Effects of a 12-Week Supervised Exercise Program on the Quality of Life and Biological Parameters of Women with Breast Cancer: A Prospective Study

Effects of a 12-Week Supervised Exercise Program on the Quality of Life and Biological Parameters of Women with Breast Cancer: A Prospective Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Effects of a 12-Week Supervised Exercise Program on the Quality of Life and Biological Parameters of Women with Breast Cancer: A Prospective Study Barrientos Vicho Gema, Posado-Domínguez Luis, José David Urchaga, and 10 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6495691/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose Physical exercise is an effective supportive strategy in oncology, yet its implementation remains limited, particularly in patients with metastatic breast cancer. This prospective study aimed to evaluate the effects of a 12-week supervised multicomponent exercise program on quality of life, functional capacity, and biological parameters in women undergoing treatment for breast cancer. Methods A total of 44 women with early or metastatic breast cancer were enrolled; 29 completed the full intervention and assessments. The program consisted of supervised aerobic, resistance, mobility, and neuromuscular training three times per week. Quality of life was assessed using the EORTC QLQ-C30 questionnaire. Strength, body composition, functional mobility (Functional Movement Screen, FMS), 6-minute walk test (6MWT), and laboratory markers (RDW, HDL, cholesterol profile) were evaluated pre- and post-intervention. Results Significant improvements were observed in global quality of life (+ 19.5%, p = 0.002), physical function ( p = 0.006), emotional function ( p = 0.003), and fatigue reduction ( p = 0.007). The FMS total score increased significantly ( p = 0.001), and 6MWT distance improved by 110 meters ( p < 0.001). Biochemical analyses showed a significant reduction in RDW ( p = 0.005), a pro-inflammatory marker, and an increase in HDL cholesterol ( p = 0.007). No serious adverse events were reported. Conclusion A 12-week supervised exercise program is feasible and beneficial for women with breast cancer, including those with metastatic disease. It improves quality of life, functional mobility, and markers of systemic inflammation. These findings support the integration of structured exercise into routine oncologic care. Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 INTRODUCTION According to data from the Spanish Society of Medical Oncology (SEOM), 296,103 new cancer cases are expected to be diagnosed in Spain in 2025, representing a 3.3% increase compared to 2024. In 2022, breast cancer was the second most common tumor in both sexes and the fourth leading cause of cancer-related mortality, with 34,735 new cases diagnosed and 6,747 deaths ( 1 ). In 2024, cancer surpassed circulatory system diseases, becoming the leading cause of death in Spain ( 2 ). This increase in incidence, along with a growing number of diagnoses in individuals under 45 years old, underscores the urgent need for multidisciplinary strategies to improve patient survival and quality of life. Advances in breast cancer treatment, even in metastatic stages, have allowed many patients to live for years with the disease, thanks to the optimization of targeted therapies and immunotherapy ( 3 ). However, this increase in survival brings the need to address complications arising from both the cancer itself and oncological treatments, as many patients maintain a good general condition for much of the disease, experiencing a rapid deterioration in the final weeks of life. Factors such as lymphedema, asthenia, depression, muscle and bone loss, as well as chemotherapy-associated toxicities (cardiotoxicity, infections, and alopecia), can significantly impact quality of life ( 4 – 6 ). During this period, the focus of care should not be exclusively on oncological treatment but on a comprehensive approach that includes physical, emotional, and functional support measures. In this context, supervised physical exercise is proposed as a key intervention to mitigate adverse effects, preserve functionality, and optimize overall well-being. The integration of exercise programs at different care levels can facilitate their implementation and improve adherence, ensuring that patients receive multidisciplinary management tailored to their clinical status. Physical exercise has proven to be an effective complementary therapeutic strategy in oncology, with positive effects on fatigue reduction, cardiovascular function optimization, and quality of life improvement. However, its implementation in clinical practice remains limited due to structural barriers, a lack of defined care pathways, and limited knowledge regarding its prescription. SEOM emphasizes the need to integrate exercise programs at various care levels, both in hospital and extrahospital settings. In this context, the role of a multidisciplinary team is essential. Specialized nurses, psychologists, social workers, rehabilitation physicians, physiotherapists, and, importantly, professionals in the field of Physical Activity and Sports Sciences can play a key role in improving these patients' quality of life. Supervised physical exercise, when the patient maintains a good general condition, can be an effective tool to preserve functionality, reduce fatigue, and optimize both physical and mental well-being. Therefore, further investigation into its impact on quality of life and various clinical parameters is necessary to promote its inclusion in the integrated management of breast cancer. Despite its potential, further research is still needed to investigate its impact on quality of life and various clinical parameters to promote its inclusion in the integrated management of breast cancer. In our study, we evaluated the effects of a 12-week supervised physical exercise program in women with breast cancer, with the aim of analyzing its influence on quality of life, physical functionality, and various clinical and analytical parameters. MATERIAL AND METHODS This prospective study was conducted as part of an interdisciplinary collaboration between specialists in Physical Activity and Sports Sciences at the Pontifical University of Salamanca and a team of medical oncologists specializing in breast cancer at the University Hospital of Salamanca. The study aimed to evaluate the effects of a 12-week supervised exercise program on patients undergoing adjuvant, neoadjuvant, or metastatic treatment for breast cancer. Patients were eligible for inclusion if they met the following criteria: women under 65 years of age, an Eastern Cooperative Oncology Group (ECOG) performance status of 0–1, and active oncologic treatment (adjuvant, neoadjuvant, or for metastatic disease). Recruitment was conducted during routine medical oncology consultations, where a total of 50 women were invited to participate. Of these, 44 agreed to enroll in the study. Prior to starting the program, participants underwent a baseline assessment that included: Laboratory analyses: Hemoglobin, red cell distribution width (RDW), total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides. Strength assessments, detailed in Supplementary Appendix 1. Quality of life evaluation using the EORTC QLQ-C30 questionnaire, including multiple subdomains (Supplementary Appendix 2). During the initial phase, seven participants withdrew from the study before the intervention began, leaving 37 active participants. Over the course of the program, one patient died due to hepatic failure secondary to tumor-related pseudocirrhosis. Additionally, seven participants completed the intervention partially or did not undergo final evaluations (including laboratory and strength measurements). As a result, 29 participants completed the study with full pre- and post-intervention data, and were included in the final analysis (Fig. 1 ). The 12-week supervised exercise program was designed to improve functional capacity, muscular strength, and overall well-being. Sessions were tailored to each participant’s baseline physical status, treatment stage, and functional capacity. The program incorporated aerobic, resistance, flexibility, and neuromuscular training,progressively adapted throughout the intervention period. Further details regarding the specific exercise regimen, intensity and session structure are provided in Supplementary Appendix 3. Statistical analyses were performed using SPSS v28 and RStudio. A descriptive analysis of baseline characteristicswas conducted, reporting means, standard deviations, and frequencies for categorical variables. To compare pre- and post-intervention measurements, different statistical tests were applied: Wilcoxon signed-rank test for non-parametric continuous variables. Paired Student’s t-test for normally distributed continuous variables. Two-tailed significance testing was conducted to determine statistically significant differences in quality of life, strength parameters, flexibility, body composition, and laboratory values after 12 weeks of intervention. Effect sizes were calculated using Cohen’s d statistic to assess the magnitude of observed changes. A p-value < 0.05 was considered statistically significant in all analyses. OBJETIVES The primary objective of this study was to evaluate the impact of a 12-week structured exercise program on quality of life and emotional well-being in patients with breast cancer. Given the increasing recognition of exercise as a fundamental component of supportive oncology care, this study aimed to assess whether a supervised intervention could yield clinically meaningful improvements in patient-reported outcomes related to physical and psychological health. In addition to the primary endpoint, several secondary objectives were established to provide a comprehensive assessment of the effects of exercise on multiple health domains. First, we sought to analyze changes in strength parameters, body mass index (BMI), and flexibility before and after the intervention, assessing whether structured physical activity could enhance overall functional capacity and musculoskeletal health. To evaluate the impact of exercise on cardiorespiratory fitness and functional endurance, the 6-Minute Walk Test (6MWT) was performed before and after the intervention. This test, widely used in clinical settings, provides an objective measure of aerobic capacity and mobility, which are critical determinants of long-term health outcomes in cancer patients. Furthermore, we examined the evolution of key biochemical markers, including albumin, C-reactive protein (CRP), hemoglobin, red cell distribution width (RDW), total cholesterol, HDL, LDL, and triglycerides, to explore potential metabolic and inflammatory changes associated with the intervention. Given the growing evidence linking systemic inflammation and metabolic dysfunction with cancer prognosis, these analyses aimed to determine whether exercise could modulate these biomarkers in a clinically meaningful way. A descriptive analysis of clinical, epidemiological, and oncologic characteristics was also conducted, including age, sex, smoking history, educational level, employment status, histological subtype, disease stage, prior surgery, and treatments received. This allowed for a deeper understanding of the study population and potential factors influencing response to the intervention. Finally, we assessed adherence to the exercise program and documented emergency department visits, hospitalizations, and adverse events during follow-up. Evaluating feasibility and safety is crucial for the broader implementation of structured exercise interventions in cancer care. These objectives collectively aim to generate robust evidence supporting the integration of physical activity into breast cancer management, reinforcing its role in improving functional capacity, metabolic health, systemic inflammation, and overall well-being in oncology patients. RESULTS 1) BASELINE CHARACTERISTICS OF THE SAMPLE A total of 29 patients diagnosed with breast cancer were included, with a median age of 50.07 ± 6.65 years. At diagnosis, 34.5% (n = 10) had metastatic disease, with the most common metastatic sites being bone (34.5%), liver (17.2%), and lung (13.8%). Regarding treatment, 27.6% (n = 8) were receiving adjuvant chemotherapy, and 34.5% (n = 10) were undergoing treatment for metastatic disease. Sociodemographic data revealed that 27.6% (n = 8) of patients were actively employed, and 37.9% (n = 11) had a history of tobacco use. Most patients (48.3%, n = 14) had a university degree. Comorbidities included antidepressant use (20.7%, n = 6), benzodiazepine use (34.5%, n = 10), and other medications such as antihypertensives and statins. Regarding treatment history, 93.1% (n = 27) underwent surgery, with lumpectomy being the most common procedure (58.6%, n = 17). Radiation therapy was received by 65.5% (n = 19) of the cohort. Adverse events during the intervention were minimal, with 13.7% (n = 4) requiring emergency visits, and 6.9% (n = 2) requiring hospitalization. No injuries leading to functional