Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study

Eva M Zopf; Gustav Joernaker; Dorothea Clauss; Mark Trevaskis; Anouk E Hiensch; Martina E Schmidt; Evelyn M Monninkhof; Philipp Zimmer; Jon Belloso; Elisa Heyrman; Rodrigo Fernandez Gonzalo; Joachim Wiskemann; Jana Müller; Kate A Bolam; Maciej Gorecki; Renske Altena; Christine Muttiah; Elsken van der Wall; Neil K Aaronson; Elzbieta Senkus; Ander Urruticoechea; Martijn M Stuiver; Karen Steindorf; Wilhelm Bloch; Yvonne Wengström; Anne M May; Helene Rundqvist

doi:10.1186/s13058-026-02235-6

Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study

Eva M Zopf
, Gustav Joernaker
, Dorothea Clauss
, Mark Trevaskis
, Anouk E Hiensch
, Martina E Schmidt
, Evelyn M Monninkhof
, Philipp Zimmer
, Jon Belloso
, Elisa Heyrman
, Rodrigo Fernandez Gonzalo
, Joachim Wiskemann
, Jana Müller
, Kate A Bolam
, Maciej Gorecki
, Renske Altena
, Christine Muttiah
, Elsken van der Wall
, Neil K Aaronson
, Elzbieta Senkus

Ander Urruticoechea, Martijn M Stuiver, Karen Steindorf, Wilhelm Bloch, Yvonne Wengström, Anne M May, Helene Rundqvist

Research output: Contribution to journal › Article › Academic › peer-review

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Abstract

Background: Low skeletal muscle mass and strength are common in patients with metastatic breast cancer (mBC) and have been associated with treatment toxicities and poor prognosis. The PREFERABLE-EFFECT study (NCT04120298) investigated exercise effects on body composition, muscle strength, and functional performance (secondary outcomes) in patients with mBC. Methods: Patients with mBC (n = 357) were randomized to a 9-month supervised aerobic, resistance and balance exercise program (EX) or control. Body composition (subset n = 66), lower body strength (subset n = 126), handgrip strength and functional performance were assessed at baseline, 3 and 6 months. Changes between groups were compared using linear mixed models for repeated measures. Results: EX significantly increased whole body lean mass at 3 months (between-group difference = 0.79 kg, 95%CI [0.14; 1.44], effect size = 0.14), appendicular skeletal muscle mass at 3 months (0.60 kg, [0.22; 0.97], ES = 0.19) and 6 months (0.48kg, [0.09; 0.87], ES = 0.15), and lower body strength at 3 months (18.32 kg, [7.58; 29.06], ES = 0.44) and 6 months (34.22 kg, [23.0; 45.45], ES = 0.83) compared to control. EX also improved functional performance, including balance, compared to control. Conclusions: The results support the promotion of supervised exercise for patients with mBC, with beneficial effects on skeletal muscle mass, muscle strength and physical performance. Trial registration: The PREFERABLE-EFFECT study was registered on ClinicalTrials.gov on October 9, 2019 (NCT04120298).

Original language	English
Article number	98
Journal	Breast Cancer Research
Volume	28
Issue number	1
Early online date	13 Apr 2026
DOIs	https://doi.org/10.1186/s13058-026-02235-6
Publication status	Published - Apr 2026

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Zopf, E. M., Joernaker, G., Clauss, D., Trevaskis, M., Hiensch, A. E., Schmidt, M. E., Monninkhof, E. M., Zimmer, P., Belloso, J., Heyrman, E., Fernandez Gonzalo, R., Wiskemann, J., Müller, J., Bolam, K. A., Gorecki, M., Altena, R., Muttiah, C., van der Wall, E., Aaronson, N. K., ... Rundqvist, H. (2026). Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study. Breast Cancer Research, 28(1), Article 98. https://doi.org/10.1186/s13058-026-02235-6

