An Aerobic Weight-Loaded Pilot Exercise Intervention for Breast Cancer Survivors: Bone Remodeling and Body Composition Outcomes

Abstract

Objective Weight gain and bone loss are commonly reported in breast cancer survivors. The purpose of this pilot study is to assess feasibility and explore the effect of an aerobic weight-loaded exercise intervention on bone remodeling, weight, and body composition. Design A one-group pre-posttest design was used to test a 16–24-week supervised walking exercise intervention among women within 2 years of menopause. Through Weeks 1–4, time and weight were progressively increased. By Week 5 and through the end of the intervention, a waist belt was loaded with 5 lb and participants spent 45 min on the treadmill 3 times/week. Bone remodeling was measured by serum biomarkers (N-terminal propeptides of type I collagen [NTX] and serum osteocalcin). Dual-energy absorptiometry scans assessed body composition. Data were collected at baseline and 16 and 24 weeks. Results The majority of the 26 participants were married, well educated, and employed, with a mean age of 51.3 years (SD = 6.2). The high adherence (M = 88.2%, SD = 6.8) demonstrated feasiblity. There were no significant changes in serum osteocalcin (p = .67), serum NTX (p = .31), lean muscle mass (p = .08), or percent fat mass for the group as a whole (p = .14), but fat mass increased for women on adjuvant endocrine therapy (p = .04). The women maintained their weight. Conclusions This novel exercise intervention for breast cancer survivors was feasible, and women otherwise at high risk for weight gain and bone loss maintained their weight and bone mass.

A review of exercise interventions to improve bone health in adult cancer survivors

“…1). Of the 36 full papers reviewed, 25 were excluded because no bone outcome was included in the trial, leaving 11 papers that met our inclusion criteria [23][24][25][26][27][28][29][30][31][32][33]. Two trials that reported BMD assessment in the methods were excluded because BMD results were not reported [32,33].…”

“…Three of the controlled trials compared an exercise group to a usual care comparison group [25,26,29] and two had pharmacologic comparison groups with one comparing exercise versus drug therapy [28] and one comparing drug therapy alone to drug therapy plus exercise [31]. Three studies reported bone health as the only primary endpoint [28,29,31], three included bone health as a primary endpoint along with body composition (lean and fat mass) [24,25] and physical function [23]. One measured BMD among several outcomes, but did not report which outcome was their primary endpoint [30] and a behavioral intervention aimed to increase physical activity included BMD as a secondary endpoint [26].…”

“…Of the eight studies, three were uncontrolled trials [23,24,30] and five were controlled trials [25,26,28,29,31]. Three of the controlled trials compared an exercise group to a usual care comparison group [25,26,29] and two had pharmacologic comparison groups with one comparing exercise versus drug therapy [28] and one comparing drug therapy alone to drug therapy plus exercise [31].…”

Physical Exercise for Secondary Osteoporosis

“…More than 70 controlled trials have examined exercise in breast cancer patients and survivors; however, only seven have examined bone health outcomes [71][72][73][74][75][76][77]. Studies assessing bone health in breast cancer patients have typically included women who are peri-or postmenopausal [71][72][73][74][75][76]78], are at least 6 months post primary chemotherapy or radiation therapy [71,72,[75][76][77] and receiving adjuvant selective estrogen receptor modulators or aromatase inhibitors [71][72][73][74][75][76][77].…”

“…In a pre-post-test design, Knobf and colleagues assessed the effects of a 16 to 24 week, weight-loaded aerobic exercise intervention for 26 Stage I and II pre-or perimenopausal breast cancer patients who had completed chemotherapy and/or radiation therapy (27% of whom were also undergoing adjuvant hormonal therapy with tamoxifen or aromatase inhibitors) [72]. The supervised, communitybased intervention consisted of treadmill walking while wearing a weight belt and weighted backpack, three times per week.…”