impairment were reported. For a complete overview of the baseline characteristics, see Table 1 . (Insert Table 1 here) Table 1 Baseline Characteristics of the sample. Characteristic Median(+/- SD) Age 50,07 ± 6,65 Age at diagnosis 46,21 ± 7,12 BMI (pre-intervention) 25,26 ± 4,98 Fat mass (pre-intervention) 44,68 ± 5,69 Waist circumference (pre-intervention) 81,69 ± 11,58 cm Hip circumference (pre-intervention) 102,0 ± 10,97 cm Characteristic (N = 29) N (%) Treatment Status - Adjuvant chemotherapy* 8 (27.6%) - Adyuvant hormone therapy 9 (31.0%) - Neoadyuvant chemotherapy* 1 (3.4%) - No active treatment 1 (3.4%) - Metastatic disease treatment* 10 (34.5%) Employment Status - Currently employed 8 (27,6%) Toxic Habits - Smoking history 11 (37,9%) Education level: - Primary education - Secondary education - Higher vocational training - High School diploma - University defree 1 (3,4%) 3 (10,3%) 6 (20,7%) 5 (17,2%) 14 (14,3%) Family History of Cancer 7 (24,1%) Metastases at Diagnosis 10 (34,5%) Bone metastases 10 (34,5%) Liver metastases 5 (17,2%) Lung metastases 4 (13,8%) Lymph node metastases 2 (6,9%) Brain metastases 1 (3,4%) Concomitant Medication - Antidepressants - Benzodiazepines - Statins - Antihypertensive drugs - Antidiabetic drugs 6 (20,7%) 10 (34,5%) 2 (6,9%) 4 (13,8%) 1 (3,4%) Hypothyroidism: - No - Yes 25 (86,2%) 4 (13.8%) Surgical Treatment - Yes - No 27 (93.1%) 2 (6.9%) Type of Surgery - Mastectomy - Lumpectomy - No surgery 10 (34.5%) 17 (58.6%) 2 (6.9%) Lymphadenectomy - Yes - No 8 (27.6%) 21 (72.4%) Radiotherapy - Yes - No 19 (65.5%) 10 (34.5%) Events During the Program - Emergency visits - Hospitalizations - Exercise-related disabling injuries 4 (13.7%) 2 (6.9%) 0 (0%) 2. Results of the EORTC QLQ-C30 Quality of Life Questionnaire Quality of life was assessed using the EORTC QLQ-C30 questionnaire, comparing scores obtained before and after the intervention. The analysis included the global quality of life scale, functional scales, and symptom scales. The EORTC QLQ-C30 questionnaire analysis revealed A significant increase of 19.5% in global quality of life (QL2.S) was observed, increasing from 58.91 (± 18.22) to 70.40 (± 13.83), with a p-value of 0.002. Significant improvements were observed across functional scales, particularly in physical function, which increased from 85.06 to 91.95 (p = 0.006), and role function, which increased from 74.71 to 89.66 (p = 0.004). Additionally, emotional functionand social function also showed significant improvements, reflecting enhanced emotional well-being and social reintegration. Regarding symptom scales, there was a significant reduction in fatigue, with scores decreasing from 37.55 to 26.82 (p = 0.007). However, no significant changes were observed in pain, nausea, appetite loss, constipation, or diarrhea. The financial impact showed a slight reduction but was not statistically significant (p = 0.527). In summary, the results suggest that the exercise program had a positive effect on physical, emotional, and social functioning, particularly in enhancing physical and role function. Additionally, the intervention significantly reduced fatigue, improving overall well-being. Detailed results can be found in Table 2 and Fig. 2 . Table 2 Global Quality of Life Scale. This table presents the pre- and post-intervention scores for various functional and quality of life parameters, as assessed using the EORTC QLQ-C30 and other relevant measures. PRE PRE POST POST P-value (two-tailed) Cohen d M SD M SD QL2.S (Global quality of life) 58,91 18,22 70,40 13,83 , 002 19,97 PF2.S (Physical function) 85,06 13,76 91,95 9,15 , 006 NA RF-2-S (Role function) 74,71 24,65 89,66 13,67 , 004 NA EF-S (Emotional function) 77,01 17,35 86,78 16,14 , 003 NA CF-S (Cognitive function) 73,56 18,10 81,03 12,38 , 034 NA SF-S (Social function) 64,94 23,71 78,74 22,23 , 005 NA FA-S (Fatigue) 37,55 18,41 26,82 15,29 , 007 NA NV-S (Nausea and vomiting) 2,87 6,41 1,72 5,17 ,317 NA PA-S (Pain) 31,03 22,15 26,44 17,55 ,222 NA DY-S (Dyspnea) 16,09 19,15 9,20 15,16 ,083 NA SL-S (Insomnia) 47,13 30,23 39,08 30,95 ,124 NA AP-S (Appetite loss) 9,20 17,59 5,75 15,61 ,366 NA CO-S (Constipation) 17,24 24,59 13,79 20,93 ,257 NA DI-S (Diarrhea) 14,94 28,99 11,49 24,03 ,317 NA FI-S (Financial difficulties) 11,49 22,32 9,20 23,40 ,527 NA BMI (Body Mass Index) 25,26 4,98 25,16 4,61 ,931 0,94 Fat mass percentage 33,11 8,47 33,05 7,77 ,456 2,78 Fat mass in kg 23,61 10,88 23,43 9,72 ,855 NA Lean mass 44,68 5,69 44,89 5,28 ,381 NA Waist circumference 81,69 11,59 81,62 9,57 ,936 NA Hip circumference 102,00 10,97 103,35 10,66 ,053 NA Waist-to-hip ratio ,80 ,07 ,79 ,05 ,336 NA FZA.DA (Right-hand grip strength) 20,14 4,73 20,03 4,75 ,781 NA FZA.IZ (Left-hand grip strength) 18,00 5,15 18,93 5,31 ,325 NA 6-Minute Walk Test (metres) 556,21 123,60 666,38 56,075 <,001 115,79 3. Global Analysis of the FMS The FMS is a screening tool used to evaluate movement quality, mobility, stability, and functional asymmetries. It consists of seven different movement tests, each rated on a scale from 0 to 3, where: 0 = Pain during movement 1 = Unable to perform the movement correctly 2 = Movement performed with compensation or minor instability 3 = Correct and stable movement without compensation The Functional Movement Screen (FMS), a standardized tool for assessing movement quality, mobility, stability, and functional asymmetries, demonstrated significant improvement following the exercise intervention. The total FMS score increased from 2.23 (± 0.46) at baseline to 2.51 (± 0.31) post-intervention, a statistically significant difference (Z = -3.218; p = 0.001). This improvement suggests enhanced movement efficiency, neuromuscular control, and overall functional capacity, reinforcing the role of structured physical exercise in optimizing movement patterns in patients with breast cancer. (Table 3 and Fig. 3 ) Table 3 The table presents the results of the Functional Movement Screen (FMS) before and after the 12-week exercise intervention. PRE PRE POST POST P-value (two-tailed) M SD M SD FMS.1. (Deep squat) 1,69 ,850 2,24 ,689 , 003 FMS.2.DA (Hurdle Step Right) 2,55 ,632 2,76 ,435 ,153 FMS.2.IZ (Hurdle Step Left) 2,59 ,682 2,83 ,384 ,100 FMS.3.DA (Incline Lunge Right) 2,03 ,865 2,76 ,577 <,001 FMS.3.IZ (Incline Lunge Left) 2,10 ,860 2,76 ,577 , 001 FMS.4.DA (Shoulder Mobility Right) 2,31 1,039 2,69 ,604 ,070 FMS.4.IZ (Shoulder Mobility Left) 2,55 ,783 2,62 ,494 ,614 FMS.5.DA (Active Straight-Leg Raise Right) 2,66 ,553 2,69 ,471 ,782 FMS.5.IZ (Active Straight-Leg Raise Left) 2,69 ,541 2,72 ,455 ,782 FMS.6 (Trunk Stability Push-Up 1,38 ,622 1,62 ,728 , 008 FMS.7.DA (Rotary Stability Right) 2,03 ,865 2,17 ,468 ,392 FMS.7.IZ (Rotary Stability Left) 2,17 ,805 2,21 ,559 ,771 Total 2,23 ,460 2,51 ,312 , 001 The most notable improvements were observed in the Deep Squat (FMS.1), Inline Lunge (FMS.3), and Trunk Stability Push-Up (FMS.6), reflecting enhanced mobility, dynamic balance, and core stability. The Deep Squat score significantly improved from 1.69 (± 0.85) to 2.24 (± 0.68) (Z = -3.017; p = 0.003), suggesting gains in hip, knee, and ankle mobility, as well as trunk control. Similarly, the Inline Lunge showed marked improvements in both the right side (2.03 ± 0.86 to 2.76 ± 0.57; Z = -3.384; p < 0.001) and left side (2.10 ± 0.86 to 2.76 ± 0.57; Z = -3.275; p = 0.001), indicating better lower limb stability, proprioception, and postural control. The Trunk Stability Push-Up score increased from 1.38 (± 0.62) to 1.62 (± 0.72) (Z = -2.646; p = 0.008), reflecting improvements in core strength and overall neuromuscular coordination. Other assessments, such as Shoulder Mobility (FMS.4) and Rotary Stability (FMS.7), showed trends toward improvement but did not reach statistical significance (p = 0.070 and p = 0.392, respectively). 4. The 6-Minute Walk Test (6MWT) The 6-Minute Walk Test (6MWT) is a widely used tool for assessing functional capacity and aerobic endurance in patients with various health conditions, including those undergoing oncologic treatments. In this study, a significant improvement in the distance walked following the structured exercise intervention was observed, suggesting a positive impact on aerobic capacity and the efficiency of the cardiovascular and muscular systems. At baseline, the mean distance covered in the 6MWT was 556.21 meters (SD = 123.60). After 12 weeks of exercise, this distance increased to 666.38 meters (SD = 56.07), representing a 19.8% improvement (110.17 meters). This increase was statistically significant (Z = -4.381; p < 0.001). (Fig. 4 ) 5. Analysis of Analytical Parameters Pre- and Post-Intervention Table 4 Hematological and Lipid Parameters Pre- and Post-Intervention. PRE POST P valor Cohen d HB 12,80 12,97 ,348 0,97 RDW 15,21 14,18 ,005 2,25 COLESTEROL 195,48 188,97 ,176 21,93 Triglicéridos 109,52 104,07 ,489 44,14 Col HDL 60,66 64,55 ,007 7,03 Col LDL 114,41 106,38 ,172 23,97 - Hematological Parameters Hemoglobin (Hb) levels and red cell distribution width (RDW) were assessed to evaluate potential hematologic and inflammatory changes following the exercise intervention. Mean hemoglobin concentration increased slightly from 12.80 g/dL (± 1.40) to 12.97 g/dL (± 1.75), though this difference was not statistically significant (t = -0.954; p = 0.174) and had a small effect size (Cohen’s d = 0.97). Conversely, a significant reduction in RDW was observed, decreasing from 15.21% (± 2.28) to 14.18% (± 1.87) (t = 2.435; p = 0.011), with a moderate effect size (Cohen’s d = 2.25) (Fig. 5 ). RDW is considered a pro-inflammatory biomarker, as increased RDW has been associated with chronic inflammation and poor prognosis in oncology patients. The significant decrease observed in this study suggests a potential reduction in systemic inflammation. - Metabolic Parameters (Lipid Profile) To assess potential metabolic changes associated with the exercise intervention, total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol levels were analyzed (Figure 6). Total cholesterol levels showed a slight decrease from 195.48 mg/dL (±33.67) to 188.97 mg/dL (±34.07), which did not reach statistical significance (t = 1.601; p = 0.060). However, the effect size was remarkably high (Cohen’s d = 21.93). Triglyceride levels decreased from 109.52 mg/dL (±55.73) to 104.07 mg/dL (±43.99), without statistical significance (t = 0.665; p = 0.256), yet the notably high effect size (Cohen’s d = 44.14) suggests a possible trend toward improved lipid metabolism. In contrast, HDL cholesterol increased significantly from 60.66 mg/dL (±15.48) to 64.55 mg/dL (±16.66) (t = -2.984; p = 0.003), with a large effect size (Cohen’s d = 7.03), indicating a favorable shift in lipid profile. A significant reduction in LDL cholesterol was also observed, decreasing from 114.41 mg/dL (±31.22) to 106.38 mg/dL (±28.87) (t = 1.805; p = 0.041), with a high effect size (Cohen’s d = 23.96), suggesting a potentially beneficial decline in atherogenic lipoproteins. DISCUSSION The impact of physical exercise on patients with metastatic breast cancer (MBC) has been underexplored in the literature, despite its growing recognition as a key strategy in the comprehensive management of the disease. Our study demonstrates that a structured 12-week multicomponent exercise program is capable of generating significant improvements in all dimensions of quality of life (HRQoL) assessed through the EORTC-QLQ-C30, as well as a reduction in RDW, a biomarker associated with systemic inflammation and prognosis in oncology. These findings reinforce the idea that exercise is not only safe for this group of patients, but it can also modulate both functional and metabolic aspects of the disease. A key aspect to consider in implementing exercise programs in patients with metastatic breast cancer is adherence to the intervention, as the dropout rate can directly influence the effectiveness of the program. In our study, a 19% dropout rate was observed among the women who started the program, highlighting the need to address barriers that hinder sustained participation in these interventions. Factors such as distance to the hospital, financial difficulties, lack of social support, or symptom burden from oncological treatment may have influenced participant continuity. Previous studies have identified that adherence to exercise in metastatic cancer patients can improve with more flexible and accessible programs, including home-based interventions, hybrid sessions (both in-person and virtual), and personalized follow-up to foster training continuity ( 7 , 8 ). Our study provides evidence in a subgroup of patients with metastatic disease, which has been excluded in most previous trials. For example, the study by Soriano-Maldonado et al. evaluated a 12-week combined exercise program, but only in patients without metastatic disease, which limits the extrapolation of their findings to populations with higher tumor and symptomatic burden ( 9 ). Additionally, although their randomized design strengthens the validity of the results, it did not include the analysis of physiological biomarkers, such as systemic inflammation, which represents a complementary