Cardiorespiratory fitness, physical activity and cancer mortality in men

Synthesis, enzyme inhibition assay, and molecular modeling study of novel pyrazolines linked to 4-methylsulfonylphenyl scaffold: antitumor activity and cell cycle analysis

Antitumor activity using 59 cancer cell lines and enzyme inhibitory activity of a newly synthesized pyrazoline-linked 4-methylsulfonylphenyl scaffold (compounds 18a-q) were measured and compared with those of standard drugs. Pyrazolines 18b, 18c, 18f, 18g, 18h, and 18n possessed significant antitumor activity, with a positive cytotoxic effect (PCE) of 22/59, 21/59, 21/59, 48/59, 51/59, and 20/59, respectively. The cancer cell lines HL60, MCF-7, and MDA-MB-231 were used to measure the IC50 values of derivatives 18c, 18g, and 18hvia the MTT assay method, and the results were compared with those of reference drugs. Derivatives 18g and 18h showed potent and broad-spectrum antitumor activities against HL60 (IC50 of 10.43, 8.99 μM, respectively), MCF-7 (IC50 of 11.7 and 12.4 μM, respectively), and MDA-MB-231 (IC50 of 4.07 and 7.18 μM, respectively). Compound 18c exhibited strong antitumor activity against HL60 and MDA-MB-231 cell lines with IC50 values of 8.43 and 12.54 μM, respectively, and moderate antitumor activity against MCF-7 cell lines with an IC50 value of 16.20 μM. Compounds 18c, 18g, and 18h remarkably inhibited VEGFR2 kinase (IC50 = 0.218, 0.168, and 0.135 μM, respectively) compared with the reference drug sorafenib (IC50 = 0.041 μM). Compounds 18g and 18h effectively inhibited HER2 kinase (IC50 = 0.496 and 0.253 μM, respectively) compared with erlotinib (IC50 = 0.085 μM). Compound 18h inhibited EGFR kinase (IC50 = 0.574 μM) with a potency comparable with that of the reference drug erlotinib (IC50 = 0.105 μM). Pyrazolines 18c, 18f, and 18h arrested the S/G2 phase of the cell cycle in HL-60 cells. In addition, derivatives 18c, 18f, and 18h revealed lower Bcl-2 protein expression anti-apoptotic levels and higher Bax, caspase-3, and caspase-9 expression levels. Molecular docking studies of derivative 18h into the binding sites of EGFR, HER2, and VEGFR2 kinases explored the interaction mode of these pyrazoline derivatives and their structural requirements for antitumor activity.

Exercise Test Predicts Both Noncardiovascular and Cardiovascular Death in a Primary Prevention Population

OBJECTIVE

To identify specific causes of death and determine the prevalence of noncardiovascular (non-CV) deaths in an exercise test referral population while testing whether exercise test parameters predict non-CV as well as CV deaths.

PATIENTS AND METHODS

Non-imaging exercise tests on patients 30 to 79 years of age from September 1993 to December 2010 were reviewed. Patients with baseline CV diseases and non-Minnesota residents were excluded. Mortality through January 2016 was obtained through Mayo Clinic Records and the Minnesota Death Index. Exercise test abnormalities included low functional aerobic capacity (ie, less than 80%), heart rate recovery (ie, less than 13 beats/min), low chronotropic index (ie, less than 0.8), and abnormal exercise electrocardiogram (ECG) of greater than or equal to 1.0 mm ST depression or elevation. We also combined these four abnormalities into a composite exercise test score (EX_SCORE). Statistical analyses consisted of Cox regression adjusted for age, sex, diabetes, hypertension, obesity, current and past smoking, and heart rate-lowering drug.

RESULTS

The study identified 13,382 patients (females: n=4736, 35.4%, 50.5±10.5 years of age). During 12.7±5.0 years of follow-up, there were 849 deaths (6.3%); of these 162 (19.1%) were from CV; 687 (80.9%) were non-CV. Hazard ratios for non-CV death were significant for low functional aerobic capacity (HR, 1.42; 95% CI, 1.19 to 1.69; P<.0001), abnormal heart rate recovery (HR, 1.36; 95% CI, 1.15 to 1.61; P<.0033), and low chronotropic index (HR, 1.49; 95% CI, 1.26 to 1.77; P<.0001), whereas abnormal exercise ECG was not significant. All exercise test abnormalities including EX_SCORE were more strongly associated with CV death versus non-CV death except abnormal exercise ECG.

CONCLUSION

Non-CV deaths predominated in this primary prevention cohort. Exercise test abnormalities not only predicted CV death but also non-CV death.

Absolute and Relative Handgrip Strength as Indicators of Self-Reported Physical Function and Quality of Life in Breast Cancer Survivors: The EFICAN Study

Simple Summary

Breast cancer is the most diagnosed type of cancer worldwide and it has a high survival rate. Thus, side effects related to breast cancer and treatments compromise lots of people’s physical functions and health-related quality of life. For this reason, it is important to manage these side effects in the follow up after treatments. The handgrip strength and the handgrip strength relative to body mass index may constitute useful, simple, quick and economically feasible tools that may help clinicians detecting these side effects, which is key to undertake actions for improving the physical function and health-related quality of life of breast cancer survivors.

