Too Few Breast Cancer Survivors Get Enough Exercise

Veronica Hackethal, MD

June 12, 2014

Many women diagnosed with breast cancer do not meet the national guidelines for weekly exercise, especially black women, according to a new study.

"Our results suggest that physical activity education should be incorporated into breast cancer care," said researcher Brionna Hair, MPH, a PhD candidate in the Department of Epidemiology at the University of North Carolina at Chapel Hill.

"The hope is that our study will encourage medical care providers to talk with their patients about the benefits of physical activity, not only for prolonging survival, but also for improving quality of life," Hair told Medscape Medical News.

The study was published online June 9 in Cancer.

Exercise has been linked to better survival, less morbidity, and improved quality of life after a diagnosis of breast cancer, according to the researchers.

National guidelines recommend 150 minutes of moderate-intensity exercise each week, or 75 minutes of vigorous exercise.

The 1735 study participants were part of the prospective Carolina Breast Cancer Study. All were diagnosed with invasive breast cancer from 2008 to 2011, and 48% of the cohort was black.

Hair and her colleagues assessed self-reported physical activity levels in women 20 to 74 years of age before and after diagnosis.

Just 35% of the women met suggested guidelines for physical activity after diagnosis, and 59% reported a decrease in physical activity.

Black women were less likely than white women to meet exercise guidelines after diagnosis (odds ratio,1.38), according to a multivariate analysis adjusted for age, race, income, education, marital status, body mass index, alcohol consumption, smoking status, comorbidities, cancer stage, type of treatment, lymph node removal, and prediagnosis exercise.

In black women, there was an association between treatment and physical activity after diagnosis (P < .01). Exercise levels were lowest in black women who received chemotherapy only or who received neither chemotherapy nor radiotherapy.

For black women in particular, who experience higher rates of breast cancer morbidity and mortality, "these results suggest that strategies to increase physical activity among breast cancer patients should be tailored to each patient's individual needs," Hair stated.

Results from the Black Women's Health Study highlight the benefits of exercise, linking it to lower risk for aggressive breast cancer.

The researchers acknowledge that an overestimation of activity levels could have resulted because participants might have been more motivated to exercise than women in the general population. In addition, the fact that the study used self-reported recall of activity could have led to an over- or underestimation of levels.

"This study provides evidence that although physical activity after a breast cancer diagnosis is important, the majority of breast cancer survivors do not meet recommended guidelines," said Vanessa Sheppard, PhD, associate professor of oncology and assistant director of health disparities research at Georgetown University Lombardi Comprehensive Cancer Center in Washington, DC.

"In fact, for many women, levels of physical activity are lower than they were before their diagnosis," she added.

Reasons for this might be related to insufficient knowledge about the benefits of exercise, physical limitations resulting from treatment, or problems with access to safe and affordable places to exercise, she told Medscape Medical News.

"We need to better understand why these women aren't exercising," Dr. Sheppard explained. "We still need more studies to examine approaches that will be most useful to help women increase their levels of physical activity."

She noted that the results for black women are concerning. Increased awareness is needed about the importance of exercise for breast cancer survivors in general and for some at-risk groups in particular, such as black and low-income women.

"From a clinical perspective, providers can encourage and facilitate exercise among breast cancer survivors by becoming aware of and providing referrals to local resources, like survivorship programs or exercise physiologists with a background in cancer rehabilitation," Dr. Sheppard said. "In many instances, simply encouraging people to walk is important. Trying to get to 10,000 steps per day is a goal that is low cost and could be encouraged."

Ms. Hair and Dr. Sheppard have disclosed no relevant financial relationships. Coauthor Mary Beth Bell, MPH, reports receiving grants from the Komen Foundation and from the National Cancer Institute. Coauthor Sandi Hayes, PhD, reports receiving research support from the National Breast Cancer Foundation of Australia.

Cancer. Published online June 9, 2014. Abstract

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