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A recent trial examined whether exercise could improve quality of life among people with metastatic breast cancer. filadendron/Getty Images
  • A recent trial led by researchers in the Netherlands examined whether exercise has benefits in people with metastatic breast cancer.
  • Metastatic breast cancer begins as breast cancer but spreads to other areas of the body.
  • Since metastatic breast cancer and treatments for it cause a number of side effects, researchers are exploring how to improve patients’ quality of life.
  • By the end of the 9-month trial, people with metastatic breast cancer who followed a regular exercise regimen experienced reduced fatigue and pain.

Researchers from Europe and Australia collaborated to carry out the PREFERABLE-EFFECT trial, which focused on the potential benefits of exercise in people with metastatic breast cancer.

Since metastatic breast cancer often causes a reduction in a person’s quality of life, the researchers wanted to see to what degree a regular exercise regimen could improve symptoms.

The researchers recruited more than 300 participants for the trial and divided them into exercise and control groups.

The study’s principal investigator, Prof. Anne May, PhD, of the University Medical Center Utrecht Julius Center in the Netherlands, will present the findings at the San Antonio Breast Cancer Symposium. The research findings have not yet been published in a peer-reviewed journal.

The scientists recruited the participants from various medical institutions in countries such as the Netherlands, Sweden, Australia, and Spain.

The trial enrolled 357 participants with metastatic breast cancer, and according to Prof. May, they only included participants with a life expectancy of at least 6months.

The scientists excluded people who had uncontrolled severe pain, currently participated in an intense exercise program, or had “unstable bone metastases.”

The researchers divided the women into two groups: the exercise and control groups. The people in the exercise group participated in an exercise program twice per week.

Prof. May told Medical News Today the exercise program had three parts that participants completed each session:

  • moderate and high intensity interval aerobic training
  • resistance exercise of all large upper and lower body muscles
  • balance training

Each exercise session lasted 1 hour, and Prof. May said a physiotherapist or an exercise professional supervised the program.

“In the first 6 months, the participants had two supervised sessions per week, and in the last 3 months, one supervised session was replaced with one unsupervised session,” Prof. May said.

The scientists also administered questionnaires to the participants to assess their fatigue levels, emotional state, and pain levels.

By the end of the study, the people in the exercise group experienced an improvement in their quality of life compared to the participants in the control group.

The questionnaire results showed that the participants in the exercise group reported lower levels of fatigue when questioned at the 3-month, 6-month, and 9-month mark.

The exercise group also experienced decreased shortness of breath compared to the control group beginning at 6 months. Shortness of breath is a common side effect people with metastatic breast cancer experience.

Not only did the exercise group experience an improvement in physical symptoms, but they also saw improvements in social functioning.

“We are excited about the results of our study because these are an important addition to current ASCO and ACSM guidelines that recommend exercise during curative treatment. Importantly, some patients with [metastatic breast cancer] worry exercise might worsen their fatigue and pain, but this study shows that exercise can actually improve these outcomes.”

— Prof. Anne May, principal investigator

Prof. May said she “would recommend the intervention to all patients with metastatic breast cancer (mBC) with a performance score of 2 or lower and with stable bone metastases.”

She added that patients should talk with their healthcare professional first and find an exercise trainer with experience in working with people with metastatic breast cancer.

Rebecca Crane-Okada, PhD, RN, advanced oncology certified nurse and director of the Cancer Navigation and Willow Sage Wellness Programs at the Margie Petersen Breast Center at Providence Saint John’s Health Center in Santa Monica, CA, spoke with MNT about the trial.

Crane-Okada said she was not surprised by the trial results and called them “encouraging.” She was not involved in the research.

“Our past views on metastasis being a potential contraindication to exercise are gradually changing as the evidence, and our breast cancer survivors inform us of the benefits of exercise on quality of life,” Crane-Okada said.

She emphasized the importance of “open dialogue” between patients with breast cancer and their doctors to figure out what is working best in terms of methods to reduce symptoms.

“This has to be tailored to the individual and their treatment in collaboration with the medical team and physical and occupational therapists. The exercise program included in this study (balance, resistance, and aerobic exercises) would be appropriate for most individuals.”

— Rebecca Crane-Okada, PhD, RN, advanced oncology certified nurse

Dr. Bhavana Pathak, a board certified hematologist and medical oncologist at MemorialCare Cancer Institute at Orange Coast and Saddleback Medical Centers in Orange County, CA, also spoke with MNT about the trial. Dr. Pathak was not involved in the research.

“Patients with breast cancer sometimes have more discrete benefits with exercise, such as in the efficacy of yoga in the breast cancer subset, based on studies to date,” Dr. Pathak noted.

“However, more studies are needed, and it can certainly be extrapolated that exercise in general will provide many feel-good effects for quality of life.”

When asked about recommendations for symptom management, Dr. Pathak said, “I encourage patients to engage in mindfulness-based therapies and yoga as tolerated.”

Doctors diagnose approximately 240,000 women in the United States each year with breast cancer.

Breast cancer can also affect men, and around 2,100 males develop this form of cancer each year.

While there are treatments available for breast cancer, and the prognosis can be good if detected early, breast cancer still claims the lives of 42,000 women yearly.

Sometimes breast cancer can spread to other parts of the body, such as the lungs, bones, or even the brain — this is called metastatic breast cancer or stage 4 breast cancer.

Researchers estimate that 20% to 30% of women diagnosed with early-stage breast cancer develop metastatic breast cancer.

People with metastatic breast cancer experience a host of side effects from their disease and treatments that often drastically reduce their quality of life. These may include:

  • fatigue
  • chronic pain
  • behavioral changes

According to the American Cancer Society, metastatic breast cancer is typically incurable, but treatments may be able to keep the cancer from growing. Some treatments include hormone therapy and chemotherapy.