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Tamayo-Torres E, Garrido A, de Cabo R, Carretero J, Gómez-Cabrera MC. Molecular mechanisms of cancer cachexia. Role of exercise training. Mol Aspects Med 2024; 99:101293. [PMID: 39059039 DOI: 10.1016/j.mam.2024.101293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 07/05/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024]
Abstract
Cancer-associated cachexia represents a multifactorial syndrome mainly characterized by muscle mass loss, which causes both a decrease in quality of life and anti-cancer therapy failure, among other consequences. The definition and diagnostic criteria of cachexia have changed and improved over time, including three different stages (pre-cachexia, cachexia, and refractory cachexia) and objective diagnostic markers. This metabolic wasting syndrome is characterized by a negative protein balance, and anti-cancer drugs like chemotherapy or immunotherapy exacerbate it through relatively unknown mechanisms. Due to its complexity, cachexia management involves a multidisciplinary strategy including not only nutritional and pharmacological interventions. Physical exercise has been proposed as a strategy to counteract the effects of cachexia on skeletal muscle, as it influences the mechanisms involved in the disease such as protein turnover, inflammation, oxidative stress, and mitochondrial dysfunction. This review will summarize the experimental and clinical evidence of the impact of physical exercise on cancer-associated cachexia.
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Affiliation(s)
- Eva Tamayo-Torres
- Department of Physiology, Faculty of Pharmacy, University of Valencia, 46100, Burjassot, Spain; Freshage Research Group. Department of Physiology. Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
| | - Amanda Garrido
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Rafael de Cabo
- Experimental Gerontology Section, Translational Gerontology Branch, National Institute on Aging, National Institutes of Health, Baltimore, MD, 21224, USA
| | - Julián Carretero
- Department of Physiology, Faculty of Pharmacy, University of Valencia, 46100, Burjassot, Spain.
| | - María Carmen Gómez-Cabrera
- Freshage Research Group. Department of Physiology. Faculty of Medicine, University of Valencia and CIBERFES, Fundación Investigación Hospital Clínico Universitario/INCLIVA, Valencia, Spain
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Petrasso C, Bayly J, Arculeo S, Bowers M, Costi S, Nottelmann L, Turola E, Vanzulli E, Maddocks M. Non-pharmacological interventions targeting mobility among people with advanced cancer: a systematic review. Support Care Cancer 2024; 32:569. [PMID: 39102127 DOI: 10.1007/s00520-024-08767-x] [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: 01/25/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE To synthesise evidence evaluating non-pharmacological interventions targeting mobility among people with advanced cancer, considering the type, efficacy and contextual factors that may influence outcome. METHODS Systematic review of studies of non-pharmacological interventions in adults (≥ 18 years) with advanced (stage III-IV) cancer, and assessing mobility using clinical or patient-reported outcome measures. Searches were conducted across three electronic databases (MEDLINE, EMBASE and CINAHL) up to June 2024. Methodological quality was assessed using Joanna Briggs Institute tools and contextual factors were evaluated through the Context and Implementation of Complex Interventions framework. A narrative synthesis was conducted due to clinical heterogeneity of included studies. RESULTS 38 studies encompassing 2,464 participants were included. The most frequent mobility outcome measure was the 6-min walk test (26/38 studies). Exercise was the most common intervention, (33 studies: 27 aerobic and resistance, 5 aerobic, 1 resistance versus aerobic training) and improvements in mobility were found in 21/33 outcomes. Electrotherapy interventions led to significant improvements in mobility in 3/5 studies. Geographical factors (e.g. distance, transport, parking requirements) potentially limited participation in 18/38 studies. A lack of ethnic diversity among populations was evident and language proficiency was an inclusion criterion in 12 studies. CONCLUSION Exercise and neuromuscular electrical stimulation appear to improve mobility outcomes in advanced cancer. The evaluation of other non-pharmacological interventions targeting mobility should consider access and inclusivity, and be adaptable to the needs of this population.
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Affiliation(s)
- Carmine Petrasso
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK.
| | - Joanne Bayly
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
| | - Simona Arculeo
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Megan Bowers
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
| | - Stefania Costi
- Physical Medicine and Rehabilitation Unit, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Surgical, Medical and Dental Department of Morphological Sciences, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Lise Nottelmann
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- The Research Unit, Department of Palliative Medicine, Bispebjerg Hospital, Copenhagen, Denmark
| | - Elena Turola
- Research and Statistics Infrastructure, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Elisa Vanzulli
- Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation Bessemer Road, London, SE5 9PJ, UK
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Reljic D, Herrmann HJ, Zopf Y. Commentary: Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations. Front Sports Act Living 2024; 6:1425233. [PMID: 39104455 PMCID: PMC11298336 DOI: 10.3389/fspor.2024.1425233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/03/2024] [Indexed: 08/07/2024] Open
Affiliation(s)
- Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Hans Joachim Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
- Department of Medicine 1—Gastroenterology, Pneumonology and Endocrinology, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
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Yule MS, Thompson J, Leesahatsawat K, Sousa MS, Anker SD, Arends J, Balstad TR, Brown LR, Bye A, Dajani O, Fallon M, Hjermstad MJ, Jakobsen G, McDonald J, McGovern J, Roeland EJ, Sayers J, Skipworth RJ, Ottestad IO, Philips I, Simpson MR, Solheim TS, Vagnildhaug OM, McMillan D, Laird BJ, Dolan RD. Biomarker endpoints in cancer cachexia clinical trials: Systematic Review 5 of the cachexia endpoint series. J Cachexia Sarcopenia Muscle 2024; 15:853-867. [PMID: 38783477 PMCID: PMC11154797 DOI: 10.1002/jcsm.13491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/11/2024] [Accepted: 05/06/2024] [Indexed: 05/25/2024] Open
Abstract
Regulatory agencies require evidence that endpoints correlate with clinical benefit before they can be used to approve drugs. Biomarkers are often considered surrogate endpoints. In cancer cachexia trials, the measurement of biomarkers features frequently. The aim of this systematic review was to assess the frequency and diversity of biomarker endpoints in cancer cachexia trials. A comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990-2023) was completed. Eligible trials met the following criteria: adults (≥18 years), prospective design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a biomarker(s) as an endpoint. Biomarkers were defined as any objective measure that was assayed from a body fluid, including scoring systems based on these assays. Routine haematology and biochemistry to monitor intervention toxicity were not considered. Data extraction was performed using Covidence, and reporting followed PRISMA guidance (PROSPERO: CRD42022276710). A total of 5975 studies were assessed, of which 52 trials (total participants = 6522) included biomarkers as endpoints. Most studies (n = 29, 55.7%) included a variety of cancer types. Pharmacological interventions (n = 27, 51.9%) were most evaluated, followed by nutritional interventions (n = 20, 38.4%). Ninety-nine different biomarkers were used across the trials, and of these, 96 were assayed from blood. Albumin (n = 29, 55.8%) was assessed most often, followed by C-reactive protein (n = 22, 42.3%), interleukin-6 (n = 16, 30.8%) and tumour necrosis factor-α (n = 14, 26.9%), the latter being the only biomarker that was used to guide sample size calculations. Biomarkers were explicitly listed as a primary outcome in six trials. In total, 12 biomarkers (12.1% of 99) were used in six trials or more. Insulin-like growth factor binding protein 3 (IGFBP-3) and insulin-like growth factor 1 (IGF-1) levels both increased significantly in all three trials in which they were both used. This corresponded with a primary outcome, lean body mass, and was related to the pharmacological mechanism. Biomarkers were predominately used as exploratory rather than primary endpoints. The most commonly used biomarker, albumin, was limited by its lack of responsiveness to nutritional intervention. For a biomarker to be responsive to change, it must be related to the mechanism of action of the intervention and/or the underlying cachexia process that is modified by the intervention, as seen with IGFBP-3, IGF-1 and anamorelin. To reach regulatory approval as an endpoint, the relationship between the biomarker and clinical benefit must be clarified.
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Affiliation(s)
- Michael S. Yule
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Joshua Thompson
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Khachonphat Leesahatsawat
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyAustralia
| | - Stefan D. Anker
- Department of Cardiology (CVK)Berlin Institute of Health Center for Regenerative Therapies (BCRT)BerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- German Centre for Cardiovascular Research (DZHK) partner site Berlin, Charité Universitätsmedizin BerlinBerlinGermany
| | - Jann Arends
- Department of Medicine IMedical Center – University of Freiburg, Faculty of Medicine, University of FreiburgFreiburg im BreisgauGermany
| | - Trude R. Balstad
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Leo R. Brown
- Department of Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Asta Bye
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet‐Oslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Marie Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Marianne J. Hjermstad
- Regional Advisory Unit for Palliative Care, Department of OncologyOslo University Hospital, University of OsloOsloNorway
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Gunnhild Jakobsen
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - James McDonald
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Josh McGovern
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | | | - Judith Sayers
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Richard J.E. Skipworth
- Department of Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Melanie R. Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Ola Magne Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt Olavs Hospital, Trondheim University HospitalTrondheimNorway
| | - Donald McMillan
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
| | - Barry J.A. Laird
- St Columba's HospiceEdinburghUK
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- European Palliative Care Research Centre, Department of OncologyOslo University Hospital and Institute of Clinical Medicine, University of OsloOsloNorway
| | - Ross D. Dolan
- Academic Department of SurgeryUniversity of Glasgow, New Lister Building, Glasgow Royal InfirmaryGlasgowUK
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Brown LR, Sousa MS, Yule MS, Baracos VE, McMillan DC, Arends J, Balstad TR, Bye A, Dajani O, Dolan RD, Fallon MT, Greil C, Hjermstad MJ, Jakobsen G, Maddocks M, McDonald J, Ottestad IO, Phillips I, Sayers J, Simpson MR, Vagnildhaug OM, Solheim TS, Laird BJ, Skipworth RJ. Body weight and composition endpoints in cancer cachexia clinical trials: Systematic Review 4 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:816-852. [PMID: 38738581 PMCID: PMC11154800 DOI: 10.1002/jcsm.13478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 02/12/2024] [Accepted: 03/16/2024] [Indexed: 05/14/2024] Open
Abstract
Significant variation exists in the outcomes used in cancer cachexia trials, including measures of body composition, which are often selected as primary or secondary endpoints. To date, there has been no review of the most commonly selected measures or their potential sensitivity to detect changes resulting from the interventions being examined. The aim of this systematic review is to assess the frequency and diversity of body composition measures that have been used in cancer cachexia trials. MEDLINE, Embase and Cochrane Library databases were systematically searched between January 1990 and June 2021. Eligible trials examined adults (≥18 years) who had received an intervention aiming to treat or attenuate the effects of cancer cachexia for >14 days. Trials were also of a prospective controlled design and included body weight or at least one anthropometric, bioelectrical or radiological endpoint pertaining to body composition, irrespective of the modality of intervention (e.g., pharmacological, nutritional, physical exercise and behavioural) or comparator. Trials with a sample size of <40 patients were excluded. Data extraction used Covidence software, and reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. This review was prospectively registered (PROSPERO: CRD42022276710). A total of 84 clinical trials, comprising 13 016 patients, were eligible for inclusion. Non-small-cell lung cancer and pancreatic cancer were studied most frequently. The majority of trial interventions were pharmacological (52%) or nutritional (34%) in nature. The most frequently reported endpoints were assessments of body weight (68 trials, n = 11 561) followed by bioimpedance analysis (BIA)-based estimates (23 trials, n = 3140). Sixteen trials (n = 3052) included dual-energy X-ray absorptiometry (DEXA)-based endpoints, and computed tomography (CT) body composition was included in eight trials (n = 841). Discrepancies were evident when comparing the efficacy of interventions using BIA-based estimates of lean tissue mass against radiological assessment modalities. Body weight, BIA and DEXA-based endpoints have been most frequently used in cancer cachexia trials. Although the optimal endpoints cannot be determined from this review, body weight, alongside measurements from radiological body composition analysis, would seem appropriate. The choice of radiological modality is likely to be dependent on the trial setting, population and intervention in question. CT and magnetic resonance imaging, which have the ability to accurately discriminate tissue types, are likely to be more sensitive and provide greater detail. Endpoints are of particular importance when aligned with the intervention's mechanism of action and/or intended patient benefit.
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Affiliation(s)
- Leo R. Brown
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care Through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyAustralia
| | - Michael S. Yule
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | | | - Donald C. McMillan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Jann Arends
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Asta Bye
- Department of OncologyOslo University HospitalOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Department of OncologyOslo University HospitalOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Christine Greil
- Department of Medicine I, Medical Centre—University of Freiburg Faculty of MedicineUniversity of FreiburgFreiburgGermany
| | | | - Gunnhild Jakobsen
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Cancer ClinicSt. Olav's Hospital, Trondheim University HospitalTrondheimNorway
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - James McDonald
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical SciencesUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Iain Phillips
- Edinburgh Cancer CentreWestern General HospitalEdinburghUK
| | - Judith Sayers
- Clinical SurgeryThe University of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
| | - Melanie R. Simpson
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Ola M. Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and TechnologyTrondheimNorway
| | - Barry J.A. Laird
- Institute of Genetics and CancerThe University of Edinburgh, Western General HospitalEdinburghUK
- St Columba's Hospice CareEdinburghUK
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Pradhan R, Dieterich W, Natarajan A, Schwappacher R, Reljic D, Herrmann HJ, Neurath MF, Zopf Y. Influence of Amino Acids and Exercise on Muscle Protein Turnover, Particularly in Cancer Cachexia. Cancers (Basel) 2024; 16:1921. [PMID: 38791998 PMCID: PMC11119313 DOI: 10.3390/cancers16101921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 05/15/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024] Open
Abstract
Cancer cachexia is a multifaceted syndrome that impacts individuals with advanced cancer. It causes numerous pathological changes in cancer patients, such as inflammation and metabolic dysfunction, which further diminish their quality of life. Unfortunately, cancer cachexia also increases the risk of mortality in affected individuals, making it an important area of focus for cancer research and treatment. Several potential nutritional therapies are being tested in preclinical and clinical models for their efficacy in improving muscle metabolism in cancer patients. Despite promising results, no special nutritional therapies have yet been validated in clinical practice. Multiple studies provide evidence of the benefits of increasing muscle protein synthesis through an increased intake of amino acids or protein. There is also increasing evidence that exercise can reduce muscle atrophy by modulating protein synthesis. Therefore, the combination of protein intake and exercise may be more effective in improving cancer cachexia. This review provides an overview of the preclinical and clinical approaches for the use of amino acids with and without exercise therapy to improve muscle metabolism in cachexia.
