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Cerulli C, Moretti E, Grazioli E, Emerenziani GP, Murri A, Tranchita E, Minganti C, Di Cagno A, Parisi A. Protective role of exercise on breast cancer-related osteoporosis in women undergoing aromatase inhibitors: A narrative review. Bone Rep 2024; 21:101756. [PMID: 38577250 PMCID: PMC10990716 DOI: 10.1016/j.bonr.2024.101756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 03/19/2024] [Accepted: 03/23/2024] [Indexed: 04/06/2024] Open
Abstract
Hormone therapy following surgery reduces the risk of breast cancer (BC) recurrence and progression of hormone-sensitive BC, especially in postmenopausal women. Despite the antitumor efficacy of hormone therapy, particularly of aromatase inhibitors, they cause long-term side effects, mainly bone density reduction. Exercise can slow the rate of bone loss, which reduces the risk of fractures from osteoporosis, and could be an integrative treatment able to mitigate the BC treatment side effects positively impacting bone health. This narrative review aims to discuss studies on the effect of exercise on bone health in BC women undergoing aromatase inhibitors, highlighting the possible role of exercise as complementary to conventional therapies. Additionally, according to the literature revision, exercise practical applications to improve bone health in these patients are summarized.
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Affiliation(s)
- Claudia Cerulli
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Elisa Moretti
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Elisa Grazioli
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Gian Pietro Emerenziani
- Department of Experimental and Clinical Medicine, “Magna Græcia” University, Viale Europa, 88100 Catanzaro, Italy
| | - Arianna Murri
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Eliana Tranchita
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Carlo Minganti
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Alessandra Di Cagno
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
| | - Attilio Parisi
- Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Piazza Lauro De Bosis, 15, 00135 Rome, Italy
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Bò MC, Merlo A, Ligabue MB, Bassi MC, Lusuardi M, Campanini I. Self-managed physical activity in breast cancer survivors: A scoping review. PLoS One 2023; 18:e0284807. [PMID: 37093839 PMCID: PMC10124851 DOI: 10.1371/journal.pone.0284807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/01/2023] [Indexed: 04/25/2023] Open
Abstract
OBJECTIVE Breast cancer survivors (BCS) experience many issues of rehabilitative concern due to the treatments they have undergone. Given the chronicity of these outcomes, the increasing number of survivors, and the positive results obtained by supervised exercise, professionals should consider offering self-managed physical activity (PA) programs to this population. Our aim was to map the currently available evidence about self-care rehabilitation for BCS. METHODS Medline, CINAHL, and Cochrane databases were searched for primary literature. Scoping review methodological frameworks were used to tackle the heterogeneity of the topic. Studies investigating self-managed PA interventions prescribed to adult BCS were included. RESULTS One hundred-eight studies were included, with sample sizes ranging from 6 to 692 patients. Information was systematically collected in tables displaying study design, type of PA, duration and recommended frequency, professional leading the study, type of supervision, initial training, strategies used to help patients integrate self-care into their daily lives, and self-managed PA efficacy. Tables were produced for every oncological side effect that BCS might experience: lymphedema, arthralgia, cancer-related fatigue, a decline in physical parameters, treatment-related cardiotoxicity, peripheral neurotoxicity, and a possible decline in the quality of life. CONCLUSIONS Self-managed PA has the potential to improve BCS oncological issues. Professionals can adopt many strategies to support patients and empower them with long-lasting self-care competencies. This scoping review provided a comprehensive and easy-to-consult overview of self-managed PA interventions for BCS. We also provided recommendations for future primary studies and secondary synthesis.
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Affiliation(s)
- Maria Chiara Bò
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
- Merlo Bioengineering, Parma, Italy
| | - Andrea Merlo
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
- Merlo Bioengineering, Parma, Italy
| | - Maria Bernadette Ligabue
- Motor Rehabilitation Unit, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
| | - Maria Chiara Bassi
- Medical Library, Azienda USL-IRCCS di Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Mirco Lusuardi
- Neuromotor and Rehabilitation Department, Azienda USL-IRCCS Reggio Emilia, Correggio (Reggio Emilia), Italy
| | - Isabella Campanini
- LAM-Motion Analysis Laboratory, Neuromotor and Rehabilitation Department, Azienda USL-IRCCS di Reggio Emilia, San Sebastiano Hospital, Correggio (Reggio Emilia), Italy
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Exercise and Bone Health in Cancer: Enemy or Ally? Cancers (Basel) 2022; 14:cancers14246078. [PMID: 36551564 PMCID: PMC9776461 DOI: 10.3390/cancers14246078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 12/05/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Bone health is often threatened in cancer patients. Bone metastasis and osteoporosis frequently occur in patients with cancer and may lead to different skeletal-related events, which may negatively affect patients' quality of life and are associated with high mortality risk. Physical exercise has been recognized as a potential adjunctive strategy in the cancer setting to improve physical function as well as treatment-related side effects. Nevertheless, exercise is often not recommended to patients with bone health impairments due to safety concerns. In the current review, we aimed, through a comprehensive review of the evidence, to explore the impact of exercise in terms of safety profile, bone outcomes, and the effects on other outcomes in patients with cancer affected by bone metastasis or at high risk of losing bone. Additionally, we explored the potential mechanisms by which exercise may act on bone, particularly the impact of mechanical load on bone remodeling. Finally, considerations about exercise prescription and programming in these populations are also discussed.
