Benefits of 24 versus 12 weeks of exercise and wellness programming for women undergoing treatment for breast cancer

Purpose

Community exercise programs can help maintain or improve health in cancer survivors. However, the most effective and feasible duration of a community exercise program for breast cancer survivors who are undergoing treatment is not known. This pre-post-design study evaluated the effects of the “Breast cancer patients Engaging in Activity while Undergoing Treatment” (BEAUTY) program on physical and psychosocial outcomes after 12 and 24 weeks.

Methods

BEAUTY is an ongoing community exercise and wellness program for breast cancer patients who are undergoing, or within 3 months of completing chemotherapy and radiation. Participants completed assessments at baseline, 12 weeks, and 24 weeks to measure body composition, hand-grip dynamometry, aerobic fitness, and flexibility. Self-report questionnaires assessed fatigue (FACIT-fatigue), cognitive function (FACT-cog), quality of life (QOL) (FACT-B), and depressive symptoms (CES-D). Main analyses were repeated measures general linear model for all outcomes.

Results

Assessments at all three time points were completed by N?=?63 participants. At 24 weeks, waist to hip ratio (p?=?.019), duration of the submaximal treadmill test (p?=?.013), and estimated VO_2max (p?=?.018) improved compared to baseline. Fatigue improved at 24 compared to 12 weeks (p?=?.002). FACT-B scores improved at 24 weeks when compared to both baseline (p?=?.002) and 12 weeks (p?=?.001). Depressive symptoms improved compared to baseline (p?=?.05) and 12 weeks (p?=?.009).

Conclusions

Additional benefits were seen after 24 versus 12 weeks, suggesting that a longer duration exercise program during, or shortly after completing treatments for breast cancer, may be necessary to see improvements in fitness and psychosocial outcomes. Findings can be applied to community exercise and rehabilitation programs for breast cancer survivors.

     

“My body was my temple”: a narrative revealing body image experiences following treatment of a spinal cord injury

Purpose: This narrative explores the lived experience of a young woman, Rebecca, and her transitioned body image after sustaining and being treated for a spinal cord injury.

Method: Data were collected from a single semi-structured in-depth interview.

Results: Rebecca disclosed her transitioned body image experiences after sustaining a spinal cord injury and being treated by medical staff immediately following her injury. Before her injury, she described a holistic body experience and named this experience her “temple”. During intensive care in the hospital, she explained her body was treated as an object. The disconnected treatment of her body led to a loss of the private self, as she described her sacred body being stripped away – her “temple” lost and in ruins.

Conclusions: Body image may be an overlooked component of health following a spinal cord injury. This narrative emphasizes the importance of unveiling body image experiences after the treatment of a spinal cord injury to medical professionals. Lessons of the importance of considering the transitioned body experiences after a spinal cord injury may help prevent body-related depression and other subsequent health impacts. Recommendations for best practice are provided.

• Implications for Rehabilitation

• Spinal Cord Injury

• ??A spinal cord injury may drastically change a person’s body image, thereby significantly impacting psychological health

• ??More effective screening for body image within the medical/rehabilitation context is needed to help practitioners recognize distress

• ??Practitioners should be prepared to refer clients to distress hotlines they may need once released from treatment

     

The evolution of supportive care needs trajectories in women with advanced breast cancer during the 12 months following diagnosis

Purpose

This longitudinal study examined if the evolution of supportive care needs differed over the first year following the diagnosis of advanced breast cancer and examined factors differentiating these trajectories.

Methods

Two hundred twenty-eight of 276 Chinese women with advanced breast cancer were assessed while they were awaiting or receiving initial chemotherapy, then again at 6 weeks, 3 months, 6 months, and 12 months post-baseline. Supportive care needs (SCNS-34-Ch), psychological distress (Hospital Anxiety and Depression scale), symptom distress (MSAS-Ch), and patient satisfaction (PSEQ-9) were assessed at baseline; supportive care needs were reassessed at each follow-up assessment. Latent growth mixture modeling explored if trajectories differed within each of four need domains: health system, information, and patient support (HSIPS); psychological; physical daily living (PDL); and sexuality needs. Logistic regression identified factors predicting trajectory patterns.

