Effects Of A Home-based Exercise Program On Sleep In Breast Cancer Survivors: A Randomized Controlled Trial

Impaired sleep is one of the most distressing symptoms experienced by Breast Cancer Survivors (BCS) with evidence suggesting that 74 % of BCS have poor sleep. PURPOSE: To study the effects of a 6-week home-based walking and resistance training program called Exercise for Cancer Patients (EXCAP©®) on sleep in BCS. METHODS: BCS were randomized to either EXCAP©® or standard care (control group). The EXCAP©® group was prescribed moderate intensity walking with a goal of progressively (5-20%) increasing daily steps (up to 12,000) and daily resistance band exercises at moderate intensity (up to 4 sets of 15 repetitions for each exercise for 6 weeks). Sleep quality was assessed using the Pittsburg Sleep Quality Index (PSQI) at baseline, post intervention and after a follow up period of 3 months. Statistical analysis was done using the ANCOVA to examine within and between group differences. RESULTS: 90 women with breast cancer (55.5 ± 9.6 years, 52.27% undergoing radiation, 43.18% receiving hormonal therapy) were recruited. The mean baseline global PSQI score was >5 in both the groups, indicating clinically impaired sleep. More participants (31% post intervention and 45% post 3 month follow up) in the EXCAP©® group showed recovery in their sleep (Global PSQI Score < 5) compared to the control group (24% post intervention & 30 % post 3 month follow up). Post intervention analysis revealed significant between group difference in subjective sleep quality (0 .33 ± 0.13, p < .05, 0.59 effect size) with a significant improvement from baseline in the EXCAP©® group (-0 .33 ± 0.11, p < .05, 0.5 effect size) but no change was seen in the control group. Within the EXCAP©® group sleep latency reduced significantly (-0.27 ± .09, p < .05) from baseline to post intervention. The 3 month follow-up analysis showed significant between group difference in sleep latency (0.28 ± .15, p < .05, effect size 0.44), with better sleep latency in the EXCAP©® group as compared to the control group. CONCLUSIONS: BCS who received the EXCAP©® program had better subjective sleep quality as compared to those who received standard care. BCS in the EXCAP©® group had better sleep latency at follow-up as compared to those in the control group. Future phase III trials are needed to confirm these findings. FUNDING: NCI K07CA120025, T32CA102618, UG1CA189961. Clinical Trial: NCT00851812