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Tan L, Yan W, Zhang B, Zhao Z, Lipowski M, Ossowski Z. Comparative efficacy of different exercise types on inflammatory markers in women with overweight and obesity: A systematic review and network meta-analysis of randomized controlled trials. J Sci Med Sport 2024; 27:458-465. [PMID: 38584010 DOI: 10.1016/j.jsams.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 02/24/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVES This study aimed to compare and rank the effectiveness of aerobic exercise, resistance training, combined aerobic and resistance exercise, and high-intensity interval training on inflammatory marker levels in women with overweight and obesity by using network meta-analysis. DESIGN Systematic review with network meta-analysis and Grading Recommendations Assessment, Development, and Evaluation of the evidence. METHODS Literature as of April 2023 was searched from databases such as Cochrane, Embase, Pubmed, Web of Science, and EBSCO, and English-language randomized controlled trials that meet the inclusion criteria were selected. A random-effects network meta-analysis was performed within a frequentist framework. RESULTS A total of 75 articles and 4048 participants were included. Resistance training was the most recommended type of exercise to decrease C-reactive protein levels (surface under cumulative ranking = 90.1; standardized mean difference = -0.79, 95 % confidence interval: -1.17, -0.42); aerobic exercise was the most effective exercise type to reduce tumor necrosis factor-α levels (surface under cumulative ranking = 87.9; standardized mean difference = -0.79, 95 % confidence interval: -1.19, -0.39); combined aerobic and resistance exercise was the most effective type of exercise to reduce interleukin-6 levels (surface under cumulative ranking = 75.8; standardized mean difference = -0.77, 95 % confidence interval: -1.38, -0.16) and leptin levels (surface under cumulative ranking = 77.1; standardized mean difference = -0.96, 95 % confidence interval: -1.72, -0.20), and high-intensity interval training was the type of exercise that was well suited to increase adiponectin levels (surface under cumulative ranking = 87.2; standardized mean difference = 0.99, 95 % confidence interval: 0.27, 1.71). CONCLUSIONS This network meta-analysis based on randomized controlled trials confirmed that different exercise types have different efficacies on inflammation indicators among women with overweight and obesity. The findings may provide clinicians and healthcare professionals with insights into the implementation of exercise programs for women struggling with overweight and obesity.
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Affiliation(s)
- Liang Tan
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Poland; Changsha College of Commerce and Tourism, China.
| | - Weihua Yan
- School of Management, Beijing Sport University, China.
| | - Bo Zhang
- China Football College, Beijing Sport University, China.
| | - Zijian Zhao
- Physical Education Institute (Main Campus), Zhengzhou University, China.
| | - Mariusz Lipowski
- Faculty of Social and Humanities, University WSB Merito, Poland.
| | - Zbigniew Ossowski
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Poland.
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Navarro-Ibarra MJ, Saucedo-Tamayo MDS, Alemán-Mateo H, Parra-Sánchez H, Othón-Ontiveros P, Hernández J, Caire-Juvera G. Association Between Interleukin 6 and C-Reactive Protein Serum Levels and Body Composition Compartments and Components in Breast Cancer Survivors. Biol Res Nurs 2024; 26:231-239. [PMID: 37844913 DOI: 10.1177/10998004231207022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
Obesity is highly prevalent in breast cancer (BC) survivors. Adipose tissue promotes inflammation, affecting recurrence, morbidity, and quality of life. This study aimed to determine the relationship of body composition parameters with the levels of C-reactive protein (CRP) and interleukin 6 (IL-6) in female BC survivors. Additionally, we evaluated the association of log-transformed serum concentrations of CRP and IL-6 with the appendicular skeletal lean mass index (ASMI). The results showed that CRP was positively associated with body fat percentage (BFP; β adjusted = .08, 95% CI: .02-.14) in all participants, and with fat mass index (FMI; β = .24, 95% CI: .08-.40) only in premenopausal women. IL-6 was positively associated with FMI (β adjusted = .16, 95% CI: .03-.29), while ASMI decreased as CRP levels increased (β adjusted = -.30, 95% CI: -.53 to -.06). Interventions to improve body composition in BC survivors should also consider the role of inflammatory markers in changes in body composition to avoid sarcopenic obesity (SO) and the risk of BC recurrence.
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Affiliation(s)
- María Jossé Navarro-Ibarra
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
- Departamento de Nutrición, Facultad de Medicina Mexicali, Universidad Autónoma de Baja California, Mexicali, Mexico
| | | | - Heliodoro Alemán-Mateo
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | - Héctor Parra-Sánchez
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | | | - Jesús Hernández
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
| | - Graciela Caire-Juvera
- Coordinación de Nutrición, Centro de Investigación en Alimentación y Desarrollo, Hermosillo, Mexico
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Kang M, Song S, Cho HJ, Kim Z, Youn HJ, Cho J, Min JW, Kim YS, Choi SW, Lee JE. Adherence to the American Cancer Society guidelines on nutrition and physical activity for cancer survivors and biomarkers of inflammation among breast cancer survivors. Epidemiol Health 2024; 46:e2024026. [PMID: 38317529 PMCID: PMC11099571 DOI: 10.4178/epih.e2024026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 01/06/2024] [Indexed: 02/07/2024] Open
Abstract
OBJECTIVES This study investigated whether adherence to the overall lifestyle recommendations in the American Cancer Society (ACS) guidelines on nutrition and physical activity for cancer survivors was associated with inflammation in breast cancer survivors. METHODS The study included 409 women who had undergone breast cancer surgery at least 1 year before enrollment. A generalized linear model was used to estimate the least square means and 95% confidence intervals of plasma levels of inflammatory markers according to lifestyle factors defined in terms of adherence to the ACS guidelines. RESULTS Higher overall adherence scores were associated with lower levels of high-sensitivity C-reactive protein (hs-CRP) (p for trend=0.015) and higher levels of adiponectin (p for trend=0.009). Similar significant associations of hs-CRP (p for trend= 0.004) and adiponectin (p for trend=0.010) levels were observed with the score for the body mass index (BMI) component of the adherence score. A higher diet component score was associated with a higher adiponectin level (p for trend=0.020), but there was no significant association for the physical activity component score. CONCLUSIONS The present study's findings suggest that maintaining a healthy lifestyle according to the ACS guidelines was associated with beneficial effects on inflammatory marker levels, especially hs-CRP and adiponectin, among breast cancer survivors. Among the 3 components of lifestyle guidelines, the BMI component exhibited the most similar tendency to the overall adherence score in relation to inflammatory indicators. Further prospective and intervention studies are needed to investigate longitudinal associations between lifestyle factors and inflammatory markers among breast cancer survivors.
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Affiliation(s)
- Minji Kang
- Department of Food and Nutrition, Duksung Women’s University, Seoul, Korea
| | - Sihan Song
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
| | - Hyun Jeong Cho
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
- K-BIO KIURI Center, Seoul National University, Seoul, Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hyun Jo Youn
- Department of Surgery, Jeonbuk National University Medical School, Jeonju, Korea
| | - Jihyoung Cho
- Department of Surgery, Keimyung University School of Medicine, Daegu, Korea
| | - Jun Won Min
- Department of Surgery, Dankook University College of Medicine, Cheonan, Korea
| | - Yoo Seok Kim
- Department of Surgery, Chosun University College of Medicine, Gwangju, Korea
| | - Sang-Woon Choi
- Chaum Life Center, CHA University, Seoul, Korea
- Department of Nutrition, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA
| | - Jung Eun Lee
- Department of Food and Nutrition, Seoul National University, Seoul, Korea
- Research Institute of Human Ecology, Seoul National University, Seoul, Korea
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Isanejad A, Nazari S, Gharib B, Motlagh AG. Comparison of the effects of high-intensity interval and moderate-intensity continuous training on inflammatory markers, cardiorespiratory fitness, and quality of life in breast cancer patients. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:674-689. [PMID: 37423313 PMCID: PMC10658315 DOI: 10.1016/j.jshs.2023.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/14/2023] [Accepted: 05/08/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND As the effectiveness of breast cancer treatment has improved, a growing number of long-term breast cancer survivors are seeking help for unique health problems. These patients may be at increased risk of cardiovascular disease due to the side effects of treatment. The positive impact of most types of exercise has been repeatedly reported in people with cancer, but the most effective exercise approaches for maximum beneficial adaptations remain controversial. Thus, this study aimed to compare the effects of high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory indices, adipokines, metabolic markers, body composition, cardiorespiratory fitness, and quality of life in breast cancer patients during adjuvant endocrine therapy. METHODS Thirty non-metastatic breast cancer patients during adjuvant endocrine therapy who had been treated with chemotherapy and/or radiotherapy were recruited from Iran and randomized to HIIT, MICT, or control groups for a supervised exercise intervention that took place 3 times a week for 12 weeks. The training intensity was determined based on the peak oxygen uptake (VO2peak), and the volume of training was matched in HIIT and MICT based on the VO2peak. Body composition, functional capacity, cardiorespiratory fitness, metabolic indices, sex hormones, adipokines, and inflammatory markers were assessed before and after the intervention. RESULTS The VO2peak increased by 16.8% in the HIIT group in comparison to baseline values (mean difference = 3.61 mL/kg/min). HIIT significantly improved the VO2peak compared to control (mean difference = 3.609 mL/kg/min) and MICT (mean differences = 2.974 mL/kg/min) groups. Both HIIT (mean difference = 9.172 mg/dL) and MICT (mean difference = 7.879 mg/dL) interventions significantly increased high-density lipoprotein cholesterol levels compared to the control group. The analysis of covariance showed that physical well-being significantly improved in MICT compared to control group (mean difference = 3.268). HIIT significantly improved the social well-being compared to the control group (mean difference = 4.412). Emotional well-being subscale was significantly improved in both MICT (mean difference = 4.248) and HIIT (mean difference = 4.412) compared to the control group. Functional well-being scores significantly increased in HIIT group compared with control group (mean difference = 3.35) . Significant increase were also observed in total functional assessment of cancer therapy-General scores in both HIIT (mean difference = 14.204) and MICT groups (mean difference = 10.036) compared with control group. The serum level of suppressor of cytokine signaling 3 increased significantly (mean difference = 0.09 pg/mL) in the HIIT group compared to the baseline. There were no significant differences between groups for body weight, body mass index, fasting blood glucose, insulin resistance, sex hormone binding globulin, total cholesterol, low-density lipoprotein cholesterol, adipokines, interleukin-6, tumor necrosis factor-α, or interleukin-10. CONCLUSION HIIT can be used as a safe, feasible, and time-efficient intervention to improve cardiovascular fitness in breast cancer patients. Both HIIT and MICT modalities enhance quality of life. Further large-scale studies will help determine whether these promising results translate into improved clinical and oncological outcomes.
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Affiliation(s)
- Amin Isanejad
- Immunoregulation Research Center, Shahed University, Tehran 1417953836, Iran; Department of Exercise Physiology, Sport Sciences Research Institute, Tehran 1587958711, Iran.
| | - Somayeh Nazari
- Department of Physical Education and Sport Sciences, Faculty of Human Sciences, Shahed University, Tehran 1417953836, Iran
| | - Behroz Gharib
- Oncology Department, Naft Hospital, Tehran 1136774114, Iran
| | - Ali Ghanbari Motlagh
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran 1516745811, Iran
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Huang S, Zhan Y, Jeon S, Bruner DW, Miller AH, Felger JC, Wommack EC, Saba NF, Higgins KA, Irwin ML, Gary RA, Xiao C. Longitudinal associations among physical activity, inflammatory markers, and quality of life in patients with head and neck cancer. Head Neck 2023; 45:1952-1966. [PMID: 37288586 PMCID: PMC10330673 DOI: 10.1002/hed.27420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 05/16/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023] Open
Abstract
INTRODUCTION The aim of this study was to explore the associations among physical activity (PA), inflammatory markers, and quality of life (QoL) from preradiotherapy to 1-year postradiotherapy for patients with head and neck cancer (HNC). METHODS This was an observational longitudinal study. Mixed-effect models incorporating within-subject correlation were used to examine the relationship among the three key variables. RESULTS Aerobically active patients had significantly lower levels of sTNFR2 (but not other inflammatory markers) than aerobically inactive patients. Being aerobically active and lower inflammation were independently associated with better total QoL scores after adjusting covariates. The trend was similar for patients engaged in strength exercises. CONCLUSIONS Being aerobically active was associated with lower inflammation as represented by sTNFR2 but not with other inflammatory markers. Higher PA (aerobic and strength) and lower inflammation were linked to better QoL. More research is warranted to validate the association among PA, inflammation, and QoL.
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Affiliation(s)
- Shuyuan Huang
- NYU Rory Meyers College of Nursing, New York, New York, USA
| | - Yan Zhan
- Yale School of Nursing, Orange, Connecticut, USA
| | | | | | | | | | | | - Nabil F Saba
- Emory University School of Medicine, Atlanta, Georgia, USA
| | | | - Melinda L Irwin
- Yale University School of Public Health, New Haven, Connecticut, USA
| | - Rebecca A Gary
- Emory University School of Nursing, Atlanta, Georgia, USA
| | - Canhua Xiao
- Emory University School of Nursing, Atlanta, Georgia, USA
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Dong B, Qi Y, Lin L, Liu T, Wang S, Zhang Y, Yuan Y, Cheng H, Chen Q, Fang Q, Xie Z, Tian L. Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53:343–352. [PMID: 36947532 DOI: 10.2519/jospt.2023.11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.
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García-Chico C, López-Ortiz S, Peñín-Grandes S, Pinto-Fraga J, Valenzuela PL, Emanuele E, Ceci C, Graziani G, Fiuza-Luces C, Lista S, Lucia A, Santos-Lozano A. Physical Exercise and the Hallmarks of Breast Cancer: A Narrative Review. Cancers (Basel) 2023; 15:cancers15010324. [PMID: 36612320 PMCID: PMC9818971 DOI: 10.3390/cancers15010324] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 12/26/2022] [Accepted: 12/27/2022] [Indexed: 01/06/2023] Open
Abstract
Growing evidence suggests that, among the different molecular/cellular pathophysiological mechanisms associated with cancer, there are 14 hallmarks that play a major role, including: (i) sustaining proliferative signaling, (ii) evading growth suppressors, (iii) activating invasion and metastasis, (iv) enabling replicative immortality, (v) inducing angiogenesis, (vi) resisting cell death, (vii) reprogramming energy metabolism, (viii) evading immune destruction, (ix) genome instability and mutations, (x) tumor-promoting inflammation, (xi) unlocking phenotypic plasticity, (xii) nonmutational epigenetic reprogramming, (xiii) polymorphic microbiomes, and (xiv) senescent cells. These hallmarks are also associated with the development of breast cancer, which represents the most prevalent tumor type in the world. The present narrative review aims to describe, for the first time, the effects of physical activity/exercise on these hallmarks. In summary, an active lifestyle, and particularly regular physical exercise, provides beneficial effects on all major hallmarks associated with breast cancer, and might therefore help to counteract the progression of the disease or its associated burden.
