Skip to main content

Advertisement

SpringerLink
Log in

Physical Activity After Breast Cancer: Effect on Survival and Patient-Reported Outcomes

  • Psycho-Oncology and Supportive Care (P. Butow, Section Editor)
  • Published:
Current Breast Cancer Reports Aims and scope Submit manuscript

Abstract

Here we discuss ongoing studies and recently published evidence on the effect of physical activity for women previously diagnosed with breast cancer. Generally consistent evidence was found for beneficial effects of physical activity on breast cancer survival across 21 observational studies and one phase II exploratory trial. An increasing number of exercise trials are investigating biological mediators of these effects. Substantial evidence exists of benefits to patient-reported outcomes and health-related fitness but important questions remain, including: the optimum type, dose, and timing of physical activity to be done during and post-treatment; whether late-stage and/or metastatic patients can also benefit; and how well treatment-related complications can be alleviated. Large prospective cohort studies will be informative, ideally using accelerometer measurements and assessment of sedentary behavior. Despite gaps in knowledge, there is sufficient evidence regarding feasibility, safety, and efficacy to recommend physical activity as a complementary adjuvant therapy for breast cancer.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Jones LW, Alfano CM. Exercise-oncology research: past, present, and future. Acta Oncol. 2013;52(2):195–215. Provides context for our paper, describing the evolution of exercise-oncology research and ongoing studies. Our systematic search for ongoing clinical trials covers studies registered with ClinicalTrials.gov since August 1, 2012 when Jones and Alfano performed a similar review.

    Article  PubMed  Google Scholar 

  2. Villarini A, Pasanisi P, Traina A, et al. Lifestyle and breast cancer recurrences: the DIANA-5 trial. Tumori. 2012;98(1):1–18.

    CAS  PubMed  Google Scholar 

  3. Courneya KS, Vallance JK, Culos-Reed SN, et al. The Alberta moving beyond breast cancer (AMBER) cohort study: a prospective study of physical activity and health-related fitness in breast cancer survivors. BMC Cancer. 2012;12:525. Our own study, ongoing in Canada, that will relate accelerometer-based and self-reported measures of physical activity and sedentary behavior prospectively to breast cancer outcomes. This large study of 1,500 breast cancer patients will be the first prospective cohort study designed specifically to examine the effects of physical activity and health-related fitness in breast cancer survivorship, from the time of diagnosis to the end of life.

    Article  PubMed Central  PubMed  Google Scholar 

  4. Carayol M, Romieu G, Bleuse J-P, et al. Adapted physical activity and diet (APAD) during adjuvant breast cancer therapy: Design and implementation of a prospective randomized controlled trial. Contemp Clin Trials. 2013;36(2):531–43.

    Article  PubMed  Google Scholar 

  5. Courneya KS, Segal RJ, McKenzie DC et al. Effects of Exercise during Adjuvant Chemotherapy on Breast Cancer Outcomes. Med Sci Sports Exerc. 2014. This exploratory analysis is the first randomized trial involving breast cancer patients to relate an exercise intervention during adjuvant chemotherapy to survival and recurrence outcomes.

  6. Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404.

    Article  PubMed  Google Scholar 

  7. Jones LW, Fels DR, West M, et al. Modulation of circulating angiogenic factors and tumor biology by aerobic training in breast cancer patients receiving neoadjuvant chemotherapy. Cancer Prev Res (Phila). 2013;6(9):925–37.

    Article  CAS  Google Scholar 

  8. Rao R, Cruz V, Peng Y, et al. Bootcamp during neoadjuvant chemotherapy for breast cancer: a randomized pilot trial. Breast Cancer (Auckl). 2012;6:39–46.

    Google Scholar 

  9. Speck RM, Courneya KS, Masse LC, et al. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):87–100.

    Article  PubMed  Google Scholar 

  10. Potthoff K, Schmidt ME, Wiskemann J, et al. Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study. BMC Cancer. 2013;13:162.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Schmidt ME, Wiskemann J, Krakowski-Roosen H, et al. Progressive resistance versus relaxation training for breast cancer patients during adjuvant chemotherapy: design and rationale of a randomized controlled trial (BEATE study). Contemp Clin Trials. 2013;34(1):117–25.

