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Tsuji K, Sasai H, Kiyohara K, Nakata Y, Nishiwaki H, Ohta T, Ochi E, Takano T, Tatematsu N, Matsuoka YJ. Japan's cancer survivorship guidelines for exercise and physical activity. Jpn J Clin Oncol 2025; 55:12-20. [PMID: 39297634 PMCID: PMC11708214 DOI: 10.1093/jjco/hyae126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/28/2024] [Indexed: 01/11/2025] Open
Abstract
OBJECTIVE This research aimed to establish the inaugural evidence-based cancer survivorship guidelines for Japan, with a particular focus on exercise and physical activity, in order to enhance health outcomes for cancer survivors. METHODS A panel of experts, including oncologists, physicians, exercise scientists, epidemiologists and patient advocates, utilized a modified Delphi process and systematic reviews to establish consensus on exercise recommendations for cancer survivors. The panel focused on setting the objectives of the Clinical Practice Guidelines and addressing crucial clinical issues in Japan. Recommendations were formulated based on the strength and certainty of evidence, the benefit-harm balance and patient values and preferences. RESULTS The panel formulated exercise recommendations for cancer survivors of two age groups: 18-64 years and ≥65 years. The recommendations for both age groups are consistent, emphasizing the importance of regular exercise and physical activity tailored to individual capabilities and health conditions. The guidelines underline the benefits of exercise in improving the overall health and quality of life of cancer survivors. This consensus on exercise recommendations marks a significant step in the development of comprehensive cancer survivorship guidelines in Japan, with potential implications for improving clinical outcomes and advancing research in cancer survivorship. CONCLUSIONS These guidelines will serve as a critical resource for cancer survivors, highlighting exercise as a key component of survivorship care, and for clinicians, in recommending appropriate physical activities to improve survivor health and well-being.
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Affiliation(s)
- Katsunori Tsuji
- Sports Research Center, Hosei University, Kawasaki-shi, Kanagawa, Japan
| | - Hiroyuki Sasai
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Kosuke Kiyohara
- Department of Food Science, Otsuma Women’s University, Chiyoda-ku, Tokyo, Japan
| | - Yoshio Nakata
- Institute of Health and Sport Sciences, University of Tsukuba, Tsukuba-shi, Ibaraki, Japan
| | - Hiroki Nishiwaki
- Division of Nephrology, Department of Internal Medicine, Showa University Fujigaoka Hospital, Yokohama-shi, Kanagawa, Japan
- Showa University Research Administration Center (SURAC), Showa University, Shinagawa-ku, Tokyo, Japan
- Institute of Clinical Epidemiology (iCE), Showa University, Shinagawa-ku, Tokyo, Japan
| | - Takahisa Ohta
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute for Geriatrics and Gerontology, Itabashi-ku, Tokyo, Japan
| | - Eisuke Ochi
- Faculty of Bioscience and Applied Chemistry, Hosei University, Koganei-shi, Tokyo, Japan
- Graduate School of Sports and Health Studies, Hosei University, Machida-shi, Tokyo, Japan
| | - Toshimi Takano
- Breast Medical Oncology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Koto-ku, Tokyo, Japan
| | - Noriatsu Tatematsu
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya-shi, Aichi, Japan
| | - Yutaka J Matsuoka
- Division of Quality Assurance Programs, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
- Division of Cancer Information Service, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
- Division of Policy Evaluation, National Cancer Center Institute for Cancer Control, Chuo-ku, Tokyo, Japan
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Nero DDSM, de Lira CRN, da Silva Lima Paz CL, de Farias Costa PR, de Magalhães Cunha C, Amador Bueno A, de Jesus RP, de Oliveira LPM. Effect of physical activity on depression, anxiety, and stress in women surviving breast cancer: A systematic review and meta-analysis of randomized clinical trials. J Health Psychol 2024. [DOI: 10.1177/13591053241298752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2025] Open
Abstract
Breast cancer treatment can lead to psychological distress, including depression, anxiety, and stress. We systematically investigated the effect of physical exercise on these factors in women surviving breast cancer (WSBC). Eight databases were searched to identify eligible randomized controlled trials (RCTs). Data extraction and bias risk analysis were conducted using standardized tools, with meta-analysis performed using RevMan® software. Out of 3529 documents initially identified, 15 RCTs were included, comprising 2756 WSBC (1284 in intervention groups and 1472 in control groups), with 2082 participants in depression analyses, 513 in anxiety analyses, and 161 in stress analyses. Meta-analyses showed that physical exercise promoted significant reduction in depression and anxiety. Subgroup analyses showed greater reduction in anxiety when aerobic and resistance exercise were combined. Only two studies investigated stress, with less robust data suggesting improvement when combining aerobic and resistance interventions. Future RCTs with standardized intervention protocols are needed to confirm these findings.
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Sitjar PHS, Tan SY, Wong M, Li J, Jalil RBA, Aw H, Lim EH, Goh J. Combined aerobic and strength exercise training on biological ageing in Singaporean breast cancer patients: protocol for the Breast Cancer Exercise Intervention (BREXINT) Pilot Study. GeroScience 2024; 46:6029-6038. [PMID: 38546907 PMCID: PMC11493934 DOI: 10.1007/s11357-024-01145-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 03/18/2024] [Indexed: 10/23/2024] Open
Abstract
Breast cancer (BC) is the most prominent cancer amongst women, but fortunately, early diagnosis and advances in multimodality treatments have improved patient survivability. Cancer survivors, however, experience increased biological ageing which may accelerate other co-morbidities. Exercise intervention is a promising clinical adjuvant approach to improve BC patients' physiological function, recovery from treatment, and quality of life. However, the effects of combined aerobic and strength exercise training on biological ageing in BC patients have not been studied. The Breast Cancer Exercise Intervention (BREXINT) Pilot Study will evaluate the effects of a 24-week combined aerobic and strength exercise intervention against usual care in 50 BC patients' post-treatment randomised to either group. The primary outcomes include changes in cardiorespiratory fitness, muscle strength, cancer-related symptoms, and rate of biological ageing following exercise intervention period. The secondary outcomes include habitual physical activity measured with tri-axial accelerometery and supporting questionnaires, including physical activity, food diary, and quality of life questionnaires. This study will identify the effects of combined aerobic exercise strength training on biological ageing in BC patients from Singapore. Results from this study could further support the implementation of regular exercise programmes as routine care for cancer patients.
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Affiliation(s)
- Patrick Henry Sebastian Sitjar
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Exercise Physiology & Biomarkers Laboratory, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
| | - Si Ying Tan
- SingHealth Duke-NUS Breast Centre, Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, Singapore General Hospital (SGH), Singapore, Singapore
- Department of Breast Surgery, Division of Surgery and Surgical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
| | - Mabel Wong
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore
- KK Breast Centre, KK Women's and Children's Hospital (KKH), Singapore, Singapore
| | - Jingmei Li
- Laboratory of Women's Health & Genetics, Agency for Science, Technology and Research (A*STAR), Genome Institute of Singapore (GIS), Singapore, Singapore
| | - Rufaihah Binte Abdul Jalil
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore
- Centre for Healthy Longevity, National University Health System (NUHS), Singapore, Singapore
| | - Huizhen Aw
- Singapore Cancer Society (SCS), Singapore, Singapore
| | - Elaine Hsuen Lim
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore.
- Division of Community Outreach and Philanthropy, National Cancer Centre Singapore (NCCS), Singapore, Singapore.
| | - Jorming Goh
- Healthy Longevity Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Exercise Physiology & Biomarkers Laboratory, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
- Division of Medical Oncology, National Cancer Centre Singapore (NCCS), Singapore, Singapore.
- Department of Physiology, Yong Loo Lin School of Medicine, National University of Singapore (NUS), Singapore, Singapore.
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Li L, Wang Y, Cai M, Fan T. Effect of different exercise types on quality of life in patients with breast cancer: A network meta-analysis of randomized controlled trials. Breast 2024; 78:103798. [PMID: 39243565 PMCID: PMC11408868 DOI: 10.1016/j.breast.2024.103798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/04/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Exercise is a rehabilitation strategy for patients with breast cancer; however, the optimal type of exercise remains uncertain. This study aimed to compare the effects of five exercise types on the quality of life of patients with breast cancer and provide a basis for their exercise rehabilitation. METHODS As of May 2024, we searched four databases: Embase, PubMed, Web of Science, and Cochrane Library, and included randomized controlled trials that analyzed the effect of exercise on the quality of life of patients with breast cancer. A network meta-analysis was performed using a frequency-based framework. RESULTS Forty-five papers involving 4092 participants were included. The five types of exercises included were all significant in the direct comparison with the control group, except yoga and mind-body exercises. Aerobic, resistance, and combination exercises were associated with quality of life. However, in indirect comparisons, only mind-body exercise versus resistance exercise had a significant effect. The effect of exercise on the quality of life(total health status) of patients with breast cancer was ranked based on surface under the cumulative ranking curve (SUCRA) values combined with effect sizes as follows: aerobic exercise (SUCRA = 84.1) > combined exercise (SUCRA = 78.8) > resistance exercise (SUCRA = 66.4) > yoga (SUCRA = 39.3) > mind-body exercise (SUCRA = 27.2) > usual care (SUCRA = 4.1). CONCLUSIONS Exercise can rehabilitate the quality of life of patients with breast cancer, and aerobic exercise may be the best type of exercise to improve their quality of life(total health status).
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Affiliation(s)
- Liang Li
- College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Yutong Wang
- College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Mingzhou Cai
- College of Wushu, Shanghai University of Sport, Shanghai, China
| | - Tonggang Fan
- College of Wushu, Shanghai University of Sport, Shanghai, China.
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Barillaro A, Feoli C, Tramontano A, Comerci M, Caroprese M, Cuocolo R, Tamburis O, Petrazzuoli M, D'Arienzo MA, Farella A, Oliviero C, Clemente S, Cella L, Magliulo M, Conson M, Pacelli R. Fatigue trajectories by wearable remote monitoring of breast cancer patients during radiotherapy. Sci Rep 2024; 14:27276. [PMID: 39516704 PMCID: PMC11549320 DOI: 10.1038/s41598-024-78805-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 11/04/2024] [Indexed: 11/16/2024] Open
Abstract
The aim of this pilot study was to assess the compliance of breast cancer (BC) patients with fitness tracker (FT) monitoring program during radiotherapy (RT) and to characterize radiation-induced fatigue (RIF) status through objective evaluation using FT-collected parameters. Thirty-six BC patients were invited to wear FT during their RT course for continuous monitoring of heart rate (HR) and step counts (STP). RIF assessment was performed weekly, according to CTCAE v5.0 and dichotomized into G0 vs. any-grade. A novel concept based on patient Repeated Activity Window (RAW) was introduced to evaluate HR and STP variations during RT. Several Machine Learning (ML) methods were trained to characterize RIF on the basis of HR and STP collected data. RIF of any grade was reported by 17 out of 36 patients (47%) included in the study. None of patient clinical variables were significantly correlated with RIF. All patients accepted the FT monitoring program, and for 32 patients FT collection efficiency was greater than 60%. For each patient, a distinct distribution of RAWs was identifiable over RT and across the entire patient cohort, with a total of 7950 RAWs processed. Six features related to RAWs, HR and STP were identified as associated with RIF. The best-performing classifier was the Bagged Trees model, showing a cross-validated ROC-AUC of 89% (95% CI 88-90%). This study confirms the feasibility of continuous biomedical monitoring of BC patients by FT. We successfully identify objective indicators of RIF through HR and STP variation measures within each patient's RAW, thus providing a novel and practical approach to assess and manage RIF. This can significantly aid medical staff in evaluating RIF trajectories, potentially leading to better individualized care strategies and improved patient outcomes.
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Affiliation(s)
- Angela Barillaro
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Chiara Feoli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Adriano Tramontano
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Marco Comerci
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Mara Caroprese
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Renato Cuocolo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Oscar Tamburis
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Mario Petrazzuoli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Maria Anna D'Arienzo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Antonio Farella
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Naples, Italy
| | - Caterina Oliviero
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Naples, Italy
| | - Stefania Clemente
- Unit of Medical Physics and Radioprotection, University Hospital Federico II, Naples, Italy
| | - Laura Cella
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy.
| | - Mario Magliulo
- Institute of Biostructures and Bioimaging, National Research Council, Naples, Italy
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy.
