Effect of physical exercise on cognitive function after chemotherapy in patients with breast cancer: a randomized controlled trial (PAM study)

Breast Cancer Research

PAM study group¹  N. A. van Holsteijn²  M. B. E. Menke-Pluijmers³  L. W. Tick⁴  E. Göker⁵  M. E. M. M. Bos⁶  G. S. Sonke⁷  E. van der Wall⁸  C. C. van der Pol⁹  M. M. Stuiver^1,10  S. B. Schagen^1,10  M. B. de Ruiter^1,10  A. M. May^1,11  E. W. Koevoets^1,11  E. M. Monninkhof^1,11  M. I. Geerlings^1,11  L. Witlox^1,11  J. J. Jobsen^1,12  J. van der Palen^1,12  M. J. Velthuis^1,13 

[1] ;Breast Cancer Center, Reinier de Graaf Hospital;Breast Clinic, Albert Schweitzer Hospital;Department of Internal Medicine, Máxima Medisch Centrum;Department of Medical Oncology, Alexander Monro Hospital;Department of Medical Oncology, ErasmusMC Cancer Institute;Department of Medical Oncology, Netherlands Cancer Institute;Department of Medical Oncology, University Medical Center Utrecht, Utrecht University;Department of Surgery, Alrijne Ziekenhuis;Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute;Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University;Medical School Twente, Medisch Spectrum Twente;Netherlands Comprehensive Cancer Organisation (IKNL);

关键词: Breast cancer;    Cancer-related cognitive impairment;    Cognition;    Cognitive complaints;    Exercise training;    Physical exercise;   

DOI  :  10.1186/s13058-022-01530-2

来源: DOAJ

【 摘 要 】

Abstract Background Up to 60% of breast cancer patients treated with chemotherapy is confronted with cognitive problems, which can have a significant impact on daily activities and quality of life (QoL). We investigated whether exercise training improves cognition in chemotherapy-exposed breast cancer patients 2–4 years after diagnosis. Methods Chemotherapy-exposed breast cancer patients, with both self-reported cognitive problems and lower than expected performance on neuropsychological tests, were randomized to an exercise or control group. The 6-month exercise intervention consisted of supervised aerobic and strength training (2 h/week), and Nordic/power walking (2 h/week). Our primary outcome was memory functioning (Hopkins Verbal Learning Test-Revised; HVLT-R). Secondary outcomes included online neuropsychological tests (Amsterdam Cognition Scan; ACS), self-reported cognition (MD Anderson Symptom Inventory for multiple myeloma; MDASI-MM), physical fitness (relative maximum oxygen uptake; VO2peak), fatigue (Multidimensional Fatigue Inventory), QoL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire; EORTC QLQ C-30), depression (Patient Health Questionnaire-9, Hospital Anxiety and Depression Scale; HADS), and anxiety (HADS). HVLT-R total recall was analyzed with a Fisher exact test for clinically relevant improvement (≥ 5 words). Other outcomes were analyzed using multiple regression analyses adjusted for baseline and stratification factors. Results We randomized 181 patients to the exercise (n = 91) or control group (n = 90). Two-third of the patients attended ≥ 80% of the exercise sessions, and physical fitness significantly improved compared to control patients (B VO2peak 1.4 ml/min/kg, 95%CI:0.6;2.2). No difference in favor of the intervention group was seen on the primary outcome. Significant beneficial intervention effects were found for self-reported cognitive functioning [MDASI-MM severity (B-0.7, 95% CI − 1.2; − 0.1)], fatigue, QoL, and depression. A hypothesis-driven analysis in highly fatigued patients showed positive exercise effects on tested cognitive functioning [ACS Reaction Time (B-26.8, 95% CI − 52.9; − 0.6) and ACS Wordlist Learning (B4.4, 95% CI 0.5; 8.3)]. Conclusions A 6-month exercise intervention improved self-reported cognitive functioning, physical fitness, fatigue, QoL, and depression in chemotherapy-exposed breast cancer patients with cognitive problems. Tested cognitive functioning was not affected. However, subgroup analysis indicated a positive effect of exercise on tested cognitive functioning in highly fatigued patients. Trial Registration Netherlands Trial Registry: Trial NL5924 (NTR6104). Registered 24 October 2016, https://www.trialregister.nl/trial/5924 .

【 授权许可】

Unknown