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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.
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