The impact of lifestyle interventions on therapy associated side effects in postmenopausal breast cancer survivors: systematic reviews and meta-analysis

Background: Medically Supervised Exercise (MSE) are advisable for the prevention and treatment related side effects among breast cancer survivors. Aerobic and resistance either exercise, separately or in combination, have been shown to improve physical functioning and manage some symptoms in breast cancer patients. However, the level of evidence on the effects of lifestyle interventions on therapy related adverse events and the required dose responses of exercises are not yet systematically reviewed. This review was conducted to assess the efficacy of medically supervised exercises(MSE) coupled with diet in preventing/managing aromatase inhibitors induced adverse events and improving range of motion(ROM) and heath related quality of life (HRQOL) in postmenopausal breast cancer patients following treatment. Methods: Two independent authors extracted data using PRISMA guidelines of published clinical trials. We searched the Cochrane Central Register of Controlled Trials, PubMed, MEDLINE, EMBASE, as well as clinical practice guidelines. We included only randomized controlled trials that examined exercise interventions coupled with diet interventions in postmenopausal breast cancer women. Health related quality of life (HRQOL) and range of motion were assessed as the main outcomes. Results: Random effects meta-analysis was conducted for pooling of the effect size. The age of patients varied from 50 to 60 years. The results illustrate that the mean difference (MD) in improving ROM in the MSE group versus no supervised exercises was 1.35% (95% CI: 0.63 to 2.07%, P = 0.0002; heterogeneity: Tau² = 0.71; Chi² = 112.14, df = 5 (P < 0.00001); I² = 96%). A summary of the data shows that supervised exercises significantly improved ROM and HRQOL in postmenopausal BCS on endocrine therapy compared to no supervised exercises 3.02 (95% CI: 2.59 to 3.45, P < 0.00001). These outcomes show that lifestyle interventions (MSE +diet) have positive effects on AI-associated adverse events and likely improve ROM and HRQOL in postmenopausal BC patients. Conclusion: The evidence was based on a body of research with moderate study quality. Moreover, further studies are recommended to assess the effect of lifestyle interventions on markers of inflammation as the predictors of treatment non-response and associated comorbidities.