{"product_id":"which-exercise-programs-improve-physical-fitness-in-women-with-breast-cancer-before-during-and-after-treatment","title":"Which Exercise Programs Improve Physical Fitness in Women with Breast Cancer Before, During, and After Treatment?","description":"\u003cp\u003eThis systematic review and meta-analysis of 68 randomized controlled trials, including 4,158 women with breast cancer, found that exercise significantly improves muscular strength, functional exercise capacity, cardiorespiratory fitness, and fat-free mass. However, the benefits differ depending on the phase of cancer care and the specific exercise prescription. The greatest improvements occurred with supervised combined aerobic-resistance exercise performed at least three times per week for a minimum of 12 weeks. During active treatment, exercise improved strength, functional capacity, and cardiorespiratory fitness but not fat-free mass, while after treatment, exercise improved strength, fat-free mass, and functional capacity but not cardiorespiratory fitness.\u003c\/p\u003e\n\n\u003ch1\u003eWhich Exercise Programs Improve Physical Fitness in Women with Breast Cancer Before, During, and After Treatment?\u003c\/h1\u003e\n\n\u003ch2\u003eTable of Contents\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003e\u003ca href=\"#ddn-key-points\"\u003eKey Points\u003c\/a\u003e\u003c\/li\u003e\n\n\u003cli\u003e\u003ca href=\"#background\"\u003eBackground: Why This Research Matters\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#methods\"\u003eHow the Research Was Conducted\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#results\"\u003eKey Findings: What the Numbers Show\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#strength\"\u003eEffects on Muscular Strength\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#fatfree\"\u003eEffects on Fat-Free Mass\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#fec\"\u003eEffects on Functional Exercise Capacity\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#cardio\"\u003eEffects on Cardiorespiratory Fitness\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#phases\"\u003eHow Cancer Treatment Phase Affects Results\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#prescription\"\u003eWhich Exercise Prescription Works Best\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#implications\"\u003eWhat This Means for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#limitations\"\u003eLimitations of the Study\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#recommendations\"\u003eRecommendations for Patients\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#ddn-faq\"\u003eFrequently Asked Questions\u003c\/a\u003e\u003c\/li\u003e\n\u003cli\u003e\u003ca href=\"#source\"\u003eSource Information\u003c\/a\u003e\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003c!-- ddn:keypoints:start --\u003e\n\u003ch2 id=\"ddn-key-points\"\u003eKey Points\u003c\/h2\u003e\n\u003cul\u003e\n\u003cli\u003eIn 68 randomized trials of 4,158 women with breast cancer, exercise improved muscular strength, functional exercise capacity, cardiorespiratory fitness, and fat-free mass.\u003c\/li\u003e\n\u003cli\u003eBenefits varied by cancer care phase: during active treatment, strength, functional capacity, and cardiorespiratory fitness improved, but not fat-free mass.\u003c\/li\u003e\n\u003cli\u003eAfter treatment, exercise improved strength, fat-free mass, and functional capacity, but not cardiorespiratory fitness.\u003c\/li\u003e\n\u003cli\u003eMost trials had some concerns or high risk of bias, and data on exercise before treatment were insufficient.\u003c\/li\u003e\n\u003c\/ul\u003e\n\u003c!-- ddn:keypoints:end --\u003e\n\n\n\u003ch2 id=\"background\"\u003eBackground: Why This Research Matters\u003c\/h2\u003e\n\n\u003cp\u003eExercise is now recognized as an essential part of cancer care for breast cancer survivors. Over the past decade, medical and scientific organizations worldwide have consistently shown that exercise plays a key role in preventing and controlling breast cancer recurrence and mortality. Exercise also helps alleviate the main adverse effects of cancer treatment.\u003c\/p\u003e\n\n\u003cp\u003eHowever, recommendations for exercise in cancer survivors remain vague and imprecise. Most exercise oncology guidelines do not address key components of exercise prescription. These components include the mode of exercise: aerobic, resistance, or combined. The components also include frequency (how often), intensity (how hard), and supervision (whether a professional supervises the sessions). The components also include the duration of the intervention (how many weeks).\u003c\/p\u003e\n\n\u003cp\u003eAmong the most recently published guidelines, only one provides specific recommendations regarding frequency, intensity, and volume. The American Society of Clinical Oncology states in its exercise guidelines that the available evidence does not offer enough specific information. That evidence is not enough to formulate precise exercise prescriptions for patients undergoing active cancer treatment.