Resistance Training for Patients with Cancer: A Conceptual Framework for Maximizing Strength, Power, Functional Mobility, and Body Composition to Optimize Health and Outcomes

Body Composition Benefits Diminish One Year After a Resistance Training Regimen in Breast Cancer Patients, Although Improvements in Strength, Balance, and Mobility Persist

OBJECTIVES

Resistance training can improve body composition and physical function during and after breast cancer treatment and improve quality of life. It is unclear whether these changes persist once a person is no longer actively enrolled in a structured exercise regimen. Thus, we analyzed participants from the EXERT-BC protocol, assessing an intense exercise regimen in women with breast cancer at one year.

METHODS

All the participants were asked to undergo reassessment at one year. Current exercise habits, injuries, changes in medical history, body composition, handgrip strength, functional mobility and balance, and patient-reported quality of life were assessed. Pairwise comparison was performed via the paired t test.

RESULTS

Out of 40 initial participants, 33 returned for reevaluation, with 6 lost to follow-up and 1 with unrelated hospitalization. The median age was 57.8 years, and stage at diagnosis was 1. Weekly exercise was reported by 16 participants (48.5%), with 14 of the 16 following structured resistance training. Between completion of the EXERT-BC and one year follow-up, five women (15.2%) experienced musculoskeletal injuries, which inhibited their ability to exercise. Three women (9%), who were no longer exercising experienced orthopedic injuries requiring medical intervention. The significant reduction in percent body fat, total body fat, excess fat, and increases in muscle mass, resting metabolic rate, and whole-body phase angle dissipated at 1 year. Activity levels and quality of life were no longer significantly improved. However, strength, mobility, and balance remained significantly improved versus pre-exercise measurements, whether a participant was still engaged in exercise or not.

CONCLUSIONS

After a 3-month dose-escalated resistance training regimen, exercise compliance was poor at one year. The anthropomorphic benefits of the regimen regressed by one year; however, the improvements in strength, balance, and mobility persisted.

EXERT-BCN: An Exercise Regimen Designed to Improve Body Composition, Functional Capacity, and Strength After Treatment for Breast Cancer With Nutrition Optimization

PURPOSE

Effective methods to improve body composition and metabolic/hormonal dysregulation are central to breast cancer care. We hypothesized that a nutrition regimen focused on food quality and an observed exercise regimen using high-load resistance training during or after cancer treatment would improve body composition and functional capacity.

METHODS

Forty-four women with breast cancer, including survivors on therapy and in surveillance, excluding chemotherapy, underwent a continuously monitored dose-escalated exercise regimen utilizing heavy weights and linear progression in an exercise oncology facility along with a diet focused on food quality and adequate protein intake. Dietary strategy was discussed during each exercise session and twice monthly meetings. Pre- and post-workout assessment of body composition, functional mobility, balance, activity levels, and quality of life were compared via paired T-test and Wilcoxon signed-rank test.

RESULTS

Forty-four women completed the protocol, with a median age of 54 years and BMI of 30.3. Most participants reported cancer-related symptoms (79.5%). Across compound exercises, composite load lifted increased by 36.5% (P < .001) and bilateral Y-balance scores increased 18% (P < .001). A 6.6% reduction in body fat was observed (1.8 kg; P < .001) alongside a 1.4% increase in muscle mass (0.5 kg; P = .003). Resting metabolic rate increased by 0.8% (P = .018). Significant improvements were uniformly demonstrated across quality-of-life scores (European Quality of Life 5-Dimension Score, Patient Health Questionnaire 9 Depression Scale, and Generalized Anxiety Disorder 7 questionnaires).

CONCLUSION

A 3-month regimen of nutrition counseling and high-intensity resistance training promoted significant muscle mass gain and adipose tissue loss, alongside significant improvements across body composition, strength, mobility, and functional status, and patient-reported quality of life.

