1
|
Martinez Aguirre-Betolaza A, Cacicedo J, Castañeda-Babarro A. Creatine Supplementation and Resistance Training in Patients With Breast Cancer (CaRTiC Study): Protocol for a Randomized Controlled Trial. Am J Clin Oncol 2024; 47:161-168. [PMID: 38018533 DOI: 10.1097/coc.0000000000001070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2023]
Abstract
BACKGROUND Creatine supplementation is an effective ergogenic nutrient for athletes, as well as for people starting a health or fitness program. Resistance training has previously been identified as an important method of increasing muscle mass and strength, especially in people with cancer to avoid sarcopenia. The potential of creatine supplementation for adaptations produced by resistance training in patients with cancer is still unknown. The primary aim of this study is to evaluate the effectiveness of a supervised resistance training program intervention with and without creatine supplementation in patients with breast cancer. METHODS Is a multicentre, randomized, blind, placebo-controlled study. Patients will be randomly assigned to a control group and 2 experimental groups. The first training resistance group (RG) will perform resistance training, while the second experimental resistance-creatine group will perform the same resistance training as the RG and will also receive a 5 g/d creatine supplementation during the intervention. RG participants will follow the same daily dosing protocol, but in their case, with dextrose/maltodextrin. Resistance training will be a 16-week supervised workout that will consist of a series of resistance exercises (leg press, knee extension, knee bends, chest press, sit-ups, back extensions, pull-ups, and shoulder press) that involve the largest muscle groups, performed 3 times a week on nonconsecutive days. Both the RG and the resistance-creatine group will receive a supplement of soluble protein powder (20 to 30 g) daily. CONCLUSION This intervention will help to better understand the potential of nonpharmacological treatment for improving strength and well-being values in patients with breast cancer with and without creatine supplementation.
Collapse
Affiliation(s)
| | - Jon Cacicedo
- Department of Radiation Oncology, Group for Radiology and Physical Medicine in Oncology, Cruces University Hospital/Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, Bilbao, Spain
| |
Collapse
|
2
|
Huo M, Zhang X, Fan J, Qi H, Chai X, Qu M, Shan Y, Xie H, Wang C. Short-term effects of a new resistance exercise approach on physical function during chemotherapy after radical breast cancer surgery: a randomized controlled trial. BMC Womens Health 2024; 24:160. [PMID: 38443932 PMCID: PMC10913245 DOI: 10.1186/s12905-024-02989-1] [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: 07/29/2023] [Accepted: 02/21/2024] [Indexed: 03/07/2024] Open
Abstract
BACKGROUND Approximately 30% of post-operative breast cancer patients develop shoulder joint movement disorders affecting routine upper limb movement. This study discusses the impact of a neuromuscular joint facilitation (NJF) method on the physical function of breast cancer patients experiencing shoulder dysfunction during chemotherapy after radical surgery. METHODS This study included 162 female patients who have unilateral breast cancer in a cancer hospital in China. They developed shoulder joint mobility disorders during chemotherapy within 1-3 months postoperatively. These patients were divided into three groups: NJF, conventional rehabilitation (conventional group), and control groups. The clinical examination included the maximum passive and active range of motion (ROM) of the shoulder (flexion, extension, abduction, adduction, and external and internal rotation). Other evaluations included a pain score using a visual analog scale (VAS), grip strength, and supraspinatus muscle thickness. All tests were evaluated pre-and post-intervention. RESULTS The NJF group showed a significant increase in all shoulder ROM angles post-intervention. In the conventional group, all other ROM values increased significantly, except passive external rotation ROM. In the control group, all other ROM values increased significantly, except passive and active external rotation ROM. All three groups had decreased VAS scores, increased grip strength, and supraspinatus muscle thickness post-intervention during active abduction. In the control group, the supraspinatus contraction rate decreased significantly at 60° and 90° abduction post-intervention compared to that at pre-intervention. CONCLUSION This study revealed that NJF during chemotherapy had positive clinical intervention effects, improving shoulder joint mobility disorders, pain, grip strength, and external rotation following radical breast cancer surgery. CLINICAL TRIAL REGISTRATION Chinese Clinical Trial Registry; https://www.chictr.org.cn/ (ChiCTR2300073170), registered (03/07/2023).
Collapse
Affiliation(s)
- Ming Huo
- University of Health and Rehabilitation Sciences, Qingdao City, Shandong Province, China
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Xin Zhang
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Jialin Fan
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Hao Qi
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Xuemei Chai
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Minghui Qu
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Yuqi Shan
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China
| | - Hualong Xie
- Wangjing Hospital of China Academy of Chinese Medical Sciences, Beijing City, China.
| | - Chao Wang
- Beijing Chaoyang District Sanhuan Cancer Hospital, Beijing City, China.
| |
Collapse
|
3
|
Dykowski S, Simoneau J, Smith SR, Walling E, Lewno A. Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity. Curr Sports Med Rep 2023; 22:380-386. [PMID: 37921391 DOI: 10.1249/jsr.0000000000001114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
ABSTRACT There is a gap in the literature on the best treatment of clinical sequelae within adolescent and young adult pediatric cancer populations. Children, adolescents, and young adults are at risk for a multitude of immediate and late effects of their disease and treatment that warrant a comprehensive, multidisciplinary team approach to optimize care. Sports medicine providers are well-equipped with their background to join the oncology rehabilitation team in diagnosing and managing cancer-related impairments to help these populations live a healthier and more active lifestyle. In this manuscript, four essential clinical components to consider when returning children, adolescents, and young adults with cancer history to physical activity are discussed: chemotherapy-induced peripheral neuropathy, cardiotoxicity, nutritional deficiencies, and deconditioning.
Collapse
Affiliation(s)
- Sara Dykowski
- Department of Physical Medicine and Rehabilitation, University of Michigan, Michigan Medicine, Ann Arbor, MI
| | - Jillian Simoneau
- Division of Hematology and Oncology, Department of Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, MI
| | - Sean R Smith
- Department of Physical Medicine and Rehabilitation, University of Michigan, Michigan Medicine, Ann Arbor, MI
| | - Emily Walling
- Division of Hematology, Oncology, and BMT, Department of Pediatrics, University of Michigan, Michigan Medicine, Ann Arbor, MI
| | - Adam Lewno
- Department of Physical Medicine and Rehabilitation, University of Michigan, Michigan Medicine, Ann Arbor, MI
| |
Collapse
|
4
|
Soriano-Maldonado A, Díez-Fernández DM, Esteban-Simón A, Rodríguez-Pérez MA, Artés-Rodríguez E, Casimiro-Artés MA, Moreno-Martos H, Toro-de-Federico A, Hachem-Salas N, Bartholdy C, Henriksen M, Casimiro-Andújar AJ. Effects of a 12-week supervised resistance training program, combined with home-based physical activity, on physical fitness and quality of life in female breast cancer survivors: the EFICAN randomized controlled trial. J Cancer Surviv 2023; 17:1371-1385. [PMID: 35314958 PMCID: PMC10442259 DOI: 10.1007/s11764-022-01192-1] [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: 10/21/2021] [Accepted: 02/08/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE This study assessed the effects of 12-week supervised resistance training combined with home-based physical activity on physical fitness, cancer-related fatigue, depressive symptoms, health-related quality of life (HRQoL), and life satisfaction in female breast cancer survivors. METHODS A parallel-group, outcome assessor-blinded, randomized controlled trial included 60 female breast cancer survivors who had completed their core treatments within the previous 10 years. Through computer-generated simple randomization, participants were assigned to resistance training (RTG; two sessions/week for 12 weeks plus instructions to undertake ≥ 10,000 steps/d) or control (CG; ≥ 10,000 steps/d only). Outcomes were evaluated at baseline and week 12. Muscular strength was assessed with electromechanical dynamometry. A standardized full-body muscular strength score was the primary outcome. Secondary outcomes included cardiorespiratory fitness, shoulder mobility, cancer-related fatigue, depressive symptoms, HRQoL, and life satisfaction. RESULTS Thirty-two participants were assigned to RTG (29 achieved ≥ 75% attendance) and 28 to CG (all completed the trial). Intention-to-treat analyses revealed that the standardized full-body muscular strength score increased significantly in the RTG compared to the CG (0.718; 95% CI 0.361-1.074, P < 0.001, Cohen's d = 1.04). This increase was consistent for the standardized scores of upper-body (0.727; 95% CI 0.294-1.160, P = 0.001, d = 0.87) and lower-body (0.709; 95% CI 0.324-1.094, P = 0.001, d = 0.96) strength. There was no effect on cardiorespiratory fitness, shoulder flexion, cancer-related fatigue, depressive symptoms, HRQoL, or life satisfaction. The sensitivity analyses confirmed these results. CONCLUSION and implication for cancer survivors. In female breast cancer survivors who had completed their core treatments within the past 10 years, adding two weekly sessions of supervised resistance training to a prescription of home-based physical activity for 12 weeks produced a large increase in upper-, lower-, and full-body muscular strength, while other fitness components and patient-reported outcomes did not improve. TRIAL REGISTRATION NUMBER ISRCTN14601208.
Collapse
Affiliation(s)
- Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - David M. Díez-Fernández
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Alba Esteban-Simón
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Manuel A. Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Eva Artés-Rodríguez
- Area of Statistics and Operative Research, Department of Mathematics, Faculty of Sciences, University of Almería, Almería, Spain
| | | | - Herminia Moreno-Martos
- Servicio Andaluz de Salud, Unidad de Gestión Clínica Almería Periferia, Distrito Sanitario, Almería, Spain
| | - Antonio Toro-de-Federico
- Servicio Andaluz de Salud, Unidad de Gestión Clínica Ciudad Jardín, Distrito Sanitario, Almería, Spain
| | - Nur Hachem-Salas
- Servicio Andaluz de Salud, Unidad de Gestión Clínica Mediterráneo-Torrecárdenas, Distrito Sanitario, Almería, Spain
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Antonio J. Casimiro-Andújar
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain
- SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| |
Collapse
|
5
|
Zhang FM, Song CH, Guo ZQ, Yu Z, Weng M, Zhou FX, Liu M, Cong MH, Li T, Li ZN, Chen JQ, Cui JW, Xu HX, Li W, Shi HP, Zhuang CL. Sarcopenia prevalence in patients with cancer and association with adverse prognosis: A nationwide survey on common cancers. Nutrition 2023; 114:112107. [PMID: 37356170 DOI: 10.1016/j.nut.2023.112107] [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: 01/20/2023] [Revised: 05/09/2023] [Accepted: 05/24/2023] [Indexed: 06/27/2023]
Abstract
OBJECTIVE Although previous studies have implicated the negative outcomes of sarcopenia, evidence is limited to one or a few types of cancer. The aim of this study was to evaluate the distribution and influencing factors of sarcopenia, and explore the relationship between sarcopenia and cancer prognosis in a large oncological population. METHODS This observational cohort study included patients diagnosed with malignant cancer between May 2011 and January 2019. Hematologic and anthropometric parameters were collected prospectively. Low skeletal muscle mass and radiodensity were diagnosed using clinical indicators, according to the two prediction models. The importance of potential risk factors for sarcopenia was estimated by subtracting the predicted degrees of freedom from the partial χ2 statistic. Hazard rates of death were calculated using the hazard function and Cox regression analyses. RESULTS We included 13 761 patients with cancer; the prevalence of sarcopenia was 33%. The median age was 58 y and 7135 patients (52%) were men. Patients with sarcopenia had a worse nutritional status and quality of life than those without sarcopenia. Age was the most important risk factor for sarcopenia compared with body mass index or TNM stage. Additionally, patients with sarcopenia had a significantly higher and earlier peak risk for mortality. After adjusting for baseline characteristics, sarcopenia was independently associated with mortality in the research population (hazard ratio, 1.429; P < 0.001) and most cancer types. CONCLUSION Age is the most important risk factor for sarcopenia even in patients with cancer. Sarcopenia is strongly associated with a poor quality of life and reduced overall survival.
