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Bolam KA, Bojsen-Møller E, Wallin P, Paulsson S, Lindwall M, Rundqvist H, Ekblom-Bak E. Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57 652 Swedish men. Br J Sports Med 2024; 58:366-372. [PMID: 38290798 PMCID: PMC10982617 DOI: 10.1136/bjsports-2023-107007] [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] [Accepted: 11/28/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES To examine the associations between changes in cardiorespiratory fitness (CRF) in adulthood and prostate cancer incidence and mortality. METHODS In this prospective study, men who completed an occupational health profile assessment including at least two valid submaximal CRF tests, performed on a cycle ergometer, were included in the study. Data on prostate cancer incidence and mortality were derived from national registers. HRs and CIs were calculated using Cox proportional hazard regression with inverse probability treatment weights of time-varying covariates. RESULTS During a mean follow-up time of 6.7 years (SD 4.9), 592 (1%) of the 57 652 men were diagnosed with prostate cancer, and 46 (0.08%) died with prostate cancer as the primary cause of death. An increase in absolute CRF (as % of L/min) was associated with a reduced risk of prostate cancer incidence (HR 0.98, 95% CI 0.96 to 0.99) but not mortality, in the fully adjusted model. When participants were grouped as having increased (+3%), stable (±3%) or decreased (-3%) CRF, those with increased fitness also had a reduced risk of prostate cancer incidence compared with those with decreased fitness (HR 0.65, 95% CI 0.49 to 0.86), in the fully adjusted model. CONCLUSION In this study of employed Swedish men, change in CRF was inversely associated with risk of prostate cancer incidence, but not mortality. Change in CRF appears to be important for reducing the risk of prostate cancer.
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Affiliation(s)
- Kate A Bolam
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Emil Bojsen-Møller
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
| | - Peter Wallin
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Sofia Paulsson
- Research Department, HPI Health Profile Institute, Stockholm, Sweden
| | - Magnus Lindwall
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
- Department of Psychology, University of Gothenburg, Goteborg, Sweden
| | - Helene Rundqvist
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elin Ekblom-Bak
- Department of Physical Activity and Health, Swedish School of Sport and Health Sciences GIH, Stockholm, Sweden
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Ortega R, Grandes G, Agulló-Ortuño MT, Gómez-Cantarino S. Changes in Cardiorespiratory Fitness and Probability of Developing Abdominal Obesity at One and Two Years. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4754. [PMID: 36981663 PMCID: PMC10048740 DOI: 10.3390/ijerph20064754] [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: 01/20/2023] [Revised: 02/27/2023] [Accepted: 03/03/2023] [Indexed: 06/18/2023]
Abstract
Low cardiorespiratory fitness (CRF) is associated with an increased risk of developing abdominal obesity (AO), but it is not known if and/or how changes in CRF affect AO. We examined the relationship between changes in CRF and the risk of developing AO. This is a retrospective observational study of a cohort of 1883 sedentary patients, who had participated in a clinical trial of physical activity promotion carried out in Spain (2003-2007). These data were not used in the clinical trial. At baseline, they were free of cardiovascular disease, hypertension, diabetes, dyslipidemia, and/or AO; with an indirect VO2max measurement; 19-80 years old; and 62% were women. All the measures were repeated at 6, 12, and 24 months. The exposure factor was the change in CRF at 6 or 12 months, categorized in these groups: unfit-unfit, unfit-fit, fit-unfit, and fit-fit. We considered fit and unfit participants as those with VO2max values in the high tertile, and in the moderate or low tertiles, respectively. The main outcome measure was the risk of developing AO at one and two years, as defined by waist circumference >102 (men) and >88 (women) cm. At two years, 10.5% of the participants had developed AO: 13.5% in the unfit-unfit group of change at 6 months; 10.3% in the unfit-fit group (adjusted odds ratio (AOR) 0.86; 95% confidence interval (CI) 0.49-1.52); 2.6% in the fit-unfit group (AOR 0.13; 95%CI 0.03-0.61); and 6.0% in the fit-fit group (AOR 0.47; 95%CI 0.26-0.84). Those who stayed fit at 6 months decreased the probability of developing abdominal obesity at two years.
