1
|
Ballin M, Berglind D, Henriksson P, Neovius M, Nordström A, Ortega FB, Sillanpää E, Nordström P, Ahlqvist VH. Adolescent Cardiorespiratory Fitness and Risk of Cancer in Late Adulthood: Nationwide Sibling-Controlled Cohort Study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.07.01.24309761. [PMID: 39006434 PMCID: PMC11245056 DOI: 10.1101/2024.07.01.24309761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
Objective To investigate whether the higher risks of certain cancers associated with high cardiorespiratory fitness can be explained by increased detection and unobserved confounders. Design Nationwide sibling-controlled cohort study of adolescents. Setting Sweden. Participants 1 124 049 men of which 477 453 were full siblings, who underwent mandatory military conscription examinations between 1972 and 1995 at a mean age of 18.3 years. Main outcome measures Hazard ratios (HR) and 95% confidence intervals (CI) of overall cancer diagnosis and cancer mortality, and 14 site-specific cancers (diagnosis or death), as recorded in the Swedish National Patient Register or Cause of Death Register until 31 December 2023, modelled using flexible parametric regressions. Results Participants were followed until a median (maximum) age of 55.9 (73.5) years, during which 98 410 were diagnosed with cancer and 16 789 had a cancer-related death (41 293 and 6908 among full siblings respectively). The most common cancers were non-melanoma skin (27 105 diagnoses & 227 deaths) and prostate cancer (24 211 diagnoses & 869 deaths). In cohort analysis, those in the highest quartile of cardiorespiratory fitness had a higher risk of prostate (adjusted HR 1.10; 95% CI: 1.05 to 1.16) and skin cancer (e.g., non-melanoma HR 1.44; 1.37 to 1.50) compared to those in the lowest quartile, which led to a higher risk of any type of cancer diagnosis (HR 1.08; 1.06 to 1.11). However, those in the highest quartile had a lower risk of cancer mortality (HR 0.71; 0.67 to 0.76). When comparing full siblings, and thereby controlling for all behavioural, environmental, and genetic factors they share, the excess risk of prostate (HR 1.01; 0.90 to 1.13) and skin cancer (e.g., non-melanoma HR 1.09; 0.99 to 1.20) attenuated to the null. In contrast, the lower risk of overall cancer mortality was still statistically significant after control for such shared confounders (HR 0.78; 0.68 to 0.89). For other site-specific cancers, the influence of such confounding tended to vary, but none showed the same excess risk as prostate and non-melanoma skin cancer. Conclusions The association between high levels of adolescent cardiorespiratory fitness and excess risk of some cancers, such as prostate and non-melanoma skin cancer, appears to be fully explained by unobserved confounders shared between full siblings. However, the protective association with cancer mortality persists even after control for such confounding. Summary box What is already known on this topic Adolescent physical activity and cardiorespiratory fitness are considered important factors for the prevention of cancer based on evidence from observational studies.Observational studies are, however, vulnerable to unobserved confounders and bias processes, including health-seeking behaviours and genetic and environmental confounders.These biases could explain why prior studies have found that high adolescent cardiorespiratory fitness is associated with higher risks of some cancers, typically low-mortality cancers such as prostate and non-melanoma skin cancer. What this study adds This nationwide cohort study of 1.1 million male adolescents showed that while higher cardiorespiratory fitness was associated with excess risk of the most common cancers - prostate and non-melanoma skin - these associations attenuated to the null when accounting for behavioural, environmental, and genetic confounders shared between full siblings.In contrast, high adolescent cardiorespiratory fitness was associated with a lower risk of overall cancer mortality, which remained after controlling for unobserved confounders shared between full siblings.
Collapse
|
2
|
Voltarelli VA, Amano MT, Tobias GC, Borges GS, Oliveira da Paixão A, Pereira MG, Saraiva Câmara NO, Caldeira W, Ribeiro AF, Otterbein LE, Negrão CE, Turner JE, Brum PC, Camargo AA. Moderate-intensity aerobic exercise training improves CD8 + tumor-infiltrating lymphocytes effector function by reducing mitochondrial loss. iScience 2024; 27:110121. [PMID: 38957793 PMCID: PMC11217614 DOI: 10.1016/j.isci.2024.110121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 02/09/2024] [Accepted: 05/24/2024] [Indexed: 07/04/2024] Open
Abstract
Aerobic exercise training (AET) has emerged as a strategy to reduce cancer mortality, however, the mechanisms explaining AET on tumor development remain unclear. Tumors escape immune detection by generating immunosuppressive microenvironments and impaired T cell function, which is associated with T cell mitochondrial loss. AET improves mitochondrial content and function, thus we tested whether AET would modulate mitochondrial metabolism in tumor-infiltrating lymphocytes (TIL). Balb/c mice were subjected to a treadmill AET protocol prior to CT26 colon carcinoma cells injection and until tumor harvest. Tissue hypoxia, TIL infiltration and effector function, and mitochondrial content, morphology and function were evaluated. AET reduced tumor growth, improved survival, and decreased tumor hypoxia. An increased CD8+ TIL infiltration, IFN-γ and ATP production promoted by AET was correlated with reduced mitochondrial loss in these cells. Collectively, AET decreases tumor growth partially by increasing CD8+ TIL effector function through an improvement in their mitochondrial content and function.
Collapse
Affiliation(s)
- Vanessa Azevedo Voltarelli
- Molecular Oncology Center, Sírio-Libanês Hospital, São Paulo, SP, Brazil
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Mariane Tami Amano
- Molecular Oncology Center, Sírio-Libanês Hospital, São Paulo, SP, Brazil
| | - Gabriel Cardial Tobias
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Department of Pediatrics, Weill Cornell Medical College, New York, NY, USA
| | - Gabriela Silva Borges
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
| | | | - Marcelo Gomes Pereira
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Leeds School of Biomedical Sciences, Faculty of Biological Sciences, University of Leeds, Leeds, UK
| | - Niels Olsen Saraiva Câmara
- Department of Immunology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | - Waldir Caldeira
- Department of Genetics and Evolutionary Biology, University of São Paulo, São Paulo, SP, Brazil
| | - Alberto Freitas Ribeiro
- Department of Genetics and Evolutionary Biology, University of São Paulo, São Paulo, SP, Brazil
| | - Leo Edmond Otterbein
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Carlos Eduardo Negrão
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Heart Institute, Faculty of Medicine, University of São Paulo, São Paulo, SP, Brazil
| | - James Edward Turner
- Department for Health, University of Bath, Bath, UK
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Patricia Chakur Brum
- School of Physical Education and Sport, University of São Paulo, São Paulo, SP, Brazil
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, University of São Paulo, São Paulo, SP, Brazil
| | | |
Collapse
|
3
|
Schneider C, Dierks A, Rabaglio M, Campbell KL, Wilhelm M, Eser P. Timing of cardio-oncological rehabilitation and cardiorespiratory fitness in patients receiving cardiotoxic chemotherapy: a longitudinal observational study. Swiss Med Wkly 2024; 154:3588. [PMID: 38885132 DOI: 10.57187/s.3588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024] Open
Abstract
AIMS Anthracycline-based chemotherapy has well-known cardiotoxic effects, butmay also cause skeletal muscle myopathy and negatively affect cardiorespiratory fitness and quality of life. The effectiveness of exercise training in improving cardiorespiratory fitness and quality of life during chemotherapy is highly variable. We set out to determine how the effect of exercise training on cardiorespiratory fitness (primary outcome) and quality of life (secondary outcome) in cancer patients is affected by the type of therapy they receive (cardiotoxic therapy with or without anthracyclines; non-cardiotoxic therapy) and the timing of the exercise training (during or after therapy). METHODS Consecutive patients with cancer who participated in an exercise-based cardio-oncology rehabilitation programme at a university hospital in Switzerland between January 2014 and February 2022 were eligible. Patients were grouped based on chemotherapy (anthracycline vs non-anthracycline) and timing of exercise training (during vs after chemotherapy). Peak oxygen uptake (VO2) was assessed with cardiopulmonary exercise testing (n = 200), and quality of life with the Functional Assessment of Cancer Therapies questionnaire (n = 77). Robust linear models were performed for change in peak VO2 including type and timing of cardiotoxic therapies, age, training impulse and baseline peak VO2; change in quality of life was analysed with cumulative linked models. RESULTS In all patients with valid VO2 (n = 164), median change in peak VO2 from before to after exercise training was 2.3 ml/kg/min (range: -10.1-15.9). The highest median change in peak VO2 was 4.1 ml/kg/min (interquartile range [IQR]: 0.7-7.7) in patients who completed exercise training during non-anthracycline cardiotoxic or non-cardiotoxic therapies, followed by 2.8 ml/kg/min (IQR: 1.2-5.3) and 2.3 ml/kg/min (IQR: 0.1-4.6) in patients who completed exercise training after anthracycline and after non-anthracycline cardiotoxic or non-cardiotoxic therapies, respectively. In patients who completed exercise training during anthracycline therapy, peak VO2 decreased by a median of -2.1 ml/kg/min (IQR: -4.7-2.0). In the robust linear model, there was a significant interaction between type and timing of cancer treatment for anthracycline therapy, with greater increases in peak VO2 when exercise training was performed after anthracycline therapy. For quality of life, higher baseline scores were negatively associated with changes in quality of life. CONCLUSION In our cohort, the increase in cardiorespiratory fitness was diminished when exercise training was performed concurrently with anthracyclines. For patients with cardiotoxic treatments other than anthracyclines, cardiorespiratory fitness and quality of life was not associated with timing of exercise training.
Collapse
Affiliation(s)
- Caroline Schneider
- Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Annika Dierks
- Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Manuela Rabaglio
- Department of Medical Oncology, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Kristin L Campbell
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Matthias Wilhelm
- Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Prisca Eser
- Rehabilitation and Sports Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
4
|
Kunutsor SK, Kaminsky LA, Lehoczki A, Laukkanen JA. Unraveling the link between cardiorespiratory fitness and cancer: a state-of-the-art review. GeroScience 2024:10.1007/s11357-024-01222-z. [PMID: 38831183 DOI: 10.1007/s11357-024-01222-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Accepted: 05/24/2024] [Indexed: 06/05/2024] Open
Abstract
Cardiorespiratory fitness (CRF) not only reflects an individual's capacity to perform physical activities but also encapsulates broader effects on the basic biology of aging. This review aims to summarize the evidence on the influence of CRF on overall and site-specific cancer risks. It delves into the biological mechanisms through which CRF may exert its effects, explores the clinical implications of these findings, identifies gaps in the current evidence base, and suggests directions for future research. The synthesis of findings reveals that higher CRF levels (general threshold of > 7 METs) are consistently associated with a reduced risk of a range of cancers, including head and neck, lung, breast, gastrointestinal, particularly pancreatic and colorectal, bladder, overall cancer incidence and mortality, and potentially stomach and liver, bile duct, and gall bladder cancers. These inverse associations between CRF and cancer risk do not generally differ across age groups, sex, race, or adiposity, suggesting a universal protective effect of CRF. Nonetheless, evidence linking CRF with skin, mouth and pharynx, kidney, and endometrial cancers is limited and inconclusive. Conversely, higher CRF levels may be potentially linked to an increased risk of prostate cancer and hematological malignancies, such as leukemia and myeloma, although the evidence is still not conclusive. CRF appears to play a significant role in reducing the risk of several cancers through various biological mechanisms, including inflammation reduction, immune system enhancement, hormonal regulation, and metabolic improvements. Overall, enhancing CRF through regular physical activity offers a vital, accessible strategy for reducing cancer risk and extending the health span. Future research should aim to fill the existing evidence gaps regarding specific cancers and elucidate the detailed dose-response relationships between CRF levels and cancer risk. Studies are also needed to elucidate the causal relationships and mechanistic pathways linking CRF to cancer outcomes.
Collapse
Affiliation(s)
- Setor K Kunutsor
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, LE5 4WP, UK.
| | - Leonard A Kaminsky
- Clinical Exercise Physiology, College of Health, Ball State University, Muncie, IN, USA
| | - Andrea Lehoczki
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Doctoral College, Health Sciences Program, Semmelweis University, Budapest, Hungary
- Department of Haematology and Stem Cell Transplantation, National Institute for Haematology and Infectious Diseases, South Pest Central Hospital, 1097, Budapest, Hungary
| | - Jari A Laukkanen
- Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland
- Department of Medicine, Wellbeing Services County of Central Finland, Jyväskylä, Finland
| |
Collapse
|
5
|
Viamonte SG, Tavares A, Alves AJ, Joaquim A, Vilela E, Capela A, Costa AJ, Duarte B, Rato ND, Afreixo V, Fontes Carvalho R, Santos M, Ribeiro F. Cost-effectiveness analysis of a cardio-oncology rehabilitation framework compared to an exercise intervention for cancer survivors with high cardiovascular risk. Eur J Prev Cardiol 2024:zwae181. [PMID: 38788778 DOI: 10.1093/eurjpc/zwae181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/04/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND A cardio-oncology rehabilitation model among cancer survivors showed superior results comparing to a community-based exercise intervention. However, questions remain about its cost-effectiveness. AIMS To assess the cost-effectiveness of a center-based cardiac rehabilitation (CBCR) program when compared to usual care encompassing a community-based exercise training (CBET), among cancer survivors with high cardiovascular risk. METHODS The CORE study was a single-center, prospective, randomized controlled trial; 80 adult cancer survivors with previous exposure to cardiotoxic cancer treatment and/or with previous cardiovascular disease were assigned (1:1 ratio) to an 8-week CBCR or CBET, twice/week. Cost-effectiveness was a pre-specified secondary endpoint. Outcomes included healthcare resource use and costs, quality-adjusted life-years (QALYs) and cost-effectiveness; incremental cost-effectiveness ratio (ICER) was computed from a societal perspective. RESULTS 75 patients completed the study (CBCR N=38; CBET N=37). The CBCR had significantly higher cost per patient (477.76 ± 39.08€) compared to CBET group (339.32 ± 53.88€), with a significant between-group difference 138.44€ (95% CI, 116.82 to 160.05€, p<0.01). A between-group difference by 0.100 points in QALYs was observed, favouring the CBCR (95% CI, -0.163 to -0.037, p=0.002). When CBCR was compared with CBET, the ICER was €1,383.24 per QALY gained; at a willingness-to-pay threshold of €5,000 per QALY, the probability of CBCR being cost-effective was 99.9% (95% CI, 99.4 to 100.0). CONCLUSION The CORE trial shows that a CBCR is a cost-effective intervention in the management of cancer survivors with high cardiovascular risk, reinforcing the potential benefits of this multidisciplinary approach in supportive care of this specific subset of cancer patients.
