Front. Public Health Frontiers in Public Health Front. Public Health 2296-2565 Frontiers Media S.A. 10.3389/fpubh.2025.1641075 Public Health Systematic Review The impact of mind–body exercise on female breast cancer patients—a systematic review and meta-analysis of randomized controlled trials Li Lei 1 * He Yuanhada 2 Yang Xiaojuan 1 Liu Yang 1 1Precision Medicine Laboratory, Hohhot Maternal and Child Health Hospital, Hohhot, China 2Department of Human Anatomy, School of Basic Medical Sciences, Inner Mongolia Medical University, Hohhot, China

Edited by: Irene Lidoriki, School of Public Health and Harvard University, United States

Reviewed by: S. Ottavio Tomasi, Paracelsus Medical University, Austria

Romate John, Central University of Karnataka, India

 *Correspondence: Lei Li, 924673848@qq.com 27 10 2025 2025 13 1641075 04 06 2025 15 09 2025 Copyright © 2025 Li, He, Yang and Liu. 2025 Li, He, Yang and Liu

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

 Objective

To evaluate the effects of mind–body exercise on breast cancer patients.

 Methods

A systematic search was conducted in the Cochrane Library, Embase, PubMed, Ovid, and Web of Science databases from inception to October 23, 2024, for randomized controlled trials (RCTs) assessing the effects of mind–body exercise on breast cancer patients. Inclusion criteria were: intervention group receiving mind–body exercises such as mindfulness or yoga; control group receiving standard care; participants aged ≥18 years with breast cancer; and outcomes including anxiety, fear of cancer recurrence (FCR), fatigue, IL-6, and 7 other indicators. Two reviewers independently screened the literature and extracted data. After assessing the methodological quality of the included studies using the Cochrane Risk of Bias tool, meta-analysis was conducted using RevMan 5.4 and Stata 15.0 software.

 Results

A total of 47 RCTs involving 4,537 breast cancer patients were included. Meta-analysis results showed that compared to standard care, mind–body exercise significantly improved anxiety (SMD = −0.50, 95% CI [−0.73, −0.27], p < 0.0001), depression (SMD = −0.43, 95% CI [−0.60, −0.26], p < 0.00001), insomnia (SMD = −0.40, 95% CI [−0.72, −0.07], p = 0.02), fatigue (SMD = −0.52, 95% CI [−0.72, −0.31], p < 0.00001), and FCR (SMD = −0.51, 95% CI [−0.88, −0.14], p = 0.007). Furthermore, it significantly reduced perceived stress (SMD = −0.65, 95% CI [−1.11, −0.20], p = 0.005), lowered IL-6 levels (SMD = −0.30, 95% CI [−0.56, −0.03], p = 0.03), and improved overall quality of life (SMD = 0.67, 95% CI [0.39, 0.95], p < 0.00001). Sensitivity analyses indicated that the pooled effect sizes were stable.

 Conclusion

Mind–body exercises can effectively alleviate anxiety, depression, and fatigue in breast cancer patients, and appear beneficial in reducing FCR. Although pooled analyses also demonstrated statistically significant improvements in perceived stress, insomnia, quality of life, and IL-6 concentrations, the strength of the current evidence is limited, and the results should be interpreted with caution.

 Systematic review registration

This systematic review was registered in PROSPERO under the registration number CRD42024568483. The registration details are available at: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024568483.

 breast cancer patients mind–body exercise complementary and alternative therapy systematic review meta-analysis section-at-acceptance Public Mental Health Introduction

According to global cancer statistics in 2020, breast cancer incidence and mortality rates have surpassed lung cancer, making it the leading cause of cancer in women. In 2022, there were 2.3 million new cases of breast cancer diagnosed in women worldwide, with 670,000 deaths from the disease. It is estimated that by 2040, the number of new breast cancer diagnoses will reach 3 million, with 1 million deaths. Additionally, the risk of developing breast cancer in women increases progressively with age.

Although the majority of patients survive for more than 5 years after breast cancer diagnosis (1), the side effects of chemotherapy and radiotherapy, surgical trauma, and physical damage such as hair loss make patients more susceptible to anxiety, depression, and other negative emotions. A meta-analysis revealed that nearly 50% of female breast cancer patients experience anxiety and/or depression (2, 3), particularly those who face significant stress due to concerns about cancer recurrence. This fear further exacerbates their mental burden and may even lead to more severe psychological disorders, such as post-traumatic stress disorder (PTSD) (4). In addition, breast cancer patients often face a range of physiological issues, including sleep disturbances, pain, and fatigue (5–8). These symptoms can not only negatively affect the overall quality of life but may also interfere with treatment outcomes. Therefore, it is essential to focus not only on the clinical efficacy of breast cancer treatment but also on the psychological and physiological impacts the disease and its treatment have on patients.

As breast cancer survival rates continue to rise, patients often require longer treatment durations, which imposes a significant economic burden on both the individuals and their families. Mind–body exercise, as a complementary and alternative therapy, plays a role in regulating mental states and promoting physical health (9–11). The National Comprehensive Cancer Network (NCCN) Breast Cancer Risk Reduction Guidelines suggest that increased physical activity can reduce the risk of breast cancer to some extent (12). Another meta-analysis found that engaging in at least 150 min of moderate-intensity physical activity per week can reduce the risk of breast cancer by 9% (13). The mind–body exercise combines the benefits of resistance training and aerobic exercise, which not only enhances physical fitness but also helps regulate mood and mental states. Existing studies indicate that mind–body exercise plays a role in alleviating anxiety and depression in breast cancer patients (14, 15). However, there is still controversy over whether it can alleviate other burdens on patients, such as fatigue, pain, sleep disturbances, quality of life, and cognitive dysfunction. Moreover, there is a lack of systematic meta-analyses on the impact of mind–body exercise on inflammatory markers in breast cancer patients. Therefore, this study will explore the effects of mind–body exercises (such as mindfulness, meditation, yoga, Tai Chi, and Baduanjin) on the physical, psychological, and inflammatory markers in breast cancer patients. The findings will provide insights to support the development of non-pharmacological treatments for breast cancer, offering substantial evidence for both patients and clinicians.

 Materials and methods

This paper was written following the Cochrane systematic review guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. It has been registered on the international prospective systematic review platform (PROSPERO; registration number = CRD42024568483).

Search strategy

A search was conducted in Cochrane, EMBASE, Ovid, PubMed, and Web of Science from their inception until October 2024. The search strategy was based on the PICOS framework: (P) Population: breast cancer patients; (I) Intervention: mind–body exercise; (C) Comparison: standard care and appropriate rehabilitation measures; (O) Outcomes: mind–body exercise assessments in breast cancer patients; (S) Study type: randomized controlled trials. The detailed search strategy is shown in Table 1 (using PubMed as an example).

Search strategy on PubMed.

#1 “Breast Neoplasms”[MeSH]
#2 (((Breast Neoplasms[Title/Abstract]) OR (Breast Neoplasm*[Title/Abstract])) OR (Breast Cancer[Title/Abstract])) OR (Breast Carcinoma[Title/Abstract])
#3 #1 OR #2
#4 “Tai Ji”[MeSH]
#5 (((((((((Tai Ji[Title/Abstract]) OR (Tai Chi[Title/Abstract])) OR (Tai Ji Quan[Title/Abstract])) OR (Tai Chi Chuan[Title/Abstract])) OR (Tai-ji[Title/Abstract])) OR (Chi, Tai[Title/Abstract])) OR (Ji Quan, Tai[Title/Abstract])) OR (Quan, Tai Ji[Title/Abstract])) OR (taijiquan[Title/Abstract])) OR (T’ai Chi[Title/Abstract])
#6 “Qigong”[MeSH]
#7 ((Qigong[Title/Abstract]) OR (Ch’i Kung[Title/Abstract])) OR (Qi Gong[Title/Abstract])
#8 (Baduanjin[Title/Abstract]) OR (Eight trigrams boxing[Title/Abstract])
#9 “Meditation”[MeSH]
#10 (Meditation[Title/Abstract]) OR (Transcendental Meditation[Title/Abstract])
#11 “Yoga”[MeSH]
#12 “Yoga”[Title/Abstract]
#13 “Mind–Body Therapies”[MeSH]
#14 ((Mind-Body Therapies[Title/Abstract]) OR (Mind Body Intervention[Title/Abstract])) OR (Mind-Body Exercise[Title/Abstract])
#15 #4 OR #5 OR #6 OR #7 OR #8 OR #9 OR #10 OR #11 OR #12 OR #13 OR #14
#16 “Randomized Controlled Trial”[MeSH]
#17 ((Randomized Controlled Trial[Title/Abstract]) OR (random*[Title/Abstract])) OR (Controlled Clinical Trial[Title/Abstract])
#17 #16 OR #17
#18 #3 AND #15 AND #17
Inclusion criteria

(1) Study design: randomized controlled trials;

(2) Participants: patients aged 18 years and older, with a pathological diagnosis of breast cancer stage 0 to IV;

(3) Intervention group: patients were subjected to interventions including mindfulness, meditation, yoga, Tai Chi, and Baduanjin;

(4) Control group: patients received only standard care and appropriate rehabilitation services;

(5) Outcome measures: anxiety, depression, fatigue, sleep, quality of life, pain, stress, cognitive function, FCR, and levels of IL-6 and CRP (C-reactive protein) in the body.

