JMIR Publications

ABSTRACT

Background:

Cognitive impairments, a prevalent quality-of-life (QoL) concern among breast cancer (BC) patients, are particularly pronounced in women who have undergone adjuvant chemotherapy. These impairments—affecting memory, attention, and processing speed—are often underdiagnosed, with no established treatments. Exercise has emerged as a potential intervention to mitigate cancer-related cognitive impairment (CRCI). Given the feasibility of virtual care delivery, there is an opportunity to explore remotely-delivered exercise interventions for symptom management in BC patients.

Objective:

This study examined the feasibility of delivering an 8-week remotely-delivered combined exercise program (aerobic + resistance training) compared to a stretching/toning active control in BC patients following chemotherapy.

Methods:

BC patients who completed (neo)adjuvant chemotherapy within 48 months were recruited across Canada from February to July 2023. The combined exercise group engaged in unsupervised aerobic exercise (30 min, 3x/week), supervised group-based resistance training (30 min, 2x/week via Zoom), and one recorded class weekly, supplemented with four biweekly behavioral counseling sessions. The active control group participated in low-intensity balance and flexibility classes (30 min, 2x/week live, 1x/week recorded). Feasibility was assessed via enrollment, adherence, attrition, measurement completion, adverse events, and participant satisfaction. Cognitive function was evaluated using the NIH Toolbox Cognitive Battery Remote Administration (V2) at baseline and post-intervention.

Results:

A total of 21 participants (Mage=51.6±7.2 years; mean months since treatment=11.8±12.9) were randomized to the combined exercise group (n=10) or the active control group (n=11). Final analyses included 18 participants (Mage=51.9±7.4 years; mean months since treatment=12.6±13.5) with nine participants in each group. The study achieved a 51.2% enrollment rate, with a 14.3% attrition rate and no adverse events. Measurement completion rates were 85.7%, and participants reported high satisfaction with the intervention, indicating minimal burden. Adherence rates for exercise classes for both groups were 70.8%. Adherence to the behavioral counseling sessions was 77.5% that was delivered to the combined exercise group only. Improvements in cognitive function favored the combined exercise group for the Picture Sequence Memory Task (MDiff=+5.33, p=0.53, ηp²=0.03), List Sorting Working Memory Test (MDiff=+8.17, p=0.18, ηp²=0.12), and Auditory Verbal Learning (MDiff=+3.22, p=0.21, ηp²=0.12), Repeat trial time (MDiff=-146.14ms, p=0.07, ηp²=0.04), and Switch trial time (MDiff=-394.35ms, ηp²=0.07). In contrast, the active control group demonstrated greater improvements in the Oral Reading Recognition Test (MDiff=-9.65, p=0.14, ηp²=0.14) and Picture Vocabulary Test (MDiff=-2.48, p=0.07, ηp²=0.20).

Conclusions:

A remotely-delivered combined exercise intervention is feasible and holds promise for improving CRCI in BC patients. Larger randomized controlled trials are warranted to confirm its efficacy in enhancing cognitive function and QoL in this population. Clinical Trial: The study is registered with http://ClinicalTrials.gov (ID NCT05704855)