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Bloomquist K, Andersen C, Munck S, Lillelund C, Lauritsen J. High-intensity interval training and thromboembolic events during chemotherapy for testicular cancer: a retrospective analysis from the Body & Cancer cohort. Acta Oncol 2023; 62:666-672. [PMID: 37450654 DOI: 10.1080/0284186x.2023.2225145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 06/07/2023] [Indexed: 07/18/2023]
Abstract
Background: Men with testicular cancer receiving platinum-based chemotherapy have an increased risk of thromboembolic events, with incidence rates between 8-24%. A recent trial evaluating the effect of high-intensity interval training (HIIT) prematurely closed as three out of nine participants (33%) in the intervention group developed a thromboembolic event. The purpose of this retrospective cohort study was: 1) (primary) to evaluate the incidence of thromboembolic events in men receiving chemotherapy for testicular cancer who had participated in HIIT during a 6-week exercise program (Body & Cancer) 2) to describe the feasibility of this program.Material and methods: Forty men who had participated in at least one HIIT session from February 2007 to February 2020 were included. Electronic medical records were searched for incident thromboembolic events (arterial and venous) during Body & Cancer and up to one-year post-chemotherapy. Attendance, cardiorespiratory fitness (VO2-peak), and upper and lower extremity muscular strength (1 repetition maximum (RM)) were obtained from the Body & Cancer database.Results: One participant developed a thromboembolic event during Body & Cancer. No participants developed a thromboembolic event in the follow-up period. In all, data represent 160 HIIT sessions with a median attendance of eight sessions [range 1-19]. Statistically significant increases in upper and lower extremity strength were observed (8.6 (4.2 to 13.0) and 26.0 (14.9 to 37.0) kg, respectively). No significant increase in cardiorespiratory fitness was found (0.14 (-0.03 to 0.31) l/min).Conclusion: While conclusions on the safety of HIIT cannot be drawn, data from the present study do not support previous findings cautioning avoidance of HIIT due to a possible added risk of thromboembolic events in men receiving platinum-based chemotherapy for testicular cancer. Considering the potential for positive effects on cardiovascular outcomes associated with HIIT, future studies with robust design should be performed in this population to confirm these observations.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christina Andersen
- University Hospitals Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Stine Munck
- University Hospitals Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Lillelund
- University Hospitals Center for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jakob Lauritsen
- Department of Oncology 5073, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Dybeck MM, Adamsen L, Sørensen V, Lillelund C, Møller T, Andersen C. Can supervised group-based multimodal exercise improve health-related quality of life in women with ovarian cancer undergoing chemotherapy? Eur J Cancer Care (Engl) 2022; 31:e13607. [PMID: 35555831 PMCID: PMC9539582 DOI: 10.1111/ecc.13607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 08/30/2021] [Accepted: 04/18/2022] [Indexed: 11/29/2022]
Affiliation(s)
| | - Lis Adamsen
- The University Hospitals Centre for Health Research, Copenhagen, Denmark
| | - Victor Sørensen
- The University Hospitals Centre for Health Research, Copenhagen, Denmark
| | | | - Tom Møller
- The University Hospitals Centre for Health Research, Copenhagen, Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Research, Copenhagen, Denmark
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Sommer MS, Vibe-Petersen J, Stærkind MB, Langer SW, Larsen KR, Trier K, Christensen M, Clementsen PF, Missel M, Christensen KB, Lillelund C, Langberg H, Pedersen JH, Quist M. Early initiated postoperative rehabilitation enhances quality of life in patients with operable lung cancer: Secondary outcomes from a randomized trial. Lung Cancer 2020; 146:285-289. [PMID: 32593918 DOI: 10.1016/j.lungcan.2020.06.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 06/06/2020] [Accepted: 06/18/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Patients with lung cancer report a lower degree of Health Related Quality of Life (HRQoL) compared with other cancer patients. HRQoL reflects how patients experience the impact of their disease and its treatment on their quality of daily living. A widely used questionnaire in lung cancer patients is the Functional Assessment of Cancer Therapy - Lung (FACT-L) questionnaire. Here we report the secondary outcomes on FACT-L data from the Postoperative Rehabilitation in Operation for Lung CAncer (PROLUCA) study, which describes the effect of early (14 days) versus late initiated (14 weeks) postoperative rehabilitation. MATERIALS AND METHODS The PROLUCA study was designed as a two-armed randomized controlled trial with an early rehabilitation group (14 days after surgery (ERG)) or a control arm with a late rehabilitation group (14 weeks after surgery (LRG)). The results for seven domain scores obtained using the FACT-L at the following time-points: baseline, 14 weeks, 26 weeks and 52 weeks after surgery are presented here. RESULTS 119 patients were randomized to the ERG and 116 to the LRG. In the ERG, HRQoL measured by both FACT-L and FACT-G (general core instrument) showed a continuous improvement up to 26 weeks after which HRQoL decreased after further 26 weeks without structured intervention. In the LRG a non-significant deterioration was detected over the first 14 weeks after surgery. After participation in the 12 weeks rehabilitation program, an increase in HRQoL was seen, without reaching the same level as the early group. CONCLUSION Analyses of the seven domain scores obtained using FACT-L and FACT-G reflect the importance of starting exercise early after surgery since the ERG avoid a temporary decrease in HRQoL. It is therefore recommended to start up a structured rehabilitation program 14 days after surgery, containing high intensity interval training and strength exercise twice a week for 12 weeks.
