Physical activity levels before and after a diagnosis of breast carcinoma: the Health, Eating, Activity, and Lifestyle (HEAL) study

Cancer survivors maintain health benefits 6 to 12 months after exercise-based rehabilitation: a systematic review and meta-analysis

PURPOSE

To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months.

METHODS

Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied.

RESULTS

Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I2 = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I2 = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I2 = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I2 = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I2 = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I2 = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence.

CONCLUSION

Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation.

[Self-sense and experiences of physical activity in breast cancer survivors: Qualitative evidence synthesis]

Breast cancer has a high incidence rate and a negative impact on women's lives. The practice of physical activity (PA) has shown strong evidence in controlling the side effects associated with the disease and its treatment. However, having an active lifestyle is influenced by socio-health inequities. The objective was to analyze the categories related to the meanings and perceived experiences with PA in breast cancer survivors (BCS). Protocol https://osf.io/7fwbs/. Articles describing the meanings of PA in BCS published after 2010 were included. Fourteen articles were analyzed using line-by-line coding. The emerging categories were: 1)PA as a strategy to re-signify and empower the body. 2)Cancer means a change in PA trajectories. 3)PA is a tool for a healthy and functional body in everyday life.

Feasibility and preliminary efficacy of a physiotherapy-led remotely delivered physical activity intervention in cancer survivors using wearable technology. The IMPETUS trial

BACKGROUND

Physical activity levels are low in cancer survivors. Remotely delivered programs which harness wearable technology may potentially be beneficial.

OBJECTIVE

To evaluate the feasibility and preliminary efficacy of a remotely delivered, physical activity intervention which harnessed wearable technology.

METHODS

This single arm pre-post longitudinal study included cancer survivors who had completed treatment in the preceding 3 years. Participants were supplied with a Fitbit One® or Flex® for 12 weeks. Physical activity goals were discussed during support phone calls. Outcome measures, assessed at baseline (T1), 12 weeks (T2), and 24 weeks (T3), included feasibility (recruitment, adherence, safety, acceptability) and efficacy [physical activity (Godin leisure time Index, ActiGraph GT3X+), quality of life (functional assessment of cancer therapy - general, short form 36 physical functioning component), functional capacity (six-minute walk test)].

RESULTS

Forty-five participants completed T1 assessments (10 males, 35 females). Thirty-nine (86.6%) of those underwent assessment at T2 and 31 (68.8%) at T3. The intervention was perceived positively with no adverse effects. There were increases in functional capacity (six-minute walk test, p = .002) between T1-T3, an increase in quality of life [short form 36 physical functioning measure (p = .0035), functional assessment of cancer total score (p = .02)] and self-report physical activity levels (p = .000123) between T1-T2, although effect sizes were generally low (d = 0.180 to d = 0.418). Objectively measured physical activity did not change.

CONCLUSION

A physical activity intervention including wearable technology was safe, feasible, and well received by cancer survivors. An intervention based on this proof of concept should be followed up in further studies.

Comparing the efficacy of a multi-dimensional breast cancer rehabilitation programme versus a home-based exercise programme during adjuvant cancer treatment

BACKGROUND

Breast cancer is the most common female malignancy worldwide and a major cause of morbidity and mortality. Exercise during adjuvant treatment improves function and relieves symptoms in breast cancer survivors. However, it is unclear if an unsupervised exercise programme may be as effective as a supervised multimodal group. We investigated the feasibility and efficacy of a centre-based multidimensional rehabilitation (MDR) programme for breast cancer survivors undergoing adjuvant treatment and compared it to an unsupervised home-based exercise (HE) programme.

METHODS

Participants were self-allocated to either MDR or HE group. MDR participants underwent 24 supervised exercise classes and 10 education classes over 12 weeks. HE participants were instructed on a home exercise regime. Outcome measures, including the 6-min walk test (6MWT) and Frenchay Activities Index (FAI), FACT-Cognitive Function scale, and European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30, were conducted at baseline (W0), post-intervention (W12) and 6-months post-intervention (M6). Variance between time points and the 2 groups were analysed using a linear mixed model (unstructured covariance matrix) and adjusted with Bonferroni.

RESULT

Twenty-five participants attended at least half of the MDR interventions, while 21 completed the HE interventions. The former showed significant improvement in 6MWT, from 406.88 m (W0) to 443.34 m (W12) to 452.81 m (M6), while the improvement in the HE group was not significant (407.67 m (W0) to 433.14 m (W12) to 430.96 m (M6)). Both groups showed a significant improvement in FAI, with earlier significant improvement noted at W12 in the MDR group (22.71 (W0) to 27.65 (W12) to 28.81 (M6)) compared to the HE group (23.16 (W0) to 26.47 (W12) to 29.85 (M6)). Dropout rate was 16% in the MDR group and 34% in HE group. Overall satisfaction with the MDR programme was high.

CONCLUSION

Both MDR and HE programmes were feasible. MDR was superior in improving endurance and earlier return to instrumental activities for those who completed at least half of the sessions. Future studies could explore use of technology to improve adherence to exercise.

TRIAL REGISTRATION

The study was registered with ClinicalTrial.gov on 01/04/2022 with the registration number NCT05306808.

Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial

BACKGROUND

Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes.

METHODS

Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression.

RESULTS

At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2-182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI-2015 (mean difference = 2.5; 95% CI, -0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA (p = .04) and higher education was associated with improved HEI-2015 (p = .001) at 1 year. Higher HEI-2015 (p = .04) and married/living with someone (p = .05) were associated with higher odds of participating in strength training at 1 year.

CONCLUSIONS

This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.

Lifestyle Factors and Breast Cancer in Females with PTEN Hamartoma Tumor Syndrome (PHTS)

Females with PTEN Hamartoma Tumor Syndrome (PHTS) have breast cancer risks up to 76%. This study assessed associations between breast cancer and lifestyle in European female adult PHTS patients. Data were collected via patient questionnaires (July 2020-March 2023) and genetic diagnoses from medical files. Associations between lifestyle and breast cancer were calculated using logistic regression corrected for age. Index patients with breast cancer before PHTS diagnosis (breast cancer index) were excluded for ascertainment bias correction. In total, 125 patients were included who completed the questionnaire at a mean age of 44 years (SD = 13). This included 21 breast cancer indexes (17%) and 39 females who developed breast cancer at 43 years (SD = 9). Breast cancer patients performed about 1.1 times less often 0-1 times/week physical activity than ≥2 times (ORtotal-adj = 0.9 (95%CI 0.3-2.6); consumed daily about 1.2-1.8 times more often ≥1 than 0-1 glasses of alcohol (ORtotal-adj = 1.2 (95%CI 0.4-4.0); ORnon-breastcancer-index-adj = 1.8 (95%CI 0.4-6.9); were about 1.04-1.3 times more often smokers than non-smokers (ORtotal-adj = 1.04 (95%CI 0.4-2.8); ORnon-breastcancer-index-adj = 1.3 (95%CI 0.4-4.2)); and overweight or obesity (72%) was about 1.02-1.3 times less common (ORtotal-adj = 0.98 (95%CI 0.4-2.6); ORnon-breastcancer-index-adj = 0.8 (95%CI 0.3-2.7)). Similar associations between lifestyle and breast cancer are suggested for PHTS and the general population. Despite not being statistically significant, results are clinically relevant and suggest that awareness of the effects of lifestyle on patients' breast cancer risk is important.

Long-Term Physical Activity and Body Composition After Exercise and Educational Programs for Breast Cancer: A Randomized Controlled Trial From the Setouchi Breast Project-10

BACKGROUND

It is unclear what interventions can sustain long-term higher physical activity (PA) to improve breast cancer outcomes. Thus, this study aimed to evaluate the long-term effects of interventions on PA after breast cancer treatment.

METHODS

This was a prospective randomized controlled trial for patients with stage 0 to III breast cancer evaluating the efficacy of exercise and educational programs on long-term PA compared with usual care. The primary endpoint was proportion of patients with recreational PA (RPA) ≥5 metabolic equivalents (METs)/week at 1 year after registration.

RESULTS

From March 16, 2016, to March 15, 2020, breast cancer patients were registered in the control (n = 120), education (n = 121), or exercise (n = 115) group. There were no significant differences in proportion of RPA ≥5 METs/week at 1 year between the exercise and control groups (54% and 53%, P = .492) and between the education and control groups (62% and 53%, P = .126). Significant difference in reductions from baseline at 1 year were noted on body weight (P = .0083), BMI (P = .0034), and body fat percentage (P = .0027) between education and control groups. Similarly, the exercise group showed significant difference in reduction in body fat percentage (P = .0038) compared to control group.

