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Exercisedampensaromataseinhibitor–relatedjointpain
http://www.internalmedicinenews.com/specialty-focus/oncology-hematology/single-article-page/exercise-dampens-aromatase-inhibitor-related-joint-pain/33383ff19a0cd42399a7cf8590708ebf.html
SANANTONIO–Adoptingastandardexerciseprogramresultedinaclinicallymeaningful30%reductioninaromataseinhibitor-associatedjointpaininbreastcancerpatientswhoparticipatedinayear-longrandomizedtrial.
TheexerciseprescriptionutilizedintheHOPE(HormonesandPhysicalExercise)trialwaswhat’srecommendedinnationalguidelinesbothforcancersurvivorsandhealthyadults:150minutesperweekofatleastmoderate-intensityaerobicactivity,suchasbriskwalking,alongwithtwostrength-trainingsessionsperweek,MelindaL.Irwin,Ph.D.,explainedattheSanAntonioBreastCancerSymposium.
TheHOPEstudiesenrolled121postmenopausalwomenwhohadstage1-3,hormonereceptor–positivebreastcancersandwerephysicallyinactiveandoverweightyetphysicallyabletoexercise.Atenrollment,theywereexperiencingmoderatearomataseinhibitor(AI)–associatedjointpain,definedasascoreof5-7onthe0-10BriefPainInventory(BPI),afterabout18monthsonthemedication.Roughlytwo-thirdsofparticipantshadnohistoryofjointpainpriortostartingAItherapy;therestreportedtheAIexacerbatedtheirpreexistingjointpain.Subjectswererandomizedtotheexerciseprogramortousualcare,whichincludedwritteninformationabouttheimportanceofexercise.
Theprimarystudyendpointwasthe12-monthchangeinBPIworstpainscore,whichdroppedbyanaverageof30%amongtheexercisegroup.Thistranslatedtoanimprovementinpainlevelfrommoderateatbaselinetomildatfollow-up.Inaddition,BPIscoresratingpainseverityandpaininterferenceimprovedbyabout20%.Incontrast,patientsintheusualcarecontrolgroupexperiencedaslightincreaseinBPIscoresinallthreedomainsovertime,addedDr.Irwin,co-leaderofthecancerpreventionandcontrolresearchprogramatYaleUniversityCancerCenter,NewHaven,Conn.
TheHOPEresultsreceivedanenthusiasticaudiencereception.Physicianswereparticularlyimpressedwiththe70%exerciseadherencerateoverthecourseofayear.Theyaskedhowtheycankeeptheirpreviouslysedentarypatients’commitmenttoregularexercisefromwaningafteraninitialburstofenthusiasm,assooftenhappens.
Dr.Irwinrepliedthatadherencetolifestylechangeisalwaysachallenge.Socialsupportisquitehelpful.TheexercisegroupinHOPEreceivedapaidgymmembershipandmetinsmallgroupswithapersonaltrainertwiceweekly.
"Thewomenreallybondedwitheachother.Andtherearenowagrowingnumberoffreeprogramsthroughoutthecountry,whichgivecancersurvivorsastartonanexerciseprogramwithafreegymmembershipforseveralmonths.Forexample,theLivestrongFoundationhaspartneredwiththeYMCAtoofferfreeexerciseprogramsforcancersurvivorsatlocalYs,"shesaid.
TheHOPEtrialwasfundedbytheNationalCancerInstitute.Dr.Irwinreportedhavingnofinancialconflictsofinterest.
Thisdegreeofimprovementinjointpainisgreaterthanreportedinstudiesofglucosamine,acupuncture,orvitaminDsupplementation,shenoted.
Theimprovementinpainscoresintheexercisegroupwasgreaterat12monthsthanat3or6,suggestingthatayear-longexerciseprogramisprobablynecessarytoseesustainedreductioninjointpain.
At12monthsoffollow-up,womenintheexercisegroupaveraged159minutesofphysicalactivityperweek,110minutesmorethancontrols.Compliancewiththesupervisedexerciseprogramwasnotablygood,withwomenattendinganaverageof70%ofthetwice-weeklysmall-groupstrength-trainingsessions.
InadditiontotheimprovementinAI-relatedarthralgias,theexercisegroupexperiencedancillarybenefits:amean6.5%improvementinpeakoxygenconsumption,orVO2max,comparedwithbaseline,alongwitha3%reductioninbodyweight.
HOPEwasthefirstrandomizedtrialtoexaminetheeffectsofexerciseonAIsideeffectsinbreastcancerpatients.TheimpetusforthestudywastherecognitionthatarthralgiasarethemostcommonreasonforpooradherencetoanddiscontinuationofAItherapy.Upto20%ofbreastcancerpatientsdiscontinuetheirAIwithinthefirstyear.Andbothearlydiscontinuationandpooradherencehavebeenshowntobepredictiveofincreasedmortalityrisk.
Figure 1. Effect of elution volume on concentration and recovery using the MicroElute® Cycle Pure Kit. Elution volume versus recovery and DNA yield; 11 µg of 3 kb PCR product was purified using the MicroElute® Cycle Pure protocol and eluted with the indicated volume of elution buffer. The standard protocol uses 15 µL elution buffer because this combines higher yield and higher concentration. The yield can be increased by increasing the elution volume.
