Abstract
BackgroundWomen with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Currently, no evidence-based fall prevention strategies exist that specifically target female cancer survivors. The purpose of the GET FIT (Group Exercise Training for Functional Improvement after Treatment) trial is to compare the efficacy of two distinct types of exercise, tai chi versus strength training, to prevent falls in women who have completed treatment for cancer. The specific aims of this study are to: 1) Determine and compare the efficacy of both tai chi training and strength training to reduce falls in older female cancer survivors, 2) Determine the mechanism(s) by which tai chi and strength training each reduces falls and, 3) Determine whether or not the benefits of each intervention last after structured training stops.Methods/DesignWe will conduct a three-group, single-blind, parallel design, randomized controlled trial in women, aged 50–75 years old, who have completed chemotherapy for cancer comparing 1) tai chi 2) strength training and 3) a placebo control group of seated stretching exercise. Women will participate in supervised study programs twice per week for six months and will be followed for an additional six months after formal training stops. The primary outcome in this study is falls, which will be prospectively tracked by monthly self-report. Secondary outcomes are maximal leg strength measured by isokinetic dynamometry, postural stability measured by computerized dynamic posturography and physical function measured by the Physical Performance Battery, all measured at baseline, 3, 6 and 12 months. The sample for this trial (N=429, assuming 25% attrition) will provide adequate statistical power to detect at least a 47% reduction in the fall rate over 1 year by being in either of the 2 exercise groups versus the control group.DiscussionThe GET FIT trial will provide important new knowledge about preventing falls using accessible and implementable exercise interventions for women following chemotherapy for cancer. ClinicalTrials.gov NCT01635413
Highlights
Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability
Women who have had cancer are significantly more likely to fall than women who have not [2,3,4] and falls are associated with serious injuries, including fractures [5]
Tai chi and strength training are 2 types of exercise that have been recommended for fall prevention in older adults [21]
Summary
Women with cancer are significantly more likely to fall than women without cancer placing them at higher risk of fall-related fractures, other injuries and disability. Chen et al reported an elevated risk of falls after women developed breast or other cancers compared to women never diagnosed with cancer (HR = 1.15, 95%CI: 1.06-1.25 and HR = 1.27, 95%CI: 1.18-1.36 for breast cancer and other cancers, respectively) [6]. In these cancer survivors, hip fracture risk was doubled after diagnosis and multiple fallers (≥2 falls in a year) were significantly more likely to break their hips (HR = 2.05, 95%CI: 1.82, 2.31) or spines (HR = 1.76, 95%CI; 1.58, 1.95) compared to women who fell once or not at all [2]. Common during and after chemotherapy [19], could further contribute to fall risk because inactivity leads to declines in neuromuscular function
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