{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T09:18:43Z","timestamp":1785403123934,"version":"3.56.0"},"reference-count":42,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["1R01HD099813-25"],"award-info":[{"award-number":["1R01HD099813-25"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"award":["1R01HD099813-25"],"award-info":[{"award-number":["1R01HD099813-25"]}],"id":[{"id":"https:\/\/ror.org\/01cwqze88","id-type":"ROR","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Breast cancer survivors frequently experience adverse changes in body composition, cardiometabolic biomarkers, functional capacity and quality of life that may worsen long-term prognosis, yet the comparative effectiveness of lifestyle interventions across delivery formats and supervision levels remains unclear. Background\/Objectives: This systematic review assessed the effects of structured diet and exercise interventions on body composition, metabolic and inflammatory biomarkers, functional capacity, dietary habits and quality of life in breast cancer survivors. Methods: Following PRISMA guidelines, Cochrane, PubMed, Scopus and Web of Science were searched for randomized controlled trials and quasi-experimental studies published in English between 2016 and 2026. Risk of bias was assessed with RoB 2 and ROBINS-I and certainty of evidence with GRADE. Results: Of 1413 records, 15 studies (11 RCTs; mean age 46\u201360 years; mostly overweight or obese post-treatment women) met the inclusion criteria; twelve interventions were supervised and three home-based or web-based. Within the assessed domains, many studies reported significant improvements in body composition, quality of life and metabolic or inflammatory biomarkers. Effects were larger in multimodal supervised programs combining caloric restriction with moderate-to-vigorous aerobic plus resistance training (5\u20138% weight loss; 19\u201329% visceral fat reduction; improved insulin, IGF-1, leptin, adiponectin and EORTC QLQ-C30 scores), whereas digital or low-intensity interventions produced smaller, less uniform objective effects despite improving dietary behaviors. GRADE certainty ranged from very low to moderate\u2013high. Conclusions: Multimodal supervised programs offer the most robust benefits; digital formats require additional supervision. Standardized protocols and longer follow-up are needed.<\/jats:p>","DOI":"10.3390\/nu18111815","type":"journal-article","created":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T17:11:04Z","timestamp":1780593064000},"page":"1815","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effects of Diet and Exercise Lifestyle Interventions on Physical and Psychological Health in Breast Cancer Survivors: A Systematic Review"],"prefix":"10.3390","volume":"18","author":[{"given":"Nuria","family":"Asencio-Mas","sequence":"first","affiliation":[{"name":"Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3146-5778","authenticated-orcid":false,"given":"Maria","family":"Mart\u00ednez-Olcina","sequence":"additional","affiliation":[{"name":"Faculty of Health Sciences, International University of La Rioja (UNIR), 26006 Logro\u00f1o, Spain"},{"name":"European Institute of Exercise and Health, 03202 Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n","family":"Leyva-Vela","sequence":"additional","affiliation":[{"name":"Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Vicente-Mart\u00ednez","sequence":"additional","affiliation":[{"name":"Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yolanda","family":"Nadal-Nicol\u00e1s","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Miguel Hern\u00e1ndez University of Elche, 03202 Elche, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5261-0236","authenticated-orcid":false,"given":"Jose Manuel Garcia-De","family":"Frutos","sequence":"additional","affiliation":[{"name":"Faculty of Sports Science, Catholic University of Murcia, 30107 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7499-1471","authenticated-orcid":false,"given":"Alejandro","family":"Mart\u00ednez-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Analytical Chemistry, Nutrition and Food Science, University of Alicante, 03690 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1007\/s10549-011-1922-3","article-title":"Outcomes of a Weight Loss Intervention among Rural Breast Cancer