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Affiliation(s)
- Ricardo Ortega
- Santa Barbara Primary, Care Centre, Servicio de Salud de Castilla-La Mancha, Av. de Santa Bárbara, 1, 45006 Toledo, Spain;
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Osakidetza Servicio Vasco de Salud, María Díaz de Haro, 58, 48010 Bilbao, Spain
| | - María Teresa Agulló-Ortuño
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, (UCLM), Avda. Carlos III, s/n, 45071 Toledo, Spain
| | - Sagrario Gómez-Cantarino
- Department of Nursing, Physiotherapy and Occupational Therapy, Faculty of Physiotherapy and Nursing, University of Castilla-La Mancha, (UCLM), Avda. Carlos III, s/n, 45071 Toledo, Spain
- Health Sciences Research Unit: Nursing (UICISA: E), Coimbra School of Nursing (ESEnfC), 3004-011 Coimbra, Portugal
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Massett MP, Matejka C, Kim H. Systematic Review and Meta-Analysis of Endurance Exercise Training Protocols for Mice. Front Physiol 2021; 12:782695. [PMID: 34950054 PMCID: PMC8691460 DOI: 10.3389/fphys.2021.782695] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/05/2021] [Indexed: 11/13/2022] Open
Abstract
Inbred and genetically modified mice are frequently used to investigate the molecular mechanisms responsible for the beneficial adaptations to exercise training. However, published paradigms for exercise training in mice are variable, making comparisons across studies for training efficacy difficult. The purpose of this systematic review and meta-analysis was to characterize the diversity across published treadmill-based endurance exercise training protocols for mice and to identify training protocol parameters that moderate the adaptations to endurance exercise training in mice. Published studies were retrieved from PubMed and EMBASE and reviewed for the following inclusion criteria: inbred mice; inclusion of a sedentary group; and exercise training using a motorized treadmill. Fifty-eight articles met those inclusion criteria and also included a "classical" marker of training efficacy. Outcome measures included changes in exercise performance, V ˙ O2max, skeletal muscle oxidative enzyme activity, blood lactate levels, or exercise-induced cardiac hypertrophy. The majority of studies were conducted using male mice. Approximately 48% of studies included all information regarding exercise training protocol parameters. Meta-analysis was performed using 105 distinct training groups (i.e., EX-SED pairs). Exercise training had a significant effect on training outcomes, but with high heterogeneity (Hedges' g=1.70, 95% CI=1.47-1.94, Tau2=1.14, I2 =80.4%, prediction interval=-0.43-3.84). Heterogeneity was partially explained by subgroup differences in treadmill incline, training duration, exercise performance test type, and outcome variable. Subsequent analyses were performed on subsets of studies based on training outcome, exercise performance, or biochemical markers. Exercise training significantly improved performance outcomes (Hedges' g=1.85, 95% CI=1.55-2.15). Subgroup differences were observed for treadmill incline, training duration, and exercise performance test protocol on improvements in performance. Biochemical markers also changed significantly with training (Hedges' g=1.62, 95% CI=1.14-2.11). Subgroup differences were observed for strain, sex, exercise session time, and training duration. These results demonstrate there is a high degree of heterogeneity across exercise training studies in mice. Training duration had the most significant impact on training outcome. However, the magnitude of the effect of exercise training varies based on the marker used to assess training efficacy.
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Affiliation(s)
- Michael P Massett
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, United States
| | - Caitlyn Matejka
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, United States
| | - Hyoseon Kim
- Department of Kinesiology and Sport Management, Texas Tech University, Lubbock, TX, United States
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Usher-Smith JA, Häggström C, Wennberg P, Lindvall K, Strelitz J, Sharp SJ, Griffin SJ. Impact of achievement and change in achievement of lifestyle recommendations in middle-age on risk of the most common potentially preventable cancers. Prev Med 2021; 153:106712. [PMID: 34242663 PMCID: PMC8633845 DOI: 10.1016/j.ypmed.2021.106712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 06/18/2021] [Accepted: 07/03/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to assess the association between achievement, and within-person change in achievement, of lifestyle recommendations in middle-age and incidence of the most common potentially preventable cancers. We used data from 44,572 participants from the Swedish Västerbotten Intervention Programme who had attended at least two health checks 9-11 years apart. We assessed the association between the mean number of healthy lifestyle recommendations achieved (lifestyle score), and change in lifestyle score between the health checks, and risk of one or more of the eight most common potentially preventable cancers using Cox regression. Participants were followed-up for 11.0 (SD 4.9) years. A higher mean lifestyle score was associated with a lower hazard of cancer in men (HR 0.81 (95%CI 0.74-0.90) per unit increase) and women (HR 0.90 (0.84-0.96)). There was no evidence of a linear association between change in lifestyle score and risk (HR 0.93 (0.85-1.03) and HR 1.004 (0.94-1.07) per unit change for men and women respectively). When comparing those with an increase in lifestyle score of ≥2 with those who improved less or declined in achievement the HR was 0.74 (0.54-1.00) and 1.02 (0.84-1.24) for men and women respectively. These findings support the inclusion of lifestyle recommendations in cancer prevention guidelines. They further suggest that interventions to change health behaviours in middle-age may reduce risk of the most common preventable cancers in men, but this association was not observed in women. Strategies to encourage healthy lifestyles earlier in the life course may be more effective.
