Breast Cancer and the Role of Exercise in Women

  • Beverly S. Reigle
  • Karen Wonders
Part of the Methods in Molecular Biology book series (MIMB, volume 472)

Abstract

Cancer of the breast is a significant health problem for women from the time of diagnosis through the treatment and survivorship trajectory. The disease and treatments are an assault to a woman's body, resulting in sequelae that can be debilitating. Although women diagnosed with breast cancer are living longer, concerns about functional limitations, recurrence, and survival remain paramount. Physical activity and exercise are preventative and rehabilitative measures that can be employed at various points along the breast cancer trajectory. Current research supports the beneficial role that physical activity and exercise play in reducing the risk for developing breast cancer and preventing or attenuating disease and treatment-related impairments.

Key words:

Breast cancer exercise prevention recurrence 

References

  1. 1.
    American Cancer Society. (2008) Cancer facts and figures 2008. Atlanta, GA.Google Scholar
  2. 2.
    Ravdin, P.M., Cronin, KA., Howlader, N., Berg, C.D. (2007) The decrease in breast-cancer incidence in 2003 in the United States. N Engl J Med 356 , 1670 –1674.CrossRefPubMedGoogle Scholar
  3. 3.
    Nelson, H. D., Humphrey, L.L., Nygren, P., Teutsch, S.M., Allan, J.D. (2002) Post-menopausal hormone replacement therapy. JAMA 288 , 872 – 891.CrossRefPubMedGoogle Scholar
  4. 4.
    Ozols, R. F., Herbst, R.S., Colson, U.L., Gralow, J., Bonner, J., Curran, W.J. Jr., et al. (2007) Clinical cancer advances 2006: Major research advances in cancer treatment, prevention and screening — a report from the American Society of Clinical Oncology. J Clin Onc 25 , 146 – 162.CrossRefGoogle Scholar
  5. 5.
    Berry, D.A., Cronin, K.A., Plevritis, S.K., et al. (2005) Effect of screening and adjuvant therapy on mortality from breast cancer. N Engl J Med 353 , 1784 – 1792.CrossRefPubMedGoogle Scholar
  6. 6.
    National Cancer Institute. A snapshot of breast cancer. September, 2006. Retrieved July 23, 2007 from http://planning.cancer gov/disease/Breast-Snapshot.pdf.
  7. 7.
    Li, C.I., Malone, K.E., Daling, J.R. (2003) Differences in breast cancer stage, treatment, and survival by race and ethnicity. Arch Intern Med 163 , 49 – 56.CrossRefPubMedGoogle Scholar
  8. 8.
    National Cancer Institute. Fact sheet: Probability of breast cancer in American women. October 5, 2006 Retrieved July 23, 2007 from http://www.cancer.gov/images/Documents/bd21295f-31fa-419b-b249-54311ca969a1/fs5_6.pdf.
  9. 9.
    Kruk, J. (2007) Lifetime physical activity and the risk of breast cancer: A case-control study. Cancer Detect Prev 31 , 19 – 28.CrossRefGoogle Scholar
  10. 10.
    McTiernan, A., Kooperberg, C., White, E., Wilcox, S., Coates, R., Adams-Campbell, L.L., Woods, N., Ockene, J. (2003) Recreational physical activity and the risk of breast cancer in postmenopausal women: The Women's Health Initiative cohort study. JAMA 290 , 1331 – 1336.CrossRefPubMedGoogle Scholar
  11. 11.
    US Department of Health and Human Services. (1966) Physical activity and health: a report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion.Google Scholar
  12. 12.
    Nagi, S.Z. (1965). Some conceptual issues in disability and rehabilitation. In M. B. Sussman (Ed.), Sociology and Rehabilitation (pp. 100 – 13). Washington, DC: American Sociological Association.Google Scholar
  13. 13.
    Pope, A.M., Tarlov, A.R. (Eds.) (1991) Disability in America: Toward a national agenda for prevention. Washington, DC: National Academy Press.Google Scholar
  14. 14.
    Reigle, B.S. (2006) The prevention of disablement: A framework for the breast cancer trajectory. Rehab Nurs 31, 174–179.Google Scholar
  15. 15.
