Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature

Table 1 1989-1999 study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Cardiorespiratory function
Bike VO2peak (L/min)
Exercise	1	45	1.02	-	1.45	-	0.43	-	-
Control	0
12-min walk test (m)
Exercise	2	25	1123.7	7.1	1216.7	42.3	93.1	-632	0.166
Control	2	16	1052.6	76.2	965.5	30.1	-87.1	-2476	0.536
Body composition
Body mass (kg)
Exercise	1	22	66.57		-		-
Control	1	24	62.16		-		-
Body fat (%)
Exercise	1	12	-		-		-0.51
Control	1	12	-		-		2.19
Lean body mass (kg)
Exercise	1	12	-		-		2.04
Control	1	12	-		-		-1.26
Quality of life
QOL Index, 0–100
Exercise	1	27	61.4	-	56.8	-	-4.60	-	-
Control	0	-	-	-	-	-	-	-	-
Fatigue
SympASF, 0-100
Exercise	2	31	12.5	2.1	22.0	5.7	9.50	-63.5	0.164
Control	2	29	19.5	7.8	41.5	5.0	22	-50.8	0.058
Depression
SymptASD, 0-100
Exercise	2	31	11.5	6.4	11.5	2.1	0.00	-76.2	1.000
Control	2	29	9.5	2.1	14.5	9.1	5.00	-127	0.500

Lower scores reflect lower fatigue and lower depression. VO_2peak: Peak oxygen uptake; QOL: Quality of life; SympASF: Symptom Assessment Scale-Fatigue; SymptASD: Symptom assessment Scale-Depression.

Table 2 2000-2006 study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Cardiorespiratory function
Bike VO2peak (mL/kg per minute)
Exercise	5	81	23.26	2.95	25.40	2.75	2.14	-4.28	0.000
Control	2	36	23.10	6.08	21.95	5.30	-1.15	-13.98	0.284
Bike VO2peak (L/min)
Exercise	1	22	1.67	0.35	1.81	0.37	0.14	-	-
Control	1	19	1.6	0.36	1.63	0.35	0.03	-	-
Est. Treadmill. VO2peak (mL/kg per minute)
Exercise	1	40	30.58	-	35.20	-	4.62	-	-
Control	0		-		-
VO2peak (L/min)
Exercise	1	22	1.67	-	1.81	-	0.14	-	-
Control	1	19	1.6	-	1.63	-	0.03	-	-
mCAFT VO2peak (mL/kg per minute)
Exercise	1	82	25.7	0.28	26.45	0.49	-0.75	-	-
Control	1	41	25.1	6.10	25.10	6.10	0.00	-	-
12-min walk test (m)
Exercise	2	56	1032.35	8.98	1264.8	126.15	232.45	-2428.16	0.248
Control	2	37	1045.2	59.11	944.8	194.03	-100.4	-2424.34	0.484
6-min walk test (m)
Exercise	1	9	672.9	-	776.03	-	103.13	-	-
Control	0
1 mile walk test (min)
Exercise	1	43	17.45	-	16.34	-	-1.11	-	-
Control	1	43	17.65	-	17.85	-	0.20	-	-
Body composition
Body mass (kg)
Exercise	9	248	69.47	10.36	68.43	9.54	-1.04	-2.83	0.131
Control	7	183	75.80	6.46	76.64	6.31	0.84	-2.62	0.166
Fat mass (kg)
Exercise	4	75	25.95	9.73	23.93	8.57	-2.03	-7.57	0.187
Control	3	73	32.90	8.18	33.20	6.52	-0.30	-8.44	0.789
Body fat (%)
Exercise	8	218	33.82	8.25	32.31	8.03	1.51	0.37-2.66	0.017
Control	6	165	36.48	9.29	36.66	8.96	0.18	-2.03	0.673
Strength
1RM UB composite (kg)
Exercise	1	21	9.1	1.93	10.16	2.08	0.96	-	-
Control	1	15	8.77	1.75	8.59	1.29	-0.18	-	-
1RM UB (kg)
Exercise	2	67	22.63	10.15	30.23	13.39	7.61	-58.33	0.187
Control	0
1RM LB (kg)
Exercise	3	76	99.87	31.29	133.19	57.10	33.32	-141.42	0.180
Control	0
Psychosocial Measures
FACT-G
Exercise	2	37	78.75	9.55	87.60	5.23	8.85	-77.50	0.211
Control	2	38	83.90	6.93	82.70	9.33	-1.20	-43.20	0.609
FACT-B
Exercise	3	47	100.3	9.30	111.03	7.42	10.73	-15.37	0.027
Control	2	38	105.75	13.79	105.05	15.20	-0.70	-25.42	0.611
SF-36
Exercise	1	42	76.30	0.28	94.75	8.98	18.45	-	-
Control	1	41	83.50	-	102.4	-	18.90	-	-
WHO-QOL BREF
Exercise	1	27	8.2	0.92	8.8	0.78	0.60	-	-
Control	0
PFS
Exercise	2	22	5.07	0.24	3.47	0.47	-1.61	0.50-4.81	0.194
Control	1	10	4.87	2.50	4.62	2.50	-0.25	-	-
SCFS
Exercise	1	44	10.70	3.75	10.20	6.00	-0.50	-	-
Control	1	27	10.80	0.00	13.40	5.60	2.60	-	-
LAS
Exercise	1	43	42.47	23.54	27.08	21.41	-15.39	-	-
Control	1	43	41.66	25.04	42.28	26.20	0.62	-	-
BDI
Exercise	1	40	5.84	4.90	3.92	4.00	-1.92	-	-
Control	0
HRSD
Exercise	1	40	9.46	6.00	6.10	5.00	-3.36	-	-
Control	0

