Exercise following breast cancer: exploratory survival analyses of two randomised, controlled trials
The Exercise for Health trials were randomised, controlled trials designed to evaluate an 8-month pragmatic exercise intervention, commencing 6 weeks post-surgery for women with newly diagnosed breast cancer residing in urban or rural/regional Australia. For these exploratory analyses, the primary and secondary outcomes were overall survival (OS) and disease-free survival (DFS), respectively.
Consenting urban- (n = 194) and rural/regional-residing women (n = 143) were randomised to exercise (intervention delivered face-to-face or by telephone) or usual care. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) for survival outcomes (exercise group, n = 207, 65% urban women; usual care group, n = 130, 46% urban women).
After a median follow-up of 8.3 years, there were 11 (5.3%) deaths in the exercise group compared with 15 (11.5%) deaths in the usual care group (OS HR for the exercise group: 0.45, 95% CI 0.20–0.96; p = 0.04). DFS events for the exercise versus usual care group were 25 (12.1%) and 23 (17.7%), respectively (HR: 0.66, 95% CI 0.38–1.17; p = 0.16). HRs for OS favoured exercise irrespective of age, body mass index, stage of disease, intervention compliance, and physical activity levels at 12 months post-diagnosis, although were stronger (p < 0.05) for younger women, women with stage II + disease, women with 1 + comorbidity at time of diagnosis, higher intervention compliance and for those who met national physical activity guidelines at 12 months post-diagnosis.
An exercise intervention delivered during and beyond treatment for breast cancer, and that was designed to cater for all women irrespective of place of residence and access to health services, has clear potential to benefit survival. Trial numbers: ACT RN: 012606000233527; ACT RN: 12609000809235.
KeywordsBreast cancer Exercise Physical activity Morbidity Survival
Study investigators would like to acknowledge and thank those who agreed to participate in the Exercise for Health trials. Their contributions to improving future breast cancer care are significant. Thank you also to the breast care nurses, exercise physiologists and research staff, in particular Sheree Rye and Tracey DiSipio, for their efforts in study recruitment, implementation and analysis, and to Emeritus Professor Beth Newman, who has provided invaluable review of this manuscript and mentorship throughout all phases of these trials.
The EfH urban and rural/regional trials were supported by two National Breast Cancer Foundation (NBCF) project grants. During the conduct of the EfH trials, SH and EE were supported by NBCF and National Health and Medical Research Council (NHMRC) research fellowships, respectively. SH is currently supported by a Cancer Council Queensland Fellowship.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Informed consent was obtained from all individual participants included in the study.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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