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Affiliation(s)
- Juliet A Usher-Smith
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK.
| | - Christel Häggström
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
| | - Patrik Wennberg
- Department of Public Health and Clinical Medicine, Family Medicine, Umeå University, Umeå, Sweden.
| | - Kristina Lindvall
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.
| | - Jean Strelitz
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK.
| | - Stephen J Sharp
- MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK.
| | - Simon J Griffin
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge School of Clinical Medicine, Box 113 Cambridge Biomedical Campus, Cambridge CB2 0SR, UK; MRC Epidemiology Unit, University of Cambridge, Institute of Metabolic Science, Cambridge CB2 0QQ, UK.
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Peterman JE, Harber MP, Imboden MT, Whaley MH, Fleenor BS, Myers J, Arena R, Finch WH, Kaminsky LA. Accuracy of Nonexercise Prediction Equations for Assessing Longitudinal Changes to Cardiorespiratory Fitness in Apparently Healthy Adults: BALL ST Cohort. J Am Heart Assoc 2020; 9:e015117. [PMID: 32458761 PMCID: PMC7428991 DOI: 10.1161/jaha.119.015117] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Repeated assessment of cardiorespiratory fitness (CRF) improves mortality risk predictions in apparently healthy adults. Accordingly, the American Heart Association suggests routine clinical assessment of CRF using, at a minimum, nonexercise prediction equations. However, the accuracy of nonexercise prediction equations over time is unknown. Therefore, we compared the ability of nonexercise prediction equations to detect changes in directly measured CRF. Methods and Results The sample included 987 apparently healthy adults from the BALL ST (Ball State Adult Fitness Longitudinal Lifestyle Study) cohort (33% women; average age, 43.1±10.4 years) who completed 2 cardiopulmonary exercise tests ≥3 months apart (3.2±5.4 years of follow‐up). The change in estimated CRF (eCRF) from 27 distinct nonexercise prediction equations was compared with the change in directly measured CRF. Analysis included Pearson product moment correlations, SEE values, intraclass correlation coefficient values, Cohen's κ coefficients, γ coefficients, and the Benjamini‐Hochberg procedure to compare eCRF with directly measured CRF. The change in eCRF from 26 of 27 equations was significantly associated to the change in directly measured CRF (P<0.001), with intraclass correlation coefficient values ranging from 0.06 to 0.63. For 16 of the 27 equations, the change in eCRF was significantly different from the change in directly measured CRF. The median percentage of participants correctly classified as having increased, decreased, or no change in CRF was 56% (range, 39%–61%). Conclusions Variability was observed in the accuracy between nonexercise prediction equations and the ability of equations to detect changes in CRF. Considering the appreciable error that prediction equations had with detecting even directional changes in CRF, these results suggest eCRF may have limited clinical utility.
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Affiliation(s)
- James E Peterman
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
| | - Matthew P Harber
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Mary T Imboden
- Health and Human Performance Department George Fox University Newberg OR
| | | | - Bradley S Fleenor
- Clinical Exercise Physiology Laboratory Ball State University Muncie IN
| | - Jonathan Myers
- Division of Cardiology Veterans Affairs Palo Alto Healthcare System and Stanford University Palo Alto CA
| | - Ross Arena
- Department of Physical Therapy College of Applied Science University of Illinois Chicago IL
| | - W Holmes Finch
- Department of Educational Psychology Ball State University Muncie IN
| | - Leonard A Kaminsky
- Fisher Institute of Health and Well-Being Ball State University Muncie IN
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Cancer and Body Composition: An Association of Global Relevance. WOMEN’S HEALTH BULLETIN 2019. [DOI: 10.5812/whb.65315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Robsahm TE, Heir T, Sandvik L, Prestgaard E, Tretli S, Erikssen JE, Falk RS. Changes in midlife fitness, body mass index, and smoking influence cancer incidence and mortality: A prospective cohort study in men. Cancer Med 2019; 8:4875-4882. [PMID: 31270954 PMCID: PMC6712445 DOI: 10.1002/cam4.2383] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 06/17/2019] [Accepted: 06/17/2019] [Indexed: 12/22/2022] Open
Abstract
Cancer prevention efforts include modification of unhealthy lifestyle, such as smoking cessation and resisting gain in body weight. Although physical activity is inversely related to risk of several cancers, it is poorly studied whether changes in physical activity or fitness influence future cancer risk. Thus, we aimed to investigate whether changes in midlife cardiorespiratory fitness (CRF), body mass index (BMI), and smoking habits influence cancer incidence and mortality. The study cohort includes 1689 initially healthy men, aged 40-59 years. Measurements of CRF, BMI and information on smoking habits were collected in two repeated waves, 7 years apart. Cox regression models estimated associations as hazard rates (HR) with 95% confidence intervals (CI), between midlife changes in the modifiable lifestyle factors and cancer incidence and mortality. The men were followed prospectively for more than 30 years. Compared to CRF loss (>5%), improved CRF (>5%) was associated with lower cancer incidence (HR 0.81, 95% CI 0.67-0.98) and mortality (HR 0.70, 95% CI 0.54-0.92), and maintaining the CRF stable yielded lower cancer incidence (HR 0.76, 95% CI 0.61-0.95). No association was seen for BMI gain, but maintaining the BMI stable was related to lower cancer incidence (HR 0.77, 95% CI 0.60-0.98), compared to BMI loss. Continue smoking was associated with higher cancer incidence and mortality, compared to men who stopped smoking. In particular, this study adds new knowledge about the potential preventive role of CRF in cancer development and emphasizes lifestyle modification as a highly important effort in cancer prevention.
