Electronic Supplementary Material, Appendix S1.Pubmed and Scopus Search Syntax

Electronic Supplementary Material

Electronic Supplementary Material, Appendix S1.PubMed and Scopus search syntax

“Breast Neoplasms” [MeSH Terms] OR Breast Neoplasms [Text Word] OR Breast Carcinoma [Text Word] OR Breast Tumo* [Text Word] OR Mammary Carcinoma [Text Word] OR Breast Cancer [Text Word] OR Cancer, Breast [Text Word] OR Cancer of the Breast [Text Word] OR “Carcinoma, Ductal, Breast” [MeSH Terms] OR Mammary Ductal Carcinoma [Text Word] AND "Resistance Training" [MeSH Terms] OR Resistance Training [Text Word] OR Strength Training [Text Word] OR Resistance exercise [Text Word] OR "weight lifting"[MeSH Terms] OR weight training [Text Word] OR Weight-lifting [Text Word] OR "weight-bearing"[MeSH Terms] OR weight-bearing [Text Word] OR weight bearing [Text Word] OR Resistance exercise program*[text Word]

((TITLE-ABS-KEY("breast cancer" OR "Breast Neoplasms" OR " Breast Carcinoma")) OR (TITLE-ABS-KEY("Ductal Breast Carcinoma" OR "Mammary Ductal Carcinoma")) OR (TITLE-ABS-KEY("Breast Tumo*" OR "Mammary Carcinoma" OR "Cancer w/3 Breast"))) AND (TITLE-ABS-KEY("Resistance Training" OR "Strength Training" OR "Resistance exercise" OR "weight lifting" OR "weight training" OR "weight bearing" OR "Resistance exercise program*"))

Electronic Supplementary Material, Appendix S2. Excluded citations (reason)

1.Basen-Engquist K, Perkins H, Carmack C, et al. Test of a weight gain prevention intervention in stage II and III breast cancer patients receiving neoadjuvant chemotherapy. Cancer Epidemiology Biomarkers and Prevention. March 2010;19 (3):895-896. (abstract)

2.Battaglini C, Bottaro M, Dennehy C, et al. The effects of resistance training on muscular strength and fatigue levels in breast cancer patients. Efeitos do treinamento de resistência na força muscular e níveis de fadiga em pacientes com câncer de mama. // 2006;12(3):153-158. (mixed training)

3.Battaglini C, Bottaro M, Dennehy C, et al. The effects of an individualized exercise intervention on body composition in breast cancer patients undergoing treatment. Sao Paulo Medical Journal. // 2007;125(1):22-28. (mixed training)

4.Baumann FT, Drosselmeyer N, Knicker A, et al. Effects of a 3-month resistance training intervention on the cognitive abilities of breast cancer patients during chemotherapy. Auswirkungen einer 3-monatigen krafttrainings-intervention auf die kognitiven fähigkeiten von mammakarzinompatientinnen während der chemotherapie. 2009;41(2):70-75. (non-English)

5.Baumann FT, Drosselmeyer N, Leskaroski A, et al. 12-week resistance training with breast cancer patients during chemotherapy: Effects on Cognitive Abilities. Breast Care. 2011;6(2):142-143. (non-randomized)

6.Baumann FT, Müller S, Krakowski-Roosen H, Knicker A, Schneider J. Effects of resistance training during the chemotherapy of breast cancer patients. Isokinetics & Exercise Science. 2008;16(3):173-173. (abstract)

7.Benton MJ, Schlairet MC, Gibson DR. Change in quality of life among breast cancer survivors after resistance training: is there an effect of age? Journal of aging and physical activity. Apr 9 2013. (non-randomized, no control group)

8.Brown JC, Troxel AB, Schmitz KH. Safety of weightlifting among women with or at risk for breast cancer-related lymphedema: musculoskeletal injuries and health care use in a weightlifting rehabilitation trial. The oncologist. 2012;17(8):1120-1128. (redundant citation)

9.Brown JC, Troxel AB, Schmitz KH. Musculoskeletal injuries and Healthcare needs among women with or at-risk for breast-cancer-related lymphedema in a weight lifting exercise trial. Medicine and Science in Sports and Exercise. May 2012;44:524-524. (abstract)

