Feasibility and Health Benefits of an Individualized Physical Activity Intervention in Women With Metastatic Breast Cancer: Intervention Study

Lidia Delrieu, Vincent Pialoux, Olivia Pérol, Magali Morelle, Agnès Martin, Christine Friedenreich, Olivia Febvey-Combes, David Pérol, Elodie Belladame, Michel Clémençon, Eva Roitmann, Armelle Dufresne, Thomas Bachelot, Pierre Etienne Heudel, Marina Touillaud, Olivier Trédan, Béatrice Fervers, Lidia Delrieu, Vincent Pialoux, Olivia Pérol, Magali Morelle, Agnès Martin, Christine Friedenreich, Olivia Febvey-Combes, David Pérol, Elodie Belladame, Michel Clémençon, Eva Roitmann, Armelle Dufresne, Thomas Bachelot, Pierre Etienne Heudel, Marina Touillaud, Olivier Trédan, Béatrice Fervers

Abstract

Background: There is limited knowledge regarding the potential benefits of physical activity in patients with metastatic breast cancer.

Objective: The Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial aimed to assess the feasibility of a physical activity intervention in women with metastatic breast cancer and to explore the effects of physical activity on functional, psychological, and clinical parameters.

Methods: The ABLE Trial was a single-arm, 6-month intervention study with a home-based, unsupervised, and personalized walking program using an activity tracker. At baseline and 6 months, we assessed anthropometrics, functional fitness, physical activity level, sedentary behavior, quality of life, fatigue, and tumor progression. Paired proportions were compared using the McNemar test and changes of parameters during the intervention were analyzed using the Wilcoxon signed-rank test, the Mann-Whitney test, and Spearman rank correlations.

Results: Overall, 49 participants (mean age 55 years; recruitment rate 94%) were enrolled and 96% adhered to the exercise prescription (attrition rate 2%). Statistically significant improvements in the 6-minute walking distance test (+7%, P<.001) and isometric quadriceps strength (+22%, P<.001), as well as decreases in body mass index (-2.5%, P=.03) and hip circumference (-4.0%, P<.001) were observed at 6 months. Quality of life remained stable and a nonstatistically significant decrease (-16%, P=.07) in fatigue was observed.

Conclusions: The high recruitment and adherence rates suggest the willingness of patients with metastatic breast cancer to participate in a physical activity program. The beneficial outcomes regarding physical fitness and anthropometry of this unsupervised physical activity program may encourage these patients to maintain a physically active lifestyle. Future randomized controlled trials with larger sample sizes are warranted.

Trial registration: ClinicalTrials.gov NCT03148886; https://ichgcp.net/clinical-trials-registry/NCT03148886.

Keywords: activity trackers; feasibility; metastatic breast cancer; physical activity; tumor progression.

Conflict of interest statement

Conflicts of Interest: None declared.

©Lidia Delrieu, Vincent Pialoux, Olivia Pérol, Magali Morelle, Agnès Martin, Christine Friedenreich, Olivia Febvey-Combes, David Pérol, Elodie Belladame, Michel Clémençon, Eva Roitmann, Armelle Dufresne, Thomas Bachelot, Pierre Etienne Heudel, Marina Touillaud, Olivier Trédan, Béatrice Fervers. Originally published in JMIR mHealth and uHealth (http://mhealth.jmir.org), 28.01.2020.

Figures

Figure 1
Figure 1
Flowchart of the Advanced stage Breast cancer and Lifestyle Exercise (ABLE) Trial.

