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Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial

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Abstract

The purpose of this study was to conduct an exploratory analysis of the START examining the effects of resistance exercise training (RET) and aerobic exercise training (AET) on sarcopenia, dynapenia, and associated quality of life (QoL) changes in breast cancer (BC) patients receiving adjuvant chemotherapy. Participants were randomized to usual care (UC) (n = 70), AET (n = 64), or RET (n = 66) for the duration of chemotherapy. Measures of sarcopenia [skeletal muscle index (SMI)] and dynapenia [upper extremity (UE) and lower extremity (LE) muscle dysfunction (MD)] were normalized relative to age-/sex-based clinical cut-points. QoL was assessed by the Functional Assessment of Cancer Therapy-Anemia (FACT-An) scales. At baseline, 25.5 % of BC patients were sarcopenic and 54.5 % were dynapenic with both conditions associated with poorer QoL. ANCOVAs showed significant differences favoring RET over UC for SMI (0.32 kg/m2; p = 0.017), UE-MD (0.12 kg/kg; p < 0.001), and LE-MD (0.27 kg/kg; p < 0.001). Chi-square analyses revealed significant effects of RET, compared to UC/AET combined, on reversing sarcopenia (p = 0.039) and dynapenia (p = 0.019). The reversal of sarcopenia was associated with clinically relevant improvements in the FACT-An (11.7 points [95 % confidence interval (CI) −4.2 to 27.6]), the Trial Outcome Index-Anemia (10.0 points [95 % CI −4.0 to 24.1]), and fatigue (5.3 points [95 % CI −1.5 to 12.1]). Early-stage BC patients initiating adjuvant chemotherapy have higher than expected rates of sarcopenia and dynapenia which are associated with poorer QoL. RET during adjuvant chemotherapy resulted in the reversal of both sarcopenia and dynapenia; however, only the reversal of sarcopenia was associated with clinically meaningful improvements in QoL.

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Abbreviations

1-RM:

One repetition maximum

AET:

Aerobic exercise training

BC:

Breast cancer

CI:

Confidence interval

DXA:

Dual X-ray absorptiometry

FACT-An:

Functional Assessment of Cancer Therapy-Anemia

HR:

Hazard ratio

LBM:

Lean body mass

LE:

Lower extremity

MD:

Muscle dysfunction

QoL:

Quality of life

RET:

Resistance exercise training

SMI:

Skeletal muscle index

START:

Supervised Trial of Aerobic and Resistance Training

TOI-An:

Trial Outcome Index-Anemia

UC:

Usual care

UE:

Upper extremity

VO2peak :

Peak oxygen uptake

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Acknowledgments

The START was supported by a grant from the Canadian Breast Cancer Research Alliance. JRV was supported by a Fredrick Banting and Charles Best Canada Graduate Scholarship from the Canadian Institutes of Health Research. CMF was supported by a Health Senior Scholar Award from Alberta Innovates-Health Solutions and the Alberta Cancer Foundation Weekend to End Women’s Cancers Breast Cancer Chair. KSC was supported by the Canada Research Chairs Program.

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Authors and Affiliations

  1. Faculty of Physical Education and Recreation, University of Alberta, 1-113 University Hall, Edmonton, AB, T6G 2H9, Canada

    Scott C. Adams, James R. Vallerand, Andria R. Morielli & Kerry S. Courneya

  2. Ottawa Regional Cancer Center, Ottawa, ON, Canada

    Roanne J. Segal

  3. University of British Columbia, Vancouver, BC, Canada

    Donald C. McKenzie

  4. Cross Cancer Institute, Edmonton, AB, Canada

    John R. Mackey

  5. British Columbia Cancer Agency, Vancouver, BC, Canada

    Karen Gelmon

  6. Alberta Health Services, Calgary, AB, Canada

    Christine M. Friedenreich

  7. University of Ottawa Heart Institute, Ottawa, ON, Canada

    Robert D. Reid

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Correspondence to Kerry S. Courneya.

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Adams, S.C., Segal, R.J., McKenzie, D.C. et al. Impact of resistance and aerobic exercise on sarcopenia and dynapenia in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Breast Cancer Res Treat 158, 497–507 (2016). https://doi.org/10.1007/s10549-016-3900-2

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