The Effects of Exercise on Body Weight and Composition in Breast Cancer Survivors: An Integrative Systematic Review

Carolyn Ingram


Kerry Courneya

Dawn Kingston

ONF 2006, 33(5), 937-950. DOI: 10.1188/06.ONF.937-950

Purpose/Objectives: To examine the research literature regarding the effects of exercise on body weight and composition in breast cancer survivors.

Data Sources: Primary studies in English published from 1989-2004, located through electronic databases, hand searches, and personal contacts.

Data Synthesis: Of 1,314 studies screened, 14 met all inclusion criteria. Body weight and composition generally were secondary endpoints. Effects on weight were less common than reduction in percentage of body fat.

Conclusions: The evidence regarding exercise as a strategy for body weight and composition management in breast cancer is sparse. Research that considers these outcomes as primary endpoints is needed. Numerous measurement issues need to be addressed in future studies.

Implications for Nursing: Exercise may help to control adverse body weight and composition changes among breast cancer survivors. Improved research that assigns these outcomes primary importance will greatly enhance clinicians' ability to assist women in body weight and composition management.

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    References

    Al Majid, S., & McCarthy, D.O. (2001). Cancer-induced fatigue and skeletal muscle wasting: The role of exercise. Biological Research for Nursing, 2, 186-197.

    American College of Sports Medicine. (1995). ACSM's guidelines for exercise testing and prescription (5th ed.). Baltimore: Williams and Wilkins.

    Aslani, A., Smith, R.C., Allen, B.J., Pavlakis, N., & Levi, J.A. (1999). Changes in body composition during breast cancer chemotherapy with the CMF-regimen. Breast Cancer Research and Treatment, 57, 285-290.

    Baldwin, M.K., & Courneya, K.S. (1997). Exercise and self-esteem in breast cancer survivors: An application of the exercise and self-esteem model. Journal of Sport and Exercise Psychology, 19, 347-358.

    Bendz, I., & Fagevik Olsen, M. (2002). Evaluation of immediate versus delayed shoulder exercises after breast cancer surgery including lymph node dissection—A randomized controlled trial. Breast, 11, 241-248.

    Blanchard, C.M., Courneya, K.S., & Laing, D. (2001). Effects of acute exercise on state anxiety in breast cancer survivors. Oncology Nursing Forum, 28, 1617-1621.

    Bonadonna, G., Valagussa, P., Rossi, A., Tancini, G., Brambilla, C., Zambetti, M., et al. (1985). Ten-year experience with CMF-based adjuvant chemotherapy in resectable breast cancer. Breast Cancer Research and Treatment, 5, 95-115.

    Brodie, D.A. (1988). Techniques of measurement of body composition: Part I. Sports Medicine, 5, 11-40.

    Burnham, T.R., & Wilcox, A. (2002). Effects of exercise on physiological and psychological variables in cancer survivors. Medicine and Science in Sports and Exercise, 34, 1863-1867.

    Camoriano, J.K., Loprinzi, C.L., Ingle, J.N., Therneau, T.M., Krook, J.E., & Veeder, M.H. (1990). Weight change in women treated with adjuvant therapy or observed following mastectomy for node-positive breast cancer. Journal of Clinical Oncology, 8, 1327-1334.

    Campbell, K.L. (2001). Body changes in women undergoing chemotherapy for breast cancer. Unpublished master's thesis, University of British Columbia, Vancouver, British Columbia, Canada.

    Cheema, B. (2002). The efficacy of a full body resistance and aerobic exercise program for breast cancer survivors. Unpublished master's thesis, University of Victoria, Victoria, British Columbia, Canada.

    Cochrane handbook for systematic reviews version 4.2.2. (2004). Chichester, UK: John Wiley and Sons.

    Courneya, K.S. (2001). Exercise interventions during cancer treatment: Biopsychosocial outcomes. Exercise and Sport Sciences Reviews, 29, 60-64.

