Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial

Abstract

Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up. Design Pragmatic randomised controlled prospective open trial. Setting Three National Health Service oncology clinics in Scotland and community exercise facilities. Participants 203 women entered the study; 177 completed the six month follow-up. Interventions Supervised 12 week group exercise programme in addition to usual care, compared with usual care. Main outcome measures Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility.Results Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted. Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864.

Nordic Walking as an Exercise Intervention to Reduce Pain in Women With Aromatase Inhibitor–Associated Arthralgia: A Feasibility Study

“…The recruitment strategy was successful, as the 25% recruitment rate was comparable to other U.K.-based exercise studies for women with breast cancer. 40,41 This suggests that it would be possible to recruit to a full trial of Nordic walking in this population. However, as 40 women were recruited from a single site, a fully powered trial would need to be multicenter.…”

“…42,43 Women declining participation gave reasons similar to those reported in other studies. 40,42,44 Providing more clarity about the intervention might have increased uptake and could be given during a follow-up phone call to nonresponders one to two weeks after sending the study invitation. This method has been found effective in previous exercise studies.…”

“…40,41 There was an indication from the evaluation that group sessions were more acceptable than independent Nordic walking. In support of this, adherence was greater and most of the effect was seen in the first six weeks when Nordic walking was supervised.…”

Physiologic considerations of Enhanced Recovery After Surgery (ERAS) programs: implications of the stress response

“…There is insufficient knowledge about the value of aerobic exercise in the immediate catabolic period, while it might be possible that resistance exercise could counteract the loss of muscle mass. Data from the oncology literature would suggest that physical exercise helps to overcome the fatigue during adjuvant therapy for breast cancer 58 and leads to lower mortality following colorectal cancer. 59 It goes without saying that adequate pain relief and minimal sedation facilitate mobilization, and therefore, integration of various elements is a necessity for better outcomes.…”

The effect of group cohesion on rehabilitation outcome in cancer survivors

“…Several of these programs were offered to individuals in group format and these reported improvement in quality of life, physical functioning and fatigue in cancer patients during primary treatment [3][4][5][6][7][8][9][10] and after completion of initial treatment [11][12][13][14]. Recently, interest has been growing in patients' experience with training within groups.…”