Adherence to an exercise program and its impact on physical fitness, bone density and quality of life in women after breast cancer treatment
Authors:
M. Šimonová
Authors‘ workplace:
Fakulta sportovních studií, Masarykova Univerzita, Brno
Published in:
Klin Onkol 2025; 38(2): 110-118
Category:
Original Articles
doi:
https://doi.org/10.48095/ccko2025110
Overview
Background: Breast cancer is the most frequently occurring malignant disease in the female population in the Czech Republic. As a result of the increasing incidence and stagnant to decreasing mortality, the number of women who have overcome this disease and have to deal with the unwanted side effects of oncological treatment is increasing. One of the possible non-drug interventions to influence these negative effects is physical activity. Materials and methods: The main aim of the presented study was to assess the effect of a twelve-week interventional exercise program on selected parameters, specifically on physical fitness, bone tissue density and quality of life, in patients after completion of curative treatment for breast cancer. A partial goal was to evaluate the degree of adherence to the proposed exercise program. Thirty-three women were included in the research, and they were divided into three groups in a non-randomized way – the SAPA group undergoing controlled supervised exercise, the HAPA group completing a controlled home exercise program and a control group without a controlled exercise program. Results: Twenty-eight women completed the initial measurement (55.18 ± 11.46 years, 165.32 ± 6.22 cm, 75.21 ± 15.93 kg, BMI 27.61 ± 5,78). VO2peak increased by 1.66% in the SAPA group, by 1.29% in the HAPA group, and decreased by 15.10% in the control group (P = 0.043; d = 0.908; CLES = 73.97%). On average, bone density decreased most in the control group (−1.1%; P = 0.028; d = 0.956, CLES = 75.05%). The quality of life questionnaires did not record a statistically or objectively significant result. Average adherence in the SAPA group was 74.59%, and in the HAPA group, 74.79%. Conclusion: Our results indicate a positive benefit of an exercise program on physical fitness and bone density, whether for supervised or home exercise. On the contrary, we cannot unequivocally confirm the benefit of our exercise program on the quality of life of breast cancer survivors. The adherence to the program was average for both groups.
Keywords:
adherence – cardiorespiratory fitness – bone quality – well-being – non-randomized controlled trial – breast cancer survivors
Sources
1. Dušek L, Mužík J, Kubásek M et al. Epidemiologie zhoubných nádorů v České republice. [online]. Dostupné z: https: //portal.med.muni.cz/clanek-583-epidemiologie-zhoubnych-nadoru-v-ceske-republice.html.
2. Dušek L, Mužík J, Malúšková D et al. Cancer incidence and mortality in the Czech Republic. Klin Onkol 2014; 27 (6): 406–423. doi: 10.14735/amko2014406.
3. Ferlay J, Colombet M, Soerjomataram I et al. Cancer statistics for the year 2020: an overview. Int J Cancer 2021; 149 (4): 778–789. doi: 10.1002/ijc.33588.
4. Krejčí D, Pehalová L, Talábová A et al. Novotvary 2018 – Současné epidemiologické trendy novotvarů v České republice. [online]. Dostupné z: https: //www.uzis.cz/res/f/008352/novotvary2018.pdf.
5. Sung H, Ferlay J, Siegel RL et al. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2021; 71 (3): 209–249. doi: 10.3322/caac.21660.
6. Denmark-Wahnefried W, Peterson BL, Winer EP et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol 2001; 19 (9): 2381–2389. doi: 10.1200/JCO.2001.19.9.2381.
7. Essue BM, Iragorri N, Fitzgerald N et al. The psychosocial cost burden of cancer: a systematic literature review. Psychooncology 2020; 29 (11): 1746–1760. doi: 10.1002/pon.5516.
8. Fitch MI, Nicoll I, Lockwood G. Exploring the impact of physical, emotional, and practical changes following treatment on the daily lives of cancer survivors. J Psychosoc Oncol 2021; 39 (2): 219–234. doi: 10.1080/07347332.2020.1848967.
9. Kapounková K, Hrnčiříková I, Svobodová Z et al. Pohybová aktivita jako účinný prostředek nefarmakologické péče v onkologii. [online]. Dostupné z: https: //munispace.muni.cz/library/catalog/book/1954.
10. Crhová M, Hrnčiříková I, Střeštíková R et al. Effect of a 3-month exercise intervention on physical performance, body composition, depression and autonomic nervous system in breast cancer survivors: a pilot study. [online]. Dostupné z: https: //conference.fsps.muni.cz/media/3250415/proceedings-12th-conference.pdf.
