Aerobic exercise during chemotherapy infusion for cancer treatment: a novel randomised crossover safety and feasibility trial

PURPOSE

Exercise is a powerful adjunct therapy for patients diagnosed with cancer which can alleviate treatment side-effects and improve a range of outcomes including fatigue and health-related quality of life. Recently, preclinical evidence has suggested that if exercise is performed during chemotherapy infusion, there is enhanced perfusion that may improve drug delivery and attenuate the hypoxic microenvironment. This study aimed to determine the safety and feasibility of delivering an aerobic exercise intervention to cancer patients during chemotherapy infusion.

METHODS

A randomised crossover trial was conducted for adults (18-60) undergoing chemotherapy treatment with non-vesicant agents for cancer. In randomised order, during two consecutive chemotherapy infusions, participants either received usual care or performed 20 min of supervised low-intensity cycling.

RESULTS

Sixty-five percent of patients approached agreed to participate, and exercise was safely delivered with neither adverse events nor interference to treatment reported for all participants with a mixed cancer diagnosis (N = 10, 90% female, 51.2 ± 7.4 years). There were no significant differences between exercise and usual care in participant-reported difficulty or comfort levels, but exercise significantly reduced boredom (p = 0.01). No significant differences were detected in the symptoms experienced following either intervention.

CONCLUSIONS

Exercise during chemotherapy infusion appears to be safe and feasible. Further research is required with a larger sample size to evaluate the impact on tumour perfusion, symptom experience, and opportunity for physical activity increase.

Qualitative Evaluation of a Community-Based Physical Activity and Yoga Program for Men Living With Prostate Cancer: Survivor Perspectives

Purpose

Physical activity (PA) programs for prostate cancer survivors have positive effects on many aspects of health-related quality of life. Translating this research into sustainable community-based settings is necessary to ensure access to programs for survivors. This study examines patient perspectives in the community-based TrueNTH Lifestyle Management (TrueNTH LM) program in Calgary, Canada.

Methods

Eleven men from programs at civic wellness centers participated in 2 small semistructured focus groups (n = 5 and 6) at the University of Calgary. Motivation for program initiation and adherence, benefits and barriers to participation, and individual satisfaction and feedback on program improvement were discussed. Audio recordings were transcribed and analyzed using thematic methodology guided by a pragmatic philosophy on the patient experience in the program.

Results

Themes identified included perceived benefits of participating (physical, psychological, and social), facilitators for involvement in the PA program (program design, initial free access, tailored to prostate cancer specific needs, psychosocial environment), and opportunities for improvement and sustainability (exercise as a part of standard care, cost structure, home-based options).

Conclusions

These findings provide valuable insight into patient perspectives on effective characteristics of prostate cancer and exercise programs. TrueNTH LM has implemented findings, and ensuring needs (benefits and barriers) are addressed for prostate cancer survivors when entering community-based PA programs.

Home-based rehabilitation in inoperable non-small cell lung cancer-the patient experience

PURPOSE

Exercise is important in lung cancer, yet most people do not meet the physical activity guidelines. The aim of this study was to characterise the views and experiences of participants with inoperable lung cancer who completed a home-based rehabilitation program.

METHODS

Ninety-two participants were recruited (45 intervention group [IG], 47 usual care). Individual semi-structured interviews were conducted with participants randomised to the IG of a trial of home-based exercise, behaviour change and symptom management. Data were independently coded by two researchers, cross-checked and analysed using content analysis with a summary of arising themes.

RESULTS

Of the IG (25/45), 55% were interviewed: mean (SD) age 67 (13) years; male 52%; disease stage n (%) III = 9 (36), IV = 11 (44); radical treatment intent n (%) 13 (52). The majority of participants reported program benefits, both in the physical domain (reduced sedentary time and improved strength, fitness and function) and the mental domain (motivation to keep healthy, preventing boredom). Support to self-manage symptoms was well received and many participants reported increased confidence in managing their symptoms. Exercise enablers included having expert health professional support; motivation to be stronger and better prepared for future challenges; and having an achievable and familiar program that was monitored. Treatment side-effects, pain from comorbidities and the weather were exercise barriers. For the majority of participants the use of a Fitbit™ activity tracker, text message exercise reminders and an exercise diary helped to promote adherence.

CONCLUSIONS

This home-based rehabilitation program was acceptable to most participants with multiple benefits reported including improved fitness, motivation and ability to manage symptoms.

