Journal of Cancer Survivorship

, Volume 8, Issue 2, pp 304–311 | Cite as

Musculoskeletal changes after 1 year of exercise in older breast cancer survivors

  • Jessica Dobek
  • Kerri M. Winters-Stone
  • Jill A. Bennett
  • Lillian Nail



We have previously reported that 1 year of supervised resistance + impact training stopped bone loss and built muscle strength in older breast cancer survivors. The purpose of this study was to determine whether these benefits persisted 1 year after completion of the intervention.


Sixty-seven women from the original trial completed baseline and post-intervention body composition and muscle strength tests, and 44 women were available 1 year later for follow-up assessments. Bone mineral density (grams per square centimeter) of the hip and spine, muscle mass (kilograms), and fat mass (kilograms) were measured by dual-energy X-ray absorptiometry and maximal upper and lower body strength were measured by one-repetition maximum tests (kilograms). We compared between group changes across baseline (pre-intervention), 1 (post-intervention), and 2 years (1 year follow up) on study outcomes using repeated-measures analysis of covariance, adjusting for age.


Significant group by time interactions were found for spine bone mineral density (BMD) (p < 0.01) and lower body muscle strength (p < 0.05), with a trend for upper body muscle strength (p = 0.05). Spine BMD remained stable across intervention and follow-up periods in exercisers compared with continuous losses in controls across 1- and 2-year periods. In contrast, lower body strength increased in exercisers across the intervention, but decreased to near-baseline levels during follow-up compared with no change over either time period in controls.


Our data suggest that spine BMD can be preserved in older breast cancer survivors even after formal exercise training stops; however, muscle strength is not similarly maintained and may require continued participation in a supervised exercise program.

Implications for Cancer Survivors

Exercise programs aimed at improving musculoskeletal health should be considered in the long-term care plan for breast cancer survivors.


