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A randomized trial of exercise and diet on body composition in survivors of breast cancer with overweight or obesity

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Abstract

Purpose

Obesity increases the risk of cancer recurrence and death in survivors of breast cancer. This study tested the hypothesis that exercise alone, diet alone, and the combination of exercise plus diet reduce body weight and improve body composition in survivors of breast cancer.

Methods

In this 2 × 2 factorial trial, 351 survivors of breast cancer with overweight or obesity were randomized to one of four treatment groups for 52 weeks: control, exercise alone, diet alone, or exercise plus diet. Endpoints included body weight and body composition measured by dual-energy x-ray absorptiometry.

Results

After 52 weeks, compared with control, diet alone [− 5.39 kg (95% CI − 7.24, − 3.55);− 6.0% (95% CI − 8.0, − 3.9)] and exercise plus diet [− 6.68 kg (95% CI − 8.46, − 4.90);− 7.4% (95% CI − 9.4, − 5.4)] reduced body weight; exercise alone did not change body weight. Compared with control, diet alone [− 3.59 kg (95% CI − 5.00, − 2.17)] and exercise plus diet [− 4.28 kg (95% CI − 5.71, − 2.84)] reduced fat mass; exercise alone did not change fat mass. Compared with control, diet alone [− 0.82 kg (95% CI − 1.50, − 0.15)] and exercise plus diet [− 1.24 kg (95% CI − 1.92, − 0.56)] reduced lean mass; exercise alone did not change lean mass. Compared with control, exercise alone, diet alone, and exercise plus diet did not change bone mineral density.

Conclusion

In survivors of breast cancer with overweight or obesity, diet alone or diet plus exercise produced clinically meaningful weight loss at week 52. The majority of weight loss was fat mass.

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Funding

This work was supported by the National Cancer Institute of the National Institutes of Health under Award Numbers U54-CA155850, UL1-TR001878, P30-CA016520, P30-CA006927. Compression garments were donated by BSN Medical, and discounted meal replacements were provided by Nutrisystem, Inc. Dr. Brown is supported by the National Cancer Institute of the National Institutes of Health under Award Numbers R00-CA218603 and R25-CA203650, the National Institute of General Medicine Sciences of the National Institutes of Health under Award Number U54-GM104940, the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number P30-DK072476, the Susan G. Komen Foundation, and the American Institute for Cancer Research. Dr. Sarwer is supported by the National Institute for Diabetes and Digestive and Kidney Disease of the National Institutes of Health under Award Number R01-DK108628. Dr. Sturgeon is supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Numbers UL1-TR002014, UL1-TR000003, and KL2-TR002015.

Author information

Authors and Affiliations

  1. Pennington Biomedical Research Center, 6400 Perkins Rd, Baton Rouge, LA, 70808, USA

    Justin C. Brown

  2. LSU Health Sciences Center New Orleans School of Medicine, 1901 Perdido St, New Orleans, LA, 70112, USA

    Justin C. Brown

  3. Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, 533 Bolivar St, New Orleans, LA, 70112, USA

    Justin C. Brown

  4. Temple University College of Public Health, 1101 W. Montgomery Ave, Philadelphia, PA, 1912, USA

    David B. Sarwer

  5. New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, USA

    Andrea B. Troxel

  6. Penn State College of Medicine, 400 University Drive, Hershey, PA, 17033, USA

    Kathleen Sturgeon & Kathryn H. Schmitz

  7. Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, Philadelphia, PA, 19104, USA

    Angela M. DeMichele

  8. Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA

    Crystal S. Denlinger

Authors
  1. Justin C. Brown
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  2. David B. Sarwer
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  3. Andrea B. Troxel
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  4. Kathleen Sturgeon
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  5. Angela M. DeMichele
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  6. Crystal S. Denlinger
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  7. Kathryn H. Schmitz
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Contributions

Conception and design of study (JCB, DBS, ABT, KS, AMD, CSD, KHS); acquisition of data (JCB, DBS, KS, AMD, CSD, KHS); analysis and/or interpretation of data (JCB, DBS, ABT, KS, KHS); drafting the manuscript (JCB, KHS); approval of the version of the manuscript to be published (JCS, DBS, ABT, KS, AMD, CSD, KHS).

Corresponding author

Correspondence to Kathryn H. Schmitz.

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Conflict of interest

Dr. Brown reports receiving grants from the National Institutes of Health, American Institute for Cancer Research, and the Susan G. Komen Foundation. Dr. Sarwer reports receiving grants from the National Institutes of Health and receiving personal fees from Ethicon and Novo Nordisk. Dr. Troxel reports receiving grants from the National Institutes of Health. Dr. DeMichele reports receiving grants from Novartis, Pfizer, Genentech, Calithera, and Menarini. Dr. Sturgeon reports receiving grants from the National Institutes of Health. Dr. Denlinger reports receiving grants from Agios Pharmaceuticals, Amgen Pharmaceuticals, Array BioPharma, Astra Zeneca, Bristol Myer Squibb, BeiGene, Genmab A/S, Loxo Oncology, and Zymeworks Inc. and honoraria from Bristol Myer Squibb, Merck, Exelixis, Taiho Oncology, and BeiGene. Dr. Schmitz reports receiving grants from the National Institutes of Health and nonfinancial support from BSN Medical, personal fees from Klose Training, and a licensed patent for a Strength After Breast Cancer course. No other disclosures were reported.

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The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The funding agencies had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.

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Brown, J.C., Sarwer, D.B., Troxel, A.B. et al. A randomized trial of exercise and diet on body composition in survivors of breast cancer with overweight or obesity. Breast Cancer Res Treat 189, 145–154 (2021). https://doi.org/10.1007/s10549-021-06284-7

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  • DOI: https://doi.org/10.1007/s10549-021-06284-7

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