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Ramírez-Morera A, Tristán M, Salazar-Vargas J, Rivera-Chavarría AL. Effects of evidence-based clinical practice guidelines for breast cancer in health care quality improvements. A second systematic review. F1000Res 2022; 11:1213. [PMID: 36619604 PMCID: PMC9780606 DOI: 10.12688/f1000research.126126.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/12/2022] Open
Abstract
Background: Traditionally, EB-CPGs have been believed to mainly improve the quality and consistency of health care, but this claim must be conclusively proven. We used the Donabedian three-dimensional model (structure, process, and patient outcomes) to assess improvements in the quality of medical care derived from implementing EB-CPGs. This study corresponds to the second systematic review carried out as a series of studies on different clinical issues that aim to evaluate the effectiveness of the application of the EB-CPG for improving the quality of care. Methods: We followed the methods described by the Cochrane Handbook and presented a descriptive analysis because of the high heterogeneity found across the included studies. We searched the Cochrane Central Register of Controlled Trials, PubMed, and EBSCO Host databases, as well as the grey literature, between 1990 and April 2021. No language restrictions were applied. Only randomised clinical trials (RCTs) were selected. Results: Of the total of 364 interventions included in the eleven RCTs evaluated, 11 (3%) were related to healthcare structure, 51 (14%) to the healthcare delivery process and 302 (83%) to patient outcomes. Regarding the impact of using the EB-CPGs, in 303 interventions (83%), there were no significant differences between the control and experimental groups. In 4 interventions (1%), the result favoured the control and intervention groups in 57 of the interventions (16%). Conclusions: Our study showed that EB-CPGs slightly enhanced the quality of health care in the three dimensions described by Donabedian. Future RCTs should improve their design and methodological rigour by considering the certainty of the evidence supporting the EB-CPGs recommendations. In that context, broader analyses could be performed, having more concise hypotheses for further research. Registration: PROSPERO CRD42020205594.
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Affiliation(s)
- Anggie Ramírez-Morera
- Cochrane Central America & Caribbean Spanish, IHCAI Foundation, San José, San José, 10101, Costa Rica,Universitat Autònoma de Barcelona, Barcelona, Catalunya, 08041, Spain,Caja Costarricense de Seguro Social, San José, San José, 10105, Costa Rica,
| | - Mario Tristán
- Cochrane Central America & Caribbean Spanish, IHCAI Foundation, San José, San José, 10101, Costa Rica
| | | | - Ana Leonor Rivera-Chavarría
- Instituto Costarricense de Investigación y Enseñanza en Nutrición y Salud, Tres Ríos, Cartago, 42250, Costa Rica
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Tock WL, Maheu C, Johnson NA. Considerations of Control Conditions Designs in Randomized Controlled Trials of Exercise Interventions for Cancer Survivors. Can J Nurs Res 2022; 54:377-391. [PMID: 35114822 PMCID: PMC9596954 DOI: 10.1177/08445621211062467] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Given the multifaceted complexity in the nature of randomized controlled trials, identifying an appropriate and comparable control condition is an essential step to ensure methodological rigor, which allows for researchers to draw unambiguous conclusions concerning the efficacy of the intervention being studied. Objectives The objectives of this paper are to (a) review the current literature and analyze the control condition designs in exercise interventions targeted for cancer survivors; (b) provide an overview of the benefits and limitations of various types of control conditions used in exercise interventions; (c) discuss the considerations in the design of control conditions for exercise interventions; and (d) suggest recommendations for control condition design in future trials of behavioral interventions. Results The review of randomized controlled trials of exercise training interventions for cancer survivors revealed that the design of control conditions varied. The most commonly employed design could be classified into two major categories: (a) active controls including attention control, add-on controls, and dismantling controls; and (b) inactive controls including no-treatment, usual care, and wait-list control. Examples from the literature are presented. Four principal considerations concerning control condition design, including appropriateness, credibility, appeal, and comparability, are discussed. Recommendations on how to avoid some major threats to validity and potential biases are also provided. Conclusions Careful planning for the control group design is as important as for the intervention group. Researchers can use the considerations presented in the paper to assist in planning for the most appropriate control condition for their study.
