Journal of Cancer Survivorship

, Volume 9, Issue 4, pp 612–619 | Cite as

Exercise training intensity prescription in breast cancer survivors: validity of current practice and specific recommendations

  • Friederike Scharhag-RosenbergerEmail author
  • Rea Kuehl
  • Oliver Klassen
  • Kai Schommer
  • Martina E. Schmidt
  • Cornelia M. Ulrich
  • Joachim Wiskemann
  • Karen Steindorf



Cancer survivors are recommended to perform 150 min/week of moderate or 75 min/week of vigorous aerobic exercise, but it remains unclear how moderate and vigorous intensities can be prescribed. Therefore, it was investigated whether and how intensity prescriptions for healthy adults by the American College of Sports Medicine (ACSM) need to be adapted for breast cancer survivors.


Fifty-two breast cancer survivors (stage 0–III, age 52 ± 9 years, BMI 25.4 ± 3.5 kg/m2) performed cardiopulmonary exercise tests at the end of primary therapy. Intensity classes defined as percentages of maximal heart rate (HRmax), heart rate reserve (HRR), and maximal oxygen uptake (VO2max) were compared to the ACSM’s intensity classes using oxygen uptake reserve as reference.


The prescriptions for moderate and vigorous exercise intensities were significantly different between breast cancer survivors and healthy adults when using VO2max (moderate 50–66 vs. 46–63 and vigorous 67–91 vs. 64–90 % VO2max) or HRR (moderate 26–50 vs. 40–59 and vigorous 51–88 vs. 60–89 % HRR), but not when using HRmax (moderate 65–76 vs. 64–76 and vigorous 77–94 vs. 77–95 % HRmax).


In breast cancer survivors, intensity prescriptions for healthy adults result in considerably too intense training if HRR is used as guiding factor. Prescriptions using VO2max result in a slightly too low exercise intensity, whereas recommendations in percentages of HRmax appear valid.

Implications for Cancer Survivors

Cancer survivors should not uncritically adopt exercise intensity prescriptions for healthy adults. Specific prescriptions for the studied population are provided.


Cancer patients Supportive therapy Physical activity Endurance training Aerobic training Aerobic exercise 


Acknowledgments and Funding Information

The BEST study was funded by the Interdisciplinary Research Funding Program (intramural) of the National Center for Tumor Diseases (NCT) Heidelberg and supported by the Foundation “Stiftung Leben mit Krebs.” Dr. Wiskemann was personally supported by the Manfred-Lautenschlaeger-Foundation.

Conflict of interest

The authors declare that they have no competing interests.