CONCLUSION

Although there were no significant effects on RPA 1 year after exercise and educational programs for breast cancer survivors, both interventions reduced body composition. Future studies on PA should investigate appropriate interventions to improve overall survival.

Post-diagnosis weight trajectories and mortality among women with breast cancer

Weight gain after breast cancer diagnosis is associated with adverse health outcomes. Yet, few studies have characterized post-diagnosis weight change in the modern treatment era or populations most at risk for weight changes. Among women diagnosed with stages I-III breast cancer in the Smilow Care Network (2013-2019; N = 5441), we abstracted demographic and clinical characteristics from electronic health records and survival data from tumor registries. We assessed if baseline characteristics modified weight trajectories with nonlinear multilevel mixed-effect models. We evaluated body mass index (BMI) at diagnosis and weight change 1-year post-diagnosis in relation to all-cause and breast cancer-specific mortality with Cox proportional hazard models. Women had 34.4 ± 25.5 weight measurements over 3.2 ± 1.8 years of follow-up. Weight gain was associated with ER/PR-, HER2+ tumors, BMI ≤ 18.5 kg/m2, and age ≤ 45 years (+4.90 kg (standard error [SE] = 0.59), +3.24 kg (SE = 0.34), and +1.75 kg (SE = 0.10), respectively). Weight loss was associated with BMI ≥ 35 kg/m2 and age ≥ 70 years (-4.50 kg (SE = 0.08) and -4.34 kg (SE = 0.08), respectively). Large weight loss (≥10%), moderate weight loss (5-10%), and moderate weight gain (5-10%) 1-year after diagnosis were associated with higher all-cause mortality (hazard ratio [HR] = 2.93, 95% confidence interval [CI] = 2.28-3.75, HR = 1.32, 95% CI = 1.02-1.70 and HR = 1.39, 95% CI = 1.04-1.85, respectively). BMI ≥ 35 kg/m2 or BMI ≤ 18.5 kg/m2 at diagnosis were also associated with higher all-cause mortality. Weight change after a breast cancer diagnosis differed by demographic and clinical characteristics highlighting subgroups at-risk for weight change during a 5-year period post-diagnosis. Monitoring and interventions for weight management early in clinical care are important.

Barriers and facilitators for weight management interventions in breast cancer patients: a systematic review of qualitative studies

INTRODUCTION

This systematic review and meta-synthesis of qualitative studies provides an overview of barriers and facilitators that breast cancer patients experience in weight management interventions.

METHODS

We included qualitative studies describing barriers and facilitators for weight management interventions as experienced by adult breast cancer patients after the completion of initial treatment . The data was extracted and using thematic analysis.

RESULTS

After analysis, eleven themes were determined. Six of those themes could be linked to the Attitude, Social Influence and self Efficacy (ASE)-model. Physical and mental benefits, anticipated regret and a lack of motivation were linked to attitude. Integrating a weight management programme in daily life, stigma and fears were linked to self-efficacy. With regard to the social influence determinant, encouragement and discouragement by family members were developed as a theme. Four additional themes were conducted related to weight management behaviour; external barriers, economic barriers, cultural barriers and physical barriers. In addition, integrating weight management in cancer care was described as a separate theme.

CONCLUSIONS

Several disease specific issues, including feeling stigmatized after cancer treatment and treatment-related side effects and peer-support should be given specific attention to maximize adherence of weight management programmes.

Potential involvement of neutrophils on exercise effects in breast cancer malignancy

PURPOSE

This review aimed to comprehensively explore and elucidate multifaceted neutrophils in breast cancer, particularly in the context of physical activity. Neutrophils play a critical role in the tumor microenvironment and systemic immune response, despite their short half-life and terminal differentiation. Through a thorough review of research related to changes in immunity in breast cancer during exercise, this review aims to provide comprehensive insights into immunological changes, especially focusing on neutrophils. Recognizing that much of the existing research has predominantly focused on T cells and nature killer (NK) cells, our review seeks to shift the spotlight toward understanding how exercise affects neutrophils, a less-explored but critical immune response component in breast cancer.

METHODS

This study involved an extensive review of the literature (from 2000 to 2023) using the PubMed, Science Direct, and Google Scholar databases. The keywords chosen for the searches were "immune cells and exercise," "exercise and breast cancer," "tumor microenvironment and neutrophils," and "neutrophils and exercise and breast cancers."

RESULTS

Neutrophils in the tumor microenvironment can exhibit distinct phenotypes and functions. These differences have yielded conflicting results regarding tumor progression. Exercise plays a positive role in breast cancer and alters the immune system. Physical activity can quantitatively and functionally regulate neutrophils under various conditions such as metabolic disruption or senescence.

CONCLUSION

This short communication outlines exercise-induced neutrophil diversification and its role in breast cancer progression, both within and systemically within the tumor microenvironment. Exercise may provide benefits through the potential neutrophil involvement in breast cancer.

Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study

PURPOSE

Successful completion of chemotherapy is critical to improve breast cancer outcomes. Relative dose intensity (RDI), defined as the ratio of chemotherapy delivered to prescribed, is a measure of chemotherapy completion and is associated with cancer mortality. The effect of exercise and eating a healthy diet on RDI is unknown. We conducted a randomized trial of an exercise and nutrition intervention on RDI and pathologic complete response (pCR) in women diagnosed with breast cancer initiating chemotherapy.

METHODS

One hundred seventy-three women with stage I-III breast cancer were randomly assigned to usual care (UC; n = 86) or a home-based exercise and nutrition intervention with counseling sessions delivered by oncology-certified registered dietitians (n = 87). Chemotherapy dose adjustments and delays and pCR were abstracted from electronic medical records. T-tests and chi-square tests were used to examine the effect of the intervention versus UC on RDI and pCR.

RESULTS

Participants randomly assigned to intervention had greater improvements in exercise and diet quality compared with UC (P < .05). RDI was 92.9% ± 12.1% and 93.6% ± 11.1% for intervention and UC, respectively (P = .69); the proportion of patients in the intervention versus UC who achieved ≥85% RDI was 81% and 85%, respectively (P = .44). The proportion of patients who had at least one dose reduction and/or delay was 38% intervention and 36% UC (P = .80). Among 72 women who received neoadjuvant chemotherapy, women randomly assigned to intervention were more likely to have a pCR than those randomly assigned to UC (53% v 28%; P = .037).

CONCLUSION

Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pCR in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.

The Essential Strategies to Mitigate Cardiotoxicity Caused by Doxorubicin

The study of mechanisms underlying cardiotoxicity of doxorubicin and the development of strategies to mitigate doxorubicin-induced cardiotoxicity are the most relevant issues of modern cardio-oncology. This is due to the high prevalence of cancer in the population and the need for frequent use of highly effective chemotherapeutic agents, in particular anthracyclines, for optimal management of cancer patients. However, while being a potent agent to counteract cancer, doxorubicin also affects the cardiovascular systems of patients undergoing chemotherapy in a significant and unfavorable fashion. Consecutively reviewed in this article are risk factors and mechanisms of doxorubicin cardiotoxicity, and the essential strategies to mitigate cardiotoxic effects of doxorubicin treatment in cancer patients are discussed.

Effects of a 12-week supervised resistance training program, combined with home-based physical activity, on physical fitness and quality of life in female breast cancer survivors: the EFICAN randomized controlled trial

PURPOSE

This study assessed the effects of 12-week supervised resistance training combined with home-based physical activity on physical fitness, cancer-related fatigue, depressive symptoms, health-related quality of life (HRQoL), and life satisfaction in female breast cancer survivors.

METHODS

A parallel-group, outcome assessor-blinded, randomized controlled trial included 60 female breast cancer survivors who had completed their core treatments within the previous 10 years. Through computer-generated simple randomization, participants were assigned to resistance training (RTG; two sessions/week for 12 weeks plus instructions to undertake ≥ 10,000 steps/d) or control (CG; ≥ 10,000 steps/d only). Outcomes were evaluated at baseline and week 12. Muscular strength was assessed with electromechanical dynamometry. A standardized full-body muscular strength score was the primary outcome. Secondary outcomes included cardiorespiratory fitness, shoulder mobility, cancer-related fatigue, depressive symptoms, HRQoL, and life satisfaction.