    Courneya, K.S., & Friedenreich, C.M. (1997). Relationship between exercise during treatment and current quality of life among survivors of breast cancer. Journal of Psychosocial Oncology, 15, 35-57.

    Courneya, K.S., Friedenreich, C.M., Sela, R.A., Quinney, H.A., Rhodes, R.E., & Handman, M. (2003). The group psychotherapy and home-based physical exercise (GROUP-HOPE) trial in cancer survivors: Physical fitness and quality of life outcomes. Psycho-Oncology, 12, 357-374.

    Courneya, K.S., Keats, M.R., & Turner, A.R. (2000). Physical exercise and quality of life in cancer patients following high dose chemotherapy and autologous bone marrow transplantation. Psycho-Oncology, 9, 127-136.

    Courneya, K.S., Mackey, J.R., Bell, G.J., Jones, L.W., Field, C.J., & Fairey, A.S. (2003). Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. Journal of Clinical Oncology, 21, 1660-1668.

    DeConti, R.C. (1982). Weight gain in the adjuvant chemotherapy of breast cancer [Abstract C279]. Proceedings of the Annual Meeting of the American Society of Clinical Oncology, 1, 73.

    DeGeorge, D., Gray, J.J., Fetting, J.H., & Rolls, B.J. (1990). Weight gain in patients with breast cancer receiving adjuvant treatment as a function of restraint, disinhibition, and hunger. Oncology Nursing Forum, 17(3, Suppl.), 23-28.

    Demark-Wahnefried, W., Hars, V., Conaway, M.R., Havlin, K., Rimer, B.K., McElveen, G., et al. (1997). Reduced rates of metabolism and decreased physical activity in breast cancer patients receiving adjuvant chemotherapy. American Journal of Clinical Nutrition, 65, 1495-1501.

    Demark-Wahnefried, W., Peterson, B.L., Winer, E.P., Marks, L., Aziz, N., Marcom, P.K., et al. (2001). Changes in weight, body composition, and factors influencing energy balance among premenopausal breast cancer patients receiving adjuvant chemotherapy. Journal of Clinical Oncology, 19, 2381-2389.

    Dwyer, J.T. (1994). Medical evaluation and classification of obesity. In G.L. Blackburn & B.S. Kanders (Eds.), Obesity: Pathophysiology, psychology, and treatment (pp. 9-38). New York: Chapman and Hall.

    Effective Public Health Practice Project. (2003). Quality assessment tool for quantitative studies. Retrieved June 29, 2006, from http://www.myhamilton.ca/nr/rdonlyres/8778406f-fc8f-4e31-b996-b3e2d9b5b12a/0/qualitytool2003.pdf

    Foltz, A.T. (1985). Weight gain among stage II breast cancer patients: A study of five factors. Oncology Nursing Forum, 12(3), 21-26.

    Freedman, R.J., Aziz, N., Albanes, D., Hartman, T., Danforth, D., Hill, S., et al. (2004). Weight and body composition changes during and after adjuvant chemotherapy in women with breast cancer. Journal of Clinical Endocrinology and Metabolism, 89, 2248-2253.

    Galantino, M.L., Capito, L., Kane, R.J., Ottey, N., Switzer, S., & Packel, L. (2003). The effects of tai chi and walking on fatigue and body mass index in women living with breast cancer: A pilot study. Rehabilitation Oncology, 21, 17-22.

    Gaskin, T.A., LoBuglio, A., Kelly, P., Doss, M., & Pizitz, N. (1989). STRETCH: A rehabilitative program for patients with breast cancer. Southern Medical Journal, 82, 467-469.

    Goodwin, P.J., Ennis, M., Pritchard, K.I., McCready, D., Koo, J., Sidlofsky, S., et al. (1999). Adjuvant treatment and onset of menopause predict weight gain after breast cancer diagnosis. Journal of Clinical Oncology, 17, 120-129.

    Goodwin, P.J., Panzarella, T., & Boyd, N.F. (1988). Weight gain in women with localized breast cancer—A descriptive study. Breast Cancer Research and Treatment, 11, 59-66.

