A feasibility study of a Nordic walking intervention for women experiencing aromatase inhibitor associated arthralgia

Abstract

Background: Women taking AIs (Aromatase Inhibitors) as treatment for breast cancer commonly experience joint pain and stiffness (aromatase inhibitor associated arthralgia; AIAA) which can lead to early discontinuation of treatment. Exercise is often recommended and there is preliminary evidence it might prove helpful. Nordic Walking is a popular form of exercise in women with breast cancer, and based on a biopsychosocial model, could provide additional benefits over normal walking alone. There is a need to find interventions for this problem; therefore a study was designed to determine the acceptability and safety of a Nordic walking intervention in women with AIAA, and to test the feasibility of a proposed randomised controlled trial in terms of recruitment, methods and measures.

Methods: A feasibility study was carried out in a sample of women with AIAA using a randomised control design, with a waiting list control. Forty women were recruited and randomised to either intervention (six weeks of supervised group Nordic walking training followed by six weeks of 4 x 30min/week self managed Nordic walking) or enhanced usual care. Data were collected on feasibility outcomes including recruitment, acceptability (attrition and adherence), safety, and research design issues. Outcome data (pain, depression, quality of life & self-efficacy) were collected at baseline, T1 (following supervised group Nordic walking training) and T2 (following self managed Nordic walking).

Findings: The recruitment rate (25%) was comparable to other breast cancer exercise studies, suggesting that there was interest in this type of intervention despite joint pain. Attrition was low (10%) and safety demonstrated. In the intervention group, adherence was high for weekly supervised Nordic walking sessions (>90%) but low for self managed sessions (average of two sessions per week, with most (70%) only managing one), although higher exercise frequencies were attained when all aerobic activity was considered together. Participants in the control group also reported increased physical activity, mainly through normal walking. Most of the outcome measures used appeared suitable for use, demonstrated responsiveness to change and gave support for using a biopsychosocial model of pain. Improvements in pain and other outcomes were demonstrated in both the intervention and control groups, possibly as both increased their physical activity.

Conclusions: Our findings indicate that women with AIAA may not adhere to an intensive programme of self-managed NW; however, increasing physical activity is feasible in this population, and may improve symptoms. A future trial should test a physical activity intervention including a supervised component throughout to maximise adherence.

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