Aquatic Exercise for Pain Intensity and Mechanical Pain Sensitivity in Women Surviving Breast Cancer: Systematic Review and Meta-Analysis
Victor Hugo G. Pinheiro, Tania Angelita I. Guesser, Antonio I. Cuesta-Vargas, Cristine L. AlbertonBackground:
Persistent pain after breast cancer treatment may involve self-reported pain intensity and mechanical pain sensitivity (MPS). Previous reviews of aquatic exercise in women surviving breast cancer mainly synthesized broad rehabilitation outcomes. This review aimed to evaluate the effects of structured aquatic exercise interventions on pain intensity and MPS in this population.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance, five databases were searched from inception to November 2025. Controlled studies including women surviving breast cancer who received structured aquatic exercise interventions were eligible. Outcomes were grouped as pain intensity or MPS. Pain intensity was synthesized using random-effects meta-analysis, certainty of evidence was assessed with Grading of Recommendations Assessment, Development and Evaluation, and risk of bias was assessed with RoB 2 and ROBINS-I.
Results:
Four studies (n = 181) were included. Interventions were delivered in heated pools and included supervised aquatic resistance exercise, multimodal water physical therapy, and aqua lymphatic therapy. Low-certainty evidence from three randomized controlled trials (n = 133) suggests that structured aquatic programs may reduce pain intensity compared with land-based exercise, usual care, or home-based exercise with compression therapy over 8 to 12 weeks (SMD = −1.47; 95% CI, −2.40 to −0.55;
Conclusions:
Structured, supervised aquatic programs may reduce self-reported pain intensity in women surviving breast cancer; however, evidence remains limited. Effects on MPS are very uncertain, and pain intensity improvements should not be assumed to reflect parallel changes in pressure pain sensitivity.