Survivors","volume":"132","author":"Befort","year":"2012","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1038\/s41523-024-00662-2","article-title":"Cook and Move for Your Life, an EHealth Intervention for Women with Breast Cancer Check for Updates","volume":"10","author":"Greenlee","year":"2024","journal-title":"npj Breast Cancer"},{"key":"ref_3","first-page":"181","article-title":"Effects of an Exercise and Hypocaloric Healthy Eating Program on Biomarkers Associated with Long-Term Prognosis after Early-Stage Breast Cancer: A Randomized Controlled Trial","volume":"24","author":"Scott","year":"2013","journal-title":"Cancer Causes Control"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1200\/JCO.2007.12.7357","article-title":"Impact of a Mixed Strength and Endurance Exercise Intervention on Insulin Levels in Breast Cancer Survivors","volume":"26","author":"Ligibel","year":"2008","journal-title":"J. Clin. Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"306","DOI":"10.1158\/1055-9965.EPI-08-0531","article-title":"Randomized Controlled Trial of Aerobic Exercise on Insulin and Insulin-like Growth Factors in Breast Cancer Survivors: The Yale Exercise and Survivorship Study","volume":"18","author":"Irwin","year":"2009","journal-title":"Cancer Epidemiol. Biomark. Prev."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1007\/s10549-016-3688-0","article-title":"The Effect of Resistance Training on Markers of Immune Function and Inflammation in Previously Sedentary Women Recovering from Breast Cancer: A Randomized Controlled Trial","volume":"155","author":"Hagstrom","year":"2016","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"927","DOI":"10.1007\/s11764-016-0539-2","article-title":"Lower Rate-Pressure Product during Submaximal Walking: A Link to Fatigue Improvement Following a Physical Activity Intervention among Breast Cancer Survivors","volume":"10","author":"Carter","year":"2016","journal-title":"J. Cancer Surviv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1089\/jwh.2015.5246","article-title":"Associations Between Physical Fitness Indices and Working Memory in Breast Cancer Survivors and Age-Matched Controls","volume":"25","author":"Mackenzie","year":"2016","journal-title":"J. Womens Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1077","DOI":"10.1249\/MSS.0000000000000210","article-title":"Biobehavioral Factors Mediate Exercise Effects on Fatigue in Breast Cancer Survivors","volume":"46","author":"Rogers","year":"2014","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1016\/j.ijnurstu.2014.04.012","article-title":"A Web-Based Self-Management Exercise and Diet Intervention for Breast Cancer Survivors: Pilot Randomized Controlled Trial","volume":"51","author":"Lee","year":"2014","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Moher, D., Liberati, A., Tetzlaff, J., and Altman, D.G. (2009). PRISMA Group. Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med., 6.","DOI":"10.1371\/journal.pmed.1000097"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1016\/S1697-2600(13)70007-3","article-title":"Standards on How to Develop and Report Systematic Reviews in Psychology and Health","volume":"13","year":"2013","journal-title":"Int. J. Clin. Health Psychol."},{"key":"ref_13","first-page":"409","article-title":"Breast Imaging Reporting and Data System (BI-RADS)","volume":"40","author":"Liberman","year":"2002","journal-title":"Radiol. Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"l4898","DOI":"10.1136\/bmj.l4898","article-title":"RoB 2: A Revised Tool for Assessing Risk of Bias in Randomised Trials as an Essential Component of A","volume":"366","author":"Sterne","year":"2019","journal-title":"BMJ"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"i4919","DOI":"10.1136\/bmj.i4919","article-title":"ROBINS-I: A Tool for Assessing Risk of Bias in Non-Randomised Studies of Interventions","volume":"355","author":"Sterne","year":"2016","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1016\/j.jclinepi.2010.04.026","article-title":"GRADE Guidelines: 1. Introduction-GRADE Evidence Profiles and Summary of Findings Tables","volume":"64","author":"Guyatt","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"n71","DOI":"10.1136\/bmj.n71","article-title":"The PRISMA 2020 Statement: An Updated Guideline for Reporting Systematic Reviews Systematic Reviews and Meta-Analyses","volume":"372","author":"Page","year":"2021","journal-title":"BMJ"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10549-021-06284-7","article-title":"CLINICAL TRIAL A Randomized Trial of Exercise and Diet on Body Composition in Survivors of Breast Cancer with Overweight or Obesity","volume":"189","author":"Brown","year":"2021","journal-title":"Breast Cancer Res. Treat."