Short- and long-term impact of adapted physical activity and diet counseling during adjuvant breast cancer therapy: the "APAD1" randomized controlled trial

Abstract

Background: Patients with breast cancer undergoing chemotherapy and radiotherapy experience fatigue and other treatment side effects. Integrative therapies combining physical activity and dietary counseling are recommended; however to date no large randomized controlled trial has been conducted during adjuvant therapy. The Adapted Physical Activity and Diet (APAD) intervention was evaluated for its ability to decrease fatigue (primary outcome), anxiety, depression, body mass index (BMI), and fat mass, and enhance muscular and cognitive performances, and quality-of-life (QoL).

Methods: Women diagnosed with early breast cancer (N = 143, mean age = 52 ± 10 years) were randomized to APAD or usual care (UC). APAD included thrice-weekly moderate-intensity mixed aerobic and resistance exercise sessions and 9 dietetic consultations. Patient-reported outcomes (PROs) and anthropometric, muscular, and cognitive variables were measured at baseline, 18 weeks (end of chemotherapy), and 26 weeks (end of radiotherapy and intervention), and at 6- and 12-month post-intervention follow-ups. Multi-adjusted linear mixed-effects models were used to compare groups over time.

Results: Significant beneficial effects of the APAD intervention were observed on all PROs (i.e., fatigue, QoL, anxiety, depression) at 18 and 26 weeks. The significant effect on fatigue and QoL persisted up to 12-month follow-up. Significant decreases in BMI, fat mass, and increased muscle endurance and cognitive flexibility were observed at 26 weeks, but did not persist afterward. Leisure physical activity was enhanced in the APAD group vs UC group at 18 and 26 weeks. No significant effect of the intervention was found on major macronutrients intake.

Conclusions: A combined diet and exercise intervention during chemotherapy and radiotherapy in patients with early breast cancer led to positive changes in a range of psychological, physiological and behavioral outcomes at the end of intervention. A beneficial effect persisted on fatigue and QoL at long term, i.e., 1 year post-intervention. Diet-exercise supportive care should be integrated into the management of early breast cancer patients.

Trial registration: The APAD study was prospectively registered on ClinicalTrials.gov (NCT01495650; date of registration: December 20, 2011).

Keywords: Adjuvant; Breast cancer; Diet; Exercise; Fatigue; Intervention; Quality of life; Supportive care.

Fig. 1

CONSORT flow diagram of patients with breast cancer participating in the APAD1 study. Note: The primary outcome (assessed by the Multidimensional Fatigue Inventory) is part of the Patient-Reported Outcomes (PROs)

Fig. 2

Effects of the APAD intervention on (a) fatigue, (b) QoL, (c) anxiety, and (d) depression in women with breast cancer at the end of chemotherapy, end of radiotherapy, and the 6-month and 1-year post-intervention follow-ups after the end of radiotherapy. Note: Means and standard errors are estimated from adjusted linear mixed analyses. Baseline score is the adjusted score. APAD: Adapted Physical Activity and Diet counseling intervention; UC: Usual Care

Fig. 3

Effects of the APAD intervention on (a) BMI, (b) fat mass, (c) cognitive flexibility, and (d) sit-and-stand ratio in women with breast cancer at the end of chemotherapy, end of radiotherapy, and at the 6-month and 1-year post-intervention follow-ups after the end of radiotherapy. Note: Means and standard errors are estimated from adjusted linear mixed analyses. Baseline score is the adjusted score. APAD: Adapted Physical Activity and Diet counseling intervention; UC: Usual Care