approach in our study. In addition to the benefits in quality of life, our study demonstrated favorable changes in hematological and lipid biomarkers, suggesting a potential impact of exercise on the regulation of systemic inflammation and lipid metabolism in patients with metastatic breast cancer. A significant reduction in red blood cell distribution width (RDW) was observed, decreasing from 15.21–14.18% (p = 0.005, d = 2.25) after 12 weeks of intervention. Since RDW has been associated with chronic inflammation, endothelial dysfunction, and poorer prognosis in oncology, this reduction may indicate an immunomodulatory effect of exercise, potentially related to the reduction of systemic inflammatory response. Regarding the lipid profile, a reduction in total cholesterol levels was observed, from 195.48 mg/dL to 188.97 mg/dL (p = 0.176, d = 21.93), although this did not reach statistical significance. However, a significant increase in HDL cholesterol levels was identified, from 60.66 mg/dL to 64.55 mg/dL (p = 0.007, d = 7.03), suggesting an improvement in the reverse cholesterol transport capacity and a potential cardioprotective effect in this population. No significant changes were observed in LDL cholesterol or triglyceride levels, although a trend toward reduction was noted. These findings are consistent with previous literature suggesting that physical exercise can optimize lipid homeostasis and modulate low-grade inflammation ( 10 )( 11 ). Finally, our study demonstrated a significant increase in physical functionality, assessed using the Functional Movement Screen (FMS). A global improvement in the total score was observed, from 2.23 ± 0.46 to 2.51 ± 0.31 (p = 0.001), suggesting a positive impact of exercise on mobility and motor control in the participants. Specifically, significant improvements were identified in the Deep Squat (p = 0.003), Incline Lunge on both sides (p < 0.001 and p = 0.001, respectively), and Trunk Stability Push-Up (p = 0.008). These improvements indicate an increase in core stability, mobility, and functional strength, which are essential in preventing muscle loss and optimizing functional capacity in patients with metastatic cancer. Similarly, the study by Aydin et al. showed that aerobic and resistance exercise improves quality of life and reduces depressive symptoms (BDI) in patients with breast cancer, although without metastatic disease ( 12 ). In our study, the impact of exercise was observed in all dimensions of quality of life, including physical, emotional, functional, social, and cognitive well-being, suggesting that the benefits may extend to a population with a worse prognosis. In this context, the systematic review by Ficarra et al. consolidated the evidence on exercise in patients with breast cancer undergoing adjuvant treatment or survivors, but it did not include studies in patients with metastatic disease ( 13 ). In contrast, our findings suggest that the implementation of exercise programs in this subgroup may be equally beneficial, reinforcing the need to expand research in this specific population. The PREFERABLE-EFFECT study currently represents the most robust evidence on the effects of exercise in patients with metastatic breast cancer, as it is a large-scale randomized controlled trial that evaluated a 9-month structured intervention ( 14 ). Its results demonstrated significant improvements in Health-Related Quality of Life (HRQoL), fatigue, and physical functionality, with observable effects from 3 months and sustained until 9 months, thus consolidating the scientific basis for incorporating exercise as part of the integrated management of this population. In our study, we observed similar benefits in terms of quality of life and fatigue reduction with an intervention of only 3 months, suggesting that the positive effects of exercise may manifest in a shorter period, facilitating its implementation in clinical practice. However, the findings from PREFERABLE-EFFECT indicate that prolonging the intervention could maximize and sustain these benefits over the long term, emphasizing the need to establish strategies that promote adherence to sustained exercise programs. Finally, our results support the integration of physical exercise as a therapeutic tool in metastatic breast cancer patients, highlighting its safety and potential to improve quality of life and mitigate fatigue. However, future research should assess the optimal duration of these programs and their impact on additional biomarkers, exploring their potential role in modulating inflammation and the tumor response. Furthermore, randomized controlled trials are needed to confirm these findings and help define long-term adherence strategies for this patient group. Despite the positive results obtained, this study has several limitations that should be considered when interpreting the findings. First, the small sample size (N = 29) limits the generalizability of the results to a larger population, highlighting the need for studies with larger samples to confirm these effects. Additionally, the absence of a control group prevents attributing the observed changes solely to the exercise program, as other uncontrolled factors could have influenced the improvements in quality of life and fatigue. Furthermore, variability in adherence to the program may have affected the results, as not all participants completed the final measurements. Finally, the follow-up was limited to 12 weeks, which prevents evaluating the long-term persistence of the benefits and determining whether these effects are sustained or evolve over time. To validate and expand on these findings, studies with a larger number of participants and a randomized controlled design are needed, which would allow for a more robust evaluation of the effectiveness of exercise in patients with metastatic breast cancer. Additionally, it would be essential to analyze the long-term impact of exercise, with measurements at 6 months or 1 year, to understand the evolution of the observed benefits. Another promising area of research would be the personalization of exercise programs based on the clinical and functional status of each patient, thus optimizing therapeutic effects. Finally, exploring the impact of exercise on additional biomarkers of inflammationand immune function would provide a deeper understanding of the underlying physiological mechanisms, potentially contributing to the integration of exercise as a complementary strategy in the management of metastatic breast cancer. CONCLUSION This study demonstrates that a 12-week structured multicomponent exercise program is safe and beneficial for patients with breast cancer, both metastatic and non-metastatic. Significant improvements were observed in quality of life (HRQoL) and physical functionality, with increases in the total score of the Functional Movement Screen (FMS). Additionally, the reduction in RDW suggests a potential anti-inflammatory effect of exercise, while the increase in HDL cholesterol could imply cardiovascular benefits in this population. Despite these improvements, the 19% dropout rate highlights the importance of addressing adherence barriers, such as distance to the hospital, symptom burden, and financial difficulties. Future studies should focus on strategies that optimize participation and assess the long-term impact of exercise on disease progression and survival. The evidence supports the integration of physical exercise as a complementary therapeutic tool in oncology, with the potential to improve quality of life and functionality in patients with breast cancer. Declarations Contributions : (I) Conception and design: Gema Barrientos Vicho; Luis Posado-Domínguez and César Augusto Rodríguez Sánchez (II) Administrative support: Fonseca-Sánchez E and César Augusto Rodríguez Sánchez (III) Provision of study materials or patients: Luis Figuero Pérez, Belén Cigarral García, Rebeca Lozano Mejorada, Monserrat Díaz Martín, César Augusto Rodríguez Sánchez and Luis Posado Domínguez. (IV) Collection and assembly of data: José David Urchaga, Luis Posado Domínguez and Luis Figuero Pérez. (V) Data analysis and interpretation: José David Urchaga and Luis Posado Domínguez. (VI) Manuscript writing: All authors (VII) Final approval of manuscript: All authors Acknowledgments: The authors would like to thank all the patients who participated in this study for their time and commitment. Funding : This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Footnote Both clinical cases comply with the requirements of the Declaration of Helsinki and the patient's informed consent has been obtained. Reporting Checklist: The authors have completed the STROBE reporting checklist. Conflicts of Interest: The authors have no conflicts of interest to declare. Ethical statement: The authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). The study was approved by the Ethics Committee for Research of the Pontifical University of Salamanca, as recorded in Meeting Minutes 11/01/2024. References El cáncer en cifras | SEOM: Sociedad Española de Oncología Médica [Internet]. [citado 1 de noviembre de 2024]. Disponible en: https://seom.org/prensa/el-cancer-en-cifras El cáncer se convierte por primera vez en la principal causa de muerte en España | España [Internet]. [citado 19 de marzo de 2025]. Disponible en: https://www.elmundo.es/espana/2024/06/26/667becaafc 6c8366688b457c.html Ye F, Dewanjee S, Li Y, Jha NK, Chen ZS, Kumar A, et al. Advancements in clinical aspects of targeted therapy and immunotherapy in breast cancer. Mol Cancer. 6 de julio de 2023;22(1):105. Siegel EL, Whiting J, Kim Y, Sun W, Laronga C, Lee MC. Effect of surgical complications on outcomes in breast cancer patients treated with mastectomy and immediate reconstruction. Breast Cancer Res Treat. agosto de 2021;188(3):641–8. Heins MJ, de Ligt KM, Verloop J, Siesling S, Korevaar JC, PSCCR group. Adverse health effects after breast cancer up to 14 years after diagnosis. Breast. febrero de 2022;61:22–8. Epstein M, Silverstein M, Lin K, Kim B, Khan S, De Leon C, et al. Acute and Chronic Complications in Breast Cancer Patients Treated with Intraoperative Radiation Therapy. Ann Surg Oncol. octubre de 2016;23(10):3304–9. Farajivafa V, Khosravi N, Rezaee N, Koosha M, Haghighat S. Effectiveness of home-based exercise in breast cancer survivors: a randomized clinical trial. BMC Sports Science, Medicine and Rehabilitation. 7 de agosto de 2023;15(1):96. Coughlin SS, Caplan L, Stone R, Stewart J. A review of home-based physical activity interventions for breast cancer survivors. Curr Cancer Rep. 2019;1(1):6–12. Soriano-Maldonado A, Carrera-Ruiz Á, Díez-Fernández DM, Esteban-Simón A, Maldonado-Quesada M, Moreno-Poza N, et al. Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial. Medicine (Baltimore). noviembre de 2019;98(44):e17625. Nishiyama Y, Niiyama H, Harada H, Katou A, Yoshida N, Ikeda H. Effect of Exercise Training on Red Blood Cell Distribution Width as a Marker of Impaired Exercise Tolerance in Patients With Coronary Artery Disease. Int Heart J. 28 de septiembre de 2016;57(5):553–7. Buss LA, Dachs GU. The Role of Exercise and Hyperlipidaemia in Breast Cancer Progression. Exerc Immunol Rev. 2018;24:10–25. Aydin M, Kose E, Odabas I, Meric Bingul B, Demirci D, Aydin Z. The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients. Asian Pac J Cancer Prev. 1 de marzo de 2021;22(3):725–32. Ficarra S, Thomas E, Bianco A, Gentile A, Thaller P, Grassadonio F, et al. Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review. Breast Cancer. mayo de 2022;29(3):402–18. Supervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial | Nature Medicine [Internet]. [citado 19 de marzo de 2025]. Disponible en: https://www.nature.com/articles/s41591-024-03143-y Additional Declarations No competing interests reported. Supplementary Files SupplementaryAppendixMaterial.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6495691","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":508132561,"identity":"56dd864d-e26c-4cd5-bd37-b765d2bab46d","order_by":0,"name":"Barrientos Vicho Gema","email":"","orcid":"","institution":"Pontifical University of Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Barrientos","middleName":"Vicho","lastName":"Gema","suffix":""},{"id":508132563,"identity":"5baf60b1-7ab5-4d4a-8c3b-07d3f5724a43","order_by":1,"name":"Posado-Domínguez Luis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACPgbGBgjrAPMBIGlBWAsbQgtbApCUIEYLDBzgMSBSi0Ry8+eCijp5vuM93yR/1Egw8PMfIKQlsU16xpnDhjPPnN0mzXNMgkFyRgJhLcy8bQcYN9zI3SYN5DIY3CDosMTmz7xtdfYbbuQ8k/zxT4LB/jxhhzVI87YxJwK1sEnwtgFtYSDkMJ6HYL8kzzxzzNiat0+CR+IGAS387OmPQSFm23e8+eHNH99s5Pj7CTgMBJiROTyE1aNrGQWjYBSMglGAAQA+mj+27oQzxQAAAABJRU5ErkJggg==","orcid":"","institution":"Complejo Hospitalario de Salamanca","correspondingAuthor":true,"prefix":"","firstName":"Posado-Domínguez","middleName":"","lastName":"Luis","suffix":""},{"id":508132564,"identity":"c9e2f203-540d-4cbe-bd14-09946334b419","order_by":2,"name":"José David Urchaga","email":"","orcid":"","institution":"Pontifical University of 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Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Emilio","middleName":"","lastName":"Fonseca-Sánchez","suffix":""},{"id":508132584,"identity":"39721a4a-44de-441b-abd7-e976d02210fb","order_by":12,"name":"Cesar Rodríguez-Sánchez","email":"","orcid":"","institution":"Complejo Hospitalario de Salamanca","correspondingAuthor":false,"prefix":"","firstName":"Cesar","middleName":"","lastName":"Rodríguez-Sánchez","suffix":""}],"badges":[],"createdAt":"2025-04-21 11:38:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6495691/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6495691/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":90470551,"identity":"a7700b7d-7147-459c-bedc-b838cb0e5266","added_by":"auto","created_at":"2025-09-03 06:14:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":224422,"visible":true,"origin":"","legend":"\u003cp\u003eThis flowchart illustrates the participant recruitment process for the exercise program in women with breast cancer undergoing active treatment at the University Hospital of Salamanca.