11. Crhová M, Bazalová P, Kapounková K et al. Cvičení pro pacientky po prodělané operaci prsu. [online]. Dostupné z: https: //static.mou.cz/d/mou.cz/files/5344.pdf/s-f5c9219b8d5b?_ts=1649063646.
12. Gebruers N, Camberlin M, Theunissen F et al. The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review. Support Care Cancer 2019; 27 (1): 109–122. doi: 10.1007/s00520-018-4490-9.
13. Hong BS, Lee KP. A systematic review of the biological mechanisms linking physical activity and breast cancer. Phys Act Nutr 2020; 24 (3): 25–31. doi: 10.20463/pan.2020.0018.
14. McTiernan A, Friedenreich CM, Katzmarzyk PT et al. Physical activity in cancer prevention and survival: a systematic review. Med Sci Sports Exerc 2019; 51 (6): 1252–1261. doi: 10.1249/MSS.0000000000001937.
15. Moore SC, Lee IM, Weiderpass E 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): 816–825. doi: 10.1001/jamainternmed.2016.1548.
16. Singh B, Spence RR, Steele ML et al. A systematic review and meta-analysis of the safety, feasibility, and effect of exercise in women with stage II+ breast cancer. Arch Phys Med Rehabil 2018; 99 (12): 2621–2636. doi: 10.1016/j.apmr.2018.03.026.
17. Spei ME, Samoli E, Bravi F et al. Physical activity in breast cancer survivors: a systematic review and meta-analysis on overall and breast cancer survival. Breast 2019; 44: 144–152. doi: 10.1016/j.breast.2019.02.001.
18. Agostini D, Natalucci V, Baldelli G et al. New insights into the role of exercise in inhibiting mTOR signaling in triple-negative breast cancer. Oxid Med Cell Longev 2018; 2018: e5896786. doi: 10.1155/2018/5896786.
19. Courneya KS, Friedenreich CM. Physical activity and cancer: an introduction. Recent Results Cancer Res 2011; 186: 1–10. doi: 10.1007/978-3-642-04231-7_1.
20. Friedenreich CM, Neilson HK, Farris MS et al. Physical activity and cancer outcomes: a precision medicine approach. Clin Cancer Res 2016; 22 (19): 4766–4775. doi: 10.1158/1078-0432.CCR-16-0067.
21. Chen X, Zheng Y, Zheng W et al. The effect of regular exercise on quality of life among breast cancer survivors. Am J Epidemiol 2009; 170 (7): 854–862. doi: 10.1093/aje/kwp209.
22. Höh JC, Schmidt T, Hübner J. Physical activity among cancer survivors – what is their perception and experience? Support Care Cancer 2018; 26 (5): 1471–1478. doi: 10.1007/s00520-017-3977-0.
23. Blanchard CM, Courney 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): 2198–2204. doi: 10.1200/JCO.2007. 14.6217.
24. Chung JY, Lee DH, Park JH et al. Patterns of physical activity participation across the cancer trajectory in colorectal cancer survivors. Support Care Cancer 2013; 21 (6): 1605–1612. doi: 10.1007/s00520-012-1703-5.
25. Salam A, Woodman A, Chu A et al. Effect of post-diagnosis exercise on depression symptoms, physical functioning and mortality in breast cancer survivors: a systematic review and meta-analysis of randomized control trials. Cancer Epidemiol 2022; 77: 102111. doi: 10.1016/j.canep.2022.102111.
26. Boing L, de Carvalho Souza Vieira M, Moratelli J et al. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy – a systematic review and meta-analysis. Maturitas 2020; 141: 71–81. doi: 10.1016/j.maturitas.2020.06.022.
27. Campbell K, Winters-Stone K, Wiskemann J et al. Exercise guidelines for cancer survivors: consensus statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 2019; 51 (11): 2375–2390. doi: 10.1249/MSS.0000000000002116.
28. Borg G. Borg’s perceived exertion and pain scales. Human Kinetics 1998.
29. Scientific Research. IBM Corp. Released (2017) IBM SPSS statistics for Windows. [online]. Dostupné z: https: //www.scirp.org/reference/referencespapers?referenceid=2757659.
