Effects of Individualized High‐Intensity Online Concurrent Exercise Guided by Autonomic Modulation on the Mental Health and Quality of Life of Breast Cancer Survivors

Background Exercise has been shown to improve mental well‐being and health‐related quality of life (HRQoL) in breast cancer survivors. However, there is no evidence on the effects of online interventions tailored using heart rate variability (HRV). Aims This study analyzed the effects of online high‐intensity interval and strength training, guided daily by autonomic modulation, compared to pre‐planned moderate to high‐intensity concurrent training and control, on HRQoL, pain, fatigue, anxiety, depression, life satisfaction, self‐esteem, and fear of movement in breast cancer survivors. Methods A 16‐week randomized controlled trial was conducted with 54 participants assigned to HRV‐guided exercise, pre‐planned exercise, or usual care. Participants trained aerobic and strength three times per week under real‐time online supervision. Intensity was adjusted based on HRV for the HRV‐guided group. HRQoL, anxiety, depression, life satisfaction, self‐esteem and fear of movement were assessed pre‐ and post‐intervention. Results Significant time‐by‐group interactions were found for HRQoL functional domains (physical p = 0.004, role p = 0.005, emotional p = 0.013, social p = 0.001) and symptoms (fatigue p < 0.001, pain p < 0.001, dyspnea p = 0.004, insomnia p = 0.012, constipation p = 0.014), as well as depression ( p < 0.001), anxiety ( p = 0.002), life satisfaction ( p = 0.003), self‐esteem ( p = 0.024), and fear of movement ( p = 0.015). HRV‐guided exercise led to greater improvements, while the control group worsened. Moreover, the exploratory analysis suggested a higher degree of interconnected changes in the HRV‐guided group, and that dyspnea and fatigue might be the variables most strongly connected with anxiety, depression, and functioning‐related variables. Conclusion Individualized online concurrent exercise, especially autonomic modulation‐guided, improves HRQoL and mental health in breast cancer survivors, representing a promising personalized rehabilitation strategy.