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, asdetermined 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 fullcompletion of definitive therapy for malignant disease. Definitive therapy isdefined as:

• Surgery plus radiation

• Surgery plus chemotherapy

• Surgery plus trastuzumab

• Exercise intolerance (i.e., patients must have a VO2peak below the predicted foractive age and sex-matched individuals. (+/- the technical error of 1.32mL/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 ECGfindings or other inappropriate response to exercise as determined by the PI, asdefined by any of the following criteria:

• Achieving a plateau in oxygen consumption, concurrent with an increase in poweroutput;

• A respiratory exchange ratio ≥ 1.10;

• Attainment of maximal predicted heart rate (HRmax) (i.e., within 10 bpm ofage-predicted HRmax [HRmax = 220-Age[years]);

• Volitional exhaustion, as measured by a rating of perceived exertion (RPE) ≥ 18on 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 plannedstudy procedures

• Thrombosis of lower extremities

• Suspected dissecting aneurysm

• Uncontrolled asthma

• Pulmonary edema

• Respiratory failure

• Acute non-cardiopulmonary disorders that may affect exercise performance or beaggravated 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 thannon-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 theinvestigator, makes the participant a poor candidate for the trial.