Collapse
Affiliation(s)
- Feng-Min Zhang
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Chun-Hua Song
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zeng-Qing Guo
- Department of Medical Oncology, Fujian Provincial Cancer Hospital, Fujian Medical University Cancer Hospital, Fuzhou, China
| | - Zhen Yu
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China
| | - Min Weng
- Department of Nutrition, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Fu-Xiang Zhou
- Department of Oncology, Zhongnan Hospital of Wuhan University, Wuhan University, Wuhan, China
| | - Ming Liu
- General Surgery Department, The Second Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, China
| | - Ming-Hua Cong
- Comprehensive Oncology Department, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Li
- Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China
| | - Zeng-Ning Li
- Department of Nutrition, the First Affiliated Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jun-Qiang Chen
- Department of Gastrointestinal Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jiu-Wei Cui
- Cancer Center, the First Hospital, Jilin University, Changchun, China
| | - Hong-Xia Xu
- Department of Nutrition, Daping Hospital, Army Medical University, Chongqing, China
| | - Wei Li
- Cancer Center, the First Hospital, Jilin University, Changchun, China
| | - Han-Ping Shi
- Department of Gastrointestinal Surgery, Beijing Shijitan Hospital, Capital Medical University/ Key Laboratory of Cancer FSMP for State Market Regulation, Beijing, China.
| | - Cheng-Le Zhuang
- Colorectal Cancer Center/Department of Gastrointestinal Surgery, Shanghai Tenth People's Hospital, Tongji University School of Medicine, Shanghai, China.
| |
Collapse
|
6
|
Wang P, Zhao S, Hu X, Tan Q, Tan Y, Shi D. Association of dietary total antioxidant capacity and its distribution across three meals with all-cause, cancer, and non-cancer mortality among cancer survivors: the US National Health and Nutrition Examination Survey, 1999-2018. Front Nutr 2023; 10:1141380. [PMID: 37485382 PMCID: PMC10359731 DOI: 10.3389/fnut.2023.1141380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 06/20/2023] [Indexed: 07/25/2023] Open
Abstract
The effect of the antioxidant capacity of diet and its distribution across three meals on mortality risk among cancer patients remains unexplored. We aimed to prospectively investigate the association of dietary total antioxidant capacity (DAC) and its distribution across three meals with all-cause, cancer, and noncancer mortality among cancer survivors. We included 5,009 patients with cancer from the National Health and Nutrition Examination Survey conducted between 1999 and 2018. The adjusted hazard ratio (aHR) was estimated using the survey-weighted Cox proportional hazards model. During a median follow-up of 7.9 years, 1811 deaths, including 575 cancer-related deaths, were recorded. Among cancer survivors, compared with participants in the lowest quartile of total DAC from three meals, those in the highest quartile had a 24% decreased risk of noncancer mortality (aHR = 0.76, 95% confidence interval [CI]: 0.60-0.92), but not of all-cause and cancer mortality (each p trend >0.1). However, this association became insignificant for total DAC after excluding dinner DAC. In addition, higher dinner DAC rather than breakfast or lunch DAC was associated with a 21% lower risk of all-cause mortality (aHR = 0.79, 95% CI: 0.65-0.98) and 28% lower risk of noncancer mortality (aHR = 0.72, 95% CI: 0.57-0.90). Similar associations were found for ΔDAC (dinner DAC - breakfast DAC) with noncancer mortality (aHR = 0.56, 95% CI: 0.38-0.83), but DAC was not associated with cancer mortality (p trend >0.3). Among cancer survivors, total DAC from three meals was associated with reduced noncancer mortality, with the primary effect attributable to increased DAC intake from dinner. Our findings emphasize that DAC consumption from dinner should be advocated to reduce mortality risk in cancer survivors.
Collapse
Affiliation(s)
- Peng Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Shengnan Zhao
- Department of Nutrition Food and Children’s Health, School of Public Health, Weifang Medical University, Weifang, China
| | - Xiao Hu
- Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology, Xi’an Jiaotong University, Xi’an, China
| | - Qilong Tan
- Department of Epidemiology and Biostatistics, School of Public Health, Zhejiang University School of Medicine, Hangzhou, China
| | - Yaoyu Tan
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
| | - Dan Shi
- Department of Nutrition and Food Hygiene, School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Environment and Human Health, School of Public Health, Chongqing Medical University, Chongqing, China
| |
Collapse
|
7
|
Seo D, Kim HS, Ahn JB, Park YR. Investigation of the Trajectory of Muscle and Body Mass as a Prognostic Factor in Patients With Colorectal Cancer: Longitudinal Cohort Study. JMIR Public Health Surveill 2023; 9:e43409. [PMID: 36947110 PMCID: PMC10131753 DOI: 10.2196/43409] [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: 10/11/2022] [Revised: 02/16/2023] [Accepted: 02/23/2023] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Skeletal muscle and BMI are essential prognostic factors for survival in colorectal cancer (CRC). However, there is a lack of understanding due to scarce studies on the continuous aspects of these variables. OBJECTIVE This study aimed to evaluate the prognostic impact of the initial status and trajectories of muscle and BMI on overall survival (OS) and assess whether these 4 profiles within 1 year can represent the profiles 6 years later. METHODS We analyzed 4056 newly diagnosed patients with CRC between 2010 to 2020. The volume of the muscle with 5-mm thickness at the third lumbar spine level was measured using a pretrained deep learning algorithm. The skeletal muscle volume index (SMVI) was defined as the muscle volume divided by the square of the height. The correlation between BMI status at the first, third, and sixth years of diagnosis was analyzed and assessed similarly for muscle profiles. Prognostic significances of baseline BMI and SMVI and their 1-year trajectories for OS were evaluated by restricted cubic spline analysis and survival analysis. Patients were categorized based on these 4 dimensions, and prognostic risks were predicted and demonstrated using heat maps. RESULTS Trajectories of SMVI were categorized as decreased (812/4056, 20%), steady (2014/4056, 49.7%), or increased (1230/4056, 30.3%). Similarly, BMI trajectories were categorized as decreased (792/4056, 19.5%), steady (2253/4056, 55.5%), or increased (1011/4056, 24.9%). BMI and SMVI values in the first year after diagnosis showed a statistically significant correlation with those in the third and sixth years (P<.001). Restricted cubic spline analysis showed a nonlinear relationship between baseline BMI and SMVI change ratio and OS; BMI, in particular, showed a U-shaped correlation. According to survival analysis, increased BMI (hazard ratio [HR] 0.83; P=.02), high baseline SMVI (HR 0.82; P=.04), and obesity stage 1 (HR 0.80; P=.02) showed a favorable impact, whereas decreased SMVI trajectory (HR 1.31; P=.001), decreased BMI (HR 1.23; P=.02), and initial underweight (HR 1.38; P=.02) or obesity stages 2-3 (HR 1.79; P=.01) were negative prognostic factors for OS. Considered simultaneously, BMI >30 kg/m2 with a low SMVI at the time of diagnosis resulted in the highest mortality risk. We observed improved survival in patients with increased muscle mass without BMI loss compared to those with steady muscle mass and BMI. CONCLUSIONS Profiles within 1 year of both BMI and muscle were surrogate indicators for predicting the later profiles. Continuous trajectories of body and muscle mass are independent prognostic factors of patients with CRC. An automatic algorithm provides a unique opportunity to conduct longitudinal evaluations of body compositions. Further studies to understand the complicated natural courses of muscularity and adiposity are necessary for clinical application.
Collapse
Affiliation(s)
- Dongjin Seo
- Department of Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Han Sang Kim
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Brain Korea 21 FOUR Project, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea
| | - Joong Bae Ahn
- Yonsei Cancer Center, Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yu Rang Park
- Brain Korea 21 FOUR Project, Graduate School of Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
- Institute for Innovation in Digital Healthcare, Severance Hospital, Seoul, Republic of Korea
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| |
Collapse
|
8
|
Bertoli J, Bezerra EDS, Winters-Stone KM, Alberto Gobbo L, Freitas IF. Mat Pilates improves lower and upper body strength and flexibility in breast cancer survivors undergoing hormone therapy: a randomized controlled trial (HAPiMat study). Disabil Rehabil 2023; 45:494-503. [PMID: 35107399 DOI: 10.1080/09638288.2022.2032410] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To evaluate the effects of 24 weeks of Mat Pilates in breast cancer survivors (BCS) undergoing hormone therapy on lower and upper body muscle strength parameters and flexibility. MATERIALS AND METHODS Forty-three BCS (≥40 years) with confirmed breast cancer stage 0-III undergoing hormone therapy were included. Participants were randomized into Mat Pilates (three times/week, 60 min session) or control group (relaxation activities every two weeks). The difficulty and number of exercise repetitions were increased over the weeks. Assessments were performed at three times points (baseline, 12 weeks, and 24 weeks). The generalized estimating equations (GEE) model was used to compare each outcome measure during the analysis of intention to treat (ITT) and "Per protocol analysis" (PPA). RESULTS The Pilates group presented significantly increased (p < 0.05) isometric flexor-extensor PT, and concentric and eccentric flexor PT and mechanical work (MW) after the intervention. Most of the upper body strength parameters, time to achieve maximal force (TFmax), maximal force (Fmax), and rapid force index (RFI) and right-left upper and lower body flexibility (p < 0.05) also improved. CONCLUSIONS From our findings, we conclude that 24 and 12-weeks of Mat Pilates induced strength and flexibility gains for lower and upper body, respectively.Implications for rehabilitationMat Pilates can be adapted to the fitness level of breast cancer survivors, with a great variety of exercises that can be performed using a mat only or a few pieces of equipment.Patients can practice at home to gain different health benefits (i.e., increasing strength, flexibility, and functional capacity level), which could positively impact on quality of life.Mat Pilates performed three times per week with systematized increments in exercise level, load, and volume throughout the intervention was effective to improve hip extensor-flexor muscles peak torque and mechanical work at different muscle contractions, as well as upper and lower body flexibility.Mat Pilates was also able to improve right-left shoulder abductor and trunk extensor muscles strength parameters after 12 weeks of intervention, as well as both surgery and non-surgery sides of the upper body.
Collapse
Affiliation(s)
- Josefina Bertoli
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | | | - Kerri M Winters-Stone
- School of Nursing, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, USA
| | - Luis Alberto Gobbo
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| | - Ismael Forte Freitas
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente, Brazil
| |
Collapse
|
9
|
Brown JC, Ma C, Shi Q, Fuchs CS, Meyer J, Niedzwiecki D, Zemla T, Couture F, Kuebler P, Kumar P, Lewis D, Tan B, Krishnamurthi S, O'Reilly EM, Shields AF, Meyerhardt JA. Physical Activity in Stage III Colon Cancer: CALGB/SWOG 80702 (Alliance). J Clin Oncol 2023; 41:243-254. [PMID: 35944235 PMCID: PMC9839249 DOI: 10.1200/jco.22.00171] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/27/2022] [Accepted: 07/05/2022] [Indexed: 01/19/2023] Open
Abstract
PURPOSE To determine the specific types, durations, and intensities of recreational physical activity associated with the greatest improvements in disease-free survival (DFS) of patients with colon cancer. METHODS We conducted a prospective cohort study nested within a randomized multicenter trial of stage III colon cancer that compared 3 versus 6 months of fluorouracil, leucovorin, and oxaliplatin with or without celecoxib. We measured recreational physical activity in the first 3 months of chemotherapy and again 6 months after completion of chemotherapy. The primary end point was DFS. RESULTS During a median follow-up of 5.9 years, 457 of 1,696 patients experienced disease recurrence or death. For total recreational physical activity volume, the 3-year DFS was 76.5% with < 3.0 metabolic equivalent task hours per week (MET-h/wk) and 87.1% with ≥ 18.0 MET-h/wk (risk difference [RD], 10.6%; 95% CI, 4.7 to 19.4; P < .001). For light-intensity to moderate-intensity activities, the 3-year DFS was 65.7% with 0.0 h/wk and 87.1% with ≥ 1.5 h/wk (RD, 21.4%; 95% CI, 9.2 to 37.1; P < .001). For vigorous-intensity activity, the 3-year DFS was 76.0% with 0.0 h/wk and 86.0% with ≥ 1.0 h/wk (RD, 10.0%; 95% CI, 4.5 to 18.9; P < .001). For brisk walking, the 3-year DFS was 81.7% with < 1.0 h/wk and 88.4% with ≥ 3.0 h/wk (RD, 6.7%; 95% CI, 3.0 to 13.8; P < .001). For muscle strengthening activity, the 3-year DFS was 81.8% with 0.0 h/wk and 88.8% for ≥ 0.5 h/wk (RD, 7.0%; 95% CI, 3.1 to 14.2; P = .003). CONCLUSION Among patients with stage III colon cancer enrolled in a trial of postoperative treatment, larger volumes of recreational physical activity, longer durations of light- to moderate-intensity aerobic physical activity, or any vigorous-intensity aerobic physical activity were associated with the greatest improvements in DFS.
