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dc.contributor.authorLahart, IM
dc.contributor.authorMetsios, GS
dc.contributor.authorNevill, AM
dc.contributor.authorCarmichael, AR
dc.date.accessioned2019-05-29T14:23:01Z
dc.date.available2019-05-29T14:23:01Z
dc.date.issued2018-01-29
dc.identifier.citationLahart, I. M., Metsios, G. S., Nevill, A. M. and Carmichael, A. R. (2018) Physical activity for women with breast cancer after adjuvant therapy, Cochrane Database of Systematic Reviews 2018, Issue 1. Art. No.: CD011292. DOI: 10.1002/14651858.CD011292.pub2.en
dc.identifier.pmid29376559
dc.identifier.doi10.1002/14651858.CD011292.pub2en
dc.identifier.urihttp://hdl.handle.net/2436/622376
dc.description.abstract© 2018 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Background: Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes. These outcomes can negatively impact prognosis, health-related quality of life (HRQoL), and psychosocial and physical function. Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy. Objectives: To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer. Search methods: We searched the Cochrane Breast Cancer Group (CBCG) Specialised Registry, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), the Physiotherapy Evidence Database (PEDro), SPORTDiscus, PsycINFO, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform, on 18 September 2015. We also searched OpenGrey and Healthcare Management Information Consortium databases. Selection criteria: We searched for randomised and quasi-randomised trials comparing physical activity interventions versus control (e.g. usual or standard care, no physical activity, no exercise, attention control, placebo) after adjuvant therapy (i.e. after completion of chemotherapy and/or radiation therapy, but not hormone therapy) in women with breast cancer. Data collection and analysis: Two review authors independently selected studies, assessed risk of bias, and extracted data. We contacted trial authors to ask for additional information when needed. We calculated an overall effect size with 95% confidence intervals (CIs) for each outcome and used GRADE to assess the quality of evidence for the most important outcomes. Main results: We included 63 trials that randomised 5761 women to a physical activity intervention (n = 3239) or to a control (n = 2524). The duration of interventions ranged from 4 to 24 months, with most lasting 8 or 12 weeks (37 studies). Twenty-eight studies included aerobic exercise only, 21 involved aerobic exercise and resistance training, and seven used resistance training only. Thirty studies described the comparison group as usual or standard care, no intervention, or control. One-fifth of studies reported at least 20% intervention attrition and the average physical activity adherence was approximately 77%. No data were available on effects of physical activity on breast cancer-related and all-cause mortality, or on breast cancer recurrence. Analysis of immediately postintervention follow-up values and change from baseline to end of intervention scores revealed that physical activity interventions resulted in significant small-to-moderate improvements in HRQoL (standardised mean difference (SMD) 0.39, 95% CI 0.21 to 0.57, 22 studies, 1996 women; SMD 0.78, 95% CI 0.39 to 1.17, 14 studies, 1459 women, respectively; low-quality evidence), emotional function (SMD 0.21, 95% CI 0.10 to 0.32, 26 studies, 2102 women, moderate-quality evidence; SMD 0.31, 95% CI 0.09 to 0.53, 15 studies, 1579 women, respectively; low-quality evidence), perceived physical function (SMD 0.33, 95% CI 0.18 to 0.49, 25 studies, 2129 women; SMD 0.60, 95% CI 0.23 to 0.97, 13 studies, 1433 women, respectively; moderate-quality evidence), anxiety (SMD -0.57, 95% CI -0.95 to -0.19, 7 studies, 326 women; SMD -0.37, 95% CI -0.63 to -0.12, 4 studies, 235 women, respectively; low-quality evidence), and cardiorespiratory fitness (SMD 0.44, 95% CI 0.30 to 0.58, 23 studies, 1265 women, moderate-quality evidence; SMD 0.83, 95% CI 0.40 to 1.27, 9 studies, 863 women, respectively; very low-quality evidence). Investigators reported few minor adverse events. Small improvements in physical activity interventions were sustained for three months or longer postintervention in fatigue (SMD -0.43, 95% CI -0.60 to -0.26; SMD -0.47, 95% CI -0.84 to -0.11, respectively), cardiorespiratory fitness (SMD 0.36, 95% CI 0.03 to 0.69; SMD 0.42, 95% CI 0.05 to 0.79, respectively), and self-reported physical activity (SMD 0.44, 95% CI 0.17 to 0.72; SMD 0.51, 95% CI 0.08 to 0.93, respectively) for both follow-up values and change from baseline scores. However, evidence of heterogeneity across trials was due to variation in intervention components (i.e. mode, frequency, intensity, duration of intervention and sessions) and measures used to assess outcomes. All trials reviewed were at high risk of performance bias, and most were also at high risk of detection, attrition, and selection bias. In light of the aforementioned issues, we determined that the evidence was of very low, low, or moderate quality. Authors' conclusions: No conclusions regarding breast cancer-related and all-cause mortality or breast cancer recurrence were possible. However, physical activity interventions may have small-to-moderate beneficial effects on HRQoL, and on emotional or perceived physical and social function, anxiety, cardiorespiratory fitness, and self-reported and objectively measured physical activity. The positive results reported in the current review must be interpreted cautiously owing to very low-to-moderate quality of evidence, heterogeneity of interventions and outcome measures, imprecision of some estimates, and risk of bias in many trials. Future studies with low risk of bias are required to determine the optimal combination of physical activity modes, frequencies, intensities, and durations needed to improve specific outcomes among women who have undergone adjuvant therapy.en
dc.formatapplication/PDFen
dc.languageeng
dc.language.isoenen
dc.publisherWileyen
dc.relation.urlhttps://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011292.pub2/fullen
dc.subjectHumansen
dc.subjectBreast Neoplasmsen
dc.subjectFatigueen
dc.subjectPrognosisen
dc.subjectChemotherapy, Adjuvanten
dc.subjectRadiotherapy, Adjuvanten
dc.subjectExerciseen
dc.subjectDepressionen
dc.subjectAnxietyen
dc.subjectQuality of Lifeen
dc.subjectPhysical Fitnessen
dc.subjectFemaleen
dc.subjectResistance Trainingen
dc.titlePhysical activity for women with breast cancer after adjuvant therapyen
dc.typeJournal articleen
dc.identifier.eissn1469-493X
dc.identifier.journalCochrane Database of Systematic Reviewsen
dc.date.updated2019-05-18T15:05:23Z
dc.contributor.institutionFaculty of Education, Health and Wellbeing, University of Wolverhampton, Gorway Road, Walsall, West Midlands, UK, WS1 3BD.
pubs.place-of-publicationEngland
dc.date.accepted2018-01-01
rioxxterms.funderUniversity of Wolverhamptonen
rioxxterms.identifier.projectUOW290519ILen
rioxxterms.versionVoRen
rioxxterms.licenseref.urihttps://creativecommons.org/licenses/by-nc-nd/4.0/en
rioxxterms.licenseref.startdate2019-05-29en
dc.source.volume2018
dc.source.issue1
dc.source.beginpageCD011292
dc.description.versionPublished version
refterms.dateFCD2019-05-29T14:22:46Z
refterms.versionFCDVoR
refterms.dateFOA2019-05-29T14:23:02Z


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