Abstract

Background: Although breast cancer (BC) is the most prevalent type of cancer in the world, its high survival rate implies that many people live long after the treatments and face their side effects. The physical function (PF) and health-related quality of life (HRQoL) of people surviving BC decreases significantly, which makes important to identify markers that may be associated with a better health status and prognosis. Previous studies suggest that handgrip strength (HGS) and HGS relative to the body mass index (rHGS) are good indicators of PF and HRQoL in different populations. However, it is unknown whether this applies to BC survivors. This study aimed to evaluate the association of HGS and rHGS with PF and HRQoL in this population. Methods: Sixty female BC survivors participated. Handgrip strength was assessed with a dynamometer. Arm volume was estimated and upper limb impairments, as well as cancer-related fatigue, depression, life satisfaction and HRQoL, were assessed using standardized questionnaires. Results: Higher levels of HGS and rHGS were associated with higher levels of HRQoL, lower cancer-related fatigue, and fewer problems with the affected arm. Conclusions: These results suggest that HGS may be a good indicator of self-reported PF and HRQoL in female BC survivors.

Exercise training-induced adaptations in lung cancer patients who have undergone a lobectomy

PURPOSE

To determine the safety and effectiveness of a prescribed, individualized, 12-week exercise intervention on cardiorespiratory function, muscular strength, and quality of life in lung cancer patients who have undergone a lobectomy. In addition, we sought to compare the exercise training response of lung cancer patients who have undergone a lobectomy to a population of cancer patients with all other cancers in order to examine the specific effects of a lobectomy when compared to cancer patients at large.

METHODS

Participants were referred by a physician, and upon entry, completed an exercise-based assessment and surveys to assess various quality of life measures. Participants were divided into two groups: lung cancer patients having undergone a lobectomy (LOB, n = 9) or those diagnosed with all other cancers (AOC, n = 201). Participants underwent 12 weeks of supervised exercise based on an individualized exercise prescription. Measures of cardiorespiratory function, muscular strength, and quality of life were collected prior to the intervention and after 12 weeks of exercise training.

RESULTS

Significant improvements to VO_2peak (p < 0.05) were seen in both groups. Significant improvements to muscular strength (p < 0.05) were seen in both groups for all measures aside from shoulder press in the LOB group. Both groups showed significant improvements to aspects of fatigue and quality of life (p < 0.05), but only the AOC group significantly improved in measures of depression (p < 0.05).

CONCLUSION

Exercise-based rehabilitation is a safe and effective intervention for lung cancer survivors who have undergone a lobectomy. These individuals saw significant improvements in cardiorespiratory fitness, muscular strength, and quality of life. Although there were similarities in the pattern of these training-induced improvements for these groups, lung cancer patients undergoing a lobectomy consistently demonstrated lower absolute values when compared to patients with all other cancer diagnoses.

Synthesis, potential antitumor activity, cell cycle analysis, and multitarget mechanisms of novel hydrazones incorporating a 4-methylsulfonylbenzene scaffold: a molecular docking study

Hydrazone is a bioactive pharmacophore that can be used to design antitumor agents. We synthesised a series of hydrazones (compounds 4–24) incorporating a 4-methylsulfonylbenzene scaffold and analysed their potential antitumor activity. Compounds 6, 9, 16, and 20 had the most antitumor activity with a positive cytotoxic effect (PCE) of 52/59, 27/59, 59/59, and 59/59, respectively, while compounds 5, 10, 14, 15, 18, and 19 had a moderate antitumor activity with a PCE of 11/59–14/59. Compound 20 was the most active and had a mean 50% cell growth inhibition (GI₅₀) of 0.26 µM. Compounds 9 and 20 showed the highest inhibitory activity against COX-2, with a half-maximal inhibitory concentration (IC₅₀) of 2.97 and 6.94 μM, respectively. Compounds 16 and 20 significantly inhibited EGFR (IC₅₀ = 0.2 and 0.19 μM, respectively) and HER2 (IC₅₀ = 0.13 and 0.07 μM, respectively). Molecular docking studies of derivatives 9, 16, and 20 into the binding sites of COX-2, EGFR, and HER2 were carried out to explore the interaction mode and the structural requirements for antitumor activity.

Criterion Validity and Responsiveness of the Steep Ramp Test to Evaluate Aerobic Capacity in Survivors of Cancer Participating in a Supervised Exercise Rehabilitation Program

OBJECTIVE

To evaluate the criterion validity and responsiveness of the steep ramp test (SRT) compared with the cardiopulmonary exercise test (CPET) in evaluating aerobic capacity in survivors of cancer participating in a rehabilitation program.

DESIGN

A prospective cohort study in which survivors of cancer performed an SRT and CPET before (T=0) and after (T=1) a 10-week exercise rehabilitation program. Peak work rate achieved during the SRT (SRT-WRpeak) was compared with peak oxygen consumption measured during the CPET (CPET-Vo₂peak), which is the criterion standard for aerobic capacity. Correlation coefficients were calculated between SRT-WRpeak and CPET-Vo₂peak at T=0 to examine criterion validity and between changes in SRT-WRpeak and CPET-Vo₂peak from T=0 to T=1 to determine responsiveness. Receiver operating characteristic analysis was performed to examine the ability of the SRT to detect a true improvement (6%) in CPET-Vo₂peak.

SETTING

University medical center.

PARTICIPANTS

Survivors of cancer (N=106).

INTERVENTIONS

Exercise rehabilitation.

MAIN OUTCOME MEASURES

Correlation coefficients between CPET-Vo₂peak and SRT-WRpeak and between changes in CPET-Vo₂peak and SRT-WRpeak.

