Older breast cancer survivors’ exercise and support group program experiences and recommendations from the IMPROVE trial: a qualitative study

BMC Cancer · 2026-01-06

BACKGROUND: Physical activity is critical for older breast cancer survivors. We explored the experiences and recommendations of older breast cancer survivors from the IMPROVE trial, including a sizable number of older African American and socioeconomically disadvantaged survivors, to inform future implementation and dissemination of sustainable programs. METHODS: Participants included women, ≥ 65 years, within five years of treatment completion for stage I-III breast cancer who were enrolled into a randomized controlled trial of supervised group moderate-intensity exercise for 20-weeks followed by 32 weeks of unsupervised exercise versus support group (SG) plus Fitbit intervention. Semi-structured exit interviews were conducted at study completion. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis with constant comparison. Two researchers independently coded transcripts, discussing discrepancies to enrich interpretation. The Social Cognitive Theory and the Transtheoretical Model guided interpretation of results. RESULTS: Between 2016 and 2020, 213 older breast cancer survivors were randomized into the exercise arm, (n = 108) or a SG + Fitbit arm, (n = 105). At study completion, 145 (68%) opted to participate in exit interviews. This included 75 Exercise and 70 Support Group participants. Participants described a range of experiences and recommendations that clustered into five broad themes: program experiences, transition challenges, Fitbit experiences, program impact, and recommendations. Survivors consistently highlighted camaraderie, peer bonding, and accountability as central benefits of participation, with enjoyment of activities and staff support further enriching their experience. Many described difficulties sustaining activity after program completion, underscoring the need for ongoing group-based support. Experiences with Fitbit were mixed: some found it motivating, while others reported technical barriers. Survivors also noted increased energy, health awareness, and reduced isolation. Recommendations included extending program duration, adding nutrition content, reducing survey burden, and addressing transportation challenges. CONCLUSION: Older breast cancer survivors, including those underrepresented in survivorship research, emphasized the importance of social support, structured exercise, and wearable technology in sustaining physical activity. Their recommendations highlight strategies for tailoring future interventions to enhance accessibility, sustainability, and long-term impact. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT02763228.

Exercise recommendations for older adults living with and beyond cancer: A consensus statement by the Advancing Capacity to Integrate Exercise Into the Care of Older Cancer Survivors expert panel

Cancer · 2026-01-07 · 2 citations

BACKGROUND: The number of cancer survivors aged older than 65 years is rising rapidly. Current evidence-based exercise guidelines lack specific guidance for older cancer survivors as a result of insufficient evidence. An expert panel was convened to develop consensus-based recommendations for exercise in older cancer survivors. METHODS: The development of recommendations was guided by the Grading of Recommendations Assessment, Development, and Evaluation Evidence-to-Decision framework for good practice statements. The panel drew from the available literature, a Delphi survey of exercise and health professionals, other exercise guidelines, clinical and research expertise, and interest-holder input provided by a community advisory board of older cancer survivors and caregivers (n = 11). Recommendations had to be deemed accessible (i.e., no added barriers) to older cancer survivors and feasible to implement. The panel voted on the strength of the recommendation for or against each statement, with consensus set at 85% agreement. RESULTS: Consensus was reached on 11 recommendations covering the following areas: medical evaluation/clearance for exercise, pre-exercise assessment, exercise prescription, exercise tolerance and safety, exercise delivery, and behavioral support. The recommendations aimed to promote engagement in and uptake of appropriately prescribed exercise programming by older cancer survivors, while keeping barriers and risks as low as possible. CONCLUSIONS: Older cancer survivors can benefit from appropriately prescribed exercise, which should be an essential component of their cancer care. Exercise and health professionals need to consider the unique needs of older cancer survivors to ensure that exercise is safe and effective for this population, while also reducing barriers to reach as many people as possible.

