Random control clinical trial on the effects of aerobic exercise training on erythrocyte levels during radiation treatment for breast cancer
ABSTRACT BACKGROUND.Erythrocyte changes from aerobic exercise training were examined during radiation treatment of breast cancer.METHODS.Twenty sedentary females with breast carcinoma who were ages 35 to 65 years were randomized to aerobic exercise (AE) of walking for 20 to 45 minutes, 3 to 5 times per week, at 50% to 70% of measured maximum heart rates or to placebo stretching (PS) activities 3 to 5 days per week during 7 weeks of radiation treatment. Measures were obtained 1 week before and after the radiation regimen. Serum blood analyses, through complete blood counts, measured red blood cell counts (RBC), hematocrit (HCT), and hemoglobin (HB). Peak aerobic capacity (peak VO2) was measured by exercise testing with oxygen uptake analysis to assess training. A Wilcoxon Mann-Whitney U test examined changes between groups (P ≤ .05 for significance).RESULTS.AE peak VO2 increased by 6.3% (P = .001) and PS decreased by 4.6% (P = .083). RBC increased in AE from 4.10 to 4.21 million cells/μL and declined in PS from 4.30 to 4.19 million cells/μL; the between-group differences were significant (P = .014). HCT increased in AE from 38.0% to 38.8% and declined in PS from 37.40% to 36.50%; the between-group differences were significant (P = .046). HB increased in AE from 12.3 to 12.4 g/dL and declined in PS from 12.25 to 11.77 g/dL; the between-group differences were significant (P = .009).CONCLUSIONS.The results of the current study suggest that moderate intensity aerobic exercise appears to maintain erythrocyte levels during radiation treatment of breast cancer compared with the declines observed in nontraining individuals. These findings suggest a safe, economical method to improve fitness and maintain erythrocytes in women during radiation treatment of breast cancer. Cancer 2006. © 2006 American Cancer Society.
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ABSTRACT: Chemotherapy for lung cancer can have a detrimental effect on white blood cell (WBC) and red blood cell (RBC) counts. Physical exercise may have a role in improving WBCs and RBCs, although few studies have examined cancer patients receiving adjuvant therapies. The purpose of this pilot trial was to examine the effects of an exercise intervention utilizing resistance bands on WBCs and RBCs in lung cancer patients receiving curative intent chemotherapy. A sample of lung cancer patients scheduled for curative intent chemotherapy was randomly assigned to the exercise intervention (EX) condition or usual care (UC) condition. The EX condition participated in a three times weekly exercise program using resistance bands for the duration of chemotherapy. A total of 14 lung cancer patients completed the trial. EX condition participants completed 79% of planned exercise sessions. The EX condition was able to maintain WBCs over the course of the intervention compared to declines in the UC condition (p = .008; d = 1.68). There were no significant differences in change scores in RBCs. Exercise with resistance bands may help attenuate declines in WBCs in lung cancer patients receiving curative intent chemotherapy. Larger trials are warranted to validate these findings. Ultimately these findings could be informative for the development of supportive care strategies for lung cancer patients receiving chemotherapy. Clinical Trials Registration #: NCT01130714.SpringerPlus 01/2014; 3:15.
