Aerobic Exercise Might Help ‘Chemo Brain’ Symptoms

As if breast cancer – and the excruciating chemotherapy used to treat it – aren’t bad enough, a growing number of women also struggle with chemotherapy-related cognitive impairment (CRCI). The research suggests that as many as three out of four women who receive the treatment report “a decreased ability to remember, concentrate, and/or think,” a condition many refer to as “chemo brain.”

And the testing appears to back that up. Chemotherapy patients “tend to perform worse on neuropsychological tests assessing executive functioning, working memory, processing speed, spatial ability, and language/verbal ability as compared to women diagnosed with breast cancer who have not received chemotherapy or to controls without a history of cancer.”

Could Aerobics Help With Chemo Brain?

This troubling jump in chemo brain cases has spurred multiple investigations into what caregivers can do to help. The ACTIVATE trial is one such inquiry. Its authors wanted to find out if aerobic exercise, embraced during chemotherapy, might help preserve cognitive function and maintain the quality of life among breast cancer patients.

Operating out of Ottawa and Vancouver, Canada, the researchers designed the ACTIVATE study as a two-arm, two-center randomized controlled trial involving nearly 60 women waiting to start chemo. Researchers randomly assigned the study participants to one of two groups:

• An aerobic exercise group, which began exercise during chemotherapy.
• Or a usual care group, whose members received chemo without exercise until after finishing their treatment. 

The exercise intervention lasted between 12 to 24 weeks and included both supervised and independent, home aerobic training. Researchers measured the primary outcome, objective cognitive function, through more than a dozen standardized neuropsychological tests. They considered secondary outcomes that included self-reported cognitive function and the perceived impact of cognitive impairment.

Mixed Results

The study results exposed no consequential differences in objective cognitive function between the exercise and usual care groups after the intervention. Based on that, the researchers inferred that aerobic exercise didn’t lead to measurable improvements in cognitive performance, based on the standard tests. This lack of difference could be attributed to multiple factors:

• Baseline cognitive function levels.
• The sensitivity of neuropsychological tests used.
• The potential dissipative effects of exercise on cognitive performance shortly after sessions.

Additionally, participants in the exercise group may have experienced domain-specific improvements not captured by standard neuropsychological testing.

But four out of six self-reported cognitive function measures showed notable improvements in the aerobic exercise group. This, the researchers insist, underscores the potential of aerobic exercise to boost perceived cognitive ability and mitigate the impact of cognitive impairments on quality of life, despite the dearth of objective gains. This discrepancy suggests that while objective tests might not reflect improvements, patients could still experience enhanced cognitive perceptions and related quality of life from aerobic exercise.

Implications and Future Directions

The ACTIVATE trial results suggest that while aerobic exercise might not lead to measurable changes in objective cognitive function, it can improve self-reported cognitive function and quality of life. And the researchers argue that this raises critical questions about the roles of subjective and objective measures in getting a better grasp of the cognitive health of cancer patients.

The trial illustrates the need for more data on answering the questions of how and why exercise influences cognitive function. Additional inquiries could explore the roles of exercise intensity, duration, and the incorporation of cognitively stimulating activities.

Future research might consider longer-term intervention periods while expanding the scope to include exercise programs that integrate strength and balance training.

Further Reading

Breast Cancer and Depression

Moving the Field Forward: New Data Regarding Women’s Mental Health

Aerobic Exercise for Erectile Dysfunction