Effects of exercise dose and type during breast cancer chemotherapy on longer‐term patient‐reported outcomes and health‐related fitness: A randomized controlled trial

Abstract

The Combined Aerobic and Resistance Exercise (CARE) Trial compared different types and doses of exercise performed during breast cancer chemotherapy. Here, we report the longer‐term follow‐up of patient‐reported outcomes, health‐related fitness and exercise behavior at 6, 12 and 24 months postintervention. A multicenter trial in Canada randomized 301 breast cancer patients initiating chemotherapy to thrice weekly, supervised exercise consisting of a standard dose of 25–30 min of aerobic exercise (STAN; n = 96), a higher dose of 50–60 min of aerobic exercise (HIGH; n = 101) or a combined dose of 50–60 min of aerobic and resistance exercise (COMB; n = 104) performed for the duration of chemotherapy (median of 17 weeks). Primary outcomes were patient‐reported outcomes including quality of life, cancer‐related symptoms and psychosocial outcomes. Secondary outcomes were objective health‐related fitness (assessed at 12 months only) and self‐reported exercise behavior. A total of 269 (89.4%) participants completed patient‐reported outcomes at all three follow‐up time points and 263 (87.4%) completed the health‐related fitness assessment at 12‐month follow‐up. COMB was significantly superior to (i) STAN for sleep quality at 6‐month follow‐up (p = 0.027); (ii) HIGH for upper body muscular endurance at 12‐month follow‐up (p = 0.020); and (iii) HIGH for meeting the resistance exercise guideline at 6‐month follow‐up (p = 0.006). Moreover, self‐reported meeting of the combined exercise guideline during follow‐up was significantly associated with better patient‐reported outcomes and health‐related fitness. Performing combined exercise during and after breast cancer chemotherapy may result in better longer‐term patient‐reported outcomes and health‐related fitness compared to performing aerobic exercise alone.

Patterns and predictors of exercise behavior during 24 months of follow-up after a supervised exercise program during breast cancer chemotherapy

“…We found that few of the short-term positive effects of the higher-dose aerobic and combined exercise programs during chemotherapy [2] were maintained during follow-up [15]. Conversely, there were strong positive associations between exercise behavior during the follow-up period and longer-term physical fitness, psychosocial outcomes, and quality of life [15]. These data suggest that longer-term maintenance of exercise after chemotherapy is critical for the sustained benefits of exercise.…”

“…Flow of participants during the follow-up phase of the CARE Trial has been reported elsewhere [15]. Briefly, of the 301 randomized participants, 264 (88%) provided complete data at all three follow-up timepoints.…”

“…Some studies have shown diminished effects as early as 6 months postintervention [5,[8][9][10] and few trials have even reported longer-term effects beyond 6 months [11][12][13][14]. We recently reported the 6-, 12-, and 24month follow-up of the Combined Aerobic and Resistance Exercise (CARE) Trial which compared different types and doses of exercise during breast cancer chemotherapy [15]. We found that few of the short-term positive effects of the higher-dose aerobic and combined exercise programs during chemotherapy [2] were maintained during follow-up [15].…”

“…We recently reported the 6-, 12-, and 24month follow-up of the Combined Aerobic and Resistance Exercise (CARE) Trial which compared different types and doses of exercise during breast cancer chemotherapy [15]. We found that few of the short-term positive effects of the higher-dose aerobic and combined exercise programs during chemotherapy [2] were maintained during follow-up [15]. Conversely, there were strong positive associations between exercise behavior during the follow-up period and longer-term physical fitness, psychosocial outcomes, and quality of life [15].…”

Home-based physical activity in breast cancer patients and cardiorespiratory fitness: during and/or after chemotherapy? A three-arm randomized controlled trial (APAC)

“…In this trial, we compared the feasibility and bene ts of a home-based PA program during or after speci c cancer treatment to provide recommendations for patients undergoing breast cancer treatment. This AP program combined aerobic and resistance exercises, as proposed for the majority of trials for cancer patients (33). We did not compare the VO 2 values with a control group without AP because it would not have been ethical to perform breast cancer adjuvant treatment without proposing an APA program, even if the modality is not precise.…”