10.Brown JC, Troxel AB, Schmitz KH. Musculoskeletal injuries in weight lifting among women with or at-risk for breast-cancer-related lymphedema. Annals of Behavioral Medicine. Apr 2012;43:S219-S219. (abstract)

11.Courneya KS, Segal RJ, Gelmon K, et al. Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer epidemiology, biomarkers & prevention. Dec 2007;16(12):2572-2578. (redundant citation)

12.Crowley SA. The effect of a structured exercise program on fatigue, strength, endurance, physical self-efficacy, and functional wellness in women with early stage breast cancer, University of Michigan; 2003. (doctoral thesis)

13.Demark-Wahnefried W, Case LD, Blackwell K, et al. Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Clinical breast cancer. Feb 2008;8(1):70-79. (mixed training)

14.Fernández-Lao C, Cantarero-Villanueva I, Ariza-Garcia A, Courtney C, Fernández-De-Las-Peñas C, Arroyo-Morales M. Water versus land-based multimodal exercise program effects on body composition in breast cancer survivors: A controlled clinical trial. Supportive Care in Cancer. 2013;21(2):521-530. (mixed training)

15.Garner D, Erck EG. Effects of aerobic exercise and resistance training on stage I and II breast cancer survivors: a pilot study. American Journal of Health Education. 2008;39(4):200-205. (mixed training)

16.Gibbs ZG, Galvao DA, Newton RU. High vs low intensity resistance exercise in late stage breast cancer patients with lymphedema: A randomised controlled trial. Asia-Pacific Journal of Clinical Oncology. November 2011;7:118. (abstract)

17.Hayes SC, Speck RM, Reimet E, Stark A, Schmitz KH. Does the effect of weight lifting on lymphedema following breast cancer differ by diagnostic method: results from a randomized controlled trial. Breast cancer research and treatment. Nov 2011;130(1):227-234. (redundant citation)

18.Herold J, Leskaroski A, Bloch W, et al. Results of a three months strength training of breast cancer patients during chemo therapy on the symptom of fatigue. Archives of Gynecology and Obstetrics. October 2010;282:S115. (abstract)

19.Karen BE, Murray JL, Baum G, Angelica MGB, Arun B. Randomized pilot study of a weight gain prevention intervention for breast cancer patients receiving neoadjuvant chemotherapy. Journal of Clinical Oncology. 20 May 2012;1). (abstract)

20.Kilbreah SL, Refshauge KM, Beith JM, Ward LC, Simpson JM, Lee MJ. Post-operative resistance training for early breast cancer survivors is not associated with increased prevalence of lymphedema. Cancer Research. Dec 2009;69(24):556S-557S. (abstract)

21.Kilbreath S. Weight training does not promote lymphoedema in breast cancer survivors. The Australian journal of physiotherapy. 2006;52(4):301. (abstract)

22.Kilbreath S, Refshauge K, Beith J, Lee M. Resistance and stretching shoulder exercises early following axillary surgery for breast cancer. Rehabilitation Oncology. 2006;24(2):9-14. (redundant citation)

23.Kilbreath S, Refshauge KM, Beith JM, et al. Efficacy of a one-year exercise program to prevent bone loss in postmenopausal women prescribed aromatase inhibitor therapy: An RCT. Journal of Clinical Oncology. 20 May 2013;1). (abstract)

24.Kilbreath SL, Refshauge KM, Beith JM, Ward LC, Simpson JM, Lee M. Does a weekly-supervised, 8-week exercise program improve health-related quality of life for women treated for breast cancer? Asia-Pacific Journal of Clinical Oncology. November 2009;5:A157. (abstract)

25.Knobf MT, Insogna K, DiPietro L, Fennie K, Thompson AS. An aerobic weight-loaded pilot exercise intervention for breast cancer survivors: Bone remodeling and body composition outcomes. Biological research for nursing. July 2008;10(1):34-43. (aerobic training)

26.Lite RS, Mejia S. Resistance training for breast cancer survivors. Strength and Conditioning Journal. Oct 2010;32(5):60-62. (not empirical study)

