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Sellami M, Puce L, Bragazzi NL. Immunological Response to Exercise in Athletes with Disabilities: A Narrative Review of the Literature. Healthcare (Basel) 2023; 11:1692. [PMID: 37372810 DOI: 10.3390/healthcare11121692] [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: 03/14/2023] [Revised: 05/26/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023] Open
Abstract
For a person with a disability, participating in sports activities and/or competitions can be a challenge for the immune system. The relationship between exercise and immunity response in disabled athletes is, indeed, extremely complex for several reasons, including (1) the chronic low-grade inflammatory and immunodepression-"secondary immune deficiency"-state imposed by the disability/impairment; (2) the impact of the disability on an array of variables, spanning from physical fitness to well-being, quality of life, sleep, and nutritional aspects, among others, which are known to mediate/modulate the effects of exercise on human health; (3) the variability of the parameters related to the exercise/physical activity (modality, frequency, intensity, duration, training versus competition, etc.); and (4) the intra- and inter-individual variability of the immunological response to exercise. In able-bodied athletes, previously published data described several exercise-induced changes affecting various immunological subsets and subpopulations, ranging from neutrophils to lymphocytes, and monocytes. Broadly, moderate intensity workout is accompanied by optimal immunity and resistance to infections such as upper respiratory tract infections (URTI) in athletes. Periods of intense training with insufficient recovery can cause a temporary state of immunosuppression, which should end with a few days of rest/recovery from exercise. Disabled athletes are relatively overlooked and understudied with respect to their able-bodied counterparts. Findings from the few studies available on paralympic and disabled athletes are here summarized and analyzed utilizing a narrative approach to review and determine the major features of the immunological and inflammatory responses to exercise in this specific population. Moreover, a few studies have reported behavioral, dietary, and training strategies that can be adopted to limit exercise-induced immunosuppression and reduce the risk of infection in people with disabilities. However, given the paucity of data and contrasting findings, future high-quality investigations on paralympic and disabled athletes are urgently needed.
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Affiliation(s)
- Maha Sellami
- Physical Education Department, College of Education, Qatar University, Doha P.O. Box 2713, Qatar
| | - Luca Puce
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
| | - Nicola Luigi Bragazzi
- Laboratory for Industrial and Applied Mathematics (LIAM), Department of Mathematics and Statistics, York University, Toronto, ON M3J 1P3, Canada
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Koivula T, Lempiäinen S, Rinne P, Rannikko JH, Hollmén M, Sundberg CJ, Rundqvist H, Minn H, Heinonen I. The effect of acute exercise on circulating immune cells in newly diagnosed breast cancer patients. Sci Rep 2023; 13:6561. [PMID: 37085562 PMCID: PMC10121717 DOI: 10.1038/s41598-023-33432-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 04/12/2023] [Indexed: 04/23/2023] Open
Abstract
The role of exercise in cancer prevention and control is increasingly recognized, and based on preclinical studies, it is hypothesized that mobilization of leukocytes plays an important role in the anti-tumor effect. Thus, we examined how 10-min acute exercise modulates immune cells in newly diagnosed breast cancer patients. Blood samples were taken at rest, immediately after exercise and 30 min after exercise and phenotypic characterization of major leukocyte subsets was done using 9-color flow cytometry. Total leukocyte count increased by 29%, CD8+ T cell count by 34%, CD19+ B cell count by 18%, CD56+CD16+ NK cell count by 130%, and CD14+CD16+ monocyte count by 51% immediately after acute exercise. Mobilization of CD45+, CD8+, CD19+, and CD56+CD16+ cells correlated positively with exercising systolic blood pressure, heart rate percentage of age predicted maximal heart rate, rate pressure product, and mean arterial pressure. Our findings indicate that a single bout of acute exercise of only 10 min can cause leukocytosis in breast cancer patients. Mobilization of leukocytes appear to be directly related to the intensity of exercise. It is possible that the positive effect of exercise on oncologic outcome might be partly due to immune cell mobilization as documented in the present study.
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Affiliation(s)
- Tiia Koivula
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland.
