Effects of aerobic exercise on late effects and quality of life in Long-Term breast cancer survivors: a randomized controlled trial

BACKGROUND Breast cancer survivors (BCSs) are at increased risk of late effects. While research has reported positive effects of exercise therapy on fatigue and health-related quality of life (HRQoL) among short-term BCSs, evidence in long-term survivors remains scarce. METHODS The CAUSE (CArdiovascUlar Survivors Exercise) trial was a two-armed randomized controlled trial. Long-term BCSs were assigned to five months of thrice-weekly supervised aerobic exercise or usual care. Late effects and HRQoL were assessed by Chalder Fatigue Questionnaire, European Organization for Research and Treatment of Cancer QLQ-BR23 and QLQ-C30 questionnaires, and Scale for Chemotherapy-Induced Long-term Neurotoxicity at baseline (T0), post-intervention (T1) and one-year follow-up (T2). RESULTS In total, 140 BCSs (mean age 59.0 ± 6.4 years, 11 ± 1 years post-treatment) were included. Loss to follow-up at T1 was 6% and 19% in the exercise- and usual care group, respectively. From T0 to T1, the exercise group significantly improved total fatigue (between groups mean difference (MD) -3.0, p < .001), body image (MD 6.7, p = .043), physical- (MD 3.2, p = <0.001), role- (MD 9.6, p = .019), and cognitive function (MD 3.4, p = .038), insomnia (MD -9.0, p = .017), and global health/QoL (MD 5.3, p = <0.001) compared to usual care. The exercise benefits were more pronounced in BCSs experiencing versus not experiencing late effects at baseline. At one-year follow-up, most improvements regressed toward baseline values. CONCLUSION Aerobic exercise significantly improves fatigue, body image, physical-, role-, and cognitive function, insomnia, and HRQoL in long-term BCSs. These findings suggest that exercise therapy should be a core component of managing late effects and enhancing HRQoL in long-term BCSs. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov/. Registration number: NCT04307407