Collapse
Affiliation(s)
- Sofia G Viamonte
- Centro de Reabilitação do Norte, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Aida Tavares
- Lisbon School of Economics and Management, University of Lisbon, Portugal
- Center for Health Studies and Research, University of Coimbra, Coimbra, Portugal
| | - Alberto J Alves
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Portugal
| | - Ana Joaquim
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Eduardo Vilela
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Cardiology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Andreia Capela
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
| | - Ana João Costa
- Centro de Reabilitação do Norte, Centro Hospitalar Vila Nova de Gaia/Espinho, Portugal
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Barbara Duarte
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
| | - Nuno Dias Rato
- ONCOMOVE® - Associação de Investigação de Cuidados de Suporte em Oncologia (AICSO), Vila Nova de Gaia, Portugal
- University of Maia, Research Center in Sports Sciences, Health Sciences and Human Development, Portugal
| | - Vera Afreixo
- Center for Research and Development in Mathematics and Applications, Department of Mathematics, University of Aveiro, Aveiro, Portugal
| | | | - Mário Santos
- Cardiology Department, Centro Hospitalar Universitário do Porto, Portugal
- Department of Immuno-Physiology and Pharmacology, Unit for Multidisciplinary Investigation in Biomedicine, Institute for Biomedical Sciences Abel Salazar, University of Porto, Portugal
| | - Fernando Ribeiro
- Institute of Biomedicine, School of Health Sciences, University of Aveiro, Portugal
| |
Collapse
|
6
|
Thomas G, Weiss E, Del Buono MG, Moroni F, West J, Myers R, Kontos E, Golino M, Abbate A, Canada JM. Early reduction in cardiorespiratory fitness and diastolic reserve following radiation therapy for lung cancer. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2024; 10:15. [PMID: 38468295 PMCID: PMC10929088 DOI: 10.1186/s40959-024-00216-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
BACKGROUND Contemporary radiotherapy for the treatment of lung cancer is effective in targeting tumor tissue while limiting heart exposure, yet cardiac toxicity still occurs, often becoming clinically apparent years later. Cardiorespiratory fitness (CRF) is an independent predictor of cardiovascular, cancer-related, and overall mortality and may serve as a sensitive measure of subclinical cardiac toxicity following anti-cancer treatments. Prior work has demonstrated a significant relationship between reduced CRF and impaired left-ventricular (LV) diastolic reserve in cancer survivors following thoracic radiotherapy. The purpose of this study was to assess early longitudinal changes in CRF and cardiac function in patients with lung cancer following radiotherapy. METHODS Ten patients (69 [61-76] years, 70% female) with lung cancer without known cardiovascular disease scheduled to receive radiotherapy involving a clinically-relevant heart dose (≥ 5 Gy to > 10% of heart volume) were evaluated prior to and following treatment. Changes in CRF (peak oxygen consumption [VO2peak], oxygen uptake efficiency slope [OUES]), cardiac function (LV ejection fraction [LVEF], rest and exercise diastolic function [diastolic functional reserve index (DFRI)]), cardiac biomarkers (N-terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity C-reactive protein [hsCRP]), and health-related quality of life (HRQOL; Functional Assessment of Cancer Therapy-General-7 [FACT-G7]) were measured. RESULTS The VO2peak was reduced at baseline (1.245 [0.882-1.605] L·min- 1; 70 [62-86] %-predicted) and significantly declined (1.095 [0.810-1.448] L·min- 1, P = 0.047; 62 [56-76] %-predicted, P = 0.005) at 6.0 [3.0-6.0] months post-radiotherapy. Similarly, a significant decline in the OUES was observed (1.63 [1.27-1.88] to 1.57 [1.12-1.75], P = 0.032). Systolic cardiac function was normal at baseline and did not change following radiotherapy (LVEF; 62 [56-65]% to 66 [57-68]%, P = 0.475). The DFRI significantly declined following radiotherapy (34.9 [22.7-41.6] vs. 12.8 [3.1-35.9]). The hsCRP increased significantly from 4.4 [1.4-5.8] to 6.1 [3.7-20.7] g/L, P = 0.047 with a trend towards higher levels of NT-proBNP (65 [49-125] to 121 [88-191] pg/mL, P = 0.110). Health-related quality of life significantly decreased (FACT-G7; 21.5 [18.8-25] to 15.5 [11.5-20]; P = 0.021) post-radiotherapy. CONCLUSIONS Patients with lung cancer receiving radiotherapy with a clinically-significant heart dose experience reductions in CRF (VO2peak, OUES) as early as six months following treatment with concurrent reductions in diastolic reserve (DFRI), HRQOL, and increases in cardiac biomarkers (NT-proBNP, hsCRP).
Collapse
Affiliation(s)
- Georgia Thomas
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA.
| | - Elisabeth Weiss
- VCU Massey Cancer Center; Department of Radiation Oncology, Virginia Commonwealth University, Richmond, VA, USA
| | - Marco Giuseppe Del Buono
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Francesco Moroni
- Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Josh West
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Rachel Myers
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Emily Kontos
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| | - Michele Golino
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
- Department of Medicine and Surgery, University of Insubria, Varese, Italy
| | - Antonio Abbate
- Berne Cardiovascular Research Center and Department of Medicine, University of Virginia, Charlottesville, VA, USA
| | - Justin M Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, 1200 East Broad Street, Richmond, VA, 23298, PO Box 980335, USA
| |
Collapse
|
7
|
Vainshelboim B, Myers J. Cardiorespiratory Fitness and Incidence of Digestive System Cancers in Men. J Gastrointest Cancer 2024; 55:410-417. [PMID: 37917299 DOI: 10.1007/s12029-023-00981-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE To assess the association between cardiorespiratory fitness (CRF) and incidence of digestive system cancers (DSCs) in men. METHODS A prospective cohort of 4,540 men aged 55.2 ± 13.1 years who were free from malignancy at baseline was studied. Exposure was CRF quantified from treadmill exercise testing (individualized ramp protocol) in metabolic equivalents (METs). Incidence of DSCs was the primary outcome, utilizing medical records of any new diagnosed DSC. Cox proportional hazard analyses were conducted adjusting for established cancer risk factors. RESULTS Mean CRF was 8.3 ± 3.5 METs. During 13 ± 7.6 years follow up, 250 (5.5%) DSC cases were diagnosed (colorectal = 163, gallbladder = 46, liver = 23, esophagus = 8, pancreas = 7 and other digestive organ cancers = 3). For each 1-MET increase in CRF there were 6% [Hazard Ratio = 0.94, 95% CI (0.91-0.98), p = 0.006], and 9% [Hazard Ratio = 0.91, 95% CI (0.85-0.97), p = 0.006] lower risks of DSC incidence in the total cohort and among men younger than 60 years old, respectively. Additionally, each 1-MET increase in CRF was associated with 9% lower risks of DSC incidence among never and current smokers. CRF was not associated with DSC incidence among men ≥ 60 years old and among former smokers. CONCLUSION Higher CRF was associated with lower risk of DSC incidence in men, particularly in those younger than 60 years, and never and current smokers. These findings suggest that higher CRF has potential preventive benefits against the development of DSCs, although additional large studies are needed. CRF screening and achieving higher levels could serve as a complementary preventive strategy for public health.
Collapse
Affiliation(s)
- Baruch Vainshelboim
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, the Ohio State University, Columbus, OH, 43214, USA.
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System and Stanford University, Palo Alto, CA, 94304, USA
| |
Collapse
|
8
|
Zhu Q, Xiong X, Zheng Q, Deng Q, Hao Y, Liu D, Zheng J, Zhang G, Li J, Yang L. High-intensity interval training versus moderate-intensity continuous training for localized prostate cancer under active surveillance: a systematic review and network meta-analysis. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00801-7. [PMID: 38378977 DOI: 10.1038/s41391-024-00801-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 01/21/2024] [Accepted: 01/25/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND High-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) have been increasingly adopted for localized prostate cancer (PCa) under active surveillance (AS). However, it is unclear which training modality is the most favorable in terms of cardiorespiratory fitness and biochemical progression. METHODS We searched PubMed, Cochrane and Embase for relevant RCTs. PRISMA guideline was adopted to ensure optimal conduct of this study. Serum prostate specific antigen (PSA) and peak VO2 were selected as primary outcomes and PSA doubling time (PSADT) and testosterone were selected as secondary outcomes. Only articles written in English were included. Cochrane risk-of-bias tool was used for risk of bias evaluation. RESULTS A total of 501 studies were selected. Six RCTs with 222 patients were included for data extraction and analysis. High-intensity interval training (HIIT) group demonstrated significantly lower PSA compared with usual care (UC) (MD = -1.4; 95%CI = -2.77 to -0.03) and moderate-intensity continuous training (MICT) group (MD = -1.67; 95%CI = -3.30 to -0.05). Both HIIT and MICT showed significantly improved peak VO2 compared with UC. No significant difference was observed in PSADT and testosterone among different training modalities and UC. Regarding peak VO2, MICT had the highest surface under cumulative ranking curve (SUCRA) scores (98.1%). For serum PSA, HIIT had the highest probability (97.8%) to be the training with the highest efficacy. The potential source of bias mainly came from poorly performed allocation concealment and blinding strategies. CONCLUSIONS The present study indicated that HIIT and MICT showed considerable cardiorespiratory benefits for localized PCa. HIIT was preferred over MICT in biochemical progression control in terms of decreasing serum PSA levels. However, MICT was favored over HIIT regarding cardiorespiratory benefits. The findings of this study may facilitate future lifestyle intervention, particularly in the form of physical training, for individuals diagnosed with localized PCa under AS.
Collapse
Affiliation(s)
- Qiyu Zhu
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, PR China
| | - Xingyu Xiong
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, PR China
| | - Qian Zheng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Qi Deng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Yun Hao
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Dingbang Liu
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Jiaming Zheng
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Guangyue Zhang
- West China School of Medicine, Sichuan University, Chengdu, Sichuan, PR China
| | - Jiakun Li
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, PR China.
| | - Lu Yang
- Department of Urology, Institute of Urology, West China Hospital of Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan, PR China.
| |
Collapse
|
9
|
Watts EL, Gonzales TI, Strain T, Saint-Maurice PF, Bishop DT, Chanock SJ, Johansson M, Keku TO, Le Marchand L, Moreno V, Newcomb PA, Newton CC, Pai RK, Purdue MP, Ulrich CM, Smith-Byrne K, Van Guelpen B, Day FR, Wijndaele K, Wareham NJ, Matthews CE, Moore SC, Brage S. Observational and genetic associations between cardiorespiratory fitness and cancer: a UK Biobank and international consortia study. Br J Cancer 2024; 130:114-124. [PMID: 38057395 PMCID: PMC10781786 DOI: 10.1038/s41416-023-02489-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 10/20/2023] [Accepted: 10/31/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The association of fitness with cancer risk is not clear. METHODS We used Cox proportional hazards models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for risk of lung, colorectal, endometrial, breast, and prostate cancer in a subset of UK Biobank participants who completed a submaximal fitness test in 2009-12 (N = 72,572). We also investigated relationships using two-sample Mendelian randomisation (MR), odds ratios (ORs) were estimated using the inverse-variance weighted method. RESULTS After a median of 11 years of follow-up, 4290 cancers of interest were diagnosed. A 3.5 ml O2⋅min-1⋅kg-1 total-body mass increase in fitness (equivalent to 1 metabolic equivalent of task (MET), approximately 0.5 standard deviation (SD)) was associated with lower risks of endometrial (HR = 0.81, 95% CI: 0.73-0.89), colorectal (0.94, 0.90-0.99), and breast cancer (0.96, 0.92-0.99). In MR analyses, a 0.5 SD increase in genetically predicted O2⋅min-1⋅kg-1 fat-free mass was associated with a lower risk of breast cancer (OR = 0.92, 95% CI: 0.86-0.98). After adjusting for adiposity, both the observational and genetic associations were attenuated. DISCUSSION Higher fitness levels may reduce risks of endometrial, colorectal, and breast cancer, though relationships with adiposity are complex and may mediate these relationships. Increasing fitness, including via changes in body composition, may be an effective strategy for cancer prevention.
Collapse
Affiliation(s)
- Eleanor L Watts
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Tomas I Gonzales
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Tessa Strain
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Pedro F Saint-Maurice
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - D Timothy Bishop
- Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Stephen J Chanock
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Mattias Johansson
- Genomics Branch, International Agency for Research on Cancer, World Health Organization, Lyon, France
| | - Temitope O Keku
- Center for Gastrointestinal Biology and Disease, University of North Carolina, Chapel Hill, NC, USA
| | | | - Victor Moreno
- Oncology Data Analytics Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine and University of Barcelona Institute for Complex Systems (UBICS), University of Barcelona, Barcelona, Spain
- ONCOBEL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
| | - Polly A Newcomb
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- School of Public Health, University of Washington, Seattle, WA, USA
| | - Christina C Newton
- Department of Population Science, American Cancer Society, Atlanta, GA, USA
| | - Rish K Pai
- Department of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mark P Purdue
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Cornelia M Ulrich
- Huntsman Cancer Institute and Department of Population Health Sciences, University of Utah, Salt Lake City, UT, USA
| | - Karl Smith-Byrne
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Bethany Van Guelpen
- Department of Radiation Sciences, Oncology Unit, Umeå University, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine, Umeå University, Umeå, Sweden
| | - Felix R Day
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Katrien Wijndaele
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Nicholas J Wareham
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Steven C Moore
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Rockville, MD, USA
| | - Soren Brage
- MRC Epidemiology Unit, School of Clinical Medicine, Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| |
Collapse
|
10
|
Gafni T, Weinstein G, Leonard D, Barlow CE, DeFina LF, Pettee Gabriel K, Berry JD, Shuval K. Independent and joint associations of cardiorespiratory fitness and BMI with dementia risk: the Cooper Center Longitudinal Study. BMJ Open 2023; 13:e075571. [PMID: 38086580 PMCID: PMC10729062 DOI: 10.1136/bmjopen-2023-075571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 11/21/2023] [Indexed: 12/18/2023] Open
Abstract
OBJECTIVE This study aimed to examine the association of midlife fitness and body mass index (BMI) with incident dementia later in life. DESIGN AND PARTICIPANTS A cohort study of 6428 individuals (mean age 50.9±7.6 years) from the Cooper Center Longitudinal Study. MEASURES Cardiorespiratory fitness and BMI were assessed twice (1970-1999) during visits to the Cooper Clinic, a preventive medicine clinic in Dallas, Texas. These measures were examined as continuous and categorical variables. As continuous variables, fitness and BMI were examined at baseline (averaged of two examinations) and as absolute change between exams (mean time 2.1±1.8 years). Variables were categorised: unfit versus fit and normal versus overweight/obese. Medicare claims data were used to obtain all-cause dementia incidence (1999-2009). Mean follow-up between midlife examinations and Medicare surveillance was 15.7 ((SD=6.2) years. Multivariable models were used to assess the associations between fitness, BMI and dementia. RESULTS During 40 773 person years of Medicare surveillance, 632 cases of dementia were identified. After controlling for BMI and covariates, each 1-metabolic equivalent increment in fitness was associated with 5% lower (HR 0.95; 95% CI 0.90 to 0.99) dementia risk. In comparison, after controlling for fitness and covariates, each 1 kg/m2 increment in BMI was associated with a 3.0% (HR 1.03; 95% CI 1.00 to 1.07) higher risk for dementia, yet without significance (p=0.051). Similar findings were observed when the exposures were categorised. Changes in fitness and BMI between examinations were not related to dementia. Jointly, participants who were unfit and overweight/obese had the highest (HR 2.28 95% CI 1.57 to 3.32) dementia risk compared with their fit and normal weight counterparts. CONCLUSION Lower midlife fitness is a risk marker for dementia irrespective of weight status. Being unfit coupled with overweight/obese status might increase one's risk for dementia even further.
