Top

Published in:

01-09-2019 | Breast Cancer | Original Article

Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial

Authors: Aude-Marie Foucaut, Magali Morelle, Anne-Sophie Kempf-Lépine, Cédric Baudinet, Renaud Meyrand, Séverine Guillemaut, Séverine Metzger, Valérie Bourne-Branchu, Elodie Grinand, Sylvie Chabaud, David Pérol, Julien Carretier, Sophie E. Berthouze, Eric Reynes, Lionel Perrier, Paul Rebattu, Pierre-Etienne Heudel, Thomas Bachelot, Patrick Bachmann, Béatrice Fervers, Olivier Trédan, Marina Touillaud

Published in: Supportive Care in Cancer | Issue 9/2019

Abstract

Purpose

Lack of physical activity (PA), weight gain, and overweight have been associated with increased risk of recurrence and mortality after breast cancer diagnosis. We evaluated the feasibility of implementing an individualized exercise program and nutritional counseling during adjuvant treatment of localized invasive breast cancer.

Methods

Sixty-one patients eligible for adjuvant chemotherapy were randomized 2:1 to receive a 6-month program of weekly aerobic exercises associated with nutritional counseling (n = 41) or usual care with nutritional counseling (n = 20, one withdrawal). The primary endpoints were the proportion of patients compliant with two weekly supervised sessions and their overall adherence (i.e., proportion of supervised and unsupervised sessions completed versus planned sessions).

Results

Ten percent of patients in the intervention group were compliant with the two weekly supervised sessions for 6 months, but the overall median adherence rate was 85% of supervised and non-supervised sessions completed. Non-adherence was mainly due to intrinsic reasons (medical, organizational, psychological barriers). Adherence was positively associated with education and baseline PA level and inversely associated with baseline weight and tumor grade. No statistically significant benefits were observed in the intervention group, even if overall PA level and body composition improved and anthropometrics were maintained over time (p < 0.05).

Conclusions

Overall, there was good adherence with the 6-month exercise program during adjuvant treatment for breast cancer, despite poor compliance to twice-weekly supervised sessions. This study highlights the need for flexible exercise modalities and innovative experimental design to reach patients who would most adhere and benefit from intervention.

Trial registration: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1

Playdon MC, Bracken MB, Sanft TB, Ligibel JA, Harrigan M, Irwin ML (2015) Weight gain after breast cancer diagnosis and all-cause mortality: systematic review and meta-analysis. J Natl Cancer Inst 107:djv275CrossRefPubMedPubMedCentral

Azrad M, Demark-Wahnefried W (2014) The association between adiposity and breast cancer recurrence and survival: a review of the recent literature. Curr Nutr Rep 3:9–15CrossRefPubMedPubMedCentral

Trédan O, Bajard A, Meunier A, Roux P, Fiorletta I, Gargi T, Bachelot T, Guastalla JP, Lallemand Y, Faure C, Pérol D, Bachmann P (2010) Body weight change in women receiving adjuvant chemotherapy for breast cancer: a French prospective study. Clin Nutr 29:187–191CrossRefPubMed

Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:243–274CrossRefPubMed

Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Fieuws S, Lefevre J et al (2010) Physical activity levels after treatment for breast cancer: one-year follow-up. Breast Cancer Res Treat 123:417–425CrossRefPubMed

Milne HM, Wallman KE, Gordon S, Courneya KS (2008) Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 108:279–288CrossRefPubMed

Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard-Barbash R (2003) Physical activity levels before and after a diagnosis of breast carcinoma: the health, eating, activity, and lifestyle (HEAL) study. Cancer 97:1746–1757CrossRefPubMed

Coughlin SS, Smith SA (2015) The insulin-like growth factor axis, adipokines, physical activity, and obesity in relation to breast cancer incidence and recurrence. Cancer Clin Oncol 4:24–31PubMedPubMedCentral

Cramp F, Byron-Daniel J (2012) Exercise for the management of cancer-related fatigue in adults. Cochrane Database Syst Rev 11:CD006145PubMed

10.

