Exercise Therapy to Improve Cardiovascular Health in Post-Menopausal Women After Treatment for Early Stage Breast Cancer

Inclusion criteria

• Aged 21-80 years
• Female
• Surgically resected early stage (I-III) primary breast cancer
• Post-menopausal, defined as one of the following:
• Age ≥ 45 with no menses for at least 2 years
• Chemically and/or surgically induced menopause through ovarian suppression, as determined by the primary oncologist
• Estradiol level of ≤30 pg/mL
• An interval of at least one year, but no more than five years, following the full completion of definitive therapy for malignant disease. Definitive therapy is defined as:
• Surgery plus radiation
• Surgery plus chemotherapy
• Surgery plus trastuzumab
• Exercise intolerance (i.e., patients must have a VO2peak below the predicted for active age and sex-matched individuals. (+/- the technical error of 1.32 mL/kg/min)\].
• Note: Normative values are available up to 80 years of age)
• Able to complete an acceptable baseline CPET, in the absence of high-risk ECG findings or other inappropriate response to exercise as determined by the PI, as defined by any of the following criteria:
• Achieving a plateau in oxygen consumption, concurrent with an increase in power output;
• A respiratory exchange ratio ≥ 1.10;
• Attainment of maximal predicted heart rate (HRmax) (i.e., within 10 bpm of age-predicted HRmax \[HRmax = 220-Age\[years\]);
• Volitional exhaustion, as measured by a rating of perceived exertion (RPE) ≥ 18 on the BORG scale
• Willingness to comply with all study-related procedures.

Exclusion criteria

• Any of the following absolute contraindications to cardiopulmonary exercise testing:
• Acute myocardial infarction within 3-5 days of any planned study procedures
• Unstable angina
• Uncontrolled arrhythmia causing symptoms or hemodynamic compromise
• Recurrent syncope
• Active endocarditis
• Acute myocarditis or pericarditis
• Symptomatic severe aortic stenosis
• Uncontrolled heart failure
• Acute pulmonary embolus or pulmonary infarction within 3 months of any planned study procedures
• Thrombosis of lower extremities
• Suspected dissecting aneurysm
• Uncontrolled asthma
• Pulmonary edema
• Respiratory failure
• Acute non-cardiopulmonary disorders that may affect exercise performance or be aggravated by exercise (e.g., infection, renal failure, thyrotoxicosis)
• Presence of any other concurrent, actively treated malignancy
• History of any other malignancy treated within the past 3 years (other than non-melanoma skin cancer)
• Presence of distant metastatic disease (i.e., stage IV)
• Room air desaturation at rest ≤ 85%
• Mental impairment leading to inability to cooperate.
• Any other condition or intercurrent illness that, in the opinion of the investigator, makes the participant a poor candidate for the trial.