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Affiliation(s)
- Celia García-Chico
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
- Correspondence:
| | - Susana López-Ortiz
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
| | - Saúl Peñín-Grandes
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
| | - José Pinto-Fraga
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
| | - Pedro L. Valenzuela
- Research Institute of the Hospital 12 de Octubre (‘Imas12’ [PaHerg Group]), 28041 Madrid, Spain
- Department of Systems Biology, University of Alcalá, 28871 Madrid, Spain
| | | | - Claudia Ceci
- Departmental Faculty of Medicine, Saint Camillus International University of Health and Medical Sciences, 00133 Rome, Italy
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Grazia Graziani
- Department of Systems Medicine, University of Rome Tor Vergata, 00133 Rome, Italy
| | - Carmen Fiuza-Luces
- Research Institute of the Hospital 12 de Octubre (‘Imas12’ [PaHerg Group]), 28041 Madrid, Spain
| | - Simone Lista
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
| | - Alejandro Lucia
- Research Institute of the Hospital 12 de Octubre (‘Imas12’ [PaHerg Group]), 28041 Madrid, Spain
- Faculty of Sport Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
| | - Alejandro Santos-Lozano
- i+HeALTH, Miguel de Cervantes European University, 27038 Valladolid, Spain
- Research Institute of the Hospital 12 de Octubre (‘Imas12’ [PaHerg Group]), 28041 Madrid, Spain
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Zhou Y, Jia N, Ding M, Yuan K. Effects of exercise on inflammatory factors and IGF system in breast cancer survivors: a meta-analysis. BMC Womens Health 2022; 22:507. [PMID: 36482346 PMCID: PMC9730577 DOI: 10.1186/s12905-022-02058-5] [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: 12/02/2021] [Accepted: 11/07/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND At present, there are multiple hypotheses regarding the mechanisms underlying the effect of exercise on the postoperative inflammatory factors and the IGF system among breast cancer patients, especially. To determine the underlying mechanisms, prevent the recurrence of breast cancer and improve its prognosis, this paper will systematically evaluate the impact of exercise on inflammatory factors and the IGF system in breast cancer survivors. METHODS The PubMed, Embase, Web of Science, CNKI, Wanfang and VIP (Chinese scientific and technical journals) databases were systematically searched until April 2021. The search terms included 'exercise', 'inflammatory factor', 'IGF system' and 'breast cancer'. A total of 1066 relevant articles were retrieved. The articles were screened according to inclusion and exclusion criteria, such as study population, intervention method and type of experiment, and 11 articles were ultimately included. All statistical results were analysed using STATA 14.0 and Rstudio 4.1.1. RESULTS We found that exercise significantly reduced the level of IGF-1 (WMD, -19.947 ng/ml; 95% CI, -22.669 to -17.225; P = 0.000). Subgroup analysis showed that in the studies with an intervention period > 12 weeks, exercise significantly reduced IL-6 levels (WMD, -0.761 pg/ml; 95% CI, -1.369 to -0.153; p = 0.014), while in the studies with an intervention period ≤ 12 weeks, exercise significantly reduced CRP (WMD, -2.381 mg/L; 95% CI, -4.835 to 0.073, P = 0.001) and IL-10 levels (WMD, -7.141 pg/ml, 95% CI, -10.853 to -3.428; P = 0.000). In addition, aerobic exercise plus resistance training significantly reduced IL-6 levels (WMD, -1.474 pg/ml; 95% CI, -1.653 to -1.296; P = 0.000). The results of the sensitivity analysis showed that after excluding the studies with high heterogeneity, exercise significantly reduced the TNF-α levels in patients with breast cancer (WMD, -1.399 pg/ml; 95% CI, -1.718 to -1.080; P = 0.000). CONCLUSION Exercise reduces the postoperative levels of IGF-1, IL-6, CRP, IL-10 and TNF-α among patients with breast cancer, which may have a significant impact on inhibiting breast cancer recurrence and improving its prognosis. Future studies should examine the effects of different durations and types of exercise to develop individualized exercise prescriptions for breast cancer patients.
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Affiliation(s)
- Yanan Zhou
- grid.410585.d0000 0001 0495 1805College of Physical Education, Shandong Normal University, Jinan, 250014 China
| | - Ningxin Jia
- grid.410585.d0000 0001 0495 1805College of Physical Education, Shandong Normal University, Jinan, 250014 China
| | - Meng Ding
- grid.410585.d0000 0001 0495 1805College of Physical Education, Shandong Normal University, Jinan, 250014 China
| | - Kai Yuan
- grid.452422.70000 0004 0604 7301Department of General Surgery, The First Affiliated Hospital of Shandong First Medical University, Jinan, 262799 Shandong China
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Friedenreich CM, Morielli AR, Lategan I, Ryder-Burbidge C, Yang L. Physical Activity and Breast Cancer Survival-Epidemiologic Evidence and Potential Biologic Mechanisms. Curr Nutr Rep 2022; 11:717-741. [PMID: 35953663 DOI: 10.1007/s13668-022-00431-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2022] [Indexed: 01/31/2023]
Abstract
PURPOSE OF REVIEW To review the biologic mechanisms that may be operative between physical activity and survival after breast cancer. RECENT FINDINGS Physical activity decreases risk of mortality from breast cancer by up to 40%. Several biologic mechanisms have been hypothesized to explain this association. Previous cohort studies and randomized trials have examined the primary mechanisms that appear to be operative, which involve a decrease in sex hormone levels, insulin resistance, and inflammation. The evidence is still inconsistent and several limitations in the existing literature exist. Understanding the biologic mechanisms involved in the association of physical activity and breast cancer survival will provide more precision to physical activity guidelines for cancer survival. To achieve this objective, future research should include direct measurements of physical activity, sedentary behaviour, and health-related fitness to provide a more comprehensive assessment of these factors and their association with biomarkers and survival after breast cancer.
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Affiliation(s)
- Christine M Friedenreich
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, 2210-2nd St SW, Calgary, AB, T2S 3C3, Canada. .,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Andria R Morielli
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, 2210-2nd St SW, Calgary, AB, T2S 3C3, Canada
| | - Irizelle Lategan
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, 2210-2nd St SW, Calgary, AB, T2S 3C3, Canada
| | - Charlotte Ryder-Burbidge
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, 2210-2nd St SW, Calgary, AB, T2S 3C3, Canada
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Cancer Care Alberta, Alberta Health Services, Holy Cross Centre, 2210-2nd St SW, Calgary, AB, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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10
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Asad S, Damicis A, Heng YJ, Kananen K, Collier KA, Adams EJ, Kensler KH, Baker GM, Wesolowski R, Sardesai S, Gatti-Mays M, Ramaswamy B, Eliassen AH, Hankinson SE, Tabung FK, Tamimi RM, Stover DG. Association of body mass index and inflammatory dietary pattern with breast cancer pathologic and genomic immunophenotype in the nurses' health study. Breast Cancer Res 2022; 24:78. [PMID: 36376974 PMCID: PMC9661734 DOI: 10.1186/s13058-022-01573-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 11/01/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast tumor immune infiltration is clearly associated with improved treatment response and outcomes in breast cancer. However, modifiable patient factors associated with breast cancer immune infiltrates are poorly understood. The Nurses' Health Study (NHS) offers a unique cohort to study immune gene expression in tumor and adjacent normal breast tissue, immune cell-specific immunohistochemistry (IHC), and patient exposures. We evaluated the association of body mass index (BMI) change since age 18, physical activity, and the empirical dietary inflammatory pattern (EDIP) score, all implicated in systemic inflammation, with immune cell-specific expression scores. METHODS This population-based, prospective observational study evaluated 882 NHS and NHSII participants diagnosed with invasive breast cancer with detailed exposure and gene expression data. Of these, 262 women (training cohort) had breast tumor IHC for four classic immune cell markers (CD8, CD4, CD20, and CD163). Four immune cell-specific scores were derived via lasso regression using 105 published immune expression signatures' association with IHC. In the remaining 620 patient evaluation cohort, we evaluated association of each immune cell-specific score as outcomes, with BMI change since age 18, physical activity, and EDIP score as predictors, using multivariable-adjusted linear regression. RESULTS Among women with paired expression/IHC data from breast tumor tissue, we identified robust correlation between novel immune cell-specific expression scores and IHC. BMI change since age 18 was positively associated with CD4+ (β = 0.16; p = 0.009), and CD163 novel immune scores (β = 0.14; p = 0.04) in multivariable analyses. In other words, for each 10 unit (kg/m2) increase in BMI, the percentage of cells positive for CD4 and CD163 increased 1.6% and 1.4%, respectively. Neither physical activity nor EDIP was significantly associated with any immune cell-specific expression score in multivariable analyses. CONCLUSIONS BMI change since age 18 was positively associated with novel CD4+ and CD163+ cell scores in breast cancer, supporting further study of the effect of modifiable factors like weight gain on the immune microenvironment.
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Affiliation(s)
- Sarah Asad
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Adrienne Damicis
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Yujing J Heng
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Kathryn Kananen
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Katharine A Collier
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Elizabeth J Adams
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
- Northwestern Feinberg School of Medicine, Chicago, IL, 60611, USA
| | - Kevin H Kensler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Gabrielle M Baker
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, 02215, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
| | - Robert Wesolowski
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Sagar Sardesai
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Margaret Gatti-Mays
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - Bhuvaneswari Ramaswamy
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Susan E Hankinson
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, 02115, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Biostatistics and Epidemiology, University of Massachusetts School of Public Health and Health Sciences, Amherst, MA, 01003, USA
| | - Fred K Tabung
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, 43210, USA
- Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Rulla M Tamimi
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
- Department of Population Health Sciences, Weill Cornell Medicine, New York, NY, 10065, USA
| | - Daniel G Stover
- Division of Medical Oncology, Stefanie Spielman Comprehensive Breast Center, Ohio State University Comprehensive Cancer Center, Biomedical Research Tower, Room 984, Columbus, OH, 43210, USA.
- Department of Biomedical Informatics, Ohio State University, Columbus, OH, 43210, USA.
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11
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Invernizzi M, Lippi L, Folli A, Turco A, Zattoni L, Maconi A, de Sire A, Fusco N. Integrating molecular biomarkers in breast cancer rehabilitation. What is the current evidence? A systematic review of randomized controlled trials. Front Mol Biosci 2022; 9:930361. [PMID: 36158576 PMCID: PMC9493088 DOI: 10.3389/fmolb.2022.930361] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background: Quality of life issues is a crucial burden in breast cancer (BC) survivors with relevant implications in terms of survivorship and health-care costs. The increasing long-term survival of these patients provides new challenges, with translational research now focusing on innovative and tailored approaches to improve their complex management. In this scenario, several emerging biomarkers have the potential to improve the clinical rehabilitative management of patients with BC. However, to date, guidelines supporting biomarker implementation in this area are still lacking. Therefore, the aim of this systematic review was to summarize the currently available biomarkers that might be potentially integrated into rehabilitation practice to promote a precision medicine approach to BC survivorship issues. Methods: On 9th March 2022, PubMed, Scopus, Web of Science, Cochrane, and PEDro were systematically searched for randomized controlled trials (RCTs) assessing rehabilitation interventions in BC patients. Molecular biomarker modifications induced by physical exercise have been assessed through the review of the study protocols and published results. The Jadad scale was used to assess the quality of the studies included. Results: Out of 2,224 records, 22 studies were included in the present systematic review. Exercise therapy showed significant results in 15 RCTs, in terms of metabolic biomarkers, including glycemic and insulin profile, and lipid profile (p ≤ 0.05). Similarly, 12 studies underlined significant effects in inflammation and immune response biomarkers, including TNF-α, IL-6, IL-10, C-reactive protein, leptin, and adiponectin (p ≤ 0.05). On the other hand, cardiac biomarkers were assessed in three studies without reporting significant differences after exercise therapy (p = NS). The quality assessment identified 19 RCTs as high-quality studies and three RCTs of low quality. Conclusion: Our findings reveal significant biochemical perturbations in key molecules induced by physical exercise in patients with BC, suggesting room for the implementation of actionable biomarkers. Future research might clarify the role of biomarkers on treatment effectiveness monitoring, to optimize rehabilitative strategies tailored to patient’s needs.
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Affiliation(s)
- Marco Invernizzi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- *Correspondence: Marco Invernizzi,
| | - Lorenzo Lippi
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Arianna Folli
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Alessio Turco
- Physical and Rehabilitative Medicine, Department of Health Sciences, University of Eastern Piedmont “A. Avogadro”, Novara, Italy
| | - Lorenzo Zattoni
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Antonio Maconi
- Dipartimento Attività Integrate Ricerca e Innovazione (DAIRI), Translational Medicine, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Alessandro de Sire
- Physical and Rehabilitative Medicine Unit, Department of Medical and Surgical Sciences, University of Catanzaro “Magna Graecia”, Catanzaro, Italy
| | - Nicola Fusco
- Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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12
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Hu C, Tang J, Gao Y, Cao R. Effects of physical exercise on body fat and laboratory biomarkers in cancer patients: a meta-analysis of 35 randomized controlled trials. Support Care Cancer 2022; 30:1-12. [PMID: 35501513 DOI: 10.1007/s00520-022-07013-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/25/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND A growing number of articles had reported the beneficial effects of physical exercise on reduced risks of cancer recurrence and mortality. However, the associations between physical exercise and laboratory biomarkers still had controversy. As we knew, this meta-analysis of randomized controlled trials (RCTs) was the first time for us to comprehensively clarify their relationships in cancer patients. METHODS We comprehensively searched the PubMed, Cochrane Central, EMBASE, Web of Science, and SportDiscus online databases to identify eligible articles, up to June 1, 2021. Pooled standardized mean differences (SMDs) with 95% confidence intervals (CIs) were utilized to clarify their associations. Sensitivity analysis was performed to assess the impact of the individual on overall and Begg's/Egger's plot was utilized to evaluate potential publication bias. RESULTS Finally, 35 randomized controlled trials (RCTs) were finally enrolled in this meta-analysis. Our results indicated that physical exercise could significantly reduce BMI (pooled SMD = -0.32 - 0.56 to -0.09)), body weight (pooled SMD = -0.31 (-0.54 to -0.08)), body fat (pooled SMD = -0.44 (-0.70 to -0.18)), waist circumference (pooled SMD = -0.50 (-0.76 to -0.23)), hip circumference (pooled SMD = -0.54 (-0.80 to -0.28)), triglyceride (pooled SMD = -0.35 (-0.69 to -0.02)), fasting insulin (pooled SMD = -0.38 (-0.54 to -0.22)), glucose (pooled SMD = -0.56 (-0.84 to -0.28)), insulin resistance (pooled SMD = -0.40 (-0.72 to -0.07)), CRP (pooled SMD = -0.97 (-1.48 to -0.46)), IGF-1 levels (pooled SMD = -0.56 (-0.83 to -0.29)) and remarkably increase IGFBP-3 levels (pooled SMD = 0.81 (0.45 to 1.17)). Further sensitivity analysis and Begg's or Egger's test suggested that our results were robust with no significant publication bias. CONCLUSIONS Our results shed light on the beneficial effects of physical exercise on cancer patients by means of BMI/weight change and various biomarkers alteration (insulin-glucose pathways or inflammatory biomarkers). Our results were anticipated for clinical application to improve cancer patients' prognosis.