  1. 1.
    Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.CrossRefPubMedGoogle Scholar
  2. 2.
    Irwin ML, Mayne ST. Impact of nutrition and exercise on cancer survival. Cancer J (Sudbury, Mass). 2008;14(6):435–41.CrossRefGoogle Scholar
  3. 3.
    Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005;293:2479–86.CrossRefPubMedGoogle Scholar
  4. 4.
    Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012;62(4):243–74.CrossRefPubMedGoogle Scholar
  5. 5.
    Hayes SC, Spence RR, Galvao DA, Newton RU. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12(4):428–34.CrossRefPubMedGoogle Scholar
  6. 6.
    Jones LW. Evidence-based risk assessment and recommendations for physical activity clearance: cancer. Appl Physiol Nutr Metab. 2011;36(S1):S101–12.CrossRefPubMedGoogle Scholar
  7. 7.
    Physical Activities Guidelines Advisory Committee. Physical activity guidelines advisory committee report. Washington: US Department of Health and Human Services; 2008.Google Scholar
  8. 8.
    Garber CE, Blissmer B, Deschenes MR, Franklin BA, Lamonte MJ, Lee IM, et al. American College of Sports Medicine position stand. Quantity and quality of exercise for developing and maintaining cardiorespiratory, musculoskeletal, and neuromotor fitness in apparently healthy adults: guidance for prescribing exercise. Med Sci Sports Exerc. 2011;43(7):1334–59.CrossRefPubMedGoogle Scholar
  9. 9.
    Musanti R. A study of exercise modality and physical self-esteem in breast cancer survivors. Med Sci Sports Exerc. 2012;44(2):352–61.CrossRefPubMedGoogle Scholar
  10. 10.
    Dimeo F, Fetscher S, Lange W, Mertelsmann R, Keul J. Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Blood. 1997;90(9):3390–4.PubMedGoogle Scholar
  11. 11.
    Courneya KS, Stevinson C, McNeely ML, Sellar CM, Friedenreich CM, Peddle-McIntyre CJ, et al. Effects of supervised exercise on motivational outcomes and longer-term behavior. Med Sci Sports Exerc. 2012;44(3):542–9.CrossRefPubMedGoogle Scholar
  12. 12.
    Lakoski SG, Eves ND, Douglas PS, Jones LW. Exercise rehabilitation in patients with cancer. Nat Rev Clin Oncol. 2012;9(5):288–96.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Jones LW, Haykowsky M, Peddle CJ, Joy AA, Pituskin EN, Tkachuk LM, et al. Cardiovascular risk profile of breast cancer patients treated with anthracycline-taxane containing adjuvant chemotherapy and/or trastuzumab. J Clin Oncol. 2006;24(18S):666.Google Scholar
  14. 14.
    Jones LW, Courneya KS, Mackey JR, Muss HB, Pituskin EN, Scott JM, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J Clin Oncol. 2012;30(20):2530–7.PubMedCentralCrossRefPubMedGoogle Scholar
  15. 15.
    Klassen O, Schmidt M, Scharhag-Rosenberger F, Sorkin M, Ulrich CM, Schneeweiss A, et al. Cardiorespiratory fitness in breast cancer patients undergoing adjuvant therapy. Acta Oncol. 2014;53(10):1356–65.CrossRefPubMedGoogle Scholar
  16. 16.
    Schneider CM, Repka CP, Brown JM, Lalonde TL, Dallow KT, Barlow CE, Hayward R. Demonstration of the need for cardiovascular and pulmonary normative data for cancer survivors. Int J Sports Med. 2014.Google Scholar
  17. 17.
    Potthoff K, Schmidt ME, Wiskemann J, Hof H, Klassen O, Habermann N, 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.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Schmidt ME, Wiskemann J, Krakowski-Roosen H, Knicker AJ, Habermann N, Schneeweiss A, 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.CrossRefPubMedGoogle Scholar
  19. 19.
    Midgley AW, McNaughton LR, Polman R, Marchant D. Criteria for determination of maximal oxygen uptake: a brief critique and recommendations for future research. Sports Med. 2007;37(12):1019–28.CrossRefPubMedGoogle Scholar
  20. 20.
    Cunha FA, Midgley AW, Monteiro WD, Farinatti PT. Influence of cardiopulmonary exercise testing protocol and resting VO2 assessment on %HRmax, %HRR, %VO2max and %VO2R relationships. Int J Sports Med. 2010;31(5):319–26.CrossRefPubMedGoogle Scholar
  21. 21.