Collapse
Affiliation(s)
- Tal Gafni
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - Galit Weinstein
- Department of Epidemiology, University of Haifa, Haifa, Israel
| | - David Leonard
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Carolyn E Barlow
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Laura F DeFina
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, The University of Alabama at Birmingham, Birmingham, Alabam, USA
| | | | - Kerem Shuval
- Department of Research, The Cooper Institute, Dallas, Texas, USA
| |
Collapse
|
11
|
Tobias GC, Gomes JLP, Fernandes LG, Voltarelli VA, de Almeida NR, Jannig PR, de Souza RWA, Negrão CE, Oliveira EM, Chammas R, Alves CRR, Brum PC. Aerobic exercise training mitigates tumor growth and cancer-induced splenomegaly through modulation of non-platelet platelet factor 4 expression. Sci Rep 2023; 13:21970. [PMID: 38081853 PMCID: PMC10713653 DOI: 10.1038/s41598-023-47217-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/10/2023] [Indexed: 12/18/2023] Open
Abstract
Exercise training reduces the incidence of several cancers, but the mechanisms underlying these effects are not fully understood. Exercise training can affect the spleen function, which controls the hematopoiesis and immune response. Analyzing different cancer models, we identified that 4T1, LLC, and CT26 tumor-bearing mice displayed enlarged spleen (splenomegaly), and exercise training reduced spleen mass toward control levels in two of these models (LLC and CT26). Exercise training also slowed tumor growth in melanoma B16F10, colon tumor 26 (CT26), and Lewis lung carcinoma (LLC) tumor-bearing mice, with minor effects in mammary carcinoma 4T1, MDA-MB-231, and MMTV-PyMT mice. In silico analyses using transcriptome profiles derived from these models revealed that platelet factor 4 (Pf4) is one of the main upregulated genes associated with splenomegaly during cancer progression. To understand whether exercise training would modulate the expression of these genes in the tumor and spleen, we investigated particularly the CT26 model, which displayed splenomegaly and had a clear response to the exercise training effects. RT-qPCR analysis confirmed that trained CT26 tumor-bearing mice had decreased Pf4 mRNA levels in both the tumor and spleen when compared to untrained CT26 tumor-bearing mice. Furthermore, exercise training specifically decreased Pf4 mRNA levels in the CT26 tumor cells. Aspirin treatment did not change tumor growth, splenomegaly, and tumor Pf4 mRNA levels, confirming that exercise decreased non-platelet Pf4 mRNA levels. Finally, tumor Pf4 mRNA levels are deregulated in The Cancer Genome Atlas Program (TCGA) samples and predict survival in multiple cancer types. This highlights the potential therapeutic value of exercise as a complementary approach to cancer treatment and underscores the importance of understanding the exercise-induced transcriptional changes in the spleen for the development of novel cancer therapies.
Collapse
Affiliation(s)
- Gabriel C Tobias
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil.
- Children's Cancer and Blood Foundation Laboratories, Departments of Pediatrics, and Cell and Developmental Biology, Drukier Institute for Children's Health, Meyer Cancer Center, Weill Cornell Medicine, New York, NY, USA.
| | - João L P Gomes
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
| | - Larissa G Fernandes
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
| | - Vanessa A Voltarelli
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Ney R de Almeida
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
| | - Paulo R Jannig
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
- Department of Physiology and Pharmacology, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Rodrigo W Alves de Souza
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Carlos E Negrão
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
- Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Edilamar M Oliveira
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
| | - Roger Chammas
- Department of Radiology and Oncology, Faculdade de Medicine, Universidade de São Paulo, São Paulo, Brazil
| | - Christiano R R Alves
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil
| | - Patricia C Brum
- School of Physical Education and Sport, Universidade de São Paulo, Avenida Professor Mello Moraes, 65-Butantã, São Paulo, SP, 05508-030, Brazil.
- Department of Physiology & Biophysics, Institute of Biomedical Sciences, Universidade de São Paulo, São Paulo, Brazil.
| |
Collapse
|
12
|
Vainshelboim B, Myers J, Matthews CE. Non-exercise estimated cardiorespiratory fitness and cancer incidence: The NIH-AARP diet and health study. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:739-746. [PMID: 36828228 PMCID: PMC10658321 DOI: 10.1016/j.jshs.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/18/2022] [Accepted: 01/11/2023] [Indexed: 05/08/2023]
Abstract
BACKGROUND Non-exercise estimated cardiorespiratory fitness (NEE-CRF) has been shown to be associated with mortality, although its association with cancer incidence is unknown. The study aimed to assess the prospective association between NEE-CRF and cancer incidence in a large cohort of men and women. METHODS The National Institutes of Health-American Association of Retired Persons diet and health study is a prospective cohort that included 402,548 participants aged 50-71 years who were free from cancer at baseline (1995-1996) (men (n = 238,835) and women (n = 163,713)) and were followed until December 31, 2015. The exposure variable was NEE-CRF expressed in metabolic equivalents. NEE-CRF was estimated using a validated equation of self-reported predictors on demographics and lifestyle behaviors derived from baseline questionnaires. Primary outcomes were total cancer incidence and incidence of prostate, breast, lung, and colorectal cancers. Cox proportional hazards models were analyzed for the association between NEE-CRF and cancer incidence outcomes adjusted for established cancer risk factors. RESULTS During 13.7 ± 3.2 years of follow-up (mean ± SD), 64,344 men and 31,315 women developed a new cancer. For every 1-metabolic equivalent higher NEE-CRF, the hazard ratios and 95% confidence intervals (95%CIs) were 0.96 (95%CI: 0.94-0.97) and 0.88 (95%CI: 0.84-0.92) of total and colorectal cancer incidence among men, and 0.95 (95%CI: 0.93-0.97) and 0.94 (95%CI: 0.91-0.97) of total and breast cancer incidence among women, respectively (all p < 0.001). NEE-CRF was not associated with incidence of prostate and lung cancers in men or colorectal and lung cancers in women. CONCLUSION These results suggest that higher CRF levels, as assessed by the applied non-exercise estimated method, may provide preventive benefits against the development of cancer, while low CRF could potentially serve as a modifiable cancer risk factor. Integrating NEE-CRF into screening paradigms and referring low-fit individuals to improve CRF could complement the public health prevention strategy against cancer.
Collapse
Affiliation(s)
- Baruch Vainshelboim
- Center for Tobacco Research, Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, Columbus, OH 43214, USA.
| | - Jonathan Myers
- Cardiology Division, Veterans Affairs Palo Alto Health Care System/Stanford University, Palo Alto, CA 94304, USA
| | - Charles E Matthews
- Metabolic Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD 20850, USA
| |
Collapse
|
13
|
Robinson R, Crank H, Humphreys H, Fisher P, Greenfield DM. Time to embed physical activity within usual care in cancer services: A qualitative study of cancer healthcare professionals' views at a single centre in England. Disabil Rehabil 2023; 45:3484-3492. [PMID: 36369938 DOI: 10.1080/09638288.2022.2134468] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 09/18/2022] [Indexed: 11/15/2022]
Abstract
PURPOSE An increasing number of people affected by cancer (PABC) are living longer lives as treatment continues to advance. There is growing evidence for physical activity (PA) supporting health in this population before, during and after cancer treatment, but PA advice is not part of usual care. This study investigates views of frontline oncology healthcare professionals (HCPs) in one NHS teaching hospital in England to understand the role of PA advice across cancer services. MATERIALS AND METHODS This was a qualitative study interviewing HCPs and using thematic analysis. RESULTS Four main themes were identified: 1. Awareness of the roles of PA in cancer; 2. Patient-specific factors in rehabilitation; 3. Cancer-specific factors in rehabilitation; 4. Barriers and opportunities to integrating PA within usual care. HCPs' awareness of the role of PA in cancer rehabilitation was low overall and PA was found not to be embedded within rehabilitation. Contrastingly, there was awareness of PA's potential to impact disease and treatment-related outcomes positively. Ideas for PA integration included training for staff and giving PA advice within consultations. CONCLUSIONS Low awareness of benefits of PA-based rehabilitation and lack of integration in usual care contrasted with HCPs' interest in this area's potential. Training HCPs to begin the conversation with patients affected by cancer in teachable moments may increase patient access.Implications for rehabilitationIntegrating physical activity education and training for trainees and existing healthcare professionals workforce would help embed physical activity into routine clinical practice.Brief advice intervention training during every consultation, such as providing relevant individualised information and signposting, can be impactful.Physical activity within a broader cancer rehabilitation programme should be integrated as standard for every cancer patient.Individualised plans may include prehabilitation, restorative rehabilitation and palliative rehabilitation.Patient preferences and the patient experience should continue to shape service design.There is a need to ensure physical activity advice is consistent throughout healthcare settings and not fragmented between primary, secondary and tertiary care.
Collapse
Affiliation(s)
- Rebecca Robinson
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Helen Crank
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Helen Humphreys
- Centre for Sport and Exercise Science, Sheffield Hallam University, Sheffield, UK
| | - Patricia Fisher
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- South Yorkshire ICB Cancer Alliance, Sheffield, UK
| | - Diana M Greenfield
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Metabolism, The University of Sheffield, Sheffield, UK
| |
Collapse
|
14
|
Onerup A, Mehlig K, Geijerstam AA, Ekblom-Bak E, Kuhn HG, Lissner L, Åberg M, Börjesson M. Associations between cardiorespiratory fitness in youth and the incidence of site-specific cancer in men: a cohort study with register linkage. Br J Sports Med 2023; 57:1248-1256. [PMID: 37582636 PMCID: PMC10579181 DOI: 10.1136/bjsports-2022-106617] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2023] [Indexed: 08/17/2023]
Abstract
OBJECTIVES To assess the associations between cardiorespiratory fitness (CRF) in young men and the incidence of site-specific cancer. METHODS A Swedish population-based cohort study with register linkage of men who underwent military conscription in 1968-2005 was undertaken. CRF was assessed by maximal aerobic workload cycle test at conscription. Cox regression models assessed linear associations and included CRF, age, year and site of conscription, body mass index and parental level of education. CRF was also categorised into low, moderate and high for facilitated interpretation and results comparing high and low CRF are reported. RESULTS Primary analyses were performed in 1 078 000 men, of whom 84 117 subsequently developed cancer in at least one site during a mean follow-up of 33 years. Higher CRF was linearly associated with a lower hazard ratio (HR) of developing cancer in the head and neck (n=2738, HR 0.81, 95% CI 0.74 to 0.90), oesophagus (n=689, HR 0.61, 95% CI 0.50 to 0.74), stomach (n=902, HR 0.79, 95% CI 0.67 to 0.94), pancreas (n=1280, HR 0.88, 95% CI 0.76 to 1.01), liver (n=1111, HR 0.60, 95% CI 0.51 to 0.71), colon (n=3222, HR 0.82, 95% CI 0.75 to 0.90), rectum (n=2337, HR 0.95, 95% CI 0.85 to 1.05), kidney (n=1753, HR 0.80, 95% CI 0.70 to 0.90) and lung (n=1635, HR 0.58, 95% CI 0.51 to 0.66). However, higher CRF predicted a higher hazard of being diagnosed with prostate cancer (n=14 232, HR 1.07, 95% CI 1.03 to 1.12) and malignant skin cancer (n=23 064, HR 1.31, 95% CI 1.27 to 1.36). CONCLUSION We report a number of protective associations between higher CRF in healthy young men and the subsequent hazard of site-specific cancers. These results have implications for public health policymaking, strengthening the incentive to promote health through improving CRF in youth.
Collapse
Affiliation(s)
- Aron Onerup
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Agnes Af Geijerstam
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences, GIH, Stockholm, Sweden
| | - Hans Georg Kuhn
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Health and Performance, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
15
|
Onerup A, Mehlig K, Ekblom‐Bak E, Lissner L, Börjesson M, Åberg M. Cardiorespiratory fitness and BMI measured in youth and 5-year mortality after site-specific cancer diagnoses in men-A population-based cohort study with register linkage. Cancer Med 2023; 12:20000-20014. [PMID: 37732468 PMCID: PMC10587926 DOI: 10.1002/cam4.6553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/30/2023] [Accepted: 09/08/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Our aim was to assess associations between cardiorespiratory fitness (CRF) and body mass index (BMI) in youth and 5-year mortality after site-specific cancer diagnoses in men. METHODS Men with cancer from a population who underwent military conscription at ages 16-25 during 1968-2005 in Sweden were included. CRF was assessed as maximal aerobic workload on a cycle ergometer test and was classified as low, moderate, or high. BMI (kg/m2 ) was classified as underweight (<18.5), normal weight (18.5-24.9), overweight (25-29.9), or obesity (>30). Conscription data were linked with register data on cancer diagnosis and mortality. Analyses included CRF, BMI, date of diagnosis, and age, year, and center for conscription. RESULTS A total of 84,621 cancer cases were included. Mean age at diagnosis was 52 years. Follow-up data were available during a mean of 6.5 years. There were linear protective associations between CRF and mortality after any cancer diagnosis (hazard ratio [HR] for high vs. low CRF 0.70), malignant skin cancer (HR 0.80), non-Hodgkin lymphoma (HR 0.78), and cancer in the lungs (HR 0.80), head and neck (HR 0.68), pancreas (HR 0.83), stomach (HR 0.78), liver (HR 0.84), rectum (HR 0.79), and bladder (HR 0.71). Overweight and/or obesity were associated with increased mortality after any cancer (HR for obesity vs. normal weight 1.89), malignant skin cancer (HR 2.03), Hodgkin lymphoma (HR 2.86) and cancer in the head and neck (HR 1.38), thyroid (HR 3.04), rectum (HR 1.53), kidney (HR 1.90), bladder (HR 2.10), and prostate (HR 2.44). CONCLUSION We report dose-dependent associations between CRF and BMI in youth and mortality after site-specific cancer diagnoses in men. The associations with mortality could be due to both cancer inhibition and an improved tolerance to withstand cancer treatment. These results strengthen the incentive for public health efforts aimed at establishing a high CRF and normal weight in youth.
Collapse
Affiliation(s)
- Aron Onerup
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Department of Pediatric Oncology, Region Västra GötalandSahlgrenska University HospitalGothenburgSweden
| | - Kirsten Mehlig
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Elin Ekblom‐Bak
- Department of Physical activity and HealthThe Swedish School of Sport and Health SciencesStockholmSweden
| | - Lauren Lissner
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
| | - Mats Börjesson
- Department of Molecular and Clinical Medicine, Center for Lifestyle Intervention, Sahlgrenska AcademyGothenburg UniversityGothenburgSweden
- Department of MGAÖRegion of Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of MedicineUniversity of GothenburgGothenburgSweden
- Region Västra Götaland, RegionhälsanGothenburgSweden
| |
Collapse
|
16
|
Woll A, Cleven L, Jekauc D, Krell-Roesch J, Bös K. A tool to assess fitness among adults in public health studies - Predictive validity of the FFB-Mot questionnaire. BMC Public Health 2023; 23:1340. [PMID: 37438718 DOI: 10.1186/s12889-023-16174-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 06/22/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Fitness has important implications for physical activity behavior and is associated with various health-related outcomes. It can be assessed through a test battery or a self-reported questionnaire. One example is the FFB-Mot (Funktionsfragebogen Motorik; engl. functional fitness questionnaire) which consist of 28 items to assess four components of fitness in adults: cardiorespiratory fitness/ endurance, muscular strength, gross motor coordination, and flexibility. The aims of this manuscript were to (1) provide an English-version of the FFB-Mot questionnaire (developed from the German-version using translation and back-translation) to the international community of researchers in the areas of physical activity, fitness and health in adults, and (2) examine the predictive validity of the FFB-Mot questionnaire in a large sample of community-dwelling adults. METHODS We used data from a longitudinal study in Germany with four measurement waves over a period of 18 years, with samples ranging between 310 and 437 participants (1572 adults in total, mean ages 46-58 years). To assess predictive validity, we calculated Pearson correlations between FFB-Mot data collected in 1997 and external health-related criteria (i.e., subjective health status, physician-rated health status, back pain, physical complaints and physical activity in minutes per week) collected in 2002, 2010, and 2015, and separately for males and females. RESULTS We observed correlations between higher FFB-Mot scores with better subjective health status (in 2002: males, r = 0.25; females, r = 0.18; in 2010: males, r = 0.29; females, r = 0.28; in 2015: males, r = 0.40), and higher physical activity (in 2002: males, r = 0.24; females, r = 0.25; in 2010: males, r = 0.30; females, r = 0.38; in 2015: females, r = 0.27). Higher FFB-Mot scores were also correlated with lower back pain (in 2002: males, r = -0.23; females, r = -0.25; in 2010: females, r = -0.22), less physical complaints (in 2002: males, r = -0.36; females, r = -0.24), and better physician-rated health status (in 2002: males, r = -0.41; females, r = -0.29, 2010: males, r = -0.38; females, r = -0.44; in 2015: males, r = -0.47). CONCLUSIONS Our results suggest that the FFB-Mot to assess fitness in adults has predictive validity for health-related outcomes as indicated by significant correlations, albeit some effect sizes are small. The FFB-Mot may be used as one-time assessment of self-reported fitness, or for repeated testing to assess change of self-reported fitness over time and in different settings (e.g., public health research).
