Feasibility of a tailored home-based exercise intervention during neoadjuvant chemotherapy in breast cancer patients

Kathleen M Sturgeon; Amanda M Smith; Elizabeth H Federici; Namratha Kodali; Renée Kessler; Edward Wyluda; Leah V Cream; Bonnie Ky; Kathryn H Schmitz

doi:10.1186/s13102-022-00420-6

Feasibility of a tailored home-based exercise intervention during neoadjuvant chemotherapy in breast cancer patients

BMC Sports Sci Med Rehabil. 2022 Feb 25;14(1):31. doi: 10.1186/s13102-022-00420-6.

Authors

Kathleen M Sturgeon^{1

2}, Amanda M Smith³, Elizabeth H Federici⁴, Namratha Kodali⁴, Renée Kessler⁵, Edward Wyluda⁴, Leah V Cream⁴, Bonnie Ky³, Kathryn H Schmitz⁶

Affiliations

¹ Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA. Kms99@psu.edu.
² Department of Public Health Sciences, Milton S. Hershey Medical Center, Penn State College of Medicine, Penn State Cancer Institute, 500 University Drive, mail code CH69, Hershey, PA, 17033, USA. Kms99@psu.edu.
³ School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
⁴ Department of Hematology/Oncology, Penn State College of Medicine, Hershey, PA, USA.
⁵ Penn State Health Medical Group, Andrews Patel Hematology/Oncology, Harrisburg, PA, USA.
⁶ Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA, USA.

Abstract

Purpose: To evaluate the feasibility of a home-based moderate-to-vigorous intensity, phased (introduction, intermediate, maintenance), exercise prescription in breast cancer patients receiving cardiotoxic neoadjuvant chemotherapy.

Methods: Nineteen breast cancer patients were randomized to intervention or control for the duration of chemotherapy (16-24 weeks). The intervention was one aerobic exercise session at 80-90% VO_2max for 25 min/week and 65%-75% VO_2max for ≥ 50 min/week. Adherence to the tailored home-based program was assessed by heart rate monitors. Acceptability, tolerability, feasibility, efficacy, change in VO_2max, and patient reported outcomes, safety, and clinical events were assessed.

Results: 25.7% of eligible women consented (acceptability). Adherence was 87.6%. Women were not able to maintain exercise intensity as chemotherapy progressed (23.7% of exercise minutes were completed at prescribed heart rate during maintenance). Efficacy of the intervention was demonstrated by maintenance of VO_2max (-1.0 ± 13.2%) compared to (-27.5 ± 7.4%) the control group. Further, during and after therapy, patients in the intervention arm reported less fatigue (control-baseline: 14.4 ± 15.9; midpoint: 19.0 ± 11.4; follow-up: 29.4 ± 20.0; intervention-baseline: 29.2 ± 24.6; midpoint: 24.6 ± 14.4; follow-up: 23.6 ± 11.9), impairment in activities (control-baseline: 13.7 ± 16.0; midpoint: 32.8 ± 17.0; follow-up: 58.6 ± 27.9; intervention-baseline: 38.7 ± 31.8; midpoint: 47.1 ± 27.5; follow-up: 47.5 ± 31.0), and pain (control-baseline: 80.8 ± 17.1; midpoint: 73.9 ± 20.7; follow-up: 50.7 ± 25.7; intervention-baseline: 68.7 ± 28.4; midpoint: 61.4 ± 22.5; follow-up: 65.3 ± 22.4). There were no differences in adverse events, treatment delays, or pathological complete response.

Conclusions: Neoadjuvant breast cancer patients maintained approximately one hour/week of moderate-intensity exercise over the course of their treatment. Further, this volume of exercise was sufficient to maintain fitness capacity and quality of life compared to the control group.

Trial registry: ClinicalTrials.gov Identifier: NCT03280836, prospectively registered 9/13/2017, https://clinicaltrials.gov/ct2/show/NCT03280836 .

Keywords: Aerobic exercise; Drug therapy; Fitness; Home-based; Quality of life.

Associated data

ClinicalTrials.gov/NCT03280836

Abstract

Associated data

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