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Datum04.04.2017
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RESULTS


Recruitment was from February 2003 to July 2005 (Fig 1). We recruited 242 (33%) of 736 eligible participants. The most common reasons for refusal were lack of interest (n = 131), too far to travel (n = 96), and too busy (n = 64). We obtained follow-up data on the patient-rated outcomes from 223 (92.1%) of 242 participants (Fig 1), which did not differ by group (P = .379). The most common reason for loss to follow-up was that the participant was unreachable after multiple attempts (n = 9).

fig 1.

Fig 1.

Flow of participants through the trial. PRO, patient-rated outcomes.

The groups were balanced at baseline (Table 1). The median length of the exercise intervention was 17 weeks (95% CI, 9 to 24 weeks), and the mean length of treatment was 17 ± 4 weeks. The AET and RET groups attended 72.0% (2,685 of 3,750 sessions) and 68.2% (2,810 of 4,079 sessions) of their supervised exercise sessions, respectively (P = .411). The AET group met their prescribed duration and intensity 95.6% and 87.2% of the time, respectively. The RET group completed all nine exercises, two sets each, and eight to 12 repetitions each set 96.8%, 96.9%, and 94.5% of the time, respectively. Less than 15% of participants reported regular exercise outside of the trial, which did not differ by group (P > .2).



Table 1.

Baseline Demographic, Medical, and Behavioral Profile of Participants Overall and by Group Assignment

Changes in Patient-Rated Outcomes


Table 2 presents the patient-rated outcomes. Self-esteem was superior in the AET (P = .015) and RET (P = .018) groups compared with UC. All other changes in patient-rated outcomes favored the exercise groups but did not reach statistical significance. Results were unchanged after adjustment for covariates (Table 2).

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Table 2.

Effects of Aerobic and Resistance Exercise on Patient-Rated Outcomes in Breast Cancer Patients Receiving Chemotherapy

Changes in Objectively Measured Outcomes


Table 3 lists the physical fitness end points. Peak oxygen consumption was superior in the AET group compared with the UC (P = .006) and RET (P = .014) groups. Lower body and upper body strength were superior in the RET compared with the UC (P < .001) and AET (P < .001) groups. Results were unchanged after adjustment for covariates (Table 3). Table 4 lists the body composition end points. Lean body mass was superior in the RET group compared with the UC group (P = .015). Adjusted analyses showed that the AET group was borderline superior to the UC group in percent body fat (adjusted P = .076). The percentage of participants who experienced a ≥ 200-mL increase in the difference between their affected and unaffected arm volumes from baseline to after intervention was 7.3% (six of 82 patients) in the UC group, 3.7% (three of 82 patients) in the RET group, and 9.0% (seven of 78 patients) in the AET group (P = .381).

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Table 3.

Effects of Aerobic and Resistance Exercise on Physical Fitness in Breast Cancer Patients Receiving Chemotherapy

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Table 4.

Effects of Aerobic and Resistance Exercise on Body Weight and Composition in Breast Cancer Patients Receiving Chemotherapy

Chemotherapy Completion Rate


RDI was 84.1% in the UC group compared with 89.8% in the RET group (mean difference = 5.7%; 95% CI, 0.4% to 11.0%; P = .033) and 87.4% in the AET group (mean difference = 3.3%; 95% CI, −2.5% to 9.2%; P = .266). The percentage of participants who received ≥ 85% of their planned RDI was 65.9% (54 of 82 patients) in the UC group compared with 78.0% (64 of 82 patients) in the RET group (mean difference = 12.1%; P = .082) and 74.4% (58 of 78 patients) in the AET group (mean difference = 8.5%; P = .241).

Associations Among Exercise Adherence and Changes in End Points


Exercise adherence in both groups was positively associated with a higher RDI (r = 0.17; P = .035). AET adherence was associated with greater improvements in aerobic fitness (r = 0.24; P = .036). RET adherence was associated with greater improvements in lower body strength (r = 0.61; P < .001), upper body strength (r = 0.53; P < .001), and lean body mass (r = 0.25; P = .037). For the AET versus UC comparison, improvements in aerobic fitness were associated with improvements in QOL (r = 0.26; P = .001), fatigue (r = 0.25; P = .002), depression (r = −0.24; P = .003), and anxiety (r = −0.18; P = .025). For the RET versus UC comparison, improvements in lean body mass were associated with improvements in QOL (r = 0.19; P = .022), self-esteem (r = 0.19; P = .022), depression (r = −0.19; P = .019), and percentage of participants completing ≥ 85% of their planned RDI (r = 0.15; P = .074). Improvement in lower body strength was associated with improvement in QOL (r = 0.15; P = .057).

Adverse Events


Two participants experienced an adverse event related to exercise after baseline maximal treadmill testing. One participant became lightheaded, hypotensive, and moderately nauseous. A second participant experienced dizziness, weakness, and mild diarrhea. Both participants recovered quickly.


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  • Changes in Patient-Rated Outcomes
  • Changes in Objectively Measured Outcomes
  • Chemotherapy Completion Rate
  • Associations Among Exercise Adherence and Changes in End Points
  • Adverse Events

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