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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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