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ABSTRACT: Cancer treatment is associated with decreased hemoglobin (Hb) concentration and aerobic fitness (VO2 max), which may contribute to cancer-related fatigue (CRF) and decreased quality of life (QoL). Endurance exercise may attenuate CRF and improve QoL, but the mechanisms have not been thoroughly investigated. Objectives. To (a) determine the feasibility of conducting an exercise intervention among women receiving treatment for breast cancer; (b) examine the effects of exercise on Hb and VO2 max and determine their association with changes in CRF and QoL; and (c) investigate changes in selected inflammatory markers. Methods. Fourteen women receiving chemotherapy for Stages I-II breast cancer were randomly assigned to exercise (n = 7) or usual care (n = 7). Women in the exercise group performed supervised, individualized treadmill exercise 2-3 times/week for the duration of chemotherapy (9-12 weeks). Data were collected 4 times over 15-16 weeks. Results. Recruitment rate was 45.7%. Sixteen women consented and 14 completed the trial, for a retention rate of 87.5%. Adherence to exercise protocol was 95-97%, and completion of data collection was 87.5-100%. Exercise was well tolerated. VO2 max was maintained at prechemotherapy levels in exercisers but declined in the usual-care group (p < .05). Hb decreased (p < .001) in all participants as they progressed through chemotherapy. Exercise did not have significant effects on CRF or QoL. Changes in inflammatory markers favored the exercise group. Conclusions. Exercise during chemotherapy may protect against chemotherapy-induced decline in VO2 max but not Hb concentration. © The Author(s) 2014.Biological Research for Nursing 01/2015; 17(1):40-8. · 1.34 Impact Factor
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ABSTRACT: The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent. However, how to promote exercise behaviour in sedentary cancer cohorts is not as well understood. A large majority of people living with or recovering from cancer do not meet exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important. To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? What adverse effects are attributed to different exercise interventions? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with increased exercise behaviour? What behaviour change techniques are most often associated with increased exercise behaviour? We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2012), MEDLINE, EMBASE, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro from inception to August 2012. We also searched the grey literature, wrote to leading experts in the field, wrote to charities and searched reference lists of other recent systematic reviews. We included only randomised controlled trials (RCTs) that compared an exercise intervention with a usual care approach in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. Two review authors working independently (LB and KH) screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that cannot be safely excluded without assessment of the full text (e.g. when no abstract is available). All eligible papers were formally abstracted by at least two members of the review author team working independently (LB and KH) and using the data collection form. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we synthesised studies as a narrative. Fourteen trials were included in this review, involving a total of 648 participants. Only studies involving breast, prostate or colorectal cancer were identified as eligible. Just six trials incorporated a target level of exercise that could meet current recommendations. Only three trials were identified that attempted to objectively validate independent exercise behaviour with accelerometers or heart rate monitoring. Adherence to exercise interventions, which is crucial for understanding treatment dose, is often poorly reported. It is important to note that the fundamental metrics of exercise behaviour (i.e. frequency, intensity and duration, repetitions, sets and intensity of resistance training), although easy to devise and report, are seldom included in published clinical trials.None of the included trials reported that 75% or greater adherence (the stated primary outcome for this review) of the intervention group met current aerobic exercise recommendations at any given follow-up. Just two trials reported six weeks of resistance exercise behaviour that would meet the guideline recommendations. However, three trials reported adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendation of 150 minutes per week. All three incorporated both supervised and independent exercise components as part of the intervention, and none placed restrictions on the control group in terms of exercise behaviour. These three trials shared programme set goals and the following behaviour change techniques: generalisation of a target behaviour; prompting of self-monitoring of behaviour; and prompting of practise. Despite the uncertainty surrounding adherence in many of the included trials, interventions caused improvements in aerobic exercise tolerance at 8 to 12 weeks (from 7 studies, SMD 0.73, 95% confidence interval (CI) 0.51 to 0.95) in intervention participants compared with controls. At six months, aerobic exercise tolerance was also improved (from 5 studies, SMD 0.70, 95% CI 0.45 to 0.94), but it should be noted that four of the five trials used in this analysis had a high risk of bias, hence caution is warranted in interpretation of results. Attrition over the course of these interventions is typically low (median 6%). Interventions to promote exercise in cancer survivors who report better levels of adherence share some common behaviour change techniques. These involve setting programme goals, prompting practise and self-monitoring and encouraging participants to attempt to generalise behaviours learned in supervised exercise environments to other, non-supervised contexts. However, expecting most sedentary survivors to achieve current guideline recommendations of at least 150 minutes per week of aerobic exercise is likely to be unrealistic. As with all well-designed exercise programmes in any context, prescriptions should be designed around individual capabilities, and frequency, duration and intensity or sets, repetitions, intensity or resistance training should be generated on this basis.Cochrane database of systematic reviews (Online) 09/2013; 9:CD010192. · 5.94 Impact Factor
Random Control Clinical Trial on the Effects
of Aerobic Exercise Training on Erythrocyte Levels
During Radiation Treatment for Breast Cancer
Jacqueline S. Drouin, PT, PhD1
Timothy J. Young, DPT1
Jerome Beeler, DPT1
Kevin Byrne, DPT1
Thomas J. Birk, PhD, MPT2
William M. Hryniuk, MD3
Lynn E. Hryniuk, RN, MSN3
1Department of Physical Therapy, School of
Health Professions and Studies, University of
Michigan–Flint, Flint, Michigan.
2Department of Health Care Sciences, Wayne
State University, Detroit, Michigan.
3CAREpath Inc., Cancer Advocacy Coalition of
Canada, Toronto, Ontario, Canada.
BACKGROUND. Erythrocyte changes from aerobic exercise training were examined
during radiation treatment of breast cancer.
