Long-term follow-up after cancer rehabilitation using high-intensity resistance training: persistent improvement of physical performance and quality of life

Effect of resistance exercise on physical fitness, quality of life, and fatigue in patients with cancer: a systematic review

Objective

The purpose of this study is to conduct a systematic review to assess the effects of different forms of resistance exercises (resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises) on physical fitness, quality of life (QOL), and fatigue of patients with cancer.

Methods

We conducted a systematic review using the Cochrane Handbook for Systematic Reviews of Interventions guidelines. We searched PubMed, Web of Science, and Scopus databases for the studies from the establishment of the database to September 2023, including randomized controlled trials and clinical trials that evaluated the effects of different resistance exercise on physical fitness, QOL, and fatigue in all patients with cancer. Two reviewers independently assessed the quality of all the included studies using the Cochrane Handbook for Systematic Reviews of Interventions and MINORS scale. We divided the intervention into three types: resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises.

Results

In total, 48 studies (3,843 participants) met the inclusion criteria. The three exercise intervention forms have significant effects on physical fitness and QOL, but the improvement effect on fatigue is not clear. A total of 34 studies reported significant and beneficial effects of resistance exercise on physical fitness across all types of cancer. There were 28 studies that reported significant or borderline improvement effects of resistance on QOL, and only 10 studies reported significant effects of resistance exercise interventions on fatigue improvement in patients with cancer.

Conclusions

Resistance exercise, resistance exercise combined with aerobic exercise, and resistance exercise combined with other exercises all have a positive effect on improving fitness and QOL in patients with cancer. Resistance exercise has an advantage in improving muscle strength, while combined resistance exercise has an advantage in improving QOL; however, there are no consistent findings in improving fatigue, although low-intensity resistance exercise is effective.

Systematic review registration

www.inplasy.com, identifier INPLASY2023110034.

Does participation in therapeutic exercise programs after finishing oncology treatment still ensure an adequate health status for long-term breast cancer survivors? A ≥ 5 years follow-up study

PURPOSE

The aims of this study were to evaluate whether the effects of two therapeutic exercise programs are sustained over time (≥ 5 years) in long-term breast cancer survivors (LTBCS). Second, to determine the influence of the current level of physical activity (PA) performed on cancer-related fatigue (CRF) that these patients may present ≥5 years later.

METHODS

A prospective observational study was conducted with a cohort of 80 LTBCS in Granada during 2018. Firstly, considering their participation in one of the programs, they were allocated into two groups: usual care and therapeutic exercise program, to assess CRF, pain and pressure pain sensitivity, muscle strength, functional capacity, and quality of life. Secondly, they were also classified into 3 groups according to current level of weekly PA performed: ≤ 3, 3.1-7.4, and ≥ 7.5 (MET-hour/week) respectively, to assess its impact over CRF.

RESULTS

Although the positive effects of the programs are not sustained over time, a trend toward significance can be observed for a greater reduction in overall CRF levels, lower intensity of pain in the affected arm and cervical region, and greater functional capacity and quality of life in the group that underwent therapeutic exercise. Additionally, 66.25% of LTBCS are inactive ≥ 5 years after completion of the program and furthermore, such inactivity is accompanied by higher CRF levels (P .013 to .046).

CONCLUSION

The positive effects of therapeutic exercise programs are not maintained over time for LTBCS. Additionally, more than half of these women (66.25%) are inactive ≥ 5 years after completion of the program, this inactivity being accompanied by higher levels of CRF.

Systematic Review of Functional Outcomes in Cancer Rehabilitation

OBJECTIVE

To systematically review the evidence regarding rehabilitation interventions targeting optimal physical or cognitive function in adults with a history of cancer and describe the breadth of evidence as well as strengths and limitations across a range of functional domains.

DATA SOURCES

PubMed, Cumulative Index to Nursing and Allied Health Plus, Scopus, Web of Science, and Embase. The time scope was January 2008 to April 2019.

STUDY SELECTION

Prospective, controlled trials including single- and multiarm cohorts investigating rehabilitative interventions for cancer survivors at any point in the continuum of care were included, if studies included a primary functional outcome measure. Secondary data analyses and pilot/feasibility studies were excluded. Full-text review identified 362 studies for inclusion.

DATA EXTRACTION

Extraction was performed by coauthor teams and quality and bias assessed using the American Academy of Neurology (AAN) Classification of Evidence Scheme (class I-IV).

DATA SYNTHESIS

Studies for which the functional primary endpoint achieved significance were categorized into 9 functional areas foundational to cancer rehabilitation: (1) quality of life (109 studies), (2) activities of daily living (61 studies), (3) fatigue (59 studies), (4) functional mobility (55 studies), (5) exercise behavior (37 studies), (6) cognition (20 studies), (7) communication (10 studies), (8) sexual function (6 studies), and (9) return to work (5 studies). Most studies were categorized as class III in quality/bias. Averaging results found within each of the functional domains, 71% of studies reported statistically significant results after cancer rehabilitation intervention(s) for at least 1 functional outcome.

CONCLUSIONS

These findings provide evidence supporting the efficacy of rehabilitative interventions for individuals with a cancer history. The findings should be balanced with the understanding that many studies had moderate risk of bias and/or limitations in study quality by AAN criteria. These results may provide a foundation for future work to establish clinical practice guidelines for rehabilitative interventions across cancer disease types.

Effect of Tai Chi and Resistance Training on Cancer-Related Fatigue and Quality of Life in Middle-Aged and Elderly Cancer Patients

OBJECTIVE

To study the effect of Tai Chi (TC) and resistance training (RT) with different intensity on the cancer-related fatigue (CRF) and quality of life (QoL) of middle-aged and elderly cancer patients.

METHODS

Totally 120 cancer patients were enrolled and randomly assigned to 4 groups by a random number table, including TC group, high-intensity 60% one repetition maximum (1-RM) RT group (HIRT), low-intensity (30% 1-RM) RT group (LIRT) and control group, 30 patients in each group. Participants in the TC group received 24-form simplified Yang-style TC training at a frequency of 40 min per day, 3 days per week for 12 weeks. Patients in the two RT groups received 10 sessions, 6 designated movements per day, 3 days per week for 12 weeks. The 1-RM of 6 muscle groups, fat mass (FM), lean body mass (LBM), along with the scores of Brief Fatigue Inventory (BFI), QoL questionnaire for Chinese cancer patients receiving chemobiotherapy (QLQ-CCC), Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9) and Pittsburgh Sleep Quality Index (PSQI) were measured before and after training. The adverse effect was also observed.

RESULTS

After 12-week intervention, patients in both TC and RT groups showed significant improvements in CRF and QLQ-CCC compared to pre-treatment (P<0.05). Compared with the LIRT and TC groups, patients in the HIRT group improved more significantly in increasing muscle strength and LBM, and reducing in FM (P<0.05). Patients in the TC group significantly increased in lower limb muscle strength compared with the LIRT group (P<0.05). In addition, patients in the TC group showed more significant improvements in scores of GAD-7, PHQ-9 and PSQI than 2 RT groups (P<0.05).

CONCLUSIONS

TC and RT, both low- and high-intensity training, can significantly increase muscle strength, reduce CRF and improve QoL in the middle-aged and elderly cancer patients. TC has a better effect than RT in terms of sleep quality and mental health. The long-term application is needed to substantiate the effect of TC as an alternative exercise in cancer patients.

Online physical activity and sedentary behaviour information for cancer survivors

PURPOSE

The purpose of this study is to assess the prevalence, content, and nature of information and/or advice regarding physical activity and sedentary behaviour available online for cancer survivors.

