Clinical factors associated with adherence to aerobic and resistance physical activity guidelines among cancer prevention patients and survivors

Feasibility and acceptability of a remote physical activity intervention coupled with short text messages in women with breast cancer and severe depressive or anxiety symptoms

PURPOSE

To test the feasibility and acceptability of a remote physical activity (PA) intervention coupled with motivational text messages among women experiencing severe depressive and/or anxiety symptoms during or after breast cancer (BC) treatment.

METHODS AND MATERIALS

A three-phase-single-case experimental study design (16-week) was conducted among 18 women diagnosed with BC reporting high levels of depressive and anxiety symptoms. Our intervention included behaviour change techniques (BCTs) and 2-3 supervised PA sessions per week, for at least 30 min, coupled with 4-7 weekly personalised text messages. Feasibility (satisfaction and drop-out rates), acceptability (participation rates, therapeutic alliance, and qualitative data), fidelity (quality of BCTs delivered), and the efficacy on PA level and physical fitness were assessed.

RESULTS

Participants expressed high satisfaction and reported an excellent working alliance with their kinesiologist. Notably, there was a very high participation rate (90%) along with a low dropout rate (11%). However, only 3 patients significantly increased their PA post-intervention.

CONCLUSION

This study highlighted the importance to personalise remote PA interventions for women with BC and severe depressive or anxiety symptoms. The combination of a remote PA intervention with daily text messages appears to be very suitable to increase their adherence.

Physical activity and exercise behaviour of breast cancer survivors: nationwide cross-sectional survey

OBJECTIVES

High physical activity levels have been associated with longer, healthier lifespans and improved quality of life among breast cancer survivors. The Japanese clinical guidelines for breast cancer survivors, similar to those in the USA, strongly recommend maintaining high physical activity levels. However, the extent of adherence to these guidelines among breast cancer survivors in Japan is unclear. This study aimed to assess adherence to guideline-recommended physical activities and identify associated factors.

METHODS

Self-administered questionnaires were distributed to breast cancer survivors without recurrence or metastasis from 34 facilities across Japan, with approximately 30 survivors per facility, between March 2019 and August 2020. The questionnaire collected information on participants' backgrounds, physical activity levels (assessed using the Global Physical Activity Questionnaire) and potential factors influencing their physical activity. Logistic regression analysis was performed to identify the factors associated with meeting the guideline recommendations.

RESULTS

In total, 791 patients (77.5%) were investigated, with 50.5% meeting the physical activity recommendations outlined in the guidelines. Factors associated with meeting the guideline recommendations included higher self-efficacy (OR 1.58, 95% CI 1.29 to 1.94), greater perceived social support (OR 1.54, 95% CI 1.26 to 1.89), lower annual household income (OR 1.58, 95% CI 1.07 to 2.33), relief from cancer-related symptoms through physical activity (OR 1.81, 95% CI 1.13 to 2.94) and urban location (OR 1.50, 95% CI 1.03 to 2.20).

CONCLUSIONS

Half of the breast cancer survivors in Japan did not meet the recommended physical activity levels, and several factors influencing adherence were identified.

Sedentary behavior and physical activity one year after colorectal cancer diagnosis: results from the ColoCare Study

PURPOSE

Physical activity plays key roles in colorectal cancer survivorship; however, the impact of different clinicodemographic outcomes on cross-sectional and longitudinal objectively measured physical activity 12 and 24 months post-diagnosis are unclear.

METHODS

ColoCare study participants (n = 165) wore an Actigraph GT3x accelerometer for 4-10 consecutive days to objectively assess activity levels 12 and 24 months after colorectal cancer diagnosis and resection. Associations between these clinical/demographic exposures and physical activity outcomes and longitudinal changes were determined using t-test, ANOVA F-test, and linear regression modeling, adjusting for common confounders (e.g., sex, age, stage).

RESULTS

Key physical activity and sedentary behavior variables significantly differed by demographic status, including minutes of weekly exercise by sex and age (age < 50: 364 min ± 303 min; age 50-70: 232 min ± 263 min; age > 70: 93 min ± 135 min, p < 0.001) and (%) daily sedentary time by age (age < 50: 64 ± 10%; age 50-70: 67 ± 7%; age > 70: 71 ± 7%, p = 0.003). Within the multivariate model, age was the primary measure consistently associated with activity differences. Participants who wore accelerometers 12- and 24-month post-resection (n = 52) significantly increased weekly exercise minutes (214 min ± 208 min vs. 288 min ± 316 min, p = 0.04).

CONCLUSION

Age is the primary clinicodemographic determinant separating physical activity levels in colorectal cancer survivors, and increases in exercise from 12 to 24 months are likely due to consolidation of sporadic daily physical activity into bouts of exercise.

IMPLICATIONS FOR CANCER SURVIVORS

Colorectal cancer survivors experience different volumes and changes in accelerometer-derived physical activity based on some (e.g., age) but not all (e.g., stage) clinicodemographic variables.

Effect of low- and moderate-intensity endurance exercise on physical functioning among breast cancer survivors: a randomized controlled trial

PURPOSE

Compare the effects of low-intensity and moderate-intensity exercise on physical functioning in breast cancer survivors.

METHODS

Women aged 50 + years and post-primary treatment for stage 0 to III breast cancer were randomly assigned to a 6-month low-intensity (LIG) or moderate-intensity (MIG) exercise group. Participants were instructed to walk (low- or moderate-intensity) for 30 min five days a week, followed by flexibility exercises, and do strengthening and balance exercises twice weekly. Exercise adherence was facilitated with seven individual counseling sessions tapered over six months and a Theory of Planned Behavior-based booklet. Assessments occurred at baseline, 6 months (post-intervention), and 12 months. Primary measures were PROMIS Physical Functioning, PROMIS Global Health, and six-minute walk test (6MWT).

RESULTS

Of 101 women randomized, 65 (64.4%) completed the study. No statistically significant between-group differences occurred at post-intervention or 12 months. Compared to baseline, within-group improvements in PROMIS physical functioning occurred (LIG increased from 45.87 ± 7.58 to 48.37 ± 7.13 post-intervention (p = 0.01); MIG increased from 45.26 ± 7.27 to 49.53 ± 8.80 post-intervention (p = 0.002) and 48.91 ± 9.29 at 12 months (p = 0.02)). Similarly, Global Health physical health improved (LIG increased from 46.04 ± 5.00 to 49.19 ± 5.76 post-intervention (p = 0.001); MIG increased from 45.06 ± 6.59 to 48.20 ± 7.33 post-intervention (p = 0.005) and 48.49 ± 7.89 at 12 months (p = 0.007)). 6MWT improved between post-intervention and 12 months for the LIG (469.99 ± 64.69 m to 492.19 ± 68.64 m, p = 0.008) and between baseline and post-intervention for the MIG (471.01 ± 62.69 m to 495.88 ± 66.64 m, p = 0.006).

CONCLUSION

Both low and moderate-intensity exercise led to significant improvement in physical functioning. When feasible and acceptable, prescribing low-intensity exercise can yield important benefits.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov identifier: NCT02982564.

