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Reimer N, Hafke R, Wrensch M, Horst P, Bloch W, Hahn T, Kirchhoff A, Kluck KL, Stein J, Baumann F. Influence of a 12-month supervised, intensive resistance, aerobic and impact exercise intervention on muscle strength in prostate cancer patients undergoing anti-hormone therapy: Study protocol for the randomized, controlled Burgdorf study. Contemp Clin Trials 2022; 114:106685. [DOI: 10.1016/j.cct.2022.106685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 12/09/2021] [Accepted: 01/14/2022] [Indexed: 11/12/2022]
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Watson G, Coyne Z, Houlihan E, Leonard G. Exercise oncology: an emerging discipline in the cancer care continuum. Postgrad Med 2021; 134:26-36. [PMID: 34854802 DOI: 10.1080/00325481.2021.2009683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exercise is an essential component of healthy living and well-being. While there is a global acceptance of the benefits of exercise for the general population, there exists hesitancy and confusion among health-care professionals, particularly oncologists, as to whether these benefits translate to cancer patients. Patient referrals to accessible, structured exercise programs in this setting are often overlooked by physicians when formulating a cancer management plan. There is however increasing awareness and acceptance of cancer survivorship as a part of the cancer care continuum, identifying multiple factors that contribute to well-being beyond just cancer outcomes. Efforts to optimize cancer survivorship have stimulated further academic interest in the benefits of healthy living and particularly exercise oncology. There is now compelling evidence that exercise, which includes daily activities such as walking, as well as structured programs, improves multiple-cancer outcomes such as fatigue, quality of life and likely survival, and warrants consideration in the multidisciplinary care of cancer patients. International guidelines have been established that recommend counseling cancer patients with regard to healthy lifestyle changes including exercise. However, there still remains a reluctance from oncology physicians to prescribe exercise for these patients, largely due to uncertainty with regard to their patients' ability to tolerate such an intervention, coupled with insufficient understanding of the potential benefits of these programs. There also exist patient barriers and attitudes that must be overcome. Exercise strategies and bespoke programs that are tailored to the unique abilities and goals of the patients will enhance participation. To move the field forward and integrate exercise oncology into standard practice, it is imperative to raise awareness of the benefits of exercise to cancer patients and their health-care providers. This will facilitate the prescription of exercise as part of the multimodal treatment plan with the ultimate aim of promoting an active lifestyle to optimize patient care and well-being.
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Affiliation(s)
- Ga Watson
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Zl Coyne
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - E Houlihan
- Department of Physiotherapy, Cancer Care West, Galway, Ireland
| | - Gd Leonard
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
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Thomas R, Kenfield SA, Yanagisawa Y, Newton RU. Why exercise has a crucial role in cancer prevention, risk reduction and improved outcomes. Br Med Bull 2021; 139:100-119. [PMID: 34426823 PMCID: PMC8431973 DOI: 10.1093/bmb/ldab019] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/30/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Exercise is one of several factors known to lower the risk of developing cancer, as well as improve outcomes in patients already diagnosed. People who exercise after cancer have lower rates of cancer complications, treatment toxicities, relapse and improved survival. This review highlights the supportive data and biochemical processes, which explain these potential benefits. SOURCES OF DATA PubMed, Embase, Medline and Cochrane libraries were searched for papers which addressed the effects of exercise and physical activity on cancer for this review. The search terms used were physical activity, exercise and cancer up to February 2021. We also referred to the background research required for international exercise intervention study involving men with prostate cancer (INTERVAL-GAP4) and scrutinized references within the robust papers published on this subject to ensure we did not miss any clinically studies. One hundred and eighty eight papers were included. AREAS OF AGREEMENT Exercise programmes mitigate many of the complications and risks associated with cancer, particularly thromboembolism, fatigue, weight gain, arthralgia, cognitive impairment and depression. AREAS OF CONTROVERSY Molecular and biomarker changes, resulting from exercise, suggest that exercise elicits beneficial changes in insulin-related pathways, down-regulates inflammation and serum oestrogen levels, and enhances oxidative, immune and cellular repair pathways. Nonetheless, the evidence remains preliminary. GROWING POINTS The timing, intensity and challenges of prehabilitation, adjunct and rehabilitation exercise programmes are being increasingly understood but their implementation remains sporadic. AREAS FOR DEVELOPING RESEARCH More robust clinical trial data are needed to substantiate a causal effect of exercise on overall and cancer-specific survival. These studies are ongoing. Research evaluating the most cost-efficient ways of incorporating prehabilitation, adjunct and rehabilitation programmes into routine practice would be helpful to funding bodies and health care strategists.
