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Move for Life

PINK SYNC · OCTOBER 24, 2026

Exercise as part of your breast cancer care

Roma Bhatia, MD, MPH

Breast Medical Oncologist

Huntsman Cancer Institute · University of Utah

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Hi, I’m Roma

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RB

Roma Bhatia, MD, MPH

Breast Medical Oncologist

Huntsman Cancer Institute

University of Utah · Salt Lake City

Now enrolling: ENERGIZE

my at-home exercise study for patients receiving Enhertu (T‑DXd)

What I do

I care for people with breast cancer at every stage: from a new diagnosis through survivorship.

Where I practice

Huntsman Cancer Institute at the University of Utah, in Salt Lake City.

What I study

Supportive oncology: helping people feel better during and after treatment with exercise, wearables, and patient-reported outcomes.

Outside of clinic

Mom of two young boys and the treadmill is my happy place!

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Quick show of hands

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Raise your hand if…

…someone told you to “take it easy” during treatment

…treatment has left you tired, achy, or stiff

…you moved on purpose this week (yes, a walk counts!)

Hold on to those answers — we’ll come back to them.

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Why I’m passionate about this

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So much of cancer care happens to you. Movement is something you get to do for yourself.

Exercise is one of the few parts of your care that is fully in your hands and it’s never too late to start.

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I see it in clinic

Patients who keep moving tend to feel stronger, sleep better, and handle treatment better.

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The science caught up

In 2025, a large randomized trial proved an exercise program can help keep cancer from coming back.

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I live it, too

30 minutes on a steep treadmill: the one part of my day that’s just mine.

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Exercise is a teammate, not a replacement

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Exercise does NOT replace

Surgery and radiation

Chemo, targeted therapy & immunotherapy

Anti-estrogen (endocrine) pills

Follow-up visits and recommended screening

Exercise CAN help you

Get through treatment with more energy

Ease side effects like fatigue and joint pain

Lift your mood, sleep, and strength

Possibly lower the risk of cancer coming back

Your best plan = the treatment your team recommends + the movement you choose

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Exercise makes treatment more livable

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Less fatigue

The top recommended way to fight cancer-related fatigue.

A calmer mind

Less anxiety and depression with regular aerobic exercise.

A stronger body

Better strength, stamina, and everyday physical function.

Better quality of life

Feeling more like yourself, during and after treatment.

Lymphedema-safe

Even weight lifting doesn’t worsen lymphedema when built up slowly.

Finishing treatment

In one trial, strength training helped more women complete their planned chemo.

Sources: ACSM exercise guidelines for cancer survivors (2019) · START trial, J Clin Oncol 2007 · PAL trial, N Engl J Med 2009 & JAMA 2010

Move for Life · PinkSync 2026

[~2 min] Here's what exercise does during and after treatment — and this part of the evidence is rock-solid, from hundreds of randomized trials. Fatigue: exercise is the number-one recommended strategy for cancer-related fatigue. It sounds backwards — when you're exhausted, the last thing you want is to move — but it works better than rest. Mood: an international expert panel in 2019 found regular aerobic exercise reduces anxiety and depression. Strength and function: you keep the muscle that treatment tries to take away. Quality of life: you feel more like yourself. Lymphedema: we used to tell women never to lift more than five pounds with the affected arm. The PAL trial showed slowly progressive weight lifting is safe. And in the START trial, women who did strength training during chemo were more likely to complete their planned chemotherapy — that matters, because finishing treatment matters.

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The aromatase inhibitor story

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Aromatase inhibitors such as anastrozole, letrozole, exemestane lower estrogen to help keep hormone-sensitive breast cancer from coming back.

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women taking an AI experience joint pain or stiffness

Joint pain is one of the main reasons women stop their AI early and lose protection they need.

Take the AI

Achy, stiff joints

Stop the pill early

What if exercise could break the chain?

A Yale trial tested exactly that.

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HOPE trial: exercise eased AI joint pain

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The study

121 women on an AI with joint pain — most weren’t exercising before

150 minutes a week of aerobic exercise, like brisk walking

Supervised strength training twice a week

For 1 year, compared with usual care

~30%

less worst joint pain

after a year of exercise, compared with usual care

Bonus: less weight and body fat, better fitness

Doable: women made it to 70% of strength sessions

Irwin et al., J Clin Oncol 2015

Take-home: moving more can help you stay on the medicine that keeps cancer away.

Move for Life · PinkSync 2026

[~2 min] The HOPE trial, led by Dr. Melinda Irwin at Yale, enrolled 121 women on an aromatase inhibitor who had joint pain — and most weren't exercising beforehand. Half were randomly assigned to a year of exercise: about 150 minutes a week of aerobic activity like brisk walking, plus supervised strength training twice a week. The other half got usual care. The result: roughly a 30% reduction in their worst joint pain. They also lost weight and body fat and got fitter. And it was realistic — women made it to about 70% of their strength sessions. Here's why I love this study: it connects the dots. Less joint pain means you're more likely to keep taking the pill — and the pill is what protects you. Exercise is helping your treatment do its job. And I've seen this play out in real life…

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Dawn’s story: moving through 5 years �(de-identified)

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Retired educator, 60

HR+ breast cancer

5 years of endocrine therapy: completed

Walked nearly every day

The steady foundation of her routine, day after day.

