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Research Article

Exercise After Diagnosis of Breast Cancer in Association with Survival

Xiaoli Chen, Wei Lu, Wei Zheng, Kai Gu, Charles E. Matthews, Zhi Chen, Ying Zheng and Xiao Ou Shu
Xiaoli Chen
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Wei Lu
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Wei Zheng
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Kai Gu
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Charles E. Matthews
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Zhi Chen
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Ying Zheng
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Xiao Ou Shu
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DOI: 10.1158/1940-6207.CAPR-10-0355 Published September 2011
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    Figure 1.

    Overall survival curves among Chinese women diagnosed with breast cancer by regular exercise participation during the first 6 months after breast cancer diagnosis (n = 4,826).

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    Figure 2.

    Disease-free survival curves among Chinese women diagnosed with breast cancer by regular exercise participation during the first 6 months after breast cancer diagnosis (n = 4,511).

Tables

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  • Table 1.

    Sociodemographic and clinical characteristics of breast cancer cases at study enrollment

    CharacteristicTotal (n = 4,826)aExercisers (n = 3,115)aNonexercisers (n = 1,711)aPb
    Age at diagnosis, y53.5 (10.0)53.4 (10.0)53.6 (10.1)0.452
    Education, %
     <High school46.545.049.20.003
     High school37.638.037.0
     >High school15.917.113.8
    Income (yuan/mo/capita), %
     <1,00057.756.559.90.008
     1,000–1,99930.430.630.0
     ≥2,00011.912.910.1
    Married/living with partner, %88.088.187.80.801
    Interval from diagnosis to study enrollment, mo6.5 (0.7)6.5 (0.7)6.5 (0.8)0.755
    Charlson comorbidity index ≥119.819.520.50.377
    TNM stage, %
     I34.836.431.9<0.001c
     IIa33.934.033.8
     IIb17.216.518.4
     III9.48.411.2
     Unknown4.74.74.9
    ER/PR status, %
     Positive (ER+/PR+)50.350.250.30.651c
     Negative (ER−/PR−)27.427.127.9
     Mixed (ER+/PR− or ER−/PR+)20.420.819.8
     Unknown1.91.82.0
    Ever received chemotherapy, %92.291.294.0<0.001
    Ever received radiotherapy, %32.429.637.5<0.001
    Ever received immunotherapy, %14.815.114.40.580
    Ever used tamoxifen, %51.954.348.0<0.001
    Type of surgery, %
     Mastectomy94.194.793.80.352
     Conservation2.62.52.8
     Others3.02.83.3
    Family history of breast cancer, %5.65.55.70.695
    BMI, kg/m224.1 (3.4)24.1 (3.3)24.2 (3.6)0.174
    Waist-to-hip ratio0.83 (0.05)0.83 (0.05)0.84 (0.06)<0.001
    Cigarette smoking, %2.62.23.30.020
    Alcohol consumption, %3.12.93.50.271
    Tea consumption, %23.625.320.5<0.001
    Postmenopausal, %51.151.151.20.935
    Meat intake, g/d82.7 (57.8)83.6 (56.8)81.1 (59.0)0.148
    Cruciferous vegetable intake, g/d74.6 (53.0)78.3 (52.1)68.0 (54.0)<0.001
    Soy protein intake, g/d11.4 (8.6)12.0 (8.8)10.1 (8.0)<0.001
    QOL score58.1 (14.2)59.3 (13.6)55.9 (14.9)<0.001
    • aUnless otherwise specified, means (SD) are presented.

    • bFor tests of differences between women with and without exercise participation.

    • cFor the χ2 test, “unknown” group was excluded.

  • Table 2.

    Associations of exercise after breast cancer diagnosis with total mortality and relapse/disease-specific mortality