RESULTS

An r of 0.86 (N=106) was found for the relation between SRT-WRpeak and CPET-Vo₂peak at T=0. An r of 0.51 was observed for the relation between changes in SRT-WRpeak and CPET-Vo₂peak (n=59). Receiver operating characteristic analysis showed an area under the curve of 0.74 for the SRT to detect a true improvement in CPET-Vo₂peak, with an optimal cutoff value of +0.26 W/kg (sensitivity 70.7%, specificity 66.7%).

CONCLUSIONS

Because SRT-WRpeak and CPET-Vo₂peak were strongly correlated, the SRT seems a valid tool to estimate aerobic capacity in survivors of cancer. The responsiveness to measure changes in aerobic capacity appears moderate. Nevertheless, the SRT seems able to detect improvement in aerobic capacity, with a cutoff value of 0.26 W/kg.

The impact of a hospital-based exercise oncology program on cancer treatment-related side effects among rural cancer survivors

Purpose

To assess the impact of the Personal Optimism With Exercise Recovery (POWER) program on cancer treatment–related side effects among rural cancer survivors.

Methods

In this retrospective study of data collected between 2016 and 2019, we assessed change in cardiorespiratory fitness, whole-body muscular endurance, physical function and strength, anthropometrics, fatigue, and quality of life (QoL), after participation in POWER. Descriptive statistics were calculated for demographic and clinical variables. Univariate analysis of variance was carried out with age and BMI at initial assessment as covariates.

Results

A total of 239 survivors, 78% rural residents, completed a follow-up assessment. Among rural cancer survivors, the most prevalent cancer sites were breast (42.5%), prostate (12.4%), and lymphoma (5.9%). The majority of survivors were female (70%), non-Hispanic (94.6%), and white (93.5%), with average age and BMI of 62.1 ± 13.2 years and 28.4 ± 6.7 kg/m², respectively. Rural cancer survivors with cancer stages I–III exhibited significant improvements in fitness (+ 3.07 ml/kg/min, 95% CI 1.93, 4.21; + 0.88 METS, 95% CI 0.55, 1.20), physical function (30-s chair stand: + 2.2 repetitions, 95% CI 1.3, 3.1), muscular endurance (10-repetition maximum: chest press + 4.1 kg, 95% CI 2.0, 6.3; lateral pulldown + 6.6 kg, 95% CI 4.4, 8.9), self-reported fatigue (FACIT-Fatigue score: + 4.9, 95% CI 1.6, 8.1), and QoL (FACT-G7 score + 2.1, 95% CI, 0.9, 3.4). Among stage IV rural and urban cancer survivors, significant improvements were observed in muscular endurance and physical function.

Conclusion

Participation in POWER was associated with attenuation of cancer treatment–related side effects and may serve as a model exercise oncology program for rural cancer survivors.

Antitumor activity, multitarget mechanisms, and molecular docking studies of quinazoline derivatives based on a benzenesulfonamide scaffold: Cell cycle analysis

The in vitro cytotoxicity of some substituted quinazolinones, 1-15, was evaluated using NCI (10 µM) in a full NCI 59-cell line panel assay. Relative to the reference drug, imatinib (PCE = 20/59), compounds 3, 4, 7, 9, and 10 exhibited remarkable antitumor activity against the tested cell lines, with positive cytotoxic effects (PCE) of 29/59, 18/59, 17/59, 44/59, and 24/59 respectively. Enzymatic inhibitory assay conducted on 3, 4, 9, and 10 as the most potent antitumor agents against EGFR, HER2 and CDK9 kinases, and COX-2 enzyme. Compound 3 possessed good COX-2 inhibitory activity (IC50 = 0.775 μM) compared to the reference drug, celecoxib (IC50 = 0.153 μM). Compounds 4 and 9 were closely potent to the reference compounds against EGFR and (HER2) tyrosine kinases, with IC50 values of 90.17 (and 131.39 for HER2) for 4 and 145.35 (and 129.07 for HER2) nM for 9; the reference drugs in this case, namely, gefitinib and erlotinib, exhibited IC50 values of 55.58 (90) and 110 (79.28) nM against the EGFR and (HER2) tyrosine kinases, respectively. Compound 4 was approximately similar potent against CDK9 kinase (IC50 = 67.04 nM) like the reference compound, dinaciclib (IC50 = 53.12 nM). Compound 9 induced cytotoxicity in the MCF-7 cell line (GI % at 10.0 μM = 47%) through pre-G1 apoptosis, thereby inhibiting cell growth at the G2/M phase. Molecular docking models of 3 and 4 with COX-2, EGFR, and CDK9 were conducted to determine their binding mode within the putative binding pockets.

Association of Prediagnostic Frailty, Change in Frailty Status, and Mortality After Cancer Diagnosis in the Women's Health Initiative

IMPORTANCE

Understanding changes in frailty in relation to cancer diagnosis can inform optimal selection of cancer treatments and survivorship care.

OBJECTIVE

To investigate associations of prediagnostic frailty and change in frailty status with mortality after a cancer diagnosis.

DESIGN, SETTING, AND PARTICIPANTS

This multicenter, prospective cohort study included 7257 community-dwelling, postmenopausal women in the United States who had frailty assessed at the Women's Health Initiative (WHI) enrollment (1993-1998) and the 3-year visit who were subsequently diagnosed as having invasive cancer. The data were analyzed from January 7, 2019, to June, 8, 2020.

EXPOSURE

Frailty scores were defined from validated questionnaire items conceptually aligned with the Fried frailty phenotype, including at least 3 of the following characteristics: self-reported unintentional weight loss, exhaustion, low physical activity, and muscle weakness or impaired walking. Physical function components of the frailty score were updated a median of 10 (range, 1-18) times.