    Bosompra, K., Ashikaga, T., O'Brien, P.J., Nelson, L., Skelly, J. (2002) Swelling, numbness, pain, and their relationship to arm function among breast cancer survivors: A disablement process model perspective. Breast J 8, 338–348.CrossRefPubMedGoogle Scholar
  16. 16.
    Mock, V., Pickett, M., Ropka, M.E., Lin, E.M., Stewart, K.J., Rhodes, V.A., et al. (2001) Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Prac 9, 119–127.CrossRefGoogle Scholar
  17. 17.
    Bender, C.M., McDaniel, R.W., Murphy-Ende, K., Pickett, M., Rittenberg, C.N., Rogeres, M.P., et al. (2002) Chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs 6, 94–102.CrossRefPubMedGoogle Scholar
  18. 18.
    Pinto, B.M., Clark, M.M., Maruyama, N.C., Feder, S.I. (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12, 118–126.CrossRefPubMedGoogle Scholar
  19. 19.
    Silverman, D.H.S., Dy, C.J., Castellon, S.A., Lai, J., Pio, B., Abraham, L., et al. (2007) Altered frontocortical, cerebellar, and basal ganglia activity in adjuvant-treated breast cancer survivors 5 – 10 years after chemotherapy. Breast Cancer Res Treat 103, 303–311.CrossRefPubMedGoogle Scholar
  20. 20.
    Hutnick, N. A., Williams, N.I., Kraemer, W.J., Orsega-Smith, E., Dixon, R.H., Bleznak, A.D., Mastro, A.M. (2005) Exercise and lymphocyte activation following chemotherapy for breast cancer. Med Sci Sports Exerc 37, 1827–1835.CrossRefPubMedGoogle Scholar
  21. 21.
    Mizuno, T., Katsumata, N., Mukai, H., Shimizu, C., Ando, M., Watanabe, T. (2007) The outpatient management of low-risk febrile patients with neutropenia: risk assessment over the telephone. Support Care Cancer 15, 287–291.CrossRefPubMedGoogle Scholar
  22. 22.
    Brady, M.J., Cella, D.F., Mo, F., Bonomi, A.E., Tulsky, D.S., Lloyd, S.R., et al. (1997) Reliability and validity of the functional assessment of cancer therapy-breast quality-of-life instrument. J Clin Oncol 15, 974–986.PubMedGoogle Scholar
  23. 23.
    Kolden, G.G., Strauman, T.J., Ward, A., et al. (2002) A pilot study of group exercise training (GET) for women with primary breast cancer: Feasibility and health benefits. Psychooncology 11,447–456.CrossRefPubMedGoogle Scholar
  24. 24.
    Darga, L.L., Megnan, M., Mood, D., Hryniuk, W.M., DiLaura, N.M., Djuric, Z. (2007) Quality of life as a predictor of weight loss in obese, early-stage breast cancer survivors. Oncol Nurs Forum 34, 86–92.CrossRefPubMedGoogle Scholar
  25. 25.
    Freidenreich, C.M., Orenstein, M.R. (2002) Physical activity and cancer prevention: Etiologic evidence and biological mechanisms. J Nutr 132, 3456S–3464S.Google Scholar
  26. 26.
    Frisch, R.E., Wyshak, G., Albright, N.L., et al. (1985) Lower prevalence of breast cancer and cancers of reproductive system among former college athletes compared to nonathletes. Br J Cancer 52, 885–891.PubMedGoogle Scholar
  27. 27.
    Bernstein, L., Henderson, B.E., Hanisch, R., et al. (1994) Physical exercise and reduced risk of breast cancer in young women. J Natl Cancer Inst 86, 1403–1408.CrossRefPubMedGoogle Scholar
  28. 28.
    Matthews, C.E., Fowke, J.H., Dai, Q., et al. (2004) Physical activity, body size, and estrogen metabolism in women. Cancer Causes Control 15, 473–481.CrossRefPubMedGoogle Scholar
  29. 29.
    Friedenreich, C.M., Thune, I., Brinton, L.A., et al. (1998) Epidemiologic issues related to the association between physical activity and breast cancer. Cancer 83, 600–610.CrossRefPubMedGoogle Scholar
  30. 30.
    Gammon, M.E., John, E.M., Britton, J.A. (1998) Recreational and occupational physical activities and risk of breast cancer. J Natl Cancer Inst 90, 100–117.CrossRefPubMedGoogle Scholar
  31. 31.
