Breast Cancer Research and Treatment

, Volume 129, Issue 2, pp 521–529 | Cite as

Associations of physical activity with quality of life and functional ability in breast cancer patients during active adjuvant treatment: the Pathways Study

  • Jeanne S. MandelblattEmail author
  • Gheorghe Luta
  • Marilyn L. Kwan
  • Solomon B. Makgoeng
  • Isaac J. Ergas
  • Janise M. Roh
  • Barbara Sternfeld
  • Lucile L. Adams-Campbell
  • Lawrence H. Kushi


Physical activity can improve quality of life (QOL) in breast cancer survivors but little is known about associations of physical activity and QOL during active cancer therapy. We examine associations between activity levels and QOL in a large cohort of breast cancer patients. Women with invasive, non-metastatic breast cancer (n = 2,279) were enrolled between 2006 and 2009 from a managed care organization; assessment were done during active therapy. A physical activity frequency questionnaire was used to calculate the average weekly metabolic equivalent task (MET) hours spent in moderate and vigorous activity during active treatment. QOL was measured by the Functional Assessment of Cancer Therapy-Breast Cancer. Linear regression models tested cross-sectional associations of QOL and functional well-being with physical activity and covariates [socio-demographics, comorbidity, body mass index (BMI), clinical variables, social support, and assessment timing]. Physical activity had a significant positive unadjusted association with all QOL sub-scales (except emotional well-being) (all P values < 0.01). Overall QOL was 4.6 points higher for women in the highest quartile of moderate and vigorous activity versus women in the lowest quartile (P < 0.001). In regression models, higher activity was associated with better overall QOL and functional well-being, controlling for covariates (P < 0.05). Increasing BMI was also independently but inversely associated with overall QOL (P < 0.001) but did not explain the relationship of activity and QOL. White women reported the higher levels of activity than minority women and activity was associated with QOL for Whites but not for minority women. Greater physical activity is associated with small but clinically meaningful increases in QOL during active breast cancer care therapy for Whites but this effect is not seen for minority women. If confirmed in longitudinal analyses, these differences may have implications for disparities research.


Breast cancer Physical activity Quality of life 



This research was supported, in part by National Cancer Institute Grants R01 CA105274 and R01 CA124924 to LK; BC043120 (Department of Defense) to LK; National Cancer Institute Grants RO1 CA 127617, U10 CA 84131, RO1 CA124924, and KO5 CA96940 to JSM; R21 CA 149996 to LAC, and the Biostatistics and Bioinformatics Shared Resources at Lombardi Comprehensive Cancer Center under National Cancer Institute Grant #P30 CA51008 covering GL.

