Clinical trial NCT05704855: A Combined Exercise Training Program for Women Living With Breast Cancer
Official title: A Remotely-Delivered, Combined Exercise Training Program for Cognitive Function in Women Living With and Beyond Breast Cancer: A Feasibility Study
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Breast Cancer
Keywords: physical activity
chemotherapy treatment
cancer-related cognitive impairment
feasibility
mental health
Lead sponsor: University of Toronto
Sponsor class: OTHER
First posted: 2023-01-30
Enrollment: 21
Sex: FEMALE
Minimum age (years): 40
Maximum age (years): 65
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Intervention model description: Participants will be randomized to one of two conditions: combined exercise (aerobic + resistance training) or stretching/toning (active control). They will receive a home-based program lasting 1 hour on 3 days per week for 12 weeks. Randomization will be performed using a computer-generated program in blocks of four for even distribution between study conditions. BCS will be assigned in a 1:1 ratio to one of two study conditions, stratified by treatment type (anthracycline vs. non-anthracycline chemotherapy; hormonal vs. no hormonal therapy).
Primary purpose: SUPPORTIVE_CARE

Brief summary: Women living with and beyond breast cancer are at a heightened risk for experiencing adverse mental health outcomes and declines in cognitive function following chemotherapy treatment. Women living with and beyond breast cancer have reported increased levels of anxiety and depression during the COVID-19 pandemic which may have significantly impacted their quality of life (QoL). Physical activity (PA) may be used to manage mental health and improve cognitive function in women living with and beyond breast cancer. Research is needed to assess the feasibility of a supervised, remotely delivered, combined (i.e., aerobic + resistance) exercise program to improve cognitive function and manage adverse mental health in women living with and beyond breast cancer. This study will pilot an 8-week, remotely delivered, combined (i.e., aerobic + resistance) exercise and behavioural counselling intervention on cognitive function and mental health outcomes (i.e.,anxiety, depression, self-efficacy and self esteem) in women living with breast cancer who received chemotherapy treatment within 12-48 months.

Detailed description: Women living with and beyond breast cancer who received chemotherapy treatment are at a heightened risk for experiencing adverse mental health outcomes (i.e., anxiety, depression, self-efficacy and self esteem) and declines in cognitive function (i.e., impairments to memory, learning, concentration, reasoning, executive function, attention, processing speed and/or visual-spatial skills deficits) compared to those without a history of cancer. These effects may be worsened among those who received chemotherapy treatment and may persist for up to 5 and 20 years following chemotherapy treatment completion, respectively. The COVID-19 pandemic has exacerbated existing adversities in the mental health of women living with and beyond breast cancer due to reduced social opportunities, greater sedentary time, fear of susceptibility to the virus and barriers to in-person support services. Physical activity (PA) may be used to manage mental health adversities and improve QoL among women living with and beyond breast cancer. In addition, preliminary evidence has demonstrated the potential mediating effect of PA on cognitive impairments among women living with and beyond breast cancer. Remote-based interventions could be an effective option to increase PA during the COVID-19 pandemic while maintaining physical distancing protocols. In addition, the combination of exercise with group-based counselling has been found to be feasible and provide favourable improvements in depression, self-efficacy, social support, and quality of life and long-term PA maintenance among women living with and beyond breast cancer, compared to exercise interventions alone. However, no studies have evaluated the feasibility and impact of a supervised, remotely delivered, combined (i.e., aerobic and resistance) exercise + behaviour counselling program on mental health and cognitive function in women living with and beyond breast cancer following chemotherapy treatment. Using a mixed-method approach, this study will address these gaps by evaluating the feasibility of a supervised, remotely delivered combined (i.e., aerobic and resistance) exercise and behavioural counselling program for mental health and cognitive function in women living with and beyond breast cancer. This project is necessary given the remote-based format of exercise delivery that has been adopted because of the COVID-19 pandemic and the need for programs to be adapted to an environment that is safe and reliable to deliver to women living with and beyond breast cancer.

Eligibility criteria: * 40 - 65 years of age
* primary diagnosis of stage I-III breast cancer (non-metastatic)
* received chemotherapy within the past 12-48 months from enrollment
* experience mild cognitive impairment as determined by the TICS \[scores between 28-31 to separate individuals with dementia (range a to b) and normal cognition (range c to d)\] (Knopman et al., 2010)
* self-reported low-active defined as \<3 days of exercise (\<20 min/day) per week in the previous six months (Godin \& Shephard, 1985)
* physician clearance to participate in testing and exercise
* no previous invasive cancer
* no neurological or musculoskeletal co-morbidity inhibiting exercise
* access to a webcam and internet for videoconferencing
* English fluency.