METHODS. Twenty sedentary females with breast carcinoma who were ages 35 to
65 years were randomized to aerobic exercise (AE) of walking for 20 to
45 minutes, 3 to 5 times per week, at 50% to 70% of measured maximum heart
rates or to placebo stretching (PS) activities 3 to 5 days per week during 7 weeks
of radiation treatment. Measures were obtained 1 week before and after the
radiation regimen. Serum blood analyses, through complete blood counts, mea-
sured red blood cell counts (RBC), hematocrit (HCT), and hemoglobin (HB). Peak
aerobic capacity (peak VO2) was measured by exercise testing with oxygen uptake
analysis to assess training. A Wilcoxon Mann-Whitney U test examined changes
between groups (P ?.05 for significance).
RESULTS. AE peak VO2increased by 6.3% (P ¼ .001) and PS decreased by 4.6%
(P ¼ .083). RBC increased in AE from 4.10 to 4.21 million cells/mL and declined
in PS from 4.30 to 4.19 million cells/mL; the between-group differences were
significant (P ¼.014). HCT increased in AE from 38.0% to 38.8% and declined in
PS from 37.40% to 36.50%; the between-group differences were significant (P
¼ .046). HB increased in AE from 12.3 to 12.4 g/dL and declined in PS from 12.25
to 11.77 g/dL; the between-group differences were significant (P ¼.009).
CONCLUSIONS. The results of the current study suggest that moderate intensity
aerobic exercise appears to maintain erythrocyte levels during radiation treat-
ment of breast cancer compared with the declines observed in nontraining indi-
viduals. These findings suggest a safe, economical method to improve fitness and
maintain erythrocytes in women during radiation treatment of breast cancer.
Cancer 2006;107:2490–5. ? 2006 American Cancer Society.
KEYWORDS: breast cancer, radiation, exercise, aerobic exercise, erythrocyte, he-
moglobin, hematocrit, red blood cell count.
several months after treatment.1,2Declines in erythrocyte levels may
be associated with radiation treatment complications that include
fatigue, anemia, depression, and diminished physical function.3–5
Reduced erythrocyte levels have also been associated with increased
local and regional failure and decreased survival rates in some can-
cers.6,7There is limited evidence that suggests that aerobic exercise
training may improve erythrocyte levels, particularly hemoglobin, in
individuals during the rehabilitation phase after chemotherapy treat-
ments; however, to our knowledge, the effect of endurance training
omen undergoing radiation treatment for breast cancer com-
monly experience declines in erythrocyte levels that may last
Platform presentation at the American Physical
Therapy Association Combined Sections Meeting,
New Orleans, Louisiana, February 23?27, 2005.
Supported by the Elsa U. Pardee Foundation
(Midland, MI) and the Max and Victoria Dreyfus
Foundation (White Plains, NY).
Address for reprints: Jacqueline S. Drouin, PT,
PhD, Physical Therapy Department, School of
Health Professions and Studies, University of Michi-
gan?Flint, 303 East Kearsley, Flint, MI 48502-
1950; Fax: (810) 766-6668; E-mail: jsdrou@umflint.
Received June 20, 2006; revision received
August 11, 2006; accepted August 17, 2006.
ª2006 American Cancer Society
Published online 9 October 2006 in Wiley InterScience (www.interscience.wiley.com).
on erythrocyte levels during radiation treatment for
women with breast cancer has not been previously
The purpose of this study was to examine whether
moderate-intensity aerobic exercise would have a posi-
tive effect on hemoglobin (HB), hematocrit (HCT),
and red blood cell counts (RBC) compared with those
of nontraining females also undergoing radiation treat-
ment of breast cancer. This study also examined whether
there was a correlation between changes in physical
fitness, using peak aerobic capacity (peak VO2) mea-
sures, and the final erythrocyte measures. This investi-
gation is a secondary analysis of data from a training
study that previously examined the effects of aerobic
exercise training on peak aerobic capacity, fatigue, and
psychological factors in females undergoing radiation
treatment of breast cancer.9
MATERIALS AND METHODS
After receipt of human investigation committee ap-
provals, subjects were recruited through medical and
radiation oncologists at a major urban cancer center.