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Affiliation(s)
- Wing Lam Tock
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, 5620McGill University, Montréal, Canada
| | - Christine Maheu
- Faculty of Medicine and Health Sciences, Ingram School of Nursing, 5620McGill University, Montréal, Canada
| | - Nathalie A Johnson
- Department of Medicine, Division of Experimental Medicine, Faculty of Medicine and Health Sciences, 5620McGill University, Montréal, Canada
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Rose GL, Skinner TL, Keating SE, Friedrich NK, Bolam KA. The effects of exercise on the bone health of people with cancer: a systematic review and meta-analysis. Osteoporos Int 2022; 33:327-338. [PMID: 34532766 DOI: 10.1007/s00198-021-06131-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE To determine the pooled effect of exercise on the bone health of people diagnosed with cancer. METHODS Four electronic databases were systematically searched. Controlled trials that assessed the effect of exercise on the bone mineral density (BMD) or content (BMC) measured by dual-energy x-ray absorptiometry or peripheral quantitative computed tomography in people who had been diagnosed with cancer were included in the study. Random-effect meta-analyses of effect size (ES) were conducted. Sub-group analyses were performed to explore the influence of intervention duration, prescription and participant characteristics. RESULTS Of 66 full-text articles screened, 22 studies, from 21 interventions, were included (primarily breast/prostate cancer, sample range n = 36-498). When all interventions were grouped, a significant pooled ES was observed for exercise on hip (ES = 0.112, 95% CI: 0.026 to 0.198; p = 0.011) and lumbar spine BMD (ES = 0.269, 95% CI: 0.036 to 0.501; p = 0.024) compared to control. There was also an influence of sex, where females had greater improvements in hip (ES = 0.120, 95% CI: 0.017 to 0.223; p = 0.022) and spine BMD (ES = 0.415, 95% CI: 0.056 to 0.774; p = 0.23) compared to males. CONCLUSION Overall, exercise regimens of studies included in this review appear to improve bone health at the hip and spine in people diagnosed with cancer. Sub-analyses suggest some influence of sex, where females had greater improvements in BMD compared to males. It is essential that future studies evaluate the dose-response of exercise training on bone health and create exercise protocols that better align with the laws of bone modelling to enhance osteogenic potential.
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Affiliation(s)
- Grace L Rose
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia.
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Shelley E Keating
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Nina K Friedrich
- Institute of Nursing Science, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
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Singh B, Toohey K. The effect of exercise for improving bone health in cancer survivors - A systematic review and meta-analysis. J Sci Med Sport 2021; 25:31-40. [PMID: 34465518 DOI: 10.1016/j.jsams.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 07/14/2021] [Accepted: 08/10/2021] [Indexed: 01/07/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of exercise for improving bone-related outcomes among cancer survivors. DESIGN Systematic review and meta-analysis. METHODS An electronic search using the following databases: SPORTDiscus, Science Direct, CINAHL, MEDLINE, Cochrane, Pubmed, Ebscohost, ProQuest Nursing and Allied Health Source. Randomised, controlled, exercise trials involving cancer survivors were eligible. Effect data on bone mineral content (BMC) and density (BMD) outcomes were extracted. Risk of bias was assessed using the Physiotherapy Evidence Database tool. Standardised mean differences (SMD) were calculated to compare differences between exercise and usual care. Subgroup analyses were conducted to assess whether effect differed by exercise mode, intervention length, supervision, treatment, cancer type and risk of bias. RESULTS Twenty-six trials were included, with intervention durations ranging between 12 weeks and 2 years. Most trials involved breast cancer (n = 13, 50%), and most interventions were supervised (n = 18, 69%) and evaluated mixed-mode (i.e., combined aerobic and resistance) exercise (n = 13, 50%). Significant effects in favour of exercise (aerobic, resistance, mixed-mode and other exercise) were observed for whole body BMD, hip BMD, trochanter BMD and femoral neck BMD (SMD range: 0.19-0.39, all p < 0.05) compared to usual care. CONCLUSION Participation in various modes (aerobic, resistance, mixed-mode and other) of supervised and unsupervised exercise is associated with improvements in BMD. The present results provide evidence for clinicians and other health care professionals (e.g., exercise physiologists and physiotherapists) to recommend exercise for cancer survivors to prevent bone loss during and following treatment.