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Affiliation(s)
| | | | - Maja Bohlbro Stærkind
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Seppo W Langer
- Department of Oncology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Karen Trier
- Copenhagen Centre for Cancer and Health, Denmark
| | - Merete Christensen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Paul F Clementsen
- Department of Internal Medicine, Zealand University Hospital, Roskilde, Denmark; Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Copenhagen, Denmark; Department of Clinical Medicine, University of Copenhagen, Denmark
| | - Malene Missel
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Karl Bang Christensen
- Section of Biostatistics, Department of Public Health, University of Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Henning Langberg
- Department of Public Health, Faculty of Health, University of Copenhagen, Denmark
| | - Jesper H Pedersen
- Department of Cardiothoracic Surgery, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Morten Quist
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
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Møller T, Andersen C, Lillelund C, Bloomquist K, Christensen KB, Ejlertsen B, Tuxen M, Oturai P, Breitenstein U, Kolind C, Travis P, Bjerg T, Rørth M, Adamsen L. Physical deterioration and adaptive recovery in physically inactive breast cancer patients during adjuvant chemotherapy: a randomised controlled trial. Sci Rep 2020; 10:9710. [PMID: 32546796 PMCID: PMC7297957 DOI: 10.1038/s41598-020-66513-9] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 05/18/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiorespiratory fitness is an independent risk factor for cardiovascular disease and shortened life expectancy in breast cancer survivors. This randomised controlled trial (n = 153) was designed for patients with a physically inactive lifestyle prediagnosis and concurrently referred to adjuvant chemotherapy. We compared two 12-week exercise interventions aimed at physiological and patient-reported outcomes (cardiorespiratory fitness, muscle strength, metabolic markers, physical activity, pain, fatigue), including a 39-week follow-up. A supervised hospital-based moderate to high intensity group exercise intervention was compared to an instructed home-based individual pedometer intervention. The two 12-week interventions included oncologists’ recommendations and systematic health counselling. Outcomes were measured at baseline and week 6, 12 and 39. Primary outcome cardiorespiratory fitness declined significantly during chemotherapy and was restored in both interventions at follow-up. The interventions effectively engaged breast cancer patients in sustaining physical activities during and following adjuvant treatment. A composite metabolic score improved significantly. Positive cardiorespiratory fitness responders had improved clinical effects on fatigue, pain and dyspnoea versus negative responders. We conclude that a loss of cardiorespiratory fitness among physically inactive breast cancer patients may be restored by early initiated interventions and by adapting to physical activity recommendations, leading to a decreased cardiovascular risk profile in breast cancer survivors.