Racial, Ethnic, and Socioeconomic Disparities in Meeting Physical Activity Guidelines among Female Breast Cancer Survivors in the United States

BACKGROUND

Cancer survivors show low physical activity participation rates in the United States. However, there are limited national-level data on disparities in the prevalence of meeting physical activity guidelines among women with and without breast cancer. We aimed to evaluate national-level trends in meeting physical activity guidelines across demographic and socioeconomic characteristics of breast cancer survivors and women without cancer.

METHODS

Data for women ≥35 years of age with and without breast cancer were obtained from the 2004 to 2018 National Health Interview Survey. We used National Health Interview Survey sample weights to generate national-level prevalence estimates and calculate absolute and relative indices of disparity for breast cancer survivors and women without cancer meeting aerobic (150 minutes/week) and muscle-strengthening guidelines (2 sessions/week) stratified by demographic (e.g., race/ethnicity) and socioeconomic (e.g., homeownership) characteristics.

RESULTS

We included 5,845 breast cancer survivors and 160,162 women without cancer. The weighted percentage of breast cancer survivors meeting aerobic guidelines was 37.7% compared with 40.9% of women without cancer. Fewer women met muscle-strengthening guidelines. There were lower proportions of women who were younger (<50-years), were non-Hispanic Black, were Hispanic, worked 35+ hours/week, or rented their home among breast cancer survivors meeting aerobic guidelines compared with women without cancer meeting aerobic guidelines.

CONCLUSIONS

Breast cancer survivors were less likely to meet physical activity guidelines compared with women without cancer. Demographic and socioeconomic disparities may exist among breast cancer survivors and women without cancer meeting physical activity guidelines.

IMPACT

Targeted interventions may be necessary to address low physical activity participation among breast cancer survivors.

Barriers and enablers of adherence to high-intensity interval training among patients with cancer: a systematic review and meta-analysis

OBJECTIVE

Physical activity confers physical and psychosocial benefits for cancer patients and decreases morbidity and mortality, but adherence varies. High-intensity interval training (HIIT) is time-efficient and may improve adherence. Our aim was to determine barriers and enablers of adherence to HIIT in patients diagnosed with cancer.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

PubMed-MEDLINE, Scopus and Web of Science.

ELIGIBILITY CRITERIA

Intervention studies including patients diagnosed with any type of cancer, who engaged in HIIT with or without co-intervention in any stage of treatment and have reported outcomes for adherence.

RESULTS

Eight hundred articles were screened and 22 were included (n=807); 19 were included in the meta-analysis (n=755). Weighted adherence to HIIT was 88% (95% CI, 81% to 94%). None of the studies reported serious adverse events. Although being a woman and having breast cancer were associated with lower adherence (p<0.05), age was not (p=0.15). Adherence was significantly lower during the treatment phase in comparison with pre- and post-treatment phases, 83% versus 94% and 96%, respectively (p<0.001). Session time of more than 60 min, when unsupervised and combined with other interventions, was associated with decreased adherence (p<0.05).

CONCLUSION

Adherence to HIIT programmes among cancer patients varies and is improved when the intervention is supervised, of shorter duration, consists of solely HIIT and not in combination with other exercise and occurs during pre- and post-treatment phases. Strategies to improve adherence to HIIT in specific subpopulations may be needed to ensure all patients with cancer are provided optimal opportunities to reap the benefits associated with physical activity.

PROSPERO REGISTRATION

CRD42023430180.

Feasibility, acceptability, and preliminary effectiveness of implementing a 12-week home-based aerobic and resistance exercise program for breast cancer patients receiving endocrine treatment in Indonesia: A mixed methods study

Objectives

To assess the feasibility, acceptability, and preliminary effectiveness of implementing a home-based aerobic and resistance exercise for patients with breast cancer receiving endocrine treatment in Indonesia.

Methods

This is a mixed methods study with concurrent design consisting of quantitative single-arm pre-post intervention and qualitative study. We recruited patients with breast cancer (N = 36) receiving endocrine treatment and assigned 12 weeks of home-based pedometer-driven walking and resistance exercises using therapeutic bands. Descriptive statistics were used to assess the feasibility (recruitment, retention, and adherence) and safety. The modified Bruce treadmill test was used to measure predicted aerobic capacity (V̇O2 peak). Quality of life and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire and fatigue severity scale. Measurements were performed at baseline and post-intervention and analyzed with the paired t-test or Wilcoxon test. Semi-structured interviews and thematic analysis were conducted post-intervention to explore patients' acceptability.

Results

The results showed a recruitment rate of 75%, retention rate of 89%, and adherence rates were 53% for aerobic and 78% for resistance exercise. No severe adverse events were reported. Post-intervention interviews identified positive attitudes toward the intervention, with low burden and high perceived benefit. Exercise duration and predicted V̇O2 peak increased significantly (+1.1 min, p = 0.001 and +2.3 ml/kg/min, p = 0.043), but no significant change was detected for Quality of Life (p > 0.050) or fatigue severity (p = 0.299).

Conclusions

A home-based aerobic and resistance exercise was feasible when implemented in the context of routine care in our study population, improving predicted aerobic capacity. Further research is required to understand limited changes to Quality of Life and fatigue and adaptations to support implementation in additional sites in Indonesia.

Resistance Exercise Participation in Community-Dwelling Older Adults in Korea: Associated Factors and Sex Differences

Background/Objectives: Despite the importance of resistance exercise in older adults, factors associated with participation remain unclear, especially regarding sex differences. This study investigated sociodemographic, behavioral, and comorbidity factors associated with insufficient resistance exercise participation among community-dwelling older adults in Korea, with analyses stratified by sex. Methods: Nationally representative cross-sectional data from 8671 participants aged ≥65 years (3758 men and 4913 women; mean age 72.8) were analyzed using the 6th-8th Korea National Health and Nutrition Examination Surveys (2014-2019). Complex-sample multivariable logistic regression identified factors associated with insufficient resistance exercise overall and by sex. Results: Women had a higher prevalence of insufficient resistance exercise than men (91.27% vs. 71.04%, p < 0.001). Older age groups, particularly those aged ≥80 years (OR: 2.39; 95% CI: 1.86-3.07), and those with lower education (OR: 1.56; 95% CI: 1.33-1.82), rural residence (OR: 1.89; 95% CI: 1.49-2.38), low household income, (OR: 1.45; 95% CI: 1.13-1.88), insufficient aerobic exercise (OR: 1.68; 95% CI: 1.46-1.94), current smoking (OR: 1.70; 95% CI: 1.26-2.29), and diabetes (OR: 1.28; 95% CI: 1.09-1.51) were independently associated with a higher likelihood of insufficient resistance exercise. The association of household income, current smoking, hypertension, and diabetes with resistance exercise adherence showed differences in sex-stratified analyses. Conclusions: Multiple sociodemographic, behavioral, and comorbid factors are linked to resistance exercise adherence among older Koreans. Tailored, sex-specific interventions are needed to promote resistance exercise in this population, informing public health strategies and further research on effective approaches for diverse older adults.

