Table1_The effects of ACSM-based exercise on breast cancer-related lymphoedema: a systematic review and meta-analysis.docx

BackgroundBreast cancer-related lymphedema (BCRL) frequently occurs after axillary lymph node dissection and remains incurable even with lymphaticovenular anastomosis. Exercise interventions have emerged as a potential non-pharmacological management approach. However, standardized exercise recommendations tailored to BCRL patients are lacking.PurposeThis study evaluated the impact of high and low compliance exercise interventions, aligned with ACSM recommendations, on quality of life (QOL), shoulder range of motion (ROM), and arm volume in BCRL patients. It further aimed to determine the optimal exercise dosage, assessed via the FITT (frequency, intensity, time, type) principle, that maximizes health benefits for BCRL patients.MethodsAdhering to the PRISMA guidelines for systematic reviews and meta-analyses, we conducted a comprehensive literature search in various databases, including PubMed, Embase, Cochrane Library, and Web of Science, encompassing the period from the inception of these databases to December 2023. We extracted data on exercise form, frequency, intensity, duration, repetitions, and sets from the identified studies. Subsequently, a meta-analysis and review were conducted. The exercise interventions were evaluated based on ACSM recommendations and categorized as either high or low compliance with ACSM standards. Fixed or random effects models were employed to compare outcomes across study subgroups with comparable results. Additionally, funnel plot analyses, sensitivity analyses, and Egger’s and Begg’s tests were conducted to evaluate the potential for bias.Results15 studies encompassing 863 patients with BCRL were analyzed. Eleven studies exhibited high ACSM compliance, while four demonstrated low ACSM compliance. Regarding QOL, the overall standard mean difference (SMD) was 0.13 (95% CI: −1.07, 1.33). Specifically, the SMD for the high-adherence subgroup was 0.91 (95% CI: 0.33, 1.49; p = 0.002). For ROM, the overall SMD was 1.21 (95% CI: −0.19, 2.61). For arm volume, the overall SMD was −0.06 (95% CI: −0.22, 0.10). QOL results differed significantly in the high-adherence subgroup, whereas no significant effect on ROM or arm volume was observed.ConclusionThe study revealed significant QOL improvements in patients with high ACSM compliance, contrasted with those with low compliance. Conversely, no notable changes in ROM or arm volume were observed. Notably, the high adherence group tended to show better ROM during exercise and stable arm volume. Future research is needed to validate these findings.

背景：乳腺癌相关淋巴水肿（BCRL）常在腋窝淋巴结清扫术后发生，即便进行淋巴静脉吻合术亦难以治愈。运动干预作为一种潜在的药物非依赖性管理方法已逐渐受到关注。然而，针对BCRL患者的标准化运动建议尚显不足。目的：本研究旨在评估符合美国运动医学学会（ACSM）推荐的高、低依从性运动干预对BCRL患者生活质量（QOL）、肩关节活动范围（ROM）及上臂体积的影响，并进一步确定通过FITT（频率、强度、时间、类型）原则评估的最优运动剂量，以最大化BCRL患者的健康效益。方法：遵循PRISMA指南进行系统评价和荟萃分析，我们在PubMed、Embase、Cochrane图书馆和Web of Science等数据库中进行了全面文献检索，涵盖自这些数据库建立以来至2023年12月的数据。从所识别的研究中提取了运动形式、频率、强度、持续时间、重复次数和组数等数据。随后，进行了荟萃分析和综述。运动干预根据ACSM推荐进行评估，并分为高依从性和低依从性两类。采用固定效应模型或随机效应模型比较具有可比结果的子研究组的结局。此外，还进行了漏斗图分析、敏感性分析和Egger's及Begg's检验，以评估潜在的偏倚。结果：分析了包括863名BCRL患者在内的15项研究。其中11项研究表现出高ACSM依从性，而4项研究表现出低ACSM依从性。在生活质量方面，总体标准均数差（SMD）为0.13（95% CI：-1.07，1.33）。具体而言，高依从性子组的SMD为0.91（95% CI：0.33，1.49；p = 0.002）。在关节活动范围方面，总体SMD为1.21（95% CI：-0.19，2.61）。在上臂体积方面，总体SMD为-0.06（95% CI：-0.22，0.10）。生活质量结果在高依从性子组中存在显著差异，而在关节活动范围或上臂体积方面未观察到显著影响。结论：研究显示，与低依从性患者相比，高ACSM依从性患者在生活质量方面有显著改善。相反，在关节活动范围或上臂体积方面未观察到明显变化。值得注意的是，高依从性组在运动期间往往表现出更好的关节活动范围和稳定的上臂体积。未来研究需要验证这些发现。