1
|
Chacon-Barba JC, Moral-Munoz JA, De Miguel-Rubio A, Lucena-Anton D. Effects of Resistance Training on Spasticity in People with Stroke: A Systematic Review. Brain Sci 2024; 14:57. [PMID: 38248272 PMCID: PMC10813883 DOI: 10.3390/brainsci14010057] [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: 12/18/2023] [Revised: 01/02/2024] [Accepted: 01/04/2024] [Indexed: 01/23/2024] Open
Abstract
Resistance training induces neuromuscular adaptations and its impact on spasticity remains inadequately researched. This systematic review (PROSPERO: CRD42022322164) aimed to analyze the effects of resistance training, compared with no treatment, conventional therapy, or other therapies, in people with stroke-related spasticity. A comprehensive search was conducted up to October 2023 in PubMed, PEDro, Cochrane, Web of Science, and Scopus databases. Selection criteria were randomized controlled trials involving participants with stroke-related spasticity intervened with resistance training. The PEDro scale was used to evaluate the methodological quality. From a total of 274 articles, 23 full-text articles were assessed for eligibility and nine articles were included in the systematic review, involving 225 participants (155 males, 70 females; mean age: 59.4 years). Benefits were found to spasticity after resistance training. Furthermore, studies measuring spasticity also reported benefits to function, strength, gait, and balance. In conclusion, resistance training was superior to, or at least equal to, conventional therapy, other therapies, or no intervention for improving spasticity, as well as function, strength, gait, and balance. However, the results should be taken with caution because of the heterogeneity of the protocols used. Further research is needed to explore the effects of resistance training programs on people with stroke.
Collapse
Affiliation(s)
- Juan Carlos Chacon-Barba
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
| | - Jose A. Moral-Munoz
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cadiz, Spain
| | - Amaranta De Miguel-Rubio
- Department of Nursing, Pharmacology and Physiotherapy, University of Cordoba, 14004 Cordoba, Spain;
| | - David Lucena-Anton
- Department of Nursing and Physiotherapy, University of Cádiz, 11009 Cadiz, Spain; (J.C.C.-B.); (D.L.-A.)
- Biomedical Research and Innovation Institute of Cadiz (INiBICA), 11009 Cadiz, Spain
| |
Collapse
|
2
|
Dovey Z, Horowitz A, Waingankar N. The influence of lifestyle changes (diet, exercise and stress reduction) on prostate cancer tumour biology and patient outcomes: A systematic review. BJUI COMPASS 2023; 4:385-416. [PMID: 37334023 PMCID: PMC10268595 DOI: 10.1002/bco2.237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 03/05/2023] [Indexed: 06/20/2023] Open
Abstract
Background The mostly indolent natural history of prostate cancer (PCa) provides an opportunity for men to explore the benefits of lifestyle interventions. Current evidence suggests appropriate changes in lifestyle including diet, physical activity (PA) and stress reduction with or without dietary supplements may improve both disease outcomes and patient's mental health. Objective This article aims to review the current evidence on the benefits of all lifestyle programmes for PCa patients including those aimed at reducing obesity and stress, explore their affect on tumour biology and highlight any biomarkers that have clinical utility. Evidence acquisition Evidence was obtained from PubMed and Web of Science using keywords for each section on the affects of lifestyle interventions on (a) mental health, (b) disease outcomes and (c) biomarkers in PCa patients. PRISMA guidelines were used to gather the evidence for these three sections (15, 44 and 16 publications, respectively). Evidence synthesis For lifestyle studies focused on mental health, 10/15 demonstrated a positive influence, although for those programmes focused on PA it was 7/8. Similarly for oncological outcomes, 26/44 studies demonstrated a positive influence, although when PA was included or the primary focus, it was 11/13. Complete blood count (CBC)-derived inflammatory biomarkers show promise, as do inflammatory cytokines; however, a deeper understanding of their molecular biology in relation to PCa oncogenesis is required (16 studies reviewed). Conclusions Making PCa-specific recommendations on lifestyle interventions is difficult on the current evidence. Nevertheless, notwithstanding the heterogeneity of patient populations and interventions, the evidence that dietary changes and PA may improve both mental health and oncological outcomes is compelling, especially for moderate to vigorous PA. The results for dietary supplements are inconsistent, and although some biomarkers show promise, significantly more research is required before they have clinical utility.
Collapse
Affiliation(s)
- Zach Dovey
- Mount Sinai Health System, Department of UrologyIcahn Medical SchoolNew YorkNew YorkUSA
| | - Amir Horowitz
- Icahn School of MedicineThe Mount Sinai HospitalNew YorkNew YorkUSA
| | | |
Collapse
|
3
|
Hanson ED, Sakkal S, Bates-Fraser LC, Que S, Cho E, Spielmann G, Kadife E, Violet JA, Battaglini CL, Stoner L, Bartlett DB, McConell GK, Hayes A. Acute exercise induces distinct quantitative and phenotypical T cell profiles in men with prostate cancer. Front Sports Act Living 2023; 5:1173377. [PMID: 37325799 PMCID: PMC10266416 DOI: 10.3389/fspor.2023.1173377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023] Open
Abstract
Background Reduced testosterone levels can influence immune system function, particularly T cells. Exercise during cancer reduces treatment-related side effects and provide a stimulus to mobilize and redistribute immune cells. However, it is unclear how conventional and unconventional T cells (UTC) respond to acute exercise in prostate cancer survivors compared to healthy controls. Methods Age-matched prostate cancer survivors on androgen deprivation therapy (ADT) and those without ADT (PCa) along with non-cancer controls (CON) completed ∼45 min of intermittent cycling with 3 min at 60% of peak power interspersed by 1.5 min of rest. Fresh, unstimulated immune cell populations and intracellular perforin were assessed before (baseline), immediately following (0 h), 2 h, and 24 h post-exercise. Results At 0 h, conventional T cell counts increased by 45%-64% with no differences between groups. T cell frequency decreased by -3.5% for CD3+ and -4.5% for CD4+ cells relative to base at 0 h with CD8+ cells experiencing a delayed decrease of -4.5% at 2 h with no group differences. Compared to CON, the frequency of CD8+CD57+ cells was -18.1% lower in ADT. Despite a potential decrease in maturity, ADT increased CD8+perforin+ GMFI. CD3+Vα7.2+CD161+ counts, but not frequencies, increased by 69% post-exercise while CD3+CD56+ cell counts increased by 127% and were preferentially mobilized (+1.7%) immediately following the acute cycling bout. There were no UTC group differences. Cell counts and frequencies returned to baseline by 24 h. Conclusion Following acute exercise, prostate cancer survivors demonstrate normal T cell and UTC responses that were comparable to CON. Independent of exercise, ADT is associated with lower CD8+ cell maturity (CD57) and perforin frequency that suggests a less mature phenotype. However, higher perforin GMFI may attenuate these changes, with the functional implications of this yet to be determined.
Collapse
Affiliation(s)
- Erik D. Hanson
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, United States
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Samy Sakkal
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Lauren C. Bates-Fraser
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, United States
| | - Shadney Que
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Eunhan Cho
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, United States
| | - Guillaume Spielmann
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, United States
| | - Elif Kadife
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - John A. Violet
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Claudio L. Battaglini
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, United States
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, United States
| | - Lee Stoner
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, United States
- Human Movement Science Curriculum, University of North Carolina, Chapel Hill, NC, United States
| | - David B. Bartlett
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Glenn K. McConell
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, VIC, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, VIC, Australia
- Department of Medicine—Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
4
|
Jongerius C, Vermeulen L, van Egmond M, Evers AWM, Buffart LM, Lenos KJ. Behavioral factors to modulate immunotherapy efficacy in cancer. Front Immunol 2022; 13:1066359. [PMID: 36591246 PMCID: PMC9800824 DOI: 10.3389/fimmu.2022.1066359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
Immune checkpoint inhibitors, including anti-PD-1 and anti-CTLA-4 therapies, are used to (re)activate the immune system to treat cancer. Despite promising results, a large group of patients does not respond to checkpoint inhibition. In the vulnerability-stress model of behavioral medicine, behavioral factors, such as stress, exercise and classical pharmacological conditioning, predict cancer incidence, recurrence and the efficacy of conventional cancer treatments. Given the important role of the immune system in these processes, certain behavior may be promising to complement immune checkpoint inhibition therapy. Here, we discuss the preliminary evidence and suitability of three behavioral mechanisms, i.e. stress modulation, exercise and classical pharmacological conditioning for the benefit of immunotherapy. It is crucial to study the potential beneficial effects of behavioral strategies that support immunotherapeutic anti-tumor effects with rigorous experimental evidence, to exploit behavioral mechanisms in improving checkpoint inhibition efficacy.
Collapse
Affiliation(s)
- C. Jongerius
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands,*Correspondence: C. Jongerius,
| | - L. Vermeulen
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands
| | - M. van Egmond
- Department of Molecular Cell Biology & Immunology, Amsterdam UMC, Location VU University, Amsterdam, Netherlands,Department of Surgery, Amsterdam UMC, Location VU University, Amsterdam, Netherlands
| | - A. W. M. Evers
- Department of Health, Medical and Neuropsychology, Leiden University, Leiden, Netherlands
| | - L. M. Buffart
- Department of Physiology, Radboudumc, Nijmegen, Netherlands
| | - K. J. Lenos
- Laboratory for Experimental Oncology and Radiobiology, Center for Experimental and Molecular Medicine, Amsterdam University Medical Centers location University of Amsterdam, Amsterdam, Netherlands,Cancer Center Amsterdam, Cancer Biology and Immunology, Amsterdam, Netherlands,Oncode Institute, Amsterdam, Netherlands
| |
Collapse
|
5
|
A Brief Overview of the Effects of Exercise and Red Beets on the Immune System in Patients with Prostate Cancer. SUSTAINABILITY 2022. [DOI: 10.3390/su14116492] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Research over the past few decades has focused on the use of functional ingredients such as an active lifestyle and proper diet as a treatment for many diseases in the world. Recent studies have shown a variety of health benefits for red beets and their active ingredients such as antioxidant, anti-inflammatory, anti-cancer, blood pressure and fat reduction, anti-diabetic, and anti-obesity effects. This review article examines the effects of exercise and red beet consumption and the effective mechanisms of these two interventions on cellular and molecular pathways in prostate cancer. However, there is a significant relationship between an active lifestyle and proper diet with the incidence of cancer, and the use of these natural interventions for cancer patients in the treatment protocol of avoidance patients. Furthermore, this review article attempts to examine the role and effect of exercise and beetroot nutrition on prostate cancer and provide evidence of the appropriate effects of using natural interventions to prevent, reduce, and even treat cancer in stages. In addition, we examine the molecular mechanisms of the effectiveness of exercise and beetroot consumption. Finally, the use of natural interventions such as exercising and eating beets due to their antioxidant, anti-inflammatory, and anti-cancer properties, due to the lack or low level of side effects, can be considered an important intervention for the prevention and treatment of cancer.