 Exclusion criteria

(1) Studies with incomplete or unreported data;

(2) Studies with duplicate publications;

(3) Non-randomized controlled trials (including animal studies, reviews, conference abstracts, and case reports).

 Literature screening

Two researchers screened and excluded the literature using EndNote reference management software.

(1) Screening of titles to exclude duplicate studies, reviews, conference proceedings, and non-randomized controlled trials;

(2) Reviewing abstracts to further determine studies for inclusion or exclusion;

(3) Reading the full texts of the included studies to finalize their inclusion.

An independent double-blind method was employed during this process. The included studies were compared, and if the findings were consistent, they were included; if there were discrepancies, a third researcher resolved them through discussion.

 Data extraction

Data from the included studies were extracted according to a 7-item data extraction form, with the following specific categories: (1) authors; (2) publication year; (3) country; (4) population; (5) sample size; (6) average age; and (7) details of the exercise intervention.

 Risk of bias assessment

Bias risk assessment of the included studies were conducted according to the Cochrane Handbook for Systematic Reviews of Interventions 5.1.0, with specific criteria based on seven aspects: (1) generation of random sequence; (2) allocation concealment; (3) blinding of participants; (4) blinding of intervention providers and outcome assessors; (5) completeness of outcome data; (6) selective reporting; and (7) other sources of bias. Based on these criteria, the included studies were categorized into three levels of bias risk: high risk (five or more aspects), moderate risk (three or four aspects), and low risk (two or fewer aspects). The bias risk assessment was independently performed by two researchers, with cross-checking. In case of disagreements, a third reviewer resolved the issues (16).

 Statistical methods

Statistical analysis was performed using Review Manager 5.4 software. As the study outcomes were continuous variables with different outcome measures, standardized mean difference (SMD) and 95% confidence intervals (CIs) were used for data analysis to minimize the impact of different measurement methods. SMD values of 0.2 to 0.5 indicate a small effect, 0.5 to 0.8 indicate a moderate effect, and values greater than 0.8 indicate a large effect (17). When the 95% CI does not include 0, the results of the meta-analysis are considered statistically significant; when the 95% CI includes 0, the results are not statistically significant. The heterogeneity of the study results was assessed using I2 and p-values. If p ≥ 0.1 and I2 ≤ 50%, a fixed-effect model was used for analysis. If p < 0.1 and I2 > 50%, indicating statistical heterogeneity, a random-effects model was applied and meta-regression was conducted to explore sources of heterogeneity. Additionally, sensitivity analysis was performed by sequentially excluding studies. If the results showed minimal change, it suggested that the findings were stable. Publication bias was primarily assessed using funnel plots and Egger’s linear regression method.

 Results Literature search and inclusion results

Through the established literature search strategy, an initial retrieval identified 5,494 articles. After removing duplicates, 2,905 articles remained. Upon reviewing the titles and abstracts, 2,717 articles were excluded, leaving 188 for full-text screening. After thoroughly reading the full text, articles that were not randomized controlled trials, had incomplete data, were conference proceedings, or did not meet the intervention criteria of this review were excluded, resulting in the removal of 141 articles. Finally, 47 articles were included (18–64) (Figure 1).

Flow diagram of literature selection.

Flowchart of a systematic review process. Records identified through five databases totaled 5,494. After removing 2,589 duplicates, 2,905 records were screened. Of these, 2,717 were excluded. Full-text articles assessed for eligibility were 188; 141 were excluded for reasons including not being randomized controlled trials (49), incomplete data (20), being articles from meetings (33), and not meeting outcome (18) or intervention criteria (21). Forty-seven studies were included in both qualitative synthesis and meta-analysis. Quality assessment of included studies

This study ultimately included 11 high-quality articles, 33 moderate-quality articles, and 3 low-quality articles. All included articles described the method of random grouping. Eighteen articles mentioned the method of concealing the allocation sequence; 12 articles described the process of implementing blinding, with 3 employing a double-blind method and 9 using a single-blind method. Thirty-nine articles provided complete outcome reports (Figures 2, 3).

Cochrane risk of bias in the included studies.

Bar graph showing risk of bias across several categories: random sequence generation, allocation concealment, blinding of participants, blinding of outcome assessment, incomplete outcome data, selective reporting, and other. The bars are colored green for low risk, yellow for unclear risk, and red for high risk.

Cochrane risk of bias summary for included studies.

Risk of bias table for studies ranging from 2007 to 2023, assessed across seven bias categories. Entries display symbols: green plus for low risk, yellow question mark for unclear risk, and red minus for high risk. Each row represents a study identified by the author's name and year. Characteristics of included studies

A total of 47 RCTs were included, comprising 4,537 diagnosed breast cancer patients. The included interventions consisted of meditation training (1 study) (18), mindfulness training (18 studies) (19–36), yoga training (20 studies) (37–56), and qigong training (8 studies) (57–64), of which 24 studies were from Asia, 22 studies were from the Americas, and 1 study was from Europe, with 11 different outcome measurement scales. The details are provided in Table 2.

Characteristics of the studies included in the meta-analysis.