Collapse
Affiliation(s)
- Justin C. Brown
- Pennington Biomedical Research Center, Baton Rouge, LA
- LSU Health Sciences Center New Orleans School of Medicine, New Orleans, LA
- Stanley S. Scott Cancer Center, Louisiana State University Health Sciences Center, New Orleans, LA
| | - Chao Ma
- Dana-Farber/Partners CancerCare, Boston, MA
| | - Qian Shi
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | | | | | - Tyler Zemla
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | | | - Philip Kuebler
- Columbus NCI Community Oncology Research Program, Columbus, OH
| | | | | | - Benjamin Tan
- Siteman Cancer Center, Washington University School of Medicine in St Louis, Saint Louis, MO
| | | | - Eileen M. O'Reilly
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical Center, New York, NY
| | | | | |
Collapse
|
10
|
Tijore A, Yang B, Sheetz M. Cancer cells can be killed mechanically or with combinations of cytoskeletal inhibitors. Front Pharmacol 2022; 13:955595. [PMID: 36299893 PMCID: PMC9589226 DOI: 10.3389/fphar.2022.955595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Accepted: 08/12/2022] [Indexed: 12/24/2022] Open
Abstract
For over two centuries, clinicians have hypothesized that cancer developed preferentially at the sites of repeated damage, indicating that cancer is basically “continued healing.” Tumor cells can develop over time into other more malignant types in different environments. Interestingly, indefinite growth correlates with the depletion of a modular, early rigidity sensor, whereas restoring these sensors in tumor cells blocks tumor growth on soft surfaces and metastases. Importantly, normal and tumor cells from many different tissues exhibit transformed growth without the early rigidity sensor. When sensors are restored in tumor cells by replenishing depleted mechanosensory proteins that are often cytoskeletal, cells revert to normal rigidity-dependent growth. Surprisingly, transformed growth cells are sensitive to mechanical stretching or ultrasound which will cause apoptosis of transformed growth cells (Mechanoptosis). Mechanoptosis is driven by calcium entry through mechanosensitive Piezo1 channels that activate a calcium-induced calpain response commonly found in tumor cells. Since tumor cells from many different tissues are in a transformed growth state that is, characterized by increased growth, an altered cytoskeleton and mechanoptosis, it is possible to inhibit growth of many different tumors by mechanical activity and potentially by cytoskeletal inhibitors.
Collapse
Affiliation(s)
- Ajay Tijore
- Centre for Biosystems Science and Engineering, Indian Institute of Science, Bangalore, India
- *Correspondence: Ajay Tijore, ; Michael Sheetz,
| | - Bo Yang
- Mechanobiology Institute, National University of Singapore, Singapore, Singapore
| | - Michael Sheetz
- Department of Biochemistry and Molecular Biology, University of Texas Medical Branch, Galveston, TX, United States
- *Correspondence: Ajay Tijore, ; Michael Sheetz,
| |
Collapse
|
11
|
Król M, Kupnicka P, Bosiacki M, Chlubek D. Mechanisms Underlying Anti-Inflammatory and Anti-Cancer Properties of Stretching-A Review. Int J Mol Sci 2022; 23:ijms231710127. [PMID: 36077525 PMCID: PMC9456560 DOI: 10.3390/ijms231710127] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 02/07/2023] Open
Abstract
Stretching is one of the popular elements in physiotherapy and rehabilitation. When correctly guided, it can help minimize or slow down the disabling effects of chronic health conditions. Most likely, the benefits are associated with reducing inflammation; recent studies demonstrate that this effect from stretching is not just systemic but also local. In this review, we present the current body of knowledge on the anti-inflammatory properties of stretching at a molecular level. A total of 22 papers, focusing on anti-inflammatory and anti-cancer properties of stretching, have been selected and reviewed. We show the regulation of oxidative stress, the expression of pro- and anti-inflammatory genes and mediators, and remodeling of the extracellular matrix, expressed by changes in collagen and matrix metalloproteinases levels, in tissues subjected to stretching. We point out that a better understanding of the anti-inflammatory properties of stretching may result in increasing its importance in treatment and recovery from diseases such as osteoarthritis, systemic sclerosis, and cancer.
Collapse
Affiliation(s)
- Małgorzata Król
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Patrycja Kupnicka
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
- Correspondence:
| | - Mateusz Bosiacki
- Chair and Department of Functional Diagnostics and Physical Medicine, Pomeranian Medical University, Żołnierska 54, 71-210 Szczecin, Poland
| | - Dariusz Chlubek
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| |
Collapse
|
12
|
Bertoli J, de Souza Bezerra E, dos Santos SFDS, Gobbo LA, Júnior IFF. The influence of mat Pilates training adherence on strength and flexibility parameters in breast cancer survivors undergoing hormone therapy. J Exerc Rehabil 2022; 18:272-283. [PMID: 36110260 PMCID: PMC9449091 DOI: 10.12965/jer.2244298.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to evaluate the influence of adherence to mat Pilates training on lower and upper body strength and flexibility in breast cancer survivors. Breast cancer survivors ( ≥ 40 years) with cancer stages 0–III undergoing hormone therapy participated in this study. For this secondary investigation only the intervention group was analyzed, divided into low and high training adherence. Participants performed a 60-min session of mat Pilates, 3 times/wk, for 24 weeks. Concentric, eccentric, and isometric hip flexor-extensor muscle peak torque, and isometric maximal strength parameters of the shoulder abductors, trunk extensors, and handgrip were assessed. Physical activity level was analyzed as a control variable. The results showed that high training adherence improved (<i>P</i>< 0.05) left shoulder abductor strength parameters and lower and upper body flexibility compared to baseline. The low training adherence group improved (<i>P</i>< 0.05) trunk extensors, right and left shoulder abductor strength parameters, handgrip strength, and extensor-flexor peak torque compared to baseline. There were no differences (<i>P</i>> 0.05) between high and low adherence for physical activity level before and after the intervention. Therefore, it appears that higher training adherence most influences some strength parameters and flexibility, while fewer sessions enable the achievement of significant results for shoulder abductor and hip extensor-flexor muscle strength parameters.
Collapse
Affiliation(s)
- Josefina Bertoli
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente-SP,
Brazil
- Corresponding author: Josefina Bertoli, Universidade Estadual Paulista, Faculdade de Ciência e Tecnologia, Rua Roberto Símonsen, 305 – Centro Educacional, Presidente Prudente - SP, 19060-900, Brazil,
| | | | | | - Luis Alberto Gobbo
- Faculdade de Ciência e Tecnologia, Universidade Estadual Paulista, Presidente Prudente-SP,
Brazil
| | | |
Collapse
|
13
|
Gentil P, de Lira CAB, Vieira CA, Ramirez-Campillo R, Haghighi AH, Clemente FM, Souza D. Resistance Training before, during, and after COVID-19 Infection: What Have We Learned So Far? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6323. [PMID: 35627861 PMCID: PMC9141848 DOI: 10.3390/ijerph19106323] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/26/2022] [Accepted: 03/02/2022] [Indexed: 02/05/2023]
Abstract
At the end of 2019, a severe acute respiratory syndrome caused by SARS-CoV-2 started a pandemic, leading to millions of deaths and many important political and social changes. Even in the absence of contamination, the mobility reduction, social distancing and closing of exercise facilities negatively affected physical activity and conditioning, which is associated with muscle atrophy, loss of muscle strength, and reductions in functional capacity. In cases of infection, it has been shown that increased physical capacity is associated with decreased hospitalization and mortality risk. Although millions of people have died from COVID-19, most contaminated individuals survived the infection, but carried different sequelae, such as the severe loss of physical function and a reduced quality of life. Among different physical exercise models that might help to prevent and treat COVID-19-related conditions, resistance training (RT) might be particularly relevant. Among its benefits, RT can be adapted to be performed in many different situations, even with limited space and equipment, and is easily adapted to an individual's characteristics and health status. The current narrative review aims to provide insights into how RT can be used in different scenarios to counteract the negative effects of COVID-19. By doing this, the authors expect to provide insights to help deal with the current pandemic and similar events the world may face in the future.
Collapse
Affiliation(s)
- Paulo Gentil
- College of Physical Education and Dance, Federal University of Goias, Goiânia 74690-900, Brazil; (C.A.B.d.L.); (C.A.V.); (D.S.)
- Hypertension League Federal University of Goias, Goiânia 74605-050, Brazil
- Instituto VIDA, Brasilia 70.000, Brazil
| | - Claudio Andre Barbosa de Lira
- College of Physical Education and Dance, Federal University of Goias, Goiânia 74690-900, Brazil; (C.A.B.d.L.); (C.A.V.); (D.S.)
| | - Carlos Alexandre Vieira
- College of Physical Education and Dance, Federal University of Goias, Goiânia 74690-900, Brazil; (C.A.B.d.L.); (C.A.V.); (D.S.)
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Laboratory, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Chile;
| | - Amir Hossein Haghighi
- Department of Exercise Physiology, Faculty of Sport Sciences, Hakim Sabzevari University, Sabzevar 9617976487, Iran;
| | - Filipe Manuel Clemente
- Escola Superior de Desporto e Lazer, Instituto Politécnico de Viana do Castelo, 4900-347 Viana do Castelo, Portugal;
- Research Center in Sports Performance, Recreation, Innovation and Technology (SPRINT), 4960-320 Melgaço, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
| | - Daniel Souza
- College of Physical Education and Dance, Federal University of Goias, Goiânia 74690-900, Brazil; (C.A.B.d.L.); (C.A.V.); (D.S.)
| |
Collapse
|
14
|
Lopez-Garzon M, Cantarero-Villanueva I, Postigo-Martin P, González-Santos Á, Lozano-Lozano M, Galiano-Castillo N. Can physical exercise prevent chemotherapy-induced peripheral neuropathy in patients with cancer? A systematic review and meta-analysis. Arch Phys Med Rehabil 2022; 103:2197-2208. [PMID: 35271844 DOI: 10.1016/j.apmr.2022.02.008] [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: 12/01/2021] [Accepted: 02/04/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This systematic review analyzed the effects of physical exercise programs in patients with cancer undergoing chemotherapy on Chemotherapy-induced Peripheral Neuropathy (CIPN) prevention. DATA SOURCES PubMed, Web of Science, Scopus, and Cochrane Library were searched for relevant studies published before December 2020. Additional references were identified by manual screening of the reference lists. STUDY SELECTION Based on the PICOS strategy, randomized controlled trials in which physical exercise was applied before or during chemotherapy to prevent or ameliorate CIPN were included. DATA EXTRACTION Two reviewers blinded and independent screened the articles, scored methodologic quality, and extracted data for analysis. The review was conducted and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA). Sensitivity and precision analysis databases was included. Risk of bias assessment and meta-analysis were conducted using the Cochrane tools. DATA SYNTHESIS Of 229 potentially relevant studies, eight randomized controlled trials were included and scored. They comprise a total of 618 patients with cancer. Medline and Scopus databases recorded the highest sensitivity. None of the studies achieved a "low" overall risk of bias. Four studies were included in meta-analysis for quality of life, and a significance standardized mean difference was found between groups from baseline of 14.62, 95% CI 6.03, 23.20, with a large effect size g= .83, 95% CI .48, 1.18) in favor to physical exercise program compared with usual care. CONCLUSIONS Physical exercise at the onset of chemotherapy has shown promising effects on the prevention of CIPN, specially improving quality of life.
Collapse
Affiliation(s)
- Maria Lopez-Garzon
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain
| | - Irene Cantarero-Villanueva
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Paula Postigo-Martin
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain
| | - Ángela González-Santos
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain.
| | - Mario Lozano-Lozano
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- 'Cuídate' Support Unit for Oncology Patients (UAPO-Cuídate), University of Granada, Granada, Spain; Department of Physical Therapy, Faculty of Health Sciences, University of Granada. Avenida de la Ilustración 60, 18016, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Av. de Madrid, 15, 18012 Granada, Spain; Sport and Health Joint University Institute (iMUDS). University of Granada Av. del Conocimiento, s/n, 18007 Granada, Spain; Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| |
Collapse
|
15
|
Watson G, Coyne Z, Houlihan E, Leonard G. Exercise oncology: an emerging discipline in the cancer care continuum. Postgrad Med 2021; 134:26-36. [PMID: 34854802 DOI: 10.1080/00325481.2021.2009683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exercise is an essential component of healthy living and well-being. While there is a global acceptance of the benefits of exercise for the general population, there exists hesitancy and confusion among health-care professionals, particularly oncologists, as to whether these benefits translate to cancer patients. Patient referrals to accessible, structured exercise programs in this setting are often overlooked by physicians when formulating a cancer management plan. There is however increasing awareness and acceptance of cancer survivorship as a part of the cancer care continuum, identifying multiple factors that contribute to well-being beyond just cancer outcomes. Efforts to optimize cancer survivorship have stimulated further academic interest in the benefits of healthy living and particularly exercise oncology. There is now compelling evidence that exercise, which includes daily activities such as walking, as well as structured programs, improves multiple-cancer outcomes such as fatigue, quality of life and likely survival, and warrants consideration in the multidisciplinary care of cancer patients. International guidelines have been established that recommend counseling cancer patients with regard to healthy lifestyle changes including exercise. However, there still remains a reluctance from oncology physicians to prescribe exercise for these patients, largely due to uncertainty with regard to their patients' ability to tolerate such an intervention, coupled with insufficient understanding of the potential benefits of these programs. There also exist patient barriers and attitudes that must be overcome. Exercise strategies and bespoke programs that are tailored to the unique abilities and goals of the patients will enhance participation. To move the field forward and integrate exercise oncology into standard practice, it is imperative to raise awareness of the benefits of exercise to cancer patients and their health-care providers. This will facilitate the prescription of exercise as part of the multimodal treatment plan with the ultimate aim of promoting an active lifestyle to optimize patient care and well-being.
