A clinical trial comparing the effectiveness of two types of physical activity programs on fitness, fatigue, quality of life and the rate of implementation of the programmed chemotherapy in patients treated for breast cancer or colon.
A Dutch randomized controlled trial of van Waart and his colleagues, published in the Journal of Clinical Oncology in 2015, for 6 months compares the effectiveness of two programs of physical activity on physical fitness, fatigue, related quality of life health, the rate of completion of chemotherapy and possible return to work of patients treated with chemotherapy for breast or colon cancer. The results show an improvement of quality of life indicators, fatigue and fitness for patients who participated in two programs of physical activity compared to those who have not benefited.
The Study Rationale
Chemotherapy of cancer has proven effective in increasing patient survival. However, this treatment causes side effects such as fatigue, muscle atrophy, reduced physical fitness, nausea, vomiting, pain and constipation. Beyond these symptoms that significantly impact daily activities, social relationships and quality of life of patients, these side effects weaken to the point patients to prevent the administration of optimal chemotherapy dose. In other words, patients easily tolerate treatment and suffer from health problems (pain, infections, dyspnea, edema, neuropathy, heart failure) sufficient to delay chemotherapy until sometimes stop in case of force majeure. Its efficiency is further reduced.
Studies are beginning to show that physical activity program put in place during chemotherapy is beneficial on fatigue, muscle strength, the completion rate of chemotherapy and the quality of life. This clinical trial is designed to compare for the first time two types of program, one home consists of low intensity exercises called “Onco-Move” and the other combining supervised endurance exercise and muscle building called ” OnTrack “.
A program of physical activity could mitigate side effects of cancer chemotherapy.
What type of exercise program recommended during chemotherapy?
The Dutch randomized controlled trial de Waart and colleagues compared two types of physical activity programs during chemotherapy, one home “Onco-Move” and the other supervised “On Track” standard care. The study evaluates their effectiveness on physical fitness, fatigue, quality of life related to health, the completion rate of chemotherapy and the return to employment. The study included 230 patients with colon cancer or breast cancer, 71 in the group “OnTrack”, 62 in the group “Onco-Move” and 64 in the control group. 12 Dutch hospitals participated in this study. It began during the first cycle of chemotherapy and continuing until three weeks after the last administered cycle. The physical tests and questionnaires were performed at three different times: at the start of chemotherapy (T0) at the end of chemotherapy (T1) and 6 months later (T2).
The physical tests mainly included an assessment of cardiorespiratory fitness and muscle strength. The questionnaires included, among others, the evaluation of fatigue using the Multidimensional Fatigue Inventory (MFI) and the quality of health-related life (EORTC QLQ-C30). The completion rate of chemotherapy was evaluated by the number of patients for whom chemotherapy doses were reduced.
The Non-Pharmacological Intervention (NPI) assessed
The “Onco-Move” program aimed to reduce the side effects of chemotherapy and improve the endurance of the participants. It was to make individual home physical exercises of low intensity. Trained nurses encouraged the participants to achieve at least 30 minutes of physical activity a day, five days a week. The intensity level of effort was set between 12 and 14 on the Borg Scale.
The “On Track” program was also designed to reduce side effects of chemotherapy and improve the physical condition of participants. He asked participants to perform supervised exercise of moderate to high intensity. This program combined endurance exercise and muscle building. The sessions were held twice a week. They were supervised by a teacher trained in adapted physical activities supportive care. Strength training was to solicit 6 major muscle groups for 20 minutes, with 2 sets of 8-80 repetitions% of repetition maximum (1RM). Each session was then followed by 30 minutes of endurance exercise. The intensity was between 50% and 80% of the maximum working load estimated by the Steep Ramp Test. The participants in this group were encouraged to be physically active 30 minutes a day, five days a week.
The study shows that at the end of the chemotherapy cycle programs “On Track” and “Onco-Move” improve fitness, aerobic fitness, muscle strength, fatigue, nausea, completion rates chemotherapy compared to control patients and delays return to work. The benefits of the supervised program are higher than in the home program except at nausea. The authors argue to say that the exercise could have a protective role against cardio-toxicity of chemotherapy.
Six months after chemotherapy, researchers observed more statistical differences between the three groups. The values returned to their level before chemotherapy.
Endurance and muscle building exercises conducted as part of a program supervised by a professional in adapted physical activities for two sessions per week are better than standard care and an endurance program at home unsupervised.
What it means for Patients
Endurance and muscle building exercises conducted as part of a program supervised by a professional in adapted physical activities for two sessions per week are better than standard care and an endurance program at home unsupervised. For more reluctant, physical endurance activity at home remains an effective alternative.
What it means for Healthcare Professionals
A supervised program of adapted physical activities of moderate to high, 150 minutes a week, is the most appropriate to fight against the decline of cardiorespiratory endurance and muscle strength and increased fatigue during a chemotherapy. In addition, it allows a better tolerance to treatments. The unsupervised endurance program presents lower profits.
What it means for Researchers
This is one of the first clinical trials comparing physical activity programs in the manner (supervised vs. unsupervised) and intensity (low vs. moderate / high). Future studies should be carried out to assess the behavioral barriers to the practice of physical activity during and after cancer treatment. It would also be interesting to develop new behavioral approaches to encourage reluctant patients to become more active.
What it means for Policymakers
Conducting a physical activity of medium / high or mild is safe and effective for chemotherapy of cancer. Both physical activity programs are preferable to standard care during treatment of cancer.
A supervised program of adapted physical activities of moderate to high, 150 minutes a week, is the most appropriate program to fight against the decline of cardiorespiratory endurance and muscle strength and increased fatigue during a chemotherapy. In addition, it allows a better tolerance to treatment and facilitates a faster return to work activities. Thus, adapted physical activity programs should be systematically integrated in the cancer supportive care.
Van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM, Maaker-Berkhof M, Boven E, Schrama J, Geenen MM, Meerum Terwogt JM, van Bochove A, Lustig V, van den Heiligenberg SM, Smorenburg CH, Hellendoorn-van Vreeswijk JA, Sonke GS, Aaronson NK (2015). Effect of Low-Intensity Physical Activity and Moderate-to High-intensity Physical Exercise During Adjuvant Chemotherapy on Physical Fitness, Fatigue, and Chemotherapy Completion Rates: Results of the PACES Randomized Clinical Trial. Journal of Clinical Oncology, 33, 1918-1927.
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To reference this Blog en Sante © article
Ninot G (2015). All physical activities are not equal during chemotherapy. Blog en Sante, A51.
© Copyright 2015 Gregory Ninot. All rights reserved.