Pinheiro Victor Hugo G, Pinto Stephanie S, Cardozo Pâmela S, Andrade Luana S, Alberton Cristine L
School of Physical Education and Physiotherapy, Federal University of Pelotas (UFPel), Rua Luís de Camões, 625, Pelotas, RS, 96055-630, Brazil.
Support Care Cancer. 2025 Jun 14;33(7):577. doi: 10.1007/s00520-025-09647-8.
Cancer-related cognitive impairment (CRCI) is a common side effect among breast cancer survivors. Emerging evidence suggests that exercise may help manage CRCI. This systematic review and meta-analysis evaluated the impact of exercise programs on cognitive function in breast cancer survivors.
PubMed, Cochrane, Embase, and Web of Science were searched in May 2023 for randomized controlled trials (RCTs). Two independent reviewers conducted the screening and selection of studies based on predefined eligibility criteria, including title/abstract and full-text screening, using the Rayyan platform. Study quality was assessed using the Cochrane Risk of Bias 2 tool. Meta-analyses were conducted in R using the "meta" package, comparing experimental and control groups for cognitive domains and self-reported cognitive outcomes post-intervention.
Eleven RCTs with 890 breast cancer survivors showed significant exercise effects on attention and working memory (SMD 0.43, 95% CI [0.20; 0.66], p < 0.001, I² = 51%), executive function (SMD -0.29, 95% CI [-0.46; -0.13], p < 0.001, I² = 0%), perceived cognitive abilities (SMD 0.95, 95% CI [0.32; 1.57], p = 0.003, I² = 69%), and cognitive complaints (SMD -0.75, 95% CI [-1.07; -0.44], p < 0.001, I² = 0%).
This systematic review with meta-analysis demonstrates that exercise improves cognitive function in breast cancer survivors, particularly attention, working memory, executive function, and self-reported cognitive outcomes. However, the heterogeneity in cognitive assessment tools underscores the need for greater standardization, including the combined use of validated self-report questionnaires and neuropsychological tests, as well as a stronger emphasis on cognitive function as a primary outcome, to enhance comparability and strengthen the evidence base.
Exercise programs should be integrated into survivorship care to address CRCI, support cognitive health, and improve overall quality of life.
癌症相关认知障碍（CRCI）是乳腺癌幸存者中常见的副作用。新出现的证据表明，运动可能有助于管理CRCI。本系统评价和荟萃分析评估了运动项目对乳腺癌幸存者认知功能的影响。
2023年5月在PubMed、Cochrane、Embase和Web of Science中检索随机对照试验（RCT）。两名独立 reviewers 使用Rayyan平台，根据预先定义的纳入标准（包括标题/摘要和全文筛选）进行研究的筛选和选择。使用Cochrane偏倚风险2工具评估研究质量。在R中使用“meta”包进行荟萃分析，比较干预后实验组和对照组在认知领域和自我报告的认知结果方面的差异。
11项RCT共纳入890名乳腺癌幸存者，结果显示运动对注意力和工作记忆有显著影响（标准化均数差[SMD]0.43，95%置信区间[CI][0.20；0.66]，p<0.001，I² = 51%），对执行功能有显著影响（SMD -0.29，95%CI[-0.46；-0.13]，p<0.001，I² = 0%），对感知认知能力有显著影响（SMD 0.95，95%CI[0.32；1.57]，p = 0.003，I² = 69%），对认知抱怨有显著影响（SMD -0.75，95%CI[-1.07；-0.44]，p<0.001，I² = 0%）。
本系统评价和荟萃分析表明，运动可改善乳腺癌幸存者的认知功能，特别是注意力、工作记忆、执行功能和自我报告的认知结果。然而，认知评估工具的异质性凸显了加强标准化的必要性，包括联合使用经过验证的自我报告问卷和神经心理学测试，以及更加强调将认知功能作为主要结局，以提高可比性并加强证据基础。
应将运动项目纳入癌症生存护理，以解决CRCI，支持认知健康，并改善总体生活质量。