Collapse
Affiliation(s)
- Ga Watson
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Zl Coyne
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - E Houlihan
- Department of Physiotherapy, Cancer Care West, Galway, Ireland
| | - Gd Leonard
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| |
Collapse
|
16
|
Randomized trial of two artificial intelligence coaching interventions to increase physical activity in cancer survivors. NPJ Digit Med 2021; 4:168. [PMID: 34887491 PMCID: PMC8660785 DOI: 10.1038/s41746-021-00539-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/12/2021] [Indexed: 11/23/2022] Open
Abstract
Physical activity (PA) has numerous health benefits. Personalized coaching may increase adherence to PA recommendations, but it is challenging to deliver personalized coaching in a scalable manner. The objective of our study was to determine whether novel artificially intelligent (AI) coaching interventions increase PA among overweight or obese, physically inactive cancer survivors compared to a control arm that receives health information. We conducted a single-center, three-arm randomized trial with equal allocation to (1) voice-assisted AI coaching delivered by smart speaker (MyCoach), (2) autonomous AI coaching delivered by text message (SmartText), and (3) control. Data collection was automated via sensors and voice technology, effectively masking outcome ascertainment. The primary outcome was change in mean steps per day from baseline to the end of follow-up at 4 weeks. Of the 42 randomized participants, 91% were female, and 36% were Black; mean age was 62.1 years, and mean BMI was 32.9 kg/m2. The majority were breast cancer survivors (85.7%). At the end of 4 weeks follow-up, steps increased in the MyCoach arm by an average of 3618.2 steps/day; the net gain in this arm was significantly greater [net difference = 3568.9 steps/day (95% CI: 1483–5655), P value <0.001] compared to control arm, and [net difference = 2160.6 steps/day (95% CI: 11–4310), P value 0.049] compared to SmartText. In conclusion, AI-based voice-assisted coaching shows promise as a practical method of delivering scalable, individualized coaching to increase physical activity in sedentary cancer survivors. Additional research is needed to replicate these findings in a broader population of cancer survivors and to investigate the effects of these interventions in the general population. ClinicalTrials.gov Identifier: NCT03212079, July 11, 2017, https://clinicaltrials.gov/ct2/show/NCT03212079.
Collapse
|
17
|
Pimiento JM, Kraemer WJ. Dudrick Research Symposium: Expanding the boundaries of cancer care through nutrition support. JPEN J Parenter Enteral Nutr 2021; 45:1683-1689. [PMID: 34633094 DOI: 10.1002/jpen.2275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The 2020 Dudrick Research Symposium, entitled "Expanding the Boundaries of Cancer Care Through Nutritional Support," was held on March 30, at the American Society for Parenteral and Enteral Nutrition (ASPEN), Nutrition Science & Practice Conference. It was scheduled to take place in Tampa, Florida, but had to be held virtually. The Dudrick Symposium honors the many pivotal and innovative contributions made by the late Dr Stanley J. Dudrick, physician scientist, academic leader, and a founding member of ASPEN. This year, in addition to honoring his legacy, we honored his life. As the 2019 recipient of the Dudrick Research Scholar Award, Dr Pimiento chaired the symposium. The presentations focused on discussing the history, the present and future frontiers in the overlapping fields of nutrition support and cancer care. The late Dr John Daly opened the presentation with a moving tribute to Dr Dudrick's life and then spoke about the impact of nutrition support on surgical care and outcomes for cancer patients. Dr Pimiento discussed the role of nutraceuticals for cancer chemoprevention, and the level 1 clinical evidence surrounding this topic. Dr Kraemer explored the role of exercise physiology for optimal nutrient utilization and the overlap between targeted physical activity and nutrition support to obtain better outcomes on the cancer population. The symposium was closed by Dr Stephen Hursting, who discussed the impact of obesity in the soaring cancer rates and its relationship with clinical outcomes. In this article, we cover the presentations by Drs Pimiento and Kraemer.
Collapse
Affiliation(s)
- Jose M Pimiento
- Gastrointestinal Oncology Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - William J Kraemer
- Department of Human Sciences, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
18
|
Díez-Fernández DM, Baena-Raya A, Alcaraz-García C, Rodríguez-Rosell D, Rodríguez-Pérez MA, Soriano-Maldonado A. Improving resistance training prescription through the load-velocity relationship in breast cancer survivors: The case of the leg-press exercise. Eur J Sport Sci 2021; 22:1765-1774. [PMID: 34353234 DOI: 10.1080/17461391.2021.1965220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The aims of this study were: (i) to analyse the load-velocity relationship in the bilateral leg-press exercise in female breast cancer survivors, (ii) to assess whether mean velocity (MV) or peak velocity (PV) show stronger relationship with the relative load, and (iii) to examine whether linear (LA) or polynomic (PA) adjustment predict the velocities associated with each %1RM with greater precision. Twenty-two female breast cancer survivors (age: 50.2 ± 10.8 years, weight: 69.6 ± 15.2 kg, height: 160.51 ± 5.25 cm) completed an incremental load test until 1RM in the bilateral leg-press exercise. The MV and the PV of the concentric phase were measured in each repetition using a linear velocity transducer, and were analysed by regression models using LA and PA. A very close relationship of MV (R2 = 0.924; p < 0.0001; SEE = 0.08m.s-1 by LA, and R² = 0.952; p < 0.0001; SEE = 0.063 m.s-1 by PA) and PV (R² = 0.928; p < 0.0001; SEE = 0.119 m.s-1 by LA and R² = 0.941; p < 0.0001; SEE = 0.108 m.s-1 by PA) with %1RM were observed. The MV of 1RM was 0.24 ± 0.03 m·s-1, whereas the PV at 1RM was 0.60 ± 0.10 m.s-1. A comprehensive analysis of the bilateral leg-press load-velocity relationship in breast cancer survivors is presented. The results suggest that MV is the most recommendable velocity variable to prescribe the relative load during resistance training, and that the PA presents better accuracy to predict velocities associated with each %1RM, although LA is sufficiently valid to use this model as an alternative to the quadratic model. The implications for resistance training in breast cancer are discussed.
Collapse
Affiliation(s)
- David M Díez-Fernández
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Andrés Baena-Raya
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Celia Alcaraz-García
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - David Rodríguez-Rosell
- Physical Performance & Sports Research Center, Universidad Pablo de Olavide, Seville, Spain.,Department of Sport and Informatics, Universidad Pablo de Olavide, Seville, Spain.,Research, development and innovation (R&D+i) Area, Investigation in Medicine and Sport department, Sevilla Football Club, Seville, Spain
| | - Manuel A Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| | - Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences, University of Almería, Almería, Spain.,SPORT Research Group (CTS-1024), CERNEP Research Center, University of Almería, Almería, Spain
| |
Collapse
|
19
|
Arietaleanizbeaskoa MS, Gil Rey E, Mendizabal Gallastegui N, García-Álvarez A, De La Fuente I, Domínguez-Martinez S, Pablo S, Coca A, Gutiérrez Santamaría B, Grandes G. Implementing Exercise in Standard Cancer Care (Bizi Orain Hybrid Exercise Program): Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e24835. [PMID: 34383676 PMCID: PMC8386357 DOI: 10.2196/24835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 04/19/2021] [Accepted: 05/18/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Despite the established benefits of regular exercise for patients with cancer to counteract the deleterious effects of the disease itself and treatment-related adverse effects, most of them do not engage in sufficient levels of physical activity and there is a paucity of data on the integration of efficacious exercise programs that are accessible and generalizable to a large proportion of patients with cancer into routine cancer care. OBJECTIVE We intend to examine the effects attributable to the implementation of a community-based exercise program on cardiorespiratory functional capacity and quality of life for patients with cancer. METHODS This will be a hybrid study. In the first experimental phase, patients diagnosed with any type of cancer will be randomized into two parallel groups. One group immediately performs Bizi Orain, a 3-month supervised exercise program (3 times a week), in addition to behavioral counseling in a primary health care setting; the other is a reference group that starts the exercise program 3 months later (delayed treatment). In the second observational phase, the entire cohort of participants will be followed-up for 5 years. Any person diagnosed with cancer in the previous 2 years is eligible for the program. The program evaluation involves the uptake, safety, adherence, and effectiveness assessed after completion of the program and with follow-ups at 3, 6, 12, 24, 36, 48, and 60 months. The primary outcomes of the experimental study, to be compared between groups, are improved physical function and quality of life, whereas overall survival is the main objective of the prospective study. To analyze the association between changes in physical activity levels and overall survival, longitudinal mixed-effects models will be used for repeated follow-up measures. RESULTS A total of 265 patients have been enrolled into the study since January 2019, with 42 patients from the hematology service and 223 from the oncology service. CONCLUSIONS Bizi Orain is the first population-based exercise program in Spain that will offer more insight into the implementation of feasible, generalizable, and sustainable supportive care services involving structured exercise to extend survival of patients with cancer, improve their physical function and quality of life, and reverse the adverse effects of their disease and related treatments, thereby reducing the clinical burden. TRIAL REGISTRATION ClinicalTrials.gov NCT03819595; http://clinicaltrials.gov/ct2/show/NCT03819595. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/24835.
Collapse
Affiliation(s)
| | | | | | | | | | | | - Susana Pablo
- Biocruces Health Research Institute, Barakaldo, Spain
| | | | | | | |
Collapse
|
20
|
Heemelaar JC, Krol ADG, Louwerens M, L M A Beeres S, Holman ER, Schalij MJ, Louisa Antoni M. Elevated resting heart rate is a marker of subclinical left ventricular dysfunction in hodgkin lymphoma survivors. IJC HEART & VASCULATURE 2021; 35:100830. [PMID: 34258382 PMCID: PMC8253957 DOI: 10.1016/j.ijcha.2021.100830] [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: 04/09/2021] [Revised: 06/16/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
Background Thoracic irradiation is one of the cornerstones of Hodgkin lymphoma (HL) treatment, which contributes to high rates of long-term survivorship, but begets a life-long increased risk of heart disease including heart failure. At the cardio-oncology (CO) clinic, persistent sinus tachycardia or elevated resting heart rate (RHR) is frequently observed in these patients. The aim of this study was to evaluate the relation between RHR and left ventricular (LV) dysfunction. Methods In 75 HL survivors visiting our CO-clinic echocardiographic evaluation of LV systolic and diastolic function including global longitudinal strain (GLS) was performed to assess subclinical LV dysfunction. Results Median age of HL diagnosis was 24 [25th-75th percentile: [19], [29]] years with a 17 [12], [25] year interval to CO-clinic visit and 31 patients (41%) were male. Average RHR was 78 ± 14 bpm and 40% of patients (N = 30) had an elevated RHR defined as ≥ 80 bpm. While there was no difference in LV ejection fraction (55.6 ± 4.3 vs. 54.8 ± 6.6; p = 0.543), patients with elevated RHR had abnormal GLS (-15.9% vs. -18.3%, p = 0.045) and higher prevalence of diastolic dysfunction (73.3% vs. 46.7%; p = 0.022). GLS, E/e' ratio and presence of diastolic dysfunction were independently associated with RHR when correcting for age, sex and mantle field irradiation. A significant improvement was observed of the RHR-association model with solely extracardiac confounders when LV-function parameters were added to the model (F-statistic = 6.36, p = 0.003). Conclusions This study indicates RHR as a possible marker for subclinical LV-dysfunction in HL survivors.
Collapse
Affiliation(s)
- Julius C Heemelaar
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Augustinus D G Krol
- Department of Radiotherapy, Leiden University Medical Centre, Leiden, the Netherlands
| | - Marloes Louwerens
- Department of Internal Medicine, Leiden University Medical Centre, Leiden, the Netherlands
| | - Saskia L M A Beeres
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Eduard R Holman
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - Martin J Schalij
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| | - M Louisa Antoni
- Department of Cardiology, Heart Lung Center, Leiden University Medical Centre, Leiden, the Netherlands
| |
Collapse
|
21
|
Montalvo RN, Doerr V, Nguyen BL, Kelley RC, Smuder AJ. Consideration of Sex as a Biological Variable in the Development of Doxorubicin Myotoxicity and the Efficacy of Exercise as a Therapeutic Intervention. Antioxidants (Basel) 2021; 10:antiox10030343. [PMID: 33669040 PMCID: PMC7996538 DOI: 10.3390/antiox10030343] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/19/2021] [Accepted: 02/22/2021] [Indexed: 02/07/2023] Open
Abstract
Doxorubicin (DOX) is an anthracycline antibiotic used to treat a wide variety of hematological and solid tumor cancers. While DOX is highly effective at reducing tumor burden, its clinical use is limited by the development of adverse effects to both cardiac and skeletal muscle. The detrimental effects of DOX to muscle tissue are associated with the increased incidence of heart failure, dyspnea, exercise intolerance, and reduced quality of life, which have been reported in both patients actively receiving chemotherapy and cancer survivors. A variety of factors elevate the probability of DOX-related morbidity in patients; however, the role of sex as a biological variable to calculate patient risk remains unclear. Uncertainty regarding sexual dimorphism in the presentation of DOX myotoxicity stems from inadequate study design to address this issue. Currently, the majority of clinical data on DOX myotoxicity come from studies where the ratio of males to females is unbalanced, one sex is omitted, and/or the patient cohort include a broad age range. Furthermore, lack of consensus on standard outcome measures, difficulties in long-term evaluation of patient outcomes, and other confounding factors (i.e., cancer type, drug combinations, adjuvant therapies, etc.) preclude a definitive answer as to whether differences exist in the incidence of DOX myotoxicity between sexes. This review summarizes the current clinical and preclinical literature relevant to sex differences in the incidence and severity of DOX myotoxicity, the proposed mechanisms for DOX sexual dimorphism, and the potential for exercise training to serve as an effective therapeutic countermeasure to preserve muscle strength and function in males and females.