Collapse
|
6
|
Papadopetraki A, Maridaki M, Zagouri F, Dimopoulos MA, Koutsilieris M, Philippou A. Physical Exercise Restrains Cancer Progression through Muscle-Derived Factors. Cancers (Basel) 2022; 14:cancers14081892. [PMID: 35454797 PMCID: PMC9024747 DOI: 10.3390/cancers14081892] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/02/2022] [Accepted: 04/07/2022] [Indexed: 02/06/2023] Open
Abstract
Simple Summary The benefits of physical exercise against cancer onset and progression, as well as the adverse effects of physical inactivity have changed the way that we utilize exercise for cancer patients. Nevertheless, although guidelines of various scientific societies and organizations propose exercise as a complementary intervention during cancer therapies, the exact cellular and molecular mechanisms by which exercise acts against cancer have not yet been elucidated. In the present review, we analyze the factors which either are secreted from skeletal muscle or are regulated by exercise and can restrain cancer evolution. We also describe the exercise-induced factors that counteract severe side effects of cancer treatment, as well as the ways that muscle-derived factors are delivered to the target cells. Abstract A growing body of in vitro and in vivo studies suggests that physical activity offers important benefits against cancer, in terms of both prevention and treatment. However, the exact mechanisms implicated in the anticancer effects of exercise remain to be further elucidated. Muscle-secreted factors in response to contraction have been proposed to mediate the physical exercise-induced beneficial effects and be responsible for the inter-tissue communications. Specifically, myokines and microRNAs (miRNAs) constitute the most studied components of the skeletal muscle secretome that appear to affect the malignancy, either directly by possessing antioncogenic properties, or indirectly by mobilizing the antitumor immune responses. Moreover, some of these factors are capable of mitigating serious, disease-associated adverse effects that deteriorate patients’ quality of life and prognosis. The present review summarizes the myokines and miRNAs that may have potent anticancer properties and the expression of which is induced by physical exercise, while the mechanisms of secretion and intercellular transportation of these factors are also discussed.
Collapse
Affiliation(s)
- Argyro Papadopetraki
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.P.); (M.K.)
| | - Maria Maridaki
- Faculty of Physical Education and Sport Science, National and Kapodistrian University of Athens, 17237 Dafne, Greece;
| | - Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (F.Z.); (M.-A.D.)
| | - Meletios-Athanasios Dimopoulos
- Department of Clinical Therapeutics, Alexandra Hospital, Medical School, National and Kapodistrian University of Athens, 11528 Athens, Greece; (F.Z.); (M.-A.D.)
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.P.); (M.K.)
| | - Anastassios Philippou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.P.); (M.K.)
- Correspondence: ; Tel./Fax: +30-210-7462690
| |
Collapse
|
7
|
Shao W, Zhang H, Qi H, Zhang Y. The effects of exercise on body composition of prostate cancer patients receiving androgen deprivation therapy: An update systematic review and meta-analysis. PLoS One 2022; 17:e0263918. [PMID: 35167609 PMCID: PMC8846498 DOI: 10.1371/journal.pone.0263918] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/29/2022] [Indexed: 12/24/2022] Open
Abstract
Androgen deprivation therapy is a common treatment for prostate cancer. However, this therapy is associated with various adverse effects, such as increased body fat and decreased bone mineral density. Exercise may be useful for ameliorating these adverse effects, although it is not completely effective. This review aimed to clarify how exercise interventions influenced body composition and bone mineral density and to explore the most effective exercise program among prostate cancer patients who received androgen deprivation therapy. We searched the PubMed, EMBASE, Web of Science, EBSCO, and Cochrane Library databases for reports of randomised controlled trials that were published until October 2021. All studies involved prostate cancer patients who received androgen deprivation therapy and completed aerobic exercise, resistance exercise, and/or impact exercise training. Outcomes were defined as lean body mass, body fat mass, body fat rate, regional and whole-body bone mineral density. Thirteen reports regarding 12 randomised clinical trials (715 participants) were included. Relative to the control group, exercise intervention provided a higher lean body mass (mean difference: 0.88, 95% confidence interval: 0.40 to 1.36, P<0.01), a lower body fat mass (mean difference: -0.60, 95% confidence interval: -1.10 to -0.10, P<0.05), and a lower body fat rate (mean difference: -0.93, 95% confidence interval: -1.39 to -0.47, P<0.01). Subgroup analyses revealed greater efficacy for exercise duration of ≥6 months (vs. <6 months) and exercise immediately after the therapy (vs. delayed exercise). No significant differences were observed in the bone mineral density outcomes. Exercise can help ameliorate the adverse effects of androgen deprivation therapy in body composition, with combination exercises including resistance exercise, 8–12 repetition maximum of resistance exercise intensity, prolonged exercise duration, and performing exercise immediately after therapy providing better amelioration. And the combination of resistance and impact exercise appears to be the best mode for improving the bone mineral density.
Collapse
Affiliation(s)
- Wenjuan Shao
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Hanyue Zhang
- Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
| | - Han Qi
- School of Sport Science, Beijing Sport University, Beijing, China
| | - Yimin Zhang
- Key Laboratory of the Ministry of Education of Exercise and Physical Fitness, Beijing Sport University, Beijing, China
- * E-mail:
| |
Collapse
|
8
|
KIM JINSOO, WILSON REBEKAHL, TAAFFE DENNISR, GALVÃO DANIELA, GRAY ELIN, NEWTON ROBERTU. Myokine Expression and Tumor-Suppressive Effect of Serum after 12 wk of Exercise in Prostate Cancer Patients on ADT. Med Sci Sports Exerc 2022; 54:197-205. [PMID: 34559721 PMCID: PMC8754092 DOI: 10.1249/mss.0000000000002783] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Although several mechanisms have been proposed for the tumor-suppressive effect of exercise, little attention has been given to myokines, even though skeletal muscle is heavily recruited during exercise resulting in myokine surges. We measured resting serum myokine levels before and after an exercise-based intervention and the effect of this serum on prostate cancer cell growth. METHODS Ten prostate cancer patients undertaking androgen deprivation therapy (age, 73.3 ± 5.6 yr) undertook a 12-wk exercise-based intervention including supervised resistance training, self-directed aerobic exercise, and protein supplementation. Body composition was assessed by dual-energy x-ray absorptiometry and muscle strength by the one-repetition maximum method. Fasting blood was collected at baseline and postintervention, and serum levels of myokines-secreted protein acidic and rich in cysteine, oncostatin M (OSM), decorin, insulin-like growth factor-1, and insulin-like growth factor binding protein-3 (IGFBP-3)-were measured. The growth of the prostate cancer cell line DU145 with baseline and postintervention serum was measured. RESULTS Body weight (P = 0.011), fat mass (P = 0.012), and percent body fat (P = 0.033) were reduced, whereas percent lean mass (P = 0.001) increased, as did strength (leg press, P = 0.006; chest press, P = 0.020) across the intervention. Serum OSM levels (P = 0.020) and relative serum OSM levels (P = 0.020) increased compared with baseline. A significant reduction in DU145 Cell Index (P = 0.012) and growth rate (P = 0.012) was observed after applying postintervention serum compared with baseline serum. CONCLUSIONS This study provides evidence for enhanced myokine expression and tumor-suppressive effects of serum from chronically exercise-trained prostate cancer patients on androgen deprivation therapy.
Collapse
Affiliation(s)
- JIN-SOO KIM
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - REBEKAH L. WILSON
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - DENNIS R. TAAFFE
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - DANIEL A. GALVÃO
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - ELIN GRAY
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
- Centre of Precision Health, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - ROBERT U. NEWTON
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, AUSTRALIA
| |
Collapse
|
9
|
Wang T, Zhang Y, Taaffe DR, Kim JS, Luo H, Yang L, Fairman CM, Qiao Y, Newton RU, Galvão DA. Protective effects of physical activity in colon cancer and underlying mechanisms: A review of epidemiological and biological evidence. Crit Rev Oncol Hematol 2022; 170:103578. [PMID: 35007701 DOI: 10.1016/j.critrevonc.2022.103578] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/07/2021] [Accepted: 01/05/2022] [Indexed: 12/24/2022] Open
Abstract
Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved.
Collapse
Affiliation(s)
- Tianzhen Wang
- Department of Pathology, Harbin Medical University, Harbin, 150081, China; Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ying Zhang
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia; Department of Physiology, Harbin Medical University, Harbin, 150081, China
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Jin-Soo Kim
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Hao Luo
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Lirui Yang
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Ciaran M Fairman
- Exercise Science Department, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Yuandong Qiao
- Laboratory of Medical Genetics, Harbin Medical University, Harbin, 150081, China
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| |
Collapse
|
10
|
Buss LA, Williams T, Hock B, Ang AD, Robinson BA, Currie MJ, Dachs GU. Effects of exercise and anti-PD-1 on the tumour microenvironment. Immunol Lett 2021; 239:60-71. [PMID: 34480981 DOI: 10.1016/j.imlet.2021.08.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 08/26/2021] [Indexed: 10/20/2022]
Abstract
Immune checkpoint inhibition is highly effective in treating a subset of patients with certain cancers, such as malignant melanoma. However, a large proportion of patients will experience treatment resistance, and other tumour types, such as breast cancer, have thus far proven largely refractory to immune checkpoint inhibitors as single agents. Exercise has been associated with improved cancer patient survival, has known immune-modulatory effects, may improve anti-tumour immunity and may normalise tumour blood vessels. Therefore, we hypothesised that post-implant exercise would boost the effect of concurrent immunotherapy by enhancing anti-tumour immune responses and improving tumour blood flow. To investigate this, mice with EO771 breast tumours or B16-F10 melanomas received anti-PD-1, an isotype control antibody or no treatment. Mice were randomised to exercise (voluntary wheel running) or no exercise at tumour implant. Exercise reduced the number of CD8+T cells in EO771 (p = 0.0011) but not B16-F10 tumours (p = 0.312), and reduced the percentage of CD8+T cells within the total T cell population in both tumour types (B16-F10: p = 0.0389; EO771: p = 0.0015). In contrast, the combination of exercise and anti-PD-1 increased the percentage of CD8+T cells in EO771 (p = 0.0339) but not B16-F10 tumours. Taken together, our results show that exercise and anti-PD-1 induce changes in the tumour immune microenvironment which are dependant on tumour type.
