Exercise and breast cancer: what research shows

The 2019 international guidelines

In 2019, an international roundtable reviewed the research on exercise and cancer and published guidelines.¹ It found strong evidence that exercise improves:

Outcome	Example prescription that helped
Fatigue	30 minutes of moderate aerobic exercise, 3 times a week
Anxiety and depression	30 to 60 minutes of moderate aerobic exercise, 3 times a week, for 12 weeks
Physical function	Aerobic, strength, or combined exercise, 3 times a week for 8 to 12 weeks
Quality of life	Combined aerobic and strength exercise, 2 to 3 times a week for at least 12 weeks

It also concluded that exercise doesn’t make lymphoedema worse, and that general guidance should be at least 3 sessions of moderate aerobic exercise a week, and strength exercise at least twice a week.¹

Key trials and reviews

• Fatigue: a Cochrane review found that exercise reduces cancer-related fatigue,⁴ and a large analysis found exercise and psychological treatments worked better than medicines.²
• During chemotherapy: a Canadian trial in women having chemotherapy for breast cancer found that aerobic or strength exercise improved fitness, self-esteem and body composition, and the strength group was more likely to complete their chemotherapy.⁵
• During radiotherapy: a German trial found that strength training twice a week reduced fatigue compared with relaxation.⁶
• After surgery: the UK PROSPER trial found that a structured exercise programme after armpit surgery improved arm function and reduced pain at a year.⁷
• Hormone therapy joint pain: a US trial found that exercise reduced joint pain in women taking aromatase inhibitors.⁸
• Lymphoedema: slowly progressed weight lifting didn’t make lymphoedema worse, or increase the risk of developing it.^{9, 10}
• Yoga: a Cochrane review found yoga improved quality of life, fatigue and sleep compared with no yoga.¹¹

Exercise and survival

The World Cancer Research Fund found limited evidence that being more active after a breast cancer diagnosis is linked to lower risk of death. The most active women had a substantially lower risk than the least active, but these studies can’t prove that exercise caused the difference.³

What this means for you

• Being active is safe for most people during and after treatment, and helps you feel better.¹
• Start where you are and build up gradually.
• Get advice first if you have particular risks, such as cancer in the bones, heart problems, or lymphoedema.^{1, 12}

See how much exercise is recommended and getting your strength back.

Related pages

• Prehabilitation research
• The evidence behind our guidance

Everyone’s treatment is different, so talk to your cancer team about what is right for you.

References

1. Campbell KL, Winters-Stone KM, Wiskemann J, et al. Exercise guidelines for cancer survivors: consensus statement from international multidisciplinary roundtable. Medicine & Science in Sports & Exercise. 2019;51(11):2375–2390. doi.org/10.1249/MSS.0000000000002116
2. Mustian KM, Alfano CM, Heckler C, et al. Comparison of pharmaceutical, psychological, and exercise treatments for cancer-related fatigue: a meta-analysis. JAMA Oncology. 2017;3(7):961–968. doi.org/10.1001/jamaoncol.2016.6914
3. World Cancer Research Fund. Breast cancer survivors: Global Cancer Update Programme (CUP Global) findings on body weight, physical activity and diet after diagnosis. www.wcrf.org/research-policy/evidence-for-our-recommendations/after-a-cancer-diagnosis-follow-recommendations/breast-cancer-survivors-research/
4. Cramp F, Byron-Daniel J. Exercise for the management of cancer-related fatigue in adults. Cochrane Database of Systematic Reviews. 2012;(11):CD006145. doi.org/10.1002/14651858.CD006145.pub3
5. Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Journal of Clinical Oncology. 2007;25(28):4396–4404. doi.org/10.1200/JCO.2006.08.2024
6. Steindorf K, Schmidt ME, Klassen O, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Annals of Oncology. 2014;25(11):2237–2243. doi.org/10.1093/annonc/mdu374
7. Bruce J, Mazuquin B, Canaway A, et al. Exercise versus usual care after non-reconstructive breast cancer surgery (UK PROSPER): multicentre randomised controlled trial and economic evaluation. BMJ. 2021;375:e066542. doi.org/10.1136/bmj-2021-066542
8. Irwin ML, Cartmel B, Gross CP, et al. Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. Journal of Clinical Oncology. 2015. doi.org/10.1200/JCO.2014.57.1547
9. Schmitz KH, Ahmed RL, Troxel A, et al. Weight lifting in women with breast-cancer-related lymphedema. New England Journal of Medicine. 2009;361(7):664–673. doi.org/10.1056/NEJMoa0810118
10. Schmitz KH, Ahmed RL, Troxel AB, et al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA. 2010;304(24):2699–2705. doi.org/10.1001/jama.2010.1837
11. Cramer H, Lauche R, Klose P, Lange S, Langhorst J, Dobos GJ. Yoga for improving health-related quality of life, mental health and cancer-related symptoms in women diagnosed with breast cancer. Cochrane Database of Systematic Reviews. 2017;(1):CD010802. doi.org/10.1002/14651858.CD010802.pub2
12. Campbell KL, Cormie P, Weller S, et al. Exercise recommendation for people with bone metastases: expert consensus for health care providers and exercise professionals. JCO Oncology Practice. 2022;18(5). napier-repository.worktribe.com/output/2839264/exercise-recommendation-for-people-with-bone-metastases-expert-consensus-for-health-care-providers-and-exercise-professionals