Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Multicenter Randomized Controlled Trial

Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada.
Journal of Clinical Oncology (Impact Factor: 18.43). 10/2007; 25(28):4396-404. DOI: 10.1200/JCO.2006.08.2024
Source: PubMed


Breast cancer chemotherapy may cause unfavorable changes in physical functioning, body composition, psychosocial functioning, and quality of life (QOL). We evaluated the relative merits of aerobic and resistance exercise in blunting these effects.
We conducted a multicenter randomized controlled trial in Canada between 2003 and 2005 that randomly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care (n = 82), supervised resistance exercise (n = 82), or supervised aerobic exercise (n = 78) for the duration of their chemotherapy (median, 17 weeks; 95% CI, 9 to 24 weeks). Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale. Secondary end points were fatigue, psychosocial functioning, physical fitness, body composition, chemotherapy completion rate, and lymphedema.
The follow-up assessment rate for our primary end point was 92.1%, and adherence to the supervised exercise was 70.2%. Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem (P = .015), aerobic fitness (P = .006), and percent body fat (adjusted P = .076). Resistance exercise was superior to usual care for improving self-esteem (P = .018), muscular strength (P < .001), lean body mass (P = .015), and chemotherapy completion rate (P = .033). Changes in cancer-specific QOL, fatigue, depression, and anxiety favored the exercise groups but did not reach statistical significance. Exercise did not cause lymphedema or adverse events.
Neither aerobic nor resistance exercise significantly improved cancer-specific QOL in breast cancer patients receiving chemotherapy, but they did improve self-esteem, physical fitness, body composition, and chemotherapy completion rate without causing lymphedema or significant adverse events.

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Available from: Caroline Proulx, Oct 08, 2015
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    • "Small feasibility studies have demonstrated that the combination of exercise with a diet intervention could be more effective in reducing weight in breast cancer survivors [106] [107]. Exercise training during chemotherapy or radiation treatment for breast cancer at minimum can prevent the peak VO 2 decline occurring in usual care controls [71], or improve peak VO 2 [70] [72] [91] [108] [109]. Exercise training following completion of breast cancer treatment improves peak VO 2 [106] [110] [111]. "
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    ABSTRACT: Thanks to increasingly effective treatment, breast cancer mortality rates have significantly declined over the past few decades. Following the increase in life expectancy of women diagnosed with breast cancer, it has been recognized that these women are at an elevated risk for cardiovascular disease due in part to the cardiotoxic side effects of treatment. This paper reviews evidence for the role of exercise in prevention of cardiovascular toxicity associated with chemotherapy used in breast cancer, and in modifying cardiovascular risk factors in breast cancer survivors. There is growing evidence indicating that the primary mechanism for this protective effect appears to be improved antioxidant capacity in the heart and vasculature and subsequent reduction of treatment-related oxidative stress in these structures. Further clinical research is needed to determine whether exercise is a feasible and effective nonpharmacological treatment to reduce cardiovascular morbidity and mortality in breast cancer survivors, to identify the cancer therapies for which it is effective, and to determine the optimal exercise dose. Safe and noninvasive measures that are sensitive to changes in cardiovascular function are required to answer these questions in patient populations. Cardiac strain, endothelial function, and cardiac biomarkers are suggested outcome measures for clinical research in this field.
    Journal of Oncology 09/2015; 2015(6). DOI:10.1155/2015/917606
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    • "Exercise intervention is increasingly being promoted in cancer patients, as numerous trials have proven safe, feasible and efficient in improving functional capacity, fitness, lean mass and strength, as well as psychosocial parameters [7], [18], [19]. Most studies have been performed in patients with breast and prostate cancer, yet studies in patient groups receiving cisplatin-based therapy are emerging [20], [21], [21]–[23]. "
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    ABSTRACT: Loss of muscle mass related to anti-cancer therapy is a major concern in cancer patients, being associated with important clinical endpoints including survival, treatment toxicity and patient-related outcomes. We investigated effects of voluntary exercise during cisplatin treatment on body weight, food intake as well as muscle mass, strength and signalling. Mice were treated weekly with 4 mg/kg cisplatin or saline for 6 weeks, and randomized to voluntary wheel running or not. Cisplatin treatment induced loss of body weight (29.8%, P<0.001), lean body mass (20.6%, P = 0.001), as well as anorexia, impaired muscle strength (22.5% decrease, P<0.001) and decreased glucose tolerance. In addition, cisplatin impaired Akt-signalling, induced genes related to protein degradation and inflammation, and reduced muscle glycogen content. Voluntary wheel running during treatment attenuated body weight loss by 50% (P<0.001), maintained lean body mass (P<0.001) and muscle strength (P<0.001), reversed anorexia and impairments in Akt and protein degradation signalling. Cisplatin-induced muscular inflammation was not prevented by voluntary wheel running, nor was glucose tolerance improved. Exercise training may preserve muscle mass in cancer patients receiving cisplatin treatment, potentially improving physical capacity, quality of life and overall survival.
    PLoS ONE 09/2014; 9(9):e109030. DOI:10.1371/journal.pone.0109030 · 3.23 Impact Factor
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    • "A limited number of studies have been conducted in clinical populations with either primary anxiety or anxiety related to another condition. Randomized clinical trials in patients with fibromyalgia (Bircan et al., 2008) and patients with breast cancer undergoing chemotherapy (Courneya et al., 2007a,b) have revealed small but non-significant anxiolytic effects of resistance training. Significant anxiolytic effects were observed after resistance training during stroke rehabilitation (Aidar et al., 2012), which is consistent with the large body of literature supporting the use of resistance exercise for stroke patients (see review by Brogardh and Lexell, 2012). "
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    ABSTRACT: Numerous studies have revealed the beneficial effects of regular exercise across a variety of mental health measures. Although a great deal of attention has been paid to the role of aerobic exercise, less is known about the role of resistance exercise (i.e., strength training) in mental health outcomes. Resistance exercise includes a broad group of procedures that evoke repeated muscle action against resistances above those encountered in daily life. A growing body of literature has identified anxiolytic effects of resistance exercise in human populations after both single-bout sessions and long-term training. This research has shown that resistance training at a low-to-moderate intensity (<70% 1 repetition maximum) produces the most reliable and robust decreases in anxiety. Importantly, anxiolytic effects have been observed across a diverse range of populations and dependent measures. These findings provide support for the use of resistance exercise in the clinical management of anxiety.
    Frontiers in Psychology 07/2014; 5:753. DOI:10.3389/fpsyg.2014.00753 · 2.80 Impact Factor
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