1. Aerobic and resistance exercise regimen improved arthralgia-related pain severity in breast cancer survivors on aromatase inhibitors compared to those on usual care.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Aromatase inhibitors (AIs) are considered the first-line therapy for post-menopausal women with hormone receptor positive breast cancer. However, previous studies have demonstrated overall poor AI adherence and compliance, most commonly as a result of negative adverse effects associated with AIs, such as arthralgia. Given that early discontinuation of AIs represent an independent risk factor for mortality, interventions that improve AI adherence may provide significant benefit. The purpose of the HOPE (Hormones and Physical Exercise) trial was to investigate the effects of exercise intervention on AI-induced arthralgia in breast cancer patients.
The trial randomized breast cancer survivors experiencing AI-associated arthralgia to either an aerobic and resistance regimen or usual care. The primary outcome was subjective severity of symptoms and degree of disability at 12-month follow-up. At the conclusion of the trial, the authors demonstrated significant reductions in arthralgia severity in the exercise group compared to the usual care group, as measured by three different validated pain questionnaires. Significant improvements in pain scores were observed at 3 months, but the largest benefit occurred after 12 months of exercise. The strength of this trial were the randomized trial design and the high level of adherence in the exercise group. However, the main limitations of the trial were the use of specialized trainers in supervising patients in the exercise group, which may reduce external generalizability. Additional randomized trials are required to determine the specific effect of exercise on AI adherence and overall breast cancer survival.
In-Depth [randomized controlled trial]: This multi-center, non-blinded, randomized trial compared the effect of 12-month exercise intervention on AI-associated arthralgia versus usual care. Patients in the exercise intervention group underwent twice-per-week supervised resistance training and home-based aerobic exercise of 150 minutes per week. Eligible patients were physically inactive postmenopausal women diagnosed with hormone receptor-positive stage I to III breast cancer who had been on AIs for at least 6 months, and who had had mild to severe arthralgia for at least 2 months that began or worsened with AI use. Primary outcomes included arthralgia symptoms assessed by validated questionnaires (Brief Pain Inventory (BPI), Western Ontario and McMaster Universities Osteoarthritis index (WOMAC), and Disabilities of the Arm Shoulder, and Hand questionnaire (DASH)). A total of 121 women were recruited and randomized. After 12 months, the worst joint pain scores decreased by 1.6 points (29%) in the exercise group compared to a 0.2 point increase (3%) in the usual care group (p < 0.001), as measured by BPI. Similar results were observed in the DASH and WOMAC questionnaires. There was no significant difference in pain medication use or AI discontinuation, although trends favored the exercise group.
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