Top

Journal of Cancer Survivorship

Published in:

01-06-2012

The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial

Authors: Kerri M. Winters-Stone, Jessica Dobek, Jill A. Bennett, Lillian M. Nail, Michael C. Leo, Anna Schwartz

Published in: Journal of Cancer Survivorship | Issue 2/2012

Abstract

Introduction

Older breast cancer survivors (BCS) report more falls and functional limitations than women with no cancer history. Exercise training could reduce risk factors for future falls and disability.

Methods

We conducted a randomized, controlled trial in 106 early-stage, postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment. Women were randomly assigned to a 1-year resistance + impact exercise program or a stretching placebo program. Endpoints were one repetition maximum bench press and leg press strength, timed five chair stands, 4 m usual walk speed, timed stance tests, handgrip strength, self-report physical function, and fatigue. We also examined the influence of age, adjuvant hormone therapy use, and exercise adherence on study outcomes.

Results

Women in the resistance + impact training program significantly improved maximal leg (p <0 .02) and bench (p <0 .02) press strength compared to the stretching group. Women who attended 50% or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women.

Conclusions

Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement.

Implications for cancer survivors

Older BCS can safely engage in resistance exercise that improves lower and upper body strength, thereby reducing a risk factor for falls and future disability. However, the ability of resistance training to shift other indices of fall and disability risk, i.e., balance and function, is unclear. Strategies to promote adherence to resistance training could lead to greater improvements in strength.

Sweeney C, Schmitz KH, Lazovich D, Virnig BA, Wallace RB, Folsom AR. Functional limitations in elderly female cancer survivors. J Natl Cancer Inst. 2006;98(8):521–9.PubMedCrossRef

Chen Z, Maricic M, Aragaki AK, Mouton C, Arendell L, Lopez AM, et al. Fracture risk increases after diagnosis of breast or other cancers in postmenopausal women: results from the Women’s Health Initiative. Osteoporos Int. 2009;20(4):527–36.PubMedCrossRef

Winters-Stone K, Torgrimson B, Horak F, Eisner A, Leo M, Nail L, et al. Identifying risk factors for falls in postmenopausal breast cancer survivors: a multidisciplinary approach. Arch Phys Med Rehab. 2011;9(4):646–52.CrossRef

Winters-Stone KM, Nail L, Bennett JA, Schwartz A. Bone health and falls: fracture risk in breast cancer survivors with chemotherapy-induced amenorrhea. Oncol Nurs Forum. 2009;36(3):315–25.PubMedCrossRef

Frost HM. Should fracture risk-of-fracture analyses include another major risk factor? The case for falls. J Clin Densitom. 2001;4:381–3.PubMedCrossRef

Centers for Disease Control aP. Falls among older adults: an overview. 2008. http://www.cdc.gov/ncipc/factsheets/adultfalls/htm.

Stevens JA, Sogolow ED. Gender differences for non-fatal unintentional fall related injuries among older adults. Inj Prev. 2005;11(2):115–9.PubMedCrossRef

Bennett JA, Winters-Stone K, Nail L. Conceptualizing and measuring physical functioning in cancer survivorship studies. Oncol Nurs Forum. 2006;33(1):41–9.PubMedCrossRef

Maccormick RE. Possible acceleration of aging by adjuvant chemotherapy: a cause of early onset frailty? Med Hypotheses. 2006;67(2):212–5.PubMedCrossRef

10.

Rantanen T. Muscle strength, disability and mortality. Scand J Med Sci Sports. 2003;13(1):3–8.PubMedCrossRef

11.

American Geriatrics Society and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. Guideline for the prevention of falls in older persons. J Am Geriatr Soc. 2001;49(5):664–72.CrossRef

12.

Orr R. Contribution of muscle weakness to postural instability in the elderly. A systematic review. Eur J Phys Rehabil Med. 2010;46(2):183–220.PubMed

13.

Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurence of falls. J Gerontol A Biol Sci Med Sci. 1995;50:64–7.PubMed

14.

Freedman RJ, Aziz N, Albanes D, Hartman T, Danforth D, Hill S, et al. Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. J Clin Endocrinol Metab. 2004;89(5):2248–53.PubMedCrossRef

15.

Demark-Wahnefried W, Peterson BL, Winer EP, Marks L, Aziz N, Marcom PK, et al. Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. J Clin Oncol. 2001;19(9):2381–9.PubMed

16.

