Most breast cancer patients don't get enough exercise

It’s hard enough motivating yourself to go for a walk or hit the gym after a long day’s work. But what if your day consists of eight hours on the job plus an oncology appointment or blast of radiation?

A new study published in CANCER, a peer-reviewed journal of the American Cancer Society, highlights an ongoing predicament among breast cancer patients. Research indicates that exercise after diagnosis is linked with prolonged survival and improved quality of life. Yet many breast cancer patients are not meeting national guidelines for physical activity.

The study, conducted at the University of North Carolina at Chapel Hill, gleaned pre- and post-diagnosis activity levels from 1,735 women aged 20 to 74 years old, all of whom had been diagnosed with invasive breast cancer between 2008 and 2011. Almost half the participants – 48 percent – were black, an unusual and data-rich sample.

Overall, about 65 percent of the women studied failed to meet national recommendations for physical activity levels six months after they were diagnosed.

The U.S. Department of Health and Human Services and the American Cancer Society recommend 2.5 hours of moderate intensity exercise (think brisk walking, vacuuming or gardening) or 1.25 hours of vigorous intensity activity (think running or heavy yard work)  each week for general health benefit s and chronic disease prevention and management.

African American women reported lower amounts of both pre-diagnosis and post-diagnosis activity, according to the study, which concluded that though “breast cancer advocates are actively promoting the message that physical activity post-diagnosis improves quality of life and survival … it’s clear that more work needs to be done to translate evidence into practice, especially among African American women.”

The case for exercise

Fred Hutch researcher Dr. Anne McTiernan, who studies the relationship between exercise, weight loss and cancer prevention, said she and her team have produced similar results, including a 2013 study that found 10 years after a diagnosis, breast cancer survivors are still not meeting national exercise recommendations. 

“Women with breast cancer significantly decrease their levels of physical activity after diagnosis and as a result, few are meeting even the minimum standards set by the Surgeon General,” she said, adding that Fred Hutch and other research centers have found associations between increased levels of activity and better survival in women with breast cancer.  

A 2011 meta-analysis of published studies regarding physical activity and survival after breast cancer found the mortality rate dropped by 34 percent for women who were very active when compared to women who weren’t. And another 2012 systematic review conducted by Fred Hutch and the National Cancer Institute found that 27 out of 45 observational studies showed consistent evidence that “physical activity is associated with reduced all-cause, breast cancer-specific and colon cancer-specific mortality.” 

Barriers to exercise

Considering the data that’s available, why aren’t breast cancer survivors exercising more?

McTiernan points to a slew of reasons. For one, they may be too fatigued or in too much pain, especially if they’re still in active treatment, like the majority of women in the UNC study. And treatment – not to mention all those doctor appointments – can eat up a lot of time.

“One problem is that life-saving treatments like surgery, radiation and chemotherapy are very time-consuming,” she said. “It can require many visits to a hospital or clinic and that’s time away from a woman’s family responsibilities, her work and her potential free time. Many women need to work after their diagnosis and those with family responsibilities continue to need time for those. So the thing to go is recreation time, including time for physical activity.”

African-American women can experience those same barriers and more, said Bridgette Hempstead, a breast cancer survivor and founder of Cierra Sisters, Inc., an African-American breast cancer survivor support group. 

“In our group, we’re trying to be more proactive and encourage each other to get out and walk together, but it can be very hard if you don’t have the money and resources,” she said.

“Some women may not have enough to buy a pair of proper shoes for walking or maybe there’s a community center nearby but they don’t have the funds to access it. You might say, ‘Well, go walk in your neighborhood’ but some neighborhoods have shootings. They’re not as safe. You may have women trying to hold onto their jobs and trying to feed their families, women who are alone because their relationship broke up after their cancer diagnosis. There are so many stressors going on – having an exercise program, even one that may save their life, is not a priority.”

And Hempstead said exercise isn’t the only thing that can fall to the bottom of the priority pile.

“A lot of women don’t even finish treatment,” she said. “They have to go to work so they don’t lose their jobs.”

