1
|
Vikmoen O, Strandberg E, Svindland KV, Henriksson A, Mazzoni AS, Johansson B, Jönsson J, Karakatsanis A, Annebäck M, Kudrén D, Lindman H, Wärnberg F, Berntsen S, Demmelmaier I, Nordin K, Raastad T. Effects of heavy-load strength training during (neo-)adjuvant chemotherapy on muscle strength, muscle fiber size, myonuclei, and satellite cells in women with breast cancer. FASEB J 2024; 38:e23784. [PMID: 38953567 DOI: 10.1096/fj.202400634r] [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: 03/22/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
To investigate the effects of heavy-load strength training during (neo-)adjuvant chemotherapy in women with breast cancer on muscle strength, body composition, muscle fiber size, satellite cells, and myonuclei. Women with stage I-III breast cancer were randomly assigned to a strength training group (ST, n = 23) performing supervised heavy-load strength training twice a week during chemotherapy, or a usual care control group (CON, n = 17). Muscle strength and body composition were measured and biopsies from m. vastus lateralis collected before the first cycle of chemotherapy (T0) and after chemotherapy and training (T1). Muscle strength increased significantly more in ST than in CON in chest-press (ST: +10 ± 8%, p < .001, CON: -3 ± 5%, p = .023) and leg-press (ST: +11 ± 8%, p < .001, CON: +3 ± 6%, p = .137). Both groups reduced fat-free mass (ST: -4.9 ± 4.0%, p < .001, CON: -5.2 ± 4.9%, p = .004), and increased fat mass (ST: +15.3 ± 16.5%, p < .001, CON: +16.3 ± 19.8%, p = .015) with no significant differences between groups. No significant changes from T0 to T1 and no significant differences between groups were observed in muscle fiber size. For myonuclei per fiber a non-statistically significant increase in CON and a non-statistically significant decrease in ST in type I fibers tended (p = .053) to be different between groups. Satellite cells tended to decrease in ST (type I: -14 ± 36%, p = .097, type II: -9 ± 55%, p = .084), with no changes in CON and no differences between groups. Strength training during chemotherapy improved muscle strength but did not significantly affect body composition, muscle fiber size, numbers of satellite cells, and myonuclei compared to usual care.
Collapse
Affiliation(s)
- Olav Vikmoen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Emelie Strandberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Anna Henriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anne-Sophie Mazzoni
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Janniz Jönsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Andreas Karakatsanis
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Matilda Annebäck
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - David Kudrén
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Wärnberg
- Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| |
Collapse
|
2
|
Anandavadivelan P, Mijwel S, Wiklander M, Kjoe PLM, Luijendijk M, Bergh J, Rundqvist H, Wengstrom Y. Five-year follow-up of the OptiTrain trial on concurrent resistance and high-intensity interval training during chemotherapy for patients with breast cancer. Sci Rep 2024; 14:15333. [PMID: 38961182 PMCID: PMC11222517 DOI: 10.1038/s41598-024-65436-z] [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: 03/20/2024] [Accepted: 06/20/2024] [Indexed: 07/05/2024] Open
Abstract
The protocol predefined aim of this study is to assess sustained effects of the OptiTrain trial on several health outcomes, 5 years after the baseline assessment. The OptiTrain study was a prospective, randomised controlled trial with 240 patients with breast cancer undergoing adjuvant chemotherapy that compared the effects of 16 weeks of two exercise programs, RT-HIIT and AT-HIIT, with usual care (UC). After a 5-year follow-up, eligible participants were evaluated for the primary outcome of cancer-related fatigue (CRF) and secondary outcomes including quality of life, symptoms, muscle strength, cardiorespiratory fitness, body mass, physical activity, and sedentary behavior. Statistical analysis was conducted using linear mixed models adjusted for baseline values. Tumour profile and menopausal status were additionally adjusted for CRF. Mean differences (MD), 95% confidence intervals (CIs), and standardized effect sizes (ES) were reported. At the 5-year follow-up, there were no statistically significant differences in total CRF between the intervention groups and the UC group. RT-HIIT reported significantly reduced pain sensitivity at the gluteus MD = 79.00 (95% CI 10.17, 147.83, ES = 0.55) compared to UC. Clinically meaningful differences for an increase in cognitive CRF and cardiorespiratory fitness were observed for the AT-HIIT versus UC group, and for lower limb strength for the RT-HIIT versus UC group, albeit without statistical significance. Engaging in targeted exercise during adjuvant chemotherapy for breast cancer provides short-term benefits in reducing fatigue and maintaining physical function. However, our 5-year follow-up indicates that these effects are limited in the long term. This underscores the need to support breast cancer survivors maintain their PA levels throughout their survivorship journey.
Collapse
Affiliation(s)
- Poorna Anandavadivelan
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden.
| | - Sara Mijwel
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Maria Wiklander
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
| | - Philippe Lee Meeuw Kjoe
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Maryse Luijendijk
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoek, Amsterdam, The Netherlands
| | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Breast Center, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Unit of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Wengstrom
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institute, Stockholm, Sweden
- Breast Center, Karolinska University Hospital, Karolinska Comprehensive Cancer Center, Stockholm, Sweden
| |
Collapse
|
3
|
Valério MV, Schaun GZ, Andrade LS, David GB, Orcy RB, Rombaldi AJ, Alberton CL. Caffeine Supplementation Effects on Concurrent Training Performance in Resistance-Trained Men: A Double-Blind Placebo-Controlled Crossover Study. RESEARCH QUARTERLY FOR EXERCISE AND SPORT 2024; 95:546-554. [PMID: 38100570 DOI: 10.1080/02701367.2023.2276401] [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: 09/14/2022] [Accepted: 10/22/2023] [Indexed: 12/17/2023]
Abstract
Purpose: The aim of the present study was to investigate the effects of acute caffeine supplementation on the performance during a session of resistance training alone (RT) or in combination with aerobic training (i.e. concurrent training; CT). Method: Fourteen resistance-trained men (23.1 ± 4.2 years) were recruited and performed both RT and CT under three different conditions: control (CONT), placebo (PLA), and caffeine (CAF; 6 mg.kg-1) for a total of six experimental conditions. Results: Both total and per set number of repetitions, and total volume load were lower during CT as compared to RT, irrespective of the supplementation condition (all p < .001), whereas a supplementation main effect was observed for the total number of repetitions (p = .001), the number of repetitions in the first (p = .002) and second sets (p = .001), and total volume load (p = .001). RPE values were higher after the CT sessions than after the RT sessions (p < .001), whereas no differences were observed between supplementation conditions (p = .865). Conclusions: Caffeine supplementation was not sufficient to minimize the acute interference effect on strength performance in a CT session when compared to RT alone. In contrast, caffeine improved strength performance during the first set of both CT and RT, while maintaining a similar RPE between the supplementation conditions. However, the overall effect was small.
Collapse
|
4
|
Austin PD, Lee W, Costa DSJ, Ritchie A, Lovell MR. Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials. Heliyon 2024; 10:e29193. [PMID: 38623224 PMCID: PMC11016720 DOI: 10.1016/j.heliyon.2024.e29193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise. Design A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout. Results Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms. Conclusions Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.
Collapse
Affiliation(s)
- Philip D. Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Wei Lee
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel SJ. Costa
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Melanie R. Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Cheng L, Tian W, Mu H. Effects of aerobic combined with resistance exercise on cardiorespiratory fitness and cardiometabolic health in breast cancer survivors: A Systematic Review, meta-analysis and meta-regression. Heliyon 2024; 10:e26318. [PMID: 38384575 PMCID: PMC10879027 DOI: 10.1016/j.heliyon.2024.e26318] [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: 07/25/2023] [Revised: 02/09/2024] [Accepted: 02/09/2024] [Indexed: 02/23/2024] Open
Abstract
Background Cardiotoxicity from chemotherapy is a serious risk to the quality of survival of breast cancer survivors (BCS), and aerobic combined with resistance exercise (CE) has the potential to combat this cardiac damage. However, there is a lack of high-quality studies to assess the specific effects of CE. This study aimed to investigate the effects of CE on cardiopulmonary function (CRF) and cardiometabolic health in BCS. Methods A comprehensively searched of the 4 databases (PubMed, Embase, Web of Science, Cochrane Library) from the database construction until March 1, 2023. The included studies were randomized controlled trials (RCTs) reporting the effects of CE on CRF and cardiometabolic health in BCS. The quality of the literature was assessed by two independent reviewers using the Cochrane Collaboration Risk of Bias Tool. Weight means difference (WMD), or standardized mean difference (SMD), were combined using random or fixed effects models. Subgroup and meta-regression explored heterogeneity as well as covariate effects. Results 40 studies were included in the meta-analysis, with 2849 participants. Results showed that CE significantly increased maximal oxygen uptake (VO2max) (WMD:4.55; 95% CI:2.84, 6.26; I2 = 91.90%, P < 0.001) and reduced body weight (BW) (WMD: 1.61; 95% CI: 2.44, -0.78; I2 = 38.60%, P = 0.032) and body mass index (BMI) (WMD: 0.86; 95% CI: 1.43, -0.29; I2 = 70.50%, P < 0.001) in BCS. Subgroup analysis showed that BMI (WMD: 1.15; 95% CI: 1.89, -0.41; I2 = 76.90%, P < 0.001) and VO2max (WMD:4.21; 95% CI:2.40, 6.02; I2 = 96.4%, P < 0.001) were more effective with supervision. Meta-regression analysis showed that sample size had a significant moderating effect on BW (Coeff: 0.03, 95% CI: 0.00, 0.06). Conclusions CE significantly increases CRF in BCS and improves most cardiometabolic health-related outcomes. In addition, there will be a need for many larger RCTs to explore the effects of CE on inflammatory biomarkers in BCS.
Collapse
Affiliation(s)
- Linjie Cheng
- Department of Sports Rehabilitation, Faculty of Physical Education and Health, College of Physical Education and Health, Longyan University, Longyan, 364012, China
| | - Wenxiang Tian
- Shandong Institute of Scientific and Technical Information, Jinan, 250101, China
| | - Hua Mu
- Shandong Institute of Scientific and Technical Information, Jinan, 250101, China
| |
Collapse
|
6
|
Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [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: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
Collapse
Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
| |
Collapse
|
7
|
Herranz-Gómez A, Suso-Martí L, Varangot-Reille C, Barrachina-Gauchia L, Casaña J, López-Bueno L, Calatayud J, Cuenca-Martínez F. The Benefit of Exercise in Patients With Cancer Who Are Receiving Chemotherapy: A Systematic Review and Network Meta-Analysis. Phys Ther 2024; 104:pzad132. [PMID: 37792792 DOI: 10.1093/ptj/pzad132] [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: 12/21/2022] [Revised: 06/08/2023] [Accepted: 09/30/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE This study aimed to determine which therapeutic exercise-based intervention is most effective in improving cardiorespiratory fitness (CRF) in patients with cancer receiving chemotherapy. METHODS The authors conducted a systematic review with network meta-analysis in MEDLINE (PubMed), Embase, Cumulative Index to Nursing and Allied Health Literature, Scopus, SPORTDiscus, and Web of Science. The authors employed the Physiotherapy Evidence Database and the Revised Cochrane Risk of Bias Tool for Randomized Trials to assess the methodological quality and risk of bias, respectively. RESULTS A total of 27 studies were included. Data were pooled using a random-effects model. Adding aerobic training (moderate to high intensity), with or without resistance training, to usual care versus usual care was statistically significant, with a small beneficial effect (aerobic training: standardized mean difference = 0.46; 95% CI= 0.17 to 0.75; aerobic and resistance training: standardized mean difference = 0.26; 95% CI = 0.00 to 0.52) for peak oxygen consumption at the postintervention assessment. CONCLUSION Therapeutic exercise-based interventions to improve short-term CRF in patients with cancer receiving chemotherapy should include moderate- to high-intensity aerobic exercise, with or without resistance training. IMPACT It is important to improve CRF in the oncological population due to its relationship with mortality. The results showed the benefit of exercise to improve cardiorespiratory fitness in the oncology population receiving chemotherapy treatment.
Collapse
Affiliation(s)
- Aida Herranz-Gómez
- Department of Physiotherapy, Faculty of Health Sciences, European University of Valencia, Valencia, Spain
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Clovis Varangot-Reille
- Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, Département d´Anesthésie-Réanimation, Lyon, Pierre-Bénite, France
| | - Laia Barrachina-Gauchia
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - José Casaña
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Laura López-Bueno
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Joaquín Calatayud
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | | |
Collapse
|
8
|
Foulkes SJ, Howden EJ, Pituskin E, Thompson RB, La Gerche A, Haykowsky MJ. A Review on the Role of Exercise Training to Prevent a Decline in Cardiorespiratory Fitness and Cardiac Function in Breast Cancer Survivors. J Cardiopulm Rehabil Prev 2024; 44:5-14. [PMID: 38032257 DOI: 10.1097/hcr.0000000000000834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2023]
Abstract
PURPOSE Improvements in diagnosis and treatment mean that the long-term health of breast cancer survivors (BCS) is increasingly dictated by cardiovascular comorbidities. This is partly a consequence of exposure to cardiotoxic therapies, which result in cardiac dysfunction and decreased cardiorespiratory fitness (CRF). Exercise training (ExT) is a key therapeutic strategy for secondary prevention and increasing CRF in adults with established cardiovascular disease. Exercise-based cardio-oncology rehabilitation (CORE) has been proposed as an emerging strategy to address CRF and cardiac impairment in BCS. This review aims to (1) provide an overview of the impact of breast cancer therapy on CRF; (2) provide an up-to-date summary of the effects of ExT on CRF and cardiac function in BCS undergoing cardiotoxic therapy; and (3) discuss how traditional ExT approaches can be adapted for BCS undergoing therapy. REVIEW METHODS A literature review was performed based on an intensive literature search for systematic reviews and meta-analyses, randomized and non-randomized controlled trials and single-arm trials investigating the impact of exercise training or cardiac rehabilitation on CRF and/or cardiac function in BCS who are undergoing or have completed cardiotoxic cancer therapy. SUMMARY Overall, current evidence suggests that ExT induces clinically meaningful benefits for CRF in BCS during and after therapy. There is also emerging evidence that ExT can improve peak exercise measures of cardiac function; however, there is a need for further research to understand how to adapt these effective ExT approaches into clinical CORE-based settings.