    Friedenreich, C.M.. (2001) Physical activity and cancer prevention from observational to intervention research. Cancer Epidemiol Biomarkers Prev 10, 287–301.PubMedGoogle Scholar
  32. 32.
    Gammon, M.D., Schoenberg, J.B., Britton, J.A., et al. (1998) Recreational physical activity and breast cancer risk among women under 45 years. Am J Epidemiol 147, 273–280.PubMedGoogle Scholar
  33. 33.
    Moore, D.B., Folsom, A.R., Mink, P.J., et al. (2000) Physical activity and incidence of postmenopausal breast cancer. Epidemiol 2000 11, 292–296.CrossRefGoogle Scholar
  34. 34.
    Carpenter, C.L., Ross, R.K., Panganini-Hill, A., et al. (1999) Lifetime exercise activity and breast cancer risk among post-menopausal women. Br J Cancer 80, 1852–1858.CrossRefPubMedGoogle Scholar
  35. 35.
    Friedenreich, C.M., Bryant, H.E., Courneya, K.S. (2001) Case-control study of lifetime physical activity and breast cancer risk. Am J Epidemiol 154, 336–347.CrossRefPubMedGoogle Scholar
  36. 36.
    Young, D., Bernstein, L., Wu, A.H. (2003) Physical activity and breast cancer. Cancer 97, 2565–2575.CrossRefGoogle Scholar
  37. 37.
    Rockhill B., Willett, W.C., Hunter, D.J., et al. (1999) A prospective study of recreational physical activity and breast cancer risk. Arch Intern Med 159, 2290–2296.CrossRefPubMedGoogle Scholar
  38. 38.
    Broocks, A., Pirke, K.M., Schweiger, U., et al. (1990) Cyclic ovarian function in recreational athletes. J Appl Physiol 68, 2083–2086.PubMedGoogle Scholar
  39. 39.
    Russell, J.B., Mitchell, D., Musey, P.I., et al. (1984) The relationship of exercise to anovulatory cycles in female athletes: Hormonal and physical characteristics. Obstet Gynecol 63, 452–456.PubMedGoogle Scholar
  40. 40.
    McTiernan, A., Kooperberg, C., White, E., et al. (2003) Is exercise effective in reducing the risk of breast cancer in postmenopausal women? JAMA 290, 1331–1336.CrossRefPubMedGoogle Scholar
  41. 41.
    Gauley, J.A., Gutai, J.P., Kuller, L.H., et al. (1989) The epidemiology of serum sex hormones in postmenopausal women. Am J Epidemiol 129, 1120–1131.Google Scholar
  42. 42.
    Cadenas, E., Davies, K.J. (2000) Mitochondrial free radical generation, oxidative stress, and aging. Free Radic Biol Med 29, 222–230.CrossRefPubMedGoogle Scholar
  43. 43.
    Kanter, M.M., Hamlin, R.L., Unverferth, D.V., et al. (1985) Effect of exercise training on antioxidant enzymes and cardiotoxicity of doxorubicin. J Appl Physiol 59, 1298–1303.PubMedGoogle Scholar
  44. 44.
    Minotti, G., Cairo, G., Monti, E. (1999) Role of iron in anthracycline cardiotoxicity: new tunes for an old song? FASEB J 13, 199–212.PubMedGoogle Scholar
  45. 45.
    Yu, B.P. (1994) Cellular defenses against damage from reactive oxygen species. Physiol Rev 74, 139–162.PubMedGoogle Scholar
  46. 46.
    Nakao, C., Ookawara, T., Kizaki, T., et al. (2000) Effects of swimming training on three superoxide dismutase isoenzymes in mouse tissues. J Appl Physiol 88, 649–654.PubMedGoogle Scholar
  47. 47.
    Meister, A., Anderson, M. E. (1983) Glutathione. Annu Rev Biochem 52, 711–760.CrossRefPubMedGoogle Scholar
  48. 48.
    Abraham, R., Basser, R.L., Green, M.D. (1996) A risk-benefit assessment of anthra-cycline antibiotics in antineoplastic therapy. Drug Saf 15, 406–429.CrossRefPubMedGoogle Scholar
  49. 49.