30. Cohen J. Statistical power analysis for the behavioral sciences. [online]. Dostupné z: chrome-extension: //efaidnbmnnnibpcajpcglclefindmkaj/https: //www.utstat.toronto.edu/brunner/oldclass/378f16/readings/CohenPower.pdf.
31. Dunlap WP. Generalizing the common language effect size indicator to bivariate normal correlations. Psychological Bulletin 1994; 116 (3): 509–511. doi: 10.1037/0033-2909.116.3.509.
32. Buffart LM, Galvao DA, Brug J et al. Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev 2014; 40 (2): 327–340. doi: 10.1016/j.ctrv.2013.06.007.
33. Buffart LM, Newton RU, Chinapaw MJ et al. The effect, moderators, and mediators of resistance and aerobic exercise on health-related quality of life in older long--term survivors of prostate cancer. Cancer 2015; 121 (16): 2821–2830. doi: 10.1002/cncr.29406.
34. Kalter J, Kampshoff CS, Chinapaw MJ et al. Mediators of exercise effects on HRQoL in cancer survivors after chemotherapy. Med Sci Sports Exerc 2016; 48 (10): 1859–1865. doi: 10.1249/MSS.0000000000000976.
35. Schwartz AL. Fatigue mediates the effects of exercise on quality of life. Qual Life Res 1999; 8 (6): 529–538. doi: 10.1023/A: 1008978611274.
36. Sweegers MG, Buffart LM, van Veldhuizen WM et al. How does a supervised exercise program improve quality of life in patients with cancer? A concept mapping study examining patients’ perspectives. Oncologist 2019; 24 (6): e374–e383. doi: 10.1634/theoncologist.2017- 0613.
37. Masi L, Bilezikian JP. Osteoporosis: new hope for the future. Int J Fertil Womens Med 1997; 42 (4): 245–254.
38. Dalla VJ, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporos Int 2018; 29 (2): 287–303. doi: 10.1007/s00198-017-4237-3.
39. Sánchez-Fernández A, Moran JM, Canal-Macías M. Review of the bone mineral density data in the meta-analysis about the effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy. Maturitas 2020; 141: 82. doi: 10.1016/j.maturitas.2020. 08.004.
40. Singh B, Toohey K. The effect of exercise for improving bone health in cancer survivors – a systematic review and meta-analysis. J Sci Med Sport 2022; 25 (1): 31–40. doi: 10.1016/j.jsams.2021.08.008.
41. Salam A, Woodman A, Chu A et al. Effect of post-diagnosis exercise on depression symptoms, physical functioning and mortality in breast cancer survivors: a systematic review and meta-analysis of randomized control trials. Cancer Epidemiol 2022; 77: 102111. doi: 10.1016/j.canep.2022.102111.
42. Saarto T, Penttinen HM, Sievänen H et al. Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Res 2012; 32 (9): 3875–3884.
43. Moshina N, Falk RS, Hofvind S. Long-term quality of life among breast cancer survivors eligible for screening at diagnosis: a systematic review and meta-analysis. Public Health 2021; 199: 65–76. doi: 10.1016/j.puhe.2021.08.008.
44. Pinto BM, Trunzo JJ, Reiss P et al. Exercise participation after diagnosis of breast cancer: trends and effects on mood and quality of life. Psychooncology 2002; 11 (5): 389–400. doi: 10.1002/pon.594.
45. Oldervoll LM, Kaasa S, Hjermstad MJ et al. Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? Eur J Cancer 2004; 40 (7): 951–962. doi: 10.1016/j.ejca.2003.12.005.
46. Paulo TRS, Rossi FE, Viezel J et al. The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial. Health Qual Life Outcomes 2019; 17 (1): 17. doi: 10.1186/s12955-019-1090-4.
47. Winters-Stone KM, Boisvert C, Li F et al. Delivering exercise medicine to cancer survivors: has COVID-19 shifted the landscape for how and who can be reached with supervised group exercise? Support Care Cancer 2022; 30 (3): 1903–1906. doi: 10.1007/s00520-021- 06669-w.
Labels
Paediatric clinical oncology Surgery Clinical oncologyArticle was published in
Clinical Oncology
2025 Issue 2
Most read in this issue
- Ivosidenib in the treatment of metastatic cholangiocarcinoma – a case report
- Napřimování čili rektifikace trajektorií v onkologii
- Cemiplimab in the treatment of non-small cell lung cancer
- The lung cancer patient quality of life during the first line of treatment – multicenter prospective data