Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes
- 426 Downloads
Purpose of Review
To review current data regarding physical activity and breast cancer including cancer risk, cancer prognosis, treatment-related side effects, and patient-reported outcomes. We will summarize current physical activity guidelines for cancer survivors and discuss opportunities to study and implement physical activity programs in cancer survivors.
Observational evidence suggests that physical activity is associated with a reduced risk of developing breast cancer, a reduced risk of breast cancer recurrence, and improved breast cancer-specific and all-cause mortality. Studies also show that physical activity improves factors important to quality of life such as chemotherapy-related fatigue and the aromatase inhibitor-induced musculoskeletal syndrome.
Physical activity is an important component of breast cancer survivorship. Challenges exist in conducting clinical trials of physical activity and implementing current guidelines, yet there are significant opportunities to advance the field through translational research efforts and utilization of available community resources.
KeywordsExercise Exercise oncology Exercise guidelines Breast cancer Physical activity Breast cancer survivorship
Compliance with Ethical Standards
Conflict of Interest
Lindsay L. Peterson and Jennifer A. Ligibel declare they have no conflict of interest.
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.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 3.Irwin ML, Smith AW, McTiernan A, Ballard-Barbash R, Cronin K, Gilliland FD, 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.CrossRefPubMedPubMedCentralGoogle Scholar
- 5.• van Vulpen JK, Peeters PH, Velthuis MJ, van der Wall E, May AM. Effects of physical exercise during adjuvant breast cancer treatment on physical and psychosocial dimensions of cancer-related fatigue: a meta-analysis. Maturitas. 2016;85:104–11. This was the first meta-analysis to evaluate the effect of exercise on different dimensions of fatigue. It included 6 studies with 784 patients receiving chemotherapy or radiation therapy and found that exercise was associated with significant improvements in general fatigue and physical fatigue but not on cognitive and affective fatigue. CrossRefPubMedGoogle Scholar
- 13.Castello A, Martin M, Ruiz A, Casas AM, Baena-Canada JM, Lope V, et al. Lower breast cancer risk among women following the World Cancer Research Fund and American Institute for Cancer Research lifestyle recommendations: EpiGEICAM case-control study. PLoS One. 2015;10(5):e0126096.CrossRefPubMedPubMedCentralGoogle Scholar
- 14.WCRF/AICR Policy and action for cancer prevention food, nutrition and physical activity: a global perspective.Google Scholar
- 16.Colditz GA, Peterson LL. Obesity and cancer: evidence, impact, and future directions. Clin Chem 2017.Google Scholar
- 23.• Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systematic review and meta-analysis of epidemiological studies. Acta oncologica (Stockholm, Sweden). 2015;54(5):635–54. Twenty-two prospective cohort studies with 124,574 participants with follow-up between 4 and 12 years were included in this analysis. Post-diagnosis physical activity was associated with significant risk reductions for all-cause and breast cancer-specific mortality (HR = 0.52, 95% CI 0.43-0.64, p < 0.01; and HR = 0.59, 95% CI 0.45-0.78, p < 0.05, respectively). CrossRefGoogle Scholar
- 26.Ligibel JA, Barry WT, Alfano C, Hershman DL, Irwin M, Neuhouser M, et al. Randomized phase III trial evaluating the role of weight loss in adjuvant treatment of overweight and obese women with early breast cancer (Alliance A011401): study design. NPJ breast cancer. 2017;3:37.CrossRefPubMedPubMedCentralGoogle Scholar
- 27.Courneya KS, Booth CM, Gill S, O’Brien P, Vardy J, Friedenreich CM, et al. The Colon Health and Life-Long Exercise Change trial: a randomized trial of the National Cancer Institute of Canada Clinical Trials Group. Current oncology (Toronto, Ont). 2008;15(6):279–85.Google Scholar
