Exercise After Treatment for Breast Cancer: Effects on Quality of Life



Whilst the incidence of breast cancer is high, survival is good and has improved significantly over the past 30 years. A diagnosis of breast cancer can be a life-changing event for women and treatment can be intense and prolonged; this can have a detrimental effect on QoL. Exercise may be a means by which the QoL of cancer survivors can be improved. Evidence from numerous trials have shown that many of the physical, functional and emotional effects that are typically experienced by women after treatment for breast cancer may be ameliorated, at least in the short term, through participation in regular exercise, regardless of mode or setting. However, despite considerable advancements in this field, we must remain cognizant that we have a long way to go and many questions remain unanswered. There is still a need for larger trials of high methodological quality that include long-term follow-up.


Breast Cancer Cancer Survivor Breast Cancer Survivor Resistance Exercise Exercise Intervention 



Amanda Daley is supported by a NIHR Senior Research Fellowship (Career Scientist Award). The views expressed in this publication are those of the authors and not necessarily those of the NHS, NIHR or the Department of Health.


  1. 1.
    Office of National Statistics. (2005) Cancer Statistics Registrations: Registrations of Cancer Diagnosed in 2003. Series MB1 No. 33, England.Google Scholar
  2. 2.
    Parkin DM, Bray F, Ferlay J, et al. (2005) Global cancer statistics 2002. CA Cancer J Clin 55:74–108.CrossRefPubMedGoogle Scholar
  3. 3.
    Office of National Statistics. (2002) Cancer survival in the health authorities of England 1993–2000. Health Stats Quart 13:95–103.Google Scholar
  4. 4.
    Hewitt M, Greenfield S, Stovall E. (2006) From Cancer Patient to Cancer Survivor: Lost in Translation. US National Academy of Sciences, Washington, DC.Google Scholar
  5. 5.
    Courneya KS, Friedenreich CM. (1999) Physical exercise and quality of life following cancer diagnosis: a literature review. Ann Behav Med 21:171–179.CrossRefPubMedGoogle Scholar
  6. 6.
    Glanz K, Lerman C. (1992) Psychosocial impact of breast cancer: a critical review. Ann Behav Med 14:204–212.Google Scholar
  7. 7.
    Byar KL, Berger AM, Bakken SL, et al. (2006) Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum 33:E18–26.CrossRefPubMedGoogle Scholar
  8. 8.
    Harmer V. (2003) Breast Cancer: Nursing Care and Management. Whurr, London.Google Scholar
  9. 9.
    Morrow GR, Shelke AR, Roscoe JA, et al. (2005) Management of cancer-related fatigue. Cancer Invest 23:229–239.CrossRefPubMedGoogle Scholar
  10. 10.
    Fialka-Moser V, Crevenna R, Korpan M, et al. (2003) Cancer rehabilitation: particularly with aspects on physical impairments. J Rehab Med 35:153–162.CrossRefGoogle Scholar
  11. 11.
    Fallowfield L, Clark A. (1992) Breast Cancer. Routledge, London.Google Scholar
  12. 12.
    Golant M, Altman T, Martin C. (2003) Managing cancer side effects to improve quality of life: a cancer psychoeducation program. Cancer Nurs 26:37–44.CrossRefPubMedGoogle Scholar
  13. 13.
    Burgress C, Ramirez A, Cornelius V, et al. (2005) Depression and anxiety in women with early breast cancer: 5-year observational cohort data. BMJ 330:702–705.CrossRefGoogle Scholar
  14. 14.
    Greeno CG, Wing RR. (1994) Stress-induced eating. Psychol Bull 115:444–464.CrossRefPubMedGoogle Scholar
  15. 15.
    Wardle J, Steptoe A, Oliver G, et al. (2000) Stress, dietary restraint and food intake. J Psychosomatic Res 48:195–202.CrossRefGoogle Scholar
  16. 16.
    Meyer T, Mark M. (1995) Effects of psychosocial interventions with adult cancer patients: a meta-analysis of randomised experiments. Health Psychol 14:101–108.CrossRefPubMedGoogle Scholar
  17. 17.