RESULTS

Thirty-two participants were assigned to RTG (29 achieved ≥ 75% attendance) and 28 to CG (all completed the trial). Intention-to-treat analyses revealed that the standardized full-body muscular strength score increased significantly in the RTG compared to the CG (0.718; 95% CI 0.361-1.074, P < 0.001, Cohen's d = 1.04). This increase was consistent for the standardized scores of upper-body (0.727; 95% CI 0.294-1.160, P = 0.001, d = 0.87) and lower-body (0.709; 95% CI 0.324-1.094, P = 0.001, d = 0.96) strength. There was no effect on cardiorespiratory fitness, shoulder flexion, cancer-related fatigue, depressive symptoms, HRQoL, or life satisfaction. The sensitivity analyses confirmed these results.

CONCLUSION

and implication for cancer survivors. In female breast cancer survivors who had completed their core treatments within the past 10 years, adding two weekly sessions of supervised resistance training to a prescription of home-based physical activity for 12 weeks produced a large increase in upper-, lower-, and full-body muscular strength, while other fitness components and patient-reported outcomes did not improve.

TRIAL REGISTRATION NUMBER

ISRCTN14601208.

Barriers, facilitators, perceptions and preferences influencing physical activity participation, and the similarities and differences between cancer types and treatment stages - A systematic rapid review

The aim of this systematic rapid review was to explore barriers, facilitators, perceptions and preferences of physical activity for people diagnosed with cancer, by cancer type and treatment stage. The search strategy, implemented through four databases, included terms relating to cancer, physical activity, barriers, facilitators, perceptions and preferences, and relevant study designs. Studies reporting the outcomes of interests for adults diagnosed with cancer and living in Western countries were included and grouped according to the Social-Ecological Model and the Health Belief Model, and pragmatically. A total of 118 studies, involving 15 cancers were included. Outcomes were most commonly explored within samples involving mixed cancers (32 studies) and breast cancer (31 studies), and at the post-treatment phase (52 studies). Across all cancers and during- and post-treatment, treatment- and disease-related side-effects were the most commonly identified barrier, social support and guidance was the most commonly identified facilitator, and promoting health and recovery was the most commonly identified perception of benefit of physical activity. Notable differences were identified in barriers, facilitators and perceptions across cancer types and treatment stages, with specific examples including: comorbidities were inconsistently reported as a barrier across cancers; time pressure was more commonly reported as a barrier post-treatment; and women with breast cancer reported inaccessibility of appropriate services more commonly during-treatment than post-treatment. Preference findings varied widely across cancer types and treatment phases. These findings can be used to aid efforts to improve physical activity levels post-cancer by providing healthcare professionals with information to facilitate individualised advice and services.

Physical Activity Levels in People with Cancer Undergoing Chemotherapy: A Systematic Review

OBJECTIVES

Physical activity (PA) has been shown to improve chemotherapy side effects, survival rates and treatment adherence in people with cancer. This review aimed to identify whether people undergoing chemotherapy in different exercise interventions meet PA guidelines during chemotherapy.

DATA SOURCES

Databases searched were CINAHL complete, PubMed, Cochrane Library, EMBASE, AMED, Joanna Briggs Institute, OVID MEDLINE, and Google Scholar. Eligibility and risk-of-bias were reviewed by two authors. PROSPERO registration: CRD42018093839.

CONCLUSION

Thirty-three studies were eligible (14 randomized controlled trials, six pre-post, and 13 cross-sectional studies), which included 2,722 people with cancer undergoing chemotherapy. Studies (n = 11/13) found PA interventions successfully increased or maintained PA participation levels, whereas PA declined without intervention. This review has identified that due to limited evidence it is not possible to determine the most appropriate intervention to improve PA for people undergoing chemotherapy. Despite the well-documented benefits of PA, most people undergoing chemotherapy do not achieve the PA guidelines. Clinicians should be aware that during treatment, participants may not meet PA guidelines even if they participate in an intervention. However, interventions may prevent PA levels from declining. Further research is required to determine the most effective approaches to increase PA levels while undergoing chemotherapy.

IMPLICATIONS FOR NURSING PRACTICE

Nurses are well placed to have conversations with patients undergoing chemotherapy regarding PA levels. PA should be considered as part of a treatment regimen. Tailored advice must be provided aiming to improve health outcomes. Referral to an exercise professional is best practice to improve the uptake of PA.

State of research, feasibility, safety, acceptability, and outcomes examined on remotely delivered exercises using technology for older adult with cancer: a scoping review

INTRODUCTION

Technology-based exercise is gaining attention as a promising strategy for increasing physical activity (PA) in older adults with cancer (OACA). However, a comprehensive understanding of the interventions, their feasibility, outcomes, and safety is limited. This scoping review (1) assessed the prevalence and type of technology-based remotely delivered exercise interventions for OACA and (2) explored the feasibility, safety, acceptability, and outcomes in these interventions.

METHODS

Studies with participant mean/median age ≥ 65 reporting at least one outcome measure were included. Databases searched included the following: PubMed, CINAHL, Embase, Cochrane Library Online, SPORTDiscus, and PsycINFO. Multiple independent reviewers completed screening and data abstractions of articles in English, French, and Spanish.

RESULTS

The search yielded 2339 citations after removing duplicates. Following title and abstract screening, 96 full texts were review, and 15 were included. Study designs were heterogeneous, and sample sizes were diverse (range 14-478). The most common technologies used were website/web portal (n = 6), videos (n = 5), exergaming (n = 2), accelerometer/pedometer with video and/or website (n = 4), and live-videoconferencing (n = 2). Over half (9/15) of the studies examined feasibility using various definitions; feasibility outcomes were reached in all. Common outcomes examined include lower body function and quality of life. Adverse events were uncommon and minor were reported. Qualitative studies identified cost- and time-savings, healthcare professional support, and technology features that encourage engagement as facilitators.

CONCLUSION

Remote exercise interventions using technology appear to be feasible and acceptable in OACA.

IMPLICATIONS FOR CANCER SURVIVORS

Some remote exercise interventions may be a viable way to increase PA for OACA.

GET FIT: A Randomized Clinical Trial of Tai Ji Quan Versus Strength Training for Fall Prevention After Chemotherapy in Older, Postmenopausal Women Cancer Survivors

PURPOSE

To compare the efficacy of tai ji quan versus strength training to prevent falls after chemotherapy in older, postmenopaual women.

METHODS

We conducted a three-arm, single-blind, randomized controlled trial where older (50+ years), postmenopausal women cancer survivors participated in one of three supervised group exercise programs (tai ji quan, strength training, or stretching control) twice weekly for 6 months and were followed up 6 months after training stopped. The primary outcome was the incidence of falls. Secondary outcomes included fall-related injuries, leg strength (1 repetition maximum; kg), and balance (sensory organization [equilibrium score] and limits of stability [LOS; %] tests).

RESULTS

Four hundred sixty-two women were enrolled (mean age, 62 ± 6.3 years). Retention was 93%, and adherence averaged 72.9%. In primary analysis, there was no difference in the incidence of falls between groups after 6 months of training, nor during 6-month follow-up. A post hoc analysis detected a significantly reduced incidence of fall-related injuries within the tai ji quan group over the first 6 months, dropping from 4.3 falls per 100 person-months (95% CI, 2.9 to 5.6) at baseline to 2.4 falls per person-months (95% CI, 1.2 to 3.5). No significant changes occurred during 6-month follow-up. Over the intervention period, leg strength significantly improved in the strength group and balance (LOS) improved in the tai ji quan group, compared with controls (P < .05).

CONCLUSION

We found no significant reduction in falls for tai ji quan or strength training relative to stretching control in postmenopausal women treated with chemotherapy.

Benefits of nature-based walking for breast cancer survivors

INTRODUCTION

Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.

METHODS AND ANALYSIS

The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.

TRIAL REGISTRATION NUMBER

NCT04896580.

Physical activity in association with mortality among Black women diagnosed with breast cancer in the Southern Community Cohort Study

PURPOSE

Physical activity (PA) is associated with many health benefits. While PA has been associated with reduced mortality after breast cancer diagnosis in many studies, few studies have examined the role of PA in breast cancer survival among underserved and minority populations, including Black women. We investigated PA in association with mortality among Black predominantly low-income breast cancer survivors in the Southern Community Cohort Study (SCCS).