Exclusion Criteria:

* previous invasive cancer
* neurological or musculoskeletal co-morbidity inhibiting exercise

Primary outcomes:
measure: Enrolment rate
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Adherence rate
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Attrition rate
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Burden and satisfaction
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Adverse events
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
Secondary outcomes:
measure: Executive/Attention
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Episodic Memory
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Language
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Crystallized Cognition
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Immediate Recall
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Processing Speed
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Self-reported anxiety and depression
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Self-efficacy
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Self-esteem
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Objectively-assessed physical activity
timeFrame: Change from baseline (pre-intervention) to post-intervention (8 weeks).
measure: Semi-structured qualitative interviews
timeFrame: Post-intervention (8 weeks).
measure: Therapeutic alliance
timeFrame: Post-intervention (8 weeks).
Other outcomes:
Locations:
city: Toronto
country: Canada
facility: Faculty of Kinesiology and Physical Education, University of Toronto
state: Ontario
Study officials:
affiliation: University of Toronto
name: Linda Trinh, PhD
role: PRINCIPAL_INVESTIGATOR
References:
citation: Castellon SA, Ganz PA, Bower JE, Petersen L, Abraham L, Greendale GA. Neurocognitive performance in breast cancer survivors exposed to adjuvant chemotherapy and tamoxifen. J Clin Exp Neuropsychol. 2004 Oct;26(7):955-69. doi: 10.1080/13803390490510905.
citation: Kesler SR, Kent JS, O'Hara R. Prefrontal cortex and executive function impairments in primary breast cancer. Arch Neurol. 2011 Nov;68(11):1447-53. doi: 10.1001/archneurol.2011.245.
citation: Koppelmans V, Breteler MM, Boogerd W, Seynaeve C, Gundy C, Schagen SB. Neuropsychological performance in survivors of breast cancer more than 20 years after adjuvant chemotherapy. J Clin Oncol. 2012 Apr 1;30(10):1080-6. doi: 10.1200/JCO.2011.37.0189. Epub 2012 Feb 27.
citation: Kesler S, Hadi Hosseini SM, Heckler C, Janelsins M, Palesh O, Mustian K, Morrow G. Cognitive training for improving executive function in chemotherapy-treated breast cancer survivors. Clin Breast Cancer. 2013 Aug;13(4):299-306. doi: 10.1016/j.clbc.2013.02.004. Epub 2013 May 4.
citation: Argyriou AA, Assimakopoulos K, Iconomou G, Giannakopoulou F, Kalofonos HP. Either called "chemobrain" or "chemofog," the long-term chemotherapy-induced cognitive decline in cancer survivors is real. J Pain Symptom Manage. 2011 Jan;41(1):126-39. doi: 10.1016/j.jpainsymman.2010.04.021. Epub 2010 Sep 15.
citation: Von Ah D, Tallman EF. Perceived cognitive function in breast cancer survivors: evaluating relationships with objective cognitive performance and other symptoms using the functional assessment of cancer therapy-cognitive function instrument. J Pain Symptom Manage. 2015 Apr;49(4):697-706. doi: 10.1016/j.jpainsymman.2014.08.012. Epub 2014 Sep 18.
citation: Zimmer P, Baumann FT, Oberste M, Wright P, Garthe A, Schenk A, Elter T, Galvao DA, Bloch W, Hubner ST, Wolf F. Effects of Exercise Interventions and Physical Activity Behavior on Cancer Related Cognitive Impairments: A Systematic Review. Biomed Res Int. 2016;2016:1820954. doi: 10.1155/2016/1820954. Epub 2016 Apr 10.
citation: Frank JS, Vance DE, Triebel KL, Meneses KM. Cognitive Deficits in Breast Cancer Survivors After Chemotherapy and Hormonal Therapy. J Neurosci Nurs. 2015 Dec;47(6):302-12. doi: 10.1097/JNN.0000000000000171.
citation: Von Ah D, Habermann B, Carpenter JS, Schneider BL. Impact of perceived cognitive impairment in breast cancer survivors. Eur J Oncol Nurs. 2013 Apr;17(2):236-41. doi: 10.1016/j.ejon.2012.06.002. Epub 2012 Aug 14.
citation: Weintraub S, Dikmen SS, Heaton RK, Tulsky DS, Zelazo PD, Bauer PJ, Carlozzi NE, Slotkin J, Blitz D, Wallner-Allen K, Fox NA, Beaumont JL, Mungas D, Nowinski CJ, Richler J, Deocampo JA, Anderson JE, Manly JJ, Borosh B, Havlik R, Conway K, Edwards E, Freund L, King JW, Moy C, Witt E, Gershon RC. Cognition assessment using the NIH Toolbox. Neurology. 2013 Mar 12;80(11 Suppl 3):S54-64. doi: 10.1212/WNL.0b013e3182872ded.