Author Country Year Population Age (mean + SD) Sample size (T/C) Intervention Control Outcome
Kim et al. (18) Korea 2013 Breast cancerStage of disease0–III T: 48.12 (7.06)C: 46.86 (7.74) T: 51/C: 51 Meditation trainingLength of intervention: 6 weeksFreq: 2 times a weekDuration: 60 min CON Anxiety, Depression, Fatigue, QOL, Pain, Cognitive ability
Pouy et al. (19) Iran 2018 Breast cancerStage of disease0–III T: 52.12 (11.07)C: 56.14 (11.04) T: 32/C: 34 MBSR trainingLength of intervention: 4 weeksFreq: 2 times a weekDuration: 90 min CON Anxiety, Depression, QOL, Perceived stress
Lengacher et al. (27) USA 2015 Breast cancerStage of disease0–III T: 56.1 (9.1)C: 58.0 (10.2) T: 38/C: 41 MBSR trainingLength of intervention: 6 weeksFreq: 120 min a weekDuration: 15–45 min/day CON Insomnia
Duval et al. (28) Canada 2022 Breast cancerStage of diseaseNA T: 49.20 (10.02)C: 53.47 (8.55) T: 30/C: 30 MBSR trainingLength of intervention:2 weeksFreq: 8 times a weekDuration: 150 min WLC Cognitive ability
Lengacher et al. (29) USA 2019 Breast cancerStage of disease0–III T: 56.5 (10.2)C: 57.6 (9.2) T: 167/C: 155 MBSR trainingLength of intervention: 6 weeksFreq: 120 min a weekDuration: 15–45 min/day CON IL-6 level
Zhu et al. (30) China 2023 Breast cancerStage of diseaseI–III T: 47.96 (8.51)C: 49.78 (7.48) T: 50/C: 51 MBSR trainingLength of intervention: 8 weeksFreq: 1 time a weekDuration: 120 min CON Anxiety, Depression, QOL
Lengacher et al. (31) USA 2010 Breast cancerStage of disease0–III T + C: 57.5 (9.4) T: 41/C: 43 MBSR trainingLength of intervention: 6 weeksFreq:6 times a weekDuration: 15–45 min CON Depression, Perceived stress, FCR
Lengacher et al. (32) USA 2016 Breast cancerStage of disease0–III T: 56.5 (10.2)C: 57.6 (9.2) T: 167/C: 155 MBSR trainingLength of intervention: 6 weeksFreq: 1 time a weekDuration: 120 min CON Depression, Fatigue, Pain, QOL, FCR
Lengacher et al. (33) USA 2012 Breast cancerStage of disease0–III T + C: 58 (9.4) T: 41/C: 43 MBSR trainingLength of intervention: 6 weeksFreq: 6 times a weekDuration: 15–45 min CON Fatigue, Pain
Reich et al. (34) USA 2017 Breast cancerStage of disease0–III T + C: 56.6 T: 147/C: 152 MBSR trainingLength of intervention: 6 weeksFreq: 120 min a weekDuration: 15–45 min/day CON Insomnia, Perceived stress
Zhang et al. (36) China 2016 Breast cancerStage of diseaseI–III T: 48.6 (8.49)C: 46.0 (5.12) T: 30/C: 30 MBSR trainingLength of intervention: 8 weeksFreq: 6–7 times a weekDuration: 40–45 min CON Perceived stress
Zhao et al. (23) China 2020 Breast cancerStage of diseaseI–III T: 52.79 (6.54)C: 53.29 (6.50) T: 68/C: 68 MBCT trainingLength of intervention: 8 weeksFreq: 6 times a weekDuration: 90 min WLC Insomnia
Johannsen et al. (24) Denmark 2016 Breast cancerStage of disease0–III T: 56.8 (9.99)C: 56.7 (8.10) T: 67/C: 62 MBCT trainingLength of intervention: 8 weeksFreq: 1 time a weekDuration: 30 min CON Pain
Park et al. (25) Tokyo 2020 Breast cancerStage of disease0–III T: 53.21 (8.4)C: 54.19 (9.27) T: 38/C: 36 MBCT trainingLength of intervention: 8 weeksFreq: 120 min a weekDuration: 20–45 min/day WLC Anxiety, Depression, Fatigue, QOL, FCR
Chu et al. (26) China 2020 Breast cancerStage of disease0–III T: 54.6 (5.7)C: 54.9 (6.3) T: 42/C: 42 MBCT trainingLength of intervention: 8 weeksFreq: 120 min a weekDuration: 20–45 min/day CON Anxiety, Depression, Fatigue, QOL, FCR
Jang et al. (21) Korea 2016 Breast cancerStage of disease0–III T: 51.75 (5.32)C: 51.42 (6.33) T: 12/C: 12 MBAT trainingLength of intervention: 12 weeksFreq: NADuration: 45 min CON QOL, Cognitive ability
Bower et al. (20) USA 2015 Breast cancerStage of disease0–III T: 46.1 (7.9)C: 47.7 (7.1) T: 39/C: 32 MAPs trainingLength of intervention: 6 weeksFreq: 6 times a weekDuration: 20 min CON Fatigue, Insomnia, Pain, FCR, IL-6 level, CRP level
Bower et al. (35) USA 2021 Breast cancerStage of disease0–III T: 44.5 (7.7)C: 45.9 (5.6) T: 85/C: 81 MAPs trainingLength of intervention: 6 weeksFreq: 120 min a weekDuration: NA WLC Depression, Fatigue, Insomnia
Shao et al. (22) China 2020 Breast cancerStage of diseaseI–IV T: 40.3 (7.0)C: 44.4 (8.2) T: 72/C: 72 MBIs trainingLength of intervention: 6 weeksFreq: 5 times a weekDuration: 20 min CON Anxiety, Depression
Taylor et al. (37) USA 2018 Breast cancerStage of diseaseNA T: 54.9 (8.8)C: 52.6 (8.2) T: 14/C: 12 Yoga trainingLength of intervention: 8 weeksFreq: 1 time a weekDuration: 75 min WLC Depression, Fatigue,Insomnia, Perceived stress
Wang et al. (38) China 2014 Breast cancerStage of diseaseNA T + C: 39 (10.5) T: 40/C: 42 Yoga trainingLength of intervention: 4 monthsFreq: 4 times a weekDuration: 50 min CON Fatigue
Taso et al. (39) Taiwan 2014 Breast cancerStage of diseaseI–III T + C: 49.27 (10.23) T: 30/C: 30 Yoga trainingLength of intervention: 8 weeksFreq: 2 times a weekDuration: 60 min CON Fatigue
Wang et al. (40) China 2015 Breast cancerStage of disease0–IV T + C: 39 (10.5) T: 40/C: 42 Yoga trainingLength of intervention: 4 monthsFreq: 4 times a weekDuration: 50 min CON QOL
Raghavendra et al. (41) India 2007 Breast cancerStage of diseaseII–III T + C: 50 (10) T: 28/C: 34 Yoga trainingLength of intervention: After fourth chemotherapyFreq: 6 times a weekDuration: 60 min CON Depression, QOL
Liu et al. (42) China 2022 Breast cancerStage of diseaseI–II T + C: 48 (2.25) T: 68/C: 68 Mindfulness yoga trainingLength of intervention: 8 weeksFreq: 90 min a weekDuration: NA CON Anxiety, Depression, Fatigue, QOL,
Prakash et al. (43) India 2020 Breast cancerStage of diseaseNA NA T: 48/C: 52 Yoga trainingLength of intervention: 3 weeksFreq: 2 times a weekDuration: 60 min CON QOL
Chandwani et al. (44) USA 2014 Breast cancerStage of disease0–III T: 52.38 (1.35)C: 52.11 (1.34) T: 53/C: 54 Yoga trainingLength of intervention: 6 weeksFreq: 3 times a weekDuration: 60 min CON Fatigue, Insomnia
Chandwani et al. (45) USA 2010 Breast cancerStage of disease0–III T: 51.39 (7.97)C: 54.02 (9.96) T: 30/C: 31 Yoga trainingLength of intervention: 6 weeksFreq: 2 times a weekDuration: 60 min WLC Depression, Fatigue, Insomnia, Pain
Moadel et al. (46) USA 2007 Breast cancerStage of diseaseI–IV T: 55.11 (10.07)C: 54.23 (9.81) T: 84/C: 44 Yoga trainingLength of intervention: 12 weeksFreq: 90 min a weekDuration: NA CON Fatigue, QOL
Cramer et al. (47) USA 2015 Breast cancerStage of diseaseI–III T: 48.3 (4.8)C: 50.0 (6.7) T: 19/C: 21 Yoga and meditation trainingLength of intervention: 12 weeksFreq: 90 min a weekDuration: NA CON Anxiety, Depression, Fatigue, QOL
Banerjee et al. (48) India 2007 Breast cancerStage of diseaseII–III T: 47 (1.1)C: 43 (1.5) T: 35/C: 23 Yoga trainingLength of intervention: 6 weeksFreq: NADuration: 90 min CON Perceived stress
Kiecolt-Glaser et al. (49) USA 2014 Breast cancerStage of disease0–III T: 51.8 (9.8)C: 51.3 (8.7) T: 100/C: 100 Hatha yoga trainingLength of intervention: 12 weeksFreq: 2 times a weekDuration: 90 min CON Depression, Fatigue, IL-6 level
Porter et al. (50) USA 2019 Breast cancerStage of diseaseIV T: 56.3 (11.6)C: 59.4 (11.3) T: 43/C: 20 Mindful yoga trainingLength of intervention: 8 weeksFreq: 8 times a weekDuration: 120 min SSG Anxiety, Depression, Fatigue, Insomnia, pain
Greaney et al. (51) USA 2022 Breast cancerStage of diseaseI–III T: 53.2 (10.1)C: 49.9 (13.5) T: 15/C: 15 Yoga trainingLength of intervention: 12–20 weeksFreq: 3 times a weekDuration: 30 min CON Fatigue, QOL, CRP level
Chaoul et al. (52) USA 2018 Breast cancerStage of diseaseI–III T: 49.5 (9.8)C: 49 (10.1) T: 74/C: 85 Tibetan yoga trainingLength of intervention: 4–12 weeksFreq: 2 times a weekDuration: 75–90 min CON Fatigue, Insomnia
Bower et al. (53) USA 2014 Breast cancerStage of disease0–II T + C: 54 (5.4) T: 16/C: 15 Yoga trainingLength of intervention: 12 weeksFreq: NADuration: NA CON IL-6 level, CRP level
Eyigor et al. (54) Turkey 2018 Breast cancerStage of diseaseNA T: 52.3 (9.5)C: 51.5 (7.3) T: 22/C: 20 Yoga trainingLength of intervention: 10 weeksFreq: 2 times a weekDuration: 60 min CON Depression, QOL
Bower et al. (55) USA 2012 Breast cancerStage of disease0–II T: 54.4 (5.7)C: 53.3 (4.9) T: 16/C: 15 Yoga trainingLength of intervention: 12 weeksFreq: 2 times a weekDuration: 90 min Health Education Depression, Fatigue, Insomnia, Perceived stress
Vadiraja et al. (56) India 2017 Breast cancerStage of diseaseIV T + C: 50.54 (8.53) T: 46/C: 45 Yoga trainingLength of intervention: 3 monthsFreq: 3 times a weekDuration: 60 min CON Fatigue, Perceived stress
Han et al. (57) China 2017 Breast cancerStage of diseaseI–III T: 46.23 (8.89)C: 47.83 (8.04) T: 32/C: 32 Baduanjin trainingLength of intervention: 3 monthsFreq: 5 times a weekDuration: 20 min CON Anxiety
Wei et al. (58) China 2022 Breast cancerStage of diseaseI–III T: 52 (4.25)C: 55 (3) T: 35/C: 35 Baduanjin trainingLength of intervention: 3 monthsFreq: 5 times a weekDuration: 30 min CON Anxiety, Depression, Fatigue, QOL, Cognitive ability
Ying et al. (59) China 2019 Breast cancerStage of diseaseI–III T + C: 54.09 (7.76) T: 46/C: 40 Baduanjin trainingLength of intervention: 6 monthsFreq: 3–4 times a weekDuration: 20 min CON Anxiety, Depression
Chen et al. (60) China 2013 Breast cancerStage of disease0–III T: 45.3 ± 6.3\u00B0C: 44.7 ± 9.7 T: 49/C: 47 Guo Lin Qigong trainingLength of intervention: 5–6 weeksFreq: 4 times a weekDuration: 31–37 min CON Depression, Fatigue, Insomnia, QOL
Chang et al. (61) China 2023 Breast cancerStage of diseaseII–III T: 51.91 (10.51)C: 52.77 (8.53) T: 30/C: 30 Chan-Chuang Qigong trainingLength of intervention: 15 weeksFreq: 5 times a weekDuration: 35 min CON Fatigue, Insomnia, Pain, Cognitive ability
Zhang et al. (62) China 2022 Breast cancerStage of diseaseI–III T: 47.79 (5.14)C: 47.20 (7.65) T: 29/C: 30 Mindfulness-based Tai Chi trainingLength of intervention: 8 weeksFreq: 2 times a weekDuration: 60 min WLC Anxiety, Perceived stress
Larkey et al. (63) USA 2015 Breast cancerStage of disease0–III T: 57.7 (8.94)C: 59.8 (8.93) T: 42/C: 45 Tai Chi trainingLength of intervention: 12 weeksFreq: 5 times a weekDuration: 30 min SQC Depression, Fatigue, Insomnia
Sprod et al. (64) USA 2011 Breast cancerStage of disease0–IIIb T: 54.33 (3.55)C: 52.70 (2.11) T: 9/C: 10 Tai Chi trainingLength of intervention: 12 weeksFreq: 3 times a weekDuration: 60 min SST QOL, IL-6 level

CON, Control Group with Routine Care (no exercise); WLC, Wait-List Control Group; SST, Standard Support Therapy Control; SQC, Sham Qigong; SSG, Social Support Group; T, Experimental Group; C, Control Group; T + C, The ages of the experimental and control groups were not reported separately in the study, only the overall age was reported; QOL, Quality of Life; FCR, Fear of Cancer Recurrence.

