Combined exercise shows highest probability of reducing inflammatory markers in breast cancer survivors.

PURPOSE: This study compares the effects of different exercise modalities on inflammatory mediators in breast cancer survivors, evaluating aerobic exercise (AE), resistance training (RT), combined exercise (CE), and low-intensity exercise (LA) on biomarkers to inform personalized exercise prescriptions. METHODS: A systematic review and network meta-analysis of 27 randomized controlled trials (RCTs) involving 1925 breast cancer survivors was conducted. Interventions included aerobic exercise (AE), resistance training (RT), combined aerobic and resistance training (CE), and low-activity exercise (LA). Primary outcomes were IL-6, TNF-α, HSCR-P, IL-8, and IL-10. Subgroup analyses by age and exercise dose were performed. RESULTS: CE showed the highest probability of reducing IL-6 (SUCRA, 88.64), IL-8 (85.74), and TNF-α (88.56). AE was most effective in reducing HSCR-P (78.92), while LA increased IL-10 (90.97). HSCR-P and IL-6 declined across most age groups, though TNF-α tended to increase in those >55 years. Dose-response analysis suggested LA was effective at lower volumes, AE at moderate doses, and CE at higher intensities. The optimal weekly dose for inflammation control ranged from 510 to 920 MET-minutes. CONCLUSIONS: CE offers the most comprehensive anti-inflammatory benefits among breast cancer survivors. Tailoring exercise prescriptions by age and hormonal status may enhance safety and therapeutic efficacy in survivorship care.