# Social Representativeness and Intervention Adherence—A Systematic Review of Clinical Physical Activity Trials in Breast Cancer Patients

## TL;DR

This review finds that breast cancer physical activity trials often exclude less privileged groups, potentially reinforcing health inequalities.

## Contribution

The study systematically examines social representativeness and its link to intervention adherence in breast cancer physical activity trials.

## Key findings

- Most studies included educated, married, and white breast cancer patients.
- Only six studies reported on socio-economic status and intervention adherence.
- Underrepresentation of less privileged groups may unintentionally reinforce health inequities.

## Abstract

Representativeness in physical activity randomised controlled trials (RCT) in breast cancer patients is essential to analyses of feasibility and validity considering privileged- social groups. A step-by-step exclusion of less privileged groups through the trial process could reinforce health inequality. This study aimed at examining representativeness in breast cancer (BC) physical activity trials, investigate associations between socio-economic status (SES) and intervention adherence, and explore associations between representativeness and the relationship between SES and intervention adherence.

Systematic, computerised searches were performed in PubMed, CINAHL, AMED, EMBASE and PsycINFO. Additional citation-based searches retrieved 37 articles. Distributions of education level, ethnicity, and marital status in study samples were compared to national populations data to estimate representativeness in less privileged groups.

A preponderance of studies favoured educated, married and white patients. Only six studies reported SES-adherence associations, hampering conclusions on this relationship and possible associations between representativeness and an SES-adherence relationship.

Less educated, unmarried and non-white individuals may be underrepresented in BC physical activity RCTs, while SES-adherence associations in such trials are inconclusive. Unintentional social misrepresentations may indicate that disguised inequity warrants revived attention.