Collapse
|
22
|
Exercise as a therapy for cancer-induced muscle wasting. SPORTS MEDICINE AND HEALTH SCIENCE 2020; 2:186-194. [PMID: 35782998 PMCID: PMC9219331 DOI: 10.1016/j.smhs.2020.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 12/17/2022] Open
Abstract
Cancer cachexia is a progressive disorder characterized by body weight, fat, and muscle loss. Cachexia induces metabolic disruptions that can be analogous and distinct from those observed in cancer, obscuring both diagnosis and treatment options. Inflammation, hypogonadism, and physical inactivity are widely investigated as systemic mediators of cancer-induced muscle wasting. At the cellular level, dysregulation of protein turnover and energy metabolism can negatively impact muscle mass and function. Exercise is well known for its anti-inflammatory effects and potent stimulation of anabolic signaling. Emerging evidence suggests the potential for exercise to rescue muscle's sensitivity to anabolic stimuli, reduce wasting through protein synthesis modulation, myokine release, and subsequent downregulation of proteolytic factors. To date, there is no recommendation for exercise in the management of cachexia. Given its complex nature, a multimodal approach incorporating exercise offers promising potential for cancer cachexia treatment. This review's primary objective is to summarize the growing body of research examining exercise regulation of cancer cachexia. Furthermore, we will provide evidence for exercise interactions with established systemic and cellular regulators of cancer-induced muscle wasting.
Collapse
|
23
|
Lavín‐Pérez AM, Collado‐Mateo D, Mayo X, Humphreys L, Liguori G, James Copeland R, Del Villar Álvarez F, Jiménez A. High‐intensity exercise to improve cardiorespiratory fitness in cancer patients and survivors: A systematic review and meta‐analysis. Scand J Med Sci Sports 2020; 31:265-294. [DOI: 10.1111/sms.13861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 10/02/2020] [Accepted: 10/12/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Ana Myriam Lavín‐Pérez
- Program of Epidemiology and Public Health (Interuniversity) PhD International School of the Rey Juan Carlos University Madrid Spain
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
- GO fitLAB Ingesport Madrid Spain
| | | | - Xián Mayo
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
| | - Liam Humphreys
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
| | | | - Robert James Copeland
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
| | | | - Alfonso Jiménez
- Centre for Sport Studies Rey Juan Carlos University Madrid Spain
- GO fitLAB Ingesport Madrid Spain
- Advanced Wellbeing Research Centre College of Health Wellbeing and Life Sciences Sheffield Hallam University Sheffield UK
| |
Collapse
|
24
|
Resistance Training Safety during and after the SARS-Cov-2 Outbreak: Practical Recommendations. BIOMED RESEARCH INTERNATIONAL 2020; 2020:3292916. [PMID: 33029503 PMCID: PMC7532374 DOI: 10.1155/2020/3292916] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 08/05/2020] [Accepted: 09/11/2020] [Indexed: 12/12/2022]
Abstract
In December of 2019, there was an outbreak of a severe acute respiratory syndrome caused by the coronavirus 2 (SARS-CoV-2 or COVID-19) in China. The virus rapidly spread into the whole world causing an unprecedented pandemic and forcing governments to impose a global quarantine, entering an extreme unknown situation. The organizational consequences of quarantine/isolation are absence of organized training and competition, lack of communication among athletes and coaches, inability to move freely, lack of adequate sunlight exposure, and inappropriate training conditions. The reduction of mobility imposed to contain the advance of the SARS-Cov-2 pandemic can negatively affect the physical condition and health of individuals leading to muscle atrophy, progressive loss of muscle strength, and reductions in neuromuscular and mechanical capacities. Resistance training (RT) might be an effective tool to counteract these adverse consequences. RT is considered an essential part of an exercise program due to its numerous health and athletic benefits. However, in the face of the SARS-Cov-2 outbreak, many people might be concerned with safety issues regarding its practice, especially in indoor exercise facilities, such as gyms and fitness centers. These concerns might be associated with RT impact in the immune system, respiratory changes, and contamination due to equipment sharing and agglomeration. In this current opinion article, we provide insights to address these issues to facilitate the return of RT practices under the new logistical and health challenges. We understand that RT can be adapted to allow its performance with measures adopted to control coronavirus outbreak such that the benefits would largely overcome the potential risks. The article provides some practical information to help on its implementation.
Collapse
|
25
|
Gentil P, Ramirez-Campillo R, Souza D. Resistance Training in Face of the Coronavirus Outbreak: Time to Think Outside the Box. Front Physiol 2020; 11:859. [PMID: 32733287 PMCID: PMC7358585 DOI: 10.3389/fphys.2020.00859] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 06/26/2020] [Indexed: 01/06/2023] Open
Affiliation(s)
- Paulo Gentil
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil.,Hypertension League, Federal University of Goias, Goiânia, Brazil
| | - Rodrigo Ramirez-Campillo
- Laboratory of Human Performance, Quality of Life and Wellness Research Group, Department of Physical Activity Sciences, Universidad de Los Lagos, Osorno, Chile
| | - Daniel Souza
- College of Physical Education and Dance, Federal University of Goiás, Goiânia, Brazil
| |
Collapse
|
26
|
Hardee JP, Fix DK, Koh HJ, Wang X, Goldsmith EC, Carson JA. Repeated eccentric contractions positively regulate muscle oxidative metabolism and protein synthesis during cancer cachexia in mice. J Appl Physiol (1985) 2020; 128:1666-1676. [PMID: 32407241 DOI: 10.1152/japplphysiol.00908.2019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Cancer-induced wasting is accompanied by disruptions to muscle oxidative metabolism and protein turnover that have been associated with systemic inflammation, whereas exercise and stimulated muscle contractions can positively regulate muscle protein synthesis and mitochondrial homeostasis. In preclinical cancer cachexia models, a single bout of eccentric contractions (ECCs) can induce protein synthesis and repeated ECC bouts prevent myofiber atrophy. The cellular mechanisms providing this protection from atrophy have not been resolved. Therefore, the purpose of this study was to determine whether repeated stimulated ECC bouts affect basal muscle oxidative metabolism and protein synthesis during cancer cachexia, and if these changes were associated with plasma IL-6 levels. Male ApcMin/+ (MIN; n = 10) mice initiating cachexia and healthy C57BL/6 (B6; n = 11) control mice performed repeated ECC bouts over 2 wk. MIN mice exhibited body weight loss and elevated plasma IL-6 before and during repeated ECC bouts. Control MIN muscle demonstrated disrupted signaling related to inflammation, oxidative capacity, and protein synthesis regulation, which were all improved by repeated ECC bouts. With cachexia, plasma IL-6 levels were negatively correlated with myofiber cross-sectional area, oxidative capacity, and protein synthesis. Interestingly, ECC improvements in these outcomes were positively correlated with plasma IL-6 levels in MIN mice. There was also a positive relationship between muscle oxidative capacity and protein synthesis after repeated ECC bouts in MIN mice. Collectively, repeated ECC bouts altered the cachectic muscle phenotype independent of systemic wasting, and there was a strong association between muscle oxidative capacity and protein synthesis in this adaptive response.NEW & NOTEWORTHY Cancer-induced muscle wasting is accompanied by disruptions to muscle oxidative metabolism and protein turnover regulation, whereas exercise is a potent stimulator of muscle protein synthesis and mitochondrial homeostasis. In a preclinical model of cancer cachexia, we report that cachectic muscle retains anabolic and metabolic plasticity to repeated eccentric contraction bouts despite an overall systemic wasting environment. The attenuation of muscle atrophy is linked to improved oxidative capacity and protein synthesis during cancer cachexia progression.
Collapse
Affiliation(s)
- Justin P Hardee
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Dennis K Fix
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Ho-Jin Koh
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Xuewen Wang
- Department of Exercise Science, University of South Carolina, Columbia, South Carolina
| | - Edie C Goldsmith
- Department of Cell Biology and Anatomy, University of South Carolina School of Medicine, Columbia, South Carolina
| | - James A Carson
- Center for Muscle Metabolism and Neuropathology, Division of Rehabilitation Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, Tennessee
| |
Collapse
|
27
|
Bertoli J, de Souza Bezerra E, Dias Reis A, Amice da Costa Barros Ê, Gobbo LA, Forte Freitas Júnior I. Long-Term Side Effects of Breast Cancer on Force Production Parameters. J Strength Cond Res 2020; 36:1450-1458. [DOI: 10.1519/jsc.0000000000003631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
28
|
Dun L, Xian-Yi W, Xiao-Ying J. Effects of Moderate-To-Vigorous Physical Activity on Cancer-Related Fatigue in Patients with Colorectal Cancer: A Systematic Review and Meta-Analysis. Arch Med Res 2020; 51:173-179. [DOI: 10.1016/j.arcmed.2019.12.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 12/10/2019] [Accepted: 12/31/2019] [Indexed: 12/19/2022]
|
29
|
Soriano-Maldonado A, Carrera-Ruiz Á, Díez-Fernández DM, Esteban-Simón A, Maldonado-Quesada M, Moreno-Poza N, García-Martínez MDM, Alcaraz-García C, Vázquez-Sousa R, Moreno-Martos H, Toro-de-Federico A, Hachem-Salas N, Artés-Rodríguez E, Rodríguez-Pérez MA, Casimiro-Andújar AJ. Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial. Medicine (Baltimore) 2019; 98:e17625. [PMID: 31689771 PMCID: PMC6946307 DOI: 10.1097/md.0000000000017625] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/24/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND The number of people living with the side effects of breast cancer treatment (eg, loss of muscular mass and muscular strength, upper-limb mobility and disability, lymphedema, cardiac toxicity, and reduced quality of life) is increasing yearly. These consequences can be improved through exercise, specially combining resistance and aerobic training. Previous exercise trials have not been consistent in applying training principles and standardized reporting, and this partly explains the variability in obtained results. The aim of this study is to assess the effect of a 12-week supervised resistance exercise program combined with home-based aerobic exercise, compared with home-based aerobic exercise only, on muscular strength and several aspects of health-related quality of life in breast cancer survivors. To maximize transparency, replicability, and clinical applicability, the intervention is described following the consensus on exercise reporting template. METHODS This study is a parallel-group randomized controlled trial in which 60 female breast cancer survivors, who have completed central treatments of the disease in the last 5 years, will be randomly assigned to either an experimental group that will perform a total of 24 progressive resistance training sessions for 12 weeks (ie, 2 weeks of individual training and 10 weeks of micro-group training) and will be requested to undertake 10,000 steps/d, or a control group that will be requested to undertake 10,000 steps/d, only. Outcomes will be evaluated at baseline and at week 12. Primary outcome measure is peak isometric muscular strength of the lower- and upper-body, assessed with several exercises through an electromechanical dynamometer. Secondary outcomes include cardiorespiratory fitness, upper-joint mobility and disability, health-related quality of life, cancer-related fatigue, depression, life satisfaction, and presence of lymphedema. DISCUSSION This study aims to investigate the extent to which a 12-week supervised and progressive resistance exercise program, in addition to home-based aerobic physical activity, might improve muscular strength and health-related quality of life in breast cancer survivors. The comprehensive description of the intervention will likely contribute to enhancing exercise prescription in this population. TRIAL REGISTRATION NUMBER ISRCTN14601208.