METHODS

A search strategy was designed to identify website links that were most likely to be accessed by cancer survivors, living in five English speaking nations, looking for information about maintaining and improving health after a cancer diagnosis. All content pertaining to physical activity and sedentary behaviour was extracted, and proportions of website links containing key information were calculated. Content analysis was performed on the data to describe the nature of information provided.

RESULTS

Of the 394 website links reviewed, 73.4% contained information about physical activity; however, most websites did not detail recommendations, strategies and potential risks of engaging in physical activity. Less than 10% of the links reviewed contained information about sedentary behaviour. Results varied according to website and cancer type.

CONCLUSIONS

Although the importance of physical activity is frequently mentioned, online content on the subject lacks comprehensive, specific advice. Health advice online for cancer survivors regarding the importance of avoiding sedentary behaviour is scarce with little to no detail on how to achieve this.

IMPLICATION OF CANCER SURVIVORS

Until website conveners improve the comprehensiveness and specificity of the information they provide, cancer survivors may find it difficult to find, via the Internet, the advice required to properly guide and facilitate their safe participation in physical activity and avoidance of sedentary behaviour.

High-intensity exercise interventions in cancer survivors: a systematic review exploring the impact on health outcomes

PURPOSE

There is an increasing body of evidence underpinning high-intensity exercise as an effective and time-efficient intervention for improving health in cancer survivors. The aim of this study was to, (1) evaluate the efficacy and (2) the safety of high-intensity exercise interventions in improving selected health outcomes in cancer survivors.

METHODS

Design Systematic review. Data sources Google Scholar and EBSCO, CINAHL Plus, Computers and Applied Sciences Complete, Health Source-Consumer Edition, Health Source: Nursing/Academic Edition, MEDLINE, Web of Science and SPORTDiscuss from inception up until August 2017. Eligibility criteria Randomized controlled trials of high-intensity exercise interventions in cancer survivors (all cancer types) with health-related outcome measures. The guidelines adopted for this review were the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA).

RESULTS

The search returned 447 articles, of which nine articles (n = 531 participants mean, age 58 ± 9.5 years) met the eligibility criteria. Exercise interventions of between 4 and 18 weeks consisting of high-intensity interval bouts of up to 4-min were compared with a continuous moderate intensity (CMIT) intervention or a control group. High-intensity exercise interventions elicited significant improvements in VO₂ max, strength, body mass, body fat and hip and waist circumference compared with CMIT and/or control groups. The studies reviewed showed low risk in participating in supervised high-intensity exercise interventions. Mixed mode high-intensity interventions which included both aerobic and resistance exercises were most effective improving the aerobic fitness levels of cancer survivors by 12.45-21.35%, from baseline to post-intervention.

CONCLUSION

High-intensity exercise interventions improved physical and physiological health-related outcome measures such as cardiovascular fitness and strength in cancer survivors. Given that high-intensity exercise sessions require a shorter time commitment, it may be a useful modality to improve health outcomes in those who are time poor. The risk of adverse events associated with high-intensity exercise was low.

Breast Cancer Survivors, Common Markers of Inflammation, and Exercise: A Narrative Review

Exercise may help positively improve inflammatory marker levels, therefore promoting better outcomes in breast cancer survivors. This narrative review is intended to provide an overview between inflammation and breast cancer, in addition to the effects exercise may have on common inflammatory markers that have been examined in both healthy populations and breast cancer survivors throughout the literature. The inconsistencies and gaps in the literature addressed may be important for future research to further understand the relationship between exercise and inflammation, as well as the underlying biological mechanisms that are responsible for these changes. For the purpose of organization, this review is structured into the following sections: (1) Breast Cancer Facts, Treatment-Related Side Effects, and General Exercise Benefits; (2) Effects of Exercise on Markers of Inflammation in Cancer-Free Populations; (3) Cancer and Markers of Inflammation; (4) Effects of Exercise on Markers of Inflammation in Breast Cancer Survivors; and (5) Conclusions.

Lessons learnt from a process evaluation of an exercise intervention in patients treated with autologous stem cell transplantation

This paper describes the process evaluation of an 18‐week supervised exercise programme in 50 patients treated with high‐dose chemotherapy followed by autologous stem cell transplantation. The intervention included 30 exercise sessions with six resistance exercises and interval training. We evaluated the context, dose delivered and received, and patients’ and physiotherapists’ satisfaction with the intervention.

Ninety‐two per cent of the patients trained within 15 km of their home address, with an average session attendance of 86%. Most patients trained at the prescribed intensity for four of the six resistance exercises, but the dose delivered and received of the two remaining resistance exercises and interval training could not be determined. Both patients and physiotherapists highly appreciated the programme (score of 8.3 and 7.9 out of 10 respectively). This process evaluation provided valuable lessons for future trials: (1) It is possible to deliver supervised exercise training to this patient group in local physiotherapy practices; (2) to determine dose received all intervention components should be standardised; and (3) to optimise data collection, all study materials should be tested more extensively prior to the start of the intervention.

Improving Provision of Care for Long-term Survivors of Lymphoma

The progressive improvement of lymphoma therapies has led to a significant prolongation of patient survival and life expectancy. However, lymphoma survivors are at high risk of experiencing a range of early and late adverse effects associated with the extent of treatment exposure. Among these, second malignancies and cardiopulmonary diseases can be fatal, and neurocognitive dysfunction, endocrinopathy, muscle atrophy, and persistent fatigue can affect patients' quality of life for decades after treatment. Early recognition and reduction of risk factors and proper monitoring and treatment of these complications require well-defined follow-up criteria, close coordination among specialists of different disciplines, and a tailored model of survivorship care. We have summarized the major aspects of therapy-related effects in lymphoma patients, reviewed the current recommendations for follow-up protocols, and described a new hospital-based model of survivorship care provision from a recent multicenter Italian experience.

Randomized controlled trial on the effects of a supervised high intensity exercise program in patients with a hematologic malignancy treated with autologous stem cell transplantation: Results from the EXIST study

BACKGROUND

This single blind, multicenter randomized controlled trial aimed to evaluate the effectiveness of a supervised high intensity exercise program on physical fitness and fatigue in patients with multiple myeloma or lymphoma recently treated with autologous stem cell transplantation.

METHODS

109 patients were randomly assigned to the 18-week exercise intervention or the usual care control group. The primary outcomes included physical fitness (VO2peak and Wpeak determined using a cardiopulmonary exercise test; grip strength and the 30s chair stand test) and fatigue (Multidimensional Fatigue Inventory) and were assessed prior to randomization and after completion of the intervention or at similar time points for the control group. Multivariable multilevel linear regression analyses were performed to assess intervention effects.

RESULTS

Patients in the intervention group attended 86% of the prescribed exercise sessions. Of the patients in the control group, 47% reported ≥10 physiotherapy sessions, which most likely included supervised exercise, suggesting a high rate of contamination. Median improvements in physical fitness ranged between 16 and 25% in the intervention group and between 12 and 19% in the control group. Fatigue decreased in both groups. There were no significant differences between the intervention and control group.

CONCLUSION

We found no significant beneficial effects of the supervised high intensity exercise program on physical fitness and fatigue when compared to usual care. We hypothesized that the lack of significant intervention effects may relate to suboptimal timing of intervention delivery, contamination in the control group and/or suboptimal compliance to the prescribed exercise intervention.

TRIAL REGISTRATION

Netherlands Trial Register-NTR2341.