    HR (95% CI)
    CharacteristicsTotalEventsFirst 6 mo postdiagnosisaFirst 18 mo postdiagnosisbFirst 36 mo postdiagnosisb
    Total mortality4,826436
    Exercise participation
     No1,7111851.001.001.00
     Yes3,1152510.80 (0.65–0.97)0.70 (0.56–0.87)0.70 (0.56–0.88)
    Exercise participation per week, h
     No exercise1,7111851.001.001.00
     <2.51,6541260.78 (0.62–0.98)0.75 (0.59–0.96)0.84 (0.66–1.08)
     ≥2.51,4611250.82 (0.64–1.04)0.66 (0.51–0.84)0.64 (0.49–0.82)
     Ptrend0.1680.0040.002
    Exercise energy expenditure, MET-hours per week
     No exercise1,7111851.001.001.00
     <8.31,5661220.79 (0.63–0.99)0.77 (0.60–0.99)0.81 (0.63–1.05)
     ≥8.31,5491290.80 (0.63–1.02)0.65 (0.51–0.83)0.65 (0.51–0.84)
     Ptrend0.1980.004<0.001
    Relapse/disease-specific mortality4,511450
    Exercise participation
     No1,5801741.001.001.00
     Yes2,9312760.91 (0.75–1.11)0.71 (0.57–0.90)0.60 (0.47–0.76)
    Exercise participation per week, h
     No exercise1,5801741.001.001.00
     <2.51,5521330.84 (0.66–1.05)0.70 (0.54–0.90)0.63 (0.48–0.82)
     ≥2.51,3791431.01 (0.80–1.27)0.73 (0.57–0.94)0.57 (0.44–0.74)
     Ptrend0.5220.3410.030
    Exercise energy expenditure, MET-hours per week
     No exercise1,5801741.001.001.00
     <8.31,4681280.85 (0.67–1.07)0.70 (0.54–0.91)0.60 (0.46–0.78)
     ≥8.31,4631480.98 (0.78–1.24)0.72 (0.57–0.93)0.59 (0.45–0.76)
     Ptrend0.4710.3240.006
    • aAdjusted for date of birth, BMI at baseline, waist-to-hip ratio at baseline, menopausal status, income, education, QOL, cruciferous vegetable intake, soy protein intake, tea consumption, chemotherapy, radiotherapy, tamoxifen use, TNM status, and ER/PR status.

    • bAdjusted for the same variables as above, but exercise was treated as a time-dependent variable.

  • Table 3.

    Associations of exercise over the first 36 months after breast cancer diagnosis with total mortality and relapse/disease-specific mortality, stratified by disease stage and hormone receptor status

    Total mortalityRelapse/disease-specific mortality
    TotalEventsHR (95% CI)TotalEventsHR (95% CI)
    Stratified by TNM a
    TNM I–IIa stage3,3161663,124190
     MET-hours per weekb
      No exercise1,123671.001,044691.00
      <8.31,097440.79 (0.51–1.22)1,032500.52 (0.32–0.80)
      ≥8.31,096550.89 (0.59–1.36)1,048710.62 (0.41–0.92)
     Ptrend0.3330.444
    TNM IIb–III stage1,2822491,176241
     MET-hours per weekb
      No exercise5051101.004611021.00
      <8.3395730.83 (0.60–1.15)364710.57 (0.40–0.82)
      ≥8.3382660.52 (0.37–0.72)351680.45 (0.32–0.64)
     Ptrend<0.001<0.002
     Pinteraction0.0370.218
    Stratified by ER/PR c
    ER+PR+ (positive)2,4261612,308189
     MET-hours per weekb
      No exercise861701.00815801.00
      <8.3809391.41 (0.87–2.27)771460.72 (0.47–1.12)
      ≥8.3756521.32 (0.83–2.12)722630.79 (0.53–1.19)
     Ptrend0.9350.540
    ER−PR− (negative)1,3231711,213155
     MET-hours per weekb
      No exercise478761.00428621.00
      <8.3429500.58 (0.39–0.86)392450.40 (0.25–0.63)
      ≥8.3416450.40 (0.29–0.59)393480.36 (0.24–0.56)
     Ptrend<0.0010.002
    ER+PR−/ER−PR+ (mixed)9868791194
     MET-hours per weekb
      No exercise338311.00308281.00
      <8.3299280.78 (0.42–1.43)282320.62 (0.32–1.23)
      ≥8.3349280.67 (0.36–1.22)321340.51 (0.27–1.00)
     Ptrend0.0510.166
     Pinteraction0.0040.375
    • aAdjusted for date of birth, BMI at baseline, waist-to-hip ratio at baseline, menopausal status, income, education, QOL, cruciferous vegetable intake, soy protein intake, tea consumption, chemotherapy, radiotherapy, tamoxifen use, and ER/PR receptor status.

    • bExercise was treated as a time-dependent variable.

    • cFurther adjusted for TNM status instead of ER/PR receptor status.

  • Table 4.

