Research table: Physical activity (exercise) and breast cancer survival

This summary table contains detailed information about research studies. Summary tables are a useful way to look at the science behind many breast cancer guidelines and recommendations. However, to get the most out of the tables, it’s important to understand some key concepts. Learn how to read a research table.

Introduction: Regular physical activity (exercise) is linked to a lower risk of breast cancer (see our summary research table on physical activity and breast cancer risk).  

After treatment for breast cancer, being active may be linked to a lower risk of:

• Breast cancer recurrence (a return of breast cancer)
• Breast cancer-specific mortality (death from breast cancer)
• Overall mortality (death from any cause, not necessarily breast cancer)

Regular physical activity has other health benefits for women who’ve had breast cancer. It improves mood, physical condition and movement, which can improve quality of life [1-2].    

Learn more about the strengths and weaknesses of different types of studies. 

Study selection criteria: Prospective cohort studies with at least 900 participants, pooled analyses and meta-analyses.

Table notes: A relative risk above 1 indicates increased risk. A relative risk below 1 indicates decreased risk.

MET (metabolic equivalent) hours are often used as a unit of measure for physical activity. One MET hour equals the energy used to sit quietly for one hour.

Different activities have different MET scores. Moderate activities, like mowing the lawn or slow dancing, range from 3-6 MET hours. Vigorous activities, like playing tennis or jogging, score higher than 6 MET hours. For example, walking is 3 MET hours and swimming is 7 MET hours.

Study	Study Population (number of participants)	Follow-up (years)	Levels of Physical Activity Compared	Breast Cancer-Specific Mortality RR (95% CI)	Overall Mortality RR (95% CI)
Prospective cohort studies
Shanghai Breast Cancer Survival Study [3]	4,829	4	Up to 8 MET hrs/wk vs. Inactive	0.60 (0.46-0.78)*	0.81 (0.63-1.05)
			8 or more MET hrs/wk vs. Inactive	0.59 (0.45-0.76)*	0.65 (0.51-0.84)
Collaborative Women’s Longevity Study [4]	4,482	6	3 to 8 vs. Less than 3 MET hrs/wk	0.65 (0.39-1.08)	0.58 (0.45-0.76)
			8 to 21 vs. Less than 3 MET hrs/wk	0.59 (0.35-1.01)	0.53 (0.40-0.69)
			21 or more vs. Less than 3 MET hrs/wk	0.51 (0.29-0.89)	0.44 (0.32-0.60)
Cancer Prevention Study II – Nutrition Cohort [5]	3,689	13	18 or more vs. 4-9 MET hrs/wk	Among women ages 46-64: 0.49 (0.26-0.95) Among women ages 65 and older: 1.00 (0.66-1.50)	Among women ages 46-64: 0.56 (0.37-0.83) Among women ages 65 and older: 0.74 (0.61-0.90)
Nurses’ Health Study [6]	2,987	8	3 to 9 vs. Less than 3 MET hrs/wk	0.80 (0.60-1.06)	0.71 (0.56-0.89)
			9 to 15 vs. Less than 3 MET hrs/wk	0.50 (0.31-0.82)†	0.59 (0.41-0.84)
			15 to 24 vs. Less than 3 MET hrs/wk	0.56 (0.38-0.84)†	0.56 (0.41-0.77)
			15 to 24 vs. Less than 3 MET hrs/wk	0.56 (0.38-0.84)†	0.56 (0.41-0.77)
			24 or more vs. Less than 3 MET hrs/wk	0.60 (0.40-0.89)	0.60 (0.40-0.89)
Women’s Health Initiative Observational Study [7]	2,910	3	Up to 3 MET hrs/wk vs. Inactive	0.30 (0.09-0.99)	0.42 (0.21-0.82)
			3 to 9 MET hrs/wk vs. Inactive	0.77 (0.43-1.38)	0.72 (0.48-1.07)
			9 or more MET hrs/wk vs. Inactive	0.61 (0.35-0.99)	0.54 (0.38-0.79)
Women’s Healthy Eating and Living (WHEL) Study [8]	2,361	7	25 or more vs. Less than 3 MET hrs/wk		0.47 (0.26-0.84)
Mammary Carcinoma Risk Factor Investigation (MARIE) study [9]	2,042	6	At least 8 MET hrs/wk vs. Inactive	0.64 (0.46-0.89)	0.73 (0.57-0.93)
Life After Cancer Epidemiology Study [10]	1,970	7	29 to 44 vs. Less than 29 MET hrs/wk	1.01 (0.57-1.78)	0.89 (0.59-1.33)
Long Island Breast Cancer Study [11]	1,423	13	More than 9 MET hrs/wk vs. Inactive	0.27 (0.15-0.46)	0.33 (0.22-0.48)
Diet, Cancer, and Health Study [12]	959	4	More than 8 vs. 8 or fewer MET hrs/wk		0.68 (0.47-0.99)
Health, Eating, Activity and Lifestyle Study [13]	933	6	Up to 9 MET hrs/wk vs. Inactive	0.72 (0.28-1.85)	0.36 (0.17-0.73)
			9 or more MET hrs/wk vs. Inactive	0.65 (0.23-1.87)	0.33 (0.15-0.73)
Pooled and meta-analyses
Lee [14]	12 studies		300-500 vs. Less than 300 minutes of activity/wk	0.72 (0.62-0.83)	0.74 (0.66-0.83)
			More than 500 vs. Less than 300 minutes of activity/wk	0.71 (0.64-0.78)	0.61 (0.56-0.66)
Spei et al. [15]	8 studies		Most active vs. Least active		0.58 (0.45-0.75)
	5 studies		Most active vs. Least active	0.60 (0.36-0.99)
After Breast Cancer Pooling Project [16-17]	13,302 (4 studies)		10 or more vs. Less than 10 MET hrs/wk	0.75 (0.65-0.85)	0.73 (0.66-0.82)
Lahart et al. [18]	7 studies		Most active vs. Least active	0.59 (0.45-0.78)	0.52 (0.43-0.64)
Schmid and Leitzmann [19]	4 studies		Active vs. Inactive	0.72 (0.60-0.85)	0.52 (0.42-0.64)
Ibrahim and Al-Homaidh [20]	4 studies		Active vs. Inactive	0.66 (0.57-0.77)†	0.59 (0.53-0.65)

