Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors

Melinda L. Irwin, Brenda Cartmel, Cary P. Gross, Elizabeth Ercolano, Fangyong Li, Xiaopan Yao, Martha Fiellin, Scott Capozza, Marianna Rothbard, Yang Zhou, Maura Harrigan, Tara Sanft, Kathryn Schmitz, Tuhina Neogi, Dawn Hershman, Jennifer Ligibel

Research output: Contribution to journalArticle

120 Citations (Scopus)

Abstract

Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

Original languageEnglish (US)
Pages (from-to)1104-1111
Number of pages8
JournalJournal of Clinical Oncology
Volume33
Issue number10
DOIs
StatePublished - Jan 1 2015

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Aromatase Inhibitors
Arthralgia
Survivors
Exercise
Breast Neoplasms
Resistance Training
Pain
Arm
Hand
Equipment and Supplies
Ontario
Osteoarthritis

All Science Journal Classification (ASJC) codes

  • Oncology
  • Cancer Research

Cite this

Irwin, M. L., Cartmel, B., Gross, C. P., Ercolano, E., Li, F., Yao, X., ... Ligibel, J. (2015). Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. Journal of Clinical Oncology, 33(10), 1104-1111. https://doi.org/10.1200/JCO.2014.57.1547
Irwin, Melinda L. ; Cartmel, Brenda ; Gross, Cary P. ; Ercolano, Elizabeth ; Li, Fangyong ; Yao, Xiaopan ; Fiellin, Martha ; Capozza, Scott ; Rothbard, Marianna ; Zhou, Yang ; Harrigan, Maura ; Sanft, Tara ; Schmitz, Kathryn ; Neogi, Tuhina ; Hershman, Dawn ; Ligibel, Jennifer. / Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. In: Journal of Clinical Oncology. 2015 ; Vol. 33, No. 10. pp. 1104-1111.
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abstract = "Purpose Arthralgia occurs in up to 50{\%} of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70{\%} (± standard deviation [SD], 28{\%}) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29{\%}) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3{\%}) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.",
author = "Irwin, {Melinda L.} and Brenda Cartmel and Gross, {Cary P.} and Elizabeth Ercolano and Fangyong Li and Xiaopan Yao and Martha Fiellin and Scott Capozza and Marianna Rothbard and Yang Zhou and Maura Harrigan and Tara Sanft and Kathryn Schmitz and Tuhina Neogi and Dawn Hershman and Jennifer Ligibel",
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Irwin, ML, Cartmel, B, Gross, CP, Ercolano, E, Li, F, Yao, X, Fiellin, M, Capozza, S, Rothbard, M, Zhou, Y, Harrigan, M, Sanft, T, Schmitz, K, Neogi, T, Hershman, D & Ligibel, J 2015, 'Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors', Journal of Clinical Oncology, vol. 33, no. 10, pp. 1104-1111. https://doi.org/10.1200/JCO.2014.57.1547

Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. / Irwin, Melinda L.; Cartmel, Brenda; Gross, Cary P.; Ercolano, Elizabeth; Li, Fangyong; Yao, Xiaopan; Fiellin, Martha; Capozza, Scott; Rothbard, Marianna; Zhou, Yang; Harrigan, Maura; Sanft, Tara; Schmitz, Kathryn; Neogi, Tuhina; Hershman, Dawn; Ligibel, Jennifer.

In: Journal of Clinical Oncology, Vol. 33, No. 10, 01.01.2015, p. 1104-1111.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors

AU - Irwin, Melinda L.

AU - Cartmel, Brenda

AU - Gross, Cary P.

AU - Ercolano, Elizabeth

AU - Li, Fangyong

AU - Yao, Xiaopan

AU - Fiellin, Martha

AU - Capozza, Scott

AU - Rothbard, Marianna

AU - Zhou, Yang

AU - Harrigan, Maura

AU - Sanft, Tara

AU - Schmitz, Kathryn

AU - Neogi, Tuhina

AU - Hershman, Dawn

AU - Ligibel, Jennifer

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

AB - Purpose Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity. Patients and Methods Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point. Results Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001). Conclusion Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.

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