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Affiliation(s)
- Chang Hu
- Guangzhou Sport University, Guangzhou, 510000, Guangdong Province, China
- Physical Education Section, Jingzhou Institute of Technology, JingZhou, 434000, Hubei Province, China
| | - Jialing Tang
- Department of Physical Education, Central South University, No.932 Lushan South Road, Changsha, 410083, Hunan Province, China.
| | - Yang Gao
- Department of Physical Education, Central South University, No.932 Lushan South Road, Changsha, 410083, Hunan Province, China
| | - Ran Cao
- College of Education and Sports Sciences, Yangtze University, Jingzhou, 434023, Hubei Province, China
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13
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Kang DW, Wilson RL, Gonzalo-Encabo P, Norris MK, Hans M, Tahbaz M, Dawson J, Nguyen D, Normann AJ, Yunker AG, Sami N, Uno H, Ligibel JA, Mittelman SD, Dieli-Conwright CM. Targeting Adiposity and Inflammation With Movement to Improve Prognosis in Breast Cancer Survivors (The AIM Trial): Rationale, Design, and Methods. Front Oncol 2022; 12:896995. [PMID: 35795051 PMCID: PMC9251632 DOI: 10.3389/fonc.2022.896995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 04/27/2022] [Indexed: 11/21/2022] Open
Abstract
Background Obesity is a significant contributor to breast cancer recurrence and mortality. A central mechanism by which obesity stimulates cancer progression is through chronic, low-grade inflammation in adipose tissue. Exercise interventions to target chronic inflammation has a potential to improve obesity- and breast cancer-related outcomes; however, no studies have investigated the roles of exercise in modulating adipose tissue inflammation in breast cancer survivors. Also, it is unclear which exercise prescription would be optimal to maximize the outcomes. Therefore, we designed a randomized controlled trial (Taking AIM at Breast Cancer: Targeting Adiposity and Inflammation with Movement to Improve Prognosis in Breast Cancer Survivors [AIM] Trial) to examine the mechanisms by which different modalities of exercise impact chronic inflammation as a biomarker of breast cancer prognosis. Methods The AIM trial is a prospective, three-armed, phase II randomized controlled trial investigating the effects of a 16-week supervised circuit aerobic and resistance exercise (CARE) program versus a traditional aerobic and resistance exercise (TARE) program and attention control (AC) on adipose tissue inflammation in breast cancer survivors. 276 patients who are diagnosed with stage 0-III breast cancer, post-treatment, sedentary, and centrally obese are randomized to one of the three groups. The CARE and TARE groups participate in thrice-weekly supervised exercise sessions for 16 weeks. The AC group are offered the CARE program after the intervention period. The primary endpoint is adipose tissue inflammation assessed by core biopsy and blood draw. The secondary and tertiary endpoints are sarcopenic obesity, physical fitness and function, and patient reported outcomes. The exploratory outcomes are long-term breast cancer outcomes. Discussion This is the first randomized controlled trial examining the effects of exercise on adipose tissue inflammation in obese, breast cancer survivors. Our findings are anticipated to contribute to a better understanding of exercise modalities and mechanisms on adipose tissue inflammation that can potentially improve breast cancer prognosis. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT03091842 identifier [NCT#03091842].
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Affiliation(s)
- Dong-Woo Kang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Rebekah L. Wilson
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Paola Gonzalo-Encabo
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Mary K. Norris
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Marybeth Hans
- Division of Breast Surgery, Brigham and Women’s Hospital, Boston, MA, United States
| | - Meghan Tahbaz
- Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Jackie Dawson
- Department of Physical Therapy, California State University, Long Beach, Long Beach, CA, United States
| | - Danny Nguyen
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Amber J. Normann
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Health Sciences, Boston University, Boston, MA, United States
| | - Alexandra G. Yunker
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States
| | - Nathalie Sami
- Department of Medicine, University of Southern California, Los Angeles, CA, United States
| | - Hajime Uno
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Jennifer A. Ligibel
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Steven D. Mittelman
- Children’s Discovery and Innovations Institute, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christina M. Dieli-Conwright
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- *Correspondence: Christina M. Dieli-Conwright,
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14
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Robbins RN, Kelleher JL, Vellanki P, O’Connor JC, Mascaro JS, Nocera JR, Serra MC. Kynurenine Metabolism as a Mechanism to Improve Fatigue and Physical Function in Postmenopausal Breast Cancer Survivors Following Resistance Training. J Funct Morphol Kinesiol 2022; 7:45. [PMID: 35736016 PMCID: PMC9225420 DOI: 10.3390/jfmk7020045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/26/2022] [Accepted: 05/30/2022] [Indexed: 11/29/2022] Open
Abstract
This pilot examines whether resistance training (RT) can induce changes in kynurenine (KYN) metabolism, which may contribute to improved physical function in breast cancer survivors (BCSs). Thirty-six BCSs (63.2 ± 1.1 years) underwent assessments of physical function and visual analog scale (100 cm) fatigue and quality of life before and after 12 weeks of RT (N = 22) or non-exercise control (CBCT©: Cognitively Based Compassion Training, N = 10). Blood was collected before and after interventions for assessment of KYN, kynurenic acid (KYNA), and peroxisome proliferator-activated receptor γ co-activator 1α (PGC-1α). At baseline, the women were moderately fatigued (mean score: 46 cm) and at risk of poor functional mobility. A group*time interaction was observed for all measures of strength with improvements (~25−35%) following RT (p’s < 0.01), but not CBCT. Time effects were observed for fatigue (−36%) and quality of life (5%) (p’s < 0.01), where both groups improved in a similar manner. A group*time interaction was observed for KYN (p = 0.02) and PGC-1α (p < 0.05), with KYN decreasing and PGC-1α increasing following RT and the opposite following CBCT. These changes resulted in KYN/KYNA decreasing 34% post-RT, but increasing 21% following CBCT. These data support RT as a therapeutic intervention to counteract the long-term side effect of fatigue and physical dysfunction in BCSs. Additionally, the results suggest that this effect may be mediated through the activation of PGC-1α leading to alterations in KYN metabolism.
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Affiliation(s)
- Ronna N. Robbins
- South Texas Veterans Health Care System, San Antonio, TX 78229, USA; (J.C.O.); (M.C.S.)
| | | | - Priyathama Vellanki
- Division of Endocrinology, Department of Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Jason C. O’Connor
- South Texas Veterans Health Care System, San Antonio, TX 78229, USA; (J.C.O.); (M.C.S.)
- Department of Pharmacology, UT Health San Antonio, San Antonio, TX 78229, USA
| | - Jennifer S. Mascaro
- Division of Preventive Medicine, Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA;
| | - Joe R. Nocera
- Atlanta VA Health Care System, Atlanta, GA 30308, USA; (J.L.K.); (J.R.N.)
- Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA 30322, USA
| | - Monica C. Serra
- South Texas Veterans Health Care System, San Antonio, TX 78229, USA; (J.C.O.); (M.C.S.)
- Division of Geriatrics, Gerontology & Palliative Medicine and the Sam & Ann Barshop Institute for Longevity & Aging, UT Health San Antonio, San Antonio, TX 78229, USA
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15
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Wilson R, Kang DW, Tahbaz M, Norris M, Uno H, Ligibel J, Guenette J, Christopher C, Dieli-Conwright C. Improving cognitive function through high-intensity interval training in breast cancer patients undergoing chemotherapy – the CLARITY Trial: Protocol for a randomized study. (Preprint). JMIR Res Protoc 2022; 12:e39740. [PMID: 37027186 PMCID: PMC10132015 DOI: 10.2196/39740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 12/23/2022] [Accepted: 12/25/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND More than 75% of patients with breast cancer treated with chemotherapy experience cognitive impairments (eg, memory and attention problems), commonly known as chemo-brain. Exercise, especially aerobic high-intensity interval training (HIIT), is associated with better cognitive function in healthy populations. However, clinical trials testing the impact of exercise interventions on chemotherapy-induced cognitive decline in patients with cancer are lacking, and the mechanisms through which exercise could improve cognitive function are unclear. OBJECTIVE The objective of the Improving Cognitive Function Through High-Intensity Interval Training in Breast Cancer Patients Undergoing Chemotherapy trial is to examine the effects of HIIT on cognitive function in patients with breast cancer undergoing chemotherapy. METHODS This 2-arm, single-center, pilot randomized controlled trial will randomize 50 patients with breast cancer undergoing chemotherapy to HIIT or attention control. The HIIT group will perform a supervised 16-week, thrice-weekly intervention, with each session including a 5-minute warm-up at 10% maximal power output (POmax), 10 sets of alternating 1-minute high-intensity (90% POmax) and 1-minute recovery (10% POmax) intervals, and a 5-minute cooldown (10% POmax). The attention control group will receive a stretching program with no exercise components and be asked to maintain their exercise levels for 16 weeks. The primary outcomes of the study are executive function and memory measured using the National Institutes of Health toolbox and resting-state connectivity and diffusion tensor imaging microstructure evaluated using magnetic resonance imaging. The secondary and tertiary outcomes include cardiorespiratory fitness, body composition, physical fitness, and psychosocial health. The study has been approved by the institutional review board of the Dana-Farber Cancer Institute (20-222). RESULTS The trial was funded in January 2019, with recruitment started in June 2021. As of May 2022, a total of 4 patients have consented and been randomized (n=2, 50% to exercise; n=1, 25% to control; and n=1, 25% nonrandomized). Trial completion is expected in January 2024. CONCLUSIONS This first-of-its-kind study incorporates a novel exercise intervention (ie, HIIT) and comprehensive cognitive measures. If positive, our findings will establish the pilot efficacy of HIIT on chemotherapy-induced cognitive function in patients with breast cancer, providing the foundation for future larger phase-II and phase-III trials to confirm the findings and potentially establish HIIT as a standard of care for women undergoing chemotherapy for breast cancer. TRIAL REGISTRATION ClinicalTrials.gov NCT04724499; https://clinicaltrials.gov/ct2/show/NCT04724499. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/39740.
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Affiliation(s)
- Rebekah Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Meghan Tahbaz
- Department of Medicine, Morsani College of Medicine, University of South Florida, Tampa, FL, United States
| | - Mary Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Hajime Uno
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
| | - Jennifer Ligibel
- Harvard Medical School, Boston, MA, United States
- Division of Breast Oncology, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Jeffrey Guenette
- Division of Neuroradiology, Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Cameron Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
| | - Christina Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
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16
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Greaney SK, Amin N, Prudner BC, Compernolle M, Sandell LJ, Tebb SC, Weilbaecher KN, Abeln P, Luo J, Tao Y, Hirbe AC, Peterson LL. Yoga Therapy During Chemotherapy for Early-Stage and Locally Advanced Breast Cancer. Integr Cancer Ther 2022; 21:15347354221137285. [PMID: 36412916 PMCID: PMC9706042 DOI: 10.1177/15347354221137285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Chemotherapy is associated with decreased quality of life (QOL), fatigue, depression, and weight gain in patients with breast cancer. Weight gain is associated with poorer prognosis. Yoga improves QOL, fatigue, and mood in women with breast cancer but its effect on treatment-related weight gain has not been studied. The aim of this trial was to determine the feasibility of personalized yoga therapy in women receiving treatment for early-stage or locally advanced breast cancer and assess its impact on weight gain. Methods: Thirty women were randomized 1:1 to receive yoga therapy by a certified yoga therapist during treatment or a control group. Participants in the yoga arm were asked to complete three 30 minute yoga sessions weekly (which included movement, breath work, mindfulness, and relaxation) throughout adjuvant or neoadjuvant chemotherapy (N = 29) or endocrine (N = 1); the control arm received breast cancer treatment without yoga. For comparability between participants randomized to yoga therapy, the single patient treated with endocrine therapy was excluded from the analysis. Primary outcomes were feasibility and weight change. Additional outcomes were mood, fatigue, QOL, serum tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP) as immune mediator biomarkers. Results: Mean age was 51.6 years, 75.9% were white and 24.1% were people of color, reflecting the cancer center population. 80% had stage II-III disease. Enrollment was completed in 9 months. Compliance was lower than predicted; however, participants participated in on average 1.7 yoga sessions/week for a mean 15.6 weeks duration. There were no adverse events. Control arm participants gained on average 2.63% body weight during treatment while yoga participants lost 0.14% body weight (weight change = −0.36 in yoga arm vs. 2.89 in standard of care arm, Wilcoxon rank sum test P = .024). Control participants reported increased fatigue and decreased QOL, while yoga participants reported no change in QOL. No significant change in TNF-alpha or CRP was noted in either arm. Conclusion: This feasibility study suggests that personalized yoga therapy is beneficial for QOL and weight maintenance among women undergoing chemotherapy for early-stage or locally advanced breast cancer. Weight maintenance associated with yoga therapy may be of clinical significance in this population given the poorer prognosis associated with weight gain in breast cancer survivors. Trial Registration: NIH Clinicaltrials.gov #NCT03262831; August 25, 2017. https://clinicaltrials.gov/ct2/show/NCT03262831
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Affiliation(s)
| | - Neha Amin
- Washington University School of Medicine, Saint Louis, MO, USA
| | | | | | | | | | | | - Peri Abeln
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Jingqin Luo
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Yu Tao
- Washington University School of Medicine, Saint Louis, MO, USA
| | - Angela C. Hirbe
- Washington University School of Medicine, Saint Louis, MO, USA
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17
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A Mixed-apprOach program To help women wIth breast cancer stay actiVE (MOTIVE program): A pilot-controlled study. Heliyon 2021; 7:e08252. [PMID: 34765775 PMCID: PMC8572138 DOI: 10.1016/j.heliyon.2021.e08252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/17/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022] Open
Abstract
Given the benefits of physical activity for breast cancer survivals, this pilot study aims to assess the feasibility of the MOTIVE program at achieving and maintaining the recommended physical activity level in women diagnosed and treated breast cancer, over 16 weeks. We conduct a pilot-controlled study of 20 women diagnosed with breast cancer stage I, II or IIIa. In this study, women of Intervention Arm (n = 10) received the MOTIVE program. This group was compared to women of Control Arm (n = 10) who received only counselling. Health-related fitness measures, and quality of life were assessed at baseline (t0) and after 4 (t1), 8 (t2) and 16 (t3) weeks. Intervention Arm women reached the recommended physical activity guidelines at t1 and t2 (eff.size = 1.9 [1.0-3.1]), and 90% continued to be active, autonomously, at t3 (eff.size = 1.12 [0.21-2.12]). Intervention Arm participants' arm strength, fitness levels and quality of life also improved over time. No significant improvements in outcome measures were observed in Control Arm participants. These results are encouraging and suggest that the MOTIVE program may be a viable, well tolerated and effective option to help breast cancer women reaching a stable physical activity level over time, which meets prevention-related goals.
