Difficulties with cognition are extremely common among breast cancer survivors treated with chemotherapy
and can significantly impact quality of life, daily functioning, and ability to return to work. Unfortunately, there is
limited evidence to guide management of cancer survivors' cognition. One promising intervention is increasing
physical activity as it has been effective in improving cognition in non-cancer populations; however, few
intervention trials have included cancer survivors. Breast cancer survivors often decrease physical activity
following treatment and have very low levels of physical activity overall. Cognitive impairments are associated
with greater anxiety and depression, while increasing physical activity has been shown to decrease anxiety
and depression, suggesting that psychological variables could mediate the association between physical
activity and cognitive impairment. Biological mechanisms may also link physical activity with cognition
including synaptic plasticity and cellular aging. This project builds upon our previous work indicating that
increased physical activity can improve objectively-measured processing speed and self-reported cognition
among breast cancer survivors. The current proposal will examine whether a physical activity intervention
improves cognition among 250 post-treatment breast cancer survivors (Stages I-III, <5 years post-treatment,
treated with chemotherapy) who are reporting cognitive difficulties. We propose to conduct a 6-month
intervention with a 12-month follow-up, 2-arm RCT comparing a physical activity intervention using individual
counseling and Fitbit activity trackers (Exercise Arm), with a healthy aging attention-comparison condition
(Healthy Aging Arm) to examine intervention effects on objectively measured processing speed and self-
reported cognition (at 3 and 6 months) and maintenance of the effect at 12 months. The primary aim is to (1)
investigate the impact of the Exercise arm on changes in cognition compared to the healthy Aging arm. The
secondary aims are to (1) investigate the impact of the Exercise arm on maintenance of changes in cognition
compared to the Healthy Aging arm; (2) examine candidate biological mechanisms and psychological
mediators of intervention-related changes in cognition. Additionally, we will explore a dose response
relationship of changes in physical activity with change in processing speed and self-reported cognition and
explore the effects of the Exercise arm compared to the Healthy Aging arm on changes to other cognitive
domains (memory, executive function, and attention) affected by chemotherapy. This study will contribute to
the scientific, public health, and intervention literature by providing new information on the impact of physical
activity for cognitive impairment in breast cancer survivors and help identify vulnerable populations and
intervention targets. Findings from this study will inform guidelines for physical activity dose and intensity to
improve the lives of millions of breast cancer survivors.
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