Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial

Abstract

Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment, but has not been sufficiently tested. We hypothesized that progressive, moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass, lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity, non-weight bearing stretching program. We conducted a randomized, controlled trial in 106 women with early stage breast cancer who were >1 year post-radiation and/or chemotherapy, ≥50 years of age at diagnosis and postmenopausal, free from osteoporosis and medications for bone loss, resistance and impact exercise naïve, and cleared to exercise by a physician. Women were randomly assigned to participate in 1 year of thrice-weekly progressive, moderate-intensity resistance + impact (jump) exercise or in a similar frequency and length control program of progressive, low-intensity stretching. Primary endpoints were bone mineral density (BMD; g/cm2) of the hip and spine and whole body bone-free lean and fat mass (kg) determined by DXA and biomarkers of bone turnover—serum osteocalcin (ng/ml) and urinary deoxypyrodiniline cross-links (nmol/mmolCr). Women in the resistance + impact training program preserved BMD at the lumbar spine (0.47 vs. −2.13%; P = 0.001) compared to controls. The resistance + impact group had a smaller increase in osteocalcin (7.0 vs. 27%, P = 0.03) and a larger decrease in deoxypyrodinoline (−49.9 vs. −32.6%, P = 0.06) than controls. Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy (P = 0.01). Our combined program of resistance + impact exercise reduced risk factors for fracture among postmenopausal breast cancer survivors (BCS) and may be particularly relevant for BCS on aromatase inhibitors (AIs) because of the additional benefit of exercise on muscle mass that could reduce falls.

AST-induced bone loss in men with prostate cancer: exercise as a potential countermeasure

“…In cancer survivors, Winters-Stone et al 95 recently reported the results of their randomized controlled trial that examined the effect of a targeted exercise program of resistance training and impact-loading activities on the bone health of women (X50 years) with breast cancer. Following the 12-month intervention, women in the exercise group maintained BMD at the lumbar spine compared with controls (0.47% versus À2.13%).…”

“…61,98 High-impact exercise has also been shown in both breast cancer survivors and non-prostate cancer populations to be well tolerated and has the potential to both prevent bone loss and increase bone mass. 87,89,93,95,96 Although high-impact exercises are particularly beneficial, activities involving high peak GRFs are not currently recommended for those with established osteoporosis because of their increased risk for fracture. Further, jumping exercises are currently not advised for those with advanced metastatic bone disease because of the increased fracture risk associated with this stage of disease progression.…”

Physical Exercise for Secondary Osteoporosis

“…More than 70 controlled trials have examined exercise in breast cancer patients and survivors; however, only seven have examined bone health outcomes [71][72][73][74][75][76][77]. Studies assessing bone health in breast cancer patients have typically included women who are peri-or postmenopausal [71][72][73][74][75][76]78], are at least 6 months post primary chemotherapy or radiation therapy [71,72,[75][76][77] and receiving adjuvant selective estrogen receptor modulators or aromatase inhibitors [71][72][73][74][75][76][77]. Three RCTs showed that exercise may prevent the typical loss of BMD experienced in patients that are not exercising [71,77,78].…”

“…Studies assessing bone health in breast cancer patients have typically included women who are peri-or postmenopausal [71][72][73][74][75][76]78], are at least 6 months post primary chemotherapy or radiation therapy [71,72,[75][76][77] and receiving adjuvant selective estrogen receptor modulators or aromatase inhibitors [71][72][73][74][75][76][77]. Three RCTs showed that exercise may prevent the typical loss of BMD experienced in patients that are not exercising [71,77,78]. Bisphosphonates appear to provide better treatment for CTIBL in breast cancer patients than exercise [74], however exercise plus bisphosphonates appears to be better than bisphosphonates alone [76].…”

“…A single blinded RCT by Winters-Stone and colleagues studied the effect of a 1-year moderate-intensity resistance plus impact-loading exercise intervention versus progressive stretching (control intervention) in 106 women who were 1 year post treatment for early stage breast cancer [77]. The impact loading exercises involved two-footed, 1 inch jumps, with weighted vests.…”