\u003c/p\u003e","description":"","filename":"image1.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/b022367facc874ce3d357deb.png"},{"id":90471188,"identity":"5faf18ae-39b7-44b8-b5d5-85f091f993ab","added_by":"auto","created_at":"2025-09-03 06:23:00","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":103129,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003ePre- and post-intervention comparison of EORTC QLQ-C30 scale scores. The data show significant improvements in cognitive function, emotional function, global quality of life, physical function, role function, and social function after the 12-week exercise program (p \u0026lt; 0.05). Post-intervention scores (blue bars) are consistently higher than pre-intervention scores (yellow bars), indicating positive changes in quality of life and functional capacity.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image2.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/18a3c20996cff1ef001c941d.png"},{"id":90470558,"identity":"65641a7d-f64c-4bac-90dd-f9f6f268778b","added_by":"auto","created_at":"2025-09-03 06:15:00","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":118502,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eMean scores of Functional Movement Screen (FMS) tests before and after a 12-week supervised exercise intervention. Bars represent mean values ± standard deviation (SD) for each functional test. Pre-intervention and post-intervention scores are shown in yellow and blue, respectively. p-values above the bars represent two-tailed paired comparisons between pre- and post-intervention scores. Abbreviations: ASLR, Active Straight-Leg Raise; L, Left; R, Right.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image3.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/1da79f3b99260711e56b451d.png"},{"id":90470562,"identity":"008288fe-76f0-49f5-9bff-8031537164b1","added_by":"auto","created_at":"2025-09-03 06:15:00","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":205744,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eEvolution of Functional Capacity (6MWT). This box plot shows the distance covered in the 6-minute walk test (6MWT) before and after the intervention. A significant improvement is observed post-intervention, with the median distance increasing from 533.9 meters pre-intervention to 677.2 meters post-intervention (p \u0026lt; 0.001, Wilcoxon). The green boxes represent post-intervention scores, while the red boxes represent pre-intervention scores, with 95% confidence intervals shown.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image4.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/639c15f8c377a7e978f9cb1d.png"},{"id":90470556,"identity":"aaed10b3-e577-4f95-81f1-c37102d06883","added_by":"auto","created_at":"2025-09-03 06:15:00","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":141190,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eSignificant Reduction in RDW Pre-Post Intervention. This box plot shows the RDW levels before and after the exercise intervention in breast cancer patients. A significant reduction in RDW was observed, with the median decreasing from 14.13% pre-intervention to 14.71% post-intervention (p = 0.011). The green boxes represent post-intervention scores, and the red boxes represent pre-intervention scores, with 95% confidence intervals shown.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image5.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/25f7c8568017ca26d8a47ba7.png"},{"id":90471190,"identity":"a7249fca-2b13-4b41-81e7-1cd75eaa29c7","added_by":"auto","created_at":"2025-09-03 06:23:00","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":124832,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eComparison of Analytical Parameters Pre and Post-Intervention. This box plot shows the comparison of LDL, HDL, and Total Cholesterol levels before and after the intervention. The post-intervention scores (green boxes) show a noticeable improvement compared to the pre-intervention scores (red boxes), with 95% confidence intervals shown.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"image6.png","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/a2b918471584eef7c7013b15.png"},{"id":95527833,"identity":"269d4824-7866-473b-9207-7c4612d97bf8","added_by":"auto","created_at":"2025-11-10 10:15:00","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1948772,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/7d189616-11f1-4f32-9935-cc24626c53d1.pdf"},{"id":90470546,"identity":"febcd1e0-3b04-4600-b593-96208fc78402","added_by":"auto","created_at":"2025-09-03 06:14:59","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":30863,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryAppendixMaterial.docx","url":"https://assets-eu.researchsquare.com/files/rs-6495691/v1/2cee52c3c76ceeee72538124.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Effects of a 12-Week Supervised Exercise Program on the Quality of Life and Biological Parameters of Women with Breast Cancer: A Prospective Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003e According to data from the Spanish Society of Medical Oncology (SEOM), 296,103 new cancer cases are expected to be diagnosed in Spain in 2025, representing a 3.3% increase compared to 2024. In 2022, breast cancer was the second most common tumor in both sexes and the fourth leading cause of cancer-related mortality, with 34,735 new cases diagnosed and 6,747 deaths (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIn 2024, cancer surpassed circulatory system diseases, becoming the leading cause of death in Spain (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). This increase in incidence, along with a growing number of diagnoses in individuals under 45 years old, underscores the urgent need for multidisciplinary strategies to improve patient survival and quality of life.\u003c/p\u003e\u003cp\u003eAdvances in breast cancer treatment, even in metastatic stages, have allowed many patients to live for years with the disease, thanks to the optimization of targeted therapies and immunotherapy (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, this increase in survival brings the need to address complications arising from both the cancer itself and oncological treatments, as many patients maintain a good general condition for much of the disease, experiencing a rapid deterioration in the final weeks of life. Factors such as lymphedema, asthenia, depression, muscle and bone loss, as well as chemotherapy-associated toxicities (cardiotoxicity, infections, and alopecia), can significantly impact quality of life (\u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eDuring this period, the focus of care should not be exclusively on oncological treatment but on a comprehensive approach that includes physical, emotional, and functional support measures. In this context, supervised physical exercise is proposed as a key intervention to mitigate adverse effects, preserve functionality, and optimize overall well-being. The integration of exercise programs at different care levels can facilitate their implementation and improve adherence, ensuring that patients receive multidisciplinary management tailored to their clinical status.\u003c/p\u003e\u003cp\u003ePhysical exercise has proven to be an effective complementary therapeutic strategy in oncology, with positive effects on fatigue reduction, cardiovascular function optimization, and quality of life improvement. However, its implementation in clinical practice remains limited due to structural barriers, a lack of defined care pathways, and limited knowledge regarding its prescription. SEOM emphasizes the need to integrate exercise programs at various care levels, both in hospital and extrahospital settings.\u003c/p\u003e\u003cp\u003eIn this context, the role of a multidisciplinary team is essential. Specialized nurses, psychologists, social workers, rehabilitation physicians, physiotherapists, and, importantly, professionals in the field of Physical Activity and Sports Sciences can play a key role in improving these patients' quality of life. Supervised physical exercise, when the patient maintains a good general condition, can be an effective tool to preserve functionality, reduce fatigue, and optimize both physical and mental well-being.\u003c/p\u003e\u003cp\u003eTherefore, further investigation into its impact on quality of life and various clinical parameters is necessary to promote its inclusion in the integrated management of breast cancer.\u003c/p\u003e\u003cp\u003eDespite its potential, further research is still needed to investigate its impact on quality of life and various clinical parameters to promote its inclusion in the integrated management of breast cancer. In our study, we evaluated the effects of a 12-week supervised physical exercise program in women with breast cancer, with the aim of analyzing its influence on quality of life, physical functionality, and various clinical and analytical parameters.\u003c/p\u003e"},{"header":"MATERIAL AND METHODS","content":"\u003cp\u003eThis prospective study was conducted as part of an interdisciplinary collaboration between specialists in Physical Activity and Sports Sciences at the Pontifical University of Salamanca and a team of medical oncologists specializing in breast cancer at the University Hospital of Salamanca. The study aimed to evaluate the effects of a 12-week supervised exercise program on patients undergoing adjuvant, neoadjuvant, or metastatic treatment for breast cancer.\u003c/p\u003e\u003cp\u003ePatients were eligible for inclusion if they met the following criteria: women under 65 years of age, an Eastern Cooperative Oncology Group (ECOG) performance status of 0\u0026ndash;1, and active oncologic treatment (adjuvant, neoadjuvant, or for metastatic disease). Recruitment was conducted during routine medical oncology consultations, where a total of 50 women were invited to participate. Of these, 44 agreed to enroll in the study.\u003c/p\u003e\u003cp\u003ePrior to starting the program, participants underwent a baseline assessment that included:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eLaboratory analyses: Hemoglobin, red cell distribution width (RDW), total cholesterol, high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, and triglycerides.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eStrength assessments, detailed in \u003cb\u003eSupplementary Appendix 1.\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eQuality of life evaluation using the EORTC QLQ-C30 questionnaire, including multiple subdomains \u003cb\u003e(Supplementary Appendix 2).\u003c/b\u003e\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eDuring the initial phase, seven participants withdrew from the study before the intervention began, leaving 37 active participants. Over the course of the program, one patient died due to hepatic failure secondary to tumor-related pseudocirrhosis. Additionally, seven participants completed the intervention partially or did not undergo final evaluations (including laboratory and strength measurements). As a result, 29 participants completed the study with full pre- and post-intervention data, and were included in the final analysis (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe 12-week supervised exercise program was designed to improve functional capacity, muscular strength, and overall well-being. Sessions were tailored to each participant\u0026rsquo;s baseline physical status, treatment stage, and functional capacity. The program incorporated aerobic, resistance, flexibility, and neuromuscular training,progressively adapted throughout the intervention period. Further details regarding the specific exercise regimen, intensity and session structure are provided in \u003cb\u003eSupplementary Appendix 3.\u003c/b\u003e\u003c/p\u003e\u003cp\u003eStatistical analyses were performed using SPSS v28 and RStudio. A descriptive analysis of baseline characteristicswas conducted, reporting means, standard deviations, and frequencies for categorical variables.