Skip to main content

Advertisement

SpringerLink
Log in

Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study

  • Published:
Journal of Cancer Survivorship Aims and scope Submit manuscript

Abstract

Purpose

Up to 50 % of postmenopausal breast cancer survivors taking aromatase inhibitors (AIs) experience AI-associated arthralgias, or joint pain, which causes many to stop taking AIs and may inhibit exercise, despite known health benefits. We thus evaluated exercise adherence and factors associated with better exercise adherence in breast cancer survivors experiencing AI-induced arthralgia in the (HOPE) year long randomized controlled trial.

Methods

We included 61 HOPE women randomized to exercise (150 min/week of moderate-intensity aerobic exercise and twice-weekly supervised strength training). Our main outcomes were aerobic exercise measured with daily activity logs, attendance at supervised exercise sessions, and changes in cardiorespiratory fitness, measured maximal oxygen consumption (VO2max). We examined means and standard deviations (SDs) for exercise adherence by demographic and medical characteristics and used the t test for mean differences. We also examined predictors of adherence using linear regression.

Results

On average, at the end of the year long trial, women reported 119 (SD 78) min/week of moderate-intensity aerobic exercise and participated in 70 % of supervised exercise training sessions. After adjustment for other factors that influence adherence, at 6 months postrandomization, only baseline VO2max was associated with higher aerobic exercise levels and at 12 months, only older age predicted better supervised exercise training attendance.

Conclusions

Breast cancer survivors taking AIs and experiencing arthralgia are able to initiate and maintain a year long exercise program, regardless of other factors that influence activity levels.

Implications for Cancer Survivors

Breast cancer survivors can exercise at levels that have been shown to improve AI-associated arthralgia.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. What are the key statistics about breast cancer? In: Society AC (ed) American Cancer Society, Atlanta, GA. (2013)

  2. Clemons M, Coleman RE, Verma S. Aromatase inhibitors in the adjuvant setting: bringing the gold to a standard? Cancer Treat Rev. 2004;30:325–32. doi:10.1016/j.ctrv.2004.03.004.

    Article  CAS  PubMed  Google Scholar 

  3. Crew KD, Greenlee H, Capodice J, Raptis G, Brafman L, Fuentes D, et al. Prevalence of joint symptoms in postmenopausal women taking aromatase inhibitors for early-stage breast cancer. J Clin Oncol. 2007;25:3877–83. doi:10.1200/jco.2007.10.7573.

    Article  PubMed  Google Scholar 

  4. Murphy CC, Bartholomew LK, Carpentier MY, Bluethmann SM, Vernon SW. Adherence to adjuvant hormonal therapy among breast cancer survivors in clinical practice: a systematic review. Breast Cancer Res Treat. 2012;134:459–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Hershman DL, Shao T, Kushi LH, Buono D, Tsai WY, Fehrenbacher L, et al. Early discontinuation and non-adherence to adjuvant hormonal therapy are associated with increased mortality in women with breast cancer. Breast Cancer Res Treat. 2011;126:529–37.

    Article  CAS  PubMed  Google Scholar 

  6. Coleman RE, Bolten WW, Lansdown M, Dale S, Jackisch C, Merkel D, et al. Aromatase inhibitor-induced arthralgia: clinical experience and treatment recommendations. Cancer Treat Rev. 2008;34:275–82. doi:10.1016/j.ctrv.2007.10.004.

    Article  CAS  PubMed  Google Scholar 

  7. Diet, nutrition, physical activity, and breast cancer survivors. In: continuous update project report: world cancer research fund international/American institute for cancer research. (2014)

  8. Ballard-Barbash R, Friedenreich CM, Courneya KS, Siddiqi SM, McTiernan A, Alfano CM. Physical activity, biomarkers, and disease outcomes in cancer survivors: a systematic review. J Natl Cancer Inst. 2012;104:815–40. doi:10.1093/jnci/djs207.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Rock CL, Doyle C, Demark‐Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, et al. Nutrition and physical activity guidelines for cancer survivors. CA: Cancer J Clin. 2012;62:242–74.

    Article  Google Scholar 

  10. Blanchard CM, Courneya KS, Stein K. Cancer survivors’ adherence to lifestyle behavior recommendations and associations with health-related quality of life: results from the American Cancer Society’s SCS-II. J Clin Oncol. 2008;26:2198–204. doi:10.1200/jco.2007.14.6217.

    Article  PubMed  Google Scholar 

  11. Irwin ML, McTiernan A, Bernstein L, Gilliland FD, Baumgartner R, Baumgartner K, et al. Physical activity levels among breast cancer survivors. Med Sci Sports Exerc. 2004;36:1484.

    PubMed  PubMed Central  Google Scholar 

  12. Haskell WL, Lee I-M, Pate RR, Powell KE, Blair SN, Franklin BA, et al. Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Circulation. 2007;116:1081.

    Article  PubMed  Google Scholar 

  13. Schmid D, Leitzmann M. Cardiorespiratory fitness as predictor of cancer mortality: a systematic review and meta-analysis. Annals Oncol: mdu250. (2014)

  14. Jones LW, Haykowsky M, Pituskin EN, Jendzjowsky NG, Tomczak CR, Haennel RG, et al. Cardiovascular reserve and risk profile of postmenopausal women after chemoendocrine therapy for hormone receptor–positive operable breast cancer. Oncologist. 2007;12:1156–64.