Results

Two distinct trajectories were identified for HSIPS and sexuality need domains and three distinct trajectories for psychological and physical daily living need domains. Most women showed stable low levels of HSIPS (78.9 %), psychological (82.4 %), PDL (83.7 %), and sexuality (97.4 %) supportive care needs. One in five and one in eight women showed high initial supportive care needs in HSIPS and psychological and PDL domains, respectively. With the exception of sexuality needs, trajectory patterns were predicted by physical symptom distress. Women in the high-decline group reported greater physical symptom distress.

Conclusions

Most Chinese women with advanced breast cancer showed low stable supportive care needs. Physical symptom distress predicted high supportive care needs. Interventions should focus on optimizing symptom assessment and management.     

Patterns of weight and body composition change in premenopausal women with early stage breast cancer: has weight gain been overestimated?

The widely documented problem of weight gain during adjuvant breast cancer chemotherapy has decreased in frequency and magnitude. However, adverse changes in body composition remain a problem. This study identified the frequency, magnitude, and patterns of weight and body composition change in a sample of premenopausal breast cancer survivors who were receiving 3 common chemotherapy regimens. The longitudinal study followed 76 women at 2 centers in Ontario, Canada. Measures were obtained at baseline, the start of every other treatment cycle and treatment completion. Participants' mean age was 44.1 years (SD = 5.9). Their mean baseline weight and body mass index were 69.3 kg (SD = 17.0) and 26 kg/m2 (SD = 6.6), respectively. Fifty-five percent maintained stable weights, while 34% gained and 10.5% lost weight. Their mean weight change during treatment was a 1.4-kg gain. Weight gainers and losers gained or lost 3 to 4 times as much fat as fat-free mass, respectively. A researcher's definition of "weight change" will influence the amount of weight gain reported, and the results of this study suggest that previous research may have overestimated the frequency and magnitude of weight gain in this population. Further research is needed to design interventions that match survivors' needs.     

The importance of a daily rhythm in a supportive environment – promoting ability in activities in everyday life among older women living alone with chronic pain

Abstract

Purpose: The aim of this study was to explore how older women living alone with chronic musculoskeletal pain, describe their ability in performing activities in everyday life and what could promote their ability in activities in everyday life as well as their perceived meaning of a changed ability to perform activities in everyday life. Method: Qualitative interviews were conducted with 12 women, and an inductive content analysis was used. Results: The results showed the importance of a daily rhythm of activities. Activities included in the daily rhythm were socializing with family and friends, physical activities, doing own activities as well as activities supported by relatives and the community. The activities described by the women also promoted their ability in activities in everyday life. Other findings were the women’s perceived meaning of being independent and maintaining that independency, along with the meaning of accepting and adapting to a changed life situation. Conclusion: This paper concludes that it is important to be sensitive of individual needs regarding the daily rhythm of activities when health-care professionals intervene in the activities in everyday life of older women living alone, promote the women’s independency, and enable them to participate in the community.

• Implications for Rehabilitation

• A daily rhythm of activities is important for older women who live alone with chronic musculoskeletal pain.

• The importance of health-care professionals being sensitive to individual needs to promote ability in activities in everyday life and to encourage the everyday activities into a daily rhythm.

• Facilitate the women’s desire and will of independency, despite their needs of help from their environment to manage their everyday life.

     

Effects of candesartan cilexetil “add-on” treatment in congestive heart failure outpatients in daily practice

Aims  In the present study, we investigated the efficacy and safety of candesartan cilexetil (candesartan) as “add-on” treatment in congestive heart failure (CHF) in daily practice. Methods and results  In this open-label, multicenter study 414 CHF outpatients (NYHA II/III) with left ventricular ejection fraction (LVEF) ≤ 40% and plasma brain natriuretic peptide (BNP) levels > 200 pg/ml at baseline were enrolled. Patients were treated with standard therapy including at least one angiotensin converting enzyme inhibitor in addition to another CHF drug; 91% of the patients received beta-blockers. Candesartan was uptitrated to 32 mg/day (target dose if tolerated) during 6 weeks followed by constant dosing over 16 weeks. The primary endpoint plasma BNP was significantly reduced by 25% at week 22 (from 394 to 295 pg/ml, P < 0.0001 vs. baseline). Candesartan produced early and sustained improvements of plasma BNP/NT-pro-BNP, LVEF, and quality of life (SF-36) compared to baseline. Of patients on beta-blockers, 37% improved towards NYHA II/I at week 22 (P < 0.0001) and 53.5% of the patients in NYHA III at baseline improved into NYHA II/I at week 22 (n = 232, P < 0.0001). Candesartan was well tolerated; no unexpected findings were reported besides known adverse reactions including hypotension, hyperkalemia, and serum creatinine elevations. Conclusion  Candesartan “add-on” treatment provides a good benefit/risk ratio in CHF outpatients in daily practice, although high-risk patients should be managed with frequent monitoring of BP, serum potassium, and renal function.     