\u003c/p\u003e\u003cp\u003eTo compare pre- and post-intervention measurements, different statistical tests were applied:\u003c/p\u003e\u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003eWilcoxon signed-rank test for non-parametric continuous variables.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003ePaired Student\u0026rsquo;s t-test for normally distributed continuous variables.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eTwo-tailed significance testing was conducted to determine statistically significant differences in quality of life, strength parameters, flexibility, body composition, and laboratory values after 12 weeks of intervention.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003eEffect sizes were calculated using Cohen\u0026rsquo;s d statistic to assess the magnitude of observed changes.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e\u003cp\u003eA p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant in all analyses.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eOBJETIVES\u003c/h2\u003e\u003cp\u003eThe primary objective of this study was to evaluate the impact of a 12-week structured exercise program on quality of life and emotional well-being in patients with breast cancer. Given the increasing recognition of exercise as a fundamental component of supportive oncology care, this study aimed to assess whether a supervised intervention could yield clinically meaningful improvements in patient-reported outcomes related to physical and psychological health.\u003c/p\u003e\u003cp\u003eIn addition to the primary endpoint, several secondary objectives were established to provide a comprehensive assessment of the effects of exercise on multiple health domains. First, we sought to analyze changes in strength parameters, body mass index (BMI), and flexibility before and after the intervention, assessing whether structured physical activity could enhance overall functional capacity and musculoskeletal health.\u003c/p\u003e\u003cp\u003eTo evaluate the impact of exercise on cardiorespiratory fitness and functional endurance, the 6-Minute Walk Test (6MWT) was performed before and after the intervention. This test, widely used in clinical settings, provides an objective measure of aerobic capacity and mobility, which are critical determinants of long-term health outcomes in cancer patients.\u003c/p\u003e\u003cp\u003eFurthermore, we examined the evolution of key biochemical markers, including albumin, C-reactive protein (CRP), hemoglobin, red cell distribution width (RDW), total cholesterol, HDL, LDL, and triglycerides, to explore potential metabolic and inflammatory changes associated with the intervention. Given the growing evidence linking systemic inflammation and metabolic dysfunction with cancer prognosis, these analyses aimed to determine whether exercise could modulate these biomarkers in a clinically meaningful way.\u003c/p\u003e\u003cp\u003eA descriptive analysis of clinical, epidemiological, and oncologic characteristics was also conducted, including age, sex, smoking history, educational level, employment status, histological subtype, disease stage, prior surgery, and treatments received. This allowed for a deeper understanding of the study population and potential factors influencing response to the intervention.\u003c/p\u003e\u003cp\u003eFinally, we assessed adherence to the exercise program and documented emergency department visits, hospitalizations, and adverse events during follow-up. Evaluating feasibility and safety is crucial for the broader implementation of structured exercise interventions in cancer care.\u003c/p\u003e\u003cp\u003eThese objectives collectively aim to generate robust evidence supporting the integration of physical activity into breast cancer management, reinforcing its role in improving functional capacity, metabolic health, systemic inflammation, and overall well-being in oncology patients.\u003c/p\u003e\u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003cp\u003e\u003cstrong\u003e1) BASELINE CHARACTERISTICS OF THE SAMPLE\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003eA total of 29 patients diagnosed with breast cancer were included, with a median age of 50.07\u0026thinsp;\u0026plusmn;\u0026thinsp;6.65 years. At diagnosis, 34.5% (n\u0026thinsp;=\u0026thinsp;10) had metastatic disease, with the most common metastatic sites being bone (34.5%), liver (17.2%), and lung (13.8%). Regarding treatment, 27.6% (n\u0026thinsp;=\u0026thinsp;8) were receiving adjuvant chemotherapy, and 34.5% (n\u0026thinsp;=\u0026thinsp;10) were undergoing treatment for metastatic disease.\u003c/p\u003e\n \u003cp\u003eSociodemographic data revealed that 27.6% (n\u0026thinsp;=\u0026thinsp;8) of patients were actively employed, and 37.9% (n\u0026thinsp;=\u0026thinsp;11) had a history of tobacco use. Most patients (48.3%, n\u0026thinsp;=\u0026thinsp;14) had a university degree. Comorbidities included antidepressant use (20.7%, n\u0026thinsp;=\u0026thinsp;6), benzodiazepine use (34.5%, n\u0026thinsp;=\u0026thinsp;10), and other medications such as antihypertensives and statins.\u003c/p\u003e\n \u003cp\u003eRegarding treatment history, 93.1% (n\u0026thinsp;=\u0026thinsp;27) underwent surgery, with lumpectomy being the most common procedure (58.6%, n\u0026thinsp;=\u0026thinsp;17). Radiation therapy was received by 65.5% (n\u0026thinsp;=\u0026thinsp;19) of the cohort.\u003c/p\u003e\n \u003cp\u003eAdverse events during the intervention were minimal, with 13.7% (n\u0026thinsp;=\u0026thinsp;4) requiring emergency visits, and 6.9% (n\u0026thinsp;=\u0026thinsp;2) requiring hospitalization. No injuries leading to functional impairment were reported.\u003c/p\u003e\n \u003cp\u003eFor a complete overview of the baseline characteristics, see Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e\n \u003cp\u003e(Insert Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e here)\u003c/p\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eBaseline Characteristics of the sample.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCharacteristic\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eMedian(+/- SD)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e50,07\u0026thinsp;\u0026plusmn;\u0026thinsp;6,65\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge at diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46,21 \u0026plusmn; 7,12\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (pre-intervention)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,26 \u0026plusmn; 4,98\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFat mass (pre-intervention)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,68 \u0026plusmn; 5,69\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaist circumference (pre-intervention)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81,69\u0026thinsp;\u0026plusmn;\u0026thinsp;11,58 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHip circumference (pre-intervention)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102,0\u0026thinsp;\u0026plusmn;\u0026thinsp;10,97 cm\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCharacteristic (N\u0026thinsp;=\u0026thinsp;29)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eN (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTreatment Status\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Adjuvant chemotherapy*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Adyuvant hormone therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9 (31.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Neoadyuvant chemotherapy*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- No active treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e- Metastatic disease treatment*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEmployment Status\u003c/p\u003e\n \u003cp\u003e- Currently employed\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e8 (27,6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eToxic Habits\u003c/p\u003e\n \u003cp\u003e- Smoking history\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e11 (37,9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEducation level:\u003c/p\u003e\n \u003cp\u003e- Primary education\u003c/p\u003e\n \u003cp\u003e- Secondary education\u003c/p\u003e\n \u003cp\u003e- Higher vocational training\u003c/p\u003e\n \u003cp\u003e- High School diploma\u003c/p\u003e\n \u003cp\u003e- University defree\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e1 (3,4%)\u003c/p\u003e\n \u003cp\u003e3 (10,3%)\u003c/p\u003e\n \u003cp\u003e6 (20,7%)\u003c/p\u003e\n \u003cp\u003e5 (17,2%)\u003c/p\u003e\n \u003cp\u003e14 (14,3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFamily History of Cancer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7 (24,1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMetastases at Diagnosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (34,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBone metastases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10 (34,5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLiver metastases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5 (17,2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLung metastases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 (13,8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymph node metastases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 (6,9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBrain metastases\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 (3,4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eConcomitant Medication\u003c/p\u003e\n \u003cp\u003e- Antidepressants\u003c/p\u003e\n \u003cp\u003e- Benzodiazepines\u003c/p\u003e\n \u003cp\u003e- Statins\u003c/p\u003e\n \u003cp\u003e- Antihypertensive drugs\u003c/p\u003e\n \u003cp\u003e- Antidiabetic drugs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e6 (20,7%)\u003c/p\u003e\n \u003cp\u003e10 (34,5%)\u003c/p\u003e\n \u003cp\u003e2 (6,9%)\u003c/p\u003e\n \u003cp\u003e4 (13,8%)\u003c/p\u003e\n \u003cp\u003e1 (3,4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypothyroidism:\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e25 (86,2%)\u003c/p\u003e\n \u003cp\u003e4 (13.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical Treatment\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e27 (93.1%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eType of Surgery\u003c/p\u003e\n \u003cp\u003e- Mastectomy\u003c/p\u003e\n \u003cp\u003e- Lumpectomy\u003c/p\u003e\n \u003cp\u003e- No surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e10 (34.5%)\u003c/p\u003e\n \u003cp\u003e17 (58.6%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLymphadenectomy\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e8 (27.6%)\u003c/p\u003e\n \u003cp\u003e21 (72.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRadiotherapy\u003c/p\u003e\n \u003cp\u003e- Yes\u003c/p\u003e\n \u003cp\u003e- No\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e19 (65.5%)\u003c/p\u003e\n \u003cp\u003e10 (34.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEvents During the Program\u003c/p\u003e\n \u003cp\u003e- Emergency visits\u003c/p\u003e\n \u003cp\u003e- Hospitalizations\u003c/p\u003e\n \u003cp\u003e- Exercise-related disabling injuries\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e4 (13.7%)\u003c/p\u003e\n \u003cp\u003e2 (6.9%)\u003c/p\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003cstrong\u003e2. Results of the EORTC QLQ-C30 Quality of Life Questionnaire\u003cbr\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eQuality of life was assessed using the EORTC QLQ-C30 questionnaire, comparing scores obtained before and after the intervention. The analysis included the global quality of life scale, functional scales, and symptom scales.\u003c/p\u003e\n \u003cp\u003eThe EORTC QLQ-C30 questionnaire analysis revealed A significant increase of 19.5% in global quality of life (QL2.S) was observed, increasing from 58.91 (\u0026plusmn;\u0026thinsp;18.22) to 70.40 (\u0026plusmn;\u0026thinsp;13.83), with a p-value of 0.002. Significant improvements were observed across functional scales, particularly in physical function, which increased from 85.06 to 91.95 (p\u0026thinsp;=\u0026thinsp;0.006), and role function, which increased from 74.71 to 89.66 (p\u0026thinsp;=\u0026thinsp;0.004).\u003c/p\u003e\n \u003cp\u003eAdditionally, emotional functionand social function also showed significant improvements, reflecting enhanced emotional well-being and social reintegration.\u003c/p\u003e\n \u003cp\u003eRegarding symptom scales, there was a significant reduction in fatigue, with scores decreasing from 37.55 to 26.82 (p\u0026thinsp;=\u0026thinsp;0.007). However, no significant changes were observed in pain, nausea, appetite loss, constipation, or diarrhea. The financial impact showed a slight reduction but was not statistically significant (p\u0026thinsp;=\u0026thinsp;0.527).