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Affiliation(s)
- Robert Thomas
- Department of Oncology, Addenbrooke's Hospital, Cambridge CB2 2QQ, UK
| | - Stacey A Kenfield
- Departments of Urology and Epidemiology and Biostatistics, University of California at San Francisco, Mission Hall, Box 1695-550, 16th Street, 6th Floor, San Francisco, CA 9414, USA
| | - Yuuki Yanagisawa
- Department of Medicine, Bedford Hospital, Kempston road, Bedford MK42 9DJ, UK
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Perth, WA 6027, Australia
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Swan F, Chen H, Forbes CC, Johnson MJ, Lind M. CANcer BEhavioural nutrition and exercise feasibility trial (CanBenefit); phase I qualitative interview findings. J Geriatr Oncol 2020; 12:641-648. [PMID: 33059998 DOI: 10.1016/j.jgo.2020.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/09/2020] [Accepted: 09/29/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Older people with lung cancer are often frail and unfit due to their cancer and co-morbidities and may tolerate cancer treatments poorly. Physical activity (PA) and a healthy diet offer quality of life benefit to people with cancer before, during, and post treatment. However, older adults are poorly represented in the clinical trials on which recommendations were made. OBJECTIVE To assess the acceptability, usefulness, and practicality of delivering a tailored wellbeing (PA and nutrition) intervention for older adults with lung cancer before, during, and after cancer treatments (chemotherapy and/or immunotherapy). METHODS Semi-structured interviews conducted with nine patients with lung cancer and three patients with mesothelioma, ≥70 years and ten informal carers, and nine Multidisciplinary Team (MDT) members. A topic guide covered the acceptability, usefulness, and practicality of a wellbeing intervention as well as specific feedback on individual components. Data were subjected to thematic analysis. FINDINGS Four themes were generated: current lack of wellbeing care in clinical work; preferred "can have" dietary and "can do" PA advice; peer support as facilitating factor; and barriers to compliance including patients' psychological and physical issues as well as current cancer pathway and staffing issues. CONCLUSION Older adults with lung cancer would welcome a proactive, clear and instructive, wellbeing intervention. Many barriers to compliance exist, particularly before and during cancer treatments due to the psycho-social impact of diagnosis, and the effects of cancer treatment. The intervention must be tailored to individual need and address physical limitations, psychological and social welfare in addition to PA and nutritional advice.
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Affiliation(s)
- Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK.
| | - Hong Chen
- Institute of Applied Health Research, Murray Learning Centre, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Michael Lind
- Academic Department of Oncology, Queen's Centre for Oncology and Haematology, Castle Hill Hospital, Cottingham, Kingston-Upon-Hull, UK
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Forbes CC, Swan F, Greenley SL, Lind M, Johnson MJ. Physical activity and nutrition interventions for older adults with cancer: a systematic review. J Cancer Surviv 2020; 14:689-711. [PMID: 32328828 PMCID: PMC7473955 DOI: 10.1007/s11764-020-00883-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 04/02/2020] [Indexed: 12/17/2022]
Abstract
Purpose The aim of this review was to summarize the current literature for the effectiveness of activity and nutritional based interventions on health-related quality of life (HRQoL) in older adults living with and beyond cancer (LWBC). Methods We conducted systematic structured searches of CINAHL, Embase, Medline, Cochrane CENTRAL databases, and bibliographic review. Two independent researchers selected against inclusion criteria: (1) lifestyle nutrition and/or activity intervention for people with any cancer diagnosis, (2) measured HRQoL, (3) all participants over 60 years of age and (4) randomized controlled trials. Results Searches identified 5179 titles; 114 articles had full text review, with 14 studies (participant n = 1660) included. Three had nutrition and activity components, one, nutrition only and ten, activity only. Duration ranged from 7 days to 1 year. Interventions varied from intensive daily prehabilitation to home-based gardening interventions. Studies investigated various HRQoL outcomes including fatigue, general and cancer-specific quality of life (QoL), distress, depression, global side-effect burden and physical functioning. Eight studies reported significant intervention improvements in one or more QoL measure. Seven studies reported using a psychosocial/theoretical framework. There is a gap in tailored nutrition advice. Conclusions Among the few studies that targeted older adults with cancer, most were activity-based programmes with half reporting improvements in QoL. Future research should focus on or include tailored nutrition components and consider appropriate behaviour change techniques to maximize potential QoL improvement. Implications for Cancer Survivors More research is needed to address the research gap regarding older adults as current recommendations are derived from younger populations. Electronic supplementary material The online version of this article (10.1007/s11764-020-00883-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cynthia C Forbes
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK. .,University of Hull, Allam Medical Building 3rd Floor, Cottingham Road, Kingston-Upon-Hull, East Yorkshire, HU6 7RX, UK.
