparison 1 Exercise versus control, Outcome 13 Mood disturbances.

Comparison 1 Exercise versus control, Outcome 14 Hospital Anxiety and Depression Scale.
Figuras y tablas -
Analysis 1.14

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

Comparison 1 Exercise versus control, Outcome 15 Self esteem.
Figuras y tablas -
Analysis 1.15

Comparison 1 Exercise versus control, Outcome 15 Self esteem.

Comparison 1 Exercise versus control, Outcome 16 Physical activity.
Figuras y tablas -
Analysis 1.16

Comparison 1 Exercise versus control, Outcome 16 Physical activity.

Comparison 1 Exercise versus control, Outcome 17 Neuropathic pain.
Figuras y tablas -
Analysis 1.17

Comparison 1 Exercise versus control, Outcome 17 Neuropathic pain.

Comparison 1 Exercise versus control, Outcome 18 Neuropathy symptoms.
Figuras y tablas -
Analysis 1.18

Comparison 1 Exercise versus control, Outcome 18 Neuropathy symptoms.

Comparison 1 Exercise versus control, Outcome 19 Endocrine symptoms.
Figuras y tablas -
Analysis 1.19

Comparison 1 Exercise versus control, Outcome 19 Endocrine symptoms.

Comparison 1 Exercise versus control, Outcome 20 Gait and balance.
Figuras y tablas -
Analysis 1.20

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

Comparison 1 Exercise versus control, Outcome 21 Lymphoedema incidence.
Figuras y tablas -
Analysis 1.21

Comparison 1 Exercise versus control, Outcome 21 Lymphoedema incidence.

Comparison 2 Exercise versus control follow‐up, Outcome 1 Physical fitness.
Figuras y tablas -
Analysis 2.1

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

Comparison 2 Exercise versus control follow‐up, Outcome 2 Fatigue.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
Analysis 2.4

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

Comparison 2 Exercise versus control follow‐up, Outcome 5 Strength.
Figuras y tablas -
Analysis 2.5

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

Comparison 2 Exercise versus control follow‐up, Outcome 6 Physical activity.
Figuras y tablas -
Analysis 2.6

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

Comparison 2 Exercise versus control follow‐up, Outcome 7 Anxiety.
Figuras y tablas -
Analysis 2.7

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

Comparison 2 Exercise versus control follow‐up, Outcome 8 Self esteem.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.
Figuras y tablas -
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.

Figuras y tablas -
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]

Figuras y tablas -
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]

Figuras y tablas -
Comparison 2. Exercise versus control follow‐up