    Courneya KS, Friedenreich CM. (1997a) The relationship between exercise pattern across the cancer experience and current quality of life in colorectal cancer survivors. J Altern Complem Med 3:215–226.CrossRefGoogle Scholar
  18. 18.
    Department of Health. (2004) At least five a week: evidence on the impact of physical activity and its relationship to health. A Report from the Chief Medical Officer. (http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4080994). Accessed 11 March 2007.
  19. 19.
    Taylor RS, Brown A, Ebrahim S, et al. (2004) Exercise-based rehabilitation for patients with coronary heart disease: systematic review and meta-analysis of randomized controlled trials. Am J Med 116:682–692.CrossRefPubMedGoogle Scholar
  20. 20.
    Pedersen BK, Saltin B. (2006) Evidence for prescribing exercise as therapy in chronic disease. Scand J Med Sci Sports 1:3–63.CrossRefGoogle Scholar
  21. 21.
    Lawlor DA, Hopker SW. (2001) The effectiveness of exercise as an intervention in the management of depression: systematic review and meta-regression analysis of randomized controlled trials. BMJ 322:1–8.CrossRefGoogle Scholar
  22. 22.
    Etnier J, Salazar W, Landers D, et al. (1997) The influence of physical fitness and exercise upon cognitive functioning: a meta-analysis. J Sport Exerc Psychol 19: 249–277.Google Scholar
  23. 23.
    King AC, Oman RF, Brassington GS, et al. (1997) Moderate-intensity exercise and self-rated quality of sleep in older adults: a randomised controlled trial. J Am Med Assoc 277:32–37.CrossRefGoogle Scholar
  24. 24.
    Blanchard CM, Courneya KS, Stein K. (2008) Cancer survivors' adherence to lifestyle behavior recommendations and associations with health-related quality of life: Results from the American Cancer Society’s SCS-II. J Clin Oncol 26:2198–2220.CrossRefPubMedGoogle Scholar
  25. 25.
    Irwin ML, McTiernan A, Bernstein L, et al. (2004) Physical activity levels among breast cancer survivors. Med Sci Sports Exerc 36:1484–1491.PubMedGoogle Scholar
  26. 26.
    Irwin M, Crumley D, McTiernan A, et al. (2003) Physical activity levels before and after a diagnosis of breast carcinoma. Cancer 97:1746–1757.CrossRefPubMedGoogle Scholar
  27. 27.
    Blanchard CM, Cokkinides V, Courneya KS, et al. (2003) Comparison of physical activity of post-treatment breast cancer survivors and non-cancer controls. Behav Med 28:140–149.CrossRefPubMedGoogle Scholar
  28. 28.
    Ness KK, Wall MM, Oakes JM, et al. (2006) Physical performance limitations and participation restrictions among cancer survivors: a population-based study. Ann Epidemiol 16:197–205.CrossRefPubMedGoogle Scholar
  29. 29.
    MacVicar M, Winningham ML. (1986) Promoting the functional capacity of cancer patients. Cancer Bull 38:235–239.Google Scholar
  30. 30.
    Winningham ML, MacVicar MG. (1988) The effect of aerobic exercise on patient reports of nausea. Oncol Nurs Forum 15:447–450.PubMedGoogle Scholar
  31. 31.
    MacVicar M, Winningham ML, Nickel JL. (1989) Effects of aerobic interval training on cancer patients' functional capacity. Nurs Res 38:348–351.CrossRefPubMedGoogle Scholar
  32. 32.
    Winningham ML, MacVicar MG, Bondoc M, et al. (1989) Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. Oncol Nurs Forum 16:683–689.PubMedGoogle Scholar
  33. 33.
    Pinto BM, Clark MM, Maruyama NC, et al. (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12:118–126.CrossRefPubMedGoogle Scholar
  34. 34.
    Courneya KS, Mackey JR, Bell GJ, et al. (2003) Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. J Clin Oncol 21:1660–1668.CrossRefPubMedGoogle Scholar
  35. 35.