Grip strength as a surrogate measure of strength, functional, and metabolic parameter increases in breast cancer survivors undergoing an exercise regimen

Grip strength, a surrogate for quantifying strength, correlates with function and longevity. However, this relationship is less clear in women with breast cancer. 138 women undergoing oncologic treatment for breast cancer were enrolled across three institutional review board-approved protocols with three months of resistance training with pre and post assessment of body composition, phase angle, functional movement screen (FMS), balance, weight lifted (load), quality of life, activity levels, and hand grip strength. Significant increases in maximum, minimum, and mean grip strength were seen. Mean grip strength increased by 12.6% and 3.5 kg. Right/left (R/L) mismatch significantly decreased from baseline to post-intervention (13.3 to 8.7%). On univariable analysis, greater baseline mean grip strength was associated with younger age, greater baseline FMS, composite load lifted, activity levels, and decreased R/L balance mismatch. On multivariable analysis, greater mean grip strength was independently associated with greater baseline mobility and composite load lifted. Baseline mean grip strength was associated with baseline lower bodyfat percentage and greater muscle mass, whole body phase angle, and resting metabolic rate (all significant on multivariable analysis, R2 = 0.247). Grip strength may be a valuable surrogate biomarker within breast cancer survivorship care, particularly in resource-limited settings.

Efficacy of Concurrent Training in Breast Cancer Survivors: A Systematic Review and Meta-Analysis of Physical, Psychological, and Biomarker Variables

BACKGROUND

Breast cancer treatments often cause serious side effects, but physical exercise has shown the potential to improve both the physical and psychological health outcomes of survivors. This review and meta-analysis aimed to synthesize and analyze the scientific evidence on the effectiveness of concurrent training on physical, psychological, and biomarkers variables on breast cancer survivors.; Methods: A systematic review and meta-analysis was registered in PROSPERO (CRD42024571851). The ISI Web of Science, PubMed, and Scopus databases were searched. The methodological quality of all the included studies was assessed using the Cochrane risk of bias tool. This review included 14 articles that met the inclusion criteria on the effect of concurrent training on breast cancer survivors.

RESULTS

The results of the meta-analysis on body composition revealed a significant overall effect on body mass (effect size [ES] = -2.23; 95% CI: -4.16, -0.29) and body mass index (ES = -0.66; 95% CI: -1.32, 0.01). In contrast, no significant differences were shown in the % fat mass (ES = -2.63; 95% CI: -5.58, 0.33). Strength significantly improved after simultaneous training (ES = 4.93; 95% CI: 1.94, 7.92). In addition, cardiorespiratory fitness (maximum oxygen consumption) showed significant improvements after simultaneous training (ES = 3.03; 95% CI: 1.88, 4.19).

CONCLUSIONS

The research shows that concurrent training, including strength and aerobic exercises, promotes significant improvements in body mass, body mass index, muscle strength, and cardiorespiratory fitness. However, the effectiveness of the training depends on the intensity, duration and frequency of the exercise, as well as the individualization of the programs.

Clinical research framework proposal for ketogenic metabolic therapy in glioblastoma

Glioblastoma (GBM) is the most aggressive primary brain tumor in adults, with a universally lethal prognosis despite maximal standard therapies. Here, we present a consensus treatment protocol based on the metabolic requirements of GBM cells for the two major fermentable fuels: glucose and glutamine. Glucose is a source of carbon and ATP synthesis for tumor growth through glycolysis, while glutamine provides nitrogen, carbon, and ATP synthesis through glutaminolysis. As no tumor can grow without anabolic substrates or energy, the simultaneous targeting of glycolysis and glutaminolysis is expected to reduce the proliferation of most if not all GBM cells. Ketogenic metabolic therapy (KMT) leverages diet-drug combinations that inhibit glycolysis, glutaminolysis, and growth signaling while shifting energy metabolism to therapeutic ketosis. The glucose-ketone index (GKI) is a standardized biomarker for assessing biological compliance, ideally via real-time monitoring. KMT aims to increase substrate competition and normalize the tumor microenvironment through GKI-adjusted ketogenic diets, calorie restriction, and fasting, while also targeting glycolytic and glutaminolytic flux using specific metabolic inhibitors. Non-fermentable fuels, such as ketone bodies, fatty acids, or lactate, are comparatively less efficient in supporting the long-term bioenergetic and biosynthetic demands of cancer cell proliferation. The proposed strategy may be implemented as a synergistic metabolic priming baseline in GBM as well as other tumors driven by glycolysis and glutaminolysis, regardless of their residual mitochondrial function. Suggested best practices are provided to guide future KMT research in metabolic oncology, offering a shared, evidence-driven framework for observational and interventional studies.