\u003c\/p\u003e\n\n\u003cp\u003eBeyond generic prescriptions, responses in cancer survivors vary depending on the phase of their cancer care. Cancer survivorship can be divided into four distinct phases:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003eAfter diagnosis and before surgery (called prehabilitation)\u003c\/li\u003e\n\u003cli\u003eAfter surgery and before adjuvant treatment\u003c\/li\u003e\n\u003cli\u003eDuring non-surgical therapy (called adjuvant and neoadjuvant treatment)\u003c\/li\u003e\n\u003cli\u003eDuring extended survival, which includes transitional survivorship\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eHowever, guidelines and meta-analyses tend to group phases of cancer care into general categories. They rarely investigate the effects of exercise programs with different frequencies, intensities, modes, and overall durations during different phases of cancer care. This vagueness contributes to generic recommendations and imprecise exercise prescriptions. It may also mask the full therapeutic potential of exercise as a supportive care intervention in cancer treatment.\u003c\/p\u003e\n\n\u003cp\u003eIn a systematic review, Bland and colleagues evaluated whether breast cancer clinical trials included key principles of exercise training. They found that no studies had fully accounted for all principles of exercise training or reported all components of the prescribed exercises in their methods. This information is relevant because the intensity, frequency, mode, and overall duration of exercise determine the principle of specificity. The principle of specificity ensures precise physiological adaptations to achieve the desired muscle phenotype and fitness outcomes.\u003c\/p\u003e\n\n\u003cp\u003eFor this reason, incorporating established exercise principles into future studies and clinical services in exercise oncology will enhance the precision and effectiveness of prescribed interventions.\u003c\/p\u003e\n\n\u003ch2 id=\"methods\"\u003eHow the Research Was Conducted\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers followed the methodology for systematic reviews proposed by the Cochrane Handbook. They reported their findings following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 statement and the PRISMA in Exercise, Rehabilitation, Sport Medicine and Sports Science (PERSiST) guidelines. The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO, No. CRD42023411705).\u003c\/p\u003e\n\n\u003cp\u003eThe researchers searched four electronic databases: PubMed, SPORTDiscus, Google Scholar, and LILACS. They looked for randomized controlled trials (RCTs) published from 1989, when the first RCT involving patients with cancer was published, through 31 December 2024. They targeted only publications available in English, Spanish, and Portuguese. The search used combinations of MeSH terms and free-text words for \"breast,\" \"cancer,\" \"physical activity,\" and \"exercise.\"\u003c\/p\u003e\n\n\u003cp\u003eTo be included, studies had to meet specific criteria using the PICO approach, which considers the population, intervention, comparison, and outcome targeted for investigation:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003ePopulation:\u003c\/strong\u003e All RCTs involving adult women (aged 18 years or older) in any phase of primary oncology treatment for breast cancer, including surgery, infusion therapy, and\/or radiotherapy. If an RCT involved other types of cancer, it was eligible if breast cancer data were reported separately.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIntervention:\u003c\/strong\u003e All RCTs entailing exercise or physical activity were eligible. All forms of intervention, counseling, or strategies aimed at improving body movement, maintaining physical capacity or performance, and health were accepted. Randomized controlled trials were eligible regardless of the prescribed exercise's mode, intensity, frequency, supervision, and duration of intervention, in addition to the phase of cancer care.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eComparison:\u003c\/strong\u003e To be eligible, RCTs had to include a control group of individuals who received standard care, were inactive, and\/or were less active than the intervention group.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eOutcomes:\u003c\/strong\u003e The primary outcomes were muscular strength, fat-free mass, functional exercise capacity (FEC), and cardiorespiratory fitness.\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eThe researchers excluded RCTs that included additional interventions not related to the primary oncology treatment. These additional interventions included dietary interventions, counseling, massage, acupuncture, or other practices alongside exercise. The researchers excluded these RCTs if the effects could not be isolated. They also excluded RCTs involving Asian practices such as yoga and tai chi, and physiotherapy interventions aimed at rehabilitating a specific body region such as the spine, arms, or legs.