Combined aerobic and resistance training improves bone health of female cancer survivors

Abstract

Introduction: Cancer pathogenesis and resulting treatment may lead to bone loss and poor skeletal health in survivorship. The purpose of this investigation was to evaluate the influence of 26 weeks of combined aerobic and resistance-training (CART) exercise on bone mineral density (BMD) in a multi-racial sample of female cancer survivors.

Methods: Twenty-six female cancer survivors volunteered to undergo CART for 1 h/day, 3 days/week, for 26 weeks. The Improving Physical Activity After Cancer Treatment (IMPAACT) Program involves supervised group exercise sessions including 20 min of cardiorespiratory training, 25 min of circuit-style resistance-training, and 15 min of abdominal exercises and stretching. BMD at the spine, hip, and whole body was assessed using dual-energy X-ray absorptiometry (DXA) before and after the intervention. Serum markers of bone metabolism (procollagen-type I N-terminal propeptide, P1NP, and C-terminal telopeptides, CTX) were measured at baseline, 13 weeks, and at study completion.

Results: Eighteen participants, with the average age of 63.0 ± 10.3 years, completed the program. Mean duration since completion of cancer treatment was 6.2 ± 10.6 years. Paired t-tests revealed significant improvements in BMD of the spine (0.971 ± 0.218 g/cm² vs. 0.995 ± 0.218 g/cm², p = 0.012), hip (0.860 ± 0.184 g/cm² vs. 0.875 ± 0.191 g/cm², p = 0.048), and whole body (1.002 ± 0.153 g/cm² vs. 1.022 ± 0.159 g/cm², p = 0.002). P1NP declined 22% at 13 weeks and 28% at 26 weeks in comparison to baseline (p < 0.01) while CTX showed a non-significant decrease of 8% and 18% respectively.

Conclusions: We report significant improvements in BMD at the spine, hip, and whole body for female cancer survivors who completed 26 weeks of CART. This investigation demonstrates the possible effectiveness of CART at improving bone health and reducing risk of osteoporosis for women who have completed cancer treatment. The IMPAACT Program appears to be a safe and feasible way for women to improve health after cancer treatment.

Keywords: BMD, bone mineral density; BTM, bone turnover marker; Bone mineral density; Bone turnover markers; CART, combined aerobic and resistance training; CTX, C-terminal telopeptides; Cancer-induced bone loss; DXA, dual-energy X-ray absorptiometry; FFQ, food frequency questionnaire; IMPAACT, improving physical activity after cancer treatment; NTX, N-telopeptide cross-linked collagen type I; Oncology; Osteoporosis; P1NP, procollagen-type I N-terminal propeptides.

Fig. 1

Bone turnover markers.