Walking behavior and resilience associated with total physical activity among breast cancer survivors after primary treatment: a cross-sectional study

Clinical guidelines recommend regular physical activity for breast cancer survivors; however, activity maintenance remains low following primary treatment. While physical activity guidelines are well established, evidence regarding real-world physical activity maintenance and its associated factors among Japanese breast cancer survivors after primary treatment remains. This study aimed to identify factors associated with total physical activity among Japanese breast cancer survivors after primary treatment. A cross-sectional web-based survey was conducted exclusively among breast cancer survivors in Japan ( n = 176). Participant eligibility was assessed based on self-report on a commercial web survey platform in accordance with CHERRIES guidelines. Total physical activity (TPA) was evaluated using the validated Japanese version of the International Physical Activity Questionnaire Short Form (IPAQ-SF). Independent variables included routine walking behavior, psychological resilience assessed via the Breast Cancer Survivor Resilience Scale (BCRS), psychological distress (Distress Thermometer), self-care behaviors, and clinical profiles. Generalized linear models (GLM) with a gamma distribution and log link were used to identify factors associated with TPA in an exploratory framework. The mean age was 53.3 ± 7.7 years, and median TPA was 777 MET-min/week (interquartile range: 239.3–1778.6). Walking behavior and resilience emerged as key factors associated with higher TPA. Participants not engaging in walking had significantly lower TPA (Exp(B) = 0.53, p = 0.009), while resilience was positively associated with TPA (Exp(B) = 1.07, p = 0.001). Treatment-related factors were not significantly associated with TPA. In this cross-sectional study, walking behavior and psychological resilience were positively associated with total physical activity among Japanese breast cancer survivors after primary treatment. Daily walking may represent a potential clinical hypothesis for an accessible, low-threshold starting point to minimize sedentary time, while resilience serves as an essential psychological asset. Supportive care programs should integrate resilience training and walking promotion to foster sustained physical activity.