Return to work of cancer patients after a multidisciplinary intervention including occupational counselling and physical exercise in cancer patients: a prospective study in the Netherlands

OBJECTIVES

To support return to work (RTW) among cancer patients, a multidisciplinary rehabilitation programme was developed which combined occupational counselling with a supervised physical exercise programme during chemotherapy. The aim was to investigate RTW rates of cancer patients and to evaluate changes in work-related quality of life and physical outcomes.

DESIGN

Longitudinal prospective intervention study using a one-group design.

SETTING

Two hospitals in the Netherlands.

PARTICIPANTS

Of the eligible patients, 56% participated; 93 patients with a primary diagnosis of cancer receiving chemotherapy and on sick leave were included. Patients completed questionnaires on RTW, the importance of work, work ability (WAI), RTW self-efficacy, fatigue (MFI), and quality of life (EORTC QLQ C-30) at baseline and 6, 12 and 18 months follow-up. Before and after the exercise programme 1-repetition maximum (1RM) muscle strength and cardiorespiratory fitness (VO₂ peak) were assessed.

RESULTS

Six months after the start of a multidisciplinary rehabilitation programme that combined occupational counselling with a supervised physical exercise programme, 59% of the cancer patients returned to work, 86% at 12 months and 83% at 18 months. In addition, significant improvements (p<0.05) in the importance of work, work ability, RTW self-efficacy, and quality of life were observed, whereas fatigue levels were significantly reduced. After completing the exercise programme, 1RM muscle strength was significantly increased but there was no improvement in VO₂ peak level.

CONCLUSIONS

RTW rates of cancer patients were high after completion of the multidisciplinary rehabilitation programme. A multidisciplinary rehabilitation programme which combines occupational counselling with a supervised physical exercise programme is likely to result in RTW, reduced fatigue and increased importance of work, work ability, and quality of life.

Feasibility of Exercise Training in Cancer Patients Scheduled for Elective Gastrointestinal Surgery

BACKGROUND/AIMS

This study examines the feasibility of a preoperative exercise program to improve the physical fitness of a patient before gastrointestinal surgery.

METHODS

An outpatient exercise program was developed to increase preoperative aerobic capacity, peripheral muscle endurance and respiratory muscle function in patients with pancreatic, liver, intestinal, gastric or esophageal cancer. During a consult at the outpatient clinic, patients were invited to participate in the exercise program when their surgery was not scheduled within 2 weeks.

RESULTS

The 115 participants followed on average 5.7 (3.5) training sessions. Adherence to the exercise program was high: 82% of the planned training sessions were attended, and no adverse events occurred. Mixed model analyses showed a significant increase of maximal inspiratory muscle strength (84.1-104.7 cm H2O; p = 0.00) and inspiratory muscle endurance (35.0-39.5 cm H2O; p = 0.00). No significant changes were found in aerobic capacity and peripheral muscle strength.

CONCLUSION

This exercise program in patients awaiting oncological surgery is feasible in terms of participation and adherence. Inspiratory muscle function improved significantly as a result of inspiratory muscle training. The exercise program however failed to result in improved aerobic capacity and peripheral muscle strength, probably due to the limited number of training sessions as a result of the restricted time interval between screening and surgery.

The effect of training during treatment with chemotherapy on muscle strength and endurance capacity: A systematic review

Background Treatment of cancer with chemotherapy decreases endurance capacity and muscle strength. Training during chemotherapy might prevent this. There are no clear guidelines concerning which type of training and which training dose are effective. This review aims to gain insight into the different training modalities during chemotherapy and the effects of such training to improve endurance capacity and muscle strength in order to obtain the knowledge to compose a future training program which trains cancer patients in the most effective way. Material and methods A systematic search of PubMed was carried out. In total, 809 studies of randomized controlled trials studying the effects of training during chemotherapy on endurance capacity and muscle strength were considered. Only 14 studies met all the inclusion criteria. The studies were assessed on methodological quality by using Cochrane criteria for randomized controlled trials. Results The quality of the studies was generally poor and the study populations varied considerably as the training programs were very heterogeneous. Variables of endurance capacity reported beneficial effects in 10 groups (59%). Increases due to training ranged from 8% to 31%. Endurance capacity decreased in nine of 13 control groups (69%), which ranged from 1% to 32%. Muscle strength improved significantly in 17 of 18 intervention groups (94%), ranging from 2% to 38%. Muscle strength also improved in 11 of 14 control groups (79%), but this increase was only minimal, ranging from 1.3% to 6.5%. Conclusions This review indicates that training during chemotherapy may help in preventing the decrease in muscle strength and endurance capacity. It is important to know which training intensity and duration is the most effective in training cancer patients, to provide a training program suitable for every cancer patient. Training should be based on good research and should be implemented into international guidelines and daily practice. More research is needed.

High levels of physical activity are associated with lower levels of fatigue among lymphoma patients: Results from the longitudinal PROFILES registry

BACKGROUND

Studies show a cross-sectional association between physical activity (PA) and fatigue among lymphoma cancer patients. However, few longitudinal studies have examined whether PA has a sustained effect on fatigue over time.

PURPOSE

To examine the longitudinal relationship between PA and fatigue.

METHODS

All living individuals diagnosed with lymphoma between 1999 and 2010 as registered by the Dutch population-based Eindhoven Cancer Registry received a questionnaire on three time points. Generalized linear mixed models were used to estimate the independent effects of PA on fatigue.

RESULTS

PA and fatigue levels did not differ between patients short-term (< 1 year) and long-term after diagnosis (1-5 years or > 5 years). PA behavior was relatively constant over time with 84% of the patients meeting the Dutch PA guidelines at all assessment periods. Fatigue scores also remained fairly stable over time with 46% of the patients never being fatigued and 29% always being fatigued. Multivariate analyses showed that patients who met the PA guidelines scored 6.2 (95% CI 3.1-9.2) points lower on total fatigue over time (between subject effect; p < 0.01), compared to patients not meeting PA guidelines.

CONCLUSION

During a period of two years, PA and fatigue levels were rather stable within lymphoma patients. Patients who met the PA guidelines reported lower levels of fatigue compared to those not meeting the guidelines, which appeared to be a constant association over time. The observed association between PA and fatigue underlines the importance to focus upon physical training in the care of cancer patients.

Impact of low-volume, high-intensity interval training on maximal aerobic capacity, health-related quality of life and motivation to exercise in ageing men

There is a demand for effective training methods that encourage exercise adherence during advancing age, particularly in sedentary populations. This study examined the effects of high-intensity interval training (HIIT) exercise on health-related quality of life (HRQL), aerobic fitness and motivation to exercise in ageing men. Participants consisted of males who were either lifelong sedentary (SED; N = 25; age 63 ± 5 years) or lifelong exercisers (LEX; N = 19; aged 61 ± 5 years). [Formula: see text] and HRQL were measured at three phases: baseline (Phase A), week seven (Phase B) and week 13 (Phase C). Motivation to exercise was measured at baseline and week 13. [Formula: see text] was significantly higher in LEX (39.2 ± 5.6 ml kg min(-1)) compared to SED (27.2 ± 5.2 ml kg min(-1)) and increased in both groups from Phase A to C (SED 4.6 ± 3.2 ml kg min(-1), 95 % CI 3.1 - 6.0; LEX 4.9 ± 3.4 ml kg min(-1), 95 % CI 3.1-6.6) Physical functioning (97 ± 4 LEX; 93 ± 7 SED) and general health (70 ± 11 LEX; 78 ± 11 SED) were significantly higher in LEX but increased only in the SED group from Phase A to C (physical functioning 17 ± 18, 95 % CI 9-26, general health 14 ± 14, 95 % CI 8-21). Exercise motives related to social recognition (2.4 ± 1.2 LEX; 1.5 ± 1.0 SED), affiliation (2.7 ± 1.0 LEX; 1.6 ± 1.2 SED) and competition (3.3 ± 1.3 LEX; 2.2 ± 1.1) were significantly higher in LEX yet weight management motives were significantly higher in SED (2.9 ± 1.1 LEX; 4.3 ± 0.5 SED). The study provides preliminary evidence that low-volume HIIT increases perceptions of HRQL, exercise motives and aerobic capacity in older adults, to varying degrees, in both SED and LEX groups.

