Physical Activity / Exercise for Women Diagnosed With Breast Cancer

By Lee W. Jones, PhD

Over the last 50 years or so numerous scientific reports have examined the relationship between exercise/physical activity and cardiovascular health. These reports have consistently demonstrated that more fit or active individuals develop less heart disease than individuals who are less active. In light of these findings, numerous reports have also examined the relationship between exercise levels and breast cancer risk. Studies have shown that active women have an approximate 30% reduction in breast cancer risk compared with women who are inactive. Following a breast cancer diagnosis, several on-going studies are assessing if active breast cancer survivors have reduced risk of breast cancer recurrence and prolonged survival. Unfortunately, the results of these trials will not be available for a few years. However, several studies have examined if exercise can help breast cancer survivors cope with the side effects of breast cancer and its treatments. The purpose of this ‘Hot Topic” is to talk about the potential role of physical exercise following a breast cancer diagnosis.

Exercise During Breast Cancer Treatment

So far, only a small number of studies have examined the potential role of physical exercise during breast cancer treatment (for example, during chemotherapy and/or radiation therapy). In most of these studies, breast cancer survivors were asked to perform aerobic based exercise such as bicycling or walking programs three times a week for 20-30 minutes each time over the course of their treatment. Overall, the results of these studies have provided some initial evidence that exercise may be beneficial during cancer treatment. On the whole, the studies completed so far have been very small and not very scientifically rigorous, therefore it cannot be concluded that exercise is beneficial for breast cancer patients during treatment.

Exercise Studies During Treatment at the Cross Cancer Institute

In light of these findings, the Behavioral Medicine Laboratory in the Faculty of Physical Education at the University of Alberta (under the direction of Dr. Kerry Courneya) and the Northern Alberta Breast Cancer Program have two more forthcoming studies that will provide better evidence of the role of exercise during breast cancer treatment. The first study is called the START trial (Supervised Trial of Aerobic versus Resistance Training). The START trial will examine if aerobic training (e.g., biking) or resistance training (e.g., weights) can improve quality of life in breast cancer survivors receiving chemotherapy. This will be the first study to compare different types of exercise on quality of life in breast cancer survivors. The second is called the EXTRA trial (Exercise TRaining and Aranesp). The EXTRA trial will examine the effects of exercise plus administration of medication developed to treat anemia (e.g., low blood count) and quality of life in several different cancer types including breast cancer. This will be the first trial to examine the combined effects of exercise and drug administration on quality of life in cancer survivors. If you would like to learn more about these trials or want to see if you are eligible for any of the forthcoming studies, please ask your doctor at the next clinic visit, or check the Research page of our program.

Exercise After Breast Cancer Treatment

Again, only a small number of studies have examined the role of exercise following the completion of treatment in breast cancer survivors. As with studies during breast cancer treatment, most of these studies asked patients to walk or cycle 3 to 5 days a week for 20-30 minutes each time for approximately 3 months. Overall, the results of these studies found that active breast cancer survivors reported less treatment and cancer related side-effects (for example, less fatigue, better sleep, less nausea, better appetite, higher overall quality of life) than survivors who were inactive during or following cancer treatment. These studies were generally more scientifically rigorous than the studies during cancer treatment and provide better evidence of the beneficial role of exercise for breast cancer survivors.

Exercise Studies Following Breast Cancer Treatment at the Cross Cancer Institute

We have recently completed a study examining the effect of exercise training on fitness and quality of life in breast cancer survivors who had completed treatment. In the REHAB trial (Rehabilitative Exercise for Health After Breast cancer) 52 women exercised three times a week for 15 weeks on exercise bikes. Women in this study attended on average 44 of 45 exercise sessions! The results of this trial found that women who exercised reported higher fitness and quality of life than women who did not exercise. This trial also examined some biologic factors associated with cancer such as immune and estrogen functioning following an exercise program. These results will be coming soon.

General Exercise Guidelines After Cancer Treatment

Unfortunately, based on insufficient evidence, exercise guidelines for breast cancer survivors during treatment currently cannot be provided. Individual responses vary from patient to patient therefore if you are currently on cancer treatment (e.g., chemotherapy or radiation) and would like to know more about exercise please consult with your oncologist at the next clinic visit.
Again, based on the small number of studies following breast cancer treatment, it is currently not known “how much” or “what type” of exercise may be most beneficial after breast cancer treatment. However, these studies allow us to provide some preliminary guidelines that you may find useful. Again, even if you have finished your cancer treatment it is important to consult with your oncologist or family doctor before starting any exercise program.

What Type of Exercise?

Exercises such as walking or cycling are very appropriate. These exercises have been shown to be safe and beneficial for breast cancer survivors. It is also very important to choose exercises that you enjoy this will help you stick with the program!
How Often Should I Exercise?

Initially try to exercise at least 3 times a week. After a few weeks try to increase this level to 4 and then 5 times a week depending on how you feel.
How Hard Should I Exercise?