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
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Zhou R, Chen Z, Zhang S, Wang Y, Zhang C, Lv Y, Yu L. Effects of Exercise on Cancer-Related Fatigue in Breast Cancer Patients: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Life (Basel) 2024; 14:1011. [PMID: 39202753 PMCID: PMC11355832 DOI: 10.3390/life14081011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2024] [Revised: 07/15/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
The primary objective of this study was to assess the influence of exercise interventions on cancer-related fatigue (CRF), specifically in breast cancer patients, with the ultimate goal of establishing an optimal exercise prescription for breast cancer patients. A comprehensive search was undertaken across multiple databases, including Embase, PubMed, Cochrane Library, Web of Science, and Scopus, covering data published up to 1 September 2023. A meta-analysis was conducted to calculate the standardized mean difference (SMD) along with its corresponding 95% confidence interval (CI), thereby quantifying the effectiveness of exercise in alleviating CRF in the breast cancer patient population. Twenty-six studies met the inclusion criteria. Aerobic exercise (SMD, -0.17, p = 0.02), resistance exercise (SMD, -0.37, p = 0.0009), and combined exercise (SMD, -0.53, p < 0.0001) significantly improved CRF in breast cancer patients. In addition, exercise intervention conducted ≥3 times per week (SMD, -0.47, p = 0.0001) for >60 min per session (SMD, -0.63, p < 0.0001) and ≥180 min per week (SMD, -0.79, p < 0.0001) had greater effects on improving CRF in breast cancer patients, especially middle-aged patients (SMD, -0.42, p < 0.0001). Exercise is an effective approach to improving CRF in breast cancer patients. When devising an exercise program, the primary consideration should be the incorporation of combined exercise as the principal intervention. This entails ensuring that participants engage in the program at least three times weekly, with each session lasting for more than 60 min. The ultimate aim is to achieve a total weekly exercise duration of 180 min by progressively increasing the frequency of exercise sessions.
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Affiliation(s)
- Runyu Zhou
- Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China;
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing 100084, China; (Z.C.); (S.Z.)
| | - Zhuying Chen
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing 100084, China; (Z.C.); (S.Z.)
| | - Shiyan Zhang
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing 100084, China; (Z.C.); (S.Z.)
| | - Yushu Wang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China; (Y.W.); (C.Z.)
| | - Chiyang Zhang
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China; (Y.W.); (C.Z.)
| | - Yuanyuan Lv
- Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China;
- China Institute of Sport and Health Science, Beijing Sport University, Beijing 100084, China; (Y.W.); (C.Z.)
| | - Laikang Yu
- Beijing Key Laboratory of Sports Performance and Skill Assessment, Beijing Sport University, Beijing 100084, China;
- Department of Strength and Conditioning Assessment and Monitoring, Beijing Sport University, Beijing 100084, China; (Z.C.); (S.Z.)
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An KO, Lee KJ. Physical fitness and blood parameters outcomes of breast cancer survivor in a low-intensity circuit resistance exercise program. Open Med (Wars) 2024; 19:20241010. [PMID: 39156757 PMCID: PMC11330159 DOI: 10.1515/med-2024-1010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 05/29/2024] [Accepted: 07/06/2024] [Indexed: 08/20/2024] Open
Abstract
There is limited evidence regarding the effect of circuit-type low-intensity resistance exercise on physical fitness and blood parameters in breast cancer survivors (BCSs). Therefore, this study aimed to investigate the effect of low-intensity circuit resistance exercise on changes in physical fitness and blood parameters in BCSs. A total of 16 BCSs participated in a low-intensity circuit resistance exercise group (LCREG). The exercise program in the LCREG consisted of 50-60% of one repetition maximum, two to three times weekly, for 24 weeks. The control group (CG) did not receive any interventions. All participants were measured for physical fitness and blood parameters before and after the exercise intervention. The results showed that LCREG significantly improved body mass index (BMI) (p = 0.012), grip strength (p = 0.017), back strength (p = 0.042), plank (p = 0.036), balance (p = 0.030), low-density lipoproteins (LDL) (p = 0.050), total cholesterol (p = 0.017), and natural killer cell activity (NKCA) (p = 0.035) after exercise compared to before exercise. The LCREG also significantly improved BMI (p = 0.001), grip strength (p = 0.014), plank (p = 0.018), balance (p = 0.012), LDL (p = 0.024), total cholesterol (p = 0.012), and NKCA (p = 0.036) compared to the CG. These findings suggest that low-intensity circuit resistance exercise can increase physical fitness levels and improve the blood index in BCSs.
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Affiliation(s)
- Keun-Ok An
- Sports Medicine Major, Division of Sports, Korea National University of Transportation, Chungju, 27469, Korea
| | - Kwang-Jin Lee
- Department of Physical Education, Chungbuk National University, Cheongju, 28644, Korea
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Han B, Duan Y, Zhang P, Zeng L, Pi P, Du G, Chen J. Effects of concurrent aerobic and strength training in women diagnosed with non-metastatic breast cancer: a systematic review and meta-analysis. J Cancer Surviv 2024:10.1007/s11764-024-01634-y. [PMID: 38970716 DOI: 10.1007/s11764-024-01634-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 06/17/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE To investigate the potential impact of concurrent aerobic and strength training (CT) on women diagnosed with breast cancer. METHODS Articles published in English and indexed in the PubMed, Web of Science, SPORTDiscus, The Cochrane Library, PsycINFO, EMBASE, and CINAHL Plus databases from their inception to 12 December 2023 were searched. Eligible studies were randomized controlled trials that involved CT and assessed cardiorespiratory fitness, cancer-related fatigue, and quality of life (QoL) using specialized tools. Subgroup analyses were conducted as per treatment status and characteristics. Risk of bias was evaluated with the Cochrane risk-of-bias tool (RoB 2.0). RESULTS This study included 29 studies involving 2071 participants. CT was found to significantly improve patients' cardiorespiratory fitness (weighted mean difference = 4.24 mL/kg/min, 95% confidence interval (CI) = 1.93-6.55, P < 0.001), cancer-related fatigue (standardized mean difference (SMD) = - 0.74, 95% CI = - 1.05 to - 0.44, P < 0.001), and QoL (SMD = 0.76, 95% CI = 0.50-1.01, P < 0.001). The analysis of secondary outcomes found that CT could significantly improve patients' body composition, anxiety, pain, sleep disorders, and anorexia and enhance upper and lower limb muscle strength, but was ineffective on depression. CONCLUSION For women with breast cancer, CT significantly enhances cardiorespiratory fitness, alleviates cancer-related fatigue, and improves QoL. The health benefits of CT are inferior in the postmenopausal cohort compared to the overall study population. IMPLICATIONS FOR CANCER SURVIVORS CT is advisable for female breast cancer survivors due to its significant effectiveness in mitigating cancer-related fatigue, enhancing cardiorespiratory fitness, and improving the QoL.
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Affiliation(s)
- Bing Han
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Yaya Duan
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peizhen Zhang
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China.
| | - Liqing Zeng
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Peng Pi
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
| | - Guoli Du
- School of Physical Education, Shandong University, Jinan, China
| | - Jiping Chen
- School of Physical Education, Shandong University, Jinan, China
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Al-Mhanna SB, Batrakoulis A, Norhayati MN, Mohamed M, Drenowatz C, Irekeola AA, Afolabi HA, Gülü M, Alkhamees NH, Wan Ghazali WS. Combined Aerobic and Resistance Training Improves Body Composition, Alters Cardiometabolic Risk, and Ameliorates Cancer-Related Indicators in Breast Cancer Patients and Survivors with Overweight/Obesity: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Sports Sci Med 2024; 23:366-395. [PMID: 38841642 PMCID: PMC11149074 DOI: 10.52082/jssm.2024.366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 04/11/2024] [Indexed: 06/07/2024]
Abstract
Breast cancer survivors with obesity are at a high risk of cancer recurrence, comorbidity, and mortality. This review aims to systematically evaluate the effects of combined aerobic and resistance training (CART) on body composition, lipid homeostasis, inflammation, adipokines, cancer-related fatigue, sleep, and quality of life in breast cancer patients and survivors with overweight/obesity. An electronic search was conducted in PubMed, Web of Science, Scopus, Science Direct, Cochrane, and Google Scholar databases from inception up to January 8, 2024. Randomized controlled trials (RCTs) meeting the inclusion criteria were selected for the analysis. The Cochrane risk of bias tool was used to assess eligible studies, and the GRADE method to evaluate the quality of evidence. A random-effects model was used, and data were analyzed using mean (MD) and standardized mean differences (SMD) for continuous variables with 95% confidence intervals (CI). We assessed the data for risk of bias, heterogeneity, sensitivity, reporting bias, and quality of evidence. A total of 17 randomized controlled trials were included in the systematic review involving 1,148 female patients and survivors (mean age: 54.0 ± 3.4 years). The primary outcomes showed significant improvements in body mass index (SMD -0.57 kg/m2, p = 0.04), body fat (SMD -0.50%, p = 0.02), fat mass (SMD -0.63 kg, p = 0.04), hip circumference (MD -3.14 cm, p = 0.02), and fat-free mass (SMD 1.03 kg, p < 0.001). The secondary outcomes indicated significant increases in high-density lipoprotein cholesterol (MD -0.05 mmol/L, p = 0.008), natural killer cells (SMD 0.42%, p = 0.04), reductions in triglycerides (MD -81.90 mg/dL, p < 0.01), total cholesterol (SMD -0.95 mmol/L, p < 0.01), tumor necrosis factor α (SMD -0.89 pg/mL, p = 0.03), and leptin (SMD -0.63 ng/mL, p = 0.03). Also, beneficial alterations were found in cancer-related fatigue (SMD -0.98, p = 0.03), sleep (SMD -1.17, p < 0.001), and quality of life (SMD 2.94, p = 0.02) scores. There was very low to low confidence in the estimated effect of most of the outcomes. The present findings reveal that CART could be considered an adjunct therapy in supporting the conventional clinical approach observed following exercise. However, further high-quality research is needed to evaluate whether CART would be a valuable intervention to lower aggressive pharmacologic use in breast cancer patients with overweight/obesity.
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Affiliation(s)
- Sameer Badri Al-Mhanna
- Center for Global Health Research, Saveetha Medical College and Hospitals, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
- Department of Physiology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Alexios Batrakoulis
- Department of Physical Education and Sport Science, School of Physical Education, Sport Science and Dietetics, University of Thessaly, Karies, Trikala, Greece
- Department of Physical Education and Sport Science, School of Physical Education and Sport Science, Democritus University of Thrace, Komotini, Greece
| | - Mohd Noor Norhayati
- Department of Family Medicine, School of Medical Sciences, Kubang Keria, Malaysia
| | - Mahaneem Mohamed
- Department of Physiology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Clemens Drenowatz
- Division of Sport, Physical Activity and Health, University of Teacher Education Upper Austria, Linz, Austria
| | - Ahmad Adebayo Irekeola
- Department of Medical Microbiology and Parasitology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Hafeez Abiola Afolabi
- Department of General Surgery, School of Medical Sciences, Hospital University Sains Malaysia, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Mehmet Gülü
- Department of Sports Management, Faculty of Sport Sciences, Kirikkale University, Kirikkale, Turkey
| | - Nouf H Alkhamees
- Department of Rehabilitation, College of Health and Rehabilitation Sciences Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | - Wan Syaheedah Wan Ghazali
- Department of Physiology, School of Medical Sciences, University Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
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Crowder SL, Li X, Himbert C, Viskochil R, Hoogland AI, Gudenkauf LM, Oswald LB, Gonzalez BD, Small BJ, Ulrich CM, Ose J, Peoples AR, Li CI, Shibata D, Toriola AT, Gigic B, Playdon MC, Hardikar S, Bower J, Siegel EM, Figueiredo JC, Jim HSL. Relationships Among Physical Activity, Sleep, and Cancer-related Fatigue: Results From the International ColoCare Study. Ann Behav Med 2024; 58:156-166. [PMID: 38141201 PMCID: PMC10858307 DOI: 10.1093/abm/kaad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2023] Open
Abstract
BACKGROUND Risk factors for cancer-related fatigue are understudied in colorectal cancer. PURPOSE This study aimed to address this critical gap in the literature by (a) describing changes in colorectal cancer-related fatigue and health behavior (physical activity, sleep problems) and (b) examining if physical activity and sleep problems predict fatigue trajectories from baseline (approximately at the time of diagnosis), to 6- and 12 months after enrollment. METHODS Patients participating in the international ColoCare Study completed self-report measures at baseline (approximately time of diagnosis), 6-, and 12 months assessing physical activity using the International Physical Activity Questionnaire (IPAQ) and fatigue and sleep using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC-QLQ-C30). Mixed-effect models examined changes in physical activity, sleep problems, and fatigue. Cross-lagged panel models examined bidirectional relationships between physical activity or sleep and fatigue across time. RESULTS Colorectal cancer patients (n = 649) had a mean age of 61 ± 13 years. Most were male (59%), non-Hispanic White (91%), diagnosed with Stages III-IV (56%) colon cancer (58%), and treated with surgery (98%). Within-person cross-lagged models indicated higher physical activity at Month 6 was associated with higher fatigue at Month 12 (β = 0.26, p = .016). When stratified by cancer stage (I-II vs. III-IV), the relationship between physical activity at Month 6 and fatigue at Month 12 existed only for patients with advanced cancer (Stages III and IV, β = 0.43, p = .035). Cross-lagged associations for sleep and fatigue from baseline to Month 6 were only observed in patients with Stages III or IV cancer, however, there was a clear cross-sectional association between sleep problems and fatigue at baseline and Month 6. CONCLUSIONS Within-person and cross-lagged association models suggest fatiguability may become increasingly problematic for patients with advanced colorectal cancer the first year after diagnosis. In addition, sleep problems were consistently associated with higher fatigue in the first year, regardless of cancer stage. TRIAL REGISTRATION The international ColoCare Study was registered on clinicaltrials.gov, NCT02328677, in December 2014.
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Affiliation(s)
- Sylvia L Crowder
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Xiaoyin Li
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Caroline Himbert
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Richard Viskochil
- Department of Exercise and Health Sciences, University of Massachusetts, Boston, MA, USA
| | - Aasha I Hoogland
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Laura B Oswald
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
| | - Brent J Small
- Department of Behavioral and Community Sciences, School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Cornelia M Ulrich
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Jennifer Ose
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Anita R Peoples
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Christopher I Li
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - David Shibata
- Department of Surgery, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adetunji T Toriola
- Department of Surgery, Washington University St. Louis, St. Louis, MO, USA
| | - Biljana Gigic
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Mary C Playdon
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Sheetal Hardikar
- Department of Population Health Sciences, Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
- Department of Population Health Sciences, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | | | - Erin M Siegel
- Department of Cancer Epidemiology, Moffitt Cancer Center, Tampa, FL, USA
| | - Jane C Figueiredo
- Department of Medicine, Samuel Oschin Comprehensive Cancer Institute, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, USA
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11
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Wu T, Yan F, Wei Y, Yuan C, Jiao Y, Pan Y, Zhang Y, Zhang H, Ma Y, Han L. Effect of Exercise Therapy on Cancer-Related Fatigue in Patients With Breast Cancer: A Systematic Review and Network Meta-analysis. Am J Phys Med Rehabil 2023; 102:1055-1062. [PMID: 37204936 DOI: 10.1097/phm.0000000000002277] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
OBJECTIVE This study aimed to explore the efficacy of different exercise therapies in reducing fatigue in patients with breast cancer. DESIGN PubMed, Embase, Web of Science, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, China Biology Medicine, China National Knowledge Infrastructure, Database of Chinese Sci-tech Periodicals, and Wanfang databases were searched from their inception to March 2022. The authors independently screened all randomized controlled trials of exercise therapy in patients with breast cancer. A network meta-analysis was performed using Stata 16.0 software. RESULTS Seventy-eight studies were analyzed, with 167 comparisons and 6235 patients. The network results showed that stretching (standardized mean difference = -0.74, confidence interval = -1.43 to -0.06), yoga (standardized mean difference = -0.49, confidence interval = -0.75 to -0.22), combined exercise (standardized mean difference = -0.47, confidence interval = -0.70 to -0.24), aerobic exercise (standardized mean difference = -0.46, confidence interval = -0.66 to -0.26), and resistance exercise (standardized mean difference = -0.42, confidence interval = -0.77 to -0.08) significantly reduced fatigue. Pairwise comparisons confirmed that yoga, combined exercise, aerobic exercise, and resistance exercise were positively associated with fatigue relief. However, no significant association was identified between reduced fatigue and traditional Chinese exercises or stretching. CONCLUSIONS The most effective exercise therapy to relieve cancer-related fatigue in patients with breast cancer was yoga, followed by combined aerobic and resistance exercises. It is expected that more randomized controlled trials will be conducted to further explore the efficacy and mechanisms of exercise.
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Affiliation(s)
- Tong Wu
- From the School of Nursing, Evidence-Based Nursing Center, Lanzhou University, Lanzhou, China (TW, FY, YW, CY, YJ, YP, YM, LH); School of Nursing and Rehabilitation, Cheeloo College of Medicine, Shandong University, Jinan, China (YZ); Department of Nursing, Gansu Provincial Hospital, Lanzhou, China (HZ); and Office of the Dean, Gansu Provincial Hospital, Lanzhou, China (LH)
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12
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Wang TC, Chen PL, Liao WC, Tsai IC. Differential Impact of Exercises on Quality-of-Life Improvement in Breast Cancer Survivors: A Network Meta-Analysis of Randomized Controlled Trials. Cancers (Basel) 2023; 15:3380. [PMID: 37444490 DOI: 10.3390/cancers15133380] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
This study aimed to assess the effectiveness of various exercise interventions in enhancing the quality of life for breast cancer survivors. To achieve this, randomized controlled trials were identified from major electronic databases, focusing on the relationship between exercise and quality of life in breast cancer survivors. The primary outcome was the impact of exercise on quality of life 12 weeks after the intervention, with a secondary outcome comparing dropout rates between intervention groups and a regular care control group. The study protocol was registered with INPLASY (INPLASY202340007). A network meta-analysis of nine randomized controlled trials involving 725 participants was conducted, examining aerobic and strength training, aerobic activity, yoga, and strength exercise. Results showed that aerobic and strength training was the most effective intervention, significantly improving the quality of life of breast cancer survivors (1.31; 95% confidence interval: 0.49 to 2.12). Aerobic activity had a borderline effect (0.83; 0.03 to 1.63), while no exercise interventions were associated with an increased dropout risk compared to the control group (regular care). The study concluded that concurrent aerobic and strength training can improve breast cancer survivors' quality of life after 12 weeks of intervention without increasing dropout risk compared to regular care.
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Affiliation(s)
- Tzu-Chieh Wang
- Doctoral Program, Department of Nursing, College of Nursing, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Department of Nursing, Taichung Veterans General Hospital, Taichung 407219, Taiwan
| | | | | | - I-Chen Tsai
- InnovaRad, Taichung 407217, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul 13572, Republic of Korea
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13
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Dong B, Qi Y, Lin L, Liu T, Wang S, Zhang Y, Yuan Y, Cheng H, Chen Q, Fang Q, Xie Z, Tian L. Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53:343–352. [PMID: 36947532 DOI: 10.2519/jospt.2023.11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.
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14
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Nuutinen M, Hiltunen AM, Korhonen S, Haavisto I, Poikonen-Saksela P, Mattson J, Manikis G, Kondylakis H, Simos P, Mazzocco K, Pat-Horenczyk R, Sousa B, Cardoso F, Manica I, Kudel I, Leskelä RL. Aid of a machine learning algorithm can improve clinician predictions of patient quality of life during breast cancer treatments. HEALTH AND TECHNOLOGY 2023. [DOI: 10.1007/s12553-023-00733-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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15
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Artese AL, Sitlinger A, MacDonald G, Deal MA, Hanson ED, Pieper CF, Weinberg JB, Brander DM, Bartlett DB. Effects of high-intensity interval training on health-related quality of life in chronic lymphocytic leukemia: A pilot study. J Geriatr Oncol 2023; 14:101373. [PMID: 36096873 DOI: 10.1016/j.jgo.2022.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 08/24/2022] [Accepted: 09/02/2022] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Chronic lymphocytic leukemia (CLL) is the most common incurable leukemia/lymphoma in the United States. Individuals with CLL are at risk for disability, frailty, and cancer-specific complications that negatively affect health-related quality of life (HRQOL). High-intensity interval training (HIIT) and resistance training (RT) are safe and feasible for individuals with chronic diseases and when combined, they may be beneficial for reducing cancer-related fatigue, symptom burden, and global quality of life. However, no studies have examined the impact of HIIT or RT on HRQOL in CLL. The purpose of this study was to investigate the effects of a 12-week HIIT and RT (HIIT+RT) intervention on HRQOL in adults with treatment naïve CLL. MATERIALS AND METHODS Changes in HRQOL was a secondary outcome in this pilot study. Individuals with CLL (63.9 ± 8.5 yrs) were non-randomly assigned to 12 weeks of HIIT+RT or a control group. The HIIT+RT protocol consisted of three 30-min sessions/week of HIIT and two sessions/week of RT. The control group maintained usual daily activities. We assessed pre and post HRQOL using the Functional Assessment of Cancer Therapy-Lymphoma (FACT-Lym) questionnaire with domains of physical (PWB), social (SWB), emotional (EWB), functional (FWB), and general (FACT-G) well-being as well as a lymphoma-specific subscale (LymS). We used a two-way mixed analysis of variance to assess changes in HRQOL. We calculated effect size (ES) using Cohen's d. RESULTS Fifteen participants (HIIT+RT: n = 9; Control: n = 6) completed the study and questionnaire. Scores for FWB improved following HIIT+RT (21.7 ± 3.4 to 23.9 ± 3.2; ES = 1.38) compared to controls (25.7 ± 2.2 to 25.7 ± 2.3). The HIIT+RT group experienced clinically meaningful improvements in total FACT-Lym, FWB, FACT-G, and LymS. The control group had clinically meaningful changes only in LymS. DISCUSSION The large effect sizes and clinically meaningful improvements associated with 12 weeks of HIIT+RT support the potential benefits of this type of exercise program for FWB, lymphoma-specific symptoms, and general well-being in CLL. A future randomized trial with an adequately powered sample size is needed to evaluate these findings. TRIAL REGISTRATION NCT04950452.
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Affiliation(s)
- Ashley L Artese
- Duke University Aging Center, Duke University School of Medicine, Durham, NC, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA
| | - Andrea Sitlinger
- Hematologic Malignancies and Cellular Therapies, Duke University School of Medicine, Durham, NC, USA.
| | - Grace MacDonald
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Michael A Deal
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA
| | - Erik D Hanson
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Carl F Pieper
- Duke University Aging Center, Duke University School of Medicine, Durham, NC, USA
| | - J Brice Weinberg
- Division of Hematology, Duke University School of Medicine and VA Medical Center, Durham, NC, USA
| | - Danielle M Brander
- Hematologic Malignancies and Cellular Therapies, Duke University School of Medicine, Durham, NC, USA
| | - David B Bartlett
- Duke University Aging Center, Duke University School of Medicine, Durham, NC, USA; Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA; Division of Medical Oncology, Duke University School of Medicine, Durham, NC, USA; School of Bioscience and Medicine, University of Surrey, Guildford, UK.
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16
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Schleicher E, McAuley E, Courneya KS, Anton P, Ehlers DK, Phillips SM, Oster RA, Pekmezi D, Rogers LQ. Moderators of physical activity and quality of life response to a physical activity intervention for breast cancer survivors. Support Care Cancer 2022; 31:53. [PMID: 36526826 PMCID: PMC11613774 DOI: 10.1007/s00520-022-07477-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/09/2022] [Indexed: 12/23/2022]
Abstract
PURPOSE Moderate-to-vigorous physical activity (MVPA) can improve the quality of life (QoL) for breast cancer survivors (BCS), yet, most do not achieve 150 + weekly minutes of MVPA. This study investigated moderators of response to a physical activity (PA) behavior change intervention for BCS. METHODS BCS (N = 222) were randomized to the 3-month intervention (BEAT Cancer) or usual care. Measurements occurred at baseline, post-intervention, and 3 months post-intervention. Measures included accelerometry, self-reported MVPA, and Functional Assessment of Cancer Therapy (FACT-General, FACT-Breast, physical well-being (PWB), social well-being (SWB), emotional well-being (EWB), functional well-being (FWB), additional concerns (AC), and Trial Outcome Index (TOI)). RESULTS Adjusted linear mixed-model analyses indicated individuals ≤ 24 months post-diagnosis and who were single reported smaller increases in weekly self-reported MVPA than those > 24 months (44.07 vs 111.93) and partnered (- 16.24 vs. 49.16 min), all p < 0.05. As for QoL, participants < 12 months post-diagnosis who received chemotherapy experienced smaller improvements than those ≥ 12 months in FACT-General, FACT-Breast, PWB, and SWB scores. Survivors with a history of chemotherapy had smaller improvements in FACT-General, FACT-Breast, PWB, SWB, TOI, and AC scores, all p < 0.05. CONCLUSION These findings indicate that being < 2 years post-diagnosis, single, and prior chemotherapy may limit MVPA and QOL responses to a PA intervention. Further studies are needed to determine if and/or what additional PA supports and resources these subgroups of BCS might find beneficial and effective. TRIAL REGISTRATION ClinicalTrials.gov number: NCT00929617.
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Affiliation(s)
- Erica Schleicher
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA.
| | - Edward McAuley
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- The Cancer Center at Illinois, Urbana, IL, USA
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Phillip Anton
- School of Human Sciences, Southern Illinois University Carbondale, Carbondale, IL, USA
| | - Diane K Ehlers
- Department of Quantitative Health Sciences, Mayo Clinic, Phoenix, AZ, USA
| | - Siobhan M Phillips
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Robert A Oster
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA
- Department of Medicine, Division of Preventive Medicine, Birmingham, AL, USA
| | - Dorothy Pekmezi
- Department of Health Behavior, School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA
| | - Laura Q Rogers
- O'Neal Comprehensive Cancer Center at the University of Alabama Birmingham (UAB), Birmingham, AL, USA
- Department of Medicine, Division of Preventive Medicine, Birmingham, AL, USA
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17
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Aune D, Markozannes G, Abar L, Balducci K, Cariolou M, Nanu N, Vieira R, Anifowoshe YO, Greenwood DC, Clinton SK, Giovannucci EL, Gunter MJ, Jackson A, Kampman E, Lund V, McTiernan A, Riboli E, Allen K, Brockton NT, Croker H, Katsikioti D, McGinley-Gieser D, Mitrou P, Wiseman M, Velikova G, Demark-Wahnefried W, Norat T, Tsilidis KK, Chan DSM. Physical Activity and Health-Related Quality of Life in Women With Breast Cancer: A Meta-Analysis. JNCI Cancer Spectr 2022; 6:pkac072. [PMID: 36474321 PMCID: PMC9727071 DOI: 10.1093/jncics/pkac072] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 06/27/2022] [Accepted: 09/16/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Physical activity (PA) is associated with improved health-related quality of life (HRQoL) among women with breast cancer; however, uncertainty remains regarding PA types and dose (frequency, duration, intensity) and various HRQoL measures. A systematic review and meta-analysis of randomized controlled trials was conducted to clarify whether specific types and doses of physical activity was related to global and specific domains of HRQoL, as part of the Global Cancer Update Programme, formerly known as the World Cancer Research Fund-American Institute for Cancer Research Continuous Update Project. METHODS PubMed and CENTRAL databases were searched up to August 31, 2019. Weighted mean differences (WMDs) in HRQoL scores were estimated using random effects models. An independent expert panel graded the evidence. RESULTS A total of 79 randomized controlled trials (14 554 breast cancer patients) were included. PA interventions resulted in higher global HRQoL as measured by the Functional Assessment of Cancer Therapy-Breast (WMD = 5.94, 95% confidence intervals [CI] = 2.64 to 9.24; I2 = 59%, n = 12), Functional Assessment of Cancer Therapy-General (WMD = 4.53, 95% CI = 1.94 to 7.13; I2 = 72%, n = 18), and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-C30 (WMD = 6.78, 95% CI = 2.61 to 10.95; I2 = 76.3%, n = 17). The likelihood of causality was considered probable that PA improves HRQoL in breast cancer survivors. Effects were weaker for physical function and mental and emotional health. Evidence regarding dose and type of PA remains insufficient for firm conclusions. CONCLUSION PA results in improved global HRQoL in breast cancer survivors with weaker effects observed for physical function and mental and emotional health. Additional research is needed to define the impact of types and doses of activity on various domains of HRQoL.
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Affiliation(s)
- Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo, Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Markozannes
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Leila Abar
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Katia Balducci
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Margarita Cariolou
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Neesha Nanu
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Rita Vieira
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Yusuf O Anifowoshe
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Darren C Greenwood
- Leeds Institute for Data Analytics, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Steven K Clinton
- The Comprehensive Cancer Center, The Ohio State University, Columbus, OH, USA
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Edward L Giovannucci
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
- Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Brigham and Women’s Hospital, Boston, MA, USA
| | - Marc J Gunter
- Section of Nutrition and Metabolism, International Agency for Research on Cancer-World Health Organization, Lyon, France
| | - Alan Jackson
- National Institute for Health Research, Southampton Biomedical Research Centre, Southampton, UK
| | - Ellen Kampman
- Division of Human Nutrition and Health, Wageningen University and Research, Wageningen, the Netherlands
| | - Vivien Lund
- World Cancer Research Fund International, London, UK
| | - Anne McTiernan
- Division of Public Health Sciences, Program in Epidemiology, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, Department of Epidemiology, University of Washington, Seattle, WA, USA
- School of Medicine, Department of Medicine (Geriatrics), University of Washington, Seattle, WA, USA
| | - Elio Riboli
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Kate Allen
- World Cancer Research Fund International, London, UK
| | | | - Helen Croker
- World Cancer Research Fund International, London, UK
| | | | | | | | | | - Galina Velikova
- School of Medicine, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | | | - Teresa Norat
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
| | - Konstantinos K Tsilidis
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Doris S M Chan
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial College London, London, UK
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18
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Andersen HH, Vinther A, Lund CM, Paludan C, Jørgensen CT, Nielsen D, Juhl CB. Effectiveness of different types, delivery modes and extensiveness of exercise in patients with breast cancer receiving systemic treatment - A systematic review and meta-analysis. Crit Rev Oncol Hematol 2022; 178:103802. [PMID: 36031174 DOI: 10.1016/j.critrevonc.2022.103802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effects of exercise in patients with breast cancer have been thoroughly investigated. The aim was to explore differences in effects regarding type, delivery mode and extensiveness (e.g. intensity; volume) of the interventions. METHODS We searched for randomised controlled trials including patients with breast cancer receiving systemic treatment, exercise-based interventions, and measures on patient reported- and objectively measured outcomes. RESULTS Exercise showed significant and moderate effects on the primary outcomes quality of life and physical function, Standardised Mean Difference: 0.52 (95 % CI 0.38-0.65) and 0.52 (95 % CI 0.38-0.66), respectively. Type of exercise had little influence on the effects, however combined aerobic- and resistance exercise seemed superior for increasing physical function, compared to aerobic or resistance exercise. Supervised interventions were superior to partly and unsupervised. Extensiveness of the intervention only influenced physical function. CONCLUSIONS Supervised interventions, more than type or extensiveness of interventions, seem to increase effects.
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Affiliation(s)
- Høgni Hammershaimb Andersen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark; Hospital Secretariat and Communication, Research, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark.
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark.
| | - Camilla Paludan
- Department of Sports Science and Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
| | - Claus Thomas Jørgensen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark.
| | - Dorte Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark.
| | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark; Department of Sports Science and Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
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19
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Wonders KY, Schmitz K, Wise R, Hale R. Cost-Savings Analysis of an Individualized Exercise Oncology Program in Early-Stage Breast Cancer Survivors: A Randomized Clinical Control Trial. JCO Oncol Pract 2022; 18:e1170-e1180. [PMID: 35363502 PMCID: PMC9287397 DOI: 10.1200/op.21.00690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 02/07/2022] [Accepted: 03/01/2022] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In an attempt to promote the integration of exercise oncology as a standard part of clinical practice, economic evaluations are warranted. Thus, the purpose of this study was to prospectively analyze cost savings of an individualized exercise oncology program when patients were randomly assigned. METHODS For this open-label, randomized, prospective, comparative clinical trial, patients with early-stage breast cancer (stage I-II) were randomly assigned into two groups: the control group (CG, n = 120) and the exercise training group (EX, n = 123). Patients in the exercise intervention group completed 12 weeks of prescribed, individualized exercise that aligned with ACSM exercise guidelines for cancer survivors. The CG received the current standard of care, which includes a resource guide with various options available to the cancer survivor. RESULTS In the EX group, all physical fitness measures significantly improved compared with baseline (P < .001), while remaining unchanged for the CG (P > .05). Patients in the CG had the highest total mean health care utilization across all measures (CG: $8,598 US dollars, compared with EX: $6,356 US dollars) for emergency visits, outpatient visits, and office-base visits that were not a part of their treatment plan. At baseline, the mean Eastern Cooperative Oncology Group (ECOG) scores did not significantly differ (P > .05); however, at follow-up, a larger proportion of the EX group had ECOG scores of 0 or 1, compared with the CG (P < .05). Finally, patient-reported outcomes were significantly higher in the exercise group, compared with the CG at the 12-week follow-up (P < .001). CONCLUSION A supervised, individualized 12-week exercise intervention led to significant improvements in fitness parameters and ECOG scores, as well as a decrease in unplanned health care utilization among early-stage breast cancer survivors.
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Affiliation(s)
- Karen Y. Wonders
- Department of Kinesiology and Health, Wright State University, Dayton, OH
- Maple Tree Cancer Alliance, Dayton, OH
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20
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Chen K, Zhang J, Beeraka NM, Tang C, Babayeva YV, Sinelnikov MY, Zhang X, Zhang J, Liu J, Reshetov IV, Sukocheva OA, Lu P, Fan R. Advances in the Prevention and Treatment of Obesity-Driven Effects in Breast Cancers. Front Oncol 2022; 12:820968. [PMID: 35814391 PMCID: PMC9258420 DOI: 10.3389/fonc.2022.820968] [Citation(s) in RCA: 55] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 05/16/2022] [Indexed: 12/11/2022] Open
Abstract
Obesity and associated chronic inflammation were shown to facilitate breast cancer (BC) growth and metastasis. Leptin, adiponectin, estrogen, and several pro-inflammatory cytokines are involved in the development of obesity-driven BC through the activation of multiple oncogenic and pro-inflammatory pathways. The aim of this study was to assess the reported mechanisms of obesity-induced breast carcinogenesis and effectiveness of conventional and complementary BC therapies. We screened published original articles, reviews, and meta-analyses that addressed the involvement of obesity-related signaling mechanisms in BC development, BC treatment/prevention approaches, and posttreatment complications. PubMed, Medline, eMedicine, National Library of Medicine (NLM), and ReleMed databases were used to retrieve relevant studies using a set of keywords, including "obesity," "oncogenic signaling pathways," "inflammation," "surgery," "radiotherapy," "conventional therapies," and "diet." Multiple studies indicated that effective BC treatment requires the involvement of diet- and exercise-based approaches in obese postmenopausal women. Furthermore, active lifestyle and diet-related interventions improved the patients' overall quality of life and minimized adverse side effects after traditional BC treatment, including postsurgical lymphedema, post-chemo nausea, vomiting, and fatigue. Further investigation of beneficial effects of diet and physical activity may help improve obesity-linked cancer therapies.
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Affiliation(s)
- Kuo Chen
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jin Zhang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Narasimha M. Beeraka
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
- Center of Excellence in Molecular Biology and Regenerative Medicine (CEMR), Department of Biochemistry, JSS Academy of Higher Education and Research (JSS AHER), JSS Medical College, Mysuru, India
| | - Chengyun Tang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Yulia V. Babayeva
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Mikhail Y. Sinelnikov
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Xinliang Zhang
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Jiacheng Zhang
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Junqi Liu
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Igor V. Reshetov
- Department of Human Anatomy, I. M. Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation (Sechenov University), Moscow, Russia
| | - Olga A. Sukocheva
- Discipline of Health Sciences, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Pengwei Lu
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruitai Fan
- Cancer Center, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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21
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Cheon J, Choi Y, Kim JS, Ko BK, Kim CR, Kim JH, Koh SJ. "Teachable Moment": Effects of an Educational Program on Knowledge and Quality of Life of Korean Breast Cancer Survivors. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:812-818. [PMID: 33025451 DOI: 10.1007/s13187-020-01888-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/27/2020] [Indexed: 06/11/2023]
Abstract
Due to prolonged survival and the relatively young median age of patients, the quality of life (QOL) of breast cancer survivors is an important issue in Korea. We conducted an educational program for breast cancer survivors, and evaluated its impact on knowledge, QOL, and lifestyle changes. This study utilized a single-arm pretest-posttest design. Participants were tested before and after an educational program to measure changes in knowledge. To measure QOL change, we conducted a QOL survey at the time of enrollment and again 6 months later. Regarding the knowledge test, mean scores increased from 9.62 to 14.74 points following education (p < 0.001). After 6 months, 97 patients completed the QOL survey and the data were analyzed, showing significant improvements in anxiety (p = 0.021), depression (p = 0.003), functional well-being (p = 0.005), and breast cancer subscales of the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) (p < 0.001). Additionally, the rates of adequate exercise significantly improved (p < 0.001), while rates of alcohol consumption and second cancer screening did not significantly change. One educational program session can improve patient knowledge, QOL, and psychosocial well-being, but is insufficient to achieve significant changes in health behavior.
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Affiliation(s)
- Jaekyung Cheon
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Yunsuk Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Jin Sung Kim
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Byung Kyun Ko
- Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Ju Hee Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Su-Jin Koh
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea.
- Division of Hematology-Oncology, Department of Internal Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, 877, Bangeojinsunhwando-ro, Dong-gu, Ulsan, South Korea.
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22
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Dimauro I, Grazioli E, Antinozzi C, Duranti G, Arminio A, Mancini A, Greco EA, Caporossi D, Parisi A, Di Luigi L. Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:9834. [PMID: 34574758 PMCID: PMC8467802 DOI: 10.3390/ijerph18189834] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/15/2021] [Accepted: 09/17/2021] [Indexed: 12/14/2022]
Abstract
Breast cancer (BC) is the most commonly diagnosed cancer among women worldwide and the most common cause of cancer-related death. To date, it is still a challenge to estimate the magnitude of the clinical impact of physical activity (PA) on those parameters producing significative changes in future BC risk and disease progression. However, studies conducted in recent years highlight the role of PA not only as a protective factor for the development of ER+ breast cancer but, more generally, as a useful tool in the management of BC treatment as an adjuvant to traditional therapies. In this review, we focused our attention on data obtained from human studies analyzing, at each level of disease prevention (i.e., primary, secondary, tertiary and quaternary), the positive impact of PA/exercise in ER+ BC, a subtype representing approximately 70% of all BC diagnoses. Moreover, given the importance of estrogen receptors and body composition (i.e., adipose tissue) in this subtype of BC, an overview of their role will also be made throughout this review.
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Affiliation(s)
- Ivan Dimauro
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Elisa Grazioli
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (E.G.); (A.P.)
| | - Cristina Antinozzi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
| | - Guglielmo Duranti
- Unit of Biocheminstry and Molecular Biology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Alessia Arminio
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
| | - Annamaria Mancini
- Dipartimento di Scienze Motorie e del Benessere (DISMeB), Università Degli Studi di Napoli “Parthenope”, Via F. Acton, 38, 80133 Naples, Italy;
- CEINGE-Biotecnologie Avanzate s.c.ar.l., Via Gaetano Salvatore 482, 80145 Naples, Italy
| | - Emanuela A. Greco
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
- Department of Health Science, University “Magna Graecia” of Catanzaro, Viale Europa, 88100 Catanzaro, Italy
| | - Daniela Caporossi
- Unit of Biology and Genetics of Movement, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy;
| | - Attilio Parisi
- Unit of Physical Exercise and Sport Sciences, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (E.G.); (A.P.)
| | - Luigi Di Luigi
- Unit of Endocrinology, Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro de Bosis 15, 00135 Rome, Italy; (C.A.); (A.A.); (E.A.G.); (L.D.L.)
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23
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Takahashi S. Fatigue and its management in cancer patients undergoing VEGFR-TKI therapy. Expert Opin Drug Saf 2021; 21:397-406. [PMID: 34461788 DOI: 10.1080/14740338.2021.1969360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Fatigue is the most common side effect of cancer and cancer treatment and is often called cancer fatigue or cancer-related fatigue. For cancer patients, cancer-related fatigue has a negative impact on participation in work and social activities, mood, and daily activities, significantly impairing quality of life. Vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) sometimes cause fatigue, and early detection and appropriate management of fatigue in cancer patients treated with a VEGFR-TKI prevent fatigue from becoming more severe, thus maximizing the benefits of the treatment. AREAS COVERED This paper focuses on fatigue and discusses its frequency, assessment, risk factors, and management methods. EXPERT OPINION The drugs currently available for treating cancer-related fatigue are not effective enough, and their mechanisms of action are not fully understood. Some agents have demonstrated efficacy as treatments for fatigue due to pharmacotherapy, and further elucidation of their mechanisms is expected, together with the development of new drugs. Since fatigue has a range of causes, its treatment requires not only medication, but also exercise, nutrition, and other therapeutic approaches. The successful treatment of fatigue will therefore need multidisciplinary therapy involving the establishment of systems of cooperation across various specialties.
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Affiliation(s)
- Shunji Takahashi
- Department of Medical Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
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24
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Lin HP, Kuo YH, Tai WY, Liu HE. Exercise effects on fatigue in breast cancer survivors after treatments: A systematic review and meta-analysis. Int J Nurs Pract 2021; 28:e12989. [PMID: 34258817 DOI: 10.1111/ijn.12989] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 03/15/2021] [Accepted: 06/12/2021] [Indexed: 01/15/2023]
Abstract
AIM The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment. BACKGROUND Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments. METHODS We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated. RESULTS Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors. CONCLUSION Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.
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Affiliation(s)
- Hui-Ping Lin
- Department of Nursing, Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Yuan Tai
- Graduate Institute of Sport Promotion, National Taiwan Sport University, Taoyuan, Taiwan
| | - Hsueh-Erh Liu
- School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan, R. O. C.,Department of Rheumatology, Chang Gung Memorial Hospital, Lin Kou & Taoyuan, Taiwan, R. O. C.,Department of Nursing, College of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, R. O. C
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25
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Murphy SP, Hayward R, Smith JD. Exercise training improves postural steadiness in cancer survivors undergoing chemotherapy. Gait Posture 2021; 87:136-142. [PMID: 33915436 DOI: 10.1016/j.gaitpost.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/02/2021] [Accepted: 04/09/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Cancer and cancer treatments negatively affect somatosensory, vestibular, and visual inputs that regulate postural stability and balance, increasing the risk of falling. Exercise training has been shown to mitigate other negative side effects of cancer treatments, such as reducing peripheral neuropathy. RESEARCH QUESTION How does 12 weeks of supervised exercise training influence postural stability in cancer survivors who receive chemotherapy? METHODS Postural stability of cancer survivors (n = 25; mass = 79.0 ± 22.6 kg; height = 1.66 ± 0.08 m; age = 61 ± 10 years) receiving chemotherapy was assessed prior to and following a 12-week individualized exercise training program by quantifying changes in center of pressure data. A series of 2-factor (pre/post x condition) analysis of variance with repeated measures were used to identify differences between conditions and pre- and post- training program on time and frequency domain measures. RESULTS Mediolateral root mean square excursion (p = 0.040; es = 0.20) and resultant mean frequency (p = 0.044; es = 0.29) of the center of pressure trajectory were found to be significantly different between pre- and post-training program. Further, participants dealt better with perturbations after completing the training program by reducing mediolateral root mean square excursion and 95 % confidence ellipse when visual stimulus was removed. SIGNIFICANCE Supervised exercise training in cancer patients undergoing chemotherapy improves postural stability in the mediolateral direction. Given that mediolateral movement of the center of pressure has previously been associated with fallers in other populations, exercise training during cancer treatments may be beneficial.
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Affiliation(s)
- Shane P Murphy
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; School of Integrative Physiology & Athletic Training, University of Montana, 32 Campus Drive, Missoula, MT, 59812, USA.
| | - Reid Hayward
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA; University of Northern Colorado Cancer Rehabilitation Institute, Campus Box 6, Greeley, CO, 80639, USA.
| | - Jeremy D Smith
- School of Sport and Exercise Science, University of Northern Colorado, Campus Box 39, Greeley, CO, 80639, USA.
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26
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Rosenberg J, Hyde PN, Yancy WS, Ford KM, Champ CE. Quantity of Resistance Exercise for Breast Cancer Patients: Does the Dose Match the Objective? J Strength Cond Res 2021; 35:1467-1476. [PMID: 33900267 DOI: 10.1519/jsc.0000000000003996] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
ABSTRACT Rosenberg, J, Hyde, PN, Yancy, WS, Ford, KM, and Champ, CE. Quantity of resistance exercise for breast cancer patients: does the dose match the objective? J Strength Cond Res 35(5): 1467-1476, 2021-There is currently a lack of consensus as to what defines exercise and resistance training in the cancer setting and whether current studies comply with exercise guidelines. This study aimed to quantify the available research studies using resistance training exercise interventions in the breast cancer setting for future clinical trial utilization. We systemically reviewed all available resistance exercise studies during and after breast cancer treatment in an attempt to quantify to the prescribed dose and whether regimens aligned with general exercise guidelines to improve functional mobility, body composition, and metabolic function. They were then compared with recommendations set forth by the national committees that create evidence-based exercise guidelines. Fifty studies met the initial criteria, with 35 meeting analysis criteria for evaluation. Fifteen studies evaluated an exercise regimen during cancer treatment, and 20 evaluated a regimen after treatment. The average adherence rates were 84% for all studies. Only 23 studies listed specific exercises used within the protocol. Most exercise regimens relied on open chain movements and machine exercises. Around half of studies met criteria to achieve hypertrophy, and 66% met American College of Sports Medicine exercise guidelines for cancer patients. A minority of breast cancer studies implementing a resistance training exercise regimen prescribed a regimen or specific dose that follows general exercise guidelines. This study highlights a potential deficiency in exercise programs designed for patients with breast cancer, and these findings should be considered in future study design.
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Affiliation(s)
- Jared Rosenberg
- Duke Diet and Fitness Center, Durham, North Carolina
- Department of Exercise Science, Syracuse University, Syracuse, New York
| | - Parker N Hyde
- Department of Human Sciences, The Ohio State University, Columbus, Ohio
- Department of Kinesiology, University of North Georgia, Dahlonega, Georgia
| | | | - Kenneth M Ford
- Institute for Human and Machine Cognition, Pensacola, Florida; and
| | - Colin E Champ
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
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27
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Effects of a personal trainer-led exercise intervention on physical activity, physical function, and quality of life of breast cancer survivors. Breast Cancer 2021; 28:737-745. [PMID: 33689150 DOI: 10.1007/s12282-020-01211-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Exercise is important to address physical and emotional effects of breast cancer treatment. This study examines effects of a personal trainer led exercise intervention on physical activity levels, physical function and quality of life (QoL) in breast cancer survivors. METHODS Women post active breast cancer treatment were recruited from 2015 to 2017, randomized to immediate exercise or wait-list control, and received three personal training sessions for up to 30 weeks. Physical activity and function were assessed by pedometer, and tests of endurance, strength, and flexibility. Self-reported physical activity, physical activity self-efficacy, and QoL were also assessed. RESULTS 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were aged (mean ± SD) 56 ± 10 years. On the endurance test, the exercise group significantly improved (increase of 18 ± 20 steps vs control 9 ± 12 steps) (p = 0.036). On the strength test, the exercise group significantly improved (increase of 4 ± 3 curls vs control 1 ± 3 curls) (p = 0.002). After intervention, change (mean ∆ ± SD) in the FACT-ES physical well-being subscale score was 1 ± 2 in the exercise group and - 1 ± 2 in the control group (p = 0.023). Improvement in Self-efficacy and Physical Activity (SEPA) score was significant with a change (mean ∆ ± SD) of 2 ± 5 for exercise vs 0 ± 5 for control (p = 0.047). The number of steps/day, back scratch test, weight, and self-reported physical activity did not significantly improve with intervention. CONCLUSIONS The intervention yielded significant improvements in endurance and strength but not physical activity or quality of life. IMPLICATIONS FOR CANCER SURVIVORS Future efforts to explore feasible ways to support patient's physical activity efforts need to be undertaken.
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28
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Evidence-Based Exercise Recommendations to Improve Mental Wellbeing in Women with Breast Cancer During Active Treatment: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13020264. [PMID: 33445739 PMCID: PMC7828164 DOI: 10.3390/cancers13020264] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/20/2020] [Accepted: 01/07/2021] [Indexed: 12/20/2022] Open
Abstract
Breast cancer was the most common cancer in women worldwide. The aims of the current systematic review and meta-analysis are: (i) to systematically examine the effects of exercise interventions on mental wellbeing; (ii) to examine the specific effect of the type of supervised exercise and its intensity, volume and frequency on mental wellbeing; and (iii) to explore which interventions are most effective in mental wellbeing among women with breast cancer during active treatment. An electronic literature search was performed using MEDLINE (via PubMed), Embase (Ovid), and Web of Science, we identified 175 full-text articles. The 57 publications included data from 6988 participants, age ranging from 18 to 78 years (weighted mean: 50.85 years). Compared with the control conditions, exercise training programs were associated with significant reductions in anxiety (d = -0.22, I2 = 53.0%), depression (d = -0.24, I2 = 66.6%), and fatigue (d = -0.47, I2 = 69.8%), as well as increases in body image (d = 0.27, I2 = 69.2%) and quality of life (overall, d = 0.46, I2 = 71.6%; emotional function, d = 0.33, I2 = 65.7%; and FACT-B, d = 0.60, I2 = 76.2%). There were a variety of frequencies, intensities, and durations of supervised exercise programs reported in the included meta-analytic approach. In addition, we found that concomitant concurrent training, at moderate-to-vigorous intensity, and with a volume ≥50 min/week had benefits on a number of health outcomes, such as fatigue, depression, and quality of life measure by the FACT-B instrument. These findings have important implications for healthcare providers and multidisciplinary teams involved in mental health management in cancer patients during active treatment.
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29
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Chaves SN, Lima FDD, Perondi BB, Vieira J, Elias JDM, Ribeiro LA, Silva AKS, Clael S, Oliveira RJD. Fatigue and depression improvements on breast cancer survivors practitioners of strength training. REVISTA BRASILEIRA DE CINEANTROPOMETRIA E DESEMPENHO HUMANO 2021. [DOI: 10.1590/1980-0037.2021v23e73039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Due to the high incidence of breast cancer worldwide, it is important to research and understand the physiological and psychological effects of this disease, like fatigue, depression, and capacity to do daily life tasks and how they modify physical activity. This study aimed to analyze the effects of strength training practice on physical fatigue (IMF-20), depression (Beck questionnaire), handgrip strength, and functional performance (time up and go). The sample was composed of 17 women breast cancer survivors, in which 8 volunteers were strength training practitioners for at least 6 months (P), and 9 volunteers were non-practitioners (NP). The T-test identified significant differences (p>0.05) between groups on fatigue (P=7.37±1.76; NP= 10.77±3.41; p=0.02) and depression (P= 8.75±5.20; NP= 14.55±4.21). There was no significant difference between groups on handgrip strength and functional performance.
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Grote S, Ricci JM, Dehom S, Modeste N, Sealy DA, Tarleton HP. Heart Rate Variability and Cardiovascular Adaptations Among Cancer-Survivors Following a 26-Week Exercise Intervention. Integr Cancer Ther 2020; 19:1534735420969816. [PMID: 33118412 PMCID: PMC7605052 DOI: 10.1177/1534735420969816] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Cardiotoxicity as a result of cancer treatment contributes to autonomic dysfunction and decreased cardiorespiratory fitness among cancer survivors. These deleterious cardiovascular outcomes reduce the survival prognosis for cancer patients and contribute to poor quality of life among survivors. Exercise interventions have been shown as effective in mitigating treatment-related side effects. However, previously published interventions have not explored the potential for improvement in autonomic dysfunction (heart rate variability, HRV). This study examined cardiovascular adaptations in cancer survivors (n = 76) who participated in a 26-week intervention consisting of combined aerobic and resistance training (CART). The most noteworthy improvements occurred during the first 13 weeks of training and were maintained throughout the end of the 26-week period. HRrest improved from baseline (PRE) to the midpoint (MID) (P = .036) and from PRE to POST timepoints (P = .029). HRV and VO2max did not initially appear to change in response to CART. However, after stratification on time since treatment, participants who were 5 or more years from their last treatment experienced improvements (ie increase) in the HRV characteristic of HF power (P = .050) and also in VO2max (P =.043), when compared to those experiencing less than 5 years of time since their last treatment. These findings highlight a need for more attention to address the cardiorespiratory deficits experienced by those who have recently completed cancer treatment. In conclusion, the CART intervention is effective in improving cardiorespiratory fitness and autonomic dysfunction. The structure of the intervention is feasible for cancer survivors to continue with at home, using minimal resources, and without supervision. This at-home model may be even more acceptable to recent survivors that may be homebound immediately following treatment.
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Affiliation(s)
| | | | | | | | - Diadrey-Ann Sealy
- University of the Southern Caribbean, Port of Spain, Saint Joseph, Trinidad and Tobago
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Zeng N, Liao N, Han C, Liu W, Gao Z. Leveraging Fitness Tracker and Personalized Exercise Prescription to Promote Breast Cancer Survivors' Health Outcomes: A Feasibility Study. J Clin Med 2020; 9:E1775. [PMID: 32521652 PMCID: PMC7356330 DOI: 10.3390/jcm9061775] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 01/10/2023] Open
Abstract
PURPOSE This feasibility study investigated whether a year-long combined fitness wristband-based and personalized exercise prescription intervention improves Chinese breast cancer survivors' (BCSs) health outcomes. METHODS Ninety-five BCSs (X̅age = 44.81 ± 7.94; X̅BMI = 22.18 ± 3.48) were recruited from Southern region of China and were delivered the exercise intervention across 12 months, using a single group pretest-posttest design. Participants' lipid profile (e.g., total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides), blood glucose, breast cancer biomarkers (e.g., carcinoembryonic antigen and cancer antigen 15-3), and functional fitness (e.g., strength in arms and legs, endurance, balance, agility, and flexibility) were assessed at baseline and 12-month post-intervention. RESULTS Thirty-three BCSs successfully completed the intervention. A significant change in blood glucose (mean difference (MD): -0.22, 95% confidence interval (CI): -0.41--0.03, t = -2.25, p = 0.028) was observed, with participants demonstrating lower levels of blood glucose at the 12-month post-intervention versus the baseline assessment. Notable changes in functional fitness were also discerned, including agility and balance (MD: -0.47, 95% CI: -0.68--0.26, t = -4.336, p < 0.001), aerobic endurance (MD: 89.25, 95% CI: 73.82-104.68, t = 11.336, p < 0.001), lower-body flexibility (left) (MD: 4.58, 95% CI: -4.4-13.56, t = 4.653, p < 0.001), and lower-body flexibility (right) (MD: 4.84, 95% CI: -4.65-14.33, t = 4.092, p < 0.001). CONCLUSION The observations suggested that our behavioral change program might promote certain health outcomes in Chinese BCSs, yet we are unable to recommend such a program given existing limitations. Future randomized control trials with diverse samples are warranted to confirm our findings.
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Affiliation(s)
- Nan Zeng
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO 80523, USA
| | - Ning Liao
- Department of Breast Cancer, Guangdong Academy of Medical Sciences, Guangzhou 510080, China
| | - Chunyuan Han
- School of Physical Education, South China University of Technology, Guangzhou 510641, China;
| | - Wenxi Liu
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA;
| | - Zan Gao
- School of Kinesiology, University of Minnesota, Minneapolis, MN 55455, USA;
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Pudkasam S, Pitcher M, Fisher M, O'Connor A, Chinlumprasert N, Stojanovska L, Polman R, Apostolopoulos V. The PAPHIO study protocol: a randomised controlled trial with a 2 x 2 crossover design of physical activity adherence, psychological health and immunological outcomes in breast cancer survivors. BMC Public Health 2020; 20:696. [PMID: 32414347 PMCID: PMC7227193 DOI: 10.1186/s12889-020-08827-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 05/01/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The PAPHIO study; a randomized controlled trial with 2X2 crossover design will implement a self-directed physical activity program in which participants will engage in self-monitoring and receive motivational interviewing to enhance physical activity adherence. The study aims to determine the effects of 24 weeks self-directed activity combined with motivational interviewing (MI) on (i) psychological health, (ii) quality of life (QoL) and (iii) immune function in female breast cancer survivors. METHODS The study will recruit 64 female breast cancer survivors within 3 years of diagnosis and at least 6 months post primary treatments at Western Health Sunshine Hospital, Melbourne, Australia. They will be randomly allocated to immediate intervention (IIG group) or delayed intervention groups (DIG group) in a 1:1 ratio. All participants will be given a wearable device (Fitbit Alta HR) and undertake self-directed physical activity for 24 weeks and will receive MI for 12 weeks (IIG; during week 0 to week 12 and DIG; during week 13 to week 24). Participants' daily step count and the changes of immune cell functionality will be assessed at the beginning (week 1: T1), week 12 (T2) and week 24 (T3) of the program. Physical activity adherence will be assessed at T2 and T3. Participants will also complete four questionnaires assessing exercise self-regulation (BREQ2), exercise barrier and task self-efficacy, mental health (DASS-21) and QoL (FACT-B) at three time points (T1 to T3). Linear-mixed models will be used to assess the relationship between physical activity volume by step counting and mental health (DASS-21), QoL (FACT-B), immune biomarkers, self-regulation (BREQ2) and self-efficacy at T1, T2 and T3;between 2 groups. DISCUSSION We expect this physical activity intervention to be acceptable and beneficial to the participants in terms of psychological and immunological well-being with the potential outcomes to be implemented more widely at relatively low cost to these or other patient populations. TRIAL REGISTRATION Australian New Zealand Clinical trials Registry- ACTRN12619001271190. Prospectively registered on 13 September 2019.
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Affiliation(s)
- Supa Pudkasam
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia.
- Bernadette de Lourdes School of Nursing Science, Assumption University, Bangkok, Thailand.
| | - Meron Pitcher
- Breast Cancer Service, Western Health, Melbourne, VIC, Australia
| | - Melanie Fisher
- Breast Cancer Service, Western Health, Melbourne, VIC, Australia
| | - Anne O'Connor
- IPC Health Altona Meadows, Melbourne, VIC, Australia
| | | | - Lily Stojanovska
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- Department of Food, Nutrition and Health, College of Food and Agriculture, United Arab Emirates University, Al Ain, UAE
| | - Remco Polman
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, Qld, Australia
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Sheehan P, Denieffe S, Murphy NM, Harrison M. Exercise is more effective than health education in reducing fatigue in fatigued cancer survivors. Support Care Cancer 2020; 28:4953-4962. [PMID: 32020356 DOI: 10.1007/s00520-020-05328-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 01/27/2020] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Cancer-related fatigue is a most debilitating side effect reported by survivors, often lasting years following treatment. PURPOSE To determine the effects of a 10-week exercise intervention compared with a health education intervention on fatigue, quality of life outcomes and functional fitness in cancer survivors with documented fatigue. METHODS This quasi-experimental study allocated 37 post-treatment fatigued cancer survivors (33 female, 30 breast cancer, aged 55 ± 2 years, time since treatment 2.3 ± 0.3 years; mean ± SEM) to an exercise group (EX, n = 19) or health education comparison group (HE, n = 18). The EX intervention emphasised brisk walking with progressive increments, stretching, exercise education and self-efficacy enhancement. The HE intervention emphasised sleep management, nutrition and cognitive behavioural therapy. All participants were evaluated at pre- and post-intervention with EX followed up at 26 W. RESULTS The intervention effect on fatigue (FACT-F) in EX was greater (p < 0.05) than that in HE, the difference being 4 times the recognised clinically important difference. The intervention also increased (p < 0.05) cognitive function, global quality of life and functional fitness scores. It reduced (p < 0.05) insomnia and fear of physical activity. All intervention effects were maintained to 26 W. The intervention effect on fatigue in EX was largely achieved by week 4. There was 100% retention rate at 10 W and no adverse events reported. CONCLUSIONS There is a reduction of considerable magnitude in cancer fatigue from group-based exercise training, that is sustainable and attributable to exercise per se. IMPLICATIONS FOR CANCER SURVIVORS Exercise training is feasible for fatigued cancer survivors and should form part of tailored rehabilitation programmes.
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Affiliation(s)
- Patricia Sheehan
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Suzanne Denieffe
- School of Humanities, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Niamh M Murphy
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland
| | - Michael Harrison
- Department of Sport and Exercise Science, Waterford Institute of Technology, Cork Road, Waterford, Ireland.
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Lee J, Vicil F. Effects of an Evidence-based Exercise Intervention on Clinical Outcomes in Breast Cancer Survivors: A Randomized Controlled Trial. THE ASIAN JOURNAL OF KINESIOLOGY 2020. [DOI: 10.15758/ajk.2020.22.1.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The number of breast cancer survivors throughout the world has increased. Breast cancer survivors need to know how to exercise to improve their clinical outcomes. The purpose of this study was to find the effects of an evidence-based combined exercise intervention on the fitness levels of breast cancer survivors.METHODS A total of 38 female breast cancer survivors were randomly assigned to an exercise group (n=19) or a control group who did usual care (n=19). Subjects in the exercise group participated eight weeks of moderate intensity aerobic exercise and bodyweight strength exercise three times per week. Weight, body mass index (BMI), cardiorespiratory fitness, handgrip strength, and flexibility were measured to assess the effects of the exercise intervention.RESULTS Women who completed the exercise intervention had decreased weight and BMI and increased cardiorespiratory fitness, handgrip strength, and flexibility.CONCLUSIONS Breast cancer survivors had improved health outcomes. A combined exercise intervention of moderate intensity three times per week for eight weeks can help breast cancer survivors improve their health. Participating in aerobic exercise and bodyweight strength exercise, which provide dynamic movements and use large muscle groups with no equipment, can help increase physical fitness levels of breast cancer survivors.
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Exercise shapes redox signaling in cancer. Redox Biol 2020; 35:101439. [PMID: 31974046 PMCID: PMC7284915 DOI: 10.1016/j.redox.2020.101439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Revised: 01/05/2020] [Accepted: 01/17/2020] [Indexed: 12/13/2022] Open
Abstract
In this paper of the special issue dedicated for the Olympics 2020, we put the light on an exciting facet of exercise-oncology, which may still be unknown to some audience. Accumulating convincing evidences show that exercise reduces cancer progression and recurrence mainly in colon and breast cancer patients. Interestingly, the positive effects of exercise on cancer outcomes were mainly observed when patients practiced vigorous exercise of 6 METs or more. At the molecular level, experimental studies highlighted that regular vigorous exercise could reduce tumor growth by driving changes in immune system, metabolism, hormones, systemic inflammation, angiogenesis and redox status. In the present review, we describe the main redox-sensitive mechanisms mediated by exercise. These redox mechanisms are of particular therapeutic interest as they may explain the emerging preclinical findings proving that the association of vigorous exercise with chemotherapy or radiotherapy improves the anti-cancer responses of both interventions. Clinical and preclinical studies converge to support the practice of exercise as an adjuvant therapy that improves cancer outcomes. The understanding of the underpinning molecular mechanisms of exercise in cancer can open new avenues to improve cancer care in patients.
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Kenzik KM, Demark-Wahnefried W, Ganz PA, Colditz G, Rock CL, Rogers LQ. Changes in Body Mass Index and Physical Activity Predict Changes in Vitality During a Weight Loss Trial in Breast Cancer Survivors. Ann Behav Med 2019; 52:999-1009. [PMID: 29617707 PMCID: PMC7189976 DOI: 10.1093/abm/kay004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background Breast cancer survivors rank fatigue (e.g., decreased vitality) as their number one concern affecting quality of life. Excess adiposity is associated with decreased vitality in breast cancer survivors, yet weight loss intervention trials report inconsistent effects on this parameter. Methods This is a secondary analysis of the Exercise and Nutrition to Enhance Recovery and Good Health for You trial, in which 692 overweight or obese breast cancer survivors ≤5 years from diagnosis, initiated weight loss interventions, and completed assessments semi-annually for 2 years. Assessments included the Godin Leisure-Time Exercise Questionnaire and the SF-36 MOS vitality subscale as an inverse measure of fatigue. Multilevel structural equation models estimated the direct effects of physical activity on vitality and indirect effects through body mass index (BMI) changes. Results Within-person findings show that at assessments with greater physical activity, BMI was significantly lower (B = -0.07, p < 0.001) and vitality was higher (B = 0.22, p < 0.001). However, there was no direct relationship between lower BMI and higher vitality (B = -0.11, p = 0.262) after controlling for the relationship of physical activity with BMI and physical activity with vitality. The between-person indirect effect of physical activity change through BMI change to vitality was significant (B = 0.03, p < 0.001). Participants whose physical activity was above the mean (B = 0.37, p < 0.001) and whose BMI was below the mean (B = -1.05, p < 0.001) were more likely to report greater vitality. Conclusion Improvements in vitality are primarily associated with increases in physical activity rather than BMI changes in this trial. Vitality was lower among survivors with higher BMI, although within-individual changes in BMI had no effect on vitality. Physical activity and weight loss share mechanistic links to vitality with physical activity potentially increasing (e.g., in an additive or synergistic manner) the effect of BMI reduction on vitality.
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Affiliation(s)
- Kelly M Kenzik
- Institute for Cancer Outcomes and Survivorship, University of Alabama at Birmingham, South Birmingham, AL, USA
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Kelly Kenzik
| | - Wendy Demark-Wahnefried
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Department of Nutrition Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Patricia A Ganz
- Departments of Health Care Organization and Policy and Medicine, Schools of Public Health and Medicine, University of California, Los Angeles (UCLA), Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Graham Colditz
- Division of Public Health Sciences, School of Medicine, Washington University, St. Louis, MO, USA
| | - Cheryl L Rock
- Department of Family Medicine and Public Health, School of Medicine, University of California, San Diego, La Jolla, San Diego, CA, USA
| | - Laura Q Rogers
- University of Alabama at Birmingham, UAB Comprehensive Cancer Center, Birmingham, AL, USA
- Department of Nutrition Sciences, School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
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Abstract
BACKGROUND Several empirical investigations have attempted to characterize the effect of physical activity on cancer mortality, but these investigations have rarely focused on patients with advanced breast cancer. OBJECTIVE The current study examined the hypothesis that greater physical activity is associated with longer survival among women with advanced breast cancer. METHODS We conducted a secondary data analysis of a prospective study of 103 patients with stage IV (n = 100) or locally recurrent (n = 3) breast cancer involved in a group psychotherapy trial. Physical activity was assessed at baseline using the Seven-Day Physical Activity Recall questionnaire, and patients were followed until April 1, 2016, at which time 93 of 103 had died. RESULTS Greater physical activity level at baseline was significantly associated with longer subsequent survival time in a Cox proportional hazards model (hazard ratio [HR], 0.90; 95% confidence interval [CI], 0.84-0.97; P < .01). Engaging in 1 additional hour per day of moderate activity reduced the hazard of subsequent mortality by 23% (HR, 0.77; 95% CI, 0.65-0.92; P < .01). These results remained significant even after controlling for demographic, medical, cancer, depression, and cortisol variables (HR, 0.91; 95% CI, 0.84-0.99; P < .05). CONCLUSIONS Women with advanced breast cancer who engaged in physical activity for 1 or more hours per day at baseline had an increased likelihood of survival compared with those who exercised less than 1 hour per day. IMPLICATIONS FOR PRACTICE Nurses should consider recommending moderate physical activity for women with advanced breast cancer. Randomized trials of physical activity interventions for this population are needed.
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van Waart H, Buffart LM, Stuiver MM, van Harten WH, Sonke GS, Aaronson NK. Adherence to and satisfaction with low-intensity physical activity and supervised moderate-high intensity exercise during chemotherapy for breast cancer. Support Care Cancer 2019; 28:2115-2126. [PMID: 31396745 DOI: 10.1007/s00520-019-05019-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 07/30/2019] [Indexed: 01/25/2023]
Abstract
PURPOSE In this study, we investigated factors associated with program adherence and patient satisfaction with a home-based physical activity program (Onco-Move, N = 77) and a supervised exercise program with a home-based component (OnTrack, N = 76). METHODS We assessed adherence via self-report (home-based program) and attendance records (supervised program). We used logistic regression analysis to identify sociodemographic, clinical and behavioural variables associated with program adherence. Patient satisfaction was assessed with self-report and is reported descriptively. RESULTS Fifty-one percent of Onco-Move and 62% of OnTrack participants were adherent to the home-based program, while 59% of OnTrack participants were adherent to the supervised sessions. Higher baseline physical fitness was associated with higher adherence to home-based components. Higher disease stage and having a partner were associated with adherence to OnTrack supervised sessions. Overall satisfaction with the exercise programs was high, but ratings of coaching provided by professionals for the home-based components were low. Patients offered suggestions for improving delivery of the programs. CONCLUSIONS These findings point to factors relevant to program adherence and suggest ways in which such programs can be improved. Providing additional time and training for health care professionals could improve the quality and hopefully the effectiveness of the interventions. The use of online diaries and smartphone apps may provide additional encouragement to participants. Finally, allowing greater flexibility in the planning and availability of supervised exercise training in order to accommodate the variability in cancer treatment schedules and the (acute) side effects of the treatments could also enhance program adherence. TRIAL REGISTRATION Netherlands Trial Register, NTR2159. http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2159.
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Affiliation(s)
- Hanna van Waart
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Departments of Epidemiology and Biostatistics and Medical Oncology, the Amsterdam Pubic Health research institute and Cancer Center, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Australia
| | - Martijn M Stuiver
- Center for Quality of Life, The Netherlands Cancer Institute, Amsterdam, The Netherlands.,ACHIEVE Center for Applied Research, Faculty of Health, Amsterdam University of Applied Science, Amsterdam, The Netherlands
| | - Wim H van Harten
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands
| | - Gabe S Sonke
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.
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The effect of a 12-week home-based walking program on reducing fatigue in women with breast cancer undergoing chemotherapy: A randomized controlled study. Int J Nurs Stud 2019; 99:103376. [PMID: 31442785 DOI: 10.1016/j.ijnurstu.2019.06.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/19/2019] [Accepted: 06/16/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Fatigue is the most common symptom experienced by cancer patients during treatment and can last long after completing treatment. Fatigue in cancer patients who have completed treatment is well known to be reduced by exercise, but the effect of exercise on reducing fatigue in patients under treatment has been inconsistent. OBJECTIVES The purposes of this study were to examine short-term and long-term effects of an individually tailored, home-based brisk walking program on reducing fatigue in breast cancer patients under chemotherapy. DESIGN, SETTING, PARTICIPANTS For this randomized controlled trial, women were recruited from a medical center in northern Taiwan if they were diagnosed with stages I-III breast cancer and experienced insomnia, fatigue, pain, or depressive symptoms after their first cycle of chemotherapy. Consenting participants (N = 159) were randomly assigned to either an exercise (12-week home-based walking program) group (n = 81) or an attention-control group (n = 78). METHODS The 12-week, home-based brisk walking program started on the first day of the third chemotherapy cycle. Fatigue was measured by the Brief Fatigue Inventory. Covariates, i.e., functional performance, sleep disturbance, anxiety, depression, and exercise-related variables, were also measured. Data were collected at baseline, two times during the exercise intervention, and five times after the exercise intervention (eight times in total). The effects of time-varying and time-invariant predictors on fatigue were analyzed by multilevel modeling. RESULTS Fatigue levels increased over time for both groups, even after completing treatment. At the end of the 12-week exercise program, the exercise group had less fatigue than the attention-control group, and this group difference was maintained for the whole study period. At the end of exercise program, women who had spent more time exercising before diagnosis had less fatigue than those who had exercised less often. In addition, patients' fatigue levels at various time points fluctuated along with their functional performance, sleep disturbance, and depression. CONCLUSIONS Our tailored, home-based brisk walking program effectively reduced fatigue in breast cancer patients under chemotherapy, and this effect lasted after completing treatment.
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Malicka I, Hanuszkiewicz J, Woźniewski M. Barriers of physical activity of women post breast cancer treatment in rural Poland. Health Care Women Int 2019; 40:682-695. [PMID: 31033414 DOI: 10.1080/07399332.2019.1608208] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Physical activity (PA) is an important element of healthy lifestyle, plays a major part in primary and secondary prevention of environmental illness. We examined the level of PA over a period of 7 days using Silva ex3 Connect pedometers in women after breast cancer treatment (BCT). Participants were selected from rural areas with restricted access to recreational and rehabilitative services. Women post BCT exhibited a low level of PA, though not deviating significantly from that of healthy women of the same age. There is a need to increase the level of PA among both: women after BCT and healthy women.
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Affiliation(s)
- Iwona Malicka
- a Department of Rehabilitation in Internal Diseases, Faculty of Physiotherapy , University School of Physical Education in Wroclaw , Wroclaw , Poland
| | - Justyna Hanuszkiewicz
- a Department of Rehabilitation in Internal Diseases, Faculty of Physiotherapy , University School of Physical Education in Wroclaw , Wroclaw , Poland
| | - Marek Woźniewski
- a Department of Rehabilitation in Internal Diseases, Faculty of Physiotherapy , University School of Physical Education in Wroclaw , Wroclaw , Poland
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Park SH, Tish Knobf M, Jeon S. Endocrine Therapy-Related Symptoms and Quality of Life in Female Cancer Survivors in the Yale Fitness Intervention Trial. J Nurs Scholarsh 2019; 51:317-325. [PMID: 30874369 DOI: 10.1111/jnu.12471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of the current study was to describe and compare endocrine therapy-related symptoms and quality of life in female cancer survivors taking aromatase inhibitors, tamoxifen, and no endocrine therapy, and to evaluate the effect of an exercise intervention on these symptoms and quality of life. DESIGN Randomized controlled trial. An aerobic resistance exercise intervention group was compared with a home-based exercise control group over 1 year. The exercise intervention was supervised for the first 6 months, followed by 6 unsupervised months. METHODS Perimenopausal and early postmenopausal female cancer survivors within 3 years of completing primary or adjuvant chemotherapy were selected. A total of 154 women were enrolled in the study. Type of endocrine or hormonal therapy was documented. Symptoms were measured by the Breast Cancer Prevention Trial Symptom Checklist and the Functional Assessment of Cancer Therapy-Endocrine Subscale. Quality of life was measured by the Functional Assessment of Cancer Therapy-General. Data were collected at baseline, and at 6 and 12 months. FINDINGS Participants generally had mild symptom distress. There was no difference in symptoms by endocrine therapy group or by exercise group. Participants taking aromatase inhibitors in the aerobic resistance exercise intervention group reported significant improvement in social, family, and functional well-being and better quality of life compared to those in the control group at 6 months but not at 12 months. CONCLUSIONS Findings were similar to those of previous large clinical trials in that no significant differences were found for endocrine therapy-related symptoms and quality of life by type of endocrine therapy taken. However, exercise may improve quality of life outcomes for women taking aromatase inhibitors. CLINICAL RELEVANCE Exercise has established efficacy for patient outcomes such as cardiovascular fitness, fatigue, weight management, and quality of life and may provide better quality of life for women who take aromatase inhibitors as adjuvant therapy.
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Affiliation(s)
- So-Hyun Park
- Alpha Zeta, Assistant Professor, Hunter Bellevue School of Nursing, City University of New York, New York, NY,, USA
| | - M Tish Knobf
- Delta Mu , Professor of Nursing and Acute Care/Health Systems Division Chair, Yale University School of Nursing, Orange, CT,, USA
| | - Sangchoon Jeon
- Research Scientist in Nursing, Yale University School of Nursing, Orange, CT,, USA
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Baglia ML, Lin IH, Cartmel B, Sanft T, Ligibel J, Hershman DL, Harrigan M, Ferrucci LM, Li FY, Irwin ML. Endocrine-related quality of life in a randomized trial of exercise on aromatase inhibitor-induced arthralgias in breast cancer survivors. Cancer 2019; 125:2262-2271. [PMID: 30840336 DOI: 10.1002/cncr.32051] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 01/18/2019] [Accepted: 01/22/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND The objective of this study was to evaluate the role of a 12-month exercise intervention on endocrine-related quality of life (QOL) and overall QOL among breast cancer survivors with aromatase inhibitor (AI)-induced arthralgia in the Hormones and Physical Exercise (HOPE) Study. METHODS This was a randomized controlled trial of 121 breast cancer survivors who were currently receiving AIs and experiencing at least mild arthralgia. QOL was assessed using the Functional Assessment of Cancer Therapy (FACT) questionnaires and the 36-Item Short Form Survey (SF-36) at baseline, 6 months, and 12 months. Participants were randomized to either a 1-year gym-based, supervised exercise intervention group (150 minutes of aerobic exercise and 2 strength-training sessions each week) or a usual care group. Effects of the intervention on QOL were assessed using mixed-model, repeated-measures analysis. RESULTS At 12 months, the exercise group had greater improvement in the overall QOL measures as well as the breast cancer-specific (scores, 2.2 vs 0.7; P = .02), endocrine-specific (scores, 5.6 vs 1.6; P < .001), and fatigue-specific (score, 5.8 vs 0.5; P < .001) subscales compared with the usual care group. The results indicated a stronger effect at 12 months versus 6 months after the intervention. CONCLUSIONS Combined aerobic and resistance exercise, such as treadmill walking and strength training, improved endocrine-related and overall QOL among breast cancer survivors who were experiencing adverse side effects from AIs. Because adverse side effects associated with AI use are quite common and this is the main reason for treatment discontinuation, this nonpharmacologic intervention could benefit many breast cancer survivors and increase successful adherence to AIs in breast cancer treatment.