    Knols R, Aaronson NK, Uebelhart D, et al. (2005) Physical exercise in cancer patients during and after medical treatment: a systematic review of randomized and controlled clinical trials. J Clin Oncol 23:3830–3842.CrossRefPubMedGoogle Scholar
  36. 36.
    Daley AJ, Mutrie N, Crank H, et al. (2004) Exercise therapy in women who have had breast cancer: design of the Sheffield women’s exercise and well-being project. Health Educ Res 19:686–697.CrossRefPubMedGoogle Scholar
  37. 37.
    Daley AJ, Crank H, Saxton JM, et al. (2007) A Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol 25:1713–1721.CrossRefPubMedGoogle Scholar
  38. 38.
    Irwin ML, Cadmus L, Alvarez-Reeves M, et al. (2008) Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial: the Yale Exercise and Survivorship Study. Cancer 112(11 Suppl):2593–2606.CrossRefPubMedGoogle Scholar
  39. 39.
    Asikainen TM, Kukkonen-Harjula K, Miilunpalo S. (2004) Exercise for health for early postmenopausal women: a systematic review of randomised controlled trials. Sports Med 34:753–778.CrossRefPubMedGoogle Scholar
  40. 40.
    Zehnacker CH, Bemis-Dougherty A. (2007) Effect of weighted exercises on bone mineral density in post menopausal women: a systematic review. J Geriatr Phys Ther 30:79–88.PubMedGoogle Scholar
  41. 41.
    Chen Z, Maricic M, Aragaki AK, Mouton C, et al. (2009) Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: Results from the Women’s Health Initiative. Osteoporosis Int 20:527–536.CrossRefGoogle Scholar
  42. 42.
    Reid DM, Doughty J, Eastell R, et al. (2008) Guidance for the management of breast cancer treatment-induced bone loss: a consensus position statement from a UK Expert Group. Cancer Treat Rev 34(Suppl 1):S3–S18.CrossRefPubMedGoogle Scholar
  43. 43.
    Ohira T, Schmitz KH, Ahmed RL, et al. (2006) Effects of weight training on quality of life in recent breast cancer survivors: the Weight Training for Breast Cancer Survivors (WTBS) study. Cancer 106:2076–2083.CrossRefPubMedGoogle Scholar
  44. 44.
    Ozaslan C, Kuru B. (2004) Lymphedema after treatment for breast cancer. Am J Surg 187:69–72.CrossRefPubMedGoogle Scholar
  45. 45.
    Mirolo BR, Bunce IH, Chapman M, et al. (1995) Psychosocial benefits of post-mastectomy lymphedema therapy. Cancer Nurs 18:197–205.CrossRefPubMedGoogle Scholar
  46. 46.
    Ahmed RL, Thomas W, Yee D, et al. (2006) Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol 24:2765–2772.CrossRefPubMedGoogle Scholar
  47. 47.
    Schmitz KH, Ahmed RL, Hannan PJ, et al. (2005) Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomark Prev 14:1672–1680.CrossRefGoogle Scholar
  48. 48.
    Nieman DC, Cook VD, Henson DA, et al. (1995) Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. Int J Sports Med 16:334–337.CrossRefPubMedGoogle Scholar
  49. 49.
    McKenzie DC, Kalda AL. (2003) Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol 21:463–466.CrossRefPubMedGoogle Scholar
  50. 50.
    Herrero F, San Juan AF, Fleck SJ, et al. (2006) Combined aerobic and resistance training in breast cancer survivors: a randomized, controlled pilot trial. Int J Sports Med 27:573–580.CrossRefPubMedGoogle Scholar
  51. 51.
    Milne HM, Wallman KE, Gordon S, et al. (2008) Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 108:279–288.CrossRefPubMedGoogle Scholar
  52. 52.
    Cella D, Eton DT, Lai JS, et al. (2002) Combining anchor and distribution-based methods to derive minimal clinically important differences on the Functional Assessment of Cancer Therapy (FACT) anemia and fatigue scales. J Pain Symptom Manag 24:547–561.CrossRefGoogle Scholar
  53. 53.
