Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial
Open accessAbstract
BACKGROUND: Exercise improves physical functioning and symptom management during breast cancer chemotherapy, but the effects of different doses and types of exercise are unknown. METHODS: A multicenter trial in Canada randomized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy consisting of either a standard dose of 25 to 30 minutes of aerobic exercise (STAN; n = 96), a higher dose of 50 to 60 minutes of aerobic exercise (HIGH; n = 101), or a combined dose of 50 to 60 minutes of aerobic and resistance exercise (COMB; n = 104). The primary endpoint was physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)-36. Secondary endpoints were other physical functioning scales, symptoms, fitness, and chemotherapy completion. All statistical tests were linear mixed model analyses, and the P values were two-sided. RESULTS: Follow-up assessment of patient-reported outcomes was 99.0%. Adjusted linear mixed-model analyses showed that neither HIGH (+0.8; 95% confidence interval [CI] = -0.8 to 2.4; P = .30) nor COMB (+0.5; 95% CI = -1.1 to 2.1; P = .52] were superior to STAN for the primary outcome. In secondary analyses not adjusted for multiple comparisons, HIGH was superior to STAN for the SF-36 physical component summary (P = .04), SF-36 bodily pain (P = .02), and endocrine symptoms (P = .02). COMB was superior to STAN for endocrine symptoms (P = .009) and superior to STAN (P < .001) and HIGH (P < .001) for muscular strength. HIGH was superior to COMB for the SF-36 bodily pain (P = .04) and aerobic fitness (P = .03). No differences emerged for body composition or chemotherapy completion. CONCLUSIONS: A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than standard volumes.
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A recent systematic review concluded that evidence for an exercise benefit to chemotherapy tolerance is insufficient.
“A recent systematic review of exercise and chemotherapy completion rate concluded that, while promising, the evidence for an exercise benefit to chemotherapy tolerance is insufficient(72).”
From Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable (2019) · cites this paper as [72]
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- Authors
- Courneya, K. S., McKenzie, D. C., Mackey, J. R., Gelmon, K., Friedenreich, C. M., Yasui, Y., Reid, R. D., Cook, D., Jespersen, D., Proulx, C., Dolan, L. B., Forbes, C. C., Wooding, E., Trinh, L., & Segal, R. J.
- Affiliations
- Alberta Health Services (CA)
- ORCID
- Venue
- JNCI: Journal of the National Cancer Institute
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-10-22
- Volume
- 105
- Issue
- 23
- Pages
- 1821-1832
- ISSN
- 0027-8874 (ISSN-L)
- 1460-2105
- OpenAlex
- W2125398770
- Cited by
- 297
- References
- 27
- Citations by year
- 2026: 13 · 2025: 16 · 2024: 25 · 2023: 23 · 2022: 19 · 2021: 27 · 2020: 24 · 2019: 25 · 2018: 33 · 2017: 27 · 2016: 24 · 2015: 21 · 2014: 20
- FWCI
- 11.59
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- JNCI Journal of the National Cancer Institute (publishedVersion)
- PubMed (publishedVersion)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Alberta Cancer Foundation
- Canadian Breast Cancer Research Alliance (09843)
- Canada Research Chairs
- Alberta Innovates
- Topics
- Health Sciences › Medicine › Oncology › Cancer survivorship and care
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cancer-related cognitive impairment studies
- Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
- Keywords
- breast cancer, chemotherapy, exercise during cancer treatment, aerobic exercise, resistance training, exercise dose, physical function, bodily pain, endocrine symptoms, muscle strength, cardiorespiratory fitness, body composition, chemotherapy completion, patient-reported outcomes
- MeSH terms
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols, Breast Neoplasms, Canada, Female, Humans, Middle Aged, Physical Fitness, Quality of Life, Exercise, Treatment Outcome, Chemotherapy, Adjuvant, Muscle Strength
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