Mishra SI, Scherer RW, Snyder C, Geigle PM, Berlanstein DR, Topaloglu O (2012) Exercise interventions on health-related quality of life for people with cancer during active treatment. Cochrane Database Syst Rev 8:CD008465. https://doi.org/10.1002/14651858. CrossRef

11.

Schwartz AL (2000) Exercise and weight gain in breast cancer patients receiving chemotherapy. Cancer Pract 8:231–237CrossRefPubMed

12.

DeNysschen CA, Brown JK, Cho MH, Dodd MJ (2011) Nutritional symptom and body composition outcomes of aerobic exercise in women with breast cancer. Clin Nurs Res 20:29–46CrossRefPubMed

13.

Courneya KS, Segal RJ, McKenzie DC, Dong H, Gelmon K, Friedenreich CM et al (2014) Effects of exercise during adjuvant chemotherapy on breast cancer outcomes. Med Sci Sports Exerc 46:1744–1751CrossRefPubMed

14.

Mason C, Alfano CM, Smith AW, Wang C-Y, Neuhouser ML, Duggan C, Bernstein L, Baumgartner KB, Baumgartner RN, Ballard-Barbash R, McTiernan A (2013) Long-term physical activity trends in breast cancer survivors. Cancer Epidemiol Biomark Prev 22:1153–1161CrossRef

15.

Schmitz KH, Speck RM, Rye SA, DiSipio T, Hayes SC (2012) Prevalence of breast cancer treatment sequelae over 6 years of follow-up: the pulling through study. Cancer 118(Suppl 8):2217–2225CrossRefPubMed

16.

Phillips M, Flemming N, Tsintzas K (2009) An exploratory study of physical activity and perceived barriers to exercise in ambulant people with neuromuscular disease compared with unaffected controls. Clin Rehabil 23:746–755CrossRefPubMed

17.

Schmidt ME, Wiskemann J, Armbrust P, Schneeweiss A, Ulrich CM, Steindorf K (2015) Effects of resistance exercise on fatigue and quality of life in breast cancer patients undergoing adjuvant chemotherapy: a randomized controlled trial. Int J Cancer 137:471–480CrossRefPubMed

18.

Travier N, Velthuis MJ, Steins Bisschop CN, van den Buijs B, Monninkhof EM, Backx F, Los M, Erdkamp F, Bloemendal HJ, Rodenhuis C, de Roos MAJ, Verhaar M, ten Bokkel Huinink D, van der Wall E, Peeters PHM, May AM (2015) Effects of an 18-week exercise programme started early during breast cancer treatment: a randomised controlled trial. BMC Med 13:121CrossRefPubMedPubMedCentral

19.

Touillaud M, Foucaut A-M, Berthouze SE, Reynes E, Kempf-Lépine A-S, Carretier J, Pérol D, Guillemaut S, Chabaud S, Bourne-Branchu V, Perrier L, Trédan O, Fervers B, Bachmann P (2013) Design of a randomised controlled trial of adapted physical activity during adjuvant treatment for localised breast cancer: the PASAPAS feasibility study. BMJ Open 3:e003855CrossRefPubMedPubMedCentral

20.

Loose BD, Christiansen AM, Smolczyk JE, Roberts KL, Budziszewska A, Hollatz CG, Norman JF (2012) Consistency of the counting talk test for exercise prescription. J Strength Cond Res 26:1701–1707CrossRefPubMed

21.

Kim C-J, Kang D-H, Park J-W (2009) A meta-analysis of aerobic exercise interventions for women with breast cancer. West J Nurs Res 31:437–461CrossRefPubMed

22.

Byar KL, Berger AM, Bakken SL, Cetak MA (2006) Impact of adjuvant breast cancer chemotherapy on fatigue, other symptoms, and quality of life. Oncol Nurs Forum 33:E18–E26CrossRefPubMed

23.

Sasso JP, Eves ND, Christensen JF, Koelwyn GJ, Scott J, Jones LW (2015) A framework for prescription in exercise-oncology research. J Cachexia Sarcopenia Muscle 6:115–124CrossRefPubMedPubMedCentral

24.

