High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship

Abstract

Purpose Whether the benefits of exercise during chemotherapy continue into survivorship is not well-known. Here, the aim was to examine the effects of two exercise interventions on self-reported health-related and objectively measured physiological outcomes 12 months following commencement of chemotherapy. Methods Two hundred and forty women with breast cancer stage I–IIIa were randomized to 16 weeks of high-intensity aerobic interval training combined with either resistance training (RT-HIIT), or moderate-intensity aerobic training (AT-HIIT), or to usual care (UC). Primary outcome: cancer-related fatigue (CRF); secondary outcomes: quality of life (QoL), symptom burden, muscle strength, cardiorespiratory-fitness, body mass, and return to work. Results Compared to UC, both RT-HIIT and AT-HIIT significantly counteracted increases in total CRF (ES = − 0.34; ES = − 0.10), daily life CRF (ES=-0.76; ES=-0.50, and affective CRF (ES=-0.60; ES=-0.39). Both RT-HIIT and AT-HIIT reported significantly lower total symptoms (ES = − 0.46, ES = − 0.46), and displayed gains in lower limb (ES = 0.73; ES = 1.03) and handgrip muscle strength (surgery side ES = 0.70, ES = 0.71; non-surgery side ES = 0.57, ES = 0.59). AT-HIIT displayed significant reductions in body mass (ES = − 0.24), improved QoL: role (ES = 0.33) and emotional functioning (ES = 0.40), and a larger proportion had returned to work ( p = 0.02) vs UC. Conclusion These findings emphasize the beneficial effects of supervised high-intensity exercise during chemotherapy to improve the health and to reduce societal costs associated with prolonged sick leave for patients with breast cancer several months following chemotherapy. Implications for Cancer Survivors These findings provide important information with substantial positive consequences for breast cancer survivorship. High-intensity exercise programs during chemotherapy and support to maintain physical activity can be a powerful strategy to manage or prevent many of the short- and long-term adverse effects of treatment for the increasing cohort of cancer survivors.

Aerobic Exercise-Induced Changes in Cardiorespiratory Fitness in Breast Cancer Patients Receiving Chemotherapy: A Systematic Review and Meta-Analysis

“…Our moderator analysis suggests that both continuous and interval aerobic training are effective at increasing VO 2max . There is some compelling evidence that vigorous intensity continuous aerobic training performed during chemotherapy counteracts cancer-related fatigue, which can last up to 12 months after treatment completion, and reduces the time to return to work as compared with the UC group [ 57 ]. However, we acknowledge that performing continuous aerobic training at vigorous intensities is very demanding and may not be feasible for women with BC undergoing chemotherapy, thus interval training should be considered as a viable alternative.…”

High-intensity interval training in the prehabilitation of cancer patients—a systematic review and meta-analysis

“…Neoadjuvant therapy strategies have been shown to improve resectability of previously inoperable cancers by reducing the complexity of operations, e.g., by successfully diminishing tumor tissue [14]. However, prehabilitation programs are also targeting non-surgical cancer patients receiving pharmacological treatment only, e.g., as chemotherapy and/or radiotherapy [15][16][17]. In this context, a recent meta-analysis on 3257 patients with cancer indicated that moderate aerobic exercise performed at 70-80% of maximum heart rate not only was feasible and safe but also showed beneficial effects in QoL and physical functioning and maintained or at least improved fitness during concomitant chemotherapy [18].…”

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

“…Generally, the RT‐HIIT intervention had larger effect sizes on patient‐reported symptoms, especially multidimensional cancer‐related fatigue and preservation of cognitive functioning compared with the AT‐HIIT group . These positive effects on total symptoms, cancer‐related fatigue and strength persisted at 1 and 2 years after chemotherapy relative to the usual care group despite no current differences between groups in objectively measured physical activity . Taken together, these results demonstrate that the combination of aerobic interval training and resistance training twice per week for 16 weeks throughout chemotherapy treatment improves the patient experience of chemotherapy, prevents negative physiological sequelae of chemotherapy, and improves long‐term patient well‐being.…”