References

    1. O'Shaughnessy J. Extending survival with chemotherapy in metastatic breast cancer. Oncologist. 2005;10 Suppl 3:20–29. doi: 10.1634/theoncologist.10-90003-20.
    1. Diaby V, Tawk R, Sanogo V, Xiao H, Montero AJ. A review of systematic reviews of the cost-effectiveness of hormone therapy, chemotherapy, and targeted therapy for breast cancer. Breast Cancer Res Treat. 2015 May;151(1):27–40. doi: 10.1007/s10549-015-3383-6.
    1. Cardoso F, Costa A, Senkus E, Aapro M, André F, Barrios CH, Bergh J, Bhattacharyya G, Biganzoli L, Cardoso MJ, Carey L, Corneliussen-James D, Curigliano G, Dieras V, El Saghir N, Eniu A, Fallowfield L, Fenech D, Francis P, Gelmon K, Gennari A, Harbeck N, Hudis C, Kaufman B, Krop I, Mayer M, Meijer H, Mertz S, Ohno S, Pagani O, Papadopoulos E, Peccatori F, Penault-Llorca F, Piccart MJ, Pierga JY, Rugo H, Shockney L, Sledge G, Swain S, Thomssen C, Tutt A, Vorobiof D, Xu B, Norton L, Winer E. 3rd ESO-ESMO International Consensus Guidelines for Advanced Breast Cancer (ABC 3) Ann Oncol. 2017 Jan 01;28(1):16–33. doi: 10.1093/annonc/mdw544.
    1. Cardoso F, Spence D, Mertz S, Corneliussen-James D, Sabelko K, Gralow J, Cardoso MJ, Peccatori F, Paonessa D, Benares A, Sakurai N, Beishon M, Barker SJ, Mayer M. Global analysis of advanced/metastatic breast cancer: Decade report (2005-2015) Breast. 2018 Jun;39:131–138. doi: 10.1016/j.breast.2018.03.002.
    1. Rautalin M, Färkkilä N, Sintonen H, Saarto T, Taari K, Jahkola T, Roine RP. Health-related quality of life in different states of breast cancer: Comparing different instruments. Acta Oncol. 2018 May;57(5):622–628. doi: 10.1080/0284186X.2017.1400683.
    1. Dimeo FC. Effects of exercise on cancer-related fatigue. Cancer. 2001 Sep 15;92(6 Suppl):1689–1693. doi: 10.1002/1097-0142(20010915)92:6+<1689::aid-cncr1498>;2-h.
    1. Speck RM, Courneya KS, Mâsse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. J Cancer Surviv. 2010 Jun;4(2):87–100. doi: 10.1007/s11764-009-0110-5.
    1. Velthuis MJ, Agasi-Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer-related fatigue during cancer treatment: A meta-analysis of randomised controlled trials. Clin Oncol (R Coll Radiol) 2010 Apr;22(3):208–221. doi: 10.1016/j.clon.2009.12.005.
    1. Lowe SS, Watanabe SM, Baracos VE, Courneya KS. Physical activity interests and preferences in palliative cancer patients. Support Care Cancer. 2010 Nov;18(11):1469–1475. doi: 10.1007/s00520-009-0770-8.
    1. Dittus KL, Gramling RE, Ades PA. Exercise interventions for individuals with advanced cancer: A systematic review. Prev Med. 2017 Nov;104:124–132. doi: 10.1016/j.ypmed.2017.07.015.
    1. Physical Activity in Patients With Metastatic Bone Disease: Guidance for Healthcare Professionals. London, UK: Macmillan Cancer Support; 2018. [2019-11-28]. .
    1. Lowe SS, Watanabe SM, Courneya KS. Physical activity as a supportive care intervention in palliative cancer patients: A systematic review. J Support Oncol. 2009;7(1):27–34.
    1. Wright SP, Hall Brown TS, Collier SR, Sandberg K. How consumer physical activity monitors could transform human physiology research. Am J Physiol Regul Integr Comp Physiol. 2017 Mar 01;312(3):R358–R367. doi: 10.1152/ajpregu.00349.2016.
    1. Kooiman TJ, Dontje ML, Sprenger SR, Krijnen WP, van der Schans CP, de Groot M. Reliability and validity of ten consumer activity trackers. BMC Sports Sci Med Rehabil. 2015;7:24. doi: 10.1186/s13102-015-0018-5.
