Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)


School of Public Health

First Advisor

Melinda Irwin

Second Advisor

Brenda Cartmel


Purpose: Despite effective therapies and treatments, breast cancer survivors often suffer from distressing side effects which may increase depressive symptomatology. Aromatase inhibitors (AI) are widely used as adjuvant treatment in breast cancer patients, but are associated with side effects such as joint pain that may impact quality of life. We conducted, in 121 breast cancer survivors receiving an AI, a yearlong randomized trial of exercise versus usual care on depressive symptomology.

Methods: Eligibility criteria included taking an AI for at least 6 months, reporting < 90 minutes per week of exercise and no strength training, and reporting > 3 on a scale of 10 for worst joint pain on the Brief Pain Inventory (BPI). Participants were randomly assigned to exercise (150 minutes per week of aerobic exercise and supervised strength training twice per week) or usual care. The Centers for Epidemiological Studies: Depression Scale (CES-D) was completed at baseline and 6- and 12 months. Intervention effects were evaluated using generalized linear models, comparing change at 6- and 12 months.

Results: Over 12 months, a 4.7 point (36%) decline in CES-D score was seen for women randomly assigned to exercise (n = 60) versus a 0.3-point (2%) decline among those receiving usual care (n = 60; p <0.05). In secondary analysis, women that scored above the generally accepted CES-D score cutoff of 16 (indicating depressive symptomatology), had a 12.6 (+2.6) point (50%) decrease (mean+SD) in CES-D score, significantly greater than those in this category who were assigned to usual care, 5.5 (+2.8) point decrease (29%). Women with later stage breast cancer, those who had taken AIs for a longer period of time, and those who had attended more supervised exercise sessions showed a greater decrease in CES-D scores compared to their counterparts.

Conclusion: Exercise led to favorably reductions in CES-D scores in previously inactive breast cancer survivors taking AIs. Exercise programs should be implemented for breast cancer survivors in an effort to reduce depressive symptoms.


This is an Open Access Thesis.

Open Access

This Article is Open Access