Collapse
Affiliation(s)
- Stephen J Foulkes
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Alberta, Canada (Drs Foulkes, Pituskin, and Haykowsky); Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (Drs Foulkes, Howden, La Gerche, and Haykowsky); Department of Cardiometabolic Health, The University of Melbourne, Melbourne, Australia (Drs Foulkes, Howden, and La Gerche); College of Health Sciences, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada (Dr Thompson); National Centre for Sports Cardiology, Fitzroy, Victoria, Australia (Dr La Gerche); and Cardiology Department, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia (Dr La Gerche)
| | | | | | | | | | | |
Collapse
|
9
|
Leźnicka K, Gasiorowska A, Pawlak M, Jażdżewska A, Maciejewska-Skrendo A, Chudecka M, Szumilewicz A. Changes in pain perception during pregnancy after one-time maximal physical exertion and an 8-week high-intensity interval training. Front Physiol 2023; 14:1304534. [PMID: 38148904 PMCID: PMC10750353 DOI: 10.3389/fphys.2023.1304534] [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: 10/10/2023] [Accepted: 11/27/2023] [Indexed: 12/28/2023] Open
Abstract
Background: Pain, a subjective sensation, poses a great challenge to the human body as a stressor. There is empirical evidence that moderate to intense physical activity increases pain tolerance and this may be critical during pregnancy for optimal pregnancy, fetal development, and delivery. To the best of our knowledge, it is the first study examining the changes in pain perception in pregnant women after a maximal progressive exercise test and after 8 weeks of high-intensity interval training (HIIT). Methods: Thirty-five women with uncomplicated singleton pregnancies between 13 and 28 weeks of gestation participated in the study. The HIIT intervention was developed in accordance with the recommendations and available data on HIIT during pregnancy. The maximal progressive cardiopulmonary exercise test was performed on a cycle ergometer with an electronically controlled load. Pressure pain threshold and pressure pain tolerance were measured with an algometer. Results: We found significant effects of the maximal exercise test and high-intensity interval training, such that the pregnant women had higher pain tolerance after the maximal exercise test than before and after the high-intensity interval training than the baseline. Conclusion: Our results suggest that post-exercise analgesia may be important in pregnant women and that high-intensity interval training appears to be beneficial for pregnant women to improve their pain tolerance while being obstetrically safe. Increased pain tolerance before labor could lead to better management of pain during labor and in the postpartum and lactation periods. Increasing pregnant women's awareness of this issue can improve their wellbeing and provide more comfort during labor.
Collapse
Affiliation(s)
- Katarzyna Leźnicka
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Agata Gasiorowska
- Faculty of Psychology in Wroclaw, SWPS University of Social Sciences and Humanities, Wroclaw, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, Poznan, Poland
| | - Aleksandra Jażdżewska
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| | - Agnieszka Maciejewska-Skrendo
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
- Institute of Physical Culture Sciences University of Szczecin, Szczecin, Poland
| | - Monika Chudecka
- Institute of Physical Culture Sciences University of Szczecin, Szczecin, Poland
| | - Anna Szumilewicz
- Faculty of Physical Culture, Gdansk University of Physical Education and Sport, Gdansk, Poland
| |
Collapse
|
10
|
Reina-Varona Á, Madroñero-Miguel B, Gaul C, Hall T, Oliveira AB, Bond DS, Fernández-de Las Peñas C, Florencio LL, Carvalho GF, Luedtke K, Varkey E, Krøll LS, Bevilaqua-Grossi D, Kisan R, La Touche R, Paris-Alemany A. Therapeutic Exercise Parameters, Considerations, and Recommendations for Migraine Treatment: An International Delphi Study. Phys Ther 2023; 103:pzad080. [PMID: 37410390 DOI: 10.1093/ptj/pzad080] [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: 12/07/2022] [Revised: 02/27/2023] [Accepted: 06/30/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVE The goal of this study was to reach consensus about the best exercise prescription parameters, the most relevant considerations, and other recommendations that could be useful for prescribing exercise to patients with migraine. METHODS This was an international study conducted between April 9, 2022 and June 30, 2022. An expert panel of health care and exercise professionals was assembled, and a 3-round Delphi survey was performed. Consensus was reached for each item if an Aiken V Validity Index ≥ 0.7 was obtained. RESULTS The study included 14 experts who reached consensus on 42 items by the third round. The most approved prescription parameters were 30 to 60 minutes of exercise per session, 3 days per week of moderate-intensity continuous aerobic exercise, and relaxation and breathing exercises for 5 to 20 minutes every day. When considering an exercise prescription, initial exercise supervision should progress to patient self-regulation; catastrophizing, fear-avoidance beliefs, headache-related disability, anxiety, depression, physical activity baseline level, and self-efficacy could influence the patients' exercise participation and efficacy; and gradual exposure to exercise could help improve these psychological variables and increase exercise efficacy. Yoga and concurrent exercise were also included as recommended interventions. CONCLUSION From the experts in the study, exercise prescriptions should be adapted to patients with migraine considering different exercise modalities, such as moderate-intensity aerobic exercise, relaxation, yoga, and concurrent exercise, based on the patients' preferences and psychological considerations, level of physical activity, and possible adverse effects. IMPACT The consensus reached by the experts can help prescribe exercise accurately to patients with migraine. Offering various exercise modalities can improve exercise participation in this population. The evaluation of the patients' psychological and physical status can also facilitate the adaptation of the exercise prescription to their abilities and diminish the risk of adverse events.
Collapse
Affiliation(s)
- Álvaro Reina-Varona
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- PhD Program in Medicine and Surgery, Doctoral School, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Madroñero-Miguel
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
| | - Charly Gaul
- Headache Center Frankfurt, Frankfurt, Hesse, Germany
| | - Toby Hall
- Curtin School of Allied Health, Curtin University, Perth, Western Australia, Australia
| | - Arão B Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, São Paulo, Brazil
| | - Dale S Bond
- Departments of Research and Surgery, Hartford Hospital/HealthCare, Hartford, Connecticut, USA
| | - César Fernández-de Las Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
| | - Lidiane L Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine. Health Sciences Faculty, Universidad Rey Juan Carlos, Alcorcon, Madrid, Spain
| | - Gabriela F Carvalho
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Schleswig-Holstein, Deutschland
| | - Kerstin Luedtke
- Institut für Gesundheitswissenschaften, Studiengang Physiotherapie, Pain and Exercise Research Luebeck (P.E.R.L), Universität zu Lübeck, Lübeck, Schleswig-Holstein, Deutschland
| | - Emma Varkey
- Department of Occupational Therapy and Physiotherapy, Region Västra Götaland, Sahlgrenska University Hospital/Östra, Gothenburg, Västra Götaland County, Sweden
| | - Lotte S Krøll
- Department of Neurology, Rigshospitalet-Glostrup, Danish Headache Centre, University of Copenhagen, Copenhagen, Zealand, Denmark
| | - Debora Bevilaqua-Grossi
- Department of Health Science, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Ravikiran Kisan
- Department of Physiology, Kodagu Institute of Medical Sciences, Karnataka, Madikeri, India
| | - Roy La Touche
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Motion in Brains Research Group, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Madrid, Spain
| | - Alba Paris-Alemany
- Motion in Brains Research Group, Departamento de Fisioterapia, Universidad Autónoma de Madrid, Aravaca, Madrid, Spain
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), Madrid, Madrid, Spain
| |
Collapse
|
11
|
Tannion K, De la Vega R, Horcajo J, Cuadrado-Peñafiel V. Mental, physical, and phychophysiological responses to FFP2/N95 face mask during HIIT in active women. PLoS One 2023; 18:e0292061. [PMID: 37773935 PMCID: PMC10540954 DOI: 10.1371/journal.pone.0292061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 09/12/2023] [Indexed: 10/01/2023] Open
Abstract
Training systems based on high-intensity interval training (HIIT) have experienced great influence in recent years within the context of exercise and sport. This study aims to provide insight on whether the immediate outcomes (e.g., central and peripheral acute responses) may be intensified or attenuated when a HIIT protocol is performed using a FFP2/N95 face mask in active healthy adult women. In other words, it strives to provide new findings relative to the use of face masks as a potential performance enhancing tool. In the current study, the same training session was carried out on two occasions under different conditions (i.e., with FFP2/N95 and without FFP2/N95) in a cross-over experimental design. The following study variables were assessed before and after the HIIT in both sessions: Lactate, cortisol, alpha-amylase, selective attention, countermovement jump (CMJ), and power output. Additionally, central and peripheral Rates of Perceived Exertion (RPE) were assessed before and during the HIIT. This study makes novel contributions to prior research, showing that the use of FFP2/N95 face mask (vs. no mask) yielded higher alpha-amylase, selective attention, and peripheral RPE scores. No significant differences were found for lactate, cortisol, CMJ, and power output. Interestingly, central RPE scores were significantly lower under FFP2/N95 face mask (vs. no mask) condition. The main suggestion in light of these results is that researchers and practitioners should consider potential peripheral and central responses to training stimuli when using FFP2/N95 face masks.
Collapse
Affiliation(s)
- Kyran Tannion
- Department of Physical Education, Sport & Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | - Ricardo De la Vega
- Department of Physical Education, Sport & Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| | - Javier Horcajo
- Departamento de Psicología Social y Metodología, Universidad Autónoma de Madrid, Madrid, Spain
| | - Víctor Cuadrado-Peñafiel
- Department of Physical Education, Sport & Human Movement, Universidad Autónoma de Madrid, Madrid, Spain
| |
Collapse
|
12
|
Chen X, Shi X, Yu Z, Ma X. High-intensity interval training in breast cancer patients: A systematic review and meta-analysis. Cancer Med 2023; 12:17692-17705. [PMID: 37587859 PMCID: PMC10524023 DOI: 10.1002/cam4.6387] [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: 06/18/2023] [Accepted: 07/19/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Women with breast cancer and improved survival often experience treatment-related impairments. High-intensity interval training (HIIT) has emerged as a promising exercise therapy modality for adult cancer patients. However, the overall effects of HIIT in breast cancer patients remain scarce and controversial. Therefore, we conducted a systematic review and meta-analysis to comprehensively evaluate the impact of HIIT on health-related outcomes in breast cancer patients. METHODS We searched the PubMed, Embase, and Web of Science from inception to November 7, 2022. Eligible studies included randomized controlled trials that compared HIIT interventions with usual care (UC) or MICT in breast cancer patients. The primary outcome assessed was physical fitness, and exploratory outcomes included body composition, blood-borne biomarkers, and patient-reported outcomes. Summary data were extracted, and standardized mean differences (SMD) were calculated for meta-analysis. For outcomes that could not be pooled, a systematic review was conducted. RESULTS Our analysis included 19 articles from 10 studies, encompassing 532 participants who met the inclusion criteria. Pooled results demonstrated that HIIT was superior to UC in improving peak oxygen uptake (VO2peak ). The SMD for VO2peak (L/min) and VO2peak (mL/kg/min) was 0.79 (95% CI 0.13, 1.45) and 0.59 (95% CI 0.01, 1.16), respectively. No significant differences in VO2peak were found between the HIIT and MICT groups. Meta-analyses on body composition and blood-borne biomarkers showed no significant differences between HIIT and UC. Systematic review indicated favorable effects of HIIT on muscle strength, fatigue, and emotional well-being. CONCLUSIONS HIIT is a time-efficient alternative to MICT for improving VO2peak and may also enhance muscle strength and alleviate fatigue and emotional symptoms in breast cancer patients. HIIT should be considered as an important component of exercise prescription in breast cancer care. Further studies with larger cohorts are needed to determine the clinical significance of HIIT-induced changes in terms of other outcomes in women with breast cancer.
Collapse
Affiliation(s)
- Xudong Chen
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduChina
- West China School of Medicine, West China HospitalSichuan UniversityChengduChina
| | - Xuyuan Shi
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduChina
- West China School of Medicine, West China HospitalSichuan UniversityChengduChina
| | - Zhiruo Yu
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduChina
- West China School of Medicine, West China HospitalSichuan UniversityChengduChina
| | - Xuelei Ma
- Department of Biotherapy, Cancer Center and State Key Laboratory of Biotherapy, West China HospitalSichuan UniversityChengduChina
| |
Collapse
|
13
|
Plinsinga ML, Singh B, Rose GL, Clifford B, Bailey TG, Spence RR, Turner J, Coppieters MW, McCarthy AL, Hayes SC. The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis. Sports Med 2023; 53:1737-1752. [PMID: 37213049 PMCID: PMC10432370 DOI: 10.1007/s40279-023-01862-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. OBJECTIVES This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. METHODS Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. RESULTS In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. CONCLUSION The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. PROSPERO REGISTRATION NUMBER CRD42021266826.
