Methodological quality of systematic reviews on physical exercise for breast cancer patients. Meta-epidemiological study

OBJECTIVE

several clinical trials have been published in recent years to investigate the potential benefits of physical exercise for women with breast cancer. This meta-epidemiological study aimed to map and critically assess the methodological quality of systematic reviews on physical activity for breast cancer patients.

METHODS

a meta-epidemiological study including systematic reviews of randomized clinical trials that evaluated the effects of physical exercise on breast cancer patients. The search was performed in MEDLINE. The methodological quality was assessed using the AMSTAR-2 tool. We collected additional information regarding included systematic review search details.

RESULTS

we included 57 systematic reviews published between 2006 and 2021, including only randomized clinical trials on the effects of any physical activity on breast cancer patients. The results showed that 58% of the included reviews were classified as low or critically low quality. Only 10% presented high methodological quality, and 32% were classified as moderate. Furthermore, complete search strategies were presented in 54,4% of the reviews, and 59,6% fully described the search date; 61,4% presented data and/or language restrictions, and 52,6% conducted additional hand searches.

CONCLUSION

The findings of this study showed the methodological frailty of most systematic reviews on the effects of physical exercises on breast cancer patients. Caution is needed on the part of health professionals, managers and policymakers in health, patients and the general population when interpreting the applicability of this evidence, and it is suggested to perform systematic reviews of high methodological quality to assist decision-making.

Etiology and treatment of cancer-related secondary lymphedema

Lymphedema and specifically cancer-related lymphedema is not the main focus for both patients and physicians dealing with cancer. Its etiology is an unfortunate complication of cancer treatment. Although lymphedema treatments have gained an appreciable consensus, many practitioners have developed and prefer their own specific protocols and this is especially true for conventional (manual) versus surgical treatments. This collection of presentations explores the incidence and genetics of cancer-related lymphedema, early detection and monitoring techniques, both conventional and operative treatment options, and the importance and role of exercise for patients with cancer-related lymphedema. These assembled presentations provide valuable insights into the challenges and opportunities presented by cancer-related lymphedema including the latest research, treatments, and exercises available to improve patient outcomes and quality of life.

Ultrasonographic features of the skin and subcutis: correlations with the severity of breast cancer-related lymphedema

PURPOSE

Assessing the severity of breast cancer-related lymphedema (BCRL) requires various clinical tools, yet no standardized methodology is available. Ultrasonography shows promise for diagnosing lymphedema and evaluating its severity. This study explored the clinical utility of ultrasonography in patients with BCRL.

METHODS

In this retrospective cross-sectional study, patients with unilateral BCRL were examined. The analyzed data included demographics, lymphedema location, International Society of Lymphology (ISL) stage, surgical history, treatment regimens, and arm circumference. Skin, subcutis, and muscle thicknesses were assessed ultrasonographically at predetermined sites, and the percentage of excess thickness was calculated. Multivariate logistic regression analysis was employed to identify associations between ultrasonographic measurements and advanced lymphedema (ISL 2 or 3). The Lymphedema Quality of Life arm questionnaire was used to evaluate patient-reported outcomes regarding lymphedema and their correlations with ultrasonographic findings.

RESULTS

Among 118 patients, 71 were classified as ISL 0-1 and 47 as ISL 2-3. Patients with advanced lymphedema were older, had higher nodal stages, underwent more axillary lymph node dissections, and had higher rates of dominant-arm lymphedema. Multivariate logistic regression revealed significant associations of greater skin thickness (adjusted odds ratio [OR], 4.634; 95% confidence interval [CI], 1.233 to 17.419), subcutis thickness (adjusted OR, 7.741; 95% CI, 1.649 to 36.347), and subcutis echogenicity (adjusted OR, 4.860; 95% CI, 1.517 to 15.566) with advanced lymphedema. Furthermore, greater skin thickness (P=0.016) and subcutis echogenicity (P=0.023) were correlated with appearance-related discomfort.

CONCLUSION

Ultrasonographic measurements were significantly associated with advanced lymphedema in BCRL. Ultrasonography represents a valuable diagnostic and severity assessment tool for lymphedema.

The Effect of Exercise on Reducing Lymphedema Severity in Breast Cancer Survivors

Exercise has been repeatedly shown to be safe and beneficial for cancer survivors. However, there is no normative guideline for exercise prescription, and it is still under exploration. Therefore, this literature review aims to provide some advice for the formulation of exercise prescriptions for patients with breast cancer-related lymphedema (BCRL) from the perspective of reducing lymphedema severity. A review of relevant studies published before November 2023 was conducted using three scientific databases: PubMed, Embase, and Scopus. A total of 2696 articles were found. Eventually, 13 studies fulfilled the inclusion criteria and were included in this literature review. We concluded that daily, or nearly daily, exercise at home can be recommended. Moreover, reduced lymphedema severity may not be maintained after ceasing the exercise program, so exercise should be a lifelong practice.