Brief daily functional strength training to improve functional performance in older adults with mobility disability: A randomized trial

PLoS ONE · 2026-03-12

OBJECTIVES: Mobility disability is associated with functional decline in older adults. Resistance training (RT) improves mobility disability, but adherence to national RT guidelines is poor. We evaluated the effects of a 12-week brief, home-based functional RT program, FAST (Functional Activity Strength Training)-2, on adherence and functional impairment in older, inactive adults ≥ 65 years of age, with pre-existing walking difficulty. METHODS: Eligible older adults were randomized using stratified assignment based on biological sex and age (65-72 and 73+) to either the FAST-2 intervention involving a 4-minute daily workout of four exercises lasting 30 seconds each or the delayed treatment control condition. Video coaching at baseline and at weeks 2, 4 and 8, provided feedback on exercise form, modifications and progression. Daily email reminders were sent for workout completion, and to report exercise performance and rate perceived exertion. Performance and adherence feedback were emailed biweekly. Functional performance was measured by video using the Five-Times Sit-to-Stand (FTSTS) test, One-Legged Stance Test (OLST) and the 30-second chair stand test at baseline and at weeks 6 and 12. RESULTS: Ninety-seven participants were randomized to either the FAST-2 treatment intervention (n = 44) or the delayed treatment control condition (n = 53). The linear mixed-effect model showed the intervention group decreased the FTSTS by 2.3 seconds (95% CI: 0.5-4.1, p = 0.01), increased OLST by 3.6 seconds (95% CI: 0.6-6.5, p = 0.02) and increased the number of chair stands by 4.2 repetitions (95% CI: 2.8-5.7, p < 0.001) more than the control group over 12 weeks. Intervention participants completed the workout 81% of the days. No significant adverse events were reported. CONCLUSION: The 12-week FAST-2 intervention, including only 60-seconds of lower extremity exercises in older individuals with pre-existing walking difficulty, yielded improvement in functional performance. TRIAL REGISTRATION: ClinicalTrials.gov: ID NCT05697497 Study Details | NCT05697497 | Functional Activity Strength Training | ClinicalTrials.gov.

Supplementary Table 6 from Body Composition, Relative Dose Intensity, and Adverse Events among Patients with Colon Cancer

2025-11-26

&lt;p&gt;Supplementary Table 6. Sex-Specific Adjusted Associations of Body Composition Measurements (Per SD Increase) with Reduced RDI and Relative Changes (%) in the Number of Moderate and Severe Adverse Events&lt;/p&gt;

If Exercise Were a Pill, We'd All Prescribe It to Patients With Cancer. But It's Not

Journal of Clinical Oncology · 2025-11-21 · 3 citations

Supplementary Table 1 from Body Composition, Relative Dose Intensity, and Adverse Events among Patients with Colon Cancer

2025-11-26

&lt;p&gt;Supplementary Table 1. The Comparisons of Patient Characteristics in All (N = 178), CT (N = 170), DXA (N = 162), and D3Cr (N = 118) Groups&lt;/p&gt;

History informing the future of exercise oncology

JNCI Monographs · 2025-08-19 · 5 citations

Exercise is increasingly recognized by patients, clinicians, and allied health professionals globally as an important component of cancer care. In this paper, we provide a viewpoint on developments in exercise oncology over the past 4 decades leading up to the creation of the International Society of Exercise Oncology (ISEO). We briefly review research in adult and pediatric cancers from early foundation studies to larger randomized controlled trials published in mainstream oncology journals alongside critical work undertaken in exercise and cancer biological mechanisms. We also discuss potential strengths, weaknesses, opportunities, and threats facing ISEO in becoming a global forum for exercise oncology. Building on the foundational work undertaken over the past 4 decades by researchers, clinicians, and practitioners, ISEO provides an opportunity to support research, leverage collaborations and partnerships, facilitate education and training, increase awareness of exercise oncology, and support translation of research to clinical practice, ultimately improving the quality and quantity of life for people with cancer.

Associations of Obesity with Function and Patient-Reported Outcomes Among Rural Advanced Cancer Patients: A Cross-Sectional Analysis of the Nurse AMIE Randomized Controlled Trial

