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Meta-Analysis
. 2020 Dec 11;12(12):CD012110.
doi: 10.1002/14651858.CD012110.pub2.

Body weight management in overweight and obese breast cancer survivors

Hassan Shaikh  1 , Peter Bradhurst  2 , Li Xin Ma  3   4 , Sim Yee Cindy Tan  3   5   6 , Sam J Egger  7 , Janette L Vardy  3   8
Affiliations
Meta-Analysis

Body weight management in overweight and obese breast cancer survivors

Hassan Shaikh et al. Cochrane Database Syst Rev. .

Abstract

Background: Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend.

Objectives: To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2).

Search methods: We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts.

Selection criteria: We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss.

Data collection and analysis: Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available.

Main results: We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality.

Authors' conclusions: Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.

Trial registration: ClinicalTrials.gov NCT02750826.

PubMed Disclaimer

Conflict of interest statement

HS: none known. PB: none known. LXM: none known. SYT: none known. JV: none known. SE: none known.

Figures

1
1
Study flow diagram.
2
2
'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.
3
3
Forest plot of comparison: 1 All weight loss interventions vs controls (no subgrouping), outcome: 1.2 Change in body weight [kg].
4
4
Funnel plot 1: Change in body weight [kg]. Assessing publication bias and/or small‐study effects. Plot includes all intervention‐comparisons with extractable data for change in body weight. The plot does not show substantial asymmetry (Egger's test P value 0.40).
5
5
Forest plot of comparison: 1 All weight loss interventions vs controls (no subgrouping), outcome: 1.3 Change in body mass index [kg/m2].
6
6
Funnel plot 2: Change in body mass index [kg/m2]. Assessing publication bias and/or small‐study effects. Plot includes all intervention‐comparisons with extractable data for change in body mass index. The plot does not show substantial asymmetry (Egger's test P value 0.13).
7
7
Forest plot of comparison: 1 All weight loss interventions vs controls (no subgrouping), outcome: 1.4 Change in waist circumference [cm].
8
8
Funnel plot 3: Change in waist circumference [cm]. Assessing publication bias and/or small‐study effects. Plot includes all intervention‐comparisons with extractable data for change in waist circumference. The plot does not show substantial asymmetry (Egger's test P value 0.20).
1.1
1.1. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 1: Cancer recurrence
1.2
1.2. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 2: Change in body weight
1.3
1.3. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 3: Change in body mass index [kg/m2]
1.4
1.4. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 4: Change in waist circumference
1.5
1.5. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 5: Adverse events
1.6
1.6. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 6: Change in quality of life ‐ overall scales
1.7
1.7. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 7: Change in quality of life ‐ physical subscales
1.8
1.8. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 8: Change in quality of life ‐ social subscales
1.9
1.9. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 9: Change in quality of life ‐ emotional subscales
1.10
1.10. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 10: Change in quality of life ‐ mental health subscales
1.11
1.11. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 11: Change in quality of life ‐ anxiety/depression subscales
1.12
1.12. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 12: Change in insulin
1.13
1.13. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 13: Change in glucose
1.14
1.14. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 14: Change in total cholesterol
1.15
1.15. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 15: Change in HDL cholesterol
1.16
1.16. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 16: Change in LDL cholesterol
1.17
1.17. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 17: Change in triglycerides
1.18
1.18. Analysis
Comparison 1: All weight loss interventions vs controls (no subgrouping), Outcome 18: Change in leptin
2.1
2.1. Analysis
Comparison 2: Subgrouped by Intervention type vs control type, Outcome 1: Change in body weight
2.2
2.2. Analysis
Comparison 2: Subgrouped by Intervention type vs control type, Outcome 2: Change in body mass index [kg/m2]
2.3
2.3. Analysis
Comparison 2: Subgrouped by Intervention type vs control type, Outcome 3: Change in waist circumference
3.1
3.1. Analysis
Comparison 3: Subgrouped by ethnicity, Outcome 1: Change in body weight
3.2
3.2. Analysis
Comparison 3: Subgrouped by ethnicity, Outcome 2: Change in body mass index [kg/m2]
3.3
3.3. Analysis
Comparison 3: Subgrouped by ethnicity, Outcome 3: Change in waist circumference
4.1
4.1. Analysis
Comparison 4: Subgrouped by menopausal status, Outcome 1: Change in body weight
4.2
4.2. Analysis
Comparison 4: Subgrouped by menopausal status, Outcome 2: Change in body mass index [kg/m2]
4.3
4.3. Analysis
Comparison 4: Subgrouped by menopausal status, Outcome 3: Change in waist circumference
5.1
5.1. Analysis
Comparison 5: Subgrouped by duration of follow‐up (months), Outcome 1: Change in body weight
5.2
5.2. Analysis
Comparison 5: Subgrouped by duration of follow‐up (months), Outcome 2: Change in body mass index [kg/m2]
5.3
5.3. Analysis
Comparison 5: Subgrouped by duration of follow‐up (months), Outcome 3: Change in waist circumference
6.1
6.1. Analysis
Comparison 6: Sensitivity analyses ‐ analyses 1.1, 1.2, 1.3 repeated but with fixed effect approach, Outcome 1: Change in body weight
6.2
6.2. Analysis
Comparison 6: Sensitivity analyses ‐ analyses 1.1, 1.2, 1.3 repeated but with fixed effect approach, Outcome 2: Change in body mass index [kg/m2]
6.3
6.3. Analysis
Comparison 6: Sensitivity analyses ‐ analyses 1.1, 1.2, 1.3 repeated but with fixed effect approach, Outcome 3: Change in waist circumference
See this image and copyright information in PMC

Update of

  • doi: 10.1002/14651858.CD012110

References

References to studies included in this review

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    1. Stendell-Hollis NR, Thomson CA, Thompson PA, Bea JW, Cussler EC, Hakim IA. Green tea improves metabolic biomarkers, not weight or body composition: a pilot study in overweight breast cancer survivors. Journal of Human Nutrition and Dietetics 2010;23(6):590-600. [DOI: 10.1111/j.1365-277X.2010.01078.x] - DOI - PMC - PubMed
Stolley 2017 {published data only (unpublished sought but not used)}
    1. NCT02482506. Moving forward: a weight loss intervention for African-American breast cancer survivors. clinicaltrials.gov/ct2/show/NCT02482506 (first received 26 June 2015).
    1. Stolley M, Sheean P, Gerber B, Arroyo C, Schiffer L, Banerjee A, et al. Efficacy of a weight loss intervention for African American breast cancer survivors. Journal of Clinical Oncology 2017;35(24):2820-8. [DOI: 10.1200/JCO.2016.71.9856] - DOI - PMC - PubMed
    1. Stolley MR, Sharp LK, Fantuzzi G, Arroyo C, Sheean P, Schiffer L, et al. Study design and protocol for moving forward: a weight loss intervention trial for African-American breast cancer survivors. BMC Cancer 2015;15:1018. - PMC - PubMed
Swisher 2015 {published data only}
    1. Swisher AK, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, et al. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Supportive Care in Cancer 2015;23(10):2995-3003. [DOI: 10.1007/s00520-015-2667-z] - DOI - PMC - PubMed
    1. Vona-Davis L, Abraham J, Bonner D, Gilleland D, Hobbs G, Kurian S, et al. Effect of a 12-week supervised physical activity and healthy eating program on body weight, functional capacity and serum biomarkers in survivors of triple-negative breast cancer: A randomized, controlled trial. Cancer Research 2015;75(9 Suppl):Abstract nr P1-09-12.
Thomson 2010 {published data only}
    1. Thomson CA, Stopeck AT, Bea JW, Cussler E, Nardi E, Frey G, et al. Changes in body weight and metabolic indexes in overweight breast cancer survivors enrolled in a randomized trial of low-fat vs. reduced carbohydrate diets. Nutrition and Cancer 2010;62(8):1142-52. [DOI: 10.1080/01635581.2010.513803] - DOI - PubMed

References to studies excluded from this review

16NCT00249015 {published data only}
    1. NCT00249015. Trial of combined aerobic and resistance exercise in breast cancer survivors. clinicaltrials.gov/ct2/show/NCT00249015 (first received 7 November 2005).
Arneil 2017 {published data only}
    1. Arneil M, Anderson D, Alexander K, McCarthy A. Investigating the impact of physical activity on cognition-related quality of life in younger women after breast cancer treatment. Asia-Pacific Journal of Clinical Oncology 2017;13(Supplement 4):207-8.
Artene 2017 {published data only}
    1. Artene DV, Bordea CI, Blidaru A. Results of 1-year diet and exercise interventions for ER+/PR±/HER2- breast cancer patients correlated with treatment type. Chirurgia 2017;112(4):457-68. - PubMed
Azamian 2015 {published data only}
    1. Azamian A, Mobarekeh BG, Vismeh Z, Gohar NP. Effect of 12 weeks of selected pilates exercise training on serum adiponectin level and insulin resistance in female survivors of breast cancer and its role in prevention of recurrence [Persian]. Scientific Journal of Kurdistan University of Medical Sciences 2015;20(5):61-73.
Bachmann 2014 {published data only}
    1. NCT01331772. Impact of nutritional intervention in women with breast cancer under adjuvant chemotherapy (PASAPAS). clinicaltrials.gov/ct2/show/NCT01331772 Complete: last update October 30, 2014.
Basen‐Engquist 2009 {published data only}
    1. Basen-Engquist K, Perkins HY, Carmack Taylor CL, Hughes DC, Jovanovic JL, Arun BK, et al. Test of weight gain prevention intervention in stage II and III breast cancer patients receiving neoadjuvant chemotherapy. Journal of Clinical Oncology 2009;27(15 Suppl):e20523.
Baumann 2010 {published data only}
    1. Baumann FT, Leskaroski A, Knicker A, Krakowski-Roosen H, Bloch W, Harbeck N. Abstract P2-13-01: Effects of 12-week resistance training on strength, fatigue syndrome and quality of life with breast cancer patients during chemotherapy. Cancer Research 2010;70(24 Suppl):Abstract nr P2-13-01.
Befort 2014 {published data only}
    1. Befort CA, Klemp JR, Fabian C, Perri MG, Sullivan DK, Schmitz KH, et al. Protocol and recruitment results from a randomized controlled trial comparing group phone-based versus newsletter interventions for weight loss maintenance among rural breast cancer survivors. Contemporary Clinical Trials 2014;37(2):261-71. - PMC - PubMed
Befort 2016 {published data only}
    1. Befort CA, Klemp JR, Sullivan DK, Diaz FJ, Schmitz KH, Perri MG, et al. Comparison of strategies for weight loss maintenance among rural breast cancer survivors: the rural women connecting for better health randomized controlled trial. Cancer Research 2016;76(4 Suppl):Abstract nr P3-08-02.
Blackburn 2007 {published data only}
    1. Blackburn GL, Wang KA. Dietary fat reduction and breast cancer outcome: results from the Women's Intervention Nutrition Study (WINS). American Journal of Clinical Nutrition 2007;86(3):s878-81. - PubMed
Bucciarelli 2017a {published data only}
    1. Bucciarelli V, Bianco F, Blasio A, Morano T, Izzicupo P, Napolitano G, et al. The role of physical exercise on endothelial dysfunction and metabolic improvement in women after breast-cancer surgery: a pilot study. European Heart Journal 2017;38(1 Suppl):124.
Bucciarelli 2017b {published data only}
    1. Bucciarelli V, Bianco F, Blasio A, Morano T, Tuosto D, Mucedola F, et al. The differential effects of a short term aerobic or resistance physical exercise protocol in the improvement of endothelial function and cardiovascular efficiency in women after breast-cancer surgery. European Heart Journal - Cardiovascular Imaging 2017;18(3):iii24.
Butalla 2012 {published data only}
    1. Butalla AC, Crane TE, Patil B, Wertheim BC, Thompson P, Thomson CA. Effects of a carrot juice intervention on plasma carotenoids, oxidative stress, and inflammation in overweight breast cancer survivors. Nutrition and Cancer 2012;64(2):331-41. - PubMed
Chen 2009 {published data only}
    1. Chen B, Luo G, Hu M. Effect of individualized rehabilitation training for postoperative breast cancer patients. Practical Clinical Medicine 2009;10(8):96-7.
Chen 2017 {published data only}
    1. Chen Y. Effect of progressive rehabilitation nursing on the motion of shoulder joint, exercise endurance and quality of life for postoperative breast cancer patients. Journal of Aerospace Medicine 2017;28(9):1116-8.
Chen 2019 {published data only}
    1. Chen S, Wu Y. Application of nutritional intervention in period of enhanced recovery after surgery for patients with breast cancer. Today Nurse 2019;26(2):66-8.
Chlebowski 1987 {published data only}
    1. Chlebowski RT, Nixon DW, Blackburn GL, Jochimsen P, Scanlon EF, Insull W, et al. A breast cancer Nutrition Adjuvant Study (NAS): protocol design and initial patient adherence. Breast Cancer Research and Treatment 1987;10(1):21-9. - PubMed
Chlebowski 1993 {published data only}
    1. Chlebowski RT, Blackburn GL, Buzzard IM, Rose DP, Martino S, Khandekar JD, et al. Adherence to a dietary fat intake reduction program in postmenopausal women receiving therapy for early breast cancer. The Women's Intervention Nutrition Study. Journal of clinical Oncology 1993;11(11):2072-80. - PubMed
Chlebowski 1994 {published data only}
    1. Chlebowski RT, Blackburn G, Richie JP, Wynder E. Unanticipated effect of dietary fat intake reduction on Change in HDL cholesterol in postmenopausal women receiving tamoxifen. Proc. Amer. Soc. Clin. Onc. 1994;13:214.
Chlebowski 2006 {published data only}
    1. Chlebowski RT, Blackburn GL, Thomson CA, Nixon DW, Shapiro A, Hoy MK, et al. Dietary fat reduction and breast cancer outcome: interim efficacy results from the Women's Intervention Nutrition Study [see comment]. Journal of the National Cancer Institute 2006;98(24):1767-76. - PubMed
Chlebowski 2008 {published data only}
    1. Chlebowski RT, Blackburn GL, Hoy MK, Thomson CA, Giuliano AE, McAndrew P, et al. Survival analyses from the Women's Intervention Nutrition Study (WINS) evaluating dietary fat reduction and breast cancer outcome. Journal of Clinical Oncology 2008;26(15 Suppl):522.
Chlebowski 2015 {published data only}
    1. Chlebowski RT, Blackburn GL. Final survival analysis from the randomized Women's Intervention Nutrition Study (WINS) evaluating dietary intervention as adjuvant breast cancer therapy. Cancer Research 2015;75(9 Suppl):Abstract nr S5-08.
Courneya 2003 {published data only}
    1. Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology 2003;21(9):1660-8. - PubMed
Courneya 2006 {published data only}
    1. Courneya KS, Jones LW, Mackey JR, Fairey AS. Exercise beliefs of breast cancer survivors before and after participation in a randomized controlled trial. International Journal of Behavioral Medicine 2006;13(3):259-64. - PubMed
Courneya 2007 {published data only}
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.[see comment]. Journal of Clinical Oncology 2007;25(28):4396-404. - PubMed
Courneya 2013a {published data only}
    1. Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, et al. Exercise dose and type effects in breast cancer patients receiving chemotherapy: a randomized trial. Cancer Research 2013;73(24 Suppl):PD2-6-PD2-6.
Courneya 2013b {published data only}
    1. Courneya KS, Segal RJ, McKenzie DC, Dong H, Gelmon K, Friedenreich CM, et al. Effects of exercise during adjuvant chemotherapy on clinical outcomes in early stage breast cancer. Cancer Research 2013;73(24 Suppl):Abstract P4-08-01.
Courneya 2014a {published data only}
    1. Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, et al. Subgroup effects in a randomised trial of different types and doses of exercise during breast cancer chemotherapy. British Journal of Cancer 2014;111(9):1718-25. - PMC - PubMed
Courneya 2014b {published data only}
    1. Courneya KS, Segal RJ, Gelmon K, Mackey JR, Friedenreich CM, Yasui Y, et al. Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. International Journal of Behavioral Nutrition & Physical Activity 2014;11:85. - PMC - PubMed
Courneya 2014c {published data only}
    1. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, et al. Effects of exercise dose and type on sleep quality in breast cancer patients receiving chemotherapy: a multicenter randomized trial. Breast Cancer Research and Treatment 2014;144(2):361-9. - PubMed
Courneya 2014d {published data only}
    1. Courneya KS, Segal RJ, McKenzie DC, Dong H, Gelmon K, Friedenreich CM, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Medicine and Science in Sports and Medicine 2014;46(9):1744-51. - PubMed
De Luca 2016 {published data only}
    1. De Luca V, Minganti C, Borrione P, Grazioli E, Cerulli C, Guerra E, et al. Effects of concurrent aerobic and strength training on breast cancer survivors: a pilot study. Public Health 2016;136:126-32. - PubMed
Demark 2006 {published data only}
    1. Demark WW, Clipp EC, Morey MC, Pieper CF, Sloane R, Snyder DC, et al. Lifestyle intervention development study to improve physical function in older adults with cancer: Outcomes from project LEAD. Journal of Clinical Oncology 2006;24(21):3465-73. - PMC - PubMed
Demark‐Wahnefried 2003 {published data only}
    1. Demark-Wahnefried W, Clipp EC, McBride C, Lobach DF, Lipkus I, Peterson B, et al. Design of FRESH START: a randomized trial of exercise and diet among cancer survivors. Medicine and Science in Sports and Exercise 2003;35(3):415-24. - PubMed
Demark‐Wahnefried 2005 {published data only}
    1. Denmark-Wahnefried W, Morey MC, Clipp EC, Snyder DC. Results of Project LEAD (Leading the Way in Exercise and Diet) - A trial testing as intervention of telephone-counseling and mailed materials in improving physical functioning among older breast and prostate cancer survivors. Journal of Clinical Oncology 2005;23(16 Suppl):8138.
Demark‐Wahnefried 2006 {published data only}
    1. Demark-Wahnefried W, Clipp E, Lipkus I, Lobach D. Results of FRESH START: A randomized controlled trial to improve diet and exercise behaviours in breast and prostate cancer survivors. Journal of Clinical Oncology 2006;24(18 Suppl):8503.
Demark‐Wahnefried 2007 {published data only}
    1. Demark-Wahnefried W, Clipp EC, Lipkus IM, Lobach D, Snyder DC, Sloane R, et al. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. Journal of Clinical Oncology 2007;25(19):2709-18. - PubMed
Demark‐Wahnefried 2008 {published data only}
    1. Demark-Wahnefried W, Case LD, Blackwell K, Marcom PK, Kraus W, Aziz N, et al. Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clinical Breast Cancer 2008;8(1):70-9. - PubMed
Demark‐Wahnefried 2018b {published data only}
    1. NCT02224807. Effects of diet and exercise on ductal carcinoma in situ (DCIS). https://clinicaltrials.gov/ct2/show/NCT02224807 (first received 25 August 2014).
Dieli‐Conwright 2013 {published data only}
    1. Dieli-Conwright CM, Tripathy D, Schroeder ET, Mortimer JE, Bernstein L. Metabolic syndrome and breast cancer: effects of a 16-week combined exercise intervention. Journal of Clinical Oncology 2013;31(15 Suppl):TPS9648.
Dieli‐Conwright 2014 {published data only}
    1. Dieli-Conwright CM, Mortimer JE, Schroeder ET, Courneya K, Demark-Wahnefried W, Buchanan TA, et al. Randomized controlled trial to evaluate the effects of combined progressive exercise on metabolic syndrome in breast cancer survivors: rationale, design, and methods. BMC Cancer 2014;14:238. - PMC - PubMed
Dieli‐Conwright 2015a {published data only}
    1. Dieli-Conwright CM, Mortimer JE, Spicer D, Tripathy D, Buchanan T, Demark-Wahenfried W. Effects of a 16-week resistance and aerobic exercise intervention on metabolic syndrome in overweight/obese Latina breast cancer survivors. Cancer Epidemiology, Biomarkers & Prevention 2015;24(4):763.
Dieli‐Conwright 2016 {published data only}
    1. Dieli-Conwright C. Post-diagnosis exercise: Implications forLlatina breast cancer survivors. Psycho-oncology 2016;25:12.
Dieli‐Conwright 2017 {published data only}
    1. Dieli-Conwright CM, Hughes-Parmentier J, Lee K, Spicer D, Mack W, Sattler F, et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16-week aerobic and resistance exercise intervention. Cancer Research 2017;77(13 Suppl):Abstract nr 985. - PMC - PubMed
Dieli‐Conwright 2018a {published data only}
    1. Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Buchanan TA, et al. Effects of aerobic and resistance exercise on metabolic syndrome, sarcopenic obesity, and circulating biomarkers in overweight or obese survivors of breast cancer: a randomized controlled trial. Journal of Clinical Oncology 2018;36(9):875-83. - PMC - PubMed
Dieli‐Conwright 2018b {published data only}
    1. Dieli-Conwright CM, Parmentier JH, Sami N, Lee K, Spicer D, Mack WJ, et al. Adipose tissue inflammation in breast cancer survivors: effects of a 16-week combined aerobic and resistance exercise training intervention. Breast Cancer Research and Treatment 2018;168(1):147-57. - PMC - PubMed
Dieli‐Conwright 2018c {published data only}
    1. Dieli-Conwright CM, Sami N, Lee K, Spicer D, Buchanan TA, Demark-Wahnefried W, et al. Effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome in overweight/obese Hispanic breast cancer survivors. Cancer Research 2018;78(4 Suppl):Abstract nr P5-13-01.
Djuric 2009 {published data only}
    1. Djuric Z, Mirasolo J, Kimbrough L, Brown DR, Heilbrun LK, Canar L, et al. A pilot trial of spirituality counseling for weight loss maintenance in African American breast cancer survivors. Journal of the National Medicine Association 2009;101(6):552-64. - PMC - PubMed
Djuric 2011 {published data only}
    1. Djuric Z, Ellsworth JS, Weldon AL, Ren J, Richardson CR, Resnicow K, et al. A diet and exercise intervention during Chemotherapy for breast cancer. Open Obesity Journal 2011;3:87-97. - PMC - PubMed
Dong 2019 {published data only}
    1. Dong X. Effect of diversified exercise with internet-based and application of social media software on postoperative rehabilitation for patients with breast cancer. Jinan, Shandong, China: Shandong Normal University 2019.
Fairey 2003 {published data only}
    1. Fairey AS, Courneya KS, Field CJ, Bell GJ, Jones LW, Mackey JR. Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial. Cancer Epidemiology, Biomarkers & Prevention 2003;12(8):721-7. - PubMed
Fang 2017 {published data only}
    1. Fang R. Observation of postoperative rehabilitation treatment for breast cancer and its effect on quality of life. Chinese Medical Guide Journal 2017;15(18):132-3.
Fang 2018 {published data only}
    1. Fang Q, Chen Y, Dong X, Zhang N, Shen K, Wu P. The relationship between body mass, physical activity and quality of life in patients with breast cancer during adjuvant chemotherapy. Journal of Shanghai Jiao Tong University (Medical Science) 2018;38(9):1080-4.
Fong 2015 {published data only}
    1. Fong A, Sabiston C, O'Loughlin E. An evaluation of a community-based physical activity program for breast cancer survivors. Psycho-Oncology 2015;24:302.
Fu 2015 {published data only}
    1. Fu J, Li S, Pang H. Clinical observation of Huangqi Zhishi Decoction on the treatment of patients with breast cancer. Journal of Sichuan of Traditional Chinese Medicine 2015;33(1):117-9.
Fu H 2017 {published data only}
    1. Fu H, Lin W, Wu M, Peng F. Effect of rehabilitation nursing on postoperative breast cancer patients. China Medicine and Pharmacy 2017;7(6):105-7.
Fu YQ 2017 {published data only}
    1. Fu Y, Wong M, Sheng A, Wang X, Chen X, Li X. Effect of rehabilitation intervention on quality of life for breast cancer patients in rural communities. China Rural Health 2017;17:43-5.
Goodwin 2015 {published data only}
    1. Goodwin PJ, Parulekar WR, Gelmon KA, Shepherd LE, Ligibel JA, Hershman DL, et al. Effect of metformin vs placebo on and metabolic factors in NCIC CTG MA.32. Journal of the National Cancer Institute 2015;107(3):djv006. - PMC - PubMed
Greenlee 2015 {published data only}
    1. Greenlee H, Lew D, Hershman DL, Pierce JP, Hansen LK, Newman VA, et al. Phase II feasibility study of a physical activity and dietary change weight loss intervention in a subset analysis of breast cancer survivors (SWOG S1008). Journal of Clinical Oncology 2015;33(15 Suppl):9572.
Guan 2018 {published data only}
    1. Guan X. Effect of aerobic rehabilitation combined with psychotherapy on patients with breast cancer in perioperative period. China Modern Medicine 2018;25(12):42-4.
Guo 2017 {published data only}
    1. Guo Yuanzhi. Application of case management in weight control for postoperative breast cancer patients during chemotherapy [D] (In Chinese). Zhengzhou, Henan, China: Zhengzhou University 2017. [DOI: ]
Guo 2019 {published data only}
    1. Guo T, Zhang Z. Advances in research of exercise therapy on quality of life for patients with breast cancer. Journal of Nurses Training 2019;34(21):1960-3.
Hao 2018 {published data only}
    1. Hao F. Analysis of complication prevention and nursing for postoperative elderly obese breast cancer patients. Guide of China Medicine 2018;16(6):279-80.
Hayes 2009 {published data only}
    1. Hayes SC, Reul-Hirche H, Turner J. Exercise and secondary lymphedema: safety, potential benefits, and research issues. Medicine and Science in Sports and Exercise 2009;41(3):483-9. - PubMed
Hayes 2010 {published data only}
    1. Hayes SC, Rye S, Eakin E, Battistutta D. Abstract PD08-08: Exercise for health: a randomised, controlled trial of an exercise intervention for women with breast cancer -- effect on upper-body function. Cancer Research 2011;70(24 Suppl):PD08-08.
Hayes 2012 {published data only}
    1. Hayes S, Battistutta D, Eakin E. Evaluating telephone versus face-to-face modes of exercise intervention delivery to women during and following treatment for breast cancer. COSA-IPOS 2012 2012;8:117-8.
Hayes 2013 {published data only}
    1. Hayes SC, Rye S, Disipio T, Yates P, Bashford J, Pyke C, et al. Exercise for health: a randomized, controlled trial evaluating the impact of a pragmatic, translational exercise intervention on the quality of life, function and treatment-related side effects following breast cancer. Breast Cancer Research and Treatment 2013;137(1):175-86. - PubMed
Hu 2013 {published data only}
    1. Hu H, Li T, Liu L, Wu C, Wang Y. Effects of a walking program on fatigue and exercise capacity in post-surgery breast cancer women. Taiwan Journal of Nursing 2013;60(5):53-63. - PubMed
Irwin 2008 {published data only}
    1. Irwin ML, Cadmus L, Alvarez RM, O'Neil M, Mierzejewski E, Latka R, et al. Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial: the Yale Exercise and Survivorship Study. Cancer 2008;112(11 Suppl):2593-606. - PMC - PubMed
Irwin 2009a {published data only}
    1. Irwin ML, varez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, et al. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity 2009;17(8):1534-41. - PMC - PubMed
Irwin 2009b {published data only}
    1. Irwin ML, Varma K, Alvarez-Reeves M, Cadmus L, Wiley A, Chung GG, et al. Randomized controlled trial of aerobic exercise on insulin and insulin-like growth factors in breast cancer survivors: the Yale Exercise and Survivorship study. Cancer Epidemiology, Biomarkers & Prevention 2009;18(1):306-13. - PMC - PubMed
Irwin 2012 {published data only}
    1. Irwin M, Cartmel B, Ercolano E, Fiellin M, Rothbard M, Capozza S, et al. Aromatase inhibitors, arthralgias, and exercise in breast cancer survivors. Journal of Clinical Oncology 2012;30(15 Suppl):TPS669.
Irwin 2015a {published data only}
    1. Irwin ML, Cartmel B, Gross CP, Ercolano E, Li F, Yao X, et al. Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. Journal of Clinical Oncology 2015;33(10):1104-11. [DOI: 10.1200/JCO.2014.57.1547] - DOI - PMC - PubMed
Irwin 2015b {published data only}
    1. Irwin ML, Cartmel B, Harrigan M, Sanft TB, Wong C, Hughes M, et al. Impact of the LIVESTRONG at the YMCA Program on physical activity, fitness, and quality of life in cancer survivors. Journal of Clinical Oncology 2015;33(15 Suppl):9508.
Irwin 2017 {published data only}
    1. Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer 2017;123(7):1249-58. - PMC - PubMed
Janelsins 2011 {published data only}
    1. Janelsins MC, Davis PG, Wideman L, Katula JA, Sprod LK, Peppone LJ, et al. Effects of Tai Chi Chuan on insulin and cytokine levels in a randomized controlled pilot study on breast cancer survivors. Clinical Breast Cancer 2011;11(3):161-70. - PMC - PubMed
Jenkins 2003 {published data only}
    1. Jenkins I, Djuric Z, Darga L, DiLaura NM, Magnan M, Hryniuk WM. Relationship of psychiatric diagnosis and weight loss maintenance in obese breast cancer survivors. Obesity Research 2003;11(11):1369-75. - PubMed
Jin 2017 {published data only}
    1. Jin C, Wang L, Wang B. Effects of yoga on cancer fatigue and quality of life for patients with breast cancer during chemotherapy. Nursing of Integrated Traditional Chinese and Western Medicine 2017;3(4):12-5.
Jones 2000 {published data only}
    1. Jones VE, Hollenbach K, Rock C, Faerber S, Haan M, Gold E, et al. The women's healthy eating and living (WHEL) study: a nutritional intervention study in breast cancer survivors. 23rd Annual San Antonio Breast Cancer Symposium 2000;64(1):49.
Kampshoff 2016 {published data only}
    1. Kampshoff CS, Mechelen W, Schep G, Nijziel MR, Witlox L, Bosman L, et al. Participation in and adherence to physical exercise after completion of primary cancer treatment. International Journal of Behavioral Nutrition and Physical Activity 2016;13(1):100. - PMC - PubMed
Kanera 2017 {published data only}
    1. Kanera IM, Willems RA, Bolman CA, Mesters I, Verboon P, Lechner L. Long-term effects of a web-based cancer aftercare intervention on moderate physical activity and vegetable consumption among early cancer survivors: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity 2017;14(1):19. - PMC - PubMed
Kim 2017 {published data only}
    1. Kim TH, Chang JS, Park KS, Park J, Kim N, Lee JI, et al. Effects of exercise training on circulating levels of Dickkpof-1 and secreted frizzled-related protein-1 in breast cancer survivors: a pilot single-blind randomized controlled trial. POS One 2017;12(2):e0171771. - PMC - PubMed
Kimmick 2007 {published data only}
    1. Kimmick GG, McCoy TP, Milhalko SL, Ribisl PM, Anderson RT. Research on optimal recovery practices in breast cancer: the RESTORE trial. 30th Annual San Antonio Breast Cancer Symposium 2007.
Knobf 2017a {published data only}
    1. Knobf MT, Jeon S, Smith B, Harris L, Thompson S, Stacy MR, et al. The Yale Fitness Intervention Trial in female cancer survivors: cardiovascular and physiological outcomes. Heart Lung 2017;46(5):375-81. - PMC - PubMed
Knobf 2017b {published data only}
    1. Knobf MT, Sinusas A, Holland M, Jeon S. Exercise, metabolic syndrome, and cardiovascular fitness in breast cancer survivors. Journal of Clinical Oncology 2017;35(5 Suppl):165.
Lahart 2018 {published data only}
    1. Lahart IM, Carmichael AR, Nevill AM, Kitas GD, Metsios GS. The effects of a home-based physical activity intervention on cardiorespiratory fitness in breast cancer survivors; a randomised controlled trial. Journal of Sports Sciences 2018;36(10):1077-86. - PubMed
Larkey 2016a {published data only}
    1. Larkey LK, Roe DJ, Smith L, Millstine D. Exploratory outcome assessment of Qigong/Tai Chi Easy on breast cancer survivors. Complementary Therapies in Medicine 2016;29:196-203. - PMC - PubMed
Li 2018 {published data only}
    1. Li Y. Effects of staged care intervention on the quality of life and upper limb function for patients with breast cancer. Women's Health Research 2018;9:153-4.
Ligibel 2008 {published data only}
    1. Ligibel JA, Campbell N, Partridge A, Chen WY, Salinardi T, Chen H, et al. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. Journal of Clinical Oncology 2008;26(6):907-12. - PubMed
Ligibel 2009 {published data only}
    1. Ligibel JA, Giobbie-Hurder A, Olenczuk D, Campbell N, Salinardi T, Winer EP, et al. Impact of a mixed strength and endurance exercise intervention on levels of adiponectin, high molecular weight adiponectin and leptin in breast cancer survivors. Cancer Causes & Control 2009;20(8):1523-8. - PubMed
Ligibel 2012 {published data only}
    1. Ligibel JA, Meyerhardt J, Pierce JP, Najita J, Shockro L, Campbell N, et al. Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting. Breast Cancer Treatment and Research 2012;132(1):205-13. - PMC - PubMed
Liu 2016 {published data only}
    1. Liu A. Effect of nursing intervention on quality of life for postoperative breast cancer patients. Journal of Clinical Medicine in Practice 2016;20(8):83-6.
Liu 2018 {published data only}
    1. Liu X, Zhou l, Li J, Zhang S. Effects of evidence-based nursing on postoperative functional exercise compliance and quality of life for patients with breast cancer. Chinese Journal of Clinical Oncology and Rehabilitation 2018;25(2):194-7.
Loftfield 2014 {published data only}
    1. Loftfield E, Harrigan M, Li F, Cartmel B, Zhou Y, Playdon M, et al. Effect of weight loss intervention on inflammatory and metabolic markers in breast cancer survivors: the lifestyle, exercise, and nutrition (LEAN) study. Journal of Clinical Oncology 2014;32(15 Suppl):1505.
Luo 2017 {published data only}
    1. Luo S, Ouyang K. The influence of TCM emotional nursing on negative mood and quality of life for postoperative breast cancer patients in community-based rehabilitation. Journal of Qiqihar University of Medicine 2017;38(09):1105-7.
Mayer 2010 {published data only}
    1. Mayer EL, Ligibel JA, Burstein HJ, Miller K, Carey LA, Rugo HS, et al. TBCRC 012: ABCDE, a phase II randomized study of adjuvant bevacizumab, metronomic chemotherapy (CM), diet and exercise after preoperative chemotherapy for breast cancer. Journal of Clinical Oncology 2010;28(15 Suppl):TPS103.
Mijwel 2018 {published data only}
    1. Mijwel S, Backman M, Bolam KA, Olofsson E, Norrbom J, Bergh J, et al. Highly favorable physiological responses to concurrent resistance and high-intensity interval training during chemotherapy: the OptiTrain breast cancer trial. Breast Cancer Research and Treatment 2018;169(1):93-103. - PMC - PubMed
Mutschler 2018 {published data only}
    1. Mutschler NS, Scholz C, Friedl TW, Zwingers T, Fasching PA, Beckmann MW, et al. Prognostic impact of weight change during adjuvant chemotherapy in patients with high-risk early breast cancer: results from the ADEBAR study. Clinical Breast Cancer 2018;18(2):175-83. - PubMed
NCT00068458 {published data only}
    1. NCT00068458. Survival TRaining for ENhancing Total Health (STRENGTH). clinicaltrials.gov/ct2/show/NCT00068458 (first received 11 September 2003).
NCT00153894 {published data only}
    1. NCT00153894. Effects of exercise intervention on insulin levels in breast cancer survivors. clinicaltrials.gov/ct2/show/NCT00153894 (first received 12 September 2005).
NCT00548236 {published data only}
    1. NCT00548236. The Active After Cancer Trial (AACT). https://www.clinicaltrials.gov/ct2/show/NCT00548236 (first received 23 October 2007).
NCT00583726 {published data only}
    1. NCT00583726. The women's healthy lifestyle study. clinicaltrials.gov/ct2/show/NCT00583726 (first received 31 December 2007).
NCT00774371 {published data only}
    1. NCT00774371. Weight reduction intervention for breast cancer survivors (SHAPE). clinicaltrials.gov/ct2/show/NCT00774371 (first received 7 October 2008).
NCT00872677 {published data only}
    1. NCT00872677. Weight loss counseling for African American women who are breast cancer survivors. clinicaltrials.gov/ct2/show/NCT00872677 (first received 31 March 2009).
NCT02030353 {published data only}
    1. NCT02030353. The use of smart scales for weight gain prevention in African American breast cancer survivors. clinicaltrials.gov/ct2/show/NCT02030353 (first received 8 January 2014).
NCT02109068 {published data only}
    1. NCT02109068. Lifestyle, exercise and nutrition study 1 (LEAN). clinicaltrials.gov/ct2/show/NCT02109068 (first received 9 April 2014).
NCT03091842 {published data only}
    1. NCT03091842. Exercise intervention in targeting adiposity and inflammation with movement to improve prognosis in breast cancer. clinicaltrials.gov/ct2/show/NCT03091842 (first received 27 March 2017).
NCT03124095 {published data only}
    1. NCT03124095. Combined training intervention for women who underwent primary treatment for breast cancer (+ Vida). clinicaltrials.gov/ct2/show/NCT03124095 (first received 21 April 2017).
NCT03284346 {published data only}
    1. NCT03284346. Exercise in targeting metabolic dysregulation in stage I-III breast or prostate cancer survivors. https://clinicaltrials.gov/ct2/show/NCT03284346 (first received 15 September 2017).
NCT03523195 {published data only}
    1. NCT03523195. Exercise intervention after cancer treatment for improving health in stage II-III breast cancer survivors (PACT). clinicaltrials.gov/ct2/show/NCT03523195 (date first received 14 May 2018).
Owusu 2019 {published data only}
    1. NCT02763228. Physical activity intervention to reduce functional health disparities among breast cancer survivors. clinicaltrials.gov/ct2/show/NCT02763228 (first received 5 May 2016).
Pegington 2018 {published data only}
    1. Pegington M, Adams JE, Bundred NJ, Campbell AM, Howell A, Howell SJ, et al. Recruitment to the "Breast-Activity and Healthy Eating After Diagnosis" (B-AHEAD) randomized controlled trial. Integrative Cancer Therapies 2018;17(1):131-7. - PMC - PubMed
Pelekasis 2016 {published data only}
    1. Pelekasis P, Zisi G, Koumarianou A, Marioli A, Chrousos G, Syrigos K, et al. Forming a stress management and health promotion program for women undergoing chemotherapy for breast cancer: a pilot randomized controlled trial. Integrative Cancer Therapies 2016;15(2):165-74. - PMC - PubMed
Pierce 1997 {published data only}
    1. Pierce JP, Faerber S, Wright FA, Newman V, Flatt SW, Kealey S, et al. Feasibility of a randomized trial of a high-vegetable diet to prevent breast cancer recurrence. Nutrition and Cancer 1997;28(3):282-8. - PubMed
Pierce 2002 {published data only}
    1. Pierce JP, Faerber S, Wright FA, Rock CL, Newman V, Flatt SW, et al. A randomized trial of the effect of a plant-based dietary pattern on additional breast cancer events and survival: the Women's Healthy Eating and Living (WHEL) Study. Controlled Clinical Trials 2002;23(6):728-56. - PubMed
Pierce 2004 {published data only}
    1. Pierce JP, Newman VA, Flatt SW, Faerber S, Rock CL, Natarajan L, et al. Telephone counseling intervention increases intakes of micronutrient- and phytochemical-rich vegetables, fruit and fiber in breast cancer survivors. Journal of Nutrition 2004;134(2):452-8. - PubMed
Pierce 2007a {published data only}
    1. Pierce JP, Natarajan L, Caan BJ, Parker BA, Greenberg ER, Flatt SW, et al. Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women's Healthy Eating and Living (WHEL) randomized trial. JAMA 2007;298(3):289-98. - PMC - PubMed
Pierce 2007b {published data only}
    1. Pierce JP, Natarajan L, Cann BJ, Parker BA, Greenberg ER, Flatt SW, et al. The influence of a very high vegetable-fruit-fiber, low-fat diet on prognosis following treatment for breast cancer: results from the Women's Healthy Eating and Living (WHEL) randomized trial. Breast Cancer Research and Treatment 2007;106(1):S16. - PMC - PubMed
Pierce 2009 {published data only}
    1. Pierce JP, Natarajan L, Caan BJ, Flatt SW, Kealey S, Gold EB, et al. Dietary change and reduced breast cancer events among women without hot flashes after treatment of early-stage breast cancer: subgroup analysis of the Women's Healthy Eating and Living Study. American Journal of Clinical Nutrition 2009;89(5):1565s-71s. - PMC - PubMed
Qin 2015 {published data only}
    1. Qin H. Effect of TCM regimen of strengthening spleen and tonifying kidney for patients with advanced breast cancer. Nei Mongol Journal of Traditional Chinese Medicine 2015;34(11):54-5. [DOI: 10.16040/j.cnki.cn15-1101.2015.11.052] - DOI
Qu 2012 {published data only}
    1. Qu W, Wu X, Feng J, Gao Q, Shao S, Zhang T, et al. Influence of Chinese herbal compound prescription on the outcomes of 5-year disease-free survival rate and overall survival rate for patients with breast cancer. China Medical Herald 2012;9(36):120-2.
Ramirez 2016 {published data only}
    1. Ramirez AG, Munoz E, Long-Parma D, Mendoza KD, Holden AE, Wargovich MJ. An anti-inflammatory dietary intervention to reduce breast cancer recurrence risk: preliminary data from a pilot study. Cancer Epidemiology, Biomarkers & Prevention 2016;25(Suppl 3):Abstract nr A66.
Ramirez 2017 {published data only}
    1. Ramirez AG, Parma DL, Munoz E, Mendoza KD, Harb C, Holden AEC, et al. An anti-inflammatory dietary intervention to reduce breast cancer recurrence risk: Study design and baseline data. Contemporary Clinical Trials 2017;57:1-7. - PMC - PubMed
Rao 2012 {published data only}
    1. Rao R, Cruz V, Peng Y, Harker-Murray A, Haley BB, Zhao H, et al. Bootcamp during neoadjuvant chemotherapy for breast cancer: a randomized pilot trial. Breast Cancer: Basic and Clinical Research 2012;6(1):39-46. - PMC - PubMed
Ren HB 2015 {published data only}
    1. Ren Hongbing. Effect of reusing astragalus combined with regimen of supporting the healthy energy on cancer-induced fatigue for breast cancer patients in rehabilitation period [D] (In Chinese). Guangzhou, China: Guangzhou University of Chinese Medicine 2015. [DOI: ]
Rock 2013 {published data only}
    1. Rock CL, Pande C, Flatt SW, Ying C, Pakiz B, Parker BA, et al. Favorable changes in serum estrogens and other biologic factors after weight loss in breast cancer survivors who are overweight or obese. Clinical Breast Cancer 2013;13(3):188-95. - PMC - PubMed
Roveda 2017 {published data only}
    1. Roveda E, Vitale JA, Bruno E, Montaruli A, Pasanisi P, Villarini A, et al. Protective effect of aerobic physical activity on sleep behaviour in breast cancer survivors. Effect of aerobic physical activity on sleep behavior in breast cancer survivors. Integrative Cancer Therapies 2017;16(1):21-31. - PMC - PubMed
Schmitt 2016 {published data only}
    1. Schmitt J, Lindner N, Reuss-Borst M, Holmberg HC, Sperlich B. A 3-week multimodal intervention involving high-intensity interval training in female cancer survivors: a randomized controlled trial. Physiological Reports 2016;4(3):e12693. - PMC - PubMed
Su X 2013 {published data only}
    1. Su X, Guo L. Postoperative preventional rehabilitation nursing for patients with breast cancer. Guide of China Medicine 2013;11(13):741-2.
Tang 2016 {published data only}
    1. Tang L. Effect of aerobic rehabilitation exercise on elderly female postoperative breast cancer patients with depression. Journal of Liaoning Medical University 2016;37(4):44-7.
Thomas 2013 {published data only}
    1. Thomas GA, Alvarez-Reeves M, Lu L, Yu H, Irwin ML. Effect of exercise on metabolic syndrome variables in breast cancer survivors. International Journal of Endocrinology 2013:Article ID 168797. - PMC - PubMed
Thomas 2017 {published data only}
    1. Thomas GA, Cartmel B, Harrigan M, Fiellin M, Capozza S, Zhou Y, et al. The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors. Obesity 2017;25(2):346-51. - PMC - PubMed
Valle 2017 {published data only}
    1. Valle CG, Deal AM, Tate DF. Preventing weight gain in African American breast cancer survivors using smart scales and activity trackers: a randomized controlled pilot study. Journal of Cancer Survivorship: Research and Practice 2017;11(1):133-48. - PMC - PubMed
Waard 1993a {published data only}
    1. Waard F, Ramlau R, Mulders Y, Vries T, Waveren S. A feasibility study on weight reduction in obese postmenopausal breast cancer patients. European Journal of Cancer Prevention 1993;2(3):233-8. - PubMed
Wan 2019 {published data only}
    1. Wan H. Effects of integrated nursing of traditional Chinese and western medicine on improving the quality of life for patients with breast cancer during chemotherapy. Medical Information 2019;32(11):185-7.
Wang 2011 {published data only}
    1. Wang Y, Wang K. Effect of Kang'ai Injection on breast cancer. Chinese Journal of Modern Drug Application 2011;5(21):59-60.
Wang 2013 {published data only}
    1. Wang G. Effects of Yoga on chemotherapy-induced cancer fatigue and quality of life for patients with breast cancer (In Chinese) [D]. Changsha, Hunan, China: Central South University 2013. [DOI: ]
Wang 2017 {published data only}
    1. Wang Y. Effects of Tai-Ji-Quan exercise on cancer fatigue and quality of life for elderly postoperative breast cancer patients (In Chinese) [D]. Wuhu, Anhui, China: Anhui Normal University 2017.
Wang 2018 {published data only}
    1. Wang L. Application of music therapy combined with aerobic exercise on improving quality of sleep for breast cancer patients undergoing chemotherapy after radical operation. Journal of Qilu Nursing 2018;24(4):13-5.
Wang 2019 {published data only}
    1. Wang H. Effect of nursing intervention based on the theory of Maslow's Needs-hierarchy on the rehabilitation for patients with breast cancer after modified radical mastectomy [Need-hierarchy theory]. Medical Innovation of China 2019;16(14):83-6.
Wang YL 2010 {published data only}
    1. Wang Y, Sun X, Wang Y, Zhou L, Fang H, Liu L. Effects of Tai-Ji-Quan on limb function and quality of life for postoperative breast cancer patients. China Sport Science and Technology 2010;46(5):125-8.
Wang YL 2011 {published data only}
    1. Wang Y, Sun X. Effects of comprehensive rehabilitation exercises on stageⅠbreast cancer patients after breast reconstruction. In: The 9th National Sports Science Congress. Shanghai, China, 2011.
Wei 2016 {published data only}
    1. Wei L. The effect of progressive rehabilitation nursing on improving the quality of life after radical operation for patients with breast cancer. Shanghai Medical and Pharmaceutical Journal 2016;37(16):60-2.
Wengstrom 2017 {published data only}
    1. Wengstrom Y, Bolam KA, Mijwel S, Sundberg CJ, Backman M, Browall M, et al. Optitrain: a randomised controlled exercise trial for women with breast cancer undergoing chemotherapy. BMC Cancer 2017;17(1):100. - PMC - PubMed
Winters‐Stone 2011 {published data only}
    1. Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, et al. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Research and Treatment 2011;127(2):447-56. - PMC - PubMed
Winters‐Stone 2013 {published data only}
    1. Winters-Stone KM, Dobek J, Nail LM, Bennett JA, Leo MC, Torgrimson-Ojerio B, et al. Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial. Osteoporosis International 2013;24(5):1637-46. - PMC - PubMed
Xianmuxiding 2015 {published data only}
    1. Yilixiati X, Adila T, Li Y, Tuluhong S, Zhu L. Effect of body mass index on recurrence and metastasis for patients with breast cancer (In Chinese). Chongqing Medicine 2015;44(33):4660-2.
Xiong 2018 {published data only}
    1. Xiong W, Peng L. Effect of routine nursing and aerobic exercise combined with music therapy for postoperative breast cancer patients. Contemporary Medicine 2018;24(2):142-4.
Xu 2011 {published data only}
    1. Xu C, Lai H. Effect of systemic upper limb functional exercise on the quality of life for breast cancer patients. Jilin Medical Journal 2011;32(4):767-8.
Xu 2013 {published data only}
    1. Xu Y, Zhu X, Gao Y. Effect of foot bath with Chinese herbal medicine on cancer related fatigue for 28 cases of breast cancer patients after chemotherapy. Guiding Journal of TCM 2013;19(7):31-3.
Yuan 2017 {published data only}
    1. Yuan P. Effects of aerobic exercise combined with continuing nursing on post-traumatic growth and mental resilience for patients with breast cancer. Chinese Nursing Research 2017;31(21):2617-9.
Zeng 2017 {published data only}
    1. Zeng M. Effect and clinical applicability of continuity of care intervention on quality of life for breast cancer patients. Journal of Practical Medical Techniques 2017;24(7):809-10.
Zhao 2011 {published data only}
    1. Zhao H. Effect of psychological intervention on mood and quality of life for postoperative breast cancer patients. Journal of Nurses Training 2011;26(15):1413-25.
Zhao 2015 {published data only}
    1. Zhao Y, Hu W, Zhang J, Song Y, Zhao H. Effect of emotional factors on prognosis for patients with breast cancer. Chinese Journal of Clinical Research 2015;28(3):303-5.
Zhao 2016 {published data only}
    1. Zhao X, Tan L, Xiao Y. Effects of psychological care combined with aerobic exercise for postoperative breast cancer patients in rehabilitation period. Journal of Nursing Practice and Research 2016;13(24):60-1.
Zhou 2015 {published data only}
    1. Zhou T, Zou F. Effect of the intervention of Gonghuan Yangxue granule on deficiency of qi and blood caused by neoadjuvant chemotherapy for patients with breast cancer. Guiding Journal of TCM 2015;21(6):63-5.
Zou 2018 {published data only}
    1. Zou X. Effects of comprehensive psychological intervention combined with aerobic exercise on postoperative breast cancer patients. Today Nurse 2018;25(26):106-8.

