Effects of exercise in breast cancer patients: implications of the trials within cohorts (TwiCs) design in the UMBRELLA Fit trial

Abstract Purpose The Trials within Cohorts (TwiCs) design aims to overcome problems faced in conventional RCTs. We evaluated the TwiCs design when estimating the effect of exercise on quality of life (QoL) and fatigue in inactive breast cancer survivors. Methods UMBRELLA Fit was conducted within the prospective UMBRELLA breast cancer cohort. Patients provided consent for future randomization at cohort entry. We randomized inactive patients 12–18 months after cohort enrollment. The intervention group (n = 130) was offered a 12-week supervised exercise intervention. The control group (n = 130) was not informed and received usual care. Six-month exercise effects on QoL and fatigue as measured in the cohort were analyzed with intention-to-treat (ITT), instrumental variable (IV), and propensity scores (PS) analyses. Results Fifty-two percent (n = 68) of inactive patients accepted the intervention. Physical activity increased in patients in the intervention group, but not in the control group. We found no benefit of exercise for dimensions of QoL (ITT difference global QoL: 0.8, 95% CI = − 2.2; 3.8) and fatigue, except for a small beneficial effect on physical fatigue (ITT difference: − 1.1, 95% CI = − 1.8; − 0.3; IV: − 1.9, 95% CI = − 3.3; − 0.5, PS: − 1.2, 95% CI = − 2.3; − 0.2). Conclusion TwiCs gave insight into exercise intervention acceptance: about half of inactive breast cancer survivors accepted the offer and increased physical activity levels. The offer resulted in no improvement on QoL, and a small beneficial effect on physical fatigue. Trial registration Netherlands Trial Register (NTR5482/NL.52062.041.15), date of registration: December 07, 2015.

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A Group Dynamics-Based Exercise Intervention to Improve Physical Activity Maintenance in Breast Cancer Survivors

Journal of Physical Activity and Health ◽

10.1123/jpah.2018-0667 ◽

2019 ◽

Vol 16 (9) ◽

pp. 785-791

Author(s):

Heather J. Leach ◽

Katie B. Potter ◽

Mary C. Hidde

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Group Dynamics ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Intervention Group ◽

Group Cohesion ◽

Self Report

Background: To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors. Methods: The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer. Results: Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182–.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11). Conclusions: These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.

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Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23053 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23053-e23053

Author(s):

Linda F. Wang ◽

Yvonne L. Eaglehouse ◽

Janette T. Poppenberg ◽

Jill Brufsky ◽

Emily Geramita ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Physical Function ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Step Test ◽

Control Group ◽

Personal Trainer

e23053 Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.

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Practice and Outcome of Exercise Intervention on Breast Cancer-Specific Quality of Life of Breast Cancer Survivors in Nigeria

Archives of Breast Cancer ◽

10.32768/abc.202183174-182 ◽

2021 ◽

pp. 174-182

Author(s):

Linda C Odikpo ◽

Edith N Chiejina

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Intervention Group ◽

Moderate Intensity ◽

Control Group ◽

Post Intervention

Background: Lifestyle modification like exercise is an essential rehabilitation measure that improves the quality of life (QoL) of women with breast cancer and helps in preventing cancer related complications. This study assessed the practice and outcome of exercise interventions on breast cancer-specific quality of life of survivors in Delta State, Nigeria. Methods: Experimental design was applied with intervention (47) and control (47) groups. This design involved a pre-test, an intervention, and a post-test. Exercise intervention (aerobic, resistance and flexibility exercises, including warm-up with Swiss ball and dance, climbing of stairs, treadmill, stationary exercise bicycle, shoulder, and arm exercises) was administered to the intervention group for twelve weeks. The assessment of breast cancer survivors' specific quality of life in the two groups was done with the English version of The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life Questionnaire (QLQ- EORTC-BR23) before and after the exercise intervention. Results: The overall pre and post-intervention breast cancer-specific functional quality of life was 65.4±22.7 (intervention group); 71.3±23.4 (control group) and 75.05 ±10.4 (intervention group); 58.65±12.9 (control group) while the pre and post breast cancer-specific symptoms QoL was 22.2±6.2 (intervention group); 24.1±9.6 (control group) and 11.8±13.0 (intervention group); 30.9±21.2 (control group), respectively. All the women in the intervention group practiced exercise only at mild/moderate intensity and no notable side effects were observed during the practice by many of them (n=39). Significant differences existed in the overall post-intervention breast cancer-specific functional and symptoms QoL between the two groups (p<0.001) and no significant differences were observed among most of the specific QoL scales in relation to age, duration of diagnosis, and stage of the cancer diagnosis. Conclusion: Exercise remains beneficial to women with breast cancer and has proven to be one of the necessary means to improve their overall well-being. Therefore, healthcare providers that manage these patients in different hospitals should always counsel and support them to initiate the recommended exercises for cancer survivors to enhance their survival.