“I know it when I see it.” The complexities of measuring resilience among parents of children with cancer

Purpose

Promoting parent resilience may provide an opportunity to improve family-level survivorship after pediatric cancer; however, measuring resilience is challenging.

Methods

The “Understanding Resilience in Parents of Children with Cancer” was a cross-sectional, mixed-methods study of bereaved and non-bereaved parents. Surveys included the Connor–Davidson Resilience scale, the Kessler-6 psychological distress scale, the Post-Traumatic Growth Inventory, and an open-ended question regarding the ongoing impact of cancer. We conducted content analyses of open-ended responses and categorized our impressions as “resilient,” “not resilient,” or “unable to determine.” “Resilience” was determined based on evidence of psychological growth, lack of distress, and parent-reported meaning/purpose. We compared consensus impressions with instrument scores to examine alignment. Analyses were stratified by bereavement status.

Results

Eighty-four (88 %) non-bereaved and 21 (88 %) bereaved parents provided written responses. Among non-bereaved, 53 (63 %) were considered resilient and 15 (18 %) were not. Among bereaved, 11 (52 %) were deemed resilient and 5 (24 %) were not. All others suggested a mixed or incomplete picture. Rater-determined “resilient” parents tended to have higher personal resources and lower psychological distress (p?=?<0.001–0.01). Non-bereaved “resilient” parents also had higher post-traumatic growth (p?=?0.02). Person-level analyses demonstrated that only 50–62 % of parents had all three instrument scores aligned with our impressions of resilience.

Conclusions

Despite multiple theories, measuring resilience is challenging. Our clinical impressions of resilience were aligned in 100 % of cases; however, instruments measuring potential markers of resilience were aligned in approximately half. Promoting resilience therefore requires understanding of multiple factors, including person-level perspectives, individual resources, processes of adaptation, and emotional well-being.     

Clinical observation on the effect of Chinese medicine-“TCM formula” intervention on recurrence and metastasis of triple negative breast cancer

ObjectiveThis study used a prospective cohort study to observe the effect of triple-negative breast cancer on the 2-year disease-free survival rate with or without “TCM formula”.MethodsFrom November 1 st, 2016, the first patient was enrolled in the cohort study. A total of 356 patients were enrolled on January 30, 2019. Among them, 154 cases were followed up for 2 years. During the follow-up, there were 6 cases of shedding, so 6 cases were affected. A total of 148 cases were included in the analysis, including 73 in the exposed group and 75 in the non-exposed group. The exposed group was given “TCM formula” on the basis of standardized treatment, and the non-exposed group was treated with simple triple-negative breast cancer. The two groups visited each of the three months. The interview included safety examination (hematology and imaging). The endpoint was the difference in 2-year invasive disease-free survival between the exposed and non-exposed groups and the safety of the “TCM formula”.ResultsThere were 6 cases of shedding during the experiment and the shedding rate was 3.9 %. The 2-year rate of invasive disease-free survival in the exposed team was 88.7 % and the non-exposed group was 82.5 %. Logistic multivariate regression analysis predicted that “TCM formula” could reduce the disease-related recurrence and metastasis rate by 11 % (OR = 0.89, 95 % CI 0.37−0.956, P＜0.05). Through K–M survival analysis, TNBC patients with age ≤35 years and regional lymph node stage N1 may be the benefit group of “TCM formula”(P＜0.05). During the study, the incidence of total adverse events was 8.2 % in the exposed group, mainly manifested as stomach discomfort, diarrhea, and hepatocyte damage.Conclusion1. In the exposed group, the two-year rate of invasive disease-free survival increased by 6.2 % compared with the non-exposed group(P＞0.05). 2. According to K–M survival analysis, TNBC patients with age ≤35 years and regional lymph node metastasis to N1 may be potential beneficiaries of “TCM formula”. 3. “TCM Formula” is safe and tolerable to most patients.     

