Skip to main content

Advertisement

SpringerLink
Log in

Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes

  • Breast Cancer (B Overmoyer, Section Editor)
  • Published:
Current Oncology Reports Aims and scope Submit manuscript

Abstract

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.

Recent Findings

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.

Summary

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Kodama S, Saito K, Tanaka S, Maki M, Yachi Y, Asumi M, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: a meta-analysis. JAMA. 2009;301(19):2024–35.

    Article  PubMed  CAS  Google Scholar 

  2. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research. Public Health Rep. 1985;100(2):126–31.

    PubMed  PubMed Central  CAS  Google Scholar 

  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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Zhong S, Jiang T, Ma T, Zhang X, Tang J, Chen W, et al. Association between physical activity and mortality in breast cancer: a meta-analysis of cohort studies. Eur J Epidemiol. 2014;29(6):391–404.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  6. Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K. Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Cancer. 2015;137(2):471–80.

    Article  PubMed  CAS  Google Scholar 

  7. Irwin ML, Cartmel B, Gross CP, Ercolano E, Li F, Yao X, et al. Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. J Clin Oncol. 2015;33(10):1104–11.

    Article  PubMed  Google Scholar 

  8. Nyrop KA, Callahan LF, Cleveland RJ, Arbeeva LL, Hackney BS, Muss HB. Randomized controlled trial of a home-based walking program to reduce moderate to severe aromatase inhibitor-associated arthralgia in breast cancer survivors. Oncologist. 2017;22:1238–49.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  9. 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):242–74.

    Article  Google Scholar 

  10. 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.

    Article  PubMed  Google Scholar 

  11. Carlson SA, Fulton JE, Schoenborn CA, Loustalot F. Trend and prevalence estimates based on the 2008 Physical Activity Guidelines for Americans. Am J Prev Med. 2010;39(4):305–13.

    Article  PubMed  Google Scholar 

  12. Blanchard CM, Courneya KS, Stein K. 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. 2008;26(13):2198–204.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. WCRF/AICR Policy and action for cancer prevention food, nutrition and physical activity: a global perspective.

  15. McMichael AJ. Food, nutrition, physical activity and cancer prevention. Authoritative report from World Cancer Research Fund provides global update. Public Health Nutr. 2008;11(7):762–3.

    Article  PubMed  CAS  Google Scholar 

  16. Colditz GA, Peterson LL. Obesity and cancer: evidence, impact, and future directions. Clin Chem 2017.

  17. Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, et al. Association of leisure-time physical activity with risk of 26 types of cancer in 1.44 million adults. JAMA Intern Med. 2016;176(6):816–25.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat. 2013;137(3):869–82.

    Article  PubMed  Google Scholar 

  19. Bernstein L, Patel AV, Ursin G, Sullivan-Halley J, Press MF, Deapen D, et al. Lifetime recreational exercise activity and breast cancer risk among black women and white women. J Natl Cancer Inst. 2005;97(22):1671–9.

    Article  PubMed  Google Scholar 

  20. McTiernan A, Kooperberg C, White E, Wilcox S, Coates R, Adams-Campbell LL, et al. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA. 2003;290(10):1331–6.

    Article  PubMed  CAS  Google Scholar 

  21. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753–65.

    Article  PubMed  Google Scholar 

  22. Li T, Wei S, Shi Y, Pang S, Qin Q, Yin J, et al. The dose-response effect of physical activity on cancer mortality: findings from 71 prospective cohort studies. Br J Sports Med. 2016;50(6):339–45.

    Article  PubMed  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).

    Article  Google Scholar 

  24. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol: Off J Eur Soc Med Oncol/ ESMO. 2014;25(7):1293–311.

    Article  CAS  Google Scholar 

  25. Park NJ, Chang Y, Bender C, Conley Y, Chlebowski RT, van Londen GJ, et al. Cardiovascular disease and mortality after breast cancer in postmenopausal women: results from the Women’s Health Initiative. PLoS One. 2017;12(9):e0184174.

    Article  PubMed  PubMed Central  CAS  Google 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.

    Article  PubMed  PubMed Central  CAS  Google 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.

    CAS  Google Scholar 

  28. Pearce A, Haas M, Viney R, Pearson S-A, Haywood P, Brown C, et al. Incidence and severity of self-reported chemotherapy side effects in routine care: a prospective cohort study. PLoS One. 2017;12(10):e0184360.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  29. Jacobsen PB, Hann DM, Azzarello LM, Horton J, Balducci L, Lyman GH. Fatigue in women receiving adjuvant chemotherapy for breast cancer: characteristics, course, and correlates. J Pain Symptom Manag. 1999;18(4):233–42.