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Affiliation(s)
| | - Kellie Toohey
- Faculty of Health, University of Canberra, Australia; Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Australia
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Vehmanen L, Sievänen H, Kellokumpu-Lehtinen P, Nikander R, Huovinen R, Ruohola J, Penttinen HM, Utriainen M, Tokola K, Blomqvist C, Saarto T. Five-year follow-up results of aerobic and impact training on bone mineral density in early breast cancer patients. Osteoporos Int 2021; 32:473-482. [PMID: 32886189 PMCID: PMC7929955 DOI: 10.1007/s00198-020-05611-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 08/25/2020] [Indexed: 11/26/2022]
Abstract
UNLABELLED A 12-month exercise program reversibly prevented hip bone loss in premenopausal women with early breast cancer. The bone-protective effect was maintained for 2 years after the end of the program but was lost thereafter. PURPOSE Breast cancer survivors are at an increased risk for osteoporosis and fracture. This 5-year follow-up of a randomized impact exercise intervention trial evaluated the maintenance of training effects on bone among breast cancer patients. METHODS Five hundred seventy-three early breast cancer patients aged 35-68 years and treated with adjuvant therapy were allocated into a 12-month exercise program or a control group. Four hundred forty-four patients (77%) were included in the 5-year analysis. The exercise intervention comprised weekly supervised step aerobics, circuit exercises, and home training. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry. Physical activity was estimated in metabolic equivalent (MET) hours per week and physical performance assessed by 2-km walking and figure-8 running tests. RESULTS In premenopausal patients, the 12-month exercise program maintained femoral neck (FN) and total hip (TH) aBMD for 3 years, but the protective effect was lost thereafter. The mean FN aBMD change in the exercise and control groups was - 0.2% and - 1.5% 1 year, - 1.1% and - 2.1% 3 years and - 3.3% versus - 2.4% 5 years after the beginning of the intervention, respectively. Lumbar spine (LS) bone loss was not prevented in premenopausal women and no training effects on aBMD were seen in postmenopausal women. The main confounding element of the study was the unexpected rise in physical activity among patients in the control group. The physical performance improved among premenopausal women in the exercise group compared with the controls. CONCLUSION The 12-month exercise program prevented FN and TH bone loss in premenopausal breast cancer patients for 3 years. The bone-protective effect was reversible and lost thereafter.
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Affiliation(s)
- L Vehmanen
- Department of Oncology, Helsinki University Central Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland.
| | - H Sievänen
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - P Kellokumpu-Lehtinen
- Department of Oncology, Faculty of Medicine, Tampere University Central Hospital, University of Tampere, Tampere, Finland
| | - R Nikander
- Department of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R Huovinen
- Department of Oncology, Turku University Central Hospital, Turku, Finland
| | - J Ruohola
- Department of Oncology, Turku University Central Hospital, Turku, Finland
| | | | - M Utriainen
- Department of Oncology, Helsinki University Central Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
| | - K Tokola
- The UKK Institute for Health Promotion Research, Tampere, Finland
| | - C Blomqvist
- Department of Oncology, Helsinki University Central Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
- Department of Oncology, Örebro University Hospital, Örebro, Sweden
| | - T Saarto
- Department of Oncology, Helsinki University Central Hospital, Comprehensive Cancer Center and University of Helsinki, Helsinki, Finland
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Kiss N, Baguley BJ, Dalla Via J, Fraser SF, Bolam KA, Daly RM. Exercise and Nutritional Approaches to Combat Cancer-Related Bone and Muscle Loss. Curr Osteoporos Rep 2020; 18:291-300. [PMID: 32270341 DOI: 10.1007/s11914-020-00589-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW The aim of this narrative review is to summarise recent literature on the effects of exercise and nutrition interventions alone or in combination on muscle and bone loss in people with cancer. RECENT FINDINGS There is emerging evidence to support the inclusion of targeted exercise and nutrition strategies to counter loss of muscle and bone associated with cancer treatments. Although research in this field is advancing, the optimal exercise and nutrition prescription to combat cancer-related bone and muscle loss remain unknown. This review identifies specific components of nutrition and exercise interventions that are promising although require further exploration through studies designed to determine the effect on muscle and bone. A focused research effort is required to elucidate the full potential of exercise and nutrition intervention for people with cancer at risk of bone and muscle loss.
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Affiliation(s)
- Nicole Kiss
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia.