METHODS

Study participants were women diagnosed with incident breast cancer (n = 949) in the SCCS, which is a prospective cohort study of predominantly low-income adults aged 40-79 years recruited from 12 Southeastern states between 2002 and 2009. Participants completed a detailed baseline questionnaire, with annual follow-up for mortality via registry linkages. Cox regression models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for associations of pre-diagnosis PA (measured via a validated questionnaire) with all-cause and breast cancer-specific mortality.

RESULTS

Breast cancer survivors had a mean age of 61.1 years and most (79.3%) had a household income of < $25,000. In adjusted models, higher levels of total PA (MET-hours/day) were inversely associated with all-cause mortality with HRs (95% CIs): 0.79 (0.59-1.06), 0.66 (0.49-0.90), and 0.60 (0.43-0.84), for Q2, Q3, and Q4 (reference: Q1), respectively, ptrend ≤ 0.01. A similar inverse association was found for breast cancer-specific mortality.

CONCLUSION

Higher levels of pre-diagnosis PA were associated with improved survival among low-income Black breast cancer survivors. Resources to reduce barriers to PA participation and increase support for education and intervention efforts to promote PA among Black women are needed.

Effects of Combined Interventions of Exercise and Diet or Exercise and Supplementation on Breast Cancer Patients: A Systematic Review

This systematic review investigated the effects of exercise interventions combined with diet and/or dietary supplement interventions on anthropometry, body composition, metabolic biomarkers, physical function, healthy lifestyles, quality of life, psychosocial variables and fatigue for women with breast cancer. A systematic search was performed in the PubMed and Web of Science databases (from inception to 1 March 2022). A review was carried out following the Preferred Reporting Items for Systematic review and Meta-Analyses (PRISMA) guidelines. The methodological quality and the risk of bias of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale. A total of 13 randomised controlled trial studies were included, comprising 1569 breast cancer patients. The main finding of this systematic review is that groups performing interventions combining exercise plus diet show significant improvements in cardiorespiratory fitness, muscular strength, body composition, quality of life, fatigue, anxiety, depression and sleep compared to control groups. On the other hand, the use of interventions combining exercise plus supplementation does not result in an improvement compared to groups using exercise alone or supplementation alone.

The level of kinesiophobia in breast cancer women undergoing surgical treatment

Introduction

Lifestyle-associated factors like physical activity (PA) play an important role in cancer prevention and oncology treatment outcomes. The aim of the study is to investigate the level of kinesiophobia (fear of movement) in breast cancer (BC) patients undergoing surgical treatment depending on socio-demographic variables, lifestyle before cancer diagnosis, stage and type of BC and comorbidities.

Methods

We interviewed 285 women (132 patients from Greater Poland Cancer Center - age: 55.7 ± 12.4; BMI: 26.7 ± 4.7 and 153 healthy women from control group - age: 49.0 ± 15.7; BMI: 25.7 ± 4.0) using Polish adaptation of the Tampa Scale of Kinesiophobia (TSK).

Results

Research results show that women with BC suffer from kinesiophobia (>37 points) signi!cantly. Approximately 3/4 of the surveyed women with BC did not know the World Health Organization (WHO) recommendations regarding the weekly dose of PA for healthy people and for people with cancer. Before cancer diagnosis more than a half of women (60%) performed PA in accordance with WHO recommendations. 7% less women performed PA during oncology treatment. Almost a half of patients are not physically active during cancer treatment and 1/5 of the respondents declared that they do not know yet if they will be physically active after oncology treatment. The level of kinesiophobia in BC women with comorbidities was the same as in the group of BC women without comorbidities. However, the highest levels of fear of movement have been observed among women with BC suffering also from osteoporosis, obesity and diabetes. In general, higher levels of kinesiophobia were reported among women in less advanced stages of the disease. There were no differences in the level of kinesiophobia depending on the type of BC (hormonally dependent luminal cancers vs. other types). The level of kinesiophobia did not differ between women who were physically active before BC diagnosis and women who were not. In terms of socio- demographic variables, we found one direct association between the level of kinesiophobia (pain) with age - the greater age, the higher level of pain kinesiophobia.

Discussion

Research on fear of movement in female oncology requires further research (including also chemotherapy, radiotherapy, immunotherapy and hormonal therapy) and in order to effectively eliminate hypokinetic attitudes at every stage of cancer treatment.

Physical Exercise and the Hallmarks of Breast Cancer: A Narrative Review

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.

Impact of physical exercise programs in breast cancer survivors on health-related quality of life, physical fitness, and body composition: Evidence from systematic reviews and meta-analyses

Background

Breast cancer is the most common cancer worldwide, and despite remarkable progress in its treatment, the survivors' quality of life is hampered by treatment-related side effects that impair psychosocial and physiological outcomes. Several studies have established the benefits of physical exercise in breast cancer survivors in recent years. Physical exercise reduces the impact of treatment-related adverse events to promote a better quality of life and functional outcomes.

Aim

This study aims to provide an overview of systematic reviews and meta-analyses on the effect of physical exercise on the health-related quality of life, cardiorespiratory fitness, muscle strength, and body composition of breast cancer survivors.

Methods

PubMed and Cochrane databases were searched for systematic reviews and meta-analyses from January 2010 to October 2022. The main focus was ascertaining the effectiveness of physical exercise in breast cancer survivors undergoing curative treatment (surgery and/or radiotherapy and/or chemotherapy). Two reviewers independently screened the literature, extracted the data, and assessed the risk of bias in the included studies.

Results

A total of 101 studies were identified, and 12 were yielded for final analysis. The eligible studies included nine systematic reviews/meta-analyses, one meta-analysis/meta-regression, and two systematic reviews. The number of randomised clinical trials included in each review varied from 11 to 63, and the number of participants was from 214 to 5761. A positive and significant effect of different physical exercise interventions on health-related quality of life was reported in 83.3% (10 studies) of the eligible studies. Physical exercise also improved cardiorespiratory fitness (3 studies; 25%) and showed to be effective in reducing body weight (3 studies; 25%) and waist circumference (4 studies; 33.3%).

Conclusions

Our results suggest that physical exercise is an effective strategy that positively affects breast cancer survivors' quality of life, cardiorespiratory fitness, and body composition. Healthcare professionals should foster the adoption of physical exercise interventions to achieve better health outcomes following breast cancer treatments.

Systematic review registration

https://inplasy.com/inplasy-2022-11-0053/, identifier INPLASY2022110053.

Screening for Physical Activity Levels in Non-Metastatic Breast Cancer Patients Undergoing Surgery: An Observational Study

BACKGROUND

Physical activity (PA) can play a role in lowering the risk of breast cancer (BC), but also in reducing perioperative complications and treatments related side effects, improving the quality of life and decreasing mortality in BC survivors. PA and nutritional screening are not offered to patients after cancer diagnosis as standard of care, even in high quality breast units.

METHODS

From February 2019 to March 2020, we performed a preoperative physical and nutritional screening in 504 consecutive BC patients waiting for surgery. The screening included an IPAQ questionnaire to evaluate the level of physical activity; nutritional screening with measurement of anthropometric parameters (weight, height, waist and hips circumference, BMI, and waist hip ratio) and evaluation of body composition using Bioelectrical Impedance Analysis (BIA).

RESULTS

The majority of patients in our series resulted physically inactive: clustering the IPAQ scores, 47% of patients proved to be physically inactive (MET score <700), 34% moderately active (MET score 700-2520), and only 19% physically active (MET score > 2520). In addition, approximately half of the patients (49.01%) resulted overweight or obese, and more than half (55.2%) had a percentage of fatty tissue over the recommended cut off for adult women.

CONCLUSIONS

Our data confirm that assessment of PA levels should become part of the standard preoperative evaluation of BC patients and behavioral interventions should be offered to them, in order to pre-habilitate for surgery and improve outcomes. IPAQ Questionnaire and body composition analysis could be quick and easy screening tools in order to identify which patients may need more support in being active during and after anticancer treatments.

