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Meta-Analysis
. 2025 Oct 1;117(10):1984-1998.
doi: 10.1093/jnci/djaf062.

Effects of exercise on inflammation in female survivors of nonmetastatic breast cancer: a systematic review and meta-analysis

Francesco Bettariga  1   2 , Dennis R Taaffe  1   2 , Anita Borsati  3   4 , Alice Avancini  4   5 , Sara Pilotto  5 , Stefano G Lazzarini  6   7 , Pedro Lopez  8   9   10 , Luca Maestroni  11 , Umberto Crainich  11 , John P Campbell  1   12 , Timothy D Clay  1   2   13 , Daniel A Galvão  1   2 , Robert U Newton  1   2   14
Affiliations
Meta-Analysis

Effects of exercise on inflammation in female survivors of nonmetastatic breast cancer: a systematic review and meta-analysis

Francesco Bettariga et al. J Natl Cancer Inst. .

Abstract

Background: Despite advances in breast cancer treatment, recurrence remains common and contributes to higher mortality risk. Among the potential mechanisms, inflammation plays a key role in recurrence by promoting tumor progression. Exercise provides a wide array of health benefits and may reduce inflammation, potentially reducing mortality risk. However, the effects of exercise, including mode (ie, resistance training [RT], aerobic training [AT], and combined RT and AT) and program duration, on inflammatory biomarkers in breast cancer survivors remain to be elucidated.

Methods: A systematic search was undertaken in PubMed, CINAHL, Embase, SPORTDiscus, and CENTRAL in August 2024. Randomized controlled trials examining the effects of exercise on interleukin-1 beta (IL-1β), interleukin 6 (IL-6), IL-8, IL-10, tumor necrosis factor alpha (TNF-α), and C-reactive protein (CRP) were included. A random-effects meta-analysis was undertaken to quantify the magnitude of change.

Results: Twenty-two studies were included (n = 968). Exercise induced small to large statistically significant reductions in IL-6 (standardized mean difference [SMD] = -0.85; 95% CI = -1.68 to -0.02; P = .05) and TNF-α (SMD = -0.40; 95% CI = -0.81 to 0.01; P = .05) and a trend for a decrease in CRP. When stratifying by exercise mode, trends toward reduction in IL-6 and TNF-α were observed for combined exercise, while changes were not generally affected by exercise program duration.

Conclusion: Exercise, especially combined RT and AT, can reduce pro-inflammatory biomarkers, and may be a suitable strategy to reduce inflammation in breast cancer survivors. However, further research is needed to investigate the effects of exercise mode and program duration on markers of inflammation in this survivor group.

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Conflict of interest statement

All authors declare that they have no conflicts of interest relevant to the content of this study.

Figures

Figure 1.
Figure 1.
Flow chart of study selection process.
Figure 2.
Figure 2.
The risk of bias assessment according to RoB 2.
Figure 3.
Figure 3.
Forest plot of overall effects of exercise on IL-6 in breast cancer survivors. Abbreviation: CI = confidence interval; IL-6 = interleukin 6.
Figure 4.
Figure 4.
Forest plot of overall effects of exercise on TNF-α in breast cancer survivors. Abbreviation: CI = confidence interval; TNF-α = tumor necrosis factor alpha.
Figure 5.
Figure 5.
Forest plot of overall effects of exercise on CRP in breast cancer survivors. Abbreviation: CI = confidence interval; CRP = C-reactive protein.
See this image and copyright information in PMC

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