Do patients with ewing's sarcoma continue with sports activities after limb salvage surgery of the lower extremity?

BACKGROUND

Limb salvage surgery has evolved to become the standard method of treating sarcomas of the extremities with acceptable oncologic results. However, little information exists relative to the activity level or ability to participate in sports after tumor reconstructions.

QUESTIONS/PURPOSES

The aims of the study were to answer the following questions: (1) Which sports activity levels and what types of sports can be expected in the long term after tumor reconstruction? (2) Which frequency durations are patients with Ewing's sarcoma able to perform in long-term followup after local control? (3) Do surgical complications affect sports activity level?

METHODS

Thirty patients (13 females, 17 males; mean age, 18 ± 8 years; range, 2-36 years at diagnosis; mean followup 16 ± 6 years [minimum, 5 years]) were included. Tumors were located in the pelvis, femur, tibia, and fibula. Surgical procedures included surgical resections alone (n = 8), surgical resection with biological reconstruction (n = 9), or endoprosthetic reconstruction (n = 13). We assessed UCLA sports activity levels, kinds of sports as well as the frequency per week and the duration of each training unit at long term (minimum followup, 5 years).

RESULTS

In long-term followup 83% patients (25 of 30) were performing athletic activity regularly. The hours/week of sports depended on type of surgery and were highest after resections in the pelvis and femur (5.8) and were lowest after megaprosthetic reconstruction of the pelvis (1.0). Patients undergoing biologic reconstructions were able to perform high-impact sports. UCLA sports activity levels were high after joint-preserving vascularized fibula for tibia reconstruction (7.4) and after megaprosthetic reconstruction of the lower extremity (6.3-6.4) and were low after tumors located in the fibula (4.2). Complications during followup did not significantly influence sports activity in long-term survivors.

CONCLUSIONS

Long-term survivors can achieve high levels of sports activity in many instances. Tumor sites are associated with the postoperative sports activity levels. This information can help surgeons counsel patients in terms of athletic expectations after limb salvage reconstruction for patients with Ewing's sarcoma.

LEVEL OF EVIDENCE

Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

Whole-Body Vibration as a Modality for the Rehabilitation of Peripheral Neuropathies: Implications for Cancer Survivors Suffering from Chemotherapy-Induced Peripheral Neuropathy

The objective was to study the effect of whole-body vibration (WBV) on strength, balance and pain in patients with peripheral neuropathies and to consider its significance for the rehabilitation of patients suffering from chemotherapy-induced peripheral neuropathy (CIPN). Using a broad search strategy, PubMed was searched for clinical trials on WBV interventions aimed at improving strength, balance or pain in patients with peripheral neuropathies, which were published in English until 5(th) June 2014. The search was performed by the first author and generated a total of 505 results, which yielded 5 articles that met the inclusion criteria, being studies: i) published in English; ii) involving adult human subjects' peripheral neuropathies; iii) evaluating the effect of WBV as a therapeutic intervention; and iv) reporting findings for at least one of the following outcomes: strength, balance or pain. Methodological quality of included studies was assessed independently by first and second author, using the physiotherapy evidence database scale. The overall methodological quality of included studies was low. Two studies found a beneficial effect of WBV on neuropathic pain, but another study failed to find the same effect. One study found significant improvements in both muscle strength and balance, while another study found improvements only in some, but not all, of the applied tests to measure muscle strength and balance. The results of this literature search suggest insufficient evidence to assess the effectiveness for the effects of WBV on neuropathic pain, muscle strength and balance in patients with peripheral neuropathies. More high-quality trials are needed to guide the optimization of rehabilitation programs for cancer survivors with CIPN in particular.

Exercise training improves mean arterial pressure in breast cancer survivors

Currently, many breast cancer survivors worldwide live with treatment-related side effects, including cardiovascular health problems. This study examined effects of a 5-month exercise intervention on non-invasive markers of cardiovascular health in breast cancer survivors. Relationships between these markers and commonly used markers of overall health were also explored. Fifty-two survivors completed the exercise training at a rehabilitation center at the University of North Carolina at Chapel Hill between 2008-2011. A combined aerobic and resistance exercise intervention (3 times/week for 1h) at intensities progressing from low (40%) to moderate (65-70% of VO2max) for aerobic and 8-12 repetitions max for the resistance exercise were implemented. Significant reduction in mean arterial pressure (MAP) was observed from baseline to final assessment. A significant correlation was found between MAP and Body Mass Index (BMI). In conclusion, 5-months combined aerobic and resistance exercise intervention positively improved MAP which was, in part, attributed to changes in BMI.

Behavioural and metabolic risk factors for mortality from colon and rectum cancer: analysis of data from the Asia-Pacific Cohort Studies Collaboration

BACKGROUND

Colorectal cancer has several modifiable behavioural risk factors but their relationship to the risk of colon and rectum cancer separately and between countries with high and low incidence is not clear.

METHODS

Data from participants in the Asia Pacific Cohort Studies Collaboration (APCSC) were used to estimate mortality from colon (International Classification of Diseases, revision 9 (ICD-9) 153, ICD-10 C18) and rectum (ICD-9 154, ICD-10 C19-20) cancers. Data on age, body mass index (BMI), serum cholesterol, height, smoking, physical activity, alcohol and diabetes mellitus were entered into Cox proportional hazards models.

RESULTS

600,427 adults contributed 4,281,239 person-years follow-up. The mean ages (SD) for Asian and Australia/New Zealand cohorts were 44.0 (9.5) and 53.4 (14.5) years, respectively. 455 colon and 158 rectum cancer deaths were observed. Increasing age, BMI and attained adult height were associated with increased hazards of death from colorectal cancer, and physical activity was associated with a reduced hazard. After multiple adjustment, any physical activity was associated with a 28% lower hazard of colon cancer mortality (HR 0.72, 95%CI 0.53-0.96) and lower rectum cancer mortality (HR 0.75, 95%CI 0.45-1.27). A 2cm increase in height increased colon and all colorectal cancer mortality by 7% and 6% respectively.

CONCLUSIONS

Physical inactivity and greater BMI are modifiable risk factors for colon cancer in both Western and Asian populations. Further efforts are needed to promote physical activity and reduce obesity while biological research is needed to understand the mechanisms by which they act to cause cancer mortality.

Chronic fatigue in Hodgkin lymphoma survivors and associations with anxiety, depression and comorbidity

BACKGROUND

Fatigue is a frequent and persistent problem among Hodgkin lymphoma (HL) survivors. We investigated the prevalence of clinically relevant fatigue in HL survivors and the relation between fatigue and anxiety and depression.

METHODS

Fatigue was measured through the generic European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30) and Fatigue Assessment Scale (FAS). Anxiety and depression were measured with the Hospital Anxiety and Depression Scale. Questionnaires were mailed to 267 HL survivors. Results were compared with a Dutch age-matched normative population.

