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Vikmoen O, Strandberg E, Svindland KV, Henriksson A, Mazzoni AS, Johansson B, Jönsson J, Karakatsanis A, Annebäck M, Kudrén D, Lindman H, Wärnberg F, Berntsen S, Demmelmaier I, Nordin K, Raastad T. Effects of heavy-load strength training during (neo-)adjuvant chemotherapy on muscle strength, muscle fiber size, myonuclei, and satellite cells in women with breast cancer. FASEB J 2024; 38:e23784. [PMID: 38953567 DOI: 10.1096/fj.202400634r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 05/30/2024] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
To investigate the effects of heavy-load strength training during (neo-)adjuvant chemotherapy in women with breast cancer on muscle strength, body composition, muscle fiber size, satellite cells, and myonuclei. Women with stage I-III breast cancer were randomly assigned to a strength training group (ST, n = 23) performing supervised heavy-load strength training twice a week during chemotherapy, or a usual care control group (CON, n = 17). Muscle strength and body composition were measured and biopsies from m. vastus lateralis collected before the first cycle of chemotherapy (T0) and after chemotherapy and training (T1). Muscle strength increased significantly more in ST than in CON in chest-press (ST: +10 ± 8%, p < .001, CON: -3 ± 5%, p = .023) and leg-press (ST: +11 ± 8%, p < .001, CON: +3 ± 6%, p = .137). Both groups reduced fat-free mass (ST: -4.9 ± 4.0%, p < .001, CON: -5.2 ± 4.9%, p = .004), and increased fat mass (ST: +15.3 ± 16.5%, p < .001, CON: +16.3 ± 19.8%, p = .015) with no significant differences between groups. No significant changes from T0 to T1 and no significant differences between groups were observed in muscle fiber size. For myonuclei per fiber a non-statistically significant increase in CON and a non-statistically significant decrease in ST in type I fibers tended (p = .053) to be different between groups. Satellite cells tended to decrease in ST (type I: -14 ± 36%, p = .097, type II: -9 ± 55%, p = .084), with no changes in CON and no differences between groups. Strength training during chemotherapy improved muscle strength but did not significantly affect body composition, muscle fiber size, numbers of satellite cells, and myonuclei compared to usual care.
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Affiliation(s)
- Olav Vikmoen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Emelie Strandberg
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | - Anna Henriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Anne-Sophie Mazzoni
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Janniz Jönsson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - Andreas Karakatsanis
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
- Section for Breast Surgery, Department of Surgery, Uppsala University Hospital, Uppsala, Sweden
| | - Matilda Annebäck
- Department of Surgical Sciences, Faculty of Medicine, Uppsala University, Uppsala, Sweden
| | - David Kudrén
- Department of Oncology, Södersjukhuset, Stockholm, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Fredrik Wärnberg
- Institute of Clinical Sciences, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
- Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Truls Raastad
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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Li X, Wang J, Zhang J, Zhang N, Wu C, Geng Z, Zhou J, Dong L. The Effect of Exercise on Weight and Body Composition of Breast Cancer Patients Undergoing Chemotherapy: A Systematic Review. Cancer Nurs 2023; Publish Ahead of Print:00002820-990000000-00093. [PMID: 36728172 DOI: 10.1097/ncc.0000000000001196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Chemotherapy is a primary adjuvant treatment strategy for breast cancer patients, accompanied by weight gain and negative changes in body composition. However, it is unknown whether exercise is effective in preventing said weight gain and mitigating body composition changes of breast cancer patients undergoing treatment. OBJECTIVES The current study used meta-analysis with trial sequential analysis to determine exercise effect on weight and body composition of breast cancer patients undergoing chemotherapy. METHODS Cochrane Library, PubMed, EMBASE, EBSCO, Scopus, and SinoMed were searched (from the database start date up to August 16, 2021) for randomized controlled studies evaluating the effect of exercise on weight or body composition among breast cancer patients during chemotherapy. RevMan software and TSA Software were used to assess the risk of bias and analyze study results. RESULTS In total, 13 studies comprising 1828 participants were included. Meta-analysis showed that exercise could lead to lower weight, body mass index (BMI), and percentage of body fat during chemotherapy for breast cancer patients, and muscular strength showed significant improvement. Trial sequential analysis showed that evidence of muscular strength was sufficient, but BMI evidence requires further confirmation. CONCLUSION This meta-analysis found significant differences in body weight, BMI, percentage of body fat, and muscular strength between exercise intervention groups and control groups. IMPLICATIONS FOR PRACTICE Exercise during chemotherapy is beneficial in preventing weight gain and negative changes in body composition. Medical practitioners should encourage patients to start exercising during chemotherapy. However, further studies are required because insufficient sample sizes meant that outcomes of body composition remain unconfirmed.
