The Long-Term Effects of Combined Training and 1-Year Follow-Up in Breast Cancer Survivors

Abstract

The use of aromatase inhibitor (AI) therapy in breast cancer survivors (BCS) has been linked to significant and negative changes in body composition and quality of life. However, the long-term effects (9 months) of combined training (CT=resistance plus aerobic training) following the interruption of CT intervention remain unclear in these variables. Thus, the present study aimed to investigate changes in body composition, bone mineral density, and quality of life during a 1-year follow-up period after 9 months of CT in BCS. Participants were randomized into two groups: CT (n=18) for 9 months, or control group (n=18), with 27 participants (CT=16; control=11) reassessed after the 1-year follow-up. There were significant group×time interactions postintervention, with lower fat mass and fat mass percentage in the CT group. However, after the follow-up period, these values returned to baseline. The CT group shows improvements in quality of life, with higher scores in physical functioning, physical health, social functioning, bodily pain, and vitality compared to the control group. These benefits were maintained after the 1-year follow-up period only in the CT group. This study reinforces the crucial role of consistently maintaining an exercise training program for BCS undergoing AI therapy.

Keywords

exercise - breast cancer - menopause - hormone therapy - physical activity

Publication History

Received: 28 January 2025

Accepted after revision: 09 June 2025

Article published online:
31 July 2025

• References

• 1 Waks AG, Winer EP. Breast Cancer Treatment: A Review. JAMA 2019; 321: 288-300
• 2 Global Burden of Disease Cancer C,. Kocarnik JM, Compton K. et al. Cancer Incidence, Mortality, Years of Life Lost, Years Lived With Disability, and Disability-Adjusted Life Years for 29 Cancer Groups From 2010 to 2019: A Systematic Analysis for the Global Burden of Disease Study 2019. JAMA Oncol 2022; 8: 420-444
• 3 Heer E, Harper A, Escandor N, Sung H, McCormack V, Fidler-Benaoudia MM. Global burden and trends in premenopausal and postmenopausal breast cancer: a population-based study. Lancet Glob Health 2020; 8: e1027-e1037
• 4 Riemsma R, Forbes CA, Kessels A. et al. Systematic review of aromatase inhibitors in the first-line treatment for hormone sensitive advanced or metastatic breast cancer. Breast Cancer Res Treat 2010; 123: 9-24
• 5 Bradley R, Braybrooke J, Gray R. et al. Aromatase inhibitors versus tamoxifen in premenopausal women with oestrogen receptor-positive early-stage breast cancer treated with ovarian suppression: a patient-level meta-analysis of 7030 women from four randomised trials. Lancet Oncol 2022; 23: 382-392
• 6 Monteverdi S, Pedersini R, Gallo F. et al. The Interaction of Lean Body Mass With Fat Body Mass Is Associated With Vertebral Fracture Prevalence in Women With Early Breast Cancer Undergoing Aromatase Inhibitor Therapy. JBMR Plus 2021; 5: e10440
• 7 Diaz-Lopez KD, Caire-Juvera G. Interventions to improve bone mineral density, muscle mass and fat mass among breast cancer survivors. J Am Nutr Assoc 2022; 41: 94-106
• 8 van Londen GJ, Perera S, Vujevich K. et al. The impact of an aromatase inhibitor on body composition and gonadal hormone levels in women with breast cancer. Breast Cancer Res Treat 2011; 125: 441-446
• 9 Saarto T, Penttinen HM, Sievänen H, Kellokumpu-Lehtinen PL. et al. Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Anticancer Res 2012; 32: 3875-3884
• 10 Akyol M, Demir L, Alacacioglu A. et al. The Effects of Adjuvant Endocrine Treatment on Serum Leptin, Serum Adiponectin and Body Composition in Patients with Breast Cancer: The Izmir Oncology Group (IZOG) Study. Chemotherapy 2016; 61: 57-64
• 11 Jang MK, Park S, Raszewski R, Park CG, Doorenbos AZ, Kim S. Prevalence and clinical implications of sarcopenia in breast cancer: a systematic review and meta-analysis. Supportive Care Cancer 2024; 32: 328
• 12 Pačarić S, Orkić Ž, Babić M. et al. Impact of immediate and delayed breast reconstruction on quality of life of breast cancer patients. Int J Environ Res Public Health 2022; 19: 8546