Collapse
Affiliation(s)
- Melanie Louise Plinsinga
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.
| | - Ben Singh
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Grace Laura Rose
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Briana Clifford
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Rosalind Renee Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Jemma Turner
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Michel Willem Coppieters
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Musculoskeletal Health Program, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| |
Collapse
|
14
|
Chiang CF, Wang ZZ, Hsu YH, Miaw SC, Lin WL. Exercise improves the outcome of anticancer treatment with ultrasound-hyperthermia-enhanced nanochemotherapy and autophagy inhibitor. PLoS One 2023; 18:e0288380. [PMID: 37437011 DOI: 10.1371/journal.pone.0288380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 06/21/2023] [Indexed: 07/14/2023] Open
Abstract
It has been shown that exercise has a direct impact on tumor growth along with functional improvement. Previous studies have shown that exercise decreases the risk of cancer recurrence across various types of cancer. It was indicated that exercise stimulates the immune system to fight cancer. Previous study demonstrated that pulsed-wave ultrasound hyperthermia (pUH) combined with PEGylated liposomal doxorubicin (PLD) and chloroquine (CQ) inhibits 4T1 tumors growth and delays their recurrence. In this study, we investigated if the combinatorial treatment with high-intensity interval training (HIIT) combined with pUH-enhanced PLD delivery and CQ improved the outcome. The mouse experiment composed of three groups, HIIT+PLD+pUH+CQ group, PLD+pUH+CQ group, and the control group. HIIT+PLD+pUH+CQ group received 6 weeks of HIIT (15 min per day, 5 days per week) before 4T1 tumor implantation. Seven days later, they received therapy with PLD (10 mg/kg) + pUH (3 MHz, 50% duty cycle, 0.65 W/cm2, 15min) + CQ (50 mg/kg daily). Results showed that HIIT+PLD+pUH+CQ significantly reduced the tumor volumes and brought about longer survival of tumor-bearing mice than PLD+pUH+CQ did. Blood cell components were analyzed and showed that neutrophil and reticulocytes decreased while lymphocytes increased after exercise.
Collapse
Affiliation(s)
- Chi-Feng Chiang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Zi-Zong Wang
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
| | - Yu-Hone Hsu
- Division of Neurosurgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shi-Chuen Miaw
- Graduate Institute of Immunology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Win-Li Lin
- Department of Biomedical Engineering, National Taiwan University, Taipei, Taiwan
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan Town, Miaoli, Taiwan
| |
Collapse
|
15
|
Moraitis AM, Rose NB, Johnson AF, Dunston ER, Garrido-Laguna I, Hobson P, Barber K, Basen-Engquist K, Coletta AM. Feasibility and acceptability of an mHealth, home-based exercise intervention in colorectal cancer survivors: A pilot randomized controlled trial. PLoS One 2023; 18:e0287152. [PMID: 37347792 PMCID: PMC10286977 DOI: 10.1371/journal.pone.0287152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 05/27/2023] [Indexed: 06/24/2023] Open
Abstract
OBJECTIVE To determine the feasibility and acceptability of an mHealth, home-based exercise intervention among stage II-III colorectal cancer (CRC) survivors within 5-years post-resection and adjuvant therapy. METHODS This pilot randomized controlled trial of a 12-week mHealth, home-based exercise intervention, randomly assigned CRC survivors to a high-intensity interval training (HIIT) or moderate-intensity continuous exercise (MICE) prescription. The following assessments were carried out at baseline and end-of-study (EOS): handgrip strength, short physical performance battery (SPPB), PROMIS physical function, neuropathy total symptom score-6 (NTSS-6), Utah early neuropathy scale (UENS), cardiopulmonary exercise testing, anthropometrics, and body composition via BOD POD, modified Godin leisure-time activity questionnaire. Feasibility, as defined by number of completed prescribed workouts and rate of adherence to individualized heart rate (HR) training zones, was evaluated at EOS. Acceptability was assessed by open-ended surveys at EOS. Descriptive statistics were generated for participant characteristics and assessment data. RESULTS Seven participants were included in this pilot study (MICE: n = 5, HIIT: n = 2). Median age was 39 years (1st quartile: 36, 3rd quartile: 50). BMI was 27.4 kg/m2 (1st quartile: 24.5, 3rd quartile: 29.7). Most participants had stage III CRC (71%, n = 5). We observed an 88.6% workout completion rate, 100% retention rate, no adverse events, and qualitative data indicating improved quality of life and positive feedback related to ease of use, accountability, motivation, and autonomy. Mean adherence to HR training zones was 95.7% in MICE, and 28.9% for the high-intensity intervals and 51.0% for the active recovery intervals in HIIT; qualitative results revealed that participants wanted to do more/work-out harder. CONCLUSION An mHealth, home-based delivered exercise intervention, including a HIIT prescription, among stage II-III CRC survivors' post-resection and adjuvant therapy was tolerable and showed trends towards acceptability.
Collapse
Affiliation(s)
- Ann Marie Moraitis
- College of Nursing, University of Utah, Salt Lake City, Utah, United States of America
| | - Nathan B. Rose
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Austin F. Johnson
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Emily R. Dunston
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
| | - Ignacio Garrido-Laguna
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Paula Hobson
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Kristin Barber
- Department of Internal Medicine, Division of Oncology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| | - Karen Basen-Engquist
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, Texas, United States of America
| | - Adriana M. Coletta
- Department of Health and Kinesiology, University of Utah, Salt Lake City, Utah, United States of America
- Huntsman Cancer Institute at the University of Utah, Salt Lake City, Utah, United States of America
| |
Collapse
|
16
|
Eaton H, Timm KN. Mechanisms of trastuzumab induced cardiotoxicity - is exercise a potential treatment? CARDIO-ONCOLOGY (LONDON, ENGLAND) 2023; 9:22. [PMID: 37098605 PMCID: PMC10127350 DOI: 10.1186/s40959-023-00172-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 04/12/2023] [Indexed: 04/27/2023]
Abstract
The use of the adjuvant therapeutic antibody trastuzumab in breast cancer is associated with a range of cardiotoxic side effects despite successfully reducing the severity of outcomes cancer patients,. The most common cardiac effect, a reduction in left ventricular ejection fraction (LVEF), is a known precursor to heart failure and often requires interruption of chemotherapy to avoid endangering patients further. An understanding of trastuzumab's cardiac-specific interactions is therefore critical in devising new methods to not only avoid permanent cardiac damage, but also prolong treatment time, and therefore effectiveness, for breast cancer patients. Increasingly, the use of exercise as a treatment has been indicated across the field of cardio-oncology due to encouraging evidence that it can protect against LVEF reductions and heart failure. This review explores the mechanisms of trastuzumab-mediated cardiotoxicity, as well as the physiological effects of exercise on the heart, in order to assess the suitability of exercise intervention for breast cancer patients on trastuzumab antibody-therapy. We furthermore draw comparison to existing evidence for exercise intervention as a cardioprotective treatment in doxorubicin-induced cardiotoxicity. Although preclinical evidence seems to support exercise-based approaches also in trastuzumab-cardiotoxicity, current clinical evidence is too limited to confidently recommend it as a treatment, largely owing to issues of adherence. Future studies should therefore examine how the variety and duration of exercise can be adjusted to improve treatment effectiveness at a more personalised level.
Collapse
Affiliation(s)
- Holden Eaton
- Merton College, University of Oxford, Merton St, Oxford, OX1 4JD, UK
| | - Kerstin Nina Timm
- Department of Pharmacology, University of Oxford, Mansfield Road, Oxford, OX1 3QT, UK.
| |
Collapse
|
17
|
Bajdek N, Merchant N, Camhi SM, Yan H. Racial Differences in Blood Pressure and Autonomic Recovery Following Acute Supramaximal Exercise in Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095615. [PMID: 37174135 PMCID: PMC10178025 DOI: 10.3390/ijerph20095615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 04/01/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
Despite the growing popularity of high-intensity anaerobic exercise, little is known about the acute effects of this form of exercise on cardiovascular hemodynamics or autonomic modulation, which might provide insight into the individual assessment of responses to training load. The purpose of this study was to compare blood pressure and autonomic recovery following repeated bouts of acute supramaximal exercise in Black and White women. A convenience sample of twelve White and eight Black young, healthy women were recruited for this study and completed two consecutive bouts of supramaximal exercise on the cycle ergometer with 30 min of recovery in between. Brachial and central aortic blood pressures were assessed by tonometry (SphygmoCor Xcel) at rest and 15-min and 30-min following each exercise bout. Central aortic blood pressure was estimated using brachial pressure waveforms and customized software. Autonomic modulation was measured in a subset of ten participants by heart-rate variability and baroreflex sensitivity. Brachial mean arterial pressure and diastolic blood pressure were significantly higher in Blacks compared to Whites across time (race effect, p = 0.043 and p = 0.049, respectively). Very-low-frequency and low-frequency bands of heart rate variability, which are associated with sympathovagal balance and vasomotor tone, were 22.5% and 24.9% lower, respectively, in Blacks compared to Whites (race effect, p = 0.045 and p = 0.006, respectively). In conclusion, the preliminary findings of racial differences in blood pressure and autonomic recovery following supramaximal exercise warrant further investigations of tailored exercise prescriptions for Blacks and Whites.
Collapse
Affiliation(s)
- Nicole Bajdek
- Exercise and Health Sciences Department, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02184, USA
| | - Noelle Merchant
- Exercise and Health Sciences Department, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02184, USA
| | - Sarah M Camhi
- Kinesiology Department, University of San Francisco, San Francisco, CA 94117, USA
| | - Huimin Yan
- Exercise and Health Sciences Department, Manning College of Nursing and Health Sciences, University of Massachusetts Boston, Boston, MA 02184, USA
| |
Collapse
|
18
|
Hucteau E, Mallard J, Pivot X, Schott R, Pflumio C, Trensz P, Favret F, Pagano AF, Hureau TJ. Exacerbated central fatigue and reduced exercise capacity in early-stage breast cancer patients treated with chemotherapy. Eur J Appl Physiol 2023:10.1007/s00421-023-05177-5. [PMID: 36939876 DOI: 10.1007/s00421-023-05177-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 03/07/2023] [Indexed: 03/21/2023]
Abstract
PURPOSE The present study aimed to characterize the etiology of exercise-induced neuromuscular fatigue and its consequences on the force-duration relationship to provide mechanistic insights into the reduced exercise capacity characterizing early-stage breast cancer patients. METHODS Fifteen early-stage breast cancer patients and fifteen healthy women performed 60 maximal voluntary isometric quadriceps contractions (MVCs, 3 s of contraction, 2 s of relaxation). The critical force was determined as the mean force of the last six contractions, while W' was calculated as the force impulse generated above the critical force. Quadriceps muscle activation during exercise was estimated from vastus lateralis, vastus medialis and rectus femoris EMG. Central and peripheral fatigue were quantified via changes in pre- to postexercise quadriceps voluntary activation (ΔVA) and quadriceps twitch force (ΔQTw) evoked by supramaximal electrical stimulation, respectively. RESULTS Early-stage breast cancer patients demonstrated lower MVC than controls preexercise (- 15%, P = 0.022), and this reduction persisted throughout the 60-MVC exercise (- 21%, P = 0.002). The absolute critical force was lower in patients than in controls (144 ± 29N vs. 201 ± 47N, respectively, P < 0.001), while W' was similar (P = 0.546), resulting in lower total work done (- 23%, P = 0.001). This was associated with lower muscle activation in the vastus lateralis (P < 0.001), vastus medialis (P = 0.003) and rectus femoris (P = 0.003) in patients. Immediately following exercise, ΔVA showed a greater reduction in patients compared to controls (- 21.6 ± 13.3% vs. - 12.6 ± 7.7%, P = 0.040), while ΔQTw was similar (- 60.2 ± 13.2% vs. - 52.8 ± 19.4%, P = 0.196). CONCLUSION These findings support central fatigue as a primary cause of the reduction in exercise capacity characterizing early-stage breast cancer patients treated with chemotherapy. CLINICAL TRIALS REGISTRATION No. NCT04639609-November 20, 2020.
Collapse
Affiliation(s)
- Elyse Hucteau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Joris Mallard
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Xavier Pivot
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Roland Schott
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Carole Pflumio
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Philippe Trensz
- Institute of Cancerology Strasbourg Europe (ICANS), Strasbourg, France
| | - Fabrice Favret
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Allan F Pagano
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France
| | - Thomas J Hureau
- Biomedicine Research Centre of Strasbourg (CRBS), Mitochondria, Oxidative Stress, and Muscular Protection Laboratory (UR 3072), Strasbourg, France.
- Faculty of Sport Sciences, European Centre for Education, Research and Innovation in Exercise Physiology (CEERIPE), University of Strasbourg, 4 rue Blaise Pascal, CS 90032, 67081, Strasbourg Cedex, France.
| |
Collapse
|
19
|
Downs TL, Whiteside EJ, Foot G, Mills DE, Bliss ES. Differences in total cognition and cerebrovascular function in female breast cancer survivors and cancer-free women. Breast 2023; 69:358-365. [PMID: 37018967 PMCID: PMC10122006 DOI: 10.1016/j.breast.2023.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/03/2023] Open
Abstract
Reduced cognition is often reported by breast cancer patients and survivors, but the mechanisms for this decline are yet to be determined. We compared the differences in cerebrovascular function and cognition in breast cancer survivors (n = 15) and cancer-free women (n = 15) matched by age and body mass index. Participants undertook anthropometric, mood, cardiovascular, exercise performance, strength, cerebrovascular, and cognitive measurements. Transcranial Doppler ultrasound was used to measure the cerebrovascular responsiveness (CVR) to physiological (hypercapnia; 5% carbon dioxide) and psychological stimuli. Breast cancer survivors had a lower CVR to hypercapnia (21.5 ± 12.8 vs 66.0 ± 20.9%, P < 0.001), CVR to cognitive stimuli (15.1 ± 1.5 vs 23.7 ± 9.0%, P < 0.001) and total composite cognitive score (100 ± 12 vs. 113 ± 7, P = 0.003) than cancer-free women. These parameters remained statistically different between the groups following adjustments for covariates using an analysis of co-variance. We observed significant correlations between multiple measures and exercise capacity the only variable positively correlated to all primary measures (CVR to hypercapnia, r = 0.492, P = 0.007; CVR to cognitive stimuli r = 0.555, P = 0.003; and total composite cognitive score, r = 0.625, P < 0.001). In this study, breast cancer survivors had lower cerebrovascular and cognitive function than age-matched cancer-free women, which may be attributable to the effects of cancer and cancer treatment on brain health.
