Abstract / Summary
Abstract Purpose Breast cancer survivors (BCS) may report cognitive complaints despite preserved neuropsychological performance, suggesting increased mental effort during executive tasks. This randomized crossover trial compared acute effects of aerobic training (AT), functional training (FT), and Brain Functional Training (BFT) on executive performance and task-evoked pupillary responses in post-treatment BCS. Methods 16 BCS who had completed primary treatment at least two years before enrollment performed AT, FT, and BFT in randomized order. The trial was registered in ReBEC (RBR-7mf7rrp). Executive performance was assessed with the Stroop Color and Word Test (SCWT) and N-back task with simultaneous pupillary recording. Outcomes were analyzed using mixed models, equivalence tests, GAMM, and integrated curvature. Results Behavioral performance did not differ for SCWT reaction time, accuracy, or Stroop effect (all p ≥ 0.508), or for N-back d′ and reaction time (both p ≥ 0.911). N-back d′ decreased with cognitive load ( p < 0.001). Pupillary trajectories differed for SCWT Δ mm and Δ%, and N-back Δ mm and Δ% (all LRT ≥ 18.849; all p < 0.001). AT showed the greatest pupil diameter change. During the SCWT, BFT showed the lowest integrated curvature in Δ mm, 95.8% lower than AT and 98.8% lower than FT, with practically null curvature in Δ%. Conclusions The three exercise modalities produced comparable executive performance with distinct pupillary dynamics. BFT sustained inhibitory control with the most stable pupillary trajectory, suggesting lower temporal fluctuation in mental effort. Implications for Cancer Survivors BFT may be a promising strategy to reduce the physiological effort required to sustain executive performance in post-treatment BCS.