The effects of home-based exercise therapy for breast cancer-related fatigue induced by radical radiotherapy

Abstract

Background: Radiotherapy (RT) can lead to cancer-related fatigue (CRF) and decreased health-related quality of life (HRQoL) in breast cancer patients. The purpose of this trial was to examine the feasibility and efficacy of a home-based resistance and aerobic exercise intervention for reducing CRF and improving HRQoL in breast cancer patients during RT.

Methods: Women with breast cancer (N = 106) commencing RT were randomized to 12 weeks of home-based resistance and aerobic exercise (EX) or usual care/control (CON). The primary endpoint was CRF, with secondary endpoints of HRQoL, sleep duration and quality, and physical activity. Measurements were undertaken prior to RT, at completion of RT (~ 6 weeks), at completion of the intervention (12 weeks), and 6 and 12 months after RT completion, while CRF was also measured weekly during RT.

Results: Eighty-nine women completed the study (EX = 43, CON = 46). Over the 12-week intervention, EX completed 1-2 resistance training sessions and accumulated 30-40 min of aerobic exercise weekly. For CRF, EX had a quicker recovery both during and post-RT compared to CON (p < 0.05). Moreover, there was a significant difference in HRQoL between groups at RT completion, with HRQoL unchanged in CON and higher in EX (p < 0.05). There was no change in sleep duration or quality for either group and there were no exercise-related adverse effects.

Conclusions: Home-based resistance and aerobic exercise during RT is safe, feasible, and effective in accelerating CRF recovery and improving HRQoL. Improvements in CRF and HRQoL for these patients can be achieved with smaller exercise dosages than stated in the generic recommendations for breast cancer.

Keywords: Behavior change; Breast cancer; Cancer-related fatigue; Home-based exercise; Quality of life; Radiotherapy.

Fig. 1

Schematic of the research project design. *The serial assessment of CRF and physical activity level at the start of each week

Fig. 2

Consort diagram of the study

Fig. 3

A Weekly sessions of resistance exercise, B weekly minutes of aerobic exercise, C resistance exercise RPE, D aerobic exercise RPE. Boxplots indicate median (black line), bottom and top indicate first and third quartiles respectively, and whiskers indicate ± 1.5 IQR

Fig. 4

FACIT-F scores for all time points (baseline, weeks 1–6, post-RT, and 6-week, 6-month, and 12-month post-RT) for both groups. Exercise: straight line and black circles; Usual care: dashed line and white circles. Characters denote significant difference of either the exercise (E) or the usual care (U) groups with their respective baselines, and * denotes significant difference between groups (p < 0.05). Error bars denote standard deviation of the mean

Fig. 5

A Brief Fatigue Inventory, B FACT-B + 4, C Pittsburg Sleep Quality Index hours of sleep, D Pittsburg Sleep Quality Index total score for all time points (baseline, post-RT, and 6 weeks, 6 months, and 12-month post-RT) for both groups. Exercise: straight line and black circles; usual care: dashed line and white circles. Characters denote significant difference of either the exercise (E) or the usual care (U) groups with their respective baselines, and *denotes significant difference between groups (p < 0.05). Error bars denote standard deviation of the mean

Fig. 6

A Mean minutes of moderate and vigorous physical activity (sum of minutes with a double weighting on vigorous intensity minutes), B mean minutes of mild physical activity. Exercise: straight line and black circles; usual care: dashed line and white circles. The (E) character denotes significant difference of the exercise group with its baseline (p < 0.05). Error bars denote standard deviation of the mean