Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the “APAD1” randomized controlled trial

Abstract

Background Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL). Methods Women diagnosed with early breast cancer ( N = 143, mean age = 52 ± 10 years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18 weeks (end of chemotherapy), and 26 weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time. Results Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26 weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26 weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26 weeks. No significant effect of the intervention was found on major macronutrients intake. Conclusions A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1 year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients. Trial registration The APAD study was prospectively registered on ClinicalTrials.gov ( NCT01495650 ; date of registration: December 20, 2011). Electronic supplementary material The online version of this article (10.1186/s12885-019-5896-6) contains supplementary material, which is available to authorized users.

Adherence to the American Cancer Society Guidelines for Cancer Survivors and Health-Related Quality of Life among Breast Cancer Survivors

“…Furthermore, several intervention studies support that healthy lifestyle behaviors (maintaining a healthy body weight, engaging in exercise, or consuming a healthy diet) improved cancer survivors' quality of life [6,8,[37][38][39]. The Programme of Accompanying women after breast Cancer treatment completion in Thermal resorts (PACThe) trial also showed that SF-36 physical and mental subscores improved among breast cancer survivors in France who participated in group physical training and nutritional education, yet this improvement was not significant after a year [6].…”

“…In the U.S. intervention study, lifestyle modification interventions regarding nutrition, physical activity, and stress management in cancer survivors (mostly breast, prostate, or skin cancer) improved quality of life [38]. Likewise, the Adapted Physical Activity and Diet (APAD) intervention in patients with early breast cancer improved fatigue and quality of life at the 1 year follow-up [39].…”

Brief Hospital Supervision of Exercise and Diet During Adjuvant Breast Cancer Therapy Is Not Enough to Relieve Fatigue: A Multicenter Randomized Controlled Trial

“…The APAD education program, which was based on the previously published trial method [ 18 ], was implemented during chemotherapy and radiotherapy (26 weeks). The intervention included twice-weekly exercise sessions and six individual nutritional therapeutic education sessions.…”

“…The combination of exercise and dietary support has been reported to induce significant weight loss in survivors of early BC (EBC) after adjuvant chemotherapy/radiotherapy [ 13 , 14 , 15 ]. Four randomized controlled trials (RCTs) have assessed the combination of exercise and diet in EBC patients undergoing adjuvant chemotherapy and/or radiotherapy, but they were designed as pilot trials with less than 30 patients in each randomization group [ 16 , 17 , 18 , 19 ]. Therefore, the benefits of an exercise-diet intervention during adjuvant chemotherapy and radiotherapy need to be evaluated in a well-powered and multicenter RCT.…”

“…Therefore, the benefits of an exercise-diet intervention during adjuvant chemotherapy and radiotherapy need to be evaluated in a well-powered and multicenter RCT. We previously reported a monocentric RCT evaluating an adapted physical activity and diet (APAD) intervention during adjuvant treatment of EBC [ 18 , 20 ] and found a beneficial effect on patient-reported outcomes (PROs). However, these results need to be validated in larger, multicenter cohorts in order to evaluate the impact of the heterogeneity of organizations and sociocultural parameters on the results of the intervention.…”