\u003c\/p\u003e\n\n\u003cp\u003eMuscular strength was represented by the results of manual dynamometry, weightlifting, and one-to-multiple maximum repetition tests for upper and\/or lower limb muscle groups. Fat-free mass was represented by measurements using anthropometry, bioelectrical impedance analysis, or any imaging method such as tomography, dual-energy X-ray absorptiometry, scanners, and nuclear resonance imagery. Functional exercise capacity was represented by the distance reached in the 6- or 12-minute walk test. Cardiorespiratory fitness was represented by the maximum or peak oxygen consumption measured by using oxygen exchange equipment. Cardiorespiratory fitness was also estimated using a field test such as the 1-mile or 400-meter walking test.\u003c\/p\u003e\n\n\u003cp\u003eThe process for including publications spanned four stages. First, duplicate publication review papers were excluded using Rayyan software. Second, at least two authors in pairs independently assessed the publications' eligibility for inclusion based on their titles and abstracts. They excluded posters, conference abstracts, non-peer-reviewed journal articles, study protocols, and any publication without full text available. Third, publications that met the specified criteria were thoroughly and independently reviewed by at least two authors in the same pairs and reassessed for inclusion. Any discrepancies that emerged within any pair of authors were resolved by a third author.\u003c\/p\u003e\n\n\u003cp\u003eStatistical heterogeneity among the included RCTs was quantified by prediction intervals when there were more than ten RCTs per analysis. When fewer than ten RCTs were analyzed, heterogeneity was quantified by the I² statistic and Q test with a significance level of p ≤ 0.05. I² values of less than 30% indicated that heterogeneity may not be important. Values of 30–60% indicated moderate heterogeneity. Values greater than 60% indicated substantial heterogeneity.\u003c\/p\u003e\n\n\u003cp\u003eRisk of bias was assessed independently by two reviewers using RoB 2, the Cochrane Collaboration's tool for assessing risk of bias, Version 2.12. Items representing blinding were excluded because blinding participants and personnel for exercise interventions is not typically feasible.\u003c\/p\u003e\n\n\u003cp\u003eEffect sizes for all individual studies were calculated by subtracting the control group's average post-intervention score from the intervention group's average post-intervention score. The result was then divided by the pooled standard deviation of both groups. All effect sizes were pooled using Hedges' g. Following Cohen's convention, the researchers interpreted effect sizes of 0.2 as being small, 0.5 as being moderate, and 0.8 as being large. Because the samples and interventions were assumed to be heterogeneous, effect sizes were pooled with a random-effects model that accounted for any systematic difference in the effects between the studies. Meta-analytical statistics were calculated in the software Comprehensive Meta-Analysis, Version 4.\u003c\/p\u003e\n\n\u003cp\u003eSubgroup analyses were conducted to evaluate the effects of each moderator of physical exercise. For the mode of exercise, aerobic exercise programs had to involve continuous or mostly continuous exercise such as walking, running, and biking. Resistance exercises encompassed weightlifting, CrossFit, and Pilates. Any combination of aerobic and resistance exercise was considered to be combined. Exercise was classified as supervised when at least 75% of the sessions were conducted face-to-face, either in person or online, under professional supervision. Interventions not meeting this criterion were considered unsupervised. The duration of intervention was categorized as either less than 12 weeks or more than 12 weeks. Frequency was either at least two times weekly or at least three times weekly.\u003c\/p\u003e\n\n\u003cp\u003eIntensity was categorized depending on the mode of exercise. For aerobic exercise interventions, low-to-moderate intensity was recorded when the maximum heart rate was less than 70%. Low-to-moderate intensity was also recorded when the maximum heart rate adjusted for age was less than 55%. Low-to-moderate intensity was also recorded when the heart rate was less than 60% with the 6-minute walk test. Low-to-moderate intensity was also recorded when the intensity was set as less than 60% of maximum oxygen consumption or peak oxygen consumption. Rating of perceived exertion (RPE) on a 6–20 scale of less than 12 also indicated low-to-moderate intensity. RPE on a 0–10 scale of less than 4 also indicated low-to-moderate intensity. Total work of 6 metabolic equivalents of task or less also indicated low-to-moderate intensity. Self-guided aerobic exercise programs using guidelines or mobile apps that did not specify the intensity or labeled it as \"moderate\" were classified as having low-to-moderate intensity as well.