    Article  CAS  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.

  31. Mustian KM, Alfano CM, Heckler C, Kleckner AS, Kleckner IR, Leach CR, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncol. 2017;3(7):961–8.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134(2):459–78.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  33. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126(2):529–37.

    Article  PubMed  CAS  Google Scholar 

  34. Vitali M, Ripamonti CI, Roila F, Proto C, Signorelli D, Imbimbo M, et al. Cognitive impairment and chemotherapy: a brief overview. Crit Rev Oncol Hematol. 2017;118:7–14.

    Article  PubMed  Google Scholar 

  35. Chang YK, Labban JD, Gapin JI, Etnier JL. The effects of acute exercise on cognitive performance: a meta-analysis. Brain Res. 2012;1453:87–101.

    Article  PubMed  CAS  Google Scholar 

  36. Erickson KI, Kramer AF. Aerobic exercise effects on cognitive and neural plasticity in older adults. Br J Sports Med. 2009;43(1):22–4.

    Article  PubMed  CAS  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;

  38. Stewart A, Bielajew C, Collins B, Parkinson M, Tomiak E. A meta-analysis of the neuropsychological effects of adjuvant chemotherapy treatment in women treated for breast cancer. Clin Neuropsychol. 2006;20(1):76–89.

    Article  PubMed  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.

    Article  PubMed  Google 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.

    Article  PubMed  PubMed Central  Google 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.

  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.

    Article  PubMed  Google Scholar 

  43. DiSipio T, Rye S, Newman B, Hayes S. Incidence of unilateral arm lymphoedema after breast cancer: a systematic review and meta-analysis. The Lancet Oncology. 2013;14(6):500–15.

    Article  PubMed  Google Scholar 

  44. Cormie P, Galvao DA, Spry N, Newton RU. Neither heavy nor light load resistance exercise acutely exacerbates lymphedema in breast cancer survivor. Integrative Cancer Therapies. 2013;12(5):423–32.

    Article  PubMed  Google Scholar 

  45. 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.

    Article  PubMed  CAS  Google Scholar 

  46. 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. JAMA. 2010;304(24):2699–705.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

  50. Patterson RE, Neuhouser ML, Hedderson MM, Schwartz SM, Standish LJ, Bowen DJ. Changes in diet, physical activity, and supplement use among adults diagnosed with cancer. J Am Diet Assoc. 2003;103(3):323–8.

    PubMed  Google Scholar 

  51. Demark-Wahnefried W, Peterson B, McBride C, Lipkus I, Clipp E. Current health behaviors and readiness to pursue life-style changes among men and women diagnosed with early stage prostate and breast carcinomas. Cancer. 2000;88(3):674–84.

    Article  PubMed  CAS  Google 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.

    Article  PubMed  Google Scholar 

  53. Schmitz KH, Troxel AB, Cheville A, Grant LL, Bryan CJ, Gross C, et al. Physical activity and lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. Contemp Clin Trials. 2009;30(3):233–45.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Beidas RS, Paciotti B, Barg F, Branas AR, Brown JC, Glanz K, et al. A hybrid effectiveness-implementation trial of an evidence-based exercise intervention for breast cancer survivors. J Natl Cancer Inst Monogr. 2014;2014(50):338–45.

    Article  PubMed  PubMed Central  Google Scholar 

  55. Wolin KY, Schwartz AL, Matthews CE, Courneya KS, Schmitz KH. Implementing the exercise guidelines for cancer survivors. J Support Oncol. 2012;10(5):171–7.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Washington University School of Medicine, 660 S Euclid Ave, Campus Box 8056, St Louis, MO, 63110, USA

    Lindsay L. Peterson

  2. Harvard Medical School, Boston, MA, USA

    Jennifer A. Ligibel

  3. Leonard P. Zakim Center for Integrative Therapies and Healthy Living, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA

    Jennifer A. Ligibel

Authors
  1. Lindsay L. Peterson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jennifer A. Ligibel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lindsay L. Peterson.

Ethics declarations

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.

Additional information

This article is part of the Topical Collection on Breast Cancer

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peterson, L.L., Ligibel, J.A. Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes. Curr Oncol Rep 20, 50 (2018). https://doi.org/10.1007/s11912-018-0702-1

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11912-018-0702-1

Keywords

Search

Navigation