Effect of exercise training on cardiorespiratory fitness, quality of life and objectively measured physical activity in patients undergoing anthracycline-based chemotherapy: the Caprice RCT

Abstract

Abstract Introduction Exercise training based cardio-oncologic rehabilitation programmes (ET) were shown to counteract the loss in cardiorespiratory fitness and quality of life (QoL) and reduce cancer fatigue during anthracycline-based chemotherapies (AC). It is unknown whether these changes are due to greater volumes of physical activity (PA) induced by ET and whether ET is associated with greater objectively measured daily PA compared to guideline-based recommendation of PA. Method Patients with breast cancer or lymphoma receiving AC were recruited from four cancer centres in Switzerland and randomly assigned to three months centre-based ET during (EXduringAC) or after (EXpostAC) AC. All patients were counselled on guideline directed PA and PA was measured with an activity tracker. Primary endpoints were peak VO2, fatigue and QoL after AC (AC-end) and at 3 months follow-up. PA and steps were compared between days with and without centre-based training session. Results Data of 51 patients were available. Neither Intention-to-Treat (ITT) nor Per-Protocol (PP) analyses revealed between group differences with regard to peak VO2, fatigue, and QoL at neither AC-end nor follow-up (Figure 1). There was also no between group difference with regard to PA and steps, however, compared to EXpostAC, in EXduringAC the steep decline in PA and steps in AC cycles 3 and 4 was prevented (PP analysis, Figure 2). PA on days with centre-based training sessions was 28 (95% confidence interval 24-32) min higher and patients performed 4382 (3995-4768) steps more compared to days without centre-based training sessions. Conclusion ET performed during or after AC had no additional effect on changes in peak VO2, fatigue, or QoL assessed at AC-end or follow-up compared to using an activity tracker alone, possibly due to the lack of additional PA completed by patients during ET. This is the first study that objectively measured the effect of ET on PA and daily step count during and following AC. While days with centre-based ET had significantly more PA and steps, this surplus was likely to be compensated on days without centre-based ET.Figure 1Figure 2