Four-year effects of exercise on fatigue and physical activity in patients with cancer

Abstract

BackgroundIn the earlier randomized controlled Physical Activity during Cancer Treatment (PACT) study, we found beneficial effects of an 18-week supervised exercise program on fatigue in patients with newly diagnosed breast or colon cancer undergoing adjuvant treatment. The present study assessed long-term effects of the exercise program on levels of fatigue and physical activity 4 years after participation in the PACT study.MethodsThe original study was a two-armed, multicenter randomized controlled trial comparing an 18-week supervised exercise program to usual care among 204 breast cancer patients and 33 colon cancer patients undergoing adjuvant treatment. Of the 237 PACT participants, 197 participants were eligible and approached to participate in the 4-year post-baseline measurements, and 128 patients responded. We assessed fatigue and physical activity levels at 4 years post-baseline and compared this to levels at baseline, post-intervention (18 weeks post-baseline), and at 36 weeks post-baseline.ResultsIntention-to-treat mixed linear effects model analyses showed that cancer patients in the intervention group reported significantly higher moderate-to-vigorous total physical activity levels (141.46 min/week (95% confidence interval (CI) 1.31, 281.61, effect size (ES) = 0.22) after 4 years compared to the usual care group. Furthermore, cancer patients in the intervention group tended to experience less physical fatigue at 4 years post-baseline compared to the usual care group (− 1.13, 95% CI –2.45, 0.20, ES = 0.22), although the result was not statistically significant.ConclusionPatients with breast or colon cancer who participated in the 18-week exercise intervention showed significant higher levels of moderate-to-vigorous total physical activity levels and a tendency towards lower physical fatigue levels 4 years post-baseline. Our result indicate that exercising during chemotherapy is a promising strategy for minimizing treatment-related side effects, both short and long term.Trial registrationCurrent Controlled Trials ISRCTN43801571, Dutch Trial Register NTR2138. Trial registered on 9 December 2009.

Effects of exercise dose and type during breast cancer chemotherapy on longer‐term patient‐reported outcomes and health‐related fitness: A randomized controlled trial

“…In other words, there were no consistent effects of the different exercise doses and types during breast cancer chemotherapy on patient-reported outcomes at all three follow-up time points. This null finding is in contrast to previous studies 5,9,10,[34][35][36] which have reported positive longer-term effects of exercise performed during breast cancer chemotherapy; however, these studies have compared an exercise intervention to no exercise, unlike that the CARE Trial that compared three different exercise interventions. One possible explanation for the null finding concerning the three different exercise prescriptions tested in the CARE Trial is that the differences in the exercise prescriptions were modest and only produced small differences in outcomes even at the immediate postintervention time point.…”

“…In other words, there were no consistent effects of the different exercise doses and types during breast cancer chemotherapy on patient‐reported outcomes at all three follow‐up time points. This null finding is in contrast to previous studies which have reported positive longer‐term effects of exercise performed during breast cancer chemotherapy; however, these studies have compared an exercise intervention to no exercise, unlike that the CARE Trial that compared three different exercise interventions.…”

“…Exercise during breast cancer chemotherapy improves quality of life, treatment‐related symptoms, health‐related fitness, chemotherapy completion rate and possibly even survival . Few exercise trials, however, have reported the effects of exercise during breast cancer chemotherapy on longer‐term patient‐reported outcomes, health‐related fitness, and exercise behavior beyond 6 months follow‐up . Moreover, few exercise trials have compared different types and doses of exercise during breast cancer chemotherapy.…”

“…7 Few exercise trials, however, have reported the effects of exercise during breast cancer chemotherapy on longer-term patient-reported outcomes, health-related fitness, and exercise behavior beyond 6 months follow-up. [8][9][10][11] Moreover, few exercise trials have compared different types and doses of exercise during breast cancer chemotherapy. Consequently, it is unclear what doses and types of exercise during breast cancer chemotherapy may be optimal for improving longer-term outcomes.…”

Patterns and predictors of exercise behavior during 24 months of follow-up after a supervised exercise program during breast cancer chemotherapy

“…Unfortunately, many of the benefits of exercise during breast cancer chemotherapy dissipate quickly after cessation of the exercise program. Some studies have shown diminished effects as early as 6 months postintervention [5,[8][9][10] and few trials have even reported longer-term effects beyond 6 months [11][12][13][14]. We recently reported the 6-, 12-, and 24month follow-up of the Combined Aerobic and Resistance Exercise (CARE) Trial which compared different types and doses of exercise during breast cancer chemotherapy [15].…”