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"Chemotherapy-periodized" exercise to accommodate for cyclical variation in fatigue
Kirkham AA, Bland KA, Zucker DS, Bovard J, Shenkier T, McKenzie DC, Davis MK, Gelmon KA, Campbell KL
Medicine and Science in Sports and Exercise 2020 Feb;52(2):278-286
clinical trial
4/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

PURPOSE: The purpose of this study was to provide a rationale for "chemotherapy-periodized" exercise by characterizing cyclical variations in fatigue and exercise response across a chemotherapy cycle and comparing exercise adherence during chemotherapy between a prescription that is periodized according to chemotherapy cycle length and a standard linearly progressed prescription. METHODS: Women with breast cancer who were prescribed taxane-based chemotherapy were randomly assigned to a supervised aerobic and resistance exercise program after a chemotherapy-periodized exercise prescription (n = 12) or to usual care during chemotherapy (n = 15). Fatigue and steady state exercise responses were assessed in both groups before the first taxane treatment and across the third treatment (ie, 0 to 3 d prior and 3 to 5 d after the third treatment, and 0 to 3 d before the fourth treatment) to assess cyclical variations. Adherence to the chemotherapy-periodized exercise prescription was compared with adherence to a standard linear prescription from a prior study in a similar population (n = 51). RESULTS: Fatigue increased from baseline (marginal mean +/- standard error 3.2 +/- 0.4) to before the third treatment (4.1 +/- 0.4, p = 0.025), then peaked at 3 to 5 d after the third treatment (5.1 +/- 0.4, p = 0.001), before recovering before the fourth treatment (4.3 +/- 0.5, p = 0.021). The peak in fatigue at 3 to 5 d post-third treatment corresponded to a decrease in steady state exercise oxygen consumption (VO2) (p = 0.013). Compared with a standard linear exercise prescription during chemotherapy, a chemotherapy-periodized exercise prescription resulted in higher attendance during the week after chemotherapy (57% +/- 30% versus 77% +/- 28%, p = 0.04) and overall attendance (63% + 25% versus 78% +/- 23%, p = 0.05). CONCLUSIONS: Fatigue and exercise VO2 vary across a chemotherapy cycle. A chemotherapy-periodized exercise prescription that accommodates cyclical variations in fatigue may increase adherence to supervised exercise.

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