Effects of Exercise Dose and Type During Breast Cancer Chemotherapy: Multicenter Randomized Trial

• Published in: JNCI : Journal of the National Cancer Institute Vol. 105; no. 23; pp. 1821 - 1832
• Main Authors: COURNEYA, Kerry S, MCKENZIE, Donald C, DOLAN, Lianne B, FORBES, Cynthia C, WOODING, Evyanne, TRINH, Linda, SEGAL, Roanne J, MACKEY, John R, GELMON, Karen, FRIEDENREICH, Christine M, YASUI, Yutaka, REID, Robert D, COOK, Diane, JESPERSEN, Diana, PROULX, Carolyn
• Format: Journal Article
• Language: English
• Published: Cary, NC Oxford University Press 04-12-2013; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Breast cancer; Breast Neoplasms - drug therapy; Canada; Chemotherapy, Adjuvant; Clinical outcomes; Exercise; Female; Gynecology. Andrology. Obstetrics; Humans; Mammary gland diseases; Medical sciences; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Muscle Strength; Oncology; Physical Fitness; Quality of Life; Treatment Outcome; Tumors; Womens health; Canada; Antineoplastic agent; Physical exercise; Human; Breast disease; Multicenter study; Breast cancer; Malignant tumor; Aerobe; Mammary gland diseases; Chemotherapy; Randomization; Type; Cancerology; Treatment; Clinical trial; Cancer
• ISSN: 0027-8874; 1460-2105
• DOI: 10.1093/jnci/djt297

Exercise improves physical functioning and symptom management during breast cancer chemotherapy, but the effects of different doses and types of exercise are unknown.
A multicenter trial in Canada randomized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy consisting of either a standard dose of 25 to 30 minutes of aerobic exercise (STAN; n = 96), a higher dose of 50 to 60 minutes of aerobic exercise (HIGH; n = 101), or a combined dose of 50 to 60 minutes of aerobic and resistance exercise (COMB; n = 104). The primary endpoint was physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)-36. Secondary endpoints were other physical functioning scales, symptoms, fitness, and chemotherapy completion. All statistical tests were linear mixed model analyses, and the P values were two-sided.
Follow-up assessment of patient-reported outcomes was 99.0%. Adjusted linear mixed-model analyses showed that neither HIGH (+0.8; 95% confidence interval [CI] = -0.8 to 2.4; P = .30) nor COMB (+0.5; 95% CI = -1.1 to 2.1; P = .52] were superior to STAN for the primary outcome. In secondary analyses not adjusted for multiple comparisons, HIGH was superior to STAN for the SF-36 physical component summary (P = .04), SF-36 bodily pain (P = .02), and endocrine symptoms (P = .02). COMB was superior to STAN for endocrine symptoms (P = .009) and superior to STAN (P < .001) and HIGH (P < .001) for muscular strength. HIGH was superior to COMB for the SF-36 bodily pain (P = .04) and aerobic fitness (P = .03). No differences emerged for body composition or chemotherapy completion.
A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than standard volumes.