Collapse
Affiliation(s)
- Alexander Woll
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany.
| | - Laura Cleven
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Darko Jekauc
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Janina Krell-Roesch
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| | - Klaus Bös
- Institute of Sports and Sports Science, Karlsruhe Institute of Technology, Engler-Bunte-Ring 15, 76131, Karlsruhe, Germany
| |
Collapse
|
17
|
Castellanos-Montealegre M, Rivera-Theruel F, García-Coll V, Rioja-Collado N, Gil-Herrero L, López-Tarruella S, Montealegre Sanz M, Cerezo González S, Fernández Aramburo A, Ruiz-Casado A, Laundos R, Casla-Barrio S. Impact of the COVID-19 Lockdown on Physical Activity Levels and Health Parameters in Young Adults with Cancer. Curr Oncol 2023; 30:5395-5408. [PMID: 37366892 DOI: 10.3390/curroncol30060409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/17/2023] [Accepted: 05/31/2023] [Indexed: 06/28/2023] Open
Abstract
The lockdown of the COVID-19 pandemic impacted physical activity (PA) levels around the world, affecting health parameters in young adults with cancer (YAC). To our knowledge, there is no evidence of the impact of the lockdown on the Spanish YAC. To analyse the changes in PA levels before, during, and after the lockdown of the YAC and its impact on health metrics in Spain, in this study, we utilized a self-reported web survey. PA levels decreased during the lockdown, and a significant increase in PA was observed after the lockdown. Moderate PA had the largest reduction (49%). Significant increases in moderate PA were noted after the lockdown (85.2%). Participants self-reported more than 9 h of sitting per day. HQoL and fatigue levels were significantly worse during the lockdown. The impact of the COVID-19 pandemic in this cohort of Spanish YAC showed a decrease in PA levels during the lockdown, affecting sedentarism, fatigue and HQoL. After lockdown, PA levels partially recovered, while HQoL and fatigue levels remained altered. This may have long-term physical effects such as cardiovascular comorbidities associated with sedentarism and psychosocial effects. It is necessary to implement strategies such as cardio-oncology rehabilitation (CORE), an intervention that can be delivered online, potentially improving participants' health behaviours and outcomes.
Collapse
Affiliation(s)
- Mónica Castellanos-Montealegre
- Department of Science of Physical Activity and Sport, Castilla-La Mancha University Toledo Av de Carlos III, n 21, 45004 Toledo, Spain
| | - Fernando Rivera-Theruel
- Toronto Rehabilitation Institute Rumsey Centre Cardiac Rehabilitation, University Health Network, Toronto, ON M4G 2V6, Canada
| | - Virginia García-Coll
- Department of Science of Physical Activity and Sport, Castilla-La Mancha University Toledo Av de Carlos III, n 21, 45004 Toledo, Spain
| | - Natalia Rioja-Collado
- Department of Science of Physical Activity and Sport, Castilla-La Mancha University Toledo Av de Carlos III, n 21, 45004 Toledo, Spain
| | - Lucía Gil-Herrero
- Spanish Cancer Association, Av Federico Rubio y Galí, n 84, 28040 Madrid, Spain
| | - Sara López-Tarruella
- Medical Oncology Service, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), 28007 Madrid, Spain
- CiberOnc, Universidad Complutense, 28040 Madrid, Spain
- GEICAM, 28703 Madrid, Spain
| | | | | | | | - Ana Ruiz-Casado
- HU Puerta de Hierro Majadahonda, IDIPHISA, 28222 Madrid, Spain
| | - Rebecca Laundos
- Toronto Rehabilitation Institute Rumsey Centre Cardiac Rehabilitation, University Health Network, Toronto, ON M4G 2V6, Canada
| | | |
Collapse
|
18
|
Ekblom-Bak E, Bojsen-Møller E, Wallin P, Paulsson S, Lindwall M, Rundqvist H, Bolam KA. Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men. JAMA Netw Open 2023; 6:e2321102. [PMID: 37382952 PMCID: PMC10311389 DOI: 10.1001/jamanetworkopen.2023.21102] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/17/2023] [Indexed: 06/30/2023] Open
Abstract
Importance Cardiorespiratory fitness (CRF) levels appear to be an important risk factor for cancer incidence and death. Objectives To examine CRF and prostate, colon, and lung cancer incidence and mortality in Swedish men, and to assess whether age moderated any associations between CRF and cancer. Design, Setting, and Participants A prospective cohort study was conducted in a population of men who completed an occupational health profile assessment between October 1982 and December 2019 in Sweden. Data analysis was performed from June 22, 2022, to May 11, 2023. Exposure Cardiorespiratory fitness was assessed as maximal oxygen consumption, estimated using a submaximal cycle ergometer test. Main Outcomes and Measures Data on prostate, colon, and lung cancer incidence and mortality were derived from national registers. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression. Results Data on 177 709 men (age range, 18-75 years; mean [SD] age, 42 [11] years; mean [SD] body mass index, 26 [3.8]) were analyzed. During a mean (SD) follow-up time of 9.6 (5.5) years, a total of 499 incident cases of colon, 283 of lung, and 1918 of prostate cancer occurred, as well as 152 deaths due to colon cancer, 207 due to lung cancer, and 141 deaths due to prostate cancer. Higher levels of CRF (maximal oxygen consumption as milliliters per minute per kilogram) were associated with a significantly lower risk of colon (HR, 0.98, 95% CI, 0.96-0.98) and lung cancer (HR, 0.98; 95% CI, 0.96-0.99) incidence, and a higher risk of prostate cancer incidence (HR, 1.01; 95% CI, 1.00-1.01). Higher CRF was associated with a lower risk of death due to colon (HR, 0.98; 95% CI, 0.96-1.00), lung (HR, 0.97; 95% CI, 0.95-0.99), and prostate (HR, 0.95; 95% CI, 0.93-0.97) cancer. After stratification into 4 groups and in fully adjusted models, the associations remained for moderate (>35-45 mL/min/kg), 0.72 (0.53-0.96) and high (>45 mL/min/kg), 0.63 (0.41-0.98) levels of CRF, compared with very low (<25 mL/min/kg) CRF for colon cancer incidence. For prostate cancer mortality, associations remained for low (HR, 0.67; 95% CI, 0.45-1.00), moderate (HR, 0.57; 95% CI, 0.34-0.97), and high (HR, 0.29; 95% CI, 0.10-0.86) CRF. For lung cancer mortality, only high CRF (HR, 0.41; 95% CI, 0.17-0.99) was significant. Age modified the associations for lung (HR, 0.99; 95% CI, 0.99-0.99) and prostate (HR, 1.00; 95% CI, 1.00-1.00; P < .001) cancer incidence, and for death due to lung cancer (HR, 0.99; 95% CI, 0.99-0.99; P = .04). Conclusions and Relevance In this cohort of Swedish men, moderate and high CRF were associated with a lower risk of colon cancer. Low, moderate, and high CRF were associated with lower risk of death due to prostate cancer, while only high CRF was associated with lower risk of death due to lung cancer. If evidence for causality is established, interventions to improve CRF in individuals with low CRF should be prioritized.
Collapse
Affiliation(s)
- Elin Ekblom-Bak
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Emil Bojsen-Møller
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Peter Wallin
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Sofia Paulsson
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Magnus Lindwall
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Psychology, University of Gothenburg, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Kate A. Bolam
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
19
|
Cuomo G, Iannone FP, Di Lorenzo A, Testa C, Ciccarelli M, Venturini E, Cesaro A, Pacileo M, Tagliamonte E, D'Andrea A, Vecchione C, Vigorito C, Giallauria F. Potential Role of Global Longitudinal Strain in Cardiac and Oncological Patients Undergoing Cardio-Oncology Rehabilitation (CORE). Clin Pract 2023; 13:384-397. [PMID: 36961060 PMCID: PMC10037613 DOI: 10.3390/clinpract13020035] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/05/2023] [Indexed: 03/09/2023] Open
Abstract
Although shown to be effective in improving survival and quality of life in patients with cancer, some treatments are well-known causes of cardiotoxicity, such as anthracyclines, monoclonal antibodies against human epidermal growth factor receptor 2 (HER2) and radiotherapy. To prevent cardiovascular disease (CVD) in patients living with cancer, cardiologists and oncologists promoted the development of cardio-oncology, an interdisciplinary field which aims to further improving life expectancy in these patients. Cardio-oncology rehabilitation (CORE), through correction of risk factors, prescription of drug therapies and structured exercise programs, tries to improve symptoms, quality of life, cardiorespiratory fitness (CRF) and survival in patients with cancer. Different imaging modalities can be used to evaluate the real effectiveness of exercise training on cardiac function. Among these, the global longitudinal strain (GLS) has recently aroused interest, thanks to its high sensitivity and specificity for cardiac dysfunction detection due to advanced ultrasound programs. This review summarizes the evidence on the usefulness of GLS in patients with cancer undergoing cardiac rehabilitation programs.
Collapse
Affiliation(s)
- Gianluigi Cuomo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Francesca Paola Iannone
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Crescenzo Testa
- Geriatric Clinic Unit, Geriatric-Rehabilitation Department, University Hospital, 43126 Parma, Italy
| | - Michele Ciccarelli
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy
| | - Elio Venturini
- Cardiac Rehabilitation Unit, Azienda USL Toscana Nord-Ovest, Cecina Civil Hospital, 57023 Cecina, Italy
| | - Arturo Cesaro
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", 80131 Naples, Italy
- Division of Cardiology, A.O.R.N. "Sant'Anna e San Sebastiano", 81100 Caserta, Italy
| | - Mario Pacileo
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
| | - Ercole Tagliamonte
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, 84014 Nocera Inferiore, Italy
- Unit of Cardiology, Department of Traslational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, 80131 Naples, Italy
| | - Carmine Vecchione
- Department of Medicine, Surgery and Dentistry, Schola Medica Salernitana, University of Salerno, 84081 Baronissi, Italy
- Vascular Pathophysiology Unit, IRCCS Neuromed, 86077 Pozzilli, Italy
| | - Carlo Vigorito
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Via S. Pansini 5, 80131 Naples, Italy
| | - Francesco Giallauria
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Via S. Pansini 5, 80131 Naples, Italy
| |
Collapse
|
20
|
Franklin BA, Wedig IJ, Sallis RE, Lavie CJ, Elmer SJ. Physical Activity and Cardiorespiratory Fitness as Modulators of Health Outcomes: A Compelling Research-Based Case Presented to the Medical Community. Mayo Clin Proc 2023; 98:316-331. [PMID: 36737120 DOI: 10.1016/j.mayocp.2022.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/29/2022] [Accepted: 09/19/2022] [Indexed: 02/04/2023]
Abstract
The beneficial health effects and prognostic significance of regular moderate-to-vigorous physical activity (PA), increased cardiorespiratory fitness (CRF), or both are often underappreciated by the medical community and the patients they serve. Individuals with low CRF have higher annual health care costs, higher rates of surgical complications, and are two to three times more likely to die prematurely than their fitter counterparts when matched for risk factor profile or coronary calcium score. Increased levels of habitual PA before hospitalization for acute coronary syndromes are also associated with better short-term cardiovascular outcomes. Accordingly, this review examines these relations and the potential underlying mechanisms of benefit (eg, exercise preconditioning), with specific reference to the incidence of cardiovascular, cancer, and coronavirus diseases, and the prescriptive implications and exercise thresholds for optimizing health outcomes. To assess the evidence supporting or refuting the benefits of PA and CRF, we performed a literature search (PubMed) and critically reviewed the evidence to date. In aggregate, these data are presented in the context of clarifying the impact that regular PA and/or increased CRF have on preventing and treating chronic and infectious diseases, with reference to evidence-based exercise thresholds that the medical community can embrace and promote.
Collapse
Affiliation(s)
- Barry A Franklin
- Preventive Cardiology and Cardiac Rehabilitation Department, Beaumont Health, Royal Oak, MI, USA; Oakland University William Beaumont School of Medicine, Rochester, MI, USA
| | - Isaac J Wedig
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA
| | - Robert E Sallis
- Department of Family and Sports Medicine, Kaiser Permanente Medical Center, Fontana, CA, USA
| | - Carl J Lavie
- Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School - The University of Queensland School of Medicine, New Orleans, LA, USA
| | - Steven J Elmer
- Department of Kinesiology and Integrative Physiology, and Health Research Institute, Michigan Technological University, Houghton, MI, USA.
| |
Collapse
|
21
|
Schumacher BT, Di C, Bellettiere J, LaMonte MJ, Simonsick EM, Parada H, Hooker SP, LaCroix AZ. Validation, Recalibration, and Predictive Accuracy of Published V̇O 2max Prediction Equations for Adults Ages 50-96 Yr. Med Sci Sports Exerc 2023; 55:322-332. [PMID: 36069964 PMCID: PMC9840647 DOI: 10.1249/mss.0000000000003033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE Maximal oxygen uptake ( ) is the criterion measure of cardiorespiratory fitness. Lower cardiorespiratory fitness is a strong predictor of poor health outcomes, including all-cause mortality. Because testing is resource intensive, several non-exercise-based V˙O 2max prediction equations have been published. We assess these equations' ability to predict measured V˙O 2max , recalibrate these equations, and quantify the association of measured and predicted V˙O 2max with all-cause mortality. METHODS Baltimore Longitudinal Study of Aging participants with valid V˙O 2max tests were included ( n = 1080). Using published V˙O 2max prediction equations, we calculated predicted V˙O 2max and present performance metrics before and after recalibration (deriving new regression estimates by regressing measured V˙O 2max on Baltimore Longitudinal Study of Aging covariates). Cox proportional hazards models were fit to quantify associations of measured, predicted, and recalibration-predicted values of V˙O 2max with mortality. RESULTS Mean age and V˙O 2max were 69.0 ± 10.4 yr and 21.6 ± 5.9 mL·kg -1 ·min -1 , respectively. The prediction equations yielded root mean square error values ranging from 4.2 to 20.4 mL·kg -1 ·min -1 . After recalibration, these values decreased to 3.9-4.2 mL·kg -1 ·min -1 . Adjusting for all covariates, all-cause mortality risk was 66% lower for the highest quartile of measured V˙O 2max relative to the lowest. Predicted V˙O 2max variables yielded similar estimates in unadjusted models but were not robust to adjustment. CONCLUSIONS Measured V˙O 2max is an extremely strong predictor of all-cause mortality. Several published V˙O 2max prediction equations yielded the following: 1) reasonable performance metrics relative to measured V˙O 2max especially when recalibrated, and 2) all-cause mortality hazard ratios similar to those of measured V˙O 2max , especially when recalibrated, yet 3) were not robust to adjustment for basic demographic covariates likely because these were used in the equation for predicted V˙O 2max .