Berthouze SE, Minaire PM, Castells J, Busso T, Vico L, Lacour JR (1995) Relationship between mean habitual daily energy expenditure and maximal oxygen uptake. Med Sci Sports Exerc 27:1170–1179CrossRefPubMed

25.

Foucaut A-M, Berthouze SE, Touillaud M, Morelle M, Bourne-Branchu V, Kempf-Lépine A-S, Carretier J, Pérol D, Trédan O, Bachmann P, Fervers B (2015) Deterioration of physical activity level and metabolic risk factors after early-stage breast cancer diagnosis. Cancer Nurs 38:E1–E9CrossRefPubMed

26.

Kyle UG, Genton L, Hans D, Karsegard L, Slosman DO, Pichard C (2001) Age-related differences in fat-free mass, skeletal muscle, body cell mass and fat mass between 18 and 94 years. Eur J Clin Nutr 55:663–672CrossRefPubMed

27.

van Waart H, Stuiver MM, van Harten WH, Geleijn E, Kieffer JM, Buffart LM, de Maaker-Berkhof M, Boven E, Schrama J, Geenen MM, Meerum Terwogt JM, van Bochove A, Lustig V, van den Heiligenberg SM, Smorenburg CH, Hellendoorn-van Vreeswijk JAJH, Sonke GS, Aaronson NK (2015) Effect of low-intensity physical activity and moderate- to high-intensity physical exercise during adjuvant chemotherapy on physical fitness, fatigue, and chemotherapy completion rates: results of the PACES randomized clinical trial. J Clin Oncol 33:1918–1927CrossRefPubMed

28.

Furmaniak AC, Menig M, Markes MH (2016) Exercise for women receiving adjuvant therapy for breast cancer. Cochrane Database Syst Rev 9:CD005001PubMed

29.

Carayol M, Delpierre C, Bernard P, Ninot G (2015) Population-, intervention- and methodology-related characteristics of clinical trials impact exercise efficacy during adjuvant therapy for breast cancer: a meta-regression analysis. Psychooncology 24:737–747CrossRefPubMed

30.

Backman M, Wengström Y, Johansson B, Sköldengen I, Börjesson S, Tärnbro S, Berglund Å (2014) A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer. Acta Oncol 53:510–520CrossRefPubMed

31.

Husebø AML, Karlsen B, Allan H, Søreide JA, Bru E (2015) Factors perceived to influence exercise adherence in women with breast cancer participating in an exercise programme during adjuvant chemotherapy: a focus group study. J Clin Nurs 24:500–510CrossRefPubMed

32.

Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM et al (2008) Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc 40:1180–1187CrossRefPubMed

33.

Hsu H-T, Dodd MJ, Guo S-E, Lee KA, Hwang S-L, Lai Y-H (2011) Predictors of exercise frequency in breast cancer survivors in Taiwan. J Clin Nurs 20:1923–1935CrossRefPubMed

34.

Ottenbacher AJ, Day RS, Taylor WC, Sharma SV, Sloane R, Snyder DC, Kraus WE, Demark-Wahnefried W (2011) Exercise among breast and prostate cancer survivors--what are their barriers? J Cancer Surviv Res Pract 5:413–419CrossRef

35.

Gho SA, Munro BJ, Jones SC, Steele JR (2014) Perceived exercise barriers explain exercise participation in Australian women treated for breast cancer better than perceived exercise benefits. Phys Ther 94:1765–1774CrossRefPubMed

36.

Courneya KS, Segal RJ, Gelmon K, Mackey JR, Friedenreich CM, Yasui Y, Reid RD, Proulx C, Trinh L, Dolan LB, Wooding E, Vallerand JR, McKenzie DC (2014) Predictors of adherence to different types and doses of supervised exercise during breast cancer chemotherapy. Int J Behav Nutr Phys Act 11:85CrossRefPubMedPubMedCentral

37.

