For years, Dr. Kerry Courneya has been researching ways of helping women with breast cancer use exercise to mitigate the physical and emotional trauma of the disease and its treatment.
With his new CARE Trial, he?s about to go one step further.
The CARE trial is a randomised controlled trial of combined aerobic and resistance exercise in breast cancer survivors receiving chemotherapy and will push the standard exercise prescription of 30 minutes of moderate intensity exercise three times per week ? which Courneya considers the standard intervention all breast cancer patients should be receiving ? by doubling the volume of exercise in two different ways.
?The question we?re asking is if increasing the volume of exercise is beneficial and if so, does it matter if it is more aerobic exercise or the addition of resistance exercise? he says of the multi-centre study, which will be taking place in Edmonton, Ottawa and Vancouver starting early 2008.
The trial is funded by a $950,000, five-year grant from the Canadian Breast Cancer Research Alliance and stems from the recently-completed START trial - an aerobic versus resistance training intervention ? which was also funded by CBCRA. Those findings will be published in the Journal of Clinical Oncology this summer and showed good results for both aerobic and reistance exercise.
?In this trial, we are going to try and build on the standard exercise prescription in two ways: one group will be asked to double the amount of aerobic exercise they do by increasing their duration and/or intensity? says Courneya, who notes that the START trial showed that the greater the fitness gains, the greater the increase in quality of life.
A second group will do a basic aerobic intervention of 30 minutes, with an additional 30 minutes of resistance training. The standard group will do the basic 30-minute aerobic intervention.
Courneya says a driver for his new research is to find a key to aiding women to complete their cancer drug regimens on time and with the prescribed doses ? a key component of the treatment?s success. ?If the oncologist has to reduce the amount of drug or has to delay the drugs, this is not good for the risk of the disease returning,? he explains.
Starting in January next year 300 women will be recruited into the trial with the help of medical oncologists at clinics like the Cross Cancer Institute.
Women must be over 18 to participate in the trial, says Courneya, and though there will be no upper age limit, he expects the mean age to be about 50 although the ages may range from the 20s to the 70s.
?We?re aiming for 80 percent adherence in this trial,? says Courneya. ?What we?ve found is that adherence problems are largely due to the medical complications of chemotherapy: diarrhoea, nausea, infections for which they have to be hospitalised. But the majority do well; some suffer side effects and we help them to deal with them with support and follow up.?
Courneya says the Behavioural Medicine Fitness Centre is set up to make study participants feel comfortable, at ease and welcomed. ?We have excellent fitness trainers, a beautiful physical environment ? and once they know that the space is just for cancer patients, they feel much more at home.?
Courneya says that while his hypothesis is that increasing the volume of exercise will lead to better outcomes, it?s possible that a higher volume of exercise is not possible for these women. But he?s hopeful.
?We don?t think we?ve hit the ceiling on how much exercise women with breast cancer can do and how much they can benefit from it. Thirty minutes is the base and we?re thinking that?s not optimal. We hope that the women can do it, and we hope to report better outcomes in terms of physical fitness, body composition, quality of life, fatigue, self-esteem and chemotherapy completion.?
With his new CARE Trial, he?s about to go one step further.
The CARE trial is a randomised controlled trial of combined aerobic and resistance exercise in breast cancer survivors receiving chemotherapy and will push the standard exercise prescription of 30 minutes of moderate intensity exercise three times per week ? which Courneya considers the standard intervention all breast cancer patients should be receiving ? by doubling the volume of exercise in two different ways.
?The question we?re asking is if increasing the volume of exercise is beneficial and if so, does it matter if it is more aerobic exercise or the addition of resistance exercise? he says of the multi-centre study, which will be taking place in Edmonton, Ottawa and Vancouver starting early 2008.
The trial is funded by a $950,000, five-year grant from the Canadian Breast Cancer Research Alliance and stems from the recently-completed START trial - an aerobic versus resistance training intervention ? which was also funded by CBCRA. Those findings will be published in the Journal of Clinical Oncology this summer and showed good results for both aerobic and reistance exercise.
?In this trial, we are going to try and build on the standard exercise prescription in two ways: one group will be asked to double the amount of aerobic exercise they do by increasing their duration and/or intensity? says Courneya, who notes that the START trial showed that the greater the fitness gains, the greater the increase in quality of life.
A second group will do a basic aerobic intervention of 30 minutes, with an additional 30 minutes of resistance training. The standard group will do the basic 30-minute aerobic intervention.
Courneya says a driver for his new research is to find a key to aiding women to complete their cancer drug regimens on time and with the prescribed doses ? a key component of the treatment?s success. ?If the oncologist has to reduce the amount of drug or has to delay the drugs, this is not good for the risk of the disease returning,? he explains.
Starting in January next year 300 women will be recruited into the trial with the help of medical oncologists at clinics like the Cross Cancer Institute.
Women must be over 18 to participate in the trial, says Courneya, and though there will be no upper age limit, he expects the mean age to be about 50 although the ages may range from the 20s to the 70s.
?We?re aiming for 80 percent adherence in this trial,? says Courneya. ?What we?ve found is that adherence problems are largely due to the medical complications of chemotherapy: diarrhoea, nausea, infections for which they have to be hospitalised. But the majority do well; some suffer side effects and we help them to deal with them with support and follow up.?
Courneya says the Behavioural Medicine Fitness Centre is set up to make study participants feel comfortable, at ease and welcomed. ?We have excellent fitness trainers, a beautiful physical environment ? and once they know that the space is just for cancer patients, they feel much more at home.?
Courneya says that while his hypothesis is that increasing the volume of exercise will lead to better outcomes, it?s possible that a higher volume of exercise is not possible for these women. But he?s hopeful.
?We don?t think we?ve hit the ceiling on how much exercise women with breast cancer can do and how much they can benefit from it. Thirty minutes is the base and we?re thinking that?s not optimal. We hope that the women can do it, and we hope to report better outcomes in terms of physical fitness, body composition, quality of life, fatigue, self-esteem and chemotherapy completion.?