- Allied Health Research, Peter MacCallum Cancer Centre, Melbourne, Australia.
| | - Brenton J Baguley
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Jack Dalla Via
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Kate A Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
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Adherence to American Cancer Society Guidelines on Nutrition and Physical Activity in Female Cancer Survivors: Results From a Randomized Controlled Trial (Yale Fitness Intervention Trial). Cancer Nurs 2020; 42:242-250. [PMID: 29746264 DOI: 10.1097/ncc.0000000000000602] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The American Cancer Society (ACS) publishes guidelines on nutrition and physical activity to minimize health risks in cancer patients and survivors. Studies show that high adherence to such guidelines is associated with a decrease in overall cancer incidence and mortality. However, there are sparse data on adherence to the ACS guidelines in cancer survivors. OBJECTIVE The aim of this study was to describe adherence to the ACS guidelines in female cancer survivors who participated in an exercise intervention trial for 1 year. METHODS Perimenopausal and early postmenopausal female cancer survivors (n = 154) participated in a randomized controlled trial that examined the efficacy of an aerobic-resistance exercise intervention. In addition to body mass index and alcohol, diet and physical activity data were collected with 4-day diet records and the International Physical Activity Questionnaire. A scoring system was used to determine adherence to the ACS guidelines, with scores ranging from 0 (no adherence) to 8 (highest adherence). RESULTS Mean total adherence scores for ACS guidelines for all intervention and control condition participants, most of whom had breast or gynecological cancers, were 4.2 (baseline), 4.9 (6 months), and 4.8 (12 months), suggesting moderate adherence. Physical activity levels improved in both groups; however, no significant change was observed for adherence to weight, dietary, or alcohol intake guidelines for either group. CONCLUSION Findings indicate only partial adherence to the ACS guidelines, even for motivated cancer survivors participating in an exercise intervention study. IMPLICATIONS FOR PRACTICE Further research is needed regarding strategies and interventions to improve adherence to ACS guidelines.
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Knobf MT, Jeon S. Metabolic Syndrome, Exercise, and Cardiovascular Fitness in Breast Cancer Survivors. J Adv Pract Oncol 2020; 11:98-102. [PMID: 33542853 PMCID: PMC7517769 DOI: 10.6004/jadpro.2020.11.1.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Comorbid illness contributes to poorer cancer outcomes and higher mortality. Metabolic syndrome (MetS) includes a cluster of risk factors that are associated with an increased risk of comorbidities. Routine physical activity represents a risk reduction strategy for cancer survivors. From 148 participants in a 12-month randomized control trial (RCT) of a fitness center exercise intervention compared to home physical activity group, a subset analysis was conducted to explore the effect of exercise on MetS risk factors. There were 32 (21.6%) breast cancer survivors who met the criteria for MetS at baseline. Over the 12 months, there were significantly fewer participants who met the criteria for MetS (p < .01), and there was significant improvement in individual risk factors, specifically fasting blood sugar (p = .01), and high-density lipoprotein (HDL; p = .02). Cardiovascular fitness was evaluated and greater heart recovery rate (HRR) was negatively associated with waist circumference, triglycerides, systolic blood pressure, fasting blood sugar, and MetS risk (p < .02) and positively associated with HDL (p = .03). Oncology advanced practitioners are uniquely qualified to integrate risk reduction into the management of at-risk oncology patients.
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Affiliation(s)
- M Tish Knobf
- Yale University School of Nursing, Orange, Connecticut
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12
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Abstract
Cancer remains a common disease with approximately 40% of Americans diagnosed with cancer in their lifetime. Medical advances in the field of oncology have led to an increased life expectancy and a decreased mortality rate. Antineoplastic agents such as taxanes and targeted therapies are indicated in the treatment of many cancers, and their use can be associated with various musculoskeletal complaints and adverse effects. Orthopaedic Surgeons are trained to identify primary bone tumors and metastasis to bones. It is also important for them to have an understanding of the profile of musculoskeletal adverse effects associated with the treatment of the more common neoplasms. This article reviews the current literature on the commonly used chemotherapeutic agents and their associated musculoskeletal effects.
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Abstract
As breast cancer relative survival continues to increase, many breast cancer patients face many issues, including recurrence of cancer and cancer-related side effects that impact several aspects of their quality of life. With breast cancer patients living longer, there is more of a concern for negative breast cancer outcomes. Although physical activity is an affordable and relatively convenient way to improve breast cancer outcomes, only about one-third of breast cancer survivors engage in the recommended level of physical activity. This article reviews articles published to date to examine whether home-based physical activity interventions are effective in improving physical activity and other outcomes among breast cancer survivors who have completed primary therapy for the disease. The present review is based upon bibliographic searches in PubMed and CINAHL and relevant search terms. Articles published in English from 1980 through February 28, 2019 were identified. A total of 360 article citations were identified in PubMed and non-duplicates in CINAHL. After screening the abstracts or full texts of these articles and reviewing the references of previous review articles, 20 studies that met the eligibility criteria. Three of the studies were pre-/post-test trials and 17 were randomized controlled trials. home-based exercise programs are effective in improving physical activity among breast cancer survivors who have completed primary therapy for the disease. Home-based exercise programs such as walking programs offer a convenient and affordable option for women who wish to increase their physical activity and maintain a healthy lifestyle.