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Department, 9701, Copenhagen, Denmark. .,University of Copenhagen, Faculty of Health and Medical Sciences, Department of Public Health, Copenhagen, Denmark.
| | - Christina Andersen
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Department, 9701, Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Department, 9701, Copenhagen, Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Department, 9701, Copenhagen, Denmark
| | - Karl Bang Christensen
- University of Copenhagen, Faculty of Health and Medical Sciences, Department of Public Health, Copenhagen, Denmark
| | - Bent Ejlertsen
- Copenhagen University Hospital, Rigshospitalet, Department of Oncology, 7301, Copenhagen, Denmark
| | - Malgorzata Tuxen
- Copenhagen University Hospital, Rigshospitalet, Department of Oncology, 7301, Copenhagen, Denmark
| | - Peter Oturai
- Copenhagen University Hospital, Rigshospitalet, Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen, Denmark
| | - Ulla Breitenstein
- Copenhagen University Hospital, Rigshospitalet, Department of Oncology, 7301, Copenhagen, Denmark
| | - Cecilie Kolind
- Copenhagen University Hospital, Herlev Hospital, Department of Oncology, Herlev, Denmark
| | - Pernille Travis
- Copenhagen University Hospital, Herlev Hospital, Department of Oncology, Herlev, Denmark
| | - Tina Bjerg
- Copenhagen University Hospital, Rigshospitalet, Department of Oncology, 7301, Copenhagen, Denmark
| | - Mikael Rørth
- Copenhagen University Hospital, Rigshospitalet, Department of Oncology, 7301, Copenhagen, Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Department, 9701, Copenhagen, Denmark.,University of Copenhagen, Faculty of Health and Medical Sciences, Department of Public Health, Copenhagen, Denmark
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Kristensen JM, Lillelund C, Kjøbsted R, Birk JB, Andersen NR, Nybo L, Mellberg K, Balendran A, Richter EA, Wojtaszewski JFP. Metformin does not compromise energy status in human skeletal muscle at rest or during acute exercise: A randomised, crossover trial. Physiol Rep 2019; 7:e14307. [PMID: 31833226 PMCID: PMC6908741 DOI: 10.14814/phy2.14307] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Revised: 11/01/2019] [Accepted: 11/04/2019] [Indexed: 12/25/2022] Open
Abstract
5´AMP-activated protein kinase (AMPK) is a mediator of a healthy metabolic phenotype in skeletal muscle. Metformin may exacerbate the energy disturbances observed during exercise leading to enhanced AMPK activation, and these disturbances may provoke early muscular fatigue. We studied acute (1 day) and short-term (4 days) effects of metformin treatment on AMPK and its downstream signaling network, in healthy human skeletal muscle and adipose tissue at rest and during exercise, by applying a randomized blinded crossover study design in 10 lean men. Muscle and fat biopsies were obtained before and after the treatment period at rest and after a single bout of exercise. Metformin treat ment elicited peak plasma and muscle metformin concentrations of 31 μM and 11 μM, respectively. Neither of the treatments affected AMPK activity in skeletal muscle and adipose at rest or during exercise. In contrast, whole-body stress during exercise was elevated as indicated by increased plasma lactate and adrenaline concentrations as well as increased heart rate and rate of perceived exertion. Also whole-body insulin sensitivity was enhanced by 4 days metformin treatment, that is reduced fasting plasma insulin and HOMA-IR. In conclusion, acute and short-term metformin treatment does not affect energy homeostasis and AMPK activation at rest or during exercise in skeletal muscle and adipose tissue of healthy subjects. However, metformin treatment is accompanied by slightly enhanced perceived exertion and whole-body stress which may provoke a lesser desire for physical activity in the metformin-treated patients.
