‘Prevention is the foundation. Treating the illness itself is too late,’ says chief physician Markéta Hovorková

After treatment ends, women want to return to their former lives. But who teaches them how to start exercising when the body is exhausted, and where?

October is Pink October, the month when breast cancer is talked about all over the world. In the Czech Republic, around 8,000 women hear this diagnosis every year. The good news is that most of them recover. What comes after treatment, however, is talked about far less.

That is exactly the subject of prim. MUDr. Markéta Hovorková, Ph.D., chief physician of Ensana Léčebné lázně Mariánské Lázně, a.s., and lead of the OnkoFit-Spa study. (“Prim.” is the Czech title of a senior consultant heading a department.) The interview was recorded for the Ensana spa podcast (in Czech), and the questions were put by Josef Pavlovic. You can watch the whole interview as a video; the transcript with editorial notes follows below.

Note: the podcast is in Czech. The full transcript of the conversation follows below in English.

What the study found, and why its conclusions became part of the regular spa stay, is also summarised in the article Post-Oncology Spa Programme in Mariánské Lázně.

What is OnkoFit-Spa?

Dr Hovorková, what is OnkoFit-Spa?

It was a clinical study that ran from 2022 to 2024 in cooperation with the Institute of Spa Care and Balneology in Karlovy Vary and the First Faculty of Medicine of Charles University in Prague. As the name suggests, it involved patients who had completed treatment for a malignant breast tumour. The aim was to demonstrate that improved fitness and a change in eating habits would improve the prognosis and quality of life of these women. It took place during a spa treatment stay with us, at Ensana Léčebné lázně Mariánské Lázně.

But allow me to start from a little further back. Breast carcinoma is the most commonly diagnosed malignant disease in women, and in the Czech Republic the second most common. Its insidiousness lies not only in its high incidence but also in its biological nature. It is dangerous above all because it can return even after a long time, when the patient is considered cured. This very ability to reactivate makes it a high-risk disease that requires long-term monitoring and consistent follow-up care.

How many women in this country fall ill with it every year?

Doctors detect approximately 8,000 new cases every year. Mortality is falling slightly. We can thank, above all, awareness of prevention, that is, breast self-examination and mammography screening, but also better surgical methods and better chemotherapy and radiotherapy, the treatment that follows removal of the tumour. All of this contributes to the fact that today almost 90% of women with this diagnosis survive.

Does that mean that once treatment has been successful, the battle is won?

Not quite. Treatment of breast cancer is not only about removing the tumour; aggressive anti-cancer treatment follows. Women carry with them marked physical and psychological after-effects: chronic pain, lymphoedema, persistent fatigue, hair loss. And, very importantly, the fear of the disease returning predominates. All of this significantly lowers their quality of life.

Two prognostic factors that can be influenced

What can women do about it themselves?

There are two prognostic factors that we can influence: physical activity and body weight, to which body composition is related. It is generally known that regular physical activity helps reduce cardiovascular risk and prevent obesity. A number of studies and meta-analyses now show that regular, structured physical activity has a positive effect on physical and mental health in cancer patients too, and can improve their prognosis and quality of life (Meneses-Echávez et al., 2015, BMC Cancer; Cano-Uceda et al., 2025, J Funct Morphol Kinesiol).

The second factor is body composition. In many women, weight gain occurs during anti-cancer treatment or after it ends. The reasons are malnutrition, that is, poor eating, for example when the taste buds are damaged and the digestive tract changes during chemotherapy, then physical inactivity and, last but not least, hormonal imbalance during the menopause. The result is that up to 20% of women gain more than 10 kilograms within two years.

The more fatty tissue we have in the body, the higher the production of oestrogen, and so the risk of the disease returning increases. That is why we try to make sure that women exercise regularly after cancer treatment has finished and that they do not gain fatty tissue.

prim. MUDr. Markéta Hovorková, Ph.D.

Why is such weight gain dangerous?

With overweight and obesity, the volume of peripheral fatty tissue grows. During the menopause, oestrogen production shifts from the ovaries to peripheral tissues, most often precisely to fatty tissue. And most breast carcinomas are hormone-dependent, specifically on oestrogen; this applies to tumours with positive hormone receptors, which make up the majority of cases. For these, the rule is: the more fatty tissue we have in the body, the higher the production of oestrogen, and so the risk of recurrence, that is, of the disease returning, increases. That is why we try to make sure that women exercise regularly after cancer treatment has finished and that they do not gain fatty tissue.