MAIN OUTCOMES AND MEASURES

Using multivariable-adjusted Cox proportional hazards models, this study examined associations of prediagnostic frailty (at the 3-year visit, before cancer diagnosis) and prediagnostic changes in frailty (from enrollment to the 3-year visit) with mortality. Women were followed up beginning from cancer diagnosis for mortality outcomes through March 2018. In linear mixed-effects models with frailty scores as a function of time since cancer diagnosis, this study evaluated whether the time slope, ie, the rate of change in frailty score, increased after cancer diagnosis.

RESULTS

This study included 7257 women in the WHI cohort who completed frailty assessments at enrollment and the 3-year WHI visit before cancer diagnosis and subsequently developed cancer. Cancer cases included 2644 breast cancers (36%), 822 lung cancers (11%), 691 colorectal cancers (10%), 445 endometrial cancers (6%), and 286 ovarian cancers (4%). At the 3-year visit, prior to cancer diagnosis, the mean (SD) age was 63 (7) years, and 1161 of 7257 (16%) of participating women met criteria for frailty; 2129 of 7257 (29%) were prefrail, and 3967 of 7257 (55%) were nonfrail. Over a median follow-up of 5.8 years after cancer diagnosis (range, 1 day to 19.9 years), 3056 women died. After multivariable adjustment, women who were frail (vs nonfrail) before cancer diagnosis had an increased risk of mortality after cancer diagnosis (hazard ratio [HR], 1.40; 95% CI, 1.26-1.55; P for trend <.001). Sustained frailty (21% [1537 of 7257] of women) or worsening frailty (22% [1578 of 7257]) vs being consistently nonfrail (45% [3266 of 7257]) before cancer diagnosis increased the risk of mortality after cancer diagnosis (HR, 1.25; 95% CI, 1.14-1.38 and 1.22; 95% CI, 1.11-1.34, respectively; P for trend <.001). In linear mixed-effects models, the rate of increase in physical frailty over time was statistically significantly higher after cancer diagnosis.

CONCLUSIONS AND RELEVANCE

Sustained and worsening frailty before cancer diagnosis was associated with an increased risk of mortality after cancer diagnosis in postmenopausal women. Furthermore, the rate of decline in physical function accelerated after cancer diagnosis. Frailty assessment could provide valuable information and perhaps prompt interventions to reduce and preempt worsening of physical frailty after cancer diagnosis.

Prehabilitative Exercise for the Enhancement of Physical, Psychosocial, and Biological Outcomes Among Patients Diagnosed with Cancer

PURPOSE OF REVIEW

This review summarizes the effects of prehabilitative exercise interventions on the physical, psychosocial, and biological outcomes among patients with cancer. Current gaps and future directions in prehabilitative exercise research will be addressed.

RECENT FINDINGS

Prehabilitative exercise mitigates the detrimental impact of cancer surgery on physical fitness, noted by increases in maximal oxygen consumption and 6-min walk distance. Beneficial effects on psychosocial and biological outcomes remain inconclusive. Aerobic exercise interventions were often prescribed and included low-, moderate-, or high-intensity exercise. Resistance exercise interventions were often performed in conjunction with aerobic exercise. Prehabilitative exercise elicits robust improvements in physical fitness; however, effect on psychosocial and biological outcomes remains inconclusive. Exercise prescription parameters varied greatly by frequency, intensity, time, and type across multiple cancer diagnoses. Future investigations are needed to systematically dose exercise for a wider variety of outcome measures, with an overall goal to set forth pre-operative exercise guidelines.

Physical health composite and risk of cancer mortality in the REasons for Geographic and Racial Differences in Stroke Study

It is unclear how resting myocardial workload, as indexed by baseline measures of rate-pressure product (RPP) and physical activity (PA), is associated with the overall risk of cancer mortality. We performed prospective analyses among 28,810 men and women from the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. We used a novel physical health (PH) composite index and categorized participants into one of four groups based on combinations from self-reported PA and RPP: 1) No PA and High RPP; 2) No PA and Low RPP; 3) Yes PA and High RPP; and 4) Yes PA and Low RPP. We examined the association between baseline PH composite and cancer mortality adjusted for potential confounders using Cox regression. A total of 1191 cancer deaths were observed over the 10-year observation period, with the majority being lung (26.87%) and gastrointestinal (21.49%) cancers. Even after controlling for sociodemographics, health behaviors, baseline comorbidity score, and medications, participants with No PA and High RPP had 71% greater risk of cancer mortality when compared to participants with PA and Low RPP (adjusted HR: 1.71, 95% CI: 1.42-2.06). These associations persisted after examining BMI, smoking, income, and gender as effect modifiers and all-cause mortality as a competing risk. Poorer physical health composite, including the novel RPP metric, was associated with a nearly 2-fold long-term risk of cancer mortality. The physical health composite has important public health implications as it provides a measure of risk beyond traditional measure of obesity and physical activity.

Synergy Between Licensed Rehabilitation Professionals and Clinical Exercise Physiologists: Optimizing Patient Care for Cancer Rehabilitation

OBJECTIVES

To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care.

DATA SOURCE

Professional organizations and peer-reviewed manuscripts.

CONCLUSION

Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy.

IMPLICATIONS FOR NURSING PRACTICE

Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.

