“Chemotherapy-periodized” Exercise to Accommodate for Cyclical Variation in Fatigue

Abstract

Purpose The purpose of this study was to provide a rationale for “chemotherapy-periodized” exercise by characterizing cyclical variations in fatigue and exercise response across a chemotherapy cycle and comparing exercise adherence during chemotherapy between a prescription that is periodized according to chemotherapy cycle length and a standard linearly progressed prescription. Methods Women with breast cancer who were prescribed taxane-based chemotherapy were randomly assigned to a supervised aerobic and resistance exercise program after a chemotherapy-periodized exercise prescription (n = 12) or to usual care during chemotherapy (n = 15). Fatigue and steady state exercise responses were assessed in both groups before the first taxane treatment and across the third treatment (i.e., 0–3 d prior and 3–5 d after the third treatment, and 0–3 d before the fourth treatment) to assess cyclical variations. Adherence to the chemotherapy-periodized exercise prescription was compared with adherence to a standard linear prescription from a prior study in a similar population (n = 51). Results Fatigue increased from baseline (marginal mean ± standard error: 3.2 ± 0.4) to before the third treatment (4.1 ± 0.4, P = 0.025), then peaked at 3 to 5 d after the third treatment (5.1 ± 0.4, P = 0.001), before recovering before the fourth treatment (4.3 ± 0.5, P = 0.021). The peak in fatigue at 3 to 5 d post–third treatment corresponded to a decrease in steady state exercise oxygen consumption (V˙O2) (P = 0.013). Compared with a standard linear exercise prescription during chemotherapy, a chemotherapy-periodized exercise prescription resulted in higher attendance during the week after chemotherapy (57% ± 30% vs 77% ± 28%, P = 0.04) and overall attendance (63% + 25% vs 78% ± 23%, P = 0.05). Conclusions Fatigue and exercise V˙O2 vary across a chemotherapy cycle. A chemotherapy-periodized exercise prescription that accommodates cyclical variations in fatigue may increase adherence to supervised exercise.

<p>ATAS Acupuncture Reduces Chemotherapy Induced Fatigue in Breast Cancer Through Regulating ADROA1 Expression: A Randomized Sham-Controlled Pilot Trial</p>

“…A study which characterized cyclical variations in fatigue across a taxane-based chemotherapy cycle showed that fatigue increased from baseline to prior to the third treatment, then peaked at 3-5 days after the third treatment, before recovering prior to the next treatment. 22 Our result was similar to this, through VAS-F, we can see that the scores of VAS-F were climbing at the time of starting the third cycle chemotherapy in sham and nonacupuncture groups.…”

Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial

“…The difficulty of attending the gym may be explained by cancer-related barriers (e.g., disease and treatment-related symptoms, and medical appointments), which have been previously described as the main reason for lower attendance during treatment. 27 , 31 , 35 , 36 Thus, our findings reflect the need to overcome such barriers where possible. A periodized exercise prescription with adjustments for such cancer-related barriers (e.g., an adapted progressive overload and recovery depending on treatment phase) could be appropriate.…”

“…For supervised group-based resistance training, exercise adherence was within the range reported in other exercise interventions involving patient undergoing curative cancer treatment. 27 , 31 - 34 However, comparisons are limited due to the lack of studies reporting adherence according to all FITT-principles and the difference in calculation methods. 16 , 24 - 26 Overall adherence and attendance were lower than adherence in terms of intensity, time and type.…”

“…Indeed, one explanatory study reported that a “chemotherapy-periodization” of exercise for patients with breast cancer participating in supervised gym-based training resulted in higher attendance rates compared with regular exercise prescription. 31 Similar adjustments could be made in future exercise interventions involving patients undergoing other cancer treatments, but research is needed to examine how such individualization could be applied. For home-based endurance training, frequency and intensity for HI training was lower in our study than previously reported in other intervention studies involving similar populations.…”

Exercise modulation of tumour perfusion and hypoxia to improve radiotherapy response in prostate cancer

“…Furthermore, not all frequency schedules will likely be feasible for a specific exercise intensity (e.g. daily exercise at high intensity) and carefully considered periodisation schedules will need to be employed to maintain exercise tolerability during treatment [44,82].…”