What lifestyle interventions are recommended for adult women with a history of breast cancer, possibly with genetic predisposition or other risk factors, to improve overall survival and mitigate treatment side effects?

Lifestyle Interventions for Breast Cancer Patients

Breast cancer survivors should engage in at least 150 minutes of moderate-intensity or 75 minutes of vigorous aerobic exercise weekly, combined with strength training twice per week, while following a plant-based dietary pattern high in vegetables, fruits, whole grains, and legumes, limiting alcohol to no more than one drink daily, and achieving a healthy body weight. 1

Physical Activity Recommendations

Regular physical activity provides the strongest evidence for improving survival and quality of life in breast cancer survivors. Observational data from 16 studies demonstrate that physically active breast cancer survivors have a 28% reduction in breast cancer-specific mortality (RR 0.72,95% CI 0.60-0.85) and a 48% reduction in all-cause mortality (RR 0.52,95% CI 0.42-0.64). 1

Specific Exercise Prescription

• Aerobic exercise: Minimum 150 minutes of moderate-intensity OR 75 minutes of vigorous-intensity exercise per week 1
• Strength training: At least 2 days per week, with particular emphasis for women receiving adjuvant chemotherapy or hormone therapy 1
• Return to activity: Resume normal daily activities as soon as possible after diagnosis to avoid deconditioning 1

Important caveat: While 150 minutes weekly is the minimum recommendation, observational evidence suggests that 3 or more hours of aerobic exercise per week may provide additional survival benefits, though this remains insufficient evidence for a formal recommendation. 1

Physical activity effectively mitigates treatment side effects including fatigue, improves physical functioning, and enhances quality of life. 1 However, only 32% of breast cancer survivors currently meet these physical activity recommendations. 1

Nutritional Guidelines

Adopt a dietary pattern emphasizing plant-based whole foods while restricting saturated fats and alcohol. 1

Dietary Components

• Increase: Vegetables, fruits, whole grains, and legumes 1
• Decrease: Saturated fats, red meat, processed meats, refined sugars 1, 2
• Limit alcohol: Maximum one drink per day for women 1

Critical evidence: Eating a diet high in vegetables, fruits, whole grains, and legumes (versus a typical Western diet) reduces all-cause mortality by 15-43%. 1 Conversely, consuming more than 3-4 alcoholic drinks per week increases breast cancer recurrence risk. 1

Only 18-34% of breast cancer survivors currently consume five or more servings of fruits and vegetables daily, indicating substantial room for improvement. 1

Weight Management

Achieve and maintain a healthy body weight (BMI <25 kg/m²) through caloric restriction and increased physical activity. 1

Approximately 62% of breast cancer survivors are overweight or obese, with 30% classified as obese (BMI ≥30 kg/m²). 1 Obesity increases risk for postoperative complications, second cancers, recurrence, and diabetes development. 1

Key finding: Data from two large randomized controlled trials demonstrate that dietary changes sufficient to produce weight loss may favorably impact breast cancer recurrence and prognosis. 1 Weight loss also mitigates symptoms and improves quality of life. 1

Refer overweight or obese survivors to multicomponent obesity treatment programs when appropriate. 1

Smoking Cessation

All breast cancer survivors who smoke must be counseled to quit and referred to cessation programs. 1

Approximately 10-12% of breast cancer survivors smoke. 1 Observational studies consistently show that women who smoke at diagnosis have substantially worse breast cancer-specific survival and overall survival compared to former and never smokers. 1

Additional Supportive Interventions

Physical Therapy and Rehabilitation

• Offer physical therapy referral as primary intervention for musculoskeletal health issues in breast cancer survivors, particularly those with shoulder mobility problems, adhesive capsulitis, or postural defects from large breasts. 3
• Physical therapy programs should include individualized exercise prescriptions targeting specific postural defects and range of motion limitations. 4
• For adhesive capsulitis (common after mastectomy), physical therapy should be attempted for 6-12 months before considering surgical intervention. 3

Complementary Approaches

Acupuncture demonstrates effectiveness for specific treatment-related symptoms including aromatase inhibitor-induced musculoskeletal symptoms, hot flashes, peripheral neuropathy, and fatigue. 2 Meta-analyses of randomized controlled trials show acupuncture reduces menopausal symptoms and hot flashes in breast cancer survivors. 1

Mind-body approaches including meditation and yoga improve emotional self-regulation, anxiety, depression, and other symptoms. 2

Implementation Considerations

Common pitfall: The majority of breast cancer survivors fail to meet these lifestyle recommendations. Only 32% meet physical activity guidelines, 18-34% consume adequate fruits and vegetables, and 62% are overweight or obese. 1

Practical approach: Assess informational needs routinely and provide or refer survivors to appropriate resources for implementing these lifestyle changes. 1 Structured lifestyle intervention programs combining dietary energy restriction and supervised aerobic exercise for 45-60 minutes three times weekly over 24 weeks significantly reduce fatigue, BMI, and improve quality of life and sleep quality. 5

Avoid supplement use during active treatment due to potential interactions with cancer therapies; any supplement use requires consultation with specialized integrative medicine practitioners. 2