RESULTS

Response rate was 68% (median age 46 years, mean time since diagnosis 4.6 years). Prevalence of fatigue was significantly higher among HL survivors than in the norm population (FAS 41% vs 23%, QLQ-C30 43% vs 28%), as were fatigue levels. There was a significant association between fatigue, anxiety and depression. Of the HL survivors with high symptom levels of depression, 97% also reported fatigue. In multivariate analysis, depression was strongly associated with high levels of fatigue and, to a lesser extent, anxiety and comorbidity.

CONCLUSIONS

Prevalence rates of fatigue are significantly higher in HL survivors than in the general population and differences are clinically relevant. Depression and anxiety were strongly associated with high levels of fatigue. Reducing fatigue levels by treatment of depression and anxiety should be further explored.

Musculoskeletal changes after 1 year of exercise in older breast cancer survivors

INTRODUCTION

We have previously reported that 1 year of supervised resistance + impact training stopped bone loss and built muscle strength in older breast cancer survivors. The purpose of this study was to determine whether these benefits persisted 1 year after completion of the intervention.

METHODS

Sixty-seven women from the original trial completed baseline and post-intervention body composition and muscle strength tests, and 44 women were available 1 year later for follow-up assessments. Bone mineral density (grams per square centimeter) of the hip and spine, muscle mass (kilograms), and fat mass (kilograms) were measured by dual-energy X-ray absorptiometry and maximal upper and lower body strength were measured by one-repetition maximum tests (kilograms). We compared between group changes across baseline (pre-intervention), 1 (post-intervention), and 2 years (1 year follow up) on study outcomes using repeated-measures analysis of covariance, adjusting for age.

RESULTS

Significant group by time interactions were found for spine bone mineral density (BMD) (p < 0.01) and lower body muscle strength (p < 0.05), with a trend for upper body muscle strength (p = 0.05). Spine BMD remained stable across intervention and follow-up periods in exercisers compared with continuous losses in controls across 1- and 2-year periods. In contrast, lower body strength increased in exercisers across the intervention, but decreased to near-baseline levels during follow-up compared with no change over either time period in controls.

CONCLUSIONS

Our data suggest that spine BMD can be preserved in older breast cancer survivors even after formal exercise training stops; however, muscle strength is not similarly maintained and may require continued participation in a supervised exercise program.

IMPLICATIONS FOR CANCER SURVIVORS

Exercise programs aimed at improving musculoskeletal health should be considered in the long-term care plan for breast cancer survivors.

Exercise in the prevention and rehabilitation of breast cancer

Breast cancer is the most common type of cancer among women worldwide. Several epidemiological studies have shown an inverse relationship between the risk of breast cancer and physical activity levels, whereas exercise training has been recognized as a significant means in the rehabilitation process of breast cancer survivors. The relative risk reduction of breast cancer for women who engaged in moderate to vigorous physical activity for 3-5 days peek week ranged between 20-40 %. Furthermore, several studies demonstrated a 24-67 % reduction in the risk of total deaths and 50-53 % reduction in the risk of breast cancer deaths in women who are physically active after breast cancer diagnosis compared with sedentary women. Breast cancer survivors should be encouraged to participate in rehabilitation programs in order to obtain numerous physiological and psychological benefits. These include reductions in fatigue and improvements in immune function, physical functioning, body composition, and quality of life. Based on recent scientific evidence, a complete rehabilitation program for patients with breast cancer should combine both strength and aerobic exercise in order to maximize the expected benefits.

Randomized controlled trial to evaluate the effects of progressive resistance training compared to progressive muscle relaxation in breast cancer patients undergoing adjuvant radiotherapy: the BEST study

Background

Cancer-related fatigue (CRF) is one of the most common and distressing side effects of cancer and its treatment. During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life (QoL). Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being, effective treatment methods are scarce.

Physical activity for breast cancer patients has been reported to decrease fatigue, to improve emotional well-being and to increase physical strength. The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise, however, are poorly understood.

In the BEST trial we aim to assess the effects of resistance training on fatigue, QoL and physical fitness as well as on molecular, immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy.

Methods/design

The BEST study is a prospective randomized, controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy. To determine the effect of exercise itself beyond potential psychosocial group effects, patients in the control group perform a group-based progressive muscle relaxation training. Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy. Main exclusion criteria are acute infectious diseases, severe neurological, musculosceletal or cardiorespiratory disorders. The primary endpoint is cancer-related fatigue; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood, saliva and urine. In addition, QoL, depression, physical performance and cognitive capacity will be assessed.

Discussion

The BEST study is the first randomized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy. Based on the analysis of physiological, immunological and inflammatory parameters it will contribute to a better understanding of the physiological and psychosocial effects and the biological mechanisms of resistance training. The ultimate goal is the implementation of optimized intervention programs to reduce fatigue, improve quality of life and potentially the prognosis after breast cancer.

Trial registration

ClinicalTrials.gov NCT01468766

Feasibility of an Isometric Maximal Voluntary Contraction Test in Hematological Cancer Patients during Thrombocytopenia

Introduction. Resistance training is rarely offered to hemato-oncological patients in the daily clinical routine due to its potential harmful impact on the cardiovascular system and the long periods of thrombocytopenia experienced by these patients. Therefore, it is important to determine a valid assessment to define and control resistance training. In this study, the feasibility of a maximal voluntary contraction (MVC) test was investigated in hemato-oncological patients. This inexpensive assessment may be a practicable alternative to the one repetition maximum test which is currently described as the gold standard. Methods. 29 hemato-oncological patients with platelet counts between 30000/μL and 70000/μL were recruited for this pilot study. Complications like petechial bleedings, muscle convulsion, and pain were assessed using the Brief Pain Inventory before and 48 hours after the MVC test, which was performed unidirectionally for the quadriceps muscle. Results. We did not detect any statistically significant test-related exacerbations or pain development. Discussion. MVC testing seems to be a feasible method to control a resistance training program in hemato-oncological patients. Further studies need to extend their methods and, for example, compare the MVC test with the one repetition maximum test.

Effects of exercise on fatigue, sleep, and performance: a randomized trial

PURPOSE/OBJECTIVES

To compare usual care with a home-based individualized exercise program (HBIEP) in patients receiving intensive treatment for multiple myeloma (MM)and epoetin alfa therapy.

DESIGN

Randomized trial with repeated measures of two groups (one experimental and one control) and an approximate 15-week experimental period.

SETTING

Outpatient setting of the Myeloma Institute for Research and Therapy at the Rockfellow Cancer Center at the University of Arkansas for Medical Sciences.

SAMPLE

187 patients with newly diagnosed MM enrolled in a separate study evaluating effectiveness of the Total Therapy regimen, with or without thalidomide.

METHODS

Measurements included the Profile of Mood States fatigue scale, Functional Assessment of Cancer Therapy-Fatigue, ActiGraph® recordings, 6-Minute Walk Test, and hemoglobin levels at baseline and before and after stem cell collection. Descriptive statistics were used to compare demographics and treatment effects, and repeated measures analysis of variance was used to determine effects of HBIEP.

MAIN RESEARCH VARIABLES

Fatigue, nighttime sleep, performance (aerobic capacity) as dependent or outcome measures, and HBIEP combining strength building and aerobic exercise as the independent variable.