Lifted weights twice a week

Strength training, two days every week.

Taught water aerobics

At her local rec center — bringing her community along with her.

Year 1

Year 2

Year 3

Year 4

Year 5 · done!

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Movement break!

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60 seconds · standing or seated · do what feels good

Shoulder rolls

Roll back slowly, 5 times

Reach up

Both arms overhead — big stretch

March in place

30 seconds — lift those knees

Deep breath

In for 4… out for 4

Notice how you feel. That little boost? That’s what we’re talking about today.

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Can exercise help keep cancer from coming back?

THE BIG QUESTION

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CHALLENGE: testing exercise like a medicine

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889

people with colon cancer who had just finished chemo

Coin-flip assignment

Group 1 · Health education

A booklet about healthy eating and physical activity

Group 2 · Booklet + a personal exercise coach for 3 years

Coaching every 2 weeks at first, then monthly

Goal: about 45–60 min of brisk walking, 3–4 times a week

Any activity they enjoyed : walking, biking, swimming

Phase 3 randomized trial · 55 centers, mostly in Canada and Australia · New England Journal of Medicine, June 2025

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The result: fewer recurrences, longer lives

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28%

lower risk of cancer coming back, a new cancer, or death

37%

lower risk of death

For every ~14 people in the program, about 1 death was prevented over 8 years.

Courneya et al., N Engl J Med 2025 · median follow-up ~8 years

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What about breast cancer?

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We don’t yet have a finished CHALLENGE-style trial in breast cancer. Here’s how the evidence stacks up:

STEP 1

Observational studies

Following thousands of women for years: the most active women do better, again and again.

STEP 2

Smaller randomized trials

Exercise clearly improves side effects and fitness : with early hints about recurrence.

STEP 3

Large randomized trials

The gold standard. Colon cancer: CHALLENGE proved it. Breast cancer: trials like BWEL are underway.

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Walking linked to fewer breast cancer deaths

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Nurses’ Health Study

~3,000 nurses with stage I–III breast cancer, followed up to 18 years

Walking 3–5 hours a week: about half the risk of dying from breast cancer

Even about an hour a week helped

More than 5 hours added no extra benefit — no marathons required

Holmes et al., JAMA 2005 · observational study · hours estimated from MET-hours at an average walking pace (2–2.9 mph)

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More evidence from breast cancer studies

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NATIONAL CHEMO TRIAL · 1,340 WOMEN

DELCaP (SWOG)

Women with high-risk breast cancer who met activity guidelines before diagnosis and again 2 years later had:

55% lower risk of recurrence and 68% lower risk of death

RANDOMIZED · 242 WOMEN

START trial

Exercise during chemo vs. usual care. Strength training helped more women finish chemo. About 7 years later:

Fewer cancer events: 16% vs. 22%: an early hint!

STUDIES COMBINED · 2023

Global review

More activity after diagnosis was linked to lower risk of dying from breast cancer, leveling off around 5 hours of brisk walking a week.

Up to 38% lower risk of breast cancer death

Important: these show strong links, not yet proof of cause and effect . That’s why randomized trials matter.

Move for Life · PinkSync 2026

[~2 min] Three more pieces of the breast cancer puzzle. DELCaP was part of a national SWOG chemotherapy trial — 1,340 women with high-risk breast cancer. Women who met physical activity guidelines both before diagnosis and two years later had about a 55% lower risk of recurrence and a 68% lower risk of death. The researchers also found some activity was better than none. START was a randomized trial of exercise during chemotherapy. Strength training helped more women complete their chemo, and about seven years later the exercise groups had fewer recurrence events — 16% versus 22%. It was too small to prove anything, but it's an encouraging hint. And a 2023 global review that pooled the observational studies found more activity after diagnosis was linked to up to a 38% lower risk of dying from breast cancer, with the benefit leveling off around 5 hours of brisk walking a week. Again — these are strong, consistent links rather than proof. Which brings us to what's next.

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What’s next: proof for breast cancer

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3,180 WOMEN · STAGE II–III

The BWEL trial

Phone-based health coaching for healthier eating and more activity, aiming for weight loss

2026: better physical function and quality of life, lasting 2 years

Still to come: does it lower the risk of recurrence?

MY STUDY · NOW ENROLLING AT HUNTSMAN

ENERGIZE

Exercise program for people receiving Enhertu (T‑DXd) for Metastatic Breast Cancer

Done at home, with remote support from an exercise physiologist

Ask me after the talk if you’d like to learn more

Clinical trials are how today’s questions become tomorrow’s answers — ask your team what’s available.

