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Symptom Management and Supportive Care

Effects of Aerobic Exercise Training in Anemic Cancer Patients Receiving Darbepoetin Alfa: A Randomized Controlled Trial

^aUniversity of Alberta, Edmonton, Canada; ^bDuke University Medical Center, Durham, North Carolina, USA; ^cCross Cancer Institute, Edmonton, Canada

Key Words. Anemia • Erythropoiesis-stimulating agent • Exercise • Fatigue • Fitness • Physical activity

Correspondence: John R. Mackey, M.D., Department of Oncology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada, T6G 1Z2. Telephone: 780-432-8221; Fax: 780-432-8888; e-mail: johnmack{at}cancerboard.ab.ca

Received January 23, 2008; accepted for publication July 21, 2008; first published online in THE ONCOLOGIST Express on September 8, 2008.

Disclosure: Employment/leadership position: None; Intellectual property rights/Inventor: None; Consultant/advisory role: John R. Mackey, Amgen Canada advisory board; Honoraria: John R. Mackey, Amgen Canada; Research funding: Amgen Canada, Inc.; Ownership interest: None; Expert testimony: None; Other: None. No author has investment, licensing, or other commercial interests in the subject under consideration. Role of the funding source: The study was an investigator-initiated protocol, with funding and drug supply provided by Amgen Canada, Inc. Amgen Canada had initial input into the design of the study, but study conduct, data collection, management, analysis, and interpretation were done independently of Amgen Canada. The prepared manuscript was reviewed by Amgen Canada prior to submission.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

Background. Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity, increased fatigue, and lower quality of life (QoL). Erythropoiesis-stimulating agents (ESAs) have been shown to improve these outcomes; however, it is unknown if additional benefits can be achieved with aerobic exercise training.

Methods. We conducted a single-center, prospective, randomized, controlled trial in 55 mild-to-moderately anemic patients with solid tumors. Patients were randomized to either darbepoetin alfa alone (DAL, n = 29) or darbepoetin alfa plus aerobic exercise training (DEX; n = 26). The DEX group performed aerobic exercise training three times per week at 60%–100% of baseline exercise capacity for 12 weeks. The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy–Anemia scale. Secondary endpoints were fatigue, cardiorespiratory fitness (VO_2peak), hemoglobin (Hb) response, and darbepoetin alfa dosing.

Results. Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences. The DEX group had a significantly greater VO_2peak than the DAL group (mean group difference, +3.0 ml/kg per minute; 95% confidence interval, 1.2–4.7; p = .001) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing.

Conclusions. Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements. Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs.

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