\u003c\/p\u003e\n\n\u003cp\u003eModerate-to-high intensity was recorded when maximum heart rate was greater than 70%. Moderate-to-high intensity was also recorded when the maximum heart rate adjusted for age was greater than 55%. Moderate-to-high intensity was also recorded when the heart rate was greater than 60% with the 6-minute walk test. Moderate-to-high intensity was also recorded when the intensity was set as greater than 60% of maximum oxygen consumption or peak oxygen consumption. RPE on a 6–20 scale of greater than 12, RPE on a 0–10 scale of greater than 4, or total work of 6 metabolic equivalents of task or greater also indicated moderate-to-high intensity.\u003c\/p\u003e\n\n\u003cp\u003eFor resistance exercise programs, the intensity was considered to be low to moderate when it was performed at less than 70% of the one repetition maximum. The intensity was also considered low to moderate when the RPE scale on a 6–20 scale was less than 14. The intensity was also considered low to moderate when the RPE scale on a 0–10 scale was less than 5. Intensity was considered moderate to high when exercise was prescribed with greater than 70% of the one repetition maximum. Intensity was also considered moderate to high with greater than 14 RPE on a 6–20 scale. Intensity was also considered moderate to high with greater than 5 RPE on a 0–10 scale. Elastic bands or bodyweight-based exercises without any additional information about intensity were considered to be low-to-moderate intensity.\u003c\/p\u003e\n\n\u003cp\u003eFor combined exercise protocols, exercise was considered to be moderate to high when one or both of the exercise modes (aerobic or resistance) were classified as having moderate-to-high intensity. When both modes were classified as having low-to-moderate intensity, the combined exercise program's intensity was considered to be low to moderate. For all analyses, the significance level was set at p \u0026lt; 0.05.\u003c\/p\u003e\n\n\u003ch2 id=\"results\"\u003eKey Findings: What the Numbers Show\u003c\/h2\u003e\n\n\u003cp\u003eThe initial search of the databases returned 2,979 publications. After removing duplicates, the researchers selected 159 publications based on their titles and abstracts and thoroughly evaluated them. They also identified 42 RCTs cited in previous systematic reviews and meta-analyses; all of these had already been captured in the search. Of the 159 studies screened, 91 were excluded for various reasons, whereas the remaining 68 were retained.\u003c\/p\u003e\n\n\u003cp\u003eThe principal investigator or corresponding author of eight RCTs was contacted because of incomplete data. After a personal communication, the researchers obtained additional information for only one RCT, which led to the exclusion of seven other publications. Thus, the meta-analysis ultimately included 68 RCTs with 108 evaluation arms.\u003c\/p\u003e\n\n\u003cp\u003eThe 68 RCTs included in the meta-analysis were published between 2001 and 2024, all in English, and included 4,158 women with breast cancer. There were 2,058 women in control groups and 2,100 women in exercise intervention groups. The average age of participants in the control and intervention groups was 52.3 ± 8.4 and 52.4 ± 8.1 years, respectively. All RCTs included patients with stage I–III breast cancer.\u003c\/p\u003e\n\n\u003cp\u003eMost RCTs (64%) assessed the effects of exercise after cancer treatment, whereas 33% evaluated its effects during active treatment such as chemotherapy and\/or radiotherapy. Only two RCTs evaluated exercise effects during pre-treatment.\u003c\/p\u003e\n\n\u003cp\u003eRegarding the exercise protocols, the average duration of the interventions was 18.6 weeks, with a range of 1 week to 52 weeks. Most RCTs (58%) required exercise at a frequency of three or more times weekly. By mode, 48% involved combined aerobic-resistance exercise, whereas 28% involved aerobic exercise. Regarding supervision, 67% involved supervised exercise. With respect to intensity, more than half (60%) described protocols with moderate-to-high-intensity workouts.\u003c\/p\u003e\n\n\u003cp\u003eMost RCTs (75%) were classified as having \"some concerns\" regarding risk of bias. Twenty-five percent of the studies were judged as having a \"high\" risk of bias, and none had a \"low\" risk of bias. Most RCTs (75%) were missing some information on the randomization process and were considered as having \"some concerns.\"\u003c\/p\u003e\n\n\u003cp\u003eAcross all 68 randomized controlled trials, exercise significantly increased muscular strength, functional exercise capacity, cardiorespiratory fitness, and fat-free mass. However, these effects varied according to the phase of cancer care and exercise prescription characteristics, including modality, frequency, supervision, intensity, and duration.