Cancers · 2025-12-19

Background/Objectives: Obesity is a common comorbidity but there remains limited understanding on how higher obesity rates in rural areas may impact physical function decline and other health domains among cancer patients. This study addresses this gap by examining the association between body mass index (BMI) and physical function among a cohort of rural advanced cancer patients. Methods: This cross-sectional analysis uses baseline data from the Nurse AMIE trial (NCT04673019). Individuals were categorized as ‘normal weight’ (BMI ≤ 25 kg/m2), ‘overweight’ (BMI &gt; 25 to 30 kg/m2), and ‘obese’ (BMI &gt; 30 kg/m2). Objective physical function was measured by the Short Physical Performance Battery (SPPB) and subjective physical function and health domains were measured using surveys (PROMIS; SF-36). Results: Of 348 patients included, 88 (25.3%) were classified as ‘normal weight’, 107 (30.7%) as ‘overweight’, and 153 (44.0%) as ‘obese’. Average age was 64.8 years (SD = 12.2), 46% (n = 160) were female, 95% were white (n = 331), and 52% (n = 182) were Stage 4. Total SPPB scores revealed poorer functioning with higher BMI (M ± SD: BMI ≤ 25 kg/m2: 9.1 ± 2.3; BMI &gt; 25–30 kg/m2: 8.3 ± 3.1; BMI &gt; 30 kg/m2: 8.1 ± 2.8; p = 0.04). Similarly, scores from the SF-36 revealed subjective physical function was lower with higher BMI (BMI ≤ 25 kg/m2: 57.9 ± 29.1; BMI &gt; 25–30 kg/m2: 53.7 ± 28.0; BMI &gt; 30 kg/m2: 47.6 ± 27.6; p = 0.004). Participants reported lower levels of energy and greater fatigue with higher BMI (BMI ≤ 25 kg/m2: 49.8 ± 26.1; BMI &gt; 25–30 kg/m2: 45.1 ± 24.6; BMI &gt; 30 kg/m2: 40.7 ± 22.6; p = 0.01). Conclusions: Higher BMI is associated with poorer physical function and increased fatigue among rural advanced cancer patients, highlighting the need for supportive care related to physical function in this at-risk group.

Exercise oncology comes of age

JNCI Monographs · 2025-08-19

Exercise oncology is coming of age, with more than 30 000 peer-reviewed citations in the scientific literature and multiple guidelines published by major medical institutions based on strong evidence from randomized controlled trials. There is enthusiasm around the formation of a new international organization that will form a nexus for exercise oncology researchers, clinicians, and practitioners. The contents of this monograph document the progression of exercise oncology research and practice, laying the groundwork for the formation of the International Society of Exercise Oncology. The society will aim to be an organizing body to shepherd the field toward the goal of using exercise as standard of care in the setting of oncology in collaboration with existing medical organizations so that every patient can benefit.

Adherence to a remote exercise program and quality of life among patients with cancer: The mediating role of symptom burden.

JCO Oncology Practice · 2025-10-01

349 Background: Remote exercise interventions are being increasingly employed in oncology, but real-world adherence and its impact on outcomes remain to be established. Understanding whether adherence is associated with better quality of life (QOL), and how symptom burden mediates this relationship, is critical to optimizing supportive care delivery for patients with cancer. Methods: We conducted a longitudinal, single-arm study of a 12-week remote exercise program among adults with cancer receiving systemic treatment. Eligible participants had ECOG ≤2 and access to a smartphone. The intervention included weekly virtual sessions with an exercise physiologist and personalized prescriptions based on the Borg scale, supported by instructional videos and remote guidance via WhatsApp. Participants were encouraged to complete a 30–45-minute exercise session per day. Assessments were conducted at baseline and 12 weeks using the Functional Assessment of Cancer Therapy–General (FACT-G) for QOL and the Edmonton Symptom Assessment Scale (ESAS) for symptom burden. Adherence was defined as high (≥8 weeks) or low (&lt; 8 weeks). Mediation analysis (PROCESS Model 4 with 5,000 bootstrap) tested whether symptom burden at 12 weeks mediated the effect of adherence on QOL. Analyses controlled for baseline FACT-G and ESAS scores. Results: Among 149 participants (median age: 68 years; range: 32–88), 55.0% were female, 67.8% were white, and 56.3% college educated. The most common cancer types were breast (24.8%), genitourinary (17.4%), and gynecological (14.8%); 67.1% had stage IV disease. Treatments included immunotherapy (46.5%), targeted therapy (21.7%), chemotherapy (16.3%), and combination regimens (15.5%). Patients with high adherence (71.1%) showed significantly greater improvement in QOL from baseline to 12 weeks. Adherence had a significant direct effect on QOL at 12 weeks (B = 10.78, SE = 1.33, p &lt; .001; 95% CI: 8.15 to 13.40) and an indirect effect via symptom burden (B = 2.30, Bootstrapped 95% CI: 0.13 to 5.81), indicating partial mediation. These findings suggest that patients who adhered more to the prescribed exercise program had subsequently better QOL, in part due to reduced symptom burden. Conclusions: High adherence to remote exercise programs may lead to meaningful improvements in QOL, partly through reduced symptom burden. Supporting adherence may enhance the effectiveness and scalability of digital exercise interventions in oncology.