 Meta-analysis results Psychological status Anxiety

A total of 13 RCTs included 1,089 breast cancer patients to compare the differences in anxiety levels between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 70%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly improved the anxiety levels of breast cancer patients (SMD = −0.50, 95% CI [−0.73, −0.27], p < 0.0001) (Figure 4A).

(A) Forest plot of the effect of mind–body exercise on anxiety in breast cancer patients. (B) Sensitivity analysis of anxiety levels.

Forest plot showing the results of a meta-analysis. Panel A lists studies comparing experimental and control groups, with standard mean differences and confidence intervals visualized as horizontal lines with squares. The plot suggests a tendency favoring the experimental group. Panel B shows a leave-one-out sensitivity analysis with circles representing individual studies, assessing the impact of omitting each study on the pooled estimate. The overall effect size is indicated as -0.50 with a confidence interval from -0.73 to -0.27. Heterogeneity statistics are also provided below Panel A. Depression

A total of 22 RCTs included 2,143 breast cancer patients to compare the differences in depression levels between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 72%), and a random-effects model was used for the analysis. The results indicated that the mind–body exercise group significantly improved the depression levels of breast cancer patients (SMD = −0.43, 95% CI [−0.60, −0.26], p < 0.00001) (Figure 5A).

(A) Forest plot of the effect of mind–body exercise on depression in breast cancer patients. (B) Sensitivity analysis of depression levels.

Forest plot and meta-analysis chart showing the standardized mean differences and confidence intervals of various studies. Panel A displays the forest plot with individual study results, their weights, and overall effect size, indicating a significant effect favoring the experimental group. Panel B is a meta-analysis chart with estimates in linear form, showing omitted studies with circles along a line indicating the effect size around -0.43. Perceived stress

A total of 9 RCTs included 774 breast cancer patients to examine the differences in stress levels between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 88%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly improved the stress levels of breast cancer patients (SMD = −0.65, 95% CI [−1.11, −0.20], p = 0.005) (Figure 6A).

(A) Forest plot of the effect of mind–body exercise on perceived stress in breast cancer patients. (B) Sensitivity analysis of perceived stress levels.

Panel A shows a forest plot comparing experimental and control groups across multiple studies, revealing standardized mean differences and confidence intervals. Panel B depicts a linear meta-analysis random-effects estimates plot, with study-specific contributions visualized along the x-axis. Both panels present data from studies conducted between 2007 and 2022. FCR

A total of 5 RCTs included 635 breast cancer patients to compare the differences in cancer recurrence fear between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 78%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly alleviated the fear of breast cancer recurrence in patients (SMD = −0.51, 95% CI [−0.88, −0.14], p = 0.007) (Figure 7A).

(A) Forest plot of the effect of mind–body exercise on FCR in breast cancer patients. (B) Sensitivity analysis of FCR levels. (C) Funnel plot of FCR. (D) Funnel plot of FCR using Trim-and-Fill method.

Panel A is a forest plot comparing experimental and control groups across five studies, showing a negative overall effect size. Panel B is a meta-analysis plot for random-effects estimates with study omissions. Panel C is a funnel plot with standard error against standard mean difference. Panel D is a filled funnel plot with pseudo 95% confidence limits. Function and health Insomnia

A total of 14 RCTs included 1,441 breast cancer patients to compare the differences in insomnia between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 89%), and a random-effects model was used for the analysis. The results indicated that, compared to the control group, the mind–body exercise group better alleviated insomnia in breast cancer patients (SMD = −0.4, 95% CI [−0.72, −0.07], p = 0.02) (Figure 8A).

(A) Forest plot of the effect of mind–body exercise on insomnia in breast cancer patients. (B) Sensitivity analysis of Insomnia levels.

On the left, a forest plot showing the standardized mean differences for various studies, each with confidence intervals, comparing experimental and control groups. The overall effect size is shown at the bottom with diamond and line markers. On the right, a meta-analysis graph displaying random-effects estimates for the same studies, indicating omission impacts on results with circles along a horizontal axis ranging from negative point eight to zero point zero. Fatigue

A total of 25 RCTs included 2,430 breast cancer patients to examine the impact of mind–body exercise on fatigue levels in patients. Significant heterogeneity was observed between the studies (I2 = 83%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly improved fatigue in breast cancer patients (SMD = −0.52, 95% CI [−0.72, −0.31], p < 0.00001) (Figure 9A).

(A) Forest plot of the effect of mind–body exercise on fatigue in breast cancer patients. (B) Sensitivity analysis of fatigue levels.

Forest plot showing a meta-analysis of various studies with standard mean differences and confidence intervals. Panel A includes study names with experimental and control group statistics, weights, and confidence intervals. The overall effect size is -0.52. Panel B presents a leave-one-out sensitivity analysis with circles representing individual studies, assessing the impact of omitting each study on the pooled estimate. Cognitive function

A total of 5 RCTs included 316 breast cancer patients to examine the impact of mind–body exercise on cognitive function in patients. Significant heterogeneity was observed between the studies (I2 = 85%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise had no significant effect on cognitive function in breast cancer patients (SMD = 0.55, 95% CI [−0.06, 1.16], p = 0.08) (Figure 10A).

(A) Forest plot of the effect of mind–body exercise on cognitive function in breast cancer patients. (B) Sensitivity analysis of cognitive function levels.

Panel A shows a forest plot of five studies comparing experimental and control groups with standardized mean differences and confidence intervals. Wei 2022 shows the highest positive effect favoring the experimental group. Panel B displays a leave-one-out sensitivity analysis with circles representing individual studies, assessing the impact of omitting each study on the pooled estimate. Pain

A total of 8 RCTs included 892 breast cancer patients to compare the differences in pain levels between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 71%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise had no significant effect on pain levels in breast cancer patients (SMD = −0.08, 95% CI [−0.34, 0.18], p = 0.55) (Figure 11A).

(A) Forest plot of the effect of mind–body exercise on pain in breast cancer patients. (B) Sensitivity analysis of pain levels.

Forest plot and sensitivity analysis of meta-analysis results. Panel A displays a forest plot showing standardized mean differences of various studies, with green squares representing individual study effects and a diamond indicating the overall effect. Heterogeneity is noted at seventy-one percent. Panel B shows a leave-one-out sensitivity analysis with circles representing individual studies, assessing the impact of omitting each study on the pooled estimate. Quality of life

A total of 18 RCTs included 1,578 breast cancer patients to compare the differences in quality of life between the mind–body exercise group and the control group. Significant heterogeneity was observed between the studies (I2 = 85%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly improved the quality of life in breast cancer patients (SMD = 0.67, 95% CI [0.39, 0.95], p < 0.00001) (Figure 12A).

(A) Forest plot of the effect of mind–body exercise on QOL in breast cancer patients. (B). Sensitivity analysis of QOL levels. (C) Funnel plot of QOL. (D) Funnel plot of QOL using Trim-and-Fill method.

Four-part statistical analysis figures: A) Forest plot showing individual study outcomes and overall effect size with confidence intervals. B) Leave-one-out sensitivity analysis plot displaying the impact of omitting each study. C) Funnel plot for detecting publication bias with standard error versus standardized mean difference. D) Filled funnel plot with pseudo ninety-five percent confidence limits indicating adjusted outcomes. Biomarkers IL-6 levels

A total of 5 RCTs included 643 breast cancer patients to compare the differences in IL-6 levels between the mind–body exercise group and the control group. Moderate heterogeneity was observed between the studies (I2 = 51%), and a random-effects model was used for the analysis. The results indicated that mind–body exercise significantly reduced the IL-6 levels in breast cancer patients (SMD = −0.30, 95% CI [−0.56, −0.03], p = 0.03) (Figure 13A).

(A) Forest plot of the effect of mind–body exercise on IL-6 levels in breast cancer patients. (B) Sensitivity analysis of IL-6 levels.

Panel A shows a forest plot of a meta-analysis comparing experimental and control groups across five studies. The standardized mean differences and confidence intervals suggest varying effects, with some favoring the experimental group. Panel B displays a linear form meta-analysis estimate plot, visually assessing the influence of omitting each study. The vertical lines indicate the overall effect, and circles mark the estimates when each study is excluded. The forest plot indicates total heterogeneity and the overall effect test result. Reactive protein (CRP)

A total of 3 RCTs included 132 breast cancer patients to compare the differences in CRP levels between the mind–body exercise group and the control group. No heterogeneity was observed between the studies (I2 = 0%), and a fixed-effects model was used for the analysis. The results indicated that the combined effect size was SMD = −0.12, 95% CI [−0.46, 0.23], p = 0.50, indicating that, compared to the control group, mind–body exercise had no significant effect on CRP levels in breast cancer patients (Figure 14A).