VO_2peak: Peak oxygen uptake; mCAFT: Modified Canadian Fitness Test; UB composite: Upper body combined strength measures; UB: Upper body strength test; LB: Lower body strength test; EORTC: European Organization for Research and Treatment of Cancer; FACT-G: Functional Assessment of Cancer Therapy-General; FACT-B: Functional Assessment of Cancer Therapy-Breast; SF-36: Short-Form-36; WHO-QOL BREF: The World Health Organization-BREF Quality of Life Instrument; PFS: Piper Fatigue Scale; SCFS: Schwartz Cancer Fatigue Scale; LAS: Linear Analog Scale; BDI: Beck Depression Inventory; HRSD: The Hamilton Rating Scale for Depression; Est. Treadmill VO_2peak: VO_2peak estimated via submaximal CPET; CPET: Cardiopulmonary exercise test.

Table 3 2007-2013 cardiorespiratory function study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Cardiorespiratory function
Treadmill VO2peak (mL/kg per minute)
Exercise	1	71	25.20	-	25.70	-	0.5	-	-
Control	1	73	24.80	-	23.50	-	-1.3	-	-
Treadmill VO2peak (L/min)
Exercise	1	71	1.72	-	1.77	-	0.05	-	-
Control	1	73	1.76	-	1.68	-	-0.08	-	-
Est. Treadmill VO2peak (mL/kg per minute)
Exercise	9	265	23.51	4.56	27.05	5.12	3.54	-4.84-2.26	< 0.0005
Control	5	88	24.45	6.08	25.02	6.80	0.57	-2.85	0.328
Bike VO2peak (mL/kg per minute)
Exercise	2	37	22.11	3.68	24.49	3.38	2.38	-5.47	0.057
Control	2	33	21.98	6.34	20.83	6.82	-1.15	-8.77	0.185
Bike VO2peak (L/min)
Exercise	1	10	1.41	-	1.59	-	0.18	-	-
Control	1	10	1.34	-	1.20	-	-0.14	-	-
Est. Bike VO2peak (mL/kg per minute)
Exercise	1	18	21.07	-	23.88	-	2.81	-	-
Control	0	0	-	-	-	-	-	-	-
6-min walk test (m)
Exercise	2	30	463.23	56.37	482.57	49.84	19.34	-117.4	0.149
Control	2	32	450.14	33.57	440.62	33.40	-9.52	8.05-10.98	0.008
12-min walk test (m)
Exercise	3	129	931.00	102.93	1093.0	160.18	162	-364.7	0.062
Control	3	124	921.03	148.50	888.13	132.92	-32.9	-258.0	0.387
2 km walk test (min)
Exercise	3	313	18.05	0.44	17.38	0.42	-0.67	-1.60	0.070
Control	3	280	17.94	0.33	17.33	0.23	-0.61	0.34-0.86	0.010

VO_2peak: Peak oxygen uptake; Treadmill VO_2peak: VO_2peak obtained directly through CPET with gas exchange; Est. Treadmill VO_2peak: VO_2peak estimated via submaximal CPET; CPET: Cardiopulmonary exercise test; Est.: Estimated.