Criteria for inclusion were: female gender, age be-
tween 20 and 65 years, histologically established
breast cancer (AJCC Stage 0 [Tis, N0, M0] to Stage
IIIC [T0-4, N3-M0]), and medical clearance through
the participant’s oncologist and a routine multiple
uptake gated scan (MUGA) of heart function, and
through stress test results with 12-lead electrocardio-
graphic analysis. Exclusion criteria were erythropoie-
pulmonary diseases, orthopedic conditions that would
limit exercise participation, refusal for randomization,
or participation in aerobic exercise training within 3
months before beginning the study.
Individuals who met the inclusion criteria and
agreed to participate in the study were given verbal
and written information regarding the investigation
and provided signed informed consent, and were
then randomly assigned by a random number table
to either the aerobic exercise training protocol (AE)
or a placebo stretching (PS) protocol. Subjects were
also informed that participation in the study was
voluntary, all data would be confidential, and that
they were free to leave the study at any time of their
own choosing without incurring changes in their
usual cancer treatment or care.
This study was a secondary analysis of data from a
prospective randomized control clinical trial using a
pretest, intervention, posttest design. The experimen-
tal intervention was radiation and AE and the control
condition was radiation and PS activities.
Tests and Measures
Testing was performed 1 week before and 1 week af-
ter a 7-week radiation and activity regimen. Partici-
pants were instructed to come to the testing sessions
wearing exercise clothing and comfortable shoes and
to abstain from food, caffeine, tobacco, or alcohol for
at least 4 hours before testing; because testing was
performed primarily in the morning, most of the par-
ticipants fasted overnight. Tests associated with this
investigation were serum blood analysis though dif-
ferential blood counts and a symptom-limited graded
exercise treadmill test, using oxygen uptake analysis,
to assess AE training effects.
Differential blood counts through serum blood draws
were used to measure RBC, HCT, and HB. Normal
values used for women were 4.2 to 5.4 million cells/mL
for RBC, 36.1% to 44.3% for HCT, and 12.1 to 15.1 g/dL
for HB.10Serum blood draws were taken from the ante-
cubital fossa on the side of the nontreated breast by
certified technicians with the participant in a seated
position. Blood draws were performed primarily in the
morning and approximately 90 minutes before the exer-
cise evaluations, with participants in a postprandial
state as described earlier.
Physical fitness assessment
Physical fitness was assessed by measuring peak VO2
during a symptom-limited graded exercise test using
the modified Bruce treadmill protocol. Peak VO2 is
the measure of an individual’s highest achieved oxy-
gen consumption during the exercise test in mL/kg/
min. The individual’s peak VO2was measured using
continuous oxygen uptake analysis through open cir-
cuit spirometry and indirect calorimetry of expired
gases using an automated metabolic cart (Oxycon-
Alpha; Jaeger, Hoechberg, Germany). Peak VO2 is a
clinically accepted measure for an individual’s maxi-
mal achieved aerobic capacity; this measure can eas-
ily be converted into metabolic equivalents (METs)
to determine an individual’s functional performance
capabilities and to develop safe and effective indivi-
dualized exercise prescriptions.11Exercise testing was
performed according to the guidelines of the Ameri-
can College of Sports Medicine with onsite physician
supervision, and screening and safety factors speci-
fic for exercise in individuals with cancer were fol-
Aerobic Exercise Effects on Erythrocytes/Drouin et al.2491
All participants in this study underwent breast sur-
gery and then received external beam radiation treat-
ments 5 days per week for 7 weeks. The affected
breast and regional lymph nodes were treated with a
4500 to 5000 centigray (cGy) dose in 200-cGy frac-
tions with a boost of 1000 to 1600 cGy delivered to
the primary tumor bed.
The results of the initial symptom-limited graded exer-
cise test were used to develop individualized exercise
prescriptions for each participant in the AE group. The
AE protocol consisted of walking for 20 to 45 minutes
3 to 5 days per week during 7 weeks of radiation, at an
intensity of 50% to 70% of each individual’s measured
maximum heart rate. Participants performed self-moni-
tored walking on home treadmills or in their neighbor-
hoods using heart rate monitors to record exercise
duration and intensity. Self-monitored exercise has
been determined to be safe and effective for women
undergoing radiation or chemotherapy for breast can-
cer and has been successfully utilized in other studies
during cancer treatments.13,14Both the AE and the PS
participants kept training journals to assist in recording
and reporting training compliance and were also con-
tacted weekly to monitor exercise adherence.
Women in the PS group performed a flexibility proto-
col that included stretching activities for the cervical
and thoracic areas as well as the upper and lower
extremities. Participants in the PS group were provided
with 1 training session by a licensed physical therapist
and given written guidelines on proper stretching
techniques. Stretching protocols were performed 3 to
5 days per week during the 7-week radiation regimen.
