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    Research Grants Awarded

    Strength Training for Older Breast Cancer Survivors: A Randomized, Controlled Trial

    Study Section:
    Population Specific

    Scientific Abstract:
    Women aged 50 and older are disproportionately affected by breast cancer, not only in terms of new diagnoses, but also in terms of survivorship. Approximately 85% of women who receive a first diagnosis of breast cancer are aged 50 and over, thus older women constitute the largest group of breast cancer survivors. Yet, few studies have focused on evaluating whether physical activity and exercise interventions affect long-term symptoms, physical fitness and function, and body composition of older breast cancer survivors. Due to the combined effects of breast cancer, related treatments and aging it is likely that exercise is even more beneficial for older breast cancer survivors than for younger survivors. Along with the cancer-related symptom of fatigue common to cancer survivors, older survivors face age-related declines in bone and muscle mass, muscle strength, and physical function (gait and balance) that are likely exacerbated by reduced physical activity in survivorship and side effects of adjuvant cancer treatment. Strength training is specifically suited to reverse or slow age-related declines in bone, muscle, strength and function and has shown promise to reduce cancer-related fatigue. However, no controlled trials of strength training in older breast cancer survivors have been conducted. Trials of aerobic exercise in breast cancer survivors, mostly in young women undergoing cancer treatment, suggest that aerobic exercise reduces fatigue and increases aerobic fitness and quality of life; but, questions about the effects of specific types of physical activity on body composition, muscle strength and objective measures of physical function remain unanswered. The long-term goal of the research is to develop exercise programs that target the specific needs of older breast cancer survivors, with a maximum benefit for a minimum cost in each individual’s time and effort. The proposed study is significant because it will be one of the first controlled trials to study the effects of strength training in older breast cancer survivors. The purpose of this study is to evaluate the beneficial effects of strength training for inactive older (aged 50+) breast cancer survivors who have completed adjuvant cancer treatment at least one year prior to enrollment. We propose to conduct a 12-month randomized controlled trial comparing two groups: 1) a progressive, supervised strength training program to 2) a control condition of supervised flexibility/relaxation sessions. Primary study aims test the following hypotheses: 1) Strength training will increase muscle strength, physical functioning (gait and balance), physical health, and mental health, and decrease fatigue, compared to a control condition and 2) Strength training will improve body composition (increased muscle and bone mass, reduced fat mass). Muscle strength will be measured by 1-repetition maximum, gait will be measured by timed 20 foot walk on an electronic gait mait, balance will be measured by timed stance tests, physical and mental health will be measured by the SF-36 health survey and fatigue will be measured by the FACIT. Body composition, including hip and spine bone mass, fat mass and muscle mass will be measured by dual energy x-ray absorptiometry. All outcome measures will be assessed at baseline, 6 and 12 months. Statistical analyses for hypothesis testing will be conducted using repeated measures ANCOVA, including age, time since diagnosis and baseline differences as covariates. If our data show evidence that strength training is beneficial for older breast cancer survivors, we will work at the local, state and national level to disseminate our findings and bring the program into community organizations that outreach to cancer survivors.

    Lay Abstract:
    Approximately 85% of women who receive a first diagnosis of breast cancer are aged 50 and over, thus older women constitute the largest group of breast cancer survivors. Yet, few studies have focused on evaluating whether physical activity and exercise interventions affect long-term symptoms, physical fitness and function, and body composition of older breast cancer survivors. Due to the combined effects of breast cancer, related treatments and aging it is likely that exercise is even more beneficial for older breast cancer survivors than for younger survivors. Breast cancer survivors almost always experience fatigue that may or may not resolve after treatment. Older survivors face age-related declines in bone and muscle mass, muscle strength, and physical function (gait and balance) that may be worsened by reduced physical activity in survivorship and long-term side effects of their cancer treatments. Strength training is specifically suited to stop age-related declines in bone, muscle, strength and function and has shown promise to reduce cancer-related fatigue. Older women can strength train and those that do benefit tremendously. Older women who strength train improve their body composition, strength, and function and in turn have greater independence, less disability and lower fall risk. However, since no well designed studies of strength training in older breast cancer survivors have been conducted, we are unsure whether older women who have been treated for breast cancer recieve similar benefits as their cancer-free counterparts. We must provide evidence for the effectiveness of strength training specifically for older breast cancer survivors so that we may promote this form of physical activity within the breast cancer community. We propose a study that would be one of the first controlled trials to study the effects of strength training in older breast cancer survivors. The purpose of this study is to evaluate the beneficial effects of strength training for inactive older (aged 50+) breast cancer survivors who have completed cancer treatment at least one year prior to enrollment. Based on our previous experience in strength training studies for women, we have designed a strength training program that is simple, inexpensive and enjoyable. We propose to conduct a 12-month randomized controlled trial comparing two groups: 1) a progressive, supervised strength training program to 2) a control condition of supervised flexibility/relaxation sessions. We expect that our study will show that strength training increases muscle strength, physical functioning (gait and balance), physical health, and mental health, and decreases fatigue, compared to a control condition and that, strength training exercise will improve body composition (increased muscle and bone mass, reduced fat mass). If our study results confirm that strength training is beneficial for older breast cancer survivors, we will work with the breast cancer community to increase awareness of the specific benefits that are derived from strength training and with cancer and general community organizations to develop similar programs within the community.