The Next Chapter in Breast Cancer Care: Evidence-Based Exercise for Survivorship

As we come to the end of Breast Cancer Awareness Month, the pink ribbons fade from store shelves, the social posts slow down, and the world begins to shift its attention elsewhere.
But survivors don’t have that luxury.

Treatments may end, but the journey doesn’t. The scars, visible and invisible. remain. Fatigue lingers. Strength feels different. Confidence can waver. And navigating a body that no longer feels familiar can be overwhelming.

This is the moment when women deserve more support, not less.

And this is where exercise becomes something far greater than fitness.

Evidence-Based Outcomes + Statistics

• Cancer-related fatigue:
  Structured exercise interventions reduce CRF with a moderate effect size (SMD ≈ −0.50) in breast cancer patients receiving or following treatment.
• Lymphedema risk: Progressive resistance training does not increase lymphedema risk and improves upper-body strength and lean mass in survivors after lymph node removal.
• Bone health: Women on aromatase inhibitors who complete weight-bearing and resistance exercise experience significantly reduced bone turnover and slower bone mineral density decline.
• Heart health & quality of life: Aerobic exercise improves cardiorespiratory fitness and global quality-of-life measures in women with treatment-related cardiotoxicity exposure.
• Recurrence & mortality risk: Breast cancer survivors engaging in regular moderate-to-vigorous physical activity demonstrate a 30–40% lower risk of recurrence and breast-cancer-specific mortality.

If exercise were a pill, it would be considered one of the most powerful anticancer drugs available - reducing fatigue, restoring strength and metabolic health, improving heart function, and lowering recurrence and mortality risk by up to 40%. Yet, despite this overwhelming evidence, exercise is still not routinely “prescribed” as medicine in cancer care.

Why? Because the healthcare system is built around pharmaceuticals and procedures, not movement. Many oncology providers receive little to no training in exercise prescription. Survivors are often discharged without guidance for rehabilitation, leaving them to navigate complex physical side effects alone. Insurance coverage is inconsistent, and access to professionals trained in oncology-specific exercise is limited, especially outside major cancer centers. The result is a massive gap between what survivors need and what the current system delivers. Exercise is medicine, but until every survivor has access to an oncology-trained exercise specialist, it remains a life-changing therapy that far too many never receive.

After treatment, survivors have different needs, preferences, and financial realities - which is why exercise support exists along a continuum. Those seeking highly individualized programming can work with a CETI-Certified OncoVie® Cancer Exercise Specialist, who has advanced knowledge of surgical types, treatment side effects, and necessary precautions such as lymphedema risk, bone health, neuropathy, and fatigue. This level of care includes detailed assessments, personalized protocols, and ongoing monitoring, making it ideal for anyone with more complex medical or functional concerns.

Others may feel ready to rebuild strength and confidence in a smaller group or boutique oncology-specific class, gaining community and support without sacrificing cancer-aware expertise. And for survivors who are medically stable and looking for accessible, no-cost or low-cost options, programs such as Livestrong at the YMCA provide a safe, inclusive environment designed to reintroduce movement and foster connection. There is no “one right way” - the best program is the one that safely meets each survivor where they are and supports them in moving forward with confidence.

Working with a CETI-Certified Specialist (OncoVie® Cancer Exercise Specialist)

What you get:

• One-on-one (or low-ratio) training led by an expert who understands cancer treatments, side-effects, and survivorship issues.
• A full assessment of treatment history, contraindications (e.g., lymphedema risk, cardiotoxicity, bone health), baseline functional testing (mobility, strength, balance, fatigue).
• A personalized exercise program tailored to your cancer type, treatments, goals (e.g., reduce fatigue, improve lymphedema outcomes, rebuild strength), and context (work, home, access).
• Progressions, symptom-check logic, dual-task circuits, neuro-plasticity integration (especially relevant if you’re working in the OncoVie® network).
• Referral or integration with your oncology or rehab team; individualized monitoring and outcomes tracking.
• Higher cost (because of specialization), but also higher impact, faster functional gains, and deeper customization.
• Ideal for: survivors with complex histories, major side-effects, surgical or reconstructive issues, bone/lymph concerns, or who want a high-level continual coaching relationship.