A longitudinal study of physical activity among Malaysian breast cancer survivors

Regular physical activity (PA) after a breast cancer diagnosis is associated with reduced mortality and better quality of life. In this prospective cohort study, we aimed to explore the trends of PA among breast cancer survivors over three years and identify factors associated with low PA. Interviews on 133 breast cancer patients were conducted at baseline, one and three years after the diagnosis of breast cancer at University Malaya Medical Centre in Kuala Lumpur. Physical activity was measured by using the Global Physical Activity Questionnaire. PA was categorised as active (≥ 600 MET-min/week) and inactive (<600 MET-min/week). We used the generalised estimating equation method to examine PA levels and factors affecting PA longitudinally. The survivors' mean age was 56.89 (±10.56) years; half were Chinese (50.4%), and 70.7% were married. At baseline, 48.1% of the patients were active, but the proportion of active patients declined to 39.8% at one year and 35.3% in the third year. The mean total PA decreased significantly from 3503±6838.3 MET-min/week to 1494.0±2679.8 MET-min/week (one year) and 792.5±1364 MET-min/week (three years) (p<0.001). Three years after diagnosis (adjusted odds ratio [AOR]: 1.74, p = 0.021); Malay ethnicity (AOR: 1.86, p = 0.042) and being underweight (AOR: 3.43, p = 0.004) were significantly associated with inactivity. We demonstrated that breast cancer survivors in Malaysia had inadequate PA levels at diagnosis, which decreased over time. Thus, it is vital to communicate about the benefits of PA on cancer outcomes and continue to encourage breast cancer survivors to be physically active throughout the extended survivorship period, especially in the Malay ethnic group and underweight patients.

Associations between Physical Exercise, Quality of Life, Psychological Symptoms and Treatment Side Effects in Early Breast Cancer

Background

Identifying and understanding modifiable factors for the well-being of cancer patients is critical in survivorship research. We studied variables associated with the exercise habits of breast cancer patients and investigated if the achievement of exercise recommendations was associated with enhanced quality of life and/or psychological well-being. Material and Methods. 311 women from Finland, Portugal, Israel, and Italy receiving adjuvant therapy for stage I-III breast cancer answered questions about sociodemographic factors and physical exercise. Quality of life was assessed by the EORTC C30 and BR23 questionnaires. Anxiety and depression were evaluated using the HADS scale.

Results

At the beginning of adjuvant therapy and after twelve months, 32% and 26% of participants were physically inactive, 27% and 30% exercised between 30 and 150 minutes per week, while 41% and 45% exercised the recommended 150 minutes or more per week. Relative to other countries, Finnish participants were more likely to be active at baseline and at twelve months (89% vs. 50%, p < 0.001 and 87% vs. 64%, p < 0.001). Participants with stage I cancer were more likely to be active at twelve months than those with a higher stage (80% vs. 70%,p < 0.05). The inactive participants reported more anxiety (p < 0.05) and depression (p < 0.001), lower global quality of life (p < 0.001), and more side effects (p < 0.05) than the others at twelve months. Accordingly, those who remained inactive or decreased their level of exercise from baseline to twelve months reported more anxiety (p < 0.01) and depression (p < 0.001), lower global quality of life (p < 0.001), and more side effects (p < 0.05) than those with the same or increased level of exercise.

Conclusion

For women with early breast cancer, exercise was associated with a better quality of life, less depression and anxiety, and fewer adverse events of adjuvant therapy. Trial registration number: NCT05095675. Paula Poikonen-Saksela on behalf of Bounce consortium (https://www.bounce-project.eu/).

Kinesiophobia among Breast Cancer Survivors One Year after Hospital Treatment

Breast cancer (BC) is one of the most dangerous health problems affecting women. Lifestyle-associated determinants like physical activity (PA) play an important role in BC treatment outcomes. Studies suggest that oncology patients are insufficiently physically active. One of the potential barriers is kinesiophobia-fear of movement due to expected pain and fatigue. The aim of this cross-sectional study is to investigate the level of kinesiophobia among women one year after BC hospital treatment depending on socio-demographic variables, stage and type of BC, lifestyle, and comorbidities. Polish women after BC (n = 138, age 46.5 ± 9.2, BMI 24.6 ± 4.0) participated in the study and the Tampa Scale of Kinesiophobia (TSK) questionnaire was used in the diagnostic survey. The study results show that women suffer from kinesiophobia after BC. Moreover, every third woman (32.6%) does not practice sport regularly one year after BC treatment. The lifestyle before BC diagnosis impacts the level of kinesiophobia after treatment-women who were not physically active before BC diagnosis declared higher levels than previously active women. The study result shows that a high level of kinesiophobia correlates with a low level of PA among women after BC. Women with obesity and diabetes also declared higher levels of kinesiophobia than women without comorbidities. The type and stage of BC have no influence on the level of kinesiophobia; however, in terms of socio-demographic variables, a direct association between kinesiophobia and age has been found-the greater the age, the higher the level of kinesiophobia. Further research on fear of movement in oncology is required in order to effectively eliminate hypokinetic attitudes in every type of female and male cancer.

Adherence to Mediterranean Diet and Nutritional Status in Women with Breast Cancer: What Is Their Impact on Disease Progression and Recurrence-Free Patients' Survival?

Introduction: Nutritional status impacts the survival of patients with cancer. There are few studies that investigate the role of nutritional status on breast cancer survival in women with breast cancer, and even fewer regarding the impact of adhering to the Mediterranean diet (MD). The present study aims to assess the nutritional status, MD adherence, physical activity levels and health-related quality of life (HRQOL) in women diagnosed with breast cancer and evaluate these parameters regarding recurrence-free survival. Methods: A total of 114 women, aged 35-87 years old, diagnosed with breast cancer in Larissa, Greece, participated in the study. Tumor histopathology was reported, and anthropometric indices were measured by a trained nurse, while questionnaires regarding nutritional status (via mini nutritional assessment), HRQOL via EORTC QLQ-C30, physical activity levels via IPAQ and Mediterranean diet adherence via MedDietScore were administered. The participants were followed-up for a maximum time interval of 42 months or until recurrence occurred. Results: A total of 74% of patients were overweight or obese, while 4% of women were undernourished, and 28% were at risk of malnutrition. After 42 months of follow-up, 22 patients (19.3%) had relapsed. The median time to recurrence was 38 months (IQR: 33-40 months) and ranged between 23 to 42 months. Higher levels of MD adherence were significantly associated with lower body mass index (BMI) values, earlier disease stage, smaller tumor size, absence of lymph node metastases and better physical activity levels (p < 0.05). Normal nutritional status was significantly associated with higher BMI values and better health-related quality of life (p ≤ 0.05). In univariate analysis, patients with higher levels of MD adherence and well-nourished patients had significantly longer recurrence-free survival (p < 0.05). In multivariate analysis, MD adherence and nutritional status were independently associated with recurrence-free patients' survival after adjustment for several confounding factors (p < 0.05). Conclusions: The impact of MD on time to recurrence is still under investigation, and future interventional studies need to focus on the role of adhering to the MD before and after therapy in survival and breast cancer progression. Furthermore, the present study also highlights the importance of an adequate nutritional status on disease progression, and the need for nutritional assessment, education and intervention in women with breast cancer.

Polish Adaptation of the Modified Tampa Scale of Kinesiophobia for Fatigue (TSK-F) and the Revision of the Tampa Scale in Terms of Pain for Cancer Patients

The aim of this study was to create a Polish adaptation of the Tampa Scale of Kinesiophobia considering fatigue, and to verify the usefulness of the scale in the context of pain in cancer patients. The study was conducted at the Breast Cancer Unit, operating at the Greater Poland Cancer Centre, and at the Poznan Centre for Specialist Medical Services in Poznan. After considering the exclusion criteria, 100 people qualified for the interviews for the final study: 50 breast cancer patients and 50 healthy respondents (without cancer). Statistical analysis of the CFA score showed that the chi-square test was not significant (χ² = 10.243, p = 0.332), indicating an acceptable fit of items across scales. The reliability of the internal consistency of the scales was tested by examining the Cronbach's alpha scores for each question/statement. The mean values for this indicator were 0.74 for the pain-related scale and 0.84 for the fatigue-related scale. Construct validity was confirmed for the scales; AVE for the pain-related scale was 0.64 and for the fatigue-related scale was 0.68. The results suggest the validity of examining kinesiophobia in the context of pain- and fatigue-related mobility anxiety among breast cancer patients in Poland, and that the Tampa Scale of Kinesiophobia can be adapted for different dimensions of the condition. Both versions of the scale demonstrated adequately prepared parametric constructs, and all correlations showed a statistically significant relationship (p < 0.05). The use of the Tampa Scale of Kinesiophobia in oncology patient studies in Poland may ultimately improve rehabilitation programs and enable the development of strategies to assist patients in supporting treatment to reduce movement anxiety.