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Park SH, Tish Knobf M, Jeon S. Endocrine Therapy-Related Symptoms and Quality of Life in Female Cancer Survivors in the Yale Fitness Intervention Trial. J Nurs Scholarsh 2019; 51:317-325. [PMID: 30874369 DOI: 10.1111/jnu.12471] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE The aim of the current study was to describe and compare endocrine therapy-related symptoms and quality of life in female cancer survivors taking aromatase inhibitors, tamoxifen, and no endocrine therapy, and to evaluate the effect of an exercise intervention on these symptoms and quality of life. DESIGN Randomized controlled trial. An aerobic resistance exercise intervention group was compared with a home-based exercise control group over 1 year. The exercise intervention was supervised for the first 6 months, followed by 6 unsupervised months. METHODS Perimenopausal and early postmenopausal female cancer survivors within 3 years of completing primary or adjuvant chemotherapy were selected. A total of 154 women were enrolled in the study. Type of endocrine or hormonal therapy was documented. Symptoms were measured by the Breast Cancer Prevention Trial Symptom Checklist and the Functional Assessment of Cancer Therapy-Endocrine Subscale. Quality of life was measured by the Functional Assessment of Cancer Therapy-General. Data were collected at baseline, and at 6 and 12 months. FINDINGS Participants generally had mild symptom distress. There was no difference in symptoms by endocrine therapy group or by exercise group. Participants taking aromatase inhibitors in the aerobic resistance exercise intervention group reported significant improvement in social, family, and functional well-being and better quality of life compared to those in the control group at 6 months but not at 12 months. CONCLUSIONS Findings were similar to those of previous large clinical trials in that no significant differences were found for endocrine therapy-related symptoms and quality of life by type of endocrine therapy taken. However, exercise may improve quality of life outcomes for women taking aromatase inhibitors. CLINICAL RELEVANCE Exercise has established efficacy for patient outcomes such as cardiovascular fitness, fatigue, weight management, and quality of life and may provide better quality of life for women who take aromatase inhibitors as adjuvant therapy.
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Affiliation(s)
- So-Hyun Park
- Alpha Zeta, Assistant Professor, Hunter Bellevue School of Nursing, City University of New York, New York, NY,, USA
| | - M Tish Knobf
- Delta Mu , Professor of Nursing and Acute Care/Health Systems Division Chair, Yale University School of Nursing, Orange, CT,, USA
| | - Sangchoon Jeon
- Research Scientist in Nursing, Yale University School of Nursing, Orange, CT,, USA
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15
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Effects of resistance plus aerobic training on body composition and metabolic markers in older breast cancer survivors undergoing aromatase inhibitor therapy. Exp Gerontol 2018; 111:210-217. [DOI: 10.1016/j.exger.2018.07.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 07/02/2018] [Accepted: 07/30/2018] [Indexed: 11/17/2022]
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Baker MK, Peddle-McIntyre CJ, Galvão DA, Hunt C, Spry N, Newton RU. Whole Body Vibration Exposure on Markers of Bone Turnover, Body Composition, and Physical Functioning in Breast Cancer Patients Receiving Aromatase Inhibitor Therapy: A Randomized Controlled Trial. Integr Cancer Ther 2018; 17:968-978. [PMID: 29952241 PMCID: PMC6142085 DOI: 10.1177/1534735418781489] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction: Women with breast cancer are often prescribed
aromatase inhibitors, which can cause rapid loss of bone mass leading to
significant potential for morbidity. Vibration training has been shown to be
helpful in reducing bone turnover in postmenopausal women without cancer.
Aim: To examine the effect of vibration stimulus on markers of
bone turnover in breast cancer patients receiving aromatase inhibitors.
Methods: Thirty-one breast cancer survivors undergoing
treatment with aromatase inhibitors were randomized to vibration stimulus (n =
14) or usual care control (n = 17). Low-frequency and low-magnitude vibration
stimulus (27-32 Hz, 0.3g) was delivered in supervised sessions
via standing on a vibration platform for 20 minutes, 3 times per week for 12
weeks. The primary outcome was blood markers of bone resorption (serum
N-telopeptide X/creatine) and formation (serum type 1 procollagen N-terminal
propeptide; P1NP). Other study outcomes body composition as well as measures of
physical functioning. Outcomes were compared between groups using analysis of
covariance adjusted for baseline values as well as time on aromatase inhibitors.
Outcomes: On average, participants were 61.5 years old and
overweight (ie, body mass index = 28.5 kg/m2). Following vibration
training, there was no significant difference between groups for bone resorption
(adjusted group difference 0.5, P = .929) or formation
(adjusted group difference 5.3, P = .286). There were also no
changes in any measure of physical functioning body composition.