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Affiliation(s)
- Jonas M. Kristensen
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Christian Lillelund
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
- The University Hospitals Centre for Health ResearchUCSFCopenhagen University HospitalCopenhagenDenmark
| | - Rasmus Kjøbsted
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Jesper B. Birk
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Nicoline R. Andersen
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Lars Nybo
- Section of Integrative PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Karin Mellberg
- Astra Zeneca R&D MölndalGothenburgSweden
- Present address:
Laird Thermal SystemsGothenburgSweden
| | - Anudharan Balendran
- Astra Zeneca R&D MölndalGothenburgSweden
- Present address:
Alligator Bioscience ABLundSweden
| | - Erik A. Richter
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
| | - Jørgen F. P. Wojtaszewski
- Section of Molecular PhysiologyDepartment of Nutrition, Exercise and SportsFaculty of ScienceUniversity of CopenhagenCopenhagenDenmark
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Bloomquist K, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, Oturai P, Ejlertsen B, Tuxen MK, Møller T. Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial. Acta Oncol 2019; 58:1667-1675. [PMID: 31354000 DOI: 10.1080/0284186x.2019.1643916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Due to long-standing concerns that heavy-load lifting could increase the risk of developing lymphedema, breast cancer survivors have been advised to refrain from resistance exercise with heavy loads. This study prospectively evaluated the effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer.Material and Methods: Physically inactive women receiving adjuvant chemotherapy for breast cancer (n = 153) were randomized to a HIGH (supervised, multimodal exercise including heavy-load resistance exercise: 85-90% 1 repetition maximum [RM], three sets of 5-8 repetitions) versus LOW (pedometer and one-on-one consultations) 12-week intervention. Outcomes (baseline, 12 and 39 weeks) included lymphedema status (extracellular fluid [bioimpedance spectroscopy] and inter-arm volume % difference [dual-energy X-ray absorptiometry], lymphedema symptoms [numeric rating scale 0-10]), upper-extremity strength (1 RM), and quality of life domains (EORTC- BR23). Linear mixed models were used to evaluate equivalence between groups for lymphedema outcomes (equivalence margins for L-Dex, % difference and symptoms scale: ±5, ±3% and ±1, respectively). Superiority analysis was conducted for muscle strength and quality of life domains.Results: Postintervention equivalence between groups was found for extracellular fluid (0.4; 90% CI -2.5 to 3.2) and symptoms of heaviness (-0.2; -0.6 to 0.2), tightness (-0.1; -0.8 to 0.6) and swelling (0.2; -0.4 to 0.8). Nonequivalence was found for inter-arm volume % difference (-3.5%; -17.3 to 10.3) and pain (-0.7; -1.3 to 0), favoring HIGH. Strength gains were superior in the HIGH versus LOW group (3 kg; 1 to 5, p < .05). Further, clinically relevant reductions in breast (-11; -15 to -7) and arm (-6; -10 to -1) symptoms were found in the HIGH group.Conclusion: Findings suggest that physically inactive breast cancer survivors can benefit from supervised heavy-load resistance exercise during chemotherapy without increasing lymphedema risk. Trial registration: ISRCTN13816000.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Sandra C. Hayes
- Institute of Health and Biomedical Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Australia
| | - Christian Lillelund
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
| | - Karl Bang Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- DBCG, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, Denmark
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Egegaard T, Rohold J, Lillelund C, Persson G, Quist M. Pre-radiotherapy daily exercise training in non-small cell lung cancer: A feasibility study. Rep Pract Oncol Radiother 2019; 24:375-382. [PMID: 31289452 DOI: 10.1016/j.rpor.2019.06.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 06/03/2019] [Indexed: 12/11/2022] Open
Abstract
Aim To examine the feasibility of an individual, supervised, structured moderate-to-high intensity cycle ergometer exercise training immediately before radiotherapy in patients undergoing concomitant chemoradiotherapy for locally advanced non-small cell lung cancer (NSCLC). Background Lung cancer is the most common form of cancer. Despite significant advancements in therapy and supportive care it is still the leading cause of cancer-related death worldwide. Materials and methods Randomized controlled study design; patients with NSCLC receiving concomitant chemoradiotherapy were recruited and randomly assigned to either the exercise (EXE) or the control (CON) group. Exercise training consisted of 20 min moderate-to-high intensity aerobic interval training 5 times per week (Mon-Fri) prior to radiotherapy. Secondary outcomes were assessed at baseline and after 7 weeks: peak oxygen consumption (VO2peak), functional capacity (6MWD), pulmonary function (FEV1), psychosocial parameters (quality of life (FACT-L), anxiety and depression (HADS)) and cancer-related side effects (reported daily). Results Fifteen patients were included. All patients completed a baseline test, while 13 patients were eligible for a posttest. The recruiting rate was 44.1% and the overall attendance rate to exercise was 90.0% with an adherence rate to full exercise participation of 88.1%. No adverse events or any unexpected reactions were observed during the exercise sessions. No significant differences were observed within or between groups from baseline to post intervention in any of the secondary outcomes. Conclusion This study demonstrated 'proof of principle' that daily moderate-to-high intensity cycle ergometer exercise was feasible, safe and well tolerated among newly diagnosed patients with locally advanced NSCLC undergoing concomitant chemoradiotherapy. Larger randomized controlled trials are warranted.
