Exercise Steps Up Quality of Life in Breast Cancer Treatment

GLASGOW, Scotland, Feb. 19 -- There's more evidence women can benefit from moderate exercise during early treatment for breast cancer, researchers here said.

They found in a randomized controlled trial that moderate exercise in a supervised group setting may improve some facets of short- and long-term quality of life. Although no advantage was seen in overall quality of life, other physical and psychological benefits persisted for six months, reported Nanette Mutrie, Ph.D., of Strathclyde University, and colleagues, online in BMJ.

These benefits included significant improvements in social (P=0.014 at six months) and breast-cancer specific quality of life (P=0.0007 at 12 weeks and P=0.039 at six months) as well as positive mood (P=0.0005 at 12 weeks and P=0.0008 at six months).

The results of their trial together with several other recent studies suggest physical exercise should be included in breast cancer rehabilitation, Dr. Mutrie and colleagues said.

"Clinicians should encourage activity for patients with cancer," they wrote, "and policy makers should consider including opportunities for exercise in cancer rehabilitation services, similar to the exercise component in cardiac rehabilitation."

Breast cancer survivors who participated in regular physical activity were 50% less likely to die than those who remained inactive after their diagnosis in one observational study, and moderate exercise yielded a reduction in fatigue, depression and anemia in a small randomized controlled trial.

However, a 2006 Cochrane review found no significant improvement for quality of life or fatigue during breast cancer treatment, the researchers noted.

So the investigators undertook a trial that randomized 203 women being treated for early breast cancer at three centers in Scotland to receive 12 weeks of supervised group exercise as an adjunct to usual care or usual care alone.

The exercise program consisted of two 45-minute classes emphasizing moderate activity and one exercise session at home each week. The usual care group received only a two-page leaflet on guidelines for safe exercise after a cancer diagnosis.

At recruitment, women in the study had been diagnosed with breast cancer for about six months and had a mean age of about 51 (range 29 to 76). All had stage 0 to III breast cancer but none had unstable cardiac, hypertensive, or respiratory disease; cognitive dysfunction; or regularly exercised.

At the end of treatment, they found no difference between the exercise and control groups on overall Functional Assessment of Cancer Therapy (FACT) quality-of-life questionnaire scores (81.0 versus 77.3, effect estimate 1.0, 95% confidence interval -2.7 to 4.7, P=0.60). Nor was there a significant effect in scores on individual domains (physical P=0.50, social P=0.10, and emotional P=0.19).

At six months, overall quality of life tended to be better for the exercise group (83.2 versus 77.1, effect estimate 3.6, 95% CI 0.0 to 7.3, P=0.053). The findings were significantly better with exercise for the social quality of life domain (23.9 versus 22.9, effect estimate 1.4, P=0.014), but not for the physical (P=0.27) or emotional domains (P=0.23).

Breast-cancer specific quality of life (P=0.0007 at 12 weeks and P=0.039 at six months) was also improved with exercise compared with usual care only. There were also nonsignificant trends toward better quality of life in relation to fatigue (effect size 2.3 points, P=0.091) and reduced depression (effect size ?1.7 points, P=0.083) in favor of exercise.

For the secondary outcome measures, the results with exercise versus control were:

• Significantly better positive mood scores on the Positive and Negative Affect Schedule (P=0.0005 at 12 weeks and P=0.0008 at six months),
• Significantly longer distances walked in 12 minutes (effect estimate 129 meters at 12 weeks, P<0.0001, and 105 meters at six months, P<0.0001),
• Significantly better shoulder mobility scores at 12 weeks (effect size 2.6, P<0.0001) and at six months (effect size 2.5, P<0.0001), and
• Significantly more leisure activity measured on the Scottish Physical Activity Questionnaire at 12 weeks (effect size 182 minutes, P=0.0009) but not at six months (P=0.23).

In the six months after the intervention, the exercise group also reported fewer nights in the hospital (P=0.044) and fewer visits to their generalist physician (P=0.011) than the control group.

While some of the effects may have been directly attributable to exercise -- such as improvements in the 12-minute walk and shoulder mobility -- the researchers said it was unclear which aspect of their group exercise intervention provided the most benefit.

They said further research is needed on the effects of exercise on patients with breast cancer, particularly for home-based programs.