Collapse
Affiliation(s)
- Alberto Soriano-Maldonado
- Department of Education, Faculty of Education Sciences
- SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería
| | | | - David M. Díez-Fernández
- Department of Education, Faculty of Education Sciences
- SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería
| | | | | | | | | | | | - Rosa Vázquez-Sousa
- Hospital Universitario Torrecárdenas, Servicio de Radiodiagnóstico, Unidad de Mama, Almería, Spain
| | | | | | - Nur Hachem-Salas
- Servicio Andaluz de Salud, Unidad de Gestión Clínica Mediterráneo-Torrecárdenas, Distrito Sanitario
| | - Eva Artés-Rodríguez
- Area of Statistics and Operative Research, Department of Mathematics, Faculty of Sciences, University of Almería, Almería, Spain
| | - Manuel A. Rodríguez-Pérez
- Department of Education, Faculty of Education Sciences
- SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería
| | - Antonio J. Casimiro-Andújar
- Department of Education, Faculty of Education Sciences
- SPORT Research Group (CTS-1024), CERNEP Research Centre, University of Almería
| |
Collapse
|
30
|
Cancer Survivors Could Get Survival Benefits from Postdiagnosis Physical Activity: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2019; 2019:1940903. [PMID: 31772591 PMCID: PMC6854247 DOI: 10.1155/2019/1940903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 08/06/2019] [Accepted: 08/19/2019] [Indexed: 12/21/2022]
Abstract
Background Physical activity presents significant protection against death from cancer in the general population, so the global recommendations on physical activity for health are recommended by the WHO. While the recommendation is a guideline for general population, whether all cancer patients could get benefits from physical activity and whether the cancer patients who did not meet the requirement of the recommendation could get benefits from the physical activity, compared with the cancer patients with no physical activity, are unclear. Accordingly, we conducted a meta-analysis to identify whether the physical activity, even if low level of physical activity, could reduce the mortality of various cancer patients. Method We conducted a systematic search of PubMed, Embase, and Cochrane Library for published cohorts and case-control studies of cancer survivors with physical activity comparing with no physical activity and reported outcomes of mortality through October 15, 2018. Two investigators independently reviewed the included studies and extracted relevant data. The effect estimate of interest was the hazard ratios (HRs). Results There are 21811 participants in total in the nine studies, and 2386 cancer deaths in this meta-analysis. Among them, 1 was a case-control study and 8 were cohort studies. The meta-analysis results showed that physical activity was associated with a significantly reduced risk of mortality in cancer survivors, with a pooled HR and 95% CI of 0.66 (0.58∼0.73), reducing mortality by 34% and also suggested that low level of physical activity could reduce the mortality with an HR and 95% CI of 0.60 (0.50∼0.69). Conclusion The results of this meta-analysis demonstrated that postdiagnosis physical activity, no matter the level of physical activity, could significantly reduce the mortality by 34%, compared with the no physical activity. At the same time, the results also suggested that cancer survivors undergoing low level of physical activity had a 40% reduction in mortality, which means that the cancer patients with poor ECOG need to do physical activity as much as they can, even if the amount of physical activity was low.
Collapse
|
31
|
Friedenreich CM, Stone CR, Cheung WY, Hayes SC. Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis. JNCI Cancer Spectr 2019; 4:pkz080. [PMID: 32337494 PMCID: PMC7050161 DOI: 10.1093/jncics/pkz080] [Citation(s) in RCA: 171] [Impact Index Per Article: 34.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 09/17/2019] [Accepted: 10/01/2019] [Indexed: 02/07/2023] Open
Abstract
Background Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival. Methods PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses. Results Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week. Conclusion Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.
Collapse
Affiliation(s)
- Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsea R Stone
- Department of Cancer Epidemiology and Prevention Research, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada
| | - Winson Y Cheung
- Division of Medical Oncology, Tom Baker Cancer Centre, CancerControl Alberta, Alberta Health Services, Calgary, Alberta, Canada.,Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sandra C Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| |
Collapse
|
32
|
Resistance training in addition to aerobic activity is associated with lower likelihood of depression and comorbid depression and anxiety symptoms: A cross sectional analysis of Australian women. Prev Med 2019; 126:105773. [PMID: 31323284 DOI: 10.1016/j.ypmed.2019.105773] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 06/11/2019] [Accepted: 07/14/2019] [Indexed: 01/08/2023]
Abstract
The mental health benefits of resistance training (RT) alone or beyond those provided by aerobic physical activity (PA) are unclear. This study aimed to determine the association between meeting recommendations for aerobic PA and/or RT, and symptoms of depression and/or anxiety. Participants were Australian female members of the 10,000 Steps project (n = 5180, 50.0 ± 11.5 years). Symptoms of depression and anxiety were determined using the Depression Anxiety Stress Score. Participants were grouped as 'depression only', 'anxiety only', 'co-occurring depression and anxiety' or 'neither depression nor anxiety' based on relevant subscale score (cut-points: depression≥14 points, anxiety≥10 points). The International Physical Activity Questionnaire-Long Form questionnaire was used to determine PA with an additional item to specify RT frequency. Participants were classified as adhering to 'aerobic PA only' (≥150 min PA/week), 'RT only' (RT ≥ 2 days/week), 'aerobic PA + RT' (≥150 min PA/week+RT ≥ 2 days/week), or 'neither aerobic PA nor RT' (<150 min PA/week+RT < 2 days/week). Adjusted relative risk ratios (RRR [95%CI]) were estimated using multinomial logistic regression models. Relative to the 'neither PA nor RT' (n = 2215), the probabilities of 'depression only' (n = 317) and 'co-occurring depression and anxiety' (n = 417) were lower for the 'aerobic PA only' (n = 1590) (RRR = 0.74 [0.56-0.97] and RRR = 0.76 [0.59-0.97] respectively), and 'both PA + RT' (n = 974) groups (RRR = 0.61 [0.43-0.86] and RRR = 0.47 [0.33-0.67] respectively). There were no associations between adhering to one or both recommendations and 'anxiety only' (n = 317), or between 'RT only' (n = 401) and depression and/or anxiety. Prevention and treatment strategies including both aerobic PA and RT may provide additional benefits for depression with or without comorbid anxiety.
Collapse
|
33
|
Lin J, Zhang W, Chen W, Huang Y, Wu R, Chen X, Shen X, Zhu G. Muscle Mass, Density, and Strength Are Necessary to Diagnose Sarcopenia in Patients With Gastric Cancer. J Surg Res 2019; 241:141-148. [DOI: 10.1016/j.jss.2019.03.022] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Revised: 02/16/2019] [Accepted: 03/21/2019] [Indexed: 12/16/2022]
|
34
|
Laforgia P, Bandera F, Alfonzetti E, Guazzi M. Exercise chronotropic incompetence phenotypes the level of cardiovascular risk and exercise gas exchange impairment in the general population. An analysis of the Euro-EX prevention trial. Eur J Prev Cardiol 2019; 27:526-535. [PMID: 31345056 DOI: 10.1177/2047487319863506] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Chronotropic insufficiency (CI) is defined as the inability of the heart to increase its rate commensurate with increased demand. Exercise CI is an established predictor of major adverse cardiovascular events in patients with cardiovascular diseases. AIM The aim of this study was to evaluate how exercise CI phenotypes different levels of cardiovascular risk and how it may better perform in defining cardiovascular risk when analysed in the context of cardiopulmonary exercise test (CPET)-derived measures and standard echocardiography in a healthy population with variable cardiovascular risk profile. METHODS Apparently healthy individuals (N = 702, 53.8% females) with at least one major cardiovascular risk factor (MCVRF; hypertension, diabetes, tabagism, dyslipidaemia, body mass index > 25), enrolled in the Euro-EX prevention trial, underwent CPET. CI was defined as the inability to reach 80% of the chronotropic index, that is, the ratio of peak heart rate - rest heart rate/peak heart rate - age predicted maximal heart rate (AMPHR: 220 - age), they were divided into four groups according to the heart rate reserve (<80%>) and respiratory gas exchange ratio (RER; < 1.05>) as a marker of achieved maximal performance. Subjects with a RER < 1.05 (n = 103) were excluded and the final population (n = 599) was divided into CI group (n = 472) and no-CI group (n = 177). RESULTS Compared with no-CI, CI subjects were more frequently females with a history of hypertension in a high rate. CI subjects also exhibited a significantly lower peak oxygen uptake (VO2) and circulatory power and an echocardiographic pattern indicative of higher left atrial volume index and left ventricular mass index. An inverse stepwise relationship between heart rate reserve and number of MCVRFs was observed (one MCVRF: 0.71 ± 0.23; two MCVRFs: 0.68 ± 0.24, three MCVRFs: 0.64 ± 0.20; four MCVRFs: 0.64 ± 0.23; five MCVRFs: 0.57 ± 18; p < 0.01). In multivariate analysis the only variable found predicting CI was peak VO2 (p < 0.05; odds ratio 0.91; confidence interval 0.85-0.97). CONCLUSIONS In a population of apparently healthy subjects, exercise CI is common and phenotypes the progressive level of cardiovascular risk by a tight relationship with MCVRFs. CI patients exhibit some peculiar abnormal exercise gas exchange patterns (lower peak VO2 and exercise oscillatory ventilation) and echo-derived measures (higher left atrium size and left ventricle mass) that may well anticipate evolution toward heart failure.
Collapse
Affiliation(s)
- Pietro Laforgia
- University of Milano, Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Francesco Bandera
- University of Milano, Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Eleonora Alfonzetti
- University of Milano, Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, Milano, Italy
| | - Marco Guazzi
- University of Milano, Cardiology University Department, Heart Failure Unit, IRCCS Policlinico San Donato, Milano, Italy
| |
Collapse
|
35
|
Caan BJ, Cespedes Feliciano EM, Kroenke CH. The Importance of Body Composition in Explaining the Overweight Paradox in Cancer-Counterpoint. Cancer Res 2019; 78:1906-1912. [PMID: 29654153 DOI: 10.1158/0008-5472.can-17-3287] [Citation(s) in RCA: 122] [Impact Index Per Article: 24.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 12/28/2017] [Accepted: 01/24/2018] [Indexed: 12/21/2022]
Abstract
Despite a greater risk of cancer associated with higher BMI, overweight (BMI 25-<30 kg/m2) and class I obese (BMI 30-<35 kg/m2) patients often have a paradoxically lower risk of overall mortality after a cancer diagnosis, a phenomenon called the "obesity paradox." Only when patients exceed a BMI ≥35 kg/m2 are elevations in mortality risk consistently noted. This paradox has been dismissed as the result of methodologic bias, which we will describe and debate here. However, even if such bias influences associations, there is growing evidence that body composition may in part explain the paradox. This phenomenon may more accurately be described as a BMI paradox. That is, BMI is a poor proxy for adiposity and does not distinguish muscle from adipose tissue, nor describe adipose tissue distribution. Low muscle mass is associated with higher risk of recurrence, overall and cancer-specific mortality, surgical complications, and treatment-related toxicities. Patients with who are overweight or obese have on average higher levels of muscle than their normal-weight counterparts. Also, there is some evidence that patients with moderate levels of subcutaneous adipose tissue may have lower mortality. More research utilizing body composition is needed to clarify the effects of adiposity on cancer mortality. Cancer Res; 78(8); 1906-12. ©2018 AACR.
Collapse
Affiliation(s)
- Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, California.
| | | | | |
Collapse
|
36
|
Metastasis as a systemic disease: molecular insights and clinical implications. Biochim Biophys Acta Rev Cancer 2019; 1872:89-102. [PMID: 31202687 DOI: 10.1016/j.bbcan.2019.06.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 12/18/2022]
Abstract
Metastasis is a complex systemic disease that develops as a result of interactions between tumor cells and their local and distant microenvironments. Local and systemic immune-related changes play especially critical roles in limiting or enabling the development of metastatic disease. Although anti-tumor immune responses likely eliminate most early primary and metastatic lesions, factors secreted by cancer or stromal cells in the primary tumor can mobilize and activate cells in distant organs in a way that promotes the outgrowth of disseminated cancer cells into macrometastatic lesions. Therefore, the prevention, detection, and effective treatment of metastatic disease require a deeper understanding of the systemic effects of primary tumors as well as predisposing hereditary and acquired host factors including chronic inflammatory conditions. The success of immunotherapy in a subset of cancer patients is an example of how modulating the microenvironment and tumor-immune cell interactions can be exploited for the effective eradiation of even advanced-stage tumors. Here, we highlight emerging insights and clinical implications of cancer as a systemic disease.
Collapse
|
37
|
Mcleod JC, Stokes T, Phillips SM. Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease. Front Physiol 2019; 10:645. [PMID: 31244666 PMCID: PMC6563593 DOI: 10.3389/fphys.2019.00645] [Citation(s) in RCA: 128] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/07/2019] [Indexed: 12/20/2022] Open
Abstract
Age is a primary risk factor for a number of chronic diseases including mobility disability, cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer. Most physical activity guidelines emphasize the performance of 150 min of moderate-to-vigorous or 75 min of vigorous aerobic exercise training (AET) weekly for reduction of chronic disease risk. Nonetheless, there is an emerging body of evidence showing that resistance exercise training (RET) appears to be as effective as AET in reducing risk of several chronic diseases. It may also be that RET is more effective than AET in some regards; the converse is likely also true. We posit that the perceived divergent exercise mode-dependent health benefits of AET and RET are likely small in most cases. In this short review, our aim is to examine evidence of associations between the performance of RET and chronic health disease risk (mobility disability, T2D, CVD, cancer). We also postulate on how RET may be influencing chronic disease risk and how it is a critical component for healthy aging. Accumulating evidence points to RET as a potent and robust preventive strategy against a number of chronic diseases traditionally associated with the performance of AET, but evidence favors RET as a potent countermeasure against declines in mobility. On the basis of this review we propose that the promotion of RET should assume a more prominent position in exercise guidelines particularly for older persons.
