Supervised aerobic and resistance exercise can improve the physical performance and strength of patients living with metastatic breast cancer, according to new data from the PREFERABLE-EFFECT study that was presented by Anne May, PhD, during the Advanced Breast Cancer Eighth International Consensus Conference.
“Exercise has proven to be effective in patients with nonmetastatic disease. The PREFERABLE-EFFECT study is the largest study to date to investigate whether physical exercise is a viable and effective option for patients with advanced breast cancer," stated Dr. May, Professor of Clinical Epidemiology of Cancer Survivorship at the University Medical Center Utrecht and the Netherlands Cancer Institute, The Netherlands.
Background and Study Methods
Interventions that may improve health-related quality of life for patients with metastatic breast cancer are greatly needed, and physical exercise has been shown to reduce side effects such as fatigue in this population.
The multinational, randomized, controlled PREFERABLE-EFFECT trial was created to assess the effects of exercise on fatigue and health-related quality of life in patients with metastatic breast cancer. The study included 357 patients from centers across five European countries and Australia. Most of these patients were receiving treatment in the first- or second-line setting, and many had bone metastases. All were enrolled between 2019 and 2022.
Patients in the study were randomized to receive standard care or join a 9-month exercise program with the use of an activity tracker. The exercise program included aerobic, strength, and balance training from a trainer twice a week for 6 months followed by more unsupervised sessions and advice to be active for at least 30 minutes per day. Prior results from the study show that the exercise program improved both physical fatigue and health-related quality of life measurements.
Key Study Findings
New data from the study showed that muscle mass and muscle strength, as well as physical performance, increased in the patients who were randomized to the exercise arm. Muscle mass in the arms and legs for patients in the exercise arm increased by an average of 0.6 kg as of 3 months and by 0.48 kg as of 6 months compared with patients in the control group. Skeletal muscle mass index increased by an average of 0.22 kg/m2 after 3 months and by 0.18 kg/m2 after 6 months in the interventional arm vs the control arm.
“Until now, there has been limited evidence that physical exercise can improve muscle mass and strength in patients with metastatic cancer, partly because they were often excluded from studies,” said Dr. May. “Treatments for the disease can affect patients’ quality of life, with debilitating side effects such as fatigue, nausea, and pain. Combined with the underlying disease itself, the treatment, and physical inactivity, these factors often cause a decrease in skeletal muscle mass, which negatively affects body composition, muscle strength, and functional performance.
“In patients who are having chemotherapy for localized or advanced breast cancer, low muscle mass has been associated with increased treatment-related toxicities, more frequent dose reductions, as well as poorer treatment outcomes and survival. In addition, hormonal therapy is associated with low muscle mass," she added.
Patients in the exercise group also reported improved balance from improved muscle mass and strength, resulting in fewer falls.
“The results from our study are important since lean body mass is linked to better treatment tolerance, prognosis, and overall health, and increased muscle strength correlates with improved quality of life and lower mortality risk. This supports the call for exercise—specifically supervised exercise with a resistance exercise component—to be integrated as a standard component of cancer care for patients with metastatic breast cancer,” Dr. May said.
Going forward, the ABC Global Alliance is planning to launch a Physical Activity Resource Hub in early 2026 for patients with advanced breast cancer, their caregivers, and their exercise and/or health-care professionals.
Disclosure: For full disclosures of the study authors, visit abc-lisbon.org.