(A) Forest plot of the effect of mind–body exercise on CRP levels in breast cancer patients. (B) Sensitivity analysis of CRP levels.

Panel A shows a forest plot comparing standardized mean differences between experimental and control groups across three studies: Bower 2014, Bower 2015, and Greaney 2022. Each study’s effect size is indicated by squares with confidence intervals marked by horizontal lines. A diamond represents the overall mean difference. Panel B displays a funnel plot showing the effect estimates with studies omitted. Both panels assess data heterogeneity and overall effects in the meta-analysis.

The summary of the meta-analysis results is provided in detail in Table 3.

Effects of mind–body exercises on outcome measures in breast cancer patients.

Outcome n Effect size SMD 95% confidence interval I2(%) Df Z P
Experimental Control Lower limit Upper limit
Anxiety 557 532 −0.50 −0.73 −0.27 70% 12 4.30 P < 0.0001
Depression 1,090 1,053 −0.43 −0.60 −0.26 72% 21 4.91 P < 0.00001
Fatigue 1,251 1,179 −0.52 −0.72 −0.31 83% 24 4.97 P < 0.00001
QOL 809 769 0.67 0.39 0.95 85% 17 4.67 P < 0.00001
Pain 468 424 −0.08 −0.34 0.18 71% 7 0.59 p = 0.05
Cognitive function 158 158 0.55 −0.06 1.16 85% 4 1.77 P = 0.08
Perceived stress 390 384 −0.65 −1.11 −0.20 88% 8 2.83 P = 0.005
FCR 327 308 −0.51 −0.88 −0.14 78% 4 2.68 P = 0.007
Insomnia 728 731 −0.40 −0.72 −0.07 89% 13 2.36 P = 0.02
IL-6 level 331 312 −0.30 −0.56 −0.03 51% 4 2.22 P = 0.03
CRP level 70 62 −0.12 −0.46 0.23 0% 2 0.67 P = 0.50

QOL, Quality of Life; FCR, Fear of Cancer Recurrence.

 Meta-regression results

To further explore the sources of heterogeneity among the included studies, we conducted a meta-regression analysis using intervention duration, region, cancer stage, patient age, and intervention type as independent variables, and the SMD of each outcome measure as the dependent variable.

The results indicated that intervention duration was an important source of heterogeneity for multiple outcomes. Specifically, the effect sizes for anxiety (β = 0.061, p = 0.040) and quality of life (β = 0.150, p = 0.005) were positively associated with intervention duration, while those for pain (β = −0.178, p = 0.005) and cognitive function (β = −0.225, p = 0.007) were negatively associated. Regional factors significantly influenced heterogeneity in depression (β = 0.526, p = 0.001), cognitive function (β = −2.765, p = 0.001), and quality of life (β = −0.990, p = 0.004), indicating clear differences across regions. Intervention type significantly affected heterogeneity in pain (β = 0.881, p = 0.004) and depression (β = 0.273, p = 0.016). Age also had significant effects on depression (β = −0.034, p = 0.040) and cognitive function (β = 0.506, p < 0.001), with the improvement in depression showing a negative correlation with age.

For other outcomes, such as fatigue, perceived stress, insomnia, and IL-6, heterogeneity could not be explained by the variables examined in this study (all p > 0.05), suggesting that these outcomes may be influenced by other unmeasured factors.” The full meta-regression results are included in the Supplementary material.

 Sensitivity analysis and publication bias

Sensitivity analysis was conducted for all outcome measures (Figures 4B–14B). The sensitivity analysis was performed using a leave-one-out approach. The results showed that the direction of effect sizes remained unchanged after excluding individual studies, indicating that the results were relatively stable. Publication bias was assessed, and Egger’s test showed no significant bias (p > 0.05), with the funnel plot displaying symmetry, indicating no publication bias. The funnel plots and Egger’s test showed symmetry for most outcome measures, with p > 0.05. Only cancer recurrence fear (Figure 7C) and quality of life (Figure 12C) showed p < 0.05 in Egger’s test (Table 4). We attempted trim-and-fill analysis (Figures 7D, 12D) but did not find any significant impact on the results.

Results of publication bias Egger’s linear regression test.

Variable b SE t 95%CI P
Anxiety −3.917 2.606 −1.50 −9.653 1.819 0.161
Depression −2.380 1.237 −1.92 −4.960 0.199 0.069
Fatigue −2.368 1.541 −1.54 −5.556 0.821 0.138
QOL* 4.086 1.477 2.77 0.956 7.227 0.014
Pain −0.890 2.224 −0.40 −6.333 4.553 0.703
Cognitive function 4.703 5.375 0.87 −12.404 21.809 0.870
Perceived stress −3.684 2.227 −1.65 −8.950 1.583 0.142
FCR* −5.337 1.020 −5.23 −8.582 −2.091 0.014
Insomnia −2.360 2.413 −0.98 −7.618 2.897 0.347
IL-6 level 3.001 2.742 1.09 −4.613 10.614 0.335
CRP level −1.100 1.568 −0.70 −21.027 18.826 0.610

*Egger’s test results P < 0.05, QOL, Quality of Life; FCR, Fear of Cancer Recurrence.

 Discussion

Anxiety and depression are common psychological issues among breast cancer patients and are significant factors contributing to higher mortality and cancer recurrence rates (65). This study is consistent with previous meta-analyses, which demonstrated that mind–body exercise significantly alleviates anxiety and depression in patients (62, 66). The heterogeneity of the combined effect sizes for anxiety and depression was moderate, with sensitivity analysis showing stable results. Meta-regression analysis suggested that the heterogeneity may be attributable to differences in intervention type, intervention duration, geographic region, and patient age. A relatively large number of clinical RCTs were included in this study, some of which were recently published, further confirming the effectiveness of mind–body exercise in addressing these common negative emotions. An increasing body of research shows that stress is closely related to various psychological and physiological problems in breast cancer patients (67–69). Stress typically refers to external circumstances or stimuli in the environment that may impact an individual’s psychological or physiological state. Perceived stress, on the other hand, focuses on an individual’s subjective experience of these stressors, emphasizing the intensity of the perceived stress. Breast cancer patients often experience significant psychological stress due to concerns about cancer recurrence. If this stress persists, it may lead to more severe mental health disorders, such as post-traumatic stress disorder (PTSD) (70–72). Therefore, perceived stress is a more accurate reflection of the actual psychological burden on breast cancer patients compared to general stress. This study demonstrates that mind–body exercise has a moderate effect in reducing perceived stress among breast cancer patients. However, due to the high heterogeneity across studies, these conclusions should be interpreted with caution. To further explore the impact of mind–body exercise on the psychological state of breast cancer patients, we included cancer recurrence fear as a research indicator and incorporated 5 RCTs. The results indicated that mind–body exercise had a moderate effect on alleviating cancer recurrence fear in patients. Sensitivity analysis confirmed the robustness of this effect, supporting the efficacy of the intervention. The Analysis of patients’ perceived stress and FCR indicates that mind–body exercise may have a potential positive effect in reducing psychological stress and enhancing psychological resilience.

Sleep disorders and fatigue are among the most common and distressing symptoms experienced by cancer patients (73). Approximately 30–75% of newly diagnosed or recently treated patients report sleep problems (73, 74), while 70–80% of patients suffer from cancer-related fatigue (75). This study included 14 RCTs with 1,441 patients and 25 RCTs with 2,430 patients, investigating the effects of mind–body exercise on insomnia and cancer-related fatigue in breast cancer patients. The results indicate that mind–body exercise has a mild effect on improving patients’ insomnia (SMD = −0.40, p = 0.02), showing a certain marginal effect, but had a more significant effect on alleviating fatigue (SMD = −0.52, p < 0.00001). This may be because insomnia is influenced not only by physiological factors but also by environmental factors, psychological states, and side effects caused by treatment. Mind–body exercise may have a short-term positive impact on sleep by improving the patient’s mindset and promoting physical relaxation. However, for long-term sleep issues, it is recommended to combine mind–body exercise with other therapeutic approaches to achieve better outcomes. Furthermore, this study found that mind–body exercise significantly improved overall quality of life in breast cancer patients (SMD = 0.67, p < 0.00001). Although the pooled effects for insomnia and quality of life showed considerable heterogeneity, the overall trend indicates that mind–body exercise can serve as an adjunctive intervention to improve both physical and psychological well-being in breast cancer patients.

However, this study did not find that mind–body exercise had a significant effect on cognitive function, pain, or C-reactive protein levels in breast cancer patients. This may be related to factors such as the duration of the intervention, individual differences, and floor effects due to insufficient sample size. Currently, research on the impact of mind–body exercise on cognitive dysfunction in breast cancer patients is limited. A retrospective analysis showed that 32% of studies found physical exercise helped improve cancer-related cognitive function, 2.1% showed no significant effect, and 66% did not draw definitive conclusions (76). Among the 5 RCTs included in this study, after excluding the study by Wei et al. (58) with high heterogeneity (I2 = 0%), a fixed-effects model was used for re-analysis. The results showed a trend of improvement in cognitive function following mind–body exercise interventions, but the effect was not statistically significant. Additionally, evidence regarding the positive impact of exercise on cancer-related pain is weak (77). This study included 8 RCTs related to breast cancer pain, but did not demonstrate a significant alleviating effect of mind–body exercise on pain. Research has shown that exercise is associated with a reduction in the levels of several pro-inflammatory cytokines (78, 79). In our meta-analysis, mind–body exercise significantly reduced IL-6 levels but did not show a significant impact on CRP levels.

