Breast Cancer, Reasoning, and Activity Intervention (BRAIN)

The objective of the proposed study is to test the effectiveness of aerobic exercise training, delivered in a community-based setting, for improving cognitive function in post-menopausal Breast Cancer Survivors (BCS).

Aim 1: This study will compare changes in cognitive function and brain health in post-menopausal breast cancer survivors (BCS) randomized to either: 1) a community-based aerobic exercise program; or 2) a health education program (control group). Aim 2: Gather information on the intervention's potential for scalability using the RE-AIM framework. Eligible BCS (N=160) will be randomized to one of the following 6-month programs: Aerobic Exercise Training (n=80; progressive moderate-intensity exercise delivered by community fitness center personal trainers) or Health Education (n=80; attention control receiving cancer support and education). To assess Aim 1, participants will complete measures at baseline (Month 0), post-intervention (Month 6), and follow-up (Month 12; i.e., 6 months after post-intervention). Aim 1 measures include: neurocognitive tasks, functional magnetic resonance imaging (fMRI; M0 and M6 only), graded exercise testing, physical activity monitoring (i.e., accelerometry), and questionnaires. To assess Aim 2, outcomes defined by the RE-AIM framework (a dissemination and implementation framework) will be measured, including: study reach(e.g., participation rate), intervention effectiveness (i.e., Aim 1), intervention adoption (e.g.,number of community sites invited that participate), implementation (e.g., fidelity of intervention delivery, participant satisfaction), and maintenance (e.g., Aim 1 maintenance of effects, participant retention). Findings of this study will lay the groundwork toward our long-term goal of disseminating an evidence-based program for managing cognitive impairment in individuals diagnosed with cancer.

Breast cancer survivors randomized to the intervention group will participate in a moderate-intensity aerobic exercise program for 24 weeks.

Individuals randomized to Health Education will receive individual education and counseling related to general cancer-related health and support across 24 weeks.

Breast cancer survivors in the intervention group will participate in a 24-week moderate intensity exercise program led by community-based fitness center personal trainers. Individually-tailored exercise prescriptions will be developed based upon each participant's baseline maximal graded exercise test (heart rate corresponding with %VO2 peak) and symptom limitation. Sessions will be progressive in nature such that the volume of exercise increases across weeks. Treadmill walking is the primary mode of exercise. However, participants will be permitted to use other cardiovascular equipment (e.g., elliptical machines, stationary bicycles) as prescribed by their exercise trainer. The trainer will supervise three weekly exercise sessions in Weeks 1-2, two in Weeks 3-4, one in Weeks 5-8, biweekly across weeks 9-16, and monthly in Weeks 17-24 (N=20 supervised sessions).

Breast cancer survivors in the Health Education group will participate in education sessions with a health educator and receive monthly newsletters/webinars (N=20 total contacts) across 24 weeks. The program will include cancer support and discussion of cancer-related wellness topics (e.g., stress management, coping). Control group participants will be offered a 6-month fitness center membership upon study completion.

Change in interference score on Stroop task, with negative values indicating lower inhibitory control.

Change in reaction time on Task-switch task, with higher values indicating lower cognitive flexibility

Change in reaction time on spatial working memory task, with faster reaction times indicating better spatial working memory

Change in number recalled on Auditory Verbal Learning task, with greater number of items recalled indicating better verbal memory

change in response time, with shorter response time associated with faster relational memory processes

change in mean cortical thickness of brain regions of interest as measured by an anatomic MRI brain scan

change in within-network pairwise correlation estimates as measured using a multiband echo planar imaging (mb-EPI) functional MRI sequence

The perceived cognitive impairments subscale of the Functional Assessment in Cancer Therapy - Cognition (FACT-Cog) will be used to measure self-reported cognition. Scores range from 0-72, with higher scores indicating better cognitive function.

sociodemographics questionnaire to describe demographics characteristics and experience among personal trainers

The Functional Assessment in Chronic Illness Therapy (FACIT) - Fatigue Scale will be used to measure cancer-related fatigue. Scores range from 0-52, with higher scores indicating less cancer-related fatigue.

Breast cancer is often classified specifically as female breast cancer, as 99% of cases occur in women. Given low rates of breast cancer among males, males would require a separate study and it is not statistically justified to include males in this study.

Inclusion Criteria Able to provide medical record release to confirm eligibility First, primary diagnosis of Stage I-IIIa breast cancer Post-menopausal at the time of diagnosis Post-surgery and completed primary treatment (i.e., surgery, chemotherapy, and/or radiation therapy) 3-24 months prior to enrollment No evidence of possible cognitive impairment as assessed using the Telephone Interview of Cognitive status (TICS-M) Self-report 20+ minutes of exercise on 2 or fewer days per week within the previous six months Receive physician's clearance to participate in an exercise program Ability to complete assessments by themselves or with assistance Exclusion Criteria: Pre- or peri-menopausal at the time of diagnosis with breast cancer Stage 0 breast cancer diagnosis OR metastatic disease Currently receiving or <3 months since receiving chemotherapy or radiation therapy for cancer, or greater than 24 months post primary treatment Planned surgery during the intervention period Second cancer diagnosis (excluding non-invasive skin cancers; including breast cancer recurrence) History of stroke, transient ischemic attack, other neurological disorders, or brain surgery involving tissue removal as confirmed via clinical determination Clinically significant TICS-M score Not able to provide physician re-clearance for exercise if required based upon clinically significant baseline exercise test Contraindications to functional magnetic resonance imaging (fMRI) in accordance with the Mayo Clinic Department of Radiology safety protocols Clinically significant MRI scan as determined by physician review in which the following is advised via radiologist overread: remarkable/abnormal limited diagnostic brain image with recommended medical follow-up Enrolled in another physical activity program Unable to walk without assistance or devices Unwilling to complete study requirements Unwilling to be randomized to the exercise group or health education group Unable or unwilling to continuously wear and regularly sync/charge an activity tracker during the study period Unable to travel regularly to the study locations for intervention sessions and data collection Unwilling to return to enrolling institution for follow-up

Although the final dataset will not include identifying information, there is still a possibility of deductive disclosure of identity. Therefore, data will not be shared via an NIH or approved public repository; however, we will share de-identified data as required for publication in scientific journals and with outside collaborators and scientists upon request.

Data will be shared via scientific journals at the time of publication and with outside collaborators before publication.

We will make data available to researchers who agree to use the data only for research purposes, protect the data using secure computer technologies, and destroy the data after relevant analyses are completed and manuscripts published.