Physical activity and survival after breast cancer diagnosis

Context Physical activity has been shown to decrease the incidence of breast cancer, but the effect on recurrence or survival after a breast cancer diagnosis is not known. Objective To determine whether physical activity among women with breast cancer decreases their risk of death from breast cancer compared with more sedentary women. Design, Setting, and Participants Prospective observational study based on responses from 2987 female registered nurses in the Nurses' Health Study who were diagnosed with stage I, II, or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002, whichever came first. Main Outcome Measure Breast cancer mortality risk according to physical activity category (<3, 3-8.9, 9-14.9,15-23.9, or >= 24 metabolic equivalenttask [MET] hours per week). Results Compared with women who engaged in less than 3 MET-hours per week of physical activity, the adjusted relative risk (RR) of death from breast cancer was 0.80 (95% confidence interval [CI], 0.60-1.06) for 3 to 8.9 MET-hours per week; 0.50 (95% Cl, 0.31-0.82) for 9 to 14.9 MET-hours per week; 0.56 (95% Cl, 0.38-0.84) for 15 to 23.9 MET-hours per week; and 0.60 (95% Cl, 0.40-0.89) for 24 or more MET-hours per week (P for trend =.004). Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour. The benefit of physical activity was particularly apparent among women with hormone-responsive tumors. The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 (95% Cl, 0.34-0.74). Compared with women who engaged in less than 3 MET-hours per week of activity, the absolute unadjusted mortality risk reduction was 6% at 10 years for women who engaged in 9 or more MET-hours per week. Conclusions Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease. The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace, with little evidence of a correlation between increased benefit and greater energy expenditure. Women with breast cancer who follow US physical activity recommendations may improve their survival.