    Grindel, C.G., Cahill, C.A., & Walker, M. (1989). Food intake of women with breast cancer during their first six months of chemotherapy. Oncology Nursing Forum, 16, 401-407.

    Harris, S.R., & Niesen-Vertommen, S.L. (2000). Challenging the myth of exercise-induced lymphedema following breast cancer: A series of case reports. Journal of Surgical Oncology, 74, 95-99.

    Headley, J.A., Theriault, R.L., LeBlanc, A.D., Vassilopoulou-Sellin, R., & Hortobagyi, G.N. (1998). Pilot study of bone mineral density in breast cancer patients treated with adjuvant chemotherapy. Cancer Investigation, 16, 6-11.

    Heasman, K.Z., Sutherland, H.J., Campbell, J.A., Elhakim, T., & Boyd, N.F. (1985). Weight gain during adjuvant chemotherapy for breast cancer. Breast Cancer Research and Treatment, 5, 195-200.

    Huntington, M.O. (1985). Weight gain in patients receiving adjuvant chemotherapy for carcinoma of the breast. Cancer, 56, 472-474.

    Ingram, C.A. (2001). Predictors of weight gain in premenopausal women with early stage breast cancer. Unpublished doctoral dissertation, University at Buffalo, State University of New York, Buffalo, New York.

    Ingram, C.A., & Brown, J.K. (2004). Patterns of weight and body composition change in premenopausal women with early stage breast cancer: Has weight gain been overestimated? Cancer Nursing, 27, 483-490.

    International Society of Lymphology. (2003). The diagnosis and treatment of peripheral lymphedema. Consensus document of the International Society of Lymphology. Lymphology, 36, 84-91.

    Irwin, M.L., Crumley, D., McTiernan, A., Bernstein, L., Baumgartner, R., Gilliland, F.D., et al. (2003). Physical activity levels before and after a diagnosis of breast carcinoma: The Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer, 97, 1746-1757.

    King, A.C., & Tribble, D.L. (1991). The role of exercise in weight regulation in nonathletes. Sports Medicine, 11, 331-349.

    Knobf, M.K., Mullen, J.C., Xistris, D., & Moritz, D.A. (1983). Weight gain in women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 10(2), 28-33.

    Knobf, M.T. (1986). Physical and psychologic distress associated with adjuvant chemotherapy in women with breast cancer. Journal of Clinical Oncology, 4, 678-684.

    Kolden, G.G., Strauman, T.J., Ward, A., Kuta, J., Woods, T.E., Schneider, K.L., et al. (2002). A pilot study of group exercise training (GET) for women with primary breast cancer: Feasibility and health benefits. Psycho-Oncology, 11, 447-456.

    Kutynec, C.L., McCargar, L., Barr, S.I., & Hislop, T.G. (1999). Energy balance in women with breast cancer during adjuvant treatment. Journal of the American Dietetic Association, 99, 1222-1227.

    Loprinzi, C.L., Athmann, L.M., Kardinal, C.G., O'Fallon, J.R., See, J.A., Bruce, B.K., et al. (1996). Randomized trial of dietician counseling to try to prevent weight gain associated with breast cancer adjuvant chemotherapy. Oncology, 53, 228-232.

    Lukaski, H.C. (1987). Methods for the assessment of human body composition: Traditional and new. American Journal of Clinical Nutrition, 46, 537-556.

    McInnes, J.A., & Knobf, M.T. (2001). Weight gain and quality of life in women treated with adjuvant chemotherapy for early-stage breast cancer. Oncology Nursing Forum, 28, 675-684.

    McKenzie, D.C., & Kalda, A.L. (2003). Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: A pilot study. Journal of Clinical Oncology, 21, 463-466.

    Mock, V., Burke, M.B., Sheehan, P., Creaton, E.M., Winningham, M.L., McKenney-Tedder, S., et al. (1994). A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Oncology Nursing Forum, 21, 899-907.