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A culturally tailored Internet cancer support group for Asian American breast cancer survivors: A randomized controlled pilot intervention study

Journal of Telemedicine and Telecare ◽

10.1177/1357633x16658369 ◽

2016 ◽

Vol 23 (6) ◽

pp. 618-626 ◽

Cited By ~ 17

Author(s):

Wonshik Chee ◽

Yaelim Lee ◽

Eun-Ok Im ◽

Eunice Chee ◽

Hsiu-Min Tsai ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Asian American ◽

Breast Cancer Survivors ◽

Intervention Study ◽

Intervention Group ◽

Control Group ◽

Randomized Controlled ◽

Cancer Support ◽

Pilot Intervention

Introduction The necessity of culturally competent Internet Cancer Support Groups (ICSGs) for ethnic minorities has recently been highlighted in order to increase its attractiveness and usage. The purpose of this study was to determine the preliminary efficacy of a culturally tailored registered-nurse-moderated ICSG for Asian American breast cancer survivors in enhancing the women’s breast cancer survivorship experience. Methods The study included two phases: (a) a usability test and an expert review; and (b) a randomized controlled pilot intervention study. The usability test was conducted among five Asian American breast cancer survivors using a one-month online forum, and the expert review was conducted among five experts using the Cognitive Walkthrough method. The randomized controlled pilot intervention study (a pre-test and post-test design) was conducted among 65 Asian American breast cancer survivors. The data were analysed using content analysis and descriptive and inferential statistics including the repeated ANOVA. Results All users and experts positively evaluated the program and provided their suggestions for the display, educational contents, and user-friendly structure. There were significant positive changes in the support care needs and physical and psychological symptoms ( p < 0.05) of the control group. There were significant negative changes in the uncertainty level of the intervention group ( p < 0.10). Controlling for background and disease factors, the intervention group showed significantly greater improvements than the control group in physical and psychological symptoms and quality of life ( p < 0.10). Discussion The findings supported the positive effects of ICSGs on support care needs, psychological and physical symptoms, and quality of life.

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Influence of a Multidisciplinary Program of Diet, Exercise, and Mindfulness on the Quality of Life of Stage IIA-IIB Breast Cancer Survivors

Integrative Cancer Therapies ◽

10.1177/1534735420924757 ◽

2020 ◽

Vol 19 ◽

pp. 153473542092475

Author(s):

Julia Ruiz-Vozmediano ◽

Sarah Löhnchen ◽

Lucas Jurado ◽

Rosario Recio ◽

Andrea Rodríguez-Carrillo ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Mediterranean Diet ◽

