How Exercise Can Decrease Breast Cancer Recurrence

When someone receives a breast cancer diagnosis, it can vastly alter their life. Many factors — such as age at the time of diagnosis, type of breast cancer and how far the cancer has progressed — determine impact on each person.

Initially, patients and their care teams focus on solidifying the correct diagnosis and beginning treatment. Research — both past and continued — has dialed in much of this process; studies and trials have led to the development of clear treatment plans that health care providers rely on. Providers and patients alike refer to this period as "active treatment."

When it comes to breast cancer survivorship, though, the guidance patients receive from the oncology world is often murkier and less direct.

To begin with, survivorship can look vastly different from patient to patient. As the National Cancer Institute explains, cancer survivorship is a state of being. 

It encompasses many different parts of a person's life — physical health, emotional state, mental well-being, social challenges and more — and is the time from a person's diagnosis through the end of their life, whether cancer-free or not.

Despite breast cancer survivorship looking vastly different for each patient, health care providers give out one piece of guidance almost universally: exercise more. 

Few can argue with the reasoning behind this advice. Exercise is known to have a wide range of health benefits, with reduction of cancer recurrence and mortality being most relevant in this case.

The issue worth exploring is that health care professionals are not consistently elaborating on the specifics, which are essential for patients to know and act on.

Erin Bustos, who became a Stage IIb breast cancer survivor at the age of 30, has experienced this firsthand.

"I have not, at any point during my treatment or post-treatment, been given exercise guidance from my team other than a generalized statement of 'You should exercise,'" she states.

Additionally, patients are not consistently connected with specialists who can help them with the exercise aspect of survivorship — and many don't even know these resources exist.

Adeline Farrington, a certified cancer exercise trainer at UPMC Hillman Cancer Center, is familiar with this situation. "As a certified cancer exercise trainer, we have to heavily advertise our programs around our cancer center and spread the word about our programs by word of mouth," she explains.

So, ideally, what should breast cancer patients know about exercise in survivorship? What type and amount of exercise actually helps to reduce the risk of a recurrence?

For answers, we turn to recent research. A study published by The Journal of the National Cancer Institute in 2020 examined the benefits of physical activity for patients with high-risk breast cancer, defined as cancer that was likely to recur or spread. 

The study looked at physical activity levels before, during and after patients had chemotherapy, using the 2018 Physical Activity Guidelines for Americans as a reference. These guidelines suggest engaging in 150 to 300 minutes of moderate-intensity physical activity or 75 to 150 minutes of vigorous aerobic activity per week.

If we break this down, the first option equates to 2.5 to 5 hours weekly of moderate physical activity, such as:

• fast walking
• leisurely bike riding
• mowing the lawn
• water aerobics

The second option equals 1.25 to 2.5 hours weekly of vigorous aerobic activity, such as:

• running
• fast biking
• playing tennis
• swimming laps

The research showed that for patients who didn't meet the above-specified exercise guidelines before diagnosis but met them at the two-year follow-up mark (in other words, these patients started to exercise more after treatment), their chance of recurrence was reduced by 46%, and their chance of death was reduced by 43%.

After learning just how much exercise can reduce recurrence risk, Bustos says, "This was shocking, as I had not been told that exercise has the potential to reduce my recurrence risk more than some of the hormone-blocking medications I was prescribed." 

Hearing the advice to exercise more is one thing. Arming patients with knowledge about the specific types and amounts of exercise that are most beneficial is another — and can be much more motivating.

If providers convey the significant benefits of these exercise guidelines, they empower patients to incorporate them more willingly into their survivorship plan. 

While the exercise guidelines outlined above may seem overwhelming or unattainable for some, it's equally important to note that the study also showed great benefits for those who engaged in regular, low-level exercise.

"I wish I could communicate to every cancer patient and survivor that some movement is better than no movement, " Farrington says. "Adding small bouts of exercise or physical activity into your daily routine is the first step to creating positive exercise habits." 

Melanie Potiaumpai, Co-Director of the UPMC Moving Through Cancer Program, believes exercise is critical to a survivorship plan. She states that, ideally, "a trained exercise and cancer specialist [would] be integrated into the clinical team. This [would] allow them to evaluate the patient's current health… and recommend safe and accessible exercise without putting an additional burden on the patient to independently find an exercise resource".

If a cancer exercise specialist hasn't been recommended to you, don't hesitate to be your own advocate and inquire about one. If there aren't specialists in your area, there are many online who can help you create a personalized exercise plan virtually.

"Think about exercise as your prescription for a healthy life — not just for cancer prevention, but for longevity," Bustos says.

Kat Zimmerman, BSN, RN, is a registered nurse, trained copywriter and breast cancer survivor turned freelance nurse writer. She aims to blend the best of three worlds when writing content: the knowledge and credibility of an RN, the skills of a trained writer, and the firsthand perspective of being a patient. She has two years of experience as a breast care nurse navigator, and she specializes in writing on topics such as breast care, breast cancer and oncology. Read More