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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.

Authors

Kerry S. Courneya

Donald C. McKenzie

John R. Mackey

Karen Gelmon

Christine M. Friedenreich

Yutaka Yasui

Robert D. Reid

Diane Cook

Diana Jespersen

Carolyn Proulx

Lianne B. Dolan

Evyanne Wooding

Linda Trinh

Roanne J. Segal



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.

Journal Article Type Article
Publication Date Dec 4, 2013
Journal JNCI: Journal of the National Cancer Institute
Print ISSN 1460-2105
Electronic ISSN 0027-8874
Publisher Oxford University Press (OUP)
Peer Reviewed Peer Reviewed
Volume 105
Issue 23
Pages 1821-1832
APA6 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. doi:10.1093/jnci/djt297
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
Publisher URL https://academic.oup.com/jnci/article/105/23/1821/902891
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