    1. Sullivan AN, Lachman ME. Behavior change with fitness technology in sedentary adults: A review of the evidence for increasing physical activity. Front Public Health. 2016;4:289. doi: 10.3389/fpubh.2016.00289. doi: 10.3389/fpubh.2016.00289.
    1. Tudor-Locke C, Bassett DR. How many steps/day are enough? Preliminary pedometer indices for public health. Sports Med. 2004;34(1):1–8. doi: 10.2165/00007256-200434010-00001.
    1. Schmid D, Leitzmann MF. Association between physical activity and mortality among breast cancer and colorectal cancer survivors: A systematic review and meta-analysis. Ann Oncol. 2014 Jul;25(7):1293–1311. doi: 10.1093/annonc/mdu012.
    1. Tudor-Locke C, Craig CL, Aoyagi Y, Bell RC, Croteau KA, De Bourdeaudhuij I, Ewald B, Gardner AW, Hatano Y, Lutes LD, Matsudo SM, Ramirez-Marrero FA, Rogers LQ, Rowe DA, Schmidt MD, Tully MA, Blair SN. How many steps/day are enough? For older adults and special populations. Int J Behav Nutr Phys Act. 2011 Jul 28;8:80. doi: 10.1186/1479-5868-8-80.
    1. Delrieu L, Pérol O, Fervers B, Friedenreich C, Vallance J, Febvey-Combes O, Pérol D, Canada B, Roitmann E, Dufresne A, Bachelot T, Heudel P, Trédan O, Touillaud M, Pialoux V. A personalized physical activity program with activity trackers and a mobile phone app for patients with metastatic breast cancer: Protocol for a single-arm feasibility trial. JMIR Res Protoc. 2018 Aug 30;7(8):e10487. doi: 10.2196/10487.
    1. The Lancet Oncology Exercise and cancer treatment: Balancing patient needs. Lancet Oncol. 2018 Jun;19(6):715. doi: 10.1016/s1470-2045(18)30376-0.
    1. World Health Organization. Noncommunicable Diseases and Mental Health Cluster . Who STEPS Surveillance Manual: The WHO STEPwise Approach to Chronic Disease Risk Factor Surveillance. Geneva, Switzerland: World Health Organization; 2005. [2019-11-28]. .
    1. Crinière L, Lhommet C, Caille A, Giraudeau B, Lecomte P, Couet C, Oppert J, Jacobi D. Reproducibility and validity of the French version of the long international physical activity questionnaire in patients with type 2 diabetes. J Phys Act Health. 2011 Aug;8(6):858–865. doi: 10.1123/jpah.8.6.858.
    1. Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, Dancey J, Arbuck S, Gwyther S, Mooney M, Rubinstein L, Shankar L, Dodd L, Kaplan R, Lacombe D, Verweij J. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1) Eur J Cancer. 2009 Jan;45(2):228–247. doi: 10.1016/j.ejca.2008.10.026.
    1. Savva C, Giakas G, Efstathiou M, Karagiannis C. Test-retest reliability of handgrip strength measurement using a hydraulic hand dynamometer in patients with cervical radiculopathy. J Manipulative Physiol Ther. 2014;37(3):206–210. doi: 10.1016/j.jmpt.2014.02.001.
    1. Ashwell M, Gibson S. Waist to height ratio is a simple and effective obesity screening tool for cardiovascular risk factors: Analysis of data from the British National Diet And Nutrition Survey of adults aged 19-64 years. Obes Facts. 2009;2(2):97–103. doi: 10.1159/000203363.
    1. Alberti KG, Zimmet P, Shaw J. Metabolic syndrome: A new world-wide definition. A Consensus Statement from the International Diabetes Federation. Diabet Med. 2006 May;23(5):469–480. doi: 10.1111/j.1464-5491.2006.01858.x.
