Medical recommendations for balanced control of exercise, physical activity, and nutritional intake after breast cancer diagnosis remain unclear. Therefore, this review aims to summarize effective exercise methods and dietary opinions by reviewing clinical trial results.
We systematically reviewed studies that evaluated 1) the relationship between exercise methods and quality of life improvement in patients with breast cancer and 2) the recommendations for physical activity, exercise, nutrition, and potential ways to improve life after breast cancer. To conduct this literature review, we searched the PubMed database for articles published until October 1, 2022, using the terms “physical activity OR exercise,” “breast cancer,” and “nutrition.” After a primary review of the retrieved articles, we included clinical trials in this systematic review.
We hypothesized that physical activity improves the quality of life after the onset of breast cancer, suggesting that a balanced approach to aerobic exercise and resistance exercise increases the efficacy of anticancer treatment. From a nutritional point of view, it is recommended that both physical activity and diet management are necessary for patients with breast cancer.
Customized exercise and diet can help with weight loss, the reduction of cancer-induced fatigue, the regulation of hormonal changes, the reduction of inflammatory factors, and the improvement of mental health and vitality. Understanding the integrated mechanisms of physical activity and nutritional balance will improve the quality of life of patients with breast cancer. Therefore, it is necessary to continuously advance exercise programs and develop an alimentary balance control program.
Breast cancer ranks first among malignancies in women worldwide (one out of every 25 women). The causes of breast cancer can be attributed to mutations in tumor suppressor factors as well as epigenetic variables in the pathogenesis of breast cancer. In most cases, radiation therapy, chemotherapy, anticancer endocrine therapy, and targeted therapy are administered as adjuvant therapies after primary surgery to prevent the recurrence of breast cancer.
Exercise and physical activity have the advantage of presenting various benefits. Evidence suggests that exercise is associated with a longer health span and delays the onset of around 40 chronic conditions or diseases [
Epidemiological studies on the relationship between physical activity and cancer progression in recent years have suggested a reduction in the risk of cancer and its associated mortality rate [
Exercise not only activates physiological activity in the body but also influences homeostasis [
This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines [
The literature search for this systematic review was conducted using three databases (PubMed) from the start of the study until October 1, 2022. This search used the following keywords in free text and medical subject headings (MeSH): “physical activity,” “breast cancer,” and “nutrition.” After a primary review of the retrieved articles, we included clinical trials in this systematic review. For this review, limits were applied to include only human studies, those conducted in English, and those conducted in patients with breast cancer. The search results were exported from the database in the “*.enl” format so that they could be included in a specific library in the reference manager, Endnote version X8 (Thomson Reuters, New York, USA).
The titles and abstracts of all retrieved publications were imported into EndNote, and duplicate and triplicate studies were excluded. When the available information on the titles and abstracts was insufficient, the full-text articles were read. The inclusion criteria were: (1) interventional studies; (2) randomized controlled trials; (3) studies on individuals with breast cancer or physical activity; and (4) studies with quality of life data as outcomes. The exclusion criteria were: (1) papers that had not undergone peer reviews, such as monographs and conference proceedings; (2) articles written in languages other than English; (3) papers that did not provide original text; (4) papers not focusing on humans; and (5) studies conducted using qualitative research methods.
The titles and abstracts were assessed for full-text retrieval. The full-text articles were assessed by two independent reviewers (PMY and CNN) by considering the inclusion and exclusion criteria to allow for adequate data extraction. The following data was extracted: type of intervention, classification of participants, sample size, and primary results. The study selection process is illustrated in
Patients with breast cancer inevitably receive adjuvant chemotherapy to reduce their risk of metastasis. These patients may have weakened immune function because of chemotherapy; therefore, it is reasonable to provide them with proper nutrition to enhance immunity. According to the cancer management guidelines, it is recommended to continuously manage weight and intervene when changes in abdominal fat threaten health. A diminished amount of food significantly regulates body weight, abdominal fat, and visceral fat in patients with breast cancer [
Frequent physical impairments occur in patients with breast cancer after surgery, including but not limited to frozen shoulder, impinging shoulder syndrome, and lymphedema [
The effectiveness of aerobic exercise on patients with breast cancer has been confirmed in one study, primarily in those with premenopausal breast cancer [
The effect of resistance exercise on patients with breast cancer was confirmed in three instances. First, the effects of resistance exercise on body composition, muscle strength, lipids, inflammation, and oxidative markers have been investigated in postmenopausal breast cancer survivors who were prescribed tamoxifen [
The effects of resistance and aerobic exercises on shoulder function in women after breast cancer surgery and radiation therapy were evaluated by measuring improved upper extremity isometric strength using the Disabilities of the Arm, Shoulder, and Hand questionnaire and Penn Shoulder Scale scores [
Mijwel et al. reported the effects of high-intensity interval training (HIIT) on pain sensitivity, cancer-related fatigue (CRF), and life expectancy in patients with breast cancer undergoing chemotherapy [
Some types of balloon dancing are aerobic exercises. The effects of light exercise on the quality of life of cancer survivors and their partners have been investigated [
Subsequently, we summarize the effects of diet and exercise on patients with breast cancer. A total of 10 interesting results from our analysis are provided below.
