title: Effect of a randomized controlled exercise trial on bone outcomes: influence of adjuvant endocrine therapy.
abstract: Bone loss is a significant clinical problem for female cancer survivors (FCS) and increases fracture risk. The aim of the Yale Fitness Intervention Trial (Yale FIT) was to determine the effects of a 12-month aerobic-resistance exercise intervention compared to a home-based physical activity group on bone outcomes [bone mineral density (BMD)] and biomarkers bone turnover). Early postmenopausal FCS (N = 154) were randomized to the exercise intervention (3 times/week) or to a home-based physical activity group. Calcium (1200 mg) and Vitamin D (400 IU) supplements were provided to both groups. BMD was measured at baseline and 12 months. No significant difference in BMD was observed for the exercise vs home-based group. However, subjects on Tamoxifen or no endocrine therapy did not significantly lose BMD, with the exception of the femoral neck (FN). In contrast subjects on aromatase inhibitors (AIs) had significant BMD loss at all sites. The majority of subjects had sufficient serum levels of Vitamin D (>20 ng/mL) but there was significantly less bone loss in subjects in the 20-29 ng/mL range at the LS (p = 0.01), hip (p = 0.03), and GT (p = 0.008) compared to lower or higher levels. Exercise stimulates bone remodeling but the intervention was not superior for BMD outcomes at one year. The dose of the osteogenic stimulus in the intervention has been effective in preserving BMD in healthy postmenopausal women but it may be inadequate for survivors with chemotherapy-induced menopause and for those on adjuvant AI therapy.
authors: Yale University School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA. tish.knobf@yale.edu.
authors: M Tish
authors: MT
authors: Knobf
authors: Yale University School of Nursing, 400 West Campus Dr., Orange, CT, 06477, USA.
authors: Sangchoon
authors: S
authors: Jeon
authors: Michigan State University, East Lansing, USA.
authors: Barbara
authors: B
authors: Smith
authors: Director Breast Cancer Program, UH Seidman Cancer Center, Cleveland, USA.|Case Western Reserve University School of Medicine, Cleveland, USA.
authors: Lyndsay
authors: L
authors: Harris
authors: University of Connecticut, Storrs, USA.
authors: Jane
authors: J
authors: Kerstetter
authors: Yale Cancer Center, New Haven, USA.
authors: A Siobhan
authors: AS
authors: Thompson
authors: Yale Musculoskeletal Center, Yale University School of Medicine, New Haven, USA.
authors: Karl
authors: K
authors: Insogna
mesh_terms: D000328:Adult; D000368:Aged; D047072:Aromatase Inhibitors / Q000008:administration & dosage; D015519:Bone Density / Q000187:drug effects; D016723:Bone Remodeling / Q000187:drug effects; D001943:Breast Neoplasms / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D002118:Calcium / Q000097:blood; D019587:Dietary Supplements; D005081:Exercise Therapy; D005260:Female; D005272:Femur Neck / Q000503:physiopathology; D006801:Humans; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000097:blood / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D017741:Survivors; D014807:Vitamin D / Q000097:blood
chemical_list: D047072:Aromatase Inhibitors; D014807:Vitamin D; D002118:Calcium
keywords: Bone mineral density; Cancer survivors; Exercise trial