Abstract
Cardiorespiratory fitness is an independent risk factor for cardiovascular disease and shortened life expectancy in breast cancer survivors. This randomised controlled trial (n = 153) was designed for patients with a physically inactive lifestyle prediagnosis and concurrently referred to adjuvant chemotherapy. We compared two 12-week exercise interventions aimed at physiological and patient-reported outcomes (cardiorespiratory fitness, muscle strength, metabolic markers, physical activity, pain, fatigue), including a 39-week follow-up. A supervised hospital-based moderate to high intensity group exercise intervention was compared to an instructed home-based individual pedometer intervention. The two 12-week interventions included oncologists’ recommendations and systematic health counselling. Outcomes were measured at baseline and week 6, 12 and 39. Primary outcome cardiorespiratory fitness declined significantly during chemotherapy and was restored in both interventions at follow-up. The interventions effectively engaged breast cancer patients in sustaining physical activities during and following adjuvant treatment. A composite metabolic score improved significantly. Positive cardiorespiratory fitness responders had improved clinical effects on fatigue, pain and dyspnoea versus negative responders. We conclude that a loss of cardiorespiratory fitness among physically inactive breast cancer patients may be restored by early initiated interventions and by adapting to physical activity recommendations, leading to a decreased cardiovascular risk profile in breast cancer survivors.
Highlights
Cardiorespiratory fitness is an independent risk factor for cardiovascular disease and shortened life expectancy in breast cancer survivors
The causal mechanisms involved in this decline in cardiorespiratory fitness (CRF) in patients with breast cancer (BC) may be related to a cascade of factors in the oxygen delivery system[15,16,17]
In the randomised feasibility study preceding the present randomised controlled trials (RCTs), we used Danish national physical activity (PA) guidelines as the initial screening inclusion criteria[35]. This simplified two-item tool was able to detect physically inactive BC patients at onset of adjuvant chemotherapy with a high correlation of low VO2peak at baseline compared with the Scandinavian background population[27]
Summary
Cardiorespiratory fitness is an independent risk factor for cardiovascular disease and shortened life expectancy in breast cancer survivors This randomised controlled trial (n = 153) was designed for patients with a physically inactive lifestyle prediagnosis and concurrently referred to adjuvant chemotherapy. In the randomised feasibility study preceding the present RCT, we used Danish national PA guidelines as the initial screening inclusion criteria[35] This simplified two-item tool was able to detect physically inactive BC patients at onset of adjuvant chemotherapy with a high correlation of low VO2peak at baseline compared with the Scandinavian background population[27]. The present RCT aimed to compare the effects of two 12-week exercise interventions on physiological outcomes (e.g. CRF, muscle strength, body composition, blood cholesterol and insulin) and patient-reported outcomes (e.g. PA, pain, fatigue, dyspnoea and anxiety), including a 39-week follow-up. The population comprised screened, physically inactive BC patients at onset of adjuvant chemotherapy that included sequential anthracycline and cyclophosphamide with docetaxel or paclitaxel-based regimens
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