High intensity exercise optimizes chemotherapy completion
Adjuvant chemotherapy improves breast cancer survival, but can also lead to fatigue, muscle wasting, and reduced physical fitness. This, in turn, can have a negative impact on activities of daily living, social interaction, and quality of life. Several studies have demonstrated that exercise programs can have a salutary effect on cardiorespiratory fitness, muscle strength, fatigue, mood, HRQoL, and immune function, and possibly on chemotherapy completion rates.
Previous studies have used a wide range of exercise types and intensities, and are difficult to compare.
In this RCT, the effectiveness of a low-intensity, home-based physical activity program (Onco-Move) and a moderate- to high-intensity, combined supervised resistance and aerobic exercise program (OnTrack) was compared to usual care (UC).
Outcomes: physical fitness (VO2 max with Steep Ramp Tets), fatigue (MFI), health-related quality of life (EORTC-QLQ-C30), and chemotherapy completion rates.
In general, physical fitness levels were maintained immediately after completion of chemotherapy in OnTrack but declined in UC and Onco-Move. After a year, no group differences were observed.
However, symptom burden like nausea, vomiting and neuropathy were significantly lower in patients in both exercise programs. Fatigue and return to work were also positively affected in both exercise groups.
The most surprising finding however, is that a significantly smaller percentage of OnTrack (12%) required dose adjustments in the prescribed chemotherapy regimen than UC (34%) or Onco-Move (34%). The average dose reduction among those who required chemotherapy adjustment in OnTrack and Onco-Move was 10%, compared with 25% in UC.
Exercise during chemotherapy is beneficial; the more intensive, the more effective. The aim is a less steep decline or a stable situation, rather than improvement of fitness.
Return to work not only has financial implications, but also carries meaning in terms of quality of life and a sense of return to normalcy. This was positively affected by exercise.
Most importantly: higher chemotherapy completion rates may improve disease-free and overall survival. In this study, a potential protective effect of exercise against cardiotoxicity correlated to Trastuzumab (Herceptin) was observed.
Excercise during chemotherapy, feasible in your setting and for your patients?
> From: Van Waart et al., J Clin Oncol 33 (2016) 1918-1927(Epub ahead of print). All rights reserved to American Society of Clinical Oncology.Click here for the Pubmed summary.