Feb. 26, 2026
Exercise plays a critical role in breast cancer care, with mounting evidence showing its benefits for recovery and long-term health. Based on robust research, the American Society of Clinical Oncology advises doctors to recommend regular aerobic and resistance exercise for people receiving cancer treatment. The recommendations were published in the Journal of Clinical Oncology.
"There are a lot of training regimens that have shown to have a myriad of positive outcomes for patients with breast cancer," says Andrea L. Cheville, M.D., a physiatrist at Mayo Clinic in Rochester, Minnesota, and a leading expert in cancer rehabilitation. She specializes in developing scalable exercise programs for patients with cancer, including the evidence-based Rapid, Easy Strength Training (REST) protocol described in an article in the Journal of Pain and Symptom Management. This home-based regimen was designed to rebuild strength and function after cancer treatment.
Exercising with breast cancer reduces treatment side effects
Many people who survive breast cancer experience significant barriers to maintaining activity levels, such as severe fatigue, nausea and pain. These barriers contribute to decreased activity levels after treatment.
According to research published in JNCI Cancer Spectrum, physical activity mitigates treatment-related side effects that patients with breast cancer commonly experience. People who participate in exercise see improvements in fatigue, mobility and sleep quality.
Exercise helps through multiple mechanisms. "When we train, we're making muscles stronger, giving them more stamina, but a lot of physical training, particularly early on, is neural — how the brain recruits and efficiently uses muscles," says Dr. Cheville.
Exercise is crucial because treatment causes damage throughout the body. People's bodies can become scarred or fibrotic in areas that are irradiated. They lose muscle mass, and neural effects can compromise their peripheral nervous systems. Physical activity trains this system to improve function.
Exercise is also effective for managing fatigue — the most prevalent and debilitating symptom of breast cancer treatment — though the reason is unclear.
Physical activity improves long-term survival outcomes
Staying active during and after breast cancer treatment not only lessens side effects but also can impact survival. Exercise is one of the most modifiable risk factors for breast cancer recurrence and breast cancer-related mortality.
Physical activity primarily improves long-term outcomes by helping maintain a healthy body weight, which can reduce estrogen levels that may predispose a person to cancer recurrence. Exercise may also lower the risk of lymphedema and other complications that people tend to experience after breast cancer treatment.
Exercise prescription considerations for patients with breast cancer
REST is a collection of exercises performed with resistance bands. These exercises are designed to improve rapid ballistic movement — the quick, high-power movements required for daily life. For patients receiving chemotherapy, the REST regimen can be strategically timed within the three-week treatment cycle to optimize outcomes.
"With chemotherapy, patients can feel very depleted the first week after, and getting from the couch to the kitchen to the bathroom is a struggle. That is not the time to ask them to exercise," says Dr. Cheville.
Typically, patients start feeling stronger the following week, and most regain considerable strength by the third week. Gradually scaling up exercise during these periods allows patients to take advantage of times when they have more energy and fewer treatment-related side effects.
It is also important to consider which types of exercise patients may find most manageable. "Walking is a good option," says Dr. Cheville. "If patients have some way of monitoring, like step counting, to quantify activity, that offers a great feedback mechanism."
While walking improves cardiovascular endurance, resistance training addresses the loss of strength and functional capacity that affects daily activities, such as getting dressed, climbing stairs or cooking meals.
Overcoming barriers to exercise adoption and adherence
Patients with breast cancer may face several impediments to starting or maintaining an exercise program, including:
- Treatment side effects.
- Time constraints.
- Limited access to resources, including transportation.
Hybrid care models that combine in-person and remote coaching have demonstrated efficacy in increasing accessibility and adherence to exercise regimens. "Patients go through all kinds of pain to come and get their cancer treatment, and then we're asking them to make more trips to exercise," she says. "The beauty of these hybrid models is we can coach them in their own homes, and we've shown that's very effective."
For more information
Ligibel JA, et al. Exercise, diet, and weight management during cancer treatment: ASCO guideline. Journal of Clinical Oncology. 2022;40:2491.
Cheville AL, et al. A home-based exercise program to improve function, fatigue, and sleep quality in patients with stage IV lung and colorectal cancer: A randomized controlled trial. Journal of Pain and Symptom Management. 2012;45:811.
Marell PS, et al. Changes in amount and intensity of physical activity over time in breast cancer survivors. JNCI Cancer Spectrum. 2023;7:pkad056.
Refer a patient to Mayo Clinic.