The association between recreational physical activity and health-related quality of life among breast cancer survivors: A systematic review.

e23183 Background: Breast cancer survivors are at increased risk of poor health-related quality-of-life (HRQOL). Clinical trials suggest that physical activity may improve HRQOL among cancer survivors. However, there are limited data on the generalizability of clinical trial findings to real-world settings. We aimed to fill this gap by evaluating the observational literature on post-diagnosis recreational physical activity and HRQOL among breast cancer survivors. Methods: A systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted using MEDLINE/PubMed and six other databases to identify studies published from January 2003 to October 2024. Study characteristics and adjusted analyses of the association between physical activity and HRQOL among breast cancer survivors were extracted. A qualitative synthesis was performed, categorizing HRQOL outcomes into global, physical, emotional, social, and breast cancer-specific domains. Clinically meaningful differences were assessed by comparing adjusted mean differences to established minimally important differences (MIDs). Risk of bias was evaluated using the Risk of Bias In Non-randomized Studies - of Exposure (ROBINS-E) tool. Results: The search identified 5,831 sources, with 11 studies meeting inclusion criteria across the U.S. and internationally. Most studies reported positive associations between physical activity and HRQOL. For breast cancer survivors meeting aerobic physical activity guidelines, five studies found clinically meaningful improvements in global HRQOL, two found clinically meaningful improvements in physical HRQOL, and one found clinically meaningful improvement in the breast cancer-specific subscale of HRQOL. Only one study found that meeting muscle-strengthening guidelines was associated with improved global and physical HRQOL; however, the estimates did not meet the MID threshold. There was no evidence on effective dosage or types of physical activity for optimal HRQOL. Studies had high to very high risk of bias due to participant selection, subjective outcome measurement (self-report), and reporting bias. Conclusions: Observational studies suggest that meeting aerobic physical activity guidelines could lead to clinically meaningful improvements in global and physical HRQOL. Further research is needed to determine the effects of muscle-strengthening exercise, dosage, and types of physical activity useful to increase HRQOL among breast cancer survivors.