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.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.