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Affiliation(s)
- Xinyu Li
- Author Affiliations: School of Nursing, Shanghai University of Traditional Chinese Medicine, Shanghai, China (Ms Li, Mr Wang, and Drs Zhang, Wu, Geng, Zhou, and Dong); and Department of Breast Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China (Ms N Zhang)
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Reallocating sedentary time to physical activity: effects on fatigue and quality of life in patients with breast cancer in the Phys-Can project. Support Care Cancer 2023; 31:151. [PMID: 36738358 PMCID: PMC9899175 DOI: 10.1007/s00520-023-07614-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/27/2023] [Indexed: 02/05/2023]
Abstract
PURPOSE We aimed to investigate the effects of reallocating sedentary time to an equal amount of light (LPA) or moderate-to-vigorous intensity physical activity (MVPA) on cancer-related fatigue and health-related quality of life (HRQoL) in patients with breast cancer. We also aimed to determine the daily amount of sedentary time needed to be reallocated to LPA or MVPA to produce minimal clinically important changes in these outcomes. METHODS Pooled baseline data from three studies were used, including women with breast cancer who participated in the Phys-Can project. Fatigue was assessed with the Multidimensional Fatigue Inventory questionnaire (MFI; five dimensions, 4-20 scale) and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30; 0-100 scale). Sedentary time and physical activity were measured with accelerometry. Isotemporal substitution modelling was used for the analyses. RESULTS Overall, 436 participants (mean age 56 years, fatigue 11 [MFI], HRQoL 66 [EORTC QLQ-C30], LPA 254 min/day, MVPA 71 min/day) were included. Fatigue significantly decreased in two MFI dimensions when reallocating 30 min/day of sedentary time to LPA: reduced motivation and reduced activity (β = - 0.21). Fatigue significantly decreased in three MFI dimensions when reallocating 30 min/day of sedentary time to MVPA: general fatigue (β = - 0.34), physical fatigue (β = - 0.47) and reduced activity (β = - 0.48). To produce minimal clinically important changes in fatigue (- 2 points on MFI), the amount of sedentary time needed to be reallocated to LPA was ≈290 min/day and to MVPA was ≥ 125 min/day. No significant effects were observed on HRQoL when reallocating sedentary time to LPA or MVPA. CONCLUSIONS Our results suggest that reallocating sedentary time to LPA or MVPA has beneficial effects on cancer-related fatigue in patients with breast cancer, with MVPA having the greatest impact. In relatively healthy and physically active breast cancer populations, a large amount of time reallocation is needed to produce clinically important changes. Future studies are warranted to evaluate such effects in broader cancer populations. TRIAL REGISTRATION NCT02473003 (10/10/2014) and NCT04586517 (14/10/2020).
