Hartman, S.J., Nelson, S.H., Myers, E., Natarajan, L., Sears, D.D., Palmer, B.W., . . . Patterson, R.E. (2018). Randomized controlled trial of increasing physical activity on objectively measured and self-reported cognitive functioning among breast cancer survivors: The memory and motion study. Cancer, 124, 192–202.

Examine the preliminary efficacy of a moderate-intensity aerobic exercise intervention, compared with a waitlist/attention control, on cognitive function among sedentary breast cancer survivors who reported cognitive problems.

The intervention included two groups: aerobic physical activity (targeting a goal of at least 150 minutes of moderate-to-vigorous physical activity over 12 weeks)  versus waitlist/attention control (i.e., matching email contact frequency for intervention group with women’s health topics).

Participants randomly assigned to the aerobic physical activity group completed an in-person walking assessment, after which study staff used motivational interviewing to set physical activity targets to reach the target goal for the study. Participants were given a Fitbit, which was used by staff to provide feedback on increasing physical activity during calls at two and six weeks. Motivational emails were sent every three days.

Participants assigned to the control group received women’s health topic emails every three days.

Study assessments were done before and at the end of the intervention (i.e., approximately 12 weeks post-baseline).

• N = 87
• MEAN AGE: 57 years (SD = 10.4)
• FEMALES: 100%
• CURRENT TREATMENT: Other
• KEY DISEASE CHARACTERISTICS: Initial diagnosis of non-metastatic, invasive breast cancer (stage I-III)
• OTHER KEY SAMPLE CHARACTERISTICS: Self-reported as sedentary at baseline, diagnosed less than 5 years before enrollment, no recurrence or other cancers within 10 years, 82% White, 71% completed college, 53% received chemotherapy (analysis stratified by receipt), 70% currently on endocrine therapy

• SITE: Single site   
• SETTING TYPE: Home    
• LOCATION: California, USA

PHASE OF CARE: Late effects and survivorship

Unblinded randomized controlled trial of moderate-to-vigorous physical activity versus waitlist/attention control with repeated measures

• Objective cognitive function: NIH Toolbox
• Self-reported cognitive function: PROMIS cognitive abilities, cognitive concerns
• Other measures: Accelerometer, BMI

• Feasibility: 98% completed the study, 60% in intervention group met goal of 150 minutes per week of moderate-to-vigorous physical activity measured by actigraphy (compared to 19% at baseline; p = 0.006); adverse events not reported
• Cognitive impairment: Self-reported cognitive concerns were lower in the physical activity group at baseline (p = 0.04). The physical activity group had greater improvements in processing speed (p = 0.049) than the control group. No group differences were found for other cognitive domains or for self-reported cognitive function.
• Other outcomes: No group differences were found at baseline or over time in BMI.

This pilot study provides evidence that moderate-to-vigorous physical activity shows preliminary efficacy to improve a specific domain of objectively-measured cognitive function, processing speed.

• Small sample (< 100)
• Baseline sample/group differences of import
• Risk of bias (no blinding)
• Risk of bias (no appropriate attentional control condition)
• Findings not generalizable
• Other limitations/explanation: The participants in the intervention group reported fewer cognitive concerns at baseline than the control group (potential ceiling effect for self-reported cognitive function). The waitlist/attention control condition only partially controlled for the attention received by the intervention group.

This study provides preliminary evidence that moderate-to-vigorous aerobic physical activity might improve the speed of doing mental tasks (i.e., processing speed), which is found to be impaired among some breast cancer survivors. The findings support future well-powered studies using aerobic physical activity to improve processing speed.