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1007\/s12282-019-01013-x","article-title":"Effects of a Structured Group Intervention on Obesity among Breast Cancer Survivors","volume":"27","author":"Suzuki","year":"2020","journal-title":"Breast Cancer"},{"key":"ref_20","first-page":"e12861","article-title":"Changes in Metabolic Risk, Insulin Resistance, Leptin and Adiponectin Following a Lifestyle Intervention in Overweight and Obese Breast Cancer Survivors","volume":"27","author":"Travier","year":"2018","journal-title":"Eur. J. Cancer Care"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1158\/1940-6207.CAPR-18-0098","article-title":"Change in In Fl Ammatory Biomarkers and Adipose Tissue in BRCA1 \/ 2 \u00fe Breast Cancer Survivors Following a Yearlong Lifestyle Modi Fi Cation Program","volume":"11","author":"Sturgeon","year":"2018","journal-title":"Cancer Prev. Res."},{"key":"ref_22","doi-asserted-by":"crossref","unstructured":"Pistelli, M., Natalucci, V., Scortichini, L., Agostinelli, V., Lenci, E., Crocetti, S., Merloni, F., Bastianelli, L., Taus, M., and Fumelli, D. (2021). The Impact of Lifestyle Interventions in High-Risk Early Breast Cancer Patients: A Modeling Approach from a Single Institution Experience. Cancers, 13.","DOI":"10.3390\/cancers13215539"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1186\/s40814-017-0160-9","article-title":"Effects of a Parallel-Arm Randomized Controlled Weight Loss Pilot Study on Biological and Psychosocial Parameters of Overweight and Obese Breast Cancer Survivors","volume":"4","author":"Arikawa","year":"2018","journal-title":"Pilot Feasibility Stud."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1111\/jhn.12621","article-title":"Changes in Dietary Intake, Plasma Carotenoids and Erythrocyte Membrane Fatty Acids in Breast Cancer Survivors after a Lifestyle Intervention: Results from a Single-Arm Trial","volume":"32","author":"Buckland","year":"2019","journal-title":"J. Hum. Nutr. Diet."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"875","DOI":"10.1200\/JCO.2017.75.7526","article-title":"Effects of Aerobic and Resistance Exercise on Metabolic Syndrome, Sarcopenic Obesity, and Circulating Biomarkers in Overweight or Obese Survivors of Breast Cancer: A Randomized Controlled Trial","volume":"36","author":"Courneya","year":"2018","journal-title":"J. Clin. Oncol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Fabian, C.J., Klemp, J.R., Marchello, N.J., Vidoni, E.D., Sullivan, D.K., Nydegger, J.L., Phillips, T.A., Kreutzjans, A.L., Hendry, B., and Befort, C.A. (2021). Rapid Escalation of High-Volume Exercise during Caloric Restriction; Change in Visceral Adipose Tissue and Adipocytokines in Obese Sedentary Breast Cancer Survivors. Cancers, 13.","DOI":"10.3390\/cancers13194871"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Garcia-Unciti, M., Palacios Samper, N., M\u00e9ndez-Sandoval, S., Idoate, F., and Ib\u00e1\u00f1ez-Santos, J. (2023). Effect of Combining Impact-Aerobic and Strength Exercise, and Dietary Habits on Body Composition in Breast Cancer Survivors Treated with Aromatase Inhibitors. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20064872"},{"key":"ref_28","first-page":"91","article-title":"Effects of a Lifestyle Interventions Program on Quality of Life in Breast Cancer Survivors","volume":"27","author":"Ghavami","year":"2017","journal-title":"UHOD\u2014Uluslar. Hematol. Derg."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Holtdirk, F., Mehnert, A., Weiss, M., Mayer, J., Meyer, B.R., Br\u00f6de, P., Claus, M., and Watzl, C. (2021). Results of the Optimune Trial: A Randomized Controlled Trial Evaluating a Novel Internet Intervention for Breast Cancer Survivors. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0251276"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1590\/1516-3180.2020.0658.28012021","article-title":"Impact of Home-Based Aerobic Training Combined with Food Orientation on Food Consumption, Daily Physical Activity and Cardiorespiratory Fitness among Breast Cancer Survivors: Six-Month Clinical Trial","volume":"139","author":"Reis","year":"2021","journal-title":"Sao Paulo Med. J."