\u003c/p\u003e\n \u003cp\u003eIn summary, the results suggest that the exercise program had a positive effect on physical, emotional, and social functioning, particularly in enhancing physical and role function. Additionally, the intervention significantly reduced fatigue, improving overall well-being. Detailed results can be found in Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e \u003cstrong\u003eand\u003c/strong\u003e Fig. \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\n \u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eGlobal Quality of Life Scale. This table presents the pre- and post-intervention scores for various functional and quality of life parameters, as assessed using the EORTC QLQ-C30 and other relevant measures.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePRE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePRE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOST\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOST\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value (two-tailed)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen d\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eQL2.S (Global quality of life)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e58,91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70,40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e002\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e19,97\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePF2.S (Physical function)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e85,06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e91,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e006\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRF-2-S (Role function)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e74,71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,65\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e89,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e004\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEF-S (Emotional function)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e77,01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e86,78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCF-S (Cognitive function)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e73,56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e12,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e034\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSF-S (Social function)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,71\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e78,74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e005\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFA-S (Fatigue)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e007\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNV-S (Nausea and vomiting)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePA-S (Pain)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e31,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26,44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,222\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDY-S (Dyspnea)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16,09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,083\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSL-S (Insomnia)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47,13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39,08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30,95\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAP-S (Appetite loss)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15,61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCO-S (Constipation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e17,24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13,79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDI-S (Diarrhea)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14,94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e28,99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,317\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFI-S (Financial difficulties)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22,32\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,527\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI (Body Mass Index)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25,16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,931\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,94\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFat mass percentage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33,11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8,47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e33,05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7,77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,456\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFat mass in kg\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,88\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e23,43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,855\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLean mass\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44,89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,381\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaist circumference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e11,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e9,57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,936\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHip circumference\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e102,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103,35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,053\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eWaist-to-hip ratio\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,336\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFZA.DA (Right-hand grip strength)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4,75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,781\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFZA.IZ (Left-hand grip strength)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e5,31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,325\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6-Minute Walk Test (metres)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e556,21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e123,60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e666,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e56,075\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e115,79\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003cstrong\u003e3. Global Analysis of the FMS\u003cbr\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eThe FMS is a screening tool used to evaluate movement quality, mobility, stability, and functional asymmetries. It consists of seven different movement tests, each rated on a scale from 0 to 3, where:\u003c/p\u003e\n \u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e0\u0026thinsp;=\u0026thinsp;Pain during movement\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e1\u0026thinsp;=\u0026thinsp;Unable to perform the movement correctly\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e2\u0026thinsp;=\u0026thinsp;Movement performed with compensation or minor instability\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e3\u0026thinsp;=\u0026thinsp;Correct and stable movement without compensation\u003c/p\u003e\n \u003c/li\u003e\n \u003c/ul\u003e\n \u003cp\u003eThe Functional Movement Screen (FMS), a standardized tool for assessing movement quality, mobility, stability, and functional asymmetries, demonstrated significant improvement following the exercise intervention. The total FMS score increased from 2.23 (\u0026plusmn;\u0026thinsp;0.46) at baseline to 2.51 (\u0026plusmn;\u0026thinsp;0.31) post-intervention, a statistically significant difference (Z = -3.218; p\u0026thinsp;=\u0026thinsp;0.001). This improvement suggests enhanced movement efficiency, neuromuscular control, and overall functional capacity, reinforcing the role of structured physical exercise in optimizing movement patterns in patients with breast cancer. (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e and Fig. \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e)\u003c/p\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eThe table presents the results of the Functional Movement Screen (FMS) before and after the 12-week exercise intervention.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePRE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePRE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOST\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOST\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP-value (two-tailed)\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eM\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.1. (Deep squat)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,850\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,689\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e003\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.2.DA (Hurdle Step Right)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,435\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,153\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.2.IZ (Hurdle Step Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,682\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.3.DA (Incline Lunge Right)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026lt;,001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.3.IZ (Incline Lunge Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,860\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,577\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.4.DA (Shoulder Mobility Right)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,604\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,070\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.4.IZ (Shoulder Mobility Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,783\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,494\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,614\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.5.DA (Active Straight-Leg Raise Right)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,553\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,471\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.5.IZ (Active Straight-Leg Raise Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,541\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,455\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,782\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.6 (Trunk Stability Push-Up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1,62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,728\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e008\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.7.DA (Rotary Stability Right)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,865\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,468\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,392\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eFMS.7.IZ (Rotary Stability Left)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,559\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,771\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,460\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2,51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,312\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,\u003cstrong\u003e001\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cp\u003eThe most notable improvements were observed in the Deep Squat (FMS.1), Inline Lunge (FMS.3), and Trunk Stability Push-Up (FMS.6), reflecting enhanced mobility, dynamic balance, and core stability. The Deep Squat score significantly improved from 1.69 (\u0026plusmn;\u0026thinsp;0.85) to 2.24 (\u0026plusmn;\u0026thinsp;0.68) (Z = -3.017; p\u0026thinsp;=\u0026thinsp;0.003), suggesting gains in hip, knee, and ankle mobility, as well as trunk control. Similarly, the Inline Lunge showed marked improvements in both the right side (2.03\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 to 2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57; Z = -3.384; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and left side (2.10\u0026thinsp;\u0026plusmn;\u0026thinsp;0.86 to 2.76\u0026thinsp;\u0026plusmn;\u0026thinsp;0.57; Z = -3.275; p\u0026thinsp;=\u0026thinsp;0.001), indicating better lower limb stability, proprioception, and postural control. The Trunk Stability Push-Up score increased from 1.38 (\u0026plusmn;\u0026thinsp;0.62) to 1.62 (\u0026plusmn;\u0026thinsp;0.72) (Z = -2.646; p\u0026thinsp;=\u0026thinsp;0.008), reflecting improvements in core strength and overall neuromuscular coordination.\u003c/p\u003e\n \u003cp\u003eOther assessments, such as Shoulder Mobility (FMS.4) and Rotary Stability (FMS.7), showed trends toward improvement but did not reach statistical significance (p\u0026thinsp;=\u0026thinsp;0.070 and p\u0026thinsp;=\u0026thinsp;0.392, respectively).