Fatigue, and changes to muscle strength and physical function in delayed versus immediate exercise for breast cancer survivors scheduled for radiation therapy: A randomised controlled trial

INTERVENTION: Arm 1 – Resistance Training during radiation therapy Arm 2 – Resistance Training post radiotherapy Arm 3 – Usual Care (Control) Sixty‐seven breast cancer survivors scheduled to undertake radiotherapy were screened for participation from November 2009 to December 2010 and randomised (n=63) to three arms: during treatment exercise (DRT n=20); post treatment exercise (PRT n=22) and usual care (UC n=21). Outcomes for fatigue (Multi‐dimensional fatigue inventory (MFI); muscle strength (1‐RM); muscle endurance (70% 1‐RM); functional performance (chair‐rise, stair climb, 400‐m walk) and quality of life (EORTC‐C30 BR‐23) were assessed at baseline (Time 1: T1), 12‐weeks (Time 2: T2) and 3‐month follow‐up post intervention (Time 3: T3). All subjects were assessed at T1. Subjects were then either randomly allocated to exercise during radiation (DRT) (6‐weeks); wait for the 6 weeks of radiation to be completed to initiate the exercise (PRT) (further 6‐weeks) or did not receive any exercise intervention ‐ usual care (UC). Both DRT and PRT were then compared at week 12 (T2). Both DRT and PRT were then also assessed at the 3‐month follow‐up (T3). UC undertook measures at baseline (T1) week‐12 (T2) and at the 3‐month follow‐up (T3). Survivors were irradiated with a total dose of 50Gy with a dose per fraction of 2Gy for 25 treatments. Some women received an additional 10Gy to the original tumour bed in 5 fractions. Exercise training intervention Participants undertook combined aerobic and progressive resistance training twice a week for 6‐weeks in a supervised clinical exercise facility. Each session lasted 50 mins. 5 minutes warm‐up and cool‐down were performed before and after the session and included light aerobic activity and stretching. The resistance exercises included the chest press, seated row, and lateral pull down, lateral raises, front raises, triceps extension, leg extension and abdominal crunches. The resistance exercise program was designed to progress from 12‐ to 6‐repetition maximum (RM) for two to four sets per exercise. The aerobic component of the training program included 15 minutes of cardiovascular exercises per session (walking/cycling/jogging) at 65% to 80% maximum heart rate and at a perceived exertion ranging from 11 to 13 (6 to 20 point Borg Scale). CONDITION: Breast Cancer Radiotherapy PRIMARY OUTCOME: Fatigue (Multi‐dimensional fatigue inventory assessed at baseline (Time 1: T1), at 12‐weeks (Time 2: T2) and at a 3‐month follow‐up (Time 3: T3). SECONDARY OUTCOME: 1‐RM Strength ; Dynamic concentric muscle strength was measured for three exercises (Chest Press, Seated Row and ; Leg Extension), using the one repetition maximum (1‐RM).The 1‐RM being the maximal weight an individual can move through a full ; range of motion without a change in body position other than that dictated by the specific exercise ; motion Cancer Specific Quality of Life using the European Organisation for Research and Treatment in Cancer (EORTC) Quality of Life Questionaire (QLQ‐C30) with the breast cancer Specific Module (BR‐23) Functional performance (repeated chair rise, 400m walk and stair climb) INCLUSION CRITERIA: Inclusion was for women with a history of unilateral breast cancer, who were scheduled for radiotherapy and had not participated in any prior structured exercise training in the past three‐months