Collapse
Affiliation(s)
- Linda A Buss
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand; Christchurch Heart Institute, Department of Medicine, University of Otago, Christchurch, New Zealand.
| | - Thomas Williams
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Barry Hock
- Hematology Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Abel D Ang
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand; Present affiliation: Centre for Free Radical Research, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Bridget A Robinson
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand; Canterbury Regional Cancer and Hematology Service, Canterbury District Health Board, Christchurch, New Zealand
| | - Margaret J Currie
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| | - Gabi U Dachs
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago, Christchurch, New Zealand
| |
Collapse
|
11
|
Kim JS, Galvão DA, Newton RU, Gray E, Taaffe DR. Exercise-induced myokines and their effect on prostate cancer. Nat Rev Urol 2021; 18:519-542. [PMID: 34158658 DOI: 10.1038/s41585-021-00476-y] [Citation(s) in RCA: 48] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 02/06/2023]
Abstract
Exercise is recognized by clinicians in the field of clinical oncology for its potential role in reducing the risk of certain cancers and in reducing the risk of disease recurrence and progression; yet, the underlying mechanisms behind this reduction in risk are not fully understood. Studies applying post-exercise blood serum directly to various types of cancer cell lines provide insight that exercise might have a role in inhibiting cancer growth via altered soluble and cell-free blood contents. Myokines, which are cytokines produced by muscle and secreted into the bloodstream, might offer multiple benefits to cellular metabolism (such as a reduction in insulin resistance, improved glucose uptake and reduced adiposity), and blood myokine levels can be altered with exercise. Alterations in the levels of myokines such as IL-6, IL-15, IL-10, irisin, secreted protein acidic risk in cysteine (SPARC), myostatin, oncostatin M and decorin might exert a direct inhibitory effect on cancer growth via inhibiting proliferation, promoting apoptosis, inducing cell-cycle arrest and inhibiting the epithermal transition to mesenchymal cells. The association of insulin resistance, hyperinsulinaemia and hyperlipidaemia with obesity can create a tumour-favourable environment; exercise-induced myokines can manipulate this environment by regulating adipose tissue and adipocytes. Exercise-induced myokines also have a critical role in increasing cytotoxicity and the infiltration of immune cells into the tumour.
Collapse
Affiliation(s)
- Jin-Soo Kim
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia. .,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Elin Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| |
Collapse
|
12
|
Natural Killer Cell Mobilization in Breast and Prostate Cancer Survivors: The Implications of Altered Stress Hormones Following Acute Exercise. ENDOCRINES 2021. [DOI: 10.3390/endocrines2020012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Natural killer (NK) cells from the innate immune system are integral to overall immunity and also in managing the tumor burden during cancer. Breast (BCa) and prostate cancer (PCa) are the most common tumors in U.S. adults. Both BCa and PCa are frequently treated with hormone suppression therapies that are associated with numerous adverse effects including direct effects on the immune system. Regular exercise is recommended for cancer survivors to reduce side effects and improve quality of life. Acute exercise is a potent stimulus for NK cells in healthy individuals with current evidence indicating that NK mobilization in individuals with BCa and PCa is comparable. NK cell mobilization results from elevations in shear stress and catecholamine levels. Despite a normal NK cell response to exercise, increases in epinephrine are attenuated in BCa and PCa. The significance of this potential discrepancy still needs to be determined. However, alterations in adrenal hormone signaling are hypothesized to be due to chronic stress during cancer treatment. Additional compensatory factors induced by exercise are reviewed along with recommendations on standardized approaches to be used in exercise immunology studies involving oncology populations.
Collapse
|
13
|
Logan L, Toohey K, Kavanagh PS, Paterson C, McKune AJ. The Effect of Exercise on Body Composition and Physical Performance in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy (ADT): A Narrative Synthesis. Semin Oncol Nurs 2020; 36:151067. [PMID: 33010982 DOI: 10.1016/j.soncn.2020.151067] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This review sought to synthesize evidence examining the effect of exercise on prostate cancer patients undergoing androgen deprivation therapy (ADT). DATA SOURCES A systematic literature search was conducted in electronic databases (CINAHL, MEDLINE, APA PsychINFO, Scopus, SPORTDiscus, and Cochrane Library) from their inception to March 31, 2020. Inclusion criteria were randomized controlled trials (RCTs) testing the effect of exercise on body composition, muscle strength and physical performance. Fourteen RCTs were included. Participant numbers within the individual RCTs ranged from 19 to 163 with heterogeneity in prostate cancer stage (localized and locally advanced diagnoses) with age of participants ranging from 43 to 90 years. The length of the interventions ranged from 12 weeks to 12 months, with the number of sessions per week ranging from 2 to 5. Resistance training intensity ranged from 60% to 90% 1RM and the aerobic training ranged from 60% to 90% HRmax. CONCLUSIONS Resistance training and sport (football) in the form of small sided games (SSGs) played an important role in preserving bone mineral density and lean mass as well as improving muscle strength and physical performance outcomes in men affected by prostate cancer undergoing ADT. IMPLICATIONS FOR NURSING PRACTICE Multimodal exercise, including resistance exercise and activity that includes repeated sprints (SSGs), benefit the maintenance of bone mineral density and lean mass as well as increase strength and physical performance in men affected by prostate cancer undergoing ADT. Based on this evidence, nurses should coordinate timely referrals to qualified exercise physiologists or physiotherapist with expertise in cancer care.
Collapse
Affiliation(s)
- Lucas Logan
- Faculty of Health, University of Canberra, Canberra, Australia
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Canberra, Australia; Prehabilitation, Activity, Cancer, Exercise, Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
| | - Phillip S Kavanagh
- Faculty of Health, University of Canberra, Canberra, Australia; Justice and Society, University of South Australia, Magill SA, Australia
| | - Catherine Paterson
- Faculty of Health, University of Canberra, Canberra, Australia; Prehabilitation, Activity, Cancer, Exercise, Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia
| | - Andrew J McKune
- Faculty of Health, University of Canberra, Canberra, Australia; Prehabilitation, Activity, Cancer, Exercise, Survivorship (PACES) Research Group, University of Canberra, Canberra, Australia; Research Institute for Sport and Exercise (UCRISE), Faculty of Health, University of Canberra, Canberra ACT, Australia; Discipline of Biokinetics, Exercise and Leisure Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa.
| |
Collapse
|
14
|
Hanson ED, Sakkal S, Que S, Cho E, Spielmann G, Kadife E, Violet JA, Battaglini CL, Stoner L, Bartlett DB, McConell GK, Hayes A. Natural killer cell mobilization and egress following acute exercise in men with prostate cancer. Exp Physiol 2020; 105:1524-1539. [PMID: 32715550 DOI: 10.1113/ep088627] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 06/29/2020] [Indexed: 01/19/2023]
Abstract
NEW FINDINGS What is the central question of this study? What are the characteristics of the NK cell response following acute moderate-intensity aerobic exercise in prostate cancer survivors and is there a relationship between stress hormones and NK cell mobilization? What is the main finding and its importance? NK cell numbers and proportions changed similarly between prostate cancer survivors and controls following acute exercise. Consecutive training sessions can likely be used without adverse effects on the immune system during prostate cancer treatment. ABSTRACT Prostate cancer treatment affects multiple physiological systems, although the immune response during exercise has been minimally investigated. The objective was to characterize the natural killer (NK) cell response following acute exercise in prostate cancer survivors. Prostate cancer survivors on androgen deprivation therapy (ADT) and those without (PCa) along with non-cancer controls (CON) completed a moderate intensity cycling bout. NK cells were phenotyped before and 0, 2 and 24 h after acute exercise using flow cytometry. CD56 total NK cell frequency increased by 6.2% at 0 h (P < 0.001) and decreased by 2.5% at 2 h (P < 0.01) with similar findings in CD56dim cells. NK cell counts also exhibited a biphasic response. Independent of exercise, ADT had intracellular interferon γ (IFNγ) expression that was nearly twofold higher than CON (P < 0.01). PCa perforin expression was reduced by 11.4% (P < 0.05), suggesting these cells may be more prone to degranulation. CD57- NK cells demonstrated increased perforin and IFNγ frequencies after exercise with no change within the CD57+ populations. All NK and leukocyte populations returned to baseline by 24 h. NK cell mobilization and egress with acute exercise appear normal, as cell counts and frequencies in prostate cancer survivors change similarly to CON. However, lower perforin proportions (PCa) and higher IFNγ expression (ADT) may alter NK cytotoxicity and require further investigation. The return of NK cell proportions to resting levels overnight suggests that consecutive training sessions can be used without adverse effects on the immune system during prostate cancer treatment.
Collapse
Affiliation(s)
- Erik D Hanson
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA.,Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - Samy Sakkal
- Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - Shadney Que
- Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - Eunhan Cho
- School of Kinesiology, Louisiana State University, Baton Rouge, LA, USA
| | | | - Elif Kadife
- Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - John A Violet
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Vic, Australia
| | - Claudio L Battaglini
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - Lee Stoner
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - David B Bartlett
- Division of Medical Oncology, Duke Cancer Institute, Duke University, Durham, NC, USA
| | - Glenn K McConell
- Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia
| | - Alan Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Vic, Australia.,Australian Institute for Musculoskeletal Science (AIMSS), Victoria University, Melbourne, Vic, Australia.,Department of Medicine, Western Health, Melbourne Medical School, University of Melbourne, Melbourne, Vic, Australia
| |
Collapse
|
15
|
Effects of resistance exercise in prostate cancer patients : A systematic review update as of March 2020. Wien Klin Wochenschr 2020; 132:452-463. [PMID: 32681360 PMCID: PMC7445198 DOI: 10.1007/s00508-020-01713-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/27/2020] [Indexed: 02/08/2023]
Abstract
Purpose The aim of this systematic review is to provide an update on the effects of resistance exercise (RE) in patients with prostate cancer (PCa), with special attention to the effects on sexual health. Methods A systematic search of the literature was conducted in March 2020 using the databases PubMed, MEDLINE, EMBASE, SCOPUS and the Cochrane Library. Only randomized, controlled trials published after 31 December 2016 were included in this update. Additionally, articles from current and previous reviews were utilized to provide a brief summary of the effects on sexual health. Results A total of 10 articles met the inclusion criteria, of which 5 were identified as independent studies. The remaining five articles presented additional data for studies, which have already been included. The identified studies further strengthened the evidence for positive effects on muscle strength, body composition and physical function. Positive effects on bone mineral density were apparent only when RE was combined with impact training. One article reported an improvement in fatigue and health-related quality of life. Only one study examined the effects of RE in isolation and three articles indicated positive effects of exercise on sexual health. Conclusion Recent evidence supports the use of RE in PCa patient rehabilitation as a countermeasure for treatment side effects. Further research is necessary to ascertain the optimal delivery methods and illuminate the effects on health-related quality of life (HRQOL), fatigue and sexual health.
