Skip to main content

Advertisement

SpringerLink
Log in

Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors

  • Clinical trial
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Obesity is a poor prognostic factor and is negatively related to quality of life (QOL) in breast cancer survivors. Exercise and Nutrition to Enhance Recovery and Good Health for You is the largest weight loss trial completed among cancer survivors. Percent losses in body weight with an intensive group-based intervention versus an attention control were 6.0 versus 1.5 % (p < 0.0001) and 3.7 versus 1.3 % (p < 0.0001) at 12 and 24 months, respectively. ENERGY also was designed to answer the research question: Does weight loss significantly improve vitality and physical function (key components of QOL)? 692 breast cancer survivors (BMI: 25–45 kg/m2) at 4 US sites were randomized to a year-long intensive intervention of 52 group sessions and telephone counseling contacts versus a non-intensive (control) of two in-person counseling sessions. Weight, self-reported QOL, and symptoms were measured semi-annually for two years. Significant decreases in physical function and increases in symptoms were observed among controls from baseline to 6 months, but not in the intervention arm, −3.45 (95 % Confidence Interval [CI] −6.10, −0.79, p = 0.0109) and 0.10 (95 %CI 0.04, 0.16, p = 0.0021), respectively. Improvements in vitality were seen in both arms but trended toward greater improvement in the intervention arm −2.72 (95 % CI −5.45, 0.01, p = 0.0508). These differences diminished over time; however, depressive symptoms increased in the intervention versus control arms and became significant at 24 months, −1.64 (95 % CI −3.13, −0.15, p = 0.0308). Increased QOL has been reported in shorter term diet and exercise trials among cancer survivors. These longer term data suggest that diet and exercise interventions improve some aspects of QOL, but these benefits may diminish over time.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Ligibel JA, Alfano CM, Courneya KS, Demark-Wahnefried W, Burger RA, Chlebowski RT, Fabian CJ, Gucalp A, Hershman DL, Hudson MM et al (2014) American Society of Clinical Oncology position statement on obesity and cancer. J Clin Oncol 32:3568–3574

    Article  PubMed  Google Scholar 

  2. Hopman WM, Berger C, Joseph L, Barr SI, Gao Y, Prior JC, Poliquin S, Towheed T, Anastassiades T (2007) The association between body mass index and health-related quality of life: data from CaMos, a stratified population study. Qual Life Tes 16:1595–1603

    Article  Google Scholar 

  3. Imayama I, Alfano CM, Neuhouser ML, George SM, Wilder Smith A, Baumgartner RN, Baumgartner KB, Bernstein L, Wang CY, Duggan C et al (2013) Weight, inflammation, cancer-related symptoms and health related quality of life among breast cancer survivors. Breast Cancer Res Treat 140:159–176

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Morey MC, Snyder DC, Sloane R, Cohen HJ, Peterson B, Hartman TJ, Miller P, Mitchell DC, Demark-Wahnefried W (2009) Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. JAMA 301:1883–1891

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Demark-Wahnefried W, Winer EP, Rimer BK (1993) Why women gain weight with adjuvant chemotherapy for breast cancer. J Clin Oncol 11:1418–1429

    CAS  PubMed  Google Scholar 

  6. Rock CL, Byers TE, Colditz GA, Demark-Wahnefried W, Ganz PA, Wolin KY, Elias A, Krontiras H, Liu J, Naughton M et al (2013) Reducing breast cancer recurrence with weight loss, a vanguard trial: the exercise and nutrition to enhance recovery and good health for you (ENERGY) Trial. Contemp Clin Trials 34:282–295

    Article  PubMed Central  PubMed  Google Scholar 

  7. Rock CL, Flatt SW, Byers TE, Colditz GA, Demark-Wahnefried W, Ganz PA, Wolin KY, Elias A, Krontiras H, Liu J et al (2015) Results of the exercise and nutrition to enhance recovery and good health for you (ENERGY) trial: a behavioral weight loss intervention in overweight or obese breast cancer survivors. J Clin Oncol 33:3169–3176

    Article  PubMed  Google Scholar 

  8. Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M et al (2012) Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin 62:243–274

    Article  PubMed  Google Scholar 

  9. Montoye H (1975) Physical activity and health: an epidemiologic study of an entire community. Prentice-Hall, Englewood Cliffs

    Google Scholar 

  10. Milne HM, Wallman KE, Gordon S, Courneya KS (2008) Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 108:279–288

    Article  PubMed  Google Scholar 

  11. Brazier J, Usherwood T, Harper R, Thomas K (1998) Deriving a preference-based single index from the UK SF-36 Health Survey. J Clin Epidemiol 51:1115–1128

    Article  CAS  PubMed  Google Scholar 

  12. Brazier J, Roberts J, Deverill M (2002) The evaluation of a preference-based measure of health from the SF-36. J Health Econ 21:271–292