References to studies awaiting assessment

BE‐WEL {published data only}
    1. ISRCTN86789850. BE-WEL (Breast - Evaluation of Weight and Exercise for Lymphoedema): a feasibility study to compare four different weight control and exercise programmes for women with breast cancer related lymphoedema. isrctn.com/ISRCTN86789850 (first received 9 August 2012).
BRIGHT {published data only}
    1. ISRCTN29623418. A weight loss trial of Weight Watchers groups with additional dietetic support compared to regular Weight Watchers groups only in women treated for breast cancer. isrctn.com/ISRCTN29623418 (first received 7 October 2013).
Fukui 2018 {published data only}
    1. Fukui JA, Kumarley N, Ciccone J, Hogan K, Fasano J, Shapiro CL, Bhardwaj AS, Irie H, Weltz C, Schmidt PH, Montgomery G, Ru M, Mandeli JP, Tiersten A. Comparison of weight loss among early stage breast cancer patients post treatment: Nutrition education in combination with weight loss acupuncture vs. nutrition education alone. Journal of Clinical Oncology 2018;36(15 Suppl):e12594. [DOI: 10.1200/JCO.2018.36.15_suppl.e12594] - DOI
    1. Fukui JA, Rothwell A, Danesh H, Adelson KB, Morris GJ, Irie H, et al. Comparison of weight loss among early-stage breast cancer patients post chemotherapy: nutrition education in combination with weight loss acupuncture versus nutrition education alone. Journal of Clinical Oncology 2014;32(15 Suppl):e12594.
    1. NCT02081612. Comparison of nutrition education alone or with acupuncture for weight loss in breast cancer patients post-chemotherapy. clinicaltrials.gov/ct2/show/NCT02081612 7 March 2014.
Hayes 2017 {published data only}
    1. Hayes SC, Steele M, Spence R, Pyke C, Saunders C, Bashford J, et al. Can exercise influence survival following breast cancer: results from a randomised, controlled trial. Journal of Clinical Oncology 2017;35(15 Suppl):10067.
Lasserre 2017 {published data only}
    1. Lasserre N. Effectiveness of a dietotherapeutic intervention on the lipids profile and the nutritional status in breast cancer women. Annals of Nutrition and Metabolism 2017;71(2 Suppl):895.
Lee 2016 {published data only}
    1. Lee K. The effects of a 16-week combined exercise training on obesity and physical fitness in breast cancer survivors: a randomized controlled trial. FASEB Journal 2016;30(Suppl 1):1240.5.
NCT01630499 {published data only}
    1. NCT01630499. My lifestyle intervention of food and exercise (MyLIFE). clinicaltrials.gov/ct2/show/NCT01630499 (first received 28 June 2012).
NCT02681965 {published data only}
    1. NCT02681965. A mail and video-based weight loss trial in breast cancer survivors. clinicaltrials.gov/ct2/show/NCT02681965 (first received 15 February 2016).
POWER‐remote {published data only}
    1. NCT01871116. POWER-remote weight loss program in early stage breast cancer. clinicalTrials.gov/show/NCT01871116 (first received 6 June 2013).
    1. Santa-Maria CA, Blackford A, Jerome GJ, Coughlin J, Snyder CF, Dalcin A, et al. POWER-remote: A randomized study evaluating the effect of a remote-based weight loss program on biomarkers in women with early-stage breast cancer. Journal of Clinical Oncology 2014;32(Suppl 15):TPS9657.
Reach for Health {published data only}
    1. NCT01302379. Reach for health study: obesity-related mechanisms and mortality in breast cancer survivors. clinicaltrials.gov/ct2/show/NCT01302379 (first received 24 February 2011).
    1. Patterson RE, Marinac CR, Natarajan L, Hartman SJ, Cadmus-Bertram L, Flatt SW, et al. Recruitment strategies, design, and participant characteristics in a trial of weight-loss and metformin in breast cancer survivors. Contemporary Clinical Trials 2016;47:64-71. - PMC - PubMed
Winkels 2017 {published data only}
    1. NCT01515124. The women in steady exercise research (WISER) survivor trial (WISER Survivor). clinicaltrials.gov/ct2/show/NCT01515124 (first received: 23 January 2012).
    1. Winkels RM, Sturgeon KM, Kallan MJ, Dean LT, Zhang Z, Evangelisti M, et al. The women in steady exercise research (WISER) survivor trial: The innovative transdisciplinary design of a randomized controlled trial of exercise and weight-loss interventions among breast cancer survivors with lymphedema. Contemporary Clinical Trials 2017;61:63-72. - PMC - PubMed
Yang 2017 {published data only}
    1. Yang FL, Hsiao-Hsuan L, Man-Ting L. Effects of nutrition intervention on nutritional status, physical activity and life quality of breast cancer survivors. FASEB journal 2018;31(Suppl 1):957.37.

References to ongoing studies

BWEL {published data only}
    1. NCT02750826. Breast Cancer WEight Loss Study (BWEL Study). https://clinicaltrials.gov/ct2/show/NCT02750826 (first received 26 April 2016).
Gnagnarella 2016 {published data only}
    1. Gnagnarella P, Draga D, Baggi F, Simoncini MC, Sabbatini A, Mazzocco K, et al. Promoting weight loss through diet and exercise in overweight or obese breast cancer survivors (InForma): study protocol for a randomized controlled trial. Trials 2016;17:363. - PMC - PubMed
    1. NCT02622711. Promoting weight loss through diet and exercise in overweight women with breast cancer (InForma). clinicaltrials.gov/ct2/show/NCT02622711 (first received 4 December 2015).
LEAN 2 {published data only}
    1. NCT02110641. Lifestyle, exercise and nutrition study 2 (LEAN 2. clinicaltrials.gov/ct2/show/NCT02110641 (first received 10 April 2014).
NCT00120029 {published data only}
    1. NCT00120029. Peer counselling for weight loss. clinicaltrials.gov/ct2/show/NCT00120029 (first received 14 July 2005).
NCT03394690 {published data only}
    1. NCT03394690. Effects of green coffee extract supplementation on change in leptin, ghrelin, adiponectin, anthropometric measurements, lipid profile in breast cancer survivors. clinicaltrials.gov/ct2/show/NCT03394690 (first received 9 January 2018).

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