Harvie MN, Campbell IT, Baildam A, Howell A. Energy balance in early breast cancer patients receiving adjuvant chemotherapy. Breast Cancer Res Treat. 2004;83(3):201–10.PubMedCrossRef

17.

Cheney CL, Mahloch J, Freeny P. Computerized tomography assessment of women with weight changes associated with adjuvant treatment for breast cancer. Am J Clin Nutr. 1997;66(1):141–6.PubMed

18.

Kutynec CL, McCargar L, Barr SI, Hislop TG. Energy balance in women with breast cancer during adjuvant treatment. J Am Diet Assoc. 1999;99(10):1222–7.PubMedCrossRef

19.

Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, et al. Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer. 2003;97(7):1746–57.PubMedCrossRef

20.

Schwartz AL. Fatigue in long-term cancer survivors. Oncology (Williston Park). 2009;23(8):33–4.

21.

Hauer K, Rost B, Rutschle K, Opitz H, Specht N, Bartsch P, et al. Exercise training for rehabilitation and secondary prevention of falls in geriatric patients with a history of injurious falls. J Am Geriatr Soc. 2001;49(1):10–20.PubMedCrossRef

22.

Campbell AJ, Robertson MC, Gardner M, Norton RN, Buchner DM. Falls prevention over 2 years: a randomized controlled trial in women 80 years and older. Age Ageing. 1999;28(6):513–8.PubMedCrossRef

23.

Latham NK, Bennett DA, Stretton CM, Anderson CS. Systematic review of progressive resistance strength training in older adults. J Gerontol A Biol Sci Med Sci. 2004;59(1):M48–61.CrossRef

24.

Twiss JJ, Waltman NL, Berg K, Ott CD, Gross GJ, Lindsey AM. An exercise intervention for breast cancer survivors with bone loss. J Nurs Scholarsh. 2009;41(1):20–7.PubMedCrossRef

25.

Schmitz KH, Ahmed RL, Troxel A, Cheville A, Smith R, Lewis-Grant L, et al. Weight lifting in women with breast-cancer-related lymphedema. N Engl J Med. 2009;361(7):664–73.PubMedCrossRef

26.

Schmitz KH, Ahmed RL, Troxel AB, Cheville A, Lewis-Grant L, Smith R, et al. Weight lifting for women at risk for breast cancer-related lymphedema. JAMA. 2010;304(24):2699–705.PubMedCrossRef

27.

Shaw JM, Snow CM. Weighted vest exercise improves indices of fall risk in older women. J Gerontol. 1998;53:M53–8.

28.

Winters KM, Snow CM. Detraining reverses positive effects of exercise on the musculoskeletal system in premenopausal women. J Bone Miner Res. 2000;15:2495–503.PubMedCrossRef

29.

Winters-Stone K, Dobek J, Nail L, Bennett JA, Naik A, Schwartz A. Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat. 2011;27(2):447–56.CrossRef

30.

Hintze J. PASS 6.0 Power Analysis and Sample Size for Windows. Keysville: NCSS; 1996.

31.

Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Exercise for women with or at risk for breast cancer-related lymphedema. Phys Ther. 2006;86(10):1398–405.PubMedCrossRef

32.

Winters-Stone K, Snow C. Site-specific response of bone to exercise in premenopausal women. Bone. 2006;39(6):1203–9.PubMedCrossRef

33.

Snow CM, Shaw JM, Winters KM, Witzke KA. Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. J Gerontol A Biol Sci Med Sci. 2000;55(9):M489–91.PubMedCrossRef

34.

Schmitz KH, Courneya KS, Matthews C, Demark-Wahnefried W, Galvao DA, Pinto BM, et al. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26.PubMedCrossRef

35.

American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708.CrossRef

36.

Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al. American College of Sports Medicine position stand. Exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30.PubMedCrossRef

37.

Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–83.PubMedCrossRef

38.

Stewart A, Mills K, King A, Haskell W, Gillis D, Ritter P. CHAMPS physical activity questionnaire for older adults: outcomes for interventions. Med Sci Sports Exerc. 2001;33(7):1126–41.PubMed

39.

American College of Sports Medicine. ACSM’s guildelines for exercise testing and prescription. 7th ed. Philadelphia: Lippincott Williams & Wilkins; 2006.

40.

den Ouden MEM, Schuurmans MJ, Arts IEMA, van der Schouw YT. Physical performance characteristics related to disability in older persons: a systematic review. Maturitas. 2011;69(3):208–19.CrossRef

41.

Bohannon RW. Hand-grip dynamometry predicts future outcomes in aging adults. J Geriatr Phys Ther. 2008;31(1):3–10.PubMedCrossRef

42.

