Women Beginning Chemotherapy for Breast Cancer Self-Report Improved Cognitive Function When Participating in Aerobic Exercise

Key Takeaways

Aerobic exercise during chemotherapy improved self-reported cognitive function and quality of life in women with breast cancer.
The ACTIVATE trial showed no significant differences in neuropsychological test results between exercise and standard care groups.
Study limitations included small sample size, pandemic impact, and potential biases in self-reported data.
Future research should consider longer, multicomponent interventions and improve accessibility through virtual methods and diverse sampling.

Despite self-reported improvements in cognitive function, neuropsychological tests showed little differences between 2 patient groups.

Image credit: Kalim | stock.adobe.com

According to findings from the ACTIVATE trial (NCT03277898), which were published in Cancer, women with breast cancer who initiated chemotherapy while simultaneously starting an aerobic exercise program had reported greater improvements in their cognitive function and quality of life compared with those only receiving standard care. Many women who receive chemotherapy experience decreases in their ability to remember, concentrate, or think.¹ This is commonly called “chemo-brain” or “brain fog” and has led to experts trying to find solutions to mitigate this.^1,2

The ACTIVATE trial is a 2-arm, 2-center, randomized controlled trial that was conducted in Ottawa and Vancouver. A total of 57 women (median age: 48.8 ± 10 years) who were diagnosed with stage I to stage III breast cancer and were awaiting chemotherapy were randomly assigned to initiate aerobic exercise with chemotherapy (n = 28) or usual care during chemotherapy with aerobic exercise following chemotherapy completion (n = 29). The intervention lasted 12 to 24 weeks and consisted of supervised aerobic training and at-home exercise.^2,3

Cognitive function assessments were conducted prior to chemotherapy initiation and again after competition. For this study, the primary outcome was objective cognitive function measured with 13 neuropsychological tests, and secondary outcomes included self-reported cognitive function, and impact on quality of life, which were assessed with questionnaires.^1-3

About the Trial

Trial Name: Aerobic Exercise and Cognitive Functioning in Women With Breast Cancer (ACTIVATE)

ClinicalTrials.gov ID: NCT03277898

Sponsor: University of British Columbia

Completion Date (Estimated): January 1, 2022

According to the findings, women with breast cancer who were assigned to and participated in the aerobic exercise program while receiving chemotherapy had self-reported better cognitive function. Additionally, they noted that their mental abilities had improved compared with those who received standard care without exercise. Despite 4 of 6 self-reported cognitive function outcomes in the aerobic exercise group, the neuropsychological testing had revealed similar performance between the 2 groups at the completion of chemotherapy.^1,2

“Our findings strengthen the case for making exercise assessment, recommendation, and referral a routine part of cancer care; this may help empower women living with and beyond cancer to actively manage both their physical and mental health during and after treatment,” said lead author Jennifer Brunet, PhD, of the University of Ottawa.¹

Further, the investigators noted that limitations of the study could include the small sample size enrolled and the COVID-19 pandemic’s influence on recruitment, the lack of consideration of chemotherapy-related adverse events, the questionnaires being subject to recall and social desirability biases, and the findings’ lack of generalizability. Although the tests did not indicate differences between the 2 groups, the authors noted that such intervention methods can still have beneficial impacts on quality of life.²

In addition, the authors suggested that future research should include intervention periods that are longer than those in ACTIVATE, multicomponent (eg, aerobic, strength, and balance) and multidomain (eg, exercise, mind and body practices, and cognitive simulation) interventions, and the introduction of virtual interviews and exercise methods—if these are found to be just as effective—to improve accessibility for those who were unable to enroll. Additionally, the authors also urged that more diverse sampling from both sociodemographic and medical standpoints should be included in future research.²

“To address this, we advocate for collaboration across various sectors—academic, health care, fitness, and community—to develop exercise programs specifically designed for women with breast cancer,” Brunet said in the news release. “These programs should be easy to adopt and implement widely, helping to make the benefits of exercise more accessible to all women facing the challenges of cancer treatment and recovery.”¹

REFERENCES

1. Wiley. Can aerobic exercise help prevent brain fog caused by chemotherapy? News release. October 21, 2024. Accessed October 23, 2024. https://www.eurekalert.org/news-releases/1061398

2. Brunet J, Sharma S, Zadravec K, et al. Aerobic exercise and CogniTIVe functioning in women with breAsT cancEr (ACTIVATE): a randomized controlled trial. Cancer. 2024; 1-14. doi:10.1002/cncr.35540

3. Aerobic Exercise and Cognitive Functioning in Women With Breast Cancer (ACTIVATE). ClinicalTrials.gov identifier: NCT03277898. Updated on February 11, 2021. October 23, 2024. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.35540