Exercise Improves Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors


Key Points

  • Exercise resulted in significant improvement in worst joint pain score.
  • Exercise also resulted in significant improvements in pain severity and pain interference.

In the HOPE study reported in the Journal of Clinical Oncology, Irwin et al found that a program of aerobic exercise and strength training produced significant improvement in aromatase inhibitor–associated arthralgia in breast cancer survivors.

Study Details

In the study, 121 women with stage I to III breast cancer who had received an aromatase inhibitor for ≥ 6 months, reported a score of ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reported < 90 minutes per week of aerobic exercise and no strength training in the past year were randomly assigned to an exercise program (n = 61) or usual care (n = 60). The program consisted of 150 minutes per week of aerobic exercise and supervised strength training twice per week.

Outcomes were changes on the BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index (0-100 score), and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaires. The primary outcome measure was change in BPI worst joint pain score at 12 months.

Most women had stage I (59%–62%) or II disease (30%–32%). At baseline, mean BPI worst joint pain scores were 5.6 in the exercise group and 5.9 in the usual care group, WOMAC total scores for lower extremities were 25.7 and 24.5, and DASH scores were 20.0 and 19.3. Women in the exercise group attended 70% of resistance training sessions and increased their exercise by 159 minutes per week.

Improvements With Exercise

Worst joint pain scores on the BPI decreased by 1.6 points (29%) in the exercise group vs an increase of 0.2 points (3%) in the usual care group at 12 months (P < .001). BPI pain severity (−1.1 vs +0.3, P < .001) and pain interference (−1.1 vs +0.4, P < .001) were also significantly improved in the exercise group at 12 months.

Changes at 12 months were significant in favor of the exercise group for the WOMAC total score for lower extremities (−9.4 points, 37% decrease, vs +0.5 points, 2% increase; P < .001) and the DASH upper-extremity score (−6.7 points, 33% decrease, vs +1.3 points, 12% increase; P = .002).

The investigators concluded: “Exercise led to improvement in [aromatase inhibitor]-induced arthralgia in previously inactive breast cancer survivors.”

Melinda L. Irwin, PhD, MPH, of Yale School of Public Health, is the corresponding author for the Journal of Clinical Oncology article.

The study was supported by grants from the National Cancer Institute, Breast Cancer Research Foundation , Yale Cancer Center, and National Institutes of Health. For full disclosures of the study authors, visit

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.