Seasonal Variation in Physical Activity among Preoperative Patients with Lung Cancer Determined Using a Wearable Device

We aim to examine how season and temperature levels affect physical activity using a wearable device among patients scheduled to undergo surgical resection of lung cancer. Physical activity (PA) data from the wearable device were analyzed by seasons for 555 preoperative lung cancer patients from the CATCH-LUNG cohort study. The seasons were divided into spring, summer, autumn, and winter using the study enrollment date before surgery. The overall mean (SD) age was 61.1 (8.9) years, and the mean (SD) daily steps at each season were 11,438 (5922), 11,147 (5065), 10,404 (4403), and 8548 (4293), respectively. In the fully-adjusted models, patients in the winter season had 27.04% fewer daily steps (95% CI = -36.68%, -15.93%) and 35.22% less time spent performing moderate to vigorous physical activity (MVPA) compared to patients in the spring. The proportion of participants with over 8000 steps and duration of MVPA were significantly lower in the winter than the spring. In particular, daily steps had a negative linear association with wind chill temperature in patients who lived in Seoul. In conclusion, PA was significantly lower in the winter and it was more robust in patients who had a low cardiorespiratory function.

The clinical, functional and disability characteristics of patients with severe obesity presenting for non-bariatric surgery

The clinical and functional characteristics of patients with severe obesity who present for non-bariatric surgery have rarely been described. For this study, 293 such patients (mean body mass index 42 kg/m2) were investigated using their medical records, a 6-minute walk test, N-terminal pro B-type natriuretic peptide measurement, and the World Health Organization Disability Assessment Schedule 2.0 measure of disability. Cardiorespiratory disease and diabetes were common, with blood tests revealing a high probability of additional unexpected and undiagnosed renal and cardiac disease in a significant proportion of patients. One-third of patients had natriuretic peptide values that identify early left ventricular dysfunction in the community, with 16% above a value described as useful in predicting adverse outcomes for elective surgical patients. Only 10% of patients walked a distance within 10% of that predicted in six minutes, and 22% did not complete the test. Over one-third of patients (34%) had a clinically significant level of disability, with those unable to walk for six minutes describing higher levels of disability. Functional capacity as measured by the 6-minute walk test was significantly lower than would be expected from age, gender, and weight alone, and was related to age and degree of disability but not body mass index. We describe a severely obese population presenting for non-bariatric surgery who had significant levels of comorbid disease, functional impairment, and disability that were not apparent on routine preoperative assessment.

Physical Activity and Mortality in Cancer Survivors: A Systematic Review and Meta-Analysis

Background

Recommendations for improved survival after cancer through physical activity (PA) exist, although the evidence is still emerging. Our primary objective was to conduct a systematic review and meta-analysis of the association between prediagnosis and postdiagnosis PA and survival (cancer-specific, all-cause, and cardiovascular disease mortality) for all cancers and by tumor site. Secondary objectives were to examine the associations within population subgroups, by PA domain, and to determine the optimal dose of PA related to survival.

Methods

PubMed, EMBASE, and SportsDiscus databases were searched from inception to November 1, 2018. DerSimonian-Laird random-effects models were used to estimate the summary hazard ratios (HRs) and 95% confidence intervals (CI) for primary and secondary analyses and to conduct dose-response analyses.

Results

Evidence from 136 studies showed improved survival outcomes with highest vs lowest levels of prediagnosis or postdiagnosis total or recreational PA for all-cancers combined (cancer specific mortality: HR = 0.82, 95% CI = 0.79 to 0.86, and HR = 0.63, 95% CI = 0.53 to 0.75, respectively) as well as for 11 specific cancer sites. For breast and colorectal cancers, greater reductions were observed for postdiagnosis PA (HR = 0.58–0.63) compared with prediagnosis PA (HR = 0.80–0.86) for cancer-specific and all-cause mortality. Survival benefits through PA were observed in most subgroups (within sex, body mass index, menopausal status, colorectal subtypes, and PA domain) examined. Inverse dose-response relationships between PA and breast cancer-specific and all-cause mortality were observed, with steep reductions in hazards to 10–15 metabolic equivalent hours per week.

Conclusion

Higher prediagnosis and postdiagnosis levels of PA were associated with improved survival outcomes for at least 11 cancer types, providing support for global promotion of PA guidelines following cancer.

Cardiorespiratory Fitness Normative Values in Latin-American Adolescents: Role of Fatness Parameters

The aim of this study was to provide percentile values for a cardiorespiratory fitness (CRF) field test for Latin-American adolescents (34,461 girls and 38,044 boys) aged 13 to 15 years. The role of fatness parameters on the CRF level across age groups was also examined, with a focus on non-obese (healthy) and obese groups. CRF was assessed using the 20-meter shuttle run test protocol. Anthropometric parameters were measured using body mass index z-score (body mass index (BMI) z-score), BMI, waist circumference (WC), and waist-to-height ratio (WHtR). Participants were categorized according to the BMI z-score, WC, and WHtR international cut-off points as healthy and obese. Age- and sex-specific reference tables for the 3rd, 10th, 25th, 50th, 75th, 90th, and 97th centile scores were calculated using Cole’s lambda, mu, and sigma method. The prevalence of obesity according to the BMI z-score, WC, and WHtR was 9.6%, 11.2%, and 15.0%, respectively. Across all age and sex groups, a negative association was found between relative peak oxygen uptake (V˙O₂peak) and BMI, WC, and WHtR. In boys and girls there were higher levels of performance across all age groups, with most apparent gains between the ages of 13 and 14 years old. Overall, participants categorized in the healthy group had shown to have significantly higher V˙O₂peak than their obese counterparts (p < 0.001; Cohen’s d > 1.0). In conclusion, our study provides age- and sex-specific reference values for CRF (V˙O₂peak, mL·kg⁻¹·min⁻¹). The anthropometric parameters were inversely associated with CRF in all ages in both sexes. The obese group had worse CRF than their healthy counterparts independent of anthropometric parameters used to determine obesity.