Mefferd et al. analyzed the bioactivity index of 85 breast cancer survivors aged ≥18 years who were diagnosed with stage 1–3A breast cancer, completed early treatment, and had a BMI of 25.0 kg/m² (overweight or obese) [
Buckland et al. studied 37 overweight and obese patients with early-stage breast cancer, aged 18–75 years, with a BMI of ≥25 kg/m2. Increased intake of fiber-rich foods and biweekly 75–minute sessions of physical activity (10 minutes of warm-up, 25 minutes of aerobic exercise up to 70% intensity on static bicycles, 25 minutes of strength training using mats, stability balls, and resistance bands, and 10 minutes of stretching and rest) were performed for 12 weeks [
In a study by Carayol et al., 14 patients with early-stage non-metastatic breast cancer with an average age of 52 ± 10 years were treated with diet and exercise for 26 weeks [
Breast cancer is the most common invasive cancer among women in developed countries; however, its survival rate is increasing with advances in medical technology [
Previous studies have shown that the causes of breast cancer are closely related to hormones [
Clinical trials in breast cancer survivors have provided evidence for the importance of exercise and nutritional balance [
In conclusion, the Mediterranean diet and moderate-intensity exercise have beneficial effects such as weight loss, reduction of CRF, hormonal changes, regulatory roles, reduced inflammatory factors, and increased mental health and vitality. Therefore, physical activity and nutritional balance can improve the quality of life of patients with breast cancer. Future research should focus on developing patient-specific exercise programs and applying them to food balance programs.
This paper was supported by the KU Research Professor Program of Konkuk University.
PRISMA Flowchart.
The PRISMA flow diagram for the systematic review detailing the database searches, the number of abstracts screened, and the full texts retrieved.
PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Effects of physical activity and nutrition on quality of life and survival rate prediction in patients with breast cancer.
Effects of food and diet on physiological activity in patients with breast cancer.
Diet / Food | Decreased factors | Increased factors | References |
---|---|---|---|
Mediterranean diet | HDL-cholesterol, body weight, body fat mass, n-6 fatty acid, waist circumference, fasting glucose, insulin resistance | Vitamin C levels, glucose polyunsaturated fatty acids n-9 Fatty acid | [ |
Green tea | Body weight | HDL, glucose homeostasis | [ |
Vitamin D | LDL-C | Muscle mass | [ |
HDL, high-density lipoprotein; LDL-C, low-density lipoprotein cholesterol.
Effects of exercise on physiological activity in patients with breast cancer.
