Effects of Exercise Dose and Type During Breast Cancer Chemotherapy: Multicenter Randomized Trial

Exercise improves physical functioning and symptom management during breast cancer chemotherapy, but the effects of different doses and types of exercise are unknown. A multicenter trial in Canada randomized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy 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 physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)36. Secondary endpoints were other physical functioning scales, symptoms, fitness, and chemotherapy completion. All statistical tests were linear mixed model analyses, and the P values were two-sided. Follow-up assessment of patient-reported outcomes was 99.0%. Adjusted linear mixed-model analyses showed that neither HIGH (0.8; 95% confidence interval [CI] 0.8 to 2.4; P .30) nor COMB (0.5; 95% CI 1.1 to 2.1; P .52] were superior to STAN for the primary outcome. In secondary analyses not adjusted for multiple comparisons, HIGH was superior to STAN for the SF-36 physical component summary (P .04), SF-36 bodily pain (P .02), and endocrine symptoms (P .02). COMB was superior to STAN for endocrine symptoms (P .009) and superior to STAN (P < .001) and HIGH (P < .001) for muscular strength. HIGH was superior to COMB for the SF-36 bodily pain (P .04) and aerobic fitness (P .03). No differences emerged for body composition or chemotherapy completion. A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than standard volumes.