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de Jesus Leite MAF, Mariano IM, Dechichi JGC, Giolo JS, Gonçalves ÁDC, Puga GM. Exercise training and detraining effects on body composition, muscle strength and lipid, inflammatory and oxidative markers in breast cancer survivors under tamoxifen treatment. Life Sci 2021; 284:119924. [PMID: 34480935 DOI: 10.1016/j.lfs.2021.119924] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 12/14/2022]
Abstract
AIMS The present study aimed to verify the effects of resistance training (RT) and successive detraining on body composition, muscle strength and lipid profile as primary outcome, and the oxidative stress and inflammatory markers as second outcome of postmenopausal Breast Cancer (BC) survivors undergoing tamoxifen (TA). MAIN METHODS Fourteen postmenopausal BC survivors underwent 12 weeks of resistance exercise training and subsequently 12 weeks of detraining. Anthropometric parameters, lipid profile, muscle strength, inflammatory cytokines and the oxidative stress markers, were assessed before, after the training period and after detraining period. KEY FINDINGS One-way ANOVA showed that fat mass decrease (39.4 ± 6.9 to 37.7 ± 6.8%) and free-fat mass increase (39.3 ± 4.9 to 40.3 ± 5.6%) after RT. Muscle strength increased in response to training but decreased after the detraining period. Triglycerides (156 ± 45 to 123 ± 43 mg/dL) and total cholesterol (202 ± 13 to 186 ± 16 mg/dL) decreased after the RT and HDL-cholesterol (47 ± 9 to 56 ± 9 mg/dL) increased after RT and remained higher (53 ± 10 mg/dL) than after detraining. IL-6 increases (24.65 ± 10.85 to 41.42 ± 22.88 pg/mL) and IL-17 (2.42 ± 0.32 to 1.69 ± 0.19 pg/mL), TBARS (1.91 ± 0.19 to 1.03 ± 0.1 μmol/L), SOD (24.65 ± 10.85 to 41.42 ± 22.88 U/gHb) and Catalase activity (445.9 ± 113.0 to 345.8 ± 81.7 k/gHb·s) reduced after RT and remained lower after detraining. SIGNIFICANCE Resistance exercise training improves health markers of BC survivors undergoing TA and detraining are not sufficient to reverse the positive effects in oxidative stress markers.
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Affiliation(s)
- Marco Aurélio Ferreira de Jesus Leite
- Laboratory of Cardiorespiratory and Metabolic Physiology, Faculty of Physical Education, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Igor Moraes Mariano
- Laboratory of Cardiorespiratory and Metabolic Physiology, Faculty of Physical Education, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Juliene Gonçalves Costa Dechichi
- Laboratory of Cardiorespiratory and Metabolic Physiology, Faculty of Physical Education, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | - Jéssica Sanjulião Giolo
- Laboratory of Cardiorespiratory and Metabolic Physiology, Faculty of Physical Education, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil
| | | | - Guilherme Morais Puga
- Laboratory of Cardiorespiratory and Metabolic Physiology, Faculty of Physical Education, Federal University of Uberlândia, Uberlândia, Minas Gerais, Brazil.
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Abbasi F, Pourjalali H, do Nascimento IJB, Zargarzadeh N, Mousavi SM, Eslami R, Milajerdi A. The effects of exercise training on inflammatory biomarkers in patients with breast cancer: A systematic review and meta-analysis. Cytokine 2021; 149:155712. [PMID: 34644675 DOI: 10.1016/j.cyto.2021.155712] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Revised: 08/17/2021] [Accepted: 09/13/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Despite several studies on the effects of exercise training on inflammatory biomarkers in patients with breast cancer, no earlier study has systematically summarized their findings. Current systematic review and meta-analysis has been done on earlier clinical trials in this topic. METHOD Relevant studies published up to August 2021 were searched through PubMed, MEDLINE, SCOPUS, EMBASE, and Google Scholar using predefined keywords. Studies that examined the effect of exercise training on inflammatory biomarkers in adult women with breast cancer were included. RESULT A total of 18 studies were included. Combining 11 effect sizes, exercise training significantly reduced CRP level (WMD: -0.55; 95% CI: -1.10, -0.01). However, it had no significant influence on serum TNF-α (WMD: -0.40; 95% CI: -1.30, 0.50) and IL-6 concentrations (WMD: -0.05, 95% CI: -0.53, 0.43) in 8 and 15 studies, respectively. Pooling 7 effect sizes, we failed to find significant changes in IL-8 following exercise training (WMD: -0.65, 95% CI: -1.57, 0.28). Moreover, we reached no significant findings for serum levels of INF-ɣ (WMD: -2.66, 95% CI: -7.67, 2.36), IL-1β (WMD: 0.03, 95% CI: -0.26, 0.21), and IL-10 (WMD: -0.70, 95% CI: -2.92, 1.52). Based on subgroup analyses, best findings were reached in long-term intervention and after concurrent training. DISCUSSION Chronic inflammation is hypothesized to be associated with breast cancer development. We found significant reduction in CRP level following exercise training, which was more considerable after concurrent aerobic and resistance training and in long-term intervention. No significant changes were seen in serum levels of TNF-α, IL-6, IL-8, IL-10, INF-ɣ, IL-1β following exercise training. Further studies are needed to find more details.
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Affiliation(s)
- Fatemeh Abbasi
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Hanieh Pourjalali
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran
| | - Israel Júnior Borges do Nascimento
- School of Medicine, Medical College of Wisconsin, Milwaukee, WI, United States; University Hospital and School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Nikan Zargarzadeh
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Mohammad Mousavi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran
| | - Rasoul Eslami
- Department of Exercise Physiology, Faculty of Physical Education and Sports Sciences, Allameh Tabataba'i University, Tehran, Iran.
| | - Alireza Milajerdi
- Research Center for Biochemistry and Nutrition in Metabolic Diseases, Institute for Basic Sciences, Kashan University of Medical Sciences, Kashan, Iran.
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Efficacy of the Motivational Interviewing-Walk Intervention for Chemotherapy-Induced Peripheral Neuropathy and Quality of Life During Oxaliplatin Treatment: A Pilot Randomized Controlled Trial. Cancer Nurs 2021; 45:E531-E544. [PMID: 34483279 DOI: 10.1097/ncc.0000000000001003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Oxaliplatin-induced peripheral neuropathy (OIPN) is prevalent among gastrointestinal cancer survivors and often impairs quality of life (QOL). OBJECTIVE This pilot randomized controlled trial aimed to explore the effect of an 8-week home-based brisk walking (the "MI-Walk") intervention on (1) OIPN severity and (2) QOL at 8 weeks, compared with physical activity (PA) education alone in oxaliplatin-receiving adults with gastrointestinal cancer. INTERVENTIONS/METHODS Participants (N = 57) recruited from 5 infusion sites received PA education at their second oxaliplatin visit, followed by phone assessments of adverse events over 8 weeks. Half (n = 29) received additional MI-Walk intervention motivational supports (eg, a Fitbit Charge 2 and motivational enhancement therapy sessions). Self-reported OIPN, QOL, and PA were measured before and after intervention. RESULTS The intervention compared with the control condition had no effect on sensory OIPN (mean difference [X¯[INCREMENT]] = -0.01; P > .99), motor OIPN (X¯[INCREMENT] = 2.39; P = .17), and QOL (X¯[INCREMENT] = -1.43; P > .99). Eight-week sensory (X¯ =11.48 ± 0.38) and motor OIPN severities (X¯ = 7.48 ± 0.36) were mild but higher than baseline (P ≤ .01). Self-reported PA level increased over time in both groups (X¯[INCREMENT] = 44.85; P = .01). Averaging ≥225 moderate to vigorous PA minutes per week led to less sensory OIPN, particularly finger/hand tingling (X¯[INCREMENT] = -26.35; P = .01). CONCLUSIONS This study failed to detect beneficial effects of the MI-Walk intervention; however, the findings suggest that aerobic walking may blunt but not completely prevent OIPN. Further research is necessary. IMPLICATIONS FOR PRACTICE Although the effectiveness of brisk walking in reducing OIPN is unclear, this study supports prior evidence that moderate to vigorous PA is beneficial and safe during chemotherapy treatment.
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Hooshmand Moghadam B, Golestani F, Bagheri R, Cheraghloo N, Eskandari M, Wong A, Nordvall M, Suzuki K, Pournemati P. The Effects of High-Intensity Interval Training vs. Moderate-Intensity Continuous Training on Inflammatory Markers, Body Composition, and Physical Fitness in Overweight/Obese Survivors of Breast Cancer: A Randomized Controlled Clinical Trial. Cancers (Basel) 2021; 13:4386. [PMID: 34503198 PMCID: PMC8430701 DOI: 10.3390/cancers13174386] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/10/2021] [Accepted: 08/25/2021] [Indexed: 12/16/2022] Open
Abstract
Background: Chronic inflammation associated with breast cancer (BC) poses a major challenge in care management and may be ameliorated by physical activity. This randomized controlled trial assessed the effects of a 12-week high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) on inflammatory markers, body composition, and physical fitness in BC survivors (BCS). Methods: Forty BCS (age = 57 ± 1 years; body mass [BM] = 74.8 ± 1.5 kg; VO2peak = 20.8 ± 2.1 mL·kg-1·min-1) were randomly assigned to three groups: HIIT (n = 15), MICT (n = 15), or control (CON; n = 15). The intervention groups (HIIT and MICT) performed their respective exercise protocols on a cycle ergometer 3 days/week for 12 weeks while the CON group maintained their current lifestyle. Baseline and post-intervention assessments included body composition (BM, fat mass (FM), lean mass (LM)), physical fitness (VO2peak, lower body strength (LBS), upper body strength (UBS)), and serum concentrations of tumor necrosis factor-alpha (TNF-α), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), leptin, and adiponectin. Results: Both intervention groups significantly (p < 0.05) decreased BM (HIIT = -1.8 kg, MICT = -0.91 kg), FM (HIIT = -0.81 kg, MICT = -0.18 kg), TNF-α (HIIT = -1.84 pg/mL, MICT = -0.99 pg/mL), IL-6 (HIIT = -0.71 pg/mL, MICT = -0.36 pg/mL), leptin (HIIT = -0.35 pg/mL, MICT = -0.16 pg/mL) and increased VO2peak (HIIT = 0.95 mL·kg-1·min-1, MICT = 0.67 mL·kg-1·min-1), LBS (HIIT = 2.84 kg, MICT = 1.53 kg), UBS (HIIT = 0.53 kg, MICT = 0.53 kg), IL-10 (HIIT = 0.63 pg/mL, MICT = 0.38 pg/mL), and adiponectin (HIIT = 0.23 ng/mL, MICT = 0.1 ng/mL) compared to baseline. The changes in BM, FM, TNF-α, leptin, and LBS were significantly greater in HIIT compared to all other groups. Conclusions: Our findings indicate that compared to the often-recommended MICT, HIIT may be a more beneficial exercise therapy for the improvement of inflammation, body composition and LBS in BCS; and consequently, merits long-term study.
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Affiliation(s)
- Babak Hooshmand Moghadam
- Department of Exercise Physiology, University of Tehran, Tehran 1961733114, Iran;
- Department of Exercise Physiology, Ferdowsi University of Mashhad, Mashhad 9177948974, Iran
| | - Fateme Golestani
- Department of Exercise Physiology, University of Birjand, Birjand 9717434765, Iran; (F.G.); (M.E.)
| | - Reza Bagheri
- Department of Exercise Physiology, University of Isfahan, Isfahan 8174673441, Iran;
| | - Neda Cheraghloo
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran 1417613151, Iran;
| | - Mozhgan Eskandari
- Department of Exercise Physiology, University of Birjand, Birjand 9717434765, Iran; (F.G.); (M.E.)
| | - Alexei Wong
- Department of Health and Human Performance, Marymount University, Arlington, VA 22207, USA; (A.W.); (M.N.)
| | - Michael Nordvall
- Department of Health and Human Performance, Marymount University, Arlington, VA 22207, USA; (A.W.); (M.N.)
| | - Katsuhiko Suzuki
- Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa 359-1192, Japan
| | - Parisa Pournemati
- Department of Exercise Physiology, University of Tehran, Tehran 1961733114, Iran;
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Zaorsky NG, Allenby T, Lin J, Rosenberg J, Simone NL, Schmitz KH. Exercise Therapy and Radiation Therapy for Cancer: A Systematic Review. Int J Radiat Oncol Biol Phys 2021; 110:973-983. [PMID: 33220396 DOI: 10.1016/j.ijrobp.2020.11.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/27/2020] [Accepted: 11/09/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Exercise therapy (ET) is shown to improve toxicity and surrogates of survival for patients receiving chemotherapy. Current National Comprehensive Cancer Network (NCCN) guidelines lack recommendations for concurrent radiation therapy (RT) and ET. The main objective was to determine the impact of concurrent ET + RT with respect to (1) acceptability, feasibility, safety; and (2) to demonstrate how incorporating ET in cancer treatment can enhance patient-reported outcomes (PROs) and physical function-defined as strength or exercise capacity. METHODS AND MATERIALS A PICOS/PRISMA selection protocol was used to search PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and Cochrane Review for prospective randomized controlled trials evaluating concurrent ET + RT, including >10 patients and with 1 or more study arms. Acceptability, feasibility, and safety rates were calculated. PROs were assessed with study-specific metrics. Physical function was defined as improvements in strength or range of motion. Statistically significant improvement was defined by P <.05. RESULTS Twenty-six of 693 screened studies including 1563 patients (831 receiving exercise, 732 controls) with localized breast cancer (67.1% of patients), prostate cancer (27.4%), head and neck cancers (2.8%), and spinal metastases (2.8%) were assessed. Objective 1: Among 3385 patients approached for ET, 1864 (55.1%) accepted the treatment; of those, 1563 patients (83.9%) completed the trials. Objective 2: Statistical improvements were noted in these PROs: quality of life (14 of 15 studies), fatigue (12 of 16 studies), mood/depression (9 of 13), and anxiety (6 of 7). Physical function improved statically in 16 of 16 studies. CONCLUSIONS Combination ET + RT is safe and well-tolerated with improvements in PROs and physical function. Additional studies are needed in patients with metastatic cancers to assess survival and to compare effectiveness of different exercise regimens.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania; Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania.
| | - Taylor Allenby
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - John Lin
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Jennifer Rosenberg
- Department of Radiation Oncology, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Nicole L Simone
- Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
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23
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Relf RL, Lee BJ, Eichhorn G, Flint MS, Beale L, Maxwell N. Thermoregulation is not impaired in breast cancer survivors during moderate-intensity exercise performed in warm and hot environments. Physiol Rep 2021; 9:e14968. [PMID: 34291605 PMCID: PMC8295682 DOI: 10.14814/phy2.14968] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
This study aimed to assess how female breast cancer survivors (BCS) respond physiologically, hematologically, and perceptually to exercise under heat stress compared to females with no history of breast cancer (CON). Twenty-one females (9 BCS and 12 CON [age; 54 ± 7 years, stature; 167 ± 6 cm, body mass; 68.1 ± 7.62 kg, and body fat; 30.9 ± 3.8%]) completed a warm (25℃, 50% relative humidity, RH) and hot (35℃, 50%RH) trial in a repeated-measures crossover design. Trials consisted of 30 min of rest, 30 min of walking at 4 metabolic equivalents, and a 6-minute walk test (6MWT). Physiological measurements (core temperature (Tre ), skin temperature (Tskin ), heart rate (HR), and sweat analysis) and perceptual rating scales (ratings of perceived exertion, thermal sensation [whole body and localized], and thermal comfort) were taken at 5- and 10-min intervals throughout, respectively. Venous blood samples were taken before and after to assess; IL-6, IL-10, CRP, IFN-γ, and TGF-β1 . All physiological markers were higher during the 35 versus 25℃ trial; Tre (~0.25℃, p = 0.002), Tskin (~3.8℃, p < 0.001), HR (~12 beats·min-1 , p = 0.023), and whole-body sweat rate (~0.4 L·hr-1 , p < 0.001), with no difference observed between groups in either condition (p > 0.05). Both groups covered a greater 6MWT distance in 25 versus 35℃ (by ~200 m; p = 0.003). Nevertheless, the control group covered more distance than BCS, regardless of environmental temperature (by ~400 m, p = 0.03). Thermoregulation was not disadvantaged in BCS compared to controls during moderate-intensity exercise under heat stress. However, self-paced exercise performance was reduced for BCS regardless of environmental temperature.
