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      Exercise Intervention Improves Clinical Outcomes, but the “Time of Session” is Crucial for Better Quality of Life in Breast Cancer Survivors: A Systematic Review and Meta-Analysis

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          Abstract

          This study examined the effects of exercise intervention on the quality of life (QoL), social functioning (SF), and physical functioning (PF) of breast cancer survivors, and identified the responsible and optimal exercise characteristics for amelioration of outcomes. Randomized controlled trials (RCTs) that adopted exercise intervention and measured the QoL, SF, and PF of breast cancer patients were included. We used meta-analysis to calculate the pooled effect, and meta-regression to identify the responsible exercise characteristics (type, frequency, duration, and time). Subgroup analysis assessed the optimal “time of session” for an improved QoL. The Cochrane risk-of-bias tool was used to determine the quality of studies. In the systematic review, we included 26 RCTs with a total of 1892 breast cancer patients, whilst 18 trials were considered for meta-analysis (exercise = 602; control = 603). The pooled effect showed that exercise intervention substantially improved the QoL (standardized mean difference (SMD) = 0.35; I 2 = 61%; 95% confidence internal (CI): 0.15–0.54; p = 0.0004), SF (SMD = 0.20; I 2 = 16%; 95% CI:0.08–0.32; p = 0.001), and PF (SMD = 0.32; I 2 = 32%; 95% CI:0.20–0.44; p < 0.00001). Meta-regression analysis showed that improved QoL was associated ( p = 0.041) with the “time of session”. More specifically, sessions conducted for medium-time (>45 to ≤60 min; p = 0.03) and longer-time (>60 to 90 min; p = 0.005) considerably improved the QoL, whilst shorter-time (≤45 min; p = 0.15) did not. To summarize, exercise interventions improved the QoL, SF, and PF of breast cancer survivors, where the “time of session” appeared to be crucial for an effective improvement in the QoL.

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          Most cited references 42

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          The global breast cancer burden: variations in epidemiology and survival.

          Breast cancer is the most common type of cancer and the most common cause of cancer-related mortality among women worldwide. However, the burden is not evenly distributed, and, according to the best available data, there are large variations in the incidence, mortality, and survival between different countries and regions and within specific regions. Many complex factors underlie these variations, including population structure (eg, age, race, and ethnicity), lifestyle, environment, socioeconomic status, risk factor prevalence, mammography use, disease stage at diagnosis, and access to high-quality care. We review recent breast cancer incidence and mortality statistics and explore why these vary so greatly across the world. Further research is needed to fully understand the reasons for variations in breast cancer outcomes. This will aid the development of tailored strategies to improve outcomes in general as well as the standard of care for underserved populations and reduce the burden of breast cancer worldwide.
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            Quality of life: Its definition and measurement

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              Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial.

              To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up. Pragmatic randomised controlled prospective open trial. Three National Health Service oncology clinics in Scotland and community exercise facilities. 203 women entered the study; 177 completed the six month follow-up. Supervised 12 week group exercise programme in addition to usual care, compared with usual care. Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility. Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted. Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864 [controlled-trials.com].
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                Author and article information

                Journal
                Cancers (Basel)
                Cancers (Basel)
                cancers
                Cancers
                MDPI
                2072-6694
                22 May 2019
                May 2019
                : 11
                : 5
                Affiliations
                [1 ]Exercise and Metabolism Research Center, College of Physical Education and Health Sciences, Zhejiang Normal University, Jinhua 321004, Zhejiang, China; fenghong0313@ 123456outlook.com (F.H.); ywbls@ 123456zjnu.cn (W.Y.); zhangyong@ 123456zjnu.cn (Y.Z.)
                [2 ]Department of Sports Sciences, University of Taipei, Taipei 11153, Taiwan; kuochiahua@ 123456gmail.com
                Author notes
                [* ]Correspondence: tyxyqyd@ 123456zjnu.cn (Y.Q.); mallik.k5@ 123456gmail.com (M.K.); Tel.: +86-579-82291009 (Y.Q. & M.K.)
                Article
                cancers-11-00706
                10.3390/cancers11050706
                6562879
                31121916
                © 2019 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

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