Women who began an aerobic exercise program during chemotherapy for breast cancer reported improved cognitive function and quality of life compared to those who received standard care. Participants in the exercise group felt they could concentrate better and remember things, helping to reduce the effects of the “chemo brain.” These findings support the integration of exercise into cancer treatment to improve mental and physical health.
Chemotherapy-related cognitive impairment (CRCI) is one of the most significant challenges faced by women diagnosed with breast cancer.
Approximately 75% of these women report difficulties with memory, concentration, and reasoning, which can be both short- and long-term.
In addition, women who undergo chemotherapy tend to perform worse on neuropsychological tests that assess functions such as working memory, information processing, spatial skills, and language skills, compared to women who have not received chemotherapy or women with no history of cancer.
This cognitive decline has a significant impact on the quality of life of these patients, and there is currently no established treatment protocol to prevent or manage CRCI.
Identifying effective interventions to improve or maintain cognitive function, and thus improve quality of life, is essential to lessening the impact of breast cancer. One promising intervention is aerobic exercise, which is effective in improving cognitive function in older adults and people with mild cognitive impairment.
Based on these findings, researchers have begun to explore whether exercise might have similar effects in cancer patients, leading to improvements in cognitive function. However, the effectiveness of exercise in improving cognitive function in women diagnosed with breast cancer remains uncertain.
Although 53 randomized controlled trials have been conducted in this area, the results are inconsistent. Many studies suffered from small sample sizes or methods that limit the ability to generalize the findings to the broader population.
Another problem is that some of these studies did not use specific measures to assess cognitive function. For example, some have used generic quality-of-life questionnaires, which do not capture the various dimensions of cognition (such as memory, attention, and executive functions).
In addition, few studies have included objective measures of cognitive function, as recommended by the International Task Force on Cognition and Cancer. Self-report data, which often differ from objective tests, do not provide a clear picture of the true impact of chemotherapy on cognition.
Therefore, without objective measures of cognitive function, it is not yet possible to reliably determine whether exercise can improve cognitive performance in women undergoing chemotherapy.
Furthermore, most studies have not focused on patients during chemotherapy treatment, highlighting the need for further research to determine whether exercise can mitigate CRCI in women undergoing treatment.
A recent study from the University of Ottawa, called ACTIVATE, was designed to assess the effects of aerobic exercise on cognitive function and quality of life in women who began chemotherapy to treat breast cancer.
The study compared a group of women who engaged in aerobic exercise during chemotherapy with a group who received only usual care. The primary goal was to measure the effects of exercise on cognitive function after chemotherapy was completed, using objective neuropsychological tests.
In the study, 57 women, with an average age of 48 and diagnosed with stage I-III breast cancer, were randomly assigned to one of two groups: 28 began an exercise program during chemotherapy and 29 received usual care, with the option of starting exercise after chemotherapy.
The intervention lasted 12 to 24 weeks and included supervised aerobic exercise sessions ranging in duration from 20 to 40 minutes. Cognitive function was assessed using 13 neuropsychological tests and quality of life questionnaires.
Although the results showed no significant differences in objectively measured cognitive function between the two groups after chemotherapy, women who exercised reported significant improvements in their perceived cognitive function and quality of life when compared to the group who did not exercise.
In summary, aerobic exercise may not have a measurable impact on objective tests of cognitive function in women undergoing chemotherapy, but the results suggest that it may improve patients’ perceptions of their cognition and increase their quality of life, which may have important implications for well-being during treatment.
READ MORE:
Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE): A randomized controlled trial
Jennifer Brunet, Sitara Sharma, Kendra Zadravec, Monica Taljaard, Nathalie LeVasseur, Amirrtha Srikanthan. et al.
Cancer. 21 October 2024
Abstract:
As the prevalence of chemotherapy-related cognitive impairment rises, investigation into treatment options is critical. The objectives of this study were to test the effects of an aerobic exercise intervention initiated during chemotherapy compared to usual care (waitlist control condition) on (1) objectively measured cognitive function and self-reported cognitive function, as well as on (2) the impact of cognitive impairment on quality of life (QOL) postintervention (commensurate with chemotherapy completion). The Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE) trial was a two-arm, two-center randomized controlled trial conducted in Ottawa and Vancouver (Canada). Fifty-seven women (Mage, 48.8 ± 10 years) diagnosed with stage I–III breast cancer and awaiting chemotherapy were randomized to aerobic exercise initiated with chemotherapy (nEX = 28) or usual care during chemotherapy with aerobic exercise after chemotherapy completion (nUC = 29). The intervention lasted 12–24 weeks and consisted of supervised aerobic training and at-home exercise. The primary outcome was objective cognitive function measured via 13 neuropsychological tests (standardized to M ± SD, 0 ± 1); secondary outcomes of self-reported cognitive function and its impact on QOL were assessed via questionnaires. Data collected pre- and postintervention (the primary endpoint) were analyzed.
Although no significant differences between groups were found for objective cognitive function outcomes postintervention after accounting for multiple tests, four of six self-reported cognitive function outcomes showed significant differences favoring the aerobic exercise group. Among women initiating chemotherapy for breast cancer, aerobic exercise did not result in significant differences in objective cognitive function postintervention after chemotherapy completion; however, the results do support the use of this intervention for improving self-reported cognitive function and its impact on QOL.
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