@article{a67f9a27078842e3a18a7f1e5ef13255,

title = "Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study",

abstract = "Background: Low skeletal muscle mass and strength are common in patients with metastatic breast cancer (mBC) and have been associated with treatment toxicities and poor prognosis. The PREFERABLE-EFFECT study (NCT04120298) investigated exercise effects on body composition, muscle strength, and functional performance (secondary outcomes) in patients with mBC. Methods: Patients with mBC (n = 357) were randomized to a 9-month supervised aerobic, resistance and balance exercise program (EX) or control. Body composition (subset n = 66), lower body strength (subset n = 126), handgrip strength and functional performance were assessed at baseline, 3 and 6 months. Changes between groups were compared using linear mixed models for repeated measures. Results: EX significantly increased whole body lean mass at 3 months (between-group difference = 0.79 kg, 95\%CI [0.14; 1.44], effect size = 0.14), appendicular skeletal muscle mass at 3 months (0.60 kg, [0.22; 0.97], ES = 0.19) and 6 months (0.48kg, [0.09; 0.87], ES = 0.15), and lower body strength at 3 months (18.32 kg, [7.58; 29.06], ES = 0.44) and 6 months (34.22 kg, [23.0; 45.45], ES = 0.83) compared to control. EX also improved functional performance, including balance, compared to control. Conclusions: The results support the promotion of supervised exercise for patients with mBC, with beneficial effects on skeletal muscle mass, muscle strength and physical performance. Trial registration: The PREFERABLE-EFFECT study was registered on ClinicalTrials.gov on October 9, 2019 (NCT04120298).",

author = "Zopf, \{Eva M\} and Gustav Joernaker and Dorothea Clauss and Mark Trevaskis and Hiensch, \{Anouk E\} and Schmidt, \{Martina E\} and Monninkhof, \{Evelyn M\} and Philipp Zimmer and Jon Belloso and Elisa Heyrman and \{Fernandez Gonzalo\}, Rodrigo and Joachim Wiskemann and Jana M{\"u}ller and Bolam, \{Kate A\} and Maciej Gorecki and Renske Altena and Christine Muttiah and \{van der Wall\}, Elsken and Aaronson, \{Neil K\} and Elzbieta Senkus and Ander Urruticoechea and Stuiver, \{Martijn M\} and Karen Steindorf and Wilhelm Bloch and Yvonne Wengstr{\"o}m and May, \{Anne M\} and Helene Rundqvist",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2026.",

year = "2026",

month = apr,

doi = "10.1186/s13058-026-02235-6",

language = "English",

volume = "28",

journal = "Breast Cancer Research",

issn = "1465-5411",

publisher = "BioMed Central Ltd.",

number = "1",

}

Zopf, EM, Joernaker, G, Clauss, D, Trevaskis, M, Hiensch, AE, Schmidt, ME, Monninkhof, EM, Zimmer, P, Belloso, J, Heyrman, E, Fernandez Gonzalo, R, Wiskemann, J, Müller, J, Bolam, KA, Gorecki, M, Altena, R, Muttiah, C, van der Wall, E, Aaronson, NK, Senkus, E, Urruticoechea, A, Stuiver, MM, Steindorf, K, Bloch, W, Wengström, Y, May, AM & Rundqvist, H 2026, 'Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study', Breast Cancer Research, vol. 28, no. 1, 98. https://doi.org/10.1186/s13058-026-02235-6