Follow-up Resistance exercise Bone density Muscle strength Neoplasms Older adult 


  1. 1.
    Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. Cancer. 2012;62(1):10–29.Google Scholar
  2. 2.
    Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, et al. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab. 2004;89(5):2248–53.CrossRefPubMedGoogle Scholar
  3. 3.
    Orr R. Contribution of muscle weakness to postural instability in the elderly. A systematic review. Eur J Phys Rehabil Med. 2010;46(2):183–220.PubMedGoogle Scholar
  4. 4.
    Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci. 1995;50:64–7.PubMedGoogle Scholar
  5. 5.
    Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97(7):1746–57.PubMedCentralCrossRefPubMedGoogle Scholar
  6. 6.
    Saad F, Adachi JD, Brown JP, Canning LA, Gelmon KA, Josse RG, et al. Cancer treatment-induced bone loss in breast and prostate cancer. J Clin Oncol. 2008;26(33):5465–76.CrossRefPubMedGoogle Scholar
  7. 7.
    Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381–9.PubMedGoogle Scholar
  8. 8.
    Vance V, Mourtzakis M, McCargar L, Hanning R. Weight gain in breast cancer survivors: prevalence, pattern and health consequences. Obes Rev. 2011;12(4):282–94.CrossRefPubMedGoogle Scholar
  9. 9.
    Zhang S, Folsom AR, Sellers TA, Kushi LH, Potter JD. Better breast cancer survival for postmenopausal women who are less overweight and eat less fat. The Iowa Women's Health Study. Cancer. 1995;76(2):275–83.CrossRefPubMedGoogle Scholar
  10. 10.
    Doyle C, Kushi LH, Byers T, Courneya KS, Demark-Wahnefried W, Grant B, et al. Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. Cancer. 2006;56(6):323–53.Google Scholar
  11. 11.
    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. Cancer. 2012;62(1):30–67.Google Scholar
  12. 12.
    Maccormick RE. Possible acceleration of aging by adjuvant chemotherapy: a cause of early onset frailty? Med Hypotheses. 2006;67(2):212–5.CrossRefPubMedGoogle Scholar
  13. 13.
    Chen Z, Maricic M, Bassford TL, Pettinger M, Ritenbaugh C, Lopez AM, et al. Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study. Arch Intern Med. 2005;165(5):552–8.CrossRefPubMedGoogle Scholar
  14. 14.
    Winters-Stone KM, Schwartz A, Nail LM. A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Survivorship Res Pract. 2010;4(3):187–201.CrossRefGoogle Scholar
  15. 15.
    Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR. Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. 2006;98(8):521–9.CrossRefPubMedGoogle Scholar
  16. 16.
    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
  17. 17.
    Twiss JJ, Waltman NL, Berg K, Ott CD, Gross GJ, Lindsey AM. An exercise intervention for breast cancer survivors with bone loss. J Nurs Scholarsh. 2009;41(1):20–7.CrossRefPubMedGoogle Scholar
  18. 18.
    Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, et al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. J Am Med Assoc. 2010;304(24):2699–705.CrossRefGoogle Scholar
  19. 19.
    Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.CrossRefPubMedGoogle Scholar
  20. 20.
    Winters-Stone KM, Dobek J, Nail L, Bennett JA, Leo MC, Naik A, et al. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial. Breast Cancer Res Treat. 2011;127(2):447–56.PubMedCentralCrossRefPubMedGoogle Scholar
  21. 21.
    Winters-Stone KM, Dobek J, Bennett JA, Nail LM, Leo MC, Schwartz A. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial. J Cancer Survivorship Res Pract. 2012;6(2):189–99.CrossRefGoogle Scholar
  22. 22.
    Campbell KL, Neil SE, Winters-Stone KM. Review of exercise studies in breast cancer survivors: attention to principles of exercise training. Br J Sports Med. 2011;46(13):909–916Google Scholar
  23. 23.
    Winters KM, Snow CM. Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. J Bone Miner Res. 2000;15(12):2495–503.CrossRefPubMedGoogle Scholar
  24. 24.
    American College of Sports Medicine. ACSM's guidelines for exercise testing and prescription. 9th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.Google Scholar
  25. 25.
    Kohrt WM, Bloomfield SA, Little KD, Nelson ME, Yingling VR. American College of Sports M. American College of Sports Medicine Position Stand: physical activity and bone health. Med Sci Sports Exerc. 2004;36(11):1985–96.CrossRefPubMedGoogle Scholar
  26. 26.
    Heinonen A, Kannus P, Sievanen H, Pasanen M, Oja P, Vuori I. Good maintenance of high-impact activity-induced bone gain by voluntary, unsupervised exercises: an 8-month follow-up of a randomized controlled trial. J Bone Miner Res. 1999;14(1):125–8.CrossRefPubMedGoogle Scholar
  27. 27.
    Mujika I, Padilla S. Muscular characteristics of detraining in humans. Med Sci Sports Exerc. 2001;33(8):1297–303.CrossRefPubMedGoogle Scholar
  28. 28.
    Frost HM. Skeletal structural adaptations to mechanical usage (SATMU): 1. Redefining Wolff's law: the bone modeling problem. Anat Rec. 1990;226(4):403–13.CrossRefPubMedGoogle Scholar
  29. 29.
    Herrero F, San Juan AF, Fleck SJ, Foster C, Lucia A. Effects of detraining on the functional capacity of previously trained breast cancer survivors. Int J Sports Med. 2007;28(3):257–64.CrossRefPubMedGoogle Scholar
  30. 30.
    Cheema BS, Gaul CA. Full-body exercise training improves fitness and quality of life in survivors of breast cancer. J Strength Cond Res. 2006;20(1):14–21.PubMedGoogle Scholar
  31. 31.
    Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, 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.CrossRefPubMedGoogle Scholar
  32. 32.
    De Backer IC, Vreugdenhil G, Nijziel MR, Kester AD, van Breda E, Schep G. Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life. Br J Cancer. 2008;99(1):30–6.PubMedCentralCrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Jessica Dobek
    • 1
  • Kerri M. Winters-Stone
    • 1
    • 2
  • Jill A. Bennett
    • 1
    • 2
  • Lillian Nail
    • 1
    • 2
  1. 1.School of NursingOregon Health and Science UniversityPortlandUSA
  2. 2.Knight Cancer InstituteOregon Health and Science UniversityPortlandUSA

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