\u003c\/p\u003e\n\n\u003ch2 id=\"strength\"\u003eEffects on Muscular Strength\u003c\/h2\u003e\n\n\u003cp\u003eThirty-nine of the 108 evaluation arms examined the effects of exercise on muscular strength. The pooled effect size for muscular strength was Hedges' g = 0.66 (95% CI 0.46–0.85). This is a moderate-to-large effect, meaning exercise produced a meaningful improvement in muscular strength across the studies.\u003c\/p\u003e\n\n\u003cp\u003eThe 39 RCTs that assessed muscular strength included participants who were, on average, 52.8 years of age. Most of these RCTs (72%) examined exercise's effects following cancer treatment. The average duration of the interventions was 19.7 weeks, with a range of 4 to 52 weeks.\u003c\/p\u003e\n\n\u003cp\u003eLittle more than half of the RCTs (55%) implemented exercise programs with a frequency of two or fewer sessions per week. Fifty-seven percent used combined exercise, and 69% were supervised.\u003c\/p\u003e\n\n\u003ch2 id=\"fatfree\"\u003eEffects on Fat-Free Mass\u003c\/h2\u003e\n\n\u003cp\u003eThirty-nine of the 108 evaluation arms examined the effects of exercise on fat-free mass. The pooled effect size for fat-free mass was Hedges' g = 0.12 (95% CI 0.03–0.20). This is a small effect, meaning exercise produced a modest but statistically significant improvement in fat-free mass.\u003c\/p\u003e\n\n\u003cp\u003eThe 39 RCTs that assessed fat-free mass included 1,071 control group participants and 1,115 intervention group participants. The average age was 52.8 years (mean control group age = 52.7 years; mean intervention group age = 52.6 years).\u003c\/p\u003e\n\n\u003cp\u003eMost of the RCTs (72%) examined exercise's effects following cancer treatment. The average duration of the interventions was 19.7 weeks, with a range of 4 to 52 weeks. Little more than half of the RCTs (55%) implemented exercise programs with a frequency of two or fewer sessions per week. Fifty-seven percent used combined exercise, and 69% were supervised.\u003c\/p\u003e\n\n\u003ch2 id=\"fec\"\u003eEffects on Functional Exercise Capacity\u003c\/h2\u003e\n\n\u003cp\u003eTwelve of the 108 evaluation arms examined the effects of exercise on functional exercise capacity (FEC). The pooled effect size for FEC was Hedges' g = 1.04 (95% CI 0.56–1.52). This is a large effect, meaning exercise produced a substantial improvement in functional exercise capacity.\u003c\/p\u003e\n\n\u003cp\u003eThe 12 RCTs that examined FEC included 613 breast cancer survivors—305 in control groups and 308 in intervention groups—with an average age of 51.1 years.\u003c\/p\u003e\n\n\u003ch2 id=\"cardio\"\u003eEffects on Cardiorespiratory Fitness\u003c\/h2\u003e\n\n\u003cp\u003eEighteen of the 108 evaluation arms examined the effects of exercise on cardiorespiratory fitness. The pooled effect size for cardiorespiratory fitness was Hedges' g = 0.96 (95% CI 0.45–1.47). This is a large effect, meaning exercise produced a substantial improvement in cardiorespiratory fitness.\u003c\/p\u003e\n\n\u003ch2 id=\"phases\"\u003eHow Cancer Treatment Phase Affects Results\u003c\/h2\u003e\n\n\u003cp\u003eThe effects of exercise on physical fitness differ depending on the specific phase of breast cancer care. The researchers analyzed results separately for pre-treatment, during active treatment, and post-treatment.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eDuring active treatment:\u003c\/strong\u003e Combined exercise significantly improved muscular strength, functional exercise capacity, and cardiorespiratory fitness, but not fat-free mass. This means that women undergoing chemotherapy and\/or radiotherapy can expect improvements in strength, functional capacity, and cardiovascular fitness from combined exercise. However, these women should not expect to gain fat-free mass during this phase.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePost-treatment:\u003c\/strong\u003e Exercise significantly enhanced muscular strength, fat-free mass, and functional exercise capacity, with no significant effect on cardiorespiratory fitness. This means that women who have completed cancer treatment can expect improvements in strength, fat-free mass, and functional capacity from exercise. However, these women should not expect significant improvements in cardiorespiratory fitness during this phase.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePre-treatment:\u003c\/strong\u003e Data for evaluating exercise's pretreatment effects were insufficient. Only two RCTs evaluated exercise effects during pre-treatment, so the researchers could not draw firm conclusions about this phase.\u003c\/p\u003e\n\n\u003cp\u003eThese findings highlight that the benefits of exercise are phase-specific. The same exercise program may produce different results depending on whether a woman is before, during, or after cancer treatment.