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Your exercise prescription

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Mon

Walk 30 min

Tue

Walk + strength

Wed

Walk 30 min

Thu

Walk + strength

Fri

Rest

Sat

Bike, swim, or dance

Sun

Rest & stretch

Aerobic

Build to 150 minutes a week — like 30 minutes, 5 days. Brisk walking, biking, swimming, and dancing all count.

Strength

2 days a week. Work the major muscle groups, 8–12 reps, start light and add slowly.

The talk test

Moderate effort means you can talk, but you can’t sing. Any movement counts. start where you are.

Based on ACSM exercise guidelines for cancer survivors (2019) and U.S. physical activity guidelines — adjust with your care team.

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Myths I hear in clinic

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MYTH

“Rest is best during treatment.”

FACT

Regular movement is one of the best-proven ways to fight treatment fatigue.

MYTH

“Lifting weights will cause lymphedema.”

FACT

In the PAL trial, slowly progressive weight lifting didn’t raise lymphedema risk — and women who had it had fewer flare-ups.

MYTH

“I’d have to train like an athlete.”

FACT

Walking 3–5 hours a week was linked to the biggest benefit. More than 5 didn’t add more.

MYTH

“It’s too late for me.”

FACT

The HOPE trial enrolled women who weren’t exercising — and their joint pain still improved.

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Start smart, stay safe

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Check in with your team first

Especially with bone metastases, neuropathy, low blood counts, heart issues, or lymphedema.

Start low, go slow

Build up gradually — aches and strains are more likely when you ramp up too fast.

Track your progress

A step counter or smartwatch makes progress visible — and motivating.

Bring a buddy

A friend, a class, or a coach keeps you accountable. Community is medicine, too.

Where to find support

Huntsman Wellness & Integrative Health Center

Free group fitness classes (in person and virtual), plus the POWER program: personalized plans with certified cancer exercise specialists

Cancer rehabilitation & physical therapy

Ask your oncology team for a referral, wherever you get care

Livestrong at the YMCA

Free or low-cost programs for survivors at many YMCAs

Move for Life · PinkSync 2026

[~1.5 min] A few ground rules for doing this safely. First, check in with your team — especially if you have cancer in the bones, neuropathy, low blood counts, heart or lung issues, or lymphedema. Exercise is still usually possible; it just may need to be tailored. Start low and go slow. Even in CHALLENGE, aches and strains were more common in the exercise group — so build gradually. Track it — a step counter or watch makes progress visible. And bring a buddy. Community — like this one — is medicine, too. For support: at Huntsman, our Wellness & Integrative Health Center offers free group fitness classes and the POWER program, with personalized plans from certified cancer exercise specialists. Wherever you get care, you can ask for a cancer rehabilitation or physical therapy referral, and many YMCAs offer Livestrong programs for survivors.

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Your challenge: start with 10

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Begin with a 10-minute walk — then build, week by week.

Write down your WHY

To keep up with the grandkids? To feel strong again? Put it where you’ll see it every day.

WEEK 1

10 min

3 days

WEEK 2

15 min

4 days

WEEK 3

20 min

5 days + 1 strength day

WEEK 4

30 min

5 days + 2 strength days = 150 min a week!

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Every step counts

THANK YOU, PINKSYNC

You are an essential member of your own treatment team.

Questions?

Roma Bhatia, MD, MPH · Huntsman Cancer Institute

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Sources

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1. Courneya KS, et al. Structured exercise after adjuvant chemotherapy for colon cancer (CHALLENGE). N Engl J Med. 2025.

2. Irwin ML, et al. Randomized exercise trial of aromatase inhibitor–induced arthralgia in breast cancer survivors (HOPE). J Clin Oncol. 2015;33:1104-11.

3. Holmes MD, et al. Physical activity and survival after breast cancer diagnosis (Nurses’ Health Study). JAMA. 2005;293:2479-86.

4. Cannioto RA, et al. Physical activity before, during, and after chemotherapy for high-risk breast cancer: relationships with survival (DELCaP / SWOG S0221). J Natl Cancer Inst.

5. Courneya KS, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy (START). J Clin Oncol. 2007;25:4396-404.

6. Courneya KS, et al. Effects of exercise during adjuvant chemotherapy on breast cancer outcomes (START follow-up). Med Sci Sports Exerc. 2014;46:1744-51.

7. Cariolou M, et al. Postdiagnosis recreational physical activity and breast cancer prognosis (CUP Global). Int J Cancer. 2023;152(4).

8. Schmitz KH, et al. Weight lifting in women with breast-cancer–related lymphedema (PAL). N Engl J Med. 2009;361:664-73; and Weight lifting for women at risk for lymphedema. JAMA. 2010.

9. Campbell KL, et al. Exercise guidelines for cancer survivors: consensus statement from an international roundtable (ACSM). Med Sci Sports Exerc. 2019.

10. Ligibel JA, et al. Effect of a weight loss intervention on quality of life and symptoms: results from the BWEL trial (Alliance A011401). ASCO Annual Meeting, 2026.

11. Huntsman Cancer Institute, Wellness & Integrative Health Center: fitness programs (healthcare.utah.edu).

Move for Life · PinkSync 2026