    Article  PubMed  Google Scholar 

  13. Ware J Jr, Sherbourne C (1992) The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructions. Med Care 31:247–263

    Google Scholar 

  14. Ware J (2004) SF-36 Health Survey update. In: Maruish ME (ed) The use of psychological testing for treatment planning and outcomes assessment, 3rd edn. Lawrence Erlbaum Associates, Mahwah (NJ)

    Google Scholar 

  15. Contopoulos-Ioannidis DG, Karvouni A, Kouri I, Ioannidis JP (2009) Reporting and interpretation of SF-36 outcomes in randomised trials: systematic review. BMJ (Clin Res ed) 338:a3006

    Article  Google Scholar 

  16. Crespi CM, Ganz PA, Petersen L, Castillo A, Caan B (2008) Refinement and psychometric evaluation of the impact of cancer scale. J Natl Cancer Inst 100:1530–1541

    Article  PubMed Central  PubMed  Google Scholar 

  17. Stanton AL, Bernaards CA, Ganz PA (2005) The BCPT symptom scales: a measure of physical symptoms for women diagnosed with or at risk for breast cancer. J Natl Cancer Inst 97:448–456

    Article  PubMed  Google Scholar 

  18. Farmer ME, Locke BZ, Moscicki EK, Dannenberg AL, Larson DB, Radloff LS (1988) Physical activity and depressive symptoms: the NHANES I epidemiologic follow-up study. Am J Epidemiol 128:1340–1351

    CAS  PubMed  Google Scholar 

  19. Fine J, Colditz G, Coakley E, Mosley G, Manson J, Willett W, Kawachi I (2009) A prospective study of weight change and health-related quality of life in women. JAMA 282:2136–2142

    Article  Google Scholar 

  20. Ganz PA, Rowland JH, Desmond K, Meyerowitz BE, Wyatt GE (1998) Life after breast cancer: understanding women’s health-related quality of life and sexual functioning. J Clin Oncol 16:501–514

    CAS  PubMed  Google Scholar 

  21. America Community Survey (2008–2012) http://statecancerprofiles.cancer.gov/demographics/index.php?stateFIPS=01&topic=pop&demo=00022&type=manyareacensus&sortVariableName=value&sortOrder=default

  22. Reeves MM, Terranova CO, Eakin EG, Demark-Wahnefried W (2014) Weight loss intervention trials in women with breast cancer: a systematic review. Obesity Rev 15:749–768

    Article  CAS  Google Scholar 

  23. Goodwin PJ, Segal RJ, Vallis M, Ligibel JA, Pond GR, Robidoux A, Blackburn GL, Findlay B, Gralow JR, Mukherjee S et al (2014) Randomized trial of a telephone-based weight loss intervention in postmenopausal women with breast cancer receiving letrozole: the LISA trial. J Clin Oncol 32:2231–2239

    Article  PubMed  Google Scholar 

  24. Kenzik KM, Morey MC, Cohen HJ, Sloane R, Demark-Wahnefried W (2015) Symptoms, weight loss, and physical function in a lifestyle intervention study of older cancer survivors. J Geriatr Oncol. doi:10.1016/j.jgo.2015.08.004

  25. Mishra SI, Scherer RW, Geigle PM, Berlanstein DR, Topaloglu O, Gotay CC, Snyder C (2012) Exercise interventions on health-related quality of life for cancer survivors. The Cochrane database of systematic reviews 8: CD007566

  26. Befort CA, Klemp JR, Austin HL, Perri MG, Schmitz KH, Sullivan DK, Fabian CJ (2012) Outcomes of a weight loss intervention among rural breast cancer survivors. Breast Cancer Res Treat 132:631–639

    Article  PubMed Central  PubMed  Google Scholar 

  27. Cachelin FM, Striegel-Moore RH, Brownell KD (1998) Beliefs about weight gain and attitudes toward relapse in a sample of women and men with obesity. Obesity Res 6:231–237

    Article  CAS  Google Scholar 

  28. Wing RR, Papandonatos G, Fava JL, Gorin AA, Phelan S, McCaffery J, Tate DF (2008) Maintaining large weight losses: the role of behavioral and psychological factors. J Consult Clin Psychol 76:1015–1021

    Article  PubMed Central  PubMed  Google Scholar 

  29. Chaput JP, Tremblay A (2010) Well-being of obese individuals: therapeutic perspectives. Future Med Chem 2:1729–1733

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

This study was supported by NCI Grant CA148791. Management of stored biological samples at the UCSD Coordinating Center was facilitated by the Diet and Physical Activity Shared Resource of the Moores UCSD Cancer Center (NCI Cancer Center Support Grant CA23100). The Colorado Clinical Translational Sciences Institute Grant (NIH CTSI Grant TR001082) supported study activities at the University of Colorado. This publication also was made possible by grant number UL1 RR024992 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of the National Center for Research Resources or NIH. We thank the Alvin J. Siteman Cancer Center at Washington University School of Medicine and Barnes-Jewish Hospital in St. Louis, Missouri, for the use of the Tissue Procurement Core, which provided sample storage and processing (supported in part by an NCI Cancer Center Support Grant CA91842). The authors thank the data and safety monitoring committee: Bernard Rosner, Ph.D, Joanne Mortimer, MD, Ken Fujioka MD, Frank Greenway, MD, and Linda Litzau. The authors thank Catherine Alfano, Ph.D (Program Officer), and Julia Rowland, Ph.D, NIH Office of Cancer Survivorship, and also Robert Croyle, Ph.D, NIH Division of Cancer Control and Population Sciences, for their assistance, guidance, and support.

