Concurrent Exercise Interventions in Breast Cancer Survivors with Cancer-related Fatigue

Abstract

This study compared the effects of two supervised concurrent training interventions in breast cancer survivors with cancer-related fatigue at baseline. Twenty-three female breast cancer survivors (50±8 years) were randomized to a high- (n=13) or a moderate-intensity (n=10) training program. Both interventions lasted 16 weeks and included the same resistance exercises, but the aerobic component was supervised and more intense in the former (i.e., rating of perceived exertion of 7–8 vs. 6 on a 1–10 scale for the high and moderate-intensity intervention, respectively). The primary endpoint was fatigue perception. Endpoints were assessed at baseline and after 16 weeks. The p-value for statistical significance was set at 0.004 after Bonferroni correction for multiple comparisons. The high-intensity training program increased lower-limb muscle strength significantly (p=0.002) and tended to improve fatigue perception (p=0.006), waist circumference (p=0.013), neutrophil-to-lymphocyte ratio (p=0.028) and some quality of life items (p=0.011). Although the moderate-intensity training program did not provide such benefits in general (i.e., higher p-values for pre vs post-intervention comparisons), no significant differences were found between interventions (all p>0.004). Further research is needed to elucidate if the benefits provided by high-intensity concurrent training are superior to those elicited by moderate-intensity training in breast cancer survivors.

Key words

exercise is medicine - physical activity - high-intensity training - quality of life - body composition - physical fitness