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1534735420924757","DOI":"10.1177\/1534735420924757","article-title":"Influence of a Multidisciplinary Program of Diet, Exercise, and Mindfulness on the Quality of Life of Stage IIA-IIB Breast Cancer Survivors","volume":"19","author":"Lohnchen","year":"2020","journal-title":"Integr. Cancer Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2375","DOI":"10.1249\/MSS.0000000000002116","article-title":"Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable","volume":"51","author":"Campbell","year":"2019","journal-title":"Med. Sci. Sports Exerc."},{"key":"ref_33","first-page":"230","article-title":"American Cancer Society Nutrition and Physical Activity Guideline for Cancer Survivors","volume":"72","author":"Rock","year":"2022","journal-title":"CA Cancer J. Clin."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3169","DOI":"10.1200\/JCO.2015.61.1095","article-title":"Results of the Exercise and Nutrition to Enhance Recovery and Good Health for You (ENERGY) Trial: A Behavioral Weight Loss Intervention in Overweight or Obese Breast Cancer Survivors","volume":"33","author":"Rock","year":"2015","journal-title":"J. Clin. Oncol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"e26318","DOI":"10.1016\/j.heliyon.2024.e26318","article-title":"Effects of Aerobic Combined with Resistance Exercise on Cardiorespiratory Fitness and Cardiometabolic Health in Breast Cancer Survivors: A Systematic Review, Meta-Analysis and Meta-Regression","volume":"10","author":"Cheng","year":"2024","journal-title":"Heliyon"},{"key":"ref_36","unstructured":"Schmitz, K.H. (2025). Exercise Oncology: Ready for Prime Time. ACSM Curre."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Zhao, Y., Tang, L., Shao, J., Chen, D., Jiang, Y., Tang, P., and Wang, X. (2023). The Effectiveness of Exercise on the Symptoms in Breast Cancer Patients Undergoing Adjuvant Treatment: An Umbrella Review of Systematic Reviews and Meta-Analyses. Front. Oncol., 13.","DOI":"10.3389\/fonc.2023.1222947"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1001\/jama.298.3.289","article-title":"Influence of a Diet Very High in Vegetables, Fruit, and Fiber and Low in Fat on Prognosis Following Treatment for Breast CancerThe Women\u2019s Healthy Eating and Living (WHEL) Randomized Trial","volume":"298","author":"Pierce","year":"2007","journal-title":"JAMA"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1767","DOI":"10.1093\/jnci\/djj494","article-title":"Dietary Fat Reduction and Breast Cancer Outcome: Interim Efficacy Results from the Women\u2019s Intervention Nutrition Study","volume":"98","author":"Chlebowski","year":"2006","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1211","DOI":"10.1080\/00498250310001615762","article-title":"Inhibition of Rat Liver Sulfotransferases SULT1A1 and SULT2A1 and Glucuronosyltransferase by Dietary Flavonoids","volume":"33","author":"Kauffman","year":"2003","journal-title":"Xenobiotica"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"269","DOI":"10.2174\/138920008784220637","article-title":"Sulfotransferase Inhibition: Potential Impact of Diet and Environmental Chemicals on Steroid Metabolism and Drug Detoxification","volume":"9","author":"Harris","year":"2008","journal-title":"Curr. Drug Metab."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"488","DOI":"10.5414\/CPP42488","article-title":"Inhibition of Human Liver and Duodenum Sulfotransferases by Drugs and Dietary Chemicals: A Review of the Literature","volume":"42","author":"Pacifici","year":"2004","journal-title":"Int. J. Clin. Pharmacol. Ther."}],"container-title":["Nutrients"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1815\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T04:12:05Z","timestamp":1780891925000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2072-6643\/18\/11\/1815"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,6,4]]},"references-count":42,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2026,6]]}},"alternative-id":["nu18111815"],"URL":"https:\/\/doi.org\/10.3390\/nu18111815","relation":{},"ISSN":["2072-6643"],"issn-type":[{"value":"2072-6643","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,6,4]]}}}