Does exercise intensity matter for fatigue during (neo‐)adjuvant cancer treatment? The Phys‐Can randomized clinical trial

Abstract

Exercise during cancer treatment improves cancer‐related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high‐ vs low‐to‐moderate‐intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo‐)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo‐)adjuvant treatment were randomized to high intensity (n = 144), low‐to‐moderate intensity (n = 144), high intensity with BCS (n = 144) or low‐to‐moderate intensity with BCS (n = 145). The 6‐month exercise intervention included supervised resistance training and home‐based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4‐20), and Functional Assessment of Chronic Illness Therapy‐Fatigue scale (FACIT‐F, score range 0‐52). Multiple linear regression for main factorial effects was performed according to intention‐to‐treat, with post‐intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high‐ vs low‐to‐moderate‐intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference −1.05 [95% CI: −1.85, −0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo‐)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high‐ or low‐to‐moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well‐controlled exercise interventions.

Who Makes It All The Way? Participants Vs. Decliners, And Completers Vs. Drop-Outs, In A 6-Month Exercise Trial During Cancer Treatment. Results From The Phys-Can RCT

“…One study with an acceptance rate below 30% [15] identi ed three main reasons for declining participation; 1) lack of interest in the study, 2) felt too busy to participate and 3) did not want to travel to the training facility. These results are in line with the ndings in the Phys-Can RCT, where travel distance was the major reason for declining participation [9]. Although not stated as a reason in the present study, it is possible that the randomization to two different exercise intensities may have deterred eligible participants as they may have been hesitant to exercise at a non-preferred intensity.…”

“…The Phys-Can randomized controlled trial This study used data from the Physical Training and Cancer (Phys-Can) intervention study [3,9]. The primary aim of the Phys-Can RCT was to compare the effects of low-to-moderate (LMI) vs high-intensity (HI) exercise, with or without additional behavior change support (goal-setting, self-monitoring, action planning, review of goal-setting and problem solving), on cancer-related fatigue in patients undergoing cancer treatment.…”

“…Moderate-to-vigorous intensity physical activity was assessed using SenseWear Armband mini (BodyMedia Inc, Pittsburgh, PA, USA) as previously described [9]. Mean time (minutes) in moderate-tovigorous intensity physical activity (MPVA) per 24 hours was considered that of at least 3 METs according to SenseWear algorithms [11].…”

Effect of Exercise Training on Quality of Life after Colorectal and Lung Cancer Surgery: A Meta-Analysis

“…Furthermore, higher exercise intensities appear to protect against chemotherapy-related inflammation [ 81 ], a mechanism involved in the pathogenesis of fatigue [ 82 ], which could be clinically relevant for patients eligible to adjuvant treatment after surgery. This rationale is supported by a large clinical trial which found that a combination of high-intensity aerobic and resistance exercise was significantly more effective to reduce physical fatigue compared to low-to-moderate-intensity exercise in cancer patients undergoing (neo-)adjuvant treatment [ 83 ].…”

Who makes it all the way? Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT

“…Moderate-to-vigorous intensity physical activity was assessed using SenseWear Armband mini (BodyMedia Inc, Pittsburgh, PA, USA) as previously described [9]. Mean time (minutes) in moderate-to-vigorous intensity physical activity (MVPV) per 24 h was considered that of at least 3 METs according to SenseWear algorithms [11].…”