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Affiliation(s)
- Rebecca L. Relf
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Ben J. Lee
- Occupational and Environmental Physiology GroupCoventry UniversityCoventryUK
| | - Gregor Eichhorn
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Melanie S. Flint
- Cancer Stress LaboratoryUniversity of BrightonMoulsecoombUK
- Centre for Stress and Age‐Related DiseaseBrightonEast SussexUK
| | - Louisa Beale
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
| | - Neil Maxwell
- Environmental Extremes LaboratoryUniversity of BrightonEastbourneUK
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Bruinsma TJ, Dyer AM, Rogers CJ, Schmitz KH, Sturgeon KM. Effects of Diet and Exercise-Induced Weight Loss on Biomarkers of Inflammation in Breast Cancer Survivors: A Systematic Review and Meta-analysis. Cancer Epidemiol Biomarkers Prev 2021; 30:1048-1062. [PMID: 33737299 PMCID: PMC8172485 DOI: 10.1158/1055-9965.epi-20-1029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/02/2020] [Accepted: 03/10/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Adiponectin, leptin, and pro- and anti-inflammatory cytokines are implicated in breast cancer risk and recurrence. Weight loss, via the dynamic interplay of energy balance through exercise and/or caloric restriction, decreases risk of breast cancer recurrence. METHODS We investigated the effects of lifestyle modifications (exercise only, or combined caloric restriction and exercise) on adipokines, IL2, IL6, IL8, IL10, C-reactive protein (CRP), and TNFα biomarkers in breast cancer survivors. Searches were completed in June and July of 2019 to identify randomized controlled trials that met inclusion criteria. Weighted mean difference was calculated using random- or fixed-effects models based on the heterogeneity of the studies. RESULTS 2501 records were identified, with 30 ultimately meeting inclusion criteria of the systematic review; 21 studies provided data suitable for meta-analysis. We observed leptin levels were significantly reduced in the exercise-only group compared with sedentary control [WMD -5.66; 95% confidence interval (CI), -11.0 to -0.33; P = 0.04]. CONCLUSIONS Leptin may be a primary mediator of exercise-induced improvements in breast cancer recurrence. IMPACT This is the first review and meta-analysis to examine combined exercise and caloric restriction programs in breast cancer survivors. Future studies should further examine combined programs and their efficacy for altering leptin.
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Affiliation(s)
- Tyler J Bruinsma
- College of Medicine, Penn State University, Hershey, Pennsylvania
| | - Anne-Marie Dyer
- College of Medicine, Penn State University, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
| | - Connie J Rogers
- Department of Nutritional Sciences, College of Health and Human Development, Penn State University, University Park, Pennsylvania
- Cancer Institute, Penn State University, Hershey, Pennsylvania
- Center for Molecular Immunology and Infectious Disease, Huck Institutes of the Life Sciences, Penn State University, University Park, Pennsylvania
| | - Kathryn H Schmitz
- College of Medicine, Penn State University, Hershey, Pennsylvania
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
- Cancer Institute, Penn State University, Hershey, Pennsylvania
| | - Kathleen M Sturgeon
- College of Medicine, Penn State University, Hershey, Pennsylvania.
- Department of Public Health Sciences, Penn State University, Hershey, Pennsylvania
- Cancer Institute, Penn State University, Hershey, Pennsylvania
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Khalafi M, Malandish A, Rosenkranz SK. The impact of exercise training on inflammatory markers in postmenopausal women: A systemic review and meta-analysis. Exp Gerontol 2021; 150:111398. [PMID: 33965553 DOI: 10.1016/j.exger.2021.111398] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 05/04/2021] [Accepted: 05/05/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The postmenopausal stage of life is associated with increased systemic inflammation that may be mitigated through exercise training. The effects of exercise training on inflammatory markers in postmenopausal women, however, require further elucidation. We therefore performed a systematic review and meta-analysis to investigate the available high-quality research on the effects of exercise training on inflammatory markers in postmenopausal women. METHOD Electronic searches in PubMed, Scopus, Cochrane Central Register of Controlled Trials (CENTRAL), Web of Science, and Google Scholar were conducted to identify articles published through April 2021, for studies comparing exercise training to a control condition, on inflammatory markers including CRP, IL-6, TNF-α and adiponectin in postmenopausal women. Randomized or non-randomized controlled trials of exercise training were included according to the following criteria: (A) English language articles; (B) involving women participants who were post-menopausal; (C) providing measures of inflammatory markers including IL-6, TNF-α, CRP or adiponectin at baseline and after completion of the intervention; (D) an exercise training intervention duration of ≥4 weeks. RESULTS Results were extracted from the included studies and standardized mean differences (SMD) and 95% confidence intervals (95% CIs) were calculated. Thirty-two studies (representing 38 intervention groups) involving 1510 postmenopausal women were retrieved from the databases for analyses. Overall, exercise training significantly reduced IL-6 [-0.75 (95% CI: -1.07 to -0.42), p < 0.001; 20 interventions], TNF-α [-0.64 (95% CI: -0.91 to -0.37), p < 0.001; 24 interventions] and CRP [-0.64 (95%CI: -0.91 to -0.38), p < 0.001; 21 interventions] and increase adiponectin [0.98 (95% CI: 0.10 to 1.86), p = 0.02; 6 interventions], when compared with control. Furthermore, subgroup analyses suggested that aerobic, resistance, and combined training significantly reduced IL-6, TNF-α and CRP (p < 0.05). Exercise training improved IL-6, TNF-α and CRP in both younger (age < 64 years) and older (age ≥ 64 years) participants (p < 0.05). CONCLUSION These results suggest that exercise training may be an effective intervention for reducing pro-inflammatory markers and increasing adiponectin in postmenopausal women.
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Affiliation(s)
- Mousa Khalafi
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
| | - Abbas Malandish
- Department of Exercise Physiology, Faculty of Sport Sciences, Urmia University, Urmia, Iran.
| | - Sara K Rosenkranz
- Department of Food, Nutrition, Dietetics and Health, Kansas State University, Manhattan, KS, USA.
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Bade BC, Gan G, Li F, Lu L, Tanoue L, Silvestri GA, Irwin ML. "Randomized trial of physical activity on quality of life and lung cancer biomarkers in patients with advanced stage lung cancer: a pilot study". BMC Cancer 2021; 21:352. [PMID: 33794808 PMCID: PMC8015735 DOI: 10.1186/s12885-021-08084-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2021] [Accepted: 03/16/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lung cancer survivors need more options to improve quality of life (QoL). It is unclear to what extent patients with advanced stage disease are willing to participate in home-based physical activity (PA) and if these interventions improve QoL. The goal of our study was to determine interest in participating in our 3-month home-based walking regimen in patients with advanced stage lung cancer. We used a randomized design to evaluate for potential benefit in PA and patient-reported outcomes. METHODS We performed an open-label, 1:1 randomized trial in 40 patients with stage III/IV non-small cell lung cancer (NSCLC) evaluating enrollment rate, PA, QoL, dyspnea, depression, and biomarkers. Compared to usual care (UC), the intervention group (IG) received an accelerometer, in-person teaching session, and gain-framed text messages for 12 weeks. RESULTS We enrolled 56% (40/71) of eligible patients. Participants were on average 65 years and enrolled 1.9 years from diagnosis. Most patients were women (75%), and receiving treatment (85%) for stage IV (73%) adenocarcinoma (83%). A minority of patients were employed part-time or full time (38%). Both groups reported low baseline PA (IG mean 37 (Standard deviation (SD) 46) vs UC 59 (SD 56) minutes/week; p = 0.25). The IG increased PA more than UC (mean change IG + 123 (SD 212) vs UC + 35 (SD 103) minutes/week; p = 0.051)). Step count in the IG was not statistically different between baseline (4707 step/day), week 6 (5605; p = 0.16), and week 12 (4606 steps/day; p = 0.87). The intervention improved EORTC role functioning domain (17 points; p = 0.022) with borderline improvement in dyspnea (- 13 points; p = 0.051) compared to UC. In patients with two blood samples (25%), we observed a significant increase in soluble PD-1 (219.8 (SD 54.5) pg/mL; p < 0.001). CONCLUSIONS Our pilot trial using a 3-month, home-based, mobile health intervention enrolled over half of eligible patients with stage III and IV NSCLC. The intervention increased PA, and may improve several aspects of QoL. We also identified potential biomarker changes relevant to lung cancer biology. Future research should use a larger sample to examine the effect of exercise on cancer biomarkers, which may mediate the association between PA and QoL. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov ( NCT03352245 ).
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Affiliation(s)
- Brett C Bade
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA.
| | - Geliang Gan
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Fangyong Li
- Yale Center for Analytical Sciences, Yale School of Public Health, New Haven, USA
| | - Lingeng Lu
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
| | - Lynn Tanoue
- Department of Internal Medicine, Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, P.O. Box 208057 300 Cedar Street TAC - 441 South, New Haven, CT, 06520-8057, USA
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Medical University of South Carolina, New Haven, USA
| | - Melinda L Irwin
- Department of Chronic Disease Epidemiology, Yale University School of Public Health, New Haven, USA
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Effects of a personal trainer-led exercise intervention on physical activity, physical function, and quality of life of breast cancer survivors. Breast Cancer 2021; 28:737-745. [PMID: 33689150 DOI: 10.1007/s12282-020-01211-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 12/24/2020] [Indexed: 12/22/2022]
Abstract
PURPOSE Exercise is important to address physical and emotional effects of breast cancer treatment. This study examines effects of a personal trainer led exercise intervention on physical activity levels, physical function and quality of life (QoL) in breast cancer survivors. METHODS Women post active breast cancer treatment were recruited from 2015 to 2017, randomized to immediate exercise or wait-list control, and received three personal training sessions for up to 30 weeks. Physical activity and function were assessed by pedometer, and tests of endurance, strength, and flexibility. Self-reported physical activity, physical activity self-efficacy, and QoL were also assessed. RESULTS 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were aged (mean ± SD) 56 ± 10 years. On the endurance test, the exercise group significantly improved (increase of 18 ± 20 steps vs control 9 ± 12 steps) (p = 0.036). On the strength test, the exercise group significantly improved (increase of 4 ± 3 curls vs control 1 ± 3 curls) (p = 0.002). After intervention, change (mean ∆ ± SD) in the FACT-ES physical well-being subscale score was 1 ± 2 in the exercise group and - 1 ± 2 in the control group (p = 0.023). Improvement in Self-efficacy and Physical Activity (SEPA) score was significant with a change (mean ∆ ± SD) of 2 ± 5 for exercise vs 0 ± 5 for control (p = 0.047). The number of steps/day, back scratch test, weight, and self-reported physical activity did not significantly improve with intervention. CONCLUSIONS The intervention yielded significant improvements in endurance and strength but not physical activity or quality of life. IMPLICATIONS FOR CANCER SURVIVORS Future efforts to explore feasible ways to support patient's physical activity efforts need to be undertaken.
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Lorenzo PM, Crujeiras AB. Potential effects of nutrition-based weight loss therapies in reversing obesity-related breast cancer epigenetic marks. Food Funct 2021; 12:1402-1414. [PMID: 33480953 DOI: 10.1039/d0fo01984d] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Obesity is a modifiable risk factor of breast cancer and epigenetic marks were proposed as a relevant mechanistic link. These mechanisms can be remodelled by modifying lifestyle factors and this fact could be useful in the treatment of obesity-related breast cancer. This review aimed to reveal the current evidence on the effects of differences in body composition and lifestyle factors on the risk, treatment, and survival of breast cancer with a focus on the effects of weight loss therapies based on different nutrients, bioactive compounds, and Mediterranean and ketogenic diets to counteract obesity-related breast cancer epigenetic marks. This review was framed on the most relevant and recently published articles and abstracts selected in PubMed using key words related to epigenetics, lifestyle, dietary habits, nutrients, bioactive compounds, ketone bodies, and weight loss treatments in obesity and breast cancer. Several studies have demonstrated that lifestyle interventions, including dietary modifications towards a healthy diet pattern, are effective therapies to prevent the onset of breast cancer and to improve the survival after treatment. These therapies reduce the main factors associated with obesity that are links between adiposity and cancer, including oxidative stress, inflammation and epigenetic mechanisms. However, although sufficient evidence exists regarding the effects of nutrients, dietary patterns, and weight loss therapies to prevent breast cancer or to improve survival, the effects of these strategies on the oncological treatment response were less studied. This review summarises the current scientific evidence regarding these nutritional strategies as adjuvant therapies in the management of obesity-related breast cancer by remodelling epigenetic marks related to carcinogenesis.
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Affiliation(s)
- Paula M Lorenzo
- Epigenomics in Endocrinology and Nutrition Group, Instituto de Investigacion Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago (CHUS/SERGAS), Santiago de Compostela, Spain.
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Abstract
Chemotherapy-induced peripheral neuropathy (CIPN) is an unsolved and potentially life-compromising problem for most patients receiving neurotoxic chemotherapy. It manifests with numbness, tingling, and possibly neuropathic pain and motor and autonomic symptoms. This review aims to provide an evidence synthesis that prepares nurses to comprehensively assess, provide supportive care for, and critically evaluate the literature on CIPN. The prevalence, significance, characteristics, mechanisms, and risk factors of CIPN will be discussed, as well as nursing-relevant evidence on the assessment, prevention, and management of CIPN. The importance of critical literature evaluation before clinical implementation to reduce physical and financial harms to patients will also be highlighted.