Editorial note: The figure “up to 20% of women gain more than 10 kilograms within two years” is the chief physician’s statement from the interview; we do not have a published source with exactly this threshold and time frame. Weight gain after breast cancer treatment is well described in the literature, albeit with differently defined thresholds. According to the review by Vance et al., 2011 (Obesity Reviews), 50 to 96% of women gain weight during treatment, and fat gain together with loss of muscle mass is common. In the Mayo Clinic registry of 4,744 women, roughly one in five gained more than 10% of their body weight within six years (Hurtado et al., 2024, J Endocr Soc, conference abstract).

Who will teach them?

Where do women look for advice on how to go about it after treatment?

After cancer treatment ends, most women of course go on attending oncology centres and outpatient clinics, but there is not enough room there for education. There is no comprehensive programme, and many women do not receive good-quality structured support. Yet after treatment ends, women want to return to their former lives: they want to start exercising, eat properly, and they do not want to gain weight. But who teaches them, and where, how to start exercising when the body is exhausted, and which foods suit them when their digestion has been damaged? So they search the internet, where there is an overwhelming and often chaotic amount of information, and they often turn to various alternative diets and practices that may end up harming them.

And this is where OnkoFit-Spa comes in.

Yes, that is why the OnkoFit-Spa programme came about. It was a three-week intensive educational and treatment programme for cancer patients, followed by six months of telemonitoring of physical activity and eating habits. It was a clinical study in which we wanted to demonstrate that improved fitness and a change in eating habits would improve the prognosis of women after completed treatment for breast cancer.

How the study worked

What exactly did such a study look like?

We selected the women before they arrived at the spa and formed them into groups of four to six. They then began a standard spa treatment stay under indication I/1 with us at Ensana, at Léčebné lázně Mariánské Lázně. After an entry examination by the doctor, they went through a series of measurements:

• anthropometric data, that is, weight, height and BMI,
• measurement on the InBody device, that is, body composition, the ratio of muscle mass to fatty tissue,
• a fitness test, the six-minute walk test, which is a good indicator of functional fitness,
• and they completed questionnaires on the subjective perception of the body and on quality of life. This is hard to measure, yet there are certified international questionnaires that objectify the perception of pain, fatigue or one’s own illness.

A three-week spa stay followed which, besides traditional spa treatments using natural healing resources, individual or group rehabilitation and treatments on modern equipment, also included intensive physical activity indoors and outdoors and repeated nutritional interventions. All of this was under the supervision of experienced physiotherapists, nutrition specialists and other experts.

How did you then establish the results?

We carried out these measurements at the start of the stay, at its end after three weeks, and finally during an educational weekend six months after the end of the spa stay. Throughout the study we monitored the patients with smartwatches and, through logging into the Čas pro zdraví (“Time for Health”) app, we followed their physical activity and eating habits. That is how we obtained long-term data.

What the measurements showed

Did it turn out that increased physical activity led to better health in the clients?

The results were really very positive. Neither during the three-week stay nor in the following six months did the women gain weight; on the contrary, there was a slight loss of fatty tissue, without any loss of muscle mass. We also recorded positive changes in eating, where fat intake fell.

Objectively, we also recorded an improvement in physical fitness, which we assessed using the six-minute walk test. In the questionnaire survey too, the perception of one’s own body, the feeling of illness and overall health improved.

And what we consider particularly important: even after six months, the women maintained their weight and their physical and mental condition at the same level as at the end of the three-week spa stay. This shows that they were able to carry the new habits they had learned during the stay over into everyday life and continued with them after returning home. It is precisely the long-term maintenance of these changes that is a very important result for us.

Editorial note: The results of the OnkoFit-Spa study are internal Ensana observations. More than forty women took part, and as of October 2026 the results have not been published in a peer-reviewed journal. Wider research on spa programmes after breast cancer is summarised in the article Post-Oncology Spa Programme in Mariánské Lázně.

On the basis of the study, you then changed your approach to treating the consequences of cancer for other women too. Did you introduce it into regular operation for all future clients?

Exactly. We were the first in the Czech Republic to include this programme in our standard treatment programmes. Every woman who has completed treatment for breast cancer and who now comes to us at Ensana, at Léčebné lázně Mariánské Lázně, under indication I/1 goes through a treatment stay with the same combination of treatments as the women who took part in the OnkoFit-Spa clinical study.

Just without the follow-up monitoring. But you know it works, because you have verified it.

The six-month follow-up by telemonitoring is no longer part of the stay. However, from the results of the study we have objectively measured data according to which the improvement achieved persisted even after half a year.

