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Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial

  • Aude-Marie Foucaut
  • Magali Morelle
  • Anne-Sophie Kempf-Lépine
  • Cédric Baudinet
  • Renaud Meyrand
  • Séverine Guillemaut
  • Séverine Metzger
  • Valérie Bourne-Branchu
  • Elodie Grinand
  • Sylvie Chabaud
  • David Pérol
  • Julien Carretier
  • Sophie E. Berthouze
  • Eric Reynes
  • Lionel Perrier
  • Paul Rebattu
  • Pierre-Etienne Heudel
  • Thomas Bachelot
  • Patrick Bachmann
  • Béatrice Fervers
  • Olivier Trédan
  • Marina TouillaudEmail author
Original Article

Abstract

Purpose

Lack of physical activity (PA), weight gain, and overweight have been associated with increased risk of recurrence and mortality after breast cancer diagnosis. We evaluated the feasibility of implementing an individualized exercise program and nutritional counseling during adjuvant treatment of localized invasive breast cancer.

Methods

Sixty-one patients eligible for adjuvant chemotherapy were randomized 2:1 to receive a 6-month program of weekly aerobic exercises associated with nutritional counseling (n = 41) or usual care with nutritional counseling (n = 20, one withdrawal). The primary endpoints were the proportion of patients compliant with two weekly supervised sessions and their overall adherence (i.e., proportion of supervised and unsupervised sessions completed versus planned sessions).

Results

Ten percent of patients in the intervention group were compliant with the two weekly supervised sessions for 6 months, but the overall median adherence rate was 85% of supervised and non-supervised sessions completed. Non-adherence was mainly due to intrinsic reasons (medical, organizational, psychological barriers). Adherence was positively associated with education and baseline PA level and inversely associated with baseline weight and tumor grade. No statistically significant benefits were observed in the intervention group, even if overall PA level and body composition improved and anthropometrics were maintained over time (p < 0.05).

Conclusions

Overall, there was good adherence with the 6-month exercise program during adjuvant treatment for breast cancer, despite poor compliance to twice-weekly supervised sessions. This study highlights the need for flexible exercise modalities and innovative experimental design to reach patients who would most adhere and benefit from intervention.

Trial registration: ClinicalTrials.gov Identifier: NCT01331772. Registered 8 April 2011, https://clinicaltrials.gov/ct2/show/NCT01331772?term=pasapas&rank=1

Keywords

Breast cancer Physical activity Exercise Clinical trial Nutrition Obesity 

Abbreviations

%BF

percentage of body fat

APA

adapted physical activity

BC

breast cancer

BMI

body mass index

CI

confidence interval

DEE

daily energy expenditure

FFM

fat free mass

HDL

high-density lipoprotein

LDL

low-density lipoprotein

MET

metabolic equivalent of task

PA

physical activity

OR

odds ratio

SBR

Scarff-Bloom-Richardson

Notes

Acknowledgements

The authors thank all the study participants for their valuable voluntary contribution. The authors thank Dr. Jean-Paul Guastalla (Center Léon Bérard, Lyon, France) for his collaboration in recruiting patients in the study. The authors also thank Margaret Haugh (MediCom Consult, Villeurbanne, France) for language editing and editorial support.

Authors’ contributions

AMF, ASKL, CB, RM, SG, VBB, DP, SB, ER, LP, PB, BF, OT, and MT contributed to conception and design of the trial. PB, BF, and OT were principal investigators. PR, PEH, TB, and OT were investigators. AMF, ASKL, CB, RM, SG, SM, VBB, EG, JC, SB, ER, PB, BF, OT, and MT acquired the data. MM and SC analyzed the data. AMF, MM, SB, PB, BF, OT, and MT participated in the interpretation of the findings. AMF, MM, BF, and MT drafted the manuscript. All of the authors read and approved the final manuscript.

Funding

This PASAPAS trial was supported by the Institut National du Cancer (2010-228/VO-HO), Ligue Contre le Cancer (PME 2010-2011), Fondation de France (2010-15024), Cancéropôle Lyon Auvergne Rhône-Alpes (CLARA Programme structurant 2010), and Association Nationale de la Recherche et de la Technologie (CIFRE/ANRT no. 426/2010).

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the French Sud-Est IV ethics committee (Comité de Protection des Personnes), the National Security Agency of Medicines and Health Products that applies for biomedical studies (Agence Nationale de Sécurité du Médicament et des produits de santé), and the French National Committee on Informatics and Privacy (Commission Nationale de l’Informatique et des Libertés).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Aude-Marie Foucaut
    • 1
    • 2
  • Magali Morelle
    • 1
    • 3
  • Anne-Sophie Kempf-Lépine
    • 1
  • Cédric Baudinet
    • 1
  • Renaud Meyrand
    • 1
  • Séverine Guillemaut
    • 1
  • Séverine Metzger
    • 1
  • Valérie Bourne-Branchu
    • 1
  • Elodie Grinand
    • 1
  • Sylvie Chabaud
    • 1
  • David Pérol
    • 1
  • Julien Carretier
    • 1
  • Sophie E. Berthouze
    • 4
  • Eric Reynes
    • 5
  • Lionel Perrier
    • 1
    • 3
  • Paul Rebattu
    • 1
  • Pierre-Etienne Heudel
    • 1
  • Thomas Bachelot
    • 1
  • Patrick Bachmann
    • 1
  • Béatrice Fervers
    • 1
    • 6
  • Olivier Trédan
    • 1
  • Marina Touillaud
    • 1
    • 6
    • 7
    Email author
  1. 1.Léon Bérard Cancer CenterLyonFrance
  2. 2.Educations and Health Practices Laboratory (LEPS) (EA 3412), UFR SMBHParis 13 University, Sorbonne Paris CiteBobignyFrance
  3. 3.GATE Lyon Saint-Etienne, UMR-CNRS 5824University of LyonLyonFrance
  4. 4.Inter-university Laboratory of Human Movement Biology EA 7424University of Lyon - University Claude Bernard Lyon 1VilleurbanneFrance
  5. 5.Laboratory of Vulnerabilities and Innovation in Sport EA 7428University of Lyon - University Claude Bernard Lyon 1 FED 4272VilleurbanneFrance
  6. 6.Cancer Research Center of Lyon, UMR Inserm 1052 CNRS 5286 CLBLyonFrance
  7. 7.Department of Cancer and EnvironmentCentre Léon BérardLyonFrance

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