You should try to exercise at a moderate intensity. A good way to judge this is that during exercise your heart should be beating faster than at rest, you should be mildly hot and maybe sweating a little. I find the “talk test” to be a very useful tool. If you can’t talk during exercise, then you are probably working too hard and need to slow down.
How Long Should I Exercise For?

Again, initially I would recommend trying to exercise non-stop for 15 minutes. Once you are comfortable at exercising for this long, try to “build-up” to 20-30 minutes each time you exercise. It may be useful to combine short bouts of exercise (5 minutes in the morning, 10 minutes at night) throughout the day to achieve this goal!
Where & When Should I Exercise?

It is important that you exercise at a time and place that will help you stick with your program. Some people have more energy at night while others (like me) prefer to exercise in the morning. Exercise is great because you don’t need fancy equipment or an expensive gym pass to do it! During the cold months, exercises can be performed at home or in combination with other indoor activities such as shopping (most shopping malls have excellent walking programs). In the summer months, exercising outside is very enjoyable, Edmonton has some excellent walking and biking trials that you should test out!
Things to Remember!

It is important that you talk to your physician/oncologist before you begin any exercise program. Responses to cancer treatments vary from person to person, so try to be flexible and modify your program based on how you feel.

If you would like more information about this topic please talk to your doctor at the next clinic visit to find out what exercise research projects might be available for you. Good Luck!

Sources

Myers, J., Froelicher, V., Do, D., Partington, S., & Atwood, J.E. (2002). Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine, 346, 793-801.
Friedenreich, C.M., Bryant, H.E., & Courneya, K.S. (2001). Case-control study of lifetime physical activity and breast cancer risk. American Journal of Epidemiology, 154, 336-347.
Friedenreich, C.M., Courneya, K.S., & Bryant, H.E. (2001). Relation between intenisty of physical activity and breast cancer risk reduction. Medicine and Science in Sports and Exercise, 33,1538-1545.
Courneya, K.S., Mackey, J.R., & McKenzie, D.C. (2002). Exercise for breast cancer survivors: Research evidence and clinical guidelines. The Physician and Sportsmedicine, 30(8), 33-42.
Courneya, K.S., Mackey, J.R., & Jones, L.W. (2000). Coping with cancer: Can exercise help? The Physician and Sportsmedicine,28 (5), 49-73.
Courneya, K.S., Mackey, J.R., Bell, G.J., Jones, L.W., Field, C.J.,& Fairey, A.S. (in press). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology.