    1. Hjermstad MJ, Fossa SD, Bjordal K, Kaasa S. Test/retest study of the European Organization for Research and Treatment of Cancer Core Quality-of-Life Questionnaire. J Clin Oncol. 1995 May;13(5):1249–1254. doi: 10.1200/JCO.1995.13.5.1249.
    1. Piper BF, Dibble SL, Dodd MJ, Weiss MC, Slaughter RE, Paul SM. The revised Piper Fatigue Scale: Psychometric evaluation in women with breast cancer. Oncol Nurs Forum. 1998 May;25(4):677–684.
    1. Sass C, Moulin J, Guéguen R, Abric L, Dauphinot V, Dupré C, Giordanella JP, Girard F, Guenot C, Labbe É, La Rosa E, Magnier P, Martin É, Royer B, Rubirola M, Gerbaud L. Bulletin Épidémiologique Hebdomadaire. 2006. Apr 04, [2019-11-28]. Le score Epices: Un score individuel de précarité. Construction du score et mesure des relations avec des données de santé, dans une population de 197 389 personnes. .
    1. Labbe E, Blanquet M, Gerbaud L, Poirier G, Sass C, Vendittelli F, Moulin J. A new reliable index to measure individual deprivation: The EPICES score. Eur J Public Health. 2015 Aug;25(4):604–609. doi: 10.1093/eurpub/cku231.
    1. Scott NW, Fayers PM, Aaronson NK, Bottomley A, de Graeff A, Groenvold M, Gundy C, Koller M, Petersen MA, Sprangers MAG, on behalf of the EORTC Quality of Life Group . EORTC QLQ-C30 Reference Values. Brussels, Belgium: European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life Group; 2008. Jul, [2019-11-28]. .
    1. Foucaut A, Berthouze SE, Touillaud M, Morelle M, Bourne-Branchu V, Kempf-Lépine AS, Carretier J, Pérol D, Trédan O, Bachmann P, Fervers B. Deterioration of physical activity level and metabolic risk factors after early-stage breast cancer diagnosis. Cancer Nurs. 2015;38(4):E1–E9. doi: 10.1097/NCC.0000000000000187.
    1. Sheean P, Kabir C, Rao R, Hoskins K, Stolley M. Exploring diet, physical activity, and quality of life in females with metastatic breast cancer: A pilot study to support future intervention. J Acad Nutr Diet. 2015 Oct;115(10):1690–1698. doi: 10.1016/j.jand.2015.03.017.
    1. Ligibel JA, Giobbie-Hurder A, Shockro L, Campbell N, Partridge AH, Tolaney SM, Lin NU, Winer EP. Randomized trial of a physical activity intervention in women with metastatic breast cancer. Cancer. 2016 Apr 15;122(8):1169–1177. doi: 10.1002/cncr.29899. doi: 10.1002/cncr.29899.
    1. Headley JA, Ownby KK, John LD. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Oncol Nurs Forum. 2004 Sep;31(5):977–983. doi: 10.1188/04.ONF.977-983.
    1. Oldervoll LM, Loge JH, Lydersen S, Paltiel H, Asp MB, Nygaard UV, Oredalen E, Frantzen TL, Lesteberg I, Amundsen L, Hjermstad MJ, Haugen DF, Paulsen Ø, Kaasa S. Physical exercise for cancer patients with advanced disease: A randomized controlled trial. Oncologist. 2011;16(11):1649–1657. doi: 10.1634/theoncologist.2011-0133.
    1. Yee J, Davis GM, Beith JM, Wilcken N, Currow D, Emery J, Phillips J, Martin A, Hui R, Harrison M, Segelov E, Kilbreath SL. Physical activity and fitness in women with metastatic breast cancer. J Cancer Surviv. 2014 Dec;8(4):647–656. doi: 10.1007/s11764-014-0378-y.
    1. Cormie P, Newton RU, Spry N, Joseph D, Taaffe DR, Galvão DA. Safety and efficacy of resistance exercise in prostate cancer patients with bone metastases. Prostate Cancer Prostatic Dis. 2015 Jun;18(2):196. doi: 10.1038/pcan.2015.6.
    1. Cheville AL, Troxel AB, Basford JR, Kornblith AB. Prevalence and treatment patterns of physical impairments in patients with metastatic breast cancer. J Clin Oncol. 2008 Jun 01;26(16):2621–2629. doi: 10.1200/JCO.2007.12.3075.
