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Cancer Med. 2018 Nov 10. doi: 10.1002/cam4.1851. [Epub ahead of print]

Supervised versus autonomous exercise training in breast cancer patients: A multicenter randomized clinical trial.

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Department of Internal Medicine III with Hematology, Medical Oncology, Hemostaseology, Infectious Diseases, Rheumatology, Oncologic Center, Paracelsus Medical University Salzburg, Salzburg, Austria.
Salzburg Cancer Research Institute with Laboratory of Immunological and Molecular Cancer Research and Center for Clinical Cancer and Immunology Trials, Salzburg, Austria.
University Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University Salzburg, Salzburg, Austria.
IVth department of Internal Medicine with Hematology and Medical Oncolocy, Klinikum Wels-Grieskirchen, Klinikum Wels-Grieskirchen, Wels, Austria.
mediFIT Wels, Medical Fitness and Training Center, Wels, Austria.
Department of Internal Medicine 3, Hematology and Oncology, Kepler University Hospital Med Campus III, Linz, Austria.
Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria.
Cancer Cluster Salzburg, Salzburg, Austria.



There is a well-known correlation between obesity, sedentary lifestyle, and breast cancer incidence and outcome. The Arbeitsgemeinschaft Medikamentöse Tumortherapie (AGMT) exercise study was a multicenter, randomized clinical trial and assessed the feasibility and efficacy of physical training in 50 breast cancer patients undergoing aromatase inhibitor treatment.


Postmenopausal, estrogen receptor-positive breast cancer patients under aromatase inhibitor treatment were randomized 1:1 to counseling and unsupervised training for 48 weeks (unsupervised arm) or counseling and a sequential training (supervised arm) with a supervised phase (24 weeks) followed by unsupervised physical training (further 24 weeks). Primary endpoint was the individual maximum power output on a cycle ergometer after 24 weeks of exercise. A key secondary endpoint was the feasibility of achieving 12 METh/week (metabolic equivalent of task hours per week).


Twenty-three patients (92%) in the unsupervised arm and 19 patients (76%) in the supervised arm with early-stage breast cancer completed the study. After 24 weeks, the supervised arm achieved a significantly higher maximum output in watt (mean 132 ±  standard deviation [SD] 34; 95% confidence interval [CI] 117-147) compared to baseline (107 ± 25; 95%CI 97-117; P = 0.012) with a numerically higher output than the unsupervised arm (week 24 115 ± 25; 95%CI 105-125; P = 0.059). Significantly higher METh/week was reported in the supervised arm compared to the unsupervised arm during the whole study period (week 1-24 unsupervised: 18.3 (7.6-58.3); supervised: 28.5 (6.7-40.1); P = 0.043; week 25-48; P = 0.041)).


This trial indicates that patients in an exercise program achieve higher fitness levels during supervised than unsupervised training.


breast cancer; early; endocrine therapy; exercise; postmenopausal

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