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Affiliation(s)
- Rashmita Pradhan
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Walburga Dieterich
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Anirudh Natarajan
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Raphaela Schwappacher
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Dejan Reljic
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Hans J. Herrmann
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
| | - Yurdagül Zopf
- Department of Medicine, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (R.P.); (W.D.); (A.N.); (R.S.); (D.R.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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7
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Anderson LJ, Paulsen L, Miranda G, Syrjala KL, Graf SA, Chauncey TR, Garcia JM. Neuromuscular electrical stimulation for physical function maintenance during hematopoietic stem cell transplantation: Study protocol. PLoS One 2024; 19:e0302970. [PMID: 38728244 PMCID: PMC11086915 DOI: 10.1371/journal.pone.0302970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/10/2024] [Indexed: 05/12/2024] Open
Abstract
Hematopoietic stem cell transplantation is a common life-saving treatment for hematologic malignancies, though can lead to long-term functional impairment, fatigue, muscle atrophy, with decreased quality of life. Although traditional exercise has helped reduce these effects, it is inconsistently recommended and infrequently maintained, and most patients remain sedentary during and after treatment. There is need for alternative rehabilitation strategies, like neuromuscular electrical stimulation, that may be more amenable to the capabilities of hematopoietic stem cell transplant recipients. Patients receiving autologous HCT are being enroled in a randomized controlled trial with 1:1 (neuromuscular electrical stimulation:sham) design stratified by diagnosis and sex. Physical function, body composition, quality of life, and fatigue are assessed prior to hematopoietic stem cell transplant (prior to initiating preparatory treatment) and 24±5 days post hematopoietic stem cell transplant (Follow-up 1); physical function and quality of life are also assessed 6-months post hematopoietic stem cell transplant (Follow-up 2). The primary outcome is between-group difference in the 6-minute walk test change scores (Follow-up 1-Pre-transplant; final enrolment goal N = 23/group). We hypothesize that 1) neuromuscular electrical stimulation will attenuate hematopoietic stem cell transplant-induced adverse effects on physical function, muscle mass, quality of life, and fatigue compared to sham at Follow-up 1, and 2) Pre-transplant physical function will significantly predict fatigue and quality of life at Follow-up 2. We will also describe feasibility and acceptability of neuromuscular electrical stimulation during hematopoietic stem cell transplant. This proposal will improve rehabilitative patient care and quality of life by determining efficacy and feasibility of a currently underutilized therapeutic strategy aimed at maintaining daily function and reducing the impact of a potent and widely used cancer treatment. This trial is registered with clinicaltrials.gov (NCT04364256).
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Affiliation(s)
- Lindsey J. Anderson
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, Washington, United States of America
| | - Lauren Paulsen
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Gary Miranda
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
| | - Karen L. Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, Unites States of America
| | - Solomon A. Graf
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Medical Oncology, Seattle, Washington, Unites States of America
| | - Thomas R. Chauncey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, United States of America
- Hospital and Specialty Medicine, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Medical Oncology, Seattle, Washington, Unites States of America
| | - Jose M. Garcia
- Geriatric Research, Education and Clinical Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, United States of America
- University of Washington Department of Medicine, Division of Gerontology and Geriatric Medicine, Seattle, Washington, United States of America
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Bozzetti F. Evolving concepts on perioperative nutrition of sarcopenic cancer patients. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:106748. [PMID: 36376142 DOI: 10.1016/j.ejso.2022.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 10/11/2022] [Indexed: 11/13/2022]
Abstract
The recent recognition of the association of sarcopenia with an increased risk of complications after a surgical procedure calls for rethinking the proper approach of the perioperative care in cancer patients. Sarcopenia is broadly considered in literature according to three different definitions: loss of muscle mass, loss of muscle mass plus reduced muscle function and myosteatosis. The aim of this short review on this issue is to define the excess of risk by type of primary and of surgical procedure, depending on the definition of sarcopenia, to speculate on this association (casual versus causal) and to examine the current therapeutical approaches. The analysis of the data shows that sarcopenia, defined as loss of muscle mass plus reduced muscle function, has the higher predictive power for the occurrence of postoperative complications than the two other definitions, and any definition of sarcopenia works better than the usual indexes or scores of surgical risk. Our analysis supports the concept that: a) sarcopenia is frequently associated with inflammation, but inflammation cannot be considered the only or the absolute cause for sarcopenia, b) sarcopenia is not a simple marker of risk but can have a direct role in the increase of risk. Data on perioperative care of sarcopenic cancer patients are scanty but a correct approach cannot rely on nutritional support alone but on a combined approach of optimized nutrition and exercise, hopefully associated with an anti-inflammatory treatment. This strategy should be applied proactively in keeping with the recent recommendations of the American Society of Clinical Oncology for the medical treatment of advanced cancer patients even if a clear demonstration of effectiveness is still lacking.
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Affiliation(s)
- Federico Bozzetti
- University of Milan, Faculty of Medicine, via Festa del Perdono, 20100, Milano, Italy.
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Haug M, Schwappacher R, Pollmann C, Ritter P, Michael M, Hermann HJ, Grützmann R, Mittelstädt A, Neurath MF, Zopf Y, Friedrich O. Effects of Adjuvant Exercise and Nutrition Therapy on Muscle Fibre Biomechanics in Gastrointestinal Cancer Patients. Cancers (Basel) 2024; 16:1608. [PMID: 38672689 PMCID: PMC11049604 DOI: 10.3390/cancers16081608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024] Open
Abstract
Patients with aggressive cancer, e.g., gastrointestinal cancer, are prone (≥50% chance) to developing cancer cachexia (CC). Little is known about the effects of CC on the biomechanical function of muscle. A promising prevention strategy was found in the form of a multi-modal therapy combining mild resistance exercise (e.g., whole-body electro-myostimulation, WB-EMS) and a protein-rich diet. In a previous study of ours, this was effective in counteracting the loss of muscle mass, yet a systematic and comprehensive assessment of active and passive single muscle fibre functions was so far absent. This pilot study investigated the biomechanical function of single muscle fibres (rectus abdominis) from the biopsies of conventionally treated (pre-)cachectic cancer ((pre-)CC) patients (m = 9), those receiving the multi-modal therapy comprising WB-EMS training and protein-rich nutrition (m = 3), and a control group (m = 5). Our findings not only align with previous findings showing the absolute force loss in CC that is accelerated by atrophy but also speak in favour of a different, potentially energy- and Ca2+-homeostasis-related effect that compromises muscle contraction (F ~0.9 mN vs. F ~0.6 mN in control patients). However, myofibrillar Ca2+ sensitivity and the quality of contraction were unaltered (pCa50: 5.6-5.8). Single fibres from the (pre-)CC patients receiving WB-EMS training and protein supplementation were significantly more compliant (p < 0.001 at ≥130% of resting length L0). Those fibres displayed a similar softness to the ones from the control patients (axial compliance ~15 m/N at ≥130% L0), while single fibres from the patients with (developing) cachexia were significantly stiffer (axial compliance ~7 m/N, p < 0.001 at ≥130% L0). Adjuvant multi-modal therapy (WB-EMS training and nutritional support) contributes to maintaining the axial compliance of single fibres and potentially improves the quality of life for patients at risk of developing CC.
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Affiliation(s)
- Michael Haug
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
| | - Raphaela Schwappacher
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Charlotte Pollmann
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
| | - Paul Ritter
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
| | - Mena Michael
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Hans Joachim Hermann
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Robert Grützmann
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany; (R.G.); (A.M.)
| | - Anke Mittelstädt
- Department of General and Visceral Surgery, Friedrich-Alexander-University Erlangen-Nürnberg, Krankenhausstr. 12, 91054 Erlangen, Germany; (R.G.); (A.M.)
| | - Markus Friedrich Neurath
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Yurdagül Zopf
- Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (H.J.H.); (Y.Z.)
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany;
| | - Oliver Friedrich
- Institute of Medical Biotechnology (MBT), Department of Chemical and Biological Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 3, 91052 Erlangen, Germany; (C.P.); (P.R.); (M.M.); (O.F.)
- Erlangen Graduate School in Advanced Optical Technologies (SAOT), Friedrich-Alexander-University Erlangen-Nürnberg, Paul-Gordan-Str. 6, 91052 Erlangen, Germany
- School of Biomedical Sciences, University of New South Wales, Wallace Wurth Building, 18 High St, Sydney, NSW 2052, Australia
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von Stengel S, Fröhlich M, Ludwig O, Eifler C, Berger J, Kleinöder H, Micke F, Wegener B, Zinner C, Mooren FC, Teschler M, Filipovic A, Müller S, England K, Vatter J, Authenrieth S, Kohl M, Kemmler W. Revised contraindications for the use of non-medical WB-electromyostimulation. Evidence-based German consensus recommendations. Front Sports Act Living 2024; 6:1371723. [PMID: 38689869 PMCID: PMC11058671 DOI: 10.3389/fspor.2024.1371723] [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: 01/23/2024] [Accepted: 04/01/2024] [Indexed: 05/02/2024] Open
Abstract
Whole-body electromyostimulation has proven to be a highly effective alternative to conventional resistance-type exercise training. However, due to adverse effects in the past, very extensive contraindications have been put in place for the commercial, non-medical WB-EMS market. Considering recent positive innovations e.g., federal regulation, mandatory trainer education, revised guidelines, and new scientific studies on WB-EMS application, we believe that a careful revision of the very restrictive contraindications on WB-EMS is needed. This applies all the more because many cohorts with limited options for conventional exercise have so far been excluded. During a first meeting of an evidence-based consensus process, stakeholders from various backgrounds (e.g., research, education, application) set the priorities for revising the contraindications. We decided to focus on four categories of absolute contraindications: "Arteriosclerosis, arterial circulation disorders", "Diabetes mellitus" (DM), "Tumor and cancer" (TC), "Neurologic diseases, neuronal disorders, epilepsy". Based on scientific studies, quality criteria, safety aspects and benefit/risk assessment of the category, DM and TC were moved to the relative contraindication catalogue, while arteriosclerosis/arterial circulation disorders and neurologic diseases/neuronal disorders/epilepsy were still considered as absolute contraindications. While missing evidence suggests maintaining the status of neurologic diseases/neuronal disorders as an absolute contraindication, the risk/benefit-ratio does not support the application of WB-EMS in people with arteriosclerosis/arterial circulation diseases. Despite these very cautious modifications, countries with less restrictive structures for non-medical WB-EMS should consider our approach critically before implementing the present revisions. Considering further the largely increased amount of WB-EMS trials we advice regular updates of the present contraindication list.
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Affiliation(s)
- S. von Stengel
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
| | - M. Fröhlich
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - O. Ludwig
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - C. Eifler
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - J. Berger
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - H. Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - F. Micke
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - B. Wegener
- Musculoskeletal University Center, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - C. Zinner
- Hessian College of Police and Administration, Wiesbaden, Germany
| | - F. C. Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | - M. Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany
| | | | | | - K. England
- Glucker Kolleg, Frankfurt, Germany
- Bundeswehr Medical Academy Munich, Munich, Germany
| | - J. Vatter
- Soccer Club Paderborn 07, Paderborn, Germany
- PT Lounge Cologne, Cologne, Germany
| | - S. Authenrieth
- Glucker Kolleg, Frankfurt, Germany
- EMS-Performance, Kornwestheim, Germany
| | - M. Kohl
- Department of Medical and Life Sciences, University of Furtwangen, Schwenningen, Germany
| | - W. Kemmler
- Institute of Radiology, University Hospital Erlangen, Erlangen, Germany
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Vagnildhaug OM, Balstad TR, Ottestad I, Bye A, Greil C, Arends J, Baracos V, Brown LR, Dajani OF, Dolan RD, Fallon M, Fraser E, Grzyb A, Hjermstad MJ, Jakobsen G, Kaasa S, McDonald J, Philips I, Sayers J, Simpson MR, Sousa MS, Skipworth RJ, Laird BJ, Solheim TS. Appetite and dietary intake endpoints in cancer cachexia clinical trials: Systematic Review 2 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2024; 15:513-535. [PMID: 38343065 PMCID: PMC10995275 DOI: 10.1002/jcsm.13434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 04/06/2024] Open
Abstract
There is no consensus on the optimal endpoint(s) in cancer cachexia trials. Endpoint variation is an obstacle when comparing interventions and their clinical value. The aim of this systematic review was to summarize and evaluate endpoints used to assess appetite and dietary intake in cancer cachexia clinical trials. A search for studies published from 1 January 1990 until 2 June 2021 was conducted using MEDLINE, Embase and Cochrane Central Register of Controlled Trials. Eligible studies examined cancer cachexia treatment versus a comparator in adults with assessments of appetite and/or dietary intake as study endpoints, a sample size ≥40 and an intervention lasting ≥14 days. Reporting was in line with PRISMA guidance, and a protocol was published in PROSPERO (2022 CRD42022276710). This review is part of a series of systematic reviews examining cachexia endpoints. Of the 5975 articles identified, 116 were eligible for the wider review series and 80 specifically examined endpoints of appetite (65 studies) and/or dietary intake (21 studies). Six trials assessed both appetite and dietary intake. Appetite was the primary outcome in 15 trials and dietary intake in 7 trials. Median sample size was 101 patients (range 40-628). Forty-nine studies included multiple primary tumour sites, while 31 studies involved single primary tumour sites (15 gastrointestinal, 7 lung, 7 head and neck and 2 female reproductive organs). The most frequently reported appetite endpoints were visual analogue scale (VAS) and numerical rating scale (NRS) (40%). The appetite item from the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ) C30/C15 PAL (38%) and the appetite question from North Central Cancer Treatment Group anorexia questionnaire (17%) were also frequently applied. Of the studies that assessed dietary intake, 13 (62%) used food records (prospective registrations) and 10 (48%) used retrospective methods (24-h recall or dietary history). For VAS/NRS, a mean change of 1.3 corresponded to Hedge's g of 0.5 and can be considered a moderate change. For food records, a mean change of 231 kcal/day or 11 g of protein/day corresponded to a moderate change. Choice of endpoint in cachexia trials will depend on factors pertinent to the trial to be conducted. Nevertheless, from trials assessed and available literature, NRS or EORTC QLQ C30/C15 PAL seems suitable for appetite assessments. Appetite and dietary intake endpoints are rarely used as primary outcomes in cancer cachexia. Dietary intake assessments were used mainly to monitor compliance and are not validated in cachexia populations. Given the importance to cachexia studies, dietary intake endpoints must be validated before they are used as endpoints in clinical trials.