How do recovery advice and behavioural characteristics influence upper-body function and quality of life among women 6 months after breast cancer diagnosis?

Goals of work After breast cancer treatment, women may experience significant and enduring problems relating to upper-body function (UBF) and quality of life (QoL). Women are often given advice to avoid problems, despite little scientific evidence to support or refute the advice given.Patients and methods This study addressed the relationships between recovery advice and subsequent behaviours on QoL (Functional Assessment of Cancer Therapy, Breast questionnaire) and UBF (Disability of Arm, Shoulder and Hand questionnaire) 6 months after treatment for unilateral breast cancer among a population-based sample of women residing in southeast Queensland (n=287).Main results Eighty-seven percent (n=249) of women reported that they received advice on facilitating arm function during their hospital stay, whereas 72% received subsequent recovery advice from medical and/or allied health professionals. Reported QoL and UBF were similar between groups, irrespective of advice received. Behaviours of interest included adherence to advice given, participation in breast cancer programmes and whether women had flight travel, used the treated side as much as the untreated side or had trauma, sunburn, injections and/or blood pressure readings on the treated side in the previous 6 months. QoL and UBF were highest among those who followed minimal advice, who used their treated side as much as their untreated side and who did not participate in any breast cancer programme (p<0.05).Conclusions The findings neither support nor refute current recommendations made to women with breast cancer, but rather raise questions about the value of this recovery advice. The study also provides novel findings regarding relationships between certain behaviours and QoL among breast cancer survivors.     

Perceptions of upper-body problems during recovery from breast cancer treatment

Despite improved recognition recently, restrictions in upper-body movement continue to cause impairment and distress for many women long after breast cancer treatment. The purpose of this research is to investigate this issue through the perceptions of breast cancer survivors in the context of their everyday lives. Twenty-four women recruited from a private breast clinic in south-eastern Queensland, Australia, participated in a qualitative study. Discussion groups comprised women treated for breast cancer within the previous 18 months. Discussions centred on experiences of physical difficulties, follow-up support, arm lymphoedema and exercise therapy during the womens recoveries. Returning to normal activities for women after breast surgery was felt to take longer than either the womens or their physicians expectations. Many women reported difficulties in upper-body tasks, which worsened simple everyday responsibilities. The physical impact leads to psychological strain, as the women are constantly reminded of their illness and the possibility they may never return to their full capacity. These upper-body difficulties may include discomfort while driving and sleeping, posture disturbances, reduced employability in physical work, and decreased ability to do housework and gardening. Having lymphoedema or the threat of developing it was very distressing for most women. The potential preventive role of physiotherapy-led exercises to prevent further decline and improve function was strongly emphasised during these discussions. Clinicians need to recognise that it is very common for women with breast cancer to experience upper-body morbidity long after their treatment, and consequently every effort to enhance recovery and avoid further deterioration in function is required.     

乳腺癌化疗前后左室舒张功能的变化

目的 对乳腺癌病人化疗前后检测反映左室舒张功能的指标,探讨化疗药物对左室舒张功能的影响。方法 27例乳腺癌病人化疗前后做超声心动图检查,常规测定反映左室舒张功能的指标二尖瓣口下的血流流速曲线,测定EA峰值,E/A比值,DT,IVRT。结果化疗前后比较EA峰值,E/A比值,IVRT有显著差异(p<0.05)。结论 化疗药物可导致左室舒张功能的下降,超声心动图的监测可为安全化疗提供参考。     

Vitamin D: an essential adjuvant therapeutic agent in breast cancer

Low serum levels of vitamin D have been reported as a risk factor for breast cancer. This narrative review provides an update on the impact of vitamin D on hormone receptors, notably estrogen receptor subunits, and gives insights on possible therapeutic interventions to overcome breast cancer. In addition, evidence that supports the beneficial use of vitamin D as adjuvant treatment of breast cancer is summarized. Vitamin D deficiency is significantly widespread in patients with triple-negative tumors. Several studies have observed a possible modulatory effect of vitamin D or its analogues on the expression of different hormone receptors in breast cancer and increased sensitivity to tamoxifen. Vitamin D possesses anti-inflammatory and immunomodulatory effects in patients with breast cancer, and the mechanism of action of vitamin D in patients with breast cancer is discussed. In conclusion, vitamin D appears to have a beneficial role in the prevention and management of breast cancer, however, large-scale, randomized controlled trials are needed to confirm the effects of vitamin D in breast cancer prevention or treatment.     

