SAN ANTONIO — A year-long exercise program contributed to the alleviation of pain in breast cancer survivors taking an aromatase inhibitor for at least 6 months, according to research presented at the San Antonio Breast Cancer Symposium.
“Our findings of exercise improving a common [aromatase inhibitor] side effect may in turn improve AI adherence, quality of life, and breast cancer recurrence and mortality risk,” Melinda L. Irwin, PhD, MPH, associate professor of chronic disease epidemiology at the Yale School of Public Health and co-leader of the Cancer Prevention and Control Research Program at the Yale Cancer Center, said in a press conference. “Arthralgia is the most common reason for drug discontinuation. … Many of these women do report pain before AIs, but if exercise can [contribute to increased] adherence, then it’s helpful.”
Melinda L. Irwin
The HOPE study evaluated 121 women (median age, 60 years) who scored 3 or higher on the Brief Pain Inventory and were not exercising more than 90 minutes per week. They were randomly assigned to either usual care, or an exercise program that consisted of twice-weekly supervised strength training sessions or 2.5 hours per week of moderate intensity aerobic exercise.
At the end of the year-long study, women in the exercise group were exercising 159 minutes per week on average. The time women in the usual care group spent exercising also increased slightly.
Irwin reported a 70% attendance to twice-weekly strength training groups, a 7% increase in cardio-respiratory fitness and a 3% change in body weight among exercisers. There were no changes in the usual care group.
Over 12 months, women in the control group reported slight increases in their pain scores. However, women in the exercise group reported a 30% decrease in worst pain and 20% decrease in pain severity (worst pain, least pain, pain now and average pain), as well as the level they determined pain interfered with eight standard activities.
“A year-long exercise program [probably is necessary to] see the sustainability of decreases in joint pain rather than shorter durations of exercise at 3 or 6 months,” Irwin said.
More adherent patients reported greater decreases in pain, but those who were less adherent still reported a 15% to 20% decrease in pain, Irwin said. Those who lost weight did not have greater improvements in joint pain.
“We don’t know if it is primarily aerobic exercise or resistance exercise or if both are necessary to improve this common side effect of AIs,” she said. “But this improvement in pain has been shown to be better than other therapies for arthralgia such as glucosamine, vitamin D and acupuncture.”
Data show 70% or more of cancer survivors are inactive, Irwin said.
“For a long time, we’ve known that exercise is beneficial [in many ways] for cancer survivors, yet, there aren’t many programs that people can be referred to,” said Jennifer A. Ligibel, MD, assistant professor of medicine at Harvard Medical School, senior physician at Dana Farber Cancer Institute and co-author of HOPE. “There has been a lack of knowing that this is better for cancer survivors than everyone. … I don’t think this is something that medical oncologists in the past have focused on. That’s changing as there are more and more studies where we see specific benefits of exercise in cancer survivors, but the overall prevalence of exercise in breast cancer survivors is not really changing. We really need to figure out how do we help people exercise more and how do we put into place programs that can help women on a large scale become more active after cancer diagnosis.”
For more information:
Irwin ML. Abstract #S3-03. Presented at: San Antonio Breast Cancer Symposium; Dec. 10-14, 2013; San Antonio.
Disclosure: The study was funded by NCI. Irwin and Ligibel report no relevant financial disclosures.