Maintenance of Fitness and Quality-of-Life Benefits From Supervised Exercise Offered as Supportive Care for Breast Cancer

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Background: Overwhelming randomized controlled trial evidence demonstrates that exercise has positive health impacts during and after treatment for breast cancer. Yet, evidence generated by studies in which exercise programs are delivered outside a tightly controlled randomized trial setting is limited. The purpose of this study was to assess the effectiveness of an evidence-based exercise program with real-world implementation on physical fitness and quality of life (QoL). Patients and Methods: Oncologists referred women with early-stage breast cancer who were scheduled to receive adjuvant chemotherapy. The program consisted of supervised aerobic and resistance exercise of moderate to vigorous intensity 3 times per week until the end of treatment (chemotherapy ± radiotherapy), then twice per week for 10 weeks, followed by once per week for 10 weeks. Health-related physical fitness and QoL were assessed at baseline, end of treatment, end of program, and 1-year follow-up. Results: A total of 73 women were enrolled. Estimated peak VO2 (VO2peak), QoL, and body weight were maintained between baseline and end of treatment, whereas muscular strength improved (P<.01). By the end of the program, VO2peak, heart rate recovery, waist circumference, and some aspects of QoL were improved (all P<.01) relative to baseline. One year later, VO2peak, QoL, and waist circumference were maintained relative to end of program, whereas the improvements in strength and heart rate recovery had dissipated (all P<.01). Conclusions: Evidence-based exercise programming delivered with real-world implementation maintained VO2peak, strength, and QoL during adjuvant treatment and improved these measures after treatment completion among women with breast cancer. Continued guidance and support may be required for long-term maintenance of strength improvements in this population.

Submitted June 16, 2018; accepted for publication January 17, 2019.Author contributions: Study concept: Kirkham, McKenzie, Van Patten, Gelmon, Campbell. Acquired funding: Van Patten, Campbell. Provided patients: Gelmon. Data acquisition: Kirkham, Bland, Wollmann, Bonsignore. Data analysis and interpretation: Kirkham. Manuscript preparation: Kirkham, Campbell.Disclosures: The authors have not received any financial consideration from any person or organization to support the preparation, analysis, results, or discussion of this article.Funding: This project was funded by the British Columbia Cancer Foundation. Dr. Kirkham was funded by the Canadian Institutes of Health Research.Correspondence: Kristin Campbell, PhD, BScPT, University of British Columbia, 212-2177 Wesbrook Mall, Vancouver, BC, Canada V6T1Z3. Email: kristin.campbell@ubc.ca
  • 1.

    Denlinger CS, Sanft T, Scott Baker K, . NCCN Clinical Practice Guidelines in Oncology: Survivorship. Version 2.2018. Accessed November 4, 2018. To view the most recent version, visit NCCN.org.

  • 2.

    van Waart H, Stuiver MM, van Harten WH, . Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol 2015;33:1918–1927.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3.

    Courneya KS, Segal RJ, Mackey JR, . Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol 2007;25:4396–4404.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4.

    Courneya KS, McKenzie DC, Mackey JR, . Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. J Natl Cancer Inst 2013;105:1821–1832.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5.

    Courneya KS. Efficacy, effectiveness, and behavior change trials in exercise research. Int J Behav Nutr Phys Act 2010;7:81.

  • 6.

    Courneya KS, Rogers LQ, Campbell KL, . Top 10 research questions related to physical activity and cancer survivorship. Res Q Exerc Sport 2015;86:107–116.

  • 7.

    Kirkham AA, Van Patten CL, Gelmon KA, . Effectiveness of oncologist-referred exercise and healthy eating programming as a part of supportive adjuvant care for early breast cancer. Oncologist 2018;23:105–115.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 8.

    Kirkham AA, Bonsignore A, Bland KA, . Exercise prescription and adherence for breast cancer: one size does not FITT all. Med Sci Sports Exerc 2018;50:177–186.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9.

