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Randomized Exercise Trial of Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors

1. Melinda L. Irwin⇑, 
2. Brenda Cartmel, 
3. Cary P. Gross, 
4. Elizabeth Ercolano,
5. Fangyong Li, 
6. Xiaopan Yao, 
7. Martha Fiellin, 
8. Scott Capozza, 
9. Marianna Rothbard,
10. Yang Zhou, 
11. Maura Harrigan, 
12. Tara Sanft, 
13. Kathryn Schmitz, 
14. Tuhina Neogi,
15. Dawn Hershman and 
16. Jennifer Ligibel

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• © 2014 by American Society of Clinical Oncology

1. Melinda L. Irwin, Brenda Cartmel, Cary P. Gross, Elizabeth Ercolano, Fangyong Li, Xiaopan Yao, Martha Fiellin, Scott Capozza, Marianna Rothbard, Yang Zhou, Maura Harrigan, and Tara Sanft, Yale University; Melinda L. Irwin, Brenda Cartmel, Cary P. Gross, Elizabeth Ercolano, Fangyong Li, Xiaopan Yao, Yang Zhou, and Tara Sanft, Yale Cancer Center, New Haven, CT; Kathryn Schmitz, University of Pennsylvania, Philadelphia, PA; Tuhina Neogi, Boston University School of Medicine; Jennifer Ligibel, Dana-Farber Cancer Institute, Boston, MA; and Dawn Hershman, Columbia University, New York, NY.

1. Corresponding author: Melinda L. Irwin, PhD, MPH, Department of Chronic Disease Epidemiology, Yale School of Public Health, P.O. Box 208034, New Haven, CT 06520-8034; e-mail: melinda.irwin@yale.edu.

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.