‘Tailored’ Exercise in Advanced Breast Cancer Improves Quality of Life

Improved quality of life in patients with advanced or metastatic breast cancer can stem from physical activity, two experts told CURE®.

Having a “tailored program” for patient needs is important, explained Dr. Maysa Abu-Khalaf.

Abu-Khalaf is the director of breast medical oncology and chief of cancer services at the Sidney Kimmel Cancer Center at Jefferson Health in Philadelphia.

“Many patients are going to live many years with this diagnosis. So it’s very important for them to be able to maintain as healthy of a lifestyle as possible,” she said.

Physical activity for patients with advanced or metastatic breast cancer can help improve several aspects of quality of life, Dr. Erin Kelly of Jefferson Health said.

Kelly is the director of cancer rehabilitation and a clinical assistant professor at Jefferson Health.

“The American College of Sports Medicine’s guidelines showed that there’s strong evidence [that exercise] improves anxiety, depression, lymphedema and physical function,” she noted. “There’s moderate evidence that it helps with bone health and sleep.”

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Importance of Exercise for Patients With Breast Cancer

Before deciding on treatments, Abu-Khalaf explained that a patient’s active status matters.

“We have calculations for whether somebody is at their normal baseline versus if there’s a decline in their performance status,” she said. “Sometimes we have to adjust chemotherapy based on how we think they will tolerate it. Unfortunately, there are times when we can’t give chemotherapy or treatment if someone has a really poor performance status.

“So, it’s important for patients to remain active and try to keep their performance statuses at a level where we can safely treat them.”

Kelly also emphasized that being physically active before starting treatment is most beneficial.

“It’s most important if patients can already be at that higher level of their performing status before starting treatment,” Kelly said. “Some of the benefits of physical activity can be seen very early on, such as helping with decreasing blood pressure, anxiety, sleep and then some others need [more time] to help with how well their heart and their lungs are functioning, improving their muscle strength and decreasing depression.”

She also explained that making exercising fun can help patients “reap the benefits” for their health.

“When we talk about doing moderate intensity, it’s to get the heart rate up. Some people might monitor that by wearing activity monitors such as their smartwatch,” Kelly explained. “So usually, I’ll tell people to monitor activities based on [whether they] can talk but can’t sing. So maybe like light biking or brisk walking. Maybe if they’re riding on a breathlessness scale, it’s like a five or six out of 10.”

Of note, Kelly said that patients should ease their way up to that breathlessness.

“We don’t expect people to go from no physical activity to where they want to start, it might not be good to start right at 30 minutes. So maybe the goal is just starting with 10 minutes at a time, and then moving up from there.”

Exercise and Side Effect Management in Breast Cancer

With treatments come side effects, which exercise can also help manage, Kelly and Abu-Khalaf said.

Specifically, exercise can help manage fatigue related to breast cancer treatments.

“There’s a lot of evidence out there for exercise being the No. 1 treatment for cancer-related fatigue in particular,” Kelly explained. “The guidelines show to exercise ideally three times a week for 30 minutes at a time, rated at a moderate level, or two times a week for resistance training. [Patients can also do] a combination of the two where they do aerobic and resistance.”

Exercising may also help other symptoms, such as neuropathy, Kelly added. Neuropathy is nerve damage outside of the brain and spinal cord, which may cause weakness and numbness in the hands and feet, the Mayo Clinic defines.

“Neuropathy is a very common side effect that can happen from cancer treatments. And so being active can help with symptoms of neuropathy,” Kelly said. “Sometimes we refer to people to go to physical therapy rather than exercising or doing physical activity on their own. If they’re having a difficult time, we may not be able to reverse the effects at that point. But we might be able to help with their balance and to try to compensate.”

Other side effects, such as musculoskeletal side effects, caused by aromatase inhibitors can be improved through exercise, Abu-Khalaf said.

“We know that there are several nonmedicinal ways to manage [musculoskeletal side effects], including increasing activity and acupuncture,” said Abu-Khalaf. “We recommend our patients try to remain active throughout this. If they sit for too long, or when they first get up out of bed, their joints are stiff. We tell them to try not to sit for too long and to get up and maintain active as much as possible.”

Ways to Ease into Exercising

“Having a buddy” is a great way to ease into exercising, Kelly said. She explained that it’s helpful for patients to have another person who is also invested or can hold them accountable.

Other ways may include finding a program and taking advantage of local community resources for exercises. Kelly emphasized that if a patient is unable to exercise alone and may need some guidance, programs can be beneficial to them.

“The other things are just seeing if they’re a good fit for a class, versus if they need that individualized program,” Kelly said. “[Also, whether they can] afford it as far as going to the gym, and some people hire a personal trainer or an exercise specialist through cancer with extra training. Other people may just need to get back into their old routine that worked for them.”

Kelly also encouraged patients with breast cancer to “make it fun” while exercising, as long as it’s safe.

“I would say make it fun [by doing] certain activities that can fit some of these [physical activity] requirements, [like skiing] or dancing,” she said. “But [they should] ask their doctor first because some people need precautions before they start exercising, especially if they’re new to exercising.”

Abu-Khalaf also noted that it’s important for patients and doctors to “weigh in” on safety.

“Within the context of having a diagnosis of metastatic breast cancer, it’s very important for the medical oncologists who are treating the patient to weigh in on the safety of being able to exercise depending on the type of exercise,” she added. “For women who have bone metastases, they have to be careful depending on where those bone metastases are and which bones are involved, to make sure that the type of activity or exercise is tailored to avoid putting high impact on an area that might be at a higher risk of fracture, for instance.”

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