Supervised Trial of Aerobic versus Resistance Training (START)

Summary of the START Trial

The Supervised Trial of Aerobic versus Resistance Training (START) was the first study to compare aerobic and resistance exercise training to usual care in breast cancer patients receiving chemotherapy. In the primary paper, we found that aerobic exercise was superior to usual care for improving self-esteem, aerobic fitness, and body fat whereas resistance exercise was superior to usual care for improving self-esteem, muscular strength, lean body mass, and chemotherapy completion rate [ Courneya et al. J. Clin. Onc. 2007; 25 :4396-4404] . The finding that resistance exercise improved chemotherapy completion rate was unexpected but exciting because of the well-known association between higher chemotherapy completion rate and lower risk of disease recurrence and death . Moreover, in subgroup analyses from the trial, we found better outcomes for patients who received their preferred exercise intervention, were unmarried, younger, received nontaxane-based chemotherapies, and had more advanced disease [ Courneya et al. Cancer 2008; 112 :1845-53 ]. Finally, we found that benefits to self-esteem and anxiety were still present at six months follow-up [ Courneya et al. Cancer Epi. Bio. Prev. 2007; 16 :2572-8 ].

The START trial also showed that exercise is feasible during breast cancer chemotherapy with a 70% adherence rate that was predicted by higher cardiorespiratory fitness, more advanced disease, and lower depression [ Courneya et al. Med. Sci. Sports Ex. 2008; 40 :1180-7] . In addition, as might be expected, the main barriers to exercise during chemotherapy were mostly chemotherapy-related side effects such as fatigue, feeling sick, and nausea/vomiting [ Courneya et al. Annals Beh. Med. 2008; 35 :116-122]. Finally, maintenance of exercise behavior at six months follow-up was predicted by higher baseline exercise, younger age, breast conserving surgery, strength gains, lower fatigue, a more positive attitude, and a lower body mass index [ Courneya et al. Breast Can. Res. Treat. 2009; 114 :179-87]. Overall, the START trial provided valuable information on the role of exercise during breast cancer chemotherapy. We concluded from the START trial that many b reast cancer patients are able to exercise during chemotherapy and that they can achieve important health benefits including the possibility of a higher chemotherapy completion rate .

Publications from the START Trial

Courneya, K.S. , Segal, R.J., Mackey, J.R., Gelmon, K., Reid, R.D., Friedenreich, C.M., Ladha, A.B. , Proulx, C., Vallance, J.K. , Lane, K., Yasui, Y., & McKenzie, D.C. (2007). Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. Journal of Clinical Oncology , 25 , 4396-4404.

Courneya, K.S. , Segal, R.J., Gelmon, K., Reid, R.D., Mackey, J.R., Friedenreich, C.M., Proulx, C., Lane, K., Ladha, A.B. , Vallance, J.K. , Liu, Q., Yasui, Y., & McKenzie, D.C. (2007). Six-month follow-up of patient-rated outcomes in a randomized controlled trial of exercise training during breast cancer chemotherapy. Cancer Epidemiology, Biomarkers & Prevention , 16 , 2572-2578.

Courneya, K.S. , McKenzie, D.C., Mackey, J.R., Gelmon, K., Reid, R.D., Friedenreich, C.M., Ladha, A.B. , Proulx, C., Vallance, J.K. , Lane, K., Yasui, Y., & Segal, R.J. (2008). Moderators of the effects of exercise training in breast cancer patients receiving chemotherapy: A randomized controlled trial. Cancer , 112 , 1845-1853.

Courneya, K.S. , Segal, R.J., Gelmon, K., Reid, R.D., Mackey, J.R., Friedenreich, C.M., Proulx, C., Lane, K., Ladha, A.B. , Vallance, J.K. , & McKenzie, D.C. (2008). Predictors of supervised exercise adherence during breast cancer chemotherapy. Medicine & Science in Sports & Exercise , 40 , 1180-1187.

Courneya, K.S. , McKenzie, D.C, Reid, R.D., Mackey, J.R., Gelmon, K., Friedenreich, C.M., Ladha, A.B. , Proulx, C., Lane, K., Vallance, J.K. , & Segal, R.J. (2008). Barriers to supervised exercise training in a randomized controlled trial of breast cancer patients receiving chemotherapy. Annals of Behavioral Medicine , 35 , 116-122.

Courneya, K.S. , Reid, R.D., Friedenreich, C.M., Gelmon, K., Proulx, C., Vallance, J.K. , McKenzie, D.C., & Segal, R.J. (2008). Understanding breast cancer patients' preference for two types of exercise training during chemotherapy in an unblinded randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity , 5 , 52.

Courneya, K.S. , Friedenreich, C.M., Reid, R.D., Gelmon, K., Mackey, J.R., Ladha, A.B. , Proulx, C., Vallance, J.K. , & Segal, R.J. (2009). Predictors of follow-up exercise behavior six months after a randomized trial of exercise training during breast cancer chemotherapy. Breast Cancer Research and Treatment , 114 , 179-187.

Dolan, L.B., Gelmon, K., Courneya, K.S. , Mackey, J.R., Segal, R.J., Lane, K., Reid, R.D., & McKenzie, D.C. (2010). Hemoglobin and aerobic fitness changes with supervised exercise training in breast cancer patients receiving chemotherapy. Cancer Epidemiology, Biomarkers & Prevention , 19 , 2826-2832.