    Koch B, Schaper C, Ittermann T, Spielhagen T, Dorr M, Volzke H, et al. Reference values for cardiopulmonary exercise testing in healthy volunteers: the SHIP study. Eur Respir J. 2009;33(2):389–97.CrossRefPubMedGoogle Scholar
  22. 22.
    Glass S, Dwyer GB. ACSM’s metabolic calculations handbook. Philadelphia: Lippincott Williams & Wilkins; 2007.Google Scholar
  23. 23.
    Wilmore JH, Stanforth PR, Gagnon J, Rice T, Mandel S, Leon AS, et al. Heart rate and blood pressure changes with endurance training: the HERITAGE Family Study. Med Sci Sports Exerc. 2001;33(1):107–16.CrossRefPubMedGoogle Scholar
  24. 24.
    Tanaka H, Monahan KD, Seals DR. Age-predicted maximal heart rate revisited. J Am Coll Cardiol. 2001;37(1):153–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS. Cardiorespiratory exercise testing in clinical oncology research: systematic review and practice recommendations. Lancet Oncol. 2008;9(8):757–65.CrossRefPubMedGoogle Scholar
  26. 26.
    Meyer T, Gabriel H, Kindermann W. Is determination of exercise intensities as percentages of VO2max or HRmax adequate? Med Sci Sports Exerc. 1999;31(9):1342–5.CrossRefPubMedGoogle Scholar
  27. 27.
    Scharhag-Rosenberger F, Meyer T, Gassler N, Faude O, Kindermann W. Exercise at given percentages of VO2max: Heterogeneous metabolic responses between individuals. J Sci Med Sport. 2010;13(1):74–9.CrossRefPubMedGoogle Scholar
  28. 28.
    Jones LW, Eves ND, Spasojevic I, Wang F, Il'yasova D. Effects of aerobic training on oxidative status in postsurgical non-small cell lung cancer patients: a pilot study. Lung Cancer. 2011;72(1):45–51.PubMedCentralCrossRefPubMedGoogle Scholar
  29. 29.
    Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, et al. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer. 2007;110(3):590–8.CrossRefPubMedGoogle Scholar
  30. 30.
    Dimeo F, Tilmann MH, Bertz H, Kanz L, Mertelsmann R, Keul J. Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation. Cancer. 1997;79(9):1717–22.CrossRefPubMedGoogle Scholar
  31. 31.
    Dolan LB, Gelmon K, Courneya KS, Mackey JR, Segal RJ, Lane K, et al. Hemoglobin and aerobic fitness changes with supervised exercise training in breast cancer patients receiving chemotherapy. Cancer Epidemiol Biomarkers Prev. 2010;19(11):2826–32.CrossRefPubMedGoogle Scholar
  32. 32.
    Vincent F, Labourey J-L, Leobon S, Antonini M-T, Lavau-Denes S, Tubiana-Mathieu N. Effects of a home-based walking training program on cardiorespiratory fitness in breast cancer patients receiving adjuvant chemotherapy: a pilot study. Eur J Phys Rehabil Med. 2013;49:319–29.PubMedGoogle Scholar
  33. 33.
    MacVicar MG, Winningham ML, Nickel JL. Effects of aerobic interval training on cancer patients’ functional capacity. Nurs Res. 1989;38(6):348–51.CrossRefPubMedGoogle Scholar
  34. 34.
    Colberg SR, Swain DP, Vinik AI. Use of heart rate reserve and rating of perceived exertion to prescribe exercise intensity in diabetic autonomic neuropathy. Diabetes Care. 2003;26(4):986–90.CrossRefPubMedGoogle Scholar
  35. 35.
    Pinet BM, Prud'homme D, Gallant CA, Boulay P. Exercise intensity prescription in obese individuals. Obesity. 2008;16(9):2088–95.CrossRefPubMedGoogle Scholar
  36. 36.
    Brawner CA, Keteyian SJ, Ehrman JK. The relationship of heart rate reserve to VO2 reserve in patients with heart disease. Med Sci Sports Exerc. 2002;34(3):418–22.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Friederike Scharhag-Rosenberger
    • 1
    • 2
    Email author
  • Rea Kuehl
    • 1
    • 2
  • Oliver Klassen
    • 2
  • Kai Schommer
    • 3
  • Martina E. Schmidt
    • 2
  • Cornelia M. Ulrich
    • 2
    • 4
  • Joachim Wiskemann
    • 1
    • 2
  • Karen Steindorf
    • 2
  1. 1.Department of Medical Oncology, National Center for Tumor Diseases (NCT) HeidelbergHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of Preventive Oncology, National Center for Tumor Diseases (NCT) HeidelbergGerman Cancer Research Center (DKFZ)HeidelbergGermany
  3. 3.First Department of Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  4. 4.Population SciencesHuntsman Cancer InstituteSalt Lake CityUSA

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