Abstract P4-10-15: Whole-body vibration combined with physical exercise to treat aromatase inhibitor-induced musculoskeletal symptoms in breast cancer women: Results of a pilot randomized controlled study
Authors: Lippi Lorenzo , de Sire Alessandro , Ammendolia Antonio , Cisari Carlo , Venetis Konstantinos , Sajjadi Elham , Fusco Nicola , Invernizzi Marco 
Published: March 2022

Abstract
BACKGROUND. Aromatase inhibitors (AIs) represent a cornerstone of hormone receptor (HR)-positive breast cancers management. However, AIs-induced musculoskeletal symptoms (AIMSS) might be frequently reported during estrogen depletion, with a crucial impact on cancer treatment adherence [1-2]. To date, physical exercise has been proposed as a promising therapeutic intervention to improve symptoms in AIMSS breast cancer patients [3] and recently, also whole-body vibration (WBV) showed promising results in these women. WBV is an effective neuromuscular training proposed to enhance muscle function and proprioception through various frequencies of mechanical vibration inducing repetitive muscle contractions. However, at present, data about tailored and effective multimodal rehabilitative exercise protocols to treat AIMSS are still controversial [3]. Therefore, this pilot randomized controlled study aimed at assessing the safety and efficacy of WBV in breast cancer women suffering from AIMSS. METHODS: In this study we recruited adults women undergoing AIs treatment for breast cancer and suffering from AIMSS. Twentytwo patients were enrolled and subsequently randomly assigned 1:1 to two groups. Group A received physical exercise and WBV, while Group B received physical exercise combined with sham WBV. The patients were assessed at the baseline (T0) and after 4 weeks of treatment (T1). The primary endpoint was the numerical pain rating scale (NPRS) for pain assessment; the secondary endpoints were the handgrip strength (HGS) test to assess appendicular muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) to assess pain, joint stiffness, and function; 10-meter walking test (10MWT) and 6MWT to evaluate physical performance; the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) to assess function, symptoms, and global health. RESULTS: Group A (n=11; mean age: 51.73±10.73 years; body mass index (BMI): 25.56±5.17 kg/m2) showed a statistically significant improvement of pain (NPRS: 6.82±1.17 vs 5.73±1.01; p=0.031). In contrast, patients in Group B, control group, (n=11; mean age: 58.55±9.71 years; BMI: 27.31±3.84 kg/m2), did not significantly improved in terms of pain (NPRS: 6.91±2.02 vs 5.91±2.51; p=0.07). Moreover, significant differences between groups at T1 were found in terms of WOMAC physical functioning (Group A: 77.56±9.853; Group B: 65.63±14.27; p=0.044). Furthermore, a significant improvement in terms of muscle strength, physical performance and quality of life (EORTC QLQ-C30) were reported in intragroup analysis in both groups, without significant differences between groups. We did not register dropouts or side effects in both groups. Lastly, both patients and the physical therapist reported a high level of satisfaction about the rehabilitative intervention performed. CONCLUSION: These findings showed that physical exercise and WBV combination therapy might be safe, well-tolerated and effective in patients with AIMSS. However, further studies are warranted to assess long terms effects of this combined rehabilitative treatment. REFERENCES: 1. Molehin D, Rasha F, Rahman RL, Pruitt K. Regulation of aromatase in cancer. Mol Cell Biochem. 2021. 2. 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(2):459-78. 3. Roberts KE, Rickett K, Feng S, Vagenas D, Woodward NE. Exercise therapies for preventing or treating aromatase inhibitor-induced musculoskeletal symptoms in early breast cancer. Cochrane Database Syst Rev. 2020;1:CD012988.
Citation Format: Lorenzo Lippi, Alessandro de Sire, Antonio Ammendolia, Carlo Cisari, Konstantinos Venetis, Elham Sajjadi, Nicola Fusco, Marco Invernizzi. Whole-body vibration combined with physical exercise to treat aromatase inhibitor-induced musculoskeletal symptoms in breast cancer women: Results of a pilot randomized controlled study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-15.