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Shaikh H, Bradhurst P, Ma LX, Tan SYC, Egger SJ, Vardy JL. Body weight management in overweight and obese breast cancer survivors. Cochrane Database Syst Rev 2020; 12:CD012110. [PMID: 33305350 PMCID: PMC8094215 DOI: 10.1002/14651858.cd012110.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Studies suggest that overweight and obese breast cancer survivors are at increased risk of cancer recurrence and have higher all-cause mortality. Obesity has an impact on breast cancer survivor's quality of life (QOL) and increases the risk of longer-term morbidities such as type 2 diabetes mellitus and cardiovascular disease. Many cancer guidelines recommend survivors maintain a healthy weight but there is a lack of evidence regarding which weight loss method to recommend. OBJECTIVES To assess the effects of different body weight loss approaches in breast cancer survivors who are overweight or obese (body mass index (BMI) ≥ 25 kg/m2). SEARCH METHODS We carried out a search in the Cochrane Breast Cancer Group's (CBCG's) Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 6), MEDLINE (2012 to June 2019), Embase (2015 to June 2019), the World Health Organisation International Clinical Trials Registry Platform (WHO ICTRP) and Clinicaltrials.gov on 17 June 2019. We also searched Mainland Chinese academic literature databases (CNKI), VIP, Wan Fang Data and SinoMed on 25 June 2019. We screened references in relevant manuscripts. SELECTION CRITERIA We included randomised controlled trials (RCTs), quasi-RCTs and randomised cross-over trials evaluating body weight management for overweight and obese breast cancer survivors (BMI ≥ 25 kg/m2). The aim of the intervention had to be weight loss. DATA COLLECTION AND ANALYSIS Two review authors independently performed data extraction and assessed risk of bias for the included studies, and applied the quality of the evidence using the GRADE approach. Dichotomous outcomes were analysed as proportions using the risk ratio (RR) as the measure of effect. Continuous data were analysed as means with the measure of effect being expressed as the mean differences (MDs) between treatment groups in change from baseline values with 95% confidence intervals (CIs), when all studies reported exactly the same outcomes on the same scale. If similar outcomes were reported on different scales the standardised mean difference (SMD) was used as the measure of effect. Quality of life data and relevant biomarkers were extracted where available. MAIN RESULTS We included a total of 20 studies (containing 23 intervention-comparisons) and analysed 2028 randomised women. Participants in the experimental groups received weight loss interventions using the core element of dietary changes, either in isolation or in combination with other core elements such as 'diet and exercise', 'diet and psychosocial support' or 'diet, exercise and psychosocial support'. Participants in the controls groups either received usual care, written materials or placebo, or wait-list controls. The duration of interventions ranged from 0.5 months to 24 months. The duration of follow-up ranged from three months to 36 months. There were no time-to-event data available for overall survival, breast cancer recurrence and disease-free survival. There was a relatively small amount of data available for breast cancer recurrence (281 participants from 4 intervention-comparisons with 14 recurrence events; RR 1.95, 95% CI 0.68 to 5.60; low-quality evidence) and the analysis was likely underpowered. Overall, we found low-quality evidence that weight loss interventions for overweight and obese breast cancer survivors resulted in a reduction in body weight (MD: -2.25 kg, 95% CI: -3.19 to -1.3 kg; 21 intervention-comparisons; 1751 women), body mass index (BMI) (MD: -1.08 kg/m2, 95% CI: -1.61 to -0.56 kg/m2; 17 intervention-comparisons; 1353 women), and waist circumference (MD:-1.73 cm, 95% CI: -3.17 to -0.29 cm; 13 intervention-comparisons; 1193 women), and improved overall quality of life (SMD: 0.74; 95% CI: 0.20 to 1.29; 10 intervention-comparisons; 867 women). No increase was seen in adverse events for women in the intervention groups compared to controls (RR 0.94, 95% CI: 0.76 to 1.17; 4 intervention-comparisons; 394 women; high-quality evidence). Subgroup analyses revealed that decreases in body weight, BMI and waist circumference were present in women regardless of their ethnicity and menopausal status. Multimodal weight loss interventions (which referred to 'diet, exercise and psychosocial support') appeared to result in greater reductions in body weight (MD: -2.88 kg, 95% CI: -3.98 to -1.77 kg; 13 intervention-comparisons; 1526 participants), BMI (MD: -1.44 kg/m2, 95% CI: -2.16 to -0.72 kg/m2; 11 studies; 1187 participants) and waist circumference (MD:-1.66 cm, 95% CI: -3.49 to -0.16 cm; 8 intervention-comparisons; 1021 participants) compared to dietary change alone, however the evidence was low quality. AUTHORS' CONCLUSIONS Weight loss interventions, particularly multimodal interventions (incorporating diet, exercise and psychosocial support), in overweight or obese breast cancer survivors appear to result in decreases in body weight, BMI and waist circumference and improvement in overall quality of life. There was no increase in adverse events. There is a lack of data to determine the impact of weight loss interventions on survival or breast cancer recurrence. This review is based on studies with marked heterogeneity regarding weight loss interventions. Due to the methods used in included studies, there was a high risk of bias regarding blinding of participants and assessors. Further research is required to determine the optimal weight loss intervention and assess the impact of weight loss on survival outcomes. Long-term follow-up in weight loss intervention studies is required to determine if weight changes are sustained beyond the intervention periods.
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Affiliation(s)
- Hassan Shaikh
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | | | - Li Xin Ma
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Food Hygiene Department, Hebei University, Baoding, China
| | - Sim Yee Cindy Tan
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Nutrition and Dietetics Department, Concord Repatriation General Hospital, Concord, Australia
- Sydney Medical School, University of Sydney, Sydney, Australia
| | - Sam J Egger
- Cancer Research Division, Cancer Council NSW, Sydney, Australia
| | - Janette L Vardy
- Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, Australia
- Faculty of Medicine and Health, Concord Clinical School, The University of Sydney, Sydney, Australia
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Xu Y, Rogers CJ. Physical Activity and Breast Cancer Prevention: Possible Role of Immune Mediators. Front Nutr 2020; 7:557997. [PMID: 33134306 PMCID: PMC7578403 DOI: 10.3389/fnut.2020.557997] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022] Open
Abstract
There is strong evidence that physical activity (PA) reduces risk, recurrence, and mortality from breast cancer. Emerging data suggest that PA induces changes in inflammatory and immune mediators that may contribute to beneficial effects on breast cancer outcomes. Thus, the goal of this review was to evaluate the evidence linking the protective benefit of PA to modulation of immune responses in breast cancer. A literature search was conducted to identify studies that evaluated the impact of PA on tumor and immune outcomes in breast cancer patients and in mammary tumor models. Nineteen studies investigated the effect of PA interventions on cancer immune outcomes using preclinical breast cancer models. Tumor growth was reduced in 11 studies, unchanged in three studies, and increased in one study. Spontaneous metastasis was reduced in two studies and survival was improved in four studies. Frequently assessed immune outcomes include splenic cell number and function, circulating inflammatory cytokines, and intratumoral immune cells and inflammatory markers. Circulating inflammatory cytokine responses were heterogeneous in preclinical models. Within the tumor microenvironment (TME), several studies documented a change in the infiltration of immune cells with an increase in effector cells and a reduction in immune suppressive cells. Twenty-three studies investigated the effect of PA interventions on immune outcomes in breast cancer patients. Thirteen studies used aerobic PA interventions and 10 studies used a combination of aerobic and resistance exercise interventions. Cycling and treadmill activities were the most commonly used PA modalities. Circulating immune cells and inflammatory cytokines were the most frequently assessed immune outcomes in the clinical studies. Among the 19 studies that evaluated a PA intervention during the post treatment period, 10 reported a reduction in the levels of at least one inflammatory cytokine. No inflammatory cytokines were quantified in the three studies that evaluated a PA intervention during treatment with chemotherapy. Immune outcomes within the tumor were assessed in only one study performing a PA intervention prior to surgery. Results from preclinical and clinical studies suggest that PA exerts heterogeneous effects on inflammatory cytokines, but may alter the gene expression profile and immune infiltrates in the tumor which may result in a reduction in immunosuppressive factors. However, additional studies are needed to better understand the effect of PA on immune outcomes in the TME.
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Affiliation(s)
- Yitong Xu
- Intercollege Graduate Degree Program in Integrative and Biomedical Physiology, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, United States
| | - Connie J Rogers
- Department of Nutritional Sciences, The Pennsylvania State University, University Park, PA, United States.,Center for Molecular Immunology and Infectious Disease, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, United States.,Penn State Cancer Institute, Hershey, PA, United States
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de Jesus Leite MA, Gonçalves Á, Portari G, Oliveira CJ, Catarino J, Bortolini M, Penha-Silva N. Application of physical exercise therapies in breast cancer survivors and their effects on the inflammatory profile: A narrative review. J Bodyw Mov Ther 2020; 24:536-545. [PMID: 33218558 DOI: 10.1016/j.jbmt.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 05/10/2020] [Accepted: 08/28/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND One of the adverse effects of cancer treatments is the exacerbation of inflammation, which generates numerous limitations and contributes to the development of several comorbidities and the recurrence of cancer itself. Physical exercise (PE) has been proposed as an efficient complementary strategy to combat the inflammatory effects of oncological treatments and to prevent the development of comorbidities, but its adequate application in breast cancer survivors (BCS) requires the establishment of consensuses and practical recommendations. OBJECTIVE This study aimed to review the randomized controlled trials that evaluated the influence of PE in the inflammatory profile of BCS. METHODS The search for articles published between 1999 and 2020 was done in PsycINFO, PubMed, Cochrane, Science Direct, and Scopus databases. RESULTS Current knowledge reveals the effectiveness of PE in the functional independence and health of BCS. Evidence of the capacity of PE to improve the inflammatory profile and the immune response in BCS has also been described. However, the heterogeneity of the studies regarding structural training variables, types of exercise, stages of intervention, and severity of the disease, still do not allow the establishment of precise guidelines for the prescription and progression of exercise to improve the inflammatory process in BCS. DISCUSSION . This review suggests a possible strategy to be used in the assessment, training prescription, and rehabilitation of BCS, to support the development of new studies and the work of exercise professionals in the prescription and application of physical training to improve health and inflammatory status in BCS.
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Affiliation(s)
| | - Álisson Gonçalves
- Health Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Guilherme Portari
- Health Sciences Institute, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Carlo José Oliveira
- Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Jonatas Catarino
- Institute of Biological and Natural Sciences, Federal University of Triângulo Mineiro, Uberaba, MG, Brazil
| | - Miguel Bortolini
- Health and Sports Sciences Center, Federal University of Acre, Rio Branco, AC, Brazil
| | - Nilson Penha-Silva
- Institute of Biotechnology, Federal University of Uberlândia, Uberlândia, MG, Brazil.
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Xu Y, Rogers CJ. Impact of physical activity and energy restriction on immune regulation of cancer. Transl Cancer Res 2020; 9:5700-5731. [PMID: 35117934 PMCID: PMC8798226 DOI: 10.21037/tcr.2020.03.38] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 03/04/2020] [Indexed: 11/06/2022]
Abstract
Cancer is a major public health issue worldwide. Lifestyle factors, such as body weight and physical activity (PA), significantly impact cancer risk and progression. There is strong evidence that PA reduces and obesity increases risk and mortality from numerous cancer types. Energy restriction (ER) in non-obese hosts significantly reduces tumor incidence in a variety of preclinical models, and reduces body weight and cardiometabolic risk factors in humans. Emerging data suggest that PA- and ER-induced changes in inflammatory and immune mediators may contribute to the cancer prevention effects of these interventions. A systematic literature search was conducted to identify studies that evaluated the impact of PA and ER on tumor and immune outcomes in humans and animal models. A total of 97 eligible studies were identified (68 studies reporting PA interventions and 30 studies reporting ER interventions). Thirty-one studies investigated the effect of PA on cancer immune outcomes using preclinical cancer models of breast (n=17, 55%), gastrointestinal (n=6, 19%), melanoma (n=4, 13%), and several other cancer types (n=4, 13%). Despite the heterogeneity in study designs, the majority of studies (n=23, 74%) reported positive effects of PA on tumor outcomes. Thirty-seven clinical studies investigated the effect of PA on cancer immune outcomes. None reported tumor outcomes, thus only immune outcomes were evaluated in these studies. PA studies were conducted in patients with breast (n=22, 59%), gastrointestinal (n=5, 14%), prostate (n=2, 5%), esophageal (n=1, 3%), lung (n=1, 3%) cancer, leukemia (n=1, 3%), or mixed cancer types (n=5, 14%). Twenty-two studies investigated the effect of ER interventions on cancer immune outcomes using preclinical cancer models including breast (n=5, 23%), gastrointestinal (n=5, 23%), lung (n=2, 9%), liver (n=2, 9%), pancreatic (n=2, 9%), and several other cancer types (n=6, 27%). Positive effects of ER on tumor outcomes were reported in 21 of 22 studies. Six clinical studies investigated the effect of ER (in combination with PA) on tumor immune outcomes in cancer patients with overweight or obesity. Five were conducted in breast cancer patients, and one recruited patients of a mix of cancer types. A wide range of immunological parameters including immune cell phenotype and function, cytokines, and other immune and inflammatory markers were assessed in multiple tissue compartments (blood, spleen, lymph nodes and tumor) in the included studies. Results from preclinical and clinical studies suggest that both PA and ER exert heterogeneous effects on circulating factors and systemic immune responses. PA + ER alters the gene expression profile and immune infiltrates in the tumor which may result in a reduction in immune suppressive factors. However, additional studies are needed to better understand the effect of PA and/or ER on immunomodulation, particularly in the tumor microenvironment (TME).
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Affiliation(s)
- Yitong Xu
- Intercollege Graduate Degree Program in Integrative and Biomedical Physiology, Huck Institutes of the Life Sciences, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
| | - Connie J. Rogers
- Department of Nutritional Sciences, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Center for Molecular Immunology and Infectious Disease, Huck Institutes of the Life Sciences, The Pennsylvania State University, University Park, PA, USA
- Penn State Cancer Institute, Hershey, PA, USA
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Burse NR, Bhuiyan N, Mama SK, Schmitz KH. Physical activity barriers and resources among black women with a history of breast and endometrial cancer: a systematic review. J Cancer Surviv 2020; 14:556-577. [PMID: 32240461 PMCID: PMC8258672 DOI: 10.1007/s11764-020-00873-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 03/04/2020] [Indexed: 12/31/2022]
Abstract
Physical inactivity is a significant public health problem among black women. However, there is limited evidence regarding barriers to physical activity and the availability of opportunities to engage in physical activity, specifically for posttreatment black women with a history of cancer. PURPOSE The purpose of this paper was to systematically review, summarize, and synthesize findings on physical activity-related research including barriers, facilitators, and resources for physical activity among posttreatment black women with a history of breast and endometrial cancer. METHODS We developed a comprehensive search strategy and conducted searches in the following databases: PsycINFO, Web of Science, Cochrane, PubMed, and Sociological Abstracts. Summary measures were described qualitatively (e.g., themes) and quantitatively (e.g., frequencies). RESULTS This review identified 35 eligible articles describing 12 intervention and 23 observational studies. We described intervention preferences (e.g., resistance activities), beliefs about physical activity, and benefits of physical activity for quality of life (e.g., improvements in social wellbeing) in black cancer survivors. In addition, very few studies identified barriers to physical activity (n = 7) and focused on increasing physical activity (n = 12) among black women with a history of cancer. The most common reported barriers among the target population were fatigue, lack of social support, weather, illness/health issues, cost, time constraints, living too far away, and inability/unwillingness to obtain physician clearance, whereas the most common facilitators were faith, other health concerns, and social support. CONCLUSIONS/IMPLICATIONS Future studies should target barriers, facilitators, and culturally adapted strategies for physical activity at all levels of influence to develop multi-level interventions to engage and improve physical activity among black women with a history of breast and endometrial cancer. PROTOCOL REGISTRATION NUMBER CRD42018110008.
