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. 2012 Aug 15;2012(8):CD008465. doi: 10.1002/14651858.CD008465.pub2

Courneya 2007a.

Study characteristics
Methods Study design: RCT
Number randomized: 242; 78 to an aerobic exercise group, 82 to a resistance exercise group, and 82 to the control group
Study start and stop dates: February 2003 to July 2005
Length of intervention: length of the chemotherapy session (median 17 weeks; 95% CI 9 to 24 weeks)
Length of follow‐up: 6 months
Participants Type cancer: breast cancer
Stage, n (%)

  • aerobic exercise group: Stage I, 18 (23.1%); Stage IIa, 33 (42.3%); Stage IIb, 17 (21.8%); Stage IIIa, 10 (12.8%)

  • resistance exercise group: Stage I, 22 (26.8%); Stage IIa, 36 (43.9%); Stage IIb, 9 (11.0%); Stage IIIa, 15 (18.3%)

  • control group: Stage I, 20 (24.4%); Stage IIa, 30 (36.6%); Stage IIb, 22 (26.8%); Stage IIIa, 10 (12.2%)


Time since cancer diagnosis: not reported
Time in active treatment: not reported
Inclusion criteria:

  • English‐ or French‐speaking 

  • ≥ 18 years old

  • Stage I to IIIA breast cancer  

  • beginning first‐line adjuvant chemotherapy

  • approval by treating oncologist


Eligibility criteria related to interest or ability, or both, to exercise:

  • none


Exclusion criteria:

  • pregnancy

  • incomplete axillary surgery

  • transabdominal rectus abdominus muscle reconstructive surgery

  • uncontrolled hypertension

  • cardiac illness

  • psychiatric illness


Gender: female
Current age, mean (range) years:

  • aerobic exercise group: 49.0 (30 to 75) years

  • resistance exercise group: 49.5 (25 to 76) years

  • control group: 49.0 (26 to 78) years


Age at cancer diagnosis: not reported
Ethnicity/race: not reported
Education level, completed university, n (%):

  • aerobic exercise group: 51 (65.4%)

  • resistance exercise group: 51 (62.2%)

  • control group: 53 (64.6%)


SES, income > USD60,000 per year, n (%):

  • aerobic exercise group: 28 (38.4%)

  • resistance exercise group: 41 (53.9%)

  • control group: 34 (42.5%)


Employment status, full time employed, n (%):

  • aerobic exercise group: 20 (25.6%)

  • resistance exercise group: 29 (35.4%)

  • control group: 23 (28.0%)


Comorbidities, hypertension, n (%):

  • aerobic exercise group: 5 (6.4%)

  • resistance exercise group: 8 (9.8%)

  • control group: 4 (4.9%)


Past exercise history, n (%)

  • aerobic exercise group: current exerciser, 15 (19.2%); current weight trainer, 4 (5.1%)

  • resistance exercise group: current exerciser, 22 (26.8%); current weight trainer, 6 (7.3%)

  • control group: current exerciser, 27 (32.9%); current weight trainer, 9 (11.3%)


On hormone therapy: not reported
Obese, n (%):

  • aerobic exercise group, 17 (21.8%)

  • resistance exercise group, 14 (17.1%)

  • control group, 19 (23.2%)


BMI, n (%):

  • aerobic exercise group, 26.7 (5.6%)

  • resistance exercise group, 26.1 (5.5%)

  • control group, 27.1 (5.4%)


Current smoker, n (%):

  • aerobic exercise group, 6 (7.7%)

  • resistance exercise group, 9 (11.0%)

  • control group, 5 (6.1%)
Interventions 78 participants assigned to the aerobic exercise intervention, including:

  • cycle ergometer, treadmill, or elliptical


82 participants assigned to the resistance exercise intervention, including:

  • performing 2 sets of 8 to 12 repetitions of 9 different exercises: leg extension, leg curl, leg press, calf raises, chest press, seated row, triceps extension, biceps curls, and modified curl‐ups


Type exercise (aerobic/anaerobic): aerobic or anaerobic
Intensity of the experimental exercise intervention:

  • aerobic: beginning at 60% of their maximal oxygen consumption, or VO2max, for weeks 1 to 6 and progressing to 70% during weeks 7 to 12 and 80% beyond week 12

  • resistance: 60% to 70% of their estimated 1 repetition maximum, resistance was increased by 10% when participants completed > 12 repetitions


Frequency: 3 times per week
Duration of individual sessions:

  • aerobic: 15 minutes for weeks 1 to 3 and increased by 5 minutes every 3 weeks until the duration reached 45 minutes at week 18

  • resistance: not reported


Duration of exercise program: length of chemotherapy (~ 17 weeks)
Total number of exercise sessions: ~ 51 sessions
Format: individual
Facility: facility
Professionally led by exercise trainers
Adherence:

  • aerobic: 72.0% adherence rate

  • resistance: 68.2% adherence rate


82 participants assigned to control group, including:

  • request not to initiate an exercise program

  • offer of a 1‐month exercise program after postintervention assessments


Contamination of control group: not reported
Outcomes No primary outcome was identified. QoL outcomes included:

  • global HRQoL, assessed using the FACT‐An


Other outcomes included:

  • psychosocial functioning, assessed by the Rosenberg Self‐Esteem Scale

  • depression, assessed using the Center for Epidemiological Studies Depression Scale

  • anxiety, assessed using the Spielberger State Anxiety Inventory


Outcomes were measured at baseline, at mid‐point, at end of the intervention, and at 6‐month follow‐up:

  • aerobic exercise group: n = 78 at baseline, n = 73 at mid‐point, n = 74 at the end of intervention, n = 68 at the 6‐month follow‐up

  • resistance exercise group: n = 82 at baseline, n = 75 at mid‐point, n = 76 at the end of intervention, n = 73 at the 6‐month follow‐up

  • control group: n = 82 at baseline, n = 75 at mid‐point, n = 73 at the end of intervention, n = 60 at the 6‐month follow‐up


Subgroup analysis: subgroups included patient preference, marital status, age, disease stage, chemotherapy protocol
Adverse events: 2 participants experienced an adverse event related to exercise after baseline maximal treadmill testing: 1 became lightheaded, hypotensive, and moderately nauseous and 1 experienced dizziness, weakness, and mild diarrhea
Notes Country: Canada
Funding: Canadian Breast Cancer Research Alliance, Canada Research Chairs Program, NCIC with funds from the CCS and the NCIC/CCS Sociobehavioral Cancer Research Network, Heart and Stroke Foundation of Canada, Canadian Institutes of Health Research, Alberta Heritage Foundation for Medical Research
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk Computer generated
Allocation concealment (selection bias) Low risk The allocation sequence was generated in Edmonton and concealed from the project directors at each site who assigned participants to groups
Blinding of participants and personnel (performance bias)
All outcomes High risk Owing to the nature of the intervention, it was not possible to conceal allocation to the intervention from the participants
Blinding of outcome assessment (detection bias)
All outcomes High risk Study personnel and outcome assessors were not masked or blinded to the study interventions
Incomplete outcome data (attrition bias)
All outcomes Low risk Used all available data in ITT analyses, using the missing at random assumption for mixed models
Selective reporting (reporting bias) Low risk There is no evidence of selective reporting of outcomes
Other bias Low risk The trial appears to be free of other problems that could put it at a high risk of bias