New Insights into the Role of Exercise in Inhibiting mTOR Signaling in Triple-Negative Breast Cancer

Table 1

Aerobic (cardiorespiratory endurance) exercise recommendations.

Intensity ()	Frequency ()	Time () (duration)	Type () (mode) (examples)	Volume () (quantity)	Progression () (rate of)	Specific notes
Light: 30–39% VO2R/HRR; 57–63% HRmax; 9–11 RPE.	At least 5 d wk^−1.	30 to 60 min each session (i.e., at least 150 min wk^−1).	Continuous and rhythmic exercises that involve major muscle groups (walking, cycling, slow dancing, jogging, running, rowing, stepping, fast dancing, etc.).	≥500–1,000 MET min wk^−1.	Increase gradually any of the FITT components as tolerated by the patient (gradual progression is required to minimize the risks of muscular soreness, injury, undue fatigue, and the long-term risk of overtraining). Initiate increasing exercise duration (as tolerated): an example for healthy people is adding 5–10 min every 1–2 wk over the first 4–6 wk and adjusting upward over the next 4–8 months to meet the recommended FITT components, but slower progression may be needed for BCS.	If tolerated without adverse effects of symptoms or side effects, moderate to vigorous intensity and 3–5 d wk^−1 frequency are recommended, but lower (light) intensities and frequencies are still beneficial when the current physical activity level is low. Avoid prescribing and monitoring intensity using %HRR (using %HRmax or RPE is recommended in BCS). Be aware of fracture risk, because bone is a common site of metastases in breast cancer: BCS with metastatic disease to the bone will require modification of their exercise program (e.g., reduced impact, intensity, and volume) given the increased risk of bone fragility and fractures.
Moderate: 40–59% VO2R/HRR; 64–75% HRmax; 12-13 RPE.	At least 5 d wk^−1.	30 to 60 min each session (i.e., at least 150 min wk^−1).
Vigorous: 60–89% VO2R/HRR; 76–95% HRmax; 14–17 RPE.	At least 3 d wk^−1.	20 to 60 min each session (i.e., at least 75 min wk^−1).

Modified from [160]. VO2R: oxygen uptake reserve, calculated as the difference between maximal oxygen uptake and resting oxygen uptake; HRR: heart rate reserve, calculated as the difference between maximal heart rate and resting heart rate; HR_max: maximal heart rate; RPE: rate of perceived exertion on the 6–20 scale; MET-min: metabolic equivalents (MET) of energy expenditure for a physical activity performed for a given number of minutes (min), calculated as MET × min; FITT: frequency, intensity, time, and type of exercise.