Objective. Weight gain and bone loss are commonly reported in breast cancer survivors. The purpose of this pilot study is to assess feasibility and explore the effect of an aerobic weight-loaded exercise intervention on bone remodeling, weight, and body composition.
Design. A one-group pre-posttest design was used to test a 16—24-week supervised walking exercise intervention among women within 2 years of menopause. Through Weeks 1—4, time and weight were progressively increased. By Week 5 and through the end of the intervention, a waist belt was loaded with 5 lb and participants spent 45 min on the treadmill 3 times/week. Bone remodeling was measured by serum biomarkers (N-terminal propeptides of type I collagen [NTX] and serum osteocalcin). Dual-energy absorptiometry scans assessed body composition. Data were collected at baseline and 16 and 24 weeks.
Results. The majority of the 26 participants were married, well educated, and employed, with a mean age of 51.3 years (SD = 6.2). The high adherence (M = 88.2%, SD = 6.8) demonstrated feasiblity. There were no significant changes in serum osteocalcin (p = .67), serum NTX (p = .31), lean muscle mass (p = .08), or percent fat mass for the group as a whole (p = .14), but fat mass increased for women on adjuvant endocrine therapy (p = .04). The women maintained their weight.
Conclusions. This novel exercise intervention for breast cancer survivors was feasible, and women otherwise at high risk for weight gain and bone loss maintained their weight and bone mass.
Ali, P.A., Al-Ghorabie, F.H., Evans, C.J., El-Sharkawt, A.M., & Hancock, D.H. (1998). Body composition measurements using DXA and other techniques in Tamoxifen-treated patients. Applied Radiation Isotope, 49, 643-645.
2.
Armer, J. (2005). The problem of post-breast cancer lymphedema: Impact and measurement issues. Cancer Investigation, 1, 76-83.
3.
Astma, F., Bartelink, M.L., Grobbee, D.E., & vander Schouw, Y.T. (2006). Postmenopausal status and early menopause as independent risk factors for cardiovascular disease: A meta-analysis. Menopause, 13(2), 265-279.
4.
Bemben, D.A., & Fetters, N.I. (2000). The independent and additive effects of exercise training and estrogen on bone metabolism. Journal of Strength Conditioning Research, 14, 114-120.
5.
Borg, G.V. (1982). Rating of perceived exertion scale. Medicine Science Sports & Exercise, 14, 377-387.
6.
Burnham, T.R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine Science Sports & Exercise, 34, 1863-1867.
7.
Campbell, A., Mutrie, N., White, F., McGuire, F., & Kearney, N. (2004). A pilot study of a supervised group exercise progamme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. European Journal of Oncology Nursing, 9, 56-63.
8.
Chen, Z., Maricic, M., Pettinger, M., Ritenbaugh, C., Lopez, A.M., Barad, D.H., et al. (2005). Osteoporosis and rate of bone loss among postmenopausal survivors of breast cancer. Cancer, 104, 1520-1530.
9.
Demark-Wahnefried, W., Aziz, N., Rowland, J., & Pinto, B. (2005). Riding the crest of the teachable moment: Promoting long-term health after the diagnosis of cancer. Journal of Clinical Oncology, 23, 5814-5830.
10.
Demark-Wahnefried, W., Hars, V., Conaway, M.R., Havlin, K., Rimer, B.K., McElveen, G., et al. (1997). Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy . American Journal Clinical Nutrition, 65, 1495-1501.
11.
Demark-Wahnefried, W., Peterson, B.L., Winer, E.P., Marks, L., Aziz, N., Marcan, P.K., et al. (2001). Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving chemotherapy. Journal of Clinical Oncology, 19, 2381-2389.
12.
Demark-Wahnefried, W., Pinto, B.M., & Gritz, E.R. (2006). Promoting health and physical function among cancer survivors: Potential for prevention and questions that remain. Journal of Clinical Oncology, 24, 5125-5131.
13.
Donnelly, J.E., Jacobsen, J., Heelan, K.S., Seip, R., & Smith, S. (2000). The effects of 18 months of intermittent vs. continuous exercise on aerobic capacity, body weight and composition, and metabolic fitness in previously sedentary moderately obese females. Journal of Obesity Related Metabolic Disorders, 24, 560-572.
14.
Doyle, C., Kusihi, L.H., Byers, T., Courneya, K.S., Demark-Wahnefried, W., Grant, B., et al. (2006). Nutrition and physical activity during and after cancer treatment: An American Cancer Society guide for informed choices. Cancer A Journal for Clinicians, 56, 323-353.
15.