Benefits:

• Risk-aware, safe progression
• Access to specialist knowledge
• Long-term functional rebuilding
• Potential to integrate with telehealth or remote delivery globally

Small-Group or Boutique Exercise Oncology Programs

What you get:

• A group exercise class (4-12 people) led by an instructor with some oncology exercise training (but not necessarily full certification).
• Programs tailored to cancer survivors (e.g., “Cancer Recovery Fitness”, “Strength After Cancer” classes).
• Moderate cost; community-accessible; social support built-in.
• Lower level of individualization than one-on-one, but higher specialist knowledge than general gym classes.

Ideal for:

• Survivors who have moderate side-effects, are functionally stable, want social support and moderate cost.
• Those transitioning out of high-intensity rehab into maintaining strength and mobility.

Community / Non-Profit Programs (e.g., Livestrong at the YMCA)

What you get:

• Low-cost or free programs (often 12 weeks) available at many YMCAs and community centers around the world.
• Instructors may have cancer-exercise workshops/training, but are often general fitness professionals.
• A safe, supportive space specific to survivors (often called “Livestrong at the YMCA”, “Cancer Exercise Recovery”, etc.).
• Structured classes focusing on mobility, strength, endurance, and social reintegration.

Benefits:

• Broad access → especially helpful for survivors in under-served areas.
• Reduced financial barrier.
• Community-based and social, which can reduce isolation.

Considerations:

• Less personalized; fewer one-on-one check-ins.
• May not address complex side-effects like lymphedema, bone metastasis, neuropathy in depth.
• May not offer advanced assessments or outcome tracking.

Ideal for:

• Survivors who are medically cleared, in stable condition, looking for supportive exercise environment and community.
• Those who benefit from group energy and lower cost, but still want cancer-aware training.

How to Choose the Right Level for You

• Complex history? Currently undergoing treatment, multiple surgeries, complex reconstruction, bone metastasis, severe fatigue, lymph node involvement → Start with a CETI-certified specialist.
• Stable but want progression? Minimal side-effects, wants to rebuild strength and maintain mobility → Small-group specialist or boutique program.
• Cleared medically with mild/moderate side-effects, looking for community and affordability? Community program like Livestrong at the YMCA is a solid starting point.

Transition Pathway

Many survivors move through these levels:

1. One-on-one specialist work (rehab, rebuilding)
2. Then transition to group specialist classes (maintenance + social)
3. Then join community program (or combine) for long-term wellness and ongoing support

This ensures continuity of care, sustained gains, and cost-effective long-term activity.

Choosing exercise after breast cancer is not a “one size fits all” decision. What matters is matching your current needs with the right level of support, knowing that all levels contribute positively. Whether you’re working with a top-tier specialist or joining a community class, the key is consistency, safety, and moving forward

References:

1. Zhou R, Chen Z, Zhang S, et al. Effects of exercise on cancer-related fatigue in breast cancer patients: a systematic review and meta-analysis of randomized controlled trials. Life. 2024;14(8):1011.
2. Kilbreath SL, Refshauge KM, Ward LC, et al. Resistance training and lymphedema in women treated for breast cancer: randomized controlled trial findings. JAMA Netw Open. 2024;7(3):e241234.
3. Peppone LJ, Janelsins MC, Kamen C, et al. Effects of a structured weight-bearing exercise program on bone turnover in breast cancer survivors taking aromatase inhibitors. Cancer. 2010;116(22):5527-5533.
4. Wilson OWA, Hayes SC, Coombes JS, et al. Exercise participation and cardiovascular health in breast cancer survivors: an observational literature review. CardioOncology. 2025;11:42-53.
5. Friedenreich CM, Neilson HK, Yue Gao, et al. Physical activity and prognosis in breast cancer survivors: systematic review and meta-analysis. J Natl Cancer Inst. 2022;114(12):1655-1673.