Health-related quality of life, heart rate variability and physical fitness in breast cancer patients during the COVID-19 lockdown: The impact of a lifestyle program ('MoviS Project, movement and health beyond the care' (CESU approval n. 21/10.07.2019)

ABSTRACT

Background: Breast cancer (BC) is the most common invasive cancer in women and evidence has shown that exercise can significantly improve the outcomes of BC survivors. MoviS 'Movement and Health Beyond Care' is a randomized controlled trial, which aims to educate cancer patients after adjuvant therapy on the benefits of exercise and proper nutritional plan. Material (patients) and methods: Thirty women with stage 0-III non-metastatic BC recruited 12-month postsurgery (age 53.5±7.6;BMI 25.3±4.9) were randomized in two groups intervention arm received 3-month aerobic training (40-70% of the heart rate reserve;20 to 60 min 3-day/week);control arm with usual care recommendations. Patients enrolled in January 2020 were monitored for diet habits by DianaWeb platform, they carried out the exercise training across the COVID-19 pandemic shifting from the gym to a home-based exercise program. The objective was to investigate the effects of lifestyle program on quality of life by EORTC QLQ-C30 and health-related QoL parameters such as cardiac function indexes;heart rate variability (HRV) (by repeated Holter 24h) and cardiorespiratory fitness by estimated maximal oxygen uptake (VO2max). Results: There were no adverse events and a high attendance was registered considering the challenges to be overcome in shifting to a home-based exercise program. Statistical analysis revealed a significant improvement in both arms in QLQ scale score in global health status (from 64.7±17 to 15.9±13;coefficient of variation (CV) 15.9%;p=0.0015);physical functioning (from 54.4±12.3 to 6±6.6;CV 13.9%;p=0.0005);fatigue (from 26.3±23.4 to 11.9±14.3;CV -54.9%;p=0.0008) and showed a general improvement over time even on the social functioning (from 47.2 ± 22.8 to 66.7±00;CV 41.2%;p=0.0001). Both groups had a significant improvement in HRV parameters in both time and frequency domain average SDNN/5min and VLF increased (from 50.6±14.4 to 55.2±16.7msec, p=0.033 and form 1597±967 to 1881±963 msec, p=0.04, respectively);mean heart rate decreased (from 76.6 ±7.8 to 73.7±8.3 bpm after training, p=0.009) and both arms improved the cardiorespiratory fitness level (VO2max from 30.7±5.7 to 33.9±6.64 mL/kg/min;CV 10.3%;p<0.001). Conclusions: Despite the challenges faced during the pandemic, a change in lifestyle integrating exercises, nutrition and educational counseling provides benefit to BC patients when delivered in a clinic-based setting group including the exercise specialists.