citation: Hartman SJ, Nelson SH, Myers E, Natarajan L, Sears DD, Palmer BW, Weiner LS, Parker BA, Patterson RE. Randomized controlled trial of increasing physical activity on objectively measured and self-reported cognitive functioning among breast cancer survivors: The memory & motion study. Cancer. 2018 Jan 1;124(1):192-202. doi: 10.1002/cncr.30987. Epub 2017 Sep 19.
citation: Freedson PS, Melanson E, Sirard J. Calibration of the Computer Science and Applications, Inc. accelerometer. Med Sci Sports Exerc. 1998 May;30(5):777-81. doi: 10.1097/00005768-199805000-00021.
citation: Weller IM, Thomas SG, Gledhill N, Paterson D, Quinney A. A study to validate the modified Canadian Aerobic Fitness Test. Can J Appl Physiol. 1995 Jun;20(2):211-21. doi: 10.1139/h95-015.
citation: Champion VL, Ziner KW, Monahan PO, Stump TE, Cella D, Smith LG, Bell CJ, Von Ah D, Sledge GW. Development and psychometric testing of a breast cancer survivor self-efficacy scale. Oncol Nurs Forum. 2013 Nov;40(6):E403-10. doi: 10.1188/13.ONF.E403-E410.
citation: Rosenberg M. Rosenberg self-esteem scale. Journal of Religion and Health. 1965 Jul.
citation: Hatcher RL, Gillaspy JA. Development and validation of a revised short version of the Working Alliance Inventory. Psychotherapy research. 2006 Jan 1;16(1):12-25.
citation: Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983 Jun;67(6):361-70. doi: 10.1111/j.1600-0447.1983.tb09716.x.
citation: Campbell KL, Winters-Stone KM, Wiskemann J, May AM, Schwartz AL, Courneya KS, Zucker DS, Matthews CE, Ligibel JA, Gerber LH, Morris GS, Patel AV, Hue TF, Perna FM, Schmitz KH. Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable. Med Sci Sports Exerc. 2019 Nov;51(11):2375-2390. doi: 10.1249/MSS.0000000000002116.
citation: Carreira H, Williams R, Muller M, Harewood R, Stanway S, Bhaskaran K. Associations Between Breast Cancer Survivorship and Adverse Mental Health Outcomes: A Systematic Review. J Natl Cancer Inst. 2018 Dec 1;110(12):1311-1327. doi: 10.1093/jnci/djy177.
citation: Jones JM, Saeed H, Katz MS, Lustberg MB, Forster VJ, Nekhlyudov L. Readdressing the Needs of Cancer Survivors During COVID-19: A Path Forward. J Natl Cancer Inst. 2021 Aug 2;113(8):955-961. doi: 10.1093/jnci/djaa200.
citation: Aguinaga S, Ehlers DK, Cosman J, Severson J, Kramer AF, McAuley E. Effects of physical activity on psychological well-being outcomes in breast cancer survivors from prediagnosis to posttreatment survivorship. Psychooncology. 2018 Aug;27(8):1987-1994. doi: 10.1002/pon.4755. Epub 2018 Jun 1.
citation: Aydin M, Kose E, Odabas I, Meric Bingul B, Demirci D, Aydin Z. The Effect of Exercise on Life Quality and Depression Levels of Breast Cancer Patients. Asian Pac J Cancer Prev. 2021 Mar 1;22(3):725-732. doi: 10.31557/APJCP.2021.22.3.725.
citation: Rock CL, Thomson CA, Sullivan KR, Howe CL, Kushi LH, Caan BJ, Neuhouser ML, Bandera EV, Wang Y, Robien K, Basen-Engquist KM, Brown JC, Courneya KS, Crane TE, Garcia DO, Grant BL, Hamilton KK, Hartman SJ, Kenfield SA, Martinez ME, Meyerhardt JA, Nekhlyudov L, Overholser L, Patel AV, Pinto BM, Platek ME, Rees-Punia E, Spees CK, Gapstur SM, McCullough ML. American Cancer Society nutrition and physical activity guideline for cancer survivors. CA Cancer J Clin. 2022 May;72(3):230-262. doi: 10.3322/caac.21719. Epub 2022 Mar 16.
citation: Chaddock-Heyman L, Mackenzie MJ, Zuniga K, Cooke GE, Awick E, Roberts S, Erickson KI, McAuley E, Kramer AF. Higher cardiorespiratory fitness levels are associated with greater hippocampal volume in breast cancer survivors. Front Hum Neurosci. 2015 Aug 26;9:465. doi: 10.3389/fnhum.2015.00465. eCollection 2015.
citation: Naumann F, Martin E, Philpott M, Smith C, Groff D, Battaglini C. Can counseling add value to an exercise intervention for improving quality of life in breast cancer survivors? A feasibility study. J Support Oncol. 2012 Sep-Oct;10(5):188-94. doi: 10.1016/j.suponc.2011.09.004. Epub 2011 Dec 14.
citation: Morrison KS, Paterson C, Toohey K. The Feasibility of Exercise Interventions Delivered via Telehealth for People Affected by Cancer: A Rapid Review of the Literature. Semin Oncol Nurs. 2020 Dec;36(6):151092. doi: 10.1016/j.soncn.2020.151092. Epub 2020 Nov 20.
citation: Sherman KA, Heard G, Cavanagh KL. Psychological effects and mediators of a group multi-component program for breast cancer survivors. J Behav Med. 2010 Oct;33(5):378-91. doi: 10.1007/s10865-010-9265-9. Epub 2010 May 26.