Novel camphor-based pyrimidine derivatives induced cancer cell death through a ROS-mediated mitochondrial apoptosis pathway

A series of novel camphor-based pyrimidine derivatives (3a–3x) have been synthesized; their structures were determined by using conventional methods and compound 3f was further confirmed through single crystal XRD analysis. The cytotoxic activity of the target compounds against a panel of human normal (GES-1) and cancer cell lines (MDA-MB-231, RPMI-8226, A549) was evaluated by MTS assay. Here we found that compound 3f exhibited the strongest anti-tumor activity, comparable to that of etoposide, and had much lower cytotoxicity to normal GES-1 cells (IC₅₀ > 50 μM) than the reference drug (IC₅₀ = 8.89 μM). Subsequent mechanism studies in MDA-MB-231 cells revealed that compound 3f caused G0/G1 phase arrest and apoptosis in a dose dependent manner. Moreover, the loss of mitochondrial membrane potential and enhancement of cellular ROS levels were also observed upon 3f treatment, which indicated that 3f exerted cytotoxic activity by a ROS-mediated mitochondrial apoptosis pathway. This result was confirmed by a significant increase in the expression of pro-apoptotic proteins Bax, cytochrome C and caspase-3, and downregulation of anti-apoptosis protein Bcl-2. Overall, 3f can be adopted for further investigation in the development of antitumor agents based on natural products.

A series of novel camphor-based pyrimidine derivatives were synthesized and characterized. We found the compound 3f exhibited strongest anti-tumor activity via ROS-mediated mitochondrial apoptosis pathway.

Multifunctional NaLnF4@MOF-Ln Nanocomposites with Dual-Mode Luminescence for Drug Delivery and Cell Imaging

Multifunctional nanomaterials for bioprobe and drug carrier have drawn great attention for their applications in the early monitoring the progression and treatment of cancers. In this work, we have developed new multifunctional water-soluble NaLnF₄@MOF-Ln nanocomposites with dual-mode luminescence, which is based on stokes luminescent mesoporous lanthanide metal-organic frameworks (MOFs-Y:Eu³⁺) and anti-stokes luminescent NaYF₄:Tm³⁺/Yb³⁺ nanoparticles. The fluorescence mechanism and dynamics are investigated and the applications of these nanocomposites as bioprobes and drug carriers in the cancer imaging and treatment are explored. Our results demonstrate that these nanocomposites with the excellent two-color emission show great potential in drug delivery, cancer cell imaging, and treatment, which are attributed to the unique spatial structure and good biocompatibility characteristics of NaLnF₄@MOF-Ln nanocomposites.

Health-Related Physical Fitness and Arterial Stiffness in Childhood Cancer Survivors

Introduction: Despite decreasing mortality in pediatric oncology as a result of standardized treatment protocols, the high number of functional and cardiovascular late sequelae due to anticarcinogenic therapy remains unchanged. The aim of this study was to further assess functional limitations in Health-related Physical Fitness (HRPF) and cardiovascular risk by means of markers of arterial stiffness in Childhood Cancer Survivors (CCS).

Materials and Methods: Between March 2016 and August 2017 a total of 92 CCS (Age 12.5 ± 4.2 years, 43 girls) were recruited from their routine follow-up outpatient visit. HRPF was assessed using five Fitnessgram® tasks. Pulse Wave Velocity (PWV) along with peripheral and central blood pressure were assessed using oscillometric measurements performed by Mobil-O-Graph. Z-scores were used to compare the test results either to German reference values or to a recent healthy reference cohort.

Results: In CCS, the HRPF was significantly reduced (z-score: −0.28 ± 1.01, p = 0.011) as compared to healthy peers. The peripheral Systolic Blood Pressure (pSBP) was significantly increased (z-score: 0.31 ± 1.11, p = 0.017) and the peripheral Diastolic Blood Pressure (pDBP) was decreased (z-score: −0.30 ± 1.25, p = 0.040), resulting in an increased pulse pressure. The PWV (p = 0.649) and cSBP (p = 0.408), were neither increased nor showed any association to HRPF.

Discussion: CCS showed functional limitations in HRPF and an increased pulse pressure, which acts as an early onset parameter of arterial stiffness. Both a low HRPF and impaired hemodynamics are independent cardiovascular risk factors and needs to be taken into consideration in tertiary prevention of CCS.

Impact of implementation intentions on physical activity practice in adults: A systematic review and meta-analysis of randomized clinical trials

OBJECTIVE

The aim of this study was to verify the efficacy of using theory-based strategies on implementation intentions in promoting physical activity (PA) among adults.

METHODS

This review was conducted in accordance with the PRISMA recommendations. The search was carried out in seven electronic databases (LILACS, PubMed, SciELO, Cochrane, Web of Science) and two searches of the "grey literature" were performed (Openthesis and OpenGrey). Randomized clinical trials (RCT), published up to September 2016, were considered eligible for this study. Two reviewers independently and systematically evaluated the eligibility criteria, and performed data extraction. A meta-analysis was performed for the purpose of comparing the effect between the intervention and control groups. The effect sizes were grouped in two subgroups with the purpose of more accurately verifying the effect caused by reinforcing the implementation intentions strategy, and using the inverse variance statistical method with random effects models to estimate the main effect of the implementation intention strategy on the PA behavior. Heterogeneity among the studies was evaluated by using I-square statistics, and the Jadad scale to evaluate the quality of included papers.

