Abstract P5-12-04: Directed exercise intervention in breast cancer patients with arthralgias receiving aromatase inhibitors: A randomized pilot study
Authors: Varadarajan R , Helm E , Arnold C , Huelsenbeck-Dill L , Ingraham-Lopresto B , Sonaad S , Swanson P , Sims-Mourtada J , Dickson-Whitmer D 
Published: May 2016

Purpose: Early discontinuation or non-adherence of AI therapy occurs in 25-50 % of patients due to treatment associated toxicities, including musculoskeletal symptoms such as arthralgias and myalgias. The goal of this pilot study is to evaluate the effect of a directed physical therapy regimen including joint mobility and stretching exercises on musculoskeletal symptoms resulting from AI therapy, in comparison to normal physical activity alone.

Patients and methods: Eligibility criteria included post-menopausal women with histological evidence of hormone receptor positive breast cancer who were currently receiving adjuvant AI therapy and experiencing significant joint discomfort/stiffness when attempting activities of daily living which began or significantly increased after initiation of AI therapy. Patients were excluded if they had preexisting rheumatoid arthritis or fibromyalgia, systemic metastasis or ECOG performance status of greater than 2. Patients were randomly assigned to an 8 week directed exercise program under the supervision of a physical therapist (Group A, n=15) or were told to participate in moderate physical activity (walking) (Group B, n=12). Before beginning the study and at the end of the 8 week intervention, patients in both groups underwent a physical therapy evaluation including performance based measures such as functional lower extremity strength and grip strength and a Patient Specific Functional Scale (PSFS) to assess functional ability to complete specific activities. Additionally, all patients answered a series of questionnaires including a pain disability index (PDI), pain scale (PS) and the PHQ4 depression scale. Effects of the directed exercise regimen were evaluated using non-parametric analysis to determine differences between the two groups.

Results: Significant improvement was observed in both left and right grip strength and right pinch in the intervention group (Group A) as compared to the control group (Group B). Additionally, significant improvement in lower body measures including 2-minute step tests and chair raises were observed in patients who underwent the directed exercise program compared to the control group. No significant differences were observed in PS, PDI or PHQ4 between the groups. However, Group A showed a slight improvement on the PS and PDI.

Conclusions: Directed exercise regimens involving joint mobility and stretching exercises may have benefits over moderate physical activity alone for joint pain and arthralgia associated with AI therapy.

Citation Format: Varadarajan R, Helm E, Arnold C, Huelsenbeck-Dill L, Ingraham-Lopresto B, Sonaad S, Swanson P, Sims-Mourtada J, Dickson-Whitmer D. Directed exercise intervention in breast cancer patients with arthralgias receiving aromatase inhibitors: A randomized pilot study. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P5-12-04.