    Article  PubMed  Google Scholar 

  12. Ballard-Barbash R, Friedenreich CM, Courneya KS, et al. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104(11):815–40.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Fontein DBY, de Glas NA, Duijm M, et al. Age and the effect of physical activity on breast cancer survival: a systematic review. Cancer Treat Rev. 2013;39(8):958–65. This review article summarizes the methods, study populations, and results of 17 observational studies that examined the relation between self-reported physical activity and survival and/or recurrence among breast cancer survivors. We identified four additional studies that have been published since the November 9, 2012 search done by Fontein et al.

    Article  CAS  PubMed  Google Scholar 

  14. Schmidt ME, Chang-Claude J, Vrieling A, et al. Association of pre-diagnosis physical activity with recurrence and mortality among women with breast cancer. Int J Cancer. 2013;133(6):1431–40.

    Article  CAS  PubMed  Google Scholar 

  15. Tao MH, Hainaut P, Marian C, et al. Association of prediagnostic physical activity with survival following breast cancer diagnosis: influence of TP53 mutation status. Cancer Causes Control. 2013;24(12):2177–86.

    Article  PubMed  Google Scholar 

  16. Urbscheit N, Brown K. The association between physical activity and breast cancer recurrence and survival. Curr Nutr Rep. 2013;3(1):16–21.

    Article  Google Scholar 

  17. McLaughlin VH, Trentham-Dietz A, Hampton JM, et al. Lifestyle factors and the risk of a second breast cancer after Ductal carcinoma in situ. Cancer Epidemiol Biomarkers Prev. 2014;23(3):450–60.

    Article  PubMed  Google Scholar 

  18. Keegan TH, Milne RL, Andrulis IL, et al. Past recreational physical activity, body size, and all-cause mortality following breast cancer diagnosis: results from the breast cancer family registry. Breast Cancer Res Treat. 2010;123(2):531–42.

    Article  PubMed Central  PubMed  Google Scholar 

  19. Abrahamson PE, Gammon MD, Lund MJ, et al. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107(8):1777–85.

    Article  PubMed  Google Scholar 

  20. Bertram LA, Stefanick ML, Saquib N, et al. Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study. Cancer Causes Control. 2011;22(3):427–35.

    Article  PubMed Central  PubMed  Google Scholar 

  21. Borugian MJ, Sheps SB, Kim-Sing C, et al. Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev. 2004;13(7):1163–72.

    CAS  PubMed  Google Scholar 

  22. Chen X, Lu W, Zheng W, et al. Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res. 2011;4(9):1409–18.

    Article  Google Scholar 

  23. Cleveland RJ, Eng SM, Stevens J, et al. Influence of prediagnostic recreational physical activity on survival from breast cancer. Eur J Cancer Prev. 2012;21(1):46–54.

    Article  PubMed Central  PubMed  Google Scholar 

  24. Dal Maso L, Zucchetto A, Talamini R, et al. Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer. 2008;123(9):2188–94.

    Article  CAS  PubMed  Google Scholar 

  25. Emaus A, Veierod MB, Tretli S, et al. Metabolic profile, physical activity, and mortality in breast cancer patients. Breast Cancer Res Treat. 2010;121(3):651–60.

    Article  PubMed  Google Scholar 

  26. Enger SM, Bernstein L. Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer. 2004;90(11):2138–41.

    CAS  PubMed Central  PubMed  Google Scholar 

  27. Friedenreich CM, Gregory J, Kopciuk KA, et al. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009;124(8):1954–62.

    Article  CAS  PubMed  Google Scholar 

  28. Hellmann SS, Thygesen LC, Tolstrup JS, Gronbaek M. Modifiable risk factors and survival in women diagnosed with primary breast cancer: results from a prospective cohort study. Eur J Cancer Prev. 2010;19(5):366–73.