Collapse
Affiliation(s)
- Benjamin T. Schumacher
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
| | - Chongzhi Di
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John Bellettiere
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
| | - Michael J. LaMonte
- Department of Epidemiology and Environmental Health, School of Public Health and Health Professions, University at Buffalo–SUNY, Buffalo, NY
| | - Eleanor M. Simonsick
- Translational Gerontology Branch, Intramural Research Program, National Institute on Aging, National Institutes of Health, Baltimore, MD
| | - Humberto Parada
- Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA
- University of California, San Diego Moores Cancer Center, La Jolla, CA
| | - Steven P. Hooker
- College of Health and Human Services, San Diego State University, San Diego, CA
| | - Andrea Z. LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, UC San Diego, La Jolla, CA
| |
Collapse
|
22
|
Wang J, Mai XM, Sun YQ. Estimated cardiorespiratory fitness in relation to overall, breast and prostate cancer incidence: the Norwegian HUNT study. Ann Epidemiol 2023; 77:103-109. [PMID: 36496149 DOI: 10.1016/j.annepidem.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 11/17/2022] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate the relationships between the estimated cardiorespiratory fitness (eCRF) and the incidence of overall, breast, and prostate cancer in a large prospective cohort study. METHODS We included 46,968 cancer-free adults who participated in the second survey of the Trøndelag Health Study in Norway. Sex-specific non-exercise algorithms were used to estimate CRF. eCRF was classified into sex and age-specific tertiles, that is, into low, medium and high levels. Cox proportional hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS Over a median of 22.1 years' follow-up, there were 7752 overall, 858 breast and 1376 prostate cancer cases. Medium and high levels of eCRF were associated with a reduced incidence of overall cancer in a dose-response manner in all participants (HR 0.96; 95% CI, 0.90-1.01 and HR 0.85; 95% CI, 0.79-0.91, respectively, and P-value for trend <.001). No association was observed between eCRF and breast cancer incidence in women. Only the high level of eCRF seemed to be associated with a reduced incidence of prostate cancer in men (HR 0.85; 95% CI, 0.72-1.02). CONCLUSIONS eCRF may be a practical and cost-effective means of investigating the association between the CRF and cancer incidence.
Collapse
Affiliation(s)
- Jin Wang
- Cancer Center, Department of Ultrasound Medicine, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China; Department of Neuromedicine and Movement Science, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Xiao-Mei Mai
- Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Yi-Qian Sun
- Department of Clinical and Molecular Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway; Department of Pathology, Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim, Norway; Center for Oral Health Services and Research Mid-Norway (TkMidt), Trondheim, Norway.
| |
Collapse
|
23
|
Chang M, Wang J, Hashim HA, Xie S, Malik AA. Effect of high-intensity interval training on aerobic capacity and fatigue among patients with prostate cancer: a meta-analysis. World J Surg Oncol 2022; 20:348. [PMID: 36261844 PMCID: PMC9580114 DOI: 10.1186/s12957-022-02807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 10/03/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE This study focused on evaluating whether high-intensity interval training (HIIT) had an effect on aerobic capacity and fatigue among patients with prostate cancer (PCa) and exploring its effect on the immune system of PCa patients. METHODS To investigate the potential effect of HIIT on patients with prostate cancer, a meta-analysis was carried out. From January 2012 to August 2022, studies that met predefined criteria were searched in the Scopus, PubMed, Web of Science, and EBSCO databases. Analysis of the standardized mean differences was performed using Review Manager 5.4.1 software with a 95% confidence interval. RESULTS This review examined a total of 6 articles. There were 215 male patients with PCa involved, and the mean age was 64.4 years. According to the results of the meta-analysis, the HIIT group (n = 63) had greater VO2peak (P<0.01) than the control group (CON) (n = 52) (P = 0.30, I2 = 19% in the heterogeneity test; MD, 1.39 [0.50, 2.27]). Moreover, fatigue was significantly different (P<0.01) between the HIIT (n = 62) and CON (n = 61) groups (P = 0.78, I2 = 0% in the heterogeneity test; SMD, -0.52 [-0.88, -0.16]). Furthermore, among PCa patients, HIIT showed higher efficacy (P < 0.01) in decreasing PSA than the CON regimen (P=0.22, I2 = 34% in the heterogeneity test; MD, -1.13 [-1.91, -0.34]). CONCLUSIONS HIIT improves aerobic capacity, fatigue, and PSA levels among PCa patients but does not significantly affect IL-6 or TNF-α content. Therefore, HIIT may be a novel and potent intervention scheme for PCa patients.
Collapse
Affiliation(s)
- Ming Chang
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Junguo Wang
- Department of Orthopaedics, Qingdao Hospital of Traditional Chinese Medicine (Hiser hospital), Qingdao, Shandong, China
| | - Hairul A Hashim
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Shihao Xie
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia
| | - Adam A Malik
- Exercise and Sports Science Programme, School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, 16150, Malaysia.
| |
Collapse
|
24
|
Zhao Y, Sun H, Qie R, Han M, Zhang M, Shi X, Yang Y, Lu J, Hu D, Sun L. Association between cardiorespiratory fitness and risk of all-cause and cause-specific mortality. Eur J Clin Invest 2022; 52:e13770. [PMID: 35294786 DOI: 10.1111/eci.13770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 02/17/2022] [Accepted: 02/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The association of cardiorespiratory fitness (CRF) with all-cause and cause-specific mortality remains unclear in Chinese population. This study aimed to evaluate the risk of all-cause, cardiovascular disease (CVD), cancer and other-cause mortality in Chinese adults using estimated CRF (eCRF). PATIENTS AND METHODS We analysed data for 15,566 participants aged ≥20 years recruited in The Rural Chinese Cohort Study during 2007 to 2008 and followed for mortality during 2013 to 2014. eCRF was calculated with sex-specific longitudinal non-exercise algorithms. Cox proportional-hazards models were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for all-cause and cause-specific mortality risk according to baseline eCRF. RESULTS During a median of 6.01 years of follow-up, 859 deaths occurred, including 359 from CVD, 221 from cancer, and 279 from other causes. Each 1 metabolic equivalent increment in eCRF was associated with decreased risk of all-cause mortality (men: HR 0.70, 95% CI [0.66-0.74]; women: 0.59, [0.54-0.64]); CVD mortality (men: 0.70 [0.64-0.77]; women: 0.55, [0.48-0.62]); and other-cause mortality (men: 0.68 [0.62-0.75]; women: 0.57, [0.49-0.66]). The area under receiver operating characteristic curve was significantly higher for eCRF than its modifiable components (waist circumference, body mass index and resting heart rate) in predicting all-cause and cause-specific mortality incidence (all p < .001). CONCLUSION eCRF was inversely associated with all-cause, CVD and other-cause mortality.
Collapse
Affiliation(s)
- Yang Zhao
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Haohang Sun
- Cardiovascular Department, Zhengzhou Yihe Hospital, Zhengzhou, China
| | - Ranran Qie
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Minghui Han
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ming Zhang
- Department of Biostatistics and Epidemiology, School of Public Health, Shenzhen University Health Science Center, Shenzhen, China
| | - Xuezhong Shi
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yongli Yang
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Jie Lu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dongsheng Hu
- Department of Epidemiology and Biostatistics, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Liang Sun
- Department of Social Medicine and Health Service Management, College of Public Health, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
25
|
Baguley BJ, Adlard K, Jenkins D, Wright ORL, Skinner TL. Mediterranean Style Dietary Pattern with High Intensity Interval Training in Men with Prostate Cancer Treated with Androgen Deprivation Therapy: A Pilot Randomised Control Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095709. [PMID: 35565100 PMCID: PMC9099512 DOI: 10.3390/ijerph19095709] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 05/02/2022] [Accepted: 05/05/2022] [Indexed: 01/25/2023]
Abstract
Background: Androgen deprivation therapy (ADT) in prostate cancer has been shown to deteriorate body composition (reduced lean mass and increased body and fat mass) and increase the risk of cardiovascular morbidity. The Mediterranean style dietary pattern (MED-diet) and high intensity interval training (HIIT) may synergistically alleviate these side effects and improve quality of life in men treated with ADT. Methods: Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 20 weeks of usual care or the MED-diet (10 nutrition consults) with HIIT (4 × 4 min 85−95% heart rate peak, 3× week, starting at 12 weeks). Results: The MED-diet with HIIT significantly improved cardiorespiratory fitness (+4.9 mL·kg−1·min, p < 0.001), and body mass (−3.3 kg, p < 0.001) compared to the usual care group at 20 weeks. Clinically meaningful (≥3 points) improvements were seen in quality of life and cancer-related fatigue after 20 weeks. Conclusions: The MED-diet with HIIT increased cardiorespiratory fitness and reduced body weight in men with prostate cancer treated with ADT. Larger trials determining whether the MED-diet with HIIT translates to cardiovascular benefits are warranted.
Collapse
Affiliation(s)
- Brenton J. Baguley
- Institute for Physical Activity and Nutrition, Deakin University, 221 Burwood Highway, Burwood, VIC 3125, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (K.A.); (D.J.); (O.R.L.W.); (T.L.S.)
- Correspondence: ; Tel.: +61-392-468-525
| | - Kirsten Adlard
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (K.A.); (D.J.); (O.R.L.W.); (T.L.S.)
| | - David Jenkins
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (K.A.); (D.J.); (O.R.L.W.); (T.L.S.)
- School of Health and Behavioural Sciences, University of the Sunshine Coast, Maroochydore, QLD 4558, Australia
- Applied Sports Science Technology and Medicine Research Centre, Swansea University, Swansea SA1 8EN, Wales, UK
| | - Olivia R. L. Wright
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (K.A.); (D.J.); (O.R.L.W.); (T.L.S.)
- Mater Research Institute, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Tina L. Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4067, Australia; (K.A.); (D.J.); (O.R.L.W.); (T.L.S.)
| |
Collapse
|
26
|
Yang JJ, Yu D, White E, Lee DH, Blot W, Robien K, Sinha R, Park Y, Takata Y, Gao YT, Smith-Byrne K, Monninkhof EM, Kaaks R, Langhammer A, Borch KB, Al-Shaar L, Lan Q, Sørgjerd EP, Zhang X, Zhu C, Chirlaque MD, Severi G, Overvad K, Sacerdote C, Aune D, Johansson M, Smith-Warner SA, Zheng W, Shu XO. Prediagnosis Leisure-Time Physical Activity and Lung Cancer Survival: A Pooled Analysis of 11 Cohorts. JNCI Cancer Spectr 2022; 6:pkac009. [PMID: 35603841 PMCID: PMC8962711 DOI: 10.1093/jncics/pkac009] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/13/2021] [Accepted: 12/10/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Little is known about the association between physical activity before cancer diagnosis and survival among lung cancer patients. In this pooled analysis of 11 prospective cohorts, we investigated associations of prediagnosis leisure-time physical activity (LTPA) with all-cause and lung cancer-specific mortality among incident lung cancer patients. METHODS Using self-reported data on regular engagement in exercise and sports activities collected at study enrollment, we assessed metabolic equivalent hours (MET-h) of prediagnosis LTPA per week. According to the Physical Activity Guidelines for Americans, prediagnosis LTPA was classified into inactivity, less than 8.3 and at least 8.3 MET-h per week (the minimum recommended range). Cox regression was used to estimate hazard ratios (HRs) and 95% confidence interval (CIs) for all-cause and lung cancer-specific mortality after adjustment for major prognostic factors and lifetime smoking history. RESULTS Of 20 494 incident lung cancer patients, 16 864 died, including 13 596 deaths from lung cancer (overall 5-year relative survival rate = 20.9%, 95% CI = 20.3% to 21.5%). Compared with inactivity, prediagnosis LTPA of more than 8.3 MET-h per week was associated with a lower hazard of all-cause mortality (multivariable-adjusted HR = 0.93, 95% CI = 0.88 to 0.99), but not with lung cancer-specific mortality (multivariable-adjusted HR = 0.99, 95% CI = 0.95 to 1.04), among the overall population. Additive interaction was found by tumor stage (Pinteraction = .008 for all-cause mortality and .003 for lung cancer-specific mortality). When restricted to localized cancer, prediagnosis LTPA of at least 8.3 MET-h per week linked to 20% lower mortality: multivariable-adjusted HRs were 0.80 (95% CI = 0.67 to 0.97) for all-cause mortality and 0.80 (95% CI = 0.65 to 0.99) for lung cancer-specific mortality. CONCLUSIONS Regular participation in LTPA that met or exceeded the minimum Physical Activity Guidelines was associated with reduced hazards of mortality among lung cancer patients, especially those with early stage cancer.
Collapse
Affiliation(s)
- Jae Jeong Yang
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Danxia Yu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Emily White
- Cancer Prevention Program, Fred Hutchinson Cancer Research
Center, Seattle, WA, USA
| | - Dong Hoon Lee
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - William Blot
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Kim Robien
- Department of Exercise and Nutrition Sciences, Milken Institute School of
Public Health, George Washington University, Washington, DC, USA
| | - Rashmi Sinha
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Yikyung Park
- Division of Public Health Sciences, Department of Surgery, Washington
University School of Medicine, St. Louis, MO, USA
| | - Yumie Takata
- Program of Nutrition, School of Biological and Population Health, College of
Public Health and Human Sciences, Oregon State University, Corvallis, OR,
USA
| | - Yu-Tang Gao
- Department of Epidemiology, Shanghai Cancer Institute, Renji Hospital, Shanghai
Jiaotong University School of Medicine, Shanghai, China
| | - Karl Smith-Byrne
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Evelyn M Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center,
Utrecht University, Utrecht, the
Netherlands
| | - Rudolf Kaaks
- Department of Cancer Epidemiology, German Cancer Research Center
(DKFZ), Heidelberg, Germany
- Translational Lung Research Center (TLRC), Member of the German Center for Lung
Research (DZL), Heidelberg, Germany
| | - Arnulf Langhammer
- HUNT Research Centre, Department of Public Health and Nursing, NTNU, Norwegian
University of Science and Technology, Levanger, Norway
- Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger,
Norway
| | | | - Laila Al-Shaar
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
- Department of Public Health Sciences, Penn State College of
Medicine, Hershey, PA, USA
| | - Qing Lan
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - Elin Pettersen Sørgjerd
- Department of Public Health and General Practice, Norwegian University of
Science and Technology, Trondheim, Norway
| | - Xuehong Zhang
- Channing Division of Network Medicine, Department of Medicine, Brigham and
Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Clair Zhu
- Division of Epidemiology & Genetics, National Cancer
Institute, Bethesda, MD, USA
| | - María Dolores Chirlaque
- Department of Epidemiology, Murcia Regional Health Council IMIBArrixaca, Ronda
de Levante, Murcia, Spain
- Department of Health and Social Sciences, University of Murcia Campus de
Espinardo, Murcia, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Calle de Melchor Fernández
Almagro, Madrid, Spain
| | - Gianluca Severi
- University Paris-Saclay, UVSQ, Inserm, Gustave Roussy, “Exposome and Heredity”
Team, CESP UMR1018, Villejuif, France
- Department of Statistics, Computer Science and Applications “G. Parenti”
(DISIA), University of Florence, Italy
| | - Kim Overvad
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Carlotta Sacerdote
- Unit of Cancer Epidemiology, Città della Salute e della Scienza
University-Hospital, Turin, Italy
| | - Dagfinn Aune
- Department of Epidemiology and Biostatistics, School of Public Health, Imperial
College London, London, UK
- Department of Nutrition, Bjørknes University College, Oslo,
Norway
- Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo
University Hospital, Oslo, Norway
| | - Mattias Johansson
- Genetic Epidemiology Group, International Agency for Research on
Cancer, Lyons, France
| | - Stephanie A Smith-Warner
- Departments of Nutrition and Epidemiology, Harvard T.H. Chan School of Public
Health, Boston, MA, USA
| | - Wei Zheng
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| | - Xiao-Ou Shu
- Vanderbilt Epidemiology Center, Division of Epidemiology, Department of
Medicine, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical
Center, Nashville, TN, USA
| |
Collapse
|
27
|
Measurement of Physical Fitness and 24/7 Physical Activity, Standing, Sedentary Behavior, and Time in Bed in Working-Age Finns: Study Protocol for FINFIT 2021. Methods Protoc 2022; 5:mps5010007. [PMID: 35076569 PMCID: PMC8788421 DOI: 10.3390/mps5010007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/08/2022] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Background: Population studies gathering measured data on fitness and physical behavior, covering physical activity, standing, sedentary behavior, and time in bed, are scarce. This article describes the protocol of the FINFIT 2021 study that measures fitness and physical behavior in a population-based sample of adults and analyzes their associations and dose–response relationships with several health indicators. Methods: The study comprises a stratified random sample of 20–69-year-old men and women (n = 16,500) from seven city-centered regions in Finland. Physical behavior is measured 24/7 by tri-axial accelerometry and analyzed with validated MAD-APE algorithms. Health and fitness examinations include fasting blood samples, measurements of blood pressure, anthropometry, and health-related fitness. Domains of health, functioning, well-being, and socio-demographics are assessed by a questionnaire. The data are being collected between September 2021 and February 2022. Discussion: The study provides population data on physical fitness and physical behavior 24/7. Physical behavior patterns by intensity and duration on an hour-by-hour basis will be provided. In the future, the baseline data will be assessed against prospective register-based data on incident diseases, healthcare utilization, sickness absence, premature retirement, and death. A similar study will be conducted every fourth year with a new random population sample.