Collapse
|
16
|
The effects of human sera conditioned by high-intensity exercise sessions and training on the tumorigenic potential of cancer cells. Clin Transl Oncol 2020; 23:22-34. [DOI: 10.1007/s12094-020-02388-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 05/10/2020] [Indexed: 02/07/2023]
|
17
|
Suzuki K, Tominaga T, Ruhee RT, Ma S. Characterization and Modulation of Systemic Inflammatory Response to Exhaustive Exercise in Relation to Oxidative Stress. Antioxidants (Basel) 2020; 9:antiox9050401. [PMID: 32397304 PMCID: PMC7278761 DOI: 10.3390/antiox9050401] [Citation(s) in RCA: 82] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/30/2020] [Accepted: 05/06/2020] [Indexed: 12/11/2022] Open
Abstract
Exhaustive exercise induces systemic inflammatory responses, which are associated with exercise-induced tissue/organ damage, but the sources and triggers are not fully understood. Herein, the basics of inflammatory mediator cytokines and research findings on the effects of exercise on systemic inflammation are introduced. Subsequently, the association between inflammatory responses and tissue damage is examined in exercised and overloaded skeletal muscle and other internal organs. Furthermore, an overview of the interactions between oxidative stress and inflammatory mediator cytokines is provided. Particularly, the transcriptional regulation of redox signaling and pro-inflammatory cytokines is described, as the activation of the master regulatory factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is involved directly or indirectly in controlling pro-inflammatory genes and antioxidant enzymes expression, whilst nuclear factor-kappa B (NF-κB) regulates the pro-inflammatory gene expression. Additionally, preventive countermeasures against the pathogenesis along with the possibility of interventions such as direct and indirect antioxidants and anti-inflammatory agents are described. The aim of this review is to give an overview of studies on the systematic inflammatory responses to exercise, including our own group as well as others. Moreover, the challenges and future directions in understanding the role of exercise and functional foods in relation to inflammation and oxidative stress are discussed.
Collapse
Affiliation(s)
- Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa 359-1192, Japan
- Correspondence: (K.S.); (S.M.); Tel.: +81-4-2947-6898 (K.S.); +81-4-2947-6753 (S.M.)
| | - Takaki Tominaga
- Graduate School of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan; (T.T.); (R.T.R.)
| | - Ruheea Taskin Ruhee
- Graduate School of Sport Sciences, Waseda University, Tokorozawa 359-1192, Japan; (T.T.); (R.T.R.)
| | - Sihui Ma
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa 359-1192, Japan
- Correspondence: (K.S.); (S.M.); Tel.: +81-4-2947-6898 (K.S.); +81-4-2947-6753 (S.M.)
| |
Collapse
|
18
|
Cormie P, Zopf EM. Exercise medicine for the management of androgen deprivation therapy-related side effects in prostate cancer. Urol Oncol 2020; 38:62-70. [DOI: 10.1016/j.urolonc.2018.10.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 07/23/2018] [Accepted: 10/03/2018] [Indexed: 12/23/2022]
|
19
|
Daou HN. Exercise as an anti-inflammatory therapy for cancer cachexia: a focus on interleukin-6 regulation. Am J Physiol Regul Integr Comp Physiol 2020; 318:R296-R310. [DOI: 10.1152/ajpregu.00147.2019] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Cancer cachexia is a complicated disorder of extreme, progressive skeletal muscle wasting. It is directed by metabolic alterations and systemic inflammation dysregulation. Numerous studies have demonstrated that increased systemic inflammation promotes this type of cachexia and have suggested that cytokines are implicated in the skeletal muscle loss. Exercise is firmly established as an anti-inflammatory therapy that can attenuate or even reverse the process of muscle wasting in cancer cachexia. The interleukin IL-6 is generally considered to be a key player in the development of the microenvironment of malignancy; it promotes tumor growth and metastasis by acting as a bridge between chronic inflammation and cancerous tissue and it also induces skeletal muscle atrophy and protein breakdown. Paradoxically, a beneficial role for IL-6 has also been identified recently, and that is its status as a “founding member” of the myokine class of proteins. Skeletal muscle is an important source of circulating IL-6 in people who participate in exercise training. IL-6 acts as an anti-inflammatory myokine by inhibiting TNFα and improving glucose uptake through the stimulation of AMPK signaling. This review discusses the action of IL-6 in skeletal muscle tissue dysfunction and the role of IL-6 as an “exercise factor” that modulates the immune system. This review also sheds light on the main considerations related to the treatment of muscle wasting in cancer cachexia.
Collapse
|
20
|
Buss LA, Dachs GU. Effects of Exercise on the Tumour Microenvironment. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1225:31-51. [PMID: 32030646 DOI: 10.1007/978-3-030-35727-6_3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Epidemiological evidence suggests that exercise improves survival in cancer patients. However, much is still unknown regarding the mechanisms of this positive survival effect and there are indications that exercise may not be universally beneficial for cancer patients. The key to understanding in which situations exercise is beneficial may lie in understanding its influence on the tumour microenvironment (TME)-and conversely, the influence of the tumour on physical functioning. The TME consists of a vast multitude of different cell types, mechanical and chemical stressors and humoral factors. The interplay of these different components greatly influences tumour cell characteristics and, subsequently, tumour growth rate and aggression. Exercise exerts whole-body physiological effects and can directly and indirectly affect the TME. In this chapter, we first discuss the possible role of exercise capacity ('fitness') and exercise adaptability on tumour responsiveness to exercise. We summarise how exercise affects aspects of the TME such as tumour perfusion, vascularity, hypoxia (reduced oxygenation) and immunity. Additionally, we discuss the role of myokines and other circulating factors in eliciting these changes in the TME. Finally, we highlight unanswered questions and key areas for future research in exercise oncology and the TME.
Collapse
Affiliation(s)
- Linda A Buss
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand
| | - Gabi U Dachs
- Mackenzie Cancer Research Group, Department of Pathology and Biomedical Science, University of Otago Christchurch, Christchurch, New Zealand.
| |
Collapse
|
21
|
Chronic Inflammation as an Immunological Abnormality and Effectiveness of Exercise. Biomolecules 2019; 9:biom9060223. [PMID: 31181700 PMCID: PMC6628010 DOI: 10.3390/biom9060223] [Citation(s) in RCA: 144] [Impact Index Per Article: 28.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 12/12/2022] Open
Abstract
Reduced levels of physical activity in people’s daily lives cause the development of metabolic syndromes or age-related disorders. Chronic inflammation is now understood to be an underlying pathological condition in which inflammatory cells such as neutrophils and monocyte/macrophages infiltrate into fat and other tissues and accumulate when people become obese due to overeating and/or physical inactivity. Pro-inflammatory mediators such as cytokines that are secreted in excess from inflammatory cells will not only lead to the development of arteriosclerosis when they chronically affect blood vessels but also bring tissue degeneration and/or dysfunction to various organs. Chronic inflammation is also involved in sarcopenia that brings hypofunction in the elderly, dementia, osteoporosis, or cancer and negatively affects many chronic diseases and people’s healthy life expectancy. In this paper, outlines of such studies are introduced in terms of homeostatic inflammation, which occurs chronically due to the innate immune system and its abnormalities, while focusing on the efficacy of exercise from aspects of immunology and oxidative stress. The preventative effects of functional food ingredients in combination with exercise are also introduced and described. The challenges and future directions in understanding the role of exercise in the control of chronic inflammation are discussed.
Collapse
|
22
|
Galvão DA, Taaffe DR, Spry N, Cormie P, Joseph D, Chambers SK, Chee R, Peddle-McIntyre CJ, Hart NH, Baumann FT, Denham J, Baker M, Newton RU. Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases. Med Sci Sports Exerc 2018; 50:393-399. [PMID: 29036016 PMCID: PMC5828380 DOI: 10.1249/mss.0000000000001454] [Citation(s) in RCA: 119] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Purpose The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. Methods Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m−2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. Results There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4–6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6–12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). Conclusions Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain. Trial Registration: ACTRN12611001158954.
Collapse
Affiliation(s)
- Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Prue Cormie
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - David Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Freerk T Baumann
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - James Denham
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Michael Baker
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, AUSTRALIA
| |
Collapse
|
23
|
Hart NH, Galvão DA, Saunders C, Taaffe DR, Feeney KT, Spry NA, Tsoi D, Martin H, Chee R, Clay T, Redfern AD, Newton RU. Mechanical suppression of osteolytic bone metastases in advanced breast cancer patients: a randomised controlled study protocol evaluating safety, feasibility and preliminary efficacy of exercise as a targeted medicine. Trials 2018; 19:695. [PMID: 30572928 PMCID: PMC6302473 DOI: 10.1186/s13063-018-3091-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Accepted: 11/30/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Skeletal metastases present a major challenge for clinicians, representing an advanced and typically incurable stage of cancer. Bone is also the most common location for metastatic breast carcinoma, with skeletal lesions identified in over 80% of patients with advanced breast cancer. Preclinical models have demonstrated the ability of mechanical stimulation to suppress tumour formation and promote skeletal preservation at bone sites with osteolytic lesions, generating modulatory interference of tumour-driven bone remodelling. Preclinical studies have also demonstrated anti-cancer effects through exercise by minimising tumour hypoxia, normalising tumour vasculature and increasing tumoural blood perfusion. This study proposes to explore the promising role of targeted exercise to suppress tumour growth while concomitantly delivering broader health benefits in patients with advanced breast cancer with osteolytic bone metastases. METHODS This single-blinded, two-armed, randomised and controlled pilot study aims to establish the safety, feasibility and efficacy of an individually tailored, modular multi-modal exercise programme incorporating spinal isometric training (targeted muscle contraction) in 40 women with advanced breast cancer and stable osteolytic spinal metastases. Participants will be randomly assigned to exercise or usual medical care. The intervention arm will receive a 3-month clinically supervised exercise programme, which if proven to be safe and efficacious will be offered to the control-arm patients following study completion. Primary endpoints (programme feasibility, safety, tolerance and adherence) and secondary endpoints (tumour morphology, serum tumour biomarkers, bone metabolism, inflammation, anthropometry, body composition, bone pain, physical function and patient-reported outcomes) will be measured at baseline and following the intervention. DISCUSSION Exercise medicine may positively alter tumour biology through numerous mechanical and non-mechanical mechanisms. This randomised controlled pilot trial will explore the preliminary effects of targeted exercise on tumour morphology and circulating metastatic tumour biomarkers using an osteolytic skeletal metastases model in patients with breast cancer. The study is principally aimed at establishing feasibility and safety. If proven to be safe and feasible, results from this study could have important implications for the delivery of this exercise programme to patients with advanced cancer and sclerotic skeletal metastases or with skeletal lesions present in haematological cancers (such as osteolytic lesions in multiple myeloma), for which future research is recommended. TRIAL REGISTRATION anzctr.org.au , ACTRN-12616001368426 . Registered on 4 October 2016.