    Milne HM, Wallman KE, Gordon S, et al. (2008) Impact of a combination resistence and aerobic exercise program on motivational variables in breast cancer survivors: a randomised controlled trial. Ann Behav Med 36:158–166.CrossRefPubMedGoogle Scholar
  54. 54.
    Mutrie N, Campbell AM, Whyte F, et al. (2007) Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ 334:517.CrossRefPubMedGoogle Scholar
  55. 55.
    Pinto BM, Frierson GM, Rabin C, et al. (2005) Home-based physical activity intervention for breast cancer patients. J Clin Oncol 23:3577–3587.CrossRefPubMedGoogle Scholar
  56. 56.
    Demark-Wahnefried W, Clipp EC, Morey MC, et al. (2006) Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from project LEAD. J Clin Oncol 24:3465–3473.CrossRefPubMedGoogle Scholar
  57. 57.
    Vallance JK, Courneya KS, Plotnikoff RC, et al. (2007) Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. J Clin Oncol 25:2352–2359.CrossRefPubMedGoogle Scholar
  58. 58.
    Vallance JK, Courneya KS, Plotnikoff RC, et al. (2008) Maintenance of physical activity in breast cancer survivors after a randomized trial. Med Sci Sports Exerc 40:173–180.PubMedGoogle Scholar
  59. 59.
    Jones LW, Courneya KS, Fairey AS, et al. (2004) Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial. Ann Behav Med 28:105–113.CrossRefPubMedGoogle Scholar
  60. 60.
    Holmes MD, Chen WY, Feskanich D, et al. (2005) Physical activity and survival after breast cancer diagnosis. J Am Med Assoc 293:2479–2486.CrossRefGoogle Scholar
  61. 61.
    Pinto BM, Rabin C, Abdow S, et al. (2008) A pilot study on disseminating physical activity promotion among cancer survivors: a brief report. Psychooncology 17:517–521.CrossRefPubMedGoogle Scholar
  62. 62.
    Mustian KM, Katula JA, Gill DL, et al. (2004) Tai Chi Chuan, health-related quality of life and self-esteem: a randomized trial with breast cancer survivors. Supp Care Cancer 12:871–876.CrossRefGoogle Scholar
  63. 63.
    Culos-Reed SN, Carlson LE, Daroux LM, et al. (2006) A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Psychooncology 15:891–897.CrossRefPubMedGoogle Scholar
  64. 64.
    Moadel AB, Shah C, Wylie-Rosett J, et al. (2007) Randomized controlled trial of yoga among a multiethnic sample of breast cancer patients: effects on quality of life. J Clin Oncol 25:4387–4395.CrossRefPubMedGoogle Scholar
  65. 65.
    Blake-Mortimer J, Gore-Felton C, Kimerling R, et al. (1999) Improving the quality and quantity of life among patients with cancer: a review of the effectiveness of group psychotherapy. Eur J Cancer 35:1581–1586.CrossRefPubMedGoogle Scholar
  66. 66.
    Courneya KS, Friedenreich CM, Sela RA, et al. (2003) The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Psychooncology 12:357–374.CrossRefPubMedGoogle Scholar
  67. 67.
    McNeely ML, Campbell KL, Rowe BH, et al. (2006) Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 175:34–41.PubMedGoogle Scholar
  68. 68.
    Rehse B, Pukrop R. (2003) Effects of psychosocial interventions on quality of life in adult cancer patients: meta analysis of 37 published controlled outcome studies. Patient Educ Counsel 50:179–186.Google Scholar
  69. 69.
    Stevinson C, Lawlor D, Fox KR. (2004) Exercise interventions for cancer patients: systematic review of controlled trials. Cancer Cause Contr 15:1035–1056.CrossRefGoogle Scholar
  70. 70.
    Oldervoll LM, Kaasa S, Hjermstad MJ, et al. (2004) Physical exercise Results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 40:951–962.CrossRefPubMedGoogle Scholar
  71. 71.
    Schmitz KH, Holtzman J, Courneya KS, et al. (2005) Controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. Cancer Epidemiol Biomark Prev 14:1588–1595.CrossRefGoogle Scholar
  72. 72.