    US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Heart, Lung, and Blood Institute. The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Bethesda, MD; National Institutes of Health; October 2000. NIH publication 00-4084.

  • 10.

    Pollock ML, Foster C, Schmidt D, . Comparative analysis of physiologic responses to three different maximal graded exercise test protocols in healthy women. Am Heart J 1982;103:363–373.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 11.

    Gulati M, Shaw LJ, Thisted RA, . Heart rate response to exercise stress testing in asymptomatic women: the St. James Women Take Heart Project. Circulation 2010;122:130–137.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12.

    Pescatello LS. ACSM’s Guidelines for Exercise Testing and Prescription, 9th ed. Philadelphia, PA: Wolters Kluwer/Lippincott Williams & Wilkins Health; 2014.

    • Search Google Scholar
    • Export Citation
  • 13.

    Kirkham AA, Campbell KL, McKenzie DC. Comparison of aerobic exercise intensity prescription methods in breast cancer. Med Sci Sports Exerc 2013;45:1443–1450.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14.

    Giallauria F, Vitelli A, Maresca L, . Exercise training improves cardiopulmonary and endothelial function in women with breast cancer: findings from the Diana-5 dietary intervention study. Intern Emerg Med 2016;11:183–189.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15.

    Knutzen KM, Brilla LR, Caine D. Validity of 1RM prediction equations for older adults. J Strength Cond Res 1999;13:242–246.

  • 16.

    Ware JE Jr. SF-36 Health Survey update. Spine 2000;25:3130–3139.

  • 17.

    Brady MJ, Cella DF, Mo F, . Reliability and validity of the Functional Assessment of Cancer Therapy-Breast quality-of-life instrument. J Clin Oncol 1997;15:974–986.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18.

    Hemingway H, Stafford M, Stansfeld S, . Is the SF-36 a valid measure of change in population health? Results from the Whitehall II Study. BMJ 1997;315:1273–1279.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 19.

    Hays RD, Sherbourne CD, Mazel RM. The RAND 36‐Item Health Survey 1.0. Health Econ 1993;2:217–227.

  • 20.

    Webster K, Cella D, Yost K. The Functional Assessment of Chronic Illness Therapy (FACIT) measurement system: properties, applications, and interpretation. Health Qual Life Outcomes 2003;1:79.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 21.

    Campbell A, Mutrie N, White F, . A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs 2005;9:56–63.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 22.

    Kim CJ, Kang DH, Smith BA, . Cardiopulmonary responses and adherence to exercise in women newly diagnosed with breast cancer undergoing adjuvant therapy. Cancer Nurs 2006;29:156–165.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 23.

    Travier N, Velthuis MJ, Steins Bisschop CN, . Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med 2015;13:121.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24.

    Segal R, Evans W, Johnson D, . Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol 2001;19:657–665.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 25.

    Battaglini CL, Mills RC, Phillips BL, . Twenty-five years of research on the effects of exercise training in breast cancer survivors: a systematic review of the literature. World J Clin Oncol 2014;5:177–190.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 26.

    Spark LC, Reeves MM, Fjeldsoe BS, . Physical activity and/or dietary interventions in breast cancer survivors: a systematic review of the maintenance of outcomes. J Cancer Surviv 2013;7:74–82.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 27.

    Courneya KS, Segal RJ, Gelmon K, . Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiol Biomarkers Prev 2007;16:2572–2578.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28.

    Mutrie N, Campbell AM, Whyte F, . Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial. BMJ 2007;334:517.

    • Crossref
    • PubMed
    • Search Google Scholar
    • Export Citation
  • 29.

    Mutrie N, Campbell A, Barry S, . Five-year follow-up of participants in a randomised controlled trial showing benefits from exercise for breast cancer survivors during adjuvant treatment: are there lasting effects? J Cancer Surviv 2012;6:420–430.

    • Crossref
    • Search Google Scholar
    • Export Citation
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