Physical Activity Programs Produce Benefits in Patients Receiving Adjuvant Therapy for Breast Cancer
In the Dutch PACES trial reported in the Journal of Clinical Oncology, van Waart et al found that both a moderate/high-intensity supervised exercise program and a low-intensity home-based program provided benefits vs usual care in women undergoing adjuvant chemotherapy for breast cancer. Benefits, which were greater with the moderate/high-intensity program, included reduced pain and nausea/vomiting and earlier return to work.
Study Details
In the study, 230 patients scheduled for adjuvant chemotherapy were randomly assigned to a low-intensity home-based physical activity program (Onco-Move; n = 77), a moderate- to high-intensity combined supervised resistance and aerobic exercise program (OnTrack; n = 76), or usual care (n = 77). In the Onco-Move group, patients were encouraged by trained nurses to engage in ≥ 30 minutes of physical activity per day on 5 days per week. In the OnTrack program, patients attended two supervised sessions per week, undergoing training of six large muscle groups for 20 minutes per session and 30 minutes of aerobic exercise (50%–80% of maximal workload) per session; patients in this group were also encouraged to be physically active for 30 minutes a day on 5 days per week. Both programs started with the first cycle of chemotherapy and continued until 3 weeks after the last cycle.
Participants had a mean age of 51 years, 68% were employed, 47% had stage II and 46% stage III disease. Approximately three-fourths had breast-conserving surgery and had received radiotherapy, and approximately one-third had undergone axillary lymph node dissection.
Benefits of Exercise Programs
At the end of chemotherapy, the Onco-Move and OnTrack groups had a smaller decline in cardiorespiratory fitness vs usual care (P < .001 for both comparisons), better physical functioning (P < .001 for both), less nausea and vomiting (P = .029 and P = .031), and less pain (P = .003 and P = .011). Patients in the OnTrack group had better muscle strength (P = .002) and reduced physical fatigue (P < .001). At 6-month follow-up, most outcomes had returned to baseline levels in all three groups.
Significantly fewer patients in the OnTrack group required chemotherapy dose adjustments (12%; odds ratio = 0.26, P = .002, for both comparisons) compared with the Onco-Move group (34%) and the usual care group (34%).
At the end of chemotherapy, significantly more patients in the OnTrack (34%) and Onco-Move groups (40%) were working compared with the usual care group (15%; P =.010 for both comparisons). At 6 month follow-up, both exercise groups had higher return to work rates (83% and 79% vs 61%; P = .012 for both) and worked a higher percentage of pre-illness hours (59% and 60% vs 42%; P =.014 for both).
The investigators concluded: “A supervised, moderate- to high-intensity, combined resistance and aerobic exercise program is most effective for patients with breast cancer undergoing adjuvant chemotherapy. A home-based, low-intensity physical activity program represents a viable alternative for women who are unable or unwilling to follow the higher intensity program.”
Neil K. Aaronson, PhD, of the Netherlands Cancer Institute, is the corresponding author for the Journal of Clinical Oncology article.
The study was supported by the Alpe d’Huzes/Dutch Cancer Society, CZ Fund, Zilveren Kruis Achmea, and Comprehensive Cancer Centre of the Netherlands. For full disclosures of the study authors, visit jco.ascopubs.org.
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®.