Breast Cancer Survivors ◽

Intervention Program ◽

Intervention Group ◽

Control Group ◽

Cancer Symptoms

Background: Integrative oncology has proven to be a useful approach to control cancer symptoms and improve the quality of life (QoL) and overall health of patients, delivering integrated patient care at both physical and emotional levels. The objective of this randomized trial was to evaluate the effects of a triple intervention program on the QoL and lifestyle of women with breast cancer. Methods: Seventy-five survivors of stage IIA-IIB breast cancer were randomized into 2 groups. The intervention group (IG) received a 6-month dietary, exercise, and mindfulness program that was not offered to the control group (CG). Data were gathered at baseline and at 6 months postintervention on QoL and adherence to Mediterranean diet using clinical markers and validated questionnaires. Between-group differences at baseline and 3 months postintervention were analyzed using Student’s t test for related samples and the Wilcoxon and Mann-Whitney U tests. Results: At 6 months postintervention, the IG showed significant improvements versus CG in physical functioning ( p = .027), role functioning ( p = .028), and Mediterranean diet adherence ( p = .02) and a significant reduction in body mass index ( p = .04) and weight ( p = .05), with a mean weight loss of 0.7 kg versus a gain of 0.55 kg by the CG ( p = .05). Dyspnea symptoms were also increased in the CG versus IG ( p = .066). Conclusions: These results demonstrate that an integrative dietary, physical activity, and mindfulness program enhances the QoL and healthy lifestyle of stage IIA-IIB breast cancer survivors. Cancer symptoms may be better managed by the implementation of multimodal rather than isolated interventions.

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The effect of aerobic exercise on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.244 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 244-244

Author(s):

E. M. Guinan ◽

J. M. Hussey ◽

J. M. Walsh ◽

M. J. Kennedy ◽

E. M. Connolly

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Aerobic Exercise ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Risk Profile ◽

Control Group ◽

Metabolic Risk ◽

Model Assessment ◽

Supervised Exercise

244 Background: Current literature suggests that weight gain during treatment for breast cancer is associated with a poorer prognosis and an increased risk of developing secondary health problems such as the metabolic syndrome (MetSyn). Physical activity (PA) can alter features of the MetSyn and improve body composition by reducing abdominal adiposity. We report metabolic results of a prospective randomized controlled trial (PEACH trial; Walsh JM, et al. [2010] BMC Cancer. 10[42]) which examines the effect of an exercise intervention on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy. Methods: All subjects gave written informed consent and were randomized to an 8-week, twice weekly aerobic exercise intervention programme or a usual care control group consisting of routine medical advice about PA. The five clinical features of the MetSyn were measured: waist circumference (WC), resting blood pressure (BP), triglycerides, high-density lipoprotein cholesterol (HDL-C) and fasting glucose. Insulin resistance was estimated by the homeostatic model assessment (HOMA). Statistical analysis was carried out using independent sample t-tests with significance set at p < 0.05. Results: Twenty-six breast cancer survivors participated (mean (± SD) age 48.13 (8.75) years). At baseline, 50% (n = 13) of subjects were overweight and 23.1% (n = 6) were obese, with 73.1% (n = 19) centrally obese. 34.6% (n = 9) of subjects were classified with the MetSyn. There were no significant differences between groups at baseline. Intention-to-treat analysis showed no significant changes, however, analysis of those who adhered to > 70% of the supervised exercise intervention showed a significant improvement in WC when compared to the control group (p < 0.05). Conclusions: Results show that an 8-week aerobic exercise intervention significantly reduced WC but did not modify other features of the MetSyn. The decrease in WC demonstrated by this short intervention may have important implications in terms of improving survival and the metabolic risk profile of breast cancer survivors. Final follow-up assessments are ongoing and will enable change in WC over time to be evaluated further.

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Breast Cancer Survivors’ Preferences and Barriers Related to ICT-Based Diet and Physical Activity Interventions

Current Developments in Nutrition ◽

10.1093/cdn/nzab051_011 ◽

2021 ◽

Vol 5 (Supplement_2) ◽

pp. 967-967

Author(s):

X Chen ◽

C Chiu ◽

HT Cheung ◽

ME White ◽

X Chen ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Intervention Program ◽

