Randomized controlled trial of the effects of high intensity and low-to-moderate intensity exercise on physical fitness and fatigue in cancer survivors: results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study.

Caroline S Kampshoff,Marten R Nijziel,Willem Van Mechelen,Jos W R Twisk,Mai J M Chinapaw,Goof Schep,Johannes Brug,Laurien M Buffart

doi:10.1186/s12916-015-0513-2

Caroline S Kampshoff, Marten R Nijziel + Show 6 more

Open Access

https://doi.org/10.1186/s12916-015-0513-2

Copy DOI

Abstract

BackgroundInternational evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors. However, at present, the optimum exercise intensity is unclear. Therefore, we aimed to evaluate the effectiveness of a high intensity (HI) and low-to-moderate intensity (LMI) resistance and endurance exercise program compared with a wait list control (WLC) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment, including chemotherapy.MethodsOverall, 277 cancer survivors were randomized to 12 weeks of HI exercise (n = 91), LMI exercise (n = 95), or WLC (n = 91). Both interventions were identical with respect to exercise type, duration and frequency, and only differed in intensity. Measurements were performed at baseline (4–6 weeks after primary treatment) and post-intervention. The primary outcomes were cardiorespiratory fitness (peakVO2), muscle strength (grip strength and 30-second chair-stand test), and self-reported fatigue (Multidimensional Fatigue Inventory; MFI). Secondary outcomes included health-related quality of life, physical activity, daily functioning, body composition, mood, and sleep disturbances. Multilevel linear regression analyses were performed to estimate intervention effects using an intention-to-treat principle.ResultsIn the HI and LMI groups, 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions, respectively (P = 0.53). HI (β = 2.2; 95 % CI, 1.2–3.1) and LMI (β = 1.3; 95 % CI, 0.3–2.3) exercise showed significantly larger improvements in peakVO2 compared to WLC. Improvements in peakVO2 were larger for HI than LMI exercise (β = 0.9; 95 % CI, −0.1 to 1.9), but the difference was not statistically significant (P = 0.08). No intervention effects were found for grip strength and the 30-second chair-stand test. HI and LMI exercise significantly reduced general and physical fatigue and reduced activity (MFI subscales) compared to WLC, with no significant differences between both interventions. Finally, compared to WLC, we found benefits in global quality of life and anxiety after HI exercise, improved physical functioning after HI and LMI exercise, and less problems at work after LMI exercise.ConclusionsShortly after completion of cancer treatment, both HI and LMI exercise were safe and effective. There may be a dose–response relationship between exercise intensity and peakVO2, favoring HI exercise. HI and LMI exercise were equally effective in reducing general and physical fatigue.Trial registrationThis study was registered at the Netherlands Trial Register [NTR2153] on the 5th of January 2010.

Highlights

International evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors
We report results of the Resistance and Endurance exercise After ChemoTherapy (REACT) study [10]. This is the largest randomized controlled trials (RCT) to date that has examined the effectiveness of a high intensity (HI) and a low-to-moderate intensity (LMI) resistance and endurance exercise program compared with a wait list control (WLC) group in cancer survivors who had completed primary cancer treatment with cardiorespiratory fitness, muscle strength, and fatigue as primary outcomes
In the HI and LMI groups, 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions, respectively (P = 0.53; Fig. 1)

Summary

Introduction

International evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors. Burnham et al [8] compared moderate versus low intensity aerobic exercise in breast cancer survivors (n = 18) and reported that both exercise programs improved cardiorespiratory fitness, compared to usual care, with no differences in effects between the interventions [8]. Gibbs et al [9] reported larger improvements in cardiorespiratory fitness in breast cancer survivors (n = 73) after high intensity (HI) resistance exercise compared to low intensity exercise and usual care. Both high and low intensity exercise significantly improved muscle strength and reduced general fatigue compared to usual care, but no significant differences between the interventions were found [9]. Due to the scarcity of studies and small sample sizes, more insight into the effects of different exercise intensities is warranted to bridge this gap in existing knowledge

Objectives

Methods

Results

Conclusion