# Exercise as it relates to Disease/Can a Home-based Physical Activity intervention for early stage Breast Cancer patients improve health or fitness?

An analysis and fact sheet of the journal article "Home-Based Physical Activity Intervention for Breast Cancer Patients" by Pinto, et al.(2005)

### What is the background to this research?

According to the World Health Organisation breast cancer is the second most common cancer world wide and is the most common diagnosed cancer in women. In conjunction with Breast cancer, women often present with various adverse conditions of both psychological and physical following diagnosis and treatment. This Study concentrated on the importance of a Home-based exercise intervention on post-treatment breast cancer patients and the impact it has on health, both psychological and physical and physical activity(PA) levels.

#### Treatments and Post-treatment

Treatment options for breast cancer include but are not limited to chemotherapy, hormone replacement therapy, surgeries, such as a mastectomy, and radiation. These treatment options are key to the survivability of patients. However, with these treatments come an array of adverse side effects.
Table 1a. Possible side effects of cancer treatments
| Psychological | Physical |
| Depression | Neuropathy |
| Anxiety | Cardio-pulmonary Disease |
| Fatigue | Heart Disease |
| | Weight Gain |
| | Chronic Pain |
Exercise has become a prominent intervention for dealing with adverse side effects of treatments and diagnosis. Various studies have examined the use of exercise interventions on post-treatment cancer patients and highlighted the importance of the effects on improving individual quality of life, physical functionality and psychological well-being.

### Where is this Research from?

This study was from the Centres for Behavioural and Preventive Medicine of Miriam Hospital and Brown Medical School and Bryant College in Rhode Island. The Miriam Hospital and Women and Infants Hospital Institutional Review boards approved this study.

### What Kind of Research was this?

This study was conducted using a randomised control trial method. This method randomly divides a population into two groups; a control group and an experimental group. The purpose of this method is to analyse the efficacy and effects of a particular intervention against a population that does not receive the intervention, the control group.

### What did this Study Involve?

Design A 12-week moderate intensity home-based exercise intervention for breast cancer patients who have completed either stage 0-2 cancer treatment. Data was collected at baseline, 12 weeks and follow ups at 6 and 9. Results were analysed using: T-tests, Multiple analyses of covariance (MANCOVAS) and Analyses of covariance (ANCOVAS).
Recruitment Recruitment was conducted via telephone calls, letters and referrals from hospital oncology departments. Eligibility Criteria:
| Eligible | Excluded |
| >18 Years old | History of other cancer(s) |
| Sedentary Activity levels | No medical clearance for mod. int. exercise |
| Diagnosed in past 5 years | |
| Completed treatment(eg, radiation) | |
Physical Activity Intervention
* PA group was instructed on moderate intensity exercise, Heart rate monitoring, pedometers and PA home log
* PA progressively increased from 10 minutes on 2 days/week to 30 minutes/day for 5 days/week
* Moderate intensity = 55-65% Heart Rate
* Exercises consisted of: home equipment(treadmill, weights), walking, swimming
* Exercises prescribed/promoted via weekly phone calls to participants, no face to face involvement excluding data collection periods
* Control group maintained current sedentary PA levels
Measurements and Tools Data was collected using 8 industry validated measurement tools.
* Body Composition - Body Mass Index and skin folds
* Weekly Activity - 7 Day weekly activity Recall
* Functional Fitness - Rockport 1 mile walk test
* Activity Monitoring - Caltrac Accelerometer use
* Motivation measurement - Stages of Motivational Readiness for PA
* Mood observation - Profile of Mood states Questionnaire
* Fatigue - Linear Analog scale for fatigue
* Self-Esteem - Body Esteem Scale
Strengths and Limitations This method gave the authors the opportunity to apply an intervention to a specific population, Breast cancer patients, without sub-group bias and make objectives inferences. The use of a home-based intervention and phone call delivery minimised costs significantly and also allowed the participants to independently perform physical activity in the comfort of their own surroundings. However, without frequent face to face contact and under and over reporting, discrepancies in the results appear. The Authors note inconsistencies between accelerometer data and 7-day recall data on physical activity levels. The inconsistencies in this data could be attributed to the lack of direct face to face contact, poor technical explanations on the use of these tools, misreporting , or lower adherence rates due to the home-based location. Raising the possibility of mismatching results because of the lack of consideration. PA levels and involvement increased in the experimental group, however no positive changes in body weight or fat percentages were seen. This suggests that a more demanding and intensive exercise protocol is required to combat the adverse side effect of weight gain in breast cancer patients.