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Affiliation(s)
- Ola Magne Vagnildhaug
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
| | - Trude R. Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Inger Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of MedicineUniversity of OsloOsloNorway
- The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineOslo University HospitalOsloNorway
| | - Asta Bye
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOsloMet—Oslo Metropolitan UniversityOsloNorway
| | - Christine Greil
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Jann Arends
- Department of Medicine I, Medical Center—University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Vickie Baracos
- Department of OncologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Leo R. Brown
- Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Olav F. Dajani
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Ross D. Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Eilidh Fraser
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Aleksandra Grzyb
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Marianne J. Hjermstad
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Gunnhild Jakobsen
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Stein Kaasa
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University HospitalUniversity of OsloOsloNorway
- European Palliative Care Research Centre (PRC), Department of Oncology, Oslo University Hospital and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - James McDonald
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Judith Sayers
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Melanie R. Simpson
- Department of Public Health and Nursing, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyNew South WalesAustralia
| | | | - Barry J.A. Laird
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- Institute of Genetics and CancerUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Tora S. Solheim
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNorwegian University of Science and Technology (NTNU)TrondheimNorway
- Cancer Clinic, St. Olavs HospitalTrondheim University HospitalTrondheimNorway
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12
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Hesketh SJ. Advancing cancer cachexia diagnosis with -omics technology and exercise as molecular medicine. SPORTS MEDICINE AND HEALTH SCIENCE 2024; 6:1-15. [PMID: 38463663 PMCID: PMC10918365 DOI: 10.1016/j.smhs.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 01/15/2024] [Accepted: 01/20/2024] [Indexed: 03/12/2024] Open
Abstract
Muscle atrophy exacerbates disease outcomes and increases mortality, whereas the preservation of skeletal muscle mass and function play pivotal roles in ensuring long-term health and overall quality-of-life. Muscle atrophy represents a significant clinical challenge, involving the continued loss of muscle mass and strength, which frequently accompany the development of numerous types of cancer. Cancer cachexia is a highly prevalent multifactorial syndrome, and although cachexia is one of the main causes of cancer-related deaths, there are still no approved management strategies for the disease. The etiology of this condition is based on the upregulation of systemic inflammation factors and catabolic stimuli, resulting in the inhibition of protein synthesis and enhancement of protein degradation. Numerous necessary cellular processes are disrupted by cachectic pathology, which mediate intracellular signalling pathways resulting in the net loss of muscle and organelles. However, the exact underpinning molecular mechanisms of how these changes are orchestrated are incompletely understood. Much work is still required, but structured exercise has the capacity to counteract numerous detrimental effects linked to cancer cachexia. Primarily through the stimulation of muscle protein synthesis, enhancement of mitochondrial function, and the release of myokines. As a result, muscle mass and strength increase, leading to improved mobility, and quality-of-life. This review summarises existing knowledge of the complex molecular networks that regulate cancer cachexia and exercise, highlighting the molecular interplay between the two for potential therapeutic intervention. Finally, the utility of mass spectrometry-based proteomics is considered as a way of establishing early diagnostic biomarkers of cachectic patients.
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Beier M, Schoene D, Kohl M, von Stengel S, Uder M, Kemmler W. Non-Athletic Cohorts Enrolled in Longitudinal Whole-Body Electromyostimulation Trials-An Evidence Map. SENSORS (BASEL, SWITZERLAND) 2024; 24:972. [PMID: 38339689 PMCID: PMC10857049 DOI: 10.3390/s24030972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 02/12/2024]
Abstract
Whole-body electromyostimulation (WB-EMS) can be considered as a time-efficient, joint-friendly, and highly customizable training technology that attracts a wide range of users. The present evidence map aims to provide an overview of different non-athletic cohorts addressed in WB-EMS research. Based on a comprehensive systematic search according to PRISMA, eighty-six eligible longitudinal trials were identified that correspond with our eligibility criteria. In summary, WB-EMS research sufficiently covers all adult age categories in males and females. Most cohorts addressed (58%) were predominately or exclusively overweight/obese, and in about 60% of them, diseases or conditions were inclusion criteria for the trials. Cohorts specifically enrolled in WB-EMS trials suffer from cancer/neoplasm (n = 7), obesity (n = 6), diabetes mellitus (n = 5), metabolic syndrome (n = 2), nervous system diseases (n = 2), chronic heart failure (n = 4), stroke (n = 1), peripheral arterial diseases (n = 2), knee arthrosis (n = 1), sarcopenia (n = 3), chronic unspecific low back pain (n = 4), and osteopenia (n = 3). Chronic kidney disease was an eligibility criterion in five WB-EMS trials. Finally, three studies included only critically ill patients, and two further studies considered frailty as an inclusion criterion. Of importance, no adverse effects of the WB-EMS intervention were reported. In summary, the evidence gaps in WB-EMS research were particular evident for cohorts with diseases of the nervous and cerebrovascular system.
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Affiliation(s)
- Miriam Beier
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Daniel Schoene
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Matthias Kohl
- Department of Medical and Life Sciences, University of Furtwangen, 78056 Villingen-Schwenningen, Germany;
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
| | - Wolfgang Kemmler
- Institute of Radiology, University Hospital Erlangen, 91054 Erlangen, Germany; (M.B.); (D.S.); (S.v.S.); (M.U.)
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany
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14
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McDonald J, Sayers J, Anker SD, Arends J, Balstad TR, Baracos V, Brown L, Bye A, Dajani O, Dolan R, Fallon MT, Fraser E, Griel C, Grzyb A, Hjermstad M, Jamal‐Hanjani M, Jakobsen G, Kaasa S, McMillan D, Maddocks M, Philips I, Ottestad IO, Reid KF, Sousa MS, Simpson MR, Vagnildhaug OM, Skipworth RJE, Solheim TS, Laird BJA. Physical function endpoints in cancer cachexia clinical trials: Systematic Review 1 of the cachexia endpoints series. J Cachexia Sarcopenia Muscle 2023; 14:1932-1948. [PMID: 37671529 PMCID: PMC10570071 DOI: 10.1002/jcsm.13321] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/19/2023] [Accepted: 08/02/2023] [Indexed: 09/07/2023] Open
Abstract
In cancer cachexia trials, measures of physical function are commonly used as endpoints. For drug trials to obtain regulatory approval, efficacy in physical function endpoints may be needed alongside other measures. However, it is not clear which physical function endpoints should be used. The aim of this systematic review was to assess the frequency and diversity of physical function endpoints in cancer cachexia trials. Following a comprehensive electronic literature search of MEDLINE, Embase and Cochrane (1990-2021), records were retrieved. Eligible trials met the following criteria: adults (≥18 years), controlled design, more than 40 participants, use of a cachexia intervention for more than 14 days and use of a physical function endpoint. Physical function measures were classified as an objective measure (hand grip strength [HGS], stair climb power [SCP], timed up and go [TUG] test, 6-min walking test [6MWT] and short physical performance battery [SPPB]), clinician assessment of function (Karnofsky Performance Status [KPS] or Eastern Cooperative Oncology Group-Performance Status [ECOG-PS]) or patient-reported outcomes (physical function subscale of the European Organisation for the Research and Treatment of Cancer Quality of Life Questionnaires [EORTC QLQ-C30 or C15]). Data extraction was performed using Covidence and followed PRISMA guidance (PROSPERO registration: CRD42022276710). A total of 5975 potential studies were examined and 71 were eligible. Pharmacological interventions were assessed in 38 trials (54%). Of these, 11 (29%, n = 1184) examined megestrol and 5 (13%, n = 1928) examined anamorelin; nutritional interventions were assessed in 21 trials (30%); and exercise-based interventions were assessed in 6 trials (8%). The remaining six trials (8%) assessed multimodal interventions. Among the objective measures of physical function (assessed as primary or secondary endpoints), HGS was most commonly examined (33 trials, n = 5081) and demonstrated a statistically significant finding in 12 (36%) trials (n = 2091). The 6MWT was assessed in 12 trials (n = 1074) and was statistically significant in 4 (33%) trials (n = 403), whereas SCP, TUG and SPPB were each assessed in 3 trials. KPS was more commonly assessed than the newer ECOG-PS (16 vs. 9 trials), and patient-reported EORTC QLQ-C30 physical function was reported in 25 trials. HGS is the most commonly used physical function endpoint in cancer cachexia clinical trials. However, heterogeneity in study design, populations, intervention and endpoint selection make it difficult to comment on the optimal endpoint and how to measure this. We offer several recommendations/considerations to improve the design of future clinical trials in cancer cachexia.
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Affiliation(s)
- James McDonald
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
| | - Judith Sayers
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
- Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Stefan D. Anker
- Department of Cardiology (CVK), Berlin Institute of Health Center for Regenerative Therapies (BCRT), and German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité UniversitätsmedizinBerlinGermany
- Institute of Heart DiseasesWroclaw Medical UniversityWroclawPoland
- German Centre for Cardiovascular Research (DZHK) partner site BerlinCharité Universitätsmedizin BerlinBerlinGermany
| | - Jann Arends
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Trude Rakel Balstad
- Department of Clinical and Molecular Medicine, Faculty of Medicine and Health SciencesNTNU–Norwegian University of Science and TechnologyTrondheimNorway
- Department of Clinical Medicine, Clinical Nutrition Research GroupUiT The Arctic University of NorwayTromsøNorway
| | - Vickie Baracos
- Division of Palliative Care Medicine, Department of OncologyUniversity of AlbertaEdmontonABCanada
| | - Leo Brown
- Clinical SurgeryUniversity of Edinburgh, Royal Infirmary of EdinburghEdinburghUK
| | - Asta Bye
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital/European Palliative Care Research Centre (PRC), and Institute of Clinical MedicineUniversity of OsloOsloNorway
- Department of Nursing and Health Promotion, Faculty of Health SciencesOslo Metropolitan UniversityOsloNorway
| | - Olav Dajani
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital/European Palliative Care Research Centre (PRC), and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Ross Dolan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Marie T. Fallon
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Eilidh Fraser
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Christine Griel
- Department of Medicine I, Medical Center – University of Freiburg, Faculty of MedicineUniversity of FreiburgFreiburg im BreisgauGermany
| | - Aleksandra Grzyb
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Marianne Hjermstad
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital/European Palliative Care Research Centre (PRC), and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Mariam Jamal‐Hanjani
- Cancer Research UK Lung Cancer Centre of ExcellenceUniversity College London Cancer InstituteLondonUK
- Cancer Metastasis LaboratoryUniversity College London Cancer InstituteLondonUK
- Department of OncologyUniversity College London HospitalsLondonUK
| | - Gunnhild Jakobsen
- Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
| | - Stein Kaasa
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital/European Palliative Care Research Centre (PRC), and Institute of Clinical MedicineUniversity of OsloOsloNorway
| | - Donald McMillan
- Academic Unit of SurgeryUniversity of Glasgow, Glasgow Royal InfirmaryGlasgowUK
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy and RehabilitationKing's College LondonLondonUK
| | - Iain Philips
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
| | - Inger O. Ottestad
- Department of Nutrition, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Norway and The Clinical Nutrition Outpatient Clinic, Section of Clinical Nutrition, Department of Clinical Service, Division of Cancer MedicineHarvard Medical SchoolOslo University HospitalNorway
| | - Kieran F. Reid
- Laboratory of Exercise Physiology and Physical Performance, Boston Claude D. Pepper Older Americans Independence Center for Function Promoting Therapies, Brigham and Women's HospitalHarvard Medical SchoolBostonMAUSA
| | - Mariana S. Sousa
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT)University of Technology SydneySydneyNSWAustralia
| | - Melanie R. Simpson
- Department of Public Health and NursingNorwegian University of Science and TechnologyTrondheimNorway
| | - Ola Magne Vagnildhaug
- Cancer ClinicSt Olavs Hospital – Trondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | | | - Tora S. Solheim
- Cancer ClinicSt Olavs Hospital – Trondheim University HospitalTrondheimNorway
- Department of Clinical and Molecular MedicineNorwegian University of Science and TechnologyTrondheimNorway
| | - Barry J. A. Laird
- Edinburgh Cancer Research CentreUniversity of EdinburghEdinburghUK
- St Columba's HospiceEdinburghUK
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Kümmerl L, Kraulich M, Lesyuk W, Binninger A, Goebell PJ, Kahlmeyer A. Sarcopenia assessments as predictors of overall survival in patients with metastatic renal cell carcinoma. Urol Oncol 2023; 41:392.e1-392.e9. [PMID: 37442742 DOI: 10.1016/j.urolonc.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/10/2023] [Accepted: 06/18/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Sarcopenia represents an important prognostic marker in tumor patients. However, measurement methods and threshold values are not uniformly defined. The aim of this study is therefore to determine the prognostic value of current definitions of sarcopenia in patients with metastatic renal cell carcinoma treated with tyrosine-kinase-inhibitors (TKIs). METHODS In 93 patients with metastatic renal cell carcinoma, sarcopenia was assessed based on manually assisted software measurements of sarcopenia indices based on different muscle areas. Whole muscle area and psoas muscle area at L3 were estimated and adjusted to patient's height in routine CT imaging before the start of first-line TKI therapy. The correlation of different sarcopenia definitions to overall survival was investigated in a univariate analysis as well as in a multivariate analysis. RESULTS The mean patients' age at inclusion was 65.8 years (21-86 years). Median survival was 12.3 months (IQR: 5.7-29.8 months), and mean survival was 18.8 months (SD: 17.2 months). As the definitions of sarcopenia differ considerably, 7.6% to 96.7% of the patients were classified as sarcopenic. In univariate analysis, sarcopenia was significantly associated with overall survival. Multivariate analysis, taking into account the Memorial Sloan Kettering Cancer Center risk score, revealed that some sarcopenia-indices are additional and independent prognostic markers. The risk of death was approximately doubled in sarcopenic patients. CONCLUSIONS Sarcopenia is an important prognostic factor in patients with metastatic renal cell carcinoma treated with TKIs. Multivariate analysis demonstrates a doubling of the risk of death in sarcopenic patients. The assessment of sarcopenia can be performed by the analysis of routine staging imaging using indices of the total muscle area or the psoas muscle area.
