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Supervised Exercise Program Enhances Quality of Life and Fitness in Patients With Metastatic Breast Cancer

January 2024, Vol 14, No 1

San Antonio—A 9-month twice weekly structured exercise program improved measures of fatigue and quality of life among patients with metastatic breast cancer, according to a randomized controlled trial presented by Anne M. May, PhD, professor, Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands, at the 2023 San Antonio Breast Cancer Symposium.

At 6-month follow-up, patients assigned to the exercise intervention reported significantly better scores on important European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-30) subscales compared with those who did not undergo supervised exercise, including an increase in social functioning, a decrease in pain, and a decrease in shortness of breath, said Dr May. Based on the findings, “we recommend adding supervised exercise as part of supportive care regimens during palliative treatment, and actually, I think that we should consider exercise as being part of the treatment that all patients with metastatic cancer receive,” said Dr May.

In 2022, ASCO published a guideline noting the convincing evidence that an exercise regimen in patients with cancer leads to improvements in cardiovascular fitness, strength, fatigue, and other patient-reported outcomes, and therefore recommended that oncology providers advise patients to incorporate regular aerobic and resistance exercise sessions during treatment with curative intent.1 Dr May noted some gaps in the literature, however. “One of the gaps was that there were no studies in the metastatic setting, so we could not publish a guideline on how patients should exercise during their metastatic disease,” she said.

This gap led to the launch of the current study, known as the PREFERABLE-EFFECT trial, which was conducted at 8 centers in 5 European countries and Australia. A total of 357 patients with stage IV breast cancer and an estimated life expectancy ≥6 months were enrolled. All participants received a physical activity tracker and generic exercise advice; 178 patients were randomly assigned to 9 months of twice-weekly exercise sessions supervised by a physical therapist or exercise professional; the sessions involved balance, resistance, and aerobic exercises. The exercise types were interval training at moderate to high intensity and strength training.

At enrollment, baseline fitness was assessed and patients completed the EORTC-QLQ-30 questionnaire to assess physical, mental, emotional, and financial quality of life. In addition, the EORTC-FA12 questionnaire was used to assess multidimensional fatigue among the participants. After 6 months, 1 supervised exercise session was replaced by an unsupervised session. The quality of life and fatigue measures were repeated at 3, 6, and 9 months.

The mean age of patients at baseline was approximately 55 years, approximately two-thirds had recurrent disease, and approximately three-fourths were on either their first or second treatment for metastatic disease. Most patients were undergoing endocrine therapy, and approximately 65% to 70% in the 2 arms had bone metastases.

At 6 months, patients assigned to the exercise intervention reported significantly better scores on several EORTC-QLQ-30 subscales compared with those in the control arm, including a 7.1-point decrease in pain and a 7.6-point decrease in shortness of breath.

“Adherence to this intervention was good,” said Dr May. “Patients were able to attend a median of 77% of our sessions.” Reasons for nonattendance were disease-related factors, as expected, and the drop-out rate was 18% at 6 months. Half of the dropouts were due to death.

“What we did not find were effects on emotional functioning and emotional fatigue,” she said, which will necessitate additional intervention if patients have these complaints before starting the exercise regimen, she added.


  1. Ligibel JA, Bohlke K, May AM, et al. Exercise, diet, and weight management during cancer treatment: ASCO Guideline. J Clin Oncol. 2022;40(22):2491-2507.

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