Aerobic-resistance exercise versus home-based exercise for BMD in female cancer survivors

Study Type: Therapy
OE Level of Evidence: 2
Journal Level of Evidence: N/A
154 female cancer survivors were randomized to receive either a 12-month aerobic-resistance exercise program or a home-based exercise regimen. The purpose of this study was to compare bone outcomes following the two treatments to determine their effect on bone loss in this patient population. Both groups experienced Please login to view the rest of this report. Please login to view the rest of this report.
Funding: Not Reported
Conflicts: Other
Why was this study needed now?
Premature bone loss is a concern among female cancer survivors, as various cancer treatments can result in nearly two times the rate of normal bone deterioration in these patients. Previous research has recommended the use of resistance exercise and weight-bearing aerobic exercise with calcium and vitamin D supplementation to maintain bone health for all women who are 50 years of age or older. Additionally, home-based exercise programs that are moderate to high intensity have also been suggested to be effective in preserving bone mass in postmenopausal women. However, few trials have investigated the effectiveness of these exercise methods in female cancer survivors, thus, the present study was conducted to determine whether there are differences in efficacy between an aerobic-resistance exercise program compared to a home-based exercise program in this patient population.
What was the principal research question?
Are there differences in bone mineral density measures and biomarkers of bone turnover between female cancer survivors receiving a 12-month aerobic resistance exercise program when compared to a 12-month home-based exercise regimen?
Population: 154 early menopausal female cancer survivors were included in this study. Inclusion criteria consisted of female participants diagnosed with breast, gynecologic, or colorectal cancers, or lymphoma who had undergone non-hormonal therapy no more than 36 months prior in the peri-menopausal or early post-menopausal stages. All patients received a 400 IU vitamin D supplement, and an additional 50,000 IU vitamin D dose if serum levels were deficient (<20 ng/mL); calcium supplements for calcium intake to reach 1200 mg a day; and the American Cancer Society Nutrition Guidelines for cancer survivors. Subgroup analyses were conducted for women on aromatase inhibitors, Tamoxifen, and those not receiving hormone therapy.
Intervention: Exercise group: Brisk walking on a treadmill, lower body resistance exercises, weight-loaded belt use, lunges, and squats were performed three times a week for a duration of 30 minutes. Duration and weight of each exercise were altered to reach a targeted heart rate of 65-70% and a weight-loaded belt of 5 pounds by week 5. Sessions were supervised for the first 6 months and unsupervised for the remainder of the study. (n=76; Mean age: 50+/-6)
Comparison: Home-based group: Moderate intensity activities taken from the American Cancer Society "Smart Steps" booklet were completed for 30 minutes on most days of the week. (n=78; Mean age: 53.1+/-7.2)
Outcomes: The outcomes of this study consisted of changes in bone mass density (BMD) in the lumbar spine, hip, femoral neck, and greater trochanter, as measured by DEXA scans (Hologic QDR 4500 X-ray Bone Densitometer). The Osteomark NTX serum kit biomarker was used to measure bone resorption, and bone formation was marked using Osteocalcin. Subgroup analyses were conducted for women on aromatase inhibitors, Tamoxifen, and those not receiving hormone therapy.
Methods: RCT; single-center
Time: Outcomes were assessed at 6 and 12 months.
What were the important findings?
What should I remember most?
How will this affect the care of my patients?
The authors responsible for this critical appraisal and ACE Report indicate no potential conflicts of interest relating to the content in the original publication.
Mr. Brandon Butt
March 10, 2017
Physiotherapist - Canada
What modality of aerobic exercise was used?
Dr. Ortho Evidence
March 13, 2017
Other - Canada
Thank you for your comment. From the publication, participants who took part in the exercise intervention performed a combination of treadmill walking, lower body resistance exercise, lunges and squats, with progression using a weight-loaded belt to achieve a target heart rate of 65-70% of maximum heart rate during activities. Further group information can also be found under the “Study Characteristics” tab of the ACE Report.