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A Prospective Study of Cardiorespiratory Fitness and Breast Cancer Mortality


Medicine & Science in Sports & Exercise: April 2009 - Volume 41 - Issue 4 - p 742-748
doi: 10.1249/MSS.0b013e31818edac7
Basic Sciences

Purpose: Physical activity may protect against breast cancer. Few prospective studies have evaluated breast cancer mortality in relation to cardiorespiratory fitness (CRF), an objective marker of physiologic response to physical activity habits.

Methods: We examined the association between CRF and risk of death from breast cancer in the Aerobics Center Longitudinal Study. Women (N = 14,811), aged 20 to 83 yr with no prior breast cancer history, received a preventive medical examination at the Cooper Clinic in Dallas, Texas, between 1970 and 2001. Mortality surveillance was completed through December 31, 2003. CRF was quantified as maximal treadmill exercise test duration and was categorized for analysis as low (lowest 20% of exercise duration), moderate (middle 40%), and high (upper 40%). At baseline, all participants were able to complete the exercise test to at least 85% of their age-predicted maximal heart rate.

Results: A total of 68 breast cancer deaths occurred during follow-up (mean = 16 yr). Age-adjusted breast cancer mortality rates per 10,000 woman-years were 4.4, 3.2, and 1.8 for low, moderate, and high CRF groups, respectively (trend P = 0.008). After further controlling for body mass index, smoking, drinking, chronic conditions, abnormal exercise ECG responses, family history of breast cancer, oral contraceptive use, and estrogen use, hazard ratios (95% CI) for breast cancer mortality across incremental CRF categories were 1.00 (referent), 0.67 (0.35-1.26), and 0.45 (0.22-0.95) (trend P = 0.04).

Conclusions: These results indicate that CRF is associated with a reduced risk of dying from breast cancer in women.

1Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC; 2Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC; 3Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC; 4Center for Health Services and Policy Research, University of South Carolina, Columbia, SC; and 5Department of Kinesiology, Health Promotion, and Recreation, University of North Texas, Denton, TX

Address for correspondence: Xuemei Sui, M.D., 921 Assembly Street, Columbia, SC 29208; E-mail:

Submitted for publication June 2008.

Accepted for publication September 2008.

©2009The American College of Sports Medicine