Reducing Exercise Intolerance through Inspiratory Muscle Training in Obese Breast Cancer Survivors, IMOCS Trial

Inclusion Criteria

• Age >= 18 years
• Completed active treatment for a stage 0–III breast cancer diagnosis within 6 months to 5 years of enrollment
• Obese as defined by a body mass index (BMI) of 30 to 50 kg/m^2
• Patients who are on adjuvant endocrine therapy will be allowed to participate

Exclusion Criteria

• Not sedentary (participating in 90 minutes (min) or more of moderate intensity activity per week)
• Have no limitations to physical activity as assessed by answering 2 (limited a little) or 1 (limited a lot) on any of the 10-questions in the RAND-36 physical function subscale (this criterion ensures that all participants have some degree of exercise intolerance)
• Functional limitations that make independent exercise unsafe (e.g., walker/wheelchair use)
• Answer 1 (limited a lot) in any of the following two items of the RAND-36 physical function subscale: 1) walking one block; 2) bathing and dressing themselves
• Metastatic breast cancer (at study start or during study period)
• Uncontrolled intercurrent illness including lung disease, heart disease, metabolic disease; no exacerbations for disease in past 4 weeks; stable on medications for chronic conditions for at least 3 weeks; change in medications during study period will lead to exclusion on a case-by-case basis after consultation with clinicians if the new medication/dose change could impact training program for participants or testing results (such as beta blockers that change the heart rate response to exercise, or diuretics that could change stroke volume, or chronic obstructive pulmonary disease (chronic obstructive pulmonary disease [COPD]/asthma medications that could change dyspnea perception, etc)
• Ongoing or active infection with recent (within 1 month) antibiotics or oral steroids
• Bilateral axillary lymph node dissection (ALND) of > 5 lymph nodes on each side, which could increase risk of lymphadenopathy with repeated blood pressure measurements during exercise or if patient has been advised by their clinician to avoid repeated blood pressure (BP) measures on both arms. Bilateral sentinel lymph node biopsy (SLNB) will be allowed
• Heart disease precluding exercise (decompensated congestive heart failure, unstable angina pectoris, uncontrolled or sustained cardiac arrhythmia)
• Psychiatric illness/social situations that would limit compliance with study requirements
• Orthopedic or neuromuscular disorders or arthritis that preclude participation in exercise
• Unwilling or unable to follow protocol requirements
• Pregnant, trying to get pregnant, or nursing
• Any condition which in the investigator’s opinion deems the subject an unsuitable candidate to participate in this study
• Presence of provokable electrocardiography (ECG) changes suggestive of heart disease, or dangerous arrhythmias or exercise induced hypertension, etc. during the cardiopulmonary exercise test
• Non-English speaking because pulmonary function and exercise testing measurements require patients to promptly comply with a series of instructions in real time with minimal lag. Having a translator available during all testing and them being able to translate all commands quickly and effectively is not feasible