Effect of various photobiomodulation regimens on breast cancer-related lymphedema: A systematic review and meta-analysis

Breast cancer-related lymphedema (BCRL) is common among patients who have completed their cancer treatment. Although low-level laser therapy (LLLT) has been explored as a treatment option for BCRL, we could not find a regimen that is more effective than others. This meta-analysis aimed to organize existing research and determine the optimal combination of LLLT parameters for BCRL treatment. Studies were collected from four online databases: Embase, Ovid Medline, Cochrane, and Cinahl. The collected studies were reviewed by two of the authors. We focused on the aspects of the treatment area, treatment regimen, and total treatment sessions across the included studies. The comparisons between LLLT and non-LLLT were performed through a meta-analysis. Post-treatment QOL was significantly better in the axillary group. The group treated "three times/week with a laser density of 1.5-2 J/cm2" had significantly better outcomes in terms of swelling reduction, both immediately post-treatment and at 1-3 months follow-ups. The group with > 15 treatment sessions had significantly better post-treatment outcomes regarding reduced swelling and improved grip strength. According to these results, LLLT can relieve the symptoms of BCRL by reducing limb swelling and improving QOL. Further exploration found that a treatment approach targeting the axilla, combined with an increased treatment frequency, appropriate laser density, and extended treatment course, yielded better outcomes. However, further rigorous, large-scale studies, including long-term follow-up, are needed to substantiate this regimen.

Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews

INTRODUCTION

Breast cancer-related lymphoedema (BCRL) is one of the most underestimated and debilitating complications associated with the treatment that women with breast cancer receive. Several systematic reviews (SRs) of different physical exercise programmes have been published, presenting disperse and contradictory clinical results. Therefore, there is a need for access to the best available and summarised evidence to capture and evaluate all the physical exercise programmes that focus on reducing BCRL.

OBJECTIVE

To evaluate the effectiveness of different physical exercise programmes in reducing the volume of lymphoedema, pain intensity and improving quality of life.

METHOD AND ANALYSIS

The protocol of this overview is reported following the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols, and its methodology is based on Cochrane Handbook for Systematic Reviews of Interventions. Only those SRs involving physical exercise by patients with BCRL will be included, whether on its own or combined with other exercises or other physical therapy interventions.The outcomes of interest to be considered will be lymphoedema volume, quality of life, pain intensity, grip strength, range of motion, upper limb function and any adverse event. The MEDLINE/PubMed, Lilacs, Cochrane Library, PEDro and Embase databases will be searched for reports published from database inception to April 2023.Two researchers will perform study selection, data extraction and risk of bias assessment independently. Any discrepancy will be resolved by consensus, or ultimately, by a third-party reviewer. We will use Grading of Recommendations Assessment, Development and Evaluation System to assess the overall quality of the body of evidence.

ETHICS AND DISSEMINATION

The results of this overview will be published in peer-reviewed scholarly journals and the scientific dissemination will take place in national or international conferences. This study does not require approval from an ethics committee, as it does not directly collect information from patients.

PROSPERO REGISTRATION NUMBER

CRD42022334433.

The effect of combined risk factors on breast cancer-related lymphedema: a study using decision trees

BACKGROUND

The effect of combined risk factors on breast cancer-related lymphedema (BCRL) development has not yet been investigated. This study aimed to determine the combination of risk factors associated with BCRL development in patients who underwent breast cancer resection, including axillary lymph node dissection (ALND).

METHODS

The participants included 129 women who were diagnosed with early-stage breast cancer and underwent breast cancer resection in this retrospective observational study. We performed a decision tree analysis to detect the combination of risk factors associated with BCRL development using age, body mass index (BMI), surgical side, mastectomy, the extent of ALND, and adjuvant therapy (chemotherapy, hormone therapy, and radiation therapy).

RESULTS

Of the 129 participants, 11 (8.5%) developed BCRL. Postoperative chemotherapy was the optimal variable selected to classify patients who developed BCRL and those who did not. In participants with postoperative chemotherapy, the extent of ALND was selected as the second layer of the decision tree. When ALND was at level 3, BMI was selected as the third layer. We found that BCRL incidence was 44.4% in individuals with a BMI of 23.0 or higher.

