The Who, What, Where, When and Sometimes, Why.

Physical activity (exercise) and breast cancer survival

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Regular physical activity (exercise) lowers the risk of breast cancer (see Table 4).  

After treatment for breast cancer, being active may lower the risk of:

  • Breast cancer recurrence (a return of breast cancer)
  • Breast cancer-specific mortality (death from breast cancer)
  • Overall mortality (death from any cause, not necessarily breast cancer)

Regular physical activity has other health benefits for breast cancer survivors. It improves mood, physical condition and movement, which can improve quality of life [1-2].    

Learn more about the strengths and weaknesses of different types of studies

Study selection criteria: Prospective cohort studies with at least 900 participants, pooled analyses and meta-analyses.

Table notes: A relative risk above 1 indicates increased risk. A relative risk below 1 indicates decreased risk.

MET (metabolic equivalent) hours are often used as a unit of measure for physical activity. One MET hour equals the energy used to sit quietly for one hour. Activities are assigned MET scores based on this measure.

For example, walking is 3 MET hours and swimming is 7 MET hours. Moderate activities, like mowing the lawn or slow dancing, range from 3-6 MET hours and vigorous activities, like playing tennis or jogging, score higher than 6 MET hours.   

StudyStudy Population
(number of breast cancer survivors)
Follow-up
(years)
Levels of Physical Activity ComparedBreast Cancer-Specific Mortality
RR (95% CI)
Overall Mortality
RR (95% CI)
Prospective cohort studies
Shanghai Breast Cancer Survival Study [3]4,8294Up to 8 MET hrs/wk
vs.
Inactive
0.60
(0.46-0.78)*
0.81
(0.63-1.05
   8 or more MET hrs/wk
vs.
Inactive
0.59
(0.45-0.76)*
0.65
(0.51-0.84)
Collaborative Women’s
Longevity Study [4]
4,48263 to 8
vs.
Less than 3 MET hrs/wk
0.65
(0.39-1.08)
0.58
(0.45-0.76)
   8 to 21
vs.
Less than 3 MET hrs/wk
0.59
(0.35-1.01)
0.53
(0.40-0.69)
   21 or more
vs.
Less than 3 MET hrs/wk
0.51
(0.29-0.89)
0.44
(0.32-0.60)
Cancer Prevention Study II – Nutrition Cohort [5]3,6891318 or more
vs.
4-9 MET hrs/wk

Among women ages 46-64:

0.49
(0.26-0.95)

Among women ages 65 and older:

1.00
(0.66-1.50)

Among women ages 46-64:

0.56
(0.37-0.83)

Among women ages 65 and older:

0.74
(0.61-0.90)