Wang C-Y, Chen L-Y. Grip strength in older adults: test–retest reliability and cutoff for subjective weakness of using the hands in heavy tasks. Arch Phys Med Rehabil. 2010;91(11):1747–51.PubMedCrossRef

43.

Guralnik JM, Ferrucci L, Pieper CF, Leveille SG, Markides KS, Ostir GV, et al. Lower extremity function and subsequent disability: consistency across studies, predictive models, and value of gait speed alone compared with the short physical performance battery. J Gerontol A Biol Sci Med Sci. 2000;55(4):M221–31.PubMedCrossRef

44.

Guralnik JM, Simonsick EM, Ferrucci L, Glynn RJ, Berkman LF, Blazer DG, et al. A short physical performance battery assessing lower extremity function: association with self-reported disability and prediction of mortality and nursing home admission. J Gerontol. 1994;49(2):M85–94.PubMed

45.

Guralnik JM, Ferrucci L, Simonsick EM, Salive ME, Wallace RB. Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. N Engl J Med. 1995;332(9):556–61.PubMedCrossRef

46.

Penninx BW, Ferrucci L, Leveille SG, Rantanen T, Pahor M, Guralnik JM. Lower extremity performance in nondisabled older persons as a predictor of subsequent hospitalization. J Gerontol A Biol Sci Med Sci. 2000;55(11):M691–7.PubMedCrossRef

47.

Mancini M, Horak FB. The relevance of clinical balance assessment tools to differentiate balance deficits. Eur J Phys Rehabil Med. 2010;46(2):239–48.PubMed

48.

Jette AM, Haley SM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, et al. Late life function and disability instrument: I. Development and evaluation of the disability component. J Gerontol A Biol Sci Med Sci. 2002;57(4):M209–16.PubMedCrossRef

49.

Haley SM, Jette AM, Coster WJ, Kooyoomjian JT, Levenson S, Heeren T, et al. Late Life Function and Disability Instrument: II. Development and evaluation of the function component. J Gerontol A Biol Sci Med Sci. 2002;57(4):M217–22.PubMedCrossRef

50.

McKenzie DC, Kalda AL. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. J Clin Oncol. 2003;21(3):463–6.PubMedCrossRef

51.

Mock V, Frangakis C, Davidson NE, Ropka ME, Pickett M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Psychooncology. 2004;14(6):464–77.

52.

Mock V, Pickett M, Ropka ME, Muscari Lin E, Stewart KJ, Rhodes VA, et al. Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Pract. 2001;9(3):119–27.PubMedCrossRef

53.

Segal R, Evans W, Johnson D, Smith J, Colletta S, Gayton J, et al. Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. J Clin Oncol. 2001;19(3):657–65.PubMed

54.

Schwartz AL. The Schwartz Cancer Fatigue Scale: testing reliability and validity. Oncol Nurs Forum. 1998;25(4):711–7.PubMed

55.

Raudenbush S, Bryk A. Hierarchical Linear Models: Applications and Data Analysis Methods. 2nd ed. Thousand Oaks: Sage Publications; 2002.

56.

Lane P. Handling drop-out in longitudinal clinical trials: a comparison of the LOCF and MMRM approaches. Pharm Stat. 2008;7:93–106.PubMedCrossRef

57.

Streiner DL. The case of the missing data: methods of dealing with dropouts and other research vagaries. Can J Psychiatry. 2002;47:68–75.PubMed

58.

SEER: Surveillance, Epidemiology, and End Results [database on the Internet]. National Cancer Institute. 2005. Available from: http://seer.cancer.gov/faststats/html/pre_breast.html. Accessed: January 19, 2005.

59.

Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: a systematic review and meta-analysis. J Cancer Surviv. 2010;4(2):87–100.PubMedCrossRef

60.

Brochu M, Savage P, Lee M, Dee J, Cress ME, Poehlman ET, et al. Effects of resistance training on physical function in older disabled women with coronary heart disease. J Appl Physiol. 2002;92(2):672–8.PubMedCrossRef

61.

Alexander NB, Gross MM, Medell JL, Hofmeyer MR. Effects of functional ability and training on chair-rise biomechanics in older adults. J Gerontol A Biol Sci Med Sci. 2001;56(9):M538–47.PubMedCrossRef

62.

Brown M, Sinacore DR, Ehsani AA, Binder EF, Holloszy JO, Kohrt WM. Low-intensity exercise as a modifier of physical frailty in older adults. Arch Phys Med Rehabil. 2000;81(7):960–5.PubMedCrossRef

63.