上海市青浦县农村老年人认知功能和生活功能相互关系调查

作者采用整群随机抽样的方法,对青浦县284名老年人进行MMSE、ADL量表测试。结果发现老年人认知功能的损害在性别、年龄、文化程度、婚姻状况方面存在明显差异,而日常生活能力的减退与文化程度联系不密切。认知功能损害与日常生活功能下降呈正相关,但也有部分二者并非平行减退,应引起临床工作者注意。     

等速训练对乳腺癌术后患者上肢功能的影响

目的 探讨等速运动对乳腺癌术后患者上肢功能的影响。 方法 选取乳腺癌女性患者70例,按随机数字表法分为等速组（36例）和对照组（34例）。2组患者均给予常规康复治疗,等速组在此基础上进行等速肌力训练。分别于治疗前和治疗2个月后（治疗后）,采用放射性核素淋巴扫描观测2组患侧上肢淋巴流量的变化,在腕横纹上10cm处测量2组双侧上臂周径,应用ISOMED2000为等速组记录等速肌力测定值,采用Constant-Murley肩功能评定标准对患者进行上肢功能的评定,采用测角器测量肩关节活动度。 结果 ①治疗后,等速组和对照组的上肢淋巴流量分别为（16.8±2.5）和（10.9±3.4）,较组内治疗前［（7.6±3.4）和（7.7±3.2）］明显增加（P<0.05）,等速组治疗后的上肢淋巴流量明显大于对照组治疗后（P<0.05）;双侧上臂周径差值［（2.1±0.2）和（4.5±0.3）cm］均较组内治疗前［（5.5±0.4）和（5.2±0.8）cm］减小（P<0.05）,等速组治疗后的双侧上臂周径差值明显小于对照组治疗后（P<0.05）。②等速组患者治疗后的等速肌力测量值（峰力矩、总功率、平均功率）均较治疗前明显增加（P<0.05）。③2组患者治疗后的上肢功能评分均较组内治疗前明显增加（P<0.05）,等速组患者治疗后的上肢功能评分总分［（96.74±12.23）分］明显高于对照组治疗后［（84.17±12.16）分］,差异有统计学意义（P<0.05）。④2组患者治疗后的肩关节活动度均较组内治疗前明显增加（P<0.05）,等速组治疗后的肩关节活动度［前屈（150.25±16.13）°、后伸（46.83±8.52）°、外展（169.38±14.53）°、内收（35.93±5.62）°］明显高于对照组治疗后［前屈（144.67±19.15）°、后伸（39.84±6.93）°、外展（137.13±11.67）°、内收（31.68±5.29）°］,且差异有统计学意义（P<0.05）。 结论 等速运动可以提高乳腺癌术后患者的上肢功能。     

乳腺癌化疗患者联合应用大蒜素胶囊对其细胞免疫功能的影响

目的探讨乳腺癌化疗患者联合应用大蒜素胶囊对其免疫功能的影响。方法选取2018年4月至2018年10月在唐山市人民医院行手术治疗,且经病理学诊断为乳腺癌患者62例作为观察对象。应用随机数字表法分为治疗组与对照组,每组各31例。治疗组给予大蒜素胶囊联合EC方案(盐酸表柔比星注射液90mg/m^2+环磷酰胺90mg/m^2,第1天,21d为1个周期,连续4个周期)。对照组患者单纯给予EC方案化疗4个疗程。记录不良反应发生情况,治疗前及治疗结束后行T淋巴细胞亚群检测评价机体免疫功能。结果治疗后两组不良反应发生次数比较(治疗组共70例次,对照组69例次),差异无统计学意义(P均>0.05)。治疗组患者化疗前CD3^+(53.76±4.29)%;CD4^+(40.19±3.71)%;CD8^+(28.61±2.75)%;CD4^+/CD8^+1.41±0.16。化疗后CD3^+(52.41±4.44)%;CD4^+(39.49±4.06)%;CD8^+(28.70±2.76)%;CD4^+/CD8^+1.35±0.94。对照组患者化疗前CD3^+(54.35±4.09)%;CD4^+(40.70±4.09)%;CD8^+(27.62±3.60)%;CD4^+/CD8^+1.49±0.24。化疗后CD3^+(44.27±6.67)%;CD4^+(35.39±4.96)%;CD8^+(30.48±3.43)%;CD4^+/CD8^+1.17±0.20。治疗组治疗后CD3^+、CD4^+、CD4^+/CD8^+有所下降、CD8^+有所上升,但差异无统计学意义(P>0.05)。对照组治疗后CD3^+[由(54.35±4.09)%降到(44.27±6.67)%]、CD4^+[由(40.70±4.09)%降到(35.39±4.96)%]、CD4^+/CD8^+[由(1.49±0.24)降到(1.17±0.20)]有所下降、CD8^+有所上升[由(27.62±3.60)%升到(30.48±3.43)%],差异有统计学意义(t值分别为7.17、4.60、5.71、-3.02,P值分别为0.000、0.000、0.002、0.000);治疗组与对照组比较,CD3^+、CD4^+、CD4^+/CD8^+明显上升、CD8^+明显下降(P均<0.01)。结论乳腺癌化疗患者应用大蒜素胶囊可以改善因化疗引起的免疫功能降低。     

