Exercise therapy in women treated for breast cancer

Treatment for breast cancer can result in reduced quality of life (QoL), psychological and physical well-being. Evidence suggests that exercise may be of therapeutic benefit for breast cancer patients. To date, however, no randomised controlled trial in the UK has examined the effects of aerobic exercise therapy upon QoL and associated outcomes in women who have completed breast cancer treatment. Furthermore no trial has included an exercise-placebo and a usual care group to control for possible attention effects arising from instructor-patient interaction. Therefore, the purpose of this thesis was to examine the effects of a supervised one-to-one aerobic exercise-therapy intervention upon QoL and associated outcomes in women who had completed treatment for breast cancer 12-36 months previously. Additional aims of the thesis were to provide detailed information about participants' adherence to the trial interventions and to examine the most effective methods of recruitment into the trial. A qualitative study was also included to explore the personal exercise experiences of participants who took part in the exercise therapy and exercise-placebo interventions.The sample consisted of 108 sedentary women who had been treated for breast cancer 12-36 months previously. The mean age of the participants was 51 years (age range 32-65years). The primary route of recruitment was via clinician invitation letters. Participants were randomised to one of three groups: exercise therapy (n=34), exercise-placebo (n=36) or usual care (n=38). The exercise therapy and exercise-placebo groups attended one-to-one supervised sessions three times a week for a period of eight weeks (24 sessions in total). The exercise therapy group participated in moderate intensity aerobic exercise and received exercise counselling designed to promote exercise participation. The exercise-placebo group participated in light flexibility, mobility and body conditioning exercises and did not receive exercise counselling.Repeated measures mixed analyses of covariance (controlling for baseline scores) revealed a significant mean difference of 9.8 units in the primary outcome (QoL), Functional Assessment of Cancer Therapy (FACT-G)-General scale, favouring exercise therapy at eight week follow-up relative to usual care. The exercise placebo group did not report similar statistical significant benefits. Significant differences favouring exercise therapy relative to usual care were found for FACT-B (breast cancer specific QoL), social/family well-being, functional well-being and breast specific concerns subscales. Outcomes including depression, physical self-worth and aerobic fitness improved significantly in the exercise therapy group compared to usual care. Adherence to both exercise interventions was excellent. The estimated trial recruitment rate based on clinician invitation was 28.6%.Findings from the qualitative study revealed participants perceived the exercise interventions had accelerated their psychological and physical recovery from breast cancer. A patient-centred approach mediated exercise enjoyment and adherence.This pioneering study demonstrated that exercise therapy was a safe, tolerable intervention that elicited short-term, clinically important benefits upon QoL in women treated for breast cancer. Future research should focus on sustaining QoL benefits through longer-term exercise participation and the feasibility of integrating exercise rehabilitation into mainstream breast cancer care.