Collapse
|
20
|
Natalucci V, Ferri Marini C, De Santi M, Annibalini G, Lucertini F, Vallorani L, Panico AR, Sisti D, Saltarelli R, Donati Zeppa S, Agostini D, Gervasi M, Baldelli G, Grassi E, Nart A, Rossato M, Biancalana V, Piccoli G, Benelli P, Villarini A, Somaini M, Catalano V, Guarino S, Pietrelli A, Monaldi S, Sarti D, Barocci S, Flori M, Rocchi MBL, Brandi G, Stocchi V, Emili R, Barbieri E. Movement and health beyond care, MoviS: study protocol for a randomized clinical trial on nutrition and exercise educational programs for breast cancer survivors. Trials 2023; 24:134. [PMID: 36814313 PMCID: PMC9946288 DOI: 10.1186/s13063-023-07153-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 02/08/2023] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND Breast cancer (BC) is the most common invasive cancer in women, and exercise can significantly improve the outcomes of BC survivors. MoviS (Movement and Health Beyond Care) is a randomized controlled trial aimed to evaluate the potential health benefits of exercise and proper nutritional habits. This study aims to assess the efficacy of aerobic exercise training in improving quality of life (QoL) and health-related factors in high-risk BC. METHODS One hundred seventy-two BC survivor women, aged 30-70 years, non-metastatic, stage 0-III, non-physically active, 6-12 months post-surgery, and post chemo- or radiotherapy, will be recruited in this study. Women will be randomly allocated to the intervention arm (lifestyle recommendations and MoviS Training) or control arm (lifestyle recommendations). The MoviS training consists of 12 weeks of aerobic exercise training (2 days/week of supervised and 1 day/week of unsupervised exercise) with a progressive increase in exercise intensity (40-70% of heart rate reserve) and duration (20-60 min). Both arms will receive counseling on healthy lifestyle habits (nutrition and exercise) based on the World Cancer Research Fund International (WCRF) 2018 guidelines. The primary outcome is the improvement of the QoL. The secondary outcomes are improvement of health-related parameters such as Mediterranean diet adherence, physical activity level, flexibility, muscular fitness, fatigue, cardiorespiratory fitness (estimated maximal oxygen uptake), echocardiographic parameters, heart rate variability (average of the standard deviations of all 5 min normal to normal intervals (ASDNN/5 min) and 24 h very low and low frequency), and metabolic, endocrine, and inflammatory serum biomarkers (glycemia, insulin resistance, progesterone, testosterone, and high-sensitivity C-reactive protein). DISCUSSION This trial aims to evaluate if supervised exercise may improve QoL and health-related factors of BC survivors with a high risk of recurrence. Findings from this project could provide knowledge improvement in the field of exercise oncology through the participation of a multidisciplinary team that will provide a coordinated program of cancer care to improve healthcare quality, improve prognosis, increase survival times and QoL, and reduce the risk of BC recurrence. TRIAL REGISTRATION ClinicalTrials.gov NCT04818359 . Retrospectively registered on March 26, 2021.
Collapse
Affiliation(s)
- Valentina Natalucci
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Carlo Ferri Marini
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Mauro De Santi
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy.
| | - Giosuè Annibalini
- Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029, Urbino, Italy.
| | - Francesco Lucertini
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Luciana Vallorani
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Andrea Rocco Panico
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Davide Sisti
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Roberta Saltarelli
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Sabrina Donati Zeppa
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Deborah Agostini
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Marco Gervasi
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Giulia Baldelli
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Eugenio Grassi
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Alessandra Nart
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Massimo Rossato
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Vincenzo Biancalana
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Giovanni Piccoli
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Piero Benelli
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Anna Villarini
- grid.9027.c0000 0004 1757 3630Department of Medicine and Surgery, University of Perugia, 06129 Perugia, Italy
| | - Matteo Somaini
- grid.4708.b0000 0004 1757 2822School of Specialization in Nutrition Science, University of Milano, Milan, Italy
| | - Vincenzo Catalano
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Stefania Guarino
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Alice Pietrelli
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Silvia Monaldi
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Donatella Sarti
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Simone Barocci
- Clinical Pathology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Marco Flori
- Cardiology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Marco Bruno Luigi Rocchi
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Giorgio Brandi
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| | - Vilberto Stocchi
- Department of Human Sciences for the Promotion of Quality of Life, University San Raffaele, 20132 Rome, Italy
| | - Rita Emili
- Medical Oncology, Hospital Santa Maria della Misericordia di Urbino, 61029 Urbino, Italy
| | - Elena Barbieri
- grid.12711.340000 0001 2369 7670Department of Biomolecular Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
| |
Collapse
|
21
|
Foulkes SJ, Howden EJ, Haykowsky MJ, Antill Y, Salim A, Nightingale SS, Loi S, Claus P, Janssens K, Mitchell AM, Wright L, Costello BT, Lindqvist A, Burnham L, Wallace I, Daly RM, Fraser SF, La Gerche A. Exercise for the Prevention of Anthracycline-Induced Functional Disability and Cardiac Dysfunction: The BREXIT Study. Circulation 2023; 147:532-545. [PMID: 36342348 DOI: 10.1161/circulationaha.122.062814] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breast cancer survivors treated with anthracycline-based chemotherapy (AC) have increased risk of functional limitation and cardiac dysfunction. We conducted a 12-month randomized controlled trial in 104 patients with early-stage breast cancer scheduled for AC to determine whether 12 months of exercise training (ExT) could attenuate functional disability (primary end point), improve cardiorespiratory fitness (VO2peak), and prevent cardiac dysfunction. METHODS Women 40 to 75 years of age with stage I to III breast cancer scheduled for AC were randomized to 3 to 4 days per week aerobic and resistance ExT for 12 months (n=52) or usual care (UC; n=52). Functional measures were performed at baseline, at 4 weeks after AC (4 months), and at 12 months, comprising: (1) cardiopulmonary exercise testing to quantify VO2peak and functional disability (VO2peak ≤18.0 mL·kg-1·min-1); (2) cardiac reserve (response from rest to peak exercise), quantified with exercise cardiac magnetic resonance measures to determine changes in left and right ventricular ejection fraction, cardiac output, and stroke volume; (3) standard-of-care echocardiography-derived resting left ventricular ejection fraction and global longitudinal strain; and (4) biochemistry (troponin and BNP [B-type natriuretic peptide]). RESULTS Among 104 participants randomized, greater study attrition was observed among UC participants (P=0.031), with 93 women assessed at 4 months (ExT, n=49; UC, n=44) and 87 women assessed at 12 months (ExT, n=49; UC, n=38). ExT attenuated functional disability at 4 months (odds ratio, 0.32 [95% CI, 0.11-0.94]; P=0.03) but not at 12 months (odds ratio, 0.27 [95% CI, 0.06-1.12]; P=0.07). In a per-protocol analysis, functional disability was prevented entirely at 12 months among participants adherent to ExT (ExT, 0% versus UC, 20%; P=0.005). Compared with UC at 12 months, ExT was associated with a net 3.5-mL·kg-1·min-1 improvement in VO2peak that coincided with greater cardiac output, stroke volume, and left and right ventricular ejection fraction reserve (P<0.001 for all). There was no effect of ExT on resting measures of left ventricular function. Postchemotherapy troponin increased less in ExT than in UC (8-fold versus 16-fold increase; P=0.002). There were no changes in BNP in either group. CONCLUSIONS In women with early-stage breast cancer undergoing AC, 12 months of ExT did not attenuate functional disability, but provided large, clinically meaningful benefits on VO2peak and cardiac reserve. REGISTRATION URL: https://www.anzctr.org.au/; Unique identifier: ACTRN12617001408370.
Collapse
Affiliation(s)
- Stephen J Foulkes
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.).,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Erin J Howden
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia
| | - Mark J Haykowsky
- Faculty of Nursing, College of Health Sciences, University of Alberta, Edmonton, Canada (M.J.H., S.J.F.)
| | - Yoland Antill
- Cabrini Health, Melbourne, VIC, Australia (Y.A.).,Faculty of Medicine, Dentistry and Health Sciences, Monash University, Melbourne, VIC, Australia (Y.A.)
| | - Agus Salim
- Epidemiology (A.S.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health (A.S.), University of Melbourne, Parkville, VIC, Australia.,School of Mathematics and Statistics (A.S.), University of Melbourne, Parkville, VIC, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia (S.S.N., S.L.)
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Belgium (P.C.)
| | - Kristel Janssens
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Amy M Mitchell
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Leah Wright
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ben T Costello
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Anniina Lindqvist
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Lauren Burnham
- Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Imogen Wallace
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Human Integrative Physiology (E.J.H., L.B., I.W.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robin M Daly
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - Steve F Fraser
- Institute for Physical Activity and Nutrition, Deakin University, Melbourne, VIC, Australia (R.M.D., S.F.F.)
| | - André La Gerche
- Sports Cardiology (S.J.F., K.J., A.M.M., L.W., B.T.C., A.L., L.B., I.W., A.L.G.), Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Baker Department of Cardiometabolic Health (S.J.F., E.J.H., A.L.G.), University of Melbourne, Parkville, VIC, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Fitzroy, VIC, Australia (A.L.G.)
| |
Collapse
|
22
|
Jiang Y, Angeletti PC, Hoffman AJ. Investigating the Physiological Mechanisms between Resistance Training and Pain Relief in the Cancer Population: A Literature Review. JOURNAL OF CANCER THERAPY 2023; 14:80-101. [PMID: 37502393 PMCID: PMC10373509 DOI: 10.4236/jct.2023.142008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
This literature review examines the mechanisms of how exercise, specifically in the form of resistance training, may lead to pain relief in the cancer population. Primary data from three different cancer populations: breast, prostate, and lung, will be examined. A number of experimental studies have been conducted to confirm the effectiveness of resistance training on pain relief as well as the biochemical pathways that relate to this process. In this review, we will examine 5 randomized controlled trials. For the purposes of this review, pain is defined as physical suffering or discomfort associated with illness. Pain is the body's natural signal, bringing attention to damage that has been sustained by tissues. However, chronic pain is common in the cancer population, and often serves no good purpose but instead will negatively impact both physical and mental health. The three types of pain: nociceptive, neuropathic, and inflammatory pathways have been investigated, and the knowledge of pain mechanisms allows for the understanding of how it is associated with pain. The purpose of this exploratory literature review is to give insight on how to maximize pain-relieving effects of resistance training. Research has indicated that resistance training modulates pain pathways by upregulating the release of pain-relieving substances including beta-endorphins, anti-inflammatory cytokines, and endocannabinoids. Understanding of the benefits of resistance training may be useful in relieving cancer pain, and reproducing effects of pain-relieving strategies while minimizing the symptoms related to cancer and its treatment.
Collapse
Affiliation(s)
- Yvonne Jiang
- College of Arts and Sciences, University of Nebraska-Lincoln, Lincoln, NE, USA
| | - Peter C. Angeletti
- Nebraska Center for Virology, University of Nebraska-Lincoln, Lincoln NE, USA
| | - Amy J. Hoffman
- College of Nursing, University of Nebraska Medical Center, Omaha, Nebraska, USA
| |
Collapse
|
23
|
Huot JR, Baumfalk D, Resendiz A, Bonetto A, Smuder AJ, Penna F. Targeting Mitochondria and Oxidative Stress in Cancer- and Chemotherapy-Induced Muscle Wasting. Antioxid Redox Signal 2023; 38:352-370. [PMID: 36310444 PMCID: PMC10081727 DOI: 10.1089/ars.2022.0149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/04/2022] [Accepted: 10/22/2022] [Indexed: 12/31/2022]
Abstract
Significance: Cancer is frequently associated with the early appearance of cachexia, a multifactorial wasting syndrome. If not present at diagnosis, cachexia develops either as a result of tumor progression or as a side effect of anticancer treatments, especially of standard chemotherapy, eventually representing the direct cause of death in up to one-third of all cancer patients. Cachexia, within its multiorgan affection, is characterized by severe loss of muscle mass and function, representing the most relevant subject of preclinical and clinical investigation. Recent Advances: The pathogenesis of muscle wasting in cancer- and chemotherapy-induced cachexia is complex, and encompasses heightened protein catabolism and reduced anabolism, disrupted mitochondria and energy metabolism, and even neuromuscular junction dismantling. The mechanisms underlying these alterations are still controversial, especially concerning the molecular drivers that could be targeted for anticachexia therapies. Inflammation and mitochondrial oxidative stress are among the principal candidates; the latter being extensively discussed in the present review. Critical Issues: Several approaches have been tested to modulate the redox homeostasis in tumor hosts, and to counteract cancer- and chemotherapy-induced muscle wasting, from exercise training to distinct classes of direct or indirect antioxidants. We herein report the most relevant results obtained from both preclinical and clinical trials. Future Directions: Including the assessment and the treatment of altered redox balance in the clinical management of cancer patients is still a big challenge. The available evidence suggests that fortifying the antioxidant defenses by either pharmacological or nonpharmacological strategies will likely improve cachexia and eventually the outcome of a broad cancer patient population. Antioxid. Redox Signal. 38, 352-370.