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Affiliation(s)
- Trude E Robsahm
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Trond Heir
- Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
| | - Erik Prestgaard
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Norway.,Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Steinar Tretli
- Department of Research, Cancer Registry of Norway, Oslo, Norway
| | - Jan E Erikssen
- Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, Oslo, Norway
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Cardiorespiratory Fitness without Exercise Testing Can Predict All-Cause Mortality Risk in a Representative Sample of Korean Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091633. [PMID: 31083309 PMCID: PMC6539211 DOI: 10.3390/ijerph16091633] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/01/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022]
Abstract
This study examined the association between cardiorespiratory fitness (CRF) without exercise testing and all-cause mortality in Korean older adults. The present study was carried out using data from the 2008 and 2011 Living Profiles of Older People Survey. A total of 14,122 participants aged 60 years and older (57% women) completed the 2008 baseline and 2011 follow-up assessments (i.e., socioeconomic status, health behaviors and conditions, and prevalence of chronic diseases), and they were included for the final analyses. CRF was estimated (eCRF) with sex-specific algorithms and classified as lower (lowest 25%), middle (middle 50%), and upper (highest 25%). Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) across eCRF categories. In total, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.059 (0.814~1.378) for the middle eCRF group, and 1.714 (1.304~2.253) for the lower eCRF group. In men, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.011 (0.716~1.427) for the middle eCRF group, and 1.566 (1.098~2.234) for the lower eCRF group. In women, multivariable-adjusted HRs and 95% CIs were 1 for the upper eCRF group (referent), 1.064 (0.707~1.602) for the middle eCRF group, and 1.599 (1.032~2.478) for the lower eCRF group. The current findings suggest that eCRF may have an independent predictor of all-cause mortality, underscoring the importance of promoting physical activity to maintain a healthful level of CRF in Korean geriatric population.
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Cardiorespiratory Fitness and Risk of All-Cause, Cardiovascular Disease, and Cancer Mortality in Men With Musculoskeletal Conditions. J Phys Act Health 2019; 16:134-140. [DOI: 10.1123/jpah.2017-0644] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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10
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GAESSER GLENNA, BLAIR STEVENN. The Health Risks of Obesity Have Been Exaggerated. Med Sci Sports Exerc 2019; 51:218-221. [DOI: 10.1249/mss.0000000000001746] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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The Association between the Change in Directly Measured Cardiorespiratory Fitness across Time and Mortality Risk. Prog Cardiovasc Dis 2018; 62:157-162. [PMID: 30543812 DOI: 10.1016/j.pcad.2018.12.003] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 12/06/2018] [Indexed: 01/19/2023]
Abstract
BACKGROUND The relationship between cardiorespiratory fitness (CRF) and mortality risk has typically been assessed using a single measurement, though some evidence suggests the change in CRF over time influences risk. This evidence is predominantly based on studies using estimated CRF (CRFe). The strength of this relationship using change in directly measured CRF over time in apparently healthy men and women is not well understood. PURPOSE To examine the association of change in CRF over time, measured using cardiopulmonary exercise testing (CPX), with all-cause and disease-specific mortality and to compare baseline and subsequent CRF measurements as predictors of all-cause mortality. METHODS Participants included 833 apparently healthy men and women (42.9 ± 10.8 years) who underwent two maximal CPXs, the second CPX being ≥1 year following the baseline assessment (mean 8.6 years, range 1.0 to 40.3 years). Participants were followed for up to 17.7 (SD 11.8) years for all-cause-, cardiovascular disease- (CVD), and cancer mortality. Cox-proportional hazard models were performed to determine the association between the change in CRF, computed as visit 1 (CPX1) peak oxygen consumption (VO2peak [mL·kg-1·min-1]) - visit 2 (CPX2) VO2peak, and mortality outcomes. A Wald-Chi square test of equality was used to compare the strength of CPX1 to CPX2 VO2peak in predicting mortality. RESULTS During follow-up, 172 participants died. Overall, the change in CPX-CRF was inversely related to all-cause, CVD, and cancer mortality (p < 0.05). Each 1 mL·kg-1·min-1 increase was associated with a ~11, 15, and 16% (all p < 0.001) reduction in all-cause, CVD, and cancer mortality, respectively. The inverse relationship between CRF and all-cause mortality was significant (p < 0.05) when men and women were examined independently, after adjusting for years since first CPX, baseline VO2peak, and age. Further, the Wald Chi-square test of equality found CPX2 VO2peak to be a significantly stronger predictor of all-cause mortality than CPX1 VO2peak (p < 0.05). CONCLUSION The change in CRF over time was inversely related to mortality outcomes, and mortality was better predicted by CRF measured at subsequent test than CPX1 CRF. These findings emphasize the importance of adopting lifestyle behaviors that promote CRF, as well as support the need for routine assessment of CRF in clinical practice to better assess risk.
