Exercise May Improve Biological Aging and Cognition After Breast Cancer

Surviving breast cancer is a tremendous feat, but can that sometimes only be the start? For instance, studies have found that 1 in 3 breast cancer survivors may experience cognitive problems, and women treated for breast cancer have increased biological aging compared to women who remain free of breast cancer. With that, two studies, both stemming from the same randomized clinical trial, examined whether exercise can be used as an effective tool in improving cognitive health and biological aging in breast cancer survivors.

Breast cancer survival and memory

With studies finding that breast cancer survivors may struggle with cognitive problems, a randomized clinical trial was designed to test whether exercise may improve cognition in breast cancer survivors.

The study featured 253 breast cancer survivors who had already completed active treatment and revealed low levels of physical activity and cognitive issues. Researchers randomly assigned participants to one of two groups for a 12-month intervention. The first group received a remotely delivered exercise program that used fitness trackers to monitor activity. They also received individualized coaching to reach 150 minutes of moderate-to-vigorous physical activity per week. The second group was assigned to a wellness program that included regular contact with a health coach but no exercise coaching.

The findings, published in the Journal of the National Cancer Institute, found that the exercise group showed greater improvements in attention at six and 12 months, and greater improvement in memory at six months,

“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,” says Sheri J. Hartman, Ph.D., lead study author, professor, UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science and member of Moores Cancer Center. “It is also encouraging that participants achieved this benefit with a modest, attainable increase in physical activity.” 

That said, the study found that while both groups showed meaningful improvements on all cognitive measures, processing speed, self-reported cognition, and executive function did not differ significantly.

Breast cancer survival and biological aging

The second study acknowledged that cancer and subsequent treatments accelerate biological aging and examined whether a 12-month exercise intervention could improve markers of epigenetic aging.

Led by Daniel Carlin, Ph.D. from the University of California San Diego in La Jolla, the study analyzed DNA from 124 participants who provided blood samples at baseline and at 6- and 12-month follow-ups. The team then used epigenetic clocks to measure each participant’s epigenetic (biological) age.

Findings published in the Journal of the National Cancer Institute showed that epigenetic aging was slower in the exercise group than in the health and wellness group. They also noted significant correlations between changes in biological aging and cognition, with greater cognitive decline associated with faster epigenetic aging, suggesting exercise may be an effective tool for improving cognitive health in those with accelerated biological ages.

Exercise as a post-cancer intervention

“What is particularly striking about these findings is that the effects of exercise were measurable both at the molecular level and in cognitive performance.” – Paula Desplats, Ph.D.., co-senior author

Desplats further adds that the changes noted by the study highlight that even a modest increase in physical activity can work to influence biological aging and keep the brain healthy,

“This gives us an important clue about how exercise may help protect brain function after cancer treatment.”

That said, both sets of researchers stress that larger studies are needed to confirm the findings and better understand how exercise may help cancer survivors’ cognitive health and biological aging.

“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.”

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In March 2024, Princess of Wales Kate Middleton publicly revealed her cancer diagnosis following abdominal surgery earlier that year. Then, in early 2025, she shared that the cancer was in remission, and more recently, she shared that the experience had led to her adopting a new approach to alcohol.

References

Carlin, D., Ott, O., Sears, D. D., Ahles, T., Desplats, P., & Hartman, S. J. (2026). Exercise slows biological aging in breast cancer survivors: secondary analysis of a randomized trial. Journal of the National Cancer Institute, djag296. Advance online publication. https://doi.org/10.1093/jnci/djag296

Hartman, S. J., Shao, L. Y., Zablocki, R. W., Natarajan, L., Ahles, T., Palmer, B. W., Sears, D. D., Tam, R. M., Mac, V., Dillon, L., Yan, C., & Parker, B. A. (2026). Effectiveness of an exercise intervention on cognition in breast cancer survivors: A randomized controlled trial. JNCI: Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djag295

Kresovich JK, O’Brien KM, Xu Z, Weinberg CR, Sandler DP, Taylor JA. (2023). Changes in methylation-based aging in women who do and do not develop breast cancer. Journal of the National Cancer Institute. https://doi.org/10.1093/jnci/djad11

Whittaker, A. L., & George, R. P. (2022). Prevalence of cognitive impairment following chemotherapy treatment for breast cancer: A systematic review and meta-analysis. Scientific Reports, 12, 2135. https://doi.org/10.1038/s41598-022-05682-1

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