Collapse
Affiliation(s)
- Joshua R. Huot
- Department of Surgery and Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dryden Baumfalk
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Aridai Resendiz
- Department of Oncology, Surgical Oncology and Digestive Surgery Unit, S Luigi University Hospital, University of Torino, Torino, Italy
| | - Andrea Bonetto
- Department of Surgery and Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Otolaryngology–Head & Neck Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Indiana Center for Musculoskeletal Health, and Indiana University School of Medicine, Indianapolis, Indiana, USA
- Simon Comprehensive Cancer Center, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Department of Pathology, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ashley J. Smuder
- Department of Applied Physiology and Kinesiology, University of Florida, Gainesville, Florida, USA
| | - Fabio Penna
- Department of Clinical and Biological Sciences, University of Torino, Torino, Italy
| |
Collapse
|
24
|
Dixit S, Tapia V, Sepúlveda C, Olate D, Berríos-Contreras L, Lorca LA, Alqahtani AS, Ribeiro IL. Effectiveness of a Therapeutic Exercise Program to Improve the Symptoms of Peripheral Neuropathy during Chemotherapy: Systematic Review of Randomized Clinical Trials. Life (Basel) 2023; 13:life13020262. [PMID: 36836620 PMCID: PMC9958632 DOI: 10.3390/life13020262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/06/2023] [Accepted: 01/14/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Therapeutic exercise has an important role to manage chemotherapy-induced peripheral neuropathy symptoms. However, there is little evidence of its effectiveness. OBJECTIVE To synthesize the evidence regarding therapeutic exercise during chemotherapy to improve peripheral neuropathy symptoms. DATABASES PubMed, CINAHL, Cochrane Library, PEDro, ScienceDirect, Scopus, Web of Science and BIREME. METHODOLOGY Randomized clinical trials were included. GRADE was used to synthesize evidence and an inverse variance model for meta-analysis. RESULTS Up to May 2022, 2172 references were analyzed and 14 studies that evaluated 1094 participants were included. The exercises were highly effective in improving pain threshold and moderately effective in improving peripheral neuropathy symptoms at the 8-week follow-up and the 4-24 weeks. Furthermore, the evidence was low in improving thermal threshold, tactile and vibratory sensitivity. CONCLUSION Therapeutic exercise generates a significant reduction in peripheral neuropathy symptoms in patients in short- and long-term follow-up with a moderate level of evidence quality.
Collapse
Affiliation(s)
- Snehil Dixit
- Department of Medical Rehabilitation Sciences, College of Applied Medical Sciences, King Khalid University, Abha 61471, Saudi Arabia
| | - Valentina Tapia
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Carolina Sepúlveda
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Daniela Olate
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Lily Berríos-Contreras
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
| | - Luz Alejandra Lorca
- Hospital del Salvador, Servicio de Salud Metropolitano Oriente, Santiago de Chile 13123, Chile
| | - Abdulfattah S. Alqahtani
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Ivana Leão Ribeiro
- Department of Kinesiology, Faculty of Healthy Sciences, Universidad Católica del Maule, Talca 3460000, Chile
- Correspondence: ; Tel.: +56-712413622
| |
Collapse
|
25
|
Henkin JS, Rosa DD, Morelle AM, Caleffi M, Pinto SS, Pinto RS. Exercise volume load in women with breast cancer: Study protocol for the ABRACE randomized clinical trial. Contemp Clin Trials Commun 2022; 31:101053. [PMID: 36589863 PMCID: PMC9798137 DOI: 10.1016/j.conctc.2022.101053] [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: 05/19/2022] [Revised: 11/11/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
Background An increased number of breast cancer patients are challenged by acute and persistent treatment side effects. Oncology guidelines have been establishing physical exercise to counteract several treatment-related toxicities throughout cancer care. However, evidence regarding the optimal dose-response, feasibility, and the minimal resistance exercise volume and/or intensity remains unclear. The ABRACE Study will assess the impact of different resistance training volumes (i.e., single or multiple sets) combined with aerobic exercise on physical and psychological outcomes of breast cancer patients undergoing primary treatment. Methods This study is a randomized, controlled, three-armed parallel trial. A total of 84 participants, aged ≥18 years, with breast cancer stages I-III, initiating adjuvant or neoadjuvant chemotherapy (≤50% of sessions completed) will be randomized to multiple sets resistance training plus aerobic training group, single set resistance training plus aerobic training group or control group. Neuromuscular and cancer-related fatigue (primary outcomes), muscle strength, muscle thickness, muscle quality by echo intensity, body composition, cardiorespiratory capacity, functional performance, upper-body endurance and quality of life will be measured before and after the 12-week intervention. Our analysis will follow the intention-to-treat approach and per-protocol criteria, with additional sub-group analysis. Discussion Findings support prescribing exercise during chemotherapy for breast cancer and elucidate the potential role of different resistance training volumes as a management strategy for physical and psychological impairments in women with early-stage breast cancer. Our main hypothesis is for superiority in physical and psychological outcomes for both training groups compared to the control group, with no difference between single or multiple sets groups. Trial registration Clinical trials NCT03314168.
Collapse
Key Words
- 1-RM, one-repetition maximum
- 3-RM, three-repetition maximum
- ABRACE, Adaptations to Breast Cancer and Exercise
- Breast neoplasms
- CG, control group
- Combined training
- DXA, Dual-energy X-ray absorptiometry
- EI, echo intensity
- ES, effect size
- Fatigue
- ITT, intent-to-treat analysis
- MQ, muscle quality
- MT, muscle thickness
- PP, per-protocol analysis
- Physical exercise
- QF, quadriceps
- QoL, quality of life
- RF, rectus femoris
- SM + AT, multiple sets resistance training plus aerobic training
- SS + AT, single set resistance training plus aerobic training
- Strength training
- VL, vastus lateralis
- VM, vastus medialis
- VT, vastus intermedius
Collapse
Affiliation(s)
- João Saldanha Henkin
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil,Corresponding author. Exercise Research Laboratory (LAPEX), Universidade Federal do Rio Grande do Sul (UFRGS), Rua Felizardo, 750 – Bairro Jardim Botânico, CEP: 90690-200, Porto Alegre, RS, Brazil.
| | - Daniela Dornelles Rosa
- Medical Oncology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil,Breast Unit, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil,Internal Medicine Department, Oncology Unit, Federal University of Rio Grande do Sul, Porto Alegre, RS, Brazil
| | | | - Maira Caleffi
- Medical Oncology, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil,Breast Unit, Hospital Moinhos de Vento, Porto Alegre, RS, Brazil
| | - Stephanie Santanna Pinto
- Neuromuscular Assessment Laboratory, Physical Education School, Universidade Federal de Pelotas, Pelotas, RS, Brazil
| | - Ronei Silveira Pinto
- Exercise Research Laboratory, Physical Education, Physiotherapy, and Dance School, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, Brazil
| |
Collapse
|
26
|
Clayton ZS, Ade CJ, Dieli-Conwright CM, Mathelier HM. A bench to bedside perspective on anthracycline chemotherapy-mediated cardiovascular dysfunction: challenges and opportunities. A symposium review. J Appl Physiol (1985) 2022; 133:1415-1429. [PMID: 36302155 PMCID: PMC9762976 DOI: 10.1152/japplphysiol.00471.2022] [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: 08/12/2022] [Revised: 10/20/2022] [Accepted: 10/21/2022] [Indexed: 01/11/2023] Open
Abstract
Cardiovascular diseases (CVD) are the leading cause of death worldwide and the risk of developing CVD is markedly increased following anthracycline chemotherapy treatment. Anthracyclines are an essential component of the cancer treatment regimen used for common forms of cancer in male and female children, adolescents, young adults, and older adults. Increased CVD risk with anthracyclines occurs, in part, due to vascular dysfunction-impaired endothelial function and arterial stiffening. These features of vascular dysfunction also play a major role in other common disorders observed following anthracycline treatment, including chronic kidney disease, dementia, and exercise intolerance. However, the mechanisms by which anthracycline chemotherapy induces and sustains vascular dysfunction are incompletely understood. This budding area of biomedical research is termed cardio-oncology, which presents the unique opportunity for collaboration between physicians and basic scientists. This symposium, presented at Experimental Biology 2022, provided a timely update on this important biomedical research topic. The speakers presented observations made at levels from cells to mice to humans treated with anthracycline chemotherapeutic agents using an array of translational research approaches. The speaker panel included a diverse mix of female and male investigators and unique insight from a cardio-oncology physician-scientist. Particular emphasis was placed on challenges and opportunities in this field as well as mechanisms that could be viewed as therapeutic targets leading to novel treatment strategies.
Collapse
Affiliation(s)
- Zachary S Clayton
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, Colorado
| | - Carl J Ade
- Department of Kinesiology, Kansas State University, Manhattan, Kansas
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Hansie M Mathelier
- Penn Medicine, University of Pennsylvania Health System, Philadelphia, Pennsylvania
| |
Collapse
|
27
|
Kim J, Hong Y, Baek S, Lee KP, Ahn S. The synergistic effect of physical activity and nutrition to improve the quality of life in breast cancer patients: a systemic review. Phys Act Nutr 2022; 26:22-31. [PMID: 36775648 PMCID: PMC9925113 DOI: 10.20463/pan.2022.0021] [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: 10/26/2022] [Accepted: 11/02/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Medical recommendations for balanced control of exercise, physical activity, and nutritional intake after breast cancer diagnosis remain unclear. Therefore, this review aims to summarize effective exercise methods and dietary opinions by reviewing clinical trial results. METHODS We systematically reviewed studies that evaluated 1) the relationship between exercise methods and quality of life improvement in patients with breast cancer and 2) the recommendations for physical activity, exercise, nutrition, and potential ways to improve life after breast cancer. To conduct this literature review, we searched the PubMed database for articles published until October 1, 2022, using the terms "physical activity OR exercise," "breast cancer," and "nutrition." After a primary review of the retrieved articles, we included clinical trials in this systematic review. RESULTS We hypothesized that physical activity improves the quality of life after the onset of breast cancer, suggesting that a balanced approach to aerobic exercise and resistance exercise increases the efficacy of anticancer treatment. From a nutritional point of view, it is recommended that both physical activity and diet management are necessary for patients with breast cancer. CONCLUSION Customized exercise and diet can help with weight loss, the reduction of cancer-induced fatigue, the regulation of hormonal changes, the reduction of inflammatory factors, and the improvement of mental health and vitality. Understanding the integrated mechanisms of physical activity and nutritional balance will improve the quality of life of patients with breast cancer. Therefore, it is necessary to continuously advance exercise programs and develop an alimentary balance control program.
Collapse
Affiliation(s)
- Jisu Kim
- Department of Sports Medicine and Science Graduate School of Konkuk University, Republic of Korea,Physical Activity & Performance Institute, Konkuk University, Republic of Korea
| | - Yoogyung Hong
- Research and Development Center, UMUST R&D Corporation, Seoul 05029, Republic of Korea
| | - Suji Baek
- Research and Development Center, UMUST R&D Corporation, Seoul 05029, Republic of Korea
| | - Kang Pa Lee
- Research and Development Center, UMUST R&D Corporation, Seoul 05029, Republic of Korea,Corresponding author : Kang Pa Lee Research and Development Center, UMUST R&D Corporation, Seoul 05029, Republic of Korea. Tel: +82-10-9288-2744 E-mail:
| | - Sanghyun Ahn
- Department of Anatomy, College of Korean Medicine, Semyung University, Chungbuk, Republic of Korea,Corresponding author : Kang Pa Lee Research and Development Center, UMUST R&D Corporation, Seoul 05029, Republic of Korea. Tel: +82-10-9288-2744 E-mail:
| |
Collapse
|
28
|
Iyengar NM. Inclusion of Exercise in Cancer Treatment Planning. JACC: CARDIOONCOLOGY 2022; 4:504-506. [PMID: 36444234 PMCID: PMC9700249 DOI: 10.1016/j.jaccao.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
29
|
Cuenca-Martínez F, Sempere-Rubio N, Varangot-Reille C, Fernández-Carnero J, Suso-Martí L, Alba-Quesada P, Touche RL. Effects of High-Intensity Interval Training (HIIT) on Patients with Musculoskeletal Disorders: A Systematic Review and Meta-Analysis with a Meta-Regression and Mapping Report. Diagnostics (Basel) 2022; 12:diagnostics12102532. [PMID: 36292221 PMCID: PMC9601160 DOI: 10.3390/diagnostics12102532] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/13/2022] [Accepted: 10/13/2022] [Indexed: 11/23/2022] Open
Abstract
The aim was to assess the impact of high-intensity interval training (HIIT) on patients with musculoskeletal disorders. We conducted a search of Medline, Embase, PEDro, and Google Scholar. We conducted a meta-analysis to determine the effectiveness of HIIT on pain intensity, maximal oxygen consumption (VO2 max), disability, and quality of life (QoL). We employed the GRADE and PEDro scales to rate the quality, certainty, and applicability of the evidence. Results showed significant differences in pain intensity, with a moderate clinical-effect (SMD = −0.73; 95% CI: −1.40–−0.06), and in VO2 max, with a moderate clinical-effect (SMD = 0.69; 95% CI: 0.42–0.97). However, the meta-analysis showed no statistically significant results for disability (SMD = −0.34; 95% CI: −0.92–0.24) and QoL (SMD = 0.40; 95% CI: −0.80–1.60). We compared HIIT against other exercise models for reducing pain intensity and increasing VO2 max. The meta-analysis showed no significant differences in favour of HIIT. Meta-regression analysis revealed that pain intensity scores were negatively associated with VO2 max (R2 = 82.99%, p = 0.003). There is low-moderate evidence that the HIIT intervention for patients with musculoskeletal disorders can reduce pain intensity and increase VO2 max but has no effect on disability and QoL. Results also showed that HIIT was not superior to other exercise models in reducing pain intensity and increasing VO2 max.