Eastell, R., Hannon, R.A., Cuzick, J., Dowsett, M., Clark, G., Adams, J.E., et al. (2006). Effect of an aromatase inhibitor on BMD and bone turnover markers: 2-year results of the Anastrozole, Tamoxifen alone or in combination (ATAC) trial (18233230). Journal of Bone Mineral Research, 21, 1215-1223.
16.
Eyre, H., Kahn, R., Robertson, R., Clark, N.G., Doyle, C., Hong, Y., et al. (2004). Preventing cancer, cardiovascular disease and diabetes. A common agenda for the American Cancer Society, the American Diabetes Association, and the American Heart Association. Circulation, 109, 3244-3255.
17.
Fallowfield, L., Fleissig, A., Edwards, R., West, A., Powles, T.J., Howell, A., et al. (2001). Tamoxifen for the prevention of breast cancer: Psychosocial impact on women participating in two randomized controlled trials. Journal of Clinical Oncology, 19, 1885-1892.
18.
Fisher, B., Dignam, J., Bryant, J., DeCillis, A., Wickerham, L., Wolmark, N., et al. (1996). Five versus more than five years of Tamxifen therapy for breast cancer patients with negative lymph nodes and estrogen receptor-positive tumors. Journal of the National Cancer Institute , 88, 1529-1542.
19.
Freedman, R.J., Aziz, N., Albanes, D., Hatman, T., Danforth, D., Hill, S., et al. (2004). Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. Journal of Clinical Endocrinology & Metabolism, 89, 2248-2253.
20.
Going, S., Lohman, T., Houtkooper, L., Metcalfe, L., Flint-Wagner, H., Blew, R., et al. (2003). Effects of exercise on bone mineral density in calcium-replete postmenopausal women with and without hormone replacement therapy. Osteoporosis International, 14, 637-643.
21.
Goodwin, P., Ennis, M., Pritchard, K.I., Trudeau, M., & Hood, N. (1999). Risk of menopause during the first year after breast cancer diagnosis. Journal of Clinical Oncology, 17, 2365-2370.
22.
Gundberg, C.M., Looker, A.C., Nieman, S.D., & Calvo, M.S. (2002). Patterns of osteocalcin and bone specific alkaline phosphatase by age, gender and race of ethnicity. Bone, 31, 703-708.
23.
Ingram, C., & Brown, J. (2004). Patterns of weight and body composition change in premenopausal women with early stage breast cancer. Cancer Nursing, 27, 483-490.
24.
Ingram, C., Courneya, K.S., & Kingston, D. (2006). The effects of exercise on body weight and composition in breast cancer survivors: An integrative systematic review. Oncology Nursing Forum, 33, 937-950.
25.
Institute of Medicine (2006). From cancer patient to cancer survivor: Lost in transition. Washington, DC: National Academies Press.
26.
Irwin, M., McTiernan, A., Baumgartner, R.N., Baumgartner, K., Bernstein, L., Gilliland, F.D., et al. (2005). Changes in body fat and weight after a breast cancer diagnosis: Influence of demographic, prognostic and lifestyle factors. Journal of Clinical Oncology, 23, 774-782.
27.
Jemal, A., Seigal, R., Ward, E., Murray, T., Xu, J., & Thun, M. (2007). Cancer statistics 2007. CA A Cancer Journal for Clinicians, 57, 43-66.
28.
Judge, J.O., Kleppinger, A., Kenny, A., Smith, J., Biskop, B., & Marcella, G. (2005). Home-based resistance training improves femoral bone mineral density in women on hormone therapy. Osteoporosis International, 16, 1096-1108.
29.
Kelly, G.A., Kelly, K.S., & Tran, Z.V. (2001). Resistance training and bone mineral density in women. A meta-analysis of controlled trials. American Journal Physical Medicine & Rehabilitation, 80, 65-77.
30.
Kemmler, W., Lauber, D., Weineck, J., Hensen, J., Kalendar, N., Engelke, K., et al. (2004). Benefits of 2 years of intense exercise on bone density, physical fitness and blood lipids in early postmenopausal osteopenic women. Archives of Internal Medicine, 164, 1084-1091.
31.
Knobf, M.T. (2001). The menopausal symptom experience in young mid-life women with breast cancer. Cancer Nursing, 24, 201-210.
32.
Knobf, M.T. (2002). Carrying on: The experience of premature menopause in women with early stage breast cancer. Nursing Research , 51, 9-17.
33.
Knobf, M.T., Avila, D., Woodward, P., Fennie, K., DiPietro, L., & Thompson, A.S. (2006). The effect of an exercise intervention on QOL and symptoms in breast cancer survivors. Oncology Nursing Forum, 33, 463, Abstract No. 243.
34.
