Women with breast cancer who begin aerobic exercise at the same time as chemotherapy may experience improvements in cognitive function and quality of life, according to the ACTIVATE trial (NCT03277898) published in Cancer. The trial investigated the impact of aerobic exercise on cognitive decline, often referred to as "chemo-brain" or "brain fog," which is a common side effect of chemotherapy.
The ACTIVATE trial was a randomized controlled trial conducted at two centers in Ottawa and Vancouver. It involved 57 women (median age 48.8 years) diagnosed with stage I to stage III breast cancer awaiting chemotherapy. Participants were randomly assigned to either initiate aerobic exercise with chemotherapy (n = 28) or receive usual care during chemotherapy, with aerobic exercise following chemotherapy completion (n = 29). The exercise intervention lasted 12 to 24 weeks and included supervised aerobic training and at-home exercise.
Cognitive function was assessed before and after chemotherapy. The primary outcome was objective cognitive function, measured using 13 neuropsychological tests. Secondary outcomes included self-reported cognitive function and impact on quality of life, assessed via questionnaires.
Self-Reported Improvements
The findings indicated that women in the aerobic exercise group self-reported better cognitive function and improved mental abilities compared to the standard care group. However, neuropsychological testing revealed similar performance between the two groups at the completion of chemotherapy across 4 of 6 self-reported cognitive function outcomes.
According to lead author Dr. Jennifer Brunet of the University of Ottawa, "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."
Limitations and Future Directions
The investigators noted several limitations, including the small sample size, the impact of the COVID-19 pandemic on recruitment, the lack of consideration of chemotherapy-related adverse events, and potential biases in self-reported data. The authors also noted that the findings’ lack of generalizability. Despite the lack of significant differences in neuropsychological testing, the authors emphasized the beneficial impacts of such interventions on quality of life.
The authors suggested that future research should include longer intervention periods, multicomponent interventions (e.g., aerobic, strength, and balance), multidomain interventions (e.g., exercise, mind and body practices, and cognitive simulation), and the introduction of virtual methods to improve accessibility. They also called for more diverse sampling from sociodemographic and medical standpoints.
Dr. Brunet emphasized the need for collaboration across academic, healthcare, fitness, and community sectors to develop accessible exercise programs specifically designed for women with breast cancer, helping to make the benefits of exercise more accessible to all women facing the challenges of cancer treatment and recovery.