    Mock, V., Dow, K.H., Meares, C.J., Grimm, P.M., Dienemann, J.A., Haisfield-Wolfe, M.E., et al. (1997). Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Oncology Nursing Forum, 24, 991-1000.

    Mock, V., Pickett, M., Ropka, M.E., Muscari, L.E., Stewart, K.J., Rhodes, V.A., et al. (2001). Fatigue and quality of life outcomes of exercise during cancer treatment. Cancer Practice, 9, 119-127.

    Muscari, E. (2004). Lymphedema: Responding to our patients' needs. Oncology Nursing Forum, 31, 905-912.

    Nieman, D.C., Cook, V.D., Henson, D.A., Suttles, J., Rejeski, W.J., Ribisl, P.M., et al. (1995). Moderate exercise training and natural killer cell cytotoxic activity in breast cancer patients. International Journal of Sports Medicine, 16, 334-337.

    Oldervoll, L.M., Kaasa, S., Hjermstad, M.J., Lund, J.A., & Loge, J.H. (2004). Physical exercise results in the improved subjective well-being of a few or is effective rehabilitation for all cancer patients? European Journal of Cancer, 40, 951-962.

    Petrek, J.A., Senie, R.T., Peters, M., & Rosen, P.P. (2001). Lymphedema in a cohort of breast carcinoma survivors 20 years after diagnosis. Cancer, 92, 1368-1377.

    Pinto, B.M., Clark, M.M., Maruyama, N.C., & Feder, S.I. (2003). Psychological and fitness changes associated with exercise participation among women with breast cancer. Psycho-Oncology, 12, 118-126.

    Ridner, S.H. (2002). Breast cancer lymphedema: Pathophysiology and risk reduction guidelines. Oncology Nursing Forum, 29, 1285-1293.

    Rock, C.L., Flatt, S.W., Newman, V., Caan, B.J., Haan, M.N., Stefanick, M.L., et al. (1999). Factors associated with weight gain in women after diagnosis of breast cancer. Women's Healthy Eating and Living Study Group. Journal of the American Dietetic Association, 99, 1212-1221.

    Schwartz, A.L. (1999). Fatigue mediates the effects of exercise on quality of life. Quality of Life Research, 8, 529-538.

    Schwartz, A.L. (2000). Exercise and weight gain in breast cancer patients receiving chemotherapy. Cancer Practice, 8, 231-237.

    Segal, R., Evans, W., Johnson, D., Smith, J., Colletta, S., Gayton, J., et al. (2001). Structured exercise improves physical functioning in women with stages I and II breast cancer: Results of a randomized controlled trial. Journal of Clinical Oncology, 19, 657-665.

    Segar, M.L., Katch, V.L., Roth, R.S., Garcia, A.W., Portner, T.I., Glickman, S.G., et al. (1998). The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. Oncology Nursing Forum, 25, 107-113.

    Subramanian, V.P., Raich, P.C., & Walker, B.K. (1981). Weight gain in breast cancer patients undergoing chemotherapy [Abstract]. Breast Cancer Research and Treatment, 1, 170.

    Williams, A.F., Vadgama, A., Franks, P.J., & Mortimer, P.S. (2002). A randomized controlled crossover study of manual lymphatic drainage therapy in women with breast cancer-related lymphoedema. European Journal of Cancer Care, 11, 254-261.

    Winningham, M.L., MacVicar, M.G., Bondoc, M., Anderson, J.I., & Minton, J.P. (1989). Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. Oncology Nursing Forum, 16, 683-689.

    Young-McCaughan, S., Mays, M.Z., Arzola, S.M., Yoder, L.H., Dramiga, S.A., Leclerc, K.M., et al. (2003). Change in exercise tolerance, activity, and sleep patterns, and quality of life in patients with cancer participating in a structured exercise program. Oncology Nursing Forum, 30, 441-454.

    Young-McCaughan, S., & Sexton, D.L. (1991). A retrospective investigation of the relationship between aerobic exercise and quality of life in women with breast cancer. Oncology Nursing Forum, 18, 751-757.