Determinants of physical activity during cancer treatment: a longitudinal exploration of psycho-cognitive variables and physician counseling

Individuals with cancer are recommended to engage in regular physical activity (PA) even during cancer therapy. The aim of this study was to explore how patient-reported physician PA counseling influences their PA intention and behavior in addition to psycho-cognitive determinants derived from the theory of planned behavior (TPB). A longitudinal study during cancer treatment was conducted among N = 115 patients with breast, prostate, or colorectal cancer (Mage = 58.0, SD = 11.5; 55.7% female). The median time since diagnosis was 2 months, and 19.1% were diagnosed with metastases. Participants provided information on PA counseling by their physicians and on psycho-cognitive variables of the TPB at three measurement points. Additionally, they wore accelerometers for seven days at baseline and three months later. Nearly half of participants (48%) reported basic PA counseling and 30% reported in-depth PA counseling. Patients in poorer health and with lower education reported significantly less in-depth counseling. In addition to patient self-efficacy in performing PA, only in-depth physician PA counseling, but not basic physician counseling, predicted intention for PA four weeks later. Patients' PA three months after baseline was predicted by patients' PA at baseline and their intention for PA. Overall, the PA level at baseline was identified as the most important predictor of PA three months later. Nevertheless, physicians seem to have the ability to increase their cancer patients' intention for PA by in-depth counseling.

Physical Activity Among Utah Cancer Survivors: Analysis From a Population-Based Statewide Survey

BACKGROUND

Regular physical activity improves cancer survivors' health-related quality of life and physical function. We estimated the proportion of Utah cancer survivors meeting U.S. Department of Health and Human Services guidelines for weekly physical activity (aerobic plus strength exercise) and identify sociodemographic, cancer, and health-related factors associated with meeting guidelines.

METHODS

Survivors randomly sampled from Utah Cancer Registry records were surveyed from 2018 to 2022 to ascertain physical activity. We calculated the percent of survivors meeting guidelines and conducted logistic regression to assess predictors of meeting guidelines. Analyses were weighted to account for complex survey sample design and nonresponse and age adjusted.

RESULTS

Among Utah cancer survivors, 20.7% (95% CI, 18.5%-23.2%) met guidelines for both aerobic activity and strength exercise. 22.4% reported no aerobic exercise in a typical week, and 59.4% reported no strength exercise. Survivors 75 or older were less likely to meet physical activity guidelines than those under 55 (adjusted odds ratio: 0.40; 95% CI, 0.25-0.65). Survivors with a bachelor's degree or higher were more likely to meet physical activity guidelines than those without a college degree. Individuals with poorer overall health were less likely to report sufficient physical activity. Individuals treated with both chemotherapy and radiation had decreased odds of meeting guidelines compared to no treatment (adjusted odds ratio: 0.54; 95% CI, 0.29-0.99).

CONCLUSIONS

Most Utah cancer survivors, and particularly those who received multiple modes of adjuvant treatment, are not participating in sufficient physical activity to improve longevity and quality of life after cancer.

Current status of research on sarcopenia in post-treatment cancer survivors in Japan:A narrative review

Sarcopenia is prevalent among 11-25% of adult cancer survivors, depending on the cancer type, although the available data on post-treatment survivors in Japan are limited. If cancer patients develop cachexia, they may experience sustained weight loss as a result, ultimately leading to sarcopenia. Conversely, some patients experience post-treatment weight gain, resulting in sarcopenic obesity. Both sarcopenia and obesity elevate the risk of cardiovascular diseases and mortality; therefore, the importance of sarcopenia prevention and management is undeniable. The Guidelines for Exercise for Cancer Survivors recommend continued physical activity. Recent studies have reported the effectiveness of multimodal interventions, combining pharmacological, nutritional, and exercise approaches, necessitating multidisciplinary care for post-treatment sarcopenia. Innovative health interventions using mobile devices have also gained attention. However, studies on sarcopenia in post-treatment cancer survivors, especially those regarding exercise interventions, remain scarce in Japan, primarily due to limited insurance coverage for such post-treatment interventions and workforce challenges. It is clear that some cancer survivors have sarcopenia, which can lead to worse survival and secondary illness. While the benefits of exercise are clear, a comprehensive approach to sarcopenia is a further challenge for the future.

Patient attitudes and experiences towards exercise during oncological treatment. A qualitative systematic review

PURPOSE

Exercise and physical activity (PA) during oncological treatment have many benefits. However, PA levels and adherence are often low. This systematic review of qualitative literature aims to explore the experience and the perceived barriers and facilitators to exercise and physical activity during treatment.

METHODS

A systematic search of the published literature was carried out in the Embase and Medline databases; full details for the protocol can be found in the Prospero database (CRD42022371206). Studies eligible for inclusion were qualitative and included participants that were either currently undergoing oncological treatment or had finished treatment within the last 6 months. The findings from each study were tabulated and synthesised into analytical themes.

RESULTS

Eighteen full texts from 309 studies met inclusion criteria with a total of 420 participants including both curative and palliative treatment intents. Four overarching themes were generated: (1) Facilitators; (2) Barriers; (3) Experience of PA/exercise and (4) Transforming attitudes. Sub-themes that showed perceptions of PA or exercise during treatment were positive, and seeing personal positive change was highly motivating, especially in a group class setting. Barriers included lack of support or guidance from healthcare professionals (HCPs), environmental challenges and disease burden/fear or worsening symptoms.

CONCLUSIONS

Despite having positive perceptions of exercise and PA during oncological treatment, there are significant barriers impacting participation. Lack of support from HCPs and fear of worsening symptoms were significant barriers. Future research should focus on impacting these barriers to ultimately improve PA and exercise levels in those undergoing oncological treatment.

Study protocol - assessing parkrun for walking rehabilitation for people living with, and beyond, cancer: acceptability, adherence, social support and physical function

INTRODUCTION

Due to a variety of barriers, the majority of cancer survivors do not do enough physical activity to meet current recommendations. This study will assess the feasibility of participation in parkrun walk-run events as a novel mode of community rehabilitation exercise.

METHODS

This protocol describes a single-arm intervention study with participants acting as their own controls. The study accepts adults diagnosed with any type of cancer, undergoing treatment or in remission. Participants must be able to walk and have medical clearance to exercise. A sample of 100 participants will be recruited across the Sunshine Coast over two years. Data will be collected over 9-months at 4 time points: Baseline (T1); after 4-weeks of usual daily activities and cancer management prior to parkrun participation(T2); after a 6-month parkrun intervention (T3); at 2-month follow-up (T4). The primary objectives are to assess the acceptability of, and adherence to, parkrun as rehabilitation exercise. Secondary outcomes include wellness, health-related quality of life, anxiety, depression, mood, physical function, parkrun metrics, dietary intake, and diet and exercise behaviour.

CONCLUSION

This study will be the first to examine the long-term effects of parkrun as a cancer rehabilitation modality with regard to physical function, psychosocial outcomes and dietary intake.

TRIAL REGISTRATION

Australian and New Zealand Clinical Trials Registry ACTRN12623000473662 registered 09/05/2023.Approved by UniSC Human Research Ethics Committee (A221828) and the UK parkrun Research Board. Original protocol. Authors SB, RB, HHW, MM, YK.

Cancer survivors' experiences of a physical activity program in primary care: a qualitative study

PURPOSE

This study aimed to gain insight into the experiences of, and reasons for, cancer survivors participating in a primary care PA program.

