Breast Surgery, Shrewsbury and Telford Hospital NHS Trust, Telford, UK
Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
BMJ Open. 2022 Oct 7;12(10):e062288. doi: 10.1136/bmjopen-2022-062288.
Elevated body mass index (BMI) in breast cancer survivors (BCS) is associated with cancer recurrence and poorer treatment response. Guidelines recommend 5%-10% weight loss for overweight or obese BCS.
To assess effectiveness of lifestyle interventions for female BCS on weight loss, BMI, body composition, health-related quality of life (HRQoL), physical functioning, psychosocial measures, biomarkers.
Systematic review of reviews and meta-analyses.
All clinical settings.
Adult female BCS (active treatment or post-treatment).
Medline, Embase, CINAHL, PsycINFO, Cochrane Library (including Database of Abstracts of Reviews of Effects) were searched for systematic reviews published in English between 1990 and 2022, with weight, BMI or body fat as primary outcome. Narrative reviews, editorials, letters, conference abstracts were excluded. Review quality was assessed using the Joanna Briggs Institute quality assessment tool.
17 reviews were included. Twelve reported significant reductions in one or more anthropometric outcomes: weight -1.36 kg (95% CI:-2.51 to -0.21) to -3.8 kg (95% CI: -5.6 to -1.9); BMI -0.89 kg/m (95% CI: -0.15 to -0.28) to -3.59 kg/m (95% CI: -6.29 to 0.89) or body fat -1.6% (95% CI: -2.31 to -0.88) to -2.6% (95% CI not reported). Significant reductions in two or more anthropometric outcomes were reported in 7/12 reviews, with effective interventions comprising aerobic exercise/aerobic exercise plus resistance training (n=5), or diet and exercise with or without counselling (n=2). Significant improvements were also reported for HRQoL (8/11 reviews), mental health (4/7) and physical functioning (2/3). Group interventions comprising aerobic exercise or aerobic exercise plus resistance training were most likely to improve outcomes.
Lifestyle interventions can significantly improve outcomes for BCS. Multimodal interventions are likely to have the greatest impact in reducing weight, BMI and body fat. Further research must define the optimal combination, intensity and duration of effective interventions.
CRD42021283481.
乳腺癌幸存者（BCS）的体重指数（BMI）升高与癌症复发和治疗反应较差有关。指南建议超重或肥胖的 BCS 减轻 5%-10%的体重。
评估针对女性 BCS 的生活方式干预对体重减轻、BMI、身体成分、健康相关生活质量（HRQoL）、身体机能、心理社会措施、生物标志物的有效性。
系统评价综述和荟萃分析。
所有临床环境。
成年女性 BCS（积极治疗或治疗后）。
在 1990 年至 2022 年期间，检索 Medline、Embase、CINAHL、PsycINFO、Cochrane 图书馆（包括效果摘要数据库）中的英文系统评价，主要结局为体重、BMI 或体脂。排除综述、社论、信件、会议摘要。使用 Joanna Briggs 研究所质量评估工具评估综述质量。
纳入了 17 项综述。12 项研究报告了一项或多项人体测量学结果的显著降低：体重减少 1.36 公斤（95%CI：-2.51 至-0.21）至-3.8 公斤（95%CI：-5.6 至-1.9）；BMI 减少 0.89kg/m（95%CI：-0.15 至-0.28）至-3.59kg/m（95%CI：-6.29 至 0.89）或体脂减少 1.6%（95%CI：-2.31 至-0.88）至-2.6%（95%CI 未报告）。7/12 项综述报告了两种或两种以上人体测量学结果的显著降低，有效的干预措施包括有氧运动/有氧运动加抗阻训练（n=5），或饮食加运动加或不加咨询（n=2）。HRQoL（8/11 项综述）、心理健康（4/7 项）和身体机能（2/3 项）也有显著改善。包括有氧运动或有氧运动加抗阻训练的小组干预最有可能改善结果。
生活方式干预可以显著改善 BCS 的结局。多模式干预可能在降低体重、BMI 和体脂方面产生最大影响。必须进一步研究确定有效干预的最佳组合、强度和持续时间。
PROSPERO 注册号：CRD42021283481。
