Four Years Posttreatment, Exercise Improves Physical Activity Levels, Reduces Fatigue in Patients With Breast and Colon Cancers

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IN PATIENTS WITH breast and colon cancers, a physical exercise intervention conducted during adjuvant chemotherapy improved total physical activity levels 4 years after treatment, with a trend toward less fatigue, according to a follow-up study from the randomized multicenter PACT study, presented by Anne May, PhD, at the Cancer Survivorship Symposium in Orlando.1 

“Offering exercise during cancer treatment, including chemotherapy, is recommended and has beneficial short- and long-term health effects.”
— Anne May, PhD

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At 4-year follow-up, patients who participated in the 18-week exercise program engaged in physical activity an average of 20 minutes more per day than those who received usual care. 

“This is important, because we know from observational studies that regular physical activity levels after a diagnosis of breast or colon cancer are associated with better prognosis,” said Dr. May, Associate Professor of Epidemiology at the University Medical Center in Utrecht, the Netherlands. 

About the Study 

CANCER-RELATED FATIGUE can be one of the most distressing side effects of cancer treatment and often persists many years after treatment is over. The PACT study sought to determine the benefits of an 18-week supervised exercise program on fatigue and physical fitness among patients with stage I to III breast or colon cancer undergoing chemotherapy after surgery. About 70% of patients in the study also received radiation therapy. 

The positive short-term effects of the exercise intervention on fatigue were previously reported, but in this follow-up study, the team sought to determine whether the intervention would prevent patients from developing severe fatigue 4 years after treatment. They also assessed whether patients were able to maintain the level of activity demonstrated during the study period. 


  • Four years after treatment, patients with breast or colon cancer who participated in an exercise program during adjuvant chemotherapy had increased physical activity levels compared to those who received usual care.
  • Since regular physical activity is associated with better prognosis in this population, the investigators recommend regular exercise during cancer treatment.

The intervention involved 60 minutes of combined moderate- to high-intensity aerobic and strength training twice a week, supervised by a physical therapist, in addition to 30 minutes of home-based physical activity 3 days per week. The program also included cognitive behavioral elements aimed at increasing patients’ confidence to be—and stay—physically active, even after the intervention was over. 

The majority of the study population was female, with a mean age of 50. Fatigue and physical activity levels were assessed using the Multidimensional Fatigue Inventory and the Short Questionnaire to Assess Health-Enhancing Physical Activity. Of 237 patients with breast and colon cancers at baseline, 197 were eligible and 128 (110 with breast cancer and 18 with colon cancer) consented to 4-year follow-up. Seventy participated in the exercise intervention, and 58 received usual care. 

Intervention Group More Active 4 Years Later 

COMPARED TO USUAL care, the exercise intervention cohort reported higher physical activity levels at 4-year follow-up. On average, patients in the exercise group reported 90 minutes a day of moderate-to-vigorous physical activity, compared to 70 minutes in the usual care group. A trend toward less fatigue was also observed in the intervention group but did not reach statistical significance. 

“The exercise program was designed to keep patients physically active long-term, so we’re really pleased to see that even 4 years later, people who received the intervention were still more active,” said Dr. May. “Offering exercise during cancer treatment, including chemotherapy, is recommended and has beneficial short- and long-term health effects.” 

By combining data with the PACES study—also conducted in the Netherlands—the PACT investigators plan to next explore whether exercise during chemotherapy is protective against cardiovascular disease risk in women who have been treated for breast cancer. ■

DISCLOSURE: Dr. May reported no conflicts of interest. 


1. May A, Hiensch AE, Witlox L, et al: Four-year effects of physical exercise during adjuvant treatment on fatigue and physical activity in breast and colon cancer patients. 2018 Cancer Survivorship Symposium. Abstract 99. Presented February 16, 2018.

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