Collapse
Affiliation(s)
- Jonathan C Mcleod
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Tanner Stokes
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| | - Stuart M Phillips
- Department of Kinesiology, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
38
|
Feliciano EMC, Kroenke CH, Meyerhardt JA, Prado CM, Bradshaw PT, Kwan ML, Xiao J, Alexeeff S, Corley D, Weltzien E, Castillo AL, Caan BJ. Association of Systemic Inflammation and Sarcopenia With Survival in Nonmetastatic Colorectal Cancer: Results From the C SCANS Study. JAMA Oncol 2019; 3:e172319. [PMID: 28796857 DOI: 10.1001/jamaoncol.2017.2319] [Citation(s) in RCA: 249] [Impact Index Per Article: 49.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance Systemic inflammation and sarcopenia are easily evaluated, predict mortality in many cancers, and are potentially modifiable. The combination of inflammation and sarcopenia may be able to identify patients with early-stage colorectal cancer (CRC) with poor prognosis. Objective To examine associations of prediagnostic systemic inflammation with at-diagnosis sarcopenia, and determine whether these factors interact to predict CRC survival, adjusting for age, ethnicity, sex, body mass index, stage, and cancer site. Design, Setting, and Participants A prospective cohort of 2470 Kaiser Permanente patients with stage I to III CRC diagnosed from 2006 through 2011. Exposures Our primary measure of inflammation was the neutrophil to lymphocyte ratio (NLR). We averaged NLR in the 24 months before diagnosis (mean count = 3 measures; mean time before diagnosis = 7 mo). The reference group was NLR of less than 3, indicating low or no inflammation. Main Outcomes and Measures Using computed tomography scans, we calculated skeletal muscle index (muscle area at the third lumbar vertebra divided by squared height). Sarcopenia was defined as less than 52 cm2/m2 and less than 38 cm2/m2 for normal or overweight men and women, respectively, and less than 54 cm2/m2 and less than 47 cm2/m2 for obese men and women, respectively. The main outcome was death (overall or CRC related). Results Among 2470 patients, 1219 (49%) were female; mean (SD) age was 63 (12) years. An NLR of 3 or greater and sarcopenia were common (1133 [46%] and 1078 [44%], respectively). Over a median of 6 years of follow-up, we observed 656 deaths, 357 from CRC. Increasing NLR was associated with sarcopenia in a dose-response manner (compared with NLR < 3, odds ratio, 1.35; 95% CI, 1.10-1.67 for NLR 3 to <5; 1.47; 95% CI, 1.16-1.85 for NLR ≥ 5; P for trend < .001). An NLR of 3 or greater and sarcopenia independently predicted overall (hazard ratio [HR], 1.64; 95% CI, 1.40-1.91 and HR, 1.28; 95% CI, 1.10-1.53, respectively) and CRC-related death (HR, 1.71; 95% CI, 1.39-2.12 and HR, 1.42; 95% CI, 1.13-1.78, respectively). Patients with both sarcopenia and NLR of 3 or greater (vs neither) had double the risk of death, overall (HR, 2.12; 95% CI, 1.70-2.65) and CRC related (HR, 2.43; 95% CI, 1.79-3.29). Conclusions and Relevance Prediagnosis inflammation was associated with at-diagnosis sarcopenia. Sarcopenia combined with inflammation nearly doubled risk of death, suggesting that these commonly collected biomarkers could enhance prognostication. A better understanding of how the host inflammatory/immune response influences changes in skeletal muscle may open new therapeutic avenues to improve cancer outcomes.
Collapse
Affiliation(s)
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jeffrey A Meyerhardt
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Carla M Prado
- Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Patrick T Bradshaw
- Division of Epidemiology, School of Public Health, University of California–Berkeley
| | - Marilyn L Kwan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Jingjie Xiao
- Department of Agricultural, Food, and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada
| | - Stacey Alexeeff
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Douglas Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Erin Weltzien
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Adrienne L Castillo
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Bette J Caan
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| |
Collapse
|
39
|
Bennie JA, Lee DC, Khan A, Wiesner GH, Bauman AE, Stamatakis E, Biddle SJH. Muscle-Strengthening Exercise Among 397,423 U.S. Adults: Prevalence, Correlates, and Associations With Health Conditions. Am J Prev Med 2018; 55:864-874. [PMID: 30458949 DOI: 10.1016/j.amepre.2018.07.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 05/15/2018] [Accepted: 07/20/2018] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Although muscle-strengthening exercise has multiple independent health benefits, little is known about muscle-strengthening exercise participation and associations with adverse health conditions among U.S. adults. METHODS In 2017, data were analyzed from the U.S. 2015 Behavioral Risk Factor Surveillance System. During telephone surveys, respondents reported how many times during the past week they engaged in muscle-strengthening exercise. Weighted weekly muscle-strengthening exercise frequencies were calculated for the total sample and across sociodemographic and lifestyle characteristics. A multivariable logistic regression assessed the odds of having self-reported adverse health conditions (e.g., diabetes, coronary heart disease) according to weekly muscle-strengthening exercise frequency. RESULTS Data were available on 397,423 adults (aged 18-80 years). Overall, 30.2% (95% CI=29.9, 30.5) met the muscle-strengthening exercise recommendations (two or more times/week) and 57.8% (95% CI=57.5, 58.2) reported no muscle-strengthening exercise. Older age, insufficient aerobic activity, lower income, lower education, poorer self-rated health, being female, and being overweight/obese were significantly associated with lower odds of meeting the muscle-strengthening exercise recommendations independently of other characteristics. After adjusting for confounders (e.g., age, sex, income, smoking, aerobic activity), when compared with those who did none, muscle-strengthening exercise was associated with lower odds for several adverse health conditions, including prevalent diabetes, cancer (non-skin), poor self-rated health, and obesity. CONCLUSIONS Three in five U.S. adults do not engage in any muscle-strengthening exercise, despite an association for muscle-strengthening exercise with better health conditions. Future muscle-strengthening exercise promotion strategies should target older adults, females, those with low education/income, and those with a poor health status.
Collapse
Affiliation(s)
- Jason A Bennie
- Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield, Queensland, Australia.
| | - Duck-Chul Lee
- Department of Kinesiology, Iowa State University, Ames, Iowa
| | - Asaduzzaman Khan
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Glen H Wiesner
- Active Living and Public Health Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, Victoria, Australia
| | - Adrian E Bauman
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre Epidemiology Unit, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Emmanuel Stamatakis
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia; Charles Perkins Centre Epidemiology Unit, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Stuart J H Biddle
- Physically Active Lifestyles Research Group (USQ PALs), Institute for Resilient Regions, University of Southern Queensland, Springfield, Queensland, Australia
| |
Collapse
|
40
|
Montalvo RN, Hardee JP, VanderVeen BN, Carson JA. Resistance Exercise's Ability to Reverse Cancer-Induced Anabolic Resistance. Exerc Sport Sci Rev 2018; 46:247-253. [PMID: 30001273 DOI: 10.1249/jes.0000000000000159] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Skeletal muscle has the dynamic capability to modulate protein turnover in response to anabolic stimuli, such as feeding and contraction. We propose that anabolic resistance, the suppressed ability to induce protein synthesis, is central to cancer-induced muscle wasting. Furthermore, we propose that resistance exercise training has the potential to attenuate or treat cancer-induced anabolic resistance through improvements in oxidative metabolism.
Collapse
Affiliation(s)
| | | | | | - James A Carson
- Department of Exercise Science and.,Center for Colon Cancer Research, University of South Carolina, Columbia, SC
| |
Collapse
|
41
|
Lin J, Zhang W, Huang Y, Chen W, Wu R, Chen X, Lou N, Wang P. Sarcopenia is associated with the neutrophil/lymphocyte and platelet/lymphocyte ratios in operable gastric cancer patients: a prospective study. Cancer Manag Res 2018; 10:4935-4944. [PMID: 30464594 PMCID: PMC6208548 DOI: 10.2147/cmar.s175421] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Sarcopenia is distinguished by decreased skeletal muscle plus low muscle strength and/or physical performance. This study was designed to demonstrate the relationship between sarcopenia and systemic inflammatory response (neutrophil/lymphocyte ratio [NLR], platelet/lymphocyte ratio [PLR], and large platelet/lymphocyte ratio [LPLR]) prior to radical gastrectomy for gastric cancer. Patients and methods We conducted a prospective study of gastric cancer patients who underwent radical gastrectomy. The clinical utility of the NLR, PLR, and LPLR was evaluated by receiver operating characteristic curves. Sarcopenia components including skeletal muscle index, handgrip strength, and 6 m usual gait speed were measured. Logistic analysis was used to identify the independent indices associated with sarcopenia. Results A total of 670 patients were included, representing 504 men and 166 women. Of these, 104 patients (15.5%) were diagnosed with sarcopenia and 567 (84.5%) were non-sarcopenia. PLR has a diagnostic sensitivity of 91.3% for sarcopenia. In addition to the indicators of preoperative age, nutritional risk screening, body mass index, preoperative albumin, and diabetes, the NLR and PLR were independent predictors for sarcopenia (P<0.05). Conclusion The present study showed that at-diagnosis sarcopenia was associated with inflammation in patients with operable gastric cancer. Due to the complex assessment of muscle condition, PLR may be used as a primary screening test for sarcopenia. How systemic inflammatory response influences changes in sarcopenia may provide new therapeutic perception toward improving outcomes.
Collapse
Affiliation(s)
- Ji Lin
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Weiteng Zhang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Yunshi Huang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Weisheng Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Ruisen Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Xiaodong Chen
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| | - Neng Lou
- Department of General Surgery, Zhejiang University Huzhou Hospital, Huzhou, Zhejiang, China,
| | - Pengfei Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital, Wenzhou Medical University, Wenzhou, Zhejiang, China,
| |
Collapse
|
42
|
Cespedes Feliciano EM, Avrutin E, Caan BJ, Boroian A, Mourtzakis M. Screening for low muscularity in colorectal cancer patients: a valid, clinic-friendly approach that predicts mortality. J Cachexia Sarcopenia Muscle 2018; 9:898-908. [PMID: 30066490 PMCID: PMC6204585 DOI: 10.1002/jcsm.12317] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/02/2018] [Accepted: 05/22/2018] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Low skeletal muscle quantified using computed tomography (CT) scans is associated with morbidity and mortality among cancer patients. However, existing methods to assess skeletal muscle from CT are time-consuming, expensive, and require training. Clinic-friendly tools to screen for low skeletal muscle in cancer patients are urgently needed. METHODS We included 807 scans from non-metastatic colorectal cancer patients. With the digital ruler available in most radiological software, we implemented an abbreviated method to assess skeletal muscle area at the third lumbar vertebra (L3), which consisted of assessing the height and width of the psoas and paraspinal muscles and computing their combined 'linear area' in centimetres squared (cm2 ). A subset of CT scans was assessed twice by two analysts to compute intra-rater and inter-rater reliability. We derived cut-points for 'low' linear area using optimal stratification and then calculated the sensitivity and specificity of these cut-points relative to standard methods (total L3 cross-sectional area assessed with Slice-O-Matic research software). We further evaluated the association of low linear area with death from any cause after colorectal cancer diagnosis in Cox proportional hazards models adjusting for demographics, smoking, body mass index category, and tumour characteristics. RESULTS The linear area was highly correlated with total cross-sectional area assessed using standard methods [r = 0.92; 95% confidence interval (CI): 0.91, 0.93] overall and within subgroups defined by age, sex, and body mass index group. Intra-rater and inter-rater reliability were equally high (both intra-class correlations = 0.98). Cut-points for low linear area were sensitive (0.75; 95% CI: 0.70, 0.80) and specific (0.77; 95% CI: 0.73, 0.80) for identifying low skeletal muscle relative to the standard of total L3 cross-sectional area. The hazard ratio and 95% CI for death associated with a low linear area were hazard ratio = 1.66; 95% CI: 1.22, 2.25. CONCLUSIONS Clinic-friendly methods that assess linear area from CT scans are an accurate screening tool to identify low skeletal muscle among non-metastatic colorectal cancer patients. These linear measures are associated with mortality after colorectal cancer, suggesting they could be clinically useful both to improve prognostication and to provide a practical screening tool to identify cancer patients who require nutrition or exercise intervention.