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Karahalios A, English DR, Simpson JA. Change in body size and mortality: a systematic review and meta-analysis. Int J Epidemiol 2018; 46:526-546. [PMID: 27864401 DOI: 10.1093/ije/dyw246] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2016] [Indexed: 12/31/2022] Open
Abstract
Background : Observational studies have reported that weight loss in later life is associated with an increased risk of mortality. However, the association with weight gain is unclear. We conducted a systematic review and meta-analysis of prospective studies assessing the association of weight gain and loss, and mortality. Methods : We searched PubMed, Scopus and Web of Science for articles published before 5 September 2015. We included prospective studies that reported enough information to extract hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) for the association between weight gain and/or weight loss, and all-cause and cause-specific mortality. The estimates were pooled using a random-effects model. Meta-regression models were fitted to explore sources of potential between-study heterogeneity. Results : A total of 25 (providing data from 437 772 participants with 34 038 deaths from all causes) and 24 studies (434 694 participants with 31 978 deaths) presented results for the exposures, weight loss and weight gain. Weight loss compared with a stable weight was associated with an increased risk of all-cause (pooled HR: 1.45; 95% CI: 1.34, 1.58), and cardiovascular disease (CVD) mortality (1.50; 1.32, 1.70) and a slightly increased risk of cancer mortality (1.19; 0.97, 1.46). Weight gain was associated with an increased risk of CVD mortality (1.21; 1.07, 1.36) and a slightly increased risk of all-cause mortality (1.07; 1.01, 1.13) and cancer mortality (1.04; 0.96, 1.13). Considerable heterogeneity was observed; the method used to ascertain body size and the proportion of the baseline sample included in the final analysis explained most of the heterogeneity. Conclusion : Weight loss and weight gain in midlife are associated with increased risk of all-cause and CVD mortality.
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Affiliation(s)
- Amalia Karahalios
- Centre for Epidemiology and Biostatistics, University of Melbourne and
| | - Dallas R English
- Centre for Epidemiology and Biostatistics, University of Melbourne and.,Cancer Epidemiology Centre, Cancer Council Victoria, Melbourne, VIC, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, University of Melbourne and
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Devin JL, Jenkins DG, Sax AT, Hughes GI, Aitken JF, Chambers SK, Dunn JC, Bolam KA, Skinner TL. Cardiorespiratory Fitness and Body Composition Responses to Different Intensities and Frequencies of Exercise Training in Colorectal Cancer Survivors. Clin Colorectal Cancer 2018; 17:e269-e279. [PMID: 29397328 DOI: 10.1016/j.clcc.2018.01.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 12/11/2017] [Accepted: 01/09/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Deteriorations in cardiorespiratory fitness (V˙o2peak) and body composition are associated with poor prognosis after colorectal cancer treatment. However, the optimal intensity and frequency of aerobic exercise training to improve these outcomes in colorectal cancer survivors is unknown. PATIENTS AND METHODS This trial compared 8 weeks of moderate-intensity continuous exercise (MICE; 50 minutes; 70% peak heart rate [HRpeak]; 24 sessions), with high-intensity interval exercise (HIIE; 4 × 4 minutes; 85%-95% HRpeak) at an equivalent (HIIE; 24 sessions) and tapered frequency (HIIE-T; 16 sessions) on V˙o2peak and on lean and fat mass, measured at baseline, 4, 8, and 12 weeks. RESULTS Increases in V˙o2peak were significantly greater after both 4 (+3.0 mL·kg-1·min-1, P = .008) and 8 (+2.3 mL·kg-1·min-1, P = .049) weeks of HIIE compared to MICE. After 8 weeks, there was a significantly greater reduction in fat mass after HIIE compared to MICE (-0.7 kg, P = .038). Four weeks after training, the HIIE group maintained elevated V˙o2peak (+3.3 mL·kg-1·min-1, P = .006) and reduced fat mass (-0.7 kg, P = .045) compared to the MICE group, with V˙o2peak in the HIIE-T also being superior to the MICE group (+2.8 mL·kg-1·min-1, P = .013). CONCLUSION Compared to MICE, HIIE promotes superior improvements and short-term maintenance of V˙o2peak and fat mass improvements. HIIE training at a reduced frequency also promotes maintainable cardiorespiratory fitness improvements. In addition to promoting accelerated and superior benefits to the current aerobic exercise guidelines, HIIE promotes clinically relevant improvements even with a substantial reduction in exercise training and for a period after withdrawal.
