The Effects of Physical and Mind-Body Exercise on Anxiety Among Patients with Breast Cancer: A Systematic Review and Meta-Analysis of Controlled Trials.

Background and Objectives: Anxiety is highly prevalent among breast cancer patients and significantly impairs quality of life. Although both conventional physical exercise (PE) and mind-body interventions (MBE) are used in supportive care, their relative efficacy remains unclear. This systematic review and meta-analysis compared the effects of PE and MBE on anxiety in breast cancer patients. Materials and Methods: PubMed, Web of Science, Embase, PsycINFO, and CINAHL were systematically searched through April 2026 for controlled trials comparing structured PE or MBE with control conditions. Effect sizes were pooled as standardized mean differences (SMDs; Hedges' g) using a random-effects model with restricted maximum likelihood estimation and modified Hartung-Knapp inference. Subgroup analyses and univariable meta-regressions explored potential moderators. Results: Twenty-four reports (N = 2197) represented 25 independent trials; 22 estimates from 21 reports entered the meta-analysis, and three reports were synthesized narratively. Interventions significantly reduced anxiety on average (SMD = -0.58, 95% CI [-1.01, -0.15], p = 0.011), with substantial heterogeneity (I2 = 85.0%) and a 95% prediction interval of -2.38 to 1.22. Both PE (SMD = -0.67) and MBE (SMD = -0.46) favored intervention numerically, although both subgroup confidence intervals included no effect, with no significant difference between modalities (p = 0.697). A larger, yet non-significant, effect was observed during active treatment (SMD = -0.84, 95% CI [-1.68, 0.01]) compared with survivorship (SMD = -0.34, 95% CI [-0.62, -0.07]); the between-phase comparison was inconclusive (p = 0.291). The comparison across diagnostic stages was also inconclusive (p = 0.366). None of the seven continuous moderators met the multiplicity-adjusted significance threshold. Conclusions: Current findings suggest an average reduction in anxiety following physical and mind-body interventions in breast cancer patients. However, no statistically significant differences were observed between intervention modalities or treatment stages. Very low certainty, substantial heterogeneity and indirect subgroup comparisons limit confidence in the size and consistency of benefit. Overall, individualized interventions may have a role in oncology care, but these findings do not establish superiority, equivalence or differential efficacy between modalities or treatment phases.