Exercise manages fatigue during breast cancer treatment: a randomized controlled trial.
Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence-based treatments are available to manage this distressing side-effect. The purpose of this multi-institutional randomized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer. Sedentary women (N=119) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were randomized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment. Of participants randomized to exercise, 72% adhered to the exercise prescription; 61% of the usual care group adhered. The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39% of the usual care group exercised and 28% of the exercise group did not. When exercise participation was considered using the data analysis method of instrumental variables with principal stratification, a clinically important and statistically significant (p=0.03) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated. Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment.
Mock
Victoria
V
Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins Hospital, USA. vmock@son.jhmi.edu
Frangakis
Constantine
C
Davidson
Nancy E
NE
Ropka
Mary E
ME
Pickett
Mary
M
Poniatowski
Barbara
B
Stewart
Kerry J
KJ
Cameron
Lane
L
Zawacki
Kristin
K
Podewils
Laura J
LJ
Cohen
Gary
G
McCorkle
Ruth
R
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000534:rehabilitation* / Q000628:therapy*; D017024:Chemotherapy, Adjuvant; D005081:Exercise Therapy; D005221:Fatigue / Q000209:etiology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008875:Middle Aged; D018714:Radiotherapy, Adjuvant; D016896:Treatment Outcome