    Wencker, D., Chandra, M., Nguyen, K., (2003) A mechanistic role for cardiac myocyte apoptosis in heart failure. J Clin Invest 111, 1497–1504.PubMedGoogle Scholar
  50. 50.
    Afford, S., Randhawa, S. (2000) Apoptosis. Am J Clinical Pathol 53, 55–63.CrossRefGoogle Scholar
  51. 51.
    Kalyanaranam, B., Joseph, J., Kalivendi, S., et al. (2002) Doxorubicin-induced apoptosis implications in cardiotoxicity. Mol Cell Biochem 234, 119–124.CrossRefGoogle Scholar
  52. 52.
    Primeau, A.J., Adhihetty, P.J., Hood, D.A. (2002) Apoptosis in heart and skeletal muscle. Can J Appl Physiol 27, 349–395.PubMedGoogle Scholar
  53. 53.
    Green, P.S., Leeuwenburg, C. (2002) Mitochondrial dysfunction is an early indicator of doxorubicin-induced apoptosis. Biochimica et Biophysica Acta 1588, 94–101.PubMedGoogle Scholar
  54. 54.
    Li, P., Nijhawan, D., Budihardjo, I., et al. (1997) Cytochrome c and dATP-dependent formation of Apaf-1/caspase-9 complex initiates an apoptotic protease cascade. Cell 91, 479–489.CrossRefPubMedGoogle Scholar
  55. 55.
    Nomura, K. Imai, H., Koumura, T., et al. (1999) Mitochondrial phospholipids hydroperoxide glutathione peroxidase suppresses apoptosis mediated by a mitochondrial death pathway. J Biol Chem 274, 29294–29302.CrossRefPubMedGoogle Scholar
  56. 56.
    Wang, X., Martindale, J.L., Liu, Y., et al. (1998) The cellular response to oxidative stress: influences of mitogen-activiated protein kinase signaling pathways on cell survival. Biochem J 333, 291–300.PubMedGoogle Scholar
  57. 57.
    Radak, Z,. Gaal, D., Taylor, A.W., et al. (2002) Attenuation of the development of murine solid leukemia tumor by physical exercise. Antioxid Redox Signal 4, 213–219.CrossRefPubMedGoogle Scholar
  58. 58.
    Ries, L.A.G., Eisner, M.P., Kosary, C. L., Hankey, B. F., Miller, B.A., Clegg, L., et al. (Eds.). (2004) SEER cancer statistics review, 1975–2001, Bethesda, MD, NCI http://seer.cancer.gov/csr/1975_2001/.Google Scholar
  59. 59.
    Courneya, K.S., Mackey, J.R., McKenzie, D.C. (2002) Exercise for breast cancer survivors. Physic Sportsmed 30, 1–12.Google Scholar
  60. 60.
    National Cancer Institute Breast cancer (PDQ): Treatment health professional version. Retrieved July 22, 2007 from http://www.cancer.gov/cancertoics/pdq/treatment/breast/healthprofessional/.
  61. 61.
    American Cancer Society. (2003) Breast cancer facts and figures 2003 – 2004. Atlanta, GA: American Cancer Society.Google Scholar
  62. 62.
    National Comprehensive Cancer Network and American Cancer Society. (2006) Breast cancer: Treatment guidelines for patients. Atlanta, GA: American Cancer Society.Google Scholar
  63. 63.
    Bender, C.M., McDaniel, R.W., Murphy-Ende, K., Pickett, M., Rittenberg, C.N., Rogeres, M.P., et al. (2002). Chemotherapy-induced nausea and vomiting. Clin J Oncol Nurs 6, 94–102.CrossRefPubMedGoogle Scholar
  64. 64.
    Batchelor, D. (2001) Hair and cancer chemotherapy: Consequences and nursing care — a literature study. Eur J Cancer Care 10, 147–163.CrossRefGoogle Scholar
  65. 65.
    Dimeo, F.C. (2001) Effects of exercise on cancer-related fatigue. Cancer 92, 1689–1693.CrossRefPubMedGoogle Scholar
  66. 66.
    Kattlove, H., Winn, R.J. (2003) Ongoing care of patients after primary treatment for cancer. Ca Cancer J Clin 54, 172–196.CrossRefGoogle Scholar
  67. 67.
