Abstract S3-03: Randomized trial of exercise vs. usual care on aromatase inhibitor-associated arthralgias in women with breast cancer: The hormones and physical exercise (HOPE) study

Abstract

PURPOSE: Arthralgias occur in up to 50% of women with breast cancer treated with adjuvant aromatase inhibitors (AIs), and are one of the most common reasons for poor adherence to therapy. We examined whether a year-long exercise program improves arthralgias in breast cancer survivors taking AIs. METHODS: Postmenopausal women diagnosed with hormone receptor-positive breast cancer were identified via the Connecticut Tumor Registry. Women who were taking an AI for at least 6-months and reported ≥ 3 out of 10 on the worst joint pain item of the Brief Pain Inventory-Short Form (BPI) were eligible and randomized to either exercise (150 min/wk of moderate-intensity aerobic exercise and twice-weekly supervised resistance exercise sessions) or usual care. The BPI questionnaire was completed at baseline, 6- and 12-months. VO2 max testing and Dual Energy X-ray Absorptiometry (DEXA) scans were also collected at baseline, 6- and 12-months. The primary outcome was change in BPI worst joint pain score between 0 and 12 months. We performed intent-to-treat statistical analyses including analysis of covariance, where each participant's change in outcome was modeled as a function of randomization group RESULTS: Out of 728 women screened that were taking an AI, we randomized 121 women, with 61 women randomized to exercise and 60 women randomized to usual care. Baseline characteristics were comparable between the two groups. Over 12 months, women randomized to exercise attended, on average, 80% ± 14% of the twice-weekly supervised resistance training exercise sessions and participated in an average 146 ± 75 min/wk of at least moderate-intensity aerobic exercise. Worst joint pain scores decreased by 20% at 12 months among women randomized to exercise vs. a 3% decrease among women randomized to usual care (p = .017). Joint pain severity also decreased significantly in exercise vs. usual care groups (p = 0.025), as well as joint pain-related interference (p = 0.005). The exercise intervention also favorably impacted body weight (p = 0.0057) and cardiorespiratory fitness (p = 0.024). Baseline to 12 month changes in BPI joint pain scores (mean (SD)) Baseline Values Change from baseline to 12 months BPI ItemExercisersUsual Carep-valueExercisersUsual Carep-valueWorst Pain5.5 (1.9)5.9 (1.9)0.29-1.1 (2.5)-0.2 (1.6)0.017Pain Severity3.9 (1.6)4.3 (1.8)0.27-0.8 (2.1)0.0 (1.5)0.025Pain Interference2.8 (2.1)2.9 (2.3)0.81-0.8 (2.0)0.2 (1.9)0.005Body weight (kg)80.9 (16.8)74.6 (14.5)0.11-3.5 (6.0)0.1 (3.7)0.0057VO2max (ml/kg/min)23.5 (4.8)23.1 (4.3)0.751.9 (1.9)0.4 (2.7)0.024 CONCLUSION: We found that participating in an exercise intervention led to clinically meaningful improvements in AI-induced arthralgias in breast cancer survivors experiencing moderate joint pain. The intervention also induced favorable changes in body weight and cardiorespiratory fitness, factors that may be linked to incidence and severity of AI-induced arthralgias. Further work is needed to determine whether exercise leads to increased AI adherence and possibly better outcomes in women with breast cancer. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr S3-03.

Aromatase inhibitor associated arthralgia: the importance of oncology provider-patient communication about side effects and potential management through physical activity

“…In our pilot study conducted among survivors age 65 or older, we found a 32% decrease in joint stiffness (Cohen’s d effect size=0.56; p=0.07) between baseline and 6 weeks (end of intervention), and an increase from 21% to 50% in the proportion of survivors who walked the targeted amount of 150 minutes per week (p<0.001) [14]. More recently, findings from a recently published RCT of breast cancer survivors on AI therapy included a 29% decrease in worst pain scores among women assigned to a 12-month exercise program as compared to a 3% increase in worst pain in the usual care control group (p<0.001) [41]. The exercise group also experienced significantly decreased pain severity and pain interference compared to the usual care group (p<0.001) [41].…”

Arthralgia induced by endocrine treatment for breast cancer: A prospective study of serum levels of insulin like growth factor-I, its binding protein and oestrogens

“…Furthermore, the recent hormones and physical exercise (HOPE) study, which randomised AI users to exercise or usual care, showed that exercise intervention led to clinical meaningful improvements in AIMSS [36].…”

Supervised physical exercise improves VO2max, quality of life, and health in early stage breast cancer patients: a randomized controlled trial

“…Improving or preserving muscle strength is important because of increased resilience to musculoskeletal injury and muscular strength, playing a fundamental role in reducing joint pain and physical limitation, thus increasing QoL [32,33]. These results are complemented with a significant improvement in affected shoulder range of motion.…”