CONCLUSIONS

The combination of postoperative chemotherapy, level 3 ALND, and BMI of 23.0 or higher may further increase the risk of developing BCRL. The decision tree model will enable the identification of patients with a high risk of developing BCRL, and thus, preventive intervention, careful monitoring, and early treatment will be possible.

Self-managed physical activity in breast cancer survivors: A scoping review

OBJECTIVE

Breast cancer survivors (BCS) experience many issues of rehabilitative concern due to the treatments they have undergone. Given the chronicity of these outcomes, the increasing number of survivors, and the positive results obtained by supervised exercise, professionals should consider offering self-managed physical activity (PA) programs to this population. Our aim was to map the currently available evidence about self-care rehabilitation for BCS.

METHODS

Medline, CINAHL, and Cochrane databases were searched for primary literature. Scoping review methodological frameworks were used to tackle the heterogeneity of the topic. Studies investigating self-managed PA interventions prescribed to adult BCS were included.

RESULTS

One hundred-eight studies were included, with sample sizes ranging from 6 to 692 patients. Information was systematically collected in tables displaying study design, type of PA, duration and recommended frequency, professional leading the study, type of supervision, initial training, strategies used to help patients integrate self-care into their daily lives, and self-managed PA efficacy. Tables were produced for every oncological side effect that BCS might experience: lymphedema, arthralgia, cancer-related fatigue, a decline in physical parameters, treatment-related cardiotoxicity, peripheral neurotoxicity, and a possible decline in the quality of life.

CONCLUSIONS

Self-managed PA has the potential to improve BCS oncological issues. Professionals can adopt many strategies to support patients and empower them with long-lasting self-care competencies. This scoping review provided a comprehensive and easy-to-consult overview of self-managed PA interventions for BCS. We also provided recommendations for future primary studies and secondary synthesis.

Long-Term Effects of Breast Cancer Therapy and Care: Calm after the Storm?

Breast cancer is still a lethal disease and the leading cause of death in women, undermining patients' survival and quality of life. Modern techniques of surgery and radiotherapy allow for the obtaining of good results in terms of survival, however they cause long-term side effects that persist over time, such as lymphedema and neuropathy. Similarly, the advent of new therapies such as endocrine therapy revolutionized breast cancer outcomes, but side effects are still present even in years of follow-up after cure. Besides the side effects of medical and surgical therapy, breast cancer is a real disruption in patients' lives considering quality of life-related aspects such as the distortion of body image, the psychological consequences of the diagnosis, and the impact on family dynamics. Therefore, the doctor-patient relationship is central to providing the best support both during treatment and afterwards. The aim of this review is to summarize the consequences of medical and surgical treatment on breast cancer patients and to emphasize the importance of early prevention of side effects to improve patients' quality of life.

Effects of Exercise Programs on Psychoemotional and Quality-of-Life Factors in Adult Patients with Cancer and Hematopoietic Stem Cell Transplantation or Bone Marrow Transplantation: A Systematic Review

This review analyzed the effects of an exercise program on psychoemotional and quality-of-life (QoL) factors in adult patients with cancer and hematopoietic stem cell transplantation (HSCT) or bone marrow transplantation (BMT). Studies were identified from the PubMed and Web of Science databases (from inception to 24 August 2022), according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. The methodological quality of the included studies was assessed with the Physiotherapy Evidence Database (PEDro) scale, based in turn on the Delphi list. A total of 20 randomized controlled studies were included with 1219 participants. The main result of this systematic review is that exercise program interventions produce improvements on psychoemotional and QoL factors in adult patients with cancer and HSCT or BMT. Moreover, exercise programs may have a beneficial effect on health, maintaining or increasing the patient's QoL. Further, it has a positive effect on the prevention and control of transplant complications in combination with medical treatment.

Development of a Mobile-Based Self-care Application for Patients with Breast Cancer-Related Lymphedema in Iran

BACKGROUND

Due to the chronic, progressive, and debilitating nature of breast cancer-related lymphedema (BCRL), it is necessary to observe and maintain self-care management accordingly. This study was conducted to develop a mobile application based on the Android operating system for self-care management of Iranian patients with BCRL.

METHODS

An applied developmental study was conducted in 2020. The users' information needs assessment as well as design, development, implementation, and evaluation of the mobile app for self-care management of patients with BCRL was done by searching the literature, reviewing the existing mobile applications, and surveying the users' needs. The mobile app was designed using the Android Studio environment and Java programming language in the Android operating system. The usability of the app was evaluated by 30 patients with BCRL using the questionnaire for user interface satisfaction-seventh version (QUIS 7).