In a recently published Racial Disparity in Breast Cancer Mortality Study, black women were, overall, 40 percent more likely to die of breast cancer than white women. This disparity is due to a confluence of factors, according to Fred Hutch researchers, some genetic and some socioeconomic. Black women are more likely to be diagnosed with a type of breast cancer that resists current drugs like tamoxifen. They also have lower breast cancer screening rates and higher rates of obesity, which increases cancer risk. Lower levels of education and income also limit access to health care.

McTiernan said African-American women are also more likely to be diagnosed at a younger age – when they may have family responsibilities that demand their time -- and are more likely to be diagnosed at a more advanced stage.

“That means they’re more likely to require radiation and chemotherapy,” she said. “And many are also lower-income, so need to continue to work.”

In addition, some women aren’t even aware that exercise can be a boon.

According to UNC study, “many participants did not receive physical activity guidelines from their health care providers,” something that resonated with Hempstead.

“I can tell you that some doctors in this area aren’t talking to [the women in my support group] about being proactive about their diet and about exercise,” she said. “This information is not being shared.”

Make a move

Exercise programs are becoming available to cancer survivors more and more. Exercise and Thrive, a partnership between Fred Hutch, Seattle Cancer Care Alliance and the YMCA, offers free twice-weekly strength-and-fitness classes at several Puget Sound YMCA locations. Team Survivor Northwest also encourages women in all stages of cancer treatment and recovery to lead a more physically active life through a variety of free programs such as walking, running, biking, paddling, snowshoeing and hiking. 

Prioritizing exercise can be a challenge – especially for someone who’s gone through mastectomy, chemotherapy, radiation and hormone treatment – but McTiernan said even small steps can make a difference.

“Survivors may want to add in movement where they can,” she said. “Try not to sit down all day, try to get up and walk around a little at work or during your lunch breaks. And ask your doctor or clinic for recommendations for an exercise program for cancer survivors. These programs tend to have a good experience with helping people through fatigue and discomfort.”

And while there are no guarantees that regular workouts will keep the cancer beast forever at bay, there are proven pluses.

“Studies have shown that regular exercise programs increase survivors’ quality of life and fitness and reduce fatigue,” she said. “Chances are a woman will feel better if she can increase and maintain her level of activity.”

Tips for making exercise part of your day:

• Take a 10-minute walk break at work rather than a snack break. 
• Walk to talk with a co-worker instead of emailing. 
• Make TV time an active time. Do some core/back/leg exercises like crunches or squats, or get an exercise machine like a stationary bike and use that while watching TV. 
• Be active with your kids – if you’re watching their soccer game, walk around the field as you watch. 
• Take active/walking vacations instead of driving ones. 
• Use stairs instead of elevators. 
• Schedule in time for exercise like you do other appointments. 
• Go for a walk with a friend instead of getting coffee or beer.

Exercise tips for cancer survivors:

• Take classes with other survivors. Many gyms or hospitals or YMCAs offer these. 
• Start walking with your spouse or friend. Start slow and advance slowly. 
• Many survivors do well with strength training programs, which have been shown to improve strength and fitness. Strength training has been shown to be safe for breast cancer survivors – it doesn’t cause or worsen arm lymphedema. 
• Some patients have reduced ability to fight infections during treatments, so for them, exercising at home or outdoors might be preferable to using a gym.

Solid tumors, such as those of the breast, are the focus of Solid Tumor Translational Research, a network comprised of Fred Hutchinson Cancer Research Center, UW Medicine and Seattle Cancer Care Alliance. STTR is bridging laboratory sciences and patient care to provide the most precise treatment options for patients with solid tumor cancers.

Diane Mapes is a staff writer at Fred Hutchinson Cancer Research Center. She has also written extensively about health issues for nbcnews.com, TODAY.com, CNN.com, MSN.com, Columns and several other publications. She also writes the breast cancer blog,  doublewhammied.com .Reach her at dmapes@fredhutch.org .