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Exercise Prescription and Adherence for Breast Cancer: One Size Does Not FITT All

Kirkham Amy A.; Bonsignore, Alis; Bland, Kelcey A.; McKenzie, Donald C.; Gelmon, Karen A.; Van Patten, Cheri L.; Campbell, Kristin L.
Medicine & Science in Sports & Exercise: Post Acceptance: October 05, 2017
doi: 10.1249/MSS.0000000000001446
Original Investigation: PDF Only

AbstractPurposeTo prospectively assess adherence to oncologist-referred, exercise programming consistent with current recommendations for cancer survivors among women with early breast cancer across the trajectory of adjuvant treatment.MethodsSixty-eight women participated in supervised, hour-long, moderate-intensity, aerobic and resistance exercise 3x/week during adjuvant chemotherapy ± radiation, with a step-down in frequency for 20 additional weeks. Adherence to exercise frequency (i.e. attendance), intensity, and time/duration, and barriers to adherence were tracked and compared during chemotherapy versus radiation, and during treatment (chemotherapy plus radiation, if received) versus after treatment.ResultsAttendance decreased with cumulative chemotherapy dose (cycles 1-2 vs. cycles 3-8, cycle 3 vs. cycles 7-8, all P ≤ 0.05), and was lower during chemotherapy than radiation (64 ± 25 vs. 71 ± 32%, P = 0.02), and after treatment than during treatment (P < 0.01). Adherence to exercise intensity trended toward being higher during chemotherapy than radiation (69 ± 23 vs. 51 ± 38%, P = 0.06), and was higher during than after treatment (P = 0.01). Adherence to duration did not differ with treatment. Overall adherence to the resistance prescription was poor, but was higher during chemotherapy than radiation (57 ± 23 vs. 34 ± 39%, P < 0.01), and was not different during than after treatment. The most common barriers to attendance during treatment were cancer-related (e.g. symptoms, appointments), and after treatment were life-related (e.g. vacation, work).ConclusionAdherence to supervised exercise delivered in a real-world clinical setting varies among breast cancer patients and across the treatment trajectory. Behavioral strategies and individualization in exercise prescriptions to improve adherence are especially important for later chemotherapy cycles, after treatment, and for resistance exercise.

Purpose

To prospectively assess adherence to oncologist-referred, exercise programming consistent with current recommendations for cancer survivors among women with early breast cancer across the trajectory of adjuvant treatment.

Methods

Sixty-eight women participated in supervised, hour-long, moderate-intensity, aerobic and resistance exercise 3x/week during adjuvant chemotherapy ± radiation, with a step-down in frequency for 20 additional weeks. Adherence to exercise frequency (i.e. attendance), intensity, and time/duration, and barriers to adherence were tracked and compared during chemotherapy versus radiation, and during treatment (chemotherapy plus radiation, if received) versus after treatment.

Results

Attendance decreased with cumulative chemotherapy dose (cycles 1-2 vs. cycles 3-8, cycle 3 vs. cycles 7-8, all P ≤ 0.05), and was lower during chemotherapy than radiation (64 ± 25 vs. 71 ± 32%, P = 0.02), and after treatment than during treatment (P < 0.01). Adherence to exercise intensity trended toward being higher during chemotherapy than radiation (69 ± 23 vs. 51 ± 38%, P = 0.06), and was higher during than after treatment (P = 0.01). Adherence to duration did not differ with treatment. Overall adherence to the resistance prescription was poor, but was higher during chemotherapy than radiation (57 ± 23 vs. 34 ± 39%, P < 0.01), and was not different during than after treatment. The most common barriers to attendance during treatment were cancer-related (e.g. symptoms, appointments), and after treatment were life-related (e.g. vacation, work).

Conclusion

Adherence to supervised exercise delivered in a real-world clinical setting varies among breast cancer patients and across the treatment trajectory. Behavioral strategies and individualization in exercise prescriptions to improve adherence are especially important for later chemotherapy cycles, after treatment, and for resistance exercise.

Corresponding author: Dr. Kristin Campbell, 212-2177 Wesbrook Mall, Vancouver, Canada V6T1Z3, Ph:(604)-827-4704; Fx:(604)-822-1870; E:Kristin.Campbell@ubc.ca

The BC Cancer Foundation funded this study. AK was funded by the Canadian Institute of Health Research. There are no conflicts of interest to declare for any authors. The results of the present study do not constitute endorsement by ACSM. The results of the study are presented clearly, honestly, and without fabrication, falsification, or inappropriate data manipulation.

Accepted for Publication: 27 September 2017

© 2017 American College of Sports Medicine