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Association of self-directed walking with toxicity moderation during chemotherapy for the treatment of early breast cancer

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Abstract

Background

In the field of exercise oncology, there is a need to quantify the potential benefits of moderate, self-directed physical activity during active treatment. In a pooled analysis of three identical single-arm intervention studies, we investigate the association of activity tracker steps with patient-reported toxicities during chemotherapy.

Methods

Women with early breast cancer who were enrolled in the intervention studies reported their symptom severity every 2–3 weeks throughout chemotherapy, and daily steps were documented through a Fitbit activity tracker. Relative risks (RR) and 95% confidence intervals (CI) were calculated using Poisson regression models with robust variance. For outcomes significant in unadjusted models, adjusted RRs were calculated controlling for race, age, and education level. Tracker step cut point (high step, low step) was determined by the means. Cumulative incidence functions of moderate, severe, and very severe (MSVS) symptoms were estimated using the Kaplan-Meier method and compared using a Cox proportional hazard model.

Results

In a sample of 283 women, mean age was 56 years and 76% were White. Mean tracker-documented steps/week were 29,625, with 55% walking below the mean (low step) and 45% above (high step). In multivariable analysis, high step patients had lower risk for fatigue [RR 0.83 (0.70, 0.99)] (p = 0.04), anxiety [RR 0.59 (0.42, 0.84)] (p = 0.003), nausea [RR 0.66 (0.46, 0.96)] (p = 0.03), depression [RR 0.59 (0.37, 0.03)] (p = 0.02), and ≥ 6 MSVS symptoms [RR 0.73 (0.54, 1.00)] (p = 0.05) and had 36% lower risk for dose reductions [RR 0.64 (95% CI 0.43, 0.97)] (p = 0.03).

Conclusion

Self-directed walking at a rate of at least 30,000 steps/week may moderate the severity of treatment side effects during chemotherapy for early breast cancer.

Trial numbers

NCT02167932, NCT02328313, NCT03761706.

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Funding

Breast Cancer Research Foundation (New York NY); Kay Yow Foundation (Raleigh NC); UNC Lineberger Comprehensive Cancer Center/University Cancer Research Fund (Chapel Hill NC).

Author information

Authors and Affiliations

  1. Division of Oncology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA

    KA Nyrop & HB Muss

  2. Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, USA

    KA Nyrop, AM Deal, EA Kelly, William A. Wood & HB Muss

  3. Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA

    A Page

  4. Faculty of Kinesiology, University of Calgary, Calgary, Canada

    C Wagoner

  5. School of Medicine, Duke University, Durham, USA

    Gretchen G. Kimmick

  6. UNC Rex Cancer Care, UNC Rex Healthcare, Raleigh, USA

    Anureet Copeland & JoEllen Speca

  7. Division of Hematology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA

    William A. Wood

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  1. KA Nyrop
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  2. A Page
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  3. AM Deal
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  4. C Wagoner
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Contributions

Kirsten A. Nyrop, Annie Page, Allison M. Deal, and Hyman B. Muss: conceptualization, data curation, formal analysis, funding acquisition, investigation, methodology, project administration, resources, software, supervision, validation, visualization, writing—original draft, and writing—review and editing. Chad Wagoner, Erin EA Kelly, Gretchen G. Kimmick, Anureet Copeland, JoEllen C. Speca, and William A Wood: writing—review and editing. All authors reviewed the manuscript.

Corresponding author

Correspondence to KA Nyrop.

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Ethics approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Institutional Review Boards of the University of North Carolina at Chapel Hill and Duke University.

Competing interests

The authors declare no competing interests.

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Lay summary:

• This study explores whether home-based, self-directed walking throughout chemotherapy for early breast cancer can moderate the severity of treatment-related side effects (symptoms).

• Study participants whose tracker steps were above the mean for the full sample (high step) reported fewer instances of moderate, severe, or very severe symptoms for 11 commonly reported chemotherapy toxicities as compared to participants who walked below the mean (low step).

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Nyrop, K., Page, A., Deal, A. et al. Association of self-directed walking with toxicity moderation during chemotherapy for the treatment of early breast cancer. Support Care Cancer 32, 68 (2024). https://doi.org/10.1007/s00520-023-08275-4

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