Impact Of Prehabilitation In Oncology Via Exercise - Breast Cancer: The Improve-B Study

Abstract

The manifold benefits of exercise during and after breast cancer therapy are well investigated and lead international agencies to recommend exercise for breast cancer patients and survivors (Schmitz, 2010). However, there is still a knowledge gap regarding the efficacy of prehabilitative exercise for patients undergoing breast cancer surgery. PURPOSE: Investigate the effects of exercise before surgery (prehabilitation), on the health perception and functional capability of women after surgery. METHODS: 33 sedentary breast cancer patients scheduled for breast cancer surgery were randomized to either a partly supervised (SE), a home based (HE) resistance exercise groups or a usual care group (UC), each consisting of 11 patients. The patients were assessed before the intervention, immediately before surgery, before and after adjuvant treatment. The data were analyzed via linear Mixed-Effect-Models, questionnaire scales were standardized to the pooled pretest standard deviation. The reported results are the incremental effects in the intervention groups compared to the UC at the post-surgical follow up. RESULTS: The interim results showed superior functional fitness for both exercise groups, with an incremental increase in the 6min walk distance of 123.5 meter (95%-CI= 41.8 - 206.1) in the HE and 113.0 meter (95%-CI= 27.3 - 198.7) in the SE. The gain of grip strength in the dominant hand surpassed the gain in the UC by 7.0kg (95%-CI= 3.6 - 10.4) in the HE and 5.4kg (95%-CI= 3.4 - 7.3) in the SE. In the non-dominant hand the strength gains were lower with 3.2kg (95%-CI= -0.15 - 6.6) in the HE and 3.1kg (95%-CI= -0.5 - 6.7) in the SE. Both exercise groups showed superior improvements in quality of life compared to the UC. With large effects of β= 1.34 (95%-CI= 0.18 - 2.50) in the HE and β= 2.60 (95%-CI= 1.31 - 3.89) in the SE in role function, and β= 0.49 (95%-CI= -0.29 - 1.27) in the HE and β= 1.54 (95%-CI= 0.66 - 2.42) in the SE, in physical function measures. CONCLUSION: These results support the implementation of a brief prehabilitative exercise intervention and display the multidimensional effects of exercise on functional, as well as psychological health parameters.