Two-year follow-up of the OptiTrain randomised controlled exercise trial

Purpose

The aim of this study was to determine if there were any differences in health-related outcomes and physical activity (PA) between the two OptiTrain exercise groups and usual care (UC), 2 years post-baseline.

Methods

The OptiTrain study was a three-arm randomised controlled trial comparing 16 weeks of concurrent aerobic high-intensity interval training (HIIT) and progressive resistance exercise (RT-HIIT) or concurrent HIIT and continuous moderate-intensity aerobic exercise (AT-HIIT) to UC in 206 patients with breast cancer undergoing chemotherapy. Eligible participants were approached 2 years following baseline to assess cancer-related fatigue, quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, PA, sedentary behaviour, and sick leave.

Results

The RT-HIIT group reported lower total cancer-related fatigue, (− 1.37, 95% CI − 2.70, − 0.04, ES = − 0.06) and cognitive cancer-related fatigue (− 1.47, 95% CI − 2.75, − 0.18, ES = − 0.28), and had higher lower limb muscle strength (12.09, 95% CI 3.77, 20.40, ES = 0.52) than UC at 2 years. The AT-HIIT group reported lower total symptoms (− 0.23, 95% CI − 0.42, − 0.03, ES = − 0.15), symptom burden (− 0.30, 95% CI − 0.60, − 0.01, ES = − 0.19), and body mass − 2.15 (− 3.71, − 0.60, ES = − 0.28) than UC at 2 years.

Conclusion

At 2 years, the exercise groups were generally experiencing positive differences in cancer-related fatigue (RT-HIIT), symptoms (AT-HIIT), and muscle strength (RT-HIIT) to UC. The findings provide novel evidence that being involved in an exercise program during chemotherapy can have long-term benefits for women with breast cancer, but that strategies are needed to create better pathways to support patients to maintain physical activity levels.

Trial registration

Clinicaltrials.gov registration number: NCT02522260. Trial registered on 9 June 2015. https://clinicaltrials.gov/ct2/show/NCT02522260. Retrospectively registered.

High-intensity interval training in the therapy and aftercare of cancer patients: a systematic review with meta-analysis

PURPOSE

This review and meta-analysis aimed to evaluate the effects of high-intensity interval training (HIIT) compared to usual care (UC) or moderate-intensity training (MIE) on physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare.

METHODS

Databases were systematically searched in accordance with the PRISMA guidelines until October 4th, 2018. Eligibility criteria included adult patients of various cancer types, performing HIIT vs. UC or MIE. Outcomes of interest included physical fitness (cardiorespiratory fitness [VO_2peak] and functional capacity) and health-related outcomes (body composition, quality of life, cancer-related fatigue, and blood-borne biomarkers). Mean differences (MD) were calculated and pooled to generate effect sizes for VO_2peak.

RESULTS

The search identified 1453 studies, out of which 12 articles were included. The average duration of interventions was 6.7 ± 3.0 weeks, with 2.8 ± 0.5 sessions per week. The meta-analysis for VO_2peak showed superiority of HIIT compared to UC (MD 3.73; 95% CI 2.07, 5.39; p < 0.001) but not MIE (MD 1.36; 95% CI - 1.62, 4.35; p = 0.370). Similarly, no superior effects of HIIT compared to MIE were found for quality of life or changes in lean mass, while evidence was provided for a larger reduction in fat mass.

CONCLUSION

This systematic review showed that short-term HIIT induces similar positive effects on physical fitness and health-related outcomes as MIE but seems to be superior compared to UC. Thus, HIIT might be a time-efficient intervention for cancer patients across all stages of therapy and aftercare.

IMPLICATIONS FOR CANCER SURVIVORS

High-intensity interval training (HIIT) is superior compared to usucal care in improving physical fitness and health-related outcomes in cancer patients across all stages of therapy and aftercare. Currently, there is no evidence for the benefits of HIIT compared to aerobic training of moderate intensity (MIE) for changes in cardiorespiratory fitness, lean mass and patient-reported outcomes. Reductions in fat mass may be more pronounced in HIIT compared to MIE when training is performed in aftercare.

Brief behavioural intervention, delivered as standard care, to support physical activity engagement in men with prostate cancer: a pilot study protocol

Introduction

Physical activity is beneficial to men with prostate cancer, but there remain barriers to fulfilling the potential of National Health Service trusts to support men with prostate cancer to be physically active. This article describes protocols for two pilot studies, each conducted in a different setting, designed to assess the potential of a behavioural intervention to affect patients’ motivation to exercise. The intervention is theory based and inspired by recent empirical observations.

