Effects of dance-based interventions on fatigue, sleep disturbance, and depressive symptoms in patients with breast cancer: a systematic review and meta-analysis

Introduction This systematic review and meta-analysis aimed to synthesize the effects of dance-based interventions on three clinically related outcomes—fatigue, sleep disturbance, and depressive symptoms—in women with breast cancer and to assess the certainty of the available evidence. Methods Five electronic databases (Web of Science, PubMed, the Cochrane Library, Embase, and ScienceDirect) were searched from inception to April 22, 2026. Randomized controlled trials evaluating structured dance-based interventions in adult women with breast cancer were included. Pooled effects were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs) using random-effects models. Heterogeneity was assessed using the I² statistic. Risk of bias was assessed using the Cochrane Risk of Bias 2 tool, and the certainty of evidence was evaluated using the GRADE approach. Results Nine randomized controlled trials involving 620 participants were included. Dance-based interventions showed small favorable effects on fatigue (SMD = 0.25, 95% CI: 0.03–0.47), sleep disturbance (SMD = 0.25, 95% CI: 0.02–0.49), and depressive symptoms (SMD = 0.37, 95% CI: 0.02–0.71). No statistical heterogeneity was observed for fatigue or sleep disturbance (I² = 0% for both outcomes), whereas low-to-moderate heterogeneity was observed for depressive symptoms (I² = 39.2%). Sensitivity analyses showed that the direction of effects was generally consistent, although statistical significance was not consistently maintained in leave-one-out analyses, particularly for fatigue. The certainty of evidence was low for all three outcomes. Conclusions Dance-based interventions may have small favorable effects on fatigue, sleep disturbance, and depressive symptoms in women with breast cancer. However, the certainty of evidence was low, and the findings were limited by the small number of trials and the limited robustness of some pooled estimates. Larger, high-quality randomized controlled trials are needed to confirm these effects. Future studies should provide clearer descriptions of intervention components, therapeutic frameworks, provider qualifications, and delivery contexts to improve intervention characterization and reproducibility. Registration PROSPERO CRD420251177930.