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Influence of Pre- and Postdiagnosis Physical Activity on Mortality in Breast Cancer Survivors: The Health, Eating, Activity, and Lifestyle Study

Melinda L. Irwin, Ashley Wilder Smith, Anne McTiernan, Rachel Ballard-Barbash, Kathy Cronin, Frank D. Gilliland, Richard N. Baumgartner, Kathy B. Baumgartner, Leslie Bernstein

From the Department of Epidemiology and Public Health, Yale School of Medicine, New Haven, CT; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD; Fred Hutchinson Cancer Research Center, Seattle, WA; University of Southern California, Los Angeles; Division of Population Sciences, City of Hope National Medical Center, Duarte, CA; and Department of Epidemiology and Population Health, School of Public Health and Information Sciences, University of Louisville, Louisville, KY

Corresponding author: Melinda L. Irwin, PhD, MPH, Department of Epidemiology and Public Health, Yale School of Medicine, P.O. Box 208034, New Haven, CT 06520-8034; e-mail: melinda.irwin{at}yale.edu

Purpose To investigate the association between pre- and postdiagnosis physical activity (as well as change in prediagnosis to postdiagnosis physical activity) and mortality among women with breast cancer.

Patients and Methods This was a prospective observational study of 933 women enrolled onto the Health, Eating, Activity, and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004, whichever came first. The primary outcomes measured were total deaths and breast cancer deaths. The primary exposures were physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity.

Results Compared with inactive women, the multivariable hazard ratios (HRs) for total deaths for women expending at least 9 metabolic equivalent hours per week (approximately 2 to 3 h/wk of brisk walking) were 0.69 (95% CI, 0.45 to 1.06; P = .045) for those active in the year before diagnosis and 0.33 (95% CI, 0.15 to 0.73; P = .046) for those active 2 years after diagnosis. Compared with women who were inactive both before and after diagnosis, women who increased physical activity after diagnosis had a 45% lower risk of death (HR = 0.55; 95% CI, 0.22 to 1.38), and women who decreased physical activity after diagnosis had a four-fold greater risk of death (HR = 3.95; 95% CI, 1.45 to 10.50).

Conclusion Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis.

Supported by National Cancer Institute Grants No. N01-CN-75036-20, NO1-CN-05228, and NO1-PC-67010 and Training Grant No. T32 CA09661. A portion of this work was conducted through the Clinical Research Center at the University of Washington and supported by the National Institutes of Health Grant No. M01-RR-00037 and the University of New Mexico Grant No. NCRR M01-RR-0997. Data collection for the Women's Contraceptive and Reproductive Experiences Study at the University of Southern California was supported by Contract No. N01-HD-3-3175 from the National Institute of Child Health and Human Development, and patient identification was supported in part by Contract No. 050Q-8709-S1528 from the California Department of Health Services.

Authors’ disclosures of potential conflicts of interest and author contributions are found at the end of this article.

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