| | - Flavia Swan
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Sarah L Greenley
- Academy of Primary Care, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Michael Lind
- Cancer Research Group, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
| | - Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Kingston-Upon-Hull, UK
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Newton RU, Kenfield SA, Hart NH, Chan JM, Courneya KS, Catto J, Finn SP, Greenwood R, Hughes DC, Mucci L, Plymate SR, Praet SFE, Guinan EM, Van Blarigan EL, Casey O, Buzza M, Gledhill S, Zhang L, Galvão DA, Ryan CJ, Saad F. Intense Exercise for Survival among Men with Metastatic Castrate-Resistant Prostate Cancer (INTERVAL-GAP4): a multicentre, randomised, controlled phase III study protocol. BMJ Open 2018; 8:e022899. [PMID: 29764892 PMCID: PMC5961562 DOI: 10.1136/bmjopen-2018-022899] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Preliminary evidence supports the beneficial role of physical activity on prostate cancer outcomes. This phase III randomised controlled trial (RCT) is designed to determine if supervised high-intensity aerobic and resistance exercise increases overall survival (OS) in patients with metastatic castrate-resistant prostate cancer (mCRPC). METHODS AND ANALYSIS Participants (n=866) must have histologically documented metastatic prostate cancer with evidence of progressive disease on androgen deprivation therapy (defined as mCRPC). Patients can be treatment-naïve for mCRPC or on first-line androgen receptor-targeted therapy for mCRPC (ie, abiraterone or enzalutamide) without evidence of progression at enrolment, and with no prior chemotherapy for mCRPC. Patients will receive psychosocial support and will be randomly assigned (1:1) to either supervised exercise (high-intensity aerobic and resistance training) or self-directed exercise (provision of guidelines), stratified by treatment status and site. Exercise prescriptions will be tailored to each participant's fitness and morbidities. The primary endpoint is OS. Secondary endpoints include time to disease progression, occurrence of a skeletal-related event or progression of pain, and degree of pain, opiate use, physical and emotional quality of life, and changes in metabolic biomarkers. An assessment of whether immune function, inflammation, dysregulation of insulin and energy metabolism, and androgen biomarkers are associated with OS will be performed, and whether they mediate the primary association between exercise and OS will also be investigated. This study will also establish a biobank for future biomarker discovery or validation. ETHICS AND DISSEMINATION Validation of exercise as medicine and its mechanisms of action will create evidence to change clinical practice. Accordingly, outcomes of this RCT will be published in international, peer-reviewed journals, and presented at national and international conferences. Ethics approval was first obtained at Edith Cowan University (ID: 13236 NEWTON), with a further 10 investigator sites since receiving ethics approval, prior to activation. TRIAL REGISTRATION NUMBER NCT02730338.
