Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes among Overweight Breast Cancer Survivors

The WISER Survivor Randomized Clinical Trial

Kathryn H. Schmitz, Andrea B. Troxel, Lorraine Dean, Angela Demichele, Justin C. Brown, Kathleen Sturgeon, Zi Zhang, Margaret Evangelisti, Bryan Spinelli, Michael J. Kallan, Crystal Denlinger, Andrea Cheville, Renate M. Winkels, Lewis Chodosh, David B. Sarwer

Research output: Contribution to journalArticle

Abstract

Importance: To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective: To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. Design, Setting, and Participants: This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. Interventions: A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. Main Outcomes and Measures: The 12-month change in the percentage of interlimb volume difference. Results: Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were -1.40 (11.10) in the control group, -2.54 (13.20) in the exercise group, -3.54 (12.88) in the weight loss group, and -3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were -0.39 (2.33) in the control group, -0.12 (2.14) in the exercise group, -0.57 (2.47) in the weight loss group, and -0.62 (2.38) in the combined group. Weight loss from baseline was -0.55% (95% CI, -2.22% to 1.11%) in the control group, -8.06% (95% CI, -9.82% to 6.29%) in the combined group, -7.37% (95% CI, -8.90% to -5.84%) in the weight loss group, and -0.44% (95% CI, -1.81% to 0.93%) in the exercise group. Conclusions and Relevance: Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.

Original languageEnglish (US)
JournalJAMA Oncology
DOIs
StateAccepted/In press - Jan 1 2019

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Weight Reduction Programs
Survivors
Randomized Controlled Trials
Exercise
Breast Neoplasms
Weight Loss
Research
Lymphedema
Control Groups
Resistance Training
Breast Cancer Lymphedema
Upper Extremity
Intention to Treat Analysis
Community Hospital

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

Cite this

Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes among Overweight Breast Cancer Survivors : The WISER Survivor Randomized Clinical Trial. / Schmitz, Kathryn H.; Troxel, Andrea B.; Dean, Lorraine; Demichele, Angela; Brown, Justin C.; Sturgeon, Kathleen; Zhang, Zi; Evangelisti, Margaret; Spinelli, Bryan; Kallan, Michael J.; Denlinger, Crystal; Cheville, Andrea; Winkels, Renate M.; Chodosh, Lewis; Sarwer, David B.

In: JAMA Oncology, 01.01.2019.

Research output: Contribution to journalArticle

Schmitz, KH, Troxel, AB, Dean, L, Demichele, A, Brown, JC, Sturgeon, K, Zhang, Z, Evangelisti, M, Spinelli, B, Kallan, MJ, Denlinger, C, Cheville, A, Winkels, RM, Chodosh, L & Sarwer, DB 2019, 'Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes among Overweight Breast Cancer Survivors: The WISER Survivor Randomized Clinical Trial', JAMA Oncology. https://doi.org/10.1001/jamaoncol.2019.2109
Schmitz, Kathryn H. ; Troxel, Andrea B. ; Dean, Lorraine ; Demichele, Angela ; Brown, Justin C. ; Sturgeon, Kathleen ; Zhang, Zi ; Evangelisti, Margaret ; Spinelli, Bryan ; Kallan, Michael J. ; Denlinger, Crystal ; Cheville, Andrea ; Winkels, Renate M. ; Chodosh, Lewis ; Sarwer, David B. / Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes among Overweight Breast Cancer Survivors : The WISER Survivor Randomized Clinical Trial. In: JAMA Oncology. 2019.
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abstract = "Importance: To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective: To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. Design, Setting, and Participants: This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. Interventions: A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. Main Outcomes and Measures: The 12-month change in the percentage of interlimb volume difference. Results: Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1{\%}) were white, 122 (34.8{\%}) were black, and 11 (3.1{\%}) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were -1.40 (11.10) in the control group, -2.54 (13.20) in the exercise group, -3.54 (12.88) in the weight loss group, and -3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were -0.39 (2.33) in the control group, -0.12 (2.14) in the exercise group, -0.57 (2.47) in the weight loss group, and -0.62 (2.38) in the combined group. Weight loss from baseline was -0.55{\%} (95{\%} CI, -2.22{\%} to 1.11{\%}) in the control group, -8.06{\%} (95{\%} CI, -9.82{\%} to 6.29{\%}) in the combined group, -7.37{\%} (95{\%} CI, -8.90{\%} to -5.84{\%}) in the weight loss group, and -0.44{\%} (95{\%} CI, -1.81{\%} to 0.93{\%}) in the exercise group. Conclusions and Relevance: Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.",
author = "Schmitz, {Kathryn H.} and Troxel, {Andrea B.} and Lorraine Dean and Angela Demichele and Brown, {Justin C.} and Kathleen Sturgeon and Zi Zhang and Margaret Evangelisti and Bryan Spinelli and Kallan, {Michael J.} and Crystal Denlinger and Andrea Cheville and Winkels, {Renate M.} and Lewis Chodosh and Sarwer, {David B.}",
year = "2019",
month = "1",
day = "1",
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TY - JOUR