METHODS

We interviewed 17 patients from 11 Dutch GP practices. Patients were selected by purposive sampling based on their general practice, gender, educational level, motivation for PA, and change in PA. Interviews were audio recorded, transcribed verbatim, and pseudonymized for inductive thematic analysis.

RESULTS

Three domains were identified with five themes: institutional domain: GP practice; program-specific domain: content sessions and PA, and activity tracker and goal setting; individual domain: experienced benefits, and personalized care needs. Participants valued the PA program because it was offered close to home, without additional costs, and by a trusted practice nurse familiar with the patients' medical background. Activity tracker use and goal setting motivated many participants but also led to demotivation and feelings of failure in others. Reported benefits included behavior change and favorable health outcomes. Many patients expressed the need to personalize psychological support and the program's timing.

CONCLUSIONS

Access to a PA program in a primary care setting is valued for its accessibility and experienced health benefits, but also seems to meet an unmet need for support in picking up life during cancer recovery.

IMPLICATIONS FOR CANCER SURVIVORS

Primary care is important for continued care of cancer survivors. An accessible PA program in this setting may fulfil a need for not only lifestyle support but also continuing life after cancer treatment.

Home-based exercise interventions' impact on breast cancer survivors' functional performance: a systematic review

INTRODUCTION

Home-based exercise (HBE) programs can be a feasible strategy to enhance functional performance and promote physical activity (PA) in breast cancer survivors. A deeper analysis of the effects of HBE interventions, structured by HBE program type and treatment phase, is needed. This systematic review aimed to synthesize the evidence on HBE interventions' impact on breast cancer survivors' functional performance, PA levels, and program adherence rates, according to HBE intervention type and treatment phase.

METHODS

A comprehensive search of peer-reviewed articles reporting HBE interventions' effects on the outcomes of interest was performed in Pubmed, Google Scholar, EBSCO, Web of Science, Science Direct, and B-ON until January 15th, 2024. Data were synthesized according to Denton's domains to classify HBE interventions (prescription: structured vs. unstructured; Delivery method: supervised vs. facilitated vs. unsupervised) and treatment phase. Methodological quality appraisal was performed using the Effective Public Health Practice Project tool.

RESULTS

Twenty-six studies were included. Most studies conducted structured/facilitated interventions and reported positive effects on functional performance (particularly aerobic capacity), increases in PA levels, and high adherence rates (> 70%) during and post-treatment.

CONCLUSION

HBE interventions may be feasible to improve functional performance and promote physical activity among breast cancer survivors. Further studies are needed to confirm which HBE intervention type is more appropriate for each treatment phase. More evidence applying HBE interventions with different designs is required to allow the drawing of more solid conclusions. Studies exploring the effects of HBE interventions on the pre-treatment phase are needed.

Differential correlates for aerobic physical activity and resistance training: a systematic review

Worldwide, physical inactivity is a major public health concern. Both aerobic physical activity (PA) and resistance training (RT) are forms of exercise that provide numerous health benefits. The present systematic review aimed to examine the evidence among studies that have formally compared the correlates of both aerobic PA and RT in the same sample. Literature searchers were concluded in April 2022 using four common databases. Eligible studies were selected from English language peer-reviewed journals which reported at least a bivariate correlation between the correlate and aerobic PA and RT. Findings were grouped by the correlate in accordance with the capability, opportunity, motivation, behavior (COM-B) model. The analysis identified 18 studies with 16 independent samples. Overall, evidence suggest that there are many similarities between aerobic PA and RT participation. There were positive associations for both aerobic PA and RT for physical and psychological capabilities, reflective and reflexive motivation. There were mixed associations for environmental opportunities, and social opportunities had no association for aerobic PA but mixed evidence for RT. The analyses emphasized that comparative research is lacking in certain areas, principally for environmental opportunity and reflexive motivation.

Long-term efficacy of a computer-tailored physical activity intervention for prostate and colorectal cancer patients and survivors: A randomized controlled trial

BACKGROUND

Physical activity (PA) can improve the physical and psychological health of prostate and colorectal cancer survivors, but PA behavior change maintenance is necessary for long-term health benefits. OncoActive is a print- and web-based intervention in which prostate and colorectal cancer patients and survivors receive automatically generated, personalized feedback aimed at integrating PA into daily life to increase and maintain PA. We evaluated the long-term outcomes of OncoActive by examining the 12-month follow-up differences between OncoActive and a control group, and we explored whether PA was maintained during a 6-month non-intervention follow-up period.

METHODS

Prostate or colorectal cancer patients were randomly assigned to an OncoActive (n = 249) or a usual care waitlist control group (n = 229). OncoActive participants received PA advice and a pedometer. PA outcomes (i.e., ActiGraph and self-report moderate-to-vigorous intensity PA (MVPA) min/week and days with ≥30 min PA) and health-related outcomes (i.e., fatigue, depression, physical functioning) were assessed at baseline, 6 months, and 12 months. Differences between groups and changes over time were assessed with multilevel linear regressions for the primary outcome (ActiGraph MVPA min/week) and all additional outcomes.

RESULTS

At 12 months, OncoActive participants did not perform better than control group participants at ActiGraph MVPA min/week, self-report MVPA min/week, or ActiGraph days with PA. Only self-report days with PA were significantly higher in OncoActive compared to the control group. For health-related outcomes only long-term fatigue was significantly lower in OncoActive. When exploratively examining PA within OncoActive, the previously found PA effects at the end of the intervention (6 months follow-up) were maintained at 12 months. Furthermore, all PA outcomes improved significantly from baseline to 12 months. The control group showed small but non-significant improvements from 6 months to 12 months (and from baseline to 12 months), resulting in a decline of differences between groups.

CONCLUSION

The majority of previously reported significant between-group differences at 6 months follow-up were no longer present at long-term follow-up, possibly because of natural improvement in the control group. At long-term follow-up, fatigue was significantly lower in OncoActive compared to control group participants. Computer-tailored PA advice may give participants an early start toward recovery and potentially contributes to improving long-term health.

Disparities in physical activity in adolescent and young adult cancer survivors

PURPOSE

There is a growing population of adolescent and young adult (AYA, ages 15-39 at diagnosis) cancer survivors at heightened risk of chronic conditions. Moderate to vigorous physical activity level (MVPA) is an important modifiable factor associated with improved cardiovascular health. Little is known about the association of sociodemographic factors with MVPA in AYA survivors.

METHODS

Self-reported data from the National Health Interview Survey (2009-2018) were used to identify AYA cancer survivors (at least 2 years post-diagnosis) and age- and sex-matched controls. MVPA level based on sociodemographic (sex, race and ethnicity, income, education), medical (heart disease, stroke, and diabetes), and cardiovascular risk factors (BMI and smoking) was determined within and between survivors and controls using multivariable linear regression models.