RESULTS

The search resulted in 12,147 records, of which 13 RCTs were considered eligible for this review. Sample age ranged from 18 to 76 years, and participants had conditions such as medullary lesion, coronary disease, obesity, diabetes mellitus, sedentarism or occupational stress. When the summary of the effect was analyzed in the meta-analysis, the result found in the subgroup with reinforcement of the implementation intentions strategy was 0.25 (IC 95% = 0.05-0.45) in favor of the intervention group. This demonstrated that application of the implementation intentions strategy was capable of increasing PA practice in the participants of these studies, in comparison with others that did not use this reinforcement.

CONCLUSION

The findings of this review indicated that application of the theory of implementation intentions promoted PA behavior among the adults who received reinforcement of this strategy. The systematic review protocol was registered in the PROSPERO database under the number CRD42018090482.

Preventing Lethal Prostate Cancer with Diet, Supplements, and Rx: Heart Healthy Continues to Be Prostate Healthy and "First Do No Harm" Part I

PURPOSE OF REVIEW

To discuss the overall and latest observations of the effect of diet, lifestyle, supplements, and some prescription heart healthy medications for prostate cancer prevention.

RECENT FINDINGS

The concept of maximizing heart health to prevent aggressive prostate cancer continues to be solidified with the addition of more prospective observational and randomized controlled trial data. Heart healthy is prostate healthy, but heart unhealthy is prostate unhealthy. The primary goal of reducing the risk of all-cause and cardiovascular disease (CVD) morbidity and mortality also allows for maximizing prostate cancer prevention. The obesity epidemic in children and adults along with recent diverse research has only strengthened the nexus between heart and prostate health. Greater dietary adherence toward a variety of healthy foods is associated with a graded improved probability of CVD and potentially aggressive cancer risk reduction. Preventing prostate cancer via dietary supplements should encourage a "first do no harm", or less is more approach until future evidence can reverse the concerning trend that more supplementation has resulted in either no impact or an increased risk of prostate cancer. Supplements to reduce side effects of some cancer treatments appear to have more encouraging data. Medications that improve heart health including statins, aspirin, and metformin (S.A.M.), and specific beta-blocker medications are primarily generic or low-cost and should continue to garner research interest. A watershed moment in medical education has arrived where the past perception of a diverse number of trees seemingly separated by vast distances, in reality, now appear to exist within the same forest.

Precancer diagnosis cardiorespiratory fitness, physical activity and cancer mortality in men

BACKGROUND

The preventive role of precancer diagnosis cardiorespiratory fitness (CRF) and physical activity (PA) in cancer mortality is poorly characterized. The aim of this study was to assess the association between CRF, PA at precancer-diagnosis and cancer mortality in men who diagnosed with cancer later in life.

METHODS

A total of 699 men (63±10 years) who were diagnosed with cancer during 7.5±4.9 years from a baseline treadmill exercise test and reported PA were analyzed. Multivariate Cox models for CRF and univariate model for PA were conducted. Population Attributable Risks (PARs%) and exposure impact number (EIN) of low CRF (<5 METs) and inactivity were determined.

RESULTS

During 6.5±5.2 years from cancer diagnosis, 56% died from cancer. CRF was inversely, graded and independently associated with cancer death. A 1-MET increase and categories of moderate and high CRF were associated with 7%, 28% and 51% reductions in risk of cancer death, respectively. Active compared to inactive individuals had a 23% reduced risk of cancer mortality (HR=0.77, 95% CI [0.63-0.94], P=0.01). PARs% of low CRF and inactivity were 4.8% and 9.4%, respectively, while the respective EIN were 3 and 9.

CONCLUSIONS

Higher CRF and being active at precancer-diagnosis were associated with lower cancer mortality and longer survival time in men who developed cancer later in life. Screening and intervening for low CRF and inactivity as risk factors during middle-age and maintaining at least moderate CRF and activity levels may be effective strategies for prevention of cancer mortality.

Main and interactive effects of physical activity, fitness and body mass in the prevention of cancer from the Copenhagen Male Study

Little knowledge exists about the role of cardiorespiratory fitness (CRF) or its interaction with excess adiposity determined by body mass index (BMI) in cancer prevention. A total of 5,128 middle-aged men, without a history of cancer at baseline in 1970–71, were examined for subsequent incidence and mortality of several cancer types. Participants’ data were linked with cancer registration and mortality data to March 2017. During 47 years of follow-up, a total of 1,920 incident cases and 1,638 cancer-related deaths were ascertained. BMI, particularly obesity, was associated with (i) incidence and (ii) mortality from respiratory/thoracic cancers; and (iii) all cancer-cause mortality. The respective adjusted hazard ratios (HRs) were: (i) 0.51 (95%CI:0.32–0.79), (ii) 0.48 (95%CI:0.30–0.75) and (iii) 0.73 (95%CI:0.59–0.89) when compared obese men (BMI ≥30 kg/m²) to men with healthy-BMI (<25 kg/m²). Increasing CRF was inversely associated with incidence and mortality of respiratory/thoracic cancers, HRs 0.78 (95%CI:0.67–0.90) and 0.73 (95%CI:0.63–0.84) respectively; and all cancer-cause incidence 0.92 (95%CI:0.86–0.98) and mortality 0.85 (95%CI:0.79–0.91). Physical activity (PA) was not associated with most outcomes. We found no evidence of interactions between CRF or PA and BMI on cancer risk. This evidence suggests that midlife CRF is associated with lowered risk of cancer incidence and mortality with no evidence of cancer risk modification by BMI.

