BACKGROUND: Although mortality rates for some cancers have declined in recent years the acute and long-term side effects have a significant, negative effect on morbidity & non-cancer related risk of mortality. The increasingly common use of adjuvant chemotherapy for early stage breast cancer has led to a rise in long-term, treatment-related side effects including early menopause, osteoporosis, increased risk for cardiovascular disease, & declines in quality of life. Alpha-interferon (IFN) is an efficacious therapy for melanoma, yet one that causes severe dose limiting side effects that call for interventions to minimize the side effects, improve quality of life, and potentially improve long-term outcomes. OBJECTIVE: To examine differences in fatigue, affect, quality of life, cognitive function, functional ability, body weight and bone density across three longitudinal exercise interventions for patients with breast cancer and melanoma. POPULATION: Breast cancer and melanoma patients beginning therapy at 2 university cancer centers or 2 private practice settings. OUTCOME VARIABLES: Fatigue, affect, quality of life, cognitve function, functional ability and body composition. DESIGN & METHODS: Study 1: A single arm trial of 72 women receiving treatment for breast cancer were followed for 9 weeks to examine effect of a home-based aerobic exercise program on fatigue, quality of life and body weight. Study 2: Women (N=66) with stage I-III breast cancer beginning adjuvant chemotherapy were randomized to aerobic exercise (N=22), resistance exercise (N=21) or usual care control group (N=23). At the beginning of chemotherapy, 3 and 6 months patients completed exercise testing and dual-energy absorptiometry of the lumbar spine and total body. Study 3: A single arm pilot study of 12 patients beginning IFN were followed for 4-months and instructed to aerobically exercise 4 days/week for 15-30 minutes and take 20mg sustained release methylphenidate every morning. FINDINGS: Study 1: Women who adhered to aerobic exercise demonstrated a different pattern of fatigue, lower fatigue scores, higher positive affect and quality of life. Significant differences in body mass index and weight gain were noted (p<.05) between women who exercised (N=42) and did not exercise (N=29). Women who exercised maintained their weight, while nonexercisers gained weight. Exercisers demonstrated improvements in functional ability of nearly16% compared to nonexercisers who demonstrated declines in functional ability of nearly 25%. Study 2: The aerobic exercise and resistance exercise groups demonstrated increases in functional ability of 16% and 4%, respectively. The control group showed a 10% decline in functional ability. The average decline in bone density at 6-months for each group were: control group -6.23%, resistance exercise group –4.92%, aerobic exercise group –1.76%. Aerobic exercise subjects demonstrated significantly smaller declines in bone density than control group subjects (F=6.49, p=.02). Premenopausal women demonstrated significantly greater declines in bone density than postmenopausal women (F=4.88, p=.05). There was a trend for improved maintenance of body weight and body fat in the aerobic exercise group compared to the usual care group. Study 3: Patients who adhered to the combined exercise and drug intervention demonstrated less fatigue than historical controls receiving the same treatment, and compared to the subjects who stopped taking the methylphenidate (N=4) had a trend toward improved cognitive function, mental health, physical function and functional ability. CONCLUSIONS: The data suggest that 1) aerobic exercise appears to reduce fatigue, improve mood and quality of life, 2) weight-bearing, aerobic exercise may reduce the remarkable declines in bone density observed over 6-months; 3) aerobic and resistance exercise may improve functional ability and muscle strength at a time when patients generally show marked declines in functional ability; and 4) aerobic exercise appears to help breast cancer patients maintain their body weight. IMPLICATIONS: Determining ways to improve tolerance for treatment and prevent the long-term side effects of cancer treatment are important in reducing the morbidity and mortality of cancer and it’s treatment. FUNDING: F31 NR07159, DAMD 17-96-1-6171, Oncology Nursing Foundation, NINR R29-05084, Integrated Therapeutics/Schering Pharmaceticals.
Back to Physical Activity and Exercise Interventions in Chronic Illnesses
Back to The Advancing Nursing Practice Excellence: State of the Science