Furmaniak, A.C., Menig, M., & Markes, M.H. (2016). Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database of Systematic Reviews, 9, CD005001. 

DOI Link


STUDY PURPOSE: To assess the effects of aerobic and resistance exercise on treatment-related side effects during adjuvant treatment for breast cancer

TYPE OF STUDY: Meta-analysis and systematic review

Search Strategy

DATABASES USED: CENTRAL, MEDLINE, EMBASE, World Health Organization Clinical Trials Registry, ClinicaTrials.gov
INCLUSION CRITERIA: Program duration of at least six weeks, any form of repeatedly performed aerobic and/or resistance exercise, during adjuvant treatment, comparison of exercise versus no exercise or versus other interventions
EXCLUSION CRITERIA: Studies in which exercise was part of a complex intervention, trials with interventions only for local muscle endurance

Literature Evaluated

EVALUATION METHOD AND COMMENTS ON LITERATURE USED: Cochrane risk of bias assessment and GRADES categorization

Sample Characteristics

  • FINAL NUMBER STUDIES INCLUDED = 32 in review, 26 in meta-analysis
  • SAMPLE RANGE ACROSS STUDIES: 20–242 patients
  • KEY SAMPLE CHARACTERISTICS: All were receiving adjuvant treatment for breast cancer

Phase of Care and Clinical Applications

PHASE OF CARE: Active antitumor treatment


  • Fatigue: SMD for in favor of exercise was –0.28 (95% confidence interval [CI] [–0.41, –0.16]) with moderate quality evidence (19 studies including 1,698 women).
  • Depression: The difference with exercise was not significant, and evidence quality was moderate (5 studies including 674 women).
  • Cognitive function assessed with Trail Making Test: MD –11.55 (95% CI [–22.06, –1.05]) with low quality evidence (2 studies including 213 women)
  • Anxiety: Three studies assessed anxiety. A meta-analysis of two studies found no significant difference with exercise.
  • A variety of other outcomes were assessed and reported, such as physical fitness, quality of life, and mood.


The findings show a moderate effect of exercise on fatigue among women receiving adjuvant treatment for breast cancer. No significant effects were seen for depression or anxiety. A statistically significant effect for cognitive function was found; however, the evidence was deemed to be of low quality.


  • High heterogeneity
  • The authors reported lack of sufficient information in reports to make clear judgments about potential bias.

Nursing Implications

Exercise probably reduces fatigue and improves physical fitness among women during treatment for breast cancer. Adherence to exercise can be a challenge, and implementation of exercise recommendations or programs will need to address factors to foster exercise participation to be successful.

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