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JAMA Oncol. 2019 Aug 15. doi: 10.1001/jamaoncol.2019.2109. [Epub ahead of print]

Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes Among Overweight Breast Cancer Survivors: The WISER Survivor Randomized Clinical Trial.

Author information

1
Department of Public Health Sciences, Pennsylvania State College of Medicine, Hershey.
2
Department of Biostatistics, New York University School of Medicine, New York.
3
Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland.
4
Department of Hematology/Oncology, Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
5
Department of Population and Public Health Sciences, Pennington Biomedical Research Center, Baton Rouge, Louisiana.
6
Department of Radiology, Harlem Hospital Center, New York, New York.
7
Department of Physical Therapy, Thomas Jefferson University, Philadelphia, Pennsylvania.
8
Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
9
Division of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania.
10
Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota.
11
Department of Social and Behavioral Sciences, Temple University, Philadelphia, Pennsylvania.

Abstract

Importance:

To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes.

Objective:

To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors.

Design, Setting, and Participants:

This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial ) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018.

Interventions:

A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs.

Main Outcomes and Measures:

The 12-month change in the percentage of interlimb volume difference.

Results:

Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were -1.40 (11.10) in the control group, -2.54 (13.20) in the exercise group, -3.54 (12.88) in the weight loss group, and -3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were -0.39 (2.33) in the control group, -0.12 (2.14) in the exercise group, -0.57 (2.47) in the weight loss group, and -0.62 (2.38) in the combined group. Weight loss from baseline was -0.55% (95% CI, -2.22% to 1.11%) in the control group, -8.06% (95% CI, -9.82% to 6.29%) in the combined group, -7.37% (95% CI, -8.90% to -5.84%) in the weight loss group, and -0.44% (95% CI, -1.81% to 0.93%) in the exercise group.

Conclusions and Relevance:

Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.

Trial Registration:

ClinicalTrials.gov identifier: NCT01515124.

PMID:
31415063
PMCID:
PMC6696732
[Available on 2020-08-15]
DOI:
10.1001/jamaoncol.2019.2109

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