None listed
Conditions
Brief summary
Purpose To compare changes in fatigue, muscle strength and physical function through prescription of either immediate exercise commenced during radiotherapy (DRT) to delayed exercise post-radiotherapy (PRT) in a randomised controlled trial in breast cancer survivors in Kenya. Patients and Methods Sixty-seven breast cancer survivors scheduled to undertake radiotherapy were screened for participation from November 2009 to December 2010 and randomised (n=63) to three arms: during treatment exercise (DRT n=20); post treatment exercise (PRT n=22) and usual care (UC n=21). Outcomes for fatigue (Multi-dimensional fatigue inventory (MFI); muscle strength (1-RM); muscle endurance (70% 1-RM); functional performance (chair-rise, stair climb, 400-m walk) and quality of life (EORTC-C30 BR-23) were assessed at baseline (Time 1: T1), 12-weeks (Time 2: T2) and 3-month follow-up (Time 3: T3). All subjects were assessed at T1. Subjects were then either randomly allocated to exercise during radiation (DRT) (6-weeks); wait for the 6 weeks of radiation to be completed to initiate the exercise (PRT) (further 6-weeks) or did not receive any exercise intervention - usual care (UC). Both DRT and PRT were then compared at week 12 (T2). Both DRT and PRT were then also assessed at a 3-month follow-up (T3). UC undertook measures at baseline (T1) week-12 (T2) and at 3-months (T3). Survivors were irradiated with a total dose of 50Gy with a dose per fraction of 2Gy for 25 treatments. Some women received an additional 10Gy to the original tumour bed in 5 fractions. Results At 12-weeks exercise groups had superior outcomes in general fatigue compared to UC (DRT -17.2 %, p=.042; PRT -14.4%, p=.031). Both DRT and PRT groups maintained their superiority over UC care at the 3-month follow-up (DRT -10.8%, p=.012; PRT -9.2%, p=.031). At 12-weeks change in physical fatigue was superior for both DRT and PRT groups over UC (DRT -18.7%, p=.034; PRT-13.0%, p=.038), and DRT experienced lower physical fatigue levels that PRT (-5.5%, p=.045). Both DRT and PRT groups maintained their superiority over UC at the 3-month follow-up (DRT -11.1%, p=.032; PRT -10.3%, p=.035). 1-RM chest press and seated row strength changes were superior for DRT and PRT compared to UC (chest press DRT +6.5Kg, p.001; PRT +5.3Kg, p=.002) (seated row DRT +7.3Kg, p=.002; PRT +4.4Kg, p=.001) at T2. At 3-months follow up superiority was seen for DRT exercise over UC for both chest press and seated row 1-RM strength (chest press +2.3Kg, p=.002; seated row +1.5Kg, p=.045). DRT was also superior over PRT for chest press (+3.2Kg, p=.026), and seated row (+3.5Kg, p=.002) at 3-months. 1-RM leg extension strength increased to a greater extent in the DRT group over UC at both 12-weeks (+5.8Kg, p=.006) and 3-months (+1.4, p=.042), but was not significantly different from PRT. Muscle endurance (70% 1-RM) for both chest press and leg extension was significantly enhanced in both DRT and PRT groups following 12-weeks in DRT and PRT compared to UC (chest press DRT +6.3rep, p=.011; PRT +4.5rep, p=.025; leg extension DRT +7.1rep, p=.022; PRT +6.9rep, p=.021), with no significant differences between DRT and PRT. At the 3-month follow-up assessment only DRT was superior to UC for chest press (+2.9rep, p=.038) and leg extension (+3.9, p=.032). At T2, there was a significant difference favouring greater improvement in global health (+23.5%, p=.006); physical functioning (+12.0%, p=.010); role functioning (+13.3%, p=.010) and emotional functioning (+20.1%, p=.002) in DRT survivors compared to UC, but no differences between DRT and PRT groups. There were no significant group differences at the 3-month follow-up for any of the function scales. Conclusion Our combined aerobic and resistance training prescribed during- or post-treatment for radiotherapy for breast cancer improves the muscle strength and functional performance, reduces fatigue and improves overall quality of life in breast cancer survivors A tendency exists for greater improvement and maintenance of these endpoints with pre-habilitative exercise during-treatment.
Interventions
Arm 1 – Resistance Training during radiation therapy
Arm 2 – Resistance Training post radiotherapy
Arm 3 – Usual Care (Control)
Sixty-seven breast cancer survivors scheduled to undertake radiotherapy were screened for participation from November 2009 to December 2010 and randomised (n=63) to three arms: during treatment exercise (DRT n=20); post treatment exercise (PRT n=22) and usual care (UC n=21). Outcomes for fatigue (Multi-dimensional fatigue inventory (MFI); muscle strength (1-RM); musc
Arm 1 – Resistance Training during radiation therapy Arm 2 – Resistance Training post radiotherapy Arm 3 – Usual Care (Control) Sixty-seven breast cancer survivors scheduled to undertake radiotherapy were screened for participation from November 2009 to December 2010 and randomised (n=63) to three arms: during treatment exercise (DRT n=20); post treatment exercise (PRT n=22) and usual care (UC n=21). Outcomes for fatigue (Multi-dimensional fatigue inventory (MFI); muscle strength (1-RM); muscle endurance (70% 1-RM); functional performance (chair-rise, stair climb, 400-m walk) and quality of life (EORTC-C30 BR-23) were assessed at baseline (Time 1: T1), 12-weeks (Time 2: T2) and 3-month follow-up post intervention (Time 3: T3). All subjects were assessed at T1. Subjects were then either randomly allocated to exercise during radiation (DRT) (6-weeks); wait for the 6 weeks of radiation to be completed to initiate the exercise (PRT) (further 6-weeks) or did not receive any exercise intervention - usual care (UC). Both DRT and PRT were then compared at week 12 (T2). Both DRT and PRT were then also assessed at the 3-month follow-up (T3). UC undertook measures at baseline (T1) week-12 (T2) and at the 3-month follow-up (T3). Survivors were irradiated with a total dose of 50Gy with a dose per fraction of 2Gy for 25 treatments. Some women received an additional 10Gy to the original tumour bed in 5 fractions. Exercise training intervention Participants undertook combined aerobic and progressive resistance training twice a week for 6-weeks in a supervised clinical exercise facility. Each session lasted 50 mins. 5 minutes warm-up and cool-down were performed before and after the session and included light aerobic activity and stretching. The resistance exercises included the chest press, seated row, and lateral pull down, lateral raises, front raises, triceps extension, leg extension and abdominal crunches. The resistance exercise program was designed to progress from 12- to 6-repetition maximum (RM) for two to four sets per exercise. The aerobic component of the training program included 15 minutes of cardiovascular exercises per session (walking/cycling/jogging) at 65% to 80% maximum heart rate and at a perceived exertion ranging from 11 to 13 (6 to 20 point Borg Scale).
Sponsors
Edith Cowan University
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
Inclusion was for women with a history of unilateral breast cancer, who were scheduled for radiotherapy and had not participated in any prior structured exercise training in the past three-months
Exclusion criteria
Exclusion was for those patients with any musculoskeletal, cardiovascular, neurological or psychiatric condition that could be exacerbated by exercise participation, inhibit their exercise response, or otherwise not approved by their oncologist. Women were not excluded based on fitness levels or body mass index nor were they excluded if they are undertaking other adjuvant therapies such as chemo- or hormone therapy, however this was noted.
Outcome results
None listed