Author contributors

The primary data were made available to the investigators for independent central review and analyses. JL performed the statistical analyses. WDW wrote the first draft of the manuscript, with review and revision by the other authors. All authors had full access to all the data in the study, made the decision to submit these data for publication, were involved in writing the manuscript and agreed on the final content of the manuscript.

Author information

Authors and Affiliations

  1. Department of Nutrition Sciences, Wallace Tumor Institute, University of Alabama at Birmingham (UAB), 1824 6th Avenue, Rm 310D, Birmingham, AL, 35294, USA

    Wendy Demark-Wahnefried

  2. Department of Surgery, Washington University in St. Louis (WUSTL), St. Louis, MO, 63110, USA

    Graham A. Colditz

  3. Department of Family Medicine and Public Health, University of California, San Diego (UCSD), La Jolla, CA, 92093-0901, USA

    Cheryl L. Rock

  4. Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Anschutz Medical Campus (UC), Aurora, CO, 80045, USA

    Rebecca L. Sedjo

  5. Department of Surgery, WUSTL, St. Louis, MO, 63110, USA

    Jingxia Liu

  6. Coeus Health, Chicago, IL, 60654, USA

    Kathleen Y. Wolin

  7. Department of Surgery, UAB, Birmingham, AL, 35294, USA

    Helen Krontiras

  8. Department of Epidemiology, Colorado School of Public Health, UC, Aurora, CO, 80045, USA

    Tim Byers

  9. Department of Family Medicine and Public Health, UCSD, La Jolla, CA, 92093, USA

    Bilgé Pakiz

  10. Department Of Medicine, UCSD, La Jolla, CA, 92093, USA

    Barbara A. Parker

  11. Department of Medicine, WUSTL, St. Louis, MO, 63110, USA

    Michael Naughton

  12. Department of Medicine, UC, Aurora, CO, 80045, USA

    Anthony Elias

  13. Department of Health Policy & Management and Medicine, Schools of Public Health and Medicine, University of California – Los Angeles, Los Angeles, CA, 90095, USA

    Patricia A. Ganz

Authors
  1. Wendy Demark-Wahnefried
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Graham A. Colditz
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Cheryl L. Rock
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Rebecca L. Sedjo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jingxia Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kathleen Y. Wolin
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Helen Krontiras
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Tim Byers
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Bilgé Pakiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Barbara A. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Michael Naughton
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Anthony Elias
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Patricia A. Ganz
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

ENERGY Trial Group

Corresponding author

Correspondence to Wendy Demark-Wahnefried.

Ethics declarations

Conflict of interests

All authors declare no competing interests, with the only exception being Dr. Wolin who reports equity from Scale Down LLC and Coeus Health LLC, personal fees from Takeda, and a pending patent for weight management software.

Additional information

On behalf of ENERGY Trial Group. The members of ENERGY Trial Group are given in Appendix.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 20 kb)

Appendix: The ENERGY Trial Group

Appendix: The ENERGY Trial Group

University of California, San Diego: Cheryl Rock, Ph.D, RD, Bilge Pakiz, EdD, Barbara Parker, MD, Christine Zoumas, MS, RD, Shirley Flatt, MS, Hava Shoshana Barkai, MS, RD, Dennis Heath, MS, Lea Jacinto, Mila Pruitt.

University of California, Los Angeles: Patricia A. Ganz, MD.

University of Colorado Denver: Tim Byers, MD, MPH, Rebecca Sedjo, Ph.D, Holly Wyatt, MD, Anthony Elias, MD, James Hill, Ph.D, Jhenny Hernandez, MBA, Kim Gorman, MS, RD, Carmen Faust, MPH, Anna Van Pelt, MPH.

Washington University in St. Louis: Graham Colditz, MD, Kathleen Wolin, ScD, Jingxia Liu, Ph.D, Michael Naughton, MD, Casey Fagin, MA, Jennifer Tappenden, Sonya Izadi.

University of Alabama at Birmingham: Wendy Demark-Wahnefried, Ph.D, RD, Helen Krontiras, MD, Maria Azrad, Ph.D, RD, Cindy Blair, Ph.D, Lahnor Powell, DO, and Laura Lee Goree, MS, RD.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Demark-Wahnefried, W., Colditz, G.A., Rock, C.L. et al. Quality of life outcomes from the Exercise and Nutrition Enhance Recovery and Good Health for You (ENERGY)-randomized weight loss trial among breast cancer survivors. Breast Cancer Res Treat 154, 329–337 (2015). https://doi.org/10.1007/s10549-015-3627-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10549-015-3627-5

Keywords

Search

Navigation