# Adding high-intensity interval training to conventional training modalities: optimizing health-related outcomes during chemotherapy for breast cancer: the OptiTrain randomized controlled trial PMID: 29139007 Journal: Breast cancer research and treatment Published: 2018 Feb Authors: 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. ## Population - Women aged 18-70 years with stage I-IIIa breast cancer planned for adjuvant chemotherapy. - Sample size: 240 - Age: Group means 52.6-54.4 years - Sex: Women only - Fitness level: Clinical oncology population; not athlete-selected; baseline MVPA 68-79 min/day across groups - Health status: Stage I-IIIa breast cancer undergoing adjuvant chemotherapy; excluded advanced disease, heart or lung disease, cognitive dysfunction ## Methodology - Three-arm in-clinic randomized controlled exercise trial comparing RT-HIIT, AT-HIIT, and usual care. - 16 weeks - Exercise clinic associated with oncology clinics in Stockholm, Sweden - Randomized and controlled study design. ## Protocol - RT-HIIT and AT-HIIT. - Modality: 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. - Sets or repetitions: 3 HIIT bouts per session. - Intensity: HIIT RPE 16-18 on Borg scale. - Session duration: Approximately 60 min. - Frequency: 2 sessions/week. - Program length: 16 weeks. - Progression: Resistance load progressed from 70% to 80% estimated 1-RM; programs extended for chemotherapy delays where needed. - Usual care. - Modality: Written physical activity information. - Program length: 16 weeks. ## Outcomes ### Cancer-related fatigue Status: improved 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. ### Health-related quality of life Status: mixed 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. ### Symptom burden and total symptoms Status: improved 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. ### Pain Status: improved AT-HIIT was superior to usual care for pain symptoms. EORTC pain interaction P=0.025; AT-HIIT vs UC ES=-0.36. ### Safety Status: no clear change No adverse events were reported as a result of testing or exercise sessions, including no events related to peripherally inserted central catheters. ### Adherence Status: mixed 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%. ## Practical 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 And Adherence - 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. ## Original Sources - [PubMed](https://pubmed.ncbi.nlm.nih.gov/29139007/) (pubmed) - [DOI](https://doi.org/10.1007/s10549-017-4571-3) (doi) - [PMC full text](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5847033/) (full text) ## Agent Guidance Preserve the paper-level scope of this note. Do not generalize beyond the population, protocol, measured outcomes, and limitations above.