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Affiliation(s)
- James L Devin
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - David G Jenkins
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Andrew T Sax
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Gareth I Hughes
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Joanne F Aitken
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia; School of Public Health and Social Work, Queensland University of Technology, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Darling Heights, QLD, Australia
| | - Suzanne K Chambers
- Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Darling Heights, QLD, Australia; Prostate Cancer Foundation of Australia, Sydney, NSW, Australia; Health and Wellness Institute, Edith Cowan University, Perth, WA, Australia
| | - Jeffrey C Dunn
- School of Social Science, The University of Queensland, Brisbane, QLD, Australia; Cancer Research Centre, Cancer Council Queensland, Brisbane, QLD, Australia; Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; Institute for Resilient Regions, University of Southern Queensland, Darling Heights, QLD, Australia
| | - Kate A Bolam
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia; Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Stockholm, Sweden
| | - Tina L Skinner
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD, Australia
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14
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Robsahm TE, Falk RS, Heir T, Sandvik L, Vos L, Erikssen J, Tretli S. Cardiorespiratory fitness and risk of site-specific cancers: a long-term prospective cohort study. Cancer Med 2017; 6:865-873. [PMID: 28317282 PMCID: PMC5387170 DOI: 10.1002/cam4.1043] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 01/23/2017] [Accepted: 01/23/2017] [Indexed: 12/13/2022] Open
Abstract
Based on self‐reported physical activity, there is epidemiologic evidence for a beneficial relation between physical activity and colon cancer in men, but findings for other cancers are inconclusive. Measured cardiorespiratory fitness (CRF) can provide knowledge about the cancer‐preventive value of physical activity. We aimed to assess relationships between CRF and risk of site‐specific cancers. A cohort of 1997 healthy Norwegian men, aged 40–59 years at inclusion in 1972–1975, was followed for cancer throughout 2012 using data from the Cancer Registry of Norway. CRF was measured by a maximal exercise bicycle test at inclusion. Relationships between CRF and site‐specific cancers were estimated using Cox regression, adjusted for age, body mass index, and smoking. During follow‐up, 898 cancer cases were diagnosed in 758 men. When comparing men in CRF tertile 1 with men in tertiles 2 and 3, respectively, we found decreased risk of proximal colon cancer in tertile 2 (HR: 0.30, 95% CI: 0.13–0.73) and decreased risk of cancers of lung (0.39 95% CI: 0.22–0.66), pancreas (0.32 95% CI: 0.10–1.00), and bladder (HR: 0.40 95% CI: 0.21–0.74) in tertile 3. Furthermore, a significant trend for lower risk by increasing CRF tertile was found for cancers of proximal colon, lung, and bladder (P‐value for trend <0.05). For other cancer sites, no significant association was found. Our results indicate that high midlife CRF may have cancer‐preventive value.