Collapse
Affiliation(s)
- Nicolas H. Hart
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- Institute for Health Research, University of Notre Dame Australia, Perth, WA Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Daniel A. Galvão
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
| | - Christobel Saunders
- St John of God Hospital, Perth, WA Australia
- Royal Perth Hospital, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
| | - Dennis R. Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
| | - Kynan T. Feeney
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- St John of God Hospital, Perth, WA Australia
- School of Medicine, University of Notre Dame Australia, Perth, WA Australia
| | - Nigel A. Spry
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Daphne Tsoi
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- St John of God Hospital, Perth, WA Australia
- School of Medicine, University of Notre Dame Australia, Perth, WA Australia
| | | | - Raphael Chee
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Medicine, University of Western Australia, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Tim Clay
- St John of God Hospital, Perth, WA Australia
- Genesis CancerCare, Perth, WA Australia
| | - Andrew D. Redfern
- School of Medicine, University of Western Australia, Perth, WA Australia
- Fiona Stanley Hospital, Perth, WA Australia
| | - Robert U. Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027 Australia
- School of Medical and Health Sciences, Edith Cowan University, Perth, WA Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, QLD Australia
| |
Collapse
|
24
|
Pring ET, Malietzis G, Kennedy RH, Athanasiou T, Jenkins JT. Cancer cachexia and myopenia – Update on management strategies and the direction of future research for optimizing body composition in cancer – A narrative review. Cancer Treat Rev 2018; 70:245-254. [DOI: 10.1016/j.ctrv.2018.10.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 12/13/2022]
|
25
|
Hanson ED, Sakkal S, Evans WS, Violet JA, Battaglini CL, McConell GK, Hayes A. Altered stress hormone response following acute exercise during prostate cancer treatment. Scand J Med Sci Sports 2018; 28:1925-1933. [PMID: 29668082 DOI: 10.1111/sms.13199] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2018] [Indexed: 02/06/2023]
Abstract
Exercise training reduces the side effects of cancer treatments; however, the stress hormone response to acute exercise during prostate cancer (PCa) treatment is unclear. The study purpose was to examine the effects of acute exercise on circulating cortisol, epinephrine (Epi), and norepinephrine (NE) concentrations during PCa treatment with and without androgen deprivation therapy (ADT). Men with PCa (n = 11), with PCa on ADT (n = 11), and with non-cancer controls (n = 8) had blood samples for stress hormones collected before and immediately (0 hour), 2 hours, and 24 hours after 45 minutes of intermittent cycling at 60% of peak wattage. NE increased by 385% (P < .001) at 0 hour and remained elevated at 2 hours (P < .05) with no group differences. Overall, cortisol significantly increased at 0 hour (36%, P < .012) and then significantly decreased below baseline at 2 hours (-24%, P < .001) before returning to resting levels at 24 hours. Cortisol levels during ADT were 32% lower than PCa (P = .006) with no differences vs controls. Epi increased immediately after exercise more in controls (817%, P < .001) than with ADT (700%) and PCa (333%) patients, and both cancer groups' absolute levels were attenuated relative to controls (ADT: -54%, PCa: -52%, P = .004). Compared with age-matched controls, PCa and ADT patients exhibited similar stress hormone responses with acute exercise for NE and cortisol but an attenuated EPI response that suggests altered adrenal function. Future studies should examine the physical stress of multiple exercise bouts to verify these findings and to explore the functional hormonal effects, such as immune and metabolic responses, during cancer treatment.
Collapse
Affiliation(s)
- E D Hanson
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA.,Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - S Sakkal
- Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - W S Evans
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - J A Violet
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, East Melbourne, Vic., Australia
| | - C L Battaglini
- Department of Exercise & Sport Science, University of North Carolina, Chapel Hill, NC, USA
| | - G K McConell
- Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia
| | - A Hayes
- Institute for Health and Sport, Victoria University, Melbourne, Vic., Australia.,Australian Institute for Musculoskeletal Science, Victoria University, Melbourne, Vic., Australia.,Department of Medicine - Western Health, Melbourne Medical School, The University of Melbourne, Melbourne, Vic., Australia
| |
Collapse
|
26
|
Galvão DA, Hayne D, Frydenberg M, Chambers SK, Taaffe DR, Spry N, Scuffham PA, Ware RS, Hart NH, Newton RU. Can exercise delay transition to active therapy in men with low-grade prostate cancer? A multicentre randomised controlled trial. BMJ Open 2018; 8:e022331. [PMID: 29678994 PMCID: PMC5914709 DOI: 10.1136/bmjopen-2018-022331] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Active surveillance is a strategy for managing low-risk, localised prostate cancer, where men are observed with serial prostate-specific antigen assessments to identify signs of disease progression. Currently, there are no strategies to support active surveillance compliance nor are there interventions that can prevent or slow disease progression, ultimately delaying transition to active treatment before it is clinically required. Recently, we proposed that exercise may have a therapeutic potential in delaying the need for active treatment in men on active surveillance. METHODS AND ANALYSIS A single-blinded, two arm, multicentre randomised controlled trial will be undertaken with 168 patients randomly allocated in a ratio of 1:1 to exercise or usual care. Exercise will consist of supervised resistance and aerobic exercise performed three times per week for the first 6 months in an exercise clinical setting, and during months 7-12, a progressive stepped down approach will be used with men transitioning to once a week supervised training. Thereafter, for months 13 to 36, the men will self-manage their exercise programme. The primary endpoint will be the time until the patients begin active therapy. Secondary endpoints include disease progression (prostate specific antigen), body composition and muscle density, quality of life, distress and anxiety and an economic analysis will be performed. Measurements will be undertaken at 6 and 12 months (postintervention) and at 24 and 36 months follow-up. The primary outcome (time to initiation of curative therapy) will be analysed using Cox proportional hazards regression. Outcomes measured repeatedly will be analysed using mixed effects models to examine between-group differences. Data will be analysed using an intention-to-treat approach. ETHICS AND DISSEMINATION Outcomes from the study will be published in peer-reviewed academic journals and presented in scientific, consumer and clinical meetings.
Collapse
Affiliation(s)
- Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dickon Hayne
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- UWA Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Victoria, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Queensland, Australia
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- Genesis CancerCare, Joondalup, Western Australia, Australia
- Faculty of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Queensland, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- UQ Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
27
|
Un enfoque integral para el manejo sobre la salud ósea en hombres con cáncer de próstata que reciben terapia de deprivación androgénica. Rev Urol 2017. [DOI: 10.1016/j.uroco.2017.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
28
|
Effects of resistance exercise in prostate cancer patients: a meta-analysis. Support Care Cancer 2017; 25:2953-2968. [PMID: 28600706 PMCID: PMC5527087 DOI: 10.1007/s00520-017-3771-z] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Accepted: 05/30/2017] [Indexed: 01/23/2023]
Abstract
PURPOSE The aim of the present meta-analysis was to quantify effects of resistance exercise (RE) on physical performance and function, body composition, health-related quality of life (HRQoL), and fatigue in patients with prostate cancer. METHODS Trial data were obtained from the databases PubMed, MEDLINE, EMBASE, SCOPUS, and the Cochrane Library as of inception to 31st of December 2016. Thirty-two trials with 1199 patients were included. Results that were measured by using the same assessment method in five or more of the original studies were pooled in a meta-analysis. RESULTS Pooled studies showed significant improvements of muscular strength in the upper and lower body (95% CI [2.52, 7.97] kg; p < 0.001 and 95% CI [10.51, 45.88] kg; p = 0.008, respectively) after RE. Furthermore, significant improvements were seen for body composition (body fat percentage 95% CI [-0.79, -0.53] %; p < 0.001; lean body mass 95% CI [0.15, 1.84] %; p = 0.028; trunk fat mass 95% CI [-0.73, -0.08] kg; p = 0.024). Additionally, the improvement of the 400-m walk time was significant (95% CI [-21.55, -14.65] s; p < 0.001). Concerning fatigue and HRQoL, there were not sufficient data for analysis. CONCLUSIONS RE seems to be a promising approach in order to counteract loss of muscle mass, muscle strength, and physical performance in patients suffering from prostate cancer and its treatment-related side effects. RE should play part in interdisciplinary cancer rehabilitation and care of this patient group. Nevertheless, further research should investigate RE further to determine which protocols are the most pragmatic, yet yielding best patient outcomes.
Collapse
|
29
|
Hart NH, Newton RU, Spry NA, Taaffe DR, Chambers SK, Feeney KT, Joseph DJ, Redfern AD, Ferguson T, Galvão DA. Can exercise suppress tumour growth in advanced prostate cancer patients with sclerotic bone metastases? A randomised, controlled study protocol examining feasibility, safety and efficacy. BMJ Open 2017; 7:e014458. [PMID: 28559456 PMCID: PMC5777463 DOI: 10.1136/bmjopen-2016-014458] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Exercise may positively alter tumour biology through numerous modulatory and regulatory mechanisms in response to a variety of modes and dosages, evidenced in preclinical models to date. Specifically, localised and systemic biochemical alterations produced during and following exercise may suppress tumour formation, growth and distribution by virtue of altered epigenetics and endocrine-paracrine activity. Given the impressive ability of targeted mechanical loading to interfere with metastasis-driven tumour formation in human osteolytic tumour cells, it is of equal interest to determine whether a similar effect is observed in sclerotic tumour cells. The study aims to (1) establish the feasibility and safety of a combined modular multimodal exercise programme with spinal isometric training in advanced prostate cancer patients with sclerotic bone metastases and (2) examine whether targeted and supervised exercise can suppress sclerotic tumour growth and activity in spinal metastases in humans. METHODS AND ANALYSIS A single-blinded, two-armed, randomised, controlled and explorative phase I clinical trial combining spinal isometric training with a modular multimodal exercise programme in 40 men with advanced prostate cancer and stable sclerotic spinal metastases. Participants will be randomly assigned to (1) the exercise intervention or (2) usual medical care. The intervention arm will receive a 3-month, supervised and individually tailored modular multimodal exercise programme with spinal isometric training. Primary endpoints (feasibility and safety) and secondary endpoints (tumour morphology; biomarker activity; anthropometry; musculoskeletal health; adiposity; physical function; quality of life; anxiety; distress; fatigue; insomnia; physical activity levels) will be measured at baseline and following the intervention. Statistical analyses will include descriptive characteristics, t-tests, effect sizes and two-way (group × time) repeated-measures analysis of variance (or analysis of covariance) to examine differences between groups over time. The data-set will be primarily examined using an intention-to-treat approach with multiple imputations, followed by a secondary sensitivity analysis to ensure data robustness using a complete cases approach. ETHICS AND DISSEMINATION Ethics approval was obtained from the Human Research Ethics Committee (HREC) of Edith Cowan University and the Sir Charles Gairdner and Osborne Park Health Care Group. If proven to be feasible and safe, this study will form the basis of future phase II and III trials in human patients with advanced cancer. To reach a maximum number of clinicians, practitioners, patients and scientists, outcomes will be disseminated through national and international clinical, conference and patient presentations, as well as publication in high-impact, peer-reviewed academic journals. TRIAL REGISTRATION NUMBER ACTRN 12616000179437.