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Affiliation(s)
- Trine Egegaard
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Julie Rohold
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
| | - Gitte Persson
- Department of Oncology, University Hospital of Copenhagen, Denmark
| | - Morten Quist
- The University Hospitals for Health Sciences, University Hospital of Copenhagen, Denmark
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Bloomquist KB, Adamsen L, Hayes SC, Lillelund C, Andersen C, Christensen KB, Oturai P, Ejlertsen B, Tuxen MK, Møller T. Heavy-load Resistance Exercise In Women At Risk Of Breast Cancer-related Lymphedema During Chemotherapy: Randomized Trial. Med Sci Sports Exerc 2019. [DOI: 10.1249/01.mss.0000560504.97843.1b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Quist M, Sommer MS, Vibe-Petersen J, Stærkind MB, Langer SW, Larsen KR, Trier K, Christensen M, Clementsen PF, Missel M, Henriksen C, Christensen KB, Lillelund C, Langberg H, Pedersen JH. Early initiated postoperative rehabilitation reduces fatigue in patients with operable lung cancer: A randomized trial. Lung Cancer 2018; 126:125-132. [DOI: 10.1016/j.lungcan.2018.10.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Revised: 10/18/2018] [Accepted: 10/28/2018] [Indexed: 10/27/2022]
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Dethlefsen C, Hansen LS, Lillelund C, Andersen C, Gehl J, Christensen JF, Pedersen BK, Hojman P. Exercise-Induced Catecholamines Activate the Hippo Tumor Suppressor Pathway to Reduce Risks of Breast Cancer Development. Cancer Res 2017; 77:4894-4904. [PMID: 28887324 DOI: 10.1158/0008-5472.can-16-3125] [Citation(s) in RCA: 99] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Revised: 04/19/2017] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
Strong epidemiologic evidence documents the protective effect of physical activity on breast cancer risk, recurrence, and mortality, but the underlying mechanisms remain to be identified. Using human exercise-conditioned serum for breast cancer cell incubation studies and murine exercise interventions, we aimed to identify exercise factors and signaling pathways involved in the exercise-dependent suppression of breast cancer. Exercise-conditioned serum from both women with breast cancer (n = 20) and healthy women (n = 7) decreased MCF-7 (hormone-sensitive) and MDA-MB-231 (hormone-insensitive) breast cancer cell viability in vitro by 11% to 19% and reduced tumorigenesis by 50% when preincubated MCF-7 breast cancer cells were inoculated into NMRI-Foxn1nu mice. This exercise-mediated suppression of cell viability and tumor formation was completely blunted by blockade of β-adrenergic signaling in MCF-7 cells, indicating that catecholamines were the responsible exercise factors. Both epinephrine (EPI) and norepinephrine (NE) could directly inhibit breast cancer cell viability, as well as tumor growth in vivo EPI and NE activate the tumor suppressor Hippo signaling pathway, and the suppressive effect of exercise-conditioned serum was found to be mediated through phosphorylation and cytoplasmic retention of YAP and reduced expression of downstream target genes, for example, ANKRD1 and CTGF. In parallel, tumor-bearing mice with access to running wheels showed reduced growth of MCF-7 (-36%, P < 0.05) and MDA-MB-231 (-66%, P < 0.01) tumors and, for the MCF-7 tumor, increased regulation of the Hippo signaling pathway. Taken together, our findings offer a mechanistic explanation for exercise-dependent suppression of breast cancer cell growth. Cancer Res; 77(18); 4894-904. ©2017 AACR.