Exercise Intervention ◽

Mobile Apps ◽

Perceived Barriers ◽

Cancer Center ◽

Lifestyle Interventions

Abstract Objectives To establish the preferences and perceived barriers related to physical activity and diet programming of breast cancer survivors (BCS) to inform the development of Information and Communication Technology (ICT)-based lifestyle interventions. Methods This was a cross-sectional study of 197 BSC aged 18 years or older and diagnosed with ductal carcinoma in situ (DCIS) or Stage I-IV breast cancer. The BCS were recruited during routine oncology appointments at a Midwestern cancer center. A survey was conducted to query survivors’ level of interest in, preferences for, and perceived barriers to participating in an exercise and dietary intervention program, with a specific emphasis on ICT-based programming. Results Overall, 85% of BCS reported they would consider participating in exercise and diet intervention research. Approximately 45% of participants reported that they had received diet and/or exercise information as part of their cancer care. However, only 15% of the participants received such information from healthcare professionals with the appropriate expertise (e.g., Dietitian, Exercise Specialist). Over two-thirds of the participants reported frequent use of mobile devices and the internet, and 80% indicated comfort using these devices (e.g., tablet, smart phone). The top three preferred formats for an ICT-based diet and exercise intervention program were “website”, “mobile apps” and “e-mails”. Older participants (>60 years) were more likely to report a preference for e-mails while younger participants (<60 years) were more likely to report a preference for websites or mobile apps. The most common perceived barriers to participation in a lifestyle intervention included fatigue, family responsibility and work. Conclusions Most BCS in this study were interested in exercise and diet interventions and would be comfortable with an ICT-based format with a preference for delivery via websites, mobile apps or e-mails. Future ICT-based lifestyle interventions should be designed with consideration of BCS’ age, barriers, facilitators and other characteristics. Funding Sources USDA-NIFA Hatch Project 1,011,487

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OR-052 Effects of Exercise Intervention on Cancer-Related Fatigue in Breast Cancer Survivors

Exercise Biochemistry Review ◽

10.14428/ebr.v1i2.9833 ◽

2018 ◽

Vol 1 (2) ◽

Author(s):

Zhiling Xie ◽

Weibing Ye

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Aerobic Exercise ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Moderate Intensity ◽

Control Group ◽

Short Term ◽

Cancer Related Fatigue ◽

Significant Difference

Objective cancer-related fatigue(CRF) is the most commonly reported and most distressing symptom in cancer patient.The purpose of this study was to review the effect of exercise intervention on cancer-related fatigue in breast cancer survivors. Methods From 1998 to 2018 in Chinese and English literature of Wanfang Database, Pubmed, SportDiscus and Springer databases, picked out the randomized controlled trials which up to standard. Keywords cancer, exercise, fatigue, etc. were used for systematic search and tracking. 12 experiments were reviewed to analyze the effect differences between exercise intervention and exercise-related fatigue. Results Most interventions use aerobic exercise as the primary form of exercise. Generally, exercise interventions are effective for cancer-related fatigue, but some findings are not. Many studies have shown that moderate intensity aerobic exercise has a significant effect on cancer-related fatigue, with 50-70% heart rate reserve and 3-5 times of exercise per week for at least 30 minutes each time. Exercise methods mainly include walking, yoga, cycling and tai chi. Firstly, Supervised aerobic exercise was statistically more effective than conventional care in improving CRF among breast cancer survivors. It has been shown that group-based, supervised exercise produces positive psychosocial‘side-effects’ due to social interactions, improved self-efficacy, and attention from a trainer. Secondly, Cancer fatigue is divided into acute and chronic fatigue, 18 weeks of exercise intervention can reduce the short-term fatigue, at 36 weeks, baseline levels of fatigue index responses and contrast on the issue of the multivariate statistics. Thirdly, usual-care group were reported that they had been actively engaged in regular exercise before study enrollment. During the exercise intervention, most studies on the control ways are according to the daily life or to take care of, but studies have reported, before intervention, to a high level of 40% in the control group often exercise, exercise also as usual during the intervention, which causes the control to the baseline level is higher, but the intervention group and control group will be difference, no significant difference, lead to the result is invalid. Conclusions First, the exercise intervention of cancer-related fatigue needs to be supervised; second, the exercise intervention is effective for short-term cancer-related fatigue; third, the daily exercise level of the control group will affect the intervention effect.