| | - Salla Lempiäinen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
| | - Petteri Rinne
- Institute of Biomedicine, University of Turku, Turku, Finland
| | - Jenna H Rannikko
- MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Maija Hollmén
- MediCity Research Laboratory, University of Turku, Turku, Finland
| | - Carl Johan Sundberg
- Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Heikki Minn
- Department of Oncology and Radiotherapy, Turku University Hospital, Turku, Finland
| | - Ilkka Heinonen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, 20520, Turku, Finland
- Rydberg Laboratory of Applied Sciences, University of Halmstad, Halmstad, Sweden
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Lin Y, Wu C, He C, Yan J, Chen Y, Gao L, Liu R, Cao B. Effectiveness of three exercise programs and intensive follow-up in improving quality of life, pain, and lymphedema among breast cancer survivors: a randomized, controlled 6-month trial. Support Care Cancer 2022; 31:9. [PMID: 36512157 DOI: 10.1007/s00520-022-07494-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
PURPOSE Postoperative complications of breast cancer (BC) seriously affect the quality of life (QOL) of survivors. Physical activity is related to prevention of complications and improvement of QOL. Follow-up can keep patients motivated to exercise. This study aimed to (1) compare the effect of three exercise programs on lymphedema, pain, and QOL in BC patients and (2) explore the effect of intensive follow-up on the outcomes of exercise programs. METHODS A single-blind randomized parallel controlled trial with a 6-month intervention was carried out in China in 2021. The study sample included 200 women with BC. The patients were randomly divided into 4 groups. G0 (control group) was joint mobility exercise (JME) group; G1 was joint mobility exercise + intensive follow-up (IF) group; G2 was JME + aerobic exercise (AE) + IF group; and G3 was JME + progressive resistance exercise (PRE) + IF group. Outcome measures were evaluated at baseline (T1), 3 months post-intervention (T2), and 6 months post-intervention (T3). The following instruments and measurements were administered before and after the intervention: the Functional Assessment of Cancer Therapy-Breast (FACT-B) instrument, the numerical rating scale (NRS), and the relative volume change (RVC). Verificating aim 1 is by comparing the results of G1, G2, and G3, and verificating aim 2 is achieved by comparing G0 and G1. Differences before and after the intervention were determined by analysis of variance of repeated measures and Kruskal-Wallis nonparametric analysis of variance. RESULTS Among the exercise programs, JME + PRE + IF resulted in the best improvement in QOL (T2: ΔG3-G0 = 13.032, P = 0.008; T2: ΔG3-G1 = 13.066, P < 0.001; ΔG3-G0 = 17.379, P < 0.001). For pain relief, JME + AE + IF had the best improvement (T3: ΔG2-G1 = - 0.931, P = 0.010; ΔG2-G0 = - 1.577, P < 0.001). For the prevention of lymphedema, JME + AE + IF (Z = 2.651, P = 0.048) and JME + PRE + IF (Z = 3.277, P = 0.006) had the similar effect, but JME + PRE + IF is better than JME + AE + IF. CONCLUSION JME + PRE have the best effect in improving the QOL and preventing lymphedema after surgery. In improving pain, the effect of JME + AE appears earlier, and the overall effect of JME + PRE is better. In addition, long-term and planned monitoring and follow-up are also important.
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Affiliation(s)
- Yawei Lin
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China.,956Th Hospital of the Chinese People's Liberation Army, Nyingchi, Tibet, China
| | - Chao Wu
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China
| | - Chunyan He
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China
| | - Jiaran Yan
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China
| | - Yi Chen
- Unit 66029 of the Chinese People's Liberation Army, Xilinguole League, Inner Mongolia Autonomous Region, Hohhot, China
| | - Li Gao
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China
| | - Rongrong Liu
- College of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, Chinese PLA Medical School, 28 Fuxing Road, Beijing, China
| | - Baohua Cao
- Department of Clinical Nursing, School of Nursing, Air Force Medical University, 169 Changle West Avenue, New Urban District, Xi'an, 710000, Shaanxi, China.
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Tan K, Naylor MJ. The Influence of Modifiable Factors on Breast and Prostate Cancer Risk and Disease Progression. Front Physiol 2022; 13:840826. [PMID: 35330933 PMCID: PMC8940211 DOI: 10.3389/fphys.2022.840826] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 02/11/2022] [Indexed: 12/31/2022] Open
Abstract
Breast and prostate cancers are among the most commonly diagnosed cancers worldwide, and together represented almost 20% of all new cancer diagnoses in 2020. For both cancers, the primary treatment options are surgical resection and sex hormone deprivation therapy, highlighting the initial dependence of these malignancies on the activity of both endogenous and exogenous hormones. Cancer cell phenotype and patient prognosis is not only determined by the collection of specific gene mutations, but through the interaction and influence of a wide range of different local and systemic components. While genetic risk factors that contribute to the development of these cancers are well understood, increasing epidemiological evidence link modifiable lifestyle factors such as physical exercise, diet and weight management, to drivers of disease progression such as inflammation, transcriptional activity, and altered biochemical signaling pathways. As a result of this significant impact, it is estimated that up to 50% of cancer cases in developed countries could be prevented with changes to lifestyle and environmental factors. While epidemiological studies of modifiable risk factors and research of the biological mechanisms exist mostly independently, this review will discuss how advances in our understanding of the metabolic, protein and transcriptional pathways altered by modifiable lifestyle factors impact cancer cell physiology to influence breast and prostate cancer risk and prognosis.
