The effects of physical activity and fatigue on cognitive performance in breast cancer survivors



Research suggests that physical activity may be a promising treatment for cancer-related cognitive impairment; however, evidence is limited by small samples and self-report measures and little is known about the underlying mechanisms. The purpose of this study was to examine the effects of physical activity on cognitive function in a national sample of breast cancer survivors (BCSs) using objective measures. We hypothesized that physical activity’s effects on cognition would be indirect through survivors’ self-reported fatigue.


Participants (N = 299; M = 57.51 ± 9.54 years) included BCSs with access to an iPad. Participants wore an accelerometer for seven consecutive days to measure their average daily minutes of moderate-to-vigorous physical activity (MVPA) and completed a battery of questionnaires and neuropsychological tests via an iPad application to measure fatigue and cognitive function. Cognitive function was modeled as two latent factors—executive function and working memory—comprising performance across seven cognitive tasks. A structural equation modeling framework was used to test the hypotheses.


MVPA was associated with less fatigue (γ = 0.19), which, in turn, was associated with faster times on executive function tasks (γ = −0.18) and greater accuracy on working memory tasks (γ = 0.16). The indirect paths from MVPA to cognitive performance were also significant (executive function: β = −0.03, memory: β = 0.03).


Findings suggest that MVPA may be associated with greater executive function and working memory in BCSs. Further, this effect may be partially indirect through cancer-related symptoms (e.g., fatigue). Results emphasize the need for additional scientific investigation in the context of prospective and efficacy trials.

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The authors would like to acknowledge Allen Best and the Team at Digital Artefacts for their development of the iPad application used for this study.

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Corresponding author

Correspondence to Diane K. Ehlers.

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Conflicts of interest

DKE is supported by an American Cancer Society Postdoctoral Fellowship (PF-16-021-01-CPPB).

Ethical approval

This study was approved by and carried out in accordance with the recommendations of the Institutional Review Board at the University of Illinois at Urbana-Champaign with signed informed consent from all participants. The study is registered with United States National Institutes of Health (ID NCT02523677).

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Ehlers, D.K., Aguiñaga, S., Cosman, J. et al. The effects of physical activity and fatigue on cognitive performance in breast cancer survivors. Breast Cancer Res Treat 165, 699–707 (2017).

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  • Cancer-related cognitive impairment
  • Physical activity
  • Fatigue
  • Breast cancer