The effects of combined aerobic and resistance exercise on metabolic blood biomarkers and quality of life in patients with breast cancer: a systematic review meta-analysis

Objective The systematic review and meta-analysis aimed to evaluate the effects of combined aerobic and resistance exercise (CE) on metabolic blood biomarkers (MBB), quality of life (QoL), and QoL subscales in women with breast cancer (BC). A secondary objective was to investigate whether exercise dose characteristics influenced these outcomes. Methods Randomized controlled trials (RCTs) were comprehensively searched for studies investigating the effects of CE on BC patients across four databases (PubMed, Cochrane, MEDLINE, and Web of Science). The standardized mean difference (Hedges’ g ) was calculated using Comprehensive Meta-Analysis (CMA V4), and the risk of bias was assessed using RevMan 5.4. Results Of the 2,654 records identified, 37 RCTs met the inclusion criteria, with 24 RCTs focusing on overall QoL, nine evaluating FACT-B, and six to nine RCTs assessing MBB outcomes. CE exercise significantly improved overall QoL (Hedges’ g = 1.10; 95% CI: 0.72, 1.48; p < 0.0001), FACT-B (Hedges’ g = 1.14; 95% CI: 0.46, 1.81; p = 0.001), HDL (Hedges’ g = 0.828; 95% CI: 0.051, 1.606; p = 0.037), HOMA-IR (Hedges’ g = − 0.581, 95% CI: − 1.059, − 0.103; p = 0.017), and DBP (Hedges’ g = − 0.39; 95% CI: − 0.786, − 0.0008; p = 0.045). No significant effects were observed for glucose, insulin, triglycerides, LDL, or SBP. Secondary analyses further suggested that higher exercise doses may be associated with greater improvements in these outcomes than shorter exercise doses. Conclusion CE was associated with significant improvements in MBB, QoL, and QoL subscales in breast cancer patients; however, substantial heterogeneity should be considered when interpreting these findings. Exercise dose characteristics may influence QoL and selected MBB outcomes. Further studies are needed to evaluate the optimal dose–response effects of CE in BC patients. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251032722 , identifier CRD420251032722.