A recent study published in Cancer highlights the significant benefits of aerobic exercise for women undergoing chemotherapy for breast cancer, particularly concerning cognitive function and overall quality of life.
The Effects of Chemotherapy on Cognitive Function
Chemotherapy, while an effective treatment for cancer, is often linked to cognitive impairment. Research indicates that up to 75% of women with breast cancer experience chemotherapy-related cognitive impairment (CRCI), which can manifest as short- and long-term deficits in memory, concentration, and overall cognitive ability. Objective assessments reveal that chemotherapy can impair executive function, working memory, language, and spatial abilities when compared to breast cancer patients not undergoing chemotherapy and to cancer-free women.
The Role of Aerobic Exercise
Aerobic exercise has been shown to help maintain or even improve cognitive function in older adults and those with mild cognitive impairment (MCI). Despite recommendations for cancer patients and survivors to engage in aerobic activities to enhance cognitive outcomes, the effectiveness of these interventions has not been thoroughly established. Over 50 randomized controlled trials (RCTs) have investigated the impact of aerobic exercise on cognitive function in cancer patients, but many of these studies were limited by small sample sizes and non-generalizable characteristics. Furthermore, several studies failed to utilize objective measures or comprehensive self-reported assessments, making it difficult to definitively link aerobic exercise to cognitive improvement.
About the Study
The study utilized data from the Aerobic Exercise and Cognitive functioning in women with breAsT cancEr (ACTIVATE) trial, which took place in Ottawa and Vancouver, Canada. A total of 57 women diagnosed with breast cancer at stages I to III, who were about to begin chemotherapy, participated in the study.
Participants were randomly assigned to either a group that engaged in aerobic exercise during chemotherapy or a control group that received standard care followed by aerobic exercise after chemotherapy concluded. The aerobic exercise regimen included both supervised sessions and at-home activities. The trial lasted between 12 to 24 weeks, depending on the chemotherapy regimen, and included 13 neuropsychological tests to objectively assess cognitive function alongside self-reported measures and quality of life assessments.
Key Findings
Most participants in the study were White women, working part-time, and earning less than CAD 100,000 annually. The majority had completed graduate school and were diagnosed with stage II breast cancer. Of the 57 participants, 31 completed the study with full metabolic data, while 32 had incomplete data due to COVID-19 restrictions. The exercise group completed an impressive average of 34 out of 43 prescribed sessions (88%), and none reported adverse events related to the exercise regimen.
The results indicated that while aerobic capacity and ventilatory threshold data showed a decline in the control group, these differences were not statistically significant. Objective cognitive function did not significantly differ between the exercise and control groups. However, self-reported cognitive function improved in four of six measures in one assessment tool for the exercise group. Additionally, the second tool indicated significant improvements in self-reported cognitive function and quality of life for the exercise group compared to controls.
Exploring the Lack of Correlation
Several factors may explain the lack of objective improvements in cognitive function despite the reported benefits. The study participants may not have experienced significant cognitive declines during chemotherapy, or the neuropsychological tests might not have been sensitive enough to detect subtle changes in cognitive performance. Another possibility is that improvements in cognitive function may have dissipated between the exercise period and the time of assessment.
Furthermore, it is possible that cognitive stimulation, alongside aerobic exercise, is necessary to achieve measurable benefits in neuropsychological performance. This approach is already a standard practice in cognitive rehabilitation for many cancer patients.
Conclusions
The findings from this study suggest that initiating aerobic exercise during chemotherapy for breast cancer improves self-reported cognitive function and overall quality of life. This supports the integration of aerobic exercise interventions into standard care for women undergoing chemotherapy. However, it is important to note that the study did not reveal measurable objective protective effects of aerobic exercise against chemotherapy-related cognitive impairment.
Future research may focus on larger sample sizes and longer intervention periods to better understand the relationship between aerobic exercise and cognitive function in cancer patients.
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