Nurses’ Health Study [6]2,98783 to 9
vs.
Less than 3 MET hrs/wk
0.80
(0.60-1.06)
0.71
(0.56-0.89)
   9 to 15
vs.
Less than 3 MET hrs/wk
0.50
(0.31-0.82)†
0.59
(0.41-0.84)
   15 to 24
vs.
Less than 3 MET hrs/wk
0.56
(0.38-0.84)†
0.56
(0.41-0.77)
   15 to 24
vs.
Less than 3 MET hrs/wk
0.56
(0.38-0.84)†
0.56
(0.41-0.77)
   24 or more
vs.
Less than 3 MET hrs/wk
0.60
(0.40-0.89)
0.60
(0.40-0.89)
Women’s Health Initiative Observational Study [7]2,9103Up to 3 MET hrs/wk
vs.
Inactive
0.30
(0.09-0.99)
0.42
(0.21-0.82)
   3 to 9 MET hrs/wk
vs.
Inactive
0.77
(0.43-1.38)
0.72
(0.48-1.07)
   9 or more MET hrs/wk
vs.
Inactive
0.61
(0.35-0.99)
0.54
(0.38-0.79)
Women’s Healthy Eating and Living (WHEL) Study [8]2,361725 or more
vs.
Less than 3 MET hrs/wk
 0.47
(0.26-0.84)
Life After Cancer
Epidemiology Study [9]
1,970729 to 44
vs.
Less than 29 MET hrs/wk
1.01
(0.57-1.78)
0.89
(0.59-1.33)
Long Island Breast Cancer Study [10]1,42313More than 9 MET hrs/wk
vs.
Inactive
0.27
(0.15-0.46)
0.33
(0.22-0.48)
Long Island Breast Cancer Study [10]1,42313More than 9 MET hrs/wk
vs.
Inactive
0.27
(0.15-0.46)
0.33
(0.22-0.48)
Diet, Cancer, and Health Study [11]9594More than 8
vs.
8 or fewer MET hrs/wk
 0.68
(0.47-0.99)
Health, Eating, Activity and Lifestyle Study [12]9336Up to 9 MET hrs/wk
vs.
Inactive
0.72
(0.28-1.85)
0.36
(0.17-0.73)
   9 or more MET hrs/wk
vs.
Inactive
0.65
(0.23-1.87)
0.33
(0.15-0.73)
Pooled and meta-analyses
After Breast Cancer Pooling Project [13-14]13,302
(4 studies)
 10 or more
vs.
Less than 10 MET hrs/wk
0.75
(0.65-0.85)
0.73
(0.66-0.82)
After Breast Cancer Pooling Project [13-14]13,302
(4 studies)
 10 or more
vs.
Less than 10 MET hrs/wk
0.75
(0.65-0.85)
0.73
(0.66-0.82)
Lahart et al. [15]7 studies Most active
vs.
Least active
0.59
(0.45-0.78)
0.52
(0.43-0.64)
Schmid and Leitzmann [16]4 studies Active
vs.
Inactive
0.72
(0.60-0.85)
0.52
(0.42-0.64)
Ibrahim and Al-Homaidh [17]4 studies Active
vs.
Inactive
0.66
(0.57-0.77)†
0.59
(0.53-0.65)

Sig = Statistically significant trend of increasing survival with increasing levels of activity

* Results combined the risk of recurrence and breast cancer-specific mortality.

† Results also showed significant decreases in breast cancer recurrence.

‡ Among survivors who had estrogen receptor-positive breast cancers, there was no difference in risk of late recurrence (5 or more years after diagnosis) between those who got the most exercise compared to those who got the least, 0.89 (0.73-1.09).

§ All participants had survived estrogen receptor-positive breast cancer for at least 5 years.

References 

  1. Mutrie N, Campbell AM, Whyte F, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 334(7592):517, 2007.
  2. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol. 25(13):1713-21, 2007.
  3. Chen X, Lu W, Zheng W, et al. Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila). 4(9):1409-18, 2011.
  4. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 17(2):379-86, 2008.
  5. Maliniak ML, Patel AV, McCullough ML, et al. Obesity, physical activity, and breast cancer survival among older breast cancer survivors in the Cancer Prevention Study-II Nutrition Cohort. Breast Cancer Res Treat. 167(1):133-145, 2018.
  6. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 293(20):2479-86, 2005.
  7. Irwin ML, McTiernan A, Manson JE, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the Women’s Health Initiative. Cancer Prev Res (Phila). 4(4):522-9, 2011.
  8. Bertram LA, Stefanick ML, Saquib N, et al. Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study. Cancer Causes Control. 22(3):427-35, 2011.
  9. Sternfeld B, Weltzien E, Quesenberry CP Jr, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 18(1):87-95, 2009.
  10. Bradshaw PT, Ibrahim JG, Khankari N, et al. Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study. Breast Cancer Res Treat. 145(3):735-42, 2014.
  11. Ammitzbøll G, Søgaard K, Karlsen RV, et al. Physical activity and survival in breast cancer. Eur J Cancer. 66:67-74, 2016.
  12. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 26(24):3958-64, 2008.
  13. Beasley JM, Kwan ML, Chen WY, et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 131(2):637-43, 2012.
  14. Nechuta S, Chen WY, Cai H, et al. A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer. 138(9):2088-97, 2016.
  15. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies. Acta Oncol. 54(5):635-54, 2015.
  16. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 25(7):1293-311, 2014. 
  17. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 28(3):753-65, 2011. 

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