SAN ANTONIO—Physical exercise during aromatase inhibitor (AI) therapy is associated with a reduction in join pain among postmenopausal breast cancer survivors, reported authors of a randomized Hormones and Physical Exercise (HOPE) study presented at the 2013 San Antonio Breast Cancer Symposium.

Postsurgical therapy with such AIs as anastrozole, letrozole, or exemestane is recommended for 5 years among postmenopausal women treated for hormone receptor–positive, stage 1 to 3 breast cancer.

As many as half of patients report join pain and stiffness during AI therapy, leading to poor compliance and discontinued therapy, which are associated with worse mortality rates, noted Melinda L. Irwin, PhD, MPH, an associate professor of chronic disease and epidemiology at the Yale School of Public Health and co-leader of the Cancer Prevention and Control Research Program at the Yale Cancer Center in New Haven, CT. “Up to 40% of women don’t take AIs daily,” she noted.

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A total of 121 postmenopausal study participants were randomly assigned to undergo a 1-year-long exercise regimen (n = 61) or usual care only (n = 60). Women in the exercise arm of the study reported exercise-dose dependent reductions in pain measurements such as worst pain, pain severity, and pain interference. Five women stopped taking AIs during the study.

Overall, women who exercised saw “about a 30% reduction” in worst-pain scores, versus a 3% decrease among women in the usual-care study arm (P = 0.017),” Dr. Irwin reported.

“Joint pain severity also decreased significantly in exercise versus usual care groups (P = 0.025), as well as joint pain-related interference (P = 0.005),” Dr. Irwin said.

Exercise-associated improvements were seen “regardless of age, disease stage, whether they received chemotherapy, radiation or both, and how long they had been taking AIs,” she noted. Moreover, the benefits might be dose-dependent: women attending at least 80% of supervised exercise sessions saw a median 25% decrease in worst pain scores, while those exercising less often saw only 14% decrease.

Exercise also “favorably impacted” body weight and cardiorespiratory fitness, she added.

The study’s 80% compliance rate with exercise regimens was due in part to assigning these previously largely sedentary patients personal trainers, and paying for their gym memberships, Dr. Irwin said. Patients were motivated in part by awareness of their health issues, she added.

“These results are a promising first step in developing clinical interventions that can improve AI-associated joint pain and, in turn, AI adherence, breast cancer survival, and quality of life,” Dr. Irwin said.

The findings suggested exercise is a better treatment for joint pain than acupuncture and vitamin D therapy, she noted.

The study was funded by the National Cancer Institute (NCI).


  1. Irwin ML et al. S3-03. Presented at: San Antonio Breast Cancer Symposium 2013. Dec. 10-14, 2013; San Antonio.