For People With Advanced Breast Cancer, Supervised Exercise Eased Fatigue

CATEGORY: EXERCISE & MOVEMENT

Nine months of supervised exercise eased physical fatigue by about five points and lifted overall quality of life by nearly five points, both on 100-point scales, in people under treatment for metastatic breast cancer, meaning cancer that has spread beyond the breast.¹ The comparison was usual care, across 357 patients in six countries. The gains were modest in size. They also lasted to the end of the program, in a setting where treatment is continuous and fatigue is among the most common complaints.

Twice a Week for Nine Months, With a Professional Watching

The trial, PREFERABLE-EFFECT, ran at eight centers in Germany, the Netherlands, Poland, Spain, Sweden and Australia. Each of the 357 participants was allocated at random to usual care or to the exercise program, which qualified exercise professionals delivered. Training came twice a week, an hour a session. It combined resistance work, with each person’s load set from a twelve-repetition strength test, aerobic work such as cycling tuned to measured fitness, and balance exercises. For the last three months, one of the two weekly sessions was done independently. Fatigue and quality of life, the two primary outcomes, were tracked with detailed standard questionnaires at three, six and nine months.¹

What Five Points Buys on a Hundred-Point Scale

At six months, physical fatigue scores sat 5.3 points lower in the exercise group than under usual care, and quality-of-life scores 4.8 points higher. At nine months the differences held at 5.6 and 4.3 points.¹ Other measures moved as well. Pain scores were about seven points better with exercise, breathlessness nearly eight points better, and output on a cycling fitness test rose by roughly 25 watts. Not everything moved. Emotional functioning and the emotional side of fatigue were no better with exercise than without it.

Smaller Than the Effect They Planned For

The researchers sized the trial expecting something on the order of what earlier exercise trials had found in early-stage breast cancer. What they measured was smaller, though statistically solid on both primary outcomes.¹ Nearly all exercise research in breast cancer has involved patients treated with the aim of cure. People whose cancer has spread, who may live for years on ongoing treatment, were largely missing from that evidence. This trial was built to fill the gap, and its answer is that structured, supervised exercise stayed doable and worthwhile during continuous treatment.

Guided Effort Where Rest Was the Old Reflex

Fatigue in advanced cancer is not ordinary tiredness. It is a persistent drain that rest does not repair, and patients rank it among the hardest symptoms to live with. The old instinct in serious illness was to spare people exertion. What this trial tested runs the other way: two supervised hours a week eased the drain rather than deepening it. The specifics matter here. What was tested was a program scaled to each person, supervised by professionals and adjusted around treatment, which is a different thing from general encouragement to stay active.

Key Takeaways

• Nine months of twice-weekly supervised exercise reduced physical fatigue by about 5 points and improved quality of life by about 5 points on 100-point scales among 357 people with metastatic breast cancer, compared with usual care.
• Pain, breathlessness and measured fitness improved too. Emotional functioning and the emotional side of fatigue did not.
• The benefit came in smaller than the researchers had expected from trials in early-stage breast cancer, but it persisted through all nine months.
• What was tested was individually tailored, professionally supervised exercise. The structure was part of the intervention, not an afterthought.

References

1. Hiensch AE, Depenbusch J, Schmidt ME, et al. Supervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial. Nat Med. 2024;30(10):2957–2966. link