Knols, R., Aaronson, N.K., Uebelhart, D., Franson, J., & Aufdemkampe, K.L. (2005). Physical exercise in cancer patients during and after medical treatment: A systematic review of randomized and controlled clinical trials. Journal of Clinical Oncology , 23, 3830-3842.
35.
Kroenke, C.H., Chen, W.Y., Rosner, B., & Holmes, M.D. (2005). Weight, weight gain and survival after breast cancer diagnosis. Journal of Clinical Oncology, 23, 1370-1378.
36.
Lanyon, L.E. (1996). Using functional loading to influence bone mass and architecture: Objectives, mechanisms and relationship with estrogen of the mechanically adaptive process in bone. Bone, 18, 37S-43S.
37.
Lauver, D., Connolly-Nelson, K., & Vang, P. (2007). Health-related goals in female cancer survivors after treatment. Cancer Nursing, 30(1), 9-15.
38.
Ligibel, J.A., Chen, W., Keshaviah, K., Adloff, L., Partridge, A., & Salinardi, T. et al (2006). The impact of an exercise intervention on body composition, fat distribution and weight in breast cancer survivors. Journal of Clinical Oncology, 24(18S), 590.
39.
Matthews, C.E., Wilcox, S., Hanby, C.L., Der Ananian, C., Heiney, S.P., Gebretsadick, T., et al. (2007). Evaluation of a 12-week home-based walking intervention for breast cancer survivors. Supportive Cancer Care, 15, 203-211.
40.
McInnes, J., & Knobf, M.T. (2001). Weight gain and quality of life in women treated with adjuvant therapy for breast cancer. Oncology Nursing Forum, 28, 675-684.
41.
McNeeley, M.L., Campbell, K.L., Rowe, B.H., Klassen, T.P., Mackey, J.R., & Courneya, K.S. (2006). Effects of exercise on breast cancer patients and survivors: A systematic review and meta-analysis . Canadian Medical Association Journal, 175, 34-41.
42.
North American Menopause Society. (2006). Management of osteoporosis in postmenopausal women: 2006 position statement of the North American Menopause Society. Menopause, 13, 340-367.
43.
Osteomark (1999). Osteomark NTX test booklet. Seattle, Washington: Ostex International.
44.
Rabin, C.S., Pinto, B.M., Trunzo, J.J., Frierson, G.M., & Bucknam, L.M. (2006). Physical activity among breast cancer survivors: Regular exercisers versus participants in a physical activity intervention . Psycho-Oncology, 15, 344-354.
45.
Schmitz, K.H., Ahmed, R.L., Hannan, P.J., & Yee, D. (2005). Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiology Biomarkers Prevention, 14, 1672-1680.
46.
Schmitz, K.H., Holtzman, J., Courneya, K., Maase, L.C., Duval, S., Kane, R., et al. (2005). Controlled physical activity trials in cancer survivors: A systematic review and meta-analysis. Cancer Epidemiology Biomarkers Prevention, 14, 1588-1595.
47.
Shapiro, C.L., Manola, J., & Leboff, M. (2001). Ovarian failure after adjuvant chemotherapy is associated with rapid bone loss in women with early stage breast cancer. Journal of Clinical Oncology, 19, 3306-3311.
48.
Snow, C.M., Shaw, J.M., Winters, K.M., & Witzke, K.A. (2000). Long-term exercise using weighted vests prevents hip bone loss in postmenopausal women. Journal of Gerontology , 55A, M489-M491.
49.
Sternfeld, B., Bhat, A.K., Wang, H., Sharp, T., & Quesenberry, C.P. (2005). Menopause, physical activity and body composition/fat distribution in mid-life women. Medicine Science Sports & Exercise, 37, 1195-1202.
50.
Taffe, J., & Dennerstein, L. (2002). Time to final menstrual period. Fertility & Sterility, 78, 397-403.
51.
Vehmanen, L., Elomaa, I., Blomqvist, C., & Saarto, T. (2006). Tamoxifen treatment after adjuvant chemotherapy has opposite effects on bone mineral density in premenopausal patients depending on menstrual status. Journal of Clinical Oncology, 24, 675-680.
52.
Wallace, B.A., & Cumming, R.G. (2000). Systematic review of randomized trials of the effects of exercise on bone mass in pre- and postmenopausal women. Calcified Tissue International, 67, 10-18.
53.
Waltman, N., Twiss, J.J., Ott, C.D., Gross, G.G., Lindsay, A., Moop, T.E., et al. (2003). Testing an intervention for preventing osteoporosis in postmenopausal breast cancer survivors. Image: Journal of Nursing Scholarship, 35, 333-338.