FINDINGS

Both groups were equivalent for age, gender, race, receipt of thalidomide, hemoglobin levels, and type of treatment regimen for MM. No statistically significant differences existed among the experimental and control groups for fatigue, sleep, or performance (aerobic capacity). Statistically significant differences (p < 0.05) were found in each of the study outcomes for all patients as treatment progressed and patients experienced more fatigue and poorer nighttime sleep and performance (aerobic capacity).

CONCLUSIONS

The effect of exercise seemed to be minimal on decreasing fatigue, improving sleep, and improving performance (aerobic capacity).

IMPLICATIONS FOR NURSING

Exercise is safe and has physiologic benefits for patients undergoing MM treatment; exercise combined with epoetin alfa helped alleviate anemia.

High fatigue scores before and after surgical treatment of bone and soft tissue tumors

The first objective of the present study was to investigate fatigue severity in patients diagnosed with bone and soft tissue tumors prior to the surgical treatment of the tumor and 6 months post-operatively. The second objective was to determine which variables are associated with severe fatigue. Patients diagnosed with benign or low-grade malignant bone and soft tissue tumors, undergoing surgical therapy for the tumor only, were included in this study. The control group contained patients scheduled for knee arthroscopy for suspected meniscus tears. Fatigue, pain, anxiety and self-efficacy were measured pre-operatively and after 6 months and each patient wore an actometer to quantify physical activity. In the tumor group of 43 patients, 35% were severely fatigued pre-operatively and 33% post-operatively. The tumor group reported a significantly higher level of anxiety. No differences were observed in pain, physical limitations, self-efficacy or actometer scores. Multiple regression analysis of the tumor group revealed that higher pain scores, higher state anxiety and lower self-efficacy were asssociated with fatigue severity. In the control group of 24 knee arthroscopy patients, the percentage of severely fatigued patients decreased from 38% (n=9) prior to treatment to 29% (n=7) 6 months later. A substantial number of patients were severely fatigued in both the tumor group and the knee arthroscopy group. Self-efficacy, pain and anxiety appear to be the most important variables associated with fatigue severity in tumor patients prior to surgery.

Alpe d'HuZes cancer rehabilitation (A-CaRe) research: four randomized controlled exercise trials and economic evaluations in cancer patients and survivors

Background

Previous studies showed that exercise in cancer patients is feasible and may reduce fatigue and improve physical fitness and quality of life. However, many previous studies had methodological weaknesses related to trial design, sample size, comparison group, outcome measures, short follow-up durations and programme content.

Purpose

This paper aims to present the rationale and design of the clinical research subprogramme of the Alpe d’HuZes Cancer Rehabilitation (A-CaRe) programme.

Method

A-CaRe Clinical Research includes four randomized controlled trials in patients: (a) after chemotherapy, (b) during chemotherapy, (c) after stem cell transplantation and (d) during childhood cancer. These trials compare high-intensity resistance and endurance exercise interventions with usual care or a waiting list control group. In two studies, a second intervention arm consisting of low-to-moderate intensity exercise is included. All four A-CaRe trials use similar methods.

Results

Outcome measures are carefully chosen based on the International Classification of Functioning Disability and Health model. Measurements will be performed prior to randomization (T0), after completion of the intervention (T1) and at follow-up (T2). The primary outcome measures are cardiorespiratory fitness, muscle strength and fatigue. Secondary outcome measures include health-related quality of life and psychosocial functioning. Furthermore, cost-effectiveness and cost-utility analyses are performed from a societal perspective.

Conclusion

We hypothesize that exercise is more effective at improving physical fitness and thereby reducing fatigue and more cost-effective compared with usual care or a waiting list control group. If so, the programmes will be implemented in the Dutch clinical practice.

Fatigue mediates the relationship between physical fitness and quality of life in cancer survivors

OBJECTIVES

This study aims to investigate whether fatigue mediates the association between physical fitness and quality of life.

DESIGN

Uncontrolled pre-post intervention design.

METHODS

Pre- and post-intervention measurements were conducted in 119 patients who completed chemotherapy treatment for various types of cancer. The intervention was an 18-week exercise programme consisting of high-intensity resistance and interval training. We assessed physical fitness - peak oxygen uptake and peak power output - self-reported fatigue (Multidimensional Fatigue Inventory - subscales general fatigue, physical fatigue, reduced activity, reduced motivation, and mental fatigue-, and fatigue symptom scale of EORTC QLQ-C30) and quality of life (EORTC QLQ-C30, subscale global quality of life). Linear regression analyses were conducted on the residual change scores of the variables. The mediated effect of fatigue on the association between physical fitness and quality of life was examined using the products of coefficient method. Bootstrapping was used to calculate the confidence intervals.

RESULTS

We found significant associations between changes in physical fitness and global quality of life, between physical fitness and fatigue, and between fatigue and global quality of life. General fatigue mediated the positive association between peak power output and global quality of life, accounting for 82% of the total association. Physical fatigue, reduced activity, reduced motivation, and fatigue symptom were also mediators of this association. The mediation effects accounted for 91%, 76%, 38% and 71% of the total association, respectively. Reduced activity and reduced motivation mediated the association between peak oxygen uptake and global quality of life. Multiple mediation analyses showed that physical aspects of fatigue were stronger mediators than mental aspects.

CONCLUSIONS

General fatigue and physical aspects of fatigue mediate the relationship between physical fitness and quality of life in cancer survivors. We found no mediating effect of mental fatigue.

Rehabilitation using high-intensity physical training and long-term return-to-work in cancer survivors

INTRODUCTION

Due to large and increasing numbers of cancer survivors, long-term cancer-related health issues have become a major focus of attention. This study examined the relation between a high-intensity physical rehabilitation program and return-to-work in cancer survivors who had received chemotherapy.

METHODS

The intervention group, consisting of 72 cancer survivors from one hospital (8 men and 64 women, mean age 49 years), followed an 18-weeks rehabilitation program including strength and interval training, and home-based activities. An age-matched control group, consisting of 38 cancer survivors (9 men and 29 women), was recruited from two other hospitals. They received only standard medical care. All subjects were evaluated during a telephone interview on employment issues, conducted at ±3 years after diagnosis. The main outcomes were change in working hours per week and time until return-to-work.

RESULTS

Patients in the intervention group showed significant less reduction in working hours per week [-5.0 h/week vs. -10.8 h/week (P = .03)]. Multivariate analyses showed that the training intervention, the age of patients, and the number of working hours pre-diagnosis could explain the improvement in long-term participation at work. Time until (partial) return-to-work was 11.5 weeks for the intervention group versus 13.2 weeks for the control group (P = .40). On long-term follow-up, 78% of the participants from the intervention group versus 66% from the control group had returned to work on the pre-diagnosis level of working hours (P = .18).

CONCLUSION

Rehabilitation using high-intensity physical training is useful for working patients to minimize the decreased ability to work resulting from cancer and its treatment.

Effects of high-intensity resistance training on strength, mobility, balance, and fatigue in individuals with multiple sclerosis: a randomized controlled trial

BACKGROUND AND PURPOSE

Resistance exercise via negative, eccentrically induced work (RENEW) has been shown to be associated with improvements in strength, mobility, and balance in multiple clinical populations. However, RENEW has not been reported for individuals with multiple sclerosis (MS).

METHODS

Nineteen individuals with MS (8 men, 11 women; age mean = 49 ± 11 years; Expanded Disability Status Scale [EDSS] mean = 5.2 ± 0.9) were randomized into either standard exercise (STAND) or standard exercise and RENEW training (RENEW) for 3×/week for 12 weeks. Outcome measures were lower extremity strength (hip/knee flexion and extension, ankle plantar and dorsiflexion, and the sum of these individual values [sum strength]); Timed Up and Go (TUG), 10-m walk, self-selected pace (TMWSS) and maximal-pace (TMWMP), stair ascent (S-A) and descent (S-D) and 6-Minute Walk Test (6MWT), Berg Balance Scale (BBS), Fatigue Severity Scale (FSS).