27.Madzima TA, Simonavice E, Liu PY, et al. Effects of resistance training on muscular strength, body composition and functionality in breast cancer survivors. Medicine and science in sports and exercise. May 2012;44:750-750. (abstract)

28.Martin E, Battaglini C, Groff D, Naumann F. Improving muscular endurance with the MVe Fitness Chair™ in breast cancer survivors: A feasibility and efficacy study. Journal of Science & Medicine in Sport. 2013;16(4):372-376. (insufficient data)

29.Mejia S, Lite RS. Breast cancer and exercise. Strength and Conditioning Journal. 2010;32(5):57-59. (not empirical study)

30.Ott CD, Lindsey AM, Waltman NL, et al. Facilitative strategies, psychological factors, and strength/weight training behaviors in breast cancer survivors who are at risk for osteoporosis. Orthopaedic nursing / National Association of Orthopaedic Nurses. Jan-Feb 2004;23(1):45-52. (no control group)

31.Sander AP. A safe and effective upper extremity resistive exercise program for women post breast cancer treatment. Rehabilitation Oncology. 2008;26(3):3-10. (non-randomized)

32.Schmidt T, Weisser B, Jonat W, Baumann FT, Mundhenke C. Gentle strength training in rehabilitation of breast cancer patients compared to conventional therapy. Anticancer research. Aug 2012;32(8):3229-3233. (insufficient data)

33.Schmitz KH, Ahmed RL, Hannan PJ, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer epidemiology, biomarkers & prevention. Jul 2005;14(7):1672-1680. (insufficient data)

34.Schmitz KH, Ahmed RL, Yee D. Effects of a 9-month strength training intervention on insulin, insulin-like growth factor (IGF)-I, IGF-binding protein (IGFBP)-1, and IGFBP-3 in 30-50-year-old women. Cancer epidemiology, biomarkers & prevention. Dec 2002;11(12):1597-1604. (non-breast cancer cohort)

35.Schwartz AL, Cunningham K, King ME, Fow L, Gralow JR. A randomized trial to examine effects of exercise on bone density and body composition in breast cancer patients receiving adjuvant chemotherapy. Breast cancer research and treatment. 2001;69(3):305. (abstract)

36.Waltman NL, Twiss JJ, Ott CD, et al. The effect of weight training on bone mineral density and bone turnover in postmenopausal breast cancer survivors with bone loss: a 24-month randomized controlled trial. Osteoporosis international. Aug 2010;21(8):1361-1369. (redundant citation)

37.Winters-Stone KM, Bennett JA, Reiner A, Dobek J, Schwartz A, Nail L. Strength Training Prevents Bone Loss at the Spine in Older Breast Cancer Survivors: Preliminary Findings from an RCT. Journal of Bone and Mineral Research. Sep 2008;23:S185-S185. (abstract)

38.Winters-Stone KM, Dobek J, Nail L, Bennett J, Naik A. One Year of Strength Training Improves Bone Density at the Spine in Older Breast Cancer Survivors. Medicine and science in sports and exercise. May 2010;42(5):344-344. (abstract)

39.Winters-Stone KM, Dobek J, Nail L, et al. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast cancer research and treatment. Jun 2011;127(2):447-456. (redundant citation)

40.Winters-Stone KM, Leo MC, Schwartz A. Exercise effects on hip bone mineral density in older, post-menopausal breast cancer survivors are age dependent. Archives of osteoporosis. Dec 2012;7(1-2):301-306. (redundant citation)

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Electronic Supplementary Material, Table S1. Quality items checklist for randomized controlled trials