\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003cstrong\u003e4. The 6-Minute Walk Test (6MWT)\u003cbr\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003cp\u003eThe 6-Minute Walk Test (6MWT) is a widely used tool for assessing functional capacity and aerobic endurance in patients with various health conditions, including those undergoing oncologic treatments. In this study, a significant improvement in the distance walked following the structured exercise intervention was observed, suggesting a positive impact on aerobic capacity and the efficiency of the cardiovascular and muscular systems.\u003c/p\u003e\n \u003cp\u003eAt baseline, the mean distance covered in the 6MWT was 556.21 meters (SD\u0026thinsp;=\u0026thinsp;123.60). After 12 weeks of exercise, this distance increased to 666.38 meters (SD\u0026thinsp;=\u0026thinsp;56.07), representing a 19.8% improvement (110.17 meters). This increase was statistically significant (Z = -4.381; p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). (Fig. \u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e\n \u003cp\u003e\u003cspan\u003e\u003cstrong\u003e5. Analysis of Analytical Parameters Pre- and Post-Intervention\u003cbr\u003e\u003c/strong\u003e\u003c/span\u003e\u003c/p\u003e\n \u003ctable id=\"Tab4\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eHematological and Lipid Parameters Pre- and Post-Intervention.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePRE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOST\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP valor\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCohen d\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e12,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,348\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0,97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRDW\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15,21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e14,18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2,25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCOLESTEROL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e195,48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e188,97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,176\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21,93\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eTriglic\u0026eacute;ridos\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e109,52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e104,07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,489\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e44,14\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCol HDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60,66\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e64,55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e7,03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCol LDL\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e114,41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e106,38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e,172\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e23,97\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003e- Hematological Parameters\u003c/h3\u003e\n\u003cp\u003eHemoglobin (Hb) levels and red cell distribution width (RDW) were assessed to evaluate potential hematologic and inflammatory changes following the exercise intervention. Mean hemoglobin concentration increased slightly from 12.80 g/dL (\u0026plusmn;\u0026thinsp;1.40) to 12.97 g/dL (\u0026plusmn;\u0026thinsp;1.75), though this difference was not statistically significant (t = -0.954; p\u0026thinsp;=\u0026thinsp;0.174) and had a small effect size (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;0.97). Conversely, a significant reduction in RDW was observed, decreasing from 15.21% (\u0026plusmn;\u0026thinsp;2.28) to 14.18% (\u0026plusmn;\u0026thinsp;1.87) (t\u0026thinsp;=\u0026thinsp;2.435; p\u0026thinsp;=\u0026thinsp;0.011), with a moderate effect size (Cohen\u0026rsquo;s d\u0026thinsp;=\u0026thinsp;2.25) (Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\n\u003cp\u003eRDW is considered a pro-inflammatory biomarker, as increased RDW has been associated with chronic inflammation and poor prognosis in oncology patients. The significant decrease observed in this study suggests a potential reduction in systemic inflammation.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e- Metabolic Parameters (Lipid Profile)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess potential metabolic changes associated with the exercise intervention, total cholesterol, triglycerides, HDL cholesterol, and LDL cholesterol levels were analyzed (Figure 6). Total cholesterol levels showed a slight decrease from 195.48 mg/dL (\u0026plusmn;33.67) to 188.97 mg/dL (\u0026plusmn;34.07), which did not reach statistical significance (t = 1.601; p = 0.060). However, the effect size was remarkably high (Cohen\u0026rsquo;s d = 21.93).\u003c/p\u003e\n\u003cp\u003eTriglyceride levels decreased from 109.52 mg/dL (\u0026plusmn;55.73) to 104.07 mg/dL (\u0026plusmn;43.99), without statistical significance (t = 0.665; p = 0.256), yet the notably high effect size (Cohen\u0026rsquo;s d = 44.14) suggests a possible trend toward improved lipid metabolism. In contrast, HDL cholesterol increased significantly from 60.66 mg/dL (\u0026plusmn;15.48) to 64.55 mg/dL (\u0026plusmn;16.66) (t = -2.984; p = 0.003), with a large effect size (Cohen\u0026rsquo;s d = 7.03), indicating a favorable shift in lipid profile.\u003c/p\u003e\n\u003cp\u003eA significant reduction in LDL cholesterol was also observed, decreasing from 114.41 mg/dL (\u0026plusmn;31.22) to 106.38 mg/dL (\u0026plusmn;28.87) (t = 1.805; p = 0.041), with a high effect size (Cohen\u0026rsquo;s d = 23.96), suggesting a potentially beneficial decline in atherogenic lipoproteins.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe impact of physical exercise on patients with metastatic breast cancer (MBC) has been underexplored in the literature, despite its growing recognition as a key strategy in the comprehensive management of the disease. Our study demonstrates that a structured 12-week multicomponent exercise program is capable of generating significant improvements in all dimensions of quality of life (HRQoL) assessed through the EORTC-QLQ-C30, as well as a reduction in RDW, a biomarker associated with systemic inflammation and prognosis in oncology. These findings reinforce the idea that exercise is not only safe for this group of patients, but it can also modulate both functional and metabolic aspects of the disease.\u003c/p\u003e\u003cp\u003eA key aspect to consider in implementing exercise programs in patients with metastatic breast cancer is adherence to the intervention, as the dropout rate can directly influence the effectiveness of the program. In our study, a 19% dropout rate was observed among the women who started the program, highlighting the need to address barriers that hinder sustained participation in these interventions. Factors such as distance to the hospital, financial difficulties, lack of social support, or symptom burden from oncological treatment may have influenced participant continuity.\u003c/p\u003e\u003cp\u003ePrevious studies have identified that adherence to exercise in metastatic cancer patients can improve with more flexible and accessible programs, including home-based interventions, hybrid sessions (both in-person and virtual), and personalized follow-up to foster training continuity (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eOur study provides evidence in a subgroup of patients with metastatic disease, which has been excluded in most previous trials. For example, the study by Soriano-Maldonado et al. evaluated a 12-week combined exercise program, but only in patients without metastatic disease, which limits the extrapolation of their findings to populations with higher tumor and symptomatic burden (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Additionally, although their randomized design strengthens the validity of the results, it did not include the analysis of physiological biomarkers, such as systemic inflammation, which represents a complementary approach in our study.\u003c/p\u003e\u003cp\u003eIn addition to the benefits in quality of life, our study demonstrated favorable changes in hematological and lipid biomarkers, suggesting a potential impact of exercise on the regulation of systemic inflammation and lipid metabolism in patients with metastatic breast cancer. A significant reduction in red blood cell distribution width (RDW) was observed, decreasing from 15.21\u0026ndash;14.18% (p\u0026thinsp;=\u0026thinsp;0.005, d\u0026thinsp;=\u0026thinsp;2.25) after 12 weeks of intervention. Since RDW has been associated with chronic inflammation, endothelial dysfunction, and poorer prognosis in oncology, this reduction may indicate an immunomodulatory effect of exercise, potentially related to the reduction of systemic inflammatory response.\u003c/p\u003e\u003cp\u003eRegarding the lipid profile, a reduction in total cholesterol levels was observed, from 195.48 mg/dL to 188.97 mg/dL (p\u0026thinsp;=\u0026thinsp;0.176, d\u0026thinsp;=\u0026thinsp;21.93), although this did not reach statistical significance. However, a significant increase in HDL cholesterol levels was identified, from 60.66 mg/dL to 64.55 mg/dL (p\u0026thinsp;=\u0026thinsp;0.007, d\u0026thinsp;=\u0026thinsp;7.03), suggesting an improvement in the reverse cholesterol transport capacity and a potential cardioprotective effect in this population. No significant changes were observed in LDL cholesterol or triglyceride levels, although a trend toward reduction was noted. These findings are consistent with previous literature suggesting that physical exercise can optimize lipid homeostasis and modulate low-grade inflammation (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e)(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eFinally, our study demonstrated a significant increase in physical functionality, assessed using the Functional Movement Screen (FMS). A global improvement in the total score was observed, from 2.23\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46 to 2.51\u0026thinsp;\u0026plusmn;\u0026thinsp;0.31 (p\u0026thinsp;=\u0026thinsp;0.001), suggesting a positive impact of exercise on mobility and motor control in the participants. Specifically, significant improvements were identified in the Deep Squat (p\u0026thinsp;=\u0026thinsp;0.003), Incline Lunge on both sides (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001 and p\u0026thinsp;=\u0026thinsp;0.001, respectively), and Trunk Stability Push-Up (p\u0026thinsp;=\u0026thinsp;0.008). These improvements indicate an increase in core stability, mobility, and functional strength, which are essential in preventing muscle loss and optimizing functional capacity in patients with metastatic cancer.\u003c/p\u003e\u003cp\u003eSimilarly, the study by Aydin et al. showed that aerobic and resistance exercise improves quality of life and reduces depressive symptoms (BDI) in patients with breast cancer, although without metastatic disease (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). In our study, the impact of exercise was observed in all dimensions of quality of life, including physical, emotional, functional, social, and cognitive well-being, suggesting that the benefits may extend to a population with a worse prognosis.\u003c/p\u003e\u003cp\u003eIn this context, the systematic review by Ficarra et al. consolidated the evidence on exercise in patients with breast cancer undergoing adjuvant treatment or survivors, but it did not include studies in patients with metastatic disease (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). In contrast, our findings suggest that the implementation of exercise programs in this subgroup may be equally beneficial, reinforcing the need to expand research in this specific population.\u003c/p\u003e\u003cp\u003eThe PREFERABLE-EFFECT study currently represents the most robust evidence on the effects of exercise in patients with metastatic breast cancer, as it is a large-scale randomized controlled trial that evaluated a 9-month structured intervention (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eIts results demonstrated significant improvements in Health-Related Quality of Life (HRQoL), fatigue, and physical functionality, with observable effects from 3 months and sustained until 9 months, thus consolidating the scientific basis for incorporating exercise as part of the integrated management of this population. In our study, we observed similar benefits in terms of quality of life and fatigue reduction with an intervention of only 3 months, suggesting that the positive effects of exercise may manifest in a shorter period, facilitating its implementation in clinical practice. However, the findings from PREFERABLE-EFFECT indicate that prolonging the intervention could maximize and sustain these benefits over the long term, emphasizing the need to establish strategies that promote adherence to sustained exercise programs.