 Strengths and limitations

A key strength of this meta-analysis is its inclusion of a large sample size, which included 47 clinical RCTs and 4,537 patients, with a comprehensive search and analysis conducted across five databases. It systematically explored the effects of mind–body exercise on both psychological and physical functioning in breast cancer patients, providing updated and comprehensive evidence for non-pharmacological treatments for breast cancer patients.

However, this study has several limitations. First, among the 47 included studies, only 11 were rated as high-quality, while 33 were of moderate quality and 3 were low-quality, resulting in an overall limited study quality that may reduce the strength and applicability of the clinical evidence. Second, most studies did not implement blinding, increasing the risk of performance and detection bias and thus partially affecting the objectivity of the results. Third, for outcomes such as anxiety and depression, the included studies used different assessment scales to measure the same outcomes. Although we converted effect sizes obtained from different scales into SMD to provide a dimensionless and comparable metric, differences in sensitivity and scoring characteristics among the scales may still introduce methodological heterogeneity, potentially limiting the precision of direct comparisons and the robustness of pooled interpretations. Fourth, the term “mind–body exercise” encompasses various forms, including yoga, Qigong, and Tai Chi. While these interventions share common theoretical foundations and core mechanisms, they differ in intervention type, frequency, and target populations. Although pooled analyses help summarize overall trends, they may introduce significant clinical heterogeneity, and some conclusions should be interpreted with caution. Fifth, most studies did not report participants’ adherence to the interventions, making it difficult to accurately assess the real-world effectiveness of these interventions, which may affect the reliability of the results. Sixth, this study focused on the immediate effects of mind–body exercise and lacked evaluations of long-term outcomes, limiting comprehensive assessment of its sustainable benefits. Future studies should extend follow-up periods to verify the durability and clinical translational value of the interventions. Finally, due to the uneven geographic distribution of included studies—primarily from Asia and North America, with only one from Europe—the generalizability of our findings to Europe and other regions remains to be further validated.

 Conclusion

This study suggests that mind–body exercise, as an adjunct intervention for breast cancer patients, shows promising potential in alleviating psychosocial distress. Pooled analyses indicate moderate and statistically significant positive effects on anxiety, depression, fatigue, and FCR. Although improvements in perceived stress, insomnia, and quality of life were also observed, the high heterogeneity led us to use a random-effects model to provide more conservative and generalizable effect estimates; nevertheless, the robustness and generalizability of these results remain limited and should be interpreted with caution. Meta-regression analyses indicated that intervention duration and regional factors were the main sources of heterogeneity for quality of life, while the sources of heterogeneity for perceived stress and insomnia could not be determined, suggesting that these outcomes may be influenced by other unmeasured variables.

In addition, mind–body exercise showed only marginal effects in reducing IL-6 levels, with limited evidence strength, and its effects on cognitive function, pain, and CRP levels were not clearly confirmed in this study. Overall, Mind–body exercise demonstrates promising short-term application value in the treatment of breast cancer patients, although its efficacy varies across different outcome measures, and long-term effects still need further validation. Future research should include rigorously designed, large-scale randomized controlled trials with extended follow-up periods, focusing on intervention type, duration, and target population characteristics, to provide more targeted and high-quality evidence for clinical practice.

 Data availability statement

The original contributions presented in the study are included in the article/Supplementary material, further inquiries can be directed to the corresponding author.

 Author contributions

LL: Formal analysis, Writing – review & editing, Data curation, Conceptualization, Investigation, Writing – original draft. YH: Investigation, Writing – review & editing, Data curation, Methodology. XY: Visualization, Software, Methodology, Writing – review & editing. YL: Validation, Supervision, Writing – review & editing.

 Funding

The author(s) declare that no financial support was received for the research and/or publication of this article.

 Conflict of interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Generative AI statement

The authors declare that no Gen AI was used in the creation of this manuscript.

Any alternative text (alt text) provided alongside figures in this article has been generated by Frontiers with the support of artificial intelligence and reasonable efforts have been made to ensure accuracy, including review by the authors wherever possible. If you identify any issues, please contact us.

 Publisher’s note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary material

The Supplementary material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpubh.2025.1641075/full#supplementary-material

