Pilates for breast cancer: A systematic review and meta-analysis

Breast cancer is the leading type of cancer causing death in women worldwide. The incidence of the disease is expected to grow worldwide due to the aging of the population and risk factors related to lifestyle behaviors. Considering the lifestyle of women with breast cancer before or after surgery, pilates exercise may be a complementary intervention additionally to standard treatment.

Objective:

To analyze the efficacy of pilates compared to other exercises and to no exercise for women with breast cancer diagnosis.

Method:

We searched Medline via Pubmed, Embase via Ovid, Amed via EBSCO, Biosis via Ovid, Lilacs and the Cochrane Library for relevant publications until March 2017. The keywords used were pilates and “breast cancer,” and only randomized controlled trials were included. Critical appraisal was done using Risk of Bias Tool and GRADE score for assessing the quality of evidence.

Results:

A total of five studies were included in our review. Our results demonstrate that pilates or home-based exercises are better than no exercise in each individual study. We observed significant improvements in the pilates groups compared to home-based exercises. Additionally, in the individual studies, we observed improvements in range of motion, pain and fatigue.

Conclusion:

The evidence shows that pilates or home-based exercise should be encouraged to women with breast cancer.

Keywords:
motor activity; exercise movement techniques; breast neoplasms; delivery of health care

Study name/location	Participants/ Loss	Mean age	Participants included	Pilates frequency	Intensity	Duration	Supervision	Experimental group	Control group	Outcomes	Main results
Eyigor 2010/Turkey	52/10	48.52±7.62 years	Female, with breast cancer with no evidence of recurrent or progressive disease, completion of treatment with surgery, radiotherapy and/or chemotherapy with or without current hormone treatment, consent to participate in the study, and cognitive functions good enough to understand the questionnaires	3 sessions per week for 8 weeks	Not informed	One hour	Physiotherapist	Pilates + home exercises + 30-minute information	Home exercise	All the patients were evaluated for functional capacity with the 6-min walk test (6MWT), flexibility (modified sit and reach test), fatigue with the Brief Fatigue Inventory (BFI), depression with the Beck Depression Index (BDI), quality of life (EORTC-QLQ-C30 and EORTC QLQ BR23) and complications before the treatment and 8 weeks after the exercise by the same physician	Both groups improved significantly in the 6MWT; Only pilates group significantly improved BDI; Only pilates group significantly improved EORTC-QLQ-C30 and EORTC QLQ BR23 functional
Azamian 2015/Iran	34/7	44.11±6.19 years	Women diagnosed with breast cancer	3 sessions per week for 12 weeks	Not informed	Not informed	Physiotherapist	Pilates	No exercise	BMI, fat percent, WHR, VO₂max, FBS level, insulin, HOMA, adiponectin	Serum adiponectin level and VO₂max significantly increased in the pilates group. Insulin level, insulin resistance and body fat percentage significantly decreased and the FBS level had no significant change after selected pilates exercise training (P<0.05)
Martin 2013/USA	26/0	44.6	Women diagnosed with stage I, II or III breast cancer that had completed all treatments within 6 months, had consent from their oncologist to participate	3 sessions per week for 8 weeks	The two protocols matched in volume of work and sequence of muscles exercised. Perceived Exertion (RPE) scale from 6 to 20	50 minutes	Bachelors or Masters of Exercise and Sport Science	Group 1 - PilatesGroup 2- Resistance exercise	No exercise	Muscular endurance and adherence to exercise programs	Pilates and traditional resistance training may be equally effective at improving muscular endurance as significant improvements in muscular endurance were observed
Zengin Alpozgen 2016/Turkey	57/2	51.94±8.05	"Stages I-III" with a diagnosis of breast cancer and development of shoulder ROM limitation (limitation of 20 ≥ ROM in shoulder flexion, abduction, external or internal rotation) secondary due to breast cancer treatment	3 sessions per week for 8 weeks	Not reported	45 minutes	Physiotherapist	Group 1 - PilatesGroup 2- Combined exercises	Home exercises	Body mass index; Pain, Range of motion; Handgrip strength; functional status of the affected limb	Levels of pain decreased significantly in the three groups analyzed. Range of motion and functional status improved in all three groups, but pilates and combined exercises showed better results

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