Background: Physical exercise is widely recommended as a non-pharmacological strategy for breast cancer survivors. However, evidence directly comparing aerobic training performed in aquatic and land-based training in this population is still limited. Aim: To compare the effects of 12 weeks of aquatic and land-based aerobic training, compared with a health education intervention, on cancer-related fatigue, quality of life, and functional capacity in breast cancer survivors. Methods: Sixty women with stage I to III breast cancer were randomized into an aquatic training group (AG, n=21; 54.2±11.7 years), a land-based training group (LG, n=20; 50.7±10.2 years), or a control group (CG, n=19; 58.7±10.6 years). The exercise groups performed two supervised 45-min aerobic sessions per week for 12 weeks plus one weekly health education session, while CG received health education only. Cancer-related fatigue, quality of life, the six-minute walk test, and the chair sit-and-reach test were assessed before and after the intervention. Data were analyzed according to the intention-to-treat principle using GEE, with Bonferroni post hoc tests when significant group-by-time interactions were identified. The trial was registered at ClinicalTrials.gov (NCT05520515). Results: Quality of life, cancer-related fatigue, and performance on the six-minute walk test improved over time, with no differences between groups. A significant interaction between group and time was observed in the chair sit-and-reach test (p=0.004), with improvement only in the aquatic training group (+4.1 cm; p<0.001). Conclusions: After 12 weeks of intervention, quality of life, cancer-related fatigue, and performance on the six-minute walk test improved over time, with no differences between the groups. Only the aquatic training group showed improvement in the chair sit-and-reach test. These results indicate that different care strategies can benefit breast cancer survivors, with a significant effect of the aquatic environment on flexibility.
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