Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies

被引:357
作者
Lahart, Ian Matthew [1 ]
Metsios, George S. [1 ]
Nevill, Alan Michael [1 ]
Carmichael, Amtul Razzaq [2 ]
机构
[1] Wolverhampton Univ, Fac Educ Hlth & Wellbeing, Walsall, W Midlands, England
[2] Russells Hall Hosp, Dept Surg, Dudley, England
关键词
ALL-CAUSE MORTALITY; LIFE-STYLE FACTORS; POSTMENOPAUSAL WOMEN; BODY-SIZE; LONG-TERM; DIAGNOSIS; EXERCISE; HEALTH; BIAS; ASSOCIATION;
D O I
10.3109/0284186X.2014.998275
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Strong evidence exists supporting the effect of lack of physical activity on the risk of developing breast cancer. However, studies examining the effects of physical activity on breast cancer outcomes, including survival and prognosis have been inconclusive. Therefore, the aim of the current study was to provide a systematic review and meta-analysis of studies investigating the association between physical activity and breast cancer recurrence and death. Methods. PubMed, EMBASE, and CENTRAL databases were searched up to 18 October 2014. Reference lists of retrieved articles and relevant previous reviews were also searched. Observational studies that reported risk estimates for all-cause and/or breast cancer-related death and/or breast cancer recurrences by levels of physical activity, were included in the review. Random effects models were used to calculate pooled hazard ratios (HR) and 95% confidence intervals (CI) and to incorporate variation between studies. The Newcastle-Ottawa scale was used to critically appraise the risk of bias across studies. Results. Twenty-two prospective cohort studies were eligible in this meta-analysis. During average follow-up periods ranging from 4.3 to 12.7 years there were 123 574 participants, 6898 all-cause deaths and 5462 breast cancer outcomes (i.e. breast cancer-related deaths or recurrences). The average Newcastle-Ottawa score was six stars (range 4-8). Compared to those who reported low/no lifetime recreational pre-diagnosis physical activity, participants who reported high lifetime recreational pre-diagnosis physical activity levels had a significantly lower risk of all-cause (HR = 0.82, 95% CI 0.70-0.96, p < 0.05) and breast cancer-related death (HR = 0.73, 95% CI 0.54-0.98, p < 0.05). Significant risk reductions for all-cause and breast cancer-related death was also demonstrated for more recent pre-diagnosis recreational physical activity (HR = 0.73, 95% CI 0.65-0.82, p < 0.001; and HR = 0.84, 95% CI 0.73-0.97, p < 0.05, respectively), post-diagnosis physical activity (HR = 0.52, 95% CI 0.43-0.64, p < 0.01; and HR = 0.59, 95% CI 0.45-0.78, p < 0.05, respectively) and meeting recommended physical activity guidelines (i. e.. 8 MET-h/wk) post-diagnosis (HR = 0.54, 95% CI 0.38-0.76, p < 0.01; and HR = 0.67, 95% CI 0.50-0.90, p < 0.01, respectively). However, there was evidence of heterogeneity across lifetime recreational pre-and post-diagnosis physical activity analyses. Both pre-diagnosis (lifetime and more recent combined) and post-diagnosis physical activity were also associated with reduced risk of breast cancer events (breast cancer progression, new primaries and recurrence combined) (HR = 0.72 95% CI 0.56-0.91, p < 0.01; and HR = 0.79, 95% CI 0.63-0.98, p < 0.05, respectively). Conclusion. There is an inverse relationship between physical activity and all-cause, breast cancer-related death and breast cancer events. The current meta-analysis supports the notion that appropriate physical activity may be an important intervention for reducing death and breast cancer events among breast cancer survivors.
引用
收藏
页码:635 / 654
页数:20
相关论文
共 59 条
  • [41] Effect of Exercise on Postmenopausal Sex Hormone Levels and Role of Body Fat: A Randomized Controlled Trial
    Monninkhof, Evelyn M.
    Velthuis, Miranda J.
    Peeters, Petra H. M.
    Twisk, Jos W. R.
    Schuit, Albertine J.
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2009, 27 (27) : 4492 - 4499
  • [42] Exercise and cardiovascular health
    Myers, J
    [J]. CIRCULATION, 2003, 107 (01) : E2 - E5
  • [43] Comparison of two methods to detect publication bias in meta-analysis
    Peters, JL
    Sutton, AJ
    Jones, DR
    Abrams, KR
    Rushton, L
    [J]. JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 2006, 295 (06): : 676 - 680
  • [44] Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity
    Pierce, John P.
    Stefanick, Marcia L.
    Flatt, Shirley W.
    Natarajan, Loki
    Sternfeld, Barbara
    Madlensky, Lisa
    Al-Delaimy, Wael K.
    Thomson, Cynthia A.
    Kealey, Sheila
    Hajek, Richard
    Parker, Barbara A.
    Newman, Vicky A.
    Caan, Bette
    Rock, Cheryl L.
    [J]. JOURNAL OF CLINICAL ONCOLOGY, 2007, 25 (17) : 2345 - 2351
  • [45] PHYSICAL-ACTIVITY AND SURVIVAL FROM BREAST-CANCER
    ROHAN, TE
    FU, W
    HILLER, JE
    [J]. EUROPEAN JOURNAL OF CANCER PREVENTION, 1995, 4 (05) : 419 - 424
  • [46] Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors
    Saquib, Nazmus
    Pierce, John P.
    Saquib, Juliann
    Flatt, Shirley W.
    Natarajan, Loki
    Bardwell, Wayne A.
    Patterson, Ruth E.
    Stefanick, Marcia L.
    Thomson, Cynthia A.
    Rock, Cheryl L.
    Jones, Lovell A.
    Gold, Ellen B.
    Karanja, Njeri
    Parker, Barbara A.
    [J]. PSYCHO-ONCOLOGY, 2011, 20 (03) : 252 - 259
  • [47] Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer
    Schmidt, Martina E.
    Chang-Claude, Jenny
    Vrieling, Alina
    Seibold, Petra
    Heinz, Judith
    Obi, Nadia
    Flesch-Janys, Dieter
    Steindorf, Karen
    [J]. INTERNATIONAL JOURNAL OF CANCER, 2013, 133 (06) : 1431 - 1440
  • [48] Hazard ratio in clinical trials
    Spruance, SL
    Reid, JE
    Grace, M
    Samore, M
    [J]. ANTIMICROBIAL AGENTS AND CHEMOTHERAPY, 2004, 48 (08) : 2787 - 2792
  • [49] Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials
    Sterne, Jonathan A. C.
    Sutton, Alex J.
    Ioannidis, John P. A.
    Terrin, Norma
    Jones, David R.
    Lau, Joseph
    Carpenter, James
    Ruecker, Gerta
    Harbord, Roger M.
    Schmid, Christopher H.
    Tetzlaff, Jennifer
    Deeks, Jonathan J.
    Peters, Jaime
    Macaskill, Petra
    Schwarzer, Guido
    Duval, Sue
    Altman, Douglas G.
    Moher, David
    Higgins, Julian P. T.
    [J]. BMJ-BRITISH MEDICAL JOURNAL, 2011, 343
  • [50] Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study
    Sternfeld, Barbara
    Weltzien, Erin
    Quesenberry, Charles P., Jr.
    Castillo, Adrienne L.
    Kwan, Marilyn
    Slattery, Martha L.
    Caan, Bette J.
    [J]. CANCER EPIDEMIOLOGY BIOMARKERS & PREVENTION, 2009, 18 (01) : 87 - 95