Cardiorespiratory fitness and adiposity in breast cancer survivors: is meeting current physical activity recommendations really enough?

PURPOSE

Breast cancer (BC) survivors are becoming increasingly predisposed to cardiovascular disease (CVD) mortality. Low cardiorespiratory fitness and physical activity (PA) levels, as well as high values of adiposity indices, contribute to CVD risk. We evaluated adiposity, cardiorespiratory profile, and PA levels in two independent cohorts of BC survivors.

METHODS

Data were collected from two groups (99% women) from different areas of Madrid (Spain): group 1, n = 110, age 51.4 ± 9.7 years, median time from diagnosis 365 days (95% confidence interval [CI], 354-401), and group 2, n = 93, age 54.7 ± 8.9 years, 1714 days (95% CI, 1502-1938). We estimated peak oxygen uptake (VO2peak) and measured body mass index (BMI), waist circumference (WC), waist-to-hip index, and accelerometry-determined PA.

RESULTS

Both groups had values of BMI in the overweight range (25.3 ± 4.3 and 27.1 ± 5.1 kg/m2, p = 0.003). Estimated VO2peak levels were lower in group 2 than in group 1 (28.1 ± 9.1 and 23.7 ± 8.8 ml/kg/min, p < 0.001), although levels in both groups were low. Yet, the majority of participants in both groups (81 and 88%, p = 0.234) met international PA recommendations (235 ± 196 and 351 ± 173 min/week of moderate-vigorous PA, p < 0.001). Both groups had very low levels of vigorous PA. These results were essentially independent of type of treatment (anthracycline/radiotherapy).

CONCLUSIONS

We found a poor cardiorespiratory profile in two independent BC cohorts that differed in median time from diagnosis (as well in socioeconomic status), supporting the notion that implementation of PA (possibly focusing on vigorous PA) and dietary intervention is urgently needed in this patient population.

Exercise and cancer mortality in Korean men and women: a prospective cohort study

Background

Little is known about longitudinal associations of exercise with different types of cancer, particularly in Asian populations. The purpose of this research was to estimate the association between the duration of exercise and all-cause and cancer-specific mortality.

Method

Data were obtained from the Korean Metabolic Syndrome Mortality Study (KMSMS), a prospective cohort study of 303,428 Korean adults aged 20 years or older at baseline between 1994 and 2004 after exclusion of individuals with missing variables on smoking and exercise. Death certificate-linked data until 31 December 2015 were provided by the Korean National Statistical Office. Cox regression models were constructed to evaluate the associations of exercise with cancer mortality after adjusting for potential confounders such as age, alcohol consumption and smoking status.

Results

During the follow-up period of 15.3 years (4,638,863 person-years), a total of 16,884 participants died. Both men and women who exercised showed approximately 30% decreased hazards of mortality, compared to those who did no exercise (hazard ratio (HR) 0.70, 95% confidence interval (CI)=0.68-0.73 for men, HR=0.71, CI : 0.67-0.75). A notable observation of this study is the curvilinear associations between the total duration of exercise per week and cancer mortality, with the lowest risk being observed at the low-to-medium levels of exercise; this trend of associations was found for esophagus, liver, lung, and colorectal cancer mortality in men, and all-cause, all-cancer and lung cancer mortality in women.

Conclusions

Individuals who exercised showed considerably lower all-cause and cancer mortality risks compared with those who did no exercise. Policies and clinical trials aimed at promoting minimal or moderate participation in exercise may minimize cancer mortality risk.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-5669-1) contains supplementary material, which is available to authorized users.

Short-term combined exercise training improves cardiorespiratory fitness and autonomic modulation in cancer patients receiving adjuvant therapy

The present study aimed to investigate the impact of a short-term exercise training (ET) on the cardiorespiratory fitness and autonomic modulation of women with breast cancer who were receiving adjuvant radiotherapy, chemotherapy or hormonotherapy. Eighteen women previously diagnosed with breast cancer receiving adjuvant radiotherapy, chemotherapy or hormone therapy were randomly allocated into breast cancer nonexercise (BC) and exercise groups (BC+Ex). Moreover, nine healthy physically inactive volunteers were recruited to compose the noncancer control group (CG). The BC+Ex group was underwent to a combined ET program, which was based on resistance, aerobic and flexibility exercises. ET was performed 3 times a week, on nonconsecutive days, for 4 weeks at the hospital room under the professional supervision. In turn, BC and CG remained without be engaged in physical exercise programs. Volunteers were evaluated regarding their cardiorespiratory fitness and autonomic modulation (i.e., time, frequency domains, and nonlinear [symbolic analysis]) before and after the end of the ET program. A priori, data indicate that women patients with breast cancer showed impaired exercise tolerance, as well as autonomic dysfunction in comparison with age-matched healthy control subjects. However, a 1-month combined ET program could reverse such impairments, so that after the intervention, BC+Ex and CG showing similar results in the cardiorespiratory test and heart rate variability analysis. In conclusion, data of the current study indicate that 1 month of ET is able to reverse impaired cardiorespiratory fitness and autonomic modulation in women with breast cancer receiving adjuvant therapy.