The Role of Structured Exercise in Breast Cancer Survivorship: A Prospective Observational Study

Introduction Cancer survivorship is defined as the time from the diagnosis of cancer and throughout the remainder of a patient's life. Survivorship care is a comprehensive approach to optimizing health maintenance after completing primary cancer treatment. Transitioning to survivorship care in breast cancer patients includes focusing on the long-term effects of cancer, its treatment, diet, and lifestyle modification. It is known that exercise during and after cancer treatment plays an essential role in preventing multiple cancer health-related outcomes such as fatigue, anxiety, and depression. However, most cancer patients remain inactive during and beyond cancer treatment due to the lack of clear recommendations for a physician-endorsed exercise program. Our pilot interventional study investigates the effect of a structured exercise program on breast cancer survivorship and quality of life when exercise is endorsed by the treating physician. Design This is a prospective observational study that included female breast cancer patients aged 18 and over who completed their active breast cancer treatment six to 12 months prior. Those who consented were enrolled in a structured exercise program when it was explicitly endorsed by their primary oncologic physician. The structured program was offered by a third-party not-for-profit organization. It included evidence-based exercises recommended for cancer patients, led by a certified cancer fitness instructor for 10 weeks, targeting strength, resistance training, cardio, balance, and flexibility. The patients consented to complete a quality-of-life survey (SF-36) before and after the program. The primary outcome of interest included improvement in overall quality of life. The secondary outcomes of interest included compliance rates to completion of the exercise program and long-term symptom improvements. Results  A total of five patients consented to the study. Overall, there was a significant improvement in various components of quality of life. These improvements were observed in their physical functioning (mean change 13.0, 95% confidence interval (CI): 5.9 to 20.1, P < 0.05), energy/fatigue (mean change 16.0, CI: 2.5 to 29.5, P < 0.05), emotional well-being (mean change 9.6, CI: 1.3 to 17.9, P < 0.05), and social functioning (mean change 12.5, 1.5 to 23.5, P < 0.05). The five female breast cancer survivors completed the exercise program with a compliance rate of 100%. There seemed to be an increase in a sense of community and accountability developed between the participants during the exercise period. Conclusion Participating in a structured exercise program when exercise was specifically endorsed by an oncologic physician significantly improves the quality of life of breast cancer patients. Participants had improved physical functioning, energy, fatigue, emotional well-being, and social functioning, which are essential components of well-optimized survivorship care. Also, when regular exercise is endorsed explicitly by a treating physician, there are high compliance rates. Moreover, we demonstrated the feasibility of investigating the impact of a structured exercise program on breast cancer patients, with the aim of expanding to a larger population size with a control group in the future for additional insights.