 References HeinsMJ de LigtKM VerloopJ SieslingS KorevaarJCPSCCR group. Adverse health effects after breast cancer up to 14 years after diagnosis. Breast. (2021) 61:22–8. doi: 10.1016/j.breast.2021.12.001 Puigpinós-RieraR Graells-SansA SerralG ContinenteX BargallóX DomènechM . Anxiety and depression in women with breast cancer: social and clinical determinants and influence of the social network and social support (DAMA cohort). Cancer Epidemiol. (2018) 55:123–9. doi: 10.1016/j.canep.2018.06.002, PMID: 29940418 KnoerlR SannesTS Giobbie-HurderA FrankES McTiernanA WinerEP . Exploring anxiety as an influencing factor of the impact of exercise and mind-body prehabilitation on cognitive functioning among women undergoing breast cancer surgery. J Psychosoc Oncol. (2024) 42:448–56. doi: 10.1080/07347332.2023.2282021, PMID: 38044630 BrownLC MurphyAR LalondeCS SubhedarPD MillerAH StevensJS. Posttraumatic stress disorder and breast cancer: risk factors and the role of inflammation and endocrine function. Cancer. (2020) 126:3181–91. doi: 10.1002/cncr.32934, PMID: 32374431 ChengWH TeoRH ChengLJ LauY LauST. Global prevalence of sleep disturbances among breast cancer survivors: a systematic review with meta-analysis. Sleep Health. (2023) 9:704–16. doi: 10.1016/j.sleh.2023.04.004, PMID: 37453906 BehzadmehrR DastyarN MoghadamMP AbavisaniM MoradiM. Effect of complementary and alternative medicine interventions on cancer related pain among breast cancer patients: a systematic review. Complement Ther Med. (2020) 49:102318. doi: 10.1016/j.ctim.2020.102318, PMID: 32147038 ZhouH WangT XuY ChenY DengL WangC . Effects of exercise interventions on cancer-related fatigue in breast cancer patients: an overview of systematic reviews. Support Care Cancer. (2022) 30:10421–40. doi: 10.1007/s00520-022-07389-5, PMID: 36326908 KreutzC SchmidtME SteindorfK. Effects of physical and mind-body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis. Breast Cancer Res Treat. (2019) 176:1–15. doi: 10.1007/s10549-019-05217-9, PMID: 30955185 GengL DuanY LiX YueS LiR LiuH . Comparative efficacy of mind-body exercise for depression in breast cancer survivors: a systematic review and network meta-analysis. Worldviews Evid-Based Nurs. (2023) 20:593–609. doi: 10.1111/wvn.12669, PMID: 37526252 BlomstrandP TesanD NylanderEM RamstrandN. Mind body exercise improves cognitive function more than aerobic- and resistance exercise in healthy adults aged 55 years and older—an umbrella review. Eur Rev Aging Phys Act. (2023) 20:15. doi: 10.1186/s11556-023-00325-4, PMID: 37558977 Casanovas-ÁlvarezA EstanyolB CiendonesM PadròsJ CuarteroJ BarnadasA . Effectiveness of an exercise and educational-based prehabilitation program in patients with breast cancer receiving neoadjuvant chemotherapy (PREOptimize) on functional outcomes: a randomized controlled trial. Phys Ther. (2024) 104:151. doi: 10.1093/ptj/pzae151, PMID: 39423256 GradisharWJ MoranMS AbrahamJ AbramsonV AftR AgneseD . NCCN clinical practice guidelines in oncology. J Natl Compr Cancer Netw. (2024) 22:331–57. doi: 10.6004/jnccn.2024.0035, PMID: 39019058 PizotC BoniolM MullieP KoechlinA BoniolM BoyleP . Physical activity, hormone replacement therapy and breast cancer risk: a meta-analysis of prospective studies. Eur J Cancer. (2016) 52:138–54. doi: 10.1016/j.ejca.2015.10.063, PMID: 26687833 HanB ZhangP ZhaoH ZhangX GaoH DongJ . Effects of exercise interventions on quality of life in patients with breast cancer: a systematic review and network meta-analysis. Psycho-Oncol. (2024) 33:e6370. doi: 10.1002/pon.6370, PMID: 38937093 GreenleeH DuPont-ReyesMJ BalneavesLG CarlsonLE CohenMR DengG . Clinical practice guidelines on the evidence-based use of integrative therapies during and after breast cancer treatment. CA Cancer J Clin. (2017) 67:194–232. doi: 10.3322/caac.21397, PMID: 28436999 HigginsJP AltmanDG GøtzschePC JüniP MoherD OxmanAD . The cochrane collaboration’s tool for assessing risk of bias in randomised trials. BMJ. (2011) 343:d5928. doi: 10.1136/bmj.d5928, PMID: 22008217 CumpstonM LiT PageMJ ChandlerJ WelchVA HigginsJP . Updated guidance for trusted systematic reviews: a new edition of the Cochrane handbook for systematic reviews of interventions. Cochrane Database Syst Rev. (2019) 10:ED000142. doi: 10.1002/14651858.ED000142, PMID: 31643080 KimYH KimHJ AhnSD SeoYJ KimSH. Effects of meditation on anxiety, depression, fatigue, and quality of life of women undergoing radiation therapy for breast cancer. Complement Ther Med. (2013) 21:379–87. doi: 10.1016/j.ctim.2013.06.005, PMID: 23876569 PouyS Attari PeikaniF NourmohammadiH SaneiP TarjomanA BorjiM. Investigating the effect of mindfulness-based training on psychological status and quality of life in patients with breast cancer. Asian Pac J Cancer Prev. (2018) 19:1993–8. doi: 10.22034/APJCP.2018.19.7.1993, PMID: 30051690 BowerJE CrosswellAD StantonAL CrespiCM WinstonD ArevaloJ . Mindfulness meditation for younger breast cancer survivors: a randomized controlled trial. Cancer. (2015) 121:1231–40. doi: 10.1002/cncr.29194, PMID: 25537522 JangSH KangSY LeeHJ LeeSY. Beneficial effect of mindfulness-based art therapy in patients with breast cancer—a randomized controlled trial. Explorer. (2016) 12:333–40. doi: 10.1016/j.explore.2016.06.003, PMID: 27473311 ShaoD ZhangH CuiN SunJ LiJ CaoF. The efficacy and mechanisms of a guided self-help intervention based on mindfulness in patients with breast cancer: a randomized controlled trial. Cancer. (2020) 127:1377–86. doi: 10.1002/cncr.33381, PMID: 33332582 ZhaoY LiuJE LewisFM NieZH QiuH HanJ . Effects of mindfulness-based cognitive therapy on breast cancer survivors with insomnia: a randomised controlled trial. Eur J Cancer Care. (2020) 29:e13259. doi: 10.1111/ecc.13259, PMID: 32424878 JohannsenM O'ConnorM O'TooleMS JensenAB HøjrisI ZachariaeR. Efficacy of mindfulness-based cognitive therapy on late post-treatment pain in women treated for primary breast cancer: a randomized controlled trial. J Clin Oncol. (2016) 34:3390–9. doi: 10.1200/JCO.2015.65.0770, PMID: 27325850 ParkS SatoY TakitaY TamuraN NinomiyaA KosugiT . Mindfulness-based cognitive therapy for psychological distress, fear of cancer recurrence, fatigue, spiritual well-being, and quality of life in patients with breast cancer—a randomized controlled trial. J Pain Symptom Manag. (2020) 60:381–9. doi: 10.1016/j.jpainsymman.2020.02.017, PMID: 32105790 ChuX LouY WangZ XuQ. Effect of mindfulness based cognitive therapy on the mental health and quality of life in patients with breast cancer. Indian J Pharm Sci. (2020) 82:48–52. doi: 10.36468/pharmaceutical-sciences.spl.143 LengacherCA ReichRR PatersonCL JimHS RamesarS AlinatCB . The effects of mindfulness-based stress reduction on objective and subjective sleep parameters in women with breast cancer: a randomized controlled trial. Psycho-Oncology. (2015) 24:424–32. doi: 10.1002/pon.3603, PMID: 24943918 DuvalA DavisCG KhooEL RomanowH ShergillY RiceD . Mindfulness-based stress reduction and cognitive function among breast cancer survivors: a randomized controlled trial. Cancer. (2022) 128:2520–8. doi: 10.1002/cncr.34209, PMID: 35385137 LengacherCA ReichRR PatersonCL SheltonM ShiversS RamesarS . A large randomized trial: effects of mindfulness-based stress reduction (MBSR) for breast cancer (BC) survivors on salivary cortisol and IL-6. Biol Res Nurs. (2019) 21:39–49. doi: 10.1177/1099800418789777, PMID: 30079756 ZhuP LiuX ShangX ChenY ChenC WuQ. Mindfulness-based stress reduction for quality of life, psychological distress, and cognitive emotion regulation strategies in patients with breast cancer under early chemotherapy—a randomized controlled trial. Holist Nurs Pract. (2023) 37:131–42. doi: 10.1097/HNP.0000000000000580, PMID: 37070838 LengacherCA Johnson-MallardV Post-WhiteJ MoscosoMS JacobsenPB KleinTW . Randomized controlled trial of mindfulness-based stress reduction (MBSR) for survivors of breast cancer. Psycho-Oncology. (2010) 18:1261–72. doi: 10.1002/pon.1529, PMID: 19235193 LengacherCA ReichRR PatersonCL RamesarS ParkJY AlinatC . Examination of broad symptom improvement resulting from mindfulness-based stress reduction in breast cancer survivors: a randomized controlled trial. J Clin Oncol. (2016) 34:2827–34. doi: 10.1200/JCO.2015.65.7874, PMID: 27247219 LengacherCA ReichRR Post-WhiteJ MoscosoM SheltonMM BartaM . Mindfulness based stress reduction in post-treatment breast cancer patients: an examination of symptoms and symptom clusters. J Behav Med. (2012) 35:86–94. doi: 10.1007/s10865-011-9346-4, PMID: 21506018 ReichRR LengacherCA AlinatCB KipKE PatersonC RamesarS . Mindfulness-based stress reduction in post-treatment breast cancer patients: immediate and sustained effects across multiple symptom clusters. J Pain Symptom Manag. (2017) 53:85–95. doi: 10.1016/j.jpainsymman.2016.08.005, PMID: 27720794 BowerJE PartridgeAH WolffAC ThornerED IrwinMR JoffeH . Targeting depressive symptoms in younger breast cancer survivors: the pathways to wellness randomized controlled trial of mindfulness meditation and survivorship education. J Clin Oncol. (2021) 39:3473–84. doi: 10.1200/JCO.21.00279, PMID: 34406839 ZhangJ ZhouY FengZ FanY ZengG WeiL. Randomized controlled trial of mindfulness-based stress reduction (MBSR) on posttraumatic growth of Chinese breast cancer survivors. Psychol Health Med. (2016) 22:94–109. doi: 10.1080/13548506.2016.1146405, PMID: 26853191 TaylorTR BarrowJ MakambiK SheppardV WallingtonSF MartinC . A restorative yoga intervention for African-American breast cancer survivors: a pilot study. J Racial Ethn Health Disparities. (2018) 5:62–72. doi: 10.1007/s40615-017-0342-4, PMID: 28411330 WangG WangS JiangP ZengC. Effect of yoga on cancer related fatigue in breast cancer patients with chemotherapy. J Cent South Univ Med Sci. (2014) 39:1077–82. doi: 10.11817/j.issn.1672-7347.2014.10.016 TasoCJ LinHS LinWL ChenSM HuangWT