Collapse
Affiliation(s)
- Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Nigel A Spry
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Kynan T Feeney
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Medical Oncology, St John of God Hospital, Perth, Australia
- School of Medicine, University of Notre Dame Australia, Perth, Australia
| | - David J Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
- Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Australia
- Department of Radiation Oncology, Genesis CancerCare, Perth, Australia
| | - Andrew D Redfern
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
- School of Medicine and Pharmacology, University of Western Australia, Perth, Australia
| | - Tom Ferguson
- Department of Medical Oncology, Fiona Stanley Hospital, Perth, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Australia
| |
Collapse
|
30
|
Wall B. Androgen-Deprivation Therapy and Cardiovascular Disease Risk - The Role of Exercise in Prostate Cancer Treatment. Front Oncol 2016; 6:200. [PMID: 27699155 PMCID: PMC5027204 DOI: 10.3389/fonc.2016.00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Accepted: 08/23/2016] [Indexed: 11/25/2022] Open
Affiliation(s)
- Bradley Wall
- School of Psychology and Exercise Science, Murdoch University , Murdoch, WA , Australia
| |
Collapse
|
31
|
Wiskemann J, Hummler S, Diepold C, Keil M, Abel U, Steindorf K, Beckhove P, Ulrich CM, Steins M, Thomas M. POSITIVE study: physical exercise program in non-operable lung cancer patients undergoing palliative treatment. BMC Cancer 2016; 16:499. [PMID: 27430336 PMCID: PMC4949758 DOI: 10.1186/s12885-016-2561-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/14/2016] [Indexed: 11/24/2022] Open
Abstract
Background Patients with advanced stage non-small cell lung cancer (NSCLC) or small cell lung cancer (SCLC) often experience multidimensional impairments, affecting quality of life during their course of disease. In lung cancer patients with operable disease, several studies have shown that exercise has a positive impact on quality of life and physical functioning. There is limited evidence regarding efficacy for advanced lung cancer patients undergoing palliative treatment. Therefore, the POSITIVE study aims to evaluate the benefit of a 24-week exercise intervention during palliative treatment in a randomized controlled setting. Methods/design The POSITIVE study is a randomized, controlled trial investigating the effects of a 24-week exercise intervention during palliative treatment on quality of life, physical performance and immune function in advanced, non-operable lung cancer patients. 250 patients will be recruited in the Clinic for Thoracic Diseases in Heidelberg, enrolment begun in November 2013. Main inclusion criterion is histologically confirmed NSCLC (stage IIIa, IIIb, IV) or SCLC (Limited Disease-SCLC, Extensive Disease-SCLC) not amenable to surgery. Patients are randomized into two groups. Both groups receive weekly care management phone calls (CMPCs) with the goal to assess symptoms and side effects. Additionally, one group receives a combined resistance and endurance training (3x/week). Primary endpoints are quality of life assessed by the Functional Assessment of Cancer Therapy for patients with lung cancer (FACT-L, subcategory Physical Well-Being) and General Fatigue measured by the Multidimensional Fatigue Inventory (MFI-20). Secondary endpoints are physical performance (maximal voluntary isometric contraction, 6-min walk distance), psychosocial (depression and anxiety) and immunological parameters and overall survival. Discussion The aim of the POSITIVE trial is the evaluation of effects of a 24-week structured and guided exercise intervention during palliative treatment stages. Analysis of various outcomes (such as quality of life, physical performance, self-efficacy, psychosocial and immunological parameters) will contribute to a better understanding of the potential of exercise in advanced lung cancer patients. In contrast to other studies with advanced oncological patients the POSITIVE trial provides weekly phone calls to support patients both in the intervention and control group and to segregate the impact of physical activity on quality of life. Trial registration ClinicalTrials.gov NCT02055508 (Date: December 12, 2013)
Collapse
Affiliation(s)
- Joachim Wiskemann
- Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and University Clinic Heidelberg, Heidelberg, Germany. .,National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany.
| | - Simone Hummler
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Clinic for Thoracic Diseases, Department of Pneumology and Intensive Care Unit, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Christina Diepold
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Melanie Keil
- Immune Monitoring Unit (G808), National Center for Tumor Diseases (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany.,CCU Neuroimmunology and Brain Tumor Immunology, National Center for Tumor Diseases, (NCT) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Ulrich Abel
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Karen Steindorf
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | - Philipp Beckhove
- National Center for Tumor Diseases (NCT) and German Cancer Research Center, Heidelberg, Germany
| | | | - Martin Steins
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| | - Michael Thomas
- Clinic for Thoracic Diseases, Department of Oncology, Thoraxklinik am Universitätsklinikum, Heidelberg, Germany.,Translational Lung Research Center Heidelberg (TLRC), Member of the German Center for Lung Research (DZL), Heidelberg, Germany
| |
Collapse
|
32
|
Østergren PB, Kistorp C, Bennedbæk FN, Faber J, Sønksen J, Fode M. The use of exercise interventions to overcome adverse effects of androgen deprivation therapy. Nat Rev Urol 2016; 13:353-64. [DOI: 10.1038/nrurol.2016.67] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
|
33
|
Hanson ED, Wagoner CW, Anderson T, Battaglini CL. The Independent Effects of Strength Training in Cancer Survivors: a Systematic Review. Curr Oncol Rep 2016; 18:31. [DOI: 10.1007/s11912-016-0511-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
|
34
|
Hagstrom AD, Marshall PWM, Lonsdale C, Papalia S, Cheema BS, Toben C, Baune BT, Fiatarone Singh MA, Green S. The effect of resistance training on markers of immune function and inflammation in previously sedentary women recovering from breast cancer: a randomized controlled trial. Breast Cancer Res Treat 2016; 155:471-82. [DOI: 10.1007/s10549-016-3688-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/20/2016] [Indexed: 01/11/2023]
|
35
|
Devin JL, Bolam KA, Jenkins DG, Skinner TL. The Influence of Exercise on the Insulin-like Growth Factor Axis in Oncology: Physiological Basis, Current, and Future Perspectives. Cancer Epidemiol Biomarkers Prev 2015; 25:239-49. [PMID: 26677213 DOI: 10.1158/1055-9965.epi-15-0406] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 11/24/2015] [Indexed: 01/02/2023] Open
Abstract
Exercise and physical activity have been shown to reduce the risk of many common cancers and strongly influence tumor biology. A cause-effect mechanism explaining this relationship is dependent on cellular pathways that can influence tumor growth and are exercise responsive. The insulin-like growth factor (IGF) axis is reported to promote the development and progression of carcinomas through cellular signaling in cancerous tissues. This review summarizes the physiologic basis of the role of the IGF axis in oncology and the influence of exercise on this process. We examined the effects of exercise prescription on the IGF axis in cancer survivors by evaluating the current scope of the literature. The current research demonstrates a remarkable heterogeneity and inconsistency in the responses of the IGF axis to exercise in breast, prostate, and colorectal cancer survivors. Finally, this review presents an in-depth exploration of the physiologic basis and mechanistic underpinnings of the seemingly disparate relationship between exercise and the IGF axis in oncology. Although there is currently insufficient evidence to categorize the effects of exercise prescription on the IGF axis in cancer survivors, the inconsistency of results suggests a multifaceted relationship, the complexities of which are considered in this review.
Collapse
Affiliation(s)
- James L Devin
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia.
| | - Kate A Bolam
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia. The Swedish School of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Stockholm, Sweden
| | - David G Jenkins
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
36
|
Kim JJ, Shin YA, Suk MH. Effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy. J Exerc Nutrition Biochem 2015; 19:255-62. [PMID: 26525495 PMCID: PMC4624127 DOI: 10.5717/jenb.2015.15092812] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 09/18/2015] [Accepted: 09/28/2015] [Indexed: 11/07/2022] Open
Abstract
PURPOSE The purpose of this study was to examine the effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy. METHODS Twenty patients (age, 47.8 ± 3.12) participated in the study. Body composition (weight, body mass index, muscle weight, body fat mass, and percent body fat) and the cell counts for immune cells (white blood corpuscles, lymphocytes, helper T cells, cytotoxic T cells, natural killer cells, and natural killer T cells) were measured before and after the 12-week walking exercise program. SPSS 17.0 statistical software was used. The two-way repeated ANOVA with post hoc was used to determine the difference between time and interaction. RESULTS There were significant reductions in the weight (p < .05), BMI (p < .01), and percent body fat (p < .05) after the 12-week walking exercise program. However, the immune cell counts did not change significantly. CONCLUSION These results indicated that the 12-week walking exercise program had an effect on the balances among weight, BMI and percent body fat in patients with breast cancer.
Collapse
Affiliation(s)
- Ji Jeong Kim
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
| | - Yun A Shin
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
| | - Min Hwa Suk
- College of Sports Science, Department of exercise prescription and rehabilitation, Dankook University, Cheonan,
Republic of Korea
| |
Collapse
|
37
|
The effects of resistance exercise on physical performance and health-related quality of life in prostate cancer patients: a systematic review. Support Care Cancer 2015; 23:2479-97. [PMID: 26003426 DOI: 10.1007/s00520-015-2782-x] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 05/17/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Physical exercise has been shown to be an effective, safe, and quite inexpensive method to reduce cardiovascular and metabolic risk factors and is currently in the process of establishing its relevance for cancer specific morbidity and mortality. The aim of this systematic review was to focus on specific effects of resistance exercise (RE) in the adjuvant therapy and rehabilitation of prostate cancer patients (PCaPs) receiving or having received androgen deprivation therapy (ADT). METHODS A systematic literature search focusing on relevant and peer-reviewed studies published between 1966 and September 2014, using PubMed, EMBASE, MEDLINE, SCOPUS, and Cochrane Library databases, was conducted. RESULTS The majority of studies demonstrated RE as an effective and safe intervention to improve muscular strength and performance, fatigue and quality of life (QoL) in PCaPs, while there is inconclusive evidence concerning cardiovascular performance, body composition, blood lipids, bone mineral density (BMD), and immune response. CONCLUSION Existing evidence leads to the conclusion that RE seems to be a safe intervention in PCaPs with beneficial effects on physical performance capacity and QoL. Nevertheless, further research in this field is urgently needed to increase understanding of exercise interventions in PCaPs.
Collapse
|
38
|
Zimmer P, Baumann FT, Bloch W, Zopf EM, Schulz S, Latsch J, Schollmayer F, Shimabukuro-Vornhagen A, von Bergwelt-Baildon M, Schenk A. Impact of a half marathon on cellular immune system, pro-inflammatory cytokine levels, and recovery behavior of breast cancer patients in the aftercare compared to healthy controls. Eur J Haematol 2015; 96:152-9. [PMID: 25865148 DOI: 10.1111/ejh.12561] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/07/2015] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Exercise has beneficial effects on cancer prevention as well as on prognosis of patients with cancer. To optimize the outcomes of exercise programs, more knowledge about the underlying mechanisms is needed. This study investigates the short-term effects of a half marathon on immune cell proportions, pro-inflammatory cytokine levels, and recovery behavior of patients with breast cancer in the aftercare compared to healthy controls. METHODS Nine patients with breast cancer in the aftercare and 9 healthy age-matched controls participated in a half marathon. Blood samples were collected before, after, and 24 h after the run. Immune status was measured by flow cytometer analysis, while serum levels of the pro-inflammatory cytokines TNF-α, IL-6, and MIF were assessed using ELISA. Recovery behavior was determined using an ADL monitor. RESULTS Both groups showed a similar recovery behavior and time courses in changes of granulocytes, monocytes, lymphocytes, and cytokine serum levels. Patients revealed increased proportions of cytotoxic and memory T cells, whereas helper and naïve T cells were decreased compared to healthy controls. Naïve and memory T-cell proportions were not affected by the intervention. CONCLUSIONS Patients with breast cancer in the aftercare and healthy subjects show a similarly recovery behavior and immune response to the intervention. The detected differences in T-cell subsets need further investigation. Based on the results of the study, we hypothesize that immune cell subsets with known relevance in cancer were mobilized through the intervention. We confirm that the hypothesis of a midterm anti-inflammatory effect of exercise is also valid for patients with breast cancer in the aftercare.
