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

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% VO2max for 25 min/week and 65%-75% VO2max for ≥ 50 min/week. Adherence to the tailored home-based program was assessed by heart rate monitors. Acceptability, tolerability, feasibility, efficacy, change in VO2max, 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 VO2max (-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://ichgcp.net/clinical-trials-registry/NCT03280836 .

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

Conflict of interest statement

The authors report no conflicts of interest.

© 2022. The Author(s).

Figures

Fig. 1

Study CONSORT diagram. Across three centers, 155 breast cancer patients scheduled to begin neoadjuvant chemotherapy were assessed for eligibility. Forty-eight percent were eligible for the study, and 19 women were enrolled. Of the 10 women in the control group, one withdrew after her first chemotherapy infusion and three had significant side effects to chemotherapy which resulted in loss to follow up for exercise testing. In the intervention group, one patient withdrew one week following randomization and another patient was lost to follow up for inability to schedule testing

Fig. 2

Study schema of research activities and neoadjuvant chemotherapy. All baseline testing (cardiopulmonary exercise test (CPET) and surveys) was conducted prior to starting chemotherapy and the exercise intervention was initiated concomitant to chemotherapy. Follow up testing was completed prior to surgical resection. Chemotherapy treatment lasted 16–24 weeks depending on treatment and individual delays. The introductory phase of the intervention lasted 4 weeks, followed by 7 weeks of an intermediate ramp phase. At week 12 the maintenance phase began and continued until chemotherapy and follow-up testing was completed

Fig. 3

Fitness capacity prior to and following neoadjuvant chemotherapy in breast cancer patients. VO2max estimated from a submaximal exercise test is presented for the control (black line) and intervention (dashed line) groups at baseline and follow up. Mean ± SD. *P = 0.04

Fig. 4

Quality of life prior to, during, and following neoadjuvant chemotherapy in breast cancer patients. Leisure score index measured with the Godin Physical Activity Questionnaire (A), P = 0.03, Fatigue Index from the MFSI-SF (B), P = 0.01, impairment in regular daily activities measured with the Work Productivity and Activity Impairment (WPAI) Questionnaire (C), P = 0.02, and several scales derived from the RAND 36-Item Short Form (SF-36) such as pain (D), P = 0.02, physical function (E), P = 0.06, and role of emotions in daily life (F), P = 0.09, are presented for the control (black line) and intervention (dashed line) groups at baseline, midpoint, and follow up. Mean ± std. error mean. *P < 0.05