Feasibility of an exercise intervention for fatigued breast cancer patients at a community-based cardiac rehabilitation program

Stefanie De Jesus,1 Lyndsay Fitzgeorge,2 Karen Unsworth,3 David Massel,4,5 Neville Suskin,4,5 Harry Prapavessis,1 Michael Sanatani6 1Department of Kinesiology, The University of Western Ontario, 2School of Health Sciences, Fanshawe College, 3Cardiac Rehabilitation & Secondary Prevention Program, St. Joseph’s Hospital, 4Division of Cardiology & Program of Experimental Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, 5Lawson Health Research Institute, 6Department of Medical Oncology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada Purpose: Exercise is beneficial to quality of life after cancer treatment, yet few cancer survivors meet exercise guidelines. Our study sought to determine the feasibility of an oncology rehabilitation exercise program embedded within a cardiac rehabilitation program. Methods: Patients who rated their fatigue >4/10 after completion of adjuvant chemotherapy for breast cancer were screened for eligibility and the outcomes were assessed (Piper Fatigue Scale, Functional Assessment of Cancer Therapy-Breast [FACT-B], Edmonton Symptom Assessment System, body composition, stress test, and physical activity measurement [accelerometer]). Participants received individualized exercise prescription. Following the 16-week program, repeat assessment plus patient acceptance and satisfaction survey was completed. The primary end point was the composite of accrual rate >25%, program adherence >80%, and mean compliance with accelerometer use >80%. Results: Twenty of 24 screened patients consented to the study and completed the baseline assessment. Adherence was 30.3%. Mean accelerometer use was 3.88/7 days (78%). Fatigue at baseline was rated at 4.82/10, and at 3.59 (p = 0.09) after the intervention. Overall well-being (FACT-B) score changed from 92.7 to 98.3 (p = 0.05). There were no significant changes in body composition (except for bone mineral content), aerobic exercise capacity, or activity patterns. Conclusion: Although the primary outcome was not met, our study indicates that an oncology exercise rehabilitation program can be incorporated into an existing cardiac rehabilitation program. Based on feedback received, we propose that in order to achieve exercise goals, frequent, encouraging, and tailored feedback and group sessions to foster a sense of community may additionally be needed to strengthen adherence to a prescribed exercise program. Keywords: breast cancer rehabilitation, fatigue, exercise, community settin