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Affiliation(s)
- Natasha R Burse
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA.
| | - Nishat Bhuiyan
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Scherezade K Mama
- Department of Kinesiology, The Pennsylvania State University, University Park, State College, PA, USA
| | - Kathryn H Schmitz
- Department of Public Health Sciences, The Pennsylvania State University College of Medicine, Hershey, PA, USA
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Xiao C, Beitler JJ, Higgins KA, Chico CE, Withycombe JS, Zhu Y, Zhao H, Lin IH, Li F, Jeon S, Irwin M, Bruner DW, Miller AH, Gary R. Pilot study of combined aerobic and resistance exercise on fatigue for patients with head and neck cancer: Inflammatory and epigenetic changes. Brain Behav Immun 2020; 88:184-192. [PMID: 32330594 PMCID: PMC7415514 DOI: 10.1016/j.bbi.2020.04.044] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 12/29/2022] Open
Abstract
This pilot study examined whether a combined aerobic resistance exercise program reduced fatigue and the potential inflammatory and epigenetic mechanisms in patients with head and neck cancer (HNC) receiving intensity-modulated radiotherapy. The exercise group (N = 12) received a 3-month supervised aerobic resistance exercise intervention that was initiated before a 6-week radiotherapy regimen; the control group (N = 14) received standard care. Fatigue was measured using Multidimensional Fatigue Inventory-20; physical function measures included a 6-minute walk distance (6MWD), chair stands, bicep curls, and hand grip strength. Inflammatory markers and DNA methylation data were acquired using standardized protocol. Patients were mostly white (93%) and male (81%) with a mean age of 57 years. At the end of the intervention, the exercise group had a marginal decrease in fatigue compared with the control (-5.0 vs. 4.9; P = 0.10). The exercise group had a significantly greater improvement in 6MWD (29.8 vs. -55.5 m; P = 0.04), and a marginally smaller decline in hand grip (-0.3 vs. -5.8 lbs; P = 0.05) at the end of the intervention than the control. No significant difference in inflammatory markers was observed between groups. Lower plasma interleukin (IL) 6, IL1 receptor antagonist, tumor necrosis factor α (TNFα), soluble TNF receptor II and C-reactive protein were significantly associated with increased 6MWD, chair stand, and bicep curl at the end of the intervention (p < 0.05). Among the 1152 differentially methylated sites (DMS) after intervention (p < 0.001), 163 DMS were located in gene promoter regions. Enrichment analysis suggested that the top 10 upstream regulators were associated with tumor (HNF4A, RPP38, HOXA9, SAHM1, CDK7, NDN, RPS15) and inflammation (IRF7, CRKL, ONECUT1). The top 5 diseases or functions annotations of the 62 hypermethylated DMS indicated anti-tumor and anti-inflammatory effects that might be linked to exercise. These findings suggest that exercise may improve physical performance and reduce fatigue, which could be further linked to decreased inflammation, during active radiotherapy for HNC patients. Larger studies are warranted.
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Affiliation(s)
- Canhua Xiao
- School of Nursing, Yale University, 400 West Campus Drive, Orange 06477, United States.
| | - Jonathan J. Beitler
- Department of Radiation, School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta, 30322, United States
| | - Kristin A. Higgins
- Department of Radiation, School of Medicine, Emory University, 1520 Clifton Road NE, Atlanta, 30322, United States
| | - Cynthia E Chico
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Janice S Withycombe
- School of Nursing, Clemson University, 508 Edward’s, Clemson, SC 29634, United States
| | - Ying Zhu
- State Key Laboratory of Medical Neurobiology and MOE Frontier Center for Brain Science, Institutes of Brain Science, Fudan University, Shanghai, China 200433
| | - Hongyu Zhao
- Department of Epidemiology and Public Health, School of Medicine, Yale University, 300 George Street, New Haven, CT 06510, United states
| | - I-Hsin Lin
- Yale Center for Analytical Sciences, School of Public Health, Yale University, 300 George Street, New Haven, CT 06510, United states
| | - Fangyong Li
- School of Public Health, Yale University, 60 College St, New Haven, CT 06510, United states
| | - Sangchoon Jeon
- School of Nursing, Yale University, 400 West Campus Drive, Orange, 06477, United states
| | - Melinda Irwin
- School of Public Health, Yale University, 60 College St, New Haven, CT 06510, United states
| | - Deborah W. Bruner
- School of Nursing, Emory University, 1520 Clifton Road NE, Atlanta, 30322, United states
| | - Andrew H. Miller
- Department of Psychiatry and Behavioral Sciences, School of Medicine, Emory University, 1365-B Clifton Road, Atlanta, GA 30322, United States
| | - Rebecca Gary
- School of Nursing, Yale University, 400 West Campus Drive, Orange, 06477, United states
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Schaffer K, Panneerselvam N, Loh KP, Herrmann R, Kleckner IR, Dunne RF, Lin PJ, Heckler CE, Gerbino N, Bruckner LB, Storozynsky E, Ky B, Baran A, Mohile SG, Mustian KM, Fung C. Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer. J Natl Compr Canc Netw 2020; 17:57-63. [PMID: 30659130 DOI: 10.6004/jnccn.2018.7082] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Background: Exercise can ameliorate cancer- and treatment-related toxicities, but poor adherence to exercise regimens is a barrier. Exercise interventions using digital activity trackers (E-DATs) may improve exercise adherence, but data are limited for patients with cancer. We conducted a systematic review examining the feasibility of E-DATs in cancer survivors and effects on activity level, body composition, objective fitness outcomes, health-related quality of life (HRQoL), self-reported symptoms, and biomarkers. Methods: We identified randomized controlled trials (RCTs) of E-DATs in adult cancer survivors published in English between January 1, 2008, and July 27, 2017. Two authors independently reviewed article titles (n=160), removed duplicates (n=50), and reviewed the remaining 110 articles for eligibility. Results: A total of 12 RCTs met eligibility criteria, including 1,450 patients (mean age, 50-70 years) with the following cancers: breast (n=5), colon or breast (n=2), prostate (n=1), acute leukemia (n=1), or others (n=3). Duration of E-DATs ranged from 4 to 24 weeks, and the follow-up period ranged from 4 to 52 weeks, with retention rates of 54% to 95%. The technology component of E-DATs included pedometers (n=8); pedometers with smartphone application (n=1), Wii Fit (n=1), heart rate monitor (n=1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n=1). Adherence by at least one measure to E-DATs was >70% in 8 of 8 RCTs. Compared with controls, E-DATs significantly improved patients' step count in 3 of 5 RCTs, activity level in 6 of 9 RCTs, and HRQoL in 7 of 9 RCTs (all P≤05), with no significant changes in biomarkers (eg, interleukin 6, tumor necrosis factor α, C-reactive protein, c-peptide, lipid panel) in 3 RCTs. Duration of E-DAT was not significantly correlated with adherence or study retention. Conclusions: This systematic review shows that E-DATs are feasible to implement in cancer survivors. Future research should examine the optimal type, dose, and schedule of E-DATs for cancer survivors.
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Abdel-Qadir H, Thavendiranathan P, Austin PC, Lee DS, Amir E, Tu JV, Fung K, Anderson GM. The Risk of Heart Failure and Other Cardiovascular Hospitalizations After Early Stage Breast Cancer: A Matched Cohort Study. J Natl Cancer Inst 2020; 111:854-862. [PMID: 30715404 PMCID: PMC6695318 DOI: 10.1093/jnci/djy218] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 09/06/2018] [Accepted: 11/21/2018] [Indexed: 12/20/2022] Open
Abstract
Background Data are limited regarding the risk of heart failure (HF) requiring hospital-based care after early stage breast cancer (EBC) and its relationship to other types of cardiovascular disease (CVD). Methods We conducted a population-based, retrospective cohort study of EBC patients (diagnosed April 1, 2005–March 31, 2015) matched 1:3 on birth-year to cancer-free control subjects. We identified hospitalizations and emergency department visits for CVD through March 31, 2017. We used cumulative incidence function curves to estimate CVD incidence and cause-specific regression models to compare CVD rates between cohorts. All statistical tests were two-sided. Results We identified 78 318 EBC patients and 234 954 control subjects. The 10-year incidence of CVD hospitalization was 10.8% (95% confidence interval [CI] = 10.5% to 11.1%) after EBC and 9.1% (95% CI = 8.9% to 9.2%) in control subjects. Ischemic heart disease was the most common reason for CVD hospitalization after EBC. After regression adjustment, the relative rates compared with control subjects remained statistically significantly elevated for HF (hazard ratio [HR] = 1.21, 95% CI = 1.14 to 1.29, P < .001), arrhythmias (HR = 1.31, 95% CI = 1.23 to 1.39, P < .001), and cerebrovascular disease (HR 1.10, 95% CI = 1.04 to 1.17, P = .002) hospitalizations. It was rare for HF hospital presentations (2.9% of cases) to occur in EBC patients without recognized risk factors (age >60 years, hypertension, diabetes, prior CVD). Anthracycline and/or trastuzumab were used in 28 950 EBC patients; they were younger than the overall cohort with lower absolute rates of CVD, hypertension, and diabetes. However, they had higher relative rates of CVD in comparison with age-matched control subjects. Conclusions Atherosclerotic diagnoses, rather than HF, were the most common reasons for CVD hospitalization after EBC. HF hospital presentations were often preceded by risk factors other than chemotherapy, suggesting potential opportunities for prevention.
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Affiliation(s)
| | | | - Peter C Austin
- See the Notes section for the full list of authors' affiliations
| | - Douglas S Lee
- See the Notes section for the full list of authors' affiliations
| | - Eitan Amir
- See the Notes section for the full list of authors' affiliations
| | - Jack V Tu
- See the Notes section for the full list of authors' affiliations
| | - Kinwah Fung
- See the Notes section for the full list of authors' affiliations
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Kang XY, Xu QY, Yu Z, Han SF, Zhu YF, Lv X. The effects of physical activity on physiological markers in breast cancer survivors: A meta-analysis. Medicine (Baltimore) 2020; 99:e20231. [PMID: 32443355 PMCID: PMC7253498 DOI: 10.1097/md.0000000000020231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To systematically evaluate the effects of physical activity on physiological markers in breast cancer survivors. METHODS A systematic search of the PubMed, Wed of Science, Medline, CNKI and Wanfang Database was performed to identify eligible randomized controlled trials to explore physical activity on physiological markers in breast cancer survivors. STATA version 13.0 (Stata Corp LP, College Station, TX) was used for all statistical analyses. RESULTS A total of 11 articles with 941 cases were eligible in this meta-analysis. The results of the meta-analysis showed that physical activity could decrease the levels of insulin (SMD = -1.90, 95%CI: -3.2 to -0.60; I = 92.3%, P < .001), insulin-like growth factor 1 (IGF-I) (WMD = -4.67, 95%CI: -23.14 to 13.79; I = 96.2%, P < .001), insulin-like growth factor binding protein-3 (IGFBP-3) (WMD = -20.09, 95%CI: -47.15 to 6.97; I = 93.3%, P < .001). However, compared with the control group, there was not the significant change of insulin-like growth factor 2 (IGF-II), insulin-like growth factor binding protein-1 (IGFBP-1), leptin, adiponectin, glucose, C-reactive protein (CRP), Interleukin-6 (IL-6), Interleukin-10 (IL-10), and tumor necrosis factor alpha (TNF-ɑ) levels after the intervention. CONCLUSIONS Physical activity could improve the insulin function that might be associated with decreasing the levels of IGF-I, IGFBP-3 and insulin in breast cancer survivors.
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Affiliation(s)
- Xin-Yao Kang
- Fourth Wards of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang
| | - Qun-Ying Xu
- Department of Breast Surgery, The First People's Hospital of Fuyang Hangzhou
| | - Ze Yu
- Department of Clinical Laboratory, People's Hospital of Shengzhou, Zhejiang Province, China
| | - Shu-Fang Han
- Fourth Wards of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang
| | - Yu-Fang Zhu
- Fourth Wards of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang
| | - Xin Lv
- Fourth Wards of General Surgery, Shengzhou People's Hospital (the First Affiliated Hospital of Zhejiang University Shengzhou Branch, Zhejiang
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Kim SH, Song YK, Han J, Ko YH, Lee H, Kang MJ, Park H, Lee H, Kim S. Pro-inflammatory Cytokine Levels and Cancer-related Fatigue in Breast Cancer Survivors: Effects of an Exercise Adherence Program. J Breast Cancer 2020; 23:205-217. [PMID: 32395379 PMCID: PMC7192752 DOI: 10.4048/jbc.2020.23.e22] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 03/19/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study aimed to determine the effect of an exercise intervention on subjective cancer-related fatigue (CRF) and pro-inflammatory cytokine levels in breast cancer survivors (BCS). Methods BCS with greater than moderate CRF (≥ 4) were recruited and randomly assigned to experimental or control groups. The experimental group participated in a 12-week exercise adherence program (Better Life after Cancer - Energy, Strength, and Support; BLESS). Interleukin (IL)-6 and tumor necrosis factor-α (TNF-α) levels were determined at 3 time points (M1: baseline, M2: post-intervention, and M4: 6 months after intervention). Subjective fatigue was measured using the Korean version of the revised Piper Fatigue Scale. Results In this analysis of participants with physiological fatigue measures available (19 experimental, 21 control), there were no statistically significant differences in IL-6 (F = 1.157, p = 0.341), TNF-α levels (F = 0.878, p = 0.436), and level of fatigue (F = 2.067, p = 0.118) between the 2 groups at baseline. Fatigue in the experimental group showed statistically significant improvement compared to the control only at M2 (p = 0.022). There was no significant relationship between subjective and physiological fatigue at the 3 measurement points. Conclusion The BLESS intervention improved CRF in BCS immediately at post-intervention, and this study presents clinical feasibility for the management of CRF in BCS in the early survivorship phase who are already experiencing fatigue.
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Affiliation(s)
- Sung Hae Kim
- Department of Nursing, College of Health. Welfare and Education, Tongmyong University, Busan, Korea
| | - Yoon Kyung Song
- Department of Sports Industry Studies, Yonsei University, Seoul, Korea
| | - Jeehee Han
- College of Nursing, Yonsei University, Seoul, Korea
| | - Yun Hee Ko
- College of Nursing, Yonsei University, Seoul, Korea
| | - Hyojin Lee
- College of Nursing, Yonsei University, Seoul, Korea
| | - Min Jae Kang
- Department of Sports Industry Studies, Yonsei University, Seoul, Korea
| | - Hyunki Park
- Biobehavioral Center, Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea
| | - Hyangkyu Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
| | - Sue Kim
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Korea
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Knoerl R, Gilchrist L, Kanzawa-Lee GA, Donohoe C, Bridges C, Lavoie Smith EM. Proactive Rehabilitation for Chemotherapy-Induced Peripheral Neuropathy. Semin Oncol Nurs 2020; 36:150983. [DOI: 10.1016/j.soncn.2019.150983] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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LEE B, CHUNG W. Effects of Aerobic Exercise on Cytokine Expression in a Breast Cancer Mouse Model. IRANIAN JOURNAL OF PUBLIC HEALTH 2020; 49:14-20. [PMID: 32309219 PMCID: PMC7152642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Regular physical activity lowers or prevents the risk of heart disease, diabetes, some cancers, the development of hypertension, and death from these diseases through a reduction in inflammation. Cytokines, such as interleukin (IL)-6, IL-18, tumor necrosis factor-alpha (TNF-α), and C-reactive protein (CRP) are major markers representing the inflammatory process. This study aimed to investigate cytokine mRNA expression levels of IL-6, IL-18, TNF-α, and CRP in hepatocytes from breast cancer xenograft mice with or without moderate exercise. METHODS Each of the 5 mice at SP Korea Company, Seoul, Korea in 2015 were randomly divided into 3 groups: control (CTL), breast cancer (BC), and breast cancer exercise (BCEX). The inflammatory markers were analyzed in 10-week-old female Balb/C nude mice hepatocytes (n = 15; CTL = 5, BC = 5, BCEX = 5). Moderate intensity physical activity in mice was performed on a treadmill at an intensity of 18 m/min for 12 weeks, at 30 min for 5 days per week. RESULTS IL-6, IL-18, TNF-α, and CRP mRNA expression levels of the BCEX group were significantly decreased compared to those of the BC group (P < 0.05), with no difference to the CTL group. CONCLUSION There might be a reduced inflammatory process via a reduction in TNF-α, IL-6, IL-18, and CRP expression in breast cancer mice that were subjected to moderate intensity exercise.