			Physical Activity / Exercise for Women Diagnosed With Breast Cancer By Lee W. Jones, PhD Over the last 50 years or so numerous scientific reports have examined the relationship between exercise/physical activity and cardiovascular health. These reports have consistently demonstrated that more fit or active individuals develop less heart disease than individuals who are less active. In light of these findings, numerous reports have also examined the relationship between exercise levels and breast cancer risk. Studies have shown that active women have an approximate 30% reduction in breast cancer risk compared with women who are inactive. Following a breast cancer diagnosis, several on-going studies are assessing if active breast cancer survivors have reduced risk of breast cancer recurrence and prolonged survival. Unfortunately, the results of these trials will not be available for a few years. However, several studies have examined if exercise can help breast cancer survivors cope with the side effects of breast cancer and its treatments. The purpose of this ‘Hot Topic” is to talk about the potential role of physical exercise following a breast cancer diagnosis. Exercise During Breast Cancer Treatment So far, only a small number of studies have examined the potential role of physical exercise during breast cancer treatment (for example, during chemotherapy and/or radiation therapy). In most of these studies, breast cancer survivors were asked to perform aerobic based exercise such as bicycling or walking programs three times a week for 20-30 minutes each time over the course of their treatment. Overall, the results of these studies have provided some initial evidence that exercise may be beneficial during cancer treatment. On the whole, the studies completed so far have been very small and not very scientifically rigorous, therefore it cannot be concluded that exercise is beneficial for breast cancer patients during treatment. Exercise Studies During Treatment at the Cross Cancer Institute In light of these findings, the Behavioral Medicine Laboratory in the Faculty of Physical Education at the University of Alberta (under the direction of Dr. Kerry Courneya) and the Northern Alberta Breast Cancer Program have two more forthcoming studies that will provide better evidence of the role of exercise during breast cancer treatment. The first study is called the START trial (Supervised Trial of Aerobic versus Resistance Training). The START trial will examine if aerobic training (e.g., biking) or resistance training (e.g., weights) can improve quality of life in breast cancer survivors receiving chemotherapy. This will be the first study to compare different types of exercise on quality of life in breast cancer survivors. The second is called the EXTRA trial (Exercise TRaining and Aranesp). The EXTRA trial will examine the effects of exercise plus administration of medication developed to treat anemia (e.g., low blood count) and quality of life in several different cancer types including breast cancer. This will be the first trial to examine the combined effects of exercise and drug administration on quality of life in cancer survivors. If you would like to learn more about these trials or want to see if you are eligible for any of the forthcoming studies, please ask your doctor at the next clinic visit, or check the Research page of our program. Exercise After Breast Cancer Treatment Again, only a small number of studies have examined the role of exercise following the completion of treatment in breast cancer survivors. As with studies during breast cancer treatment, most of these studies asked patients to walk or cycle 3 to 5 days a week for 20-30 minutes each time for approximately 3 months. Overall, the results of these studies found that active breast cancer survivors reported less treatment and cancer related side-effects (for example, less fatigue, better sleep, less nausea, better appetite, higher overall quality of life) than survivors who were inactive during or following cancer treatment. These studies were generally more scientifically rigorous than the studies during cancer treatment and provide better evidence of the beneficial role of exercise for breast cancer survivors. Exercise Studies Following Breast Cancer Treatment at the Cross Cancer Institute We have recently completed a study examining the effect of exercise training on fitness and quality of life in breast cancer survivors who had completed treatment. In the REHAB trial (Rehabilitative Exercise for Health After Breast cancer) 52 women exercised three times a week for 15 weeks on exercise bikes. Women in this study attended on average 44 of 45 exercise sessions! The results of this trial found that women who exercised reported higher fitness and quality of life than women who did not exercise. This trial also examined some biologic factors associated with cancer such as immune and estrogen functioning following an exercise program. These results will be coming soon. General Exercise Guidelines After Cancer Treatment Unfortunately, based on insufficient evidence, exercise guidelines for breast cancer survivors during treatment currently cannot be provided. Individual responses vary from patient to patient therefore if you are currently on cancer treatment (e.g., chemotherapy or radiation) and would like to know more about exercise please consult with your oncologist at the next clinic visit. Again, based on the small number of studies following breast cancer treatment, it is currently not known “how much” or “what type” of exercise may be most beneficial after breast cancer treatment. However, these studies allow us to provide some preliminary guidelines that you may find useful. Again, even if you have finished your cancer treatment it is important to consult with your oncologist or family doctor before starting any exercise program. What Type of Exercise? Exercises such as walking or cycling are very appropriate. These exercises have been shown to be safe and beneficial for breast cancer survivors. It is also very important to choose exercises that you enjoy this will help you stick with the program! How Often Should I Exercise? Initially try to exercise at least 3 times a week. After a few weeks try to increase this level to 4 and then 5 times a week depending on how you feel. How Hard Should I Exercise? You should try to exercise at a moderate intensity. A good way to judge this is that during exercise your heart should be beating faster than at rest, you should be mildly hot and maybe sweating a little. I find the “talk test” to be a very useful tool. If you can’t talk during exercise, then you are probably working too hard and need to slow down. How Long Should I Exercise For? Again, initially I would recommend trying to exercise non-stop for 15 minutes. Once you are comfortable at exercising for this long, try to “build-up” to 20-30 minutes each time you exercise. It may be useful to combine short bouts of exercise (5 minutes in the morning, 10 minutes at night) throughout the day to achieve this goal! Where & When Should I Exercise? It is important that you exercise at a time and place that will help you stick with your program. Some people have more energy at night while others (like me) prefer to exercise in the morning. Exercise is great because you don’t need fancy equipment or an expensive gym pass to do it! During the cold months, exercises can be performed at home or in combination with other indoor activities such as shopping (most shopping malls have excellent walking programs). In the summer months, exercising outside is very enjoyable, Edmonton has some excellent walking and biking trials that you should test out! Things to Remember! It is important that you talk to your physician/oncologist before you begin any exercise program. Responses to cancer treatments vary from person to person, so try to be flexible and modify your program based on how you feel. If you would like more information about this topic please talk to your doctor at the next clinic visit to find out what exercise research projects might be available for you. Good Luck! Sources Myers, J., Froelicher, V., Do, D., Partington, S., & Atwood, J.E. (2002). Exercise capacity and mortality among men referred for exercise testing. New England Journal of Medicine, 346, 793-801. Friedenreich, C.M., Bryant, H.E., & Courneya, K.S. (2001). Case-control study of lifetime physical activity and breast cancer risk. American Journal of Epidemiology, 154, 336-347. Friedenreich, C.M., Courneya, K.S., & Bryant, H.E. (2001). Relation between intenisty of physical activity and breast cancer risk reduction. Medicine and Science in Sports and Exercise, 33,1538-1545. Courneya, K.S., Mackey, J.R., & McKenzie, D.C. (2002). Exercise for breast cancer survivors: Research evidence and clinical guidelines. The Physician and Sportsmedicine, 30(8), 33-42. Courneya, K.S., Mackey, J.R., & Jones, L.W. (2000). Coping with cancer: Can exercise help? The Physician and Sportsmedicine,28 (5), 49-73. Courneya, K.S., Mackey, J.R., Bell, G.J., Jones, L.W., Field, C.J.,& Fairey, A.S. (in press). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology.

			Copyright © 2000-2012 Alberta Breast Cancer Program Last updated: Feb 11/2003