Study identification / Treatment Allocation (each worth 0.5 points): (1) evidence of randomization method; (2) evidence of concealment of treatment allocation / Were groups similar at baseline regarding the most important prognostic indicators? / Were the eligibility criteria specified? / Were outcomes assessors blinded? (0.5 for partial blinded assessment of outcomes) / Was compliance to the intervention reported?
Ahmed et al, 2006 / 1.0 / 1.0 / 1.0 / 0.5 / 1.0
Ohiraet al, 2006 / 1.0 / 1.0 / 1.0 / 0.5 / 1.0
Courneyaet al, 2007 / 1.0 / 1.0 / 1.0 / 0.0 / 1.0
Schwartz et al, 2007 / 0.0 / 1.0 / 1.0 / 0.0 / 0.0
Twisset al, 2009 / 0.5 / 1.0 / 1.0 / 0.0 / 1.0
Schmitz et al, 2009 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Schmitz et al, 2010 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Speck et al, 2010 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Kim et al, 2010 / 0.0 / 1.0 / 1.0 / 0.5 / 0.0
Winters-Stone et al, 2012 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Musanti, 2012 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Kilbreathet al, 2012 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Winters-Stone et al, 2013 / 1.0 / 1.0 / 1.0 / 1.0 / 1.0
Cormieet al, 2013 / 1.0 / 1.0 / 1.0 / 0.0 / 1.0
Courneyaet al, 2013 / 1.0 / 1.0 / 1.0 / 0.5 / 1.0

(continued>)

Were exercise sessions supervised (0.5 for partial supervision) / Were dropouts reported? / Were data presented for primary and secondary outcome measures? / Did the analysis include an intention to treat analysis? / Were adverse events reported? / Total quality score (out of 10)
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.0
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.0
1.0 / 1.0 / 1.0 / 1.0 / 1.0 / 9.0
0.0 / 1.0 / 1.0 / 1.0 / 0.0 / 5.0
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 8.0
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5
0.5 / 0.0 / 1.0 / 1.0 / 1.0 / 6.0
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5
0.0 / 1.0 / 1.0 / 0.0 / 1.0 / 8.0
0.5 / 1.0 / 1.0 / 1.0 / 0.0 / 8.5
0.5 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5
1.0 / 1.0 / 1.0 / 1.0 / 1.0 / 9.0
1.0 / 1.0 / 1.0 / 1.0 / 1.0 / 9.5

(<continued)

Electronic Supplementary Material, Figure S1. Funnel plot assessing the symmetry of the standardized mean difference in arm volume outcomes between the treatment and control groups

Electronic Supplementary Material, Figure S2. Funnel plot assessing the symmetry of the standardized mean difference in breast cancer-related lymphedema symptomseverity between the treatment and control groups

Electronic Supplementary Material, Table S2. Sensitivity analysis of randomized controlled trials investigating upper body muscular strength

Sensitivity analysis / Studies (n) / Sample (n) / SMD / LCL / UCL / P-value / I2 / I2P-value
Fixed effects model / 11 / 1143 / 0.55 / 0.43 / 0.67 / <0.001 / 58.40% / 0.008
Exclusion of 2 studies where BCRL was an entry criterion / 9 / 983 / 0.49 / 0.29 / 0.68 / <0.001 / 53.20% / 0.029
Exclusion of 4 studies outside the USA / 7 / 618 / 0.55 / 0.28 / 0.82 / <0.001 / 57.50% / 0.028
Exclusion of 5 studies that did not include a no-treatment control group / 6 / 626 / 0.68 / 0.37 / 0.99 / <0.001 / 70.60% / 0.004
Exclusion of 3 studies that did not prescribe isolated PRT / 8 / 612 / 0.67 / 0.44 / 0.91 / <0.001 / 46.80% / 0.068
Exclusion of 1 study in an older cohort (≥60 years) / 10 / 1076 / 0.60 / 0.40 / 0.8 / <0.001 / 57.10% / 0.013
Exclusion of 3 studies of shorter duration (≤12 weeks) / 8 / 931 / 0.58 / 0.38 / 0.78 / <0.001 / 53.90% / 0.034
Exclusion of 1 study with baseline difference between groups / 10 / 993 / 0.62 / 0.43 / 0.81 / <0.001 / 48.20% / 0.043
Exclusion of 3 studies where PRT prescribed during chemotherapy treatment phase / 8 / 765 / 0.56 / 0.29 / 0.83 / <0.001 / 67.10% / 0.003
Exclusion of 1 study of lower quality (quality score ≤6.0) / 10 / 1099 / 0.59 / 0.38 / 0.79 / <0.001 / 61.20% / 0.006