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Affiliation(s)
- Luca Kümmerl
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany; Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany.
| | - Matthias Kraulich
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Wladimir Lesyuk
- Radiologisches Institut, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Adrian Binninger
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | - Peter J Goebell
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
| | - Andreas Kahlmeyer
- Urologische und Kinderurologische Klinik, Universitätsklinikum Erlangen, Erlangen, Germany
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16
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Hardt LM, Herrmann HJ, Reljic D, Jaensch P, Zerth J, Neurath MF, Zopf Y. Are Guideline Recommendations on Supportive Nutrition and Exercise Therapy for Cancer Patients Implemented in Clinical Routine? A National Survey with Real-Life Data. Nutrients 2023; 15:3172. [PMID: 37513591 PMCID: PMC10383016 DOI: 10.3390/nu15143172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/13/2023] [Accepted: 07/15/2023] [Indexed: 07/30/2023] Open
Abstract
Malnutrition and cancer cachexia are highly prevalent comorbidities of cancer, limiting patients' quality of life and being relevant to prognosis. International and national clinical guidelines recommend supportive nutrition and exercise therapy for cancer patients. However, there is little current epidemiological evidence on the implementation of these guideline recommendations in clinical routine. To close this data gap, a national survey in Germany using an online questionnaire was conducted. There were 261 of a total of 5074 contacted hospitals and medical offices who participated in the survey (5.1% response rate). The data indicated that nutrition and exercise therapy for cancer patients is so far inadequately implemented, with 59% of the respondents reporting nutrition therapy as an integral part of oncological treatment, 66.7% having a nutrition specialist/team, and 65.1% routinely conducting a screening for nutritional status. Only half of the participants stated that there are defined goals in nutrition therapy. The majority of respondents (85.8%) generally recommend exercise therapy, but only a few of them provide specific offers at their own institution (19.6%) or at cooperation partners (31.7%). In order to implement the recommended combined nutrition and exercise therapy as part of regular care, there is a need for nationwide availability of multidisciplinary nutrition teams and targeted offers of individualized exercise therapy. Health policy support would be important to create the structural, financial, and staff conditions for appropriate guideline implementation in order to achieve the optimal treatment of cancer patients.
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Affiliation(s)
- Luisa M Hardt
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Hans J Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Peter Jaensch
- IDC Research Institute, SRH University Wilhelm Löhe, 90763 Fürth, Germany
| | - Jürgen Zerth
- IDC Research Institute, SRH University Wilhelm Löhe, 90763 Fürth, Germany
- Faculty of Social Work, Catholic University Eichstätt-Ingolstadt, 85071 Eichstätt, Germany
| | - Markus F Neurath
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
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17
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Ikeda T, Katayama S, Kitagawa T. The combined intervention of neuromuscular electrical stimulation and nutrition therapy: A scoping review. Clin Nutr ESPEN 2023; 54:239-250. [PMID: 36963869 DOI: 10.1016/j.clnesp.2023.01.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 01/26/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND & AIMS Neuromuscular electrical stimulation (NMES) is a safe and appropriate complement to voluntary resistance training for muscle weakness. However, its feasibility and effectiveness in combination with nutritional therapy remains unclear. This scoping review aimed to summarize the evidence on combined interventions for individuals with or at risk of sarcopenia for guiding future relevant research. METHODS A systematic electronic search was conducted using the following databases and registry: MEDLINE, CINAHL, Web of Science, PEDro, and ClinicalTrials. gov. Two independent reviewers summarized the characteristics, effectiveness, and feasibility of the combined intervention and the risk of bias in the literature. RESULTS Nine RCTs and four non-RCTs involving 802 participants were eligible. A diverse group of participants were included: older adults with sarcopenic obesity, patients in intensive care, and patients with cancer. Evidence-based interventions combining NMES and nutritional therapy were tailored to each patient's underlying disease. Although most studies were of low to moderate quality, it can be suggested that combined interventions may be feasible and effective for increasing skeletal muscle mass. CONCLUSION This scoping review demonstrates the potential of combined interventions as a new sarcopenia treatment strategy and highlights the need to examine the effects in high-quality RCTs with larger sample sizes.
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Affiliation(s)
- Tomohiro Ikeda
- Department of Rehabilitation Medicine, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan.
| | - Sho Katayama
- Department of Rehabilitation Medicine, Okayama University, 2-5-1 Shikatacho, Kita-ku, Okayama 700-8558, Japan
| | - Takashi Kitagawa
- Department of Physical Therapy, School of Health Sciences, Shinshu University, 3-1-1 Asahi, Matsumoto, Nagano 390-8621, Japan
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18
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Kemmler W, Fröhlich M, Ludwig O, Eifler C, von Stengel S, Willert S, Teschler M, Weissenfels A, Kleinöder H, Micke F, Wirtz N, Zinner C, Filipovic A, Wegener B, Berger J, Evangelista A, D’Ottavio S, Singh Sara JD, Lerman A, Perez de Arrilucea Le Floc’h UA, Carle-Calo A, Guitierrez A, Amaro-Gahete FJ. Position statement and updated international guideline for safe and effective whole-body electromyostimulation training-the need for common sense in WB-EMS application. Front Physiol 2023; 14:1174103. [PMID: 37035684 PMCID: PMC10075322 DOI: 10.3389/fphys.2023.1174103] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 03/13/2023] [Indexed: 04/11/2023] Open
Abstract
Whole-Body Electromyostimulation (WB-EMS) is a training technology that enables simultaneous stimulation of all the main muscle groups with a specific impulse intensity for each electrode. The corresponding time-efficiency and joint-friendliness of WB-EMS may be particularly attractive for people unable or unmotivated to conduct (intense) conventional training protocols. However, due to the enormous metabolic and musculoskeletal impact of WB-EMS, particular attention must be paid to the application of this technology. In the past, several scientific and newspaper articles reported severe adverse effects of WB-EMS. To increase the safety of commercial non-medical WB-EMS application, recommendations "for safe and effective whole-body electromyostimulation" were launched in 2016. However, new developments and trends require an update of these recommendations to incorporate more international expertise with demonstrated experience in the application of WB-EMS. The new version of these consensus-based recommendations has been structured into 1) "general aspects of WB-EMS", 2) "preparation for training", recommendations for the 3) "WB-EMS application" itself and 4) "safety aspects during and after training". Key topics particularly addressed are 1) consistent and close supervision of WB-EMS application, 2) mandatory qualification of WB-EMS trainers, 3) anamnesis and corresponding consideration of contraindications prior to WB-EMS, 4) the participant's proper preparation for the session, 5) careful preparation of the WB-EMS novice, 6) appropriate regeneration periods between WB-EMS sessions and 7) continuous interaction between trainer and participant at a close physical distance. In summary, we are convinced that the present guideline will contribute to greater safety and effectiveness in the area of non-medical commercial WB-EMS application.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
- *Correspondence: Wolfgang Kemmler,
| | - Michael Fröhlich
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Oliver Ludwig
- Department of Sports Science, Rheinland-Pfälzische Technische Universität Kaiserslautern-Landau, Kaiserslautern, Germany
| | - Christoph Eifler
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - Simon von Stengel
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
| | - Sebastian Willert
- Institute of Radiology, University Hospital Erlangen (UKER), Erlangen, Germany
| | - Marc Teschler
- Department of Rehabilitation Sciences, University of Witten/Herdecke, Witten, Germany
| | - Anja Weissenfels
- Institute of Sports Science, Friedrich-Alexander University of Erlangen-Nürnberg, Erlangen, Germany
| | - Heinz Kleinöder
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Florian Micke
- Institute of Training Science and Sport Informatics, German Sport University Cologne, Cologne, Germany
| | - Nicolas Wirtz
- Central Library for Sport Sciences, German Sport University Cologne, Cologne, Germany
| | - Christoph Zinner
- University of Applied Sciences for Police and Administration of Hesse, Wiesbaden, Germany
| | | | - Bernd Wegener
- Musculoskeletal University Center, Ludwig-Maximilian-University of Munich, Munich, Germany
| | - Joshua Berger
- German University for Prevention and Health Management, Saarbrücken, Germany
| | - Alexandre Evangelista
- Experimental Physiology and Biochemistry, Center for Physical Education and Sport, University Federal do Espírito Santo, Vitória, Brazil
| | - Stefano D’Ottavio
- Clinical Sciences and Translational Medicine Department, University of Rome, Rome, Italy
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo College of Medicine, Rochester, MN, United States
| | | | - Abraham Carle-Calo
- Department of Physical Education and Sport, University of Granada, Granada, Spain
| | | | - Francisco J. Amaro-Gahete
- Department of Physical Education and Sport, University of Granada, Granada, Spain
- Department of Physiology, University of Granada, Granada, Spain
- Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
- Instituto de Investigación Biosanitaria de Granada (ibs.GRANADA), Granada, Spain
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Storck LJ, Uster A, Gafner L, Ruehlin M, Gaeumann S, Gisi D, Schmocker M, Meffert PJ, Imoberdorf R, Pless M, Ballmer PE. Effect of combined therapies including nutrition and physical exercise in advanced cancer patients: A pooled analysis. Front Nutr 2023; 10:1063279. [PMID: 36937336 PMCID: PMC10014851 DOI: 10.3389/fnut.2023.1063279] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/06/2023] [Indexed: 03/04/2023] Open
Abstract
Background and aims Although many cancer patients suffer from malnutrition or cancer cachexia, there is no standard of care so far due to limited intervention trials. Pooled data from two combined trials were analyzed regarding nutritional status and survival time. Materials and methods Data from two trials with advanced cancer patients were included. In both trials, patients in the intervention group received at least three times nutritional counseling and supervised training sessions. Patients in the control group continued being treated according to usual care. Nutritional status was measured using BMI, body composition and handgrip strength. Survival time was analyzed using the Cox proportional hazard model with the period between the beginning of the trial and death as underlying time scale. Results 68 men (61.8%) and 42 women (38.2%) were randomized either to the intervention (n = 56) or the control (n = 54) group. The inter-group difference for changes in BMI and body composition was not statistically significant after 3 months. Handgrip strength improved significantly from 34.4 ± 10.2 kg to 36.3 ± 9.9 kg at 3 months in the intervention compared to 33.9 ± 9.2 kg to 34.9 ± 9.1 kg in the control group (p = 0.006). The analysis of survival time showed no inter-group difference for all patients. A detailed analysis for different diagnoses showed that in patients with lung cancer, the covariates "CRP value," "days from first diagnosis to randomization" as well as "gender" were significantly associated with survival time. Patients with higher CRP value had a shorter survival time and female patients had a shorter survival time than male patients in our analysis. In addition, patients with pancreatic cancer randomized to the control group had a 20% shorter survival time than those in the intervention group (p = 0.048). Conclusion The pooled analysis showed a significant improvement of handgrip strength in advanced cancer patients through the implementation of a combined therapy. Handgrip strength is of prognostic significance in hospitalized patients due to its association with mortality and morbidity. However, no improvements in further tests were detected. There is great need for further investigations examining the effect of nutritional and exercise therapy on survival time with focus on different cancer diagnoses.
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Affiliation(s)
- Lena J. Storck
- Zentrum für Allgemeine Innere Medizin, Ernährungstherapie/-Beratung, Kantonsspital Winterthur, Winterthur, Switzerland
- Medizinische Kliniken, Klinikum Konstanz, Konstanz, Germany
| | - Alexandra Uster
- Division of Research, Innovation, and Development, Swiss Cancer League, Bern, Switzerland
| | - Lucia Gafner
- Zentrum für Allgemeine Innere Medizin, Ernährungstherapie/-Beratung, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Maya Ruehlin
- Zentrum für Allgemeine Innere Medizin, Ernährungstherapie/-Beratung, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Sabine Gaeumann
- Zentrum für Allgemeine Innere Medizin, Ernährungstherapie/-Beratung, Kantonsspital Winterthur, Winterthur, Switzerland
| | - David Gisi
- Institut für Therapien und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Martina Schmocker
- Institut für Therapien und Rehabilitation, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | - Reinhard Imoberdorf
- Zentrum für Allgemeine Innere Medizin, Klinik für Innere Medizin, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Miklos Pless
- Klinik für Medizinische Onkologie und Hämatologie, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Peter E. Ballmer
- Past President GESKES-SSNC, Winterthur, Switzerland
- *Correspondence: Peter E. Ballmer,
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20
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Bibliometric Analysis of Studies on Whole Body Electromyostimulation. BIOLOGY 2022; 11:biology11081205. [PMID: 36009832 PMCID: PMC9405447 DOI: 10.3390/biology11081205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/05/2022] [Accepted: 08/08/2022] [Indexed: 11/17/2022]
Abstract
Simple Summary This work consists of a review with bibliometric analysis on WB-EMS. One hundred and two articles were analyzed in the period from 2010 to 2022 to find out which country, author and institutions produce the most knowledge on this topic. The results of this work are important to know to determine publication growth trend as well as the most relevant clusters and authors. Abstract Whole Body Electromyostimulation [WB-EMS] is a training methodology that applies electrostimulation in the main muscle groups of the human body superimposed with active training exercises. This study aims to carry out a bibliometric analysis on WB-EMS to provide an overview of the state of research and provide new insights for research in the field. Method: One hundred and two citations extracted were examined using a bibliometric approach based on data stored in the Web of Science Core Collection, applying traditional bibliometric laws, and using VOSviewer and excel for data and metadata processing. Results: Among the results, this study points out that Germany is the country that produces more scientific knowledge on WB-EMS. Wolfgang Kemmler is the most relevant author in this field. Moreover, Frontier of Physiology is the journal where the authors publish the most. Conclusion: Research on WB-EMS has been growing in recent years. German and Spanish researchers lead two clusters where most studies and collaborations in this field are carried out. These findings will provide a better understanding of the state of WB-EMS research and may guide the emergence of new lines of investigation and research ideas.
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21
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Siebert S, Kersten J, Theurich S, Baumann FT. [Physical activity in cancer - effectiveness of exercise therapy approaches]. Dtsch Med Wochenschr 2022; 147:831-840. [PMID: 35785781 DOI: 10.1055/a-1685-6919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
The positive effects of oncological exercise therapy are sufficiently proven according to scientific studies. International evidence-based guidelines confirm this importance and recommend physical exercise as part of the standard therapy for cancer. The effects of physical activity on cancer-specific deficits are versatile ranging from positive impact on fatigue syndrome, mortality, incontinence, lymphoedema, CIPN, anxiety, depression to reduction of pain. According to current knowledge, sensorimotor training is recommended for the treatment of polyneuropathy. The actual effectiveness of vibration training in reducing symptom burden is undetermined. There are more than 100 randomized, controlled studies with the highest evidence rating for the management of CrF available. In this regard, exercise therapy is more effective than drug therapy in alleviating the symptomatology of CrF. In addition to the movement-therapeutic approach, a coordinated diet is necessary to avoid nutrition shortages.The evidence on physical activity in oncology must be considered not only in theory, but also in practice and be accepted as a general recommendation for oncology patients. The personalized OTT treatment concept represents a practical implementation and offers a targeted treatment option with low side effects.
