Effects of physical and mind–body exercise on sleep problems during and after breast cancer treatment: a systematic review and meta-analysis

  • Charlotte Kreutz
  • Martina E. Schmidt
  • Karen SteindorfEmail author



We conducted a meta-analysis evaluating the effects of different exercise interventions on self-reported and objective sleep measurements during or after breast cancer treatment.


Three databases were systematically searched for randomized controlled trials with any type of exercise intervention in women with breast cancer. Outcomes were self-reported or objective sleep measurements. Standardized mean differences (SMDs) were calculated using random-effects models.


The meta-analysis included 22 trials with 2107 participants. Of these, 17 studies used the Pittsburgh Sleep Quality Index (PSQI), six studies included objective sleep assessments (ActiGraph). Physical exercise interventions included walking, aerobic exercise, resistance exercise or a combination of both. Mind–body exercise interventions included yoga, Tai Chi and Qigong. Most interventions were supervised. Both, physical (SMD − 0.32; 95% CI − 0.54 to − 0.10) and mind–body exercise interventions (SMD − 0.27; 95% CI − 0.44 to − 0.09), resulted in improvements of total sleep scores. Subgroup analyses revealed no clear differences between interventions conducted during versus after breast cancer treatment. Considering the PSQI subscales, exercise resulted in improvements of sleep quality (SMD − 0.28; 95% CI − 0.44 to − 0.11) and sleep disturbances (SMD − 0.26; 95% CI − 0.45 to − 0.06). Regarding the objective measurements, no significant effects were found.


Physical as well as mind–body exercise can improve subjective sleep problems in breast cancer patients. In contrast, there was no effect of exercise on objective sleep measures. Future studies should clarify which type of intervention might be most effective depending on individual patients’ and treatments’ characteristics.


Breast neoplasm Sleep Exercise interventions Yoga Insomnia Actigraphy 


Compliance of ethical standards

Conflict of interest

Author KS has received research grants from the German Cancer Aid Foundation, awards from the Claudia-von-Schilling Foundation and Lilly Pharma Germany, as well as speaker and consulting honoraria from Pfizer Pharmaceuticals, BIC health insurance, Asklepios hospitals, and Adviva.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Physical Activity, Prevention and CancerGerman Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT) HeidelbergHeidelbergGermany
  2. 2.Faculty of Medicine HeidelbergHeidelbergGermany
  3. 3.Division of Physical Activity, Prevention and Cancer (C110)German Cancer Research Center (DKFZ), National Center for Tumor Diseases (NCT) HeidelbergHeidelbergGermany

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