RESULTS

A total of 4766 AYA cancer survivors and 47,660 controls were included. Less than half of survivors (41.9%) and controls (43.2%) met MVPA guideline recommendations, and one-third of survivors (33.4%) reported no MVPA. Black race was associated with reduced MVPA compared with White race (ratio: 0.58 (95% CI: 0.37-0.90). Household income < $50,000/year, education < high school, diagnoses of diabetes or heart disease, and current smoking were all significantly associated with reduced MVPA in AYA survivors. There were no differences in MVPA between survivors and controls by sociodemographic factors, medical history, and cardiovascular risk factors.

CONCLUSIONS AND IMPLICATIONS FOR CANCER SURVIVORS

We found disparities in MVPA in AYA cancer survivors by sociodemographic, medical, and cardiovascular risk factors. Understanding trajectories of MVPA among different sociodemographic populations is needed to identify opportunities for intervention.

Patient Comments on a Hospital- and University-Based Exercise Oncology Program

The purpose of this study was to identify referral source and patient-reported factors that promoted follow-through and participation in exercise oncology rehabilitation programs. A three question open-ended survey was administered to patients enrolled in trainer-supervised, hospital-based (n = 101), or university-based (n = 17) cancer rehabilitation program that provided 12 weeks of individualized one on one aerobic and resistance training 1-3 days per week. Significant themes for each question were as follows: Question #1. Who referred you to the program/facility? Oncology team (Χ² = 145.814 P ≤ 0.001); Question #2. What convinced you to follow through with the referral? Health, fatigue, and need for supervision (Χ² = 74.814 P ≤ 0.001); and Question #3. What motivates you to continue in the program? Personal results, getting healthy, and the trainer (Χ² = 108.729 P ≤ 0.001). In this study, oncology team referral confirms previous work. Patient follow-through and continuation appear largely self-motivated as patients' health and the attainment of health through personal results are primary motivators for continuation in the program. Question #3 responses note the importance of the trainer in maintaining continuation in an exercise oncology rehabilitation program.

Movement and health beyond care, MoviS: study protocol for a randomized clinical trial on nutrition and exercise educational programs for breast cancer survivors

BACKGROUND

Breast cancer (BC) is the most common invasive cancer in women, and exercise can significantly improve the outcomes of BC survivors. MoviS (Movement and Health Beyond Care) is a randomized controlled trial aimed to evaluate the potential health benefits of exercise and proper nutritional habits. This study aims to assess the efficacy of aerobic exercise training in improving quality of life (QoL) and health-related factors in high-risk BC.

METHODS

One hundred seventy-two BC survivor women, aged 30-70 years, non-metastatic, stage 0-III, non-physically active, 6-12 months post-surgery, and post chemo- or radiotherapy, will be recruited in this study. Women will be randomly allocated to the intervention arm (lifestyle recommendations and MoviS Training) or control arm (lifestyle recommendations). The MoviS training consists of 12 weeks of aerobic exercise training (2 days/week of supervised and 1 day/week of unsupervised exercise) with a progressive increase in exercise intensity (40-70% of heart rate reserve) and duration (20-60 min). Both arms will receive counseling on healthy lifestyle habits (nutrition and exercise) based on the World Cancer Research Fund International (WCRF) 2018 guidelines. The primary outcome is the improvement of the QoL. The secondary outcomes are improvement of health-related parameters such as Mediterranean diet adherence, physical activity level, flexibility, muscular fitness, fatigue, cardiorespiratory fitness (estimated maximal oxygen uptake), echocardiographic parameters, heart rate variability (average of the standard deviations of all 5 min normal to normal intervals (ASDNN/5 min) and 24 h very low and low frequency), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein).

DISCUSSION

This trial aims to evaluate if supervised exercise may improve QoL and health-related factors of BC survivors with a high risk of recurrence. Findings from this project could provide knowledge improvement in the field of exercise oncology through the participation of a multidisciplinary team that will provide a coordinated program of cancer care to improve healthcare quality, improve prognosis, increase survival times and QoL, and reduce the risk of BC recurrence.

TRIAL REGISTRATION

ClinicalTrials.gov  NCT04818359 . Retrospectively registered on March 26, 2021.

Barriers and facilitators to the engagement of physical activity among Black and African American cancer survivors during and after treatments

PURPOSE

To identify physical activity (PA) barriers and facilitators among Black and African American (Black/AA) cancer survivors that should be considered in future PA intervention development for this population.

METHODS

A community advisory board (CAB) of Black/AA cancer survivors and patient advocates guided in-depth qualitative interviews (n = 19) that were completed via telephone using a semi-structured interview guide. Interviews were transcribed verbatim, and data were analyzed using directed content analysis to detail a report of PA barriers and facilitators during and after cancer treatment. The CAB reviewed and interpreted these barriers and facilitators to identify the final results.

RESULTS

Survivors (n = 19) of nine different types of cancer completed interviews. PA barriers during cancer treatments included physical and psychological suffering. PA barriers after cancer treatments included social and environmental constraints (e.g., lack of access needed for PA, safety concerns, and competing priorities). PA facilitators both during and after cancer treatments included family support, faith, and support from other survivors. PA facilitators during treatment also included feeling better after doing PA, setting realistic and flexible goals, and gaining a sense of control of one's health by striving for PA goals.

CONCLUSIONS

To increase PA among Black/AA cancer survivors, PA interventions are needed that address structural barriers, include the role of faith, leverage family support, highlight the psychological benefits of PA, and use goal setting.

"OPERATION PHALCO"-Adapted Physical Activity for Breast Cancer Survivors: Is It Time for a Multidisciplinary Approach?

The international literature emphasizes the importance of physical activity (PA) in the first steps after cancer surgery. The regular practice of physical exercise causes positive adaptations on several functional capacities, with positive consequences on patients' quality of life. This project aims to evaluate the effect of a post-operative training protocol, structured by taking into account both cancer-related issues and the presence of comorbidities, on functional capacities and quality of life of breast cancer survivors. Therefore, it was necessary to create a synergy between oncologists (referring physicians), sport medicine physicians (risk stratification and exercise prescription) and kinesiologists (trainers). Thirty-five post-surgery BC patients decided on a voluntary basis to attend an online Adapted PA (APA) protocol for 4 months, twice a week (APA Group) or Usual Care Group (UC Group). Functional capacity of the APA Group significantly increased, by 13.1% (p = 0.000), whereas perceived exertion decreased by 19.7% (p = 0.020). In the same group, the general health evaluated through the questionnaire EORTC-QLQ-C30 increased (p = 0.050). No differences were found in the UC Group. Operation Phalco, creating a network between oncologists, sports medicine physicians and kinesiologists, confirms the importance of structuring a post-operative path where APA should be included as early as possible in the cancer patient care.

Exercise Interventions for Women with Ovarian Cancer: A Realist Review

Background: Despite evidence indicating the benefits of exercise interventions for women with ovarian cancer both during and following treatment, uptake is poor. There is limited research exploring the implementation of such interventions for this cohort of women. The purpose of this review was to identify implementation theories in relation to exercise interventions for women with stages I–IV ovarian cancer, both during and following treatment; to explain positive and negative contextual factors, which may help or hinder implementation; and to develop a theory on how exercise interventions for women with ovarian cancer may be implemented. Methods: This realist review sourced literature from five electronic databases: CINAHL plus, Medline, Embase, PsycINFO and Google Scholar. Methodological rigour was assessed using the relevant critical appraisal skills programme tools. Results: Nine papers were included. Two intervention stages were identified: first, optimising uptake by providing education to patients on the benefits of exercise, approaching patients when symptoms are adequately managed and offering a personalised exercise programme; second, adherence and retention are influenced by the provision of an “autoregulated” exercise programme with additional supportive infrastructure, individualised goal setting and symptom management support where required. Conclusion: Women with ovarian cancer are reluctant to engage in exercise interventions, despite the supporting evidence in terms of positive clinical outcomes. This realist review elucidates underlying mechanisms and important contextual factors that will support and guide the implementation of exercise interventions for this cohort of women.