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Affiliation(s)
- Christine Dethlefsen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, University of Copenhagen, Denmark
| | - Louise S Hansen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, University of Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
| | - Julie Gehl
- Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
| | - Jesper F Christensen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, University of Copenhagen, Denmark
| | - Bente K Pedersen
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, University of Copenhagen, Denmark
| | - Pernille Hojman
- Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, University of Copenhagen, Denmark. .,Department of Oncology, Copenhagen University Hospital, Herlev, Denmark
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Adamsen L, Andersen C, Lillelund C, Bloomquist K, Møller T. Rethinking exercise identity: a qualitative study of physically inactive cancer patients' transforming process while undergoing chemotherapy. BMJ Open 2017; 7:e016689. [PMID: 28838897 PMCID: PMC5629696 DOI: 10.1136/bmjopen-2017-016689] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To explore physically inactive breast and colon cancer patients' prediagnosis exercise history and attitudes to physical activity (PA) and experiences in initiating PA while undergoing adjuvant chemotherapy. DESIGN An explorative qualitative study guided the interpretive analysis of semistructured, open-ended interviews conducted at initiation of chemotherapy and after 12 weeks. The study was embedded in a pilot randomised controlled trial. SETTING Participants were recruited from the Oncological Department at a hospital in Copenhagen, Denmark. PARTICIPANTS 33 patients with cancer, median age 49 years: 25 patients with breast cancer and 8 with colon cancer, 72% with a low cardiac respiratory fitness level and the majority with a high level of education. Patients received adjuvant chemotherapy, oncologist's PA recommendation and exercise, cancer nurse specialist's counselling prior to allocation to PA interventions or waitlist control group. RESULTS Prediagnosis exercise had been excluded from patients' daily lives due to perceptions of exercise as boring, lack of discipline and stressful work conditions for both genders. Recommendations from oncologists and nurses inspired the patients to reconsider their attitudes and behaviour by accepting recruitment and participation in PA interventions during chemotherapy. Despite extensive side effects, most patients adhered to their PA commitment due to their perception of the bodily, emotional and social benefits and support of healthcare professionals, peers and family. CONCLUSION The patients' attitude towards exercise transformed from having no priority in patients' daily lives prediagnosis to being highly prioritised. This study identified four important phases in the exercise transformation process during the patients' treatment trajectory of relevance to clinicians in identifying, motivating and supporting physically inactive patients with cancer at long-term risk. Clinicians should address young, highly educated patients with cancer at onset of adjuvant chemotherapy due to their specific risk of a sedentary lifestyle resulting from being in stressful, ambitious careers. TRIAL REGISTRATION NUMBER Current Controlled Trials (ISRCTN24901641), Stage: Qualitative results.
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Affiliation(s)
- Lis Adamsen
- The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Department 9701, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Department 9701, Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Department 9701, Copenhagen, Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Department 9701, Copenhagen, Denmark
| | - Tom Møller
- The University Hospitals Centre for Health Research, UCSF Copenhagen University Hospital Rigshospitalet, Department 9701, Copenhagen, Denmark
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Adamsen L, Andersen C, Bloomquist K, Lillelund C, Moeller T. Rethinking exercise identity – a qualitative study among sedentary cancer patients. Eur J Cancer 2017. [DOI: 10.1016/s0959-8049(17)30618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Dethlefsen C, Lillelund C, Midtgaard J, Andersen C, Pedersen BK, Christensen JF, Hojman P. Exercise regulates breast cancer cell viability: systemic training adaptations versus acute exercise responses. Breast Cancer Res Treat 2016; 159:469-79. [PMID: 27601139 DOI: 10.1007/s10549-016-3970-1] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 08/29/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Exercise decreases breast cancer risk and disease recurrence, but the underlying mechanisms are unknown. Training adaptations in systemic factors have been suggested as mediating causes. We aimed to examine if systemic adaptations to training over time, or acute exercise responses, in breast cancer survivors could regulate breast cancer cell viability in vitro. METHODS Blood samples were collected from breast cancer survivors, partaking in either a 6-month training intervention or across a 2 h acute exercise session. Changes in training parameters and systemic factors were evaluated and pre/post exercise-conditioned sera from both studies were used to stimulate breast cancer cell lines (MCF-7, MDA-MB-231) in vitro. RESULTS Six months of training increased VO2peak (16.4 %, p < 0.001) and muscle strength, and reduced resting levels of plasma cholesterol (-18.2 %, p = 0.003) and cytokines. Yet, these systemic adaptations had no effect on breast cancer cell viability in vitro. During 2 h of acute exercise, increases in serum lactate (6-fold, p < 0.001), epinephrine (2.9-fold, p = 0.009), norepinephrine (2.2-fold, p < 0.001), and cytokines, including IL-6 (2.1-fold, p < 0.001) were detected. Incubation with serum obtained after exercise reduced viability by -9.2 % in MCF-7 (p = 0.04) and -9.4 % in MDA-MB-231 (p < 0.001) compared to resting serum. CONCLUSION Systemic changes to a 2 h exercise session reduced breast cancer viability, while adaptations to 6 months of training had no impact. Our data question the prevailing dogma that training-dependent baseline reductions in risk factors mediate the protective effect of exercise on breast cancer. Instead, we propose that the cancer protection is driven by accumulative effects of repeated acute exercise responses.