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Affiliation(s)
- Trude E Robsahm
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, 0304, Norway
| | - Ragnhild S Falk
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, PB 4950 Nydalen, Oslo, 0424, Norway
| | - Trond Heir
- Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Oslo Centre for Biostatistics and Epidemiology, Oslo University Hospital, PB 4950 Nydalen, Oslo, 0424, Norway
| | - Linda Vos
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, 0304, Norway
| | - Jan Erikssen
- Oslo Ischemia Study, Oslo University Hospital, Oslo, Norway
| | - Steinar Tretli
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, 0304, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, PB 8905, Trondheim, 7491, Norway
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15
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Haas B, Hermanns M, Kimmel G. Incorporating Exercise Into the Cancer Treatment Paradigm. Clin J Oncol Nurs 2016; 20:S17-S24. [DOI: 10.1188/16.cjon.s2.17-24] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Robsahm TE, Falk RS, Heir T, Sandvik L, Vos L, Erikssen JE, Tretli S. Measured cardiorespiratory fitness and self-reported physical activity: associations with cancer risk and death in a long-term prospective cohort study. Cancer Med 2016; 5:2136-44. [PMID: 27227704 PMCID: PMC4884631 DOI: 10.1002/cam4.773] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 12/11/2022] Open
Abstract
Physical activity is inversely associated with risk of some cancers. The relation with cancer‐specific death remains uncertain. Mainly, studies on relationships between physical activity and cancer are based on self‐reported physical activity (SPA). Hereby, we examined whether measured cardiorespiratory fitness (CRF) is associated with cancer risk, mortality, and case fatality. We also describe relationships between SPA and these outcomes, and between CRF and SPA. A cohort of 1997 healthy Norwegian men, aged 40–59 years at inclusion in 1972–75, was followed throughout 2012. At baseline, CRF was objectively measured. SPA (leisure time and occupational) was obtained through a questionnaire. Relationships between CRF or SPA, and the outcomes were estimated using Cox regression, adjusted for age, body mass index (BMI), and smoking. Pearson correlation coefficients evaluated agreements between CRF and SPA. During follow‐up, 758 men were diagnosed with cancer and 433 cancer deaths occurred. Analyses revealed lower cancer risk (Hazard ratio [HR] 0.85, 95% confidence intervals [CI]: 0.68–1.00), mortality (HR 0.68, 95% CI: 0.53–0.88), and case fatality (HR 0.74, 95% CI: 0.57–0.96), in men with high CRF compared to low CRF. Light leisure time SPA was associated with lower cancer risk (HR 0.70, 95% CI: 0.56–0.86) and mortality (HR 0.64 95% CI: 0.49–0.83), whereas strenuous occupational SPA was associated with higher risks (HR 1.42, 95% CI: 1.13–1.78 and HR 1.45, 95% CI: 1.09–1.93). Correlations between CRF and SPA were 0.351 (P < 0.001) and −0.106 (P < 0.001) for leisure time and occupational SPA, respectively. A high midlife CRF may be beneficial for cancer risk, cancer mortality, and case fatality.
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Affiliation(s)
- Trude E Robsahm
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, N-0304, Norway
| | - Ragnhild S Falk
- Oslo centre for biostatistics and epidemiology, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway
| | - Trond Heir
- Oslo Ischemia study, Oslo University Hospital, Oslo, Norway
| | - Leiv Sandvik
- Oslo centre for biostatistics and epidemiology, Oslo University Hospital, Pb 4950 Nydalen, Oslo, 0424, Norway
| | - Linda Vos
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, N-0304, Norway
| | - Jan E Erikssen
- Oslo Ischemia study, Oslo University Hospital, Oslo, Norway
| | - Steinar Tretli
- Department of Research, Cancer Registry of Norway, PB 5313 Majorstuen, Oslo, N-0304, Norway.,Department of Public Health and General Practice, Norwegian University of Science and Technology, PB 8905, Trondheim, 7491, Norway
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17
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Wood WA, Phillips B, Smith-Ryan AE, Wilson D, Deal AM, Bailey C, Meeneghan M, Reeve BB, Basch EM, Bennett AV, Shea TC, Battaglini CL. Personalized home-based interval exercise training may improve cardiorespiratory fitness in cancer patients preparing to undergo hematopoietic cell transplantation. Bone Marrow Transplant 2016; 51:967-72. [PMID: 26999467 PMCID: PMC4935591 DOI: 10.1038/bmt.2016.73] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Revised: 01/26/2016] [Accepted: 01/28/2016] [Indexed: 01/30/2023]
Abstract
Impaired cardiorespiratory fitness is associated with inferior survival in patients preparing to undergo hematopoietic cell transplantation (HCT). Exercise training based on short, higher-intensity intervals has the potential to efficiently improve cardiorespiratory fitness. We studied home-based interval exercise training (IET) in 40 patients prior to autologous (N=20) or allogeneic (N=20) HCT. Each session consisted of 5, three-minute intervals of walking, jogging, or cycling at 65-95% maximal heart rate (MHR) with 3 minutes of low intensity exercise (<65% MHR) between intervals. Participants were asked to perform sessions at least 3 times weekly. The duration of the intervention was at least 6 weeks, depending on each patient’s scheduled transplantation date. Cardiorespiratory fitness was assessed from a peak oxygen consumption test (VO2peak) and a 6 minute walk (6MWD) before and after the intervention period. For the autologous HCT cohort, improvements in VO2peak (p=0.12) and 6MWD (p=0.19) were not statistically significant. For the allogeneic cohort, the median VO2peak improvement was 3.7ml/kg*min (p=0.005) and the median 6MWD improvement was 34 meters (p=0.006). Home-based, interval exercise training can be performed prior to HCT and has the potential to improve cardiorespiratory fitness.