Implementation and evaluation of a physical activity counselling programme in primary care among cancer survivors: SoDA study protocol

INTRODUCTION

Physical activity (PA) favourably affects various health outcomes in cancer survivors, but little is known about how to implement a PA programme in primary care. We therefore aim to implement and evaluate such a programme for cancer survivors in general practice.

METHODS AND ANALYSES

The Stimulation of Daily Activity study is an implementation study with a single-arm longitudinal design in 15 Dutch general practices. Patients aged ≥18 years who finished cancer treatment more than 6 months ago will be eligible for inclusion. The intervention will comprise six coaching sessions with the practice nurse in 9 months, seeking to increase PA in daily activities and using an activity tracker for goal setting and feedback. The Reach, Effectiveness, Adoption, Implementation and Maintenance framework will be used to evaluate implementation in terms of the health outcomes, extent of implementation and barriers and facilitators to implementation, using a mixed methods approach. Descriptive analyses and linear mixed model analyses will be performed on the quantitative data, while qualitative data from focus groups and interviews will be analysed by thematic analyses.

ETHICS AND DISSEMINATION

The Medical Research Ethics Committee of the University Medical Centre Groningen, the Netherlands, concluded that this study was not subject to the Dutch Medical Research Involving Human Subjects Act (registration number: 201900586). The study results will be made available to patients and general practitioners via (inter)national publications and conferences, newsletters, public summaries and via (social) media.

Correlates of physical activity among older breast cancer survivors: Findings from the Women's Health Initiative LILAC study

INTRODUCTION

Physical activity can attenuate cancer-related declines in physical functioning, improve emotional well-being, and prolong survival among older (≥65 years) breast cancer survivors. However, factors associated with physical activity among older breast cancer survivors are not well-understood.

MATERIALS AND METHODS

Participants were enrolled in the Women's Health Initiative (WHI) Life and Longevity After Cancer (LILAC) study. Descriptive statistics, multiple linear regression, and relative risk [RR] regression were used to assess the association of demographic, clinical, physical and psychosocial variables with the total duration of and participation in physical activity among postmenopausal breast cancer survivors. Age-specific correlates (65-74 years vs. 75-84 years vs. ≥85 years) of physical activity were also examined.

RESULTS

The majority of participants (n = 3710, mean age = 78.8 ± 5.9) were white (90.7%) and had in situ/localized breast cancer (78.9%). Women who had higher education (RR = 1.47 for graduate/professional school versus high school or less, 95% CI: 1.32, 1.63), higher self-rated health (RR = 1.04 for 10 point increase, 95% CI:1.02, 1.07), higher physical functioning (RR = 1.03 for 5 point increase, 95% CI: 1.02, 1.04), and higher social support (RR = 1.41 for social support all of the time versus none of the time, 95% CI: 1.01, 1.96), were more likely to engage in any physical activity. Similar results were observed for duration of physical activity. Among women aged <75, radiation therapy, but not chemotherapy, was associated with longer duration of total physical activity (adjusted difference = 19.7 min/week, 95% CI: 6.1, 33.3), but was not associated with duration among older women. The association between pain and duration of moderate/strenuous activity also differed with age: among women aged <75, those with moderate pain averaged fewer minutes of moderate/strenuous physical activity than those with no pain (adjusted difference:-14.4 min/week, 95% CI:-28.5, -0.1). However, among women aged ≥85, those with moderate pain averaged more minutes of moderate/strenuous physical activity per week than those with no pain (adjusted difference:16.6 min/week; 95% CI:2.9, 30.3).

DISCUSSION

Multiple factors were associated with physical activity among older breast cancer survivors in the WHI. Future physical activity interventions should focus on age-related (e.g., comorbidities) and treatment-related factors (e.g., radiation) as well as certain subgroups, such as women with higher symptom burden.

Decisional balance, self-leadership, self-efficacy, planning, and stages of change in adopting exercise behaviors in patients with stomach cancer: A cross-sectional study

PURPOSE

Previous studies have suggested the benefits of regular exercise in motivating the survivors of cancer; however, most survivors are insufficiently active, showing high rates of nonadherence to physical activity guidelines. Using the I-Change model, this study sought to determine the association of decisional balance and self-efficacy for exercise, planning, and self-leadership with the stages of change in exercise behavior among patients with stomach cancer.

METHODS

This cross-sectional study was conducted in February 2021 and included 145 patients diagnosed with primary stomach cancer via quota sampling in South Korea. Sociodemographics, comorbidity, decisional balance for exercise, self-efficacy for exercise, planning, self-leadership, and stages of change in exercise behavior were assessed.

RESULTS

Of the participants, 4% were in the precontemplation stage of exercise behavior, 10% contemplation, 37% preparation, 23% action, and 27% maintenance. The male sex (p = 0.043), higher self-efficacy for resisting relapse (p < 0.0001), higher coping planning (p = 0.029), and higher self-leadership for behavior awareness and volition (p = 0.023) were associated with more readiness for changes in exercise behavior.

CONCLUSIONS

From the results obtained using the I-Change model, self-efficacy for resisting relapse to previous habits, coping planning, and behavior awareness and volition were associated with more readiness for changes in exercise behavior. These findings may help reduce stomach cancer survivors' nonadherence to physical activity guidelines.

Effects from physical exercise on reduced cancer-related fatigue: a systematic review of systematic reviews and meta-analysis

BACKGROUND

Cancer-related fatigue is one of the most prevalent and distressing symptoms among cancer patients, resulting in a great cancer research challenge. Numerous systematic reviews of physical training interventions have been conducted to find the most effective approach. However, evidence remains fragmented, and in which cancer population physical training is more effective than other populations is still unclear. Thus, this study critically appraised systematic reviews and meta-analyses on physical training to reduce adults' cancer-related fatigue.

METHODS

A systematic review of systematic reviews and meta-analysis (PROSPERO: CRD42020189049), assessing the efficacy of exercise training for reducing cancer-related fatigue in adults, was conducted in PubMed, CINAHL, Cochrane Database of Systematic Reviews, and the Database of Abstracts of Reviews of Effects, and Pedro. The selected studies (standardized mean difference, SMD; 95%CI), was quantitatively pooled using a random-effects model. Heterogeneity was tested using chi-squared (Q) and I-square statistics (I²).

RESULTS

Of 1438 identified articles, 11 met the inclusion criteria, and ten were meta-analyzed. The results yielded a positive effect of physical training on fatigue in all cancer populations, SMD = -0.33 (-0.43, -0.23). Subgroup analysis based on tumor localization showed a slightly higher physical training effect on fatigue in adults with breast cancer, SMD = -0.36 (-0.57, -0.15), and prostate cancer SMD = -0.34 (-0.45, -.0.22).

