title: Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial.
abstract: The purpose of this study was to conduct an exploratory analysis of the START examining the effects of resistance exercise training (RET) and aerobic exercise training (AET) on sarcopenia, dynapenia, and associated quality of life (QoL) changes in breast cancer (BC) patients receiving adjuvant chemotherapy. Participants were randomized to usual care (UC) (n = 70), AET (n = 64), or RET (n = 66) for the duration of chemotherapy. Measures of sarcopenia [skeletal muscle index (SMI)] and dynapenia [upper extremity (UE) and lower extremity (LE) muscle dysfunction (MD)] were normalized relative to age-/sex-based clinical cut-points. QoL was assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scales. At baseline, 25.5 % of BC patients were sarcopenic and 54.5 % were dynapenic with both conditions associated with poorer QoL. ANCOVAs showed significant differences favoring RET over UC for SMI (0.32 kg/m(2); p = 0.017), UE-MD (0.12 kg/kg; p < 0.001), and LE-MD (0.27 kg/kg; p < 0.001). Chi-square analyses revealed significant effects of RET, compared to UC/AET combined, on reversing sarcopenia (p = 0.039) and dynapenia (p = 0.019). The reversal of sarcopenia was associated with clinically relevant improvements in the FACT-An (11.7 points [95 % confidence interval (CI) -4.2 to 27.6]), the Trial Outcome Index-Anemia (10.0 points [95 % CI -4.0 to 24.1]), and fatigue (5.3 points [95 % CI -1.5 to 12.1]). Early-stage BC patients initiating adjuvant chemotherapy have higher than expected rates of sarcopenia and dynapenia which are associated with poorer QoL. RET during adjuvant chemotherapy resulted in the reversal of both sarcopenia and dynapenia; however, only the reversal of sarcopenia was associated with clinically meaningful improvements in QoL.
authors.affiliation: Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada.
authors.forename: Scott C
authors.initials: SC
authors.lastname: Adams
authors.affiliation: Ottawa Regional Cancer Center, Ottawa, ON, Canada.
authors.forename: Roanne J
authors.initials: RJ
authors.lastname: Segal
authors.affiliation: University of British Columbia, Vancouver, BC, Canada.
authors.forename: Donald C
authors.initials: DC
authors.lastname: McKenzie
authors.affiliation: Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada.
authors.forename: James R
authors.initials: JR
authors.lastname: Vallerand
authors.affiliation: Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada.
authors.forename: Andria R
authors.initials: AR
authors.lastname: Morielli
authors.affiliation: Cross Cancer Institute, Edmonton, AB, Canada.
authors.forename: John R
authors.initials: JR
authors.lastname: Mackey
authors.affiliation: British Columbia Cancer Agency, Vancouver, BC, Canada.
authors.forename: Karen
authors.initials: K
authors.lastname: Gelmon
authors.affiliation: Alberta Health Services, Calgary, AB, Canada.
authors.forename: Christine M
authors.initials: CM
authors.lastname: Friedenreich
authors.affiliation: University of Ottawa Heart Institute, Ottawa, ON, Canada.
authors.forename: Robert D
authors.initials: RD
authors.lastname: Reid
authors.affiliation: Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada. kerry.courneya@ualberta.ca.
authors.forename: Kerry S
authors.initials: KS
authors.lastname: Courneya
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects*; D015444:Exercise / Q000502:physiology*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D055070:Resistance Training / Q000379:methods*; D055948:Sarcopenia / Q000139:chemically induced / Q000628:therapy*; D016896:Treatment Outcome
keywords: Body composition; Muscle dysfunction; Quality of life; Resistance exercise; Skeletal muscle index