Commentary: Key Aspects of Multimodal Prehabilitation in Surgical Patients With Cancer. A Practical Approach to Integrating Resistance Exercise Programs

Surgical prehabilitation aims to optimise patients' physiological reserves to better withstand the stress of surgery, reduce the risk of postoperative complications, and promote a faster and optimal recovery. The purpose of this commentary is to outline the key aspects of prehabilitation before surgery for cancer which seem to impact its effectiveness and wider implementation. Particular attention is paid to the role and integration of resistance training programmes as a key component of multimodal prehabilitation for patients with cancer. We firstly analyse some of the barriers currently hindering the implementation of prehabilitation programmes in the National Health Service (United Kingdom). Later, we describe essential aspects of resistance training design, such as exercise modality and order execution, volume and intensity, rest periods between sets or exercises, and workout frequency. Furthermore, we propose a methodology to use the perception of effort to control patients' progression during a prehabilitation programme.

Effects of resistance training on quality of life, fatigue, physical function, and muscular strength during chemotherapy treatment: a systematic review and meta-analysis

PURPOSE

To systematically review and meta-analyse the efficacy of resistance training on quality of life (QOL), fatigue, physical function, and muscular strength in people diagnosed with cancer undergoing chemotherapy.

METHODS

Electronic databases PubMed, Cochrane Central, CINAHL, SCOPUS and Web of Science were systematically searched for randomised controlled trials (RCTs) that compared the effects of resistance training to control on QOL, fatigue, physical function, and lower-body and upper-body muscular strength in adults undergoing chemotherapy. Standardised mean differences (SMDs) were pooled using a random effects model. Risk of bias was assess using the risk of bias tool for randomised trials (RoB 2).

RESULTS

Seven RCTs encompassing 561 participants were included. The pooled results of seven RCTs showed that resistance training during chemotherapy significantly improved lower-body strength (n = 555, SMD 0.33, 95% CI 0.12 to 0.53, moderate-quality evidence, I2 = 23%) compared to control. There was no evidence for an effect of resistance training on QOL (n = 373, SMD 0.13, 95% CI -0.15 to 0.42, low-quality evidence, I2 = 0%), fatigue (n = 373, SMD -0.08, 95% CI -0.37 to 0.22, low-quality evidence, I2 = 20%), physical function (n = 198, SMD 0.61, 95% CI -0.73 to 1.95, very low-quality evidence, I2 = 83%), or upper-body strength (n = 413, SMD 0.37, 95% CI -0.07 to 0.80, very low-quality evidence, I2 = 69%).

CONCLUSIONS

Resistance training may improve lower-body strength in patients undergoing chemotherapy treatment compared to control.

EXERT-BC: A pilot study of an exercise regimen designed to improve functional mobility, body composition, and strength after the treatment for breast cancer

PURPOSE

Resistance training may offer several unique advantages within breast cancer (BC) survivorship care; however, safety concerns have limited the application of high-intensity compound movements necessary to elicit optimal changes in body composition, strength, and quality of life in this population. The EXERT-BC trial assesses the safety and feasibility of an evidence-based, dose-escalated resistance training regimen among BC survivors, with the goal of improving physical and metabolic function, mobility, muscle mass, and body composition.

METHODS

Participants included women with breast cancer underwent a 3-month thrice weekly exercise regimen involving dose escalation of high-intensity compound exercises. Coprimary outcomes included safety and adherence. Pre- and post-regimen assessment included body composition testing, functional mobility and balance, total load (weight × repetitions × sets) across compound exercises, and patient reported quality of life. Pairwise comparison was performed via the paired t test.

RESULTS

Fourty participants completed a 3-month exercise regimen, with a median age of 57 years (range, 27-74 years) and 73% having stage 0-2 BC. BC therapies concurrent with exercise included anti-estrogen therapy (80%), radiotherapy (30%), and non-hormonal systemic therapy (15%). No adverse events were observed aside from a single case of self-limited knee pain. Session attendance exceeded a prespecified threshold of 75%, and 98% patients reported ongoing compliance to an exercise regimen following regimen completion. Significant reductions in percent body fat (p < 0.001) and increases in percent muscle mass (p = 0.011) were observed. Significant increases in resting metabolic rate (p = 0.023), bilateral grip strength (p < 0.001), functional movement screen (p < 0.001), bilateral Y-Balance testing (p < 0.001), and Godin questionnaire scores (p < 0.001) were observed.

CONCLUSION

A 3-month dose-escalated resistance training regimen comprising high-intensity compound movements appears safe with a high degree of adherence among breast cancer survivors, resulting in demonstrable improvements in body composition, metabolic parameters, strength increases, and patient-reported quality of life.