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In a randomized trial of 253 breast cancer survivors, a remotely delivered exercise program was associated with greater improvements in attention at six and 12 months than a health and wellness program. Memory improved more in the exercise group at six months, but the difference was not maintained at 12 months; a companion study also found slower epigenetic aging markers in the exercise group.
A 12-month exercise program was associated with greater improvements in attention among breast cancer survivors than a health and wellness program, according to a randomized clinical trial published September 30 in the Journal of the National Cancer Institute. The study included 253 survivors who had completed active treatment, reported low physical activity and experienced cognitive difficulties. A companion analysis found slower changes in markers of epigenetic aging among participants assigned to exercise, though the researchers say larger studies are needed to confirm the findings.
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 coaching to increase activity. Participants in that group used fitness trackers and worked toward 150 minutes of moderate-to-vigorous physical activity per week. They increased their activity more than participants in the comparison group.
Both groups improved on all cognitive measures. The researchers found no significant between-group differences in either primary outcome: processing speed and self-reported cognition. The exercise group showed greater gains in attention at six and 12 months. It also had greater improvement in memory at six months, but that difference was no longer present at 12 months. The groups did not differ significantly in executive function.
The companion study analyzed blood samples from a random subset of 124 participants, collected at the start of the trial and at six and 12 months. Using two epigenetic clocks, researchers estimated changes in biological aging based on DNA methylation patterns. They reported that the exercise group’s aging markers changed more slowly over the study period. 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 measurements are estimates based on biological markers and do not represent changes in participants’ chronological ages.
Attention Gains in Daily Life
Attention supports everyday tasks such as following conversations, absorbing information and completing work accurately. Cognitive problems after cancer treatment can make these activities harder and may affect survivors’ quality of life. The trial’s sustained attention finding may matter because it appeared at both follow-ups, while the memory difference appeared only at six months.
The results do not establish that exercise will improve cognition for every survivor. Both groups improved, and the trial did not find a significant difference in its primary measures of processing speed or self-reported cognition. The findings offer evidence that a remotely delivered program with individualized coaching and activity tracking may be a feasible way to support increased physical activity, and point to attention as an area for further study.
The companion findings connect changes in biological aging markers with cognitive outcomes, but they do not show that slower epigenetic aging caused the attention gains. Across both groups, faster epigenetic aging was associated with less improvement in attention and worse self-reported cognition. That relationship may help researchers investigate how physical activity and cognitive health are connected after cancer treatment.
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Trial Focused on Survivors
The trial enrolled people who had finished active breast cancer treatment and reported both low physical activity and cognitive difficulties. Researchers have proposed that post-treatment cognitive problems can arise from several factors, including treatment effects, inflammation, hormonal changes, fatigue and stress. Such difficulties may continue after treatment ends, but this study tested a specific exercise program rather than identifying the cause of participants’ symptoms.
Exercise was compared with a health and wellness program that offered regular health-coach contact without exercise coaching. This design gave both groups contact with a coach, while allowing researchers to compare the added exercise support. The research team included investigators from the University of California San Diego, including the Moores Cancer Center. The companion study was based on a subset of the same randomized trial, rather than a separate trial of exercise.
Epigenetic age is an estimate derived from patterns of DNA methylation; it can differ from a person’s age in years. At the start of the study, participants in both groups had epigenetic ages averaging about 8.7 years older than their chronological ages. That starting estimate describes the trial sample and should not be taken as a finding about all breast cancer survivors.
“Attention is central to our everyday activities. It helps us follow conversations, absorb information and complete tasks without making errors.”
— Sheri Hartman, lead author and professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science
Questions on Cause and Durability
The studies do not establish whether changes in epigenetic aging directly contributed to cognitive benefits, or whether another factor explains the association. They also do not show whether the attention gains would continue beyond the 12-month study period. The memory advantage seen at six months was not maintained at the final follow-up, and the primary outcomes of processing speed and self-reported cognition did not differ significantly between groups.
The trial was limited to 253 survivors who had completed active treatment and reported low activity and cognitive difficulties. It is not clear from the reported findings whether the results would apply to survivors with different activity levels, treatment histories or cognitive experiences. The researchers say larger studies are needed to confirm the results and clarify who benefits and how much activity may be needed.
Larger Studies Needed
The researchers say further studies should test whether the findings can be replicated, determine whether epigenetic aging changes contribute directly to cognitive outcomes, and examine how exercise could support lasting improvements in attention and memory. Hartman said the team wants to identify who is most likely to benefit and what level of activity may help.
For now, the reported results describe associations observed during a 12-month trial, not a guarantee of cognitive improvement. No longer-term follow-up or next study date was specified in the source report. The next evidence needed is confirmation in larger groups and a clearer account of how activity, biological aging markers and cognitive changes relate over time.
Key Questions
What did the exercise study find?
The exercise group showed greater improvements in attention at six and 12 months than the health and wellness group. It also showed greater memory improvement at six months, but the difference was not maintained at 12 months.
Did exercise improve every cognitive measure?
No. Both groups improved on all cognitive measures, but researchers found no significant difference between groups in the primary outcomes of processing speed and self-reported cognition, or in executive function.
How many people took part?
The randomized trial included 253 breast cancer survivors who had completed active treatment and reported low physical activity and cognitive difficulties. The companion blood-sample analysis included a random subset of 124 participants.
What did the epigenetic aging analysis measure?
Researchers used two epigenetic clocks to estimate biological age from DNA methylation patterns. The exercise group showed slower changes in these markers over 12 months, but the study does not establish that this caused the cognitive findings.
Do the findings show that exercise will help every survivor?
No. The researchers say larger studies are needed to confirm the results and learn who may benefit and how much activity may be needed. The trial describes outcomes in a specific group and does not guarantee an individual cognitive benefit.
Source: rss