- 30.Furmaniak AC, Menig M, Markes MH. Exercise for women receiving adjuvant therapy for breast cancer. The Cochrane database of systematic reviews. 2016;9:Cd005001.Google Scholar
- 37.Campbell KL, Kam JW, Neil-Sztramko SE, Liu Ambrose T, Handy TC, Lim HJ, et al. Effect of aerobic exercise on cancer-associated cognitive impairment: a proof-of-concept RCT. Psychooncology. 2017;Google Scholar
- 39.Janelsins MC, Peppone LJ, Heckler CE, Kesler S, Sprod LK, Atkins J, et al. YOCAS©® yoga reduces self-reported memory difficulty in cancer survivors in a nationwide randomized clinical trial: investigating relationships between memory and sleep. Integrative Cancer Therapies. 2016;15(3):263–71.CrossRefPubMedGoogle Scholar
- 40.Gokal K, Munir F, Wallis D, Ahmed S, Boiangiu I, Kancherla K. Can physical activity help to maintain cognitive functioning and psychosocial well-being among breast cancer patients treated with chemotherapy? A randomised controlled trial: study protocol. BMC Public Health. 2015;15:414.CrossRefPubMedPubMedCentralGoogle Scholar
- 41.Markes M, Brockow T, Resch KL. Exercise for women receiving adjuvant therapy for breast cancer. The Cochrane database of systematic reviews. 2006(4):Cd005001.Google Scholar
- 42.• Buffart LM, Kalter J, Sweegers MG, Courneya KS, Newton RU, Aaronson NK, et al. Effects and moderators of exercise on quality of life and physical function in patients with cancer: an individual patient data meta-analysis of 34 RCTs. Cancer Treat Rev. 2017;52:91–104. This meta-analysis included data from 4,519 patients (including over 3,000 with breast cancer) and found significant improvements in quality of life ( β = 0.15, 95%CI = 0.10;0.20) and physical function ( β = 0.18, 95%CI = 0.13;0.23). Supervised exercise had larger effects on quality of life ( β difference_in_effect = 0.13, 95%CI = 0.04;0.23) and physical function ( β difference_in_effect = 0.11, 95%CI = 0.01;0.20) than unsupervised exercise interventions. CrossRefPubMedGoogle Scholar
- 47.• Nelson NL. Breast cancer-related lymphedema and resistance exercise: a systematic review. J Strength Cond Res. 2016;30(9):2656–65. This systematic review included 6 RCTs (including the PAL trials by Schimtz et al.) with 805 breast cancer survivors and concluded that the methodologic quality of the RCTs was good and that there is strong evidence that resistance exercise training (2 to 3 nonconsecutive days per week) increases strength without exacerbating lymphedema and without other adverse events. CrossRefPubMedGoogle Scholar
- 48.Kushi LH, Doyle C, McCullough M, Rock CL, Demark-Wahnefried W, Bandera EV, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA Cancer J Clin. 2012;62(1):30–67.CrossRefPubMedGoogle Scholar
- 49.•• Ligibel JA, Wollins D. American Society of Clinical Oncology Obesity Initiative: rationale, progress, and future directions. J Clin Oncol. 2016;34(35):4256–60. The American Society of Clinical Oncology (ASCO) developed an Energy Balance Working Group in 2012 to review the data supporting a link between obesity and cancer. This working group developed patient and provider resources which are available online. This publication summarizes the recommendations from the working group as well as the efforts of ASCO to combat obesity. CrossRefPubMedGoogle Scholar
- 52.•• Irwin ML, Cartmel B, Harrigan M, Li F, Sanft T, Shockro L, et al. Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors. Cancer. 2017;123(7):1249–58. This is a randomized trial of a 12-week twice-weekly exercise program (LIVESTRONG at the YMCA) vs. control. Patients randomized to the exercise program had improvements in activity (71% meeting the recommended 150 min/week compared to 26% in control), improvements in the 6-min walk test (33.8 m increase vs. 4.9 m in control), and quality of life (1.6 unit increase in FACT-G vs. 1.0 unit decrease in control), with no adverse events reported. CrossRefPubMedGoogle Scholar