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Affiliation(s)
- Keely Tan
- Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Matthew J Naylor
- Charles Perkins Centre, School of Medical Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
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Bartlett DB, Hanson ED, Lee JT, Wagoner CW, Harrell EP, Sullivan SA, Bates LC, Alzer MS, Amatuli DJ, Deal AM, Jensen BC, MacDonald G, Deal MA, Muss HB, Nyrop KA, Battaglini CL. The Effects of 16 Weeks of Exercise Training on Neutrophil Functions in Breast Cancer Survivors. Front Immunol 2021; 12:733101. [PMID: 34777343 PMCID: PMC8578958 DOI: 10.3389/fimmu.2021.733101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/07/2021] [Indexed: 12/17/2022] Open
Abstract
Following therapy, breast cancer survivors (BCS) have an increased risk of infections because of age and cancer dysregulation of inflammation and neutrophil functions. Neutrophil functions may be improved by exercise training, although limited data exist on exercise and neutrophil functions in BCS.Sixteen BCS [mean age: 56 (SD 11) years old] completed 16 weeks of community-based exercise training and a 45-minute acute bout of cycling before (Base) and after (Final) the exercise training program. Exercise training consisted of 3 x 40 – 60 minute mixed mode aerobic exercises, comprising 10 – 30 minutes aerobic and 30 minutes resistance training. At Base and Final, we took BCS blood samples before (PRE), immediately after (POST), and 1 hour after (1Hr) acute exercise to determine neutrophil counts, phenotype, bacterial killing, IL-6, and IL-8 levels. Eleven healthy, age- and physical activity levels-matched women (Control) completed the acute bout of exercise once as a healthy response reference. Resting Responses. BCS and Controls had similar Base PRE absolute neutrophil counts [mean (SD): 3.3 (1.9) v 3.1 (1.2) x 109/L, p=0.801], but BCS had lower bacterial phagocytosis [3991 (1233) v 4881 (417) MFI, p=0.035] and higher oxidative killing [6254 (1434) v 4709 (1220) MFI, p=0.005], lower CD16 [4159 (1785) v 7018 (1240) MFI, p<0.001], lower CXCR2 [4878 (1796) v 6330 (1299) MFI, p=0.032] and higher TLR2 [98 (32) v 72 (17) MFI, p=0.022] expression, while IL-6 [7.4 (5.4) v 4.0 (2.7) pg/mL, p=0.079] levels were marginally higher and IL-8 [6.0 (4.7) v 7.9 (5.0) pg/mL, p=0.316] levels similar. After 16 weeks of training, compared to Controls, BCS Final PRE phagocytosis [4510 (738) v 4881 (417) MFI, p=0.146] and TLR2 expression [114 (92) v 72 (17) MFI, p=0.148] were no longer different. Acute Exercise Responses. As compared to Controls, at Base, BCS phagocytic Pre-Post response was lower [mean difference, % (SD): 12% (26%), p=0.042], CD16 Pre-Post response was lower [12% (21%), p=0.016] while CD16 Pre-1Hr response was higher [13% (25%), p=0.022], TLR2 Pre-Post response was higher [15% (4%) p=0.002], while IL-8 Pre-Post response was higher [99% (48%), p=0.049]. As compared to Controls, following 16 weeks of training BCS phagocytic Pre-Post response [5% (5%), p=0.418], CD16 Pre-1Hr response [7% (7%), p=0.294], TLR2 Pre-Post response [6% (4%), p=0.092], and IL-8 Pre-Post response [1% (9%), p=0.087] were no longer different. Following cancer therapy, BCS may have impaired neutrophil functions in response to an acute bout of exercise that are partially restored by 16 weeks of exercise training. The improved phagocytosis of bacteria in BCS may represent an exercise-induced intrinsic improvement in neutrophil functions consistent with a reduced risk of infectious disease.
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Affiliation(s)
- David B Bartlett
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, United States.,Duke Molecular Physiology Institute, Duke University, Durham, NC, United States.,Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Erik D Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Jordan T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Chad W Wagoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Elizabeth P Harrell
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Stephanie A Sullivan
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Lauren C Bates
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Mohamdod S Alzer
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Dean J Amatuli
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Brian C Jensen
- Division of Cardiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Grace MacDonald
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, United States.,Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Michael A Deal
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, United States.,Duke Molecular Physiology Institute, Duke University, Durham, NC, United States
| | - Hyman B Muss
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Kirsten A Nyrop
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Department of Medicine, University of North Carolina, Chapel Hill, NC, United States
| | - Claudio L Battaglini
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Human Movement Science Curriculum, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
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