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A randomized trial of 253 breast cancer survivors found that participants offered remotely coached exercise improved attention more than those in a health and wellness program over 12 months. The groups did not differ significantly on the trial’s two primary outcomes, processing speed and self-reported cognition; a companion analysis also found slower changes in epigenetic aging markers in the exercise group.
In a randomized trial of 253 breast cancer survivors, researchers found that participants offered a 12-month exercise program had greater improvements in attention than participants in a health and wellness program, while the groups did not differ significantly on the trial’s two primary cognitive outcomes. A companion study reported slower changes in markers of epigenetic aging in the exercise group, findings that may help guide research into cognitive health after cancer treatment.
The trial enrolled survivors who had completed active treatment and reported both low physical activity and cognitive difficulties. Participants were randomly assigned to a remotely delivered exercise program or a health and wellness program. Both groups had regular contact with a health coach, but only the exercise group received exercise coaching and used fitness trackers. Coaches helped participants work toward 150 minutes of moderate-to-vigorous activity per week.
The exercise group increased its activity more than the comparison group. Both groups improved on all cognitive measures, but researchers found no significant between-group differences in processing speed or self-reported cognition, the two primary outcomes. The exercise group had greater gains in attention at six and 12 months. It also had greater memory improvement at six months, but that difference was not maintained at 12 months. The groups did not differ significantly in executive function.
A companion analysis examined blood samples from a random subset of 124 participants, collected at the start and at six and 12 months. Using two epigenetic clocks, the researchers found slower changes in aging markers over the study period in the exercise group. The health and wellness group showed nearly 10 months of epigenetic aging markers during the 12 months, compared with about one month in the exercise group. These clock readings estimate biological age from DNA methylation patterns; they are not measurements of chronological age or proof that exercise reverses aging.
Attention Gains After Treatment
Thinking problems can affect daily activities and quality of life for people who have completed breast cancer treatment. The study adds evidence that a remotely coached activity program may be associated with gains in attention, a skill used to follow conversations, take in information and complete tasks. The researchers say the activity increase was attainable for participants, though the report does not establish a specific exercise prescription for all survivors.
The results need to be read alongside the null findings: the exercise group did not outperform the comparison group on the trial’s primary measures of processing speed and self-reported cognition. The memory advantage was seen at six months but not at 12 months. The study therefore points to possible benefits in particular cognitive areas rather than a broad improvement across all measured functions.
The companion findings connect activity with changes in biological aging markers, but they do not show that those markers caused the attention results. Taken together, the studies offer leads for future research, not proof of a biological mechanism or a guaranteed benefit for an individual.
Trial Design and Study Groups
The two papers, published Sept. 30 in the Journal of the National Cancer Institute, stem from the same randomized clinical trial. Random assignment helps researchers compare outcomes between groups, while the health and wellness program provided regular coach contact that served as a comparison for the exercise intervention.
Researchers say cognitive difficulties after breast cancer may arise from multiple factors, including treatment effects, inflammation, hormonal changes, fatigue and stress. The source report estimates that one in three survivors experiences cognitive problems, which can involve attention, memory and processing speed. Such problems may continue after treatment, but the trial findings apply specifically to survivors who reported cognitive difficulties and low activity when they enrolled.
“Attention is central to our everyday activities. It helps us follow conversations, absorb information and complete tasks without making errors, so the sustained improvements we saw in this trial is particularly encouraging.”
— Sheri Hartman, lead author and UC San Diego professor
Limits of the Current Findings
The trial does not show a significant exercise advantage on processing speed or self-reported cognition, and the memory difference observed at six months was not sustained at 12 months. It is also unclear whether changes in epigenetic aging markers directly contributed to cognitive outcomes, or whether the reported pattern will hold in a larger and more varied group of survivors.
The source report does not provide detailed information on participant demographics, the size of each cognitive effect, or outcomes beyond 12 months. It also does not establish whether the program would produce the same results for survivors without reported cognitive difficulties or for people with different activity levels.
Larger Studies Needed
The researchers say larger studies are needed to confirm the findings, test whether epigenetic aging changes contribute to cognitive benefits and determine whether attention improvements can be sustained over time. Further research could also clarify which survivors are most likely to benefit and how much activity may be needed.
For now, the results describe outcomes from one 12-month trial and its companion blood-sample analysis. The source material does not announce a next trial or a date for further results.
Key Questions
What did the exercise trial find?
Participants offered exercise coaching had greater improvements in attention at six and 12 months than participants in a health and wellness program. The groups did not differ significantly on processing speed or self-reported cognition, the two primary outcomes.
Did exercise improve memory?
The exercise group showed greater memory improvement at six months. That difference was not maintained at 12 months, when the groups had similar results.
What did the epigenetic aging analysis measure?
Researchers used two epigenetic clocks to estimate biological age from DNA methylation patterns in blood samples from 124 participants. The exercise group had slower changes in those markers over 12 months; the result does not prove that exercise reverses aging.
Do the findings prove that exercise caused better cognitive health?
The randomized design supports a comparison between the study groups, but the results were mixed across cognitive measures. The companion analysis also does not establish that epigenetic changes caused cognitive benefits. Researchers say larger studies are needed.
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