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22
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王 杰, 贾 维, 厉 丹, 宋 艳, 孙 宁, 杨 科, 李 洪, 尹 崇. [Research Progress of Pharmacological Therapy and Nutritional Support for Cachexia
in Lung Cancer Patients]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2022; 25:420-424. [PMID: 35747921 PMCID: PMC9244501 DOI: 10.3779/j.issn.1009-3419.2022.101.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/08/2022] [Indexed: 11/13/2022]
Abstract
Cachexia is a common complication in patients with lung cancer. It aggravates the toxic and side effects of chemotherapy, hinders the treatment plan, weakens the responsiveness of chemotherapy, reduces the quality of life, increases complications and mortality, and seriously endangers the physical and mental health of patients with lung cancer. The causes and pathogenesis of tumor cachexia are extremely complex, which makes its treatment difficult and complex. Controlling cachexia in lung cancer patients requires many means such as anti-tumor therapy, inhibition of inflammatory response, nutritional support, physical exercise, and relief of symptoms to exert the synergistic effect of multimodal therapy against multiple mechanisms of tumor cachexia. To date, there has been a consensus within the discipline that no single therapy can control the development of cachexia. Some therapies have made some progress, but they need to be implemented in combination with multimodal therapy after fully assessing the individual characteristics of lung cancer patients. This article reviews the application of drug therapy and nutritional support in lung cancer patients, and looks forward to the research direction of cachexia control in lung cancer patients.
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Affiliation(s)
- 杰敏 王
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 维慧 贾
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 丹阳 厉
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 艳梅 宋
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 宁鑫 孙
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 科 杨
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
| | - 洪利 李
- 261053 潍坊,潍坊医学院医学研究实验中心Medical Research Center, Weifang Medical University, Weifang 261053, China
| | - 崇高 尹
- 261053 潍坊,潍坊医学院护理学院Colloge of Nursing, Weifang Medical University, Weifang 261053, China
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Rodríguez-Bies E, Rizo I, Peña-Vázquez M, Fuentes T, López-Lluch G. Pilates with whole body electromyostimulation exercise produces high levels of muscle damage. Sci Sports 2022. [DOI: 10.1016/j.scispo.2022.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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24
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Barnes O, Wilson RL, Gonzalo-Encabo P, Kang DW, Christopher CN, Bentley T, Dieli-Conwright CM. The Effect of Exercise and Nutritional Interventions on Body Composition in Patients with Advanced or Metastatic Cancer: A Systematic Review. Nutrients 2022; 14:nu14102110. [PMID: 35631251 PMCID: PMC9145470 DOI: 10.3390/nu14102110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/11/2022] [Accepted: 05/16/2022] [Indexed: 02/07/2023] Open
Abstract
Advanced and metastatic cancers significantly alter body composition, leading to decreased lean mass and variable effects on fat mass. These effects on body composition are associated with significant physical dysfunction and poor prognosis in patients with cancer. Whilst exercise and nutritional interventions are likely to be of benefit in counteracting these effects, relatively little is known about using such interventions in patients with advanced or metastatic cancer. Therefore, in this systematic review we examine the effect of exercise and combined exercise and nutritional interventions on lean mass and fat mass among patients diagnosed with advanced or metastatic cancer. Following PRISMA guidelines, we identified 20 articles from PubMed, EMBASE, CINAHL, Cochrane CENTRAL, PEDro, SPORTDiscus, and REHABDATA. Overall, advanced or metastatic cancer populations comprising of mixed cancer types were most commonly examined (n = 8) with exercise or combined exercise and nutritional interventions being well-tolerated with few adverse effects. Both intervention approaches may preserve lean mass, while only combined interventions may lead to alterations in fat mass. However, further exercise and nutritional studies are needed to definitively understand their effects on body composition. As exercise and nutrition-related research continues in this understudied population, the knowledge gained will help guide supportive clinical treatments.
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Affiliation(s)
- Oscar Barnes
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Rebekah L. Wilson
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Paola Gonzalo-Encabo
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Dong-Woo Kang
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
| | - Cami N. Christopher
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Epidemiology, Boston University, Boston, MA 02118, USA
| | - Thomas Bentley
- Green Templeton College, University of Oxford, Oxford OX2 6HG, UK; (O.B.); (T.B.)
| | - Christina M. Dieli-Conwright
- Division of Population Sciences, Department of Medical Oncology, Dana-Farber Cancer Institute, 375 Longwood Avenue, Boston, MA 02215, USA; (R.L.W.); (P.G.-E.); (D.-W.K.); (C.N.C.)
- Department of Medicine, Harvard Medical School, Boston, MA 02215, USA
- Correspondence:
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25
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Rodríguez-Cañamero S, Cobo-Cuenca AI, Carmona-Torres JM, Pozuelo-Carrascosa DP, Santacruz-Salas E, Rabanales-Sotos JA, Cuesta-Mateos T, Laredo-Aguilera JA. Impact of physical exercise in advanced-stage cancer patients: Systematic review and meta-analysis. Cancer Med 2022; 11:3714-3727. [PMID: 35411694 PMCID: PMC9554454 DOI: 10.1002/cam4.4746] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 11/17/2022] Open
Abstract
Health professionals predict that the number of people who will suffer and die from oncological diseases will continue to increase. It is vitally important to provide comprehensive care to these patients and prescribe physical exercise programs as adjuvant therapy. The objective of this systematic review was to determine the impact of physical exercise on advanced‐stage cancer patients. A literature search was performed in eight different databases. This search focused on randomized controlled trials (RCTs) published during the last 10 years. To assess the methodological quality of the sample of 15 RCTs finally obtained, the PEDro scale was used. Aerobic and strength training methods were used. The combination of both aerobic and strength training methods was the most frequently reported. Likewise, different physical and psychological variables were recorded, from which improvements were seen in fatigue, independence, quality of life and sleep, among others. The participation in physical exercise programs by advanced‐stage cancer patients has a positive impact on health. Providing these programs serves as adjuvant therapy, facilitating the comprehensive care of patients. Similarly, aerobic, strength or mixed training programs increase the muscle mass of patients and therefore reduce hypotonia, the main side effect during the advanced‐stages of cancer.
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Affiliation(s)
- Sergio Rodríguez-Cañamero
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Clínica Hemodiálisis Avericum Toledo, Toledo, Spain
| | - Ana Isabel Cobo-Cuenca
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Juan Manuel Carmona-Torres
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Diana Patricia Pozuelo-Carrascosa
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Esmeralda Santacruz-Salas
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
| | - Joseba Aingerun Rabanales-Sotos
- Department of Nursing, Physiotherapy and Occupational Therapy, Facultad de Enfermería, Universidad de Castilla-La Mancha, Albacete, Spain.,Grupo de Actividades Preventivas en el ámbito Universitario de Ciencias de la Salud (GAP-CS), Universidad de Castilla-La Mancha, Albacete, Spain
| | | | - José Alberto Laredo-Aguilera
- Grupo de Investigación Multidisciplinar en Cuidados (IMCU), Universidad de Castilla-La Mancha, Toledo, Spain.,Facultad de Fisioterapia y Enfermería de Toledo, Universidad de Castilla-La Mancha (UCLM), Toledo, Spain
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26
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The effect of 6 weeks electrical muscle stimulation training and aerobic exercise on body composition of overweight women: a randomized controlled study. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00910-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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27
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Cortiula F, Hendriks LEL, van de Worp WRPH, Schols AMWJ, Vaes RDW, Langen RCJ, De Ruysscher D. Physical exercise at the crossroad between muscle wasting and the immune system: implications for lung cancer cachexia. J Cachexia Sarcopenia Muscle 2022; 13:55-67. [PMID: 35014216 PMCID: PMC8818640 DOI: 10.1002/jcsm.12900] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/11/2021] [Accepted: 11/28/2021] [Indexed: 02/06/2023] Open
Abstract
Cachexia is a syndrome characterized by involuntary weight loss and wasting of skeletal muscle mass. It is associated with worse overall survival and quality of life. The cancer-induced systemic inflammation and the consequent host derived catabolic stimuli, trigger cachexia by inhibiting muscle protein synthesis and enhancing muscle catabolism. The muscle itself may further promote chronic inflammation, introducing a vicious catabolic circle. Nutritional support alone plays a limited role in the treatment of cancer cachexia and should be combined with other interventions. Physical exercise lowers systemic inflammation and promotes muscle anabolism. It also attenuates the age-related physical decline in elderly and it might counteract the muscle wasting induced by the cancer cachexia syndrome. This review describes how cancer-induced systemic inflammation promotes muscle wasting and whether physical exercise may represent a suitable treatment for cancer-induced cachexia, particularly in patients with non-small cell lung cancer. We summarized pre-clinical and clinical studies investigating whether physical exercise would improve muscle performance and whether this improvement would translate in a clinically meaningful benefit for patients with cancer, in terms of survival and quality of life. Moreover, this review describes the results of studies investigating the interplay between physical exercise and the immune system, including the role of the intestinal microbiota.
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Affiliation(s)
- Francesco Cortiula
- Department of Radiation Oncology (MAASTRO), Department of Respiratory Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Medicine (DAME), University of Udine, Udine, Italy
| | - Lizza E L Hendriks
- Department of Respiratory Medicine, GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center +, Maastricht, The Netherlands
| | - Wouter R P H van de Worp
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Annemie M W J Schols
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Rianne D W Vaes
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ramon C J Langen
- Department of Respiratory Medicine, NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Dirk De Ruysscher
- Department of Radiation Oncology (MAASTRO), GROW School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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28
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Martins AD, Oliveira R, Brito JP, Costa T, Silva J, Ramalho F, Santos-Rocha R, Pimenta N. Effect of exercise on phase angle in cancer patients: a systematic review. J Sports Med Phys Fitness 2021; 62:1255-1265. [PMID: 34821490 DOI: 10.23736/s0022-4707.21.12727-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Body composition is one of the main variables of interest in clinical practice in cancer patients. Specific markers from bioelectrical impedance analysis, such as phase angle (PhA), have been assuming increasing relevance in this population. The aim of the present systematic review was to study and systematise the effect of exercise on PhA in cancer survivors, as compared to control conditions, namely usual care, with no exercise. The effect of exercise on PhA in the population of cancer survivors is not yet established. EVIDENCE ACQUISITIONː This systematic review was conducted on October 13, 2021, through PubMed, Web of Science, Wiley Online Library, Directory of Open Access Journals, Science Direct and JSTOR, following PRISMA guidelines and PICOS model that include: cancer survivors with ≥18 years; intervention of any exercise program for the target group; comparison between intervention group and control group that followed control conditions, namely usual care, with no exercise; outcome related to PhA; and studies of randomized control trials. EVIDENCE SYNTHESIS We founded a total of 1244 publications, using selected keywords. Eight studies were included in this systematic review, after inclusion/exclusion criteria considered. Compared with the control conditions, exercise training programs seem associated with a positive effect on PhA, both in solid tumours and haematologic cancer types, but only when using resistance exercise alone. According to the best evidence synthesis criteria, we could not conclude the superiority of any exercise program analysed in the value of the PhA. CONCLUSIONS There were several exercise details that may have potential to be beneficial for PhA in cancer patients, including an early start of the exercise intervention (during treatment and immediately after discharge from hospital), the use of resistance exercise or/and aerobic exercise, and mainly a long follow-up period (≥ 4 months) to verify the structural effects of exercise on the PhA. However, there were no effects on the PhA value immediately after the intervention, regardless of the type of protocol and the intervention time.
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Affiliation(s)
- Alexandre D Martins
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal - .,CIEQV, Life Quality Research Centre, Rio Maior, Portugal - .,Comprehensive Health Research Centre (CHRC), Departamento de Desporto e Saúde, Escola de Saúde e Desenvolvimento Humano, Universidade de Évora, Évora, Portugal -
| | - Rafael Oliveira
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIEQV, Life Quality Research Centre, Rio Maior, Portugal.,CIDESD, Research Center in Sport Sciences, Health Sciences and Human Development, Vila Real, Portugal
| | - João P Brito
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIEQV, Life Quality Research Centre, Rio Maior, Portugal.,CIDESD, Research Center in Sport Sciences, Health Sciences and Human Development, Vila Real, Portugal
| | - Tiago Costa
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
| | - Júlia Silva
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal
| | - Fátima Ramalho
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Rita Santos-Rocha
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
| | - Nuno Pimenta
- Sports Science School of Rio Maior, Polytechnic Institute of Santarém, Rio Maior, Portugal.,CIPER, Interdisciplinary Centre for the Study of Human Performance, Faculty of Human Kinetics (FMH), University of Lisbon, Cruz Quebrada, Portugal
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29
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Niels T, Tomanek A, Freitag N, Schumann M. Can Exercise Counteract Cancer Cachexia? A Systematic Literature Review and Meta-Analysis. Integr Cancer Ther 2021; 19:1534735420940414. [PMID: 32954861 PMCID: PMC7503012 DOI: 10.1177/1534735420940414] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: Cancer-cachexia is associated with chronic inflammation, impaired muscle metabolism and body mass loss, all of which are classical targets of physical exercise. Objectives: This systematic review and meta-analysis aimed to determine the effects of exercise on body and muscle mass in cachectic cancer hosts. Data Sources: PubMed/Medline, EMBASE, CINHAL, ISI Web of Science, and Cochrane Library were searched until July 2019. Study Selection: Trials had to be randomized controlled trials or controlled trials including cancer patients or animal models with cachexia-inducing tumors. Only sole exercise interventions over at least 7 days performed in a controlled environment were included. Data Extraction: Risk of bias was assessed and a random-effects model was used to pool effect sizes by standardized mean differences (SMD). Results: All eligible 20 studies were performed in rodents. Studies prescribed aerobic (n = 15), strength (n = 3) or combined training (n = 2). No statistical differences were observed for body mass and muscle weight of the gastrocnemius, soleus, and tibialis muscles between the exercise and control conditions (SMD = ‒0.05, 95%CI-0.64-0.55, P = 0.87). Exercise duration prior to tumor inoculation was a statistical moderator for changes in body mass under tumor presence (P = 0.04). Limitations: No human trials were identified. A large study heterogeneity was present, probably due to different exercise modalities and outcome reporting. Conclusion: Exercise does not seem to affect cancer-cachexia in rodents. However, the linear regression revealed that exercise duration prior to tumor inoculation led to reduced cachexia-severity, possibly strengthening the rationale for the use of exercise in cancer patients at cachexia risk.
