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Pilates for breast cancer: A systematic review and meta- analysis
Rev Assoc Med B ras 2017; 63(11):1006-1011 1007
Despite providing longer survival with early diagno-
sis of breast cancer, treatment leaves sequelae with adverse
effects such as: influence on functional capacity, fatigue,
depression, neuropathic lymphoedema, low immunity
and loss of flexibility. All of these effects end up affecting
the quality of life.1
From the previously described weaknesses that post-
treatment for breast cancer provides to patients, the pilates
method aims to aid in symptom relief by helping patients
regain functionality, improve performance in daily life
activities and help reduce fatigue and improve quality of
life.8 Lastly, pilates exercise may be a complementary in-
tervention, additionally to standard treatment. It is based
on the main movements of the body, encouraging the
performance of a mind-body connection, using principles
such as: breathing, concentration, body alignment, preci-
sion, control, rhythm and endurance.17,18
The evidence to support the recommendation and
widespread use of pilates in women with breast cancer or
after surgery has not been well reported yet. Some studies
compared the efficacy of pilates compared to other types
of exercises on functional capacity, pain and muscular
strength showing the benefits of any type of exercise, espe-
cially with pilates. Thus, the aim of our study was to analyze
the efficacy of pilates compared to other exercises and to
no exercise for women with breast cancer diagnosis.
Method
Data sources and searches
The protocol for this systematic review was registered at
PROSPERO (international prospective register of sys-
temic reviews,
display_record.asp?ID=CRD42016050360). We searched
Medical Literature databases Analysis and Retrieval Sys-
tem Online (Medline) via Pubmed, Excerpta Medical
Database (Embase) via Ovid, Allied and Complementary
Medicine Database (Amed) via EBSCO, Global health,
Biological Abstracts/Reports, Reviews, Meetings (Biosis)
via Ovid, as well as the Latin American and Caribbean
Health Sciences (Lilacs) and the Cochrane Library for
relevant publications until March 2017. All searches were
run individually. Additionally, we searched the WHO
ICTRP (International Clinical Trials Registry Platform)
and ClinicalTrials.gov for completed and ongoing studies.
The search, Cochrane Highly Sensitive Search Strategy,
used the following keywords: Pilates AND “Breast Neo-
plasms” [Mesh] OR “breast cancer.” The search was sensi-
tive and did not use study filters. We checked the reference
lists of all primary studies included for additional refer-
ences. We applied no language or publication restrictions.
We included only randomized controlled trials about
women with breast cancer or women after breast cancer
surgery undergoing treatment and doing pilates exer-
cises in one arm of the study comparing to no exercise or
a different type of exercise in the control group.
Study selection
Two review authors (AJG, GBN) independently assessed
all studies identified from the database searches by screen-
ing titles and abstracts using the Review Management
website Covidence ). We sepa-
rated potential studies for full-text reading. A third review
author (ET) resolved any disagreements. We described
the reasons for including and excluding trials.
Data extraction and quality assessment
Two review authors (AJG, GBN) independently extracted
data from the included studies using a standard data
extraction form. In this form we extracted information
regarding study design, participant description, pilates
exercises, control description, each outcomes explored in
the studies.
All included studies were assessed for their method-
ological quality using the Risk of Bias tool from Cochrane
Collaboration. The tool is composed of six categories of
bias (selection, performance, detection, attrition, report-
ing and other biases). Items were scored as positive (low
risk of bias), negative (high risk of bias) or insufficient
information (unclear risk of bias). A figure described the
assessment for each study in the results section.
Data synthesis and statistical analysis
All included studies were organized in Table 1, which
summarizes all of the participants’ data, all interventions
and characteristics of the control group participants, as
well as all published outcomes.
A meta-analysis was possible only for the functional
capacity outcome. All the tables were organized using
Microsoft Excel 2016 and the review was performed using
RevMan 5.3 (The Nordic Cochrane Centre, Copenhagen,
Denmark).
Results
The search led to the identification of 34 studies and two
additional studies were found by manual search, four of
which were excluded as duplicates (Figure 1). A total of 32
studies were assessed based on title and abstract, of which
21 were excluded because they did not fulfill inclusion
criteria. Full-text studies were retrieved for 11 titles, of
which seven were excluded.