Saarto, T., Penttinen, H. M., Sievänen, H., Kellokumpu-Lehtinen, P. L., Hakamies-Blomqvist, L., Nikander, R., . . . Luoma, M. L. (2012). Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Research, 32, 3875–3884.

To determine whether physical exercise training improves the quality of life and physical fitness of survivors of breast cancer.

Patients were randomized to the exercise intervention or control group. The duration of the exercise intervention was 12 months, with the aim of attaining permanent changes in lifestyle. The intervention consisted of both supervised and home training.  Supervised training, delivered to a group of 15 to 20 individuals, included step aerobics and circuit training. Home training consisted of walking, aerobics cued by a video, cycling, or swimming; participants could choose the activity.

• The sample was comprised of 573 participants.
• Participant age ranged from 35 to 68 years.
• All participants were female.
• All participants had breast cancer; were pre- or postmenopausal; and had undergone adjuvant chemotherapy within four months, started adjuvant endocrine therapy no fewer than four months previously, or had started a combination of chemotherapy and endocrine therapy no fewer than four months previously.

• Multisite
• Outpatient
• Multiple locations in Finland

• Patients were undergoing multiple phases of care.
• The study has clinical applicability for palliative care.

This was a randomized, controlled trial.

• European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30)
• EORTC QLQ-BR-23 questionnaire to assess quality of life of patients with breast cancer
• Functional Assessment of Cancer Therapy-Fatigue (FACT-F)
• Finnish version of the Beck Depression Inventory (BDI)
• Two-hour walking test
• Figure-eight running test

No significant differences were found between the exercise group and control group in regard to changes in quality of life during the intervention or in regard to depression or fatigue.

This study did not show that the exercise intervention had an effect on fatigue, depression, or quality of life. Lack of effect may be due to a ceiling effect in both groups because most study participants had relatively high activity levels at baseline.

• The study had risks of bias due to no blinding, no appropriate attentional control condition, and as a result of sample characteristics. Key sample group differences could have influenced the results.
• Most participants were physically active before the study. (Only a few patients [0.25%] were sedentary before the study.) Control patients were also motivated to remain active. Actual activity levels of control patients were not analyzed.
• Findings were not generalizable.
• One of the physical fitness tests used, two-hour walking test, cannot be generalized to other countries.
• The main strength of this study was its size.   

The ability of physical exercise, especially group exercise, to improve quality of life and reduce fatigue and depression in patients with breast cancer during and following treatment is generally known. The fact that this study did not support the widely held view may be due to the fact that most participants had a high level of activity at baseline. The study did not clarify whether exercise interventions are needed or effective for individuals who already have an active lifestyle and are motivated to maintain it.