Cardioprotective Strategies from Cardiotoxicity in Cancer Patients: A Comprehensive Review

Cardiotoxicity is a significant complication of chemotherapeutic agents in cancer patients. Cardiovascular incidents including LV dysfunction, heart failure (HF), severe arrhythmias, arterial hypertension, and death are associated with high morbidity and mortality. Risk stratification of cancer patients prior to initiation of chemotherapy is crucial, especially in high-risk patients for cardiotoxicity. The early identification and management of potential risk factors for cardiovascular side effects seems to contribute to the prevention or minimization of cardiotoxicity. Screening of cancer patients includes biomarkers such as cTnI and natriuretic peptide and imaging measurements such as LV function, global longitudinal strain, and cardiac MRI. Cardioprotective strategies have been investigated over the last two decades. These strategies for either primary or secondary prevention include medical therapy such as ACE inhibitors, ARBs, b-blockers, aldosterone antagonists, statins and dexrazoxane, physical therapy, and reduction of chemotherapeutic dosages. However, data regarding dosages, duration of medical therapy, and potential interactions with chemotherapeutic agents are still limited. Collaboration among oncologists, cardiologists, and cardio-oncologists could establish management cardioprotective strategies and approved follow-up protocols in patients with cancer receiving chemotherapy.

Effect of a telehealth-based exercise intervention on the physical activity of patients with breast cancer: A systematic review and meta-analysis

Telehealth-based exercise intervention as a non-pharmacological intervention has gradually emerged in breast cancer (BC), which shows feasibility and high levels of patient satisfaction. This systematic review aims to identify the effect of telehealth-based exercise interventions on the physical activity (PA) of patients with BC. We searched CENTRAL, CINAHL, PsycINFO, EMBASE, PubMed, Web of Science, ClinicalTrials.gov, CNKI, Wanfang, VIP, and SinoMed. Study selection and quality appraisal were performed independently by two reviewers. The review protocol was registered in PROSPERO (CRD42022326484). Nine studies, which included 1127 patients with BC, were identified. Compared with usual care, the telehealth-based exercise intervention had a significantly positive effect on PA (Standardized mean difference (SMD) = 0.26, 95% confidence interval (CI) 0.09 to 0.43, P = 0.003), aerobic capacity (SMD = 0.20, 95% CI 0.03 to 0.38, P = 0.02), upper body function (Mean difference (MD) = −4.56, 95% CI −7.66 to −1.47, P = 0.004), upper muscle strength (SMD = 0.26, 95% CI 0.09 to 0.42, P = 0.002), lower muscle strength (SMD = −0.95, 95% CI −1.27 to −0.62, P < 0.00001), abdominal muscle strength (MD = 23.85, 95% CI 13.84 to 33.86, P < 0.000,01), fatigue (SMD = 0.56, 95% CI 0.13 to 1.00, P = 0.01), and quality of life (SMD = 0.26, 95% CI 0.04 to 0.49, P = 0.02). Conversely, anthropometric and body composition and pain did not differ significantly between the two groups. Telehealth-based exercise intervention improved PA, physical performance, fatigue, and quality of life of patients with BC compared with routine care, which should be promoted clinically as a comprehensive treatment for BC.

Reducing Metabolic Dysregulation in Obese Latina and/or Hispanic Breast Cancer Survivors Using Physical Activity (ROSA) Trial: A Study Protocol

Background

Latina and Hispanic breast cancer survivors (LHBCS) are at increased risk for long-term complications and poorer metabolic health, including metabolic dysregulation (MetD) before and following breast cancer diagnosis. MetD can increase risk of cancer recurrence, death, and comorbid conditions by increasing inflammation and cancer cell proliferation. While exercise improves physical fitness and metabolic outcomes in breast cancer survivors, there is a lack of studies including underrepresented and disadvantaged minority groups such as LHBCS.

Methods

Our 12-month randomized (exercise or attention control) controlled trial (the ROSA trial) aims to utilize a progressive combined aerobic and resistance exercise program to improve MetD, insulin resistance, and visceral adiposity among obese LHBCS. We aim to recruit 160 women with Stage I-III breast cancer who are sedentary, centrally obese, and have completed treatment (e.g., surgery, radiation, chemotherapy) prior to enrollment. Participants randomized to the exercise group receive 16-weeks of virtually supervised aerobic and resistance training, followed by 16-weeks of unsupervised home-based aerobic and resistance exercise, and 16-weeks of follow-up. The attention control group receive a 12-month home-based stretching program. Primary and secondary outcomes are measured every 4-weeks during study visits.

Discussion

The ROSA trial is the first exercise oncology trial targeting high-risk sedentary, obese LHBCS to improve MetD-related outcomes. Results of this trial will help illuminate how exercise impacts health-related outcomes, survivorship, and recurrence, and inform future exercise oncology guidelines to reduce health disparities among minority cancer survivors.

Updated Understanding of the Causes of Cancer, and a New Theoretical Perspective of Combinational Cancer Therapies, a Hypothesis

We present an integrative understanding of cancer as a metabolic multifactorial, multistage disease. We focus on underlying genetics-environmental interactions, evidenced by telomere changes. A range of genetic and epigenetic factors, including physical agents and predisposing factors such as diet and lifestyle are included. We present a structured model of the causes of cancer, methods of investigations, approaches to cancer prevention, and polypharmaceutical multidisciplinary complex treatment within a framework of personalized medicine. We searched PubMed, National Cancer Institute online, and other databases for publications regarding causes of cancer, reports of novel mitochondrial reprogramming, epigenetic, and telomerase therapies and state-of-the-art investigations. We focused on multistep treatment protocols to enhance early detection of cancer, and elimination or neutralization of the causes and factors associated with cancer formation and progression.Our aim is to suggest a model therapeutic protocol that incorporates the patient's genome, metabolism, and immune system status; stage of tumor development; and comorbidity(ies), if any. Investigation and treatment of cancer is a challenge that requires further holistic studies that improve the quality of life and survival rates, but are most likely to aid prevention.

Metabolic syndrome and breast cancer survivors: a follow-up analysis after completion of chemotherapy

BACKGROUND

We previously reported that (neo)adjuvant chemotherapy adversely altered metabolic syndrome (MetS) components, body composition, and related biomarkers after a 12 to 18-week chemotherapy treatment course in women. Here, we sought to determine whether these measures worsened within 4-5 years post-chemotherapy among the same sample of early stage breast cancer survivors.

METHODS

Twenty-eight breast cancer survivors were reassessed within 4-5 years post-chemotherapy. Participants were tested for MetS, lipid profile (total cholesterol; TC, low-density lipoprotein cholesterol; LDL-C), glucose metabolism (insulin, homeostatic model- insulin resistance; HOMA-IR, glycosylated hemoglobin; HbA1c), inflammation (C-reactive protein; CRP) and body composition (body weight; BW, percent body fat; BF, fat mass; FM) during follow-up physical exams. A comparison of measurements between post-chemotherapy and follow-up periods was performed using repeated measures analysis of covariance.

RESULTS

Most study patients were Caucasian (44%) or Hispanic (30%) with a mean age of 48.2 years. Average time from completion of chemotherapy was 4.75 years. At follow-up, MetS components significantly increased (p < 0.01) compared with the post chemotherapy assessment. Additionally, BF, FM, lipids (TC, LDL), glucose metabolism (HOMA-IR, insulin, HbA1c), and inflammation (CRP) significantly increased (p < 0.01). Notably BW significantly increased; mean weight gain after chemotherapy was 6.1 kg and increased an additional 8.2% at follow-up (p < 0.01).

CONCLUSION

MetS components, body composition, and biomarkers continued to worsen within 4-5 years post-chemotherapy in breast cancer survivors. Energy balance interventions should target breast cancer patients to reduce the exacerbation of MetS.

Cardioprotective Strategies for Doxorubicin-induced Cardiotoxicity: Present and Future

The improvement of drugs and protocols of chemotherapeutic treatment has led to improved outcomes and survival in patients with cancer. But along with this, at first glance a positive point, there was another interdisciplinary problem, which is the need for early detection and treatment of developing cardiotoxicity when taking chemotherapy drugs. The study of cardioprotective strategies has recently become increasingly relevant, due to the fact that many patients who have successfully undergone treatment for cancer have a high risk of developing or are at high risk of death from cardiovascular diseases. One of the main drugs for the treatment of a number of oncological diseases is an anthracycline – type antibiotic-doxorubicin. This review briefly examines the risk factors and pathophysiological mechanisms underlying anthracycline cardiotoxicity. The current possibilities of cardioprotection of anthracycline cardiotoxicity are considered in detail, and some promising targets and drugs for improving cardioprotective strategies are discussed.