    Midtgaard J, Stelter R, Rorth M, et al. (2007) Regaining a sense of agency and shared self-reliance: the experience of advanced disease cancer patients participating in a multidimensional exercise intervention while undergoing chemotherapy – analysis of patient diaries. Scand J Psychol 48:181–190.CrossRefPubMedGoogle Scholar
  73. 73.
    Midtgaard J, Rorth M, Stelter R, et al. (2006) The group matters: an explorative study of group cohesion and quality of life in cancer patients participating in physical exercise intervention during treatment. Eur J Cancer Care 15:25–33.CrossRefGoogle Scholar
  74. 74.
    Adamsen L, Rasmussen JM, Pedersen LS. (2001) 'Brothers in arms': how men with cancer experience a sense of comradeship through group intervention which combines physical activity with information relay. J Clin Nurs 10:528–537.CrossRefPubMedGoogle Scholar
  75. 75.
    Coon SK, Coleman EA. (2004) Keep moving: patients with myeloma talk about exercise and fatigue. Oncol Nurs Forum 31:1127.CrossRefPubMedGoogle Scholar
  76. 76.
    Stevinson C, Fox KR. (2006) Feasibility of an exercise rehabilitation programme for cancer patients. Eur J Cancer Care 15:386–396.CrossRefGoogle Scholar
  77. 77.
    Hennessy EM, Stevinson C, Fox KR. (2005) Preliminary study of the lived experience of exercise for cancer survivors. Eur Onco Nurs 9:155–166.CrossRefGoogle Scholar
  78. 78.
    Unruh AM, Elvin N. (2004) In the eye of the dragon: women’s experience of breast cancer and the occupation of dragon boat racing. Can J Occup Ther 71:138–149.PubMedGoogle Scholar
  79. 79.
    Mitchell TL, Yakiwchuk CV, Griffin KL, et al. (2007) Survivor dragon boating: a vehicle to reclaim and enhance life after treatment for breast cancer. Health Care Women Int 28:122–140.CrossRefPubMedGoogle Scholar
  80. 80.
    Sabiston CM, McDonough MH, Crocker PR. (2007) Psychosocial experiences of breast cancer survivors involved in a dragon boat program: exploring links to positive psychological growth. J Sport Exerc Psychol 29:419–438.PubMedGoogle Scholar
  81. 81.
    Courneya KS, Mackay JR, Jones LW. (2000) Coping with cancer: can exercise help? Phys Sports Med 28:49–73.Google Scholar
  82. 82.
    Doyle C, Kushi LH, Byers T, et al. (2006) Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices. CA Cancer J Clin 56:323–353.CrossRefPubMedGoogle Scholar
  83. 83.
    Humpel N, Iverson DC. (2005) Review and critique of the quality of exercise recommendations for cancer patients and survivors. Supp Care Cancer 13:493–502.CrossRefGoogle Scholar
  84. 84.
    Rogers LQ, Courneya KS, Shah P, et al. (2007) Exercise stage of change, barriers, expectations, values and preferences among breast cancer patients during treatment: a pilot study. Eur J Cancer Care 16:55–66.CrossRefGoogle Scholar
  85. 85.
    Eversley R, Estrin D, Dibble S, et al. (2005) Post-treatment symptoms among ethnic minority breast cancer survivors. Oncol Nurs Forum 32:250–256.CrossRefPubMedGoogle Scholar
  86. 86.
    Northouse LL, Caffey M, Deichelbohrer L, et al. (1999) The quality of life of African American women with breast cancer. Res Nurs Health 22:449–460.CrossRefPubMedGoogle Scholar
  87. 87.
    Roux L, Pratt M, Tengs TO, et al. (2008) Cost effectiveness of community-based physical activity interventions. Am J Prev Med 35:578–588.CrossRefPubMedGoogle Scholar

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© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  1. 1.Faculty of Health and Wellbeing, Centre for Sport and Exercise ScienceSheffield Hallam UniversitySheffieldUK
  2. 2.Primary Care Clinical Sciences, School of Health and Population Sciences, College of Medical and Dental SciencesUniversity of BirminghamBirminghamUK

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