\u003c/p\u003e\u003cp\u003eFinally, our results support the integration of physical exercise as a therapeutic tool in metastatic breast cancer patients, highlighting its safety and potential to improve quality of life and mitigate fatigue. However, future research should assess the optimal duration of these programs and their impact on additional biomarkers, exploring their potential role in modulating inflammation and the tumor response. Furthermore, randomized controlled trials are needed to confirm these findings and help define long-term adherence strategies for this patient group.\u003c/p\u003e\u003cp\u003eDespite the positive results obtained, this study has several limitations that should be considered when interpreting the findings. First, the small sample size (N\u0026thinsp;=\u0026thinsp;29) limits the generalizability of the results to a larger population, highlighting the need for studies with larger samples to confirm these effects. Additionally, the absence of a control group prevents attributing the observed changes solely to the exercise program, as other uncontrolled factors could have influenced the improvements in quality of life and fatigue. Furthermore, variability in adherence to the program may have affected the results, as not all participants completed the final measurements. Finally, the follow-up was limited to 12 weeks, which prevents evaluating the long-term persistence of the benefits and determining whether these effects are sustained or evolve over time.\u003c/p\u003e\u003cp\u003eTo validate and expand on these findings, studies with a larger number of participants and a randomized controlled design are needed, which would allow for a more robust evaluation of the effectiveness of exercise in patients with metastatic breast cancer. Additionally, it would be essential to analyze the long-term impact of exercise, with measurements at 6 months or 1 year, to understand the evolution of the observed benefits. Another promising area of research would be the personalization of exercise programs based on the clinical and functional status of each patient, thus optimizing therapeutic effects. Finally, exploring the impact of exercise on additional biomarkers of inflammationand immune function would provide a deeper understanding of the underlying physiological mechanisms, potentially contributing to the integration of exercise as a complementary strategy in the management of metastatic breast cancer.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study demonstrates that a 12-week structured multicomponent exercise program is safe and beneficial for patients with breast cancer, both metastatic and non-metastatic. Significant improvements were observed in quality of life (HRQoL) and physical functionality, with increases in the total score of the Functional Movement Screen (FMS). Additionally, the reduction in RDW suggests a potential anti-inflammatory effect of exercise, while the increase in HDL cholesterol could imply cardiovascular benefits in this population.\u003c/p\u003e\u003cp\u003eDespite these improvements, the 19% dropout rate highlights the importance of addressing adherence barriers, such as distance to the hospital, symptom burden, and financial difficulties. Future studies should focus on strategies that optimize participation and assess the long-term impact of exercise on disease progression and survival. The evidence supports the integration of physical exercise as a complementary therapeutic tool in oncology, with the potential to improve quality of life and functionality in patients with breast cancer.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eContributions\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e(I) Conception and design: Gema Barrientos Vicho; Luis Posado-Dom\u0026iacute;nguez and C\u0026eacute;sar Augusto Rodr\u0026iacute;guez S\u0026aacute;nchez\u003c/p\u003e\n\u003cp\u003e(II) Administrative support: Fonseca-S\u0026aacute;nchez E and C\u0026eacute;sar Augusto Rodr\u0026iacute;guez S\u0026aacute;nchez\u003c/p\u003e\n\u003cp\u003e(III) Provision of study materials or patients: Luis Figuero P\u0026eacute;rez, Bel\u0026eacute;n Cigarral Garc\u0026iacute;a, Rebeca Lozano Mejorada, Monserrat D\u0026iacute;az Mart\u0026iacute;n, C\u0026eacute;sar Augusto Rodr\u0026iacute;guez S\u0026aacute;nchez and Luis Posado Dom\u0026iacute;nguez.\u003c/p\u003e\n\u003cp\u003e(IV) Collection and assembly of data: Jos\u0026eacute; David Urchaga, Luis Posado Dom\u0026iacute;nguez and Luis Figuero P\u0026eacute;rez.\u003c/p\u003e\n\u003cp\u003e(V) Data analysis and interpretation: Jos\u0026eacute; David Urchaga and Luis Posado Dom\u0026iacute;nguez.\u003c/p\u003e\n\u003cp\u003e(VI) Manuscript writing: All authors\u003c/p\u003e\n\u003cp\u003e(VII) Final approval of manuscript: All authors\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eThe authors would like to thank all the patients who participated in this study for their time and commitment.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFootnote\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth clinical cases comply with the requirements of the Declaration of Helsinki and the patient\u0026apos;s informed consent has been obtained.\u003c/p\u003e\n\u003cp\u003eReporting Checklist: The authors have completed the STROBE reporting checklist.\u003c/p\u003e\n\u003cp\u003eConflicts of Interest: The authors have no conflicts of interest to declare.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical statement:\u0026nbsp;\u003c/strong\u003eThe authors are accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee(s) and with the Helsinki Declaration (as revised in 2013). The study was approved by the Ethics Committee for Research of the Pontifical University of Salamanca, as recorded in Meeting Minutes 11/01/2024.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eEl c\u0026aacute;ncer en cifras | SEOM: Sociedad Espa\u0026ntilde;ola de Oncolog\u0026iacute;a M\u0026eacute;dica [Internet]. [citado 1 de noviembre de 2024]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://seom.org/prensa/el-cancer-en-cifras\u003c/span\u003e\u003cspan address=\"https://seom.org/prensa/el-cancer-en-cifras\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEl c\u0026aacute;ncer se convierte por primera vez en la principal causa de muerte en Espa\u0026ntilde;a | Espa\u0026ntilde;a [Internet]. [citado 19 de marzo de 2025]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.elmundo.es/espana/2024/06/26/667becaafc\u003c/span\u003e\u003cspan address=\"https://www.elmundo.es/espana/2024/06/26/667becaafc\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e6c8366688b457c.html\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eYe F, Dewanjee S, Li Y, Jha NK, Chen ZS, Kumar A, et al. Advancements in clinical aspects of targeted therapy and immunotherapy in breast cancer. Mol Cancer. 6 de julio de 2023;22(1):105.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSiegel EL, Whiting J, Kim Y, Sun W, Laronga C, Lee MC. Effect of surgical complications on outcomes in breast cancer patients treated with mastectomy and immediate reconstruction. Breast Cancer Res Treat. agosto de 2021;188(3):641\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eHeins MJ, de Ligt KM, Verloop J, Siesling S, Korevaar JC, PSCCR group. Adverse health effects after breast cancer up to 14 years after diagnosis. Breast. febrero de 2022;61:22\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eEpstein M, Silverstein M, Lin K, Kim B, Khan S, De Leon C, et al. Acute and Chronic Complications in Breast Cancer Patients Treated with Intraoperative Radiation Therapy. Ann Surg Oncol. octubre de 2016;23(10):3304\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFarajivafa V, Khosravi N, Rezaee N, Koosha M, Haghighat S. Effectiveness of home-based exercise in breast cancer survivors: a randomized clinical trial. BMC Sports Science, Medicine and Rehabilitation. 7 de agosto de 2023;15(1):96.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eCoughlin SS, Caplan L, Stone R, Stewart J. A review of home-based physical activity interventions for breast cancer survivors. Curr Cancer Rep. 2019;1(1):6\u0026ndash;12.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSoriano-Maldonado A, Carrera-Ruiz \u0026Aacute;, D\u0026iacute;ez-Fern\u0026aacute;ndez DM, Esteban-Sim\u0026oacute;n A, Maldonado-Quesada M, Moreno-Poza N, et al. Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial. Medicine (Baltimore). noviembre de 2019;98(44):e17625.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eNishiyama Y, Niiyama H, Harada H, Katou A, Yoshida N, Ikeda H. Effect of Exercise Training on Red Blood Cell Distribution Width as a Marker of Impaired Exercise Tolerance in Patients With Coronary Artery Disease. Int Heart J. 28 de septiembre de 2016;57(5):553\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eBuss LA, Dachs GU. The Role of Exercise and Hyperlipidaemia in Breast Cancer Progression. Exerc Immunol Rev. 2018;24:10\u0026ndash;25.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eAydin M, Kose E, Odabas I, Meric Bingul B, Demirci D, Aydin Z. The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients. Asian Pac J Cancer Prev. 1 de marzo de 2021;22(3):725\u0026ndash;32.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eFicarra S, Thomas E, Bianco A, Gentile A, Thaller P, Grassadonio F, et al. Impact of exercise interventions on physical fitness in breast cancer patients and survivors: a systematic review. Breast Cancer. mayo de 2022;29(3):402\u0026ndash;18.\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eSupervised, structured and individualized exercise in metastatic breast cancer: a randomized controlled trial | Nature Medicine [Internet]. [citado 19 de marzo de 2025]. Disponible en: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.nature.com/articles/s41591-024-03143-y\u003c/span\u003e\u003cspan address=\"https://www.nature.com/articles/s41591-024-03143-y\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"","lastPublishedDoi":"10.21203/rs.3.rs-6495691/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6495691/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e\u003cp\u003ePhysical exercise is an effective supportive strategy in oncology, yet its implementation remains limited, particularly in patients with metastatic breast cancer. This prospective study aimed to evaluate the effects of a 12-week supervised multicomponent exercise program on quality of life, functional capacity, and biological parameters in women undergoing treatment for breast cancer.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eA total of 44 women with early or metastatic breast cancer were enrolled; 29 completed the full intervention and assessments. The program consisted of supervised aerobic, resistance, mobility, and neuromuscular training three times per week. Quality of life was assessed using the EORTC QLQ-C30 questionnaire. Strength, body composition, functional mobility (Functional Movement Screen, FMS), 6-minute walk test (6MWT), and laboratory markers (RDW, HDL, cholesterol profile) were evaluated pre- and post-intervention.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eSignificant improvements were observed in global quality of life (+\u0026thinsp;19.5%, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002), physical function (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.006), emotional function (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003), and fatigue reduction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). The FMS total score increased significantly (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001), and 6MWT distance improved by 110 meters (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Biochemical analyses showed a significant reduction in RDW (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.005), a pro-inflammatory marker, and an increase in HDL cholesterol (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007). No serious adverse events were reported.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eA 12-week supervised exercise program is feasible and beneficial for women with breast cancer, including those with metastatic disease. It improves quality of life, functional mobility, and markers of systemic inflammation. These findings support the integration of structured exercise into routine oncologic care.\u003c/p\u003e","manuscriptTitle":"Effects of a 12-Week Supervised Exercise Program on the Quality of Life and Biological Parameters of Women with Breast Cancer: A Prospective Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-09-03 06:14:54","doi":"10.21203/rs.3.rs-6495691/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"3566306b-c1cf-43f5-b011-77ca1210c0bb","owner":[],"postedDate":"September 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-11-09T07:38:31+00:00","versionOfRecord":[],"versionCreatedAt":"2025-09-03 06:14:54","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6495691","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6495691","identity":"rs-6495691","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}