    Aziz, N.M. (2002) Cancer survivorship research: Challenge and opportunity. J Nutr 132, 3494S–3503S.PubMedGoogle Scholar
  68. 68.
    Winick, L., Robbins, G.F. (1977) Physical and psychologic readjustment after mastectomy. Cancer 39, 478–486.CrossRefPubMedGoogle Scholar
  69. 69.
    Pinto, B.M., Clark, M.M., Maruyama, N.C., Feder, S.I. (2003) Psychological and fitness changes associated with exercise participation among women with breast cancer. Psychooncology 12, 118–126.CrossRefPubMedGoogle Scholar
  70. 70.
    Lash, T.L., Silliman, R.A. (2000) Patient characteristics and treatments associated with a decline in upper-body function following breast cancer therapy. J Clinl Epidemiol 53, 615–622.CrossRefGoogle Scholar
  71. 71.
    Satariano, W.A., Ragland, D.R., DeLorenze, G.N. (1996) Limitations in upper-body strength associated with breast cancer: A comparison of black and white women. J Clin Epidemiol 49, 535–544.CrossRefPubMedGoogle Scholar
  72. 72.
    Box, R.C., Reul-Hirche, H.M., Bullock-Saxton, J.E., Furnival, C.M. (2002) Shoulder movement after breast cancer surgery: Results of a randomized controlled study of postoperative physiotherapy. Breast Cancer Res Treat 75, 35–50.CrossRefPubMedGoogle Scholar
  73. 73.
    Brown, J.R. (2004) A clinically useful method for evaluating lymphedema. Clin J Oncol Nurs 8, 35–38.CrossRefPubMedGoogle Scholar
  74. 74.
    Pasket, E.D., Stark, N. (2000) Lymphedema: Knowledge, treatment, and impact among breast cancer survivors. Breast J 6, 373–378.CrossRefGoogle Scholar
  75. 75.
    Miller, L.T. (2002). Management of breast cancer-related edemas. In Macken, E.J., Callahan, A.D., Osterman, A.L., Skirven, T.M., Schneider, L.H., Hunter, J.M., eds. Rehablitiation of the Hand and Upper Extremity. St. Louis, MO: Mosby, 914–928.Google Scholar
  76. 76.
    Holmes, M.D., Kroenke, C.H. (2004) Beyond treatment: Lifestyle choices after breast cancer to enhance quality of life and survival. Women's Health Issues 14, 11–13.CrossRefPubMedGoogle Scholar
  77. 77.
    Fogelman, I., Blake, G.M., Blamey, R., Palmer, M., Sauerbrei, W., Schumacher, M., et al. (2003) Bone mineral density in premenopausal women treated for node-positive early breast cancer with 2 years of goserelin or 6 months of cyclophosphamide, methotrexate and 5-fluorouracil (CMF). Osteoporos Int 14, 1001–1006.CrossRefPubMedGoogle Scholar
  78. 78.
    Shimozuma, K., Ganz, P.A., Petersen, L., Hirji, K. (1999) Quality of life in the first year after breast cancer surgery: Rehabilitation needs and patterns of recovery. Breast Cancer Res Treat 56, 45057.CrossRefGoogle Scholar
  79. 79.
    Harris, S.R., Campbell, K.L., McNeely, M.L. (2005) Upper extremity rehabilitation for women who have been treated for breast cancer. Physiother Can 56, 202–214.CrossRefGoogle Scholar
  80. 80.
    Rietman, J.S., Kijkstra, P.U., Geertzen, J.H.B., Baas, P., de Vries, J., Dolsma, W., et al. (2003) Short-term morbidity of the upper limb after sentinel lymph node biopsy or axillary lymph node dissection for stage I or II breast carcinoma. Cancer 98, 690–696.CrossRefPubMedGoogle Scholar
  81. 81.
    Baron, R.H, Fey, J.V., Borgen, P.I., et al. (2004) Eighteen sensations after breast cancer surgery: A two-year comparison of sentinel lymph node biopsy and axillary lymph node dissection. Oncol Nurs Forum 31, 691–698.CrossRefPubMedGoogle Scholar
  82. 82.
    Luini, A., Galimberti, V., Gati, G., Arnone, P., et al. (2005) The sentinel node biopsy after previous breast surgery: Preliminary results on 543 patients treated at the European Institute of Oncology. Breast Cancer Res Treat 89, 159–163.CrossRefPubMedGoogle Scholar
  83. 83.