Collapse
Affiliation(s)
- Ferran Cuenca-Martínez
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Núria Sempere-Rubio
- UBIC, Department of Physiotherapy, Faculty of Physiotherapy, Universitat de València, 46010 Valencia, Spain
| | - Clovis Varangot-Reille
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Josué Fernández-Carnero
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28933 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Correspondence: (J.F.-C.); (L.S.-M.); Tel.: +34-914-88-88-00 (J.F.-C.); +34-963-98-38-55 (L.S.-M.)
| | - Luis Suso-Martí
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
- Correspondence: (J.F.-C.); (L.S.-M.); Tel.: +34-914-88-88-00 (J.F.-C.); +34-963-98-38-55 (L.S.-M.)
| | - Patricio Alba-Quesada
- Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, 46022 Valencia, Spain
| | - Roy La Touche
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28049 Madrid, Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN), 28003 Madrid, Spain
| |
Collapse
|
30
|
de Boniface J, Altena R, Haddad Ringborg C, Bolam KA, Wengström Y. Physical exercise during neoadjuvant chemotherapy for breast cancer as a mean to increase pathological complete response rates: Trial protocol of the randomized Neo-ACT trial. PLoS One 2022; 17:e0274804. [PMID: 36227931 PMCID: PMC9562167 DOI: 10.1371/journal.pone.0274804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION In early breast cancer, neoadjuvant chemotherapy (NACT) is increasingly used. The proof of efficacy is pathologically complete response (pCR), i.e. the absence of invasive tumour in breast and lymph nodes at surgery. Today, pCR is a common endpoint in pharmaceutical trials since it is significantly associated with survival especially in triple-negative and HER2-positive subtypes. Apart from the mitigation of treatment-related toxicity and symptoms, physical exercise mediates anti-tumoral systemic effects associated with tumour regression in preclinical and clinical models. The aim of Neo-ACT is to test the hypothesis that physical exercise can improve pCR rates in breast cancer patients receiving NACT. METHOD The Neo-ACT trial is a prospective clinical trial, randomising T1-3N0-2 breast cancer patients planned for NACT to either a home-based physical exercise intervention supported by a mobile application or routine care. The primary endpoint is pCR; secondary endpoints are patient-reported quality of life, toxicity-related outcomes, and oncological outcomes such as Residual Cancer Burden, objective radiological tumour response, as well as overall, breast cancer-specific and disease-free survival at 2, 5 and 10 years. The intervention consists of a combination of high-intensity interval and resistance training of progressing intensity, and includes at least 150 min of moderate to vigorous physical activity per week, inclusive of two weekly 60-min exercise sessions. In order to show an improvement in pCR of 10%, a total of 712 participants need to be included in the analysis. The Neo-ACT has been registered at clinicaltrials.gov on January 11, 2022 (NCT05184582). EXPECTED RESULTS If Neo-ACT can prove the oncological efficacy of physical exercise, implementation of training programmes into NACT schedules will be pursued. The use of a digitally led exercise intervention aims to test the potential of such a strategy for use in rural areas and areas of limited resources.
Collapse
Affiliation(s)
- Jana de Boniface
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Department of Surgery, Capio St. Göran’s Hospital, Stockholm, Sweden
- * E-mail:
| | - Renske Altena
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Haddad Ringborg
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Kate A. Bolam
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
- Karolinska Comprehensive Cancer Center, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
31
|
Song JS, Yamada Y, Kataoka R, Wong V, Spitz RW, Bell ZW, Loenneke JP. Training-induced hypoalgesia and its potential underlying mechanisms. Neurosci Biobehav Rev 2022; 141:104858. [PMID: 36096206 DOI: 10.1016/j.neubiorev.2022.104858] [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: 06/20/2022] [Revised: 08/25/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022]
Abstract
It is well-established that a single bout of exercise can reduce pain sensitivity (i.e., exercise-induced hypoalgesia) in healthy individuals. However, exercise-induced hypoalgesia is often impaired in individuals with chronic pain. This might suggest that repeated bouts of exercise (i.e., exercise training) are needed in order to induce a reduction in pain sensitivity (i.e., training-induced hypoalgesia) among individuals with chronic pain, given that a single bout of exercise seems to be insufficient to alter pain. However, the effect of repeated bouts of exercise on pain sensitivity and its underlying mechanisms remain poorly understood. Therefore, the purpose of this review was to provide an overview of the existing literature on training-induced hypoalgesia, as well as discuss potential mechanisms of training-induced hypoalgesia and offer considerations for future research. Existing literature suggests that training interventions may induce hypoalgesic adaptations potentially driven by central nervous system and immune system factors. However, the limited number of randomized controlled trials available, along with the lack of understanding of underlying mechanisms, provides a rationale for future research.
Collapse
Affiliation(s)
- Jun Seob Song
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Yujiro Yamada
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Ryo Kataoka
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Vickie Wong
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Robert W Spitz
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Zachary W Bell
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA
| | - Jeremy P Loenneke
- Department of Health, Exercise Science, and Recreation Management. Kevser Ermin Applied Physiology Laboratory, The University of Mississippi, MS, USA.
| |
Collapse
|
32
|
The Impact of Exercise on Cardiotoxicity in Pediatric and Adolescent Cancer Survivors: A Scoping Review. Curr Oncol 2022; 29:6350-6363. [PMID: 36135069 PMCID: PMC9497997 DOI: 10.3390/curroncol29090500] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/17/2022] Open
Abstract
Childhood and adolescent cancer survivors are disproportionately more likely to develop cardiovascular diseases from the late effects of cardiotoxic therapies (e.g., anthracycline-based chemotherapy and chest-directed radiotherapy). Currently, dexrazoxane is the only approved drug for preventing cancer treatment-related cardiac damage. While animal models highlight the beneficial effects of exercise cancer treatment-related cardiac dysfunction, few clinical studies have been conducted. Thus, the objective of this scoping review was to explore the designs and impact of exercise-based interventions for managing cancer treatment-related cardiac dysfunction in childhood and adolescent cancer survivors. Reviewers used Joanna Briggs Institute’s methodology to identify relevant literature. Then, 4616 studies were screened, and three reviewers extracted relevant data from six reports. Reviewers found that exercise interventions to prevent cancer treatment-related cardiac dysfunction in childhood and adolescent cancer survivors vary regarding frequency, intensity, time, and type of exercise intervention. Further, the review suggests that exercise promotes positive effects on managing cancer treatment-related cardiac dysfunction across numerous indices of heart health. However, the few clinical studies employing exercise interventions for childhood and adolescent cancer survivors highlight the necessity for more research in this area.
Collapse
|
33
|
Vikmoen O, Wiestad TH, Thormodsen I, Nordin K, Berntsen S, Demmelmaier I, Strandberg E, Raastad T. Effects of high and low-to-moderate intensity exercise during (neo-)adjuvant chemotherapy on muscle cells, cardiorespiratory fitness and muscle function in women with breast cancer: Protocol for a randomized controlled trial (Preprint). JMIR Res Protoc 2022; 11:e40811. [DOI: 10.2196/40811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
|
34
|
Botta RM, Palermi S, Tarantino D. High-intensity interval training for chronic pain conditions: a narrative review. J Exerc Rehabil 2022; 18:10-19. [PMID: 35356137 PMCID: PMC8934613 DOI: 10.12965/jer.2142718.359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic pain is defined as pain that persists past the normal healing time. Physical activity and exercise programs are increasingly being promoted and used for a variety of chronic pain conditions. Evidence suggests that physical exercise is an intervention with few adverse events that may improve pain severity and physical function, thus improving the quality of life. High-intensity interval training (HIIT) has been shown to improve physical outcome measures and to decrease disorder-related disability in people with chronic disorders. Since an overview of the benefits of HIIT on chronic pain conditions has not been published yet, this review aims to report the effects of HIIT alone or in combination with other forms of training on different kind of chronic pain conditions. A search in the main scientific electronic databases was performed. The results of the studies included in this review showed that HIIT is beneficial for several chronic pain conditions, improving pain and physical function. Since HIIT could represent a valid help to conventional drug therapies, it could improve the quality of life of these subjects. The actual quality of evidence remains very low, and further high evidence studies are needed to confirm the promising outcomes reported in this review.
Collapse
Affiliation(s)
- Riccardo Maria Botta
- Anesthesia and Intensive Care, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro,
Italy
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, Naples,
Italy
| | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, Naples,
Italy
- Corresponding author: Domiziano Tarantino, Department of Public Health, University of Naples Federico II, Via Sergio Pansini nr. 5, 80131 Naples, Italy,
| |
Collapse
|
35
|
Nicol JL, Woodrow C, Cunningham BJ, Mollee P, Weber N, Smith MD, Nicol AJ, Gordon LG, Hill MM, Skinner TL. An Individualized Exercise Intervention for People with Multiple Myeloma—Study Protocol of a Randomized Waitlist-Controlled Trial. Curr Oncol 2022; 29:901-923. [PMID: 35200576 PMCID: PMC8870457 DOI: 10.3390/curroncol29020077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 01/28/2022] [Accepted: 01/31/2022] [Indexed: 11/16/2022] Open
Abstract
People with multiple myeloma (MM) are second only to people with lung cancer for the poorest reported health-related quality of life (HRQoL) of all cancer types. Whether exercise can improve HRQoL in MM, where bone pain and lesions are common, requires investigation. This trial aims to evaluate the efficacy of an exercise intervention compared with control on HRQoL in people with MM. Following baseline testing, people with MM (n = 60) will be randomized to an exercise (EX) or waitlist control (WT) group. EX will complete 12-weeks of supervised (24 sessions) and unsupervised (12 sessions) individualized, modular multimodal exercise training. From weeks 12–52, EX continue unsupervised training thrice weekly, with one optional supervised group-based session weekly from weeks 12–24. The WT will be asked to maintain their current activity levels for the first 12-weeks, before completing the same protocol as EX for the following 52 weeks. Primary (patient-reported HRQoL) and secondary (bone health and pain, fatigue, cardiorespiratory fitness, muscle strength, body composition, disease response, and blood biomarkers) outcomes will be assessed at baseline, 12-, 24- and 52-weeks. Adverse events, attendance, and adherence will be recorded and cost-effectiveness analysis performed. The findings will inform whether exercise should be included as part of standard myeloma care to improve the health of this unique population.
Collapse
Affiliation(s)
- Jennifer L. Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- Correspondence:
| | - Carmel Woodrow
- Haematology, Division of Cancer, Princess Alexandra Hospital, Brisbane 4102, Australia; (C.W.); (P.M.)
| | - Brent J. Cunningham
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
| | - Peter Mollee
- Haematology, Division of Cancer, Princess Alexandra Hospital, Brisbane 4102, Australia; (C.W.); (P.M.)
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
| | - Nicholas Weber
- Haematology, Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane 4006, Australia;
| | - Michelle D. Smith
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane 4072, Australia;
| | - Andrew J. Nicol
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
- Brisbane Clinic for Lymphoma, Myeloma and Leukaemia, Greenslopes Private Hospital, Brisbane 4120, Australia
| | - Louisa G. Gordon
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
- Palliative Care Outcomes Centre, School of Nursing and Cancer, Queensland University of Technology, Brisbane 4059, Australia
| | - Michelle M. Hill
- QIMR Berghofer Medical Research Institute, Brisbane 4006, Australia; (L.G.G.); (M.M.H.)
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane 4006, Australia
| | - Tina L. Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane 4072, Australia; (B.J.C.); (A.J.N.); (T.L.S.)
| |
Collapse
|
36
|
Gerland L, Baumann FT, Niels T. Resistance Exercise for Breast Cancer Patients? Evidence from the Last Decade. Breast Care (Basel) 2022; 16:657-663. [PMID: 35087367 DOI: 10.1159/000513129] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 11/14/2020] [Indexed: 11/19/2022] Open
Abstract
Background Breast cancer is associated with many therapy-induced side effects that impact patients' lives from diagnosis to long-term survivorship. Physical activity has become an important and proven supportive measure in treating side effects like loss of muscle strength, fatigue, chemotherapy-induced peripheral neuropathy, lymphedema, and loss of quality of life. Resistance training (RT) is an established exercise intervention for breast cancer patients, but the correct type, timing, intensity, and duration of exercise remain unclear. It is necessary to investigate different resistance training interventions and their effects on breast cancer patients by covering all stages of treatment, beginning with prehabilitation, through the period of acute therapy, to long-term survivorship. Conclusion Upon evaluation of randomized controlled trials (RCTs) from the past decade, RT was found to be feasible and safe. Furthermore, there is evidence on the impact of RT on muscle strength, CRF and QoL amongst other factors. Studies implementing mixes of aerobic and strength exercises are rather common, but RCTs of RT-only protocols remain scarce. Different strength training protocols at distinct stages of breast cancer treatment have been conducted, but with the complexity of treatments and the variety of training styles, a large field of study remains. Key Messages Although the overall data on RT for breast cancer patients has increased, there are many different methodological approaches and testing measures as well as gaps in study documentation. There is still very little of the evidence that would facilitate the compilation of standardized and individualized guidelines.
