An optimal exercise option for breast cancer patients: Combining aerobic and resistance exercise programs

A young, bald Asian woman flexes both biceps

Share Click here for a print copy (5 pages, PDF).

Don't miss the next WellSpring. Subscribe to CAL's Active Living E-News to receive our monthly notice.


By Ki-Yong Ana, Andria R. Moriellia, Dong-Woo Kanga, Christine M. Friedenreichb, Donald C. McKenziec, Karen Gelmonc, John R. Mackeya, Robert D. Reidd, and Kerry S. Courneyaa
aUniversity of Alberta, bUniversity of Calgary, cUniversity of British Columbia, dUniversity of Ottawa

Summary

Being physically active while battling breast cancer can have many benefits to one’s health. However, how much excercise is best and what types of exercises are most beneficial?

This WellSpring provides an overview of the benefits as well as exercise recommendations.

Introduction

Previous studies have reported that exercise has many benefits on physical and mental health in cancer patients. During chemotherapy, exercise improves quality of life,1,2 treatment-related symptoms,3-5 physical fitness,3-6 chemotherapy completion rate,5,6 and possibly even survival7 in breast cancer patients.

Two important questions are: what type of exercise and how much exercise is optimal for breast cancer patients?

To answer these questions, we designed the Combined Aerobic and Resistance Exercise (CARE) Trial to compare the effects of different types and doses of exercise performed during breast cancer chemotherapy.4

The Combined Aerobic and Resistance Exercise (CARE) Trial: different doses and types of exercise

Between 2008 and 2014, the CARE trial was conducted at three sites in Canada, including the Cross Cancer Institute in Edmonton, Alberta, the Ottawa Hospital Cancer Centre in Ottawa, Ontario, and the British Columbia Cancer Agency in Vancouver, British Columbia.

Participants (301 in total) with stage one, two, or three breast cancer were in the CARE Trial and assigned to one of three exercise program groups:

  1. Standard group: a standard dose of 25-30 minutes of vigorous aerobic exercise (e.g., bike, treadmill, elliptical, and/or rowing machine) three times per week.
  2. High dose group: a higher dose of 50-60 minutes of vigorous aerobic exercise (e.g., bike, treadmill, elliptical, and/or rowing machine) three times per week.
  3. Combined exercise group: a higher dose of 50-60 minutes of combined aerobic (e.g., bike, treadmill, elliptical, and/or rowing machine) and resistance exercise (e.g., leg press, leg extension, leg curl, calf raise, chest press, seated row, triceps extension, biceps curl, and curl-up) three times per week.

A middle-aged woman smiles while exercising on an elliptical

All participants started the exercise intervention within one to two weeks of their first chemotherapy treatment and completed the intervention within three to four weeks after their final chemotherapy treatment.

We compared the effects of these three different exercise groups after their exercise programs were completed. We found that those participants in the high dose and the combined exercise groups had better physical functioning, treatment-related symptoms, sleep quality, and physical fitness compared to participants in the standard exercise group.4,8

Our team also sought to determine if the effects of exercise during chemotherapy would last after completing their chemotherapy treatment. To do this, our team looked at the long-term effects of these three exercises during chemotherapy on exercise behaviour, quality of life, treatment-related symptoms, psychosocial factors (e.g., stress, happiness, self-esteem, depression, anxiety, and sleep quality), and health-related fitness (e.g., aerobic fitness, muscular strength and endurance, lean body, and body fat) in breast cancer patients. Here are some of the long-term results of the study.9

The benefits of exercise during chemotherapy do not last long

Once the exercise program during chemotherapy was completed, participants were encouraged to continue both aerobic and resistance exercises. However, they were not provided with behavioural or exercise support, and they were free to do exercises of their choosing.

At 6, 12, and 24 months after treatment, we assessed participants’ exercise behaviour, quality of life, treatment-related symptoms, and psychosocial factors. We also assessed their physical fitness at 12 months after the intervention.

Unfortunately, the benefits of exercise did not last long after the program was completed. Specifically, the benefits of combined and high dose exercise on physical functioning, treatment-related symptoms, and sleep quality dissipated within 24 months. Participants who did the combined exercise during chemotherapy generally showed superior effects at 6 months, inferior effects at 12 months, and no difference in effects at 24 months for several psychosocial outcomes, such as stress, happiness, anxiety, and sleep quality. Participants in chemotherapy for longer terms showed no difference in the effects between the three different exercises on quality of life, treatment-related symptoms, and psychosocial factors.

Pink running shoes are walking on a treadmill

Importance of continuous exercise after treatment

We also examined the association between continuing exercise after treatment and quality of life, treatment-related symptoms, psychosocial factors, and physical fitness.

Interestingly, participants who consistently exercised after treatment reported having a better quality of life, treatment-related symptoms, psychosocial factors, and physical fitness compared to those who were not exercising enough, regardless of which exercise they did during chemotherapy. These findings suggest that consistent exercise participation after treatment is important for breast cancer patients for improving and maintaining their physical and mental health gains. Exercising only during treatment is not enough for their continuous health management.

Combined aerobic and resistance exercise as an optimal exercise approach

Based on the CARE Trial, combining aerobic and resistance exercises may be the optimal exercise option for breast cancer patients and survivors. Although there was no difference between different exercise groups during chemotherapy on long-term quality of life, treatment-related symptoms, and psychosocial factors, participants who participated in the combined exercise had better muscular endurance and were doing more resistance exercise than those who participated in the high dose exercise. These findings suggest that performing resistance during chemotherapy may result in continued participation in resistance exercise and better muscular endurance after chemotherapy.

Moreover, after treatment, participants who maintained exercise following the exercise guidelines for cancer survivors—at least 150 min/week of moderate aerobic exercise and 2 days/week of resistance exercise—had superior effects for quality of life, treatment-related symptoms, psychosocial factors, and physical fitness compared to those who did only one or neither types of exercise.

Participants who met only aerobic exercise guidelines after treatment had more superior effects for quality of life, treatment-related symptoms, psychosocial factors, and physical fitness compared to those who met only resistance exercise guidelines or neither guidelines.

These findings indicate that the combined aerobic and resistance exercise during and after treatment may be the optimal exercise option for breast cancer patients.

A male and female older adult are both walking on treadmills

Conclusion and take home messages

Our study supports several messages.