TY - JOUR

T1 - Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer

T2 - the randomized controlled PREFERABLE-EFFECT study

AU - Zopf, Eva M

AU - Joernaker, Gustav

AU - Clauss, Dorothea

AU - Trevaskis, Mark

AU - Hiensch, Anouk E

AU - Schmidt, Martina E

AU - Monninkhof, Evelyn M

AU - Zimmer, Philipp

AU - Belloso, Jon

AU - Heyrman, Elisa

AU - Fernandez Gonzalo, Rodrigo

AU - Wiskemann, Joachim

AU - Müller, Jana

AU - Bolam, Kate A

AU - Gorecki, Maciej

AU - Altena, Renske

AU - Muttiah, Christine

AU - van der Wall, Elsken

AU - Aaronson, Neil K

AU - Senkus, Elzbieta

AU - Urruticoechea, Ander

AU - Stuiver, Martijn M

AU - Steindorf, Karen

AU - Bloch, Wilhelm

AU - Wengström, Yvonne

AU - May, Anne M

AU - Rundqvist, Helene

PY - 2026/4

Y1 - 2026/4

N2 - Background: Low skeletal muscle mass and strength are common in patients with metastatic breast cancer (mBC) and have been associated with treatment toxicities and poor prognosis. The PREFERABLE-EFFECT study (NCT04120298) investigated exercise effects on body composition, muscle strength, and functional performance (secondary outcomes) in patients with mBC. Methods: Patients with mBC (n = 357) were randomized to a 9-month supervised aerobic, resistance and balance exercise program (EX) or control. Body composition (subset n = 66), lower body strength (subset n = 126), handgrip strength and functional performance were assessed at baseline, 3 and 6 months. Changes between groups were compared using linear mixed models for repeated measures. Results: EX significantly increased whole body lean mass at 3 months (between-group difference = 0.79 kg, 95%CI [0.14; 1.44], effect size = 0.14), appendicular skeletal muscle mass at 3 months (0.60 kg, [0.22; 0.97], ES = 0.19) and 6 months (0.48kg, [0.09; 0.87], ES = 0.15), and lower body strength at 3 months (18.32 kg, [7.58; 29.06], ES = 0.44) and 6 months (34.22 kg, [23.0; 45.45], ES = 0.83) compared to control. EX also improved functional performance, including balance, compared to control. Conclusions: The results support the promotion of supervised exercise for patients with mBC, with beneficial effects on skeletal muscle mass, muscle strength and physical performance. Trial registration: The PREFERABLE-EFFECT study was registered on ClinicalTrials.gov on October 9, 2019 (NCT04120298).

AB - Background: Low skeletal muscle mass and strength are common in patients with metastatic breast cancer (mBC) and have been associated with treatment toxicities and poor prognosis. The PREFERABLE-EFFECT study (NCT04120298) investigated exercise effects on body composition, muscle strength, and functional performance (secondary outcomes) in patients with mBC. Methods: Patients with mBC (n = 357) were randomized to a 9-month supervised aerobic, resistance and balance exercise program (EX) or control. Body composition (subset n = 66), lower body strength (subset n = 126), handgrip strength and functional performance were assessed at baseline, 3 and 6 months. Changes between groups were compared using linear mixed models for repeated measures. Results: EX significantly increased whole body lean mass at 3 months (between-group difference = 0.79 kg, 95%CI [0.14; 1.44], effect size = 0.14), appendicular skeletal muscle mass at 3 months (0.60 kg, [0.22; 0.97], ES = 0.19) and 6 months (0.48kg, [0.09; 0.87], ES = 0.15), and lower body strength at 3 months (18.32 kg, [7.58; 29.06], ES = 0.44) and 6 months (34.22 kg, [23.0; 45.45], ES = 0.83) compared to control. EX also improved functional performance, including balance, compared to control. Conclusions: The results support the promotion of supervised exercise for patients with mBC, with beneficial effects on skeletal muscle mass, muscle strength and physical performance. Trial registration: The PREFERABLE-EFFECT study was registered on ClinicalTrials.gov on October 9, 2019 (NCT04120298).

U2 - 10.1186/s13058-026-02235-6

DO - 10.1186/s13058-026-02235-6

M3 - Article

C2 - 41975453

SN - 1465-5411

VL - 28

JO - Breast Cancer Research

JF - Breast Cancer Research

IS - 1

M1 - 98

ER -

Exercise effects on lean body mass, muscle strength and functional performance in patients with metastatic breast cancer: the randomized controlled PREFERABLE-EFFECT study

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