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

KIRKHAM, AMY A.1; BONSIGNORE, ALIS2; BLAND, KELCEY A.3; MCKENZIE, DONALD C.2; GELMON, KAREN A.3; VAN PATTEN, CHERI L.4; CAMPBELL, KRISTIN L.1,5

Medicine & Science in Sports & Exercise: February 2018 - Volume 50 - Issue 2 - p 177–186
doi: 10.1249/MSS.0000000000001446
Clinical Sciences

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 thrice per 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).

Conclusions 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.

Supplemental digital content is available in the text.

1Department of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, CANADA; 2Department of Kinesiology, University of British Columbia, Vancouver, BC, CANADA; 3Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, BC, CANADA; 4Department of Oncology Nutrition, British Columbia Cancer Agency, Vancouver, BC, CANADA; and 5Department of Physical Therapy, British Columbia Cancer Agency, Vancouver, BC, CANADA

Address for correspondence: Kristin Campbell, Ph.D., 212-2177 Wesbrook Mall, Vancouver, Canada V6T1Z3; E-mail: Kristin.Campbell@ubc.ca.

Submitted for publication June 2017.

Accepted for publication September 2017.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (www.acsm-msse.org).

© 2018 American College of Sports Medicine