Home-Based Physical Activity in Patients With Breast Cancer: During and/or After Chemotherapy? Impact on Cardiorespiratory Fitness. A 3-Arm Randomized Controlled Trial (APAC)

Abstract

Objectives: Physical activity (PA) programs are recommended for breast cancer care. However, their modalities remain to be discussed. This study determined the best time to begin a personalized or adapted program based on cardiopulmonary exercise test function. This randomized controlled trial evaluated the effect of home-based adapted PA (APA) performed during or after treatment on cardiorespiratory fitness (CRF) at 12 months. Method: The primary endpoint was the peak oxygen consumption (VO2peak) at 12 months (group A vs C and B vs C). Secondary endpoints included the 6-minute walking test, assessment of muscle strength, fatigue, quality of life, anxiety, and depression, and a questionnaire on PA levels. All tests were evaluated at baseline and at 6 and 12 months. A total of 94 patients with breast cancer were randomized to 3 different groups: group A, performing 6 months of APA during adjuvant care; group B, 6 months of APA after adjuvant care; and group C, 12 months of APA during and after specific care. The program combined 1 resistance session and 2 aerobic sessions per week. Analysis of variance was used for repeated measures, Student’s t-test or the Mann–Whitney U-test for continuous variables, and χ2 test for binary or categorical variables. Results: The study assessed 81 participants at 6 months and 73 at 12 months. The majority of patients completed more than 85% of the exercise sessions. The baseline for VO2peak and secondary outcomes did not differ among the groups. VO2peak increased during the exercise period and decreased during the chemotherapy period without APA, but at 12 months no significant difference was observed. The same variation was observed in the 6-minute walking test, with significance at 6 months between A+C versus B ( P = .04), but no difference among the groups at 12 months. In the 3 groups, no decreases in other studied parameters were noted, except at 6 months in group B without APA. Conclusion: Home-based APA in breast cancer patients has a positive effect on CRF and physical functions, with no differences based on the timing of this program based on specific cancer treatment. Trial Registration: ClinicalTrials.gouv.fr (NCT01795612). Registered 20 February 2013.

Weight changes according to treatment in a diverse cohort of breast cancer patients

“…Our group is assessing a tailored exercise program for breast cancer patients undergoing various treatments (S, SR, SE, SC). Other studies have evaluated physical activity regimens during chemotherapy and found improvements in cardiorespiratory fitness [26] chemotherapy related fatigue [27] and less nausea and pain [28]. Our data suggest the initial 3 months post initial surgical intervention to be the most dynamic and potentially important period for addressing weight loss changes in patients with early stage breast cancer undergoing chemotherapy.…”

Weight Changes According to Treatment in a Diverse Cohort of Breast Cancer Patients

“…Our group is assessing a tailored exercise program for breast cancer patients undergoing various treatments (S, SR, SE, SC). Other studies have evaluated physical activity regimens during chemotherapy and found improvements in cardiorespiratory tness (26) chemotherapy related fatigue (27) and less nausea and pain (28). Our data suggest the initial 3 months post initial surgical intervention to be the most dynamic and potentially important period for addressing weight loss changes in patients with early stage breast cancer undergoing chemotherapy.…”

Can the Six-Minute Walk Test Be Used to Individualize Physical Activity Intensity in Patients with Breast Cancer?

“…Data were collected from the patients included in our two prospective trials, the SAPA ( —NCT01322412) [ 11 ] and APAC ( —NCT0179561) trials [ 23 ], both of which were conducted at Limoges University Hospital. Eligible patients were women aged 18–75 years with early-stage breast cancer treated with chemotherapy (neoadjuvant or adjuvant) followed by radiotherapy.…”

“…The first VT was defined as being when CO 2 production began to increase disproportionately to O 2 consumption, as measured using the Wasserman method [ 26 ]. This test was supervised by a respiratory physiologist (more details in previous work) [ 23 ].…”

“…Here, we determined the extent of agreement between the ventilatory threshold HR (VT-HR) measured during the CPET and the HR measured during the last 3 min of the 6MWT (6WMT-HR) before and after adjuvant treatment. We used data on patients enrolled in our two published prospective studies that evaluated the impact of APA on peak oxygen uptake (VO 2peak ) values during breast cancer treatments [ 11 , 23 ].…”