The principle investigator communicated with each
participant in both the training and nontraining
groups weekly either by telephone or in person. The
purpose of the weekly communications was to pro-
mote compliance, monitor training, answer ques-
tions, and oversee safety issues or concerns about
the activities. All participants were instructed to con-
tact their physician in the event that they developed
any unusual signs or symptoms related to the radia-
tion treatment or to their activity.
Because the sample size was small and data did not
meet parametric assumptions, statistical analyses
were conducted using nonparametric tests. The Wil-
coxon-Mann-Whitney U (WMWU) test evaluated
between-group differences, the Wilcoxon signed rank
test (WSRT) evaluated differences between pretest
and posttest measures in each group, and correla-
tions between final erythrocyte measures and changes
in peak VO2were determined by Spearman rho anal-
yses. Probability for all tests was set at ?.05 and sta-
tistical analyses were performed using the Statistical
Package for Social Sciences software program (ver-
sion 10.1; SPSS Inc., Chicago, IL).
Thirty-eight women were referred by their oncolo-
gists to take part in this study; 23 individuals agreed
to participate, whereas 15 declined. Reasons for
declining participation included lack of time, lack of
transportation, child care issues, refusal to be rando-
mized, or currently exercising. Twenty-one subjects
completed the study: 13 in the AE group and 8 in the
PS group. Two participants in the PS group did not
return for the final testing session due to conflicts
with work schedules and data from 1 subject in the
PS group was also eliminated from the final analyses
due to marked irregularities in her pretest and post-
test physical measures from moderate to severe fluid
retention during the initial test session. Participant
demographic information appears in Table 1. Partici-
pants in the AE group exercised an average of 3.68
6 1.4 days per week during the 7-week radiation reg-
imen. Because testing occurred approximately 1 week
Age, y6 SD
49.4 6 7.0
51.9 6 10.0
Surgery and chemotherapy
Stage and classifications
Stage 0: Tis, N0, M0
Stage I: T1, N0, M0
Stage IIA: T0-2, N0-1, M0
Stage IIB: T2-3, N0-1, M0
Stage IIIA: T-0-2, N1-2, M0
Stage IIIB: T4, N0-2, M0
2492 CANCER November 15, 2006 / Volume 107 / Number 10
before and 1 week after radiation, the average train-
ing duration was between 8 and 9 weeks. Individuals
in the PS group performed their activity 4.16 6 1.1
days per week during this same time. Evidence to
support an aerobic exercise training effect was the
significant improvement in peak VO2 by a median
measure of 6.3% (P <.001) in the AE group, whereas
the PS group experienced a nonsignificant decline of
4.6% (P ¼.083) during the intervention time.
WMWU analyses of pretest scores found no signifi-
cant differences between the AE and the PS groups
on all baseline measures for RBC (P ¼ .164), HB (P
¼ .385), and HCT (P ¼ .443). After the intervention,
RBC values in the AE group increased nonsignifi-
cantly by 2.68% from 4.10 to 4.21 million cells/mL (P
¼ .147), whereas RBC values in the PS group
declined significantly by 2.55% from 4.30 to 4.19 mil-
lion cells/mL (P ¼ .014). Differences in changes
between groups for RBC were statistically significant
HB measures in the AE group also increased
nonsignificantly after training by 0.81% from 12.30 to
12.40 g/dL (P ¼ .067), whereas PS group HB meas-
ures decreased significantly by 3.91% from 12.25 to
11.77 g/dL (P ¼.009). Differences between groups for
changes in HB values were significant (P ¼ .009).
HCT measures in the AE group increased nonsignifi-
cantly after training by 2.10% from 38.00 to 38.80%
(P ¼ .232), whereas HCT measures in the PS group
declined significantly by 2.46% from 37.35 to 36.45%
(P ¼.045). Differences in changes between groups for
HCT were statistically significant (P ¼ .046). Table 2
and Figures 1 to 3 show a summary of these results.
Spearman’s rho analysis of correlations found
that changes in peak VO2measures were significant
and positively correlated to the final measures for
RBC (P ¼ .050), HB (P ¼ .013), and HCT (P ¼ .015).
Table 3 shows the correlation analyses.