RESULTS

No significant time effects or interactions were observed for strength, TUG, TMWSS, TMWMP, or 6MWT. However, the mean difference in sum strength in the RENEW group was 38.60 (representing a 15% increase) compared to the sum strength observed in the STAND group with a mean difference of 5.58 (a 2% increase). A significant interaction was observed for S-A, S-D, and BBS as the STAND group improved whereas the RENEW group did not improve in these measures.

DISCUSSION AND CONCLUSIONS

Contrary to results in other populations, the addition of eccentric training to standard exercises did not result in significantly greater lower extremity strength gains in this group of individuals with MS. Further this training was not as effective as standard exercise alone in improving balance or the ability to ascend and descend stairs. Following data collection, reassessment of required sample size indicates we were likely underpowered to detect strength differences between groups.

Colorectal cancer survivorship: movement matters

Colorectal cancer survivorship begins at diagnosis and continues throughout life. After diagnosis, survivors face the possibility of second cancers, long-term effects of cancer treatment, and comorbid conditions. Interventions that can provide primary, secondary, and tertiary prevention in this population are important. Physical activity has been shown to decrease colon cancer incidence and recurrence risk as well as improve quality of life and noncancer health outcomes including cardiovascular fitness in colon cancer survivors. The data are less robust for rectal cancer incidence and recurrence, although improvements in quality of life and health outcomes in rectal cancer survivors are also seen. Potential mechanisms for this benefit may occur through inflammatory or insulin-like growth factor pathways. The issues of colorectal cancer survivorship and the impact of physical activity on these issues are reviewed, with discussion of possible biologic mechanisms, barriers to physical activity intervention studies, and future research directions for physical activity in this burgeoning survivor population.

Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes

BACKGROUND

Exercise improves quality of life (QOL) in cancer survivors, although characteristics of efficacious exercise interventions for this population have not been identified.

PURPOSE

The present meta-analysis examines the efficacy of exercise interventions in improving QOL in cancer survivors, as well as features that may moderate such effects.

METHOD

Studies were identified and coded, and QOL effect sizes were calculated and analyzed for trends.

RESULTS

Overall, exercise interventions increased QOL, but this tendency depended to some extent on exercise and patient features. Although several features were associated with effect sizes, models revealed that interventions were particularly successful if they targeted more intense aerobic exercise and addressed women. These tendencies emerged over longer periods of time and were more prominent in studies with higher methodological quality.

CONCLUSION

Appropriately designed exercise interventions enhance QOL for cancer survivors and this pattern is especially evident for women. Limitations are discussed.

Eccentric exercise versus usual-care with older cancer survivors: the impact on muscle and mobility--an exploratory pilot study

Background

Resistance exercise programs with high compliance are needed to counter impaired muscle and mobility in older cancer survivors. To date outcomes have focused on older prostate cancer survivors, though more heterogeneous groups of older survivors are in-need. The purpose of this exploratory pilot study is to examine whether resistance exercise via negative eccentrically-induced work (RENEW) improves muscle and mobility in a diverse sample of older cancer survivors.

Methods

A total of 40 individuals (25 female, 15 male) with a mean age of 74 (± 6) years who have survived (8.4 ± 8 years) since their cancer diagnosis (breast, prostate, colorectal and lymphoma) were assigned to a RENEW group or a non-exercise Usual-care group. RENEW was performed for 12 weeks and measures of muscle size, strength, power and mobility were made pre and post training.

Results

RENEW induced increases in quadriceps lean tissue average cross sectional area (Pre: 43.2 ± 10.8 cm²; Post: 44.9 ± 10.9 cm²), knee extension peak strength (Pre: 248.3 ± 10.8 N; Post: 275.4 ± 10.9 N), leg extension muscle power (Pre: 198.2 ± 74.7 W; Post 255.5 ± 87.3 W), six minute walk distance (Pre: 417.2 ± 127.1 m; Post 466.9 ± 125.1 m) and a decrease on the time to safely descend stairs (Pre: 6.8 ± 4.5 s; Post 5.4 ± 2.5 s). A significant (P < 0.05) group x time interaction was noted for the muscle size and mobility improvements.

Conclusions

This exploration of RENEW in a heterogeneous cohort of older cancer survivors demonstrates increases in muscle size, strength and power along with improved mobility. The efficacy of a high-force, low perceived exertion exercise suggests RENEW may be suited to older individuals who are survivors of cancer.

Trial Registration

ClinicalTrials.gov Identifier: NCT00335491

Design of the EXercise Intervention after Stem cell Transplantation (EXIST) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of an individualized high intensity physical exercise program on fitness and fatigue in patients with multiple myeloma or (non-) Hodgkin's lymphoma treated with high dose chemotherapy and autologous stem cell transplantation

Background

The use of high-dose chemotherapy combined with autologous stem cell transplantation has improved the outcome of hematologic malignancies. Nevertheless, this treatment can cause persistent fatigue and a reduced global quality of life, role and physical function. Physical exercise interventions may be beneficial for physical fitness, fatigue and quality of life. However, the trials conducted so far to test the effects of physical exercise interventions in this group of patients were of poor to moderate methodological quality and economic evaluations are lacking. Hence there is need for a rigorous, appropriately controlled assessment of the effectiveness of exercise programs in these patients. The aims of the present study are (1) to determine the effectiveness of an individualized high intensity strength and interval training program with respect to physiological and psychological health status in patients with multiple myeloma or (non-)Hodgkin's lymphoma who have recently undergone high dose chemotherapy followed by autologous stem cell transplantation; and (2) to evaluate the cost-effectiveness of this program.

Methods

A multicenter, prospective, single blind randomized controlled trial will be performed. We aim to recruit 120 patients within an inclusion period of 2 years at 7 hospitals in the Netherlands. The patients will be randomly assigned to one of two groups: (1) intervention plus usual care; or (2) usual care. The intervention consists of an 18-week individualized supervised high-intensity exercise program and counselling. The primary outcomes (cardiorespiratory fitness, muscle strength and fatigue) and secondary outcomes are assessed at baseline, at completion of the intervention and at 12 months follow-up.

Discussion

The strengths of this study include the solid trial design with clearly defined research groups and standardized outcome measures, the inclusion of an economic evaluation and the inclusion of both resistance and endurance exercise in the intervention program.

Trial registration

This study is registered at the Netherlands Trial Register (NTR2341)

Design of the Resistance and Endurance exercise After ChemoTherapy (REACT) study: a randomized controlled trial to evaluate the effectiveness and cost-effectiveness of exercise interventions after chemotherapy on physical fitness and fatigue

BACKGROUND

Preliminary studies suggest that physical exercise interventions can improve physical fitness, fatigue and quality of life in cancer patients after completion of chemotherapy. Additional research is needed to rigorously test the effects of exercise programmes among cancer patients and to determine optimal training intensity accordingly. The present paper presents the design of a randomized controlled trial evaluating the effectiveness and cost-effectiveness of a high intensity exercise programme compared to a low-to-moderate intensity exercise programme and a waiting list control group on physical fitness and fatigue as primary outcomes.

