Comparative Study of Aerobic Exercise and Weight training on Metabolic Syndrome among Breast Cancer Survivors

 

Manikumar. M¹, R. Monisha²

¹Professor, Saveetha College of Physiotherapy, Saveetha University, Chennai

²Assistant Professor, SRM College of Physiotherapy, SRMIST, Chennai

 

ABSTRACT:

Introduction: Breast cancer is the most frequent‑occurring cancer among women and the leading cause deaths. Despite this Breast cancer treatments still have side effects that may negatively impact recovery and quality of life (QOL) after initial treatments. BCRL is a chronic swelling of the arm, hand and associated trunk quadrant. It usually develops after damage to the axillary lymph nodes due to breast cancer therapies. Methods: Participants who had fulfilled the eligibility criteria were randomized to either the aerobic exercise group (n = 20) and weight training group (n = 20). Exercise program was divided into a warm‑up period, moderate intensity of aerobic exercises, and cool‑down period. Weight-training exercise of low to moderate intensity with relatively slow progression significantly improved the upper limb strength, lower limb strength and incidence of breast cancer-related lymphoedema. Outcomes were assessed at baseline and post intervention. Results: Outcome were assessed by the functional assessment of cancer therapy‑breast (FACT‑B) scale and 6 min walk test (6MWT) Depressive symptoms are assessed using the CES-D scale. Upper limb musculoskeletal disorders is assessed using the DASH (Disabilities of the Arm, Shoulder, and Hand) The results confirmed the hypothesis that 12 week of moderate‑intensity aerobic exercise program significantly reduces BCRL. Conclusion: There have been many studies of resistance exercise in breast cancer survivors, Findings of this trial revels that aerobic exercise will contribute to the reduction of metabolic syndrome in best cancer survivors.

 

 

 

INTRODUCTION:

The metabolic syndrome, as a cluster of cardiovascular risk factors, may represent an important connection between cancer treatment and its common late effect of cardiovascular disease.¹ Evidence suggesting that certain cancer therapies may place cancer survivors at an increased risk of developing post-treatment characteristics of metabolic syndrome.^2,3 As a result of their metabolic abnormalities, these individuals are at a significantly elevated risk for cardiovascular disease, diabetes, and liver disease, while emerging evidence has begun to implicate metabolic syndrome as a long-term cancer risk factor.⁴

 

The increasing incidence of breast cancer in Indian women has been coupled with a significant rise in the population of metabolic syndrome in breast cancer survivors, particularly among women with estrogen receptor-positive tumors.⁵ Metabolic syndrome (MS) is a cluster of pathophysiological disorders comprising central obesity, insulin resistance, high blood pressure, and dyslipidemia. In addition, although individual components of MS may not be strongly associated with the development of breast cancer, their combination may elevate the risk^6,7 QOL issues for breast cancer patients include factors such as pain, fear of recurrence, fatigue,⁸ altered sense of femininity and problems⁹ associated  with treatment‑related arm swelling.¹⁰

 

Aerobic exercise is an effective intervention to improve QOL, and physical functioning, as well as to reduce fatigue, in breast cancer survivors. Weight training appears to be safe and beneficial in improving limb strength and physical components of quality of life in women with or at risk of lymphoedema. people with or at risk of lymphoedema have been advised not to do strenuous activity or exercises with the operated side arm in order to reduce the risk of causing or exacerbating lymphoedema. Guidelines advise to not lift heavy weights or children and to avoid doing repeated activities. Recent studies, however, have reported that weight training did not induce or exacerbate BCRL when it was performed under supervision with slow progression¹⁰.

 

METHODOLOGY:

Sample design adapted is Non probability randomized sampling. A Total of 40 Women with breast cancer- stage I to III with the age group of 30-40 years who underwent mastectomy and completed with radiation/chemotherapy with BMI>25 kg/m2 or body fat > 30% and Nonsmokers (No smoking during previous 12 months) were included in the study and randomly assigned to Group A and Group B

 

EXCLUSION CRITERIA:

·       Patients with diabetes, hypertension, thyroid

·       Weight reduction greater than 10% in the past  6 months.

·       Cardiovascular, respiratory, or musculoskeletal or joint problems that preclude moderate physical activity.

·       Planned reconstructive surgery with flap repair during trial or follow-up period.

·       Metastatic disease.

 

Assessment parameters:

·       6MWTdistance in meters

·       CES-D score

·       FACT-B score

·       DASH score

The parameters are measured at baseline, 4th week, 8th week and at 12th week

 

STUDY PROTOCOL:

Group 1: Aerobic exercise group:

Training protocol:

Women assigned to the group 1 attended a supervised group exercise program, three times per week for 12 weeks. The exercise program was divided into a warm‑up period, followed by moderate intensity of aerobic exercises, and finishing with a cool‑down period.

 

Warm‑up period consisted of 5 min of cycling. The core portion consisted of aerobic exercise program that was performed on stationary bicycles. The duration of aerobic exercise was initially 15 min. exercise duration is increased by 5minutes every 3 weeks resulting in a total of 35mins of aerobic exercise per session by week 12 of the intervention. Sessions ended with 5 min of cool down exercises. The participants exercise intensity has been prescribed based on the Karvonen formula. HR is monitored throughout the exercise session to maintain an exercise HR at 65-80% of maximum HR.

