Effects of different exercise interventions on quality of life in breast cancer survivors after treatment: a systematic review and network meta-analysis

Background: With more than 7.8 million breast cancer survivors worldwide and five-year survival rates approaching 90%, optimizing quality of life (QoL) has become a central priority in survivorship care. Exercise is a cornerstone non-pharmacological intervention; however, current guidelines lack modality-specific evidence, and existing meta-analyses often rely on overly broad classifications that obscure clinically meaningful differences among exercise types. Methods: This systematic review involved comprehensive searches of six electronic databases (Embase, PubMed, Web of Science, the Cochrane Library, EBSCO, and Scopus) from inception through October 2025. We identified randomized controlled trials (RCTs) that evaluated how exercise interventions affect QoL in breast cancer survivors. Using frequentist network meta-analysis, we synthesized the evidence to determine which exercise modalities demonstrated superior effectiveness across the included RCTs. Results: Sixty-nine randomized controlled trials involving 5,294 breast cancer survivors from 19 countries met the inclusion criteria. All exercise modalities except high-intensity interval training and Pilates were associated with significant improvements in QoL compared with usual care. Surface under the cumulative ranking curve analyses identified combined exercise as the most effective modality (SMD = 1.40, 95% CI: 0.95-1.86; SUCRA = 95.4%), followed by Tai Chi (SMD = 0.98, SUCRA = 71.5%), aerobic exercise (SMD = 0.79, SUCRA = 63.4%), Qigong (SMD = 0.77, SUCRA = 60.1%), yoga (SMD = 0.58, SUCRA = 45.4%), and resistance training (SMD = 0.54, SUCRA = 42.1%). Conclusions: Combined exercise integrating aerobic and resistance components provides the greatest improvement in QoL among breast cancer survivors. These findings offer hierarchical, modality-specific evidence to support personalized exercise prescription in survivorship care. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251173721, identifier CRD420251173721.