    Article  PubMed  Google Scholar 

  29. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomark Prev. 2008;17(2):379–86.

    Article  Google Scholar 

  30. Holmes MD, Chen WY, Feskanich D, et al. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293(20):2479–86.

    Article  CAS  PubMed  Google Scholar 

  31. Irwin ML, McTiernan A, Manson JE, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res. 2011;4(4):522–9.

    Article  Google Scholar 

  32. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958–64.

    Article  PubMed Central  PubMed  Google Scholar 

  33. Rohan TE, Fu W, Hiller JE. Physical activity and survival from breast cancer. Eur J Cancer Prev. 1995;4(5):419–24.

    Article  CAS  PubMed  Google Scholar 

  34. Sternfeld B, Weltzien E, Quesenberry Jr CP, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 2009;18(1):87–95.

    Article  PubMed Central  PubMed  Google Scholar 

  35. West-Wright CN, Henderson KD, Sullivan-Halley J, et al. Long-term and recent recreational physical activity and survival after breast cancer: the California Teachers Study. Cancer Epidemiol Biomarkers Prev. 2009;18(11):2851–9.

    Article  PubMed Central  PubMed  Google Scholar 

  36. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65.

    Article  PubMed  Google Scholar 

  37. Beasley JM, Kwan ML, Chen WY, et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131(2):637–43.

    Article  PubMed Central  PubMed  Google Scholar 

  38. Ballard-Barbash R, Hunsberger S, Alciati MH, et al. Physical activity, weight control, and breast cancer risk and survival: clinical trial rationale and design considerations. J Natl Cancer Inst. 2009;101(9):630–43.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Guinan E, Hussey J, Broderick JM, et al. The effect of aerobic exercise on metabolic and inflammatory markers in breast cancer survivors–a pilot study. Support Care Cancer. 2013;21(7):1983–92.

    Article  CAS  PubMed  Google Scholar 

  40. Rogers LQ, Fogleman A, Trammell R, et al. Effects of a physical activity behavior change intervention on inflammation and related health outcomes in breast cancer survivors: pilot randomized trial. Integr Cancer Ther. 2013;12(4):323–35.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  41. Betof AS, Dewhirst MW, Jones LW. Effects and potential mechanisms of exercise training on cancer progression: a translational perspective. Brain Behav Immun. 2013;30:S75–87.

    Article  PubMed Central  PubMed  Google Scholar 

  42. Löf M, Bergström K, Weiderpass E. Physical activity and biomarkers in breast cancer survivors: a systematic review. Maturitas. 2012;73(2):134–42.

    Article  PubMed  Google Scholar 

  43. Fong DY, Ho JW, Hui BP, et al. Physical activity for cancer survivors: meta-analysis of randomised controlled trials. BMJ. 2012;344:e70. Summarizes results from 34 randomized exercise trials conducted on cancer patients who completed their cancer treatment; 65 % of trials involved breast cancer patients. Reports on biomarkers for breast cancer, health-related fitness, and patient-reported outcomes.

    Article  PubMed Central  PubMed  Google Scholar 

  44. Scott E, Daley AJ, Doll H, et al. Effects of an exercise and hypocaloric healthy eating program on biomarkers associated with long-term prognosis after early-stage breast cancer: a randomized controlled trial. Cancer Causes Control. 2012;24(1):181–91.

    Article  PubMed  Google Scholar 

  45. Schmitz K. Physical activity and breast cancer survivorship. Recent Results Cancer Res. 2011;186:189–215. Provides a historical basis for our review, providing an overview of physical activity effects during breast cancer survivorship. All randomized trials of exercise in breast cancer survivors are identified (21 during treatment; 36 after treatment) and characterized in summary tables.

    Article  PubMed  Google Scholar 

  46. Courneya KS, McKenzie DC, Mackey JR, et al. Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. J Natl Cancer Inst. 2013;105(23):1821–32. Presents the results of a trial comparing, low aerobic, high aerobic, and resistance training versus usual care. First results to suggest that higher doses obtain signficant improvements in patient reported outcomes.

