Effects of different types of exercise intervention for alleviating breast cancer-related lymphedema: a systematic review protocol and network meta-analysis

Introduction Exercise is the main treatment for patients with breast cancer-related lymphedema (BCRL) and different types of exercises were performed in these patients. However, it is unclear which type of exercise or combination of these is the most effective in reducing arm swelling and lymphedema-related symptoms, and quality of life in patients with BCRL. Aims This study aimed to compare the relative efficacy of different types of exercise in treating BCRL and determine the most effective exercise therapy for patients with BCRL. Methods and analysis This review will search English-language databases (Cochran Library, Cumulative Index to Nursing and Allied Health Literature, EBSCO, EMBASE, PubMed/Medline and Web of Science). The following Chinese-language databases will also be searched: Chinese Biomedical Literature Database (SinoMed), China National Knowledge Infrastructure, Wanfang Data and China Science and Technology Journal Database. The search was conducted up to 31 December 2024. Randomised controlled trials comparing different types of exercise on BCRL will be eligible. Data will be extracted from eligible trials by two independent researchers based on the selection criteria. Two reviewers will ascertain the risk of bias of the selected studies using a modified version of the Cochrane Risk of Bias Tool. The study’s characteristics (study type, characteristics of the patients, intervention prescriptions) and primary outcomes (limb volume, physical function, physical and psychological symptoms) will be summarised in a narrative format. Meta-analyses (ie, network and pairwise) will be used to assess the indirect and direct effects of the exercise interventions. The relative effects of different types of exercise in treating BCRL will be examined by the surface under the cumulative ranking curve to calculate the ranking of treatments and determine the most effective intervention. Ethics and dissemination This review does not require ethical approval. The findings will be submitted for peer-reviewed publication. PROSPERO registration number The systematic review protocol has been registered in the International Prospective Register for Systematic Reviews (CRD42022370817).