Do Breast Cancer Patients Manage to Participate in an Outdoor, Tailored, Physical Activity Program during Adjuvant Breast Cancer Treatment, Independent of Health and Socio-Demographic Characteristics?

Exercise could reduce the side-effects of adjuvant breast cancer treatment; however, socio-demographic, health, and intervention conditions may affect patients’ adherence to interventions. This study aimed to examine adherence to a 12-month outdoor post-surgery exercise program among newly diagnosed breast cancer patients during adjuvant treatment, and to identify socio-demographic and health-related predictors. In total, 47 women with invasive breast cancer stage I–II or ductal/lobular carcinoma grade 3 were included pre-surgery and randomized two weeks post-surgery to exercise (2 × 60 min/week). Patient characteristics (body-mass index (BMI), socioeconomic status, comorbidity, physical activity, and maximal oxygen uptake (VO2max)) were recorded pre-surgery. Correlations between adherence and patient characteristics and statistics for between-group differences were performed. The mean age was 54.2 years, mean BMI 27.8 kg/m², and 54.2% received chemotherapy. Completers had a mean adherence of 81%, independent of season. Withdrawals (23%) occurred after a mean of 6.5 weeks (0–24 weeks), they were suggestively older, had lower socioeconomic status and pre-surgery VO2max, and higher BMI. Household income was significantly lower among withdrawals. There were insignificant correlations between adherence and health conditions. High adherence is achievable in a Nordic outdoor physical exercise program in breast cancer patients during adjuvant treatment, including chemotherapy. Additional studies are needed to clarify follow-up needs in some groups.

Exercise-Based Interventions to Counteract Skeletal Muscle Mass Loss in People with Cancer: Can We Overcome the Odds?

Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic.

Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT

BACKGROUND

Upper limb problems are common after breast cancer treatment.

OBJECTIVES

To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery.

DESIGN

This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1).

SETTING

Breast cancer centres, secondary care.

PARTICIPANTS

Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status.

INTERVENTIONS

All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies).

MAIN OUTCOME MEASURES

The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded.

RESULTS

Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial.

LIMITATIONS

Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported.

CONCLUSIONS

This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life.

FUTURE WORK

Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems.

TRIAL REGISTRATION

This trial is registered as ISRCTN35358984.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.

The Alberta moving beyond breast cancer (AMBER) cohort study: baseline description of the full cohort

Purpose

The Alberta Moving Beyond Breast Cancer (AMBER) Study is an ongoing prospective cohort study investigating how direct measures of physical activity (PA), sedentary behavior (SB), and health-related fitness (HRF) are associated with survival after breast cancer.

Methods

Women in Alberta with newly diagnosed stage I (≥ T1c) to IIIc breast cancer were recruited between 2012 and 2019. Baseline assessments were completed within 90 days of surgery. Measurements included accelerometers to measure PA and SB; a graded treadmill test with gas exchange analysis to measure cardiorespiratory fitness (VO_2peak); upper and lower body muscular strength and endurance; dual-X-ray absorptiometry to measure body composition; and questionnaires to measure self-reported PA and SB.

Results

At baseline, the 1528 participants’ mean age was 56 ± 11 years, 59% were post-menopausal, 62% had overweight/obesity, and 55% were diagnosed with stage II or III disease. Based on device measurements, study participants spent 8.9 ± 1.7 h/day sedentary, 4.4 ± 1.2 h/day in light-intensity activity, 0.9 ± 0.5 h/day in moderate-intensity activity, and 0.2 ± 0.2 h/day in vigorous-intensity activity. For those participants who reached VO_2peak, the average aerobic fitness level was 26.6 ± 6 ml/kg/min. Average body fat was 43 ± 7.1%.

Conclusion

We have established a unique cohort of breast cancer survivors with a wealth of data on PA, SB, and HRF obtained through both direct and self-reported measurements. Study participants are being followed for at least ten years to assess all outcomes after breast cancer. These data will inform clinical and public health guidelines on PA, SB, and HRF for improving breast cancer outcomes.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10552-021-01539-6.

Physical Activity Levels of Breast Cancer Patients Before Diagnosis Compared to a Reference Population: A Cross-Sectional Comparative Study

PURPOSE

We hypothesize that prediagnosis physical activity (PA) levels of breast cancer patients are below those of a reference population without breast cancer. Therefore, the aim of the present study was to compare prediagnosis PA levels (including total-, occupational-, sport- and household activity levels) of breast cancer patients with activity levels of a reference population.

METHODS

Female patients with primary breast cancer (n = 265) filled in the Flemish Physical Activity Computerized Questionnaire (FPACQ) the day before surgery recalling the year before diagnosis. PA levels were expressed as Metabolic Equivalent Task (MET) values. Smooth reference curves of PA levels were estimated in a representative sample of 3466 women without breast cancer with the LMS method, which allowed comparison of prediagnosis PA data of the breast cancer sample with this reference.

RESULTS

Compared to women without breast cancer, total PA levels were significantly lower in the year prior to breast cancer diagnosis over all age groups (Mean ± SD z-scores (95% CI) = -1.51 ± 1.86 (-1.74 to -1.29)). More specifically, household PA levels of breast cancer patients were significantly lower between ages 40-60, while occupational PA levels were significantly higher in this age group. No differences were found between sports PA levels.

CONCLUSIONS

Patients with breast cancer show significantly lower total PA levels during the year prior to surgery compared to a reference population. Especially household activity levels are lower in patients between ages 40 and 60. Given this, a return to prediagnosis PA levels may not be sufficient for protection from disease in the future.

Randomised controlled trial of intermittent vs continuous energy restriction during chemotherapy for early breast cancer

BACKGROUND

Excess adiposity at diagnosis and weight gain during chemotherapy is associated with tumour recurrence and chemotherapy toxicity. We assessed the efficacy of intermittent energy restriction (IER) vs continuous energy restriction (CER) for weight control and toxicity reduction during chemotherapy.

METHODS

One hundred and seventy-two women were randomised to follow IER or CER throughout adjuvant/neoadjuvant chemotherapy. Primary endpoints were weight and body fat change. Secondary endpoints included chemotherapy toxicity, cardiovascular risk markers, and correlative markers of metabolism, inflammation and oxidative stress.

RESULTS

Primary analyses showed non-significant reductions in weight (-1.1 (-2.4 to +0.2) kg, p = 0.11) and body fat (-1.0 (-2.1 to +0.1) kg, p = 0.086) in IER compared with CER. Predefined secondary analyses adjusted for body water showed significantly greater reductions in weight (-1.4 (-2.5 to -0.2) kg, p = 0.024) and body fat (-1.1 (-2.1 to -0.2) kg, p = 0.046) in IER compared with CER. Incidence of grade 3/4 toxicities were comparable overall (IER 31.0 vs CER 36.5%, p = 0.45) with a trend to fewer grade 3/4 toxicities with IER (18%) vs CER (31%) during cycles 4-6 of primarily taxane therapy (p = 0.063).

CONCLUSIONS

IER is feasible during chemotherapy. The potential efficacy for weight control and reducing toxicity needs to be tested in future larger trials.

CLINICAL TRIAL REGISTRATION

ISRCTN04156504.

A pilot feasibility study of Exercising Together© during radiation therapy for prostate cancer: a dyadic approach for patients and spouses

Introduction

Prostate cancer can negatively impact the health of patients and their spouse, particularly early on in the cancer trajectory.

Purpose

To determine the feasibility and acceptability of dyadic exercises during radiation therapy and preliminary efficacy on physical, mental, and relational outcomes for men and their spouses. Exercising Together©, originally designed as a 6-month dyadic resistance training program for couples post-treatment, was adapted for the radiation setting.

Methods

We conducted a single-group pilot feasibility study of Exercising Together© in men scheduled for radiation therapy for prostate cancer and their spouse. Couples attended supervised exercise sessions thrice weekly throughout radiation treatment and were followed up 8 weeks later. Primary outcomes were feasibility and acceptability with secondary outcomes of changes in physical (physical functioning (short physical performance battery (sPPB)), gait speed (m/s), functional capacity (400-m walk (min), physical activity (min/week)), mental (depressive symptoms (CES-D), and anxiety (SCL-90 ANX)), and relationship (Dyadic Coping, Role Overload, and Physical Intimacy Behavior Scales) health outcomes for each partner. Participants completed an evaluation post-intervention.

