Randomized Exercise Trial of Aromatase Inhibitor–Induced Arthralgia in Breast Cancer Survivors

TLDR

Arthralgia affects up to half of breast cancer survivors on aromatase inhibitors and is the leading cause of poor drug adherence. The study tested whether a yearlong exercise program could reduce AI‑induced arthralgia compared with usual care in 121 survivors. Participants were randomized to 150 min/week aerobic exercise plus supervised strength training twice weekly or usual care, with joint pain and function measured at baseline and every 3 months using the BPI, WOMAC, and DASH, and analyzed by mixed‑model repeated measures. Exercise lowered worst joint pain by 1.6 points (29%) versus a 0.2‑point increase in usual care, and also significantly reduced pain severity, interference, DASH, and WOMAC scores, demonstrating improved arthralgia.

Abstract

Arthralgia occurs in up to 50% of breast cancer survivors treated with aromatase inhibitors (AIs) and is the most common reason for poor AI adherence. We conducted, in 121 breast cancer survivors receiving an AI and reporting arthralgia, a yearlong randomized trial of the impact of exercise versus usual care on arthralgia severity.Eligibility criteria included receiving an AI for at least 6 months, reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory (BPI), and reporting < 90 minutes per week of aerobic exercise and no strength training. Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The BPI, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index, and Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire were completed at baseline and at 3, 6, 9, and 12 months. Intervention effects were evaluated using mixed-model repeated measures analysis, with change at 12 months as the primary end point.Over 12 months, women randomly assigned to exercise (n = 61) attended 70% (± standard deviation [SD], 28%) of resistance training sessions and increased their exercise by 159 (± SD, 136) minutes per week. Worst joint pain scores decreased by 1.6 points (29%) at 12 months among women randomly assigned to exercise versus a 0.2-point increase (3%) among those receiving usual care (n = 60; P < .001). Pain severity and interference, as well as DASH and WOMAC pain scores, also decreased significantly at 12 months in women randomly assigned to exercise, compared with increases for those receiving usual care (all P < .001).Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors.