Case Control Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Feb 10, 2018; 9(1): 1-12
Published online Feb 10, 2018. doi: 10.5306/wjco.v9.i1.1
Does low volume high-intensity interval training elicit superior benefits to continuous low to moderate-intensity training in cancer survivors?
Kellie Toohey, Kate Pumpa, Andrew McKune, Julie Cooke, Katrina D DuBose, Desmond Yip, Paul Craft, Stuart Semple
Kellie Toohey, Kate Pumpa, Andrew McKune, Julie Cooke, Stuart Semple, Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, Canberra 2605, Australia
Kellie Toohey, Kate Pumpa, Andrew McKune, Julie Cooke, Stuart Semple, Research Institute for Sport and Exercise, University of Canberra, Canberra 2605, Australia
Kellie Toohey, Stuart Semple, Health Research Institute, University of Canberra, Canberra 2605, Australia
Andrew McKune, Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban 4000, South Africa
Katrina D DuBose, the College of Health and Human Performance, East Carolina University, Greenville, NC 27858, United States
Desmond Yip, Paul Craft, ANU Medical School, the Australian National University, Canberra 2605, Australia
Author contributions: Toohey K performed all experiments; Pumpa K, McKune A, Cooke J, DuBose KD, Yip D, Craft P and Semple S provided vital reagents and analytical tools and were also involved in editing the manuscript; Toohey K co-ordinated and provided the collection of all the human material; Toohey K and Semple S designed the study and wrote the manuscript.
Institutional review board statement: National Statement on Ethical Conduct in Human Research (National Health and Medical Research Council, 2007), Human research Ethics Committee, No. 13-153.
Informed consent statement: This approval is only granted if the project meets the ethical guidelines of the National Health and Medical Research Council. Individual forms which the patients signed are not able to be provided as this is against privacy laws and ethical agreements.
Conflict-of-interest statement: No potential conflicts of interest relevant to this article were reported.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Kellie Toohey, BSc, MA, Assistant Professor, Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Canberra 2605, Australia. kellie.toohey@canberra.edu.au
Telephone: +61-2-62068873
Received: November 23, 2017
Peer-review started: November 23, 2017
First decision: December 27, 2017
Revised: December 31, 2017
Accepted: January 23, 2018
Article in press: January 23, 2018
Published online: February 10, 2018
ARTICLE HIGHLIGHTS
Research background

Research into the optimum exercise guidelines for cancer survivors are not conclusive. Little evidence exists for the use of low-volume high-intensity interval training (LVHIIT) within the cancer population, even though it shows promise in other chronic populations. LVHIIT has been used in populations such as stroke, diabetes, cardiovascular disease (CVD), cardiac rehabilitation showing more pronounced health benefits than the more commonly prescribed continuous low-moderate intensity training (CLMIT). Therefore, it should be further investigated for use with cancer survivors as it is a time efficient exercise modality, with greater health benefits.

Research motivation

Using LVHIIT in the cancer population shows promise as a more efficient exercise prescription. The encouraging results of this study has opens the possibility of introducing LVHIIT into rehabilitation programs. LVHIIT is a time efficient exercise modality, which could be used to increase the fitness levels in cancer survivors. The LVHIIT protocol in this study improved fitness and functional capacity and decreased waist circumference compared with CLMIT and the control group. Both LVHIIT and CLMIT improved QoL. LVHIIT may be an effective alternative to traditional exercise prescription within this population. The benefit of LVHIIT is that for selected variables it produces more pronounced results compared with CMIT and it is short, which could entice more cancer survivors to participate in exercise as time is a barrier.

Research objectives

To determine the effectiveness of LVHIIT compared to CLMIT and a control group and to determine if LVHIIT and CLMIT improved CVD risk and health outcomes in cancer survivors. The significance of these objectives is that this form of exercise can be used to achieve more pronounced improvements in health outcomes than the commonly prescribed CLMIT.

Research methods

The experiments and data analysis used in this study were a mix of validated methods used before within this population (6MWT, STS, DXA, hip/waist circumference) and unique protocols which have been used with other populations, but not commonly with cancer survivors (Sphygmocor). The use of the ANCOVA analysis and effect size analysis was chosen due to the robustness that this analysis provides for the data collected.

Research results

There were significant improvements in functional capacity, specifically cardiorespiratory fitness, lower-limb strength, and waist circumference in participants who completed the LVHIIT compared with the CLMIT and control groups. QoL improved in both the LVHIIT group and the CLMIT group when compared with the control group, however a greater effect was observed in the LVHIIT group. Additional research is required to fully understand the mechanisms involved in the changes identified in this study in relation to different doses of exercise. This research would be highly beneficial to assist clinicians in the optimisation of clinical exercise recommendations for cancer survivors.

Research conclusions

Present exercise guidelines for cancer survivors lack detail on the type, mode, duration and intensity of exercise necessary to achieve best outcomes. This current research was required to fill the gaps in current knowledge to further improve exercise recommendations. LVHIIT is the use of small doses of high-intensity exercise to elicit physiological responses such as improved VO2 max and positive metabolic changes in skeletal muscle which seem greater than the commonly prescribed CLMIT. The LVHIIT physiological changes show potential for use in clinical practice in the rehabilitation of cancer survivors. At present there is limited research examining the effects of LVHIIT in improving health outcomes for cancer survivors. This study shows promise for the use of LVHIIT in the cancer population. The encouraging results opens up the possibility of introducing LVHIIT in therapy programs, as a shorter and more efficacious exercise to increase the fitness levels in cancer survivors. The benefit of LVHIIT is that for selected variables it produces more pronounced results compared with CMIT and it is short in duration which could entice more cancer survivors to participate in exercise. This study highlights that the most commonly prescribed CLMIT may not be enough to induce clinically relevant changes in cancer survivors.

Research perspectives

The use of VO2 max testing would be beneficial if it can be tolerated well by cancer survivors post treatment. Future research should analyse ways to measure the mechanisms involved in the changes seen in the study results and clarify how and why these changes occur.