Abstract / Summary
Abstract Background Breast cancer‑related lymphedema (BCRL) is a common and debilitating complication of cancer treatment, negatively impacting upper limb function and quality of life. Pilates has been proposed as a potential therapeutic exercise modality, yet its efficacy and safety in this population remain unclear. Purpose To systematically evaluate the effects of Pilates on clinical outcomes in women with BCRL, and to assess the safety and methodological quality of the available evidence. Methods A systematic search was conducted in nine electronic databases (from inception to April 2026) for randomized controlled trials (RCTs) evaluating Pilates interventions in women with BCRL. Two independent reviewers performed study selection, data extraction, and risk of bias assessment using the PEDro scale. The primary outcomes were upper limb volume, function, and quality of life; secondary outcomes included pain, range of motion (ROM), and adverse events. The certainty of evidence for each outcome was evaluated according to the GRADE framework. Results Four RCTs comprising 353 women with BCRL were included. Pilates interventions varied in frequency (2–5 sessions/week), duration (8–16 weeks), and supervision, with no serious adverse events reported across any study. The included trials demonstrated improvements in upper limb function and quality of life, although heterogeneity in outcome measures precluded meta‑analysis. GRADE assessment rated the certainty of evidence as low for upper limb function and very low for quality of life, downgraded predominantly for risk of bias, imprecision, and inconsistency. Risk of bias was low in two studies and unclear in two. Conclusion Current evidence suggests that Pilates may be a safe and potentially beneficial rehabilitation strategy for women with BCRL. However, the limited number of RCTs and methodological heterogeneity underscore the need for future high‑quality, adequately powere11111d trials with standardized outcome measures. Implications for Cancer Survivors: Clinicians may consider Pilates as a supervised, low-impact exercise option for women with BCRL, with preliminary evidence suggesting improvements in upper limb function and quality of life. However, given the low certainty of evidence and the observation that benefits diminish if practice is discontinued, Pilates should be offered as part of a multimodal rehabilitation program with emphasis on long-term adherence rather than as a standalone treatment.