Conclusions: Short-term low-magnitude vibration stimulus does
not appear to be useful for reducing markers of bone turnover secondary to
aromatase inhibitors in breast cancer patients; nor is it useful in improving
physical function or symptoms. However, further investigations with larger
samples and higher doses of vibration are warranted. Trial
Registration: Australian and New Zealand Clinical Trials Registry
(ACTRN12611001094965).
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Affiliation(s)
- Michael K Baker
- 1 Australian Catholic University, Strathfield, New South Wales, Australia
| | | | - Daniel A Galvão
- 2 Edith Cowan University, Joondalup, Western Australia, Australia
| | - Catherine Hunt
- 3 Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Nigel Spry
- 2 Edith Cowan University, Joondalup, Western Australia, Australia.,3 Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Robert U Newton
- 2 Edith Cowan University, Joondalup, Western Australia, Australia
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Dalla Via J, Daly RM, Fraser SF. The effect of exercise on bone mineral density in adult cancer survivors: a systematic review and meta-analysis. Osteoporos Int 2018; 29:287-303. [PMID: 28971226 DOI: 10.1007/s00198-017-4237-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 09/20/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Certain cancer treatments are associated with bone loss and increased fracture risk. Weight-bearing impact exercise, resistance training or the combination, are recommended to preserve or improve bone mineral density (BMD) inhealthy older adults, but their efficacy in cancer survivors is less well understood. The aim of this systematic review with meta-analysis of randomised control trials (RCT) was to review the evidence regarding the role of exercise to counteract cancer treatment-induced bone loss. METHODS Four databases were searched systematically with 12 RCTs of at least 6-month duration investigating the effects of exercise on BMD compared to a control group in adult cancer survivors identified. RESULTS Meta-analysis was completed using available data from six studies enrolling 814 participants, with lumbar spine, femoral neck and/or total hip BMD as the primary outcome measures. Overall, there was no significant benefit of exercise compared to controls on BMD at the lumbar spine (0.0071 g/cm , 95% CI -0.0002 to 0.0145, p = 0.057), femoral neck (0.0044 g/cm , 95% CI -0.0005 to 0.0093, p = 0.077), or total hip (0.0024 g/cm , 95% CI -0.0038 to 0.0086, p = 0.443). Subgroup analysis revealed a positive effect on lumbar spine BMD in three studies implementing a combined resistance and impact exercise intervention (0.015 g/cm , 95% CI 0.003 to 0.028, p = 0.019). CONCLUSIONS From the evidence available, exercise may not be sufficient to improve bone health in cancer survivors, but given the heterogeneity in the participant characteristics and several exercise programs which may not have been designed to specifically optimise bone health, these findings should be interpreted with caution.
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Affiliation(s)
- J Dalla Via
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia.
| | - R M Daly
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
| | - S F Fraser
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, 3220, Australia
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Knobf MT, Jeon S, Smith B, Harris L, Thompson S, Stacy MR, Insogna K, Sinusas AJ. The Yale Fitness Intervention Trial in female cancer survivors: Cardiovascular and physiological outcomes. Heart Lung 2017; 46:375-381. [PMID: 28803675 PMCID: PMC6129386 DOI: 10.1016/j.hrtlng.2017.06.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Induced premature menopause and cardio-toxic therapy increase cardiovascular disease risk in female cancer survivors. OBJECTIVE To compare the effects of a 12 month aerobic-resistance fitness center intervention to home based physical activity on cardiovascular function and metabolic risk factors. METHODS Subjects (N = 154) who had completed primary and/or adjuvant chemotherapy (past 3 years) were randomized to a fitness center intervention or a home based group. The fitness center intervention was a structured thrice weekly aerobic (30 min brisk walking treadmill in target heart range) combined with resistance (30 min of lower body strength training) exercise program, supervised for the first 6 months. The home based group received national guidelines for 30 min moderate intensity exercise most days of the week. Fasting serum samples were collected at baseline, 6 and 12 months for insulin, glucose, lipids and hemoglobin A-1C. A graded exercise stress test was also performed at baseline and 6 months. RESULTS The majority of subjects were white (85.7%), had breast cancer (83.1%) and the average age was 51.9 years. Subjects in the fitness center intervention had significantly improved time on treadmill (p = .039), improved heart rate recovery at 1 min (p = .028), greater MET minutes/week (p ≤ .0001), a trend for improved insulin resistance (p = .067) and stable insulin levels (p = .045) compared to the home based physical activity group. CONCLUSIONS Exercise represents a potential cardiac risk reduction intervention for cancer survivors. CLINICAL TRIALS.GOV: NCT01102985.