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Wang Y, Jin B, Paxton RJ, Yang W, Wang X, Jiao Y, Yu C, Chen X. The effects of exercise on insulin, glucose, IGF-axis and CRP in cancer survivors: Meta-analysis and meta-regression of randomised controlled trials. Eur J Cancer Care (Engl) 2019; 29:e13186. [PMID: 31823458 DOI: 10.1111/ecc.13186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 08/19/2019] [Accepted: 10/14/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between physical activity and biological mediators of cancer recurrence and survival. METHODS We conducted a comprehensive literature search of PubMed, ScienceDirect and Web of Science for randomised controlled trials examining the association between physical activity and C-reactive protein (CRP), glucose, insulin, insulin resistance and insulin growth factor-one (IGF-1) up to December 2017. Standardised mean difference (SMD) scores were calculated, and meta-regression was performed. RESULTS The meta-analysis indicated that survivors randomised to physical activity conditions experienced greater improvements in Insulin (SMD = -0.59; 95% CI, -1.05 to -0.14), CRP (SMD = -0.52; 95% CI, -0.87 to -0.17), insulin resistance (SMD = -0.20; 95% CI, -0.41 to -0.003) and glucose (SMD = -0.19; 95% CI, -0.35 to -0.02) than survivors randomised to control conditions. The meta-regression showed that study duration was positively, albeit marginally related (p = .056) to change in CRP levels among survivors in the physical activity conditions. Furthermore, higher baseline insulin levels in the physical activity conditions were associated with improving insulin levels throughout the intervention (p = .007). CONCLUSIONS Promoting physical activity throughout the survivorship continuum is an effective intervention strategy for improving levels of insulin, glucose control, insulin resistance and CRP among cancer survivors.
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Affiliation(s)
- Yafeng Wang
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Ben Jin
- Department of Urology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Raheem J Paxton
- Department of Community Medicine and Population Health, The University of Alabama, Tuscaloosa, AL, USA
| | - Weili Yang
- Department of Pediatric Surgery, The Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xirui Wang
- Department of Epidemiology and Biostatistics, Xi'an Jiaotong University, Xi'an, China
| | - Yurui Jiao
- Department of endocrinology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Health Sciences, Wuhan University, Wuhan, China
| | - Xiong Chen
- Department of Endocrinology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Bekhet AH, Abdallah AR, Ismail HM, Genena DM, Osman NA, El Khatib A, Abbas RL. Benefits of Aerobic Exercise for Breast Cancer Survivors: A Systematic Review of Randomized Controlled Trials. Asian Pac J Cancer Prev 2019; 20:3197-3209. [PMID: 31759342 PMCID: PMC7063018 DOI: 10.31557/apjcp.2019.20.11.3197] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background: Physical exercise may be beneficial to breast cancer (BC) survivors. Here, we systematically summarized the effects of aerobic exercise in BC survivors. We conducted a systematic review of randomized controlled trials (RCTs). Methods: We searched PubMed, Web of knowledge, Scopus, Cochrane Central, Virtual Health Library and PEDRO databases for relevant RCTs, comparing aerobic exercise with usual care among BC survivors. Data were extracted and evidence was synthesized narratively. Results: Twelve studies were included in this systematic review. Studies reported that aerobic exercise can significantly improve the quality of life in BC survivors. Moreover, aerobic exercise alleviated the symptoms of depression and anxiety. However, current evidence from the included studies showed that there was no significant benefit for aerobic exercise in terms of weight loss. Conclusion: Our study suggests that aerobic exercise is beneficial to BC survivors. Clinical Relevance: Aerobic exercise should be recommended in the therapeutic and rehabilitative regimens of BC survivors.
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Affiliation(s)
- Amira Hassan Bekhet
- Faculty of Physical Therapy, Cairo University, Cairo, Egypt.,Medical Research Group of Egypt, Cairo, Egypt
| | | | - Horeya M Ismail
- Medical Research Group of Egypt, Cairo, Egypt.,Cancer Research Cluster, Alexandria, University, Alexandria, Egypt
| | - Doaa M Genena
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Nermin A Osman
- Medical Research Institute, Alexandria University, Alexandria, Egypt
| | - Ayman El Khatib
- Department of Physical therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Rami Labib Abbas
- Department of Physical therapy, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
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Exercise training, circulating cytokine levels and immune function in cancer survivors: A meta-analysis. Brain Behav Immun 2019; 81:92-104. [PMID: 31454519 DOI: 10.1016/j.bbi.2019.08.187] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 08/06/2019] [Accepted: 08/21/2019] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Anti-cancer therapies lead to chronic non-resolving inflammation and reduced immune function. One potential therapy is exercise training, but the effectiveness of these interventions to improve immune-related outcomes, the gaps in the literature, and recommendations to progress the field need to be determined. OBJECTIVES (1) to conduct separate meta-analyses in cancer survivors to determine the effects of exercise training on pro- and anti-inflammatory markers, and immune cell proportions and function; and (2) to perform subgroup analyses to determine whether exercise modality, cancer type, and specific markers help to explain heterogeneity in each meta-analysis. DATA SOURCES Electronic databases (PubMed/MEDLINE, EMBASE, CENTRAL, and CINAHL) from inception to March 2018. The reference lists of eligible articles and relevant reviews were also checked. STUDY SELECTION Inclusion criteria were adult cancer survivors from randomized controlled trials performing structured exercise intervention (aerobic, resistance or combined training or Tai Chi/yoga) compared to usual care control group and included pro-inflammatory, anti-inflammatory, and/or immune cell outcomes. APPRAISAL AND SYNTHESIS METHODS A total of 5349 potentially eligible articles were identified, of which 26 articles (27 trials) met the inclusion criteria. Effect sizes were calculated as standardized mean differences (SMD), where <0.2 was defined as trivial, 0.2-0.3 as small, 0.4-0.8 as moderate, and >0.8 as a large effect. RESULTS Exercise training decreased pro-inflammatory markers (SMD: -0.2, 95% CI: -0.4, -0.1, p < 0.001). Sub-group analysis for the pro-inflammatory markers indicated that combined aerobic and resistance training had the greatest effect (SMD: -0.3, 95% CI: -0.5, -1.9, p < 0.001), that prostate (SMD: -0.5, 95% CI: -0.8, 0.1, p = 0.004) and breast cancer populations were most responsive (SMD: -0.2, 95% CI: -0.3, -0.1, p = 0.001), and that C-reactive protein (SMD: -0.5, 95% CI: -0.9, -0.06, p = 0.025) and tumor necrosis factor (SMD: -0.3, 95% CI: -0.5, -0.06, p = 0.004) were the most sensitive to change. Exercise training tended to decrease anti-inflammatory markers (p = 0.072) but had no effect on natural killer or natural killer T cell proportions or cytotoxic activity. CONCLUSIONS Exercise training reduces pro-inflammatory markers in cancer survivors, with the strongest evidence for combined training and for prostate and breast cancer survivors. Further research is warranted to determine if these changes are clinically relevant or are associated with improvements in symptoms. To strengthen future research, focusing on novel immune populations that include functional parameters and standardized reporting of key immune outcomes is recommended.
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Albergoni A, Hettinga FJ, La Torre A, Bonato M, Sartor F. The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review. SPORTS MEDICINE-OPEN 2019; 5:41. [PMID: 31512075 PMCID: PMC6739434 DOI: 10.1186/s40798-019-0214-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
Background The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. Methods This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: “Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?”. Results The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1–12) and three low levels (56% week-12, 41% year-2, 14 year-3). Conclusion The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
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Affiliation(s)
- Andrea Albergoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
| | - Florentina J Hettinga
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK.,Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Sartor
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands. .,School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK. .,College of Health & Behavioural Science, Bangor University, Bangor, UK. .,Philips Electronics Nederland B.V, HTC 34 1.011, P.O. Box WB61, 5656, AE, Eindhoven, The Netherlands.
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Lozano-Lozano M, Melguizo-Rodríguez L, Fernández-Lao C, Galiano-Castillo N, Cantarero-Villanueva I, Martín-Martín L, Arroyo-Morales M. Association Between the Use of a Mobile Health Strategy App and Biological Changes in Breast Cancer Survivors: Prospective Pre-Post Study. J Med Internet Res 2019; 21:e15062. [PMID: 31414667 PMCID: PMC6712956 DOI: 10.2196/15062] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 07/31/2019] [Accepted: 07/31/2019] [Indexed: 12/13/2022] Open
Abstract
Background There is a bidirectional relationship between chronic low-grade inflammation and cancer. Inflammatory markers, such as interleukin-6 (IL-6), have been associated with both the malignant transformation of epithelial cells and tumor progression, thus linking low-grade inflammation with a higher risk of cancer and recurrence in the survival phase. Therefore, they are considered valuable prognostic biomarkers. Knowing and finding appropriate primary prevention strategies to modify these parameters is a major challenge in reducing the risk of cancer recurrence and increasing survival. Different therapeutic strategies have shown efficacy in the modification of these and other biological parameters, but with contradictory results. There are apparently no strategies in which telemedicine, and specifically mobile health (mHealth), are used as a means to potentially cause biological changes. Objective The objectives of this study were to: (1) check whether it is feasible to find changes in inflammation biomarkers through an mHealth strategy app as a delivery mechanism of an intervention to monitor energy balance; and (2) discover potential predictors of change of these markers in breast cancer survivors (BCSs). Methods A prospective quasi-experimental pre-post study was conducted through an mHealth energy balance monitoring app with 73 BCSs, defined as stage I-IIIA of breast cancer and at least six months from the completion of the adjuvant therapy. Measurements included were biological salivary markers (IL-6 and C-reactive protein [CRP]), self-completed questionnaires (the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30, the user version of the Mobile Application Rating Scale [uMARS] and an ad hoc clinical and sociodemographic questionnaire) and physical objective measures (accelerometry, weight and height). In addition, using the logging data of the mHealth app, the rate of use (in days) was recorded during the entire experimental phase of the study. Using Stata software, a paired two-tailed t test, Pearson and Spearman correlations, and a stepwise multiple regression analysis were used to interpret the data. Results Analyzing changes in inflammatory biomarker concentrations after using the mHealth app, differences between preassessment CRP (4899.04 pg/ml; SD 1085.25) and IL-6 (87.15 pg/ml; SD 33.59) and postassessment CRP (4221.24 pg/ml; SD 911.55) and IL-6 (60.53 pg/ml; SD 36.31) showed a significant decrease in both markers, with a mean difference of –635.25 pg/ml (95% CI –935.65 to –334.85; P<.001) in CRP and –26.61 pg/ml (95% CI –42.51 to –10.71; P=.002) in IL-6. Stepwise regression analyses revealed that changes in global quality of life, as well as uMARS score and hormonal therapy, were possible predictors of change in CRP concentration after using the mHealth app. In the same way, the type of tumor removal surgery conducted, as well as changes in weight and pain score, were possible predictors of change in IL-6 concentration after using the app. Conclusions In conclusion, through the results of this study, we hypothesize that there is a possible association between an mHealth energy balance monitoring strategy and biological changes in BCSs. These changes could be explained by different biopsychosocial parameters, such as the use of the application itself, quality of life, pain, type of tumor removal surgery, hormonal treatment or obesity.
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Affiliation(s)
- Mario Lozano-Lozano
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
| | - Lucia Melguizo-Rodríguez
- Biohealth Research Institute, Granada, Spain.,Biomedical Group (BIO277), Department of Nursing, Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
| | - Irene Cantarero-Villanueva
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
| | - Manuel Arroyo-Morales
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,Sport and Health Joint University Institute, Granada, Spain.,Biohealth Research Institute, Granada, Spain.,"Cuidate" Support Unit for Oncology Patients, Granada, Spain
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Alizadeh AM, Isanejad A, Sadighi S, Mardani M, kalaghchi B, Hassan ZM. High-intensity interval training can modulate the systemic inflammation and HSP70 in the breast cancer: a randomized control trial. J Cancer Res Clin Oncol 2019; 145:2583-2593. [DOI: 10.1007/s00432-019-02996-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/05/2019] [Indexed: 12/13/2022]
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Resistance training reduces inflammation and fatigue and improves physical function in older breast cancer survivors. Menopause 2019; 25:211-216. [PMID: 28832427 DOI: 10.1097/gme.0000000000000969] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Resistance training (RT) reduces fatigue and improves physical function and quality of life (QOL) in breast cancer survivors (BCS). This may be related to reductions in systemic and tissue-specific inflammation. This pilot study examines the hypothesis that RT induces changes in systemic and tissue-specific inflammation that contribute to improvements in physical and behavioral function in postmenopausal BCS. METHODS Eleven BCS (60 ± 2 years old, body mass index 30 ± 1 kg/m, mean ± SEM) underwent assessments of fatigue (Piper Fatigue Scale), physical function, QOL (SF-36), glucose and lipid metabolism, and systemic, skeletal muscle, and adipose tissue inflammation (n = 9) before and after 16 weeks of moderate-intensity whole-body RT. RESULTS Muscle strength improved by 25% to 30% (P < 0.01), QOL by 10% (P = 0.04), chair stand time by 15% (P = 0.01), 6-minute walk distance by 4% (P = 0.03), and fatigue decreased by 58% (P < 0.01), fasting insulin by 18% (P = 0.04), and diastolic and systolic blood pressure by approximately 5% (P = 0.04) after RT. BCS with the worst fatigue and QOL demonstrated the greatest improvements (absolute change vs baseline: fatigue: r = -0.95, P < 0.01; QOL: r = -0.82, P < 0.01). RT was associated with an approximately 25% to 35% relative reduction in plasma and adipose tissue protein levels of proinflammatory interleukin (IL)-6sR, serum amyloid A, and tumor necrosis factor-α, and 75% relative increase in muscle pro-proliferative, angiogenic IL-8 protein content by 75% (all P < 0.05). BCS with the highest baseline proinflammatory cytokine levels had the greatest absolute reductions, and the change in muscle IL-8 correlated directly with improvements in leg press strength (r = 0.53, P = 0.04). CONCLUSIONS These preliminary results suggest that a progressive RT program effectively lowers plasma and tissue-specific inflammation, and that these changes are associated with reductions in fatigue and improved physical and behavioral function in postmenopausal BCS.
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The response of pre-inflammatory cytokines factors to different exercises (endurance, resistance, concurrent) in overweight men. ALEXANDRIA JOURNAL OF MEDICINE 2019. [DOI: 10.1016/j.ajme.2015.12.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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