PMID 29139007

Research
All papers

Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial

Mijwel S, Backman M, Bolam KA, Jervaeus A, Sundberg CJ, Margolin S, Browall M, Rundqvist H, Wengström Y

Question

Do supervised resistance plus HIIT or moderate aerobic plus HIIT improve cancer-related fatigue, health-related quality of life, and symptom burden compared with usual care in women with breast cancer undergoing chemotherapy?

Summary

This randomized trial tested two supervised exercise programs that both included high-intensity intervals during chemotherapy for women with breast cancer. Resistance training plus HIIT prevented worsening cancer-related fatigue and reduced symptom burden compared with usual care, while aerobic training plus HIIT helped maintain or improve some quality-of-life outcomes. Attendance and adherence were moderate, and no adverse events were reported from testing or exercise sessions.

Methodology

  • Women aged 18-70 years with stage I-IIIa breast cancer planned for adjuvant chemotherapy.
  • 240 participants.
  • Cycle ergometer HIIT combined with resistance training or moderate continuous aerobic training.
  • Work intervals: 3 min at RPE 16-18.
  • Recovery: 1 min low-intensity active recovery.
  • Intensity: HIIT RPE 16-18 on Borg scale.
  • Approximately 60 min.
  • 2 sessions/week.
  • 16 weeks.
  • Three-arm in-clinic randomized controlled exercise trial comparing RT-HIIT, AT-HIIT, and usual care.
  • Cancer-related fatigue, Health-related quality of life, Symptoms and symptom burden, and Adherence and attendance were tracked.

Outcomes

Cancer-related fatigue

RT-HIIT prevented increases in total, sensory/physical, and behavior/daily life CRF compared with usual care; EORTC fatigue favored both exercise groups versus usual care.

PFS total CRF RT-HIIT vs UC adjusted mean change -1.17 (95% CI -2.18 to -0.16), P=0.02, ES=-0.51; sensory/physical P=0.03; behavior/daily life P<0.01. EORTC fatigue P=0.01 for interaction, ES=-0.61 RT-HIIT vs UC and -0.47 AT-HIIT vs UC.

Improved

Health-related quality of life

Both exercise groups maintained or improved important HRQoL aspects compared with declines in usual care; RT-HIIT had strong role-functioning benefit and AT-HIIT improved emotional functioning.

Role functioning P<0.01, ES=0.81 RT-HIIT vs UC and 0.64 AT-HIIT vs UC; emotional functioning AT-HIIT vs UC adjusted mean change 8.81 (95% CI 1.72 to 15.90), P=0.01; cognitive functioning RT-HIIT vs UC P=0.02.

Mixed

Symptom burden and total symptoms

RT-HIIT reduced symptom burden and was superior to usual care for total symptoms; AT-HIIT maintained symptom burden compared with usual-care deterioration.

Symptom burden P<0.01, ES=-0.43 RT-HIIT vs UC and -0.42 AT-HIIT vs UC; total symptoms RT-HIIT vs UC adjusted mean change -0.20 (95% CI -0.37 to -0.04), P=0.01, ES=-0.52.

Improved

Pain

AT-HIIT was superior to usual care for pain symptoms.

EORTC pain interaction P=0.025; AT-HIIT vs UC ES=-0.36.

Improved

Safety

No adverse events were reported as a result of testing or exercise sessions, including no events related to peripherally inserted central catheters.

No clear change

Adherence

Attendance and adherence were moderate, with RT-HIIT higher than AT-HIIT.

Attendance RT-HIIT 68%, AT-HIIT 63%; adherence RT-HIIT 83%, AT-HIIT 75%.

Mixed

Insights

  • Clinical HIIT during chemotherapy should be framed as medically screened and professionally supervised.
  • Combining resistance training with HIIT may be more useful for multidimensional cancer-related fatigue and symptom burden than aerobic plus HIIT alone.
  • Adherence support is central: time burden, illness, and group preference affected participation.

Limitations

  • High usual-care dropout directly after randomization may have caused selection bias
  • Participants, exercise supervisors, and outcome assessors were not blinded
  • The HIIT effect cannot be isolated from resistance or moderate aerobic components
  • Supervised oncology exercise-clinic setting limits direct consumer translation
  • Attendance and adherence were incomplete

Safety

  • No adverse events were reported as a result of testing or exercise sessions.
  • No adverse events were reported in relation to peripherally inserted central catheters.
  • Participants were screened with cardiovascular health history and resting echocardiogram; heart or lung disease was excluded.