\u003c\/p\u003e\n\n\u003ch2 id=\"prescription\"\u003eWhich Exercise Prescription Works Best\u003c\/h2\u003e\n\n\u003cp\u003eThe greatest improvements across outcomes were observed with supervised combined aerobic-resistance exercise programs performed at least three times per week for a minimum of 12 weeks. This specific combination of exercise characteristics produced the largest benefits for physical fitness.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers found that exercise mode, frequency, intensity, supervision, and duration of intervention all affect breast cancer survivors' physical fitness. The principle of specificity ensures precise physiological adaptations to achieve the desired muscle phenotype and fitness outcomes. This means that the intensity, frequency, mode, and overall duration of exercise determine the specific benefits that patients achieve.\u003c\/p\u003e\n\n\u003cp\u003eKey components of the optimal exercise prescription include:\u003c\/p\u003e\n\n\u003cul\u003e\n\u003cli\u003e\n\u003cstrong\u003eMode:\u003c\/strong\u003e Combined aerobic-resistance exercise (both types together)\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eFrequency:\u003c\/strong\u003e At least three sessions per week\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIntensity:\u003c\/strong\u003e Moderate-to-high intensity\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSupervision:\u003c\/strong\u003e Supervised by a professional\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eDuration:\u003c\/strong\u003e At least 12 weeks\u003c\/li\u003e\n\u003c\/ul\u003e\n\n\u003cp\u003eWhen exercise was performed during active treatment, combined exercise significantly improved muscular strength, functional exercise capacity, and cardiorespiratory fitness, but not fat-free mass. When exercise was performed post-treatment, it significantly enhanced muscular strength, fat-free mass, and functional exercise capacity, with no significant effect on cardiorespiratory fitness.\u003c\/p\u003e\n\n\u003ch2 id=\"implications\"\u003eWhat This Means for Patients\u003c\/h2\u003e\n\n\u003cp\u003eThis research has important implications for women with breast cancer and their healthcare providers. The findings show that exercise is not a one-size-fits-all prescription. Instead, the benefits of exercise depend on when a woman receives the exercise program and what specific components the program includes.\u003c\/p\u003e\n\n\u003cp\u003eFor women currently undergoing active cancer treatment, the research suggests that combined aerobic-resistance exercise can improve muscular strength, functional exercise capacity, and cardiorespiratory fitness. However, fat-free mass may not improve during this phase. This information can help patients set realistic expectations for their exercise program during treatment.\u003c\/p\u003e\n\n\u003cp\u003eFor women who have completed cancer treatment, exercise can improve muscular strength, fat-free mass, and functional exercise capacity. However, cardiorespiratory fitness may not improve significantly during this phase. Again, this helps patients understand what to expect from their exercise program.\u003c\/p\u003e\n\n\u003cp\u003eThe finding that supervised combined aerobic-resistance exercise performed at least three times per week for at least 12 weeks produces the greatest improvements is particularly important. This provides a specific, evidence-based prescription that healthcare providers can use when recommending exercise to breast cancer survivors.\u003c\/p\u003e\n\n\u003cp\u003eThe research also highlights the importance of supervision. Most of the RCTs that showed the greatest benefits involved supervised exercise, where at least 75% of sessions were conducted face-to-face under professional supervision. This suggests that working with a qualified exercise professional may help patients achieve better results.\u003c\/p\u003e\n\n\u003cp\u003eThe study also found that the average duration of exercise interventions was 18.6 weeks, with a range of 1 week to 52 weeks. This means that exercise programs can vary widely in length, but the greatest benefits were seen with programs lasting at least 12 weeks.\u003c\/p\u003e\n\n\u003ch2 id=\"limitations\"\u003eLimitations of the Study\u003c\/h2\u003e\n\n\u003cp\u003eThe researchers identified several limitations to their study. First, most RCTs (75%) were classified as having \"some concerns\" regarding risk of bias. Twenty-five percent of the studies were judged as having a \"high\" risk of bias, and none had a \"low\" risk of bias. This means that the quality of the included studies was not optimal, which could affect the reliability of the findings.\u003c\/p\u003e\n\n\u003cp\u003eSecond, most RCTs (75%) were missing some information on the randomization process. This lack of information made it difficult to fully assess the risk of bias in these studies.\u003c\/p\u003e\n\n\u003cp\u003eThird, data for evaluating exercise's pretreatment effects were insufficient. Only two RCTs evaluated exercise effects during pre-treatment, so the researchers could not draw firm conclusions about this phase. This is a significant gap in the research, as prehabilitation (exercise before surgery) is an important phase of cancer care.