A clinical trial comparing three intensity physical activity programs and different modality from women with breast cancer and treated with chemotherapy.
A Canadian randomized controlled trial of Courneya and colleagues published in the Journal of the National Cancer Institute in 2013, compared the effectiveness of three physical activity programs on physical functioning, fatigue, physical condition and the rate of completion of chemotherapy in patients treated for breast cancer. The results show that a high dose of exercise is more effective than standard dose. A high volume endurance exercise slows the negative impact of chemotherapy on aerobic capacity, physical functioning, bodily pain, fatigue and endocrine symptoms. A program combining endurance and strength training improves muscle fitness and attenuated worsening of endocrine symptoms.
The Study Rationale
Physical exercise endurance and muscle building, separate or combined, improve physical functioning and management of symptoms in patients treated with chemotherapy for breast cancer. Some clinical studies have compared the doses and types of physical exercises to highlight optimal prescribing and derive the best benefits. However, it is unclear whether the effects are due to an effect of the type of exercise or simply an effect of the dose of exercise. This trial is designed to compare the efficacy of doses and different types of exercises on physical functioning and symptoms of patients with cancer and treated with chemotherapy.
The benefits of a physical activity program found in many studies they are from the dose of physical activity, type, or combination of both?
At what dose and according to what effort do we get the best benefits on the physical, symptom management and fatigue during breast cancer chemotherapy treatments?
The Canadian controlled randomized trial Courneya and colleagues compared three groups with a program of physical activities separate. 301 patients over 18 years with breast cancer stage I to III and being treated with chemotherapy, were enrolled in three Canadian hospitals (Edmonton, Ottawa and Vancouver).
Patients were evaluated with questionnaires and physical tests at the beginning and end of chemotherapy. They have ironed these evaluations at six months, one year and two years.
The Non-Pharmacological Intervention (NPI) assessed
The three programs of Adapted Physical Activities debuted in the first two weeks of the start of chemotherapy and ended between three and four weeks after the end of chemotherapy. Endurance exercises were carried out on exercise bike, elliptical bike, treadmill or rowing machine carpet. Early in the program, the intensity was set at between 55% and 60% of VO2max. At 6 weeks, it was set between 70% and 75% of VO2max. All programs were supervised by a trained professional. Exercise programs were as follows.
Patients should achieve 75 minutes per week of intense endurance exercise. The sessions are spread over three days of the week. Each session lasted 25 to 30 minutes.
Patients should achieve 150 minutes of endurance exercise a week, three days a week. Each session lasted 50 to 60 minutes.
Patients followed the same endurance program STAN. In addition, they had to perform strengthening exercises. This included two sets of 10 to 12 repetitions of 9 classic exercises muscle building (leg extension, leg curl, press, extension of calves, bench press, work trapezoids, extension of triceps, bicep curls, abdominal). The maximum load was estimated between 60% and 75% of the maximum weight that can lift patients (one repetition maximum). The program combined COMB 30-35 minute strength training 25 to 30 minutes of endurance exercise for a total of 50-60 minutes per session. The program therefore lasted 150 minutes per week.
The program HIGH (150 minutes of endurance effort week) further reduces body pain and fatigue that the STAN program (75 minutes of endurance effort week). The reduction in body pain is also greater with HIGH COMB program with the program.
The HIGH COMB and programs are more effective in reducing symptoms as endocrine STAN program.
The COMB program better profits on muscle strength and endurance that STAN programs and HIGH. The study showed no difference between the three programs of physical activity on overall physical functioning.
No health problems were reported among participants.
Two and a half hours per week of physical endurance or practice combining endurance and strength training improve the health status and quality of life of patients and do not interfere with chemotherapy.
What it means for Patients
Any patient treated for breast cancer should practice two hours and a half of sustained physical activity during the period of chemotherapy. Efforts can be combined or endurance (stamina and muscle building). They should be supervised by professionals of Adapted Physical Activities.
What it means for Healthcare Professionals
Any patient treated for breast cancer should practice two hours and a half of sustained physical activity during chemotherapy to reduce side effects, increase fitness and improve quality of life. This practice should register routinely in cancer supportive care. It is necessary to recommend them to patients since a professional supervises to avoid problems.
What it means for Researchers
This multicenter clinical trial is innovative about the type and dose of physical activity for patients treated with chemotherapy for breast cancer.
What it means for Policymakers
A physical activity program supervised by a professional of Adapted Physical Activities combining or not endurance exercises with muscle building exercises at a high intensity is feasible and safe during chemotherapy for breast cancer patients
Courneya KS, McKenzie DC, Mackey JR, Gelmon K, Friedenreich CM, Yasui Y, Reid RD, Cook D, Jespersen D, Proulx C, Dolan LB, Forbes CC, Wooding E, Trinh L (2013). Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. Journal of the National Cancer Institute, 105, 1821-1832.
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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.