Collapse
|
28
|
Coletta AM, Playdon MC, Baron KG, Wei M, Kelley K, Vaklavas C, Beck A, Buys SS, Chipman J, Ulrich CM, Walker D, White S, Oza S, Zingg RW, Hansen PA. The association between time-of-day of habitual exercise training and changes in relevant cancer health outcomes among cancer survivors. PLoS One 2021; 16:e0258135. [PMID: 34637457 PMCID: PMC8509995 DOI: 10.1371/journal.pone.0258135] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 09/17/2021] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. METHODS Retrospective analysis of data collected from 2016-2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program's assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. RESULTS Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. CONCLUSION Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.
Collapse
Affiliation(s)
- Adriana M. Coletta
- Department of Health & Kinesiology, The University of Utah, Salt Lake City, UT, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Mary C. Playdon
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Nutrition and Integrative Physiology, The University of Utah, Salt Lake City, UT, United States of America
| | - Kelly G. Baron
- Department of Family and Preventive Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Mei Wei
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Kristen Kelley
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Christos Vaklavas
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Anna Beck
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Saundra S. Buys
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Internal Medicine, The University of Utah, Salt Lake City, UT, United States of America
| | - Jonathan Chipman
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Population Health Sciences, The University of Utah, Salt Lake City, UT, United States of America
| | - Cornelia M. Ulrich
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Department of Population Health Sciences, The University of Utah, Salt Lake City, UT, United States of America
| | - Darren Walker
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Shelley White
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
| | - Sonal Oza
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
| | - Rebecca W. Zingg
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
| | - Pamela A. Hansen
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, UT, United States of America
- Division of Physical Medicine and Rehabilitation, The University of Utah, Salt Lake City, UT, United States of America
| |
Collapse
|
29
|
Zopf EM, Schulz H, Poeschko J, Aschenbroich K, Wilhelm T, Eypasch E, Kleimann E, Severin K, Benz J, Liu E, Bloch W, Baumann FT. Effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy-a pilot study. Support Care Cancer 2021; 30:1945-1955. [PMID: 34623488 PMCID: PMC8795052 DOI: 10.1007/s00520-021-06608-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 09/29/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Colorectal cancer and its treatment are associated with debilitating side effects. Exercise may improve the physical and psychological wellbeing of cancer patients; however, evidence in colorectal cancer patients undergoing adjuvant chemotherapy is limited. This pilot study aimed to explore the effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy. METHODS Patients who had undergone curative resection for colorectal cancer (stages II-III) and were scheduled to receive adjuvant chemotherapy were enrolled into this non-randomized controlled trial. Patients in the intervention group (IG) took part in a 6-month supervised aerobic exercise program, while the control group (CG) received usual care. Cardiorespiratory fitness (measured by peak oxygen consumption) was assessed at baseline and 6 months. Fatigue, quality of life, and physical activity levels were additionally assessed at 3 months. RESULTS In total, 59 patients (33 in IG vs. 26 in CG) were enrolled into this study. Eighteen patients (9 in IG vs. 9 in CG) dropped out of the study prior to the 6-month follow-up. Significant improvements in cardiorespiratory fitness (p = .002) and selected patient-reported health outcomes, such as reduced motivation (p = .015) and mental fatigue (p = .018), were observed in the IG when compared to the CG. CONCLUSION To our knowledge, this is the first study to investigate the effects of a supervised aerobic exercise program in colorectal cancer patients undergoing adjuvant chemotherapy. The significant and clinically meaningful improvements in CRF warrant further randomized controlled trials to confirm these findings. TRIALS REGISTRATION German Clinical Trials Register Identifier: DRKS00005793, 11/03/2014, retrospectively registered.
Collapse
Affiliation(s)
- Eva M Zopf
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany.,Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Holger Schulz
- Praxis Internistischer Onkologie und Hämatologie (Pioh), Frechen, Germany
| | - Jonas Poeschko
- Augustinian Hospital, Cologne, Germany.,Department of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | - Kerstin Aschenbroich
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany.,Department of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany
| | | | - Ernst Eypasch
- Heilig Geist-Hospital Cologne-Longerich, Cologne, Germany
| | | | - Kai Severin
- MV-Zentrum für Hämatologie und Onkologie, Cologne, Germany
| | - Jutta Benz
- St. Elisabeth-Hospital Cologne-Hohenlind, Cologne, Germany
| | - Enwu Liu
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia
| | - Wilhelm Bloch
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany
| | - Freerk T Baumann
- Department of Molecular and Cellular Sports Medicine, Institute of Cardiology and Sports Medicine, German Sport University Cologne, Cologne, Germany. .,Department of Internal Medicine, Center of Integrated Oncology Cologne Bonn, University Hospital of Cologne, Cologne, Germany.
| |
Collapse
|
30
|
Kunutsor SK, Voutilainen A, Laukkanen JA. Cardiorespiratory fitness is not associated with reduced risk of prostate cancer: A cohort study and review of the literature. Eur J Clin Invest 2021; 51:e13545. [PMID: 33763858 DOI: 10.1111/eci.13545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/15/2021] [Accepted: 03/15/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiorespiratory fitness (CRF) has a strong inverse relationship with several chronic disease outcomes, including some cancers. The association between CRF and prostate cancer is controversial. We aimed to assess the prospective association of CRF with prostate cancer risk using a cohort study and review of the literature. MATERIAL AND METHODS Cardiorespiratory fitness was assessed using a respiratory gas exchange analyser during exercise testing in 2204 cancer-free middle-aged men. Hazard ratios (HRs) with 95% confidence interval (CIs) were estimated. We corrected for within-person variability in CRF levels using repeat measurements. RESULTS During a median follow-up of 24.9 years, 216 prostate cancer cases occurred. The age-adjusted regression dilution ratio of CRF was 0.58 (95% CI: 0.53-0.64). The HR (95% CI) of prostate cancer per 1 standard deviation increase in CRF in age-adjusted analysis was 1.10 (0.95-1.27). The association remained consistent after further adjustment for several risk factors (HR 1.13; 95% CI 0.96-1.33). The corresponding adjusted HRs were 1.24 (95% CI: 0.87-1.77) and 1.28 (95% CI: 0.87-1.88), respectively, when comparing the extreme tertiles of CRF levels. Previous studies mostly reported no evidence of an association or an increased risk of prostate cancer in relation to high CRF. Studies reporting positive associations had short-term follow-up durations (<10 years). CONCLUSIONS Primary data and a review of previous studies suggest that elevated CRF is not associated with reduced prostate cancer risk. Previous findings of significant evidence of associations could be attributed to increased screening and detection as well as reverse causation bias.
Collapse
Affiliation(s)
- Setor K Kunutsor
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, UK.,Translational Health Sciences, Bristol Medical School, Southmead Hospital, University of Bristol, Bristol, UK
| | - Ari Voutilainen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Jari A Laukkanen
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.,Department of Medicine, Central Finland Health Care District, Jyväskylä, Finland.,Department of Medicine, Institute of Clinical Medicine, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
31
|
Zimmerman A, Planek MIC, Chu C, Oyenusi O, Paner A, Reding K, Skeete J, Clark B, Okwuosa TM. Exercise, cancer and cardiovascular disease: what should clinicians advise? Cardiovasc Endocrinol Metab 2021; 10:62-71. [PMID: 34113793 PMCID: PMC8186519 DOI: 10.1097/xce.0000000000000228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 07/05/2020] [Indexed: 12/18/2022]
Abstract
Cardiovascular disease is one of the leading causes of morbidity and mortality in persons with cancer. The elevated risk is thought to derive from the combination of cardiovascular risk factors and direct cardiotoxicity from cancer therapies. Exercise may be a potential strategy to counteract these toxicities and maintain cardiovascular reserve. In this article, we review the evidence for the potential cardioprotective effects of exercise training in cancer patients before, during, and following treatment. We also propose a patient-tailored approach for the development of targeted prescriptions based on individual exercise capacity and cardiovascular reserve.
Collapse
Affiliation(s)
| | | | - Catherine Chu
- Rush Medical College, Rush University Medical Center
| | | | - Agne Paner
- Division of Hematology/Oncology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois
| | - Kerryn Reding
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Jamario Skeete
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian Clark
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Tochi M. Okwuosa
- Division of Cardiology, Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
32
|
Ezzatvar Y, Ramírez-Vélez R, Sáez de Asteasu ML, Martínez-Velilla N, Zambom-Ferraresi F, Lobelo F, Izquierdo M, García-Hermoso A. Cardiorespiratory fitness and all-cause mortality in adults diagnosed with cancer systematic review and meta-analysis. Scand J Med Sci Sports 2021; 31:1745-1752. [PMID: 33909308 DOI: 10.1111/sms.13980] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 04/13/2021] [Accepted: 04/23/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION The inverse association between cardiorespiratory fitness and all-cause mortality in apparently healthy populations has been previously reported; however, the existence of this association among adults diagnosed with cancer is unclear. AIM To determine the association between cardiorespiratory fitness and all-cause mortality in adults diagnosed with cancer. METHODS Medline, Embase, and SPORTDiscus databases were searched. Eligible prospective cohort studies that examined the association of cardiorespiratory fitness with all-cause mortality in adults diagnosed with cancer were included. Hazard ratios (HRs) with associated 95% confidence intervals (CIs) were extracted from studies for all-cause mortality and pooled HRs were calculated using the random-effects inverse-variance model with the Hartung-Knapp-Sidik-Jonkman adjustment. RESULTS Data from 13 studies with 6,486 adults were included. Compared with lower levels of cardiorespiratory fitness, high levels were associated with a reduced risk of all-cause mortality among adults diagnosed with any cancer (HR = 0.52; 95% CI, 0.35-0.77), lung cancer (HR = 0.62; 95% CI, 0.46-0.83), and among those with cardiorespiratory fitness measurement via indirect calorimetry (HR = 0.47; 95% CI, 0.27-0.80). Pooled HRs for the reduction in all-cause mortality risk per 1-MET increase were also statistically significant (HR = 0.82; 95% CI, 0.69-0.99). Neither age at baseline nor the length of follow-up had a significant influence on the HR estimates for all-cause mortality risk. CONCLUSION Cardiorespiratory fitness may confer an independent protective benefit against all-cause mortality in adults diagnosed with cancer. The use of cardiorespiratory fitness as a prognostic parameter might help determine risk for future adverse clinical events and optimize therapeutic management strategies to reduce long-term treatment-related effects in adults diagnosed with cancer.
Collapse
Affiliation(s)
- Yasmin Ezzatvar
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, Universitat de València, Valencia, Spain
| | - Robinson Ramírez-Vélez
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain
| | - Mikel L Sáez de Asteasu
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Nicolás Martínez-Velilla
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
| | - Fabricio Zambom-Ferraresi
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Geriatric Department, Complejo Hospitalario de Navarra (CHN), Pamplona, Spain
| | - Felipe Lobelo
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA.,Exercise is Medicine Global Research and Collaboration Center, Atlanta, GA, USA
| | - Mikel Izquierdo
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio García-Hermoso
- Navarrabiomed, Complejo Hospitalario de Navarra (CHN), Universidad Pública de Navarra (UPNA), IdiSNA, Pamplona, Spain.,CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain.,Universidad de Santiago de Chile (USACH), Escuela de Ciencias de la Actividad Física, el Deporte y la Salud, Santiago, Chile
| |
Collapse
|
33
|
Schulz SVW, Schumann U, Otto S, Kirsten J, Treff G, Janni W, Huober J, Leinert E, Steinacker JM, Bizjak DA. Two-year follow-up after a six-week high-intensity training intervention study with breast cancer patients: physiological, psychological and immunological differences. Disabil Rehabil 2021; 44:4813-4820. [PMID: 33974472 DOI: 10.1080/09638288.2021.1921861] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Previously we demonstrated the feasibility of a six-week-long combination of high-intensity interval endurance and strength training (HIT/HIRT) for women with nonmetastatic breast cancer leading to improvements in psychological well-being and performance. Now we report results of a 24-month follow-up. METHODS Previous intervention (IG, n = 10; 58.7 ± 8.4yrs) and control group (CG, n = 9; 58.8 ± 6.6yrs) were asked for follow-up examinations 12 (T12) and 24 months (T24) after cessation of the supervised training (POST). Medical history, mental well-being, performance and immunological variables were analyzed with respect to intervention start (PRE). RESULTS IG maximum oxygen consumption (⩒O2peak) 12%-improved POST (p = 0.05) and declined to baseline values T24, while CG ⩒O2peak increased 12% T24 (p = 0.01). IG strength (1RM) increased 31% POST (p < 0.001) and remained above baseline level T24 (p = 0.003), whereas CG 1RM slightly improved T24 (+19%, p = 0.034). IG Anxiety and Depression decreased POST and did not change until T24. IG C-reactive protein decreased POST and increased to pre-exercise levels T24. CG immunological/inflammatory/life quality markers did not change. CONCLUSIONS Six weeks of HIT/HIRT by breast cancer patients can induce similar beneficial effects like two years of convalescence, but outcomes were unstable and showed a fast backslide in aerobic capacity, activity level and in pro-inflammatory state within 12 months.IMPLICATIONS FOR REHABILITATIONHigh-intensity interval endurance and strength training (HIT/HIRT) for female breast cancer patients was shown to improve psychological well-being and performance, but long-term effects/adherence are unknown.Significant backslides in aerobic capacity, activity level as well as in the pro-inflammatory response after one and two years are observed and should be monitored.Continuous supervision and/or support of breast cancer patients before, during, and after medical care due to poor training adherence when voluntarily executed is recommended.
Collapse
Affiliation(s)
- Sebastian V W Schulz
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Uwe Schumann
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Stephanie Otto
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Johannes Kirsten
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Gunnar Treff
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Wolfgang Janni
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Jens Huober
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Elena Leinert
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| | - Daniel A Bizjak
- Division of Sports and Rehabilitation Medicine, Ulm University Hospital, Ulm, Germany
| |
Collapse
|
34
|
Soares-Miranda L, Lucia A, Silva M, Peixoto A, Ramalho R, da Silva PC, Mota J, Macedo G, Abreu S. Physical Fitness and Health-related Quality of Life in Patients with Colorectal Cancer. Int J Sports Med 2021; 42:924-929. [PMID: 33634458 DOI: 10.1055/a-1342-7347] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Colorectal cancer is now a frequently treatable illness for most and a chronic disease for many. The number of people living with a diagnosis of colorectal cancer is thus expected to rise. Yet even after successful treatment, colorectal cancer survivors, mostly the elderly, frequently experience health problems and impaired health-related quality of life. We investigated the cross-sectional association between physical fitness, measured with the 6-min walk test, 30-second chair-stand test, and isometric handgrip strength, as well as health-related quality of life, in a cohort of colorectal cancer patients (n=71, mean [SD] age 67±10 years, 63% men; 35, 39 and 25% in stages I, II and III, respectively). Greater performance in the 6-minute walk test and 30-second chair-stand test was associated with higher levels of global health status (p<0.001, p=0.001 respectively), higher functioning (p<0.001) and lower levels of symptomatology (p<0.001; pain and fatigue). Additionally, greater 6-min walk test performance was associated with a better cognitive function (p=0.005). Our results suggest that greater aerobic fitness and lower-extremity muscle strength are cross-sectionally associated with higher levels of global health status, higher functioning and lower levels of symptomatology such as pain and fatigue in colorectal cancer patients.