Table 4 2007-2013 body composition study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Body composition
Body mass (kg)
Exercise	10	550	74.66	3.94	74.25	3.84	-0.41	-0.38 to 1.20	0.268
Control	9	527	73.59	4.63	74.72	4.69	+1.13	-2.35 to 0.09	0.065
Fat mass (kg)
Exercise	1	262	25.73	-	26.43	-	+0.70	-	-
Control	1	236	24.45	-	25.12	-	+0.67	-	-
Body fat (%)
Exercise	13	609	38.00	5.03	37.15	5.80	-0.85	0.06 to 1.64	0.037
Control	11	536	38.50	4.41	39.00	4.12	+0.50	-0.84 to -0.16	0.009
Lean body mass (kg)
Exercise	3	330	43.91	0.32	44.29	0.31	+0.38	-0.45 to -0.31	0.002
Control	3	308	43.45	0.37	43.27	0.56	-0.18	-0.49 to 0.87	0.358
Lean body mass (%)
Exercise	1	10	71.00	-	74.10	-	+3.10	-	-
Control	1	10	69.10	-	68.90	-	-0.20	-	-

Table 5 2007-2013 patient reported outcomes study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Quality of life
EORTC, 0-100
Exercise	2	296	74.05	13.36	79.95	7.71	+5.90	-101.64	0.379
Control	1	236	80.90	-	84.30	-	3.40	-	-
FACT-G, 0-104
Exercise	4	165	78.98	3.30	85.88	4.22	6.90	-10.05	0.022
Control	4	178	79.74	6.89	79.63	10.88	-0.11	-21.22	0.976
FACT-B, 0-104
Exercise	5	99	103.92	6.75	110.32	4.25	6.40	-17.44	0.111
Control	5	82	108.76	5.72	106.53	9.98	-2.23	-22.82	0.616
SF-36 physical function, 0-100
Exercise	1	25	47.41	-	50.80	-	3.39	-	-
Control	0	0	-	-	-	-	-	-	-
Fatigue1 piper, 0-10
Exercise	3	140	3.88	1.05	3.08	0.41	-0.80	-4.34	0.250
Control	2	45	3.78	0.17	3.91	0.35	0.13	-3.30	0.500
FSI, 1-10
Exercise	1	11	3.40	-	3.40	-	0.00	-	-
Control	1	9	3.25	-	3.30	-	0.05	-	-
FACIT-F
Exercise	4	373	37.85	2.95	39.58	5.87	1.73	-10.49	0.372
Control	4	351	40.11	4.07	40.08	3.73	-0.03	-6.12	0.975
Depression2 BDI, 0-63
Exercise	2	93	11.75	0.07	8.35	0.35	-3.40	0.86-5.94	0.037
Control	2	102	10.96	2.89	11.21	0.42	0.25	-44.48	0.910
R-Beck Inventory
Exercise	2	295	8.53	7.11	4.60	1.98	-3.93	-92.24	0.475
Control	2	271	7.15	5.15	6.67	5.18	-0.48	0.23-0.73	0.027
CES-D, 0-24
Exercise	1	71	12.80	-	9.70	-	-3.10	-	-
Control	1	73	13.90	-	10.80	-	-3.10	-	-
HADS, 0-21
Exercise	1	30	4.17	-	2.70	-	-1.47	-	-
Control	1	28	4.79	-	4.64	-	-0.15	-	-

¹Lower scores reflect lower fatigue;

²Lower scores reflect lower depression. BDI: Beck Depression Inventory; EORTC: European Organization for Research and Treatment of Cancer; FACT-G: Functional Assessment of Cancer Therapy-General; FACT-B: Functional Assessment of Cancer Therapy-Breast; SF-36: Short-Form-36; FSI: The Fatigue Symptom Inventory; FACIT-F: Functional Assessment of Chronic Illness Therapy-Fatigue; BDI: Beck Depression Inventory; R-Beck Inventory: R-Beck Depression Inventory; CES-D: Center for epidemiologic studies depression scale (short-form); HADS: Hospital anxiety and depression scale.