ChenSW. The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer: a randomized controlled trial. J Nurs Res. (2014) 22:155–64. doi: 10.1097/jnr.0000000000000044, PMID: 25111109 WangG WangS JiangP ZengC. Effect of yoga on quality of life in breast cancer patients with chemotherapy. Chin J Nurs. (2015) 8:937–41. doi: 10.3761/j.issn.0254-1769.2015.08.009 RaghavendraRM NagarathnaR NagendraHR GopinathKS SrinathBS RaviBD . Effects of an integrated yoga programme on chemotherapy-induced nausea and emesis in breast cancer patients. Eur J Cancer Care. (2007) 16:462–74. doi: 10.1111/j.1365-2354.2006.00739.x, PMID: 17944760 LiuW LiuJ MaL ChenJ. Effect of mindfulness yoga on anxiety and depression in early breast cancer patients received adjuvant chemotherapy: a randomized clinical trial. J Cancer Res Clin Oncol. (2022) 148:2549–60. doi: 10.1007/s00432-022-04167-y, PMID: 35788727 PrakashK SainiSK PugazhendiS. Effectiveness of yoga on quality of life of breast cancer patients undergoing chemotherapy: a randomized clinical controlled study. Indian J Palliat Care. (2020) 26:323–31. doi: 10.4103/IJPC.IJPC_192_19, PMID: 33311874 ChandwaniKD PerkinsG NagendraHR RaghuramNV SpelmanA NagarathnaR . Randomized, controlled trial of yoga in women with breast cancer undergoing radiotherapy. J Clin Oncol. (2014) 32:1058–65. doi: 10.1200/JCO.2012.48.2752, PMID: 24590636 ChandwaniKD ThorntonB PerkinsGH ArunB RaghuramNV NagendraHR . Yoga improves quality of life and benefit finding in women undergoing radiotherapy for breast cancer. J Soc Integr Oncol. (2010) 8:43–55. doi: 10.2310/7200.2010.0002 MoadelAB ShahC Wylie-RosettJ HarrisMS PatelSR HallCB . Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol. (2007) 25:4387–95. doi: 10.1200/JCO.2006.06.6027, PMID: 17785709 CramerH RabsilberS LaucheR KümmelS DobosG. Yoga and meditation for menopausal symptoms in breast cancer survivors—a randomized controlled trial. Cancer. (2015) 121:2175–84. doi: 10.1002/cncr.29330, PMID: 25739642 BanerjeeB VadirajHS RamA RaoR JayapalM GopinathKS . Effects of an integrated yoga program in modulating psychological stress and radiation-induced genotoxic stress in breast cancer patients undergoing radiotherapy. Integr Cancer Ther. (2007) 6:242–50. doi: 10.1177/1534735407306214, PMID: 17761637 Kiecolt-GlaserJK BennettJM AndridgeR PengJ ShapiroCL MalarkeyWB . Yoga’s impact on inflammation, mood, and fatigue in breast cancer survivors: a randomized controlled trial. J Clin Oncol. (2014) 32:1040–9. doi: 10.1200/JCO.2013.51.8860, PMID: 24470004 PorterLS CarsonJW OlsenM CarsonKM SandersL JonesL . Feasibility of a mindful yoga program for women with metastatic breast cancer: results of a randomized pilot study. Support Care Cancer. (2019) 27:4307–16. doi: 10.1007/s00520-019-04710-7, PMID: 30877596 GreaneySK AminN PrudnerBC CompernolleM SandellLJ TebbSC . Yoga therapy during chemotherapy for early-stage and locally advanced breast cancer. Integr Cancer Ther. (2022) 21:7285. doi: 10.1177/15347354221137285, PMID: 36412916 ChaoulA MilburyK SpelmanA Basen-EngquistK HallMH WeiQ . Randomized trial of Tibetan yoga in patients with breast cancer undergoing chemotherapy. Cancer. (2018) 124:36–45. doi: 10.1002/cncr.30938, PMID: 28940301 BowerJE GreendaleG CrosswellAD GaretD SternliebB GanzPA . Yoga reduces inflammatory signaling in fatigued breast cancer survivors: a randomized controlled trial. Psychoneuroendocrinology. (2014) 43:20–9. doi: 10.1016/j.psyneuen.2014.01.019, PMID: 24703167 EyigorS UsluR ApaydınS CaramatI YesilH. Can yoga have any effect on shoulder and arm pain and quality of life in patients with breast cancer? A randomized, controlled, single-blind trial. Complement Ther Clin Pract. (2018) 32:40–5. doi: 10.1016/j.ctcp.2018.04.010, PMID: 30057055 BowerJE GaretD SternliebB GanzPA IrwinMR OlmsteadR . Yoga for persistent fatigue in breast cancer survivors: a randomized controlled trial. Cancer. (2012) 118:3766–75. doi: 10.1002/cncr.26702, PMID: 22180393 VadirajaHS RaoRM NagarathnaR NagendraHR PatilS DiwakarRB . Effects of yoga in managing fatigue in breast cancer patients: a randomized controlled trial. Indian J Palliat Care. (2017) 23:247–52. doi: 10.4103/IJPC.IJPC_95_17, PMID: 28827926 HanY WangQ LuoD XueJ. Effects of Baduanjin training on anxiety and anxiety-related serum protein in postoperative patients with breast cancer. J Nurs Sci. (2017) 32:42–4. doi: 10.3870/j.issn.1001-4152.2017.08.042 WeiX YuanR YangJ ZhengW JinY WangM . Effects of Baduanjin exercise on cognitive function and cancer-related symptoms in women with breast cancer receiving chemotherapy: a randomized controlled trial. Support Care Cancer. (2022) 30:6079–91. doi: 10.1007/s00520-022-07015-4, PMID: 35416502 YingW MinQW LeiT NaZX LiL JingL. The health effects of Baduanjin exercise (a type of qigong exercise) in breast cancer survivors: a randomized, controlled, single-blinded trial. Eur J Oncol Nurs. (2019) 39:90–7. doi: 10.1016/j.ejon.2019.01.007, PMID: 30850143 ChenZ MengZ MilburyK BeiW ZhangY ThorntonB . Qigong improves quality of life in women undergoing radiotherapy for breast cancer: results of a randomized controlled trial. Cancer. (2013) 119:1690–8. doi: 10.1002/cncr.27904, PMID: 23355182 ChangCI YehML LiaoJ. Chan-Chuang qigong with breathing meditation improves quality of life and interoceptive awareness in patients with breast cancer: a randomised controlled trial. Support Care Cancer. (2023) 31:140. doi: 10.1007/s00520-023-07578-w, PMID: 36707489 ZhangJ LiS MengL ZhouY. Effectiveness of a nurse-led mindfulness-based tai chi Chuan (MTCC) program on posttraumatic growth and perceived stress and anxiety of breast cancer survivors. Eur J Psychotraumatol. (2022) 13:2023314. doi: 10.1080/20008198.2021.2023314, PMID: 35140880 LarkeyLK RoeDJ WeihsKL JahnkeR LopezAM RogersCE . Randomized controlled trial of qigong/tai chi easy on cancer-related fatigue in breast cancer survivors. Ann Behav Med. (2015) 49:165–76. doi: 10.1007/s12160-014-9645-4, PMID: 25124456 SprodLK JanelsinsMC PaleshOG CarrollJK HecklerCE PepponeLJ . Health-related quality of life and biomarkers in breast cancer survivors participating in tai chi Chuan. J Cancer Surviv. (2011) 6:146–54. doi: 10.1007/s11764-011-0205-7, PMID: 22160628 WangX WangN ZhongL WangS ZhengY YangB . Prognostic value of depression and anxiety on breast cancer recurrence and mortality: a systematic review and meta-analysis of 282,203 patients. Mol Psychiatry. (2020) 25:3186–97. doi: 10.1038/s41380-020-00865-6, PMID: 32820237 MillerKJ Gonçalves-BradleyDC AreerobP HennessyD MesagnoC GraceF. Comparative effectiveness of three exercise types to treat clinical depression in older adults: a systematic review and network meta-analysis of randomised controlled trials. Ageing Res Rev. (2019) 58:100999. doi: 10.1016/j.arr.2019.100999 BorgiM CollacchiB OrtonaE CirulliF. Stress and coping in women with breast cancer: unravelling the mechanisms to improve resilience. Neurosci Biobehav Rev. (2020) 119:406–21. doi: 10.1016/j.neubiorev.2020.10.011, PMID: 33086128 BowenDJ Fernandez PooleS WhiteM LynR FloresDA HaileHG . The role of stress in breast cancer incidence: risk factors, interventions, and directions for the future. Int J Environ Res Public Health. (2021) 18:1871. doi: 10.3390/ijerph18041871, PMID: 33671879 KnoerlR Giobbie-HurderA SannesTS ChagparAB DillonD DominiciLS . Exploring the impact of exercise and mind-body prehabilitation interventions on physical and psychological outcomes in women undergoing breast cancer surgery. Support Care Cancer. (2022) 30:2027–36. doi: 10.1007/s00520-021-06617-8, PMID: 34648061 DingX ZhaoF ZhuM WangQ WeiS XueJ . A systematic review and meta-analysis of interventions to reduce perceived stress in breast cancer patients. Complement Ther Clin Pract. (2024) 54:101803. doi: 10.1016/j.ctcp.2023.101803, PMID: 38159534 DahabreR BentleyG Poikonen-SakselaP MazzoccoK SousaB Pat-HorenczykR. Can mindfulness facilitate posttraumatic growth in breast cancer patients? The mediating role of illness perceptions and positive emotions. J Health Psychol. (2024) 29:438–51. doi: 10.1177/13591053231223484, PMID: 38312012 VazquezD RosenbergS GelberS RuddyKJ MorganE RecklitisC . Posttraumatic stress in breast cancer survivors diagnosed at a young age. Psycho-Oncology. (2020) 29:1312–20. doi: 10.1002/pon.5438, PMID: 32515073 Ancoli-IsraelS MoorePJ JonesV. The relationship between fatigue and sleep in cancer patients: a review. Eur J Cancer Care. (2001) 10:245–55. doi: 10.1046/j.1365-2354.2001.00263.x, PMID: 11806675 LiuL RisslingM NatarajanL FiorentinoL MillsPJ DimsdaleJE . The longitudinal relationship between fatigue and sleep in breast cancer patients undergoing chemotherapy. Sleep. (2012) 35:237–45. doi: 10.5665/sleep.1630, PMID: 22294814 HofmanM RyanJL Figueroa-MoseleyCD Jean-PierreP MorrowGR. Cancer-related fatigue: the scale of the problem. Oncologist. (2007) 12:4–10. doi: 10.1634/theoncologist.12-S1-4, PMID: 17573451 BrunetJ SharmaS. A scoping review of studies exploring physical activity and cognition among persons with cancer. J Cancer Surviv. (2024) 18:2033–51. doi: 10.1007/s11764-023-01441-x, PMID: 37561316 PlinsingaML SinghB RoseGL CliffordB BaileyTG SpenceRR . The effect of exercise on pain in people with cancer: a systematic review with meta-analysis. Sports Med. (2023) 53:1737–52. doi: 10.1007/s40279-023-01862-9, PMID: 37213049 LuoB XiangD JiX ChenX LiR ZhangS . The anti-inflammatory effects of exercise on autoimmune diseases: a 20-year systematic review. J Sport Health Sci. (2024) 13:353–67. doi: 10.1016/j.jshs.2024.02.002, PMID: 38341137 IsanejadA NazariS GharibB MotlaghAG. Comparison of the effects of high-intensity interval and moderate-intensity continuous training on inflammatory markers, cardiorespiratory fitness, and quality of life in breast cancer patients. J Sport Health Sci. (2023) 12:674–89. doi: 10.1016/j.jshs.2023.07.001, PMID: 37423313