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Affiliation(s)
- Timo Niels
- University Hospital of Cologne, Cologne, Germany
| | | | - Nils Freitag
- German Sport University Cologne, Cologne, Germany
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30
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Teschler M, Heimer M, Schmitz B, Kemmler W, Mooren FC. Four weeks of electromyostimulation improves muscle function and strength in sarcopenic patients: a three-arm parallel randomized trial. J Cachexia Sarcopenia Muscle 2021; 12:843-854. [PMID: 34105256 PMCID: PMC8350212 DOI: 10.1002/jcsm.12717] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/24/2021] [Accepted: 04/30/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Sarcopenia, defined as loss of muscle mass, quality, and function, is associated with reduced quality of life and adverse health outcomes including disability and mortality. Electromyostimulation (EMS) has been suggested to attenuate the loss of muscle mass and function in elderly, sedentary individuals. This study aimed to investigate the effects of EMS on muscle strength and function during 4 weeks of inpatient medical rehabilitation. METHODS Patients receiving 4 weeks of inpatient medical rehabilitation diagnosed with sarcopenia using bioimpedance analysis were eligible to participate. One hundred and thirty-four patients (55.7 ± 7.9 years, 25.4% female) were randomly assigned to three groups: whole-body (WB) EMS (n = 48): stimulation of major muscle groups (pectoral muscles, latissimus, trapezius, abdominals, upper arm and leg, lower back muscles, gluteal muscles, and thighs); part-body (PB) EMS (n = 42): stimulation of leg muscles including gluteal muscles and thighs; and control group (CG, n = 44). All participants performed six 20 min training sessions including dynamic movements (squats, lunges, biceps curl, chest press, butterfly reverse, reverse lunges, standing diagonal crunches, etc.) with superimposed (WB-, PB-) EMS or without EMS (CG) in addition to the standard rehabilitation programme. Primary outcome variables included muscle function assessed by chair rise test and 6 min walking test as well as muscle strength (isometric grip strength, leg, arm, and back extension). RESULTS Primary outcome variables chair rise test and leg extension improved significantly (P = 0.001, η2 = 0.06 and P = 0.008, η2 = 0.06; EMS vs. CG) in that chair rise test results increased in WB-EMS from 5 (4; 7) to 7 (5; 9), in PB-EMS from 5 (5; 7) to 7 (6; 8), and in CG from 6 (4; 7) to 7 (5; 8) repetitions. Knee extension increased in WB-EMS from 692.3 ± 248.6 to 831.7 ± 298.7 N, in PB-EMS from 682.8 ± 257.8 to 790.2 ± 270.2 N, and in CG from 638.5 ± 236.9 to 703.2 ± 218.6 N. No adverse events or side effects occurred. CONCLUSIONS We conclude that EMS might be an additional training option to improve muscle function and strength in sarcopenic patients during a 4 week rehabilitation programme. EMS provides greater functional and strength improvements compared with standard treatment with additional potential health benefits for sarcopenic cardiac and orthopaedic patients.
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Affiliation(s)
- Marc Teschler
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.,Klinik Königsfeld der DRV, Department of Cardiology and Orthopedics Clinic, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Melina Heimer
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.,Klinik Königsfeld der DRV, Department of Cardiology and Orthopedics Clinic, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Boris Schmitz
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.,Klinik Königsfeld der DRV, Department of Cardiology and Orthopedics Clinic, Center for Medical Rehabilitation, Ennepetal, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University Erlangen-Nürnberg, Erlangen, Germany
| | - Frank C Mooren
- Department of Rehabilitation Sciences, Faculty of Health, University of Witten/Herdecke, Witten, Germany.,Klinik Königsfeld der DRV, Department of Cardiology and Orthopedics Clinic, Center for Medical Rehabilitation, Ennepetal, Germany
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31
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Schwappacher R, Dieterich W, Reljic D, Pilarsky C, Mukhopadhyay D, Chang DK, Biankin AV, Siebler J, Herrmann HJ, Neurath MF, Zopf Y. Muscle-Derived Cytokines Reduce Growth, Viability and Migratory Activity of Pancreatic Cancer Cells. Cancers (Basel) 2021; 13:cancers13153820. [PMID: 34359731 PMCID: PMC8345221 DOI: 10.3390/cancers13153820] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 07/11/2021] [Accepted: 07/23/2021] [Indexed: 01/10/2023] Open
Abstract
Simple Summary Pancreatic cancer (PC) is a highly fatal malignancy. A major reason for the poor prognosis of patients with PC is the insensitivity to most oncological treatment approaches. It is known that regular exercise reduces the cancer risk. We have already shown that serum from advanced prostate and colon cancer patients after exercise reduces growth and viability of cancer cells. The aim of this study was to identify exercise-induced cytokines in serum from patients with advanced-stage PC that regulate cancer cell proliferation and apoptosis. Our data suggest that a mild resistance exercise training in advanced PC patients induces the release of CXCL1, IL10 and CCL4 from contracting skeletal muscle. We demonstrate that these myokines inhibit growth and migration of PC cells, and induce PC cell death. With this report we provide new knowledge on the cancer-protective function of exercise in PC. Our data strongly support sport therapies for cancer patients. Abstract The evidence that regular physical exercise reduces the risk of developing cancer is well described. However, the interaction between physical exercise and cancer is not fully clarified yet. Several myokines released by skeletal muscle appear to have a direct anti-tumour function. There are few data on myokine secretion after exercise in patients with advanced tumours. Pancreatic cancer (PC) is a very aggressive and usually fatal cancer. To investigate the effects of exercise in PC, the blood of advanced-stage PC patients was analysed after 12 weeks of resistance training using whole-body electromyostimulation. After the 12-week training period, the patient serum inhibited the proliferation and the motility of PC cells and enhanced PC cell apoptosis. The impact of exercise training was also investigated in an exercise-mimicking in vitro model using electric pulse stimulation of human myotubes and revealed similar anti-tumour effects on PC cells, clearly indicating direct cancer-protective properties of activated skeletal muscle. Protein and gene expression analyses in plasma from exercise-trained patients and in myotube cultures after in vitro exercise showed that interleukin 10 (IL10), C-X-C motif ligand 1 (CXCL1) and C-C motif chemokine ligand 4 (CCL4) are myokines released from activated skeletal muscle. In accordance with the effects of serum from exercise-trained patients, the supplementation with recombinant IL10, CXCL1 and CCL4 impaired growth and migration of PC cells. Treatment of PC cells with these myokines upregulated caspase 3/7 expression and the cleavage of poly(ADP-ribose) polymerase, leading to enhanced PC cell death. The identification of myokines with anti-tumour properties in advanced-stage PC patients after exercise opens a new perspective in supportive therapy with sports and exercise for cancer patients.
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Affiliation(s)
- Raphaela Schwappacher
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Walburga Dieterich
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Dejan Reljic
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Christian Pilarsky
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
- Department of Surgery, Friedrich-Alexander University Erlangen-Nürnberg, Schwabachanlage 12, 91054 Erlangen, Germany
| | - Debabrata Mukhopadhyay
- Biochemistry and Molecular Biology, Mayo Clinic College of Medicine and Science, 4500 San Pablo Road, Jacksonville, FL 32224, USA;
| | - David K. Chang
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate Switchback Road, Glasgow G61 1QH, UK; (D.K.C.); (A.V.B.)
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - Andrew V. Biankin
- Wolfson Wohl Cancer Research Centre, Institute of Cancer Sciences, University of Glasgow, Garscube Estate Switchback Road, Glasgow G61 1QH, UK; (D.K.C.); (A.V.B.)
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, 84 Castle Street, Glasgow G4 0SF, UK
| | - Jürgen Siebler
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Hans J. Herrmann
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Markus F. Neurath
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
| | - Yurdagül Zopf
- Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany; (R.S.); (W.D.); (D.R.); (J.S.); (H.J.H.); (M.F.N.)
- Hector-Center for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander University Erlangen-Nürnberg, Ulmenweg 18, 91054 Erlangen, Germany
- Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Östliche Stadtmauerstraße 30, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-09131-8545218; Fax: +49-09131-8535228
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Zink-Rückel C, Kohl M, Willert S, von Stengel S, Kemmler W. Once-Weekly Whole-Body Electromyostimulation Increases Strength, Stability and Body Composition in Amateur Golfers. A Randomized Controlled Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115628. [PMID: 34070315 PMCID: PMC8197524 DOI: 10.3390/ijerph18115628] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 12/12/2022]
Abstract
Whole-body electromyostimulation (WB-EMS), an innovative training technology, is considered as a joint-friendly, highly customizable and particularly time-effective option for improving muscle strength and stability, body composition and pain relief. The aim of the present study was to determine the effect of 16 weeks of once-weekly WB-EMS on maximum isometric trunk (MITS), leg extensor strength (MILES), lean body mass (LBM) and body-fat content. A cohort of 54 male amateur golfers, 18 to 70 years old and largely representative for healthy adults, were randomly assigned to a WB-EMS (n = 27) or a control group (CG: n = 27). Bipolar low-frequency WB-EMS combined with low-intensity movements was conducted once per week for 20 min at the participants’ locations, while the CG maintained their habitual activity. The intention to treat analysis with multiple imputation was applied. After 16 weeks of once-weekly WB-EMS application with an attendance rate close to 100%, we observed significant WB-EMS effects on MITS (p < 0.001), MILES (p = 0.001), LBM (p = 0.034), but not body-fat content (p = 0.080) and low-back pain (LBP: p ≥ 0.078). In summary, the commercial setting of once-weekly WB-EMS application is effective to enhance stability, maximum strength, body composition and, to a lower extent, LBP in amateur golfers widely representative for a healthy male cohort.
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Affiliation(s)
- Carina Zink-Rückel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany; (C.Z.-R.); (S.W.); (S.v.S.)
| | - Matthias Kohl
- Faculty Medical and Life Sciences, University of Furtwangen, 78056 Villingen-Schwenningen, Germany;
| | - Sebastian Willert
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany; (C.Z.-R.); (S.W.); (S.v.S.)
| | - Simon von Stengel
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany; (C.Z.-R.); (S.W.); (S.v.S.)
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander University of Erlangen-Nürnberg, 91052 Erlangen, Germany; (C.Z.-R.); (S.W.); (S.v.S.)
- Correspondence: ; Tel.: +49-9131-8523999
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Reljic D, Herrmann HJ, Neurath MF, Zopf Y. Iron Beats Electricity: Resistance Training but Not Whole-Body Electromyostimulation Improves Cardiometabolic Health in Obese Metabolic Syndrome Patients during Caloric Restriction-A Randomized-Controlled Study. Nutrients 2021; 13:nu13051640. [PMID: 34068089 PMCID: PMC8152778 DOI: 10.3390/nu13051640] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 01/09/2023] Open
Abstract
Caloric restriction (CR) and exercise are cornerstones in the treatment of obesity and cardiometabolic disorders. Recently, whole body electromyostimulation (WB-EMS) has emerged as a more time-efficient alternative to traditional resistance training (RT). However, the effects of WB-EMS compared to RT on cardiometabolic health in obese metabolic syndrome (MetS) patients performed during CR are still unclear. In total, 118 obese MetS patients (52.7 ± 11.8 years, BMI: 38.1 ± 6.9 kg/m2) undergoing CR over 12 weeks (aim: −500 kcal deficit/day) were randomly allocated to either WB-EMS, single-set RT (1-RT), 3-set RT (3-RT) or an inactive control group (CON). Primary outcome was MetS severity (MetS z-score). Secondary outcomes were body composition, muscle strength and quality of life (QoL). All groups significantly reduced body weight (~3%) and fat mass (~2.6 kg) but only 1-RT and 3-RT preserved skeletal muscle mass (SMM). All exercise groups increased muscle strength in major muscle groups (20–103%). However, only the two RT-groups improved MetS z-score (1-RT: −1.34, p = 0.003; 3-RT: −2.06, p < 0.001) and QoL (1-RT: +6%, p = 0.027; 3-RT: +12%, p < 0.001), while WB-EMS and CON had no impact on these outcomes. We conclude that traditional RT has superior effects on cardiometabolic health, SMM and QoL in obese MetS patients undergoing CR than WB-EMS.
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Affiliation(s)
- Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (Y.Z.)
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Correspondence: ; Tel.: +49-9131-85-45220
| | - Hans J. Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (Y.Z.)
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
| | - Markus F. Neurath
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
- Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany; (H.J.H.); (Y.Z.)
- German Center Immunotherapy (DZI), University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany;
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Kemmler W, Shojaa M, Steele J, Berger J, Fröhlich M, Schoene D, von Stengel S, Kleinöder H, Kohl M. Efficacy of Whole-Body Electromyostimulation (WB-EMS) on Body Composition and Muscle Strength in Non-athletic Adults. A Systematic Review and Meta-Analysis. Front Physiol 2021; 12:640657. [PMID: 33716787 PMCID: PMC7952886 DOI: 10.3389/fphys.2021.640657] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 01/19/2021] [Indexed: 12/12/2022] Open
Abstract
This systematic review and meta-analysis set out to determine the efficacy on whole-body electromyostimulation (WB-EMS) on body composition and strength parameters in non-athletic cohorts. A systematic review of the literature according to the PRISMA statement included (a) controlled trials, (b) WB-EMS trials with at least one exercise and one control group, (c) WB-EMS as primary physical intervention, (d) WB-EMS with at least six electrodes covering most muscle groups, (e) non-athletic cohorts. We searched eight electronic databases up to June 30, 2020, without language restrictions. Standardized mean differences (SMD) for muscle mass parameters, total body fat mass, maximum leg extension, and trunk extension strength were defined as outcome measures. In summary, 16 studies with 19 individual WB-EMS groups representing 897 participants were included. Studies vary considerably with respect to age, BMI, and physical conditions. Impulse protocols of the studies were roughly comparable, but training frequency (1-5 sessions/week) and intervention length (6-54 weeks) differed between the studies. SMD average was 1.23 (95%-CI: 0.71-1.76) for muscle mass, 0.98 (0.74-1.22) for maximum leg, and 1.08 (0.78-1.39) for maximum trunk extension strength changes (all p < 0.001). SMD for body fat changes (-0.40, [-0.98 to 0.17]), however, did not reach significance. I 2 and Q-statistics revealed substantial heterogeneity of muscle and fat mass changes between the trials. However, rank and regression tests did not indicate positive evidence for small-study bias and funnel plot asymmetries. This work provided further evidence for significant, large-sized effects of WB-EMS on muscle mass and strength parameters, but not on body fat mass. Clinical Trial Registration: ClinicalTrials.gov, PROSPERO; ID: CRD42020183059.