育肾养血抑瘤方结合GnRH-a对早期乳腺癌妇女化疗后卵巢功能保护的临床疗效分析

目的:评价育肾养血抑瘤方结合Gn RH-a对早期乳腺癌妇女化疗后卵巢功能保护的临床疗效。方法:选择2012年1月~2014年6月我院乳腺外科就诊的Ⅰ期、Ⅱ期乳腺癌妇女90例,随机分为三组,每组30例。A组为对照组。B组为西药治疗组,在开始化疗前7~10 d皮下注射0.1 mg醋酸曲普瑞林注射液,隔日注射1次,连续3次,后每周1次,直至化疗结束。C组为中西医结合治疗组,在B组治疗基础上,在开始化疗的同时进行中药(育肾养血抑瘤方)的介入治疗。结果:三组化疗后引起的月经变化有明显差异性(P0.05)。C组化疗后出现闭经时间长于A组和B组(P0.01)。C组的月经恢复时间短于A组和B组(P0.05)。三组化疗后引起的更年期症状有明显相关性(P0.05)。结论:育肾养血抑瘤方结合Gn RH-a对早期乳腺癌妇女化疗后卵巢功能进行了保护,可延长化疗引起闭经的出现时间,最快地恢复化疗引起的闭经,同时提高药物使用的安全性。     

Real-time exercise reduces impaired cardiac function in breast cancer patients undergoing chemotherapy: A randomized controlled trial

BackgroundPrevious studies have reported that chemotherapy results in substantial long-term risk of heart failure. Exercise ameliorates exercise responses and exercise tolerance in patients receiving chemotherapy. The cardioprotective effect of real-time exercise in breast cancer is still unclear.ObjectivesThe aim of the present study was to determine the effect of real-time moderate-to-high–intensity exercise training in women with breast cancer undergoing chemotherapy and to follow up on parameters of cardiac function and exercise capacity at different times. We hypothesized that early moderate-to-high–intensity exercise training has beneficial effects on cardiac function in women with breast cancer undergoing chemotherapy.MethodsThis was a randomized controlled study that included 32 women randomly allocated into the control or exercise group. Exercise began with the first cycle of chemotherapy, and the training program was maintained during chemotherapy with 2 to 3 sessions per week for 3 months. Patients were instructed to perform moderate-to-high–intensity training with aerobic and resistance training. Outcome measurements were echocardiography and cardiopulmonary exercise test. The primary outcome was the change in left ventricle ejection fraction (LVEF). The secondary outcome was peak oxygen consumption (peak VO₂).ResultsThe control group showed lower cardiac systolic function than the exercise group [mean (SD) LVEF 62% (2) and 70% (5), P < 0.05], reduced cardiac diastolic function, and cardiac hypertrophy at 3, 6 and 12 months after chemotherapy. At 6 months after chemotherapy, the exercise group exhibited relatively higher exercise capacity than controls [mean (SD) VO₂ 12.1 (2.2) and 13.6 (2.2) mL/kg/min, P < 0.05]. The main effect size of the study based on echocardiography outcomes was 0.25 (95% confidence interval 0.23 to 0.27), a medium effect size.ConclusionsModerate-to-high–intensity exercise training in breast cancer patients undergoing chemotherapy may prevent impaired cardiac function.Clinical trial registrationhttps://www.clinicaltrials.in.th (Identifier TCTR20190330002).