Collapse
Affiliation(s)
- Lars Gerland
- Department I of Internal Medicine, Center of Integrated Oncology, Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - Freerk T Baumann
- Department I of Internal Medicine, Center of Integrated Oncology, Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| | - Timo Niels
- Department I of Internal Medicine, Center of Integrated Oncology, Aachen Bonn Cologne Düsseldorf, University Hospital of Cologne, Cologne, Germany
| |
Collapse
|
37
|
Kang DW, Wilson RL, Christopher CN, Normann AJ, Barnes O, Lesansee JD, Choi G, Dieli-Conwright CM. Exercise Cardio-Oncology: Exercise as a Potential Therapeutic Modality in the Management of Anthracycline-Induced Cardiotoxicity. Front Cardiovasc Med 2022; 8:805735. [PMID: 35097024 PMCID: PMC8796963 DOI: 10.3389/fcvm.2021.805735] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 12/23/2021] [Indexed: 12/19/2022] Open
Abstract
Anthracyclines are one of the most effective chemotherapy agents and have revolutionized cancer therapy. However, anthracyclines can induce cardiac injuries through ‘multiple-hits', a series of cardiovascular insults coupled with lifestyle risk factors, which increase the risk of developing short- and long-term cardiac dysfunction and cardiovascular disease that potentially lead to premature mortality following cancer remission. Therefore, the management of anthracycline-induced cardiotoxicity is a serious unmet clinical need. Exercise therapy, as a non-pharmacological intervention, stimulates numerous biochemical and physiologic adaptations, including cardioprotective effects, through the cardiovascular system and cardiac muscles, where exercise has been proposed to be an effective clinical approach that can protect or reverse the cardiotoxicity from anthracyclines. Many preclinical and clinical trials demonstrate the potential impacts of exercise on cardiotoxicity; however, the underlying mechanisms as well as how to implement exercise in clinical settings to improve or protect against long-term cardiovascular disease outcomes are not clearly defined. In this review, we summarize the current evidence in the field of “exercise cardio-oncology” and emphasize the utilization of exercise to prevent and manage anthracycline-induced cardiotoxicities across high-risk and vulnerable populations diagnosed with cancer.
Collapse
Affiliation(s)
- Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Epidemiology, School of Public Health, Boston University, Boston, MA, United States
| | - Amber J. Normann
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Health Sciences, Boston University, Boston, MA, United States
| | - Oscar Barnes
- Green Templeton College, University of Oxford, Oxford, United Kingdom
| | - Jordan D. Lesansee
- Department of Environmental and Radiological Health Sciences, Colorado State University, Fort Collins, CO, United States
| | | | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, United States
- Department of Medicine, Harvard Medical School, Boston, MA, United States
- *Correspondence: Christina M. Dieli-Conwright
| |
Collapse
|
38
|
McGovern A, Mahony N, Mockler D, Fleming N. Efficacy of resistance training during adjuvant chemotherapy and radiation therapy in cancer care: a systematic review and meta-analysis. Support Care Cancer 2022; 30:3701-3719. [PMID: 34993651 DOI: 10.1007/s00520-021-06708-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE To determine the effect of resistance training during adjuvant chemotherapy and radiation therapy in cancer patients on measures of lean mass and muscle strength. Secondary aims were to analyse the prescription and tolerability of supervised resistance training in this population. METHODS EMBASE, Medline, CINAHL, Cochrane Library and Web of Science were searched from inception until 29 March 2021. Eligible randomised controlled trials (RCTs) examining supervised resistance training > 6 weeks duration during adjuvant chemotherapy and/or radiation therapy in cancer patients with objective measurement of muscle strength and/or lean mass were included. The meta-analysis was performed using Revman 5.4. RESULTS A total of 1910 participants from 20 articles were included (mean age: 54 years, SD = 10) and the majority were female (76.5%). Resistance training was associated with a significant increase in upper body strength (standardised mean difference (SMD) = 0.57, 95% CI 0.36 to 0.79, I2 = 64%, P < 0.0001), lower body strength (SMD = 0.58, 95% CI 0.18 to 0.98, I2 = 91%, P = 0.005), grip strength (mean difference (MD) = 1.32, 95% CI 0.37 to 2.27, I2 = 0%, P < 0.01) and lean mass (SMD = 0.23, 95% CI 0.03 to 0.42, I2 = 0%, P = 0.02). A P value of < 0.05 was considered statistically significant. The quality of the studies included was moderate to high with low risk of bias as per the PEDro scale. CONCLUSION Resistance training is an effective adjunct therapy to improve muscle strength and lean mass in cancer patients undergoing chemotherapy and/or radiation therapy. PROSPERO REGISTRATION NUMBER CRD42020180643.
Collapse
Affiliation(s)
- Aoife McGovern
- Department of Anatomy, School of Medicine, Trinity College, Dublin, Ireland.
| | - Nicholas Mahony
- Department of Anatomy, School of Medicine, Trinity College, Dublin, Ireland
| | - David Mockler
- John Stearne Library, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Neil Fleming
- Department of Anatomy, School of Medicine, Trinity College, Dublin, Ireland
| |
Collapse
|
39
|
Bell KE, Pfeiffer AG, Schmidt S, Bos L, Russell C, Barnes T, Di Sebastiano KM, Avrutin E, Gibson M, Dubin JA, Mourtzakis M. Low-frequency exercise training improves cardiovascular fitness and strength during treatment for breast cancer: a single-arm intervention study. Sci Rep 2021; 11:22758. [PMID: 34815445 PMCID: PMC8610997 DOI: 10.1038/s41598-021-01962-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 10/26/2021] [Indexed: 11/09/2022] Open
Abstract
Aerobic and resistance exercise during and after cancer treatment are important for health-related outcomes, however treatment-specific barriers may inhibit adherence. We explored the effect of lower-frequency exercise training on fitness, body composition, and metabolic markers (i.e. glucose and lipids) in a group of recently diagnosed breast cancer patients. Fifty-two females ≥ 18 years with stage I-IIIB breast cancer were instructed to attend 2 cardiovascular and strength training sessions/week over 12 weeks, but program length was expanded as needed to accommodate missed sessions. Pre- and post-intervention, we measured: (1) cardiovascular fitness, (2) isometric strength, (3) body composition (dual-energy X-ray absorptiometry), and (4) fasting glucose, insulin, c-peptide, and lipids. Pre-intervention, participants were 53 ± 10 years old (mean ± SD) and overweight (BMI: 27.5 ± 5.4 kg m-2, 40.1 ± 6.5% body fat). Forty participants completed the program over a median 20 weeks (range: 13-32 weeks, median frequency: 1.2 sessions/week), over which predicted VO2peak improved by 7% (2.2[0.1-4.4] mL/kg/min) (delta[95% CI]), and strength increased by 7-9% (right arm: 2.3[0.1-4.5] N m; right leg: 7.9[2.1-13.7] N m; left leg: 7.8[1.9-13.7] N m). Body composition and metabolic markers were unchanged. An exercise frequency of 1.2 sessions/week stimulated significant improvements in fitness, and may represent a practical target for patients during active treatment.
Collapse
Affiliation(s)
- Kirsten E Bell
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Amanda G Pfeiffer
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Schuyler Schmidt
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Lisa Bos
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Caryl Russell
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Tyler Barnes
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Katie M Di Sebastiano
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Egor Avrutin
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Marielle Gibson
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Joel A Dubin
- School of Public Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada
| | - Marina Mourtzakis
- Department of Kinesiology and Health Sciences, University of Waterloo, Waterloo, ON, N2L 3G1, Canada.
| |
Collapse
|
40
|
Exercise to Reduce Anthracycline-Mediated Cardiovascular Complications in Breast Cancer Survivors. ACTA ACUST UNITED AC 2021; 28:4139-4156. [PMID: 34677269 PMCID: PMC8535000 DOI: 10.3390/curroncol28050351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 09/22/2021] [Accepted: 09/23/2021] [Indexed: 01/12/2023]
Abstract
While developments in cancer therapeutics have greatly reduced morbidity and mortality in females with breast cancer, it comes at a cost of an increased risk of cardiovascular complications. In particular, anthracyclines, like doxorubicin, which are a mainstay of current chemotherapy regimens, are associated with dose-dependent cardiotoxicity. Exercise has been widely accepted as an effective intervention in reducing cardiovascular risk in a variety of different clinical conditions. However, the benefits of exercise in anthracycline-mediated cardiotoxicity are not clearly understood. First, this review discusses the pre-clinical studies which have elucidated the cardioprotective mechanisms of aerobic and resistance exercise in improving cardiovascular function in the setting of anthracycline treatment. Next, it aims to summarize the results of aerobic and resistance exercise clinical trials conducted in females with breast cancer who received anthracycline-based chemotherapy. The review further discusses the current exercise guidelines for women undergoing chemotherapy and contraindications for exercise. Finally, the review addresses gaps in research, specifically the need for further clinical trials to establish a recommended exercise prescription within this patient population.
Collapse
|
41
|
Mallard J, Hucteau E, Hureau TJ, Pagano AF. Skeletal Muscle Deconditioning in Breast Cancer Patients Undergoing Chemotherapy: Current Knowledge and Insights From Other Cancers. Front Cell Dev Biol 2021; 9:719643. [PMID: 34595171 PMCID: PMC8476809 DOI: 10.3389/fcell.2021.719643] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Accepted: 08/10/2021] [Indexed: 01/18/2023] Open
Abstract
Breast cancer represents the most commonly diagnosed cancer while neoadjuvant and adjuvant chemotherapies are extensively used in order to reduce tumor development and improve disease-free survival. However, chemotherapy also leads to severe off-target side-effects resulting, together with the tumor itself, in major skeletal muscle deconditioning. This review first focuses on recent advances in both macroscopic changes and cellular mechanisms implicated in skeletal muscle deconditioning of breast cancer patients, particularly as a consequence of the chemotherapy treatment. To date, only six clinical studies used muscle biopsies in breast cancer patients and highlighted several important aspects of muscle deconditioning such as a decrease in muscle fibers cross-sectional area, a dysregulation of protein turnover balance and mitochondrial alterations. However, in comparison with the knowledge accumulated through decades of intensive research with many different animal and human models of muscle atrophy, more studies are necessary to obtain a comprehensive understanding of the cellular processes implicated in breast cancer-mediated muscle deconditioning. This understanding is indeed essential to ultimately lead to the implementation of efficient preventive strategies such as exercise, nutrition or pharmacological treatments. We therefore also discuss potential mechanisms implicated in muscle deconditioning by drawing a parallel with other cancer cachexia models of muscle wasting, both at the pre-clinical and clinical levels.
Collapse
Affiliation(s)
- Joris Mallard
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France.,Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle, UR 3072, Université de Strasbourg, Strasbourg, France.,Faculté des Sciences du Sport, Centre Européen d'Enseignement de Recherche et d'Innovation en Physiologie de l'Exercice (CEERIPE), Université de Strasbourg, Strasbourg, France
| | - Elyse Hucteau
- Institut de Cancérologie Strasbourg Europe (ICANS), Strasbourg, France.,Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle, UR 3072, Université de Strasbourg, Strasbourg, France.,Faculté des Sciences du Sport, Centre Européen d'Enseignement de Recherche et d'Innovation en Physiologie de l'Exercice (CEERIPE), Université de Strasbourg, Strasbourg, France
| | - Thomas J Hureau
- Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle, UR 3072, Université de Strasbourg, Strasbourg, France.,Faculté des Sciences du Sport, Centre Européen d'Enseignement de Recherche et d'Innovation en Physiologie de l'Exercice (CEERIPE), Université de Strasbourg, Strasbourg, France
| | - Allan F Pagano
- Centre de Recherche en Biomédecine de Strasbourg (CRBS), Fédération de Médecine Translationnelle, UR 3072, Université de Strasbourg, Strasbourg, France.,Faculté des Sciences du Sport, Centre Européen d'Enseignement de Recherche et d'Innovation en Physiologie de l'Exercice (CEERIPE), Université de Strasbourg, Strasbourg, France
| |
Collapse
|
42
|
Vermeer CJC, Hiensch AE, Cleenewerk L, May AM, Eijkelkamp N. Neuro-immune interactions in paclitaxel-induced peripheral neuropathy. Acta Oncol 2021; 60:1369-1382. [PMID: 34313190 DOI: 10.1080/0284186x.2021.1954241] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Paclitaxel is a taxane-based chemotherapeutic agent used as a treatment in breast cancer. There is no effective prevention or treatment strategy for the most common side effect of peripheral neuropathy. In this manuscript, we reviewed the molecular mechanisms that contribute to paclitaxel-induced peripheral neuropathy (PIPN) with an emphasis on immune-related processes. METHODS A systematic search of the literature was conducted in PubMed, EMBASE and Cochrane Library. The SYRCLE's risk of bias tool was used to assess internal validity. RESULTS 156 studies conducted with rodent models were included. The risk of bias was high due to unclear methodology. Paclitaxel induces changes in myelinated axons, mitochondrial dysfunction, and mechanical hypersensitivity by affecting ion channels expression and function and facilitating spinal transmission. Paclitaxel-induced inflammatory responses are important contributors to PIPN. CONCLUSION Immune-related processes are an important mechanism contributing to PIPN. Studies in humans that validate these mechanistic data are highly needed to facilitate the development of therapeutic strategies.
Collapse
Affiliation(s)
- Cornelia J. C. Vermeer
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anouk E. Hiensch
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Laurence Cleenewerk
- Center of Translational Immunology (CTI), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niels Eijkelkamp
- Center of Translational Immunology (CTI), University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
43
|
Virtual Reality as a Promising Tool Supporting Oncological Treatment in Breast Cancer. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168768. [PMID: 34444513 PMCID: PMC8393836 DOI: 10.3390/ijerph18168768] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 08/11/2021] [Accepted: 08/16/2021] [Indexed: 01/22/2023]
Abstract
Breast cancer (BC) treatment is associated with many physical and psychological symptoms. Psychological distress or physical dysfunction are one of the most common side effects of oncological treatment. Functional dysfunction and pain-related evasion of movement may increase disability in BC. Virtual reality (VR) can offer BC women a safe environment within which to carry out various rehabilitation interventions to patient support during medical procedures. The aim of this systematic review was to conduct an overview of the clinical studies that used VR therapy in BC. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines method: the initial search identified a total of 144 records, and 11 articles met the review criteria and were selected for the analysis. The results showed that VR seems to be a promising tool supporting oncological treatment in BC patients. VR can have a positive effect on mental and physical functions, such as relieving anxiety during oncotherapy, diminution pain syndrome, and increasing the range of motion and performance in daily activities.
