Oncology · Medical Literature
Comparative efficacy of various exercise modalities on sleep quality in breast cancer survivors after primary treatment: A systematic review and dose-response network meta-analysis.
Abstract
This study aims to assess the dose-response relationship between different exercise modalities and sleep quality in breast cancer survivors who have completed their primary treatment, and to propose evidence-based exercise prescriptions for clinical practice. Bayesian network and dose-response meta-analyses using a random-effects model were conducted to evaluate the impact of exercise on sleep quality in breast cancer survivors. Exercise dose was calculated as the product of duration, frequency, and intensity, expressed in metabolic equivalent of task minutes per week (METs-min/week), for comparison across studies. A total of 24 studies involving 1495 patients were included. An inverted U-shaped, nonlinear dose-response relationship between exercise and sleep quality was observed, with an effective dose range of 0 to 1100 METs-min/week and maximum effect at 780 METs-min/week (standardized mean differences = 0.7, 95% CrI: 0.38, 1.06). Stratified by modality, aerobic exercise, combined aerobic-resistance training, and mind-body exercise all showed significant associations with improved sleep quality. The comprehensive ranking indicated that 500 METs-min/week of mind-body exercise (standardized mean differences = 1.06, 95% CrI: 0.3, 1.83) may be the most effective modality and dose for enhancing sleep quality. Based on the results of the dose-response network meta-analysis, we developed 9 exercise prescriptions to effectively improve sleep quality in individuals with breast cancer. Mind-body exercise may provide the most significant benefits, while aerobic and combined aerobic-resistance training are supported by more robust evidence due to larger sample sizes. However, the evidence supporting these exercise modalities is of low evidence, highlighting the need for further high-quality studies to validate the recommended doses.
Clinical relevance
Sleep disturbance is a highly prevalent and debilitating sequela in breast cancer survivors following primary treatment, yet evidence-based exercise prescriptions targeting sleep quality in this population have remained poorly defined. This systematic review and dose-response network meta-analysis addresses that gap by quantifying the optimal exercise type, dose, and modality across 24 randomized studies involving 1,495 patients. As survivorship care continues to expand, oncologists and primary care physicians managing post-treatment breast cancer patients need actionable, non-pharmacologic recommendations to improve patient-reported outcomes.
Key findings
1. An inverted U-shaped, nonlinear dose-response relationship was identified between exercise dose and sleep quality improvement, with an effective dose range of 0–1,100 METs-min/week and peak effect at 780 METs-min/week (SMD = 0.7, 95% CrI: 0.38–1.06). 2. Mind-body exercise at 500 METs-min/week demonstrated the highest efficacy for improving sleep quality across all modalities (SMD = 1.06, 95% CrI: 0.30–1.83), ranking first in the comprehensive modality comparison. 3. Aerobic exercise and combined aerobic-resistance training both showed statistically significant associations with improved sleep quality, supported by larger sample sizes and more robust evidence bases than mind-body exercise alone. 4. A total of 9 distinct evidence-based exercise prescriptions were derived from the dose-response network meta-analysis to guide clinical application across modalities. 5. The overall body of evidence supporting all exercise modalities was graded as low quality, underscoring important limitations in certainty of effect estimates. 6. The analysis encompassed 24 studies and 1,495 breast cancer survivors who had completed primary treatment, representing one of the most comprehensive quantitative syntheses on this topic to date.
Practice implications
Clinicians should consider prescribing mind-body exercise (e.g., yoga, tai chi, qigong) at approximately 500 METs-min/week as a first-line non-pharmacologic intervention for sleep disturbance in breast cancer survivors post-primary treatment, given its superior ranking for sleep benefit; however, aerobic or combined aerobic-resistance programs remain reasonable alternatives with stronger evidentiary volume. Exercise dose should be carefully titrated within the effective range of 0–1,100 METs-min/week, targeting approximately 780 METs-min/week for maximal effect, while avoiding supramaximal dosing that may attenuate benefit per the observed inverted U-shaped curve. Given the low-certainty evidence base, these prescriptions should be implemented alongside shared decision-making and individualized patient assessment, and clinicians are encouraged to enroll eligible patients in high-quality prospective trials to further validate optimal dosing parameters.