Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial

Abstract

Objectives: To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer, with six month follow-up.

Design: Pragmatic randomised controlled prospective open trial.

Setting: Three National Health Service oncology clinics in Scotland and community exercise facilities.

Participants: 203 women entered the study; 177 completed the six month follow-up.

Interventions: Supervised 12 week group exercise programme in addition to usual care, compared with usual care.

Main outcome measures: Functional assessment of cancer therapy (FACT) questionnaire, Beck depression inventory, positive and negative affect scale, body mass index, seven day recall of physical activity, 12 minute walk test, and assessment of shoulder mobility.

Results: Mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age gave intervention effect estimates (intervention minus control) at 12 weeks of 129 (95% confidence interval 83 to 176) for metres walked in 12 minutes, 182 (75 to 289) for minutes of moderate intensity activity reported in a week, 2.6 (1.6 to 3.7) for shoulder mobility, 2.5 (1.0 to 3.9) for breast cancer specific subscale of quality of life, and 4.0 (1.8 to 6.3) for positive mood. No significant effect was seen for general quality of life (FACT-G), which was the primary outcome. At the six month follow-up, most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged. No adverse effects were noted.

Conclusion: Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later. Clinicians should encourage activity for their patients. Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services. Trial registration Current controlled trials ISRCTN12587864 [controlled-trials.com].

Fig 1 Flow of participants through trial

Fig 2 Effect estimates (intervention minus control), with 95% confidence intervals and P values, for outcome variables at the 12 week assessment (top) and the six month follow-up assessment (bottom), expressed in units of one standard deviation (SD) of the outcome distributions, based on mixed effects models with adjustment for baseline values, study site, treatment at baseline, and age. BDI=Beck depression inventory; FACT=functional assessment of cancer therapy (see text for core domains and subscales); PANAS=positive and negative affect scale; SPAQ=Scottish physical activity questionnaire

Fig 3 Percentages of patients in the control and intervention groups who reported at least one night in hospital or at least one visit to their general practitioner during the study