METHODS

After baseline measurements, cancer patients who completed chemotherapy are randomly assigned to either a 12-week high intensity exercise programme or a low-to-moderate intensity exercise programme. Next, patients from both groups are randomly assigned to immediate training or a waiting list (i.e. waiting list control group). After 12 weeks, patients of the waiting list control group start with the exercise programme they have been allocated to.Both interventions consist of equal bouts of resistance and endurance interval exercises with the same frequency and duration, but differ in training intensity. Additionally, patients of both exercise programmes are counselled to improve compliance and achieve and maintain an active lifestyle, tailored to their individual preferences and capabilities.Measurements will be performed at baseline (t = 0), 12 weeks after randomization (t = 1), and 64 weeks after randomization (t = 2). The primary outcome measures are cardiorespiratory fitness and muscle strength assessed by means of objective performance indicators, and self-reported fatigue. Secondary outcome measures include health-related quality of life, self-reported physical activity, daily functioning, body composition, mood and sleep disturbances, and return to work. In addition, compliance and satisfaction with the interventions will be evaluated. Potential moderation by pre- and post-illness lifestyle, health and exercise-related attitudes, beliefs and motivation will also be assessed. Finally, the cost-effectiveness of both exercise interventions will be evaluated.

DISCUSSION

This randomized controlled trial will be a rigorous test of effects of exercise programmes for cancer patients after chemotherapy, aiming to contribute to evidence-based practice in cancer rehabilitation programmes.

TRIAL REGISTRATION

This study is registered at the Netherlands Trial Register (NTR2153).

Exercise interventions for cancer survivors: a meta-analysis of quality of life outcomes

BACKGROUND

Exercise improves quality of life (QOL) in cancer survivors, although characteristics of efficacious exercise interventions for this population have not been identified.

PURPOSE

The present meta-analysis examines the efficacy of exercise interventions in improving QOL in cancer survivors, as well as features that may moderate such effects.

METHOD

Studies were identified and coded, and QOL effect sizes were calculated and analyzed for trends.

RESULTS

Overall, exercise interventions increased QOL, but this tendency depended to some extent on exercise and patient features. Although several features were associated with effect sizes, models revealed that interventions were particularly successful if they targeted more intense aerobic exercise and addressed women. These tendencies emerged over longer periods of time and were more prominent in studies with higher methodological quality.

CONCLUSION

Appropriately designed exercise interventions enhance QOL for cancer survivors and this pattern is especially evident for women. Limitations are discussed.

The feasibility and efficacy of eccentric exercise with older cancer survivors: a preliminary study

INTRODUCTION

Older individuals who have survived cancer and the commensurate treatment often experience a reduced quality of life in part due to their impaired muscular abilities and deficits in mobility. The purpose of this preliminary study was to determine the feasibility and preliminary efficacy of resistance exercise via negative, eccentrically induced work (RENEW) with older cancer survivors.

METHODS

Older cancer survivors with a perception of moderate muscle weakness and fatigue participated in 12 weeks of RENEW. Measures of feasibility included (1) the participant's ability to progress the total amount of work of RENEW; (2) whether peak knee extension torque production became impaired; and (3) whether RENEW induced leg muscle pain as measured on a visual analog scale. The preliminary measure of efficacy included the performance of a timed up-and-go mobility test.

RESULTS

The participants significantly increased the total average work per week over the 12 weeks of RENEW. Participants increased (P < .001) their work approximately 3-fold from week 3 (7.6 [5.11 kJ) to week 12 (22.1 [14.8] kJ) without muscle pain over the 12-week RENEW training period. Knee extension peak torque production improved (11%) significantly (P = .02) (pretest: 248 [92] N; posttest: 275 [99] N) after 12 weeks of RENEW. The time to perform the up-and-go test improved (14%) significantly (P < .001) (pretest: 8.4 [2.7]; posttest: 7.2 [2.3] s) after 12 weeks of RENEW, suggesting preliminary efficacy.

CONCLUSION

Collectively, RENEW appears feasible and potentially efficacious for older, weak, and fatigued cancer survivors.

IMPLICATIONS FOR CANCER SURVIVORS

The use of eccentric muscle exercise may be ideally suited for older cancer survivors due to its high force and low energetic-cost capabilities.

Integrative review: behavioral interventions for physical activity practice

This study aimed to carry out an integrative literature review on the effectiveness of interventions in physical activity (PA) practice in the general population. The search was carried out in articles indexed in online databases: Scopus, CINAHL and Medline. Studies in English or Brazilian Portuguese were included, with evidence levels 2 or 3, published between 2004 and 2008. The final sample consisted of 14 studies. In 57.1% of the studies, interventions were effective for behavior change to practice PA. The diversity of target populations, assessment instruments and intervention designs makes it difficult to compare results and build evidence on the effectiveness of interventions for PA promotion.

The effect of regular exercise on quality of life among breast cancer survivors

The authors evaluated the effect of regular exercise during the first 36 months after cancer diagnosis on quality of life (QOL) in a population-based cohort study of 1,829 Chinese women diagnosed with breast cancer. The women were identified between 2002 and 2004 and were invited to participate in the study about 6 months after cancer diagnosis. Exercise was assessed approximately 6, 18, and 36 months after diagnosis, and a metabolic equivalent task (MET) score in hours per week was derived. A cumulative, weighted exercise-MET score was created for regular exercise during the 36-month postdiagnosis period. QOL was evaluated at 6 and 36 months postdiagnosis. Multiple linear regression and mixed models were conducted to evaluate the association between regular exercise and QOL, with adjustment for clinical prognostic factors and other potential confounders. Both exercise-MET scores measured during the first 6 or 36 months postdiagnosis and the weighted exercise-MET score over the 36-month postdiagnosis period were positively associated with total QOL score and physical, psychological, and social well-being scores assessed at 36 months postdiagnosis (all P for trend < 0.05). Compared with nonregular exercisers, women with higher exercise-MET scores (> or =8.3 MET-hours/week) were more likely to have higher scores for total QOL and specific QOL domains (all P < 0.05). The exercise-QOL association remained stable over time after cancer diagnosis. This study suggests that regular exercise after breast cancer diagnosis improves QOL.

Return to work of breast cancer survivors: a systematic review of intervention studies

Background

Breast cancer management has improved dramatically in the past three decades and as a result, a population of working age women is breast cancer survivor. Interventions for breast cancer survivors have shown improvements in quality of life and in physical and psychological states. In contrast, efforts aimed at stimulating re-employment and return-to-work interventions for breast cancer survivors have not kept pace. The objective of this review was to study the effects and characteristics of intervention studies on breast cancer survivors in which the outcome was return to work.

Methods

The Cochrane Controlled Trials Register (The Cochrane Library, Issue 4, 2006), Medline, Ovid, EMBASE and PsychInfo were systematically searched for studies conducted between 1970 to February 2007. Intervention studies for female breast cancer survivors that were focused on return to work were included.

Results

Our search strategy identified 5219 studies. Four studies out of 100 potentially relevant abstracts were selected and included 46–317 employed women who had had mastectomy, adjuvant therapy and rehabilitation, with the outcome return to work. The intervention programs focused on improvement of physical, psychological and social recovery. Although a substantial percentage (between 75% to 85%) of patients included in these studies returned to work after rehabilitation, it is not clear whether this proportion would have been lower for patients without counseling or exercise, or any other interventions, as three out of four studies did not include a comparison group.

Conclusion

The most important finding of this review is the lack of methodologically sound intervention studies on breast cancer survivors with the outcome return to work. Using evidence from qualitative and observational studies on cancer and the good results of intervention studies on return to work programs and vocational rehabilitation, return to work interventions for breast cancer survivors should be further developed and evaluated.