Effects of exercise dose and type during breast cancer chemotherapy: Multicenter randomized trial

Courneya, Kerry S.; McKenzie, Donald C.; Mackey, John R.; Gelmon, Karen; Friedenreich, Christine M.; Yasui, Yutaka; Reid, Robert D.; Cook, Diane; Jespersen, Diana; Proulx, Carolyn; Dolan, Lianne B.; Forbes, Cynthia C.; Wooding, Evyanne; Trinh, Linda; Segal, Roanne J.

Abstract

Background
Exercise improves physical functioning and symptom management during breast cancer chemotherapy, but the effects of different doses and types of exercise are unknown.

Methods
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.

Results
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.

Conclusions
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.

Citation

Courneya, K. S., McKenzie, D. C., Mackey, J. R., Gelmon, K., Friedenreich, C. M., Yasui, Y., …Segal, R. J. (2013). Effects of exercise dose and type during breast cancer chemotherapy: Multicenter randomized trial. JNCI: Journal of the National Cancer Institute, 105(23), 1821-1832. https://doi.org/10.1093/jnci/djt297

• Journal Article Type: Article
• Acceptance Date: Aug 15, 2013
• Online Publication Date: Oct 22, 2013
• Publication Date: Dec 4, 2013
• Deposit Date: Sep 6, 2018
• Journal: JNCI: Journal of the National Cancer Institute
• Print ISSN: 1460-2105
• Electronic ISSN: 0027-8874
• Publisher: Oxford University Press
• Peer Reviewed: Peer Reviewed
• Volume: 105
• Issue: 23
• Pages: 1821-1832
• DOI: https://doi.org/10.1093/jnci/djt297
• Keywords: Aerobic exercise; Chemotherapy regimen; Exercise; Canada; Pain; Palliative care; Breast cancer; Exercise; Resistive; Surrogate endpoints; sf-36; Patient self-report; Physical function
• Public URL: https://hull-repository.worktribe.com/output/1024157
• Publisher URL: https://academic.oup.com/jnci/article/105/23/1821/902891