Conflict of interest



  1. 1.
    Kwan ML, Ergas IJ, Somkin CP, Quesenberry CP Jr, Neugut AI, Hershman DL et al (2010) Quality of life among women recently diagnosed with invasive breast cancer: the Pathways Study. Breast Cancer Res Treat 123(2):507–524PubMedCrossRefGoogle Scholar
  2. 2.
    Lu W, Cui Y, Chen X, Zheng Y, Gu K, Cai H et al (2009) Changes in quality of life among breast cancer patients three years post-diagnosis. Breast Cancer Res Treat 114(2):357–369PubMedCrossRefGoogle Scholar
  3. 3.
    Avis NE, Crawford S, Manuel J (2005) Quality of life among younger women with breast cancer. J Clin Oncol 23(15):3322–3330PubMedCrossRefGoogle Scholar
  4. 4.
    Hayes SC, Rye S, Battistutta D, DiSipio T, Newman B (2010) Upper-body morbidity following breast cancer treatment is common, may persist longer-term and adversely influences quality of life. Health Qual Life Outcomes 8:92−98PubMedCrossRefGoogle Scholar
  5. 5.
    Carling M, Goodare H, Ironside A, Millington J, Rogers C (2010) Quality of life after breast radiotherapy. Lancet Oncol 11(7):612–613PubMedCrossRefGoogle Scholar
  6. 6.
    McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 175(1):34–41PubMedCrossRefGoogle Scholar
  7. 7.
    Galvao DA, Newton RU (2005) Review of exercise intervention studies in cancer patients. J Clin Oncol 23(4):899–909PubMedCrossRefGoogle Scholar
  8. 8.
    Kwan ML, Ambrosone CB, Lee MM, Barlow J, Krathwohl SE, Ergas IJ et al (2008) The Pathways Study: a prospective study of breast cancer survivorship within Kaiser Permanente Northern California. Cancer Causes Control 19(10):1065–1076PubMedCrossRefGoogle Scholar
  9. 9.
    Brady MJ, Cella DF, Mo F, Bonomi AE, Tulsky DS, Lloyd SR et al (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15(3):974–986PubMedGoogle Scholar
  10. 10.
    Sternfeld B, Weltzien E, Quesenberry CP Jr, Castillo AL, Kwan M, Slattery ML et al (2009) Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev 18(1):87–95PubMedCrossRefGoogle Scholar
  11. 11.
    Staten LK, Taren DL, Howell WH, Tobar M, Poehlman ET, Hill A et al (2001) Validation of the Arizona activity frequency questionnaire using doubly labeled water. Med Sci Sports Exerc 33(11):1959–1967PubMedCrossRefGoogle Scholar
  12. 12.
    Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ et al (2000) Compendium of physical activities: an update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl):S498–S504PubMedGoogle Scholar
  13. 13.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40(5):373–383PubMedCrossRefGoogle Scholar
  14. 14.
    Oehrli M, Quesenberry C, Leyden W (2006) Annual report on trends, incidence, and outcomes. Kaiser Permanente NCCRGoogle Scholar
  15. 15.
    Radloff LS (1977) The CES-D scale: a self-report depression scale for research in the general population. Appl Pscyhol Meas 1:385–401CrossRefGoogle Scholar
  16. 16.
    Sherbourne CD, Stewart AL (1991) The MOS social support survey. Soc Sci Med 32(6):705–714PubMedCrossRefGoogle Scholar
  17. 17.
    Knols R, Aaronson NK, Uebelhart D, Fransen J, Aufdemkampe G (2005) Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 23(16):3830–3842PubMedCrossRefGoogle Scholar
  18. 18.
    Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR (2009) Effects of exercise on quality of life in women living with breast cancer: a systematic review. Breast J 15(1):45–51PubMedCrossRefGoogle Scholar
  19. 19.
    Kendall AR, Mahue-Giangreco M, Carpenter CL, Ganz PA, Bernstein L (2005) Influence of exercise activity on quality of life in long-term breast cancer survivors. Qual Life Res 14(2):361–371PubMedCrossRefGoogle Scholar
  20. 20.
    Caan B, Sternfeld B, Gunderson E, Coates A, Quesenberry C, Slattery ML (2005) Life After Cancer Epidemiology (LACE) Study: a cohort of early stage breast cancer survivors (United States). Cancer Causes Control 16(5):545–556PubMedCrossRefGoogle Scholar
