BACKGROUND: Supervised exercise may provide greater functional and quality of life benefits than unsupervised programs after cancer and is recommended for those with or at risk of breast cancer-related lymphedema. These exploratory analyses compared the effect of low- versus high-supervision exercise on the secondary, survivorship outcomes of the SAFE breast cancer trial. METHODS: This randomized study (ANZCTR: ACTRN12616000547448) compared a 12-week, exercise program (target 150 minutes/week, moderate-intensity) supported by either five (LOW) or 20 (HIGH) supervised sessions. Inclusion criteria included: stage ll+ breast cancer within five years, >= one comorbidity and/or treatment-related adverse effect and insufficiently active. Outcomes included lymphedema (self-report and bioimpedance spectroscopy), arm symptoms, upper-extremity function (PROMIS Bank v1.2-Upper- Extremity), fatigue, pain, pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, and satisfaction with social roles (PROMIS-43 Profile v1.0). Chi-square tests evaluated between-group symptom changes. Generalized estimating equations assessed time, group, and timexgroup effects under an intention-to-treat, two-sided framework. RESULTS: Sixty women (mean age 50 years) were randomized to LOW (n = 30) versus HIGH (n = 30). At follow-up, both groups showed similar lymphedema prevalence, comparable rates of maintained or improved arm symptoms, and within-group improvements (p < 0.005) in fatigue, physical function, sleep, anxiety, depression, and satisfaction with social roles and activities. Potential for superior benefit in HIGH versus LOW was observed for self-reported range of movement, upper-extremity function, and pain interference and intensity (p < 0.005). CONCLUSION: Findings indicate that breast cancer survivors with or at risk of lymphedema can benefit from exercise, even when supervision is limited.

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