Nature-based physical activity in breast cancer survivors: a new frontier in supportive care

Breast cancer (BC) survivors frequently experience long-term physical and psychosocial sequelae following treatment, including cancer-related fatigue, cardiovascular dysfunction, sarcopenia, sleep disturbances, and emotional distress, which can significantly affect quality of life. Structured physical activity is widely recognized as a key component of supportive oncology care and has demonstrated benefits in improving physical function, psychological wellbeing, and survival outcomes. However, adherence to exercise recommendations remains suboptimal in cancer patients mostly due to treatment-related symptoms, motivational barriers, and limited access to tailored supervised programs. Though the field remains relatively underexplored within exercise oncology, nature-based physical activity (NBPA), defined as exercise performed in natural environments, is emerging as a promising complementary approach that integrates the physiological benefits of physical exercise with the restorative effects of nature exposure. Growing evidence indicates that natural settings can support stress reduction, autonomic regulation, immune function, and psychological resilience, potentially enhancing the overall benefits of physical activity. Several effects have been documented in broader populations and, to a lesser degree, among cancer survivors, while direct evidence specifically addressing BC survivors remains limited. Therefore, many of the proposed psychophysiological mechanisms should currently be regarded as plausible and biologically supported hypotheses requiring further validation through dedicated clinical studies. This perspective paper synthesizes current evidence on the role of NBPA in BC survivorship by discussing the psychophysiological mechanisms underlying health effects of nature exposure in this vulnerable population and the main investigated outdoor activities, including walking and Nordic walking, aquatic disciplines, green mind-body practices, and forest-based programs. Finally, the article highlights research gaps and future directions aiming at providing concrete hints to stably integrate nature-based interventions into multidisciplinary survivorship care pathways addressing BC survivors.