Collapse
Affiliation(s)
- Philipp Zimmer
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | - Freerk T Baumann
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | - Wilhelm Bloch
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | - Eva Maria Zopf
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | - Saskia Schulz
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | - Joachim Latsch
- Institute of Cardiology and Sportsmedicine, German Sport University Cologne, Cologne, Germany
| | - Friederike Schollmayer
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| | | | - Michael von Bergwelt-Baildon
- Cologne Interventional Immunology, Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany
| | - Alexander Schenk
- Department for molecular and cellular sports medicine, German Sport University Cologne, Cologne, Germany
| |
Collapse
|
39
|
Harrington JM, Schwenke DC, Epstein DR. Exercise preferences among men with prostate cancer receiving androgen-deprivation therapy. Oncol Nurs Forum 2014; 40:E358-67. [PMID: 23989028 DOI: 10.1188/13.onf.e358-e367] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To investigate acceptability of and preferences for physical activity participation in men receiving androgen-deprivation therapy (ADT) for prostate cancer, to identify influencing clinical and demographic factors, and to determine the percentage meeting national exercise guidelines. DESIGN Cross-sectional, descriptive. SETTING Ambulatory care clinic of a large medical center. SAMPLE 135 men receiving ADT. METHODS A structured interview with a systematic procedure was used to elicit preferences for physical activity. MAIN RESEARCH VARIABLES Exercise preferences and acceptability; evidence-based exercise intervention. FINDINGS Participants expressed high levels of acceptability of and willingness to participate in aerobic (64% and 79%) and muscle-strengthening (79% and 81%) programs. Preferences were expressed for muscle-strengthening activities performed at home, either alone or in the company of a family member. Flexible, spontaneous, and self-paced programs were preferred. Significant associations were identified for distance, age, obesity, duration of ADT, and meeting American College of Sports Medicine (ACSM) and American Heart Association (AHA) guidelines. Nineteen percent of the study population met the guidelines for weekly physical activity. CONCLUSIONS High levels of expressed acceptance of and willingness to participate in physical activity programs as well as the small number of participants meeting ACSM and AHA guidelines suggest feasibility of and support the need for the development of exercise programs in this population. IMPLICATIONS FOR NURSING Incorporating patient preferences and evidence-based practice is integral to providing high-quality patient-centered care and is the foundation for appropriate intervention programs. Insight from this study will facilitate the design of programs that better reflect actual preferences of prostate cancer survivors. KNOWLEDGE TRANSLATION ADT-induced changes in body composition are believed to contribute to a reduction in insulin sensitivity and dyslipidemia that contribute to increased cardiovascular risk profile. Exercise has the potential to mitigate the harmful effects of ADT.
Collapse
Affiliation(s)
- Joanne M Harrington
- Division of Hematology/Oncology, Phoenix Veterans Affairs Health Care System, Phoenix, AZ
| | | | | |
Collapse
|
40
|
Gardner JR, Livingston PM, Fraser SF. Effects of Exercise on Treatment-Related Adverse Effects for Patients With Prostate Cancer Receiving Androgen-Deprivation Therapy: A Systematic Review. J Clin Oncol 2014; 32:335-46. [DOI: 10.1200/jco.2013.49.5523] [Citation(s) in RCA: 187] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Androgen-deprivation therapy is a commonly used treatment for men with prostate cancer; however, the adverse effects can be detrimental to patient health and quality of life. Exercise has been proposed as a strategy for ameliorating a range of these treatment-related adverse effects. We conducted a systematic review of the literature regarding the effects of exercise on treatment-related adverse effects in men receiving androgen-deprivation therapy for prostate cancer. Methods An online electronic search of the Cochrane Library, EMBASE, MEDLINE, CINAHL, SPORTDiscus, and Health Source databases was performed to identify relevant peer-reviewed articles published between January 1980 and June 2013. Eligible study designs included randomized controlled trials as well as uncontrolled trials with pre- and postintervention data. Information was extracted regarding participant and exercise intervention characteristics as well as the effects of exercise on bone health, body composition, physical performance, cardiometabolic risk, fatigue, and quality of life. Results Ten studies were included, with exercise interventions involving aerobic and/or resistance training. Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task performance, lean body mass, and fatigue, with inconsistent effects observed for adiposity. The impact of exercise on bone health, cardiometabolic risk markers, and quality of life are currently unclear. Conclusion Among patients with prostate cancer treated with androgen-deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced adverse effects. Ongoing research of high methodologic quality is required to consolidate and expand on current knowledge and to allow the development of specific evidence-based exercise prescription recommendations.
Collapse
Affiliation(s)
| | | | - Steve F. Fraser
- All authors: Deakin University, Melbourne, Victoria, Australia
| |
Collapse
|
41
|
Karvinen KH, Esposito D, Raedeke TD, Vick J, Walker PR. Effect of an exercise training intervention with resistance bands on blood cell counts during chemotherapy for lung cancer: a pilot randomized controlled trial. SPRINGERPLUS 2014; 3:15. [PMID: 24683529 PMCID: PMC3967733 DOI: 10.1186/2193-1801-3-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 01/06/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Chemotherapy for lung cancer can have a detrimental effect on white blood cell (WBC) and red blood cell (RBC) counts. Physical exercise may have a role in improving WBCs and RBCs, although few studies have examined cancer patients receiving adjuvant therapies. The purpose of this pilot trial was to examine the effects of an exercise intervention utilizing resistance bands on WBCs and RBCs in lung cancer patients receiving curative intent chemotherapy. METHODS A sample of lung cancer patients scheduled for curative intent chemotherapy was randomly assigned to the exercise intervention (EX) condition or usual care (UC) condition. The EX condition participated in a three times weekly exercise program using resistance bands for the duration of chemotherapy. RESULTS A total of 14 lung cancer patients completed the trial. EX condition participants completed 79% of planned exercise sessions. The EX condition was able to maintain WBCs over the course of the intervention compared to declines in the UC condition (p = .008; d = 1.68). There were no significant differences in change scores in RBCs. CONCLUSIONS Exercise with resistance bands may help attenuate declines in WBCs in lung cancer patients receiving curative intent chemotherapy. Larger trials are warranted to validate these findings. Ultimately these findings could be informative for the development of supportive care strategies for lung cancer patients receiving chemotherapy. TRIAL REGISTRATION Clinical Trials Registration #: NCT01130714.
Collapse
Affiliation(s)
- Kristina H Karvinen
- />School of Physical and Health Education, Nipissing University, 100 College Drive, North Bay, Ontario P1B 8 L7 Canada
| | - David Esposito
- />Department of Kinesiology, East Carolina University, Minges Coliseum, Greenville, North Carolina 27858 USA
| | - Thomas D Raedeke
- />Department of Kinesiology, East Carolina University, Minges Coliseum, Greenville, North Carolina 27858 USA
| | - Joshua Vick
- />Department of Kinesiology, East Carolina University, Minges Coliseum, Greenville, North Carolina 27858 USA
| | - Paul R Walker
- />Department of Internal Medicine, Division of Medical Oncology, Brody School of Medicine at East Carolina University, Greenville, North Carolina 27834 USA
| |
Collapse
|
42
|
Brown JC, Winters-Stone K, Lee A, Schmitz KH. Cancer, physical activity, and exercise. Compr Physiol 2013; 2:2775-809. [PMID: 23720265 DOI: 10.1002/cphy.c120005] [Citation(s) in RCA: 197] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This review examines the relationship between physical activity and cancer along the cancer continuum, and serves as a synthesis of systematic and meta-analytic reviews conducted to date. There exists a large body of epidemiologic evidence that conclude those who participate in higher levels of physical activity have a reduced likelihood of developing a variety of cancers compared to those who engage in lower levels of physical activity. Despite this observational evidence, the causal pathway underlying the association between participation in physical activity and cancer risk reduction remains unclear. Physical activity is also a useful adjunct to improve the deleterious sequelae experienced during cancer treatment. These deleterious sequelae may include fatigue, muscular weakness, deteriorated functional capacity, and many others. The benefits of physical activity during cancer treatment are similar to those experienced after treatment. Despite the growing volume of literature examining physical activity and cancer across the cancer continuum, a number of research gaps exist. There is little evidence on the safety of physical activity among all cancer survivors, as most trials have selectively recruited participants. The specific dose of exercise needed to optimize primary cancer prevention or symptom control during and after cancer treatment remains to be elucidated.
Collapse
Affiliation(s)
- Justin C Brown
- University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | | | | | | |
Collapse
|
43
|
Murphy R, Wassersug R, Dechman G. The role of exercise in managing the adverse effects of androgen deprivation therapy in men with prostate cancer. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/1743288x11y.0000000029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
44
|
Buffart LM, Ros WJG, Chinapaw MJM, Brug J, Knol DL, Korstjens I, van Weert E, Mesters I, van den Borne B, Hoekstra-Weebers JEHM, May AM. Mediators of physical exercise for improvement in cancer survivors' quality of life. Psychooncology 2013; 23:330-8. [DOI: 10.1002/pon.3428] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Revised: 08/01/2013] [Accepted: 09/12/2013] [Indexed: 11/12/2022]
Affiliation(s)
- L. M. Buffart
- Department of Epidemiology and Biostatistics; VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - W. J. G. Ros
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| | - M. J. M. Chinapaw
- Department of Public and Occupational Health; VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - J. Brug
- Department of Epidemiology and Biostatistics; VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - D. L. Knol
- Department of Epidemiology and Biostatistics; VU University Medical Center Amsterdam, EMGO Institute for Health and Care Research; Amsterdam the Netherlands
| | - I. Korstjens
- Research Department Midwifery Science, Faculty of Midwifery Education and Studies; Zuyd University; Maastricht the Netherlands
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht the Netherlands
| | - E. van Weert
- Centre for Rehabilitation; University of Groningen, University Medical Center Groningen; Groningen the Netherlands
| | - I. Mesters
- Department Epidemiology, School for Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht the Netherlands
| | - B. van den Borne
- Department of Health Promotion, School for Public Health and Primary Care (CAPHRI); Maastricht University; Maastricht the Netherlands
| | - J. E. H. M. Hoekstra-Weebers
- Comprehensive Cancer Center Netherlands; Groningen the Netherlands
- Wenckebach Institute; University of Groningen, University Medical Centre Groningen; Groningen the Netherlands
| | - A. M. May
- Julius Center for Health Sciences and Primary Care; University Medical Centre Utrecht; Utrecht the Netherlands
| |
Collapse
|
45
|
Hvid T, Winding K, Rinnov A, Dejgaard T, Thomsen C, Iversen P, Brasso K, Mikines KJ, van Hall G, Lindegaard B, Solomon TPJ, Pedersen BK. Endurance training improves insulin sensitivity and body composition in prostate cancer patients treated with androgen deprivation therapy. Endocr Relat Cancer 2013; 20:621-32. [PMID: 23744766 DOI: 10.1530/erc-12-0393] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Insulin resistance and changes in body composition are side effects of androgen deprivation therapy (ADT) given to prostate cancer patients. The present study investigated whether endurance training improves insulin sensitivity and body composition in ADT-treated prostate cancer patients. Nine men undergoing ADT for prostate cancer and ten healthy men with normal testosterone levels underwent 12 weeks of endurance training. Primary endpoints were insulin sensitivity (euglycemic-hyperinsulinemic clamps with concomitant glucose-tracer infusion) and body composition (dual-energy X-ray absorptiometry and magnetic resonance imaging). The secondary endpoint was systemic inflammation. Statistical analysis was carried out using two-way ANOVA. Endurance training increased VO2max (ml(O2)/min per kg) by 11 and 13% in the patients and controls respectively (P<0.0001). The patients and controls demonstrated an increase in peripheral tissue insulin sensitivity of 14 and 11% respectively (P<0.05), with no effect on hepatic insulin sensitivity (P=0.32). Muscle protein content of GLUT4 (SLC2A4) and total AKT (AKT1) was also increased in response to the training (P<0.05 and P<0.01 respectively). Body weight (P<0.0001) and whole-body fat mass (FM) (P<0.01) were reduced, while lean body mass (P=0.99) was unchanged. Additionally, reductions were observed in abdominal (P<0.01), subcutaneous (P<0.05), and visceral (P<0.01) FM amounts. The concentrations of plasma markers of systemic inflammation were unchanged in response to the training. No group × time interactions were observed, except for thigh intermuscular adipose tissue (IMAT) (P=0.01), reflecting a significant reduction in the amount of IMAT in the controls (P<0.05) not observed in the patients (P=0.64). In response to endurance training, ADT-treated prostate cancer patients exhibited improved insulin sensitivity and body composition to a similar degree as eugonadal men.