Collapse
|
44
|
Tang X. The effect of multi-supportive nursing on the postoperative rehabilitation of breast cancer patients. Am J Transl Res 2021; 13:7327-7334. [PMID: 34306501 PMCID: PMC8290794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 02/21/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To explore the effect of multi-supportive nursing on the postoperative rehabilitation of breast cancer (BC) patients. METHODS A total of 96 BC patients who underwent radical mastectomies in our hospital from January 2014 to January 2017 were recruited as the study cohort. The patients were equally divided into a regular group and a research group, with 48 cases in each group. The regular group underwent conventional postoperative nursing, and the research group underwent multi-supportive nursing. We compared the changes in the two groups of patients' quality of life, their psychological states, and their upper limb function before and after the nursing. The nursing satisfaction and the two groups' survival times were also analyzed after the 3-year follow-up. RESULTS The Functional Assessment of Cancer Therapy-Breast (FACT-B) and the Connor- Davidson Resilience Scale (CD-RISC) subitem scores and the activity angles of the involved shoulder joints in the two groups were increased after the nursing and were better in the research group (all P < 0.05). The involved upper limb lymphedema scores in the two groups were reduced after the nursing and the research group showed a lower level than the regular group (all P < 0.05). The nursing satisfaction was higher in the research group compared with the regular group (97.92% vs. 85.42%, P < 0.05). During the 3-year follow-up, the Progression Free Survival (PFS) in the research group was longer than it was in the regular group (P < 0.05). CONCLUSION Multi-supportive nursing plays a positive role in promoting patients' postoperative rehabilitation.
Collapse
Affiliation(s)
- Xiaoxiao Tang
- Medical Oncology 1, Xingtai People's Hospital Xingtai, China
| |
Collapse
|
45
|
Lee K, Norris MK, Wang E, Dieli-Conwright CM. Effect of high-intensity interval training on patient-reported outcomes and physical function in women with breast cancer receiving anthracycline-based chemotherapy. Support Care Cancer 2021; 29:6863-6870. [PMID: 34018031 DOI: 10.1007/s00520-021-06294-7] [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: 09/21/2020] [Accepted: 05/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE The purpose of this study was to determine the effects of an 8-week HIIT intervention on patient-reported outcomes and physical function in breast cancer patients undergoing anthracycline-based chemotherapy. METHODS Thirty breast cancer patients were recruited prior to initiating treatment and randomized into the HIIT group (n = 15) or control (CON) group (n = 15). The HIIT group attended HIIT sessions three days per week for eight weeks. The CON group was asked to maintain their current level of physical activity. Patient-reported outcomes were assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Multidimensional Fatigue Inventory with 20 questions (MFI-20), and the 15-item Five-Facet Mindfulness Questionnaire (FFMQ-15). Physical function was assessed using the timed up and go (TUG), 30-s sit-to-stand (30STS), Margaria-Kalamen stair climb test, and 6-min walk test (6MWT). Repeated measures ANCOVA and paired t-tests were performed to assess group differences. RESULTS All patients completed the 8-week study with 82.3% adherence to the intervention among the HIIT group. Post-intervention, significant improvements were found for the Margaria-Kalamen stair climb test (- 3.39%; P = 0.013) and 6MWT (+ 11.6%; P = 0.008) in the HIIT group compared to baseline and CON group. No changes in patient-reported outcomes, TUG, and 30STS were observed following the 8-week study period in both groups (P > 0.05). CONCLUSIONS HIIT may be an effective strategy to improve physical function and possibly maintain QOL in breast cancer patients undergoing the anthracycline-based chemotherapy. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov: NCT02454777.
Collapse
Affiliation(s)
- Kyuwan Lee
- Department of Population Sciences, Beckman Research Institute, City of Hope (COH), Duarte, CA, 91010, USA
| | - Mary K Norris
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Avenue, Boston, MA, 02215, USA
| | - Ellice Wang
- Department of Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Christina M Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 375 Longwood Avenue, Boston, MA, 02215, USA.
| |
Collapse
|
46
|
Schutz S, Aidar FJ, Souza RLM, dos Santos JL, Voltarelli FA, Vieira Junior RC, Soares NMM, Marçal AC. Different Methods of Physical Training Applied to Women Breast Cancer Survivors: A Systematic Review. Front Physiol 2021; 12:639406. [PMID: 33935799 PMCID: PMC8079809 DOI: 10.3389/fphys.2021.639406] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 03/22/2021] [Indexed: 01/15/2023] Open
Abstract
Objective: The objective of this systematic review was to identify the effects of different training methods in women who have survived breast cancer (WSBC). Data Sources: Studies were identified by searching SportDiscus, Web of Science, PubMed, Scopus, Scielo, and Bireme. Study Selection: The inclusion criteria were articles that addressed only breast cancer in women, were randomized clinical trials, and interventions involving physical training with Consort ≥80. Data Extraction: The PICO and CONSORT strategies were used for the selection of articles and quality assessment of randomized clinical trials, respectively. Two independent reviewers searched for articles among the databases. Disagreements were discussed, and in the case of an impasse, a third reviewer was consulted. Data Synthesis: Evidence that demonstrated the beneficial effects of physical exercise programs carried out by WSBC. Moderate or high-intensity exercise sessions have been shown to benefit women survivors of breast cancer. Among the modalities, the resistance exercise showed effects from 55% of one-repetition maximum (1 RM), exclusively or associated with other training regimes, such as aerobic (from 48% of heart rate), high-intensity interval training (HIIT), or impact. The main benefits include increased muscle strength, promoted by the practice of resistance exercise in combination with other types of exercises or alone; decreased fatigue; improved quality of life; improved psychosocial effects, and increased leisure time. Conclusions: Physical training performed at a moderate or high intensity (aerobic or anaerobic) can reduce fatigue, improve quality of life, improve sleep quality, and increase bone mineral density in women survivors of breast cancer.
Collapse
Affiliation(s)
- Silvia Schutz
- Department of Physical Education, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | - Felipe J. Aidar
- Department of Physical Education, Universidade Federal de Sergipe, São Cristóvão, Brazil
- Group of Studies and Research of Performance, Sport, Health, and Paralympic Sports, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | | | - Jymmys Lopes dos Santos
- Department of Physical Education, Universidade Federal de Sergipe, São Cristóvão, Brazil
- Department of Physiology, Universidade Federal de Sergipe, São Cristóvão, Brazil
| | - Fabrício Azevedo Voltarelli
- Graduate Program of Health Sciences, Faculty of Medicine, Universidade Federal de Mato Grosso, Cuiabá, Brazil
| | | | | | | |
Collapse
|
47
|
Understanding the biology of volumetric muscle loss for an individualized exercise rehabilitation approach in breast cancer patients. Curr Opin Pharmacol 2021; 58:27-34. [PMID: 33848933 DOI: 10.1016/j.coph.2021.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/11/2021] [Accepted: 03/14/2021] [Indexed: 12/11/2022]
Abstract
Muscle maintenance relies on a multidimensional biologic balance that is extremely delicate in breast cancer patients, particularly those with advanced-stage disease. The biology that underpins breast cancer tumorigenesis, tumor progression and response to pharmacotherapies can modify muscle homeostasis, resulting in volumetric muscle loss. This condition dramatically increases the overall patients' frailty, leading to reduced survival and impaired quality of life. Physical activity may potentially improve muscle health in these patients, providing that an optimal patients selection is performed. The understanding of volumetric muscle loss biology in breast cancer survivors, coupled with focused clinical studies, would allow for the implementation of individualized rehabilitation protocols.
Collapse
|
48
|
Exercise-A Panacea of Metabolic Dysregulation in Cancer: Physiological and Molecular Insights. Int J Mol Sci 2021; 22:ijms22073469. [PMID: 33801684 PMCID: PMC8037630 DOI: 10.3390/ijms22073469] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/21/2021] [Accepted: 03/24/2021] [Indexed: 12/14/2022] Open
Abstract
Metabolic dysfunction is a comorbidity of many types of cancers. Disruption of glucose metabolism is of concern, as it is associated with higher cancer recurrence rates and reduced survival. Current evidence suggests many health benefits from exercise during and after cancer treatment, yet only a limited number of studies have addressed the effect of exercise on cancer-associated disruption of metabolism. In this review, we draw on studies in cells, rodents, and humans to describe the metabolic dysfunctions observed in cancer and the tissues involved. We discuss how the known effects of acute exercise and exercise training observed in healthy subjects could have a positive outcome on mechanisms in people with cancer, namely: insulin resistance, hyperlipidemia, mitochondrial dysfunction, inflammation, and cachexia. Finally, we compile the current limited knowledge of how exercise corrects metabolic control in cancer and identify unanswered questions for future research.
Collapse
|
49
|
Strandberg E, Vassbakk-Svindland K, Henriksson A, Johansson B, Vikmoen O, Kudrén D, Schauer T, Lindman H, Wärnberg F, Berntsen S, Demmelmaier I, Nordin K, Raastad T. Effects of heavy-load resistance training during (neo-)adjuvant chemotherapy on muscle cellular outcomes in women with breast cancer. Medicine (Baltimore) 2021; 100:e24960. [PMID: 33725859 PMCID: PMC7969308 DOI: 10.1097/md.0000000000024960] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION (Neo-)adjuvant chemotherapy for breast cancer has a deleterious impact on muscle tissue resulting in reduced cardiorespiratory fitness, skeletal muscle mass and function. Physical exercise during treatment may counteract some of these negative effects. However, the effects of resistance training (RT) alone have never been explored. The present study aims to investigate if heavy-load RT during (neo-)adjuvant chemotherapy counteracts deleterious effects on skeletal muscle in women diagnosed with breast cancer. We hypothesize that (neo-)adjuvant treatment with chemotherapy will reduce muscle fiber size, impair mitochondrial function, and increase indicators of cellular stress and that RT during treatment will counteract these negative effects. We also hypothesize that RT during (neo-)adjuvant chemotherapy will increase muscle and blood levels of potential antitumor myokines and reduce treatment-related side effects on muscle strength and cardiorespiratory fitness. METHODS Fifty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to either randomized to either intervention group or to control group.The intervention group will perform supervised heavy-load RT twice a week over the course of chemotherapy (approximately 16-weeks) whereas the control group will be encouraged to continue with their usual activities. Muscle biopsies from m. vastus lateralis will be collected before the first cycle of chemotherapy (T0), after chemotherapy (T1), and 6 months later (T2) for assessment of muscle cellular outcomes. The primary outcome for this study is muscle fiber size. Secondary outcomes are: regulators of muscle fiber size and function, indicators of cellular stress and mitochondrial function, myokines with potential antitumor effects, muscle strength, and cardiorespiratory fitness. ETHICS AND DISSEMINATION Ethical approval has been obtained from the Regional Ethical Review Board in Uppsala, Sweden (Dnr:2016/230/2). Results will be disseminated through presentations at scientific meetings, publications in peer-reviewed journals, social media, and patient organizations. TRIAL REGISTRATION NUMBER NCT04586517.
Collapse
Affiliation(s)
| | | | | | - Birgitta Johansson
- Department of Public Health and Caring Sciences
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Olav Vikmoen
- Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway
| | - David Kudrén
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Tim Schauer
- Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Lindman
- Department of Oncology, Uppsala University Hospital, Uppsala
| | - Fredrik Wärnberg
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | | | | | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Science, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| |
Collapse
|
50
|
Wiggenraad F, Bolam KA, Mijwel S, van der Wall E, Wengström Y, Altena R. Long-Term Favorable Effects of Physical Exercise on Burdensome Symptoms in the OptiTrain Breast Cancer Randomized Controlled Trial. Integr Cancer Ther 2021; 19:1534735420905003. [PMID: 32090630 PMCID: PMC7040931 DOI: 10.1177/1534735420905003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose: We evaluate longitudinal changes in symptom clusters and core burdensome symptoms in breast cancer patients who participated in the OptiTrain trial. Methods: 240 women were randomized to 16 weeks of supervised exercise (RT-HIIT or AT-HIIT) or usual care (UC) during adjuvant chemotherapy. Symptom clusters were composed using the Memorial Symptom Assessment Scale (MSAS), assessed at baseline, 16 weeks and 12 months later. Three symptom clusters were formed. Results: Three symptom clusters were identified: "emotional," "treatment-related toxicity," and "physical," with core burdensome symptoms present over time. At 16 weeks, the reported burdens of "feeling sad" (RT-HIIT vs UC: effect size [ES] = -0.69; AT-HIIT vs UC: ES = -0.56) and "feeling irritable" (ES = -0.41 RT-HIIT; ES = -0.31 AT-HIIT) were significantly lower in both intervention groups compared with UC. At 12 months, the AT-HIIT group continued to have significantly lower scores for the core burdensome symptoms "feeling sad" (ES = -0.44), "feeling irritable" (ES = -0.44), and "changes in the way food tastes" (ES = -0.53) compared with UC. No between-group differences were found for physical symptoms. Conclusion: We identified 3 symptom clusters in breast cancer patients during and after adjuvant chemotherapy, composed of "emotional," "treatment-related toxicity," and "physical" symptoms. After treatment completion up to 12 months post-baseline, patients in the physical exercise groups reported lower symptom burden scores for emotional symptoms, compared with UC. Our findings indicate a preserved and long-term beneficial effect of physical exercise on self-reported emotional well-being in chemotherapy-treated breast cancer patients.
Collapse
Affiliation(s)
| | | | | | | | - Yvonne Wengström
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| | - Renske Altena
- Karolinska Institutet, Stockholm, Sweden.,Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|