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Affiliation(s)
- Wolfgang Kemmler
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Mahdieh Shojaa
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - James Steele
- Ukactive Research Institute, London, United Kingdom.,Faculty of Sport, Health, and Social Sciences, Solent University, Southampton, United Kingdom
| | - Joshua Berger
- Department of Sports Science, Technische Universität Kaiserslauter, Kaiserslautern, Germany
| | - Michael Fröhlich
- Department of Sports Science, Technische Universität Kaiserslauter, Kaiserslautern, Germany
| | - Daniel Schoene
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | - Simon von Stengel
- Institute of Medical Physics, University of Erlangen-Nürnberg, Erlangen, Germany
| | | | - Matthias Kohl
- Faculty Medical and Life Sciences, University of Furtwangen, Villingen-Schwenningen, Germany
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35
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Wang Y, Zhang T, Liu R, Chang M, Wei W, Jin Q, Wang X. New perspective toward nutritional support for malnourished cancer patients: Role of lipids. Compr Rev Food Sci Food Saf 2021; 20:1381-1421. [PMID: 33533186 DOI: 10.1111/1541-4337.12706] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 12/01/2020] [Accepted: 12/28/2020] [Indexed: 12/13/2022]
Abstract
To improve the difficulties related to malnutrition, nutritional support has become an essential part of multidisciplinary comprehensive treatment for cancer. Lipids are essential nutrient source for the human body, and nowadays in clinical practices, it has a positive interventional effect on patients suffering from cancer. However, contribution of lipids in nutritional support of cancer patients is still poorly understood. Moreover, the sensory and physicochemical properties of lipids can severely restrict their applications in lipid-rich formula foods. In this review article, for the first time, we have presented a summary of the existing studies which were related to the associations between different lipids and improved malnutrition in cancer patients and discussed possible mechanisms. Subsequently, we discussed the challenges and effective solutions during processing of lipids into formula foods. Further, by considering existing problems in current lipid nutritional support, we proposed a novel method for the treatment of malnutrition, including developing individualized lipid nutrition for different patients depending on the individual's genotype and enterotype. Nonetheless, this review study provides a new direction for future research on nutritional support and the development of lipid-rich formula foods for cancer patients, and probably will help to improve the efficacy of lipids in the treatment of cancer malnutrition.
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Affiliation(s)
- Yandan Wang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Tao Zhang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Ruijie Liu
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Ming Chang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Wei Wei
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Qingzhe Jin
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
| | - Xingguo Wang
- National Engineering Research Center for Functional Food, Collaborative Innovation Center of Food Safety and Quality Control in Jiangsu Province, State Key Lab of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, China
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36
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Looijaard SMLM, Te Lintel Hekkert ML, Wüst RCI, Otten RHJ, Meskers CGM, Maier AB. Pathophysiological mechanisms explaining poor clinical outcome of older cancer patients with low skeletal muscle mass. Acta Physiol (Oxf) 2021; 231:e13516. [PMID: 32478975 PMCID: PMC7757176 DOI: 10.1111/apha.13516] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 05/25/2020] [Accepted: 05/25/2020] [Indexed: 12/14/2022]
Abstract
Low skeletal muscle mass is highly prevalent in older cancer patients and affects 5% to 89% depending on the type and stage of cancer. Low skeletal muscle mass is associated with poor clinical outcomes such as post-operative complications, chemotherapy toxicity and mortality in older cancer patients. Little is known about the mediating pathophysiological mechanisms. In this review, we summarize proposed pathophysiological mechanisms underlying the association between low skeletal muscle mass and poor clinical outcomes in older cancer patients including a) systemic inflammation; b) insulin-dependent glucose handling; c) mitochondrial function; d) protein status and; e) pharmacokinetics of anticancer drugs. The mechanisms of altered myokine balance negatively affecting the innate and adaptive immune system, and altered pharmacokinetics of anticancer drugs leading to a relative overdosage of anticancer drugs are best-substantiated. The effects of glucose intolerance and circulating mitochondrial DNA as a consequence of low skeletal muscle mass are topics of interest for future research. Restoring myokine balance through physical exercise, exercise mimetics, neuro-muscular activation and adapting anticancer drug dosing on skeletal muscle mass could be targeted approaches to improve clinical outcomes in older cancer patients with low skeletal muscle mass.
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Affiliation(s)
- Stéphanie M L M Looijaard
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Miriam L Te Lintel Hekkert
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Rob C I Wüst
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - René H J Otten
- University Library, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Carel G M Meskers
- Department of Rehabilitation Medicine, Amsterdam University Medical Center, VU University Medical Center, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Andrea B Maier
- Department of Human Movement Sciences, @AgeAmsterdam, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands.,Department of Medicine and Aged Care, @AgeMelbourne, The Royal Melbourne Hospital, University of Melbourne, Melbourne, Australia
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37
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Storck LJ, Ruehlin M, Gaeumann S, Gisi D, Schmocker M, Meffert PJ, Imoberdorf R, Pless M, Ballmer PE. Effect of a leucine-rich supplement in combination with nutrition and physical exercise in advanced cancer patients: A randomized controlled intervention trial. Clin Nutr 2020; 39:3637-3644. [DOI: 10.1016/j.clnu.2020.04.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/28/2020] [Accepted: 04/04/2020] [Indexed: 01/05/2023]
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38
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Aquila G, Re Cecconi AD, Brault JJ, Corli O, Piccirillo R. Nutraceuticals and Exercise against Muscle Wasting during Cancer Cachexia. Cells 2020; 9:E2536. [PMID: 33255345 PMCID: PMC7760926 DOI: 10.3390/cells9122536] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/17/2020] [Accepted: 11/18/2020] [Indexed: 12/12/2022] Open
Abstract
Cancer cachexia (CC) is a debilitating multifactorial syndrome, involving progressive deterioration and functional impairment of skeletal muscles. It affects about 80% of patients with advanced cancer and causes premature death. No causal therapy is available against CC. In the last few decades, our understanding of the mechanisms contributing to muscle wasting during cancer has markedly increased. Both inflammation and oxidative stress (OS) alter anabolic and catabolic signaling pathways mostly culminating with muscle depletion. Several preclinical studies have emphasized the beneficial roles of several classes of nutraceuticals and modes of physical exercise, but their efficacy in CC patients remains scant. The route of nutraceutical administration is critical to increase its bioavailability and achieve the desired anti-cachexia effects. Accumulating evidence suggests that a single therapy may not be enough, and a bimodal intervention (nutraceuticals plus exercise) may be a more effective treatment for CC. This review focuses on the current state of the field on the role of inflammation and OS in the pathogenesis of muscle atrophy during CC, and how nutraceuticals and physical activity may act synergistically to limit muscle wasting and dysfunction.
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Affiliation(s)
- Giorgio Aquila
- Neuroscience Department, Mario Negri Institute for Pharmacological Research IRCCS, 20156 Milan, Italy; (G.A.); (A.D.R.C.)
- Italian Institute for Planetary Health, IIPH, 20156 Milan, Italy;
| | - Andrea David Re Cecconi
- Neuroscience Department, Mario Negri Institute for Pharmacological Research IRCCS, 20156 Milan, Italy; (G.A.); (A.D.R.C.)
- Italian Institute for Planetary Health, IIPH, 20156 Milan, Italy;
| | - Jeffrey J. Brault
- Indiana Center for Musculoskeletal Health, Department of Anatomy, Cell Biology & Physiology, Indiana University School of Medicine, Indianapolis, IN 46202, USA;
| | - Oscar Corli
- Italian Institute for Planetary Health, IIPH, 20156 Milan, Italy;
- Oncology Department, Mario Negri Institute for Pharmacological Research IRCCS, 20156 Milan, Italy
| | - Rosanna Piccirillo
- Neuroscience Department, Mario Negri Institute for Pharmacological Research IRCCS, 20156 Milan, Italy; (G.A.); (A.D.R.C.)
- Italian Institute for Planetary Health, IIPH, 20156 Milan, Italy;
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39
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Effects of Nanomaterials on the Body Composition of Patients with Dyslipidemia Based on Different Strength Sports Equipment. J CHEM-NY 2020. [DOI: 10.1155/2020/3649157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Relevant studies have shown that the use of sports equipment for exercise can regulate the body composition of patients, thereby achieving the purpose of improving the metabolism of blood lipids in the body. Based on this, this article takes patients with dyslipidemia as the research object and explores the changes in their body composition and shape using different strength sports equipment made of nanomaterials during sports rehabilitation training. In this study, 200 patients with dyslipidemia were selected as experimental subjects in the form of interviews and questionnaires. According to the type of exercise, they were divided into 56 men in the men’s running group, 56 men in the men’s spinning group, 44 women in the women’s running group, and 44 women in the women’s spinning group. 12 weeks of incremental exercise training were carried out. The results of the experiment found that after the end of the 12-week exercise training, the body composition of the subjects in each group changed significantly (
). The changes in the male and female spinning group were more obvious than those in the running group, and the weight of the male spinning group, waist circumference, and hip circumference decreased by 2.3%, 3%, and 3.5% and those of women’s spinning group decreased by 3.1%, 3.4%, and 3.9%. In addition, blood lipids in each group also changed significantly (
); there is a significant statistical difference. Through a return visit two years after the end of the experiment, it was found that most of the subjects had symptoms of discomfort, indicating that the nanomaterials have a certain negative impact on the human body.
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Schwappacher R, Schink K, Sologub S, Dieterich W, Reljic D, Friedrich O, Herrmann HJ, Neurath MF, Zopf Y. Physical activity and advanced cancer: evidence of exercise-sensitive genes regulating prostate cancer cell proliferation and apoptosis. J Physiol 2020; 598:3871-3889. [PMID: 32648302 DOI: 10.1113/jp279150] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 07/06/2020] [Indexed: 01/05/2023] Open
Abstract
KEY POINTS Physical activity is known to protect against cancer. The resistance exercise method whole-body electromyostimulation (WB-EMS) has a significant anti-cancer effect. WB-EMS-conditioned serum from advanced prostate cancer patients decreased human prostate carcinoma cell growth and viability in vitro. Multiplex analysis revealed that genes associated with human prostate cancer cell proliferation and apoptosis are sensitive for exercise. Feasible exercise should be part of multimodal anti-cancer therapies, also for physically weakened patients. ABSTRACT Regular physical activity is known to protect against cancer development. In cancer survivors, exercise reduces the risk of cancer recurrence and mortality. However, the link between exercise and decreased cancer risk and improved survival is still not well understood. Serum from exercising healthy individuals inhibits proliferation and activates apoptosis in various cancer cells, suggesting that mechanisms regulating cancer cell growth are affected by exercise. For the first time, we analysed serum from advanced-stage cancer patients with prostate (exercise group n = 8; control group n = 10) or colorectal (exercise n = 6; control n = 6) cancer, after a 12-week whole-body electromyostimulation training (20 min/session, 2×/week; frequency 85 Hz; pulse width 350 µs; 6 s stimulation, 4 s rest), a tolerable, yet effective, resistance exercise for physically weakened patients. We report that serum from these advanced cancer patients inhibits proliferation and enhances apoptosis of human prostate and colon cancer cells in vitro using cell growth and death assays (5-bromo-2'-deoxyuridine incorporation, cell counting, DNA fragmentation). Exercise-mimicking electric pulse stimulation of human primary myotubes showed that electric pulse stimulation-conditioned myotube medium also impairs human cancer cell viability. Gene expression analysis using a multiplex array of cancer-associated genes and subsequent quantitative RT-PCR revealed the presence of exercise-sensitive genes in human prostate cancer cells that potentially participate in the exercise-mediated regulation of malignant cell growth and apoptosis. Our data document the strong efficiency of the anti-oncogenic effects of physical activity and will further support the application of regular therapeutic exercise during cancer disease.
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Affiliation(s)
- Raphaela Schwappacher
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Kristin Schink
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Svetlana Sologub
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Walburga Dieterich
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Dejan Reljic
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Oliver Friedrich
- Institute of Medical Biotechnology, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Hans J Herrmann
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Markus F Neurath
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.,Hector-Centre for Nutrition, Exercise and Sports, Medical Department 1, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
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Pano-Rodriguez A, Beltran-Garrido JV, Hernandez-Gonzalez V, Reverter-Masia J. Effects of Whole Body Electromyostimulation on Physical Fitness and Health in Postmenopausal Women: A Study Protocol for a Randomized Controlled Trial. Front Public Health 2020; 8:313. [PMID: 32793536 PMCID: PMC7391420 DOI: 10.3389/fpubh.2020.00313] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 06/09/2020] [Indexed: 12/29/2022] Open
Abstract
Background: Age-related problems such as chronic diseases, functional limitation and dependence, reduce the quality of life in the elderly, and increase public spending in health. It has been established that physical activity plays a fundamental role in the health of the elderly. The whole body electromyostimulation (WB-EMS) could be a successful methodology as high-intensity training to improve the physical fitness of older people. Methods: A minimum of 13 women between 55 and 70 years old will be randomized in two groups. The exercise with WB-EMS group (EX + WB-EMS) will conduct a resistance strength training program with superimposed WB-EMS while the exercise group (EX) will perform only resistance strength and aerobic training. Balance, strength, flexibility, agility, speed, and aerobic performance (EXERNET battery and progressive resistance test), as well as body composition, blood parameters and physical activity reporting (IPAQ-E) will be assessed to analyze the effects of whole body electromyostimulation in the physical fitness and the health in postmenopausal women. Discussion: Innovative and scientifically well-designed protocols are needed to enhance the knowledge of the body's responses within this training methodology which is being used by a big quantity of population. This trial will provide evidence on the effectiveness of whole-body electromyostimulation in physical fitness and health in elderly women. Trial Registration: ISRCTN15558857 registration data: 27/11/2019 (retrospectively registered).
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Zanetti M, Gortan Cappellari G, Barazzoni R, Sanson G. The Impact of Protein Supplementation Targeted at Improving Muscle Mass on Strength in Cancer Patients: A Scoping Review. Nutrients 2020; 12:nu12072099. [PMID: 32708527 PMCID: PMC7400018 DOI: 10.3390/nu12072099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 06/15/2020] [Accepted: 07/03/2020] [Indexed: 12/25/2022] Open
Abstract
Deterioration of muscle strength during cancer results in functional limitation, poor quality of life and reduced survival. The indirect effects on muscle strength of nutritional interventions based on protein and amino acid derivatives targeted at improving muscle mass are poorly documented. A scoping review was performed to examine the available evidence on the effects of proteins, amino acids and their derivatives on muscle strength in adult cancer patients. Pubmed and Scopus databases were searched to identify research articles published in the last 10 years. Fourteen studies met the inclusion criteria, showing that changes in muscle strength following protein or amino acid supplementation are generally concordant with those in muscle mass in cancer patients. Administration of both energy and proteins in the presence of reduced oral intakes results in more robust effects on both muscle strength and mass. It is not clear whether this is due to the correction of the energy deficit or to an interaction between proteins and other macronutrients. The optimal mixture, type, and dose of amino acid/protein supplementation alone or in combination with other anabolic strategies should be determined to provide the best nutritional approach in cancer.
