Exercise advice can land awkwardly when someone is already managing ongoing cancer treatment. There are appointments to get to, side effects to manage and days when ordinary tasks take more effort than they used to.
I want the conversation to start with support. What could make daily life more manageable, and who will help adapt a plan when things change?
Evidence at a glance
Population: people living with metastatic breast cancer who could participate safely. Approach: supervised, individualized aerobic, resistance and balance training. Benefit: modest average improvements in fatigue and quality of life, with newer strength findings. Boundary: these results do not establish longer survival or tumor control.
PREFERABLE-EFFECT: what changed in fatigue?
The 2024 PREFERABLE-EFFECT randomized trial enrolled 357 people. About two thirds had bone metastases, although unstable bone lesions were excluded. This matters: advanced cancer was part of the study, but the participants still underwent selection for exercise safety.
At the primary six-month assessment, physical fatigue was 5.3 points lower with exercise (95% confidence interval, 0.6 to 10.0 points lower; EORTC QLQ-FA12). Health-related quality of life was 4.8 points higher (95% confidence interval, 2.2 to 7.4; EORTC QLQ-C30 summary score). Both scales run from 0 to 100. These adjusted differences favor exercise, with modest average effects; the fatigue result is a point difference, not a 5.3% reduction. Individual responses vary. Read the primary trial and its results.
The nine-month trial program combined aerobic, resistance and balance exercise. Participants attended two supervised 60-minute sessions each week for six months, then one supervised and one unsupervised session weekly for the final three months. Qualified exercise professionals adjusted the intensity to each person’s fitness and health. Participants also received support for activity between sessions, including an exercise app; the app’s independent effect was not tested. The research program offers further background.
What this means on a tired day
Use these findings to ask for a supported exercise plan that can change with your symptoms. The trial does not tell every person to exercise for an hour, or establish that a short walk produces the same benefit as the full program. Ask your oncology team which activities, duration and level of effort fit your situation, and how to adapt the plan on difficult days.
The study compared supervised training with usual care, activity advice and a tracker. Participants knew their group, and the findings may not apply to people who could not safely enroll. Severe or newly worsening fatigue deserves a conversation with the care team before increasing activity.
What the 2026 analysis adds
A secondary analysis published April 13, 2026 found better lower-body strength and performance. At six months, participants completed five chair rises about 1.5 seconds faster relative to controls. Measurements in a 66-person subgroup also suggested small gains in arm-and-leg muscle mass.
There were negative findings too: whole-body lean mass was not significantly different at six months, and handgrip strength did not differ between groups. Some measurements came from small subsets, and participants and assessors were not blinded. These are additional outcomes from the same trial, not an independent replication.
Safety is part of the program
The International Bone Metastases Exercise Working Group supports appropriately tailored activity. Its recommendations emphasize the location of bone lesions, treatment effects, balance and individual risk. A clinician and qualified exercise professional should decide which movements and loads fit.
With bone involvement, rapid twisting, heavily loaded bending or impact around an affected area may need modification. Controlled technique and fall prevention matter. An oncology physical therapist can help turn that assessment into practical options for walking, stairs, lifting and exercise.
The trial reported two exercise-related serious events: a wrist fracture and a sacral stress fracture. Neither was attributed to a bone metastasis. Even supervised exercise is not risk-free; new or increasing pain deserves reassessment rather than a push-through-it approach.
Questions for the care team
- Are my bone lesions and current symptoms compatible with this type of exercise?
- Can I see an oncology physical therapist or qualified exercise specialist?
- Which movements should change, and what symptoms mean I should stop?
- Could we track a useful goal, such as climbing stairs or rising from a chair?
The aim is a plan that leaves someone more capable, with room for difficult days. Access, transportation and cost belong in that conversation too. A recommendation becomes far more useful when help comes with it.
Primary PREFERABLE-EFFECT fatigue results and exercise schedule rechecked October 13, 2026; other sections last reviewed October 7, 2026. Educational review; individual treatment decisions belong with your care team. Explore the fatigue evidence collection, the Missing Script article library and the podcast—coming soon. Summary of Hiensch et al., Nature Medicine (2024), condensed and adapted from the original article under CC BY 4.0.
