Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

Objective We examined the effect of 12 months aerobic and resistance exercise vs. usual care on changes in body composition in postmenopausal breast cancer survivors taking aromatase inhibitors (AIs). Methods 121 breast cancer survivors were enrolled in the Hormones and Physical Exercise (HOPE) study and randomized to either supervised twice-weekly resistance exercise training and 150 minutes per week of aerobic exercise (N=61) or a usual care (N=60) group. Dual energy X-ray absorptiometry (DXA) scans were conducted at baseline, 6-months, and 12-months to assess changes in body mass index (BMI), percent body fat (%FM), lean body mass (LBM) and bone mineral density (BMD). Results At 12-months, the exercise group relative to the usual care group had a significant increase in LBM (0.32 vs −0.88 kg, p=0.03), a decrease in %FM (−1.4 vs 0.48 %, p=0.03), and a decrease in BMI (−0.73 vs 0.17 kg/m2, p=0.03). Change in BMD was not significantly different between groups at 12 months (0.001 g/cm2 vs. −0.006 g/cm2, p=0.37). Conclusions A combined resistance and aerobic exercise intervention improved body composition in breast cancer survivors taking AIs. Exercise interventions may help to mitigate the negative side effects of AIs and improve health outcomes in breast cancer survivors.

Purpose Up to 50% of postmenopausal breast cancer survivors taking aromatase inhibitors (AIs) experience AI-associated arthralgias, or joint pain, which causes many to stop taking AIs and may inhibit exercise, despite known health benefits. We thus evaluated exercise adherence and factors associated with better exercise adherence in breast cancer survivors experiencing AI-induced arthralgia in the Hormones and Physical Exercise (HOPE) year-long randomized controlled trial. Methods We included the 61 HOPE women randomized to exercise (150 min/wk of moderate-intensity aerobic exercise and twice-weekly supervised strength training). Our main outcomes were aerobic exercise measured with daily activity logs, attendance at supervised exercise sessions, and changes in cardiorespiratory fitness, measured maximal oxygen consumption (VO2max). We examined means and standard deviations (SD) for exercise adherence by demographic and medical characteristics and used the t-test for mean differences. We also examined predictors of adherence using linear regression. Results On average, at the end of the year-long trial, women reported 119 (SD 78) min/wk of moderate-intensity aerobic exercise and participated in 70% of supervised exercise training sessions. After adjustment for other factors that influence adherence, at 6-months post-randomization only baseline VO2max was associated with higher aerobic exercise levels and at 12-months only older age predicted better supervised exercise training attendance. Conclusions Breast cancer survivors taking AIs and experiencing arthralgia are able to initiate and maintain a yearlong exercise program, regardless of other factors that influence activity levels. Implications Breast cancer survivors can exercise at levels that have been shown to improve AI-associated arthralgia.

PURPOSE: Arthralgias occur in up to 50% of women with breast cancer treated with adjuvant aromatase inhibitors (AIs), and are one of the most common reasons for poor adherence to therapy. We examined whether a year-long exercise program improves arthralgias in breast cancer survivors taking AIs. METHODS: Postmenopausal women diagnosed with hormone receptor-positive breast cancer were identified via the Connecticut Tumor Registry. Women who were taking an AI for at least 6-months and reported ≥ 3 out of 10 on the worst joint pain item of the Brief Pain Inventory-Short Form (BPI) were eligible and randomized to either exercise (150 min/wk of moderate-intensity aerobic exercise and twice-weekly supervised resistance exercise sessions) or usual care. The BPI questionnaire was completed at baseline, 6- and 12-months. VO2 max testing and Dual Energy X-ray Absorptiometry (DEXA) scans were also collected at baseline, 6- and 12-months. The primary outcome was change in BPI worst joint pain score between 0 and 12 months. We performed intent-to-treat statistical analyses including analysis of covariance, where each participant's change in outcome was modeled as a function of randomization group RESULTS: Out of 728 women screened that were taking an AI, we randomized 121 women, with 61 women randomized to exercise and 60 women randomized to usual care. Baseline characteristics were comparable between the two groups. Over 12 months, women randomized to exercise attended, on average, 80% ± 14% of the twice-weekly supervised resistance training exercise sessions and participated in an average 146 ± 75 min/wk of at least moderate-intensity aerobic exercise. Worst joint pain scores decreased by 20% at 12 months among women randomized to exercise vs. a 3% decrease among women randomized to usual care (p = .017). Joint pain severity also decreased significantly in exercise vs. usual care groups (p = 0.025), as well as joint pain-related interference (p = 0.005). The exercise intervention also favorably impacted body weight (p = 0.0057) and cardiorespiratory fitness (p = 0.024). Baseline to 12 month changes in BPI joint pain scores (mean (SD)) Baseline Values  Change from baseline to 12 months  BPI ItemExercisersUsual Carep-valueExercisersUsual Carep-valueWorst Pain5.5 (1.9)5.9 (1.9)0.29-1.1 (2.5)-0.2 (1.6)0.017Pain Severity3.9 (1.6)4.3 (1.8)0.27-0.8 (2.1)0.0 (1.5)0.025Pain Interference2.8 (2.1)2.9 (2.3)0.81-0.8 (2.0)0.2 (1.9)0.005Body weight (kg)80.9 (16.8)74.6 (14.5)0.11-3.5 (6.0)0.1 (3.7)0.0057VO2max (ml/kg/min)23.5 (4.8)23.1 (4.3)0.751.9 (1.9)0.4 (2.7)0.024 CONCLUSION: We found that participating in an exercise intervention led to clinically meaningful improvements in AI-induced arthralgias in breast cancer survivors experiencing moderate joint pain. The intervention also induced favorable changes in body weight and cardiorespiratory fitness, factors that may be linked to incidence and severity of AI-induced arthralgias. Further work is needed to determine whether exercise leads to increased AI adherence and possibly better outcomes in women with breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-03.