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Affiliation(s)
- W A Wood
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - B Phillips
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - A E Smith-Ryan
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - D Wilson
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - A M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - C Bailey
- Cedars Sinai Medical Center, Los Angeles, CA, USA
| | | | - B B Reeve
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - E M Basch
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - A V Bennett
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - T C Shea
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - C L Battaglini
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
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18
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Bouchard C, Blair SN, Katzmarzyk PT. Less Sitting, More Physical Activity, or Higher Fitness? Mayo Clin Proc 2015; 90:1533-40. [PMID: 26422244 DOI: 10.1016/j.mayocp.2015.08.005] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 10/23/2022]
Abstract
Epidemiological studies have found that time spent in sedentary behaviors, levels of physical activity, and cardiorespiratory fitness are all associated with mortality rates. They are also related to the risks of obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease, aging-associated frailty, and cancer. The evidence is such that the National Institutes of Health recently launched a new Common Fund initiative aimed at identifying the molecular transducers of adaptation to physical activity in various tissues and organs. It has been estimated that 9.4% of all 57 million deaths in the world in 2008 could be attributed to physical inactivity, which translates into more than 5 million deaths worldwide. Physical inactivity has a deleterious effect that is comparable to smoking and obesity. Importantly, this global estimate relates to levels of physical activity and does not take into account sedentary behavior and cardiorespiratory fitness. Currently, there are national and international guidelines for physical activity level that are highly concordant. The weekly recommendations include 150 minutes of moderate-intensity activity, 75 minutes of vigorous-intensity activity, or some combination of moderate and vigorous activity with 2 days of resistance exercise. However, these guidelines offer no recommendations regarding sedentary time or goals for cardiorespiratory fitness levels. It will be increasingly important for disease prevention, successful aging, and reduction of premature mortality to broaden the focus of the public health message to include not only more physical activity but also less sitting and higher cardiorespiratory fitness. We briefly review the evidence and discuss key issues to be addressed to make this approach a reality.
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Affiliation(s)
| | - Steven N Blair
- Arnold School of Public Health, University of South Carolina, Columbia
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19
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The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial. J Cancer Surviv 2015; 10:467-79. [PMID: 26482384 DOI: 10.1007/s11764-015-0490-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Following colorectal cancer diagnosis and anti-cancer therapy, declines in cardiorespiratory fitness and body composition lead to significant increases in morbidity and mortality. There is increasing interest within the field of exercise oncology surrounding potential strategies to remediate these adverse outcomes. This study compared 4 weeks of moderate-intensity exercise (MIE) and high-intensity exercise (HIE) training on peak oxygen consumption (V̇O2peak) and body composition in colorectal cancer survivors. METHODS Forty seven post-treatment colorectal cancer survivors (HIE = 27 months post-treatment; MIE = 38 months post-treatment) were randomised to either HIE [85-95 % peak heart rate (HRpeak)] or MIE (70 % HRpeak) in equivalence with current physical activity guidelines and completed 12 training sessions over 4 weeks. RESULTS HIE was superior to MIE in improving absolute (p = 0.016) and relative (p = 0.021) V̇O2peak. Absolute (+0.28 L.min(-1), p < 0.001) and relative (+3.5 ml.kg(-1).min(-1), p < 0.001) V̇O2 peak were increased in the HIE group but not the MIE group following training. HIE led to significant increases in lean mass (+0.72 kg, p = 0.002) and decreases in fat mass (-0.74 kg, p < 0.001) and fat percentage (-1.0 %, p < 0.001), whereas no changes were observed for the MIE group. There were no severe adverse events. CONCLUSIONS In response to short-term training, HIE is a safe, feasible and efficacious intervention that offers clinically meaningful improvements in cardiorespiratory fitness and body composition for colorectal cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS HIE appears to offer superior improvements in cardiorespiratory fitness and body composition in comparison to current physical activity recommendations for colorectal cancer survivors and therefore may be an effective clinical utility following treatment.
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20
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A Hand G, N Blair S. Energy Flux and its Role in Obesity and Metabolic Disease. EUROPEAN ENDOCRINOLOGY 2014; 10:131-135. [PMID: 29872477 PMCID: PMC5983082 DOI: 10.17925/ee.2014.10.02.131] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Accepted: 05/01/2014] [Indexed: 01/22/2023]
Abstract
In order to reverse the global obesity pandemic, there is a need for an enhanced understanding of the energy dynamics that underlie the problem. To maintain a stable body weight, energy intake must, over time, match or equal energy expenditure, a concept known as energy balance. Obesity results from a positive state of energy balance (i.e. when energy intake exceeds energy expenditure). However, recent research suggests that strategies to combat obesity should focus on energy flux (the amount of calories going through a system), rather than energy balance alone. In other words, it is easier to maintain weight loss at higher levels of physical activity. Recent findings suggest that a high energy flux, maintained by increasing energy expenditure, can improve an individual's metabolic profile without changing weight. Further understanding of this concept may help in the design of interventions to achieve and maintain a healthy weight.
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Affiliation(s)
| | - Steven N Blair
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, US
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