CLEVELAND, Ohio — A small pilot study in Cleveland, and a much larger national study, have reached similar conclusions about black women who have been treated for breast cancer: They’re likely not getting enough crucial exercise that could help with staying healthy and avoiding a cancer recurrence.
The problem isn’t unique to black women; the national study, published online last week in the journal Cancer, found that most women in the study, regardless of race or ethnicity, didn’t meet the national physical activity guidelines – at least 150 minutes of moderate activity or 75 minutes of vigorous activity each week — after they were diagnosed. But as a group, black women were even less likely to do so.
Researchers at the University of North Carolina at Chapel Hill looked at the levels of and changes in physical activity – before and after diagnosis – in 1,735 women ages 20 to 74, who were diagnosed with breast cancer between 2008 and 2011.
Only 35 percent were getting the recommended physical activity; nearly 60 percent had experienced a decrease in activity (an average of the equivalent of five hours of brisk walking each week) six months after being diagnosed.
When compared with white women, black women in the study were about 40 percent less likely to meet physical activity recommendation guidelines post-diagnosis.
Most of the previous clinical trials that look at the effect of aerobic exercise and resistance (weight) training on outcomes for breast cancer patients had been conducted in academic and clinic-based settings; the patients taking part in those studies – like the University of North Carolina study – were typically white.
Because black women have higher breast cancer mortality rates than white women, researchers in Cleveland decided to focus on them exclusively. They wanted to see how exercise could positively affect their body composition and improve cancer-related biomarkers, such as lowering insulin levels and certain hormone levels.
“There’s emerging evidence that exercise may be beneficial for breast cancer survivors in terms of lowering the risk of a recurrence, and for survival,” said Dr. Cynthia Owusu, an oncologist at University Hospitals Case Medical Center and one of the study investigators.
“The concern is that in African Americans, they have the worst prognosis when it comes to breast cancer; it is really a shame that they’re the least likely to engage in physical activity,” she said. “The [University of North Carolina] study confirmed it. And these are the women who bear the highest burden.”
Owusu and colleagues from Case Western Reserve University, the Cleveland Clinic and MetroHealth Medical Center teamed up with the staff at the Beachwood location of The Gathering Place, a non-profit cancer support organization. They designed a study in which black women would take part in 20 weeks of exercise in a group setting along with a support group and independent walking. All of the women had either completed treatment or were within a year of doing so.
The feasibility study was small on purpose – only 19 participants ended up taking part – so the researchers could see if it could be done successfully in a community setting before trying to conduct it on a much larger scale.
While the participants as a group didn’t experience much weight loss, there was a significant decrease in waist circumference and percent total body fat among those who attended at least 70 percent of the exercise sessions.
Additionally, the women’s overall quality of life improved, including lowering levels of depression, decreasing insulin resistance and improving physical function.
The findings were published last December in the Journal of Physical Therapy Health Promotion.
“For us to be able to make a positive impact, the programs that are designed must have in place strategies and measures to encourage adherence,” Owusu said. “That’s where we saw changes in body composition.”
While the researchers continue to analyze data from the study, they’re also applying for funding to do a larger study. If all goes well, researchers will begin enrolling in mid-2015, with the goal of getting 280 patients (not only black patients but those who are of lower economic status) and split them into two groups, one that exercises and one that doesn’t.
When Alisha Bates’s oncologist asked her if she would be interested in taking part in the study she jumped at the chance.
Not only was it an opportunity for Bates to become more physically active, it would also give her a chance to meet other women like her.
Diagnosed with breast cancer in 2011 at age 29, Bates underwent lumpectomy surgery at MetroHealth Medical Center, followed by chemotherapy and radiation.
Treatment had not only derailed Bates’s regular exercise routine, it also included drugs whose side effects caused weight gain.
“Before, I could diet and go to the gym and drop five pounds, no problem,” said Bates, of South Euclid. “It’s frustrating.”
The study motivated Bates to get back into an exercise routine. Today she tries to exercise at least three days a week, either at the gym or on her own.
But it’s not easy.
“To this day, I get exhausted so fast,” she said. “With the surgery, you have to be mindful of how much weight you can lift.”
Bates said she hopes the studies and their findings will get all black women – not just breast cancer survivors – to pay attention more to their eating and exercise habits, and become more active.
“I’m walking more, I’m using the stairs at work instead of the elevator,” she said. “The study just motivated me to want to move more. And I can now move more.”
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