• 13 Ettridge K, Scharling-Gamba K, Miller C, Roder D, Prichard I. Body image and quality of life in women with breast cancer: Appreciating the body and its functionality. Body Image 2022; 40: 92-102
• 14 Chow K, Hung K, Yeung S. Body Image and Quality of Life Among Breast Cancer Survivors: A Literature Review. World J Oncol Res 2016; 3: 9
• 15 Joaquim A, Leão I, Antunes P. et al. Impact of physical exercise programs in breast cancer survivors on health-related quality of life, physical fitness, and body composition: Evidence from systematic reviews and meta-analyses. Front Oncol 2022; 12: 955505
• 16 Narimatsu H, Yaguchi YT. The Role of Diet and Nutrition in Cancer: Prevention, Treatment, and Survival. Nutrients 2022; 14: 3329
• 17 Winters-Stone KM, Schwartz A, Nail LM. A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Surviv 2010; 4: 187-201
• 18 Khosravi N, Hanson ED, Farajivafa V. et al. Exercise-induced modulation of monocytes in breast cancer survivors. Brain Behav Immun Health 2021; 14: 100216
• 19 Boing L, Vieira M, Moratelli J, Bergmann A, Guimarães A. Effects of exercise on physical outcomes of breast cancer survivors receiving hormone therapy–a systematic review and meta-analysis. Maturitas 2020; 141: 71-81
• 20 Mokhtari-Hessari P, Montazeri A. Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health Qual Life Outcomes 2020; 18: 338
• 21 Campbell KL, Winters-Stone KM, Wiskemann J. et al. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc 2019; 51: 2375-2390
• 22 Stout NL, Baima J, Swisher AK, Winters-Stone KM, Welsh J. A Systematic Review of Exercise Systematic Reviews in the Cancer Literature (2005-2017). PM & R 2017; 9: S347-S384
• 23 de Paulo TRS, Winters-Stone KM, Viezel J. et al. Effects of resistance plus aerobic training on body composition and metabolic markers in older breast cancer survivors undergoing aromatase inhibitor therapy. Exp Gerontol 2018; 111: 210-217
• 24 Paulo TRS, Rossi FE, Viezel J. et al. The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial. Health Qual Life Outcomes 2019; 17: 17
• 25 Schulz SVW, Schumann U, Otto S. et al. Two-year follow-up after a six-week high-intensity training intervention study with breast cancer patients: physiological, psychological and immunological differences. Disabil Rehabil 2022; 44: 4813-4820
• 26 Courneya KS. Exercise in cancer survivors: an overview of research. Med Sci Sports Exerc 2003; 35: 1846-1852
• 27 CONSORT Group. Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. BMC Med 2010; 8: 18
• 28 Rossi FE, Fortaleza AC, Neves LM. et al. Combined training (aerobic plus strength) potentiates a reduction in body fat but demonstrates no difference on the lipid profile in postmenopausal women when compared with aerobic training with a similar training load. J Strength Cond Res 2016; 30: 226-234
• 29 Hays RD, Sherbourne CD, Mazel RM. The RAND 36-Item Health Survey 1.0. Health Econ 1993; 2: 217-227
• 30 Murtezani A, Ibraimi Z, Bakalli A, Krasniqi S, Disha ED, Kurtishi I. The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial. J Cancer Res Ther 2014; 10: 658-664
• 31 Thomas GA, Cartmel B, Harrigan M. et al. The effect of exercise on body composition and bone mineral density in breast cancer survivors taking aromatase inhibitors. Obesity (Silver Spring, Md) 2017; 25: 346-351
• 32 Rossi FE, Diniz TA, Neves LM. et al. The beneficial effects of aerobic and concurrent training on metabolic profile and body composition after detraining: a 1-year follow-up in postmenopausal women. Eur J Clin Nutr 2017; 71: 638-645
• 33 Schmiegelow MD, Hedlin H, Mackey RH. et al. Race and ethnicity, obesity, metabolic health, and risk of cardiovascular disease in postmenopausal women. J Am Heart Assoc 2015; 4: e001695
• 34 Zhong S, Chen C, Thompson L. Sarcopenia of ageing: functional, structural and biochemical alterations. Rev Bras Fisioter 2007; 11: 91-97
• 35 Bunout D, de La Maza MP, Barrera G, Leiva L, Hirsch S. Association between sarcopenia and mortality in healthy older people. Australas J Ageing 2011; 30: 89-92
• 36 Peterson LL, Ligibel JA. Physical Activity and Breast Cancer: an Opportunity to Improve Outcomes. Curr Oncol Rep 2018; 20: 50