In this publication of the PREFERABLE-EFFECT study, we demonstrate that individuals who participated in the exercise program gained more muscle mass and became stronger, especially in their lower body, compared to those who did not exercise. They also showed improvements in physical abilities such as balance and previously reported function. The results further support our overall study findings that supervised exercise can be a safe and effective way to help people with metastatic breast cancer maintain or improve their health and wellbeing.

How can we better support physical activity in people living with metastatic breast cancer? As exercise becomes a more integral part of cancer care, understanding how and why patients do so is essential for promoting its uptake. In this study, we used our international dataset from the PERSPECTIVE survey to analyse underlying drivers for exercise behaviour through the lens of the Theory of Planned Behaviour. Our data highlights that people who feel more confident in their abilities report fewer obstacles to exercising. It also highlights the importance of tackling health-related barriers to physical activity, whether by reducing or removing them. To optimize uptake and adherence to exercise initiatives, future interventions for this population should include strategies aimed at increasing self-efficacy, and allocate time to discussing how perceived barriers could be overcome.

As survival improves for people living with metastatic breast cancer, maintaining participation in work becomes increasingly important. In this paper, published in Cancer Medicine, we explored which factors influence patients’ employment status and quality of working life. We found that over half the patients in working age were employed, but many had reduced their working hours due to fatigue, cognitive difficulties, or challenges meeting job demands. Higher fatigue levels and more mentally demanding work were each linked to a lower quality of working life in working patients, while pain reduced the likelihood of being employed altogether. These results underline the importance of flexible work arrangements, effective symptom management, and supportive workplaces to help people with metastatic breast cancer remain engaged and fulfilled in their professional lives.

Unlike the clinical side effects for which recognized treatment recommendations exist, sexual and vaginal problems are still often a taboo subject that is rarely discussed or researched. Therefore, this analysis of the PREFERABLE-EFFECT study investigated these and other understudied issues that are of high relevance for many women with metastatic breast cancer. The results show that many study participants suffered from low sexual functionality, reduced sexual enjoyment, vaginal dryness, or pain during sexual intercourse at the beginning of the study. The supervised exercise program led to an improvement in these problems as well as an alleviation of other chemotherapy side effects, such as pain in the mouth and irritated eyes, compared to the control group.

We are proud to share the latest publication from the PREFERABLE-II Consortium, demonstrating that supervised exercise is a cost-effective intervention for patients with metastatic breast cancer. The findings, now published in the Journal of Clinical Oncology (JCO), stem from a cost-utility analysis conducted alongside our PREFERABLE-EFFECT randomized controlled trial. Key findings from this study are that (1) Supervised exercise enhances well-being and daily functioning for patient, (2) The intervention reduces overall healthcare costs while delivering significant benefits, and (3) These results provide essential evidence to support reimbursement decisions, improving accessibility and availability of supervised exercise programs for patients with metastatic breast cancer.

This study explores how patients with metastatic breast cancer (MBC) prefer to engage in exercise programs, aiming to support more tailored and effective implementation of exercise interventions. Using data from a multinational survey of 409 MBC patients, we identified four distinct preference groups ranging from those favoring moderate, supervised exercise within healthcare settings to those preferring self-directed recreational walking. Differences in preferences were linked to patient characteristics such as age, education, and disease status. The findings highlight that many MBC patients’ exercise preferences align with current guidelines, while others may benefit from targeted education to support safe and beneficial physical activity.

This paper shows that our PREFERABLE exercise intervention resulted in significant positive effects fatigue and quality of life: Physical fatigue was significantly lower and quality of life significantly higher in the exercise group than in the control group at 6 months. In addition, beneficial effects on clinically relevant outcomes such as physical functioning, role functioning, physical fitness, dyspnea and pain were observed. These results demonstrate that supervised exercise has positive effects in patients with metastatic breast cancer and should be recommended as part of supportive care.

The first results from the PREFERABLE-EFFECT trial were unveiled at the San Antonio Breast Cancer Symposium (SABCS), held December 5-9, 2023. This publication contains the press release about this presentation, as well as the abstract submitted by Anne May. It was presented that, among patients with metastatic breast cancer, those who took part in a nine-month structured exercise program reported less fatigue and an improved quality of life compared to those who did not undergo the exercise program. We also found that the nine-month intervention was not only effective but may have encouraged longer-term compliance as well. Based on these findings, we suggest that physicians and nurses should routinely recommend supervised exercise to patients with metastatic breast cancer and that policymakers and insurance companies should ensure cost coverage for exercise programs.

The aim of the PERSPECTIVE survey was to identify patient’s perspectives on exercise and exercise programming. A total of 420 patients from Germany, Sweden, Poland, Spain and The Netherlands participated in a survey. The survey included questions about exercise knowledge and skills, outcome expectations, barriers to and facilitators of participation in exercise programs. Respondents expected exercise to have multiple physical benefits, but also experienced barriers to engage in exercise programs. Patients with metastatic breast cancer may benefit from personalized advice and appropriate training facilities to overcome these barriers.

In a case study, of one of our EFFECT participants, published in the October 2023 issue of Medicine & Science in Sports & Exercise, we describe that exercise trainers by the nature of their profession can detect small but important changes in motor function that patients, relatives or clinicians themselves may not be able to detect in the early stages of brain metastases. This highlights the value of adding supervised exercise to the treatment of patients with metastatic disease. Please find more details in the publication.

The aim of the PERSPECTIVE focus group study was to gain a better understanding of the views of people with metastatic breast cancer on exercise programs. For this purpose, we conducted 11 group discussions with a total of 44 individuals from five European countries. The study revealed that patients with metastatic breast cancer were generally interested in supervised exercise, but experienced physical limitations and insecurities that inhibited their participation. Their individual conditions and needs, as well as varying preferences regarding exercise type and setting suggested that a one-size-fits-all approach to exercise is not advisable for this patient group. Instead, exercise programs should be adjusted to patients’ abilities and preferences and allow for flexibility.

In July 2022, we published the study design of the multinational randomized controlled PREFERABLE-EFFECT study in Trials. The aim of this study is to assess the effects of a structured and individualized 9-month exercise intervention in patients with metastatic breast cancer on quality of life, fatigue, and other cancer- and treatment-related side effects. In this paper, you can read details on the study population, recruitment procedures, the primary and secondary outcomes and the design of the exercise intervention. This large randomized controlled trial will provide evidence regarding the (cost-) effectiveness of exercise during treatment of metastatic breast cancer.

This is the first exercise intervention study in cancer patients with spinal metastases at high risk of fracture. The intervention proved safe and feasible, given adaptations due to pain, immobility and weakness. Now, larger studies are needed to confirm safety and investigate exercise effects on clinical endpoints. @Patients: Please do not try these exercises alone but under 1:1 supervision by a qualified and experienced exercise professional only!