“Impact of Exercise on Sexual Health, Body Image, and Therapy-Related Symptoms in Women with Metastatic Breast Cancer: The randomized controlled PREFERABLE-EFFECT trial”
Martina E. Schmidt, Anouk E. Hiensch, Johanna Depenbusch, Evelyn M. Monninkhof, Jon Belloso, Dorothea Clauss, et al. Int. J. Cancer. 2025;157:490–503.
Summary
The multinational PREFERABLE-EFFECT trial addressed a neglected area of supportive cancer care—sexual health, body image, and therapy-related symptoms in women with metastatic breast cancer (mBC). Conducted across six countries and involving 355 women, the study randomized participants to either a 9-month supervised exercise program or usual care. The exercise regimen combined aerobic, resistance, and balance training, progressing from two supervised weekly sessions to one supervised and one self-directed session after six months.
Key Findings
At baseline, the cohort demonstrated profoundly impaired sexual function—over 90% reported little or no sexual activity, 46% of sexually active participants experienced little sexual enjoyment, and over one-third suffered from vaginal dryness. Nearly a quarter of participants reported poor body image, with common complaints including loss of attractiveness and dissatisfaction with breast appearance following surgery. Chemotherapy- and endocrine-related symptoms, such as hot flashes, joint pain, and fatigue, further reduced quality of life.
After six months, the exercise group showed clinically meaningful improvements:
- Sexual functioning improved (between-group difference = +5.6; effect size = 0.28).
- Vaginal symptoms decreased (–7.1; ES = 0.25).
- Chemotherapy side effects lessened, particularly among those on active chemotherapy (–8.2; ES = 0.48).
- Body image improved modestly (ES = 0.14).
The positive effects on sexual function and chemotherapy side effects persisted at nine months, though slightly attenuated. The benefits were most pronounced in younger women (≤50 years) for sexual and vaginal outcomes and in older women (>60 years) for skeletal symptom relief.
Clinical Importance
This trial is among the first large-scale randomized studies to demonstrate that structured exercise directly benefits sexual health and treatment-related symptoms in women with advanced breast cancer—a population often excluded from exercise oncology research. These improvements are clinically relevant because sexual dysfunction, vaginal dryness, and poor body image substantially impair emotional well-being, intimacy, and quality of life, yet remain underrecognized and undertreated in metastatic care.
Exercise appears to mitigate these burdens through physiological and psychosocial pathways: enhanced circulation and muscle tone, improved hormonal balance, and reductions in fatigue, anxiety, and depressive symptoms. Moreover, the intervention was safe, feasible, and adaptable across diverse healthcare systems, underscoring its translational potential.
Clinical Implications
- Integration of exercise oncology into metastatic care should become standard practice. Structured, supervised exercise programs can be safely prescribed even during active systemic therapy.
- Sexual health assessment must be part of holistic symptom management, with exercise serving as a non-pharmacologic, empowering adjunct to conventional care.
- Interdisciplinary collaboration between oncologists, physiotherapists, and psycho-oncology specialists is essential to sustain participation and maximize benefit.
- Future guidelines should formally recognize exercise as a therapeutic modality not only for fatigue and physical function but also for sexual health and body image restoration in women with mBC.
In sum, the PREFERABLE-EFFECT trial expands the therapeutic value of exercise from survival and symptom control to encompass sexual well-being and self-perception, redefining quality of life care in advanced breast cancer.