Sig = Statistically significant trend of increasing survival with increasing levels of activity

* Results combined the risk of breast cancer recurrence and breast cancer-specific mortality.

† Results also showed significant decreases in breast cancer recurrence.

References 

1. Mutrie N, Campbell AM, Whyte F, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ. 334(7592):517, 2007.
2. Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast cancer. J Clin Oncol. 25(13):1713-21, 2007.
3. Chen X, Lu W, Zheng W, et al. Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila). 4(9):1409-18, 2011.
4. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 17(2):379-86, 2008.
5. Maliniak ML, Patel AV, McCullough ML, et al. Obesity, physical activity, and breast cancer survival among older breast cancer survivors in the Cancer Prevention Study-II Nutrition Cohort. Breast Cancer Res Treat. 167(1):133-145, 2018.
6. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 293(20):2479-86, 2005.
7. Irwin ML, McTiernan A, Manson JE, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the Women’s Health Initiative. Cancer Prev Res (Phila). 4(4):522-9, 2011.
8. Bertram LA, Stefanick ML, Saquib N, et al. Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study. Cancer Causes Control. 22(3):427-35, 2011.
9. Jung AY, Behrens S, Schmidt M, et al. Pre- to postdiagnosis leisure-time physical activity and prognosis in postmenopausal breast cancer survivors. Breast Cancer Res. 21(1):117, 2019.
10. Sternfeld B, Weltzien E, Quesenberry CP Jr, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 18(1):87-95, 2009.
11. Bradshaw PT, Ibrahim JG, Khankari N, et al. Post-diagnosis physical activity and survival after breast cancer diagnosis: the Long Island Breast Cancer Study. Breast Cancer Res Treat. 145(3):735-42, 2014.
12. Ammitzbøll G, Søgaard K, Karlsen RV, et al. Physical activity and survival in breast cancer. Eur J Cancer. 66:67-74, 2016.
13. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 26(24):3958-64, 2008.
14. Lee J. A meta-analysis of the association between physical activity and breast cancer mortality. Cancer Nurs. 42(4):271-285, 2019.
15. Spei ME, Samoli E, Bravi F, La Vecchia C, Bamia C, Benetou V. Physical activity in breast cancer survivors: A systematic review and meta-analysis on overall and breast cancer survival. Breast. 44:144-152, 2019.
16. Beasley JM, Kwan ML, Chen WY, et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 131(2):637-43, 2012.
17. Nechuta S, Chen WY, Cai H, et al. A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Int J Cancer. 138(9):2088-97, 2016.
18. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: A systematic review and meta-analysis of epidemiological studies. Acta Oncol. 54(5):635-54, 2015.
19. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: a systematic review and meta-analysis. Ann Oncol. 25(7):1293-311, 2014. 
20. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 28(3):753-65, 2011. 

Updated 03/15/21