title: A multicenter randomized trial of the effects of exercise dose and type on psychosocial distress in breast cancer patients undergoing chemotherapy.
abstract: BACKGROUND
  Exercise may improve psychosocial distress in patients with cancer; however, few studies have examined the effects of different types or doses of exercise, or whether exercise effects are related to baseline depression levels.
  
  
  METHODS
  In a multicenter trial in Canada, we randomized 301 patients with breast cancer initiating chemotherapy to thrice weekly, supervised exercise consisting of either a standard dose of 25 to 30 minutes of aerobic exercise (STAN; n = 96), a higher dose of 50 to 60 minutes of aerobic exercise (HIGH; n = 101), or a combined dose of 50 to 60 minutes of aerobic and resistance exercise (COMB; n = 104). The primary endpoint was depression assessed by the Center for Epidemiological Studies-Depression scale at baseline, twice during chemotherapy, and postchemotherapy. Secondary endpoints were anxiety, perceived stress, and self-esteem.
  
  
  RESULTS
  Repeated measures ANOVA indicated that neither HIGH [mean difference = -0.9; 95% confidence interval (CI), +0.0 to -1.8; P = 0.061] nor COMB (mean difference = -0.4; 95% CI, +0.5 to -1.3; P = 0.36) was superior to STAN for managing depressive symptoms. In a planned subgroup analysis, there was a significant interaction with baseline depression levels (P interaction = 0.027) indicating that COMB and HIGH were effective for managing depressive symptoms in patients with clinical levels of depressive symptoms at baseline.
  
  
  CONCLUSIONS
  Compared with a standard volume of aerobic exercise, higher volumes of exercise did not help manage depressive symptoms in unselected patients with breast cancer receiving chemotherapy, but they were effective in patients with clinical levels of depressive symptoms at baseline.
  
  
  CONCLUSIONS
  A phase III exercise trial targeting depressed patients with breast cancer is warranted.
authors.affiliation: Authors' Affiliations: University of Alberta; Cross Cancer Institute, Edmonton; Alberta Health Services, Calgary, Alberta; University of British Columbia; British Columbia Cancer Agency, Vancouver, British Columbia; University of Ottawa Heart Institute; The Ottawa Hospital Cancer Center; and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Courneya
authors.forename: Donald C
authors.initials: DC
authors.lastname: McKenzie
authors.forename: Karen
authors.initials: K
authors.lastname: Gelmon
authors.forename: John R
authors.initials: JR
authors.lastname: Mackey
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Yasui
authors.forename: Christine M
authors.initials: CM
authors.lastname: Friedenreich
authors.forename: Cynthia C
authors.initials: CC
authors.lastname: Forbes
authors.forename: Linda
authors.initials: L
authors.lastname: Trinh
authors.forename: Diana
authors.initials: D
authors.lastname: Jespersen
authors.forename: Diane
authors.initials: D
authors.lastname: Cook
authors.forename: Carolyn
authors.initials: C
authors.lastname: Proulx
authors.forename: Evyanne
authors.initials: E
authors.lastname: Wooding
authors.forename: Lianne B
authors.initials: LB
authors.lastname: Dolan
authors.forename: Roanne J
authors.initials: RJ
authors.lastname: Segal
mesh_terms: D000223:Adaptation, Psychological; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001943:Breast Neoplasms / Q000188:drug therapy / Q000534:rehabilitation*; D017024:Chemotherapy, Adjuvant; D005081:Exercise Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D011379:Prognosis; D011788:Quality of Life; D013315:Stress, Psychological / Q000517:prevention & control*