    Article  PubMed  Google Scholar 

  47. Ewertz M, Jensen AB. Late effects of breast cancer treatment and potentials for rehabilitation. Acta Oncol. 2011;50(2):187–93.

    Article  PubMed  Google Scholar 

  48. Smith LA, Cornelius VR, Plummer CJ, et al. Cardiotoxicity of anthracycline agents for the treatment of cancer: systematic review and meta-analysis of randomised controlled trials. BMC Cancer. 2010;10:337.

    Article  PubMed Central  PubMed  Google Scholar 

  49. Khouri MG, Douglas PS, Mackey JR, et al. Cancer therapy-induced cardiac toxicity in early breast cancer: addressing the unresolved issues. Circulation. 2012;126(23):2749–63.

    Article  PubMed Central  PubMed  Google Scholar 

  50. Sturgeon KM, Ky B, Libonati JR, Schmitz KH. The effects of exercise on cardiovascular outcomes before, during, and after treatment for breast cancer. Breast Cancer Res Treat. 2014;143(2):219–26.

    Article  CAS  PubMed  Google Scholar 

  51. Patnaik JL, Byers T, Diguiseppi C, et al. The influence of comorbidities on overall survival among older women diagnosed with breast cancer. J Natl Cancer Inst. 2011;103(14):1101–11.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Patnaik JL, Byers T, DiGuiseppi C, et al. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: a retrospective cohort study. Breast Cancer Res. 2011;13(3):R64.

    Article  PubMed Central  PubMed  Google Scholar 

  53. Scott JM, Khakoo A, Mackey JR, et al. Modulation of anthracycline-induced cardiotoxicity by aerobic exercise in breast cancer: current evidence and underlying mechanisms. Circulation. 2011;124(5):642–50.

    Article  PubMed Central  PubMed  Google Scholar 

  54. Jones L, V D, M H et al., editors. Effects of aerobic training to improve cardiovascular function and prevent cardiac remodeling after cytotoxic therapy in early breast cancer. 102nd Annual Meeting of the American Association for Cancer Research 2011 April 2–6. Orlando, Florida. Philadelphia (PA): AACR. 2011; Abstract no. 502.

  55. Knobf MT, Coviello J. Lifestyle interventions for cardiovascular risk reduction in women with breast cancer. Curr Cardiol Rev. 2011;7(4):250–7.

    Article  PubMed  Google Scholar 

  56. Janelsins MC, Mustian KM, Peppone LJ et al. Interventions to alleviate symptoms related to breast cancer treatments and areas of needed research. J Cancer Sci Ther. 2011;Suppl 2: S2-001.

  57. Buffart LM, Ros WJG, Chinapaw MJM, et al. Mediators of physical exercise for improvement in cancer survivors’ quality of life. Psychooncology. 2014;23(3):330–8.

    Article  CAS  PubMed  Google Scholar 

  58. Rizzoli R, Body JJ, Censi A, et al. Guidance for the prevention of bone loss and fractures in postmenopausal women treated with aromatase inhibitors for breast cancer: an ESCEO position paper. Osteoporos Int. 2012;23(11):2567–76.

    Article  CAS  PubMed  Google Scholar 

  59. Saarto T, Sievanen H, Kellokumpu-Lehtinen P, et al. Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial. Osteoporos Int. 2012;23(5):1601–12.

    Article  CAS  PubMed  Google Scholar 

  60. Irwin M, Cartmel B, Ercolano E, et al. editors. Aromatase inhibitors, arthralgias, and exercise in breast cancer survivors. ASCO Annual Meeting, 2012: J Clin Oncol 2012; 30 (supplement):Abstract Number TPS669.

  61. Irwin ML, Cartmel B, Gross C, et al., editors. Randomized trial of exercise vs. usual care on aromatase inhibitor-associated arthralgias in women with breast cancer: The hormones and physical exercise (HOPE) study San Antonio Breast Cancer Symposium, 2013 December 10-14; :S3–03.