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Affiliation(s)
| | - I-Hsin Lin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Brenda Cartmel
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Tara Sanft
- Yale Cancer Center, New Haven, Connecticut
| | | | - Dawn L Hershman
- Herbert Irving Comprehensive Cancer Center, Columbia University, New York, New York
| | | | - Leah M Ferrucci
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Fang-Yong Li
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
| | - Melinda L Irwin
- Yale School of Public Health, New Haven, Connecticut.,Yale Cancer Center, New Haven, Connecticut
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43
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Foucaut AM, Morelle M, Kempf-Lépine AS, Baudinet C, Meyrand R, Guillemaut S, Metzger S, Bourne-Branchu V, Grinand E, Chabaud S, Pérol D, Carretier J, Berthouze SE, Reynes E, Perrier L, Rebattu P, Heudel PE, Bachelot T, Bachmann P, Fervers B, Trédan O, Touillaud M. Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial. Support Care Cancer 2019; 27:3449-3461. [DOI: 10.1007/s00520-019-4658-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/16/2019] [Indexed: 01/05/2023]
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Lambert M, Brunet J, Couture-Lalande ME, Bielajew C. Aerobic physical activity and salivary cortisol levels among women with a history of breast cancer. Complement Ther Med 2019; 42:12-18. [PMID: 30670229 DOI: 10.1016/j.ctim.2018.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 10/10/2018] [Accepted: 10/22/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Physical activity (PA) helps reduce cancer-related symptoms and improves overall functioning for women with and without a history of breast cancer (BC). Few researchers have examined the associations between PA and physiological stress measures. The aim of this study was to determine whether aerobic PA was associated with diurnal and reactive cortisol patterns, and whether these associations differed for women with and without a history of BC. METHODS Participants were 25 women with a history of BC and 23 women without a history of BC who self-reported aerobic PA frequency. To assess diurnal cortisol patterns, participants provided five saliva samples collected on two consecutive days at the following times: upon awakening, 30 min after waking, 12 PM, 4 PM, and 9 PM. To measure reactive cortisol patterns, participants provided seven saliva samples collected before, during, and after doing the Trier Social Stress Test. RESULTS Cortisol patterns differed statistically based on women's cancer history, whereby women without a history of BC had significantly higher overall cortisol reactivity to an acute stressor, and a marginally significant (p = .05) cancer experience by aerobic PA interaction was observed when analyzing diurnal cortisol data. CONCLUSIONS Findings suggest that PA may not have the same effect on women with and without a history of BC.
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Affiliation(s)
- M Lambert
- School of Psychology, University of Ottawa, Ontario, Canada.
| | - J Brunet
- School of Psychology, University of Ottawa, Ontario, Canada; School of Human Kinetics, University of Ottawa, Ontario, Canada
| | | | - C Bielajew
- School of Psychology, University of Ottawa, Ontario, Canada
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45
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Paulo TRS, Rossi FE, Viezel J, Tosello GT, Seidinger SC, Simões RR, de Freitas R, Freitas IF. The impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy: a randomized controlled trial. Health Qual Life Outcomes 2019; 17:17. [PMID: 30658629 PMCID: PMC6339353 DOI: 10.1186/s12955-019-1090-4] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 01/11/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND This study evaluated the impact of an exercise program on quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy. METHODS Older breast cancer survivors were randomized into two groups: combined training: resistance + aerobic exercise program for nine months (n = 18) or control group (n = 18). Quality of life was assessed by the questionnaires SF36, EORTC QLQ-C30, and EORTC QLQ-BR23 at baseline, and at three, six, and nine months. The exercise group performed 40 min of resistance exercises on machines followed by 30 min of aerobic training on a treadmill 3x/wk. Repeated measures ANOVA was used to compare the groups over time. RESULTS Significant time x group interactions and moderate to high effect sizes were found for physical functioning, physical health, bodily pain, general health perception, vitality, social functioning, fatigue, sleep disturbance, body image, and upset by hair loss, favoring the exercise group. CONCLUSION This study demonstrated the potential benefits and high clinical relevance of exercise programs to improve quality of life in older breast cancer survivors undergoing aromatase inhibitor therapy.
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Affiliation(s)
- Thais R S Paulo
- State University of Sao Paulo, UNESP, School of Technology and Sciences, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Paulo, CEP 19060-900, Brazil.
- Federal University of Rio Grande do Norte, UFRN, Natal, Brazil.
| | - Fabricio E Rossi
- State University of Sao Paulo, UNESP, School of Technology and Sciences, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Paulo, CEP 19060-900, Brazil
- Federal University of Piauí, UFPI, Teresina, Brazil
| | - Juliana Viezel
- State University of Sao Paulo, UNESP, School of Technology and Sciences, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Paulo, CEP 19060-900, Brazil
| | | | - Sylvia C Seidinger
- State University of Sao Paulo, UNESP, School of Technology and Sciences, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Paulo, CEP 19060-900, Brazil
| | - Regina R Simões
- Federal University of Triângulo Mineiro, UFTM, Uberaba, Brazil
| | | | - Ismael F Freitas
- State University of Sao Paulo, UNESP, School of Technology and Sciences, Rua Roberto Simonsen, 305, Presidente Prudente, Sao Paulo, CEP 19060-900, Brazil
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46
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Dieli-Conwright CM, Courneya KS, Demark-Wahnefried W, Sami N, Lee K, Sweeney FC, Stewart C, Buchanan TA, Spicer D, Tripathy D, Bernstein L, Mortimer JE. Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial. Breast Cancer Res 2018; 20:124. [PMID: 30340503 PMCID: PMC6194749 DOI: 10.1186/s13058-018-1051-6] [Citation(s) in RCA: 164] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 09/13/2018] [Indexed: 01/12/2023] Open
Abstract
Background Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors. Methods One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65–85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis. Results At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO2max (p < 0.001), muscular strength (p < 0.001), osteocalcin (p = 0.01), and BSAP (p = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (p < 0.01). Conclusions A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care. Trial registration This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.
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Affiliation(s)
- Christina M Dieli-Conwright
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA. .,Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA.
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, T6G 2H9, Canada
| | - Wendy Demark-Wahnefried
- Department of Nutrition Sciences, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Nathalie Sami
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Kyuwan Lee
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Frank C Sweeney
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Christina Stewart
- Division of Biokinesiology and Physical Therapy, University of Southern California (USC),
- 1540 E. Alcazar St., CHP 155, Los Angeles, CA, 90089, USA
| | - Thomas A Buchanan
- Division of Endocrinology and Diabetes, Keck School of Medicine, USC, Los Angeles, CA, 90033, USA
| | - Darcy Spicer
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Debu Tripathy
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Leslie Bernstein
- Division of Biomarkers of Early Detection and Prevention, Beckman Research Institute, City of Hope (COH), Duarte, CA, 91010, USA
| | - Joanne E Mortimer
- Division of Medical Oncology and Experimental Therapeutics, COH, Duarte, CA, 91010, USA
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Abstract
Physical Activity and Cancer Abstract. This article aims to summarize the literature on the role of physical activity in cancer patients and to propose exercise programs based on studies and recommendations. Medical advances with improved early diagnosis and treatment have increased the number of cancer survivors. At the same time, the quality of life of these patients must also be improved. In the different stages of the disease physical activity has an important role to play with its beneficial effects on fatigue, physical condition, mood etc. Collaboration between health system actors and patient education are the key to success in this multi-disciplinary care.
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Affiliation(s)
| | | | - Pierre Molnar
- 1 Hôpital du Jura, Centre de Rééducation, Porrentruy
| | - Serdar Koçer
- 1 Hôpital du Jura, Centre de Rééducation, Porrentruy
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48
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Zhang X, Li Y, Liu D. Effects of exercise on the quality of life in breast cancer patients: a systematic review of randomized controlled trials. Support Care Cancer 2018; 27:9-21. [DOI: 10.1007/s00520-018-4363-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/17/2018] [Indexed: 12/01/2022]
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49
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Foley MP, Hasson SM, Kendall E. Effects of a Translational Community-Based Multimodal Exercise Program on Quality of Life and the Influence of Start Delay on Physical Function and Quality of Life in Breast Cancer Survivors: A Pilot Study. Integr Cancer Ther 2018; 17:337-349. [PMID: 28929821 PMCID: PMC6041921 DOI: 10.1177/1534735417731514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 07/06/2017] [Accepted: 08/12/2017] [Indexed: 12/20/2022] Open
Abstract
The purpose of this investigation was 2-fold: (1) to investigate the effects of a translational 12-week community-based multimodal exercise program on quality of life (QoL) in breast cancer survivors (BCS) and (2) to examine the influence of a start delay on physical function and QoL in BCS. Fifty-two female BCS completed a 12-week program consisting of 90-minute supervised exercise sessions at a frequency of 2 supervised sessions per week. Exercise sessions consisted of three 30-minute components: (1) aerobic conditioning, (2) resistance exercise training, and (3) balance and flexibility training. Significant ( P < .05) improvements in QoL were identified post-program completion. Cohort stratification comparison between the early start (<1 year since completion of oncologic treatment) and late start (>1 year since completion of oncologic treatment) revealed no significant ( P > .05) differences between the early start and late start groups on improvements in physical function. Regarding the influence of start delay on QoL, the early start group showed significant ( P < .05) improvement in emotional well-being. No other significant differences in improvement in QoL were detected between the early start and late start groups. Regardless of start delay, meaningful improvements in physical function and QoL were found after completing the community-based multimodal exercise program. Early participation in community-based exercise programming may benefit BCS' emotional well-being compared to later participation.
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50
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Singh B, Spence RR, Steele ML, Sandler CX, Peake JM, Hayes SC. A Systematic Review and Meta-Analysis of the Safety, Feasibility, and Effect of Exercise in Women With Stage II+ Breast Cancer. Arch Phys Med Rehabil 2018; 99:2621-2636. [PMID: 29730319 DOI: 10.1016/j.apmr.2018.03.026] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 02/24/2018] [Accepted: 03/23/2018] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To systematically evaluate the safety, feasibility, and effect of exercise among women with stage II+ breast cancer. DATA SOURCES CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, Science Direct and SPORTDiscus were searched for articles published before March 1, 2017. STUDY SELECTION Randomized, controlled, exercise trials involving at least 50% of women diagnosed with stage II+ breast cancer were included. DATA EXTRACTION Risk of bias was assessed and adverse event severity was classified using the Common Terminology Criteria. Feasibility was evaluated by computing median (range) recruitment, withdrawal, and adherence rates. Meta-analyses were performed to evaluate exercise safety and effects on health outcomes only. The influence of intervention characteristics (mode, supervision, duration and timing) on exercise outcomes were also explored. DATA SYNTHESIS There were no differences in adverse events between exercise and usual care (risk difference: <0.01 ([95% CI: -0.01, 0.01], P=0.38). Median recruitment rate was 56% (1%-96%), withdrawal rate was 10% (0%-41%) and adherence rate was 82% (44%-99%). Safety and feasibility outcomes were similar, irrespective of exercise mode, supervision, duration, or timing. Effects of exercise for quality of life, fitness, fatigue, strength, anxiety, depression, body mass index and waist circumference compared with usual care were significant (standardized mean difference range: 0.17-0.77, P<0.05). CONCLUSION The findings support the safety, feasibility, and effects of exercise for those with stage II+ breast cancer, suggesting that national and international exercise guidelines appear generalizable to women with local, regional, and distant breast cancer.
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Affiliation(s)
- Ben Singh
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia.
| | - Rosalind R Spence
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia
| | - Megan L Steele
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia
| | - Carolina X Sandler
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia; Cancer Prevention Research Centre, School of Public Health, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Jonathan M Peake
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia; School of Biomedical Sciences, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Queensland, Australia
| | - Sandra C Hayes
- School of Public Health and Social Work, Queensland University of Technology, Victoria Park Road, Brisbane, Queensland, Australia; Institute of Health and Biomedical Innovation, Queensland University of Technology, Musk Avenue, Kelvin Grove, Queensland, Australia
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