\u003c\/p\u003e\n\n\u003cp\u003eFourth, the study found substantial heterogeneity among the included RCTs. This means that the studies varied widely in their methods, populations, and exercise prescriptions. The researchers used a random-effects model to account for this heterogeneity, but it remains a limitation.\u003c\/p\u003e\n\n\u003cp\u003eFifth, the researchers were unable to obtain additional information from seven RCTs because the principal investigators or corresponding authors did not respond to requests for incomplete data. This led to the exclusion of these publications from the meta-analysis.\u003c\/p\u003e\n\n\u003cp\u003eFinally, the study only included publications available in English, Spanish, and Portuguese. This language restriction may have excluded relevant studies published in other languages.\u003c\/p\u003e\n\n\u003ch2 id=\"recommendations\"\u003eRecommendations for Patients\u003c\/h2\u003e\n\n\u003cp\u003eBased on the findings of this systematic review and meta-analysis, the following recommendations can be made for women with breast cancer:\u003c\/p\u003e\n\n\u003col\u003e\n\u003cli\u003e\n\u003cstrong\u003eExercise during active treatment:\u003c\/strong\u003e Women undergoing chemotherapy and\/or radiotherapy should engage in combined aerobic-resistance exercise to improve muscular strength, functional exercise capacity, and cardiorespiratory fitness. Fat-free mass may not improve during this phase, so patients should focus on other benefits.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eExercise after treatment:\u003c\/strong\u003e Women who have completed cancer treatment should engage in exercise to improve muscular strength, fat-free mass, and functional exercise capacity. Cardiorespiratory fitness may not improve significantly during this phase, so patients should focus on other benefits.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eOptimal exercise prescription:\u003c\/strong\u003e To achieve the greatest improvements in physical fitness, women with breast cancer should participate in supervised combined aerobic-resistance exercise programs. These programs should be performed at least three times per week for a minimum of 12 weeks.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIntensity:\u003c\/strong\u003e Exercise should be performed at moderate-to-high intensity. For aerobic exercise, this means working at greater than 70% of maximum heart rate or greater than 60% of maximum oxygen consumption. For resistance exercise, this means working at greater than 70% of one repetition maximum.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSupervision:\u003c\/strong\u003e Working with a qualified exercise professional is recommended. At least 75% of exercise sessions should be conducted face-to-face under professional supervision to achieve the best results.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eDuration:\u003c\/strong\u003e Exercise programs should last at least 12 weeks to produce meaningful improvements in physical fitness.\u003c\/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eIndividualization:\u003c\/strong\u003e Exercise prescriptions should be tailored to the individual patient's phase of cancer care, as the benefits of exercise differ depending on whether a woman is before, during, or after cancer treatment.\u003c\/li\u003e\n\u003c\/ol\u003e\n\n\u003cp\u003ePatients should discuss their exercise plans with their healthcare team before starting any new exercise program. This is especially important for women undergoing active cancer treatment, as exercise may need to be adjusted based on treatment side effects and overall health status.\u003c\/p\u003e\n\n\u003cp\u003eThe researchers conclude that exercise improves breast cancer survivors' physical fitness. However, its effects differ depending on its mode, frequency, intensity, supervision, and total duration. Its effects also differ depending on the phase of cancer care. This means that exercise prescriptions should be specific and individualized, not generic.\u003c\/p\u003e\n\n\u003c!-- ddn:faq:start --\u003e\n\u003ch2 id=\"ddn-faq\"\u003eFrequently Asked Questions\u003c\/h2\u003e\n\u003ch3\u003eWhat did this review of 68 randomized trials find about exercise for women with breast cancer?\u003c\/h3\u003e\n\u003cp\u003eAcross 68 randomized controlled trials including 4,158 women with breast cancer, exercise significantly improved muscular strength, functional exercise capacity, cardiorespiratory fitness, and fat-free mass. However, the benefits differed depending on the phase of cancer care and the specific exercise prescription, such as mode, frequency, intensity, supervision, and duration. The largest improvements occurred with supervised combined aerobic-resistance exercise performed at least three times weekly for at least 12 weeks.