Abstract
Purpose
Sleep problems frequently affect breast cancer patients during and after treatment and reduce their quality of life. Treatment strategies are mostly unknown. Thus, we assessed within a randomized controlled trial whether a 12-week exercise program starting with the radiotherapy influences sleep trajectories.
Methods
Sleep quality and problems were assessed via self-report in 160 breast cancer patients before, during, and 2, 6, and 12 months after participation in a trial investigating resistance exercise versus a relaxation control group concomitant with radiotherapy. As additional comparison group, 25 age-matched healthy women exercised and followed identical study procedures. Ordinal logistic regression analyses were used.
Results
The exercise intervention significantly decreased sleep problems compared to the relaxation control group (scale: 0–100, with between-group mean differences of −10.2 (p = 0.03) from baseline to the end of radiotherapy and −10.9 (p = 0.005) to the end of the intervention), with sleep problems decreasing in the exercise group and increasing in the control group. At 12 months, differences were still observed but statistically non-significant (mean difference = −5.9, p = 0.20). Further adjustment for potential confounders did not change the results. Several determinants of sleep problems at baseline were identified, e.g., previous chemotherapy and higher body mass index.
Conclusions
Our randomized exercise intervention trial confirmed results from earlier but mostly smaller studies that radiotherapy aggravates sleep problems in breast cancer patients and that exercise can ameliorate these effects. Considering that sleep quality can be a major predictor of quality of life, our findings are of substantial importance to many breast cancer patients.
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Abbreviations
- ANCOVA:
-
Analysis of covariance
- BC :
-
Breast Cancer
- BMI:
-
Body mass index
- CES-D:
-
Center for epidemiological studies depression scale
- FAQ:
-
Fatigue assessment questionnaire
- MSPSS:
-
Multidimensional scale of perceived social support
- OLR:
-
Ordinal logistic regression
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Acknowledgements
We would like to thank the patients who participated in this clinical trial. We also thank the Institute of Sports and Sports Science of the University of Heidelberg for providing the training facilities; Lena Kempf, Marcel Bannasch, Nadine Ungar, and Beate Biazeck for performing the interventions; Karin Potthoff, MD, Jan Oelmann, MD, Ulrike Bussas, MD, Simone Hummler, MD, Holger Hof, MD, and Andrea Koffka, MD, for medical support and/or help with recruitment; Oliver Klassen, PhD, Sabine Wessels, PhD, and Sandra Gollhofer, MD, for study assistance; Werner Diehl, PhD, for data management, and Christina Bock, PhD, for helping with searching literature.
Funding
This work was supported by the Interdisciplinary Research Funding Program (intramural) of the National Center for Tumor Diseases (NCT), Heidelberg, Germany. The foundation “Stiftung Leben mit Krebs” partially supported the intervention programs and the foundation “Manfred-Lautenschlaeger-Stiftung” supported JW.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Informed consent was obtained from all individual participants included in the study.
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Steindorf, K., Wiskemann, J., Ulrich, C.M. et al. Effects of exercise on sleep problems in breast cancer patients receiving radiotherapy: a randomized clinical trial. Breast Cancer Res Treat 162, 489–499 (2017). https://doi.org/10.1007/s10549-017-4141-8
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DOI: https://doi.org/10.1007/s10549-017-4141-8