### Basic Results

Table 2 - Results
| Measurement | Improvement | Significant |
| Body Fat Percentage | No | No |
| Physical Activity Levels | Yes | Yes |
| Functional Fitness | Yes | Yes |
| Everyday Activity(caltrac Accelerometer) | Yes | Borderline |
| Motivation for PA | Yes | Yes |
| Mood | Yes | Borderline |
| Fatigue | Yes | Yes |
| Self Esteem | Yes | Yes |
The Experimental group showed significant improvements in time(minutes/day/week) doing PA and PA levels. The Authors concluded that the Home-based exercise intervention had positive effects on fatigue, self-esteem, mood and the PA group were more likely to continue doing PA. No improvements were reported for body composition measures.

### Conclusions

The conclusions we can take from this research is the strength of home-based physical activity programs, delivered over the phone is effective in improving physical fitness and healthy well-being in post-treatment breast cancer patients. Although no beneficial changes occurred for body composition measurements, the authors have shown the efficacy of utilising a home-based exercise intervention protocol. A focus on instructing participants on measurement tool technical skills will aid in preventing potential skewed data in future research. Further research is needed to assess whether this protocol is applicable to other pathological populations and if the results can be replicated.

### Practical Advice

Exercise has been shown to combat adverse side effects of cancer treatment. Enhancing the intervention protocol to increase PA duration at moderate to high intensity will combat weight gain in susceptible individuals. Furthermore, aerobic capacity is a key indicator for Cardio-vascular heart disease(CVD). Continued exercise to increase aerobic capacity will aid in combating CVD side effect.

### Further Information

Physical Activity Guidelines: http://www.health.gov.au/internet/main/publishing.nsf/content/health-pubhlth-strateg-phys-act-guidelines

### References

* 1 2 3 4 5 6 7 Pinto et al. (2005) 'Home-Based Physical Activity Intervention for Breast Cancer Patients' Journal of Clinical Oncology. 2005;23(15):3577-3587.
* ↑ Ferlay et al. (2014) 'Cancer incidence and mortality worldwide: Sources, methods and major patterns in GLOBOCAN 2012', International Journal of Cancer. 2014;136(5):E359-E386.
* 1 2 Beisecker et al (1997) "Side Effects of Adjuvant Chemotherapy: Perceptions of Node‐Negative Breast Cancer Patients" Psycho‐Oncology. 1997;6(2):85-93.
* 1 2 Bleiker et al. (2000) "Psychological distress two years after diagnosis of breast cancer: frequency and prediction" Patient Education and Counseling. 2000;40(3):209-217.
* ↑ Maughan et al. (2010) "Treatment of Breast Cancer". American Family Physician. 2010;91(11):1339-1346
* ↑ Burgess et al (2005) "Depression and anxiety in women with early breast cancer: five year observational cohort" BMJ. 2005;330(7493):702-0.
* ↑ Loescher et al (1989) "Surviving Adult Cancers. Part 1: Physiologic Effects" Annals of Internal Medicine. 1989;111(5):411.
* 1 2 Mcneely et al. (2006) "Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis" Canadian Medical Association Journal. 2006;175(1):34-41.
* 1 2 Duijts et al. (2011) "Effectiveness of behavioural techniques and physical exercise on psychological functioning and health-related quality of life in breast cancer patients and survivors-a meta-analysis" Psycho-Oncology. 2011;20(2):115-126.
* ↑ Donnelly et al. (2009) "Appropriate Physical Activity Intervention Strategies for Weight Loss and Prevention of Weight Regain for Adults". Medicine & Science in Sports & Exercise. 2009;41(2):459-471.
* ↑ Wisloff et al. (2007) "Superior Cardiovascular Effect Of Aerobic Interval-training Versus Moderate Continuous Training In Elderly Heart Failure Patients". Medicine & Science in Sports & Exercise. 2007;39(Supplement):S32.