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Affiliation(s)
- Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Stacey A Kenfield
- Department of Urology, University of California San Francisco, San Francisco, California, USA
| | - Nicolas H Hart
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
- Institute for Health Research, University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - June M Chan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | - Kerry S Courneya
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - James Catto
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Stephen P Finn
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Daniel C Hughes
- Institute for Health Promotion Research, University of Texas Health, San Antonio, Texas, UK
| | - Lorelei Mucci
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, Massachusetts, USA
| | - Stephen R Plymate
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
| | - Stephan F E Praet
- Division of Gerontology and Geriatric Medicine, University of Washington, Seattle, Washington, USA
- University of Canberra Research Institute for Sport and Exercise, University of Canberra, Canberra, Australia
| | | | - Erin L Van Blarigan
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
| | | | - Mark Buzza
- Movember Foundation, Melbourne, Victoria, Australia
| | - Sam Gledhill
- Movember Foundation, Melbourne, Victoria, Australia
| | - Li Zhang
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Perth, Western Australia, Australia
- School of Medical and Health Science, Edith Cowan University, Perth, Western Australia, Australia
| | - Charles J Ryan
- Department of Urology, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of California San Francisco, San Francisco, California, USA
- Department of Medicine, University of Minnesota, Minneapolis, Minnesota, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de L'Universite de Montreal, Montreal, Quebec, Canada
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Thomas RJ, Kenfield SA, Jimenez A. Exercise-induced biochemical changes and their potential influence on cancer: a scientific review. Br J Sports Med 2017; 51:640-644. [PMID: 27993842 PMCID: PMC5466928 DOI: 10.1136/bjsports-2016-096343] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2016] [Indexed: 12/20/2022]
Abstract
AIM To review and discuss the available international literature regarding the indirect and direct biochemical mechanisms that occur after exercise, which could positively, or negatively, influence oncogenic pathways. METHODS The PubMed, MEDLINE, Embase and Cochrane libraries were searched for papers up to July 2016 addressing biochemical changes after exercise with a particular reference to cancer. The three authors independently assessed their appropriateness for inclusion in this review based on their scientific quality and relevance. RESULTS 168 papers were selected and categorised into indirect and direct biochemical pathways. The indirect effects included changes in vitamin D, weight reduction, sunlight exposure and improved mood. The direct effects included insulin-like growth factor, epigenetic effects on gene expression and DNA repair, vasoactive intestinal peptide, oxidative stress and antioxidant pathways, heat shock proteins, testosterone, irisin, immunity, chronic inflammation and prostaglandins, energy metabolism and insulin resistance. SUMMARY Exercise is one of several lifestyle factors known to lower the risk of developing cancer and is associated with lower relapse rates and better survival. This review highlights the numerous biochemical processes, which explain these potential anticancer benefits.
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Affiliation(s)
| | - Stacey A Kenfield
- Department of Urology, University of California, San Francisco, California, USA
| | - Alfonso Jimenez
- Centre for Applied Biological and Exercise Sciences, Faculty of Health and Life Sciences, Coventry University, Coventry, UK
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Apostolopoulos V, Borkoles E, Polman R, Stojanovska L. Physical and immunological aspects of exercise in chronic diseases. Immunotherapy 2014; 6:1145-57. [DOI: 10.2217/imt.14.76] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Physical inactivity and sedentary lifestyles are believed to be independent risk factors for the occurrence of numerous diseases, including, obesity, Type 2 diabetes, metabolic syndrome, cardiovascular disease, cancer and mental health, all leading to substantial morbidity and/or premature death. It has been found that regular exercise, is associated with better quality of life and health outcomes, and reduces the risk of cardiovascular disease and cancer. Here, we review the effects regular exercise has on mental health and well-being, on the immune system and in cancer, cardiovascular disease, autoimmunity and metabolic syndrome. Is exercise the new immunotherapy to treat diseases?
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Affiliation(s)
- Vasso Apostolopoulos
- Centre for Chronic Disease Prevention & Management, College of Health & Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia
- VA Consulting Services, PO Box 6437, Melbourne, Victoria 3030, Australia
| | - Erika Borkoles
- College of Sport & Exercise Science, Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia
| | - Remco Polman
- College of Sport & Exercise Science, Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia
| | - Lily Stojanovska
- Centre for Chronic Disease Prevention & Management, College of Health & Biomedicine, Victoria University, PO Box 14428, Melbourne, Victoria 8001, Australia
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