T1 - Effect of Home-Based Exercise and Weight Loss Programs on Breast Cancer-Related Lymphedema Outcomes among Overweight Breast Cancer Survivors

T2 - The WISER Survivor Randomized Clinical Trial

AU - Schmitz, Kathryn H.

AU - Troxel, Andrea B.

AU - Dean, Lorraine

AU - Demichele, Angela

AU - Brown, Justin C.

AU - Sturgeon, Kathleen

AU - Zhang, Zi

AU - Evangelisti, Margaret

AU - Spinelli, Bryan

AU - Kallan, Michael J.

AU - Denlinger, Crystal

AU - Cheville, Andrea

AU - Winkels, Renate M.

AU - Chodosh, Lewis

AU - Sarwer, David B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Importance: To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective: To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. Design, Setting, and Participants: This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. Interventions: A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. Main Outcomes and Measures: The 12-month change in the percentage of interlimb volume difference. Results: Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were -1.40 (11.10) in the control group, -2.54 (13.20) in the exercise group, -3.54 (12.88) in the weight loss group, and -3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were -0.39 (2.33) in the control group, -0.12 (2.14) in the exercise group, -0.57 (2.47) in the weight loss group, and -0.62 (2.38) in the combined group. Weight loss from baseline was -0.55% (95% CI, -2.22% to 1.11%) in the control group, -8.06% (95% CI, -9.82% to 6.29%) in the combined group, -7.37% (95% CI, -8.90% to -5.84%) in the weight loss group, and -0.44% (95% CI, -1.81% to 0.93%) in the exercise group. Conclusions and Relevance: Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.

AB - Importance: To our knowledge, no randomized clinical trials have assessed the effects of the combination of weight loss and home-based exercise programs on lymphedema outcomes. Objective: To assess weight loss, home-based exercise, and the combination of weight loss and home-based exercise with clinical lymphedema outcomes among overweight breast cancer survivors. Design, Setting, and Participants: This randomized clinical trial (Women in Steady Exercise Research [WISER] Survivor clinical trial) of 351 overweight breast cancer survivors with breast cancer-related lymphedema (BCRL) was conducted in conference rooms at academic and community hospitals and in the homes of participants from March 12, 2012, to May 28, 2016; follow-up was conducted for 1 year from the start of the intervention. Statistical analysis by intention to treat was performed from September 26, 2018, to October 28, 2018. Interventions: A 52-week, home-based exercise program of strength/resistance training twice per week and 180 minutes of walking per week, a weight loss program of 20 weeks of meal replacements and 52 weeks of lifestyle modification counseling, and a combination of the home-based exercise and weight loss programs. Main Outcomes and Measures: The 12-month change in the percentage of interlimb volume difference. Results: Of 351 participants, 90 were randomized to the control group (facility-based lymphedema care with no home-based exercise or weight loss intervention), 87 to the exercise intervention group, 87 to the weight loss intervention group, and 87 to the combined exercise and weight loss intervention group; 218 (62.1%) were white, 122 (34.8%) were black, and 11 (3.1%) were of other races or ethnicities. Median time since breast cancer diagnosis was 6 years (range, 1-29 years). Mean (SD) total upper extremity score changes from the objective clinical evaluation were -1.40 (11.10) in the control group, -2.54 (13.20) in the exercise group, -3.54 (12.88) in the weight loss group, and -3.84 (10.09) in the combined group. Mean (SD) overall upper extremity score changes from the self-report survey were -0.39 (2.33) in the control group, -0.12 (2.14) in the exercise group, -0.57 (2.47) in the weight loss group, and -0.62 (2.38) in the combined group. Weight loss from baseline was -0.55% (95% CI, -2.22% to 1.11%) in the control group, -8.06% (95% CI, -9.82% to 6.29%) in the combined group, -7.37% (95% CI, -8.90% to -5.84%) in the weight loss group, and -0.44% (95% CI, -1.81% to 0.93%) in the exercise group. Conclusions and Relevance: Study results indicate that weight loss, home-based exercise, and combined interventions did not improve BCRL outcomes; a supervised facility-based program of exercise may be more beneficial than a home-based program for improving lymphedema outcomes.

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