CONCLUSIONS

Our analysis demonstrated some potential improvement in cancer-related fatigue in adult patients undergoing physical training during and after cancer treatments, particularly in patients with breast or prostate cancer.

Physical activity counseling to cancer patients: How are patients addressed and who benefits most?

OBJECTIVE

This study examined cancer patients' reporting on physicians' physical activity (PA) counseling, its associations with patients' PA, and comparisons of patients' and physicians' reports of the type(s) of PA counseling provided.

METHODS

Patients with breast, colorectal, or prostate cancer (n = 1206) participated in a nationwide cross-sectional study. Cancer patients' sociodemographic and treatment-related characteristics as well as self-reported PA levels (pre- and post-diagnosis) were assessed. PA counseling was queried according to the counseling steps of the 5As framework (Assess/Advise/Agree/Assist/Arrange). For a subsample (n = 135), matched patient-physician data were available.

RESULTS

Patient-reported PA counseling was categorized into "no counseling" (indicated by 20.8% of participants), "basic counseling" (Assess and/or Advise; 58.8%), and "in-depth counseling" (Agree, Assist, and/or Arrange; 20.4%). "In-depth counseling" was associated with an increase in PA levels pre- to post-diagnosis. This relationship was enhanced for patients with metastases. There were low agreements between patients' and physicians' reporting of PA counseling steps.

CONCLUSION

In-depth PA counseling is rarely provided to cancer patients but seems to be required to affect PA levels. Patients often report receiving less intensive PA counseling than reported by their physician.

PRACTICE IMPLICATIONS

Physicians should be enabled to provide routine in-depth PA counseling to all patients with cancer.

Home-based Physical Activity to Alleviate Fatigue in Cancer Survivors: A Systematic Review and Meta-analysis

PURPOSE

Physical activity (PA) affects fatigue and mental health in cancer survivors favorably, but participation in PA interventions tends to be low. More participants may be reached by home-based PA owing to greater accessibility and self-monitoring. This systematic review therefore evaluated the effects of home-based PA of low to moderate intensity on symptoms of fatigue, depression, and anxiety among cancer survivors.

METHODS

PubMed, CINAHL, PsycINFO, and Web of Science were systematically searched for randomized controlled trials. We included investigations of home-based PA interventions in adults treated curatively for cancer and evaluating fatigue, depression, or anxiety as outcomes. We performed a random-effect meta-analysis for the effects of PA interventions on fatigue in the short and long terms. Subgroup analyses were performed for the frequency of counseling. Standardized mean differences (SMD) and 95% confidence intervals are reported.

RESULTS

Eleven articles comprising 1066 participants were included: 77% had a history of breast cancer; 14%, ovarian cancer; 4%, colorectal cancer; 4%, prostate cancer; and 1%, "other" cancer (not specified). Concerning the outcomes, nine articles reported on fatigue and two reported on depression or anxiety. Meta-analyses showed a significant effect of home-based PA on fatigue immediately after the intervention (SMD = 0.22 [0.06-0.37]), at 3 months' follow-up (SMD = 0.27 [0.04-0.51]), and at 6-9 months' follow-up (SMD = 0.31 [0.08-0.55]). PA interventions that used frequent counseling were associated with larger improvements in fatigue than those using no or infrequent counseling.

CONCLUSIONS

Home-based PA interventions can reduce fatigue among adult cancer survivors for up to 9 months, and frequent counseling may improve the benefits of these interventions.

A Mixed-apprOach program To help women wIth breast cancer stay actiVE (MOTIVE program): A pilot-controlled study

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.

Rapid Escalation of High-Volume Exercise during Caloric Restriction; Change in Visceral Adipose Tissue and Adipocytokines in Obese Sedentary Breast Cancer Survivors

Simple Summary

Aerobic exercise reduces risk for developing breast cancer or for breast cancer recurrence. In obese women exercise can significantly augment the effects of caloric restriction on visceral fat, reducing metabolic abnormalities and cancer. Women who are older, obese, and sedentary, especially those who have been treated for breast cancer, find it difficult to initiate and achieve the minimum or optimum levels of exercise. In a two-part pilot we found that by providing older, obese, sedentary breast cancer survivors 12 weeks of twice weekly personal training sessions, they could safely increase exercise to ≥200 min/week by 9 weeks during caloric restriction. At 24 weeks, high levels of exercise were still observed with continued behavioral support and study-provided exercise facility. Substantial improvement in visceral fat and breast cancer risk biomarkers were observed with this affordable intervention that is readily exportable to the community.

Abstract

Aerobic exercise reduces risk for breast cancer and recurrence and promotes visceral adipose tissue (VAT) loss in obesity. However, few breast cancer survivors achieve recommended levels of moderate to vigorous physical activity (MVPA) without supervision. In a two-cohort study, feasibility of 12 weeks of partially supervised exercise was started concomitantly with caloric restriction and effects on body composition and systemic risk biomarkers were explored. In total, 22 obese postmenopausal sedentary women (including 18 breast cancer survivors) with median age of 60 and BMI of 37 kg/m² were enrolled. Using personal trainers twice weekly at area YMCAs, MVPA was escalated to ≥200 min/week over 9 weeks. For cohort 2, maintenance of effect was assessed when study provided trainer services were stopped but monitoring, group counseling sessions, and access to the exercise facility were continued. Median post-escalation MVPA was 219 min/week with median 12-week mass and VAT loss of 8 and 19%. MVPA was associated with VAT loss which was associated with improved adiponectin:leptin ratio. In total, 9/11 of cohort-2 women continued the behavioral intervention for another 12 weeks without trainers. High MVPA continued with median 24-week mass and VAT loss of 12 and 29%. This intervention should be further studied in obese sedentary women.

Evolution of physical activity and body weight changes in breast cancer survivors five years after diagnosis - VICAN 2 & 5 French national surveys

Background

Regular physical activity (PA) and healthy body weight have proven benefits on survival in breast cancer (BC) survivors. We aimed to define predictors of long-term PA and weight gain in a representative sample of BC survivors.

Methods

Data were analysed from 723 women with BC who participated in both the 2012 and 2015 French National VICAN surveys.

Results

Five years after diagnosis, 26.0, 60.6, and 13.4 % of BC survivors reported regular, occasional and no PA, respectively. Moreover, 27.4 % had a weight gain ≥5 kg. In multinomial logistic regressions, regular and occasional PA were both associated with not having depressive disorders, with higher post-traumatic growth, and with a healthy and stable Body Mass Index. Occasional PA was associated with the use of non-conventional medicine, and regular PA with better mental quality of life and normal arm mobility. Weight gain ≥5 kg was associated with younger age, heavier body weight at diagnosis, and lymphedema 5 years after diagnosis.

Conclusions

Mental well-being is associated with successful long-term patient investment in PA. Psychological support and early management of disease sequelae are needed to help ensure BC survivors engage in and maintain healthy lifestyles.

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A quarter of breast cancer survivors at 5 years reported regular physical activity.

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Occasional physical activity was associated with use of non-conventional medicine.