Collapse
Affiliation(s)
| | - Egor Avrutin
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| | - Bette J. Caan
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Adam Boroian
- Division of ResearchKaiser Permanente Northern California200 Broadway, 5th FloorOaklandCAUSA
| | - Marina Mourtzakis
- Department of KinesiologyUniversity of Waterloo200 University Ave WWaterlooONN2L 3G1Canada
| |
Collapse
|
43
|
Fairman CM, Zourdos MC, Helms ER, Focht BC. A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology. Sports Med 2018; 47:1457-1465. [PMID: 28074412 DOI: 10.1007/s40279-017-0673-7] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies. However, despite research progression and international recognition, current exercise oncology-based exercise prescriptions remain relatively basic and underdeveloped, particularly in regards to resistance training. Recent publications have called for a more precise manipulation of training variables such as volume, intensity, and frequency (i.e., periodization), given the large heterogeneity of a cancer population, to truly optimize clinically relevant patient-reported outcomes. Indeed, increased attention to integrating fundamental principles of exercise physiology into the exercise prescription process could optimize the safety and efficacy of resistance training during cancer care. The purpose of this article is to give an overview of the current state of resistance training prescription and discuss novel methods that can contribute to improving approaches to exercise prescription. We hope this article may facilitate further evaluation of best practice regarding resistance training prescription, monitoring, and modification to ultimately optimize the efficacy of integrating resistance training as a supportive care intervention for survivors or and patients with cancer.
Collapse
Affiliation(s)
- Ciaran M Fairman
- Kinesiology, Department of Human Sciences, The Ohio State University, 305 W Anne and John Glenn Ave, Columbus, OH, 43201, USA.
| | - Michael C Zourdos
- Department of Exercise Science and Health Promotion, Muscle Physiology Laboratory, Florida Atlantic University, Boca Raton, FL, USA
| | - Eric R Helms
- Sport Performance Research Institute New Zealand (SPRINZ), Auckland University of Technology, Auckland, New Zealand
| | - Brian C Focht
- Kinesiology, Department of Human Sciences, The Ohio State University, 305 W Anne and John Glenn Ave, Columbus, OH, 43201, USA
| |
Collapse
|
44
|
Stretching Reduces Tumor Growth in a Mouse Breast Cancer Model. Sci Rep 2018; 8:7864. [PMID: 29777149 PMCID: PMC5959865 DOI: 10.1038/s41598-018-26198-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Accepted: 05/02/2018] [Indexed: 12/31/2022] Open
Abstract
There is growing interest in developing non-pharmacological treatments that could boost natural defenses against cancer and contribute to primary and secondary cancer prevention. Recent studies have shown that gentle daily stretching for 10 minutes can reduce local connective tissue inflammation and fibrosis. Because mechanical factors within the stroma can influence the tumor microenvironment, we hypothesized that stretching would reduce the growth of tumors implanted within locally stretched tissues and tested this hypothesis in a mouse orthotopic breast cancer model. Female FVB mice (N = 66) underwent bilateral injection of p53/PTEN double-null primary mouse mammary tumor cells into the third mammary fat pad. Mice were randomized to stretch vs. no stretch, and treated for 10 minutes once a day, for four weeks. Tumor volume at end-point was 52% smaller in the stretch group, compared to the no-stretch group (p < 0.001) in the absence of any other treatment. Cytotoxic immune responses were activated and levels of Specialized Pro-Resolving Mediators were elevated in the stretch group. These results suggest a link between immune exhaustion, inflammation resolution and tumor growth. Stretching is a gentle, non-pharmacological intervention that could become an important component of cancer treatment and prevention.
Collapse
|
45
|
Newton RU, Kenfield SA, Hart NH, Chan JM, Courneya KS, Catto J, Finn SP, Greenwood R, Hughes DC, Mucci L, Plymate SR, Praet SFE, Guinan EM, Van Blarigan EL, Casey O, Buzza M, Gledhill S, Zhang L, Galvão DA, Ryan CJ, Saad F. Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol. BMJ Open 2018; 8:e022899. [PMID: 29764892 PMCID: PMC5961562 DOI: 10.1136/bmjopen-2018-022899] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC). METHODS AND ANALYSIS Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation. ETHICS AND DISSEMINATION Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation. TRIAL REGISTRATION NUMBER NCT02730338.
Collapse
Affiliation(s)
- Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Stacey A Kenfield
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - June M Chan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kerry S Courneya
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - James Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Stephen P Finn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Daniel C Hughes
- Institute for Health Promotion Research, University of Texas Health, San Antonio, Texas, UK
| | - Lorelei Mucci
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen R Plymate
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Stephan F E Praet
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | | | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Mark Buzza
- Movember Foundation, Melbourne, Victoria, Australia
| | - Sam Gledhill
- Movember Foundation, Melbourne, Victoria, Australia
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Charles J Ryan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
| |
Collapse
|
46
|
Abstract
Although higher body mass index (BMI) increases the incidence of many cancers, BMI can also exhibit a null or U-shaped relationship with survival among patients with existing disease; this association of higher BMI with improved survival is termed the obesity paradox. This review discusses possible explanations for the obesity paradox, the prevalence and consequences of low muscle mass in cancer patients, and future research directions. It is unlikely that methodological biases, such as reverse causality or confounding, fully explain the obesity paradox. Rather, up to a point, higher BMI may truly be associated with longer survival in cancer patients. This is due, in part, to the limitations of BMI, which scales weight to height without delineating adipose tissue distribution or distinguishing between adipose and muscle tissue. Thus, cancer patients with higher BMIs often have higher levels of protective muscle. We assert that more precise measures of body composition are required to clarify the relationship of body size to cancer outcomes, inform clinical decision-making, and help tailor lifestyle interventions.
Collapse
Affiliation(s)
| | - Candyce H Kroenke
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA; , ,
| | - Bette J Caan
- Division of Research, Kaiser Permanente, Oakland, California 94612, USA; , ,
| |
Collapse
|
47
|
Stamatakis E, Lee IM, Bennie J, Freeston J, Hamer M, O’Donovan G, Ding D, Bauman A, Mavros Y. Does Strength-Promoting Exercise Confer Unique Health Benefits? A Pooled Analysis of Data on 11 Population Cohorts With All-Cause, Cancer, and Cardiovascular Mortality Endpoints. Am J Epidemiol 2018; 187:1102-1112. [PMID: 29099919 DOI: 10.1093/aje/kwx345] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 10/17/2017] [Indexed: 01/06/2023] Open
Abstract
Public health guidance includes recommendations to engage in strength-promoting exercise (SPE), but there is little evidence on its links with mortality. Using data from the Health Survey for England and the Scottish Health Survey from 1994-2008, we examined the associations between SPE (gym-based and own-body-weight strength activities) and all-cause, cancer, and cardiovascular disease mortality. Multivariable-adjusted Cox regression was used to examine the associations between SPE (any, low-/high-volume, and adherence to the SPE guideline (≥2 sessions/week)) and mortality. The core sample comprised 80,306 adults aged ≥30 years, corresponding to 5,763 any-cause deaths (736,463 person-years). Following exclusions for prevalent disease/events occurring in the first 24 months, participation in any SPE was favorably associated with all-cause (hazard ratio (HR) = 0.77, 95% confidence interval (CI): 0.69, 0.87) and cancer (HR = 0.69, 95% CI: 0.56, 0.86) mortality. Adhering only to the SPE guideline was associated with all-cause (HR = 0.79, 95% CI: 0.66, 0.94) and cancer (HR = 0.66, 95% CI: 0.48, 0.92) mortality; adhering only to the aerobic activity guideline (equivalent to 150 minutes/week of moderate-intensity activity) was associated with all-cause (HR = 0.84, 95% CI: 0.78, 0.90) and cardiovascular disease (HR = 0.78, 95% CI: 0.68, 0.90) mortality. Adherence to both guidelines was associated with all-cause (HR = 0.71, 95% CI: 0.57, 0.87) and cancer (HR = 0.70, 95% CI: 0.50, 0.98) mortality. Our results support promoting adherence to the strength exercise guidelines over and above the generic physical activity targets.
Collapse
Affiliation(s)
- Emmanuel Stamatakis
- Epidemiology Unit, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - I -Min Lee
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Jason Bennie
- Institute of Sport, Exercise and Active Living, Victoria University, Melbourne, Victoria, Australia
| | | | - Mark Hamer
- Research Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care and Faculty of Population Health Sciences, University College London, London, United Kingdom
- National Center for Sport and Exercise Medicine–East Midlands, Loughborough University, Loughborough, United Kingdom
| | - Gary O’Donovan
- National Center for Sport and Exercise Medicine–East Midlands, Loughborough University, Loughborough, United Kingdom
| | - Ding Ding
- Epidemiology Unit, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Adrian Bauman
- Epidemiology Unit, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- Prevention Research Collaboration, Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Yorgi Mavros
- Exercise Health and Performance Faculty Research Group, Faculty of Health Sciences, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
48
|
Newton RU. Overwhelming research and clinical evidence of exercise medicine efficacy in cancer management-translation into practice is the challenge before us. ACTA ACUST UNITED AC 2018; 25:117-118. [PMID: 29719426 DOI: 10.3747/co.25.4101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The paper “Connecting people with cancer to physical activity and exercise programs: a pathway to create accessibility and engagement” is very timely. [...]
Collapse
Affiliation(s)
- R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia
| |
Collapse
|
49
|
Kimball BC, Asiedu GB, Thompson CA. Building a Healthy Body After Cancer: Young Adult Lymphoma Survivors' Perspectives on Exercise After Cancer Treatment. J Adolesc Young Adult Oncol 2017; 7:217-229. [PMID: 29272188 DOI: 10.1089/jayao.2017.0093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE Our goals were to evaluate young adult lymphoma survivors' perceptions regarding benefits of exercise after cancer treatment, to identify barriers to exercise, and to understand the types of exercise interventions that may be useful in this patient population. METHODS Young adult lymphoma survivors were invited to participate in a survey and focus group. Questions focused on elucidating barriers to exercise as well as potential opportunities for supporting patients in adequate exercise. Focus groups were audiorecorded and transcribed, and data were coded inductively for themes and applied findings. RESULTS Eight survivors participated. Findings were categorized into five main themes: barriers to exercise, facilitators of exercise, personal responsibility for being active, interconnectedness of exercise with a healthy lifestyle, and recommendations. CONCLUSIONS Fatigue and frustration with postcancer physical limitations are major barriers to exercise for young adult survivors, whereas support from others, data tracking, and survivor-specific resources are facilitators. Interventions that incorporate fitness tracking technology, are individually tailored, and/or create a community with other young adult survivors may be successful in this population.
Collapse
Affiliation(s)
| | - Gladys B Asiedu
- 2 Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery , Health Services Research Program, Mayo Clinic, Rochester, Minnesota
| | - Carrie A Thompson
- 3 Department of Internal Medicine, Division of Hematology, Mayo Clinic , Rochester, Minnesota
| |
Collapse
|
50
|
Toohey K, Pumpa K, McKune A, Cooke J, Semple S. High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes. J Cancer Res Clin Oncol 2017; 144:1-12. [PMID: 29210001 DOI: 10.1007/s00432-017-2552-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Accepted: 11/27/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE There is an increasing body of evidence underpinning high-intensity exercise as an effective and time-efficient intervention for improving health in cancer survivors. The aim of this study was to, (1) evaluate the efficacy and (2) the safety of high-intensity exercise interventions in improving selected health outcomes in cancer survivors. METHODS Design Systematic review. Data sources Google Scholar and EBSCO, CINAHL Plus, Computers and Applied Sciences Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Web of Science and SPORTDiscuss from inception up until August 2017. Eligibility criteria Randomized controlled trials of high-intensity exercise interventions in cancer survivors (all cancer types) with health-related outcome measures. The guidelines adopted for this review were the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). RESULTS The search returned 447 articles, of which nine articles (n = 531 participants mean, age 58 ± 9.5 years) met the eligibility criteria. Exercise interventions of between 4 and 18 weeks consisting of high-intensity interval bouts of up to 4-min were compared with a continuous moderate intensity (CMIT) intervention or a control group. High-intensity exercise interventions elicited significant improvements in VO2 max, strength, body mass, body fat and hip and waist circumference compared with CMIT and/or control groups. The studies reviewed showed low risk in participating in supervised high-intensity exercise interventions. Mixed mode high-intensity interventions which included both aerobic and resistance exercises were most effective improving the aerobic fitness levels of cancer survivors by 12.45-21.35%, from baseline to post-intervention. CONCLUSION High-intensity exercise interventions improved physical and physiological health-related outcome measures such as cardiovascular fitness and strength in cancer survivors. Given that high-intensity exercise sessions require a shorter time commitment, it may be a useful modality to improve health outcomes in those who are time poor. The risk of adverse events associated with high-intensity exercise was low.
Collapse
Affiliation(s)
- Kellie Toohey
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Bruce, Canberra, ACT, 2617, Australia. .,Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia. .,Health Research Institute, University of Canberra, Canberra, Australia.
| | - Kate Pumpa
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Bruce, Canberra, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Andrew McKune
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Bruce, Canberra, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia.,Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Julie Cooke
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Bruce, Canberra, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | - Stuart Semple
- Discipline of Sport and Exercise Science, Faculty of Health, University of Canberra, University Drive, Bruce, Canberra, ACT, 2617, Australia.,Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia.,Health Research Institute, University of Canberra, Canberra, Australia
| |
Collapse
|