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Results from Cochrane Systematic Review:

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Results from Cochrane Systematic Review:

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We found evidence that physical exercise during adjuvant treatment for breast cancer probably improves physical fitness (SMD 0.42, 95% confidence interval (CI) 0.25 to 0.59; 15 studies; 1310 women; moderate‐quality evidence) and slightly reduces fatigue (SMD ‐0.28, 95% CI ‐0.41 to ‐0.16; 19 studies; 1698 women; moderate‐quality evidence).

We think that the confidence intervals are too big for the results to be precise and reliable - there are 19 studies involved so you would hope the confidence intervals would be smaller.

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This systematic review shows an increase in physical functioning and a decrease in fatigue were observed after a physical exercise intervention with a SMD of 0.27 (0.12, 0.41) and −0.32 (−0.49, - 0.14).

We think that the confidence intervals are similar to the other paper and too big for the results to be precise and reliable. To us, we think that this sparks that there isn't enough significance in the findings.

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We can't answer our original question because we don't have reliable evidence to do so.

For this reason, we will search the three databases once a month to monitor any new evidence to help us answer this question. We cannot disseminate this evidence due to the high level of bias involved in the systematic reviews- we cant trust them.

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As a group, we have decided to reject both of the papers due to the high level of bias that has been introduced. In both papers, due to the nature of the intervention - the exercise, blinding was not possible or allocation concealment, so, therefore, we already have a risk of performance bias and participants performing differently and altering their behaviour due to knowing which group they are in.

Additionally, in both papers, some patients were treated with different therapies which may cause different side effects, potentially making them more fatigued, whereby they may perform differently. Some patients were also at different stages on their cancer.

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P- Patients with breast cancer
I- Exercise
C- No exercise
O- Improved quality of life

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'Does exercise improve quality of life of patients with breast cancer?'

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'The effect of exercise on fatigue and physical functioning in breast cancer patients during and after treatment and at 6 months follow-up: A meta-analysis'
https://pubmed.ncbi.nlm.nih.gov/28415013/

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- The results are significant and proven accurate that there was a slight increase in physical functioning and a decrease in fatigue were observed after an exercise intervention.
-Interventions were continuously supervised 2/weeks over 12 weeks
- A clear and comprehensive overview of the evidence was displayed.
- Databases which were searched were accurate increasing validity.
- A simple conclusion was found and a 6 month follow up was requested to improve the accuracy of the findings.
- This was published in 2017 therefore still relevant.
- A total of 3418 women were included who were aged 18 years or older with non-metastatic invasive breast cancer. These breast cancer patients had all undergone surgical procedures followed by chemotherapy or radiotherapy or both. In the majority of the studies, the included patients were early stage breast cancer patients who were recruited at least 12 months after their diagnosis.
- Only studies of high or moderate quality were included
- No clear difference could be seen from the subgroups where they divided the study populations into groups who received chemotherapy as adjuvant treatment or both chemotherapy and radiotherapy as adjuvant therapy after surgery. None of the studies in this systematic review included patients who received only radiotherapy.

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- Difficult to blind participants in the included studies - blinding of outcome assessors was limiting as exercise itself cannot be blinded in the control group. The possibility that patients allocated to the exercise intervention subjectively feel better and therefore report better  cannot be ruled out.
-  Benefits resulting from exercise might vary depending on the specific medical treatment of the patient, the cancer stage, the cancer type and the patient's current lifestyle.

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Weaknesses of Cochrane Systematic Review:

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Weaknesses of Cochrane Systematic Review:

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- Due to the nature of exercise as an intervention, blinding of participants and exercise supervisors is not possible. The precise effect of the absence of blinding on the magnitude and direction of the treatment effect is unclear but constitutes a high risk for performance bias.
- Women were treated in some studies with radiation treatment only, chemotherapy only, or a combination of the two, resulting in large variation in the duration and frequency of adjuvant treatment as well as differences in possible side effects.
- Data reporting was often poor and did not provide estimates of effect size that could be pooled.
-  23 studies provided insufficient details on group allocation concealment.
-One trial used in the study used a non-random component to generate the sequence thus, was judged to be at a high risk of selection bias.

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1. TRIP (The Turning Research into Practice database)
2. Cochrane library
3. PubMed

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The best level of evidence that would answer the question:

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The best level of evidence that would answer the question:

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Systematic Review

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Strengths of Cochrane Systematic Review:

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Strengths of Cochrane Systematic Review:

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- Well displayed and laid out, therefore makes it easier to read and understand.
-Methods included multiple RCT's and included women going through all types of breast cancer stages and different types of treatments which gives a good variation of results.
-Good evidence is use in order to back up ideas and makes the paper more trustworthy
-includes diagrams which explains the situation.
-2016 is relevant and means it is up to date data.
-One systematic review assessed depression and anxiety statistically it showed an improvement in fatigue levels and quality of life while it showed anxiety levels were borderline significant

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'Exercise for women receiving adjuvant therapy for breast cancer'

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005001.pub3/full?highlightAbstract=improving%7Cexercis%7Cof%7Cexercise%7Ccancer%7Cimprov%7Cbreast%7Clife%7Cquality%7Cqualiti

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Key words, boolean operators, wildcards:

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Key words, boolean operators, wildcards:

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Breast cancer
Lymphedema
Tumours
Mammary cancer
Breast malignant tumour
Patient(s)
Client(s)
Service users
Physical fitness
Physical exercise
Acute exercise
Physical activity
Exercise
Training
Health Care Quality
Quality of healthcare
Healthcare quality
Quality of care
Care Quality

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- Quality of life AND breast cancer AND exercise
- Breast Cancer AND exercise or physical activity AND quality of life