Optimal Timing of a Physical Exercise Intervention to Improve Cardiorespiratory Fitness

Figures

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  Figure 1. Design of the ACT Trial Patients were randomized in a 1:1 ratio to an exercise intervention initiated during (group A) or after (group B) chemotherapy. Randomization was stratified by hospital and cancer diagnosis. The 24-week physical exercise intervention consisted of 2 components: 12 weeks of supervised exercise followed by 12 weeks of home-based unsupervised exercise. ACT = Optimal Timing of a Tailored Physical Activity Program During Chemotherapeutic Cancer Treatment to Reduce Long-Term Cardiovascular Morbidity; VO2peak = peak oxygen uptake; X months = duration varied from 0 to 12 weeks depending on chemotherapy regimen.

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  Figure 2. Consort Diagram of the ACT Trial In total, 502 patients were screened for eligibility, of whom 100 were deemed ineligible, 130 declined to participate, and 6 could not be screened. A total of 266 patients were included and randomized to group A or group B. In total, 139 patients with breast cancer, 95 patients with testicular cancer, 30 patients with colon cancer, and 2 patients with B-cell non-Hodgkin lymphoma were included. After randomization, 30 patients dropped out of group A, and 29 patients dropped out of group B. CT = chemotherapy.

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  Central Illustration. Effects of Exercise on Peak Oxygen Uptake, Health-Related Quality of Life, and Fatigue This randomized clinical trial in patients with breast, testicular, and colon cancer examined effects of physical exercise initiated during or after chemotherapy. In the first weeks during chemotherapy, groups A and B declined similarly in terms of (A) peak oxygen uptake, (B) health-related quality of life, and (C) general fatigue. However, at the completion of chemotherapy, these parameters in group A had increased, whereas the values in group B continued to decline. Three months after completion of chemotherapy and 1 year after the exercise intervention, the values were similar in both groups. HRQoL = health-related quality of life; VO2peak = peak oxygen uptake.

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  Figure 3. Between-Group Changes From Baseline: HRQoL, Functioning, and Cancer-Related Symptoms Between-group changes from baseline were calculated using intention-to-treat linear mixed-models analyses, adjusted for baseline values, cancer type, and hospital. The dotted lines denote the threshold for a clinical meaningful difference. An adjusted mean difference that is positive suggests that the measure was greater in group A. After chemotherapy, HRQoL and the physical functioning subscale declined significantly less in group A than in group B. The dyspnea and appetite loss subscales favored group A. HRQoL = health-related quality of life.