  62. Courneya KS, Friedenreich CM. Relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complement Med. 1997;3(3):215–26.

    Article  CAS  PubMed  Google Scholar 

  63. Lynch BM, Dunstan DW, Vallance JK, Owen N. Don't take cancer sitting down. Cancer. 2013;119(11):1928–35. A compelling commentary advocating further research into the emerging effect of sedentary behavior in cancer survivorship. Emphasises a need for further research in breast cancer survivors.

    Article  PubMed  Google Scholar 

  64. George SM, Alfano CM, Wilder Smith A, et al. Sedentary behavior, health-related quality of life, and fatigue among breast cancer survivors. J Phys Act Health. 2013;10(3):350–8.

    PubMed Central  PubMed  Google Scholar 

  65. George SM, Smith AW, Alfano CM, et al. The association between television watching time and all-cause mortality after breast cancer. J Cancer Surviv. 2013;7(2):247–52.

    Article  PubMed Central  PubMed  Google Scholar 

  66. George SM, Alfano CM, Groves J, et al. Objectively measured sedentary time is related to quality of life among cancer survivors. PLoS ONE. 2014;9(2):e87937.

    Article  PubMed Central  PubMed  Google Scholar 

  67. Lynch BM, Dunstan DW, Healy GN, et al. Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: findings from NHANES (2003-2006). Cancer Causes Control. 2010;21(2):283–8.

    Article  PubMed  Google Scholar 

  68. Rogers LQ, Markwell SJ, Courneya KS, et al. Physical activity type and intensity among rural breast cancer survivors: patterns and associations with fatigue and depressive symptoms. J Cancer Surviv. 2010;5(1):54–61.

    Article  PubMed Central  PubMed  Google Scholar 

  69. Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.

    Article  PubMed  Google Scholar 

  70. Rock CL, Doyle C, Demark-Wahnefried W, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):242–74.

    Article  Google Scholar 

  71. Carmichael AR. Physical activity as an adjuvant treatment for breast cancer; is it time for guidelines? Eur J Surg Oncol. 2014;40(2):137–9.

    Article  CAS  PubMed  Google Scholar 

  72. Schmitz KH. Exercise for secondary prevention of breast cancer: moving from evidence to changing clinical practice. Cancer Prev Res. 2011;4(4):476–80.

    Article  Google Scholar 

  73. Muraca L, Leung D, Clark A, et al. Breast cancer survivors: taking charge of lifestyle choices after treatment. Eur J Oncol Nurs. 2011;15(3):250–3.

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The authors wish to thank Qinggang Wang for producing the forest plot of observational breast cancer survival studies.

Compliance with ethics guidelines

ᅟ

Conflict of Interest

Darren R. Brenner has received compensation for travel and/or study from Alberta Innovates Health Solutions, and grants from the Canadian Institutes of Health Research. Kerry S. Courneya holds a Canada Research Chair in Physical Activity and Cancer. Christine M. Friedenreich holds an Alberta Innovates Health Solutions – Health Senior Scholar Award and the Alberta Cancer Foundation Weekend to End Women’s Cancers Breast Cancer Chair. Heather K. Neilson has nothing to disclose.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

  1. Department of Population Health Research, CancerControl Alberta, Alberta Health Services, 1820 Richmond Road SW, Calgary, Alberta, Canada, T2T 5C7

    Darren R. Brenner, Heather K. Neilson & Christine M. Friedenreich

  2. Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada

    Kerry S. Courneya

  3. Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

    Christine M. Friedenreich

  4. Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada

    Christine M. Friedenreich

Authors
  1. Darren R. Brenner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Heather K. Neilson
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kerry S. Courneya
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christine M. Friedenreich
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine M. Friedenreich.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brenner, D.R., Neilson, H.K., Courneya, K.S. et al. Physical Activity After Breast Cancer: Effect on Survival and Patient-Reported Outcomes. Curr Breast Cancer Rep 6, 193–204 (2014). https://doi.org/10.1007/s12609-014-0147-y

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12609-014-0147-y

Keywords

Search

Navigation