Comparison of the effects of low- versus high-supervision exercise on breast cancer survivorship outcomes

Background Supervised exercise may provide greater functional and quality of life benefits than unsupervised programs after cancer and is recommended for those with or at risk of breast cancer-related lymphedema. These exploratory analyses compared the effect of low- vs high-supervision exercise on the secondary survivorship outcomes of the SAFE breast cancer trial. Methods This randomized study (ANZCTR: ACTRN12616000547448) compared a 12-week exercise program (target 150min.week⁻¹, moderate intensity) supported by either 5 (low supervision [LOW]) or 20 (high supervision [HIGH)] supervised sessions. Inclusion criteria included: stage II+ breast cancer within 5 years, ≥1 comorbidity and/or treatment-related adverse effect, and insufficiently active. Outcomes included lymphedema (self-report and bioimpedance spectroscopy), arm symptoms, upper-extremity function (Patient Reported Outcomes Measurement Information System [PROMIS] Bank v1.2-Upper-Extremity), fatigue, pain, pain interference, pain intensity, physical function, sleep disturbance, anxiety, depression, and satisfaction with social roles (PROMIS-43 Profile v1.0). Chi-square tests evaluated between-group symptom changes. Generalized estimating equations assessed time, group, and time×group effects under an intention-to-treat, 2-sided framework. Results Sixty women (mean age, 50years) were randomized to LOW (n=30) vs HIGH (n=30). At follow-up, both groups showed similar lymphedema prevalence, comparable rates of maintained or improved arm symptoms, and within-group improvements (P<.05) in fatigue, physical function, sleep, anxiety, depression, and satisfaction with social roles and activities. Potential for superior benefit in HIGH vs LOW was observed for self-reported range of movement, upper-extremity function, and pain interference and intensity (P<.05). Conclusion Findings indicate that breast cancer survivors with or at risk of lymphedema can benefit from exercise, even when supervision is limited.