Casla S, López-Tarruella S, Jerez Y, Marquez-Rodas I, Galvão DA, Newton RU, Cubedo R, Calvo I, Sampedro J, Barakat R, Martín M (2015) Supervised physical exercise improves VO2max, quality of life, and health in early stage breast cancer patients: a randomized controlled trial. Breast Cancer Res Treat 153:371–382CrossRefPubMed

38.

Bluethmann SM, Vernon SW, Gabriel KP, Murphy CC, Bartholomew LK (2015) Taking the next step: a systematic review and meta-analysis of physical activity and behavior change interventions in recent post-treatment breast cancer survivors. Breast Cancer Res Treat 149:331–342CrossRefPubMedPubMedCentral

39.

Luoma M-L, Hakamies-Blomqvist L, Blomqvist C, Nikander R, Gustavsson-Lilius M, Saarto T (2014) Experiences of breast cancer survivors participating in a tailored exercise intervention –a qualitative study. Anticancer Res 34:1193–1199PubMed

40.

Daley AJ, Crank H, Mutrie N, Saxton JM, Coleman R (2007) Determinants of adherence to exercise in women treated for breast cancer. Eur J Oncol Nurs 11:392–399CrossRefPubMed

41.

Carayol M, Bernard P, Boiché J, Riou F, Mercier B, Cousson-Gélie F, Romain AJ, Delpierre C, Ninot G (2013) Psychological effect of exercise in women with breast cancer receiving adjuvant therapy: what is the optimal dose needed? Ann Oncol 24:291–300CrossRefPubMed

42.

Rütten A, Abu-Omar K (2004) Prevalence of physical activity in the European Union. Soz Praventivmed 49:281–289PubMed

43.

Gerovasili V, Agaku IT, Vardavas CI, Filippidis FT (2015) Levels of physical activity among adults 18-64 years old in 28 European countries. Prev Med 81:87–91CrossRefPubMed

44.

Courneya KS, Rogers LQ, Campbell KL, Vallance JK, Friedenreich CM (2015) Top 10 research questions related to physical activity and cancer survivorship. Res Q Exerc Sport 86:107–116CrossRefPubMed

Title: Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial
Authors: Aude-Marie Foucaut
Magali Morelle
Anne-Sophie Kempf-Lépine
Cédric Baudinet
Renaud Meyrand
Séverine Guillemaut
Séverine Metzger
Valérie Bourne-Branchu
Elodie Grinand
Sylvie Chabaud
David Pérol
Julien Carretier
Sophie E. Berthouze
Eric Reynes
Lionel Perrier
Paul Rebattu
Pierre-Etienne Heudel
Thomas Bachelot
Patrick Bachmann
Béatrice Fervers
Olivier Trédan
Marina Touillaud
Publication date: 01-09-2019
Publisher: Springer Berlin Heidelberg
Keywords: Breast Cancer
Breast Cancer
Cytostatic Therapy
Published in: Supportive Care in Cancer / Issue 9/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-019-4658-y

Webinar | 19-02-2024 | 17:30 (CET)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer

Watch now

Antibody–drug conjugates (ADCs) are novel agents that have shown promise across multiple tumor types. Explore the current landscape of ADCs in breast and lung cancer with our experts, and gain insights into the mechanism of action, key clinical trials data, existing challenges, and future directions.

Dr. Véronique Diéras

Prof. Fabrice Barlesi

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 9/2019

Web-based videoconferencing for rural palliative care consultation with elderly patients at home

End-of-life care preferences for people with advanced cancer and their families in intensive care units: a systematic review

Self-perceived burden mediates the relationship between self-stigma and quality of life among Chinese American breast cancer survivors

Acupuncture for reduction of symptom burden in multiple myeloma patients undergoing autologous hematopoietic stem cell transplantation: a randomized sham-controlled trial. Respond to author

The impact of cancer type, treatment, and distress on health-related quality of life: cross-sectional findings from a study of Australian cancer patients

Development of the PROMIS-based Research Assessment and Clinical Tool-Fatigue (ReACT-F)

Keynote webinar | Spotlight on antibody–drug conjugates in cancer