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Vikmoen O, Wiestad TH, Thormodsen I, Nordin K, Berntsen S, Demmelmaier I, Strandberg E, Raastad T. Effects of high and low-to-moderate intensity exercise during (neo-)adjuvant chemotherapy on muscle cells, cardiorespiratory fitness and muscle function in women with breast cancer: Protocol for a randomized controlled trial (Preprint). JMIR Res Protoc 2022; 11:e40811. [DOI: 10.2196/40811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 09/21/2022] [Accepted: 09/21/2022] [Indexed: 11/13/2022] Open
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Kiesl D, Kuzdas-Sallaberger M, Fuchs D, Brunner S, Kommenda R, Tischler C, Hornich H, Akbari K, Kellermair J, Blessberger H, Ocenasek H, Hofmann P, Zimmer P, Vosko MR. Protocol for the Exercise, Cancer and Cognition - The ECCO-Study: A Randomized Controlled Trial of Simultaneous Exercise During Neo-/Adjuvant Chemotherapy in Breast Cancer Patients and Its Effects on Neurocognition. Front Neurol 2022; 13:777808. [PMID: 35401389 PMCID: PMC8990905 DOI: 10.3389/fneur.2022.777808] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 02/10/2022] [Indexed: 12/21/2022] Open
Abstract
Introduction Epidemiological studies show that increased physical activity is linked to a lower risk of breast cancer and mortality. As a result, physical activity can significantly improve patients' quality of life (QOL) both during and after therapy.Many breast cancer patients demonstrate a decrease in cognitive capacity, referred to as the symptom-complex cancer related cognitive impairment (CRCI). Most frequently reported impairments are mild to moderate deficits in processing speed, attention, memory, and executive functions. Cognitive symptoms persist for months or even years, following medical treatment in roughly 35% of afflicted people, impairing everyday functioning, limiting the ability to return to work, and lowering the overall QOL. Recent studies point toward a key role of inflammatory pathways in the CRCI genesis. Attention to physical activity as a potential supportive care option is therefore increasing. However, evidence for the positive effects of exercise on preventing CRCI is still lacking. Patients and Methods Against this background, the prospective, two-arm, 1:1 randomized, controlled trial investigates the influence of first line chemotherapy accompanied by exercise training on preventing CRCI in 126 patients with breast cancer at the local University Hospital. The study will evaluate biomarkers and secondary assessments suspected to be involved in the pathogenesis of CRCI in addition to objective (primary outcome) and subjective cognitive function. CRCI is believed to be connected to either functional and/or morphological hippocampal damage due to chemotherapy. Thus, cerebral magnetic resonance imaging (MRI) and hippocampal volume measurements are performed. Furthermore, a specific neuropsychological test battery for breast cancer patients has been developed to detect early signs of cognitive impairments in patients and to be integrated into practice. Discussion This study will explore how a long-term supervised exercise intervention program might prevent CRCI, enables optimization of supportive care and objectifies limits of psychological and physical resilience in breast cancer patients during and after chemotherapy treatment. Trial Registration ClinicalTrials.gov: Identifier: NCT04789187. Registered on 09 March 2021.
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Affiliation(s)
- David Kiesl
- Department for Internal Medicine III, Kepler University Hospital, Linz, Austria
| | | | - David Fuchs
- Department for Palliative Care, Ordensklinikum Linz, Sisters of Mercy Hospital, Linz, Austria
| | - Silvana Brunner
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | - Romana Kommenda
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | - Clemens Tischler
- Department for Clinical Psychology, Kepler University Hospital, Linz, Austria
| | | | - Kaveh Akbari
- Central Radiology Institute, Kepler University Hospital, Johannes Kepler University, Linz, Austria
| | - Jörg Kellermair
- Department of Cardiology, Medical Faculty of the Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | - Hermann Blessberger
- Department of Cardiology, Medical Faculty of the Johannes Kepler University, Kepler University Hospital, Linz, Austria
| | | | - Peter Hofmann
- Institute of Human Movement Science, Sport & Health, Exercise Physiology, Training & Training Therapy Research Group, University of Graz, Graz, Austria
| | - Philipp Zimmer
- Divison of Performance and Health (Sports Medicine), Institute for Sport and Sport Science, TU Dortmund University, Dortmund, Germany
| | - Milan R Vosko
- Department of Neurology, Kepler University Hospital, Linz, Austria
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Breast Cancer Patients’ Experiences with Online Group-Based Physical Exercise in a COVID-19 Context: A Focus Group Study. J Pers Med 2022; 12:jpm12030356. [PMID: 35330356 PMCID: PMC8950528 DOI: 10.3390/jpm12030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/17/2022] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
In patients with breast cancer, physical exercise reduces the toxicity of treatment; however, this physical exercise must meet a set of criteria, such as being guided by knowledgeable instructors. Thus, the aim of this study was to explore the perceptions of female breast cancer patients regarding the impact of an online physical exercise programme in the context of the COVID-19 pandemic. Nineteen female breast cancer patients participated in four focus group interviews as part of a qualitative study using a thematic analysis between December 2020 and May 2021. Three major themes emerged: “Experiences and perceptions of online physical exercise with breast cancer”; “Incorporating exercise-based activity for cancer-related side effects”; and “Increasing self-esteem and empowerment”. Online, live-streamed, and supervised group activities help breast cancer patients engage and prevent the recurrence of cancer-related side effects, as well as to control COVID-19-related fear and provide an alternative to promote mental health-related quality of life.
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