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Effect of Low-Intensity Physical Activity and Moderate- to High-Intensity Physical Exercise During Adjuvant
Hanna van Waart1, Martijn M Stuiver1, Wim H van Harten1
1Hanna van Waart, Martijn M. Stuiver, Wim H. van Harten, Jacobien M. Kieffer, Marianne de Maaker-Berkhof, Gabe S. Sonke, Neil K. Aaronson, The Netherlands Cancer Institute; Edwin Geleijn, Laurien M. Buffart, and Epie Boven, VU University Medical Center; Laurien M. Buffart, EMGO Institute for Health and Care Research; Maud M. Geenen, Sint Lucas Andreas Hospital; Jetske M. Meerum Terwogt, Onze Lieve Vrouwe Gasthuis; Jeanette A.J.H. Hellendoom-van Vreeswijk, Comprehensive Cancer Centre of the Netherlands, Amsterdam; Jolanda Schrama, Spaarne Hospital, Hoofddorp; Aart van Bochove and Simone M. van den Heiligenberg, Esperanz, North Holland; Aart van Bochove, Zaans Medisch Centrum, Zaandam; Vera Lustig, Flevohospital, Almere; Simone M. van den Heiligenberg, Westfries Gasthuis, Hoorn; and Carolien H. Smorenburg, Medical Center Alkmaar, Alkmaar, the Netherlands.
Purpose:
We evaluated the effectiveness of a low-intensity, home-based physical activity program (Onco-Move) and a moderate- to high-intensity, combined supervised resistance and aerobic exercise program (OnTrack) versus usual care (UC) in maintaining or enhancing physical fitness, minimizing fatigue, enhancing health-related quality of life, and optimizing chemotherapy completion rates in patients undergoing adjuvant chemotherapy for breast cancer.
Patients And Methods:
We randomly assigned patients who were scheduled to undergo adjuvant chemotherapy (N = 230) to Onco-Move, OnTrack, or UC. Performance-based and self-reported outcomes were assessed before random assignment, at the end of chemotherapy, and at the 6-month follow-up. We used generalized estimating equations to compare the groups over time.
Results:
Onco-Move and OnTrack resulted in less decline in cardiorespiratory fitness (P < .001), better physical functioning (P ≤ .001), less nausea and vomiting (P = .029 and .031, respectively) and less pain (P = .003 and .011, respectively) compared with UC. OnTrack also resulted in better outcomes for muscle strength (P = .002) and physical fatigue (P < .001). At the 6-month follow-up, most outcomes returned to baseline levels for all three groups. A smaller percentage of participants in OnTrack required chemotherapy dose adjustments than those in the UC or Onco-Move groups (P = .002). Both intervention groups returned earlier (P = .012), as well as for more hours per week (P = .014), to work than the control group.
Conclusion:
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.
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