Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Impact of Physical Activity on Recurrence Dynamics in Early Breast Cancer Patients

Version 1 : Received: 31 January 2021 / Approved: 2 February 2021 / Online: 2 February 2021 (08:24:31 CET)

A peer-reviewed article of this Preprint also exists.

Biganzoli, E.; Desmedt, C.; Demicheli, R. Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients? J. Clin. Med. 2021, 10, 831. Biganzoli, E.; Desmedt, C.; Demicheli, R. Does Physical Activity Have an Impact on Recurrence Dynamics in Early Breast Cancer Patients? J. Clin. Med. 2021, 10, 831.


Several studies have suggested that pre and/or postdiagnosis physical activity can reduce the risk of recurrence in breast cancer patients, however its effect according to follow-up time has not yet been investigated. We analyzed recurrence and mortality dynamics in randomized clinical trials (RCTs) from Australia and Canada. The combined Australian RCTs evaluated, at median follow-up of 8.3 years, an 8-month pragmatic exercise intervention in 337 women with newly diagnosed breast cancer, while the Canadian RCT evaluated, at median follow-up of 7.4 years, supervised aerobic or resistance exercise during chemotherapy in 242 patients. For each RCT, the control arm consisted of patients undergoing usual care. We estimated the event dynamics by the discrete hazard function, through flexible regression of yearly conditional event probabilities with generalized additive models. In the considered RCTs, the recurrence and mortality risk of patients enrolled in the physical activity arm was stably reduced at medium/long term after five year of follow-up. In the Australian RCTs where patients were recruited by urban versus rural area, the latter group did not display benefit from physical activity. Estimated Odds Ratios (95% Confidence Intervals) for Disease Free Survival (DFS) in urban women were 0.63 (0.22-1.85); 0.27 (0.079-0.90); 0.11 (0.013-0.96) at the 3rd, 5th and 7th year of follow-up, respectively. For rural women, DFS patterns were overlapping with ORs approximating 1 at the different years of follow-up. Although not reaching statistical evidence, the estimates in the Canadian trial were in line with the results from the Australian urban women with ORs (95% CI) forDFS of 0.70 (0.33-1.50); 0.47 (0.19-1.18); 0.32 (0.077-1.29) at 3rd, 5th, 7th follow-up year, respectively. While we acknowledge that the analyzed RCTs were not designed for investigating disease recurrence over time, these results support the evidence that physical activity reduces the risk of developing medium/long-term metastases. Additional translational research is needed to clarify the mechanisms underlying these observations.


early breast cancer; prognosis; physical activity; tumor dormancy; recurrence


Medicine and Pharmacology, Immunology and Allergy

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