Collapse
Affiliation(s)
- Luisa Soares-Miranda
- Research Center in Physical Activity Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Alejandro Lucia
- Research Institute of Hospital 12 de Octubre ('i+12'), Madrid, Spain.,Universidad Europa de Madrid (Faculty of Sports Sciences), Madrid, Spain
| | - Marco Silva
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Armando Peixoto
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Rosa Ramalho
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | | | - Jorge Mota
- Research Center in Physical Activity Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| | - Guilherme Macedo
- Gastroenterology Department, Centro Hospitalar São João, Porto, Portugal
| | - Sandra Abreu
- Research Center in Physical Activity Health and Leisure, Faculty of Sport, University of Porto, Porto, Portugal
| |
Collapse
|
35
|
Reiter-Brennan C, Dzaye O, Al-Mallah MH, Dardari Z, Brawner CA, Lamerato LE, Keteyian SJ, Ehrman JK, Blaha MJ, Visvanathan K, Marshall CH. Fitness and prostate cancer screening, incidence, and mortality: Results from the Henry Ford Exercise Testing (FIT) Project. Cancer 2021; 127:1864-1870. [PMID: 33561293 DOI: 10.1002/cncr.33426] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/23/2020] [Accepted: 12/15/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND The relation between cardiorespiratory fitness (CRF) and prostate cancer is not well established. The objective of this study was to determine whether CRF is associated with prostate cancer screening, incidence, or mortality. METHODS The Henry Ford Exercise Testing Project is a retrospective cohort study of men aged 40 to 70 years without cancer who underwent physician-referred exercise stress testing from 1995 to 2009. CRF was quantified in metabolic equivalents of task (METs) (<6 [reference], 6-9, 10-11, and ≥12 METs), estimated from the peak workload achieved during a symptom-limited, maximal exercise stress test. Prostate-specific antigen (PSA) testing, incident prostate cancer, and all-cause mortality were analyzed with multivariable adjusted Poisson regression and Cox proportional hazard models. RESULTS In total, 22,827 men were included, of whom 739 developed prostate cancer, with a median follow-up of 7.5 years. Men who had high fitness (≥12 METs) had an 28% higher risk of PSA screening (95% CI, 1.2-1.3) compared with those who had low fitness (<6 METs. After adjusting for PSA screening, fitness was associated with higher prostate cancer incidence (men aged <55 years, P = .02; men aged >55 years, P ≤ .01), but not with advanced prostate cancer. Among the men who were diagnosed with prostate cancer, high fitness was associated with a 60% lower risk of all-cause mortality (95% CI, 0.2-0.9). CONCLUSIONS Although men with high fitness are more likely to undergo PSA screening, this does not fully account for the increased incidence of prostate cancer seen among these individuals. However, men with high fitness have a lower risk of death after a prostate cancer diagnosis, suggesting that the cancers identified may be low-risk with little impact on long-term outcomes.
Collapse
Affiliation(s)
- Cara Reiter-Brennan
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Radiology and Neuroradiology, Charite, Berlin, Germany
| | - Omar Dzaye
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Department of Radiology and Neuroradiology, Charite, Berlin, Germany.,Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mouaz H Al-Mallah
- Houston Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Zeina Dardari
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Clinton A Brawner
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | | | - Steven J Keteyian
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Jonathan K Ehrman
- Division of Cardiovascular Medicine, Henry Ford Health System, Detroit, Michigan
| | - Michael J Blaha
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Kala Visvanathan
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Catherine H Marshall
- Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
36
|
The impact of a hospital-based exercise oncology program on cancer treatment-related side effects among rural cancer survivors. Support Care Cancer 2021; 29:4663-4672. [PMID: 33502590 PMCID: PMC7838462 DOI: 10.1007/s00520-021-06010-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 01/19/2021] [Indexed: 12/18/2022]
Abstract
Purpose To assess the impact of the Personal Optimism With Exercise Recovery (POWER) program on cancer treatment–related side effects among rural cancer survivors. Methods In this retrospective study of data collected between 2016 and 2019, we assessed change in cardiorespiratory fitness, whole-body muscular endurance, physical function and strength, anthropometrics, fatigue, and quality of life (QoL), after participation in POWER. Descriptive statistics were calculated for demographic and clinical variables. Univariate analysis of variance was carried out with age and BMI at initial assessment as covariates. Results A total of 239 survivors, 78% rural residents, completed a follow-up assessment. Among rural cancer survivors, the most prevalent cancer sites were breast (42.5%), prostate (12.4%), and lymphoma (5.9%). The majority of survivors were female (70%), non-Hispanic (94.6%), and white (93.5%), with average age and BMI of 62.1 ± 13.2 years and 28.4 ± 6.7 kg/m2, respectively. Rural cancer survivors with cancer stages I–III exhibited significant improvements in fitness (+ 3.07 ml/kg/min, 95% CI 1.93, 4.21; + 0.88 METS, 95% CI 0.55, 1.20), physical function (30-s chair stand: + 2.2 repetitions, 95% CI 1.3, 3.1), muscular endurance (10-repetition maximum: chest press + 4.1 kg, 95% CI 2.0, 6.3; lateral pulldown + 6.6 kg, 95% CI 4.4, 8.9), self-reported fatigue (FACIT-Fatigue score: + 4.9, 95% CI 1.6, 8.1), and QoL (FACT-G7 score + 2.1, 95% CI, 0.9, 3.4). Among stage IV rural and urban cancer survivors, significant improvements were observed in muscular endurance and physical function. Conclusion Participation in POWER was associated with attenuation of cancer treatment–related side effects and may serve as a model exercise oncology program for rural cancer survivors.
Collapse
|
37
|
Groarke JD, Payne DL, Claggett B, Mehra MR, Gong J, Caron J, Mahmood SS, Hainer J, Neilan TG, Partridge AH, Di Carli M, Jones LW, Nohria A. Association of post-diagnosis cardiorespiratory fitness with cause-specific mortality in cancer. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2020; 6:315-322. [PMID: 32167560 PMCID: PMC9989596 DOI: 10.1093/ehjqcco/qcaa015] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 03/10/2020] [Indexed: 01/19/2023]
Abstract
AIMS The prognostic importance of post-diagnosis assessment of cardiorespiratory fitness (CRF) in cancer patients is not well established. We sought to examine the association between CRF and mortality in cancer patients. METHODS AND RESULTS This was a single-centre cohort analysis of 1632 patients (58% male; 64 ± 12 years) with adult-onset cancer who were clinically referred for exercise treadmill testing a median of 7 [interquartile range (IQR): 3-12] years after primary diagnosis. Cardiorespiratory fitness was defined as peak metabolic equivalents (METs) achieved during standard Bruce protocol and categorized by tertiles. The association between CRF and all-cause and cause-specific mortality was assessed using multivariable Cox proportional hazard models adjusting for important covariates. Median follow-up was 4.6 (IQR: 2.6-7.0) years; a total of 411 deaths (229, 50, and 132 all-cause, cardiovascular (CV), and cancer related, respectively) occurred during this period. Compared with low CRF (range: 1.9-7.6 METs), the adjusted hazard ratio (HR) for all-cause mortality was 0.38 [95% confidence interval (CI): 0.28-0.52] for intermediate CRF (range: 7.7-10.6 METs) and 0.17 (95% CI: 0.11-0.27) for high CRF (range: 10.7-22.0 METs). The corresponding HRs were 0.40 (95% CI: 0.19-0.86) and 0.41 (95% CI: 0.16-1.05) for CV mortality and 0.40 (95% CI: 0.26-0.60) and 0.16 (95% CI: 0.09-0.28) for cancer mortality, respectively. The adjusted risk of all-cause, CV, and cancer mortality decreased by 26%, 14%, and 25%, respectively with each one MET increment in CRF. CONCLUSION Cardiorespiratory fitness is a strong, independent predictor of all-cause, CV, and cancer mortality, even after adjustment for important clinical covariates in patients with certain cancers.
Collapse
Affiliation(s)
- John D Groarke
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Adult Survivorship Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA 02215, USA
| | - David L Payne
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Brian Claggett
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Mandeep R Mehra
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jingyi Gong
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Jesse Caron
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA
| | - Syed S Mahmood
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jon Hainer
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Tomas G Neilan
- Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114-2696, USA
| | - Ann H Partridge
- Adult Survivorship Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA 02215, USA
| | - Marcelo Di Carli
- Noninvasive Cardiovascular Imaging Program, Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115, USA
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Anju Nohria
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.,Adult Survivorship Program, Department of Medical Oncology, Dana-Farber Cancer Institute, Brigham and Women's Hospital, 450 Brookline Avenue, Boston, MA 02215, USA
| |
Collapse
|
38
|
Abstract
Cardiovascular disease (CVD) is a major competing cause of morbidity and mortality in patients with cancer. Cancer treatment can have detrimental short- and long-term cardiovascular effects. Moreover, cancer patients may have a significant loss in cardiorespiratory fitness, a key CVD risk factor, during and after cancer treatment. Exercise training has emerged as a potential intervention to improve fitness and reduce the risk of CVD in cancer. In this review, we discuss the role of cardiorespiratory fitness to predict cancer and CVD outcomes, as well as explore the impact of exercise training to improve fitness and other key outcomes in patients with cancer. The role of cardio-oncology rehabilitation will also be highlighted.
Collapse
Affiliation(s)
- Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
- Heart Institute, Cincinnati Children's Hospital, Cincinnati, OH, USA.
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention & Cardiology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
39
|
Shimizu T, Ishizuka M, Shiraki T, Sakuraoka Y, Mori S, Abe A, Iso Y, Takagi K, Aoki T, Kubota K. The clinical influence of the preoperative lymphocyte-to-monocyte ratio on the postoperative outcome of patients with early-stage gastrointestinal cancer. Ann Gastroenterol Surg 2020; 4:580-590. [PMID: 33005853 PMCID: PMC7511555 DOI: 10.1002/ags3.12369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 05/20/2020] [Accepted: 06/02/2020] [Indexed: 01/19/2023] Open
Abstract
AIM The lymphocyte-to-monocyte ratio (LMR) is useful for predicting the prognosis of patients with gastric cancer (GC) and those with colorectal cancer (CRC) undergoing surgery. The relationship between the LMR and postoperative outcome of patients with early-stage gastrointestinal cancers such as stage I GC and CRC remains unclear. METHODS We retrospectively evaluated 323 stage I GC and 152 stage I CRC patients undergoing surgery. Univariate and multivariate analyses using the Cox proportional hazards model were performed to identify the clinical characteristics associated with overall survival (OS), and the cut-off values of these variables were determined by receiver operating characteristic analysis. The Kaplan-Meier method and log-rank test were used for postoperative survival comparisons according to the LMR (GC: LMR < 4.2 vs ≥4.2; CRC: LMR < 3.0 vs ≥3.0). RESULTS Univariate and multivariate analyses revealed that OS was significantly associated with the LMR (<4.2/≥4.2) (HR, 2.489; 95% CI, 1.317-4.702; P = 0.005), as well as age (>75/≤75 years) (HR, 3.511; 95% CI, 1.881-6.551; P < 0.001) and albumin level (≤3.5/>3.5 g/dL) (HR, 3.040; 95% CI, 1.575-5.869; P = 0.001), in stage I GC patients. Survival analysis demonstrated a significantly poorer OS in stage I GC patients with a LMR < 4.2 compared with ≥4.2 (P < 0.001). In stage I CRC patients, despite a significant difference in OS according to the LMR (<3.0 vs ≥3.0) (P = 0.040), univariate analysis revealed no significant association between the LMR and OS. CONCLUSION LMR is a useful predictor of the postoperative outcome of stage I GC patients treated surgically.
Collapse
Affiliation(s)
- Takayuki Shimizu
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Mitsuru Ishizuka
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Takayuki Shiraki
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Yuhki Sakuraoka
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Shozo Mori
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Akihito Abe
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Yukihiro Iso
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Kazutoshi Takagi
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Taku Aoki
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| | - Keiichi Kubota
- Second Department of SurgeryDokkyo Medical UniversityTochigiJapan
| |
Collapse
|
40
|
Thomsen SN, Sundberg A, Osterkamp J, Thorsen-Streit S, Østerlind K, Krarup PM, Vistisen K, Pedersen BK, Christensen JF. Interindividual changes in peak oxygen consumption in patients with colorectal cancer following endurance training: a secondary analysis of the I-WALK-CRC study. Acta Oncol 2020; 59:1098-1102. [PMID: 32459127 DOI: 10.1080/0284186x.2020.1765414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Simon Nørskov Thomsen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Anna Sundberg
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jens Osterkamp
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| | - Sarah Thorsen-Streit
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Kell Østerlind
- Department of Oncology, Rigshospitalet, Copenhagen, Denmark
| | - Peter-Martin Krarup
- Digestive Disease Center, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Surgical Science, Zealand University Hospital, Roskilde, Denmark
| | - Kirsten Vistisen
- Department of Oncology, Herlev and Gentofte Hospital, Copenhagen University, Copenhagen, Denmark
| | - Bente Klarlund Pedersen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Frank Christensen
- Centre of Inflammation and Metabolism and Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Surgical Gastroenterology, Rigshospitalet, Copenhagen, Denmark
| |
Collapse
|
41
|
Determinants of cardiorespiratory fitness in very long-term survivors of allogeneic hematopoietic stem cell transplantation: a national cohort study. Support Care Cancer 2020; 29:1959-1967. [PMID: 32827056 PMCID: PMC7892519 DOI: 10.1007/s00520-020-05644-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 07/20/2020] [Indexed: 11/13/2022]
Abstract
Purpose Survivors of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are at risk for cardiopulmonary adverse events. Data on long-term effects on cardiorespiratory fitness are limited. To address the gap in knowledge, we aimed to determine peak oxygen uptake (V̇O2peak) and identify associations between cardiorespiratory fitness and clinical characteristics, self-reported physical activity, cardiac, and pulmonary function. Methods In a nationwide, single-center cross-sectional study, 90 survivors [aged median (range) 35 (17–54) years, 56% females] were examined, 17 (6–26) years after allo-HSCT. Myeloablative conditioning comprised busulfan/cyclophosphamide or cyclophosphamide only. Methods included pulmonary function tests, echocardiography, and cardiopulmonary exercise test. Results Chronic graft-versus-host disease (cGVHD) was found in 31% of the subjects, of whom 40% had bronchiolitis obliterans syndrome (BOS). Seventy-one percent of the survivors did not meet WHO recommendations for physical activity and 42% were overweight. Reduced gas diffusion (DLCO) and systolic ventricular dysfunction (LVEF) were found in 44% and 31%, respectively. For the group, mean (95% CI), V̇O2peak was 36.4 (34.7–38.0) mL/min/kg [89 (85–93)% of predicted]. V̇O2peak was low at 43%. Cardiopulmonary factors and deconditioning were equally common limitations for exercise. In a multiple linear regression model, low V̇O2peak was associated with low DLCO, low LVEF, BOS, overweight, and inactivity. Conclusion Half of the survivors had reduced cardiorespiratory fitness median 17 years after allo-HSCT. Cardiopulmonary factors and deconditioning were equally common limitations to exercise. We encourage long-term cardiopulmonary monitoring of allo-HSCT survivors and targeted advice on modifiable lifestyle factors. Electronic supplementary material The online version of this article (10.1007/s00520-020-05644-1) contains supplementary material, which is available to authorized users.
