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A randomized clinical trial of 253 breast cancer survivors found that a 12-week remotely delivered exercise program was associated with greater improvements in attention and, at six months, memory compared with a health coaching program. A companion study of the same trial suggests exercise also slowed epigenetic aging markers. Both studies were published Sept. 30, 2026 in the Journal of the National Cancer Institute.
Researchers at the University of California San Diego have found that a 12-month exercise program was associated with improved attention and memory among breast cancer survivors, and that exercise may also slow markers of biological aging. The findings, drawn from a randomized clinical trial of 253 survivors, were published on Sept. 30, 2026 in the Journal of the National Cancer Institute.
The trial enrolled 253 breast cancer survivors who had completed active treatment and reported both low physical activity and cognitive difficulties. Participants were randomly assigned to either a remotely delivered exercise program or a health and wellness program that included regular contact with a health coach but no exercise coaching. Those in the exercise group used fitness trackers and received individualized coaching aimed at reaching 150 minutes of moderate-to-vigorous physical activity per week. According to the researchers, the exercise group increased its moderate-to-vigorous activity more than the comparison group.
The results were mixed on the trial’s primary endpoints. Both groups showed meaningful improvements across all cognitive measures, but the researchers found no significant differences between groups in the two primary outcomes: processing speed and self-reported cognition. There were also no significant differences in executive function. However, participants in the exercise group showed greater improvements in attention at six and 12 months, and greater improvement in memory at six months. The memory benefit was not maintained at 12 months, when the exercise group’s results matched those of the health and wellness group.
A companion study examined a random subset of 124 participants who provided blood samples at the start of the study and at six- and 12-month follow-ups. Using two epigenetic clocks — tools that estimate biological age from DNA methylation patterns — researchers found the exercise group aged more slowly at the epigenetic level over the 12 months. At the start, participants in both groups had epigenetic ages averaging about 8.7 years older than their chronological ages. Over the study period, the health and wellness group accumulated nearly 10 months of epigenetic aging markers, compared with about one month in the exercise group. Across both groups, faster epigenetic aging was associated with less improvement in attention and worse self-reported cognition.
Why Survivors’ Attention Gains Matter
Roughly one in three breast cancer survivors experiences cognitive problems, including difficulties with attention, memory and processing speed, according to the researchers. These issues are believed to stem from a combination of treatment effects, inflammation, hormonal changes, fatigue and stress, and can persist after treatment, affecting everyday activities and quality of life.
The sustained attention improvements stand out because attention underpins daily functioning — following conversations, absorbing information and completing tasks without errors. The researchers also highlighted that participants achieved the benefit with a modest, attainable increase in physical activity, suggesting a low-barrier, remotely delivered intervention could be scaled to survivors who report cognitive difficulties after treatment.
The Trial Behind Both Studies
Both studies stem from the same randomized clinical trial, designed to test whether increasing physical activity could improve cognitive health in breast cancer survivors. The trial compared structured, coached exercise against a health coaching control condition, allowing researchers to distinguish the effects of exercise from the effects of regular contact with a health professional. The companion epigenetic study added a molecular dimension, using blood samples from a subset of participants to test whether biological aging markers tracked with the cognitive outcomes.
“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 is particularly encouraging. It is also encouraging that participants achieved this benefit with a modest, attainable increase in physical activity.”
— Sheri Hartman, PhD, lead author and professor at UC San Diego Herbert Wertheim School of Public Health and Human Longevity Science
Findings That Need Confirmation
The trial did not meet its primary endpoints: there were no significant between-group differences in processing speed or self-reported cognition, and the memory advantage seen at six months was no longer present at 12 months. It is also not yet clear whether the observed slowing of epigenetic aging directly caused the cognitive improvements, as the association does not establish causation.
The researchers themselves emphasize that larger studies are needed to confirm the findings, determine whether changes in epigenetic aging contribute to cognitive benefits, and understand how exercise sustains improvements in attention and memory over time.
Next Steps for Exercise Research
The researchers say future work should identify which survivors benefit most, how much activity is needed, and what biological changes explain the benefits — information they say could support more targeted approaches to cognitive health after cancer treatment. No timeline for follow-up studies was announced. For now, the findings add to existing evidence that moderate physical activity is a reasonable option for survivors experiencing cognitive difficulties, though anyone managing health after cancer treatment should discuss exercise plans with their care team.
Key Questions
Did exercise improve all aspects of thinking in the study?
No. Both study groups improved on all cognitive measures, but the exercise group outperformed the comparison group only on attention at six and 12 months and memory at six months. There were no significant differences in the primary outcomes of processing speed and self-reported cognition, or in executive function.
What kind of exercise program did participants follow?
A remotely delivered program combining fitness trackers with individualized coaching, designed to build up to 150 minutes of moderate-to-vigorous physical activity per week — the same general target used in public health activity guidelines.
What is epigenetic aging?
Epigenetic age is an estimate of biological age based on DNA methylation patterns, measured with tools called epigenetic clocks. It can differ from chronological age. In this study, survivors in the exercise group accumulated roughly one month of epigenetic aging markers over 12 months, versus nearly 10 months in the comparison group.
No. The study showed an association between a modest increase in physical activity and improvements in some cognitive measures, and between exercise and slower epigenetic aging. The researchers say larger studies are needed to confirm the findings and determine whether the aging changes directly contribute to cognitive benefits.
How common are cognitive problems after breast cancer treatment?
According to the researchers, about one in three breast cancer survivors experiences cognitive problems, which may include difficulties with attention, memory and processing speed. These can persist after treatment and affect daily activities and quality of life.
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