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Kim TH, Chang JS, Kong ID. Effects of Exercise Training on Physical Fitness and Biomarker Levels in Breast Cancer Survivors. J Lifestyle Med 2017; 7:55-62. [PMID: 29026725 PMCID: PMC5618735 DOI: 10.15280/jlm.2017.7.2.55] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 06/13/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Exercise has been identified as a beneficial intervention to enhance quality of life in breast cancer survivors. In addition, there has been a noteworthy increase in studies emphasizing the benefits of exercise in cancer. We sought to summarize the empirical literature concerning the effects of exercise on physical fitness and biomarker levels in breast cancer survivors according to the type of exercise. METHODS We searched PubMed and PubMed Central for studies on the association of exercise with the levels of various biomarkers and physical fitness in breast cancer survivors. We investigated the effects of different types of exercise (aerobic, resistance, or combined) on breast cancer survivors, with changes in physical fitness and biomarker levels as the primary outcomes. RESULTS In total, 118 research papers published from 2012 to July 2016 were retrieved from PubMed and PubMed Central. Of these, 24 papers met our inclusion criteria. All types of exercise were found to improve physical fitness in breast cancer survivors. However, the results with regard to biomarkers were controversial. CONCLUSION The findings of this review suggest that combined exercise is associated with better outcomes than aerobic or resistance exercise alone in breast cancer survivors.
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Affiliation(s)
- Tae Ho Kim
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - Jae Seung Chang
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
| | - In Deok Kong
- Department of Physiology, Yonsei University Wonju College of Medicine, Yonsei Institute of Sports Science & Exercise Medicine, Wonju, Korea
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Exercise for improving bone health in women treated for stages I–III breast cancer: a systematic review and meta-analyses. J Cancer Surviv 2017. [DOI: 10.1007/s11764-017-0622-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Hadji P, Aapro MS, Body JJ, Gnant M, Brandi ML, Reginster JY, Zillikens MC, Glüer CC, de Villiers T, Baber R, Roodman GD, Cooper C, Langdahl B, Palacios S, Kanis J, Al-Daghri N, Nogues X, Eriksen EF, Kurth A, Rizzoli R, Coleman RE. Management of Aromatase Inhibitor-Associated Bone Loss (AIBL) in postmenopausal women with hormone sensitive breast cancer: Joint position statement of the IOF, CABS, ECTS, IEG, ESCEO IMS, and SIOG. J Bone Oncol 2017; 7:1-12. [PMID: 28413771 PMCID: PMC5384888 DOI: 10.1016/j.jbo.2017.03.001] [Citation(s) in RCA: 153] [Impact Index Per Article: 21.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 03/10/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several guidelines have been reported for bone-directed treatment in women with early breast cancer (EBC) for averting fractures, particularly during aromatase inhibitor (AI) therapy. Recently, a number of studies on additional fracture related risk factors, new treatment options as well as real world studies demonstrating a much higher fracture rate than suggested by randomized clinical controlled trials (RCTs). Therefore, this updated algorithm was developed to better assess fracture risk and direct treatment as a position statement of several interdisciplinary cancer and bone societies involved in the management of AI-associated bone loss (AIBL). PATIENTS AND METHODS A systematic literature review identified recent advances in the management of AIBL. Results with individual agents were assessed based on trial design, size, follow-up, and safety. RESULTS Several fracture related risk factors in patients with EBC were identified. Although, the FRAX algorithm includes fracture risk factors (RF) in addition to BMD, it does not seem to adequately address the effects of AIBL. Several antiresorptive agents can prevent and treat AIBL. However, concerns regarding compliance and long-term safety remain. Overall, the evidence for fracture prevention is strongest for denosumab 60 mg s.c. every 6 months. Additionally, recent studies as well as an individual patient data meta-analysis of all available randomized trial data support additional anticancer benefits from adjuvant bisphosphonate treatment in postmenopausal women with a 34% relative risk reduction in bone metastasis and 17% relative risk decrease in breast cancer mortality that needs to be taken into account when advising on management of AIBL. CONCLUSIONS In all patients initiating AI treatment, fracture risk should be assessed and recommendation with regard to exercise and calcium/vitamin D supplementation given. Bone-directed therapy should be given to all patients with a T-score<-2.0 or with a T-score of <-1.5 SD with one additional RF, or with ≥2 risk factors (without BMD) for the duration of AI treatment. Patients with T-score>-1.5 SD and no risk factors should be managed based on BMD loss during the first year and the local guidelines for postmenopausal osteoporosis. Compliance should be regularly assessed as well as BMD on treatment after 12 - 24 months. Furthermore, because of the decreased incidence of bone recurrence and breast cancer specific mortality, adjuvant bisphosphonates are recommended for all postmenopausal women at significant risk of disease recurrence.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - John Kanis
- Catholic University of Australia, Melbourne, Australia and University of Sheffield, UK
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