Barrett CJ, Smerdely P. A comparison of community-based resistance exercise and flexibility exercise for seniors. Aust J Physiother. 2002;48(3):215–9.PubMed

64.

Rider RA, Daly J. Effects of flexibility training on enhancing spinal mobility in older women. J Sports Med Phys Fit. 1991;31(2):213–7.

65.

Christiansen CL. The effects of hip and ankle stretching on gait function of older people. Arch Phys Med Rehabil. 2008;89(8):1421–8.PubMedCrossRef

66.

Chodzko-Zajko WJ, Proctor DN, Fiatarone Singh MA, Minson CT, Nigg CR, Salem GJ, et al. American College of Sports Medicine position stand: exercise and physical activity for older adults. Med Sci Sports Exerc. 2009;41(7):1510–30.PubMedCrossRef

67.

Campbell KL, Neil SE, Winters-Stone KM. Review of exercise studies in breast cancer survivors: attention to principles of exercise training. Br J Sports Med. 2011. doi:10.1136/bjsm.2010.082719.

68.

Perera S, Mody SH, Woodman RC, Studensk SA. Meaningful change and responsiveness in common physical performance measures in older adults. J Am Geriatr Soc. 2006;54(5):743–9.PubMedCrossRef

69.

Wennie Huang W-N, Perera S, VanSwearingen J, Studenski S. Performance measures predict onset of activity of daily living difficulty in community-dwelling older adults. J Am Geriatr Soc. 2010;58(5):844–52.PubMedCrossRef

70.

Brach JS, VanSwearingen JM, Newman AB, Kriska AM. Identifying early decline of physical function in community-dwelling older women: performance-based and self-report measures. Phys Ther. 2002;82(4):320–8.PubMed

71.

Taaffe D, Duret C, Wheeler S, Marcus R. Once-weekly resistance exercise improves muscle strength and neuromuscular performance in older adults. J Am Geriatr Soc. 1999;47(10):1208–14.PubMed

72.

Sinaki M, Nwaogwugwu NC, Phillips BE, Mokri MP. Effect of gender, age, and anthropometry on axial and appendicular muscle strength. Am J Phys Med Rehabil. 2001;80(5):330–8.PubMedCrossRef

73.

Whitehead S, Lavelle K. Older breast cancer survivors’ views and preferences for physical activity. Qual Health Res. 2009;19(7):894–906.PubMedCrossRef

74.

Fried LP, Bandeen-Roche K, Chaves PH, Johnson BA. Preclinical mobility disability predicts incident mobility disability in older women. J Gerontol A Biol Sci Med Sci. 2000;55(1):M43–52.PubMedCrossRef

75.

Vermeulen J, Neyens J, van Rossum E, Spreeuwenberg M, de Witte L. Predicting ADL disability in community-dwelling elderly people using physical frailty indicators: a systematic review. BMC Geriatr. 2011;11(1):33.PubMedCrossRef

76.

Edwards BK, Howe HL, Ries LA, Thun MJ, Rosenberg HM, Yancik R, et al. Annual report to the nation on the status of cancer, 1973–1999, featuring implications of age and aging on U.S. cancer burden. Cancer. 2002;94(10):2766–92.PubMedCrossRef

Title: The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial
Authors: Kerri M. Winters-Stone
Jessica Dobek
Jill A. Bennett
Lillian M. Nail
Michael C. Leo
Anna Schwartz
Publication date: 01-06-2012
Publisher: Springer US
Published in: Journal of Cancer Survivorship / Issue 2/2012
Print ISSN: 1932-2259
Electronic ISSN: 1932-2267
DOI: https://doi.org/10.1007/s11764-011-0210-x

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 sleep in brain health

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusions

Implications for cancer survivors

Please log in to get access to this content

Other articles of this Issue 2/2012

“Weaving Balance into Life”: Development and cultural adaptation of a cancer symptom management toolkit for Southwest American Indians

A systematic review of large-scale surveys of cancer survivors conducted in North America, 2000–2011

Patient perceptions of communications on the threshold of cancer survivorship: implications for provider responses

Family doctor-driven follow-up for adult childhood cancer survivors supported by a web-based survivor care plan

Factors that contribute to post-treatment follow-up care for survivors of childhood cancer

A randomized trial of exercise on well-being and function following breast cancer surgery: the RESTORE trial

Keynote webinar | Spotlight on antibody–drug conjugates in cancer