RESULTS

The mobile app for BCRL included demographic information, clinical information, lifestyle and system functions (drug use, nutrition, exercise, smoking cessation, communication, and test time reminder). User usability evaluation of the app content and functions confirmed that it was appropriate and satisfactory for the self-management of women with BCRL.

CONCLUSION

The mobile app was appropriate in terms of the content, function, and quality for improving the patients' lifestyle and education and self-management of BCRL symptoms according to its usability evaluation from the end-users' (patients) perspective. It is suggested that studies should be performed to confirm the effectiveness and identify the clinical significance of the app.

Which physical therapy intervention is most effective in reducing secondary lymphoedema associated with breast cancer? Protocol for a systematic review and network meta-analysis

INTRODUCTION

Lymphoedema associated with breast cancer is caused by an interruption of the lymphatic system, together with factors such as total mastectomy, axillary dissection, positive lymph nodes, radiotherapy, use of taxanes and obesity. Physiotherapy treatment consists of complex decongestive therapy, manual lymphatic drainage and exercises, among other interventions. Currently, there are several systematic review and randomised controlled trials that evaluate the efficacy of these interventions. However, at present, there are no studies that compare the effectiveness of all these physical therapy interventions. The purpose of this study is to determine which physical therapy treatment is most effective in reducing breast cancer-related lymphoedema, improving quality of life and reducing pain.

METHODS AND ANALYSIS

MEDLINE, PEDro, CINAHL, EMBASE, LILACS and Cochrane Central Register of Controlled Trials will be searched for reports of randomised controlled trials published from database inception to June 2022. We will only include studies that are written in English, Spanish and Portuguese. We will also search grey literature, preprint servers and clinical trial registries. The primary outcomes are reduction of secondary lymphoedema associated with breast cancer, improvements in quality of life and pain reduction. The risk of bias of individual studies will be evaluated using the Cochrane Risk of Bias 2.0 Tool. A network meta-analysis will be performed using a random-effects model. First, pairs will be directly meta-analysed and indirect comparisons will be made between the different physical therapy treatments. The GRADE system will be used to assess the overall quality of the body of evidence associated with the main results.

ETHICS AND DISSEMINATION

This protocol does not require approval from an ethics committee. The results will be disseminated via peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CDR42022323541.

The Effect of Exercise for the Prevention and Treatment of Cancer-Related Lymphedema: A Systematic Review with Meta-analysis

INTRODUCTION

The purpose of this systematic review and meta-analysis was to evaluate the effects of exercise on (i) the prevention of cancer-related lymphedema (CRL) and (ii) the treatment of CRL, lymphedema-associated symptoms, and other health outcomes among individuals with CRL.

METHODS

An electronic search was undertaken for exercise studies measuring lymphedema and involving individuals at risk of developing or with CRL. The Effective Public Health Practice Project Quality scale was used to assess study quality, and overall quality of evidence was assessed using the Grading of Recommendation, Assessment, Development and Evaluation approach. Meta-analyses were performed to evaluate effects of exercise on CRL incidence, existing CRL status, lymphedema-associated symptoms, and health outcomes.

RESULTS

Twelve studies ( n = 1955; 75% moderate-high quality) and 36 studies ( n = 1741; 58% moderate-high quality) were included in the prevention and treatment aim, respectively. Relative risk of developing CRL for those in the exercise group compared with the nonexercise group was 0.90 (95% confidence interval (CI), 0.72 to 1.13) overall and 0.49 (95% CI, 0.28 to 0.85) for those with five or more lymph nodes removed. For those with CRL in the exercise group, the standardized mean difference (SMD) before to after exercise of CRL was -0.11 (95% CI, -0.22 to 0.01), and compared with usual care postintervention, the SMD was -0.10 (95% CI, -0.24 to 0.04). Improvements after intervention were observed for pain, upper-body function and strength, lower-body strength, fatigue, and quality of life for those in the exercise group (SMD, 0.3-0.8; P < 0.05).

CONCLUSIONS

Findings support the application of exercise guidelines for the wider cancer population to those with or at risk of CRL. This includes promotion of aerobic and resistance exercise, and not just resistance exercise alone, as well as unsupervised exercise guided by symptom response.

Breast cancer-related lymphoedema and resistance exercise: An evidence-based review of guidelines, consensus statements and systematic reviews

AIMS AND OBJECTIVES

Breast cancer-related lymphoedema (BCRL) is a side effect of cancer treatment and can be alleviated by resistance exercise. This systematic, evidence-based review examined the existing best evidence on resistance exercise for BCRL to accurately describe the current status of the field and offer recommendations for clinicians.