\u003c\/p\u003e\n\u003ch3\u003eCan exercise help during active cancer treatment, such as chemotherapy or radiotherapy?\u003c\/h3\u003e\n\u003cp\u003eDuring active treatment, combined exercise significantly improved muscular strength, functional exercise capacity, and cardiorespiratory fitness, but not fat-free mass. This means women undergoing chemotherapy and\/or radiotherapy can expect improvements in strength, functional capacity, and cardiovascular fitness from combined exercise. However, they should not expect to gain fat-free mass during this phase. These findings come from a review of 68 randomized controlled trials including 4,158 women with breast cancer.\u003c\/p\u003e\n\u003ch3\u003eWhat can exercise do after I have finished cancer treatment?\u003c\/h3\u003e\n\u003cp\u003eAfter treatment, exercise significantly enhanced muscular strength, fat-free mass, and functional exercise capacity, with no significant effect on cardiorespiratory fitness. This means women who have completed cancer treatment can expect improvements in strength, fat-free mass, and functional capacity from exercise. However, they should not expect significant improvements in cardiorespiratory fitness during this phase. These findings are based on a review of 68 randomized controlled trials including 4,158 women with breast cancer.\u003c\/p\u003e\n\u003ch3\u003eAre there any limitations to this research that I should know about?\u003c\/h3\u003e\n\u003cp\u003eYes. Most trials (75%) had \"some concerns\" regarding risk of bias, and 25% had a high risk of bias; none had a low risk of bias. Data for exercise before treatment were insufficient, as only two trials evaluated that phase. There was substantial heterogeneity among the trials, and the review only included publications in English, Spanish, and Portuguese. These factors may affect the reliability of the findings.\u003c\/p\u003e\n\u003ch3\u003eI have breast cancer and my exercise plan is just 'stay active' — when should I get a second opinion on what exercise program is right for me?\u003c\/h3\u003e\n\u003cp\u003eA second opinion can help when the exercise advice you receive is generic rather than matched to your phase of care. Exercise improves muscular strength, functional exercise capacity, cardiorespiratory fitness, and fat-free mass, but benefits differ before, during, and after treatment. During active treatment, combined aerobic-resistance exercise improved strength, functional capacity, and cardiorespiratory fitness, but not fat-free mass; after treatment, strength, fat-free mass, and functional capacity improved, but not cardiorespiratory fitness. The largest gains came from supervised combined aerobic-resistance exercise at least three times weekly for 12 weeks or more. Diagnostic Detectives Network provides independent expert second opinions.\u003c\/p\u003e\n\u003c!-- ddn:faq:end --\u003e\n\n\u003ch2 id=\"source\"\u003eSource Information\u003c\/h2\u003e\n\n\u003cp\u003e\u003cstrong\u003eOriginal article title:\u003c\/strong\u003e Which Exercise Prescriptions Improve Physical Fitness in Patients with Breast Cancer Before, During, and Following Treatment? A Systematic Review and Meta-analysis of Randomized Controlled Trials.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthors:\u003c\/strong\u003e Cassaroti VSS, Lopes MR, Palma GHD, Cella PS, Godinho LRLC, Azevedo TG, Nunes JHC, Borges MBS, Deminice R.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003ePublication details:\u003c\/strong\u003e Sports Medicine (2026) 56:1175–1190. https:\/\/doi.org\/10.1007\/s40279-025-02390-4. Accepted: 26 December 2025. Published online: 25 March 2026.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eAuthor affiliations:\u003c\/strong\u003e Department of Physical Education, Faculty of Physical Education and Sport, State University of Londrina, Londrina, Paraná, Brazil; State University of Northern Paraná, Jacarzinho, Paraná, Brazil; State University of Maringa, Maringá, Paraná, Brazil.\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u003c\/strong\u003e Rafael Deminice (rdeminice@uel.br)\u003c\/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRegistration:\u003c\/strong\u003e International Prospective Register of Systematic Reviews (PROSPERO, No. CRD42023411705).\u003c\/p\u003e\n\n\u003cp\u003e\u003cem\u003eThis patient-friendly article is based on peer-reviewed research.\u003c\/em\u003e\u003c\/p\u003e","brand":"DiagnosticDetectives.Com","offers":[{"title":"Default Title","offer_id":47876173070492,"sku":null,"price":0.0,"currency_code":"USD","in_stock":true}],"thumbnail_url":"\/\/cdn.shopify.com\/s\/files\/1\/0599\/5449\/5644\/files\/ddn-medical-article-which-exercise-programs-improve-physical-fitness-in-women-with-breast-cancer-before-during-and-after-treatment-hero.png?v=1793254907","url":"https:\/\/diagnosticdetectives.com\/ja\/products\/which-exercise-programs-improve-physical-fitness-in-women-with-breast-cancer-before-during-and-after-treatment","provider":"DiagnosticDetectives.Com","version":"1.0","type":"link"}