 

Warm up exercise	5 minutes cycling
Moderate intensity aerobic exercise	5 minutes of treadmill, cycling
Cool down	5 minutes cycling

 

If sessions are missed, reasons are documented with makeup sessions extending program to 14 to 16 weeks. Aerobic exercise types include treadmill walking, jogging, hill walking or stationary cycling.

 

GROUP 2: WEIGHT TRAINING:

Each resistance exercise session includes the following exercises:

1) leg press;

2) lunges;

3) leg flexion;

4) leg extension;

5) chest press;

6) seated row;

7) biceps curls; and

8) triceps pushdown. Initial resistance is set at 80% of the estimated 1-repetition maximum (1-RM) for lower body exercises and 60% 1-RM for upper body exercises. When the participant is able to complete 3 sets of 10 repetitions at the set weight in 2 consecutive sessions then the weight is increased by 10%.

 

Warm up on cycle or treadmill	5 minutes
Static stretching	10 minutes

 

Each daily session begins with a 5 minute warm up on the treadmill or cycle and 10 minutes of static stretching . Estimated 1 –RM and estimated vo2 max obtained during baseline testing is used to determine resistance load for each exercise- ACSM guidelines. Participants wear a polar-heart monitor during exercise session.

 

When participants is able to complete 3 sets of 10 repetitions at the set weight in 2 session then the weight is increased by 10%.

 

OUTCOME MEASURES:

·         6MWT

·         CES-D score

·         FACT-B score

·         DASH score

 

 

 

DATA ANALYSIS:

Table 1: Paired Samples Statistics

 

Table 2: Paired Samples Correlations

 

Table 3: Paired Samples Test

		Paired Differences					t	df	Sig. (2-tailed)
		Mean	Std. Deviation	Std. Error Mean	95% Confidence Interval of the Difference
					Lower	Upper
Pair 1	SMWD GRP A PRETEST - SMWD GRP A POSTTEST	-53.000	26.127	5.842	-65.228	-40.772	-9.072	19	.000
Pair 2	SMWD GRP B PRETEST - SMWD GRP B POSTTEST	-19.750	17.879	3.998	-28.118	-11.382	-4.940	19	.000
Pair 3	DSS GRP A PRETEST - DSS GRP A POSTEST	31.750	11.295	2.526	26.464	37.036	12.572	19	.000
Pair 4	DSS GRP B PRETEST - DSS GRP B POSTTEST	17.200	13.017	2.911	11.108	23.292	5.909	19	.000
Pair 5	FACT B-SCORE GRP A PRETEST - FACT B-SCORE GRP A POSTTEST	53.950	25.863	5.783	41.846	66.054	9.329	19	.000
Pair 6	FACT B-SCORE GRP B PRETEST - FACT B-SCORE GRP B POSTTEST	34.150	48.761	10.903	11.329	56.971	3.132	19	.005
Pair 7	DASH GRP A PRETEST - DASH GRP A POSTTEST	59.250	16.889	3.777	51.346	67.154	15.689	19	.000
Pair 8	DASH GRP B PRETEST - DASH GRP B POSTTEST	16.700	25.578	5.719	4.729	28.671	2.920	19	.009

 

DISCUSSION:

Exercises will definitely benefit the patients who survived breast cancer and the number of cancer survivors will continue to increase as a result of treatment advancement and early detection made it possible to improve the survival rate of these patient population. The major drawback for these survivors is the associated complications and the adverse effects of the treatment they receive during their treatment. The symptoms with distract the survivors in a long run mainly in the quality of life. Exercise has been shown to be beneficial in relieving some of the adverse effects of cancer and its treatment. Exercises using weight such as dumbbell has been encouraged among breast cancer survivors. This study will add to the existing exercise protocol, comparing aerobic exercise and weight training among breast cancer survivors in several ways. first, through evaluation of physical activity levels and quality of life components following light resistance dumbbell exercise, second, the use of light resistance dumbbells in exercise therapy training and the addition of premenopausal women will contribute to this expanding field, third, inclusion of ‘early’ breast cancer survivors, and the 12-week follow-up period after intervention to test the sustainability effects of the exercise, will also add to the available literature. Evidence continues to emerge on the potential benefits of physical activity intervention programmes on the levels of physical activity and quality of life outcomes in breast cancer survivors. This is observed from the increasing number of exercise therapy trials being recorded in clinical trials. gov. According to the current literature, physical activity intervention programmes after breast cancer treatment have small to large effects on breast cancer-specific concerns, symptoms and side effects, fatigue, aerobic fitness, physical activity level, and overall quality of life. Similarly, during the course of treatment these effects are reported on bodyweight, aerobic fitness, functional quality of life, anxiety. Patients received aerobic exercise program shows maximum improvement in 6 MWT, CES-D score, FACT-B score, DASH score.

 

CONCLUSION:

In summary, this exercise trial shall contribute to a better understanding of metabolic-related effects of combined aerobic and resistance exercise in breast cancer survivors who have recently completed cancer-related treatments. The ultimate goal is the implementation of an optimized intervention program to reduce metabolic syndrome. Aerobic exercises show greater improvement in reduction of metabolic symptoms.

 

REFERENCES:

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Received on 19.01.2019           Modified on 21.02.2019

Accepted on 29.03.2019         © RJPT All right reserved