Exercise Reduces Joint Pain From Aromatase Inhibitors

Nick Mulcahy

December 17, 2013

SAN ANTONIO — Exercise might help women with hormone-receptor-positive breast cancer stay on aromatase inhibitor treatment.

An exercise regimen overseen by a fitness coach reduced baseline joint pain scores over a 12-month period in a group of women in a randomized trial, according to investigators.

Arthralgia, or joint pain and stiffness, is the number one reason women discontinue aromatase inhibitors, said lead author Melinda L. Irwin, PhD, MPH, coleader of the Cancer Prevention and Control Research Program at the Yale Cancer Center in New Haven, Connecticut.

She spoke about the 121-patient Hormone and Physical Exercise (HOPE) study, which is the first ever to assess the effect of exercise on joint pain in this population, during a press conference here at the 36th Annual San Antonio Breast Cancer Symposium.

Those in the exercise group received a free gym membership, participated in 2 supervised strength training sessions a week (6 exercises, 10 reps, 3 sets), and performed at least 150 minutes of aerobic exercise per week. This is a current guideline-based exercise prescription for healthy adults and cancer survivors in the United States.

Those in the usual care group received written instruction on the benefits of exercise.

At 1 year, there was a 30% reduction in overall pain measures (Brief Pain Inventory) from baseline in the exercise group (P < .05). "Their pain went from moderate to mild," said Dr. Irwin.

There was a small increase in the overall pain measures in the usual care group. The 2 groups had comparable pain scores at baseline.

The results represent the "most significant reduction in pain" ever recorded in various studies of interventions for arthralgia associated with aromatase inhibitors, said coauthor Jennifer Ligabel, MD, in an interview with Medscape Medical News. She is from the Dana-Farber Cancer Institute in Boston.

The pain improvement was better than that seen in studies of other interventions, including acupuncture, vitamin D, and glucosamine.

This study fills a void, said symposium cochair Carlos L. Arteaga, MD, from the Vanderbilt–Ingram Comprehensive Cancer Center in Nashville, Tennessee, and president-elect of the American Association for Cancer Research.

Clinicians regularly recommend exercise to women with breast cancer, including those on aromatase inhibitors, but usually in a vague way, he told Medscape Medical News after moderating the press conference. This study provides a specific exercise regimen and shows a specific associated outcome for a treatment-related problem. "We need marching orders by experts," Dr. Arteaga explained.

At the same time, he noted, the findings might be limited by the fact that the women in the study, whose average age was 60 years, likely had a car to get to the gym, family support to have the time to participate, and were "highly educated."

However, the study participants had the common problems of being physically inactive before enrollment (<90 minutes of exercise a week) and, on average, being overweight. At enrollment, they had been taking an aromatase inhibitor for at least 6 months and were experiencing at least minor arthralgia.

There was a dose-response relation in the exercise group. Those who attended 80% or more of the exercise sessions reported a 25% reduction in their Brief Pain Inventory score. Those who attended fewer than 80% of sessions had a 14% reduction.

Those in the exercise group also had improved cardiorespiratory fitness and lost about 7% of their body weight over the study period; those in the usual care group experienced a slight weight gain.

The researchers plan a follow-up study on whether improvements in joint pain occurred at the beginning, middle, or end of the year-long intervention.

This study was funded by the National Cancer Institute. Dr. Irwin has disclosed no relevant financial relationships.

36th Annual San Antonio Breast Cancer Symposium (SABCS): Abstract S3-03. Presented December 12, 2013.

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