A SUPERVISED and individualized exercise program can reduce fatigue and pain while improving cardiovascular health and quality of life in women being treated for advanced breast cancer, according to research presented by Eduardo Oliveira, PhD, Professor of Exercise Physiology and Exercise Cancer Specialist at Mama Help Breast Cancer Support Center at the University of Porto, Portugal, at the European School of Oncology (ESO)/European Society for Medical Oncology (ESMO) 4th International Consensus Conference for Advanced Breast Cancer (ABC4) in Lisbon.¹ 

“There is no known pharmacologic way to improve physical fitness, but exercise can improve quality of life by increasing cardiac output, oxygen transport, and strength; improving skeletal muscle function; and fostering socialization,” he said. “Women with advanced breast cancer can adapt to exercise without inducing fatigue or pain.” 

Cancer-Related vs Exercise-Related Fatigue 

CANCER-RELATED FATIGUE significantly diminishes strength and performance at daily tasks, and though it has been established that exercise reduces daily fatigue and improves quality of life in women with early-stage breast cancer, there is a lack of scientific knowledge about physical exercise and quality-of-life outcomes in women with advanced breast cancer. 

In contrast to cancer-related fatigue, exercise-induced fatigue is generally regarded as a positive and natural tiredness and is associated with improved physical well-being, tranquility, relaxation, and improved sleep. 

“The literature describes exercise as having potential importance in the quantitative reduction of fatigue,” Dr. Oliveira explained. “The qualitative data in this study highlight the experience of cancer patients having a comfortable sense of fatigue while simultaneously improving their physical form and increasing their strength.” 

Highly Significant Improvements in Fitness, Fatigue, and Pain 

DR. OLIVEIRA and colleagues studied a group of 15 women aged 34 to 68 years who were all being treated for metastatic breast cancer and were not exercising prior to the study. Eight women were allocated to a 12-week exercise program consisting of an hour of exercise twice a week. At each session, patients did a combination of cardiovascular exercises, specific rehabilitation arm exercises, and resistance training utilizing body weight. Exercise regimens were individualized to each patient, and physical capacity (VO2 max) and health-related quality of life were assessed pre- and postintervention. The remaining seven patients in the study continued to receive standard care. 

Highly significant improvements in cardiorespiratory fitness and strength were seen in patients who exercised, with an average increase of 13.3% in VO2 max in the intervention group, vs 2.7% in the control group. “Moreover, strength and capacity—for example, flexibility—also improved,” he noted. 

VO2 max power—the patient’s rate of maximum power during exercise—improved by 37.2% in the exercise group, compared to 3.9% in the control group, suggesting that the physical endurance of women taking part in the exercise program also improved. 

Exercise induced a pronounced decrease in fatigue and pain symptoms, assessed via a questionnaire that was translated into a point system by the researchers. Fatigue decreased by an average of 14.4 points in the intervention group, compared with only 2.2 points in the control group (P < .001), whereas pain decreased by 21.4 points in the intervention group vs 2.6 points in the control group (P < .001). 

For emotional well-being, there was an improvement of 16.6 points compared to 11.0 points, and for the patients’ ability to carry out normal daily tasks, there was an improvement of 14.9 points compared to a 0.1-point deterioration in the intervention and control groups, respectively. The regimen was also well tolerated, as all of the women who took part in the exercise intervention remained in the program for the full 12 weeks. 

According to Dr. Oliveira, women with advanced breast cancer generally agree that exercise has the potential to improve their quality of life, but it is not easy for them to initiate exercise protocols due to adverse side effects of treatment, pain, and fatigue. 

“We want to change cancer-related fatigue to exercise-related fatigue,” he said. “In some states of treatment, rest is not best. With exercise, we can improve physical capacity, cardiovascular fitness, and health-related quality of life in women with advanced breast cancer.” 

Chair of the ABC4 conference, Fatima Cardoso, MD, Director of the Breast Unit of the Champalimaud Cancer Centre in Lisbon, Portugal said in a press release, “The effects of exercise in early breast cancer have been well studied, but very little research around the world has focused on its role in advanced breast cancer patients, and this is what makes the work by Professor Oliveira and his colleagues so unique and important.” 

Dr. Cardoso continued, “The research shows that participating in a moderate exercise program for 12 weeks had a good impact on overall quality of life and, importantly, on control of pain and fatigue, which is a common and hard-to-control cancer symptom. These findings are excellent news for advanced breast cancer patients. The fact that the program is easy to implement makes these findings potentially practice-changing when confirmed in larger numbers of patients.” ■

DISCLOSURE: Drs. Oliveira and Cardoso reported no conflicts of interest. 

REFERENCE 

1. Oliveira E, Soares J, Seabra A, et al: Effect of exercise on cardiovascular fitness and quality of life outcomes in advanced breast cancer patients. ESO/ ESMO 4th International Consensus Conference for Advanced Breast Cancer (ABC4). Presented November 2, 2017.