October 1, 2014

Impact of Running vs Walking on Breast Cancer Survival

Does type of exercise affect outcomes?
Breast cancer patients have long been advised to take up brisk walking to improve outcomes, but this analysis found that runners have significantly reduced mortality over walkers, with runners’ risk for breast cancer mortality decreasing more than 40%.


Williams PT. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Int J Cancer. 2014;135(5):1195-202. Epub 2014 Feb 28. 


Cox proportional hazard analyses were used prospectively to compare breast cancer mortality to baseline exercise energy and to determine whether postdiagnosis running and walking differ significantly in their association with breast cancer mortality.


Data used in this analysis came from 272 runners and 714 walkers from the National Runners’ and Walkers’ Health Studies who were previously diagnosed with breast cancer. Diagnosis occurred (mean±standard deviation) 7.9±7.3 years before baseline. Forty-six women (13 runners and 33 walkers) died from breast cancer during the 9.1-year mortality surveillance.

Study Medication and Dosage 

Metabolic equivalents (METs) per hour per day were calculated based on survey data.

Outcome Measures

Breast cancer–related mortality

Key Findings

When data from runners and walkers were evaluated together, the risk for breast cancer mortality decreased an average of 24% per MET hours per day of exercise, where 1 MET hour equals a little less than a mile of brisk walking or about two-thirds of a mile of running.
The possibility that such a simple intervention will prove useful in the long run is certainly intriguing.
When the runners and walkers were analyzed separately, there was significantly lower mortality in the runners. The runners’ risk for breast cancer mortality decreased over 40% per MET hour per day. Runners who averaged more than 2.25 miles per day were at 95% lower risk for breast cancer mortality than those that did not meet current exercise recommendations. In contrast, the walkers’ risk for breast cancer mortality decreased a nonsignificant 5% per MET hour per day.

Practice Implications

For the past half dozen years, we have strongly encouraged breast cancer patients to walk rigorously almost daily based on data from Irwin et al that suggested a possible 45% reduction in death rate.1 It was not clear back then that more exercise would be better. Based on this new paper by Williams, it seems we should be encouraging more rigorous exercise—running in fact, even suggesting an optimal distance of 2.25 miles per day. 
Almost a quarter of women diagnosed with invasive breast cancer die within 15 years of diagnosis.2
Physical activity may improve survival in women diagnosed with breast cancer, but the evidence is mixed. A number of other studies have already shown that physical activity significantly reduces breast cancer mortality.1,3-7 Several other studies have not demonstrated a significant reduction.8-12 Still, when data are combined via meta-analyses, there is stronger evidence for improved survival with greater physical activity. For example data from 13,302 breast cancer survivors of the After Breast Cancer Pooling Project suggest that meeting the current physical activity recommendations is associated with a 25% reduction in breast cancer mortality.13 These recommendations for physical activity suggest that 
all healthy adults aged 18 to 65 years need moderate-intensity aerobic (endurance) physical activity for a minimum of 30 min on five days each week or vigorous-intensity aerobic physical activity for a minimum of 20 min on three days each week.14
Two other meta-analyses reached similar conclusions. Patterson et al found a 29% reduction (including both physical activity measured for lifetime and at diagnosis),15 and Ibrahim et al found a 34% reduction16 in breast cancer mortality with postdiagnosis physical activity when various study results were combined.
There are aspects of this study that will be criticized—in particular the self-reporting of activity by the participants, absence of information on cancer stage at diagnosis, type of breast cancer participants had, and which treatment(s) the women underwent.
There is low risk of harm from encouraging more physical activity and encouraging greater exercise intensity in women who have been diagnosed with breast cancer. The possibility that such a simple intervention will prove useful in the long run is certainly intriguing. We now have reason, at least for the moment, to encourage these patients to take up running.

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  1. Irwin ML, Smith AW, McTiernan A, et al. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. J Clin Oncol. 2008;26(24):3958-3964. 
  2. American Cancer Society. Cancer Facts and Figures, 2013. Available at: http://www.cancer.org/acs/groups/content/@epidemiologysurveilance/documents/document/acspc-036845.pdf. Accessed September 16, 2014. 
  3. Holick CN, Newcomb PA, Trentham-Dietz A, et al. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev. 2008;17(2):379-386.
  4. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis.  JAMA. 2005;293(20):2479-2486.
  5. Irwin ML, McTiernan A, Manson JE, et al. Physical activity and survival in postmenopausal women with breast cancer: results from the women's health initiative. Cancer Prev Res (Phila). 2011;4(4):522-529.
  6. Friedenreich CM, Gregory J, Kopciuk KA, Mackey JR, Courneya KS. Prospective cohort study of lifetime physical activity and breast cancer survival. Int J Cancer. 2009;124(8):1954-1962. 
  7. Abrahamson PE, Gammon MD, Lund MJ, et al. Recreational physical activity and survival among young women with breast cancer. Cancer. 2006;107(8):1777-1785.
  8. Sternfeld B, Weltzien E, Quesenberry CP Jr, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epidemiol Biomarkers Prev. 2009;18(1):87-95.
  9. Pierce JP, Stefanick ML, Flatt SW, et al. Greater survival after breast cancer in physically active women with high vegetable-fruit intake regardless of obesity. J Clin Oncol. 2007;25(17):2345-2351.
  10. Borugian MJ, Sheps SB, Kim-Sing C, et al. Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? Cancer Epidemiol Biomarkers Prev. 2004;13(7):1163-1172.
  11. Enger SM, Bernstein L. Exercise activity, body size and premenopausal breast cancer survival. Br J Cancer. 2004;90(11):2138-2141.
  12. Dal Maso L, Zucchetto A, Talamini R, et al; Prospective Analysis of Case-control studies on Environmental factors and health (PACE) study group. Effect of obesity and other lifestyle factors on mortality in women with breast cancer. Int J Cancer. 2008;123(9):2188-2194.
  13. Beasley JM, Kwan ML, Chen WY, et al. Meeting the physical activity guidelines and survival after breast cancer: findings from the after breast cancer pooling project. Breast Cancer Res Treat. 2012;131(2):637-643.
  14. Haskell WL, Lee IM, Pate RR, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc. 2007;39(8):1423-1434.
  15. Patterson RE, Cadmus LA, Emond JA, Pierce JP. Physical activity, diet, adiposity and female breast cancer prognosis: a review of the epidemiologic literature. Maturitas. 2010;66(1):5-15.
  16. Ibrahim EM, Al-Homaidh A. Physical activity and survival after breast cancer diagnosis: meta-analysis of published studies. Med Oncol. 2011;28(3):753-765.