Table 6 2007-2013 resistance exercise study results summary

Measure	No. of studies	N	Baseline		Post-intervention		Change		P
			Mean	SD	Mean	SD	Mean	95%CI
Cardiorespiratory fitness
Treadmill VO2peak (mL/kg per minutes)
Exercise	1	77	25.5	-	24.20	-	-1.30	-	-
Control	1	73	24.8	-	23.50	-	-1.30	-	-
Treadmill VO2peak (L/min)
Exercise	1	77	1.73	-	1.67	-	-0.06	-	-
Control	1	73	1.76	-	1.68	-	-0.08	-	-
Est. Treadmill VO2peak (mL/kg per minutes)
Exercise	1	9	23.46	-	24.22	-	0.76	-	-
Control	0	0	-	-	-	-	-	-	-
12-min walk test (m)
Exercise	1	21	1020.00	-	1055.00	-	35.00	-	-
Control	1	23	1035.00	-	944.00	-	-91.00	-	-
Body composition
Body mass (kg)
Exercise	3	136	72.53	2.96	73.73	2.70	1.20	-1.32	0.016
Control	3	129	72.33	1.81	73.30	0.95	0.97	-4.29	0.192
Fat mass (kg)
Exercise	2	59	28.10	3.25	28.70	3.11	0.60	-2.54	0.105
Control	2	56	26.70	3.25	27.50	2.12	0.80	-20.32	0.500
Body fat (%)
Exercise	4	145	36.75	2.82	36.60	3.05	-0.15	-1.18	0.476
Control	3	129	37.27	2.57	37.97	2.15	0.70	-3.94	0.266
Lean body mass (kg)
Exercise	2	59	44.35	1.34	45.00	1.41	0.65	-1.29 to -0.01	0.049
Control	2	56	44.70	0.00	45.15	0.07	+0.45	-1.28	0.070
Muscular strength
1-RM upper body composite (kg)
Exercise	1	43	32.93	-	39.38	-	6.45	-	-
Control	1	19	31.45	-	32.30	-	0.85	-	-
1-RM upper body single test (kg)
Exercise	5	166	26.37	5.03	31.68	4.78	5.31	-7.94 to -2.69	0.005
Control	4	152	27.60	3.79	28.65	3.15	+1.05	-2.27	0.059
1-RM lower body single test (kg)
Exercise	5	200	70.58	29.80	88.40	38.01	17.82	-32.06 to -3.58	0.025
Control	5	171	68.19	25.36	73.61	27.74	+5.42	-8.51 to -2.33	0.008
Quality of Life
SF-36 physical function, 0-100
Exercise	2	79	47.80	3.54	50.28	2.02	+2.48	-27.31	0.261
Control	2	50	49.00	3.96	48.85	4.88	-0.15	-16.52	0.856
Fatigue1 SCFS, 6-36
Exercise	1	36	9.90	-	10.10	-	0.20	-	-
Control	1	31	9.30	-	9.00	-	-0.30	-	-
FACIT-F
Exercise	1	77	34.30	-	36.30	-	2.00	-	-
Control	1	73	34.60	-	34.90	-	0.30	-	-
Depression2 CES-D, 0-24
Exercise	1	77	13.80	-	10.60	-	-3.20	-	-
Control	1	73	13.90	-	10.80	-	-3.10	-	-

¹Lower scores reflect lower fatigue;

²Lower scores reflect lower depression. VO_2peak: Peak oxygen uptake; Est. Treadmill VO_2peak: VO_2peak estimated via submaximal CPET; CPET: Cardiopulmonary exercise test; Est.: Estimated; RM: Repetition Maximum; SF-36: Short-Form-36; SCFS: Schwartz cancer fatigue scale; FACIT-F: Functional assessment of chronic illness therapy-fatigue; CES-D: Center for Epidemiologic Studies Depression Scale (short-form).