  21. 21.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293(20):2479–2486PubMedCrossRefGoogle Scholar
  22. 22.
    Humpel N, Iverson DC (2007) Depression and quality of life in cancer survivors: is there a relationship with physical activity? Int J Behav Nutr Phys Act 4:65−75PubMedCrossRefGoogle Scholar
  23. 23.
    Brucker PS, Yost K, Cashy J, Webster K, Cella D (2005) General population and cancer patient norms for the Functional Assessment of Cancer Therapy-General (FACT-G). Eval Health Prof 28(2):192–211PubMedCrossRefGoogle Scholar
  24. 24.
    Eton DT, Cella D, Yost KJ, Yount SE, Peterman AH, Neuberg DS et al (2004) A combination of distribution- and anchor-based approaches determined minimally important differences (MIDs) for four endpoints in a breast cancer scale. J Clin Epidemiol 57(9):898–910PubMedCrossRefGoogle Scholar
  25. 25.
    Ligibel JA, Partridge A, Giobbie-Hurder A, Campbell N, Shockro L, Salinadri T, Winer EP (2010) Physical and psychological outcomes among women in a telephone-based exercise intervention during adjuvant therapy for early stage breast cancer. J Womens Health 19(8):1553–1559CrossRefGoogle Scholar
  26. 26.
    Spence RR, Heesch KC, Brown WJ (2010) Exercise and cancer rehabilitation: a systematic review. Cancer Treat Rev 36(2):185–194PubMedCrossRefGoogle Scholar
  27. 27.
    Markes M, Brockow T, Resch KL (2006) Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 4:CD005001PubMedGoogle Scholar
  28. 28.
    van Waart H, Stuiver MM, van Harten WH, Sonke GS, Aaronson NK (2010) Design of the Physical exercise during Adjuvant Chemotherapy Effectiveness Study (PACES): a randomized controlled trial to evaluate effectiveness and cost-effectiveness of physical exercise in improving physical fitness and reducing fatigue. BMC Cancer 10:673−683PubMedCrossRefGoogle Scholar
  29. 29.
    Velthuis MJ, May AM, Koppejan-Rensenbrink RA, Gijsen BC, van Breda E, de Wit GA et al (2010) Physical Activity during Cancer Treatment (PACT) Study: design of a randomised clinical trial. BMC Cancer 10:272−281PubMedCrossRefGoogle Scholar
  30. 30.
    Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH (2010) An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv 4(2):87–100PubMedCrossRefGoogle Scholar
  31. 31.
    Demark-Wahnefried W, Aziz NM, Rowland JH, Pinto BM (2005) Riding the crest of the teachable moment: promoting long-term health after the diagnosis of cancer. J Clin Oncol 23(24):5814–5830PubMedCrossRefGoogle Scholar
  32. 32.
    Schwartz MB, Brownell KD (2004) Obesity and body image. Body Image 1(1):43–56PubMedCrossRefGoogle Scholar
  33. 33.
    Ewertz M, Jensen MB, Gunnarsdottir KA, Hojris I, Jakobsen EH, Nielsen D et al (2011) Effect of obesity on prognosis after early-stage breast cancer. J Clin Oncol 29(1):25–31PubMedCrossRefGoogle Scholar
  34. 34.
    Calle EE, Rodriguez C, Walker-Thurmond K, Thun MJ (2003) Overweight, obesity, and mortality from cancer in a prospectively studied cohort of US adults. N Engl J Med 348(17):1625–1638PubMedCrossRefGoogle Scholar
  35. 35.
    Majed B, Moreau T, Senouci K, Salmon RJ, Fourquet A, Asselain B (2008) Is obesity an independent prognosis factor in woman breast cancer? Breast Cancer Res Treat 111(2):329–342PubMedCrossRefGoogle Scholar
  36. 36.
    Carmichael AR, Daley AJ, Rea DW, Bowden SJ (2010) Physical activity and breast cancer outcome: a brief review of evidence, current practice and future direction. Eur J Surg Oncol 36(12):1139–1148PubMedGoogle Scholar
  37. 37.
    Brown JC, Huedo-Medina TB, Pescatello LS, Pescatello SM, Ferrer RA, Johnson BT (2011) Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis. Cancer Epidemiol Biomarkers Prev 20(1):123–133PubMedCrossRefGoogle Scholar
  38. 38.
    McTiernan A (2008) Mechanisms linking physical activity with cancer. Nat Rev Cancer 8(3):205–211PubMedCrossRefGoogle Scholar
  39. 39.