Results

Ten couples enrolled and 8 completed the intervention, attending 83% of scheduled sessions. Couple satisfaction with the intervention was high (patients: mean difference (MD) = 9.4 ± 1.9 and spouses: MD = 10.0 ± 0.0, on a 1–10 scale). At post-intervention, gait speed (MD = 0.1; 95%CI: 0.1, 0.2; p = 0.003; d = 0.94) and functional capacity (MD = −0.6; 95%CI: −0.9, 0.3; p = 0.002; d = −0.42) improved in patients and sPPB in spouses (MD = 1.3; 95%CI: 0.3, 2.2; p = 0.02; d = 0.71). Total physical activity increased non-significantly for patients and significantly for spouses at post-intervention and decreased at follow-up (MD = 179.6; 95%CI: 55.4, 303.7; p = 0.01; d = 1.35 and MD = −139.9; 95%CI: −266.5, 13.3; p = 0.03; d=1.06). Among patients, anxiety and active engagement significantly improved post-intervention (MD = −2.3; 95%CI: −3.8, 0.7; p = 0.01; d = −0.43 and MD = 2.5; 95%CI: 0.7, 4.3; p = 0.01; d = 0.98, respectively). There were modest effects on other physical, mental, and relationship health domains in patients and spouses.

Conclusion

A modified version of Exercising Together© is a feasible and acceptable program during radiation therapy for prostate cancer and shows preliminary evidence for improvements on physical, mental, and relational health in both patient and spouse. A larger, fully powered randomized controlled trial is warranted and could help shift the landscape toward dyadically targeted interventions.

Trial registration

This study was registered on ClinicalTrials.gov on February 18th, 2018 (NCT03418025).

Relationship between physical activity, objective sleep parameters, and circadian rhythm in patients with head and neck cancer receiving chemoradiotherapy: A longitudinal study

OBJECTIVES

This study was developed to assess the relationship between physical activity, sleep and circadian rhythm using accelerometer and urine melatonin levels in patients with head and neck cancer (HNC). Also, this study evaluated the changes in physical activity, sleep, and circadian rhythm during the seven-week course of chemoradiotherapy.

METHODS

This longitudinal study recruited 27 participants diagnosed with HNC who were planning to undergo chemoradiotherapy. Accelerometers worn for 3 days during the 1st, 3rd, and 7th weeks of chemoradiotherapy were used to assess physical activity levels (step count and metabolic equivalents [METs]) and sleep quality (total sleep time [TST], sleep onset latency [SOL], and sleep efficiency [SE]). Urine melatonin analysis was conducted using the morning void urine sample on 1st, 3rd, and 7th weeks. The change in variables during the seven weeks and the correlation between them were analyzed.

RESULTS

During the seven weeks, trends of reduction in variables of physical activity, sleep and circadian rhythm were observed with significant decrease in step count, TST and melatonin levels. SE was found to have strong negative correlation with physical activity. TST was found to have moderate correlation with SE and step count. The variables of physical activity also showed moderate correlation among them.

CONCLUSION

This study concludes that higher physical activity is associated with poor SE due to increased night-time activity. There was a significant reduction in physical activity and sleep observed during seven weeks with moderate association between them. The significant circadian rhythm deregulation however showed poor association with the other variables.Level of Evidence: 2b.

Association between Fruit and Vegetable Intake and Physical Activity among Breast Cancer Survivors: A Longitudinal Study

This study examines the association between rates of change in daily fruit and vegetable intake and in weekly levels of moderate-to-vigorous intensity physical activity (MVPA) over a 15-month period in women following primary treatment completion for breast cancer. Breast cancer survivors (N = 199) self-reported fruit and vegetable intake and wore an accelerometer for 7 consecutive days to measure levels of MVPA on five occasions every 3 months. Multivariate latent growth modeling revealed that the rate of change in fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Baseline (Mean = 3.46 months post-treatment) levels of MVPA were not associated with the rate of change of daily fruit and vegetable intake; likewise, baseline fruit and vegetable intake was not associated with the rate of change in levels of MVPA. Behavioral interventions promoting fruit and vegetable intake should not be assumed to yield concomitant effects in promoting MVPA or vice versa.

Feasibility of a Remotely Delivered Strength and Balance Training Program for Older Adults with Cancer

Falls are a major issue among older adults with cancer and lead to interruptions in cancer treatment. Resistance and balance training can prevent falls in older adults, but minimal evidence is available regarding the older cancer population, who often have unique risk factors. We used a pre-post design to assess the feasibility of a remotely delivered exercise program that progressed in difficulty and its efficacy on lower body strength, balance, and falls in older adults with cancer who had prior in-person exercise experience. Twenty-six older adults with cancer completed the intervention. Attendance rate for the virtual component was 97.6% and for the independent component was 84.7%. Participants perceived the program as rewarding and enjoyable (100%), felt this program prepared them to exercise on their own (92%), were confident to continue exercising on their own (81%), and would recommend the program to other patients (100%). The median balance score at baseline and end-of-study was 4 (IQR = 0). The median chair-stand time decreased from 9.2 s (IQR = 3.13) to 7.7 s (IQR = 4.6). A statistically significant difference in lower body strength (r = 0.68, p = 0.001) was detected post-intervention. The findings from this study can inform the design of a larger randomized trial.

Exercise Improves Cancer-free Survival and Health Span in a Model of Radiation-induced Cancer

INTRODUCTION

Radiation therapy increases the risk of secondary malignancy and morbidity in cancer survivors. The role of obesity and exercise training in modulating this risk is not well understood. As such, we used a preclinical model of radiation-induced malignancy to investigate whether diet-induced obesity and/or endurance exercise training altered lifelong survival, cancer incidence, and morbidity.

METHODS

Male CBA mice were randomly divided into control diet/sedentary group (CTRL/SED), high-fat diet (45% fat)/sedentary group (HFD/SED), control diet/exercise group (2-3 d·wk-1; CTRL/EX), or high-fat diet/exercise group (HFD/EX) groups then exposed to whole-body radiation (3 Gy). End point monitoring and pathology determined mortality and cancer incidence, respectively. Health span index, a measure of morbidity, was determined by a composite measure of 10 anthropometric, metabolic, performance, and behavioral measures.

RESULTS

Overall survival was higher in HFD/SED compared with CTRL/SED (P < 0.05). The risk of cancer-related mortality by 18 months postradiation was 1.99 and 1.63 in HFD/SED compared with CTRL/EX (RR = 1.99, 95% confidence interval = 1.20-3.31, P = 0.0081) and CTRL/SED (RR = 1.63, 95% confidence interval = 1.06-2.49, P = 0.0250), respectively. The number of mice at end point with cancer was higher in HFD/SED compared with CTRL/EX and CTRL/SED (P < 0.05). Health span index was highest in CTRL/EX (score = +2.5), followed by HFD/EX (score = +1), and HFD/SED (score = -1) relative to CTRL/SED.

CONCLUSION

This work provides the basis for future preclinical studies investigating the dose-response relationship between exercise training and late effects of radiation therapy as well as the mechanisms responsible for these effects.

Association between cardiac autonomic modulation and sedentary behavior in breast cancer survivors: a 12-month cohort study

PURPOSE

This study aimed to analyze the longitudinal influence of sitting time (ST) on cardiac autonomic modulation (CAM) and resting heart rate (RHR) in a 12-month cohort of 67 breast cancer survivors.

METHODS

CAM was assessed by heart rate variability with heart monitor which also assessed RHR, and ST was self-reported. The relationship between the variables was analyzed by the Pearson correlation and its magnitude by linear regression.

RESULTS

At baseline, no associations were found between ST and CAM or RHR. In the delta analyses, a decrease in RMSSD, SD1, and HF(ms²) was associated with sitting time. At 12-month follow-up, there was an increase in the ST and a decrease in RHR. ST was negatively related with CAM (RMSSD, PNN50, and SD1), but no association was observed between ST and RHR.

CONCLUSION

The increase in ST was associated with worsening of CAM after 12-month follow-up. Promoting reduction in ST will be an important strategy against cardiovascular impairment in breast cancer survivors.

A Randomized Controlled Pilot Trial About the Influence of Kyusho Jitsu Exercise on Self-efficacy, Fear, Depression, and Distress of Breast Cancer Patients within Follow-up Care

Introduction

Breast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression.

Methods

Breast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS).

Results

Analysis of the original data showed a significant difference between both groups regarding the subscale “joy” (P = .018). Several significant results within the intervention group were seen in self-efficacy (P = .014), fear (P = .009) and the overall score for fear and depression (P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” (P = .019).

Conclusion

To summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.