Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study

Abstract

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.

Predictors of adherence to exercise interventions during and after cancer treatment: A systematic review

“…After screening based on title and abstract, 30 papers were potentially eligible for inclusion. Fifteen of these papers met predefined eligibility criteria, of which the oldest paper was published in 2002 …”

“…In total, 2279 cancer patients were included in the 15 studies analyzed . Of these patients, 1383 were assigned to an exercise intervention and these patients had a mean age of 55.5 years.…”

“…Applied timing of exercise interventions varied. Five studies applied their exercise intervention after systemic (neo‐) adjuvant treatment, 5 studies both during and after treatment, and 5 studies during treatment . Furthermore, 4 studies included a population with multiple cancer types, whereas 11 other studies included a single cancer type population .…”

“…Duration of exercise interventions ranged from 5 weeks to 24 months. Various physical exercise modalities were used in the selected studies: aerobic (brisk walking, cycling, treadmill, or swimming), strength (resistance, stretching, and postural exercises), or combined aerobic and strength exercises …”

“…In 7 studies, adherence to exercise intervention was measured using an exercise log . In 2 studies, patients used a pedometer to measure adherence .…”