Collapse
Affiliation(s)
- Thine Hvid
- The Centre of Inflammation and Metabolism, Department of Infectious Diseases, Rigshospitalet, Faculty of Health Sciences, University of Copenhagen, Denmark.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Buffart LM, Galvão DA, Brug J, Chinapaw MJM, Newton RU. Evidence-based physical activity guidelines for cancer survivors: current guidelines, knowledge gaps and future research directions. Cancer Treat Rev 2013; 40:327-40. [PMID: 23871124 DOI: 10.1016/j.ctrv.2013.06.007] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Revised: 06/20/2013] [Accepted: 06/25/2013] [Indexed: 01/22/2023]
Abstract
Physical activity during and after cancer treatment has beneficial effects on a number of physical and psychosocial outcomes. This paper aims to discuss the existing physical activity guidelines for cancer survivors and to describe future research directions to optimize prescriptions. Studies on physical activity during and after cancer treatment were searched in PubMed, Clinicaltrials.gov, Australian New Zealand Clinical Trials Registry, and Dutch Trial registry. Physical activity guidelines for cancer survivors suggest that physical activity should be an integral and continuous part of care for all cancer survivors. However, the development of these guidelines has been limited by the research conducted. To be able to develop more specific guidelines, future studies should focus on identifying clinical, personal, physical, psychosocial, and intervention moderators explaining 'for whom' or 'under what circumstances' interventions work. Further, more insight into the working mechanisms of exercise interventions on health outcomes in cancer survivors is needed to improve the efficacy and efficiency of interventions. Finally, existing programs should embrace interests and preferences of patients to facilitate optimal uptake of interventions. In conclusion, current physical activity guidelines for cancer survivors are generic, and research is needed to develop more personalized physical activity guidelines.
Collapse
Affiliation(s)
- L M Buffart
- EMGO Institute for Health and Care Research and the VU University Medical Center, Department of Epidemiology and Biostatistics, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands.
| | | | | | | | | |
Collapse
|
47
|
Rundqvist H, Augsten M, Strömberg A, Rullman E, Mijwel S, Kharaziha P, Panaretakis T, Gustafsson T, Östman A. Effect of acute exercise on prostate cancer cell growth. PLoS One 2013; 8:e67579. [PMID: 23861774 PMCID: PMC3702495 DOI: 10.1371/journal.pone.0067579] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 05/23/2013] [Indexed: 11/18/2022] Open
Abstract
Physical activity is associated with reduced risk of several cancers, including aggressive prostate cancer. The mechanisms mediating the effects are not yet understood; among the candidates are modifications of endogenous hormone levels. Long-term exercise is known to reduce serum levels of growth stimulating hormones. In contrast, the endocrine effects of acute endurance exercise include increased levels of mitogenic factors such as GH and IGF-1. It can be speculated that the elevation of serum growth factors may be detrimental to prostate cancer progression into malignancy. The incentive of the current study is to evaluate the effect of acute exercise serum on prostate cancer cell growth. We designed an exercise intervention where 10 male individuals performed 60 minutes of bicycle exercise at increasing intensity. Serum samples were obtained before (rest serum) and after completed exercise (exercise serum). The established prostate cancer cell line LNCaP was exposed to exercise or rest serum. Exercise serum from 9 out of 10 individuals had a growth inhibitory effect on LNCaP cells. Incubation with pooled exercise serum resulted in a 31% inhibition of LNCaP growth and pre-incubation before subcutaneous injection into SCID mice caused a delay in tumor formation. Serum analyses indicated two possible candidates for the effect; increased levels of IGFBP-1 and reduced levels of EGF. In conclusion, despite the fear of possible detrimental effects of acute exercise serum on tumor cell growth, we show that even the short-term effects seem to add to the overall beneficial influence of exercise on neoplasia.
Collapse
Affiliation(s)
- Helene Rundqvist
- Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
Chipperfield K, Fletcher J, Millar J, Brooker J, Smith R, Frydenberg M, Oh T, Burney S. Factors associated with adherence to physical activity guidelines in patients with prostate cancer. Psychooncology 2013; 22:2478-86. [PMID: 23749430 DOI: 10.1002/pon.3310] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 04/22/2013] [Accepted: 04/24/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE This study aimed to estimate the proportion of patients with prostate cancer (PCa) meeting the National Physical Activity Guidelines of Australia (NPAGA) and determine sociodemographic and medical factors associated with meeting these guidelines. Secondary aims included examining physical activity (PA) levels by treatment type and domain (leisure, work, transport and domestic) and establishing a predictive model of the likelihood that men with PCa would meet NPAGA. METHODS A questionnaire was mailed to 638 men with PCa attending for treatment at the Alfred, Cabrini or Latrobe Regional Hospitals during 2010 and 2011, with a response rate of 59%. Measures included International Physical Activity Questionnaire, Hospital Anxiety and Depression Scale, Functional Assessment of Cancer Therapy - Prostate and sociodemographic items. Inclusion criteria were English speaking men aged 40 to 80 years, who had undergone radiotherapy (RT) between 9 and 30 months prior to the survey. RESULTS Of 356 men with PCa, less than half were meeting NPAGA (41.9%). Lower education and quality of life (QoL), a higher number of comorbid conditions and symptoms of depression and anxiety were associated with decreased leisure-time PA. Patients treated with androgen deprivation therapy were significantly less active than patients treated with RT only. Logistic regression analyses indicated that the likelihood of meeting NPAGA was significantly lower with higher levels of depressive symptoms and lower levels of education. CONCLUSIONS Meeting NPAGA is associated with higher QoL and psychosocial well-being in men with PCa. These findings contribute important information for targeting PA interventions to PCa survivors.
Collapse
Affiliation(s)
- Kelly Chipperfield
- School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | | | | | | | | | | | | | | |
Collapse
|
49
|
Gould DW, Lahart I, Carmichael AR, Koutedakis Y, Metsios GS. Cancer cachexia prevention via physical exercise: molecular mechanisms. J Cachexia Sarcopenia Muscle 2013; 4:111-24. [PMID: 23239116 PMCID: PMC3684702 DOI: 10.1007/s13539-012-0096-0] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/14/2012] [Indexed: 01/09/2023] Open
Abstract
Cancer cachexia is a debilitating consequence of disease progression, characterised by the significant weight loss through the catabolism of both skeletal muscle and adipose tissue, leading to a reduced mobility and muscle function, fatigue, impaired quality of life and ultimately death occurring with 25-30 % total body weight loss. Degradation of proteins and decreased protein synthesis contributes to catabolism of skeletal muscle, while the loss of adipose tissue results mainly from enhanced lipolysis. These mechanisms appear to be at least, in part, mediated by systemic inflammation. Exercise, by virtue of its anti-inflammatory effect, is shown to be effective at counteracting the muscle catabolism by increasing protein synthesis and reducing protein degradation, thus successfully improving muscle strength, physical function and quality of life in patients with non-cancer-related cachexia. Therefore, by implementing appropriate exercise interventions upon diagnosis and at various stages of treatment, it may be possible to reverse protein degradation, while increasing protein synthesis and lean body mass, thus counteracting the wasting seen in cachexia.
Collapse
Affiliation(s)
- Douglas W Gould
- School of Sport, Performing Arts and Leisure, Department of Physical Activity, Exercise and Health, University of Wolverhampton, Walsall, West Midlands, UK,
| | | | | | | | | |
Collapse
|
50
|
Chipperfield K, Fletcher J, Millar J, Brooker J, Smith R, Frydenberg M, Burney S. Predictors of depression, anxiety and quality of life in patients with prostate cancer receiving androgen deprivation therapy. Psychooncology 2013; 22:2169-76. [DOI: 10.1002/pon.3269] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 11/07/2012] [Accepted: 01/28/2013] [Indexed: 11/10/2022]
Affiliation(s)
- Kelly Chipperfield
- School of Psychology and Psychiatry; Monash University; Melbourne Australia
| | - Jane Fletcher
- School of Psychology and Psychiatry; Monash University; Melbourne Australia
- Cabrini Monash Psycho-Oncology; Cabrini Institute; Cabrini Melbourne Australia
| | - Jeremy Millar
- William Buckland Radiotherapy Centre; The Alfred Hospital; Melbourne Australia
- Department of Epidemiology and Preventive Medicine; Monash University; Melbourne Australia
| | - Joanne Brooker
- School of Psychology and Psychiatry; Monash University; Melbourne Australia
- Cabrini Monash Psycho-Oncology; Cabrini Institute; Cabrini Melbourne Australia
| | - Robin Smith
- William Buckland Radiotherapy Centre; The Alfred Hospital; Melbourne Australia
| | - Mark Frydenberg
- Department of Surgery; Monash University; Melbourne Australia
- Department of Urology; Monash Medical Centre, Southern Health; Melbourne Australia
| | - Sue Burney
- School of Psychology and Psychiatry; Monash University; Melbourne Australia
- Cabrini Monash Psycho-Oncology; Cabrini Institute; Cabrini Melbourne Australia
| |
Collapse
|