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Affiliation(s)
- Christine Dethlefsen
- The Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, Copenhagen University Hospital, 7641, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
| | - Julie Midtgaard
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Research, Rigshospitalet, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- The Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, Copenhagen University Hospital, 7641, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jesper Frank Christensen
- The Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, Copenhagen University Hospital, 7641, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Pernille Hojman
- The Centre of Inflammation and Metabolism (CIM) and Centre for Physical Activity Research (CFAS), Rigshospitalet, Faculty of Health Science, Copenhagen University Hospital, 7641, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
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Møller T, Lillelund C, Andersen C, Bloomquist K, Christensen KB, Ejlertsen B, Nørgaard L, Wiedenbein L, Oturai P, Breitenstein U, Adamsen L. The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med 2015; 1:e000021. [PMID: 27900123 PMCID: PMC5117008 DOI: 10.1136/bmjsem-2015-000021] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients. It remains unclear what is the optimal setting, dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients. Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a randomised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention, with usual care. Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness (VO2 peak) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients. The study demonstrated convincing recruitment (67%), safety and intervention adherence among breast cancer patients; while the attendance rate for colon cancer patients was notably lower (33%). VO2-peak declined on average 12% across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention. Pedometer use was well adapted in both breast and colon cancer patients. Conclusions Despite a fair adherence and safety, the current study calls into question whether aerobic exercise, regardless of intensity, is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients. Trial Registration: ISRCTN24901641
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Karl Bang Christensen
- Faculty of Health and Medical Sciences, Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Bent Ejlertsen
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lone Nørgaard
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Liza Wiedenbein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Ulla Breitenstein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Møller T, Lillelund C, Andersen C, Ejlertsen B, Nørgaard L, Christensen KB, Vadstrup E, Diderichsen F, Hendriksen C, Bloomquist K, Adamsen L. At cancer diagnosis: a 'window of opportunity' for behavioural change towards physical activity. A randomised feasibility study in patients with colon and breast cancer. BMJ Open 2013; 3:e003556. [PMID: 24189081 PMCID: PMC3822303 DOI: 10.1136/bmjopen-2013-003556] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Challenges exist in identifying, recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels. We hypothesise that the onset period of adjuvant chemotherapy can be 'the open window of opportunity' to identify and motivate sedentary patients with breast and colon cancers, at risk for developing coronary heart disease, to initiate and sustain lifestyle changes. AIMS To investigate the feasibility of oncologists/nurses screening for physical inactivity, in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy. Furthermore, the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks; (1) hospital-based, high intensity, group exercise intervention (2) home-based, low intensity, individual, pedometer intervention. Both arms will be compared with a control group. METHODS AND ANALYSES All newly referred patients will be screened for sedentary behaviour, using national recommendations. Testing at baseline, 6, 12 and 39 weeks will include; (1) physiological testing (VO2-peak, one repetition maximum muscle strength and lung function (2) fasting full body dual-energy X-ray absorptiometry scan (3) fasting blood glucose, insulin, lipids and cholesterols, (4) psychometric questionnaires (general well-being, quality of life, anxiety and depression, motivational readiness). The randomised controlled trial feasibility design is selected in order to examine barriers for recruitment, programme adherence, safety aspects and potential efficacy to the interventions during adjuvant chemotherapy. ETHICS AND DISSEMINATION The Scientific Committee of the Capital Region (case No. H-1-2011-131) and the Danish Data Protection Agency (j. No. 2011-41-6349) approved the study. Data will be entered and locked into a database hosted by the Copenhagen Trial Unit, Rigshosptialet. Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test. Results will be published in peer-reviewed scientific journals. TRIAL REGISTRATION Current Controlled Trials ISRCTN24901641.
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Affiliation(s)
- Tom Møller
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Lillelund
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Christina Andersen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Bent Ejlertsen
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Lone Nørgaard
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Karl Bang Christensen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Eva Vadstrup
- Department of Oncology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Finn Diderichsen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hendriksen
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
| | - Kira Bloomquist
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
| | - Lis Adamsen
- Department of Rigshospitalet, The University Hospitals Centre for Health Care Research UCSF Copenhagen University Hospital, Copenhagen, Denmark
- Faculty of Health, Institute of Public Health, The University of Copenhagen, Copenhagen, Denmark
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