Collapse
|
42
|
Crump C, Stattin P, Brooks JD, Stocks T, Sundquist J, Sieh W, Sundquist K. Early-Life Cardiorespiratory Fitness and Long-term Risk of Prostate Cancer. Cancer Epidemiol Biomarkers Prev 2020; 29:2187-2194. [PMID: 32856610 DOI: 10.1158/1055-9965.epi-20-0535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/30/2020] [Accepted: 08/03/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Adolescence is a period of rapid prostatic growth, yet is understudied for susceptibility for future risk of prostate cancer. We examined cardiorespiratory fitness (CRF) in late adolescence in relation to long-term prostate cancer risk. METHODS A population-based cohort study was conducted of all 699,125 Swedish military conscripts during 1972-1985 (97%-98% of 18-year-old men) in relation to risk of prostate cancer overall, aggressive prostate cancer, and prostate cancer mortality during 1998-2017 (ages 50-65 years). CRF was measured by maximal aerobic workload, and prostate cancer was ascertained using the National Prostate Cancer Register. Muscle strength was examined as a secondary predictor. RESULTS In 38.8 million person-years of follow-up, 10,782 (1.5%) men were diagnosed with prostate cancer. Adjusting for sociodemographic factors, height, weight, and family history of prostate cancer, high CRF was associated with a slightly increased risk of any prostate cancer [highest vs. lowest quintile: incidence rate ratio (IRR), 1.10; 95% CI, 1.03-1.19; P = 0.008], but was neither significantly associated with aggressive prostate cancer (1.01; 0.85-1.21; P = 0.90) nor prostate cancer mortality (1.24; 0.73-2.13; P = 0.42). High muscle strength also was associated with a modestly increased risk of any prostate cancer (highest vs. lowest quintile: IRR, 1.14; 95% CI, 1.07-1.23; P < 0.001), but neither with aggressive prostate cancer (0.88; 0.74-1.04; P = 0.14) nor prostate cancer mortality (0.81; 0.48-1.37; P = 0.43). CONCLUSIONS High CRF or muscle strength in late adolescence was associated with slightly increased future risk of prostate cancer, possibly related to increased screening, but neither with risk of aggressive prostate cancer nor prostate cancer mortality. IMPACT These findings illustrate the importance of distinguishing aggressive from indolent prostate cancer and assessing for potential detection bias.
Collapse
Affiliation(s)
- Casey Crump
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York. .,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - James D Brooks
- Department of Urology, Stanford University School of Medicine, Stanford, California
| | - Tanja Stocks
- Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Jan Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Weiva Sieh
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristina Sundquist
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York.,Center for Primary Health Care Research, Lund University, Malmö, Sweden
| |
Collapse
|
43
|
Fardman A, Banschick GD, Rabia R, Percik R, Fourey D, Segev S, Klempfner R, Grossman E, Maor E. Cardiorespiratory fitness and survival following cancer diagnosis. Eur J Prev Cardiol 2020; 28:1242-1249. [PMID: 34551084 DOI: 10.1177/2047487320930873] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 05/11/2020] [Indexed: 12/20/2022]
Abstract
Abstract
Aims
Data on the association of cardiorespiratory fitness with survival of cancer patients are limited. This study aimed to evaluate the association between midlife cardiorespiratory fitness and survival after a subsequent cancer diagnosis.
Methods
We evaluated 19,134 asymptomatic self-referred adults who were screened in preventive healthcare settings. All subjects were free of cardiovascular disease and cancer at baseline and completed a maximal exercise stress test. Fitness was categorised into age-specific and sex-specific quintiles according to the treadmill time and dichotomised to low (quintiles 1–2) and high fitness groups.
Results
The mean age was 50 ± 8 years and 72% were men. During a median follow-up of 13 years (interquartile range 7–16) 517 (3%) died. Overall, 1455 (7.6%) subjects developed cancer with a median time to cancer diagnosis of 6.4 years (interquartile range 3–10). Death from the time of cancer diagnosis was significantly lower among the high fitness group (Plog rank = 0.03). Time-dependent analysis showed that subjects who developed cancer during follow-up were more likely to die (P < 0.001). The association of cancer with survival was fitness dependent such that in the lower fitness group cancer was associated with a higher risk of death, whereas among the high fitness group the risk of death was lower (hazard ratio 20 vs. 15; Pfor interaction = 0.047). The effect modification persisted after applying a 4-year blanking period between fitness assessment and cancer diagnosis (Pfor interaction = 0.003).
Conclusion
Higher midlife cardiorespiratory fitness is associated with better survival among cancer patients. Our findings support fitness assessment in preventive healthcare settings.
Collapse
Affiliation(s)
| | | | - Razi Rabia
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Ruth Percik
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Dana Fourey
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Shlomo Segev
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute for Medical Screening, Chaim Sheba Medical Center, Israel
| | - Robert Klempfner
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| | - Ehud Grossman
- Sackler School of Medicine, Tel-Aviv University, Israel
| | - Elad Maor
- Sackler School of Medicine, Tel-Aviv University, Israel
- Institute of Endocrinology, Chaim Sheba Medical Center, Israel, Leviev Heart Center, Chaim Sheba Medical Center, Israel
| |
Collapse
|
44
|
Lee K, Zhou J, Norris MK, Chow C, Dieli-Conwright CM. Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer. Curr Oncol Rep 2020; 22:71. [PMID: 32537699 DOI: 10.1007/s11912-020-00932-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the effects of prehabilitative exercise interventions on the physical, psychosocial, and biological outcomes among patients with cancer. Current gaps and future directions in prehabilitative exercise research will be addressed. RECENT FINDINGS Prehabilitative exercise mitigates the detrimental impact of cancer surgery on physical fitness, noted by increases in maximal oxygen consumption and 6-min walk distance. Beneficial effects on psychosocial and biological outcomes remain inconclusive. Aerobic exercise interventions were often prescribed and included low-, moderate-, or high-intensity exercise. Resistance exercise interventions were often performed in conjunction with aerobic exercise. Prehabilitative exercise elicits robust improvements in physical fitness; however, effect on psychosocial and biological outcomes remains inconclusive. Exercise prescription parameters varied greatly by frequency, intensity, time, and type across multiple cancer diagnoses. Future investigations are needed to systematically dose exercise for a wider variety of outcome measures, with an overall goal to set forth pre-operative exercise guidelines.
Collapse
Affiliation(s)
- Kyuwan Lee
- Department of Population Sciences, City of Hope, Duarte, CA, 91010, USA
| | - Judy Zhou
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Mary K Norris
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA
| | - Christina Chow
- Division of Biokinesiology and Physical Therapy, Ostrow School of Dentistry, University of Southern California (USC), Los Angeles, CA, 90089, USA
| | - Christina M Dieli-Conwright
- Division of Populations Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Ave, Boston, MA, 02215, USA.
| |
Collapse
|
45
|
Beneficial Molecular Adaptations In BRCA-Mutation Carriers By Combined HIT/HIRT Intervention: Results From A Pilot Study. Cancers (Basel) 2020; 12:cancers12061526. [PMID: 32532068 PMCID: PMC7352264 DOI: 10.3390/cancers12061526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 06/02/2020] [Accepted: 06/06/2020] [Indexed: 12/30/2022] Open
Abstract
Based on growing evidence that breast cancer (BRCA) also plays a pivotal role in the regulation of skeletal muscle metabolism and the response to anti-oxidative stress, we examined the influence of regular exercise in human BRCA mutation carriers on their BRCA1 gene/protein expression and inflammatory/oxidative response. Sixteen BRCA-mutation carriers were assigned to an intervention (IG) or control group (CG). IG received a combination of high-intensity interval endurance (HIT) and strength training (HIRT) for six weeks, whereas CG received a low-intensity activity program. Before (T0) and at the end of the intervention (T1), muscle biopsy, physiological performance, blood withdrawal and anthropometry were obtained. Parameters included: Muscle BRCA1 gene/protein expression, inflammatory/oxidative stress, anti-oxidative capacity, peak oxygen capacity (VO2peak) and 1-repetition maximum (1-RM) at six different training machines. VO2peak and 1-RM of IG were increased at T1 compared to T0, whereas CG performance, physiological and molecular parameters remained unchanged. IG showed increased BRCA1 protein concentration as well as anti-oxidative capacity, whereas gene expression was unaltered. IG inflammatory and oxidative damage did not differ between time points. Combined HIT/HIRT increases aerobic and strength performance of BRCA-mutation carriers with up regulated BRCA1 protein expression and improved anti-oxidative status without showing an increased inflammatory response.
Collapse
|
46
|
Coletta AM, Brewster AM, Chen M, Li Y, Bevers TB, Basen-Engquist K, Gilchrist SC. High-Intensity Interval Training Is Feasible in Women at High Risk for Breast Cancer. Med Sci Sports Exerc 2020; 51:2193-2200. [PMID: 31269007 PMCID: PMC7028472 DOI: 10.1249/mss.0000000000002048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Purpose This trial aimed to demonstrate the feasibility of high-intensity interval training (HIIT) in postmenopausal, overweight/obese women at high risk of invasive breast cancer and to explore HIIT on changes in cardiorespiratory fitness (CRF), body weight, and body mass index (BMI) compared with moderate-intensity continuous training (MICT) and usual care (UC). Methods Forty-four women were randomized to HIIT, MICT, or UC for a 12-wk, thrice weekly, supervised exercise intervention. HIIT included a 5-min warm-up at 50%–70% HRpeak, four cycles of 4 min at 90%–100% HRpeak, followed by 3 min at 50%–70% HRpeak. MICT consisted of 41 min at 60%–70% HRpeak. Feasibility was assessed by consent, adherence, compliance, and retention rates. CRF, body weight, and BMI were measured at baseline and end of study. Repeated-measures linear mixed models were used to assess within- and between-group differences. Results Average age was 63.9 ± 8.8 yr. BMI was 30.9 ± 5.7 kg·m−2. Participants completed 90% and 89% of HIIT and MICT workouts, respectively, with 100% compliance to the exercise prescriptions. No serious adverse events were reported. Compared with MICT and UC, HIIT exhibited improvements in change in treadmill time (101 s greater than MICT, and 125 s greater than UC, respectively, P < 0.001). Compared with UC, HIIT exhibited improvement in changes in absolute and relative V˙O2peak (a 0.15-L·min−1 increase, P = 0.005, and a 2.3-mL·kg−1⋅min−1 increase, P = 0.004). There were no significant differences between groups for body weight or BMI (P > 0.05). Conclusions HIIT is feasible, safe, and seems to promote greater improvements in CRF compared with MICT and UC in women at high risk for breast cancer.
Collapse
Affiliation(s)
- Adriana M Coletta
- Cancer Control and Population Sciences Program, Huntsman Cancer Institute, Salt Lake City, UT.,Department of Health, Kinesiology, and Recreation, The University of Utah, Salt Lake City, UT
| | - Abenaa M Brewster
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Minxing Chen
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yisheng Li
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Susan C Gilchrist
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX.,Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| |
Collapse
|
47
|
Wallen MP, Hennessy D, Brown S, Evans L, Rawstorn JC, Wong Shee A, Hall A. High‐intensity interval training improves cardiorespiratory fitness in cancer patients and survivors: A meta‐analysis. Eur J Cancer Care (Engl) 2020; 29:e13267. [DOI: 10.1111/ecc.13267] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 02/13/2020] [Accepted: 04/30/2020] [Indexed: 01/17/2023]
Affiliation(s)
- Matthew P. Wallen
- School of Health and Life Sciences Federation University Australia Ballarat Vic. Australia
| | - Declan Hennessy
- School of Health and Life Sciences Federation University Australia Ballarat Vic. Australia
| | | | - Luke Evans
- Ballarat Health Services Ballarat Vic. Australia
| | - Jonathan C. Rawstorn
- Institute for Physical Activity and Nutrition School of Exercise and Nutrition Sciences Deakin University Geelong Vic. Australia
| | - Anna Wong Shee
- School of Medicine Deakin University Geelong Vic. Australia
- Ballarat Health Services Ballarat Vic. Australia
| | - Adrian Hall
- Department of Anaesthesia Princess Alexandra Hospital Woolloongabba Qld Australia
| |
Collapse
|
48
|
Jaques R, Xu S, Matsakas A. Evaluating Trastuzumab in the treatment of HER2 positive breast cancer. Histol Histopathol 2020; 35:1059-1075. [PMID: 32323293 DOI: 10.14670/hh-18-221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The transmembrane oncoprotein HER2 is encoded by ERBB2 gene and overexpressed in around 20% of invasive breast cancers. It can be specifically targeted by Trastuzumab (Herceptin®), a humanised IgG1 antibody. Trastuzumab has been regarded as one of the most effective therapeutic drugs targeted to HER2 positive cancers. However, there are drawbacks, notably cardiotoxicity and resistance, which have raised awareness in clinical use. Therefore, understanding the mechanism of action is vital to establish improved therapeutic strategies. Here we evaluate Trastuzumab application in the treatment of HER2 positive breast cancer, focusing on its mechanistic actions and clinical effectiveness. Alternative therapies targeting the HER2 receptor and its downstream anomalies will also be discussed, as these could highlight further targets that could be key to improving clinical outcomes.
Collapse
Affiliation(s)
- Ryan Jaques
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK.
| | - Sam Xu
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| | - Antonios Matsakas
- Centre for Atherothrombotic and Metabolic Disease, Hull York Medical School, University of Hull, Hull, UK
| |
Collapse
|
49
|
Effect of Physical Condition on Outcomes in Transplant Patients: A Retrospective Data Analysis. REHABILITATION ONCOLOGY 2020. [DOI: 10.1097/01.reo.0000000000000215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
50
|
Tsopanidou AΑ, Chatzakis PΕ, Drimalas PV, Stavridis IS, Dallas GC, Zacharogiannis EG. Effect of acupuncture in physiological parameters and endurance running performance. J Sports Med Phys Fitness 2020; 60:841-847. [PMID: 32253895 DOI: 10.23736/s0022-4707.20.10325-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Few studies have examined the effect of acupuncture (AC) treatment in aerobic capacity and endurance performance in healthy adults. Thus, the aim of the present study was to evaluate the effects of AC on selected physiological parameters and 3 km running performance. METHODS Twenty-four healthy subjects with low to moderate aerobic capacity participated in the study and randomly assigned in two groups: AC group (ACG - N.=14) and control group (CG - N.=10). The subjects completed an incremental test to exhaustion and a 3 km race on a treadmill to evaluate their physiological responses and endurance running performance respectively, prior and after 4 weeks (8 sessions, twice a week) of acupuncture treatment. RESULTS AC treatment had a significant main effect in T3km [F(1, 21)=7.173, P=0.014, partial η2=0.255], as well as in VT [F(1, 21)=8.476, P=0.008, partial η2=0.288] and HRmax@3km [F(1, 21)=4.930, P=0.038, partial η2=0.190], after controlling for the effect of the pre-test, while no other significant main effects were detected. CONCLUSIONS Healthy physically active adults significantly improved their endurance running performance after 4 weeks of AC treatment. This is mainly due to the enhancement of the speed corresponding with VT, comparing with their baseline values.
Collapse
Affiliation(s)
- Angela Α Tsopanidou
- School of Physical Education and Sport Science, National and Kapodistrian University, Athens, Greece -
| | - Prokopios Ε Chatzakis
- School of Physical Education and Sport Science, National and Kapodistrian University, Athens, Greece
| | | | - Ioannis S Stavridis
- School of Physical Education and Sport Science, National and Kapodistrian University, Athens, Greece
| | - George C Dallas
- School of Physical Education and Sport Science, National and Kapodistrian University, Athens, Greece
| | - Elias G Zacharogiannis
- School of Physical Education and Sport Science, National and Kapodistrian University, Athens, Greece
| |
Collapse
|