SMD=standardized mean difference, LCL=lower confidence interval, UCL=upper confidence interval;I2=I-squared statistic

Electronic Supplementary Material, Table S3. Sensitivity analysis of randomized controlled trials investigating lower body muscular strength

Sensitivity analysis / Studies (n) / Sample (n) / SMD / LCL / UCL / P-value / I2 / I2P-value
Fixed effects model / 9 / 979 / 0.48 / 0.35 / 0.61 / <0.001 / 46.70% / 0.059
Exclusion of 3 studies outside the USA / 6 / 604 / 0.48 / 0.21 / 0.75 / <0.001 / 59.60% / 0.03
Exclusion of 4 studies that did not include a no-treatment control group / 5 / 481 / 0.59 / 0.26 / 0.92 / <0.001 / 65.10% / 0.022
Exclusion of 2 studies that did not prescribe isolated PRT / 7 / 596 / 0.51 / 0.25 / 0.78 / <0.001 / 57.00% / 0.03
Exclusion of 1 study in an older cohort (≥60 years) / 8 / 912 / 0.51 / 0.32 / 0.71 / <0.001 / 48.10% / 0.061
Exclusion of 1 study of shorter duration (≤12 weeks) / 8 / 938 / 0.46 / 0.27 / 0.64 / <0.001 / 47.30% / 0.066
Exclusion of 1 study with baseline difference between groups / 8 / 857 / 0.40 / 0.27 / 0.54 / <0.001 / 0% / 0.763
Exclusion of 3 studies where PRT prescribed during chemotherapy treatment phase / 6 / 601 / 0.57 / 0.3 / 0.84 / <0.001 / 58.50% / 0.034
Exclusion of 1 study of lower quality (quality score ≤6.0) / 8 / 935 / 0.51 / 0.32 / 0.7 / <0.001 / 49.20% / 0.055

SMD=standardized mean difference, LCL=lower confidence interval, UCL=upper confidence interval;I2=I-squared statistic

Electronic Supplementary Material, Table S4. Sensitivity analysis of randomized controlled trials investigating health-related quality of life

Sensitivity Analysis / Studies (n) / Sample (n) / SMD / LCL / UCL / P-value / I2 / P-value
Fixed effects model / 7 / 806 / 0.13 / -0.01 / 0.27 / 0.06 / 47.0% / 0.079
Exclusion of 2 studies of shorter duration (≤12 weeks) where BCRL was an entry criterion / 5 / 725 / 0.11 / -0.11 / 0.32 / 0.33 / 49.0% / 0.097
Exclusion of 4 studies outside the USA / 3 / 378 / 0.23 / -0.11 / 0.56 / 0.186 / 55.7% / 0.105
Exclusion of 3 studies that did not include a no-treatment control group / 4 / 501 / 0.24 / 0.01 / 0.46 / 0.038 / 29.2% / 0.237
Exclusion of 2 studies that did not prescribe isolated PRT / 5 / 568 / 0.19 / -0.02 / 0.4 / 0.078 / 29.5% / 0.225
Exclusion of 1 study in an older cohort (≥60 years) / 6 / 739 / 0.21 / -0.01 / 0.44 / 0.067 / 51.7% / 0.066
Exclusion of 2 studies where PRT prescribed during chemotherapy treatment phase / 5 / 459 / 0.3 / 0.04 / 0.55 / 0.023 / 37.0% / 0.174
Exclusion of 1 study of lower quality (quality score ≤6.0) / 6 / 766 / 0.12 / -0.07 / 0.32 / 0.213 / 40.9% / 0.132

SMD=standardized mean difference; LCL=lower confidence interval; UCL=upper confidence interval;I2=I-squared statistic

Electronic Supplementary Material, Figure S3. Funnel plot assessing the symmetry of the standardized mean difference in upper body muscular strength between the treatment and control groups

Electronic Supplementary Material, Figure S4. Funnel plot assessing the symmetry of the standardized mean difference in lower body muscular strength between the treatment and control groups

Electronic Supplementary Material, Figure S5. Funnel plot assessing the symmetry of the standardized mean difference in quality of life between the treatment and control groups

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