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Pano-Rodriguez A, Beltran-Garrido JV, Hernandez-Gonzalez V, Nasarre-Nacenta N, Reverter-Masia J. Impact of Whole Body Electromyostimulation on Velocity, Power and Body Composition in Postmenopausal Women: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4982. [PMID: 32664361 PMCID: PMC7400631 DOI: 10.3390/ijerph17144982] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/02/2020] [Accepted: 07/02/2020] [Indexed: 02/08/2023]
Abstract
Menopause is associated with losses in strength and power along with weight and fat mass gains, which may result from menopause-related hormonal changes, aging-associated diseases, and decreased physical activity time. The objective of this study is to analyze if whole-body electromyostimulation (WB-EMS) is suitable for the prevention and treatment of postmenopausal physical deterioration. Thirty-four healthy sedentary women between 55 and 69 years followed an experimental design pre-post test. Both groups conducted 10 weeks of aerobic and strength training program. The experimental group conducted the training with superimposed WB-EMS during exercise. At the end of the intervention, the experimental group obtained better power (Squat: mean difference (MD) = 38.69 W [1.75,75.62], d = 0.81; Bench press: MD = 25.64 W [17.48, 33.82], d = 2.39) and velocity (Squat: MD = 0.04 m·s-1 [0.01, 0.08], d = 0.98; Bench press: MD = 0.10 m·s-1 [0.06, 0.14], d = 1.90) score improvements than the other group (pBonferroni < 0.05). Furthermore, trivial to small effects were found in the body composition of the participants of both groups (p > 0.050). WB-EMS showed a favorable isolated effect on the development of power and velocity, but it induced negligible effects on the body composition of postmenopausal women.
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Affiliation(s)
| | - Jose Vicente Beltran-Garrido
- EUSES Escola Universitària de la Salut i l’Esport, Rovira i Virgili University, 43870 Tarragona, Spain; (J.V.B.-G.); (J.R.-M.)
| | | | | | - Joaquin Reverter-Masia
- EUSES Escola Universitària de la Salut i l’Esport, Rovira i Virgili University, 43870 Tarragona, Spain; (J.V.B.-G.); (J.R.-M.)
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Hirahara N, Matsubara T, Fujii Y, Kaji S, Hyakudomi R, Yamamoto T, Uchida Y, Miyazaki Y, Ishitobi K, Kawabata Y, Tajima Y. Preoperative geriatric nutritional risk index is a useful prognostic indicator in elderly patients with gastric cancer. Oncotarget 2020; 11:2345-2356. [PMID: 32595832 PMCID: PMC7299529 DOI: 10.18632/oncotarget.27635] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 05/25/2020] [Indexed: 12/28/2022] Open
Abstract
Background: The geriatric nutritional risk index (GNRI) was developed to evaluate the prognosis in elderly hospitalized patients at risk of malnutrition and related morbidity and mortality. This study aimed to evaluate the relationship between preoperative GNRI and long-term outcomes in elderly gastric cancer patients. Materials and Methods: We retrospectively reviewed 297 consecutive patients aged ≥ 65 years who underwent laparoscopic gastrectomy with R0 resection and evaluated their overall survival (OS) and cancer-specific survival (CSS). Results: In the univariate analyses, OS was significantly associated with the American Society of Anesthesiologists Physical Status (ASA-PS), tumor size, tumor differentiation, pathological stage, carcinoembryonic antigen (CEA), C-reactive protein, postoperative complications, and GNRI, whereas in the univariate analyses of CSS, ASA-PS, tumor size, tumor differentiation, pathological stage, CEA, postoperative adjuvant chemotherapy, and GNRI were significantly associated with poor prognosis. In the multivariate analysis, ASA-PS, tumor differentiation, pathological stage, and GNRI were significant independent prognostic factors of OS, whereas ASA-PS, pathological stage, and CEA were significant independent prognostic factors of CSS. Conclusions: GNRI is significantly associated with OS and CSS in elderly gastric cancer patients and is an independent predictor of OS. It is a simple, cost-effective, and promising nutritional index for predicting OS in elderly patients.
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Affiliation(s)
- Noriyuki Hirahara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Takeshi Matsubara
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yusuke Fujii
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Shunsuke Kaji
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Ryoji Hyakudomi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Tetsu Yamamoto
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yuki Uchida
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshiko Miyazaki
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Kazunari Ishitobi
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoshitsugu Tajima
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
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Pano-Rodriguez A, Beltran-Garrido JV, Hernandez-Gonzalez V, Reverter-Masia J. Effects of Whole-Body Electromyostimulation on Physical Fitness in Postmenopausal Women: A Randomized Controlled Trial. SENSORS 2020; 20:s20051482. [PMID: 32182674 PMCID: PMC7085547 DOI: 10.3390/s20051482] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/12/2022]
Abstract
Whole-body electromyostiulation (WB-EMS) has experienced a boom in recent years, even though its effectiveness is controversial. A sedentary lifestyle is deeply rooted in the European population, mainly in the elderly. This experimental study analyzed the impact of WB-EMS on the physical fitness of postmenopausal women. Thirty-four healthy sedentary women between 55 and 69 years followed an experimental design pre–post-test. Both groups conducted a ten-week aerobic and strength training program. The experimental group overlaid the WB-EMS during exercise. At the end of the intervention, both groups improved upper and lower body strength, lower extremity flexibility, agility, and speed levels (pBonferroni < 0.05). Significant interactions were observed at upper and lower body strength, agility, speed, and cardiovascular endurance (p < 0.05). The WB-EMS group scored better agility than the control group at the end of the intervention (pBonferroni < 0.05) and was the only group that improved cardiovascular endurance. WB-EMS shows a favorable isolate effect on the development of dynamic leg strength, agility, and cardiovascular endurance but did not in dynamic arm strength, gait speed, balance, or flexibility of postmenopausal women.
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Affiliation(s)
- Alvaro Pano-Rodriguez
- Research Group Human Movement, University of Lleida, Av. de l’Estudi General, n.4 E-25001 Lleida, Spain; (V.H.-G.); (J.R.-M.)
- Correspondence: ; Tel.: +346-4954-6894
| | - Jose Vicente Beltran-Garrido
- EUSES Health and Sport Sciences School, Rovira i Virgili University, C/Sebastià Joan Arbó, 2, 43870 Amposta, Spain;
| | - Vicenç Hernandez-Gonzalez
- Research Group Human Movement, University of Lleida, Av. de l’Estudi General, n.4 E-25001 Lleida, Spain; (V.H.-G.); (J.R.-M.)
| | - Joaquín Reverter-Masia
- Research Group Human Movement, University of Lleida, Av. de l’Estudi General, n.4 E-25001 Lleida, Spain; (V.H.-G.); (J.R.-M.)
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Stöllberger C, Finsterer J. Side effects of and contraindications for whole-body electro-myo-stimulation: a viewpoint. BMJ Open Sport Exerc Med 2019; 5:e000619. [PMID: 31908835 PMCID: PMC6937082 DOI: 10.1136/bmjsem-2019-000619] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Whole-body electro-myo-stimulation (WB-EMS) has been introduced as an alternative to physical training. Data about side effects and contraindications of WB-EMS are summarised. From healthy subjects, elevation of creatine-kinase (CK) activity with inter-individual variability was reported after WB-EMS. No data about applied current types, stimulation frequency and risk factors were given. In randomised trials investigating WB-EMS, CK activity was not measured. Seven cases of rhabdomyolysis after WB-EMS were found, and it remains open whether WB-EMS was the only risk factor. In healthy subjects, WB-EMS does not seem to affect blood pressure, heart rate and oxygen uptake. The lists of exclusion criteria are, in part, contradictory between different studies, especially regarding malignancy and heart failure. Risk factors for rhabdomyolysis are not mentioned as contraindications for WB-EMS. Scientific research should concentrate on muscle damage as a side effect of WB-EMS considering current types applied, stimulation frequency and risk factors for rhabdomyolysis. Research about WB-EMS should include longitudinal muscle force measurements and MRI. Subjects, intending to perform WB-EMS, should undergo investigations by a physician comprising a screen for risk factors for rhabdomyolysis. The education of operators working in gyms with WB-EMS should be regulated and improved. Regulatory authorities should become aware of the problem. Those working in the field should start an initiative on an international level to increase the safety of WB-EMS.
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Schink K, Gaßner H, Reljic D, Herrmann HJ, Kemmler W, Schwappacher R, Meyer J, Eskofier BM, Winkler J, Neurath MF, Klucken J, Zopf Y. Assessment of gait parameters and physical function in patients with advanced cancer participating in a 12-week exercise and nutrition programme: A controlled clinical trial. Eur J Cancer Care (Engl) 2019; 29:e13199. [PMID: 31829481 DOI: 10.1111/ecc.13199] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 09/12/2019] [Accepted: 11/22/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Gait is a sensitive marker for functional declines commonly seen in patients treated for advanced cancer. We tested the effect of a combined exercise and nutrition programme on gait parameters of advanced-stage cancer patients using a novel wearable gait analysis system. METHODS Eighty patients were allocated to a control group with nutritional support or to an intervention group additionally receiving whole-body electromyostimulation (WB-EMS) training (2×/week). At baseline and after 12 weeks, physical function was assessed by a biosensor-based gait analysis during a six-minute walk test, a 30-s sit-to-stand test, a hand grip strength test, the Karnofsky Index and EORTC QLQ-C30 questionnaire. Body composition was measured by bioelectrical impedance analysis and inflammation by blood analysis. RESULTS Final analysis included 41 patients (56.1% male; 60.0 ± 13.0 years). After 12 weeks, the WB-EMS group showed higher stride length, gait velocity (p < .05), six-minute walking distance (p < .01), bodyweight and skeletal muscle mass, and emotional functioning (p < .05) compared with controls. Correlations between changes in gait and in body composition, physical function and inflammation were detected. CONCLUSION Whole-body electromyostimulation combined with nutrition may help to improve gait and functional status of cancer patients. Sensor-based mobile gait analysis objectively reflects patients' physical status and could support treatment decisions.
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Affiliation(s)
- Kristin Schink
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Heiko Gaßner
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Dejan Reljic
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Hans J Herrmann
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Wolfgang Kemmler
- Institute of Medical Physics, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Raphaela Schwappacher
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Julia Meyer
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
| | - Björn M Eskofier
- Machine Learning and Data Analytics Lab, Department of Computer Science, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Jürgen Winkler
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Markus F Neurath
- Department of Medicine 1 - Gastroenterology, Pneumology and Endocrinology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Jochen Klucken
- Department of Molecular Neurology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), University Hospital Erlangen, Erlangen, Germany
| | - Yurdagül Zopf
- Department of Medicine 1, Hector Center for Nutrition, Exercise and Sports, Friedrich-Alexander-Universität Erlangen-Nürnberg, University Hospital Erlangen, Erlangen, Germany
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Circadian rhythm disruption is associated with an increased risk of sarcopenia: a nationwide population-based study in Korea. Sci Rep 2019; 9:12015. [PMID: 31427694 PMCID: PMC6700184 DOI: 10.1038/s41598-019-48161-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 07/29/2019] [Indexed: 12/22/2022] Open
Abstract
Reduced sleep quality is associated with an increased risk of sarcopenia. However, the potential effects of disturbing the regular circadian rhythm, as occurs with shift work, on the risk of sarcopenia have not been established. Data from 9105 workers from the 2008–2011 Korean National Health and Nutrition Examination Survey were analyzed. Sarcopenia, measured by dual-energy X-ray absorptiometry, was defined as one standard deviation below the mean of the appendicular skeletal muscle/body mass index value of a young reference group. Compared to the group that had never experienced shift work, the odds ratio (OR) for sarcopenia with a 95% confidence interval (95% CI) for the shift work group was 1.7 (1.5–1.9); the association remained even after adjusting for confounding variables, including age, sex, total fat mass, insulin resistance profile, smoking, alcohol intake, diet, and physical activity. The results of the subgroup analysis indicated that the highest risk of sarcopenia was among workers engaging in shift work with an irregular schedule (OR 1.8, 95% CI 1.3–2.4). Disruption of circadian rhythm by shift work was associated with increased risk of sarcopenia. Intervention strategies are needed to prevent sarcopenia in shift workers.
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Schink K, Reljic D, Herrmann HJ, Meyer J, Mackensen A, Neurath MF, Zopf Y. Whole-Body Electromyostimulation Combined With Individualized Nutritional Support Improves Body Composition in Patients With Hematological Malignancies - A Pilot Study. Front Physiol 2018; 9:1808. [PMID: 30618820 PMCID: PMC6305403 DOI: 10.3389/fphys.2018.01808] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 11/30/2018] [Indexed: 12/22/2022] Open
Abstract
Patients undergoing the complex treatment for hematological malignancies are exposed to a high physiological and psychological distress inducing fatigue and physical inactivity. In line with cancer-related metabolic changes patients are predisposed for skeletal muscle mass loss that leads to a functional decline, affects therapeutic success, and quality of life. Benefits of physical exercise and nutritional interventions on muscle maintenance are observed in solid cancer patients, but marginally investigated in patients with hematological cancer. We here studied the effects of a combined supportive exercise and nutrition intervention using whole-body electromyostimulation (WB-EMS) training and individualized nutritional support in patients actively treated for hematological malignancy. In a controlled pilot trial, 31 patients (67.7% male; 58.0 ± 16.7 years) with various hematological cancers were allocated to a control group (n = 9) receiving nutritional support of usual care regarding a high protein intake (>1.0 g/kg/d) or to a physical exercise group (n = 22) additionally performing WB-EMS training twice weekly for 12 weeks. Bodyweight and body composition assessed by bioelectrical impedance analysis were measured every 4 weeks. Physical function, blood parameters, quality of life and fatigue were assessed at baseline and after 12 weeks. No WB-EMS-related adverse effects occurred. Patients attending the exercise program presented a higher skeletal muscle mass than controls after 12-weeks (1.51 kg [0.41, 2.60]; p = 0.008). In contrast, patients of the control group showed a higher fat mass percentage than patients of the WB-EMS group (-4.46% [-7.15, -1.77]; p = 0.001) that was accompanied by an increase in serum triglycerides in contrast to a decrease in the WB-EMS group (change ± SD, control 36.3 ± 50.6 mg/dl; WB-EMS -31.8 ± 68.7 mg/dl; p = 0.064). No significant group differences for lower limb strength, quality of life, and fatigue were detected. However, compared to controls the WB-EMS group significantly improved in physical functioning indicated by a higher increase in the 6-min-walking distance (p = 0.046). A combined therapeutic intervention of WB-EMS and protein-rich nutritional support seems to be safe and effective in improving skeletal muscle mass and body composition in hematological cancer patients during active oncological treatment. Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT02293239.
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Affiliation(s)
- Kristin Schink
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Dejan Reljic
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Hans J. Herrmann
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Julia Meyer
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Andreas Mackensen
- Department of Medicine 5 – Haematology and Oncology, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Markus F. Neurath
- Department of Medicine 1 – Gastroenterology, Pneumology and Endocrinology, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
| | - Yurdagül Zopf
- Hector-Center for Nutrition, Exercise and Sports, Department of Medicine 1, University Hospital Erlangen, Friedrich–Alexander University Erlangen–Nürnberg, Erlangen, Germany
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