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 150 min.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, 50 years) 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.