Exercise program supports better attention and slows biological aging in breast cancer survivors
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One in three breast cancer survivors will experience cognitive problems, which can include difficulties with attention, memory, processing speed and other aspects of thinking. Researchers believe these problems can arise from a combination of treatment effects, inflammation, hormonal changes, fatigue and stress. They may persist after treatment and affect everyday activities and quality of life.
In a new study, researchers from the University of California San Diego, including members of the Moores Cancer Center, found that a 12-month exercise intervention was associated with improvements in attention and memory among breast cancer survivors. A companion study suggests exercise may also slow epigenetic aging. The two studies, both stemming from the same randomized clinical trial, were published Sept. 30, 2026, in the Journal of the National Cancer Institute.
Exercise coaching put to the test
The randomized clinical trial was designed to test whether increasing physical activity could improve cognitive health in breast cancer survivors. It included 253 survivors who had completed active treatment and reported both low levels of physical activity and cognitive difficulties.
Participants were randomly assigned to either a remotely delivered exercise program or a health and wellness program that provided regular contact with a health coach but did not include exercise coaching. The exercise group used fitness trackers to monitor activity and received individualized coaching designed to help participants work toward 150 minutes of moderate-to-vigorous physical activity per week.
Attention gains persisted for a year
The exercise group increased its moderate-to-vigorous physical activity more than the health and wellness group. While both groups showed meaningful improvements on all cognitive measures, researchers found no significant differences in the study's two primary outcomes—processing speed and self-reported cognition.
Participants in the exercise group, however, showed greater improvements in attention at six and 12 months. They also showed greater improvement in memory at six months, but the difference between groups was no longer evident at 12 months. There were no significant differences between groups in executive function.
"Attention is central to our everyday activities. It helps us follow conversations, absorb information and complete tasks without making errors, so the sustained improvements we saw in this trial are particularly encouraging," said Sheri Hartman, Ph.D., lead author of the study, professor at the UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and a member of Moores Cancer Center. "It is also encouraging that participants achieved this benefit with a modest, attainable increase in physical activity."
Slower aging in blood markers
The companion study looked at a random subset of 124 participants who provided blood samples at the beginning of the study and at six- and 12-month follow-ups. The researchers used epigenetic clocks to measure their epigenetic age—an estimate of a person's biological age based on DNA methylation patterns. Because these clocks measure biological markers of aging, a person's epigenetic age can differ significantly from their chronological age—their actual years lived.
Using two epigenetic clocks, researchers found that participants in the exercise group had slower rates of epigenetic aging over the 12-month study than those in the health and wellness group. At the start of the study, participants in both groups had epigenetic ages that were, on average, about 8.7 years older than their chronological ages.
By 12 months, the epigenetic aging markers had changed much more slowly in the exercise group than in the health and wellness group. The health and wellness group showed nearly 10 months of epigenetic aging over the 12-month study, compared with about one month in the exercise group.
The researchers also found that across both groups, faster epigenetic aging was associated with less improvement in attention and worse self-reported cognition. The results suggest that exercise may help buffer against some of the cognitive effects associated with accelerated epigenetic aging.
"What is particularly striking about these findings is that the effects of exercise were measurable both at the molecular level and in cognitive performance," said Paula Desplats, professor of neurology at The Ohio State University, adjunct professor of neuroscience at UC San Diego School of Medicine and co-senior author of the companion study. "The changes we saw in markers of epigenetic aging suggest that even a relatively modest increase in physical activity may influence biological processes that help keep the brain healthy. This gives us an important clue about how exercise may help protect brain function after cancer treatment."
Questions about lasting benefits remain
The researchers emphasize that larger studies are needed to confirm these findings, determine whether changes in epigenetic aging directly contribute to cognitive benefits and better understand how exercise may help sustain improvements in attention and memory over time.
"Ultimately, we want to understand not just whether exercise helps, but who is most likely to benefit, how much activity is needed and what changes in the body might explain those benefits," Hartman said. "That knowledge could help us develop more targeted ways to support cognitive health after cancer treatment."
Publication details
Effectiveness of an Exercise Intervention on Cognition in Breast Cancer Survivors: A Randomized Controlled Trial, Journal of the National Cancer Institute (2026). doi.org/10.1093/jnci/djag295
Exercise Slows Biological Aging in Breast Cancer Survivors: Secondary Analysis of a Randomized Trial, Journal of the National Cancer Institute (2026). doi.org/10.1093/jnci/djag296
Journal information: Journal of the National Cancer Institute
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OncologyFitness & Physical activityNeurologyHealthy agingWomen's health Provided by University of California - San Diego Who's behind this story?
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