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Perceived physical fatigability improves after an exercise intervention among breast cancer survivors: A pilot randomized clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12050 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12050-12050

Author(s):

Yujia (Susanna) Qiao ◽

G J. Van Londen ◽

Jill Brufsky ◽

Janette T. Poppenberg ◽

Rebecca W. Cohen ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Cancer Survivors ◽

Randomized Clinical Trial ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Whole Body ◽

Control Group ◽

Patient Reported

12050 Background: Among breast cancer populations, exercise interventions resulted in positive but relatively small improvements on fatigue, which may have been masked by using single-item, non-specific measures of global fatigue. Perceived fatigability – whole-body tiredness anchored to standardized tasks/activities of specific intensity and duration – accounts for self-pacing bias as an individual likely titrates their usual activities and exertion level to avoid exhaustion. We examined whether this novel fatigability measure could replace global fatigue in an exercise intervention trial in breast cancer survivors. Methods: This pilot single-center randomized clinical trial of 49 breast cancer survivors was conducted from 2015-17, among which 41 participants (exercise = 22, control = 19) completed the trial and reported their perceived physical fatigability and global fatigue at the first (V1) and the last visit (V3). Perceived physical fatigability was measured using the 10-item, self-administered Pittsburgh Fatigability Scale (PFS) scored 0-50, higher PFS Physical scores = greater fatigability. Global fatigue was assessed with a single question “I have a lack of energy” scored 0 “not at all” to 4 “very much” from the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). The exercise intervention consisted of three one-on-one training sessions over 6-14 weeks, plus two optional email/phone consultations. The trainer developed a personalized, home-based exercise program with a goal of achieving the recommended ≥150 minutes/week of moderate to vigorous exercise based on ACSM guidelines. Those randomized to the control group met the trainer for V1 and again 6-14 weeks later at V3, but no exercise prescription was provided. We computed mean differences in perceived physical fatigability and global fatigue between V3 and V1 and compared by intervention groups. Results: Among the 41 women in the study (mean age = 54.9±9.8 years; 80% white), sociodemographic and clinical characteristics were similar by intervention groups, except for antiestrogen use. Post-intervention changes (mean ± SE) in PFS Physical scores were -4.4±1.4 (-22.5%) in the exercise group and 0.2±1.4 (+1.0%) in the control group (p =.022), whereas change in global fatigue scores were -0.64±0.23 in the exercise group and 0.00±0.22 in the control group (p =.054). Conclusions: These findings add to mounting evidence that an exercise intervention reduces fatigue among breast cancer survivors. Importantly, the PFS showed a clinically meaningful reduction after the exercise intervention that was masked when using global fatigue as the measurement. Therefore, the PFS serves as a more sensitive instrument to measure perceived physical fatigability and can better evaluate patient-reported outcomes in future cancer trials, especially those focused on cancer survivorship. Clinical trial information: NCT 02770781.

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Effects of Mindfulness-Based Stress Reduction (MBSR) on Health Among Breast Cancer Survivors

Western Journal of Nursing Research ◽

10.1177/0193945910385363 ◽

2010 ◽

Vol 33 (8) ◽

pp. 996-1016 ◽

Cited By ~ 40

Author(s):

Yaowarat Matchim ◽

Jane M. Armer ◽

Bob R. Stewart

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Stress Reduction ◽

Breast Cancer Survivors ◽

Early Stage ◽

Intervention Group ◽

Psychological Outcomes ◽

Control Group ◽

Control Group Design ◽

Quasi Experimental

The purpose of this study was to examine the effects of a MBSR program on physiological and psychological outcomes among early-stage breast cancer survivors. A quasi-experimental, pre-and posttest control group design was selected. The intervention group received the MBSR intervention. The control group received no MBSR intervention. ANOVA and ANCOVA were used to analyze data. The intervention group demonstrated statistically significant improvement in physiological and psychological outcomes including reduced blood pressure, heart rate, and respiratory rate and increased mindfulness state at the level of p = .05 to p = .001. The effects of MBSR on reducing stress in this sample were statistically significant on the physiological outcome (morning cortisol) at the measurement after the intervention completion, but this effect was not sustained at 1-month follow-up. MBSR showed a trend toward improving psychological outcomes by reducing mood disturbance in this sample.

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