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Mental well-being was associated with long-term investment in physical activity.

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Early sequelae managing may help survivors engage in and maintain healthy lifestyles.

Strengthening the Case for Cluster Set Resistance Training in Aged and Clinical Settings: Emerging Evidence, Proposed Benefits and Suggestions

Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations.

Special Attention to Physical Activity in Breast Cancer Patients during the First Wave of COVID-19 Pandemic in Italy: The DianaWeb Cohort

Recent evidence highlights that physical activity (PA) is associated with decreased recurrence risk, improved survival and quality of life for breast cancer (BC) patients. Our study aimed to explore patterns of increased/decreased PA, and sedentary behaviors among BC women of the DianaWeb cohort during the first wave of COVID-19 pandemic, and examined the association with residential locations, work changes, different modality used to increase PA, and quality of life. The study analyzed the questionnaires completed by the 781 BC women (age 54.68 ± 8.75 years on both December 2019 and June 2020. Results showed a decrease of 22%, 57%, and 26% for walking activity, vigorous activity, and total PA, respectively. Sitting/lying time increased up to 54.2% of the subjects recruited. High quality of life was associated with lower odds of being sedentary (p = 0.003). Our findings suggest that innovative health management fostering compliance with current guidelines for PA and active behavior should be implemented, especially in unpredictable emergency conditions.

Physical activity and cancer risk. Actual knowledge and possible biological mechanisms

Background

Scientific evidence has shown that an increase in regular physical activity is associated with a decrease in the development of many types of cancer. Potential mechanisms that link physical activity to reduced cancer risk include a decrease in systemic inflammation, hyperinsulinemia, insulin-like growth factor (IGF-I), sex hormones, pro-inflammatory leptin and other obesity-related cytokines, and a significant increase in anti-inflammatory adiponectin levels. In addition, physical activity improves immune function and the composition and diversity of the gastrointestinal microbiota. Moderate physical activity is important for cancer protection, but the most significant changes in the inflammatory profile are conferred by physical activity performed at higher intensities. Thus, there is a need for further investigation into the type, intensity, and duration of physical activity for the prevention of some types of cancer and the development of effective recommendations.

Conclusions

There is a strong evidence that physical activity of moderate to vigorous intensity protects against colon and breast cancer, and probably against cancer at all other sites.

[Cardiovascular fitness in oncology : Exercise and sport]

BACKGROUND

Malignant diseases lead to a decline in physical performance in a large number of patients. This includes a reduction of the musculoskeletal system, restrictions in cardiovascular fitness and psychogenically influenced syndromes such as fatigue and asthenia. It is not yet clear to what extent physical training can counteract these limitations or undesirable side effects and how this training needs to be designed in the individual situation.

AIM OF THIS ARTICLE

The aim of this article is to find out whether physical training can be performed in cancer patients, how this training should be designed and which physical disorders can be influenced favorably.

MATERIALS AND METHODS

In this review, the currently available work on this topic was evaluated and classified with regard to its feasibility and effects in cancer patients.

RESULTS AND DISCUSSION

Physical training can be performed without complications in most patients even under treatment for the underlying malignant disease. It has a positive effect on physical performance, cardiovascular function, the perception of one's own cancer and overall well-being. Ideally, physical training for cancer patients should include a mixture of strength and endurance training. It should be carried out regularly and its intensity should be slowly increased. The type of physical activity should be adapted to the individual needs of the patient, take into account the particularities of the malignant disease and exclude any risk to the patient.

CONCLUSION

In summary, a physical training program to accompany cancer therapy should be offered to virtually all patients with malignant disease.

Exercise shapes redox signaling in cancer

In this paper of the special issue dedicated for the Olympics 2020, we put the light on an exciting facet of exercise-oncology, which may still be unknown to some audience. Accumulating convincing evidences show that exercise reduces cancer progression and recurrence mainly in colon and breast cancer patients. Interestingly, the positive effects of exercise on cancer outcomes were mainly observed when patients practiced vigorous exercise of 6 METs or more. At the molecular level, experimental studies highlighted that regular vigorous exercise could reduce tumor growth by driving changes in immune system, metabolism, hormones, systemic inflammation, angiogenesis and redox status. In the present review, we describe the main redox-sensitive mechanisms mediated by exercise. These redox mechanisms are of particular therapeutic interest as they may explain the emerging preclinical findings proving that the association of vigorous exercise with chemotherapy or radiotherapy improves the anti-cancer responses of both interventions. Clinical and preclinical studies converge to support the practice of exercise as an adjuvant therapy that improves cancer outcomes. The understanding of the underpinning molecular mechanisms of exercise in cancer can open new avenues to improve cancer care in patients.

"Shanghuo" increases disease susceptibility: Modern significance of an old TCM theory

ETHNOPHARMACOLOGICAL RELEVANCE

"Shanghuo", a concept based on Traditional Chinese Medicine (TCM) theory, describes a status of Yin-Yang imbalance when Yang overwhelms Yin. The imbalance of Yin-Yang resembles the breaking of homeostasis and manifests by the impaired physiological functions, which leads to the onset, recurrence, and progression of diseases. Since ancient times, Chinese Materia Medica (CMM), such as herbal tea, has been applied as a treatment for "Shanghuo".

AIM OF THE STUDY

This review is aimed to describe the origin of "Shanghuo" from the Yin-Yang theory in TCM, as well as explore the relevance and correlations between "Shanghuo" and diseases susceptibility from the perspective of modern medicine. We also propose several strategies from CMM to improve the status of "Shanghuo" for the purpose of treating diseases.

METHODS

Systematic research of articles with keywords including Shanghuo, Yin-Yang, emotional stress and disease susceptibility was done by using the literature databases (Web of Science, Google Scholar, PubMed, CNKI). Related books, PhD and master's dissertations were also researched. Full scientific plant names were validated by "The Plant List" (www.theplantlist.org).

RESULTS

To date, a large number of publications have reported research on sub-health status, but studies about the theory or intervention of "Shanghuo" are rarely found. The articles we reviewed indicate that accumulated emotional stress is critical for the cause of "Shanghuo". As a status similar to sub-health, "Shanghuo" is also manifested by impaired physiological functions and decreased nonspecific resistance, which increase susceptibility to various diseases. What's more, some studies highlight the importance of TCM treatment towards "Shanghuo" in maintaining normal physiological functions, such as immunity, lipid metabolism and ROS clearance.

CONCLUSIONS

Researches on "Shanghuo" and its mechanism are every rare currently and are in need of investigation in the future. Studies on disease susceptibility recently are mostly about susceptible genes that relate to a few parts of people, however, for most of the people, accumulated emotional stress or other stressors is accountable for the susceptibility of diseases. Given that emotional stress plays an important factor in the causation of "Shanghuo", we reviewed the articles about this relevance and discussed the connection of "Shanghuo" with disease susceptibility in a novel perspective. In addition, we have reviewed the disease susceptibility model of restraint stress from its biochemical manifestation to application in CMM assessment. Although it would be a breakthrough in evaluating CMM efficacy of attenuating disease-susceptibility, understanding the comprehensive theory and establishing more models of "Shanghuo" would be required in further investigation.