The power of sharing

Did anything surprise you during the study? Perhaps a finding you had not expected, or a reaction that caught your attention?

I was surprised by how important a role mutual sharing and support among the patients played. They were connected in a shared WhatsApp group and also went to the individual activities and treatments together. That gave them room to share their experiences, feelings and difficulties and to support one another. It was precisely this sense of belonging, and the chance to speak openly with someone going through a similar experience, that contributed significantly to the results of our study.

I was also surprised that some of the clients who went through the study return to us regularly for week-long stays. They formed a strong bond with one another, they have become friends, and once a year they always meet here for a week.

Prevention is the foundation

What role do spas play in prevention? You mentioned factors that increase the likelihood of developing breast cancer. Can a person learn, on a preventive stay here, how to reduce the risk of one day finding themselves among those 8,000 women?

It is not only about cancer. Diseases of civilisation, that is, illnesses that arise as a result of an unhealthy lifestyle, are on the increase. It is important to realise that prevention is absolutely fundamental. The sooner we turn our attention to our health and risk factors, the greater our chance of preventing disease or catching it in time. So let us not wait for the moment when the illness itself has to be dealt with.

Even during a short stay we can educate and motivate a patient or client: teach them how to start exercising and how to eat properly. The client should be an active participant in spa treatment and should not merely receive treatments passively. They should take an active part in the programme and learn how to look after their health properly. We show them what they can do for themselves, how to go about it and, above all, how to do it correctly.

Thank you very much for all the information.

In closing, I would like to say that we are aware of how important both prevention and the treatment of cancer are. Thank you for the invitation, and I believe that our oncology programme will be of benefit to all the clients who come to us, whether as part of treatment, follow-up care or prevention.

What this means for you

The extended care based on the study is now part of the standard spa stay under indication I/1, not an extra-cost item. The specific combination of treatments, the intensity of exercise and the form of nutritional support are determined by the spa physician at the entry examination, according to your current condition and the discharge report from oncology. The spa physician therefore always decides on inclusion in the treatment plan.

• Post-Oncology Spa Programme in Mariánské Lázně: Comprehensive Recovery After Cancer Treatment
• Indications and contraindications for spa treatment in Mariánské Lázně
• Paying for spa treatment in Mariánské Lázně

Want to know more?

You can watch the whole interview in the video at the start of the article (in Czech) or in the Ensana spa podcast (in Czech), where you will find further episodes. You can come to Ensana Léčebné lázně Mariánské Lázně for a preventive stay or for a spa stay tailored to your particular problem; an overview of stays is available on ensanahotels.com.

Sources

Studies and official documents this article relies on. Our content does not replace medical advice.

1. Interview with prim. MUDr. Markéta Hovorková, Ph.D., chief physician of Ensana Léčebné lázně Mariánské Lázně, a.s. — Ensana spa podcast (in Czech), October 2026 — Primary source of the article. The OnkoFit-Spa results mentioned in the interview are internal Ensana observations; as of October 2026 they have not been published in a peer-reviewed journal.
2. ÚZIS ČR — SVOD, epidemiology of malignant tumours in the Czech Republic, diagnosis C50 (malignant neoplasm of the breast) — Source for the number of newly diagnosed women per year and the trend in mortality quoted by the chief physician in the interview; check current values in the database.
3. Vance VA et al. 2011, Obesity Reviews — review: weight gain in women after breast cancer, prevalence, course and health consequences — 50–96% of women gain weight during treatment, and fat gain together with loss of muscle mass is common; a review of English-language literature.
4. Hurtado MD et al. 2024, J Endocr Soc — Mayo Clinic registry, 4,744 women after breast cancer — Roughly one in five women gained more than 10% of their body weight within six years. A different threshold and time frame from the figure in the interview (more than 10 kg within two years), which it therefore does not support but only places in context. Conference abstract.
5. Meneses-Echávez JF et al. 2015, BMC Cancer — meta-analysis of supervised exercise after breast cancer — Both aerobic and resistance exercise under supervision reduce fatigue; heterogeneity of the studies.
6. Cano-Uceda A et al. 2025, J Funct Morphol Kinesiol — meta-analysis of 26 randomised trials — Supervised exercise improves quality of life after breast and prostate cancer; certainty of evidence is low.
7. Mourgues C et al. 2014, Eur J Oncol Nurs — randomised trial PACThe, 181 women in remission from breast cancer — The spa programme increased the return to work and family activities after 12 months; open-label trial.

Health claims last reviewed:2 October 2026

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