    1. Kokkonen K, Saarto T, Mäkinen T, Pohjola L, Kautio H, Järvenpää S, Puustjärvi-Sunabacka K. The functional capacity and quality of life of women with advanced breast cancer. Breast Cancer. 2017 Jan;24(1):128–136. doi: 10.1007/s12282-016-0687-2.
    1. Scott JM, Iyengar NM, Nilsen TS, Michalski M, Thomas SM, Herndon J, Sasso J, Yu A, Chandarlapaty S, Dang CT, Comen EA, Dickler MN, Peppercorn JM, Jones LW. Feasibility, safety, and efficacy of aerobic training in pretreated patients with metastatic breast cancer: A randomized controlled trial. Cancer. 2018 Jun 15;124(12):2552–2560. doi: 10.1002/cncr.31368. doi: 10.1002/cncr.31368.
    1. Oldervoll LM, Loge JH, Paltiel H, Asp MB, Vidvei U, Wiken AN, Hjermstad MJ, Kaasa S. The effect of a physical exercise program in palliative care: A phase II study. J Pain Symptom Manage. 2006 May;31(5):421–430. doi: 10.1016/j.jpainsymman.2005.10.004.
    1. Gulde I, Oldervoll LM, Martin C. Palliative cancer patients' experience of physical activity. J Palliat Care. 2011;27(4):296–302.
    1. Phillips SM, Conroy DE, Keadle SK, Pellegrini CA, Lloyd GR, Penedo FJ, Spring B. Breast cancer survivors' preferences for technology-supported exercise interventions. Support Care Cancer. 2017 Oct;25(10):3243–3252. doi: 10.1007/s00520-017-3735-3.
    1. Prado CM, Baracos VE, McCargar LJ, Reiman T, Mourtzakis M, Tonkin K, Mackey JR, Koski S, Pituskin E, Sawyer MB. Sarcopenia as a determinant of chemotherapy toxicity and time to tumor progression in metastatic breast cancer patients receiving capecitabine treatment. Clin Cancer Res. 2009 Apr 15;15(8):2920–2926. doi: 10.1158/1078-0432.CCR-08-2242.
    1. Blauwhoff-Buskermolen S, Langius JAE, Becker A, Verheul HMW, de van der Schueren MAE. The influence of different muscle mass measurements on the diagnosis of cancer cachexia. J Cachexia Sarcopenia Muscle. 2017 Aug;8(4):615–622. doi: 10.1002/jcsm.12200. doi: 10.1002/jcsm.12200.
    1. Hartman SJ, Marinac CR, Bellettiere J, Godbole S, Natarajan L, Patterson RE, Kerr J. Objectively measured sedentary behavior and quality of life among survivors of early stage breast cancer. Support Care Cancer. 2017 Aug;25(8):2495–2503. doi: 10.1007/s00520-017-3657-0.
    1. Nelson SH, Marinac CR, Patterson RE, Nechuta SJ, Flatt SW, Caan BJ, Kwan ML, Poole EM, Chen WY, Shu X, Pierce JP. Impact of very low physical activity, BMI, and comorbidities on mortality among breast cancer survivors. Breast Cancer Res Treat. 2016 Feb;155(3):551–557. doi: 10.1007/s10549-016-3694-2.
    1. Yennurajalingam S, Palmer JL, Zhang T, Poulter V, Bruera E. Association between fatigue and other cancer-related symptoms in patients with advanced cancer. Support Care Cancer. 2008 Oct;16(10):1125–1130. doi: 10.1007/s00520-008-0466-5.
    1. Prince SA, Adamo KB, Hamel ME, Hardt J, Connor Gorber S, Tremblay M. A comparison of direct versus self-report measures for assessing physical activity in adults: A systematic review. Int J Behav Nutr Phys Act. 2008 Nov 06;5:56. doi: 10.1186/1479-5868-5-56.
    1. Sallis JF, Saelens BE. Assessment of physical activity by self-report: Status, limitations, and future directions. Res Q Exerc Sport. 2000 Jun;71(2 Suppl):S1–S14.
    1. . Alexandria, VA: American Society of Clinical Oncology (ASCO); 2019. Apr, [2019-11-28]. Breast cancer—metastatic: Living with metastatic breast cancer. .

Source: PubMed

Подписаться