Dance-Based Exercise for Cancer-Related Fatigue in Breast Cancer Patients

Cancer-related fatigue is one of the most prevalent and burdensome symptoms experienced by patients with breast cancer during systemic anticancer treatment. Unlike ordinary tiredness, cancer-related fatigue may persist despite rest and can negatively affect physical functioning, psychological well-being, daily activities, and quality of life. Exercise has been recognized as an important supportive strategy for the management of cancer-related fatigue; however, adherence to conventional exercise programs during intensive cancer treatment may be challenging.

Dance-based exercise represents a multimodal form of physical activity combining aerobic exercise, coordination, balance, rhythmic movement, and social and cognitive engagement. Its enjoyable and adaptable nature may provide an alternative approach to maintaining physical activity during cancer treatment. Nevertheless, evidence regarding the effects of structured dance-based exercise during neoadjuvant treatment for breast cancer remains limited.

This randomized controlled study will investigate the effects of a structured dance-based exercise intervention in women with breast cancer undergoing neoadjuvant treatment. The study is designed to determine whether incorporating supervised dance-based exercise into the period of neoadjuvant treatment can reduce cancer-related fatigue and support physical and psychosocial functioning compared with standard oncological care alone.

The intervention is structured as a progressive, supervised dance-based exercise program delivered during neoadjuvant treatment. The program combines dance-based aerobic activity with movements targeting coordination, mobility, balance, and muscular function. Exercise intensity and complexity will be individually adapted according to participants' physical condition, exercise tolerance, and treatment-related symptoms. This approach is intended to maintain an appropriate exercise stimulus while allowing flexibility in response to changes in health status during oncological treatment.

In addition to evaluating the clinical and functional effects of the intervention, the study includes an exploratory mechanistic component. Cancer treatment and physical activity may influence systemic metabolism, inflammatory processes, and the intestinal microbial ecosystem. The study will therefore investigate changes in the gut microbiome and selected circulating biological markers and explore their relationships with changes in fatigue, physical fitness, body composition, physical activity, and other clinical and functional characteristics.

The gut microbiome component will characterize microbial composition and diversity using stool samples collected during the study. Blood-based analyses will complement the microbiome assessment by examining selected biological pathways potentially involved in the response to exercise and cancer treatment. Integrating these biological data with functional and patient-reported data may provide insight into mechanisms through which exercise influences health and recovery during neoadjuvant breast cancer treatment.

The longitudinal design will also allow the investigators to examine whether changes observed during the intervention period are maintained during recovery following surgery. By combining a randomized exercise intervention with clinical, functional, behavioral, and biological assessments, the study aims to provide a comprehensive evaluation of dance-based exercise as a supportive strategy during neoadjuvant treatment for breast cancer.

Inclusion criteria

Signed and dated written informed consent. Female patients with histologically confirmed, newly diagnosed, non-metastatic invasive breast cancer.

Age 18-60 years. Body mass index (BMI) <35 kg/m². Indication for and planned initiation of neoadjuvant treatment at the National Cancer Institute in Bratislava, Slovakia, or St. Elizabeth Cancer Institute in Bratislava, Slovakia.

Planned definitive breast surgery following completion of neoadjuvant treatment.

Eastern Cooperative Oncology Group (ECOG) performance status of 0-1. Ability to understand and complete the study questionnaires and comply with study procedures.

Ability and willingness to participate in the supervised dance intervention, as determined by the investigator.

Medical clearance for participation in moderate-intensity physical activity.

Exclusion criteria

Metastatic breast cancer at the time of study enrollment. Recurrent breast cancer or previous treatment for the current breast cancer, except for diagnostic biopsy and other diagnostic procedures.

Previous invasive malignancy within the preceding 5 years, except for adequately treated non-melanoma skin cancer, carcinoma in situ, or another malignancy considered by the investigator unlikely to interfere with study outcomes.

ECOG performance status ≥2. Any uncontrolled cardiovascular, respiratory, neurological, musculoskeletal, or other medical condition that, in the investigator's judgment, would make participation in the dance intervention unsafe.

Clinically significant laboratory abnormalities that, in the investigator's judgment, would make participation in the physical intervention unsafe.

Pregnancy or breastfeeding. Inability or unwillingness to comply with study procedures, the intervention schedule, sample collection, or follow-up assessments.

Any psychological, cognitive, social, or language-related condition that would prevent provision of valid informed consent or reliable completion of study assessments.