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Exercise improved aromatase inhibitor-induced arthralgia in breast cancer survivors
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A regimen of aerobic exercise and strength training decreased aromatase inhibitor-induced arthralgia in previously inactive breast cancer survivors, according to results of a randomized trial.
Arthralgia — or pain and joint stiffness — is the most common reason for poor adherence to and discontinuation of aromatase inhibitor therapy. Up to 50% of patients with breast cancer experience arthralgia within 6 months of beginning aromatase inhibitor therapy.
Melinda L. Irwin
Melinda L. Irwin, PhD, MPH, associate professor of epidemiology at Yale School of Public Health and co-program leader of the Cancer Prevention and Control Research Program at Yale Cancer Center, and colleagues conducted a yearlong randomized trial to measure the effect of exercise on aromatase inhibitor-induced arthralgia.
The analysis included 121 breast cancer survivors who received an aromatase inhibitor for at least 6 months. All study participants experienced at least mild arthralgia — as defined by a “worst pain score” of ≥3 on the Brief Pain Inventory (BPI) scale — for at least 2 months. They also performed less than 90 minutes of aerobic activity weekly in the 6 months prior to study entry and no strength training in the year prior to study entry.
Investigators randomly assigned participants to an exercise intervention group or a usual-care group. Those in the exercise intervention group performed 150 minutes per week of aerobic exercise and supervised strength training twice per week. Those in the usual care group were instructed not to make any modifications to their daily routines.
Participants filled out three types of questionnaires — the BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and the Disabilities of the Arm, Shoulder and Hand (DASH) — at baseline and at 3, 6, 9 and 12 months to measure pain severity and interference.
Women in the exercise intervention group increased their physical activity by 159 minutes per week, while women in the usual care group increased their physical activity by 49 minutes.
Breast cancer survivors in the exercise intervention group saw an improvement in aromatase inhibitor-induced arthralgia after 3 months, but the greatest benefit was observed after 12 months of monitored physical activity.
At 12 months, worst joint pain scores declined by 1.6 points (29%) among women assigned to the exercise arm, and scores increased by 0.2 points (3%) among those who received usual care (P<.001).
WOMAC and DASH pain scores, as well as pain severity and interference, decreased significantly at 12 months among those in the exercise regimen but increased among those assigned usual care (P<.001 for both).
Participants in the exercise group did not experience adverse events due to physical activity, the study found.
“Given that our results show a beneficial effect of exercise on treating arthralgia, additional work is needed to determine whether exercise can improve aromatase inhibitor adherence,” Irwin and colleagues wrote.
Disclosure: The researchers report research funding, honoraria or other remuneration from; employment relationships with; stock or other ownership in; and consultant/advisory or speakers’ bureau roles with bioTheranostics, Johnson & Johnson, Medtronic, Merck, Molecular NeuroImaging and Pfizer.
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