    Smith AW, Alfano CM, Reeve BB, Irwin ML, Bernstein L, Baumgartner K et al (2009) Race/ethnicity, physical activity, and quality of life in breast cancer survivors. Cancer Epidemiol Biomarkers Prev 18(2):656–663PubMedCrossRefGoogle Scholar
  40. 40.
    Sheppard VB, Christopher J, Nwabukwu I (2010) Breaking the silence barrier: opportunities to address breast cancer in African-born women. J Natl Med Assoc 102(6):461–468PubMedGoogle Scholar
  41. 41.
    Bowen DJ, Alfano CM, McGregor BA, Kuniyuki A, Bernstein L, Meeske K et al (2007) Possible socioeconomic and ethnic disparities in quality of life in a cohort of breast cancer survivors. Breast Cancer Res Treat 106(1):85–95PubMedCrossRefGoogle Scholar
  42. 42.
    Baum M, Buzdar A, Cuzick J, Forbes J, Houghton J, Howell A et al (2003) Anastrozole alone or in combination with tamoxifen versus tamoxifen alone for adjuvant treatment of postmenopausal women with early-stage breast cancer: results of the ATAC (arimidex, tamoxifen alone or in combination) trial efficacy and safety update analyses. Cancer 98(9):1802–1810PubMedCrossRefGoogle Scholar
  43. 43.
    Garreau JR, Delamelena T, Walts D, Karamlou K, Johnson N (2006) Side effects of aromatase inhibitors versus tamoxifen: the patients’ perspective. Am J Surg 192(4):496–498PubMedCrossRefGoogle Scholar
  44. 44.
    Demark-Wahnefried W, Morey MC, Sloane R, Snyder DC, Cohen HJ (2009) Promoting healthy lifestyles in older cancer survivors to improve health and preserve function. J Am Geriatr Soc 57(Suppl 2):S262–S264PubMedCrossRefGoogle Scholar
  45. 45.
    Emery CF, Yang HC, Frierson GM, Peterson LJ, Suh S (2009) Determinants of physical activity among women treated for breast cancer in a 5-year longitudinal follow-up investigation. Psychooncology 18(4):377–386PubMedCrossRefGoogle Scholar
  46. 46.
    Perkins HY, Baum GP, Taylor CL, Basen-Engquist KM (2009) Effects of treatment factors, comorbidities and health-related quality of life on self-efficacy for physical activity in cancer survivors. Psychooncology 18(4):405–411PubMedCrossRefGoogle Scholar
  47. 47.
    Patterson RE, Cadmus LA, Emond JA, Pierce JP (2010) Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas 66(1):5–15PubMedCrossRefGoogle Scholar
  48. 48.
    Patterson RE, Saquib N, Natarajan L, Rock CL, Parker BA, Thomson CA, Pierce JP (2010) Improvement in self-reported physical health predicts longer survival among women with a history of breast cancer. Breast Cancer Res Treat. doi: 10.1007/s10549-010-1236-x
  49. 49.
    Braithwaite D, Satariano WA, Sternfeld B, Hiatt RA, Ganz PA, Kerlikowske K et al (2010) Long-term prognostic role of functional limitations among women with breast cancer. J Natl Cancer Inst 102(19):1468–1477PubMedCrossRefGoogle Scholar
  50. 50.
    Saquib N, Pierce JP, Saquib J, Flatt SW, Natarajan L, Bardwell WA et al (2011) Poor physical health predicts time to additional breast cancer events and mortality in breast cancer survivors. Psychooncology 20:252–259PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC. 2011

Authors and Affiliations

  • Jeanne S. Mandelblatt
    • 1
    Email author
  • Gheorghe Luta
    • 2
  • Marilyn L. Kwan
    • 3
  • Solomon B. Makgoeng
    • 1
  • Isaac J. Ergas
    • 3
  • Janise M. Roh
    • 3
  • Barbara Sternfeld
    • 3
  • Lucile L. Adams-Campbell
    • 4
  • Lawrence H. Kushi
    • 3
  1. 1.Cancer Control Program, Lombardi Cancer Center and Department of OncologyGeorgetown University Medical CenterWashingtonUSA
  2. 2.Department of Biostatistics, Bioinformatics and Biomathematics and Lombardi Cancer CenterGeorgetown University Medical CenterWashingtonUSA
  3. 3.Division of ResearchKaiser PermanenteOaklandUSA
  4. 4.Carcinogenesis, Biomarkers and Epidemiology Program, Lombardi Cancer Center and Department of OncologyGeorgetown University Medical CenterWashingtonUSA

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