High levels of post-diagnosis recreational physical activity reduce breast cancer recurrence risk by 13% compared to minimal activity (RR=0.87).
Does high post-diagnosis recreational physical activity reduce breast cancer recurrence in female survivors?
High levels of recreational physical activity post-diagnosis, but not merely meeting minimum guidelines, significantly reduces the risk of breast cancer recurrence in female survivors.
Abstract Background: Breast cancer (BC) recurrence risk is highest within the first 5-years following initial diagnosis, making survivorship care a critical window for intervention. As survivorship rates increase, identifying modifiable lifestyle factors that may reduce recurrence risk becomes increasingly important. While the protective factors of recreational physical activity (rPA) before BC diagnosis are well-documented, the role of post-diagnosis rPA, particularly its impact on recurrence remains less explored. Objectives: This study aimed to determine 1) if high levels of post-diagnosis rPA reduce BC recurrence risk in female survivors compared to minimal rPA and 2) if adhering to the Physical Activity Guidelines for Americans (i.e., 150 minutes of moderate-intensity physical activity weekly) reduces recurrence risk. Methods: We included observational cohort studies evaluating the association between post-diagnosis rPA and recurrence risk among adult female BC survivors published up to January 2025, in any language or geographic location. Excluded studies were interventional studies, hospital/clinical studies, male BC survivors, and those under 18 years. Databases (Medline, CINAHL, Web of Science) were searched in February 2025. Two reviewers independently screened studies at all stages. Data synthesis and analysis used pooled risk estimates (RR/HRs) and 95% confidence intervals. A meta-analysis was conducted on Stata using a random-effects model to examine the effects of post-diagnosis of rPA on BC recurrence, separately for minimal vs high rPA and meeting vs not meeting recommended guidelines. Subgroup analyses explored BC subtypes, study characteristics, menopausal status, and follow-up period as potential sources of heterogeneity. Heterogeneity was assessed using Cochran’s Q test and I2 statistics. Results: Out of 2,635 studies screened, 22 passed the initial screening for full-text review, and 9 were included in the meta-analysis (9 high versus low; 5 meeting vs not meeting guidelines). The analysis included 37,787 BC survivors and 4,524 recurrences were reported. Meta-analysis showed that female BC survivors who engaged in high levels of rPA after diagnosis had a 13% lower risk of BC recurrence compared to those with minimal activity (RR=0.87, CI=0.77-0.96, I2=0.00%, n=9). However, meeting the minimum recommendations of rPA alone was not associated with a reduced risk of recurrence (RR=0.93, 95% CI=0.85-1.02, I2=0.00%, n=5). Subgroup analysis showed stronger associations in studies conducted in the Netherlands and Germany, as well as in those with rPA assessment periods greater than 5 years after diagnosis. Using the Newcastle Ottawa Scale, study quality was classified as good (n=7) or fair (n=2). Conclusion: These findings suggest that high levels of rPA postdiagnosis reduces recurrence risk by 13%. Because the current minimum recommendations may not be sufficient to reduce recurrence risk, further research is needed to determine optimal rPA recommendations and guidelines for BC survivors. Additionally, these findings emphasize the value of healthcare professionals promoting higher levels of rPA within survivorship care plans for BC survivors. Citation Format: J. Weathington, I. Lynch, B. Sukhu, T. Glatz, E. Lee. The Relationship between Post-Diagnosis Recreational Physical Activity and Breast Cancer Recurrence: A Systematic Review and Meta-Analysis abstract. In: Proceedings of the San Antonio Breast Cancer Symposium 2025; 2025 Dec 9-12; San Antonio, TX. Philadelphia (PA): AACR; Clin Cancer Res 2026;32(4 Suppl):Abstract nr PS1-05-25.
Weathington et al. (2026) studied this question. High levels of post-diagnosis recreational physical activity reduce breast cancer recurrence risk by 13% compared to minimal activity (RR=0.87).