Physical Activity and All-Cause Mortality Among Postmenopausal Breast Cancer Survivors

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In a cohort study reported in JAMA Network Open, Chen et al found that postmenopausal breast cancer survivors with exercise patterns categorized as active or moderately active had significantly reduced risk for all-cause mortality compared to those with patterns categorized as insufficiently active.

Study Details

The study included 315 women who were members of the Kaiser Permanente Southern California health-care plan and who were initially diagnosed with stage 0 to II breast cancer between 1996 and 2012. Baseline interviews for the study were conducted between August 2013 and March 2015, and patients were followed until the date of their death or the end of the study (April 2022).

Leisure time physical activity and fatigue were ascertained during the baseline interview using the Godin-Shephard Leisure-Time Physical Activity Questionnaire (GSLTPAQ) and the Fatigue Severity Inventory. Data from the GSLTPAQ were used to provide composite physical activity scores that categorized patients as active, moderately active, or insufficiently active at baseline.

Key Findings

The mean age at baseline interview was 71 years (range = 57–86 years). Of the 315 women, 20.9% were Black, 8.9% were Asian/Pacific Islander, 1.3% were Hispanic, and 68.9% were non-Hispanic White.

Maximum follow-up from baseline interview was 8.7 years, with a median follow-up of 7.8 years (interquartile range = 7.3–8.3 years). Overall, 45 patients (14.3%) died from any cause, with 5 dying from breast cancer.

Overall, there were 14 deaths among 141 active patients, 8 among 77 moderately active patients, and 23 among 97 insufficiently active patents. Mortality rates were 12.9/1,000 person-years (PY) for active patients, 13.4/1,000 PY for moderately active patients, and 32.9/1,000 PY for insufficiently active patients (overall P = .004).

On multivariate analysis adjusted for age at baseline, breast cancer stage, fatigue, Charlson Comorbidity Index, years since cancer diagnosis, self-reported race/ethnicity, lifetime history of insomnia and depression, and adjuvant cancer treatments, compared with insufficiently active patients, active patients (hazard ratio [HR] = 0.42, 95% CI = 0.21–0.85) and moderately active patients (HR = 0.40, 95% CI = 0.17–0.95) had significantly reduced risk of all-cause mortality.

The investigators stated, “The findings of this cohort study suggest that even moderate physical activity was associated with a 60% lower risk of death among breast cancer survivors, similar to [findings in] a previous cohort…. The mortality risk was similar among participants who were active and those with moderate physical activity levels. Our findings further suggest that survivorship care plans should consider incorporating physical activity, because even moderate activity may be vital for extending survival as well as health-related quality of life.”

Reina Haque, PhD, MPH, of the Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, is the corresponding author for the JAMA Network Open article.

Disclosure: The study was supported by grants from the National Cancer Institute. For full disclosures of the study authors, visit

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