Methods and analysis

The intervention consists of a 10 min talk, delivered to patients by a man with a history of prostate cancer treatment and a good experience of exercise, as part of their standard care. This talk either takes place in a preradical prostatectomy seminar (study one), or a post-treatment seminar designed to assist patients in adjusting to life after treatment (study two). Outcomes will be compared between patients attending the existing seminar format, and patients attending the novel seminar format. The two primary outcomes are: (1) differences in self-reported physical activity before and 90 days after the seminar and (2) the likelihood of the patient seeing an in-house exercise physiotherapist in those 90 days. Data on quality of life, fatigue and exercise behavioural regulations will also be captured at the same time points.

Ethics and dissemination

These two projects have been approved by internal clinical audit committees due to their focus on service improvement. Findings from these pilot studies will be presented at oncology meetings and submitted for publication in academic journals.

Physical activity counselling and referrals by general practitioners for prostate cancer survivors in Australia

Physical activity is an important component of standard care to ensure quality of life for prostate cancer survivors. This paper describes the frequency of physical activity management (physical activity counselling or referrals) by GPs for prostate cancer survivors. A secondary aim is to explore GP characteristics that may influence physical activity recommendations, such as GP or patient age, GP gender and GP geographical location. Analysis was conducted using the longitudinal survey data from the Bettering the Care and Evaluation of Health (BEACH) study. Consultations where prostate cancer was managed, but not classified as a new problem or associated with palliative care, were included. GPs provided physical activity recommendations at 2.0% (n = 58/2882) of prostate cancer survivorship management contacts. The physical activity management provided was physical activity counselling on 39 occasions and a physical activity referral on 19 occasions. All physical activity referrals were made to physiotherapy. After controlling for potential confounding factors, results showed that younger GPs used physical activity management at four-fold the rate of older GPs, and that GPs in major cities used physical activity management at twice the rate of rural GPs. No patient characteristics influenced physical activity management. Australian GPs rarely incorporate physical activity management as part of their management of prostate cancer. Strategies are needed to increase the frequency with which GPs recommend physical activity for prostate cancer survivors.

An Interactive Web Portal for Tracking Oncology Patient Physical Activity and Symptoms: Prospective Cohort Study

BACKGROUND

Physical activity levels typically decline during cancer treatment and often do not return to prediagnosis or minimum recommended levels. Interventions to promote physical activity are needed. Support through the use of digital health tools may be helpful in this situation.

OBJECTIVE

The goal of the research was to evaluate the feasibility, usability, and acceptability of an interactive Web portal developed to support patients with cancer to increase daily physical activity levels.

METHODS

A Web portal for supportive cancer care which was developed to act as a patient-clinician information and coaching tool focused on integrating wearable device data and remote symptom reporting. Patients currently receiving or who had completed intensive anticancer therapy were recruited to 3 cohorts. All cohorts were given access to the Web portal and an activity monitor over a 10-week period. Cohort 2 received additional summative messaging, and cohort 3 received personalized coaching messaging. Qualitative semistructured interviews were completed following the intervention. The primary outcome was feasibility of the use of the portal assessed as both the number of log-ins to the portal to record symptoms and the completion of post-program questionnaires.

RESULTS

Of the 49 people were recruited, 40 completed the intervention. Engagement increased with more health professional contact and was highest in cohort 3. The intervention was found to be acceptable by participants.

CONCLUSIONS

The portal was feasible for use by people with a history of cancer. Further research is needed to determine optimal coaching methods.

The impact of gynaecological cancer treatment on physical activity levels: a systematic review of observational studies

BACKGROUND

The natural history of physical activity levels during and following gynaecological cancer treatment is not well understood. This is required in order to establish the time at which physical activity levels are lowest in order to target cancer rehabilitation or exercise interventions in gynaecological cancer population accordingly.

OBJECTIVES

To conduct a systematic review to evaluate the impact of gynaecological cancer treatments on physical activity levels and to summarise the pattern of changes in physical activity levels over time among patients with gynaecological cancer.

