Irwin, M.L., Cartmel, B., Gross, C.P., Ercolano, E., Li, F., Yao, X., . . . Ligibel, J. (2015). Randomized exercise trial of aromatase inhibitor-induced arthralgia in breast cancer survivors. Journal of Clinical Oncology, 33, 1104–1111. 

To examine the effects of an exercise intervention on the severity of aromatase inhibitor (AI)-induced arthralgia in women with breast cancer

Patients were randomly assigned to a year-long exercise program consisting of twice weekly supervised resistance training and home-based aerobic exercise for 150 minutes per week. Participants wore heart rate monitors during workouts, and after each exercise session, participants recorded exercise type, duration, and average heart rate in logs. The aerobic component was usually brisk walking although patients could choose other activities such as stationary bike use. Strength training consisted of six exercises with gradually increasing weight. Women in the usual care group were instructed to continue usual activities. Those in the usual care group received monthly phone calls to determine AI adherence. 

• N = 107 (completed six months), 24 (completed 12 months)
• MEAN AGE = 61.3 years
• FEMALES: 100%
• KEY DISEASE CHARACTERISTICS: All had breast cancer and were receiving AIs; 60% had stage 1 disease 
• OTHER KEY SAMPLE CHARACTERISTICS: The majority of participants were Caucasian (88%). Women who were physically active were excluded.

• SITE: Single site  
• SETTING TYPE: Home  
• LOCATION: New England, United States

• PHASE OF CARE: Late effects and survivorship

Randomized, controlled trial

• Brief Pain Inventory (BPI)
• Western Ontario and McMaster Universities Osteoarthritis Index (WOMUOI)
• Disabilities of the Arm Shoulder and Hand (DASH) questionnaire 
• Grip strength 

Women assigned to exercise increased their physical activity by an average of 159 minutes per week compared to an average of 49 minutes per week in the usual care group (p < 0.001). Over 12 months, worst joint pain decreased by 29% in the exercise group while usual care patients showed a 3% increase (p < 0.001). The same patterns were shown in the DASH and osteoarthritis index measures. There was no dose response from exercise effects on arthralgia pain or functional measures. Adherence to AIs was 76% in the usual care group and 80% in the exercise group. AI-associated joint pain worsened slightly over time in the usual care group. The strongest benefit of exercise was seen after 12 months.

The findings of this study suggested that an exercise program including aerobic, resistance, and strength training may reduce pain from arthralgia caused by AIs among women with breast cancer.

• Small sample (< 30)
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Subject withdrawals ≥ 10%  
• Other limitations/explanation: More patients in the usual care group did not complete the study.

Exercise has been recommended for patients with cancer to ameliorate multiple symptoms. This study showed that exercise also can reduce arthralgia-related pain associated with AIs and improve function among breast cancer survivors. Nurses can educate patients regarding the numerous benefits of exercise and can encourage and recommend regular exercise.