    Article  PubMed  Google Scholar 

  15. Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: a meta-analysis. Oncologist. 2011;16:112–20.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Irwin ML, Cartmel B, Gross CP, Ercolano E, Li F, Yao X, Fiellin M, Capozza S, Rothbard M, Zhou Y. Randomized exercise trial of aromatase inhibitor–induced arthralgia in breast cancer survivors. J Clin Oncol: JCO. (2014). 2057. 1547.

  17. Cleeland C, Ryan K. Pain assessment: global use of the brief pain inventory. Ann Acad Med Singap. 1994;23:129–38.

    CAS  PubMed  Google Scholar 

  18. 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;42:1409–26. doi:10.1249/MSS.0b013e3181e0c112.

    Article  PubMed  Google Scholar 

  19. Blair SN, Haskell WL, Ho P, Paffenbarger RS, Vranizan KM, Farquhar JW, et al. Assessment of habitual physical activity by a seven day recall in a community survey and controlled experiments. Am J Epidemiol. 1985;122:794–804.

    CAS  PubMed  Google Scholar 

  20. Courneya KS, Segal RJ, Gelmon K, Reid RD, Mackey JR, Friedenreich CM, et al. Predictors of supervised exercise adherence during breast cancer chemotherapy. Med Sci Sports Exerc. 2008;40:1180–7. doi:10.1249/MSS.0b013e318168da45.

    Article  PubMed  Google Scholar 

  21. Latka RN, Alvarez-Reeves M, Cadmus L, Irwin ML. Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: the Yale exercise and survivorship study. J Cancer Surviv. 2009;3:148–57. doi:10.1007/s11764-009-0088-z.

    Article  PubMed  Google Scholar 

  22. Pinto BM, Rabin C, Dunsiger S. Home-based exercise among cancer survivors: adherence and its predictors. Psycho-Oncology. 2009;18:369–76. doi:10.1002/pon.1465.

    Article  PubMed  PubMed Central  Google Scholar 

  23. Myers J, Prakash M, Froelicher V, Do D, Partington S, Atwood JE. Exercise capacity and mortality among men referred for exercise testing. N Engl J Med. 2002;346:793–801.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We thank Marianna Rothbard, Dan Root, Willie Moore, Liz Fraser, Michelle Baglia, Adrienne Viola, Yanchang Zhang, Bridget Winterhalter, Norbert Hootsmans, Celeste Wong, and Meghan Hughes for their assistance. We thank Rajni Mehta and the Rapid Case Ascertainment of Yale Cancer Center, as well as Smilow Cancer Hospital at Yale-New Haven, St. Raphael’s Hospital, St. Vincent’s Medical Center, Bridgeport Hospital and Greenwich Hospital and all the clinicians who consented or referred their patients to our study. Most importantly, we are indebted to the participants for their dedication and time to the HOPE study.

HA is supported by the intramural research program at the National Cancer Institute. HOPE was supported by NCI R01 CA132931 and in part by a grant from the Breast Cancer Research Foundation. This study was also supported in part by the Yale Cancer Center Support Grant (CCSG) P30 CA016359 and the CTSA Grant Number UL1 TR000142 from the National Center for Advancing Translational Science (NCATS), a component of the National Institutes of Health (NIH). Certain data used in this study were obtained from the Connecticut Tumor Registry located in the Connecticut Department of Public Health. The authors assume full responsibility for analyses and interpretation of these data.

Author information

Authors and Affiliations

  1. Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA

    Hannah Arem

  2. Yale School of Public Health, New Haven, CT, USA

    Mia Sorkin, Brenda Cartmel, Martha Fiellin, Scott Capozza, Maura Harrigan, Elizabeth Ercolano & Melinda L. Irwin

  3. Yale Cancer Center, New Haven, CT, USA

    Brenda Cartmel, Elizabeth Ercolano, Yang Zhou, Tara Sanft, Cary Gross & Melinda L. Irwin

  4. University of Pennsylvania, Philadelphia, PA, USA

    Kathryn Schmitz

  5. Boston University School of Medicine, Boston, MA, USA

    Tuhina Neogi

  6. Columbia University, New York, NY, USA

    Dawn Hershman

  7. Dana Farber Cancer Institute, Boston, MA, USA

    Jennifer Ligibel

  8. Department of Chronic Disease Epidemiology, Yale School of Public Health, P.O. Box 208034, New Haven, CT, 06520-8034, USA

    Melinda L. Irwin

Authors
  1. Hannah Arem
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mia Sorkin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Brenda Cartmel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martha Fiellin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Scott Capozza
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Maura Harrigan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Elizabeth Ercolano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Yang Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Tara Sanft
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Cary Gross
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Kathryn Schmitz
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Tuhina Neogi
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Dawn Hershman
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Jennifer Ligibel
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Melinda L. Irwin
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Melinda L. Irwin.

Ethics declarations

Conflicts of interest

Cary P. Gross: Research funding from 21st Century Oncology, Medtronic, Johnson & Johnson.

Tara Sanft: Consulting or Advisory Role at bioTheranostics; Research funding from bioTheranostics.

All other authors report no conflicts of interest.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Arem, H., Sorkin, M., Cartmel, B. et al. Exercise adherence in a randomized trial of exercise on aromatase inhibitor arthralgias in breast cancer survivors: the Hormones and Physical Exercise (HOPE) study. J Cancer Surviv 10, 654–662 (2016). https://doi.org/10.1007/s11764-015-0511-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11764-015-0511-6

Keywords

Search

Navigation