Types of exercise | Exercise period | Clinical trial participants | Efficacy | References |
---|---|---|---|---|
Aerobic training | 5 times a week for 16 weeks | Patients with premenopausal breast cancer (n = 966) | Increased of estrogen metabolites (2-OHE1/16α-OHE1) and lean body mass | [ |
Decreased the fat mass and body fat | ||||
Resistance training | 3 time a week for 12 weeks | Patients with postmenopausal breast cancer (n = 14) | Decreased the fat mass, triglycerides, total cholesterol, IL-6, IL-17, TBARS, SOD activity, and catalase activity | [ |
Increased free-fat mass and HDL-cholesterol | ||||
3 times a week for 16 weeks | Patients with breast cancer (n = 39) | Decreased the NK T-cell expression of TNF-α and NK cell expression of TNF-α | [ |
|
3 times a week for 16 weeks | Patients with breast cancer (n = 39) | Improved fatigue and quality of life | [ |
|
Aerobic and resistance training | 3 times a week for 16 months | Patients with breast cancer (n = 100) | Increased in shoulder active range of motion | [ |
2 times a week for 16 months | Patients with breast cancer (n = 100) | Improved fatigue, depression, muscular strength, osteocalcin, and BSAP | [ |
|
For 12 weeks | Patients with breast lymph- oedema (n = 88) | No exacerbations of lymphoedema | [ |
|
2 times a week for 18 weeks | Patients with breast cancer (n = 204) | Positive effects on physical fatigue, cardiorespiratory function, and muscle strength | [ |
|
2 times a week for 16 months | Patients with obese breast cancer (n = 100) | Decreased Framingham Risk Score, systolic blood pressure, LDL-cholesterol, diabetes presence | [ |
|
High-intensity exercise (VO2 peak: 75–80%) | Maintaining exercise habits | [ |
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Improved quality of life | ||||
High-Intensity interval training | For 16 weeks | Patients with breast cancer (n = 206) | Improved muscle strength and reduced pain sensitivity | [ |
Prevented the decline in cardiorespiratory fitness | ||||
For 16 weeks | Patients with breast cancer (n = 206) | Decreased cancer-related fatigue and pain sensitivity | [ |
|
Dance lessons | Ballroom dance for 12 weeks (at least 5 METs) | Patients with breast cancer (n = 31) | Improved physical activity, mental component of quality of life | [ |
Partners of patients with breast cancer (n = 31) |
HDL, high-density lipoprotein; LDL, low-density lipoprotein, MET, metabolic events; VO2, maximal oxygen consumption; BSAP, B-cell-specific activator protein; NK, natural killer; TNF, tumor necrosis factor; SOD, superoxide dismutase; TBARS, thiobarbituric acid reactive substances; 2-OHE1/16α-OHE1, 2-hydroxyestrone to 16α-hydroxyestrone.
A summary of the effects of combining exercise and diet on various clinical trial participants.
Condition |
Clinical trial participants | Efficacy | References | |
---|---|---|---|---|
Exercise | Diet | |||
Physical activity (1 hour/day for 16 weeks) | Low-calorie diet (500–1000 kcal) | Overweight or obese breast cancer survivors (n = 85) | Decreased the weight, body mass index, percent fat, trunk fat, leg fat, waist, and hip circumference | [ |
Muscle-strengthening exercises (2–3/weeks for 16 weeks) | ||||
Physical activity (75 minutes, biweekly for 12 weeks) | 1200–1500 kcal | Overweight or obese breast cancer survivors (n = 112) | Decreased the body mass, fat mass, and waist circumference | [ |
Increased quality of life and cardiorespiratory fitness | ||||
Physical activity (75 minutes, biweekly for 12 weeks) | Low-calorie diet (vegetables, fish, and fiber-rich foods) | Overweight or obese breast cancer survivors (n = 112) | Decreased percentage of saturated fatty acids and n-6 polyunsaturated fatty acids, and ratio of long-chain n-6 to n-3 polyunsaturated fatty acids | [ |
Increased the monounsaturated fatty acids and total and long-chain n-3 polyunsaturated fatty acids | ||||
Resistance and aerobic exercise | Low-calorie diet | Patients with breast cancer (n = 38) | Reduced the waist circumference | [ |
Improved the self-reported vitality scores | ||||
Physical activity (for 12 months) | Mediterranean diet | Patients with breast cancer (n = 227) | Increased physical role and social functioning, body image, future perspective, and well-being | [ |
Reduced the fatigue, nausea and vomiting, dyspnea, and constipation | ||||
Resistance and aerobic exercise (3 times per week for 26 weeks) | Lipids (30–35%), carbohydrates (50–55%), proteins (5%) | Patients with breast cancer (n = 14) | Positive changes in a range of psychological, physiological, and behavioral outcomes | [ |
Improved fatigue and quality of life | ||||
Physical activity (3 times per week for 10 weeks) | High proteins, vitamins, fiber and high energy diet | Patients with breast cancer treated with systemic adjuvant endocrine drug therapy | Improved depression, sleep quality, cancer-induced fatigue, and life quality | [ |
Resistance and aerobic exercise (3 times per week for 24 weeks) | low-calorie diet | Patients with breast cancer (n = 85) | Reduced the depressive symptoms | [ |
Normalization of HPA axis regulation |
HPA, hypothalamic-pituitary-adrenal; IL, interleukin.