Publikationsverlauf

Eingereicht: 17. September 2019

Angenommen: 19. März 2020

Artikel online veröffentlicht:
29. Juni 2020

• References

• 1 Bray F, Ferlay J, Soerjomataram I. et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68: 394-424
• 2 Allemani C, Weir HK, Carreira H. et al. Global surveillance of cancer survival 1995-2009: analysis of individual data for 25 676 887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 2015; 385: 977-1010
• 3 Schmidt ME, Chang-Claude J, Vrieling A. et al. Fatigue and quality of life in breast cancer survivors: temporal courses and long-term pattern. J Cancer Surviv 2012; 6: 11-19
• 4 Winters-Stone KM, Bennett JA, Nail L. et al. Strength, physical activity, and age predict fatigue in older breast cancer survivors. Oncol Nurs Forum 2008; 35: 815-821
• 5 Kilgour RD, Vigano A, Trutschnigg B. et al. Cancer-related fatigue: The impact of skeletal muscle mass and strength in patients with advanced cancer. J Cachexia Sarcopenia Muscle 2010; 1: 177-185
• 6 Neil SE, Klika RJ, Garland SJ. et al. Cardiorespiratory and neuromuscular deconditioning in fatigued and non-fatigued breast cancer survivors. Support Care Cancer 2013; 21: 873-881
• 7 Cleeland CS, Bennett GJ, Dantzer R. et al. Are the symptoms of cancer and cancer treatment due to a shared biologic mechanism? A cytokine-immunologic model of cancer symptoms. Cancer 2003; 97: 2919-2925
• 8 Saligan LN, Olson K, Filler K. et al. The biology of cancer-related fatigue: A review of the literature. Support Care Cancer 2015; 23: 2461-2478
• 9 Thornton LM, Andersen BL, Blakely WP. The pain, depression, and fatigue symptom cluster in advanced breast cancer: covariation with the hypothalamic-pituitary-adrenal axis and the sympathetic nervous system. Health Psychol 2010; 29: 333-337
• 10 Schmidt ME, Semik J, Habermann N. et al. Cancer-related fatigue shows a stable association with diurnal cortisol dysregulation in breast cancer patients. Brain Behav Immun 2016; 52: 98-105
• 11 Sha F, Zhuang S, Zhou L. et al. Biomarkers for cancer-related fatigue and adverse reactions to chemotherapy in lung cancer patients. Mol Clin Oncol 2015; 3: 163-166
• 12 Ruiz-Casado A, Verdugo AS, Solano MJ. et al. Objectively assessed physical activity levels in Spanish cancer survivors. Oncol Nurs Forum 2014; 41: E12-20
• 13 Peel JB, Sui X, Adams SA. et al. A prospective study of cardiorespiratory fitness and breast cancer mortality. Med Sci Sports Exerc 2009; 41: 742-748
• 14 Klassen O, Schmidt ME, Ulrich CM. et al. Muscle strength in breast cancer patients receiving different treatment regimes. J Cachexia Sarcopenia Muscle 2017; 8: 305-316
• 15 Caan BJ, Cespedes Feliciano EM, Prado CM. et al. Association of muscle and adiposity measured by computed tomography with survival in patients with nonmetastatic breast cancer. JAMA. Oncol 2018; 4: 798-804
• 16 Christensen JF, Jones LW, Andersen JL. et al. Muscle dysfunction in cancer patients. Ann Oncol 2014; 25: 947-958
• 17 Shachar SS, Williams GR, Muss HB. et al. Prognostic value of sarcopenia in adults with solid tumours: A meta-analysis and systematic review. Eur J Cancer 2016; 57: 58-67
• 18 Fuller JT, Hartland MC, Maloney LT. et al. Therapeutic effects of aerobic and resistance exercises for cancer survivors: A systematic review of meta-analyses of clinical trials. Br J Sports Med 2018; 52: 1311
• 19 Padilha CS, Marinello PC, Galvão DA. et al. Evaluation of resistance training to improve muscular strength and body composition in cancer patients undergoing neoadjuvant and adjuvant therapy: A meta-analysis. J Cancer Surviv 2017; 11: 339-349
• 20 Sweegers MG, Altenburg TM, Brug J. et al. Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: A meta-analysis of individual patient data. Br J Sports Med 2019; 53: 812
• 21 Toohey K, Pumpa K, McKune A. et al. High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes. J Cancer Res Clin Oncol 2018; 144: 1-12
• 22 Moher D, Schulz KF, Altman DG. et al. The CONSORT statement: Revised recommendations for improving the quality of reports of parallel group randomized trials. BMC Med Res Methodol 2001; 1: 2
• 23 Chan AW, Tetzlaff JM, Gøtzsche PC. et al. SPIRIT 2013 explanation and elaboration: guidance for protocols of clinical trials. BMJ 2013; 346: e7586
• 24 Harriss DJ, Macsween A, Atkinson G. Ethical standards in sport and exercise science research: 2020 update. Int J Sports Med 2019; 40: 813-817
• 25 World Health Organization W. Global recommendations on physical activity for health. In: http://apps.who.int/iris/handle/10665/44399; 2010
• 26 Borg GA. Psychophysical bases of perceived exertion. Med Sci Sports Exerc 1982; 14: 377-381
• 27 Santana Sosa E, Groeneveld IF, Gonzalez-Saiz L. et al. Intrahospital weight and aerobic training in children with cystic fibrosis: A randomized controlled trial. Med Sci Sports Exerc 2012; 44: 2-11
• 28 Baró E, Carulla J, Cassinello J. et al. Psychometric properties of the Perform Questionnaire: A brief scale for assessing patient perceptions of fatigue in cancer. Support Care Cancer 2011; 19: 657-666
• 29 Santos-Lozano A, Marín PJ, Torres-Luque G. et al. Technical variability of the GT3X accelerometer. Med Eng Phys 2012; 34: 787-790
• 30 Lucía A, Pardo J, Durántez A. et al. Physiological differences between professional and elite road cyclists. Int J Sports Med 1998; 19: 342-348
• 31 Ruiz-Ruiz J, Mesa JL, Gutiérrez A. et al. Hand size influences optimal grip span in women but not in men. J Hand Surg Am 2002; 27: 897-901
• 32 Arraras J, Illarramendi J, Valerdi J. El Cuestionario de Calidad de Vida para cáncer de la EORTC, QLQ-C30. Estudio estadístico de validación con una muestra española. Revista de Psicología de la Salud 1995; 7: 13-33
• 33 Arraras J, Tejedor M, Illarramendi J. et al. El cuestionario de calidad de vida para cáncer de mama de la EORTC, QLQ-BR23. Estudio psicométrico con una muestra española. Psicol Conduct 2001; 9: 81-98
• 34 Rogers LQ, Vicari S, Trammell R. et al. Biobehavioral factors mediate exercise effects on fatigue in breast cancer survivors. Med Sci Sports Exerc 2014; 46: 1077-1088
• 35 Cella D, Davis K, Breitbart W. et al. Cancer-related fatigue: prevalence of proposed diagnostic criteria in a United States sample of cancer survivors. J Clin Oncol 2001; 19: 3385-3391
• 36 Lipsett A, Barrett S, Haruna F. et al. The impact of exercise during adjuvant radiotherapy for breast cancer on fatigue and quality of life: A systematic review and meta-analysis. Breast 2017; 32: 144-155
• 37 Mijwel S, Backman M, Bolam KA. et al. Adding high-intensity interval training to conventional training modalities: Optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial. Breast Cancer Res Treat 2018; 168: 79-93
• 38 Adams SC, DeLorey DS, Davenport MH. et al. Effects of high-intensity interval training on fatigue and quality of life in testicular cancer survivors. Br J Cancer 2018; 118: 1313-1321
• 39 Dibaba DT, Ogunsina K, Braithwaite D. et al. Metabolic syndrome and risk of breast cancer mortality by menopause, obesity, and subtype. Breast Cancer Res Treat 2019; 174: 209-218
• 40 Azab B, Bhatt VR, Phookan J. et al. Usefulness of the neutrophil-to-lymphocyte ratio in predicting short- and long-term mortality in breast cancer patients. Ann Surg Oncol 2012; 19: 217-224
• 41 Fu TC, Wang CH, Lin PS. et al. Aerobic interval training improves oxygen uptake efficiency by enhancing cerebral and muscular hemodynamics in patients with heart failure. Int J Cardiol 2013; 167: 41-50
• 42 Scott JM, Zabor EC, Schwitzer E. et al. Efficacy of exercise therapy on cardiorespiratory fitness in patients with cancer: A systematic review and meta-analysis. J Clin Oncol 2018; 36: 2297-2305