Comparative efficacy of mind-body exercises on quality of life, anxiety, and depression in patients with breast cancer: a systematic review with pairwise and network meta-analysis of randomized controlled trials

Background: Comparative evidence on the effects of different mind-body exercises (MBEs) for psychological outcomes in breast cancer patients remains limited. This study aimed to compare the effects of Yoga, Tai Chi, Qigong, Pilates, and Dance on quality of life, anxiety, and depression in breast cancer patients. Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to January 31, 2026. Pairwise meta-analyses were performed using random-effects models with Hedges' g. Bayesian network meta-analyses were conducted to estimate standardized mean differences (SMDs) with 95% credible intervals (CrIs). Ranking probabilities were summarized using SUCRA values. Risk of bias and evidence certainty were assessed using the RoB 2 tool and GRADE framework, respectively. Results: Fifty-five RCTs involving 3,770 participants were included. Network meta-analysis showed that Qigong, Dance, and Yoga significantly improved quality of life compared with control, with Qigong showing the highest ranking probability (SUCRA 83.9%). For anxiety, Dance was significantly superior to control and showed the highest ranking probability (SUCRA 90.6%). For depression, Yoga was significantly superior to control and ranked highest, closely followed by Tai Chi (SUCRA 64.3% and 64.1%, respectively). No significant differences were detected between active interventions. Exercise frequency and total dose appeared to be consistent moderators across outcomes. Overall, 55% of included trials were judged to be at high risk of bias, and the certainty of evidence was low to very low. Conclusion: Mind-body exercises may improve quality of life, anxiety, and depression in breast cancer patients. However, because no significant differences were found between active interventions and the certainty of evidence was low to very low, SUCRA rankings should be interpreted as exploratory and hypothesis-generating rather than as evidence of definitive superiority. Higher exercise dose may be associated with greater improvements. Future high-quality head-to-head RCTs are needed to strengthen the evidence base. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261335679, Identifier: CRD420261335679.