METHODS

A comprehensive literature search was performed via MEDLINE (1946-2018), CINAHL (1982-2018), EMBASE (1947-2018), Ovid Emcare (1947-2018), PsycINFO (1806-2018) and the Cochrane Library (1991-2018). Studies were eligible for inclusion if they had assessed changes in physical activity levels during and after gynaecological cancer treatment. The methodological quality of the eligible studies was assessed by two independent reviewers using the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

In total, six studies (three cohort studies and three cross-sectional studies) with 1607 participants were included. All studies used patient-reported physical activity measures. Two of the three cohort studies measured patient-recalled physical activity levels before diagnosis (baseline), and length of follow-up varied across all studies. The majority of participants were treated surgically±adjuvant therapy. Physical activity levels decreased at 6 months following surgery when compared with pre-treatment levels. Approximately 91% of participants did not meet physical activity guidelines 2 years following diagnosis, and 58% reported being less physically active 3 years after diagnosis, compared with the pre-diagnosis levels.

CONCLUSIONS

Despite the paucity of evidence and limitations in the current body of literature, this review demonstrated that compared to pre-diagnosis, levels of physical activity remain low in gynaecological cancer survivors up to 3 years after diagnosis. More research is warranted to better characterise the pattern of change of physical activity levels across the disease trajectory and identify changes in physical activity patterns by cancer treatments and gynaecological tumour streams in order to target interventions accordingly.

General practitioner referrals to exercise physiologists during routine practice: A prospective study

OBJECTIVES

Physical activity is essential in the primary and secondary prevention of several chronic diseases and should be a standard component of clinical care. The aims of this study were to examine the trends and characteristics of referrals to exercise physiologists in routine care in a nationally representative sample of general practitioners (GPs) in Australia.

DESIGN

This prospective study was an analysis of Bettering the Evaluation and Care of Health (BEACH) GP data from April 2009 to March 2016.

METHODS

In total, each of 6827 randomly sampled GPs recorded details of 100 consecutive encounters (N=682,700). The rate of exercise physiologist referrals was calculated by patient and GP characteristics.

RESULTS

Over the study period, the rate at which GPs referred their patients significantly increased from 0.38 to 1.44 per 1000 encounters. Patients aged 45-64 years were most likely to be referred (1.32 per 1000 encounters). Patients from non-English-speaking backgrounds were referred at less than half the rate (0.41 per 1000) of those from English speaking backgrounds (0.96). Female GPs referred patients (1.27 per 1000 encounters) twice as often as male GPs (0.64). One-third (35.3%) of GP referrals were made for problems relating to the endocrine, nutritional and metabolic systems (e.g., obesity, diabetes mellitus); only 1.6% of referrals were made for mental health conditions.

CONCLUSIONS

Although increasing, the rate of GP referral to exercise physiologists was low and associated with patient and GP characteristics. Education of GPs about the role of exercise physiologists in the prevention and management of chronic disease is needed.

Is preoperative physical activity level of patients undergoing cancer surgery associated with postoperative outcomes? A systematic review and meta-analysis

BACKGROUND

There is uncertainty about the role of preoperative physical activity (PA) level and its influence on postoperative outcomes, especially for patients undergoing cancer surgery.

AIM

To investigate if the level of preoperative PA in patients undergoing cancer surgery is associated with postoperative complication rates, length of hospital stay (LOS) and quality of life (QOL).

METHODS

An electronic search was performed from inception to 26th November 2017 in MEDLINE, Embase, AMED and CINAHL. Studies investigating the association between objective or subjective level of PA and postoperative complication rates, LOS and QOL were included. Risk of bias was assessed using the Quality in Prognosis Studies (QUIPS) tool. When possible, summary odds ratios (OR) and 95% confidence intervals (CI) were calculated using random-effect models.

RESULTS

13 studies (5523 unique patients) were included. Overall, most studies were rated as having low or moderate risk of bias. Higher preoperative level of PA was not significantly associated with absence of postoperative complications (OR = 2.60; 95%CI = 0.59 to 11.37) but was significantly associated with shorter LOS (OR = 3.66; 95%CI = 1.38 to 9.6) and postoperative QOL (OR = 1.29; 95%CI = 1.11 to 1.49).

CONCLUSIONS

The available literature suggests higher levels of preoperative PA in patients undergoing cancer surgery may be associated with better postoperative outcomes, particularly shorter LOS and better QOL. There is a need for high-quality studies investigating the association between preoperative PA and postoperative outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2017 CRD42017082334. Available from:http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017082334.