    Associations of exercise over the first 36 months after breast cancer diagnosis with total mortality and relapse/disease-specific mortality, stratified by menopausal status, QOL, and BMI

    Total mortalityRelapse/disease-specific mortality
    TotalEventsHR (95% CI)TotalEventsHR (95% CI)
    Stratified by menopausal status a
    Premenopause2,3591862,202208
     MET-hours per weekb
      No exercise835761.00773811.00
      <8.3764490.87 (0.58–1.10)714550.59 (0.39–0.89)
      ≥8.3760610.86 (0.58–1.26)715720.69 (0.47–1.00)
     Ptrend0.3170.631
    Postmenopause2,4672502,309242
     MET-hours per weekb
      No exercise8761091.00807931.00
      <8.3802730.82 (0.59–1.14)754730.63 (0.44–0.91)
      ≥8.3789680.55 (0.40–0.77)748760.52 (0.36–0.74)
     Ptrend<0.0010.001
     Pinteraction0.2330.300
    Stratified by QOL c
    QOL < median2,2782052,138222
     MET-hours per weekb
      No exercise9021011.00827991.00
      <8.3723560.63 (0.44–0.90)681590.45 (0.31–0.65)
      ≥8.3653480.50 (0.35–0.71)630640.47 (0.33–0.66)
     Ptrend<0.0010.006
    QOL ≥ median2,5482312,373228
     MET-hours per weekb
      No exercise809841.00753751.00
      <8.3843661.06 (0.73–1.55)787690.80 (0.53–1.21)
      ≥8.3896810.83 (0.58–1.21)833840.74 (0.50–1.10)
     Ptrend0.1110.289
     Pinteraction0.2940.218
    Stratified by BMI d
    BMI<253,1282672,914266
     MET-hours per weekb
      No exercise1,1021131.001,015981.00
      <8.3999760.76 (0.55–1.05)932810.70 (0.47–0.96)
      ≥8.31,027780.62 (0.45–0.85)967870.66 (0.47–0.94)
     Ptrend0.0020.033
    BMI ≥ 251,6981691,597184
     MET-hours per weekb
      No exercise609721.00565761.00
      <8.3567460.91 (0.60–1.38)536470.53 (0.35–0.81)
      ≥8.3522510.70 (0.46–1.05)496610.50 (0.38–0.74)
      Ptrend0.0270.095
     Pinteraction0.6420.704
    Stratified by Charlson comorbidity index
    Charlson comorbidity index <13,8693393,601350
     MET-hours per weekb
      No exercise1,3601381.001,2531331.00
      <8.31,258980.89 (0.66,1.18)1,1721010.65 (0.47–0.89)
      ≥8.31,2511030.68 (0.50–0.90)1,1761160.66 (0.49–0.90)
     Ptrend0.0030.162
    Charlson comorbidity index ≥195797910100
     MET-hours per weekb
      No exercise351471.00327411.00
      <8.3308240.63 (0.36–1.10)296270.49 (0.26–0.78)
      ≥8.3298260.62 (0.37–1.05)287320.39 (0.23–0.66)
     Ptrend0.0500.009
     Pinteraction0.1980.651
    • aAdjusted for date of birth, BMI at baseline, waist-to-hip ratio at baseline, income, education, QOL, cruciferous vegetable intake, soy protein intake, tea consumption, chemotherapy, radiotherapy, tamoxifen use, TNM status, and ER/PR receptor status.

    • bExercise was treated as a time-dependent variable.

    • cFurther adjusted for TNM status instead of QOL.

    • dFurther adjusted for QOL instead of BMI.

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Cancer Prevention Research: 4 (9)
September 2011
Volume 4, Issue 9
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Exercise After Diagnosis of Breast Cancer in Association with Survival
Xiaoli Chen, Wei Lu, Wei Zheng, Kai Gu, Charles E. Matthews, Zhi Chen, Ying Zheng and Xiao Ou Shu
Cancer Prev Res September 1 2011 (4) (9) 1409-1418; DOI: 10.1158/1940-6207.CAPR-10-0355

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Exercise After Diagnosis of Breast Cancer in Association with Survival
Xiaoli Chen, Wei Lu, Wei Zheng, Kai Gu, Charles E. Matthews, Zhi Chen, Ying Zheng and Xiao Ou Shu
Cancer Prev Res September 1 2011 (4) (9) 1409-1418; DOI: 10.1158/1940-6207.CAPR-10-0355
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