    Ververs, J.M.M.A., Roumen, R.M.H., Vingerhoets, A.J.J.M., Vreugdenhil, G., Coebergh, J.W.W., Crommelin, M.A., et al. (2001) Risk, severity and predictors of physical and psychological morbidity after axillary lymph node dissection for breast cancer. Eur J Cancer 37, 991–999.CrossRefPubMedGoogle Scholar
  84. 84.
    Harris, S.R., Niesen-Vertommen, S.L. (2000) Challenging the myth of exercise-induced lymphedema following breast cancer: A series of case reports. J Surg Oncol 74, 95–99.CrossRefPubMedGoogle Scholar
  85. 85.
    Lane, K., Jespersen, D., McKenzie, D.C. (2005) The effect of a whole body exercise programme and dragon boat training on arm volume and arm circumference in women treated for breast cancer. Eur J Cancer Care 14, 353–358.CrossRefGoogle Scholar
  86. 86.
    Holleb, A.I. (1990) Two decades of Reach to Recovery: A tribute to the volunteers. CA Cancer J Clin 40, 5–7.CrossRefPubMedGoogle Scholar
  87. 87.
    Shamley, D.R., Barker, K., Simonite, V., Beardshaw, A. (2005) Delayed versus immediate exercises following surgery for breast cancer: A systematic review. Breast Cancer Res Treat 90, 263–271.CrossRefPubMedGoogle Scholar
  88. 88.
    Na,Y.M., Lee, J.S., Park, J.S., Kang, S.W., Lee, H.D., Koo, J.Y. (1999) Early rehabilitation program in postmastectomy patients: A prospective clinical trial. Yonsei Med J 40, 1–8.PubMedGoogle Scholar
  89. 89.
    Wingate, L. (1985) Efficacy of physical therapy for patients who have undergone mastectomies: A prospective study. Phys Ther 65, 896–900.PubMedGoogle Scholar
  90. 90.
    Kirshbaum, M.N. (2006) A review of the benefits of whole body exercise during and after treatment for breast cancer. J Clin Nurs 16, 104–121.CrossRefGoogle Scholar
  91. 91.
    Headley, J.A, Ownby, K., John, L.D. (2004) The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncol Nurs Forum 31, 977–983.CrossRefPubMedGoogle Scholar
  92. 92.
    Lee, T.S., Kilbreath, S.L., Refshauge, K.M., Pendlebur y, S.C., Beith, J.M., Lee, M .J. (2007) Pectoral stretching program for women undergoing radiotherapy for breast cancer. Breast Cancer Res Treat 102, 313–321.CrossRefPubMedGoogle Scholar
  93. 93.
    Matthew, C.E., Wilcox, S., Hanby, C.L., Ananian, C.D., Heiney, S.P., Gebretsadik, T., et al. (2007) Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Support Care Cancer 15, 203–211.CrossRefGoogle Scholar
  94. 94.
    Ohira, T., Schmitz, K.H, Ahmed, R.L., Ye, D. (2006) Effects of weight training on quality of life in recent breast cancer survivors. Cancer 106, 2076–2083.CrossRefPubMedGoogle Scholar
  95. 95.
    Holmes, M.D., Chen, W.Y., Feskanich, D., Kroenke, C.H., Colditz, G.A. (2005) Physical activity and survival after breast cancer diagnosis. JAMA 293, 2479–2486.CrossRefPubMedGoogle Scholar
  96. 96.
    Denmark-Wahnefried, W., Pinto, B.M., Gritz, E.R. (2006) Promoting health and physical function among cancer survivors: Potential for prevention and questions that remain. J Clin Oncol 24, 5125–5131.CrossRefGoogle Scholar
  97. 97.
    Kushi, L.H., Kwan, M.I., Lee, M.M., Ambrosone, C.B. (2007) Lifestyle factors and survival in women with breast cancer. J Nutr 137, 236S–242S.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Beverly S. Reigle
    • 1
  • Karen Wonders
    • 2
  1. 1.College of NursingUniversity of CincinnatiCincinnatiUSA
  2. 2.Department of Health, Physical Education and RecreationWright State UniversityDaytonUSA

Personalised recommendations