Effects of Exercise on Chemotherapy Completion and Hospitalization Rates: The OptiTrain Breast Cancer Trial

Abstract

Background Exercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. Despite this, few randomized controlled exercise trials have reported on such clinical endpoints. From the OptiTrain trial we previously showed positive effects on physiological and health‐related outcomes after 16 weeks of supervised exercise in patients with breast cancer undergoing chemotherapy. Here, we examined the effects of exercise on rates of chemotherapy completion and hospitalization, as well as on blood cell concentrations during chemotherapy. Patients and Methods Two hundred forty women scheduled for chemotherapy were randomized to 16 weeks of resistance and high‐intensity interval training (RT‐HIIT), moderate‐intensity aerobic and high‐intensity interval training (AT‐HIIT), or usual care (UC). Outcomes included chemotherapy completion, hospitalization, hemoglobin, lymphocyte, thrombocyte, and neutrophil concentrations during chemotherapy. Results No significant between‐groups differences were found in the proportion of participants who required dose reductions (RT‐HIIT vs. UC: odds ratio [OR], 1.08; AT‐HIIT vs. UC: OR, 1.39), or average relative dose intensity of chemotherapy between groups (RT‐HIIT vs. UC: effect size [ES], 0.08; AT‐HIIT vs. UC: ES, −0.07). A significantly lower proportion of participants in the RT‐HIIT group (3%) were hospitalized during chemotherapy compared with UC (15%; OR, 0.20). A significantly lower incidence of thrombocytopenia was found for both RT‐HIIT (11%) and AT‐HIIT (10%) versus UC (30%; OR, 0.27; OR, 0.27). Conclusion No beneficial effects of either RT‐HIIT or AT‐HIIT on chemotherapy completion rates were found. However, combined resistance training and high‐intensity interval training were effective to reduce hospitalization rates, and both exercise groups had a positive effect on thrombocytopenia. These are important findings with potential positive implications for the health of women with breast cancer and costs associated with treatment‐related complications. Implications for Practice Completing the prescribed chemotherapy regimen is strongly associated with a good prognosis for patients with primary breast cancer. Despite this, treatment‐induced side effects make it necessary to reduce or alter the treatment regimen and can also lead to hospitalization. Exercise during chemotherapy is suggested to provide clinical benefits, including improved chemotherapy completion. This study showed that combined resistance and high‐intensity interval training during chemotherapy resulted in lower hospitalization rates and a lower incidence of thrombocytopenia in women with breast cancer undergoing chemotherapy. However, no beneficial effects of either exercise program on chemotherapy completion rates were found, which is in contrast to previous findings in this population. The findings reported in the current article have positive implications for the health of women with breast cancer and costs associated with treatment‐related complications.

Supervised, Multimodal Exercise: The Chemotherapy Supportive Therapy That Almost Does It All

“…In line with these results, the high‐quality, multimodal OptiTrain interventions did not have an impact on RDI, despite the RT‐HIIT intervention achieving the proposed biologic mechanism of enhanced muscle mass, strength, and physical fitness. There was no difference between either exercise group and usual care in achieved RDI, prevalence of a single dose reduction, or percentage of participants receiving ≥85% of RDI . Receipt of >85% of RDI is a known threshold for achievement of chemotherapy effectiveness .…”

“…As such, a therapy that could maximize delivery of chemotherapy relative dose intensity (RDI), reduce treatment toxicities, and improve quality of life, with positive side effects of improved physical fitness, reduced anxiety and depression, and extended overall survival, would likely be prescribed by every medical oncologist in every cancer treatment center. Although such a therapy does not currently exist, Mijwel et al report on a therapy that comes close in this issue of The Oncologist .…”

“…In this article, Mijwel et al report results of the OptiTrain trial, a 3‐arm randomized trial of two different exercise interventions versus usual care, on rates of chemotherapy completion, hospitalization, and hematological toxicity . The trial compared 16 weeks of high‐intensity aerobic interval training (three sets of 3 minutes with 1‐minute recovery) combined with either resistance training (RT‐HIIT) or moderate‐intensity aerobic training (AT‐HIIT) to usual cancer care.…”

“…Receipt of >85% of RDI is a known threshold for achievement of chemotherapy effectiveness . Notably, although approximately one quarter of all patients in the OptiTrain trial required at least one single chemotherapy dose reduction, the majority (83%) still received >85% RDI, likely thanks to other supportive therapies such as antiemetics and granulocyte colony‐stimulating factor (G‐CSF) offered as standard of care with modern regimens . This leaves relatively little room for improvement in chemotherapy tolerance in this population from any supportive therapy.…”

Exploration of High-Intensity Interval Training for Breast Cancer Survivors: Taking a Home-based Approach Toward New Normal

“…Three of the 13 studies did not specify who supervised the intervention. In those that did specify, the supervisor was an exercise trainer [9][10][11][12], an exercise physiologist [13][14][15][16][17][18], or an oncology nurse [13][14][15][16]. In Mijwel et al, the intervention was supervised by an exercise physiologist or oncology nurse.…”