A common problem after radiation treatment for
breast cancer is a decline in erythrocyte levels that
may be associated with negative treatment sequela
including fatigue, anemia, depression, loss of physi-
cal function, increased risk for local and regional fail-
ure, and decreased survival.1–3,5,14The current study
found that women who performed moderate inten-
sity aerobic exercise during radiation treatment of
breast cancer were able to prevent the declines in
erythrocyte levels that were experienced by their
nontraining peers. This study also found significant
positive correlations between changes in peak aero-
bic capacity and final erythrocyte measures, lending
support to the relation between erythrocyte measures
and improving physical fitness levels during this
Three prior studies were found that examined
the effects of aerobic exercise training on erythrocyte
measures in individuals with cancer. Dimeo et al.8
Median, Interquartile Range, Percent Change, and P
Variable MedianIQR 25th–75th% D
Pre/PostBetween AE and PS
2.68%P ¼ .147P ¼ .014*
?2.55%P ¼ .014*
0.81%P ¼ .067P ¼ .004*
?3.91%P ¼ .009*
2.10%P ¼ .232P ¼ .046*
?2.46%P ¼ .045*
IQR indicates interquartile range; % D, percent change; Pre/Post, pretest/posttest; AE, aerobic exer-
cise; PS, placebo-stretching group; RBC, red blood cell count in million cells/microliter; HB, hemo-
globin in g/dL; HCT, hematocrit %.
* Significant change (P ? .05).
yBelow normal clinical values.
FIGURE 1. Red blood cells, measured in million cells/mL, increased non-
significantly in the aerobic exercise group by 2.68%, whereas values in the
nontraining group declined significantly by 2.55%. PRE/POST indicates pret-
Aerobic Exercise Effects on Erythrocytes/Drouin et al.2493
examined the effects of 6 weeks of treadmill walking
after the completion of high-dose chemotherapy and
autologous peripheral stem cell transplantation. After
training, maximum walking speed and hemoglobin
increased significantly in the training subjects, whereas
nontraining subjects’ values remained statistically un-
Two subsequent training studies on this topic
did not find significant differences in erythrocyte
levels between training and nontraining subjects. In
the first study, which was performed during high-
dose chemotherapy, training intensity (50% of maxi-
mum heart rates) and training duration (13–15 days)
may not have been sufficient to cause changes in
erythrocyte measures.15In the second study, which
was performed during either conventional or high-
dose chemotherapy with stem cell rescue, although
participants walked daily on treadmills for 30 6 10
days, physical performance
unchanged, suggesting that the training intensity or
duration may not have been sufficient for training
effects to occur.16
The major limitation of the current study was
the small sample size. Because effect sizes for
changes in the AE group for RBC, HCT, and HB were
small to moderate (.20, .13, and .38 respectively), this
study required 45 to 50 subjects in each condition
for adequate statistical power to determine whether
improvements in the training group were signifi-
cant.17Therefore, although the AE group experienced
modest increases in their erythrocyte levels, subse-
quent studies using larger samples would be of bene-
fit to support this phenomenon. A second limitation
was that although the activity condition was con-
trolled, there was no control of dietary intake during
the course of this study, which may also have an
impact erythrocyte measures.
The results of the current study suggest that moder-
ate-intensity aerobic exercise performed during ra-
diation treatment may preserve or maintain erythrocyte
levels in females being treated for breast cancer com-
pared with declines observed in nontraining peers.
This study also found significant positive correlations
between changes in peak aerobic capacity and final
erythrocyte measures, suggesting an association be-
tween fitness and erythrocyte values during radiation
treatment of breast cancer. The study results support
the potential for moderate aerobic exercise to be a
safe, effective, and economical method for improving
physical fitness and maintaining erythrocyte levels in
females undergoing radiation treatment of breast
cancer. Future studies would be of benefit to deter-
mine whether improvements in erythrocyte levels
from aerobic exercise training have a positive effect
of physical function, other health conditions, and
FIGURE 2. Hemoglobin, measured in g/dL, increased nonsignificantly in
the aerobic exercise group by 0.81% and decreased significantly by 3.91%
in the nontraining group to levels that were below the normal clinical values
of 12.1 to 15.1 g/dL. PRE/POST indicates pretest/posttest.
FIGURE 3. Hematocrit percentage increased nonsignificantly in the aerobic
exercise group by 2.10% and declined significantly by 2.46% in the non-
training group. PRE/POST indicates pretest/posttest.
Correlations between Peak VO2Changes and Erythrocytes
Red blood cellsHemoglobin Hematocrit
VO2indicates aerobic capacity.
* Significant (P ? .05).
2494 CANCER November 15, 2006 / Volume 107 / Number 10
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