METHODS

This review adheres to the PRISMA guidelines. Clinical practice guidelines, consensus documents, systematic reviews and other related evidence-based resources about resistance exercise for BCRL were retrieved through the English databases and guideline websites. The publication data limit was set to December 2020. The following search terms were used: 'breast cancer/breast neoplasm/breast carcinoma/breast tumor/breast malignancy, lymphedema/swelling/edema/lymphoedema, resistance/weight/strength training, best practice/clinical practice/guideline/consensus documents'. The quality of the included studies was evaluated by two authors independently using AGREE II and AMSTAR II tools. Evidence-based recommendations on resistance exercise relevant for BCRL were synthesised and categorised.

RESULTS

Twenty two articles (seven guidelines, four consensus documents and eleven systematic reviews) were included. The overall quality of the eleven eligible guidelines and consensus documents was moderate to high according to the AGREE II criteria. The quality of the eleven systematic reviews was critically low to high according to the AMSTAR criteria. Six clinical topics involving 43 recommendations were identified. Recommendations were categorised by safety of resistance training, effectiveness of resistance training, evaluation prior to resistance exercise, resistance exercise prescription, resistance training outcome index and points for attention.

CONCLUSIONS

This study summarises 43 recommendations for resistance training for BCRL and provides guidance for clinicians. Based on randomised trials and systematic reviews published in recent years, there is an urgent need to update the guidelines and consensus documents in terms of topics, for example effectiveness of resistance training and resistance training outcome index.

Effect of Supervised Resistance Training on Arm Volume, Quality of Life and Physical Perfomance Among Women at High Risk for Breast Cancer-Related Lymphedema: A Study Protocol for a Randomized Controlled Trial (STRONG-B)

Objectives

To determine the preventive effects of supervised resistance training on arms volume, quality of life, physical performance, and handgrip strength in Chilean women at high risk for breast cancer-related lymphedema (BCRL) undergoing chemotherapy.

Design

Randomized control trial.

Participants

One hundred and six women at high risk for breast cancer-related lymphedema aged 18 to 70 years.

Interventions

Participants will be randomized into two groups: [a] intervention, who will receive 12 weeks of supervised resistance training (STRONG-B) during adjuvant chemotherapy; and [b] control, who will receive education to promote lymphatic and venous return, maintain range of motion, and promote physical activity.

Main Outcome Measures

The primary outcome will be arms volume measured with an optoelectric device (perometer NT1000). Secondary outcomes will be quality of life, handgrip strength, and physical performance. Primary and secondary outcomes will be measured at baseline, just after the intervention, and 3 and 6 months after. Statistical analysis will be performed following intention-to-treat and per-protocol approaches. The treatment effect will be calculated using linear mixed models.

Discussion

The STRONG-B will be a tailored supervised resistance training that attempts to prevent or mitigate BCRL in a population that, due to both intrinsic and extrinsic factors, will commonly suffer from BCRL.

Clinical Trial Registration

[https://clinicaltrials.gov/ct2/show/NCT04821609], identifier NCT04821609.

Breast Cancer-Related Lymphedema Risk-Management Behaviors Among Chinese Breast Cancer Survivors and Relationships with Socio-Demographic and Clinical Characteristics: A Longitudinal Study

PURPOSE

We sought to determine changes in breast cancer-related lymphedema (BCRL) risk-management behaviors in the six-month period after surgery among Chinese breast cancer survivors and to explore the relationship between their socio-demographic and clinical characteristics and these behaviors.

PATIENTS AND METHODS

A longitudinal study design was adopted. Females aged ≥18 years with a first breast cancer diagnosis and who had undergone modified radical mastectomy were recruited from a cancer hospital in China. Respondents with a history of other malignant tumors, mental illness, or cognitive impairment were excluded from the study. Socio-demographic and clinical factors were assessed at baseline. BCRL risk-management behaviors were assessed with the Lymphedema Risk-Management Behavior Questionnaire (LRMBQ) and Functional Exercise Adherence Scale (FEAS) in the first, third, and sixth months after surgery. Repeated-measures analysis of variance was used to examine changes in BCRL risk-management behaviors over the three study time periods, and a generalized linear mixed model was used to determine socio-demographic and clinical factors associated with BCRL risk-management behaviors.

RESULTS

A total of 166 participants completed all three assessments. The scores of the total LRMBQ and its "Skin care" and "Lifestyle" subscales did not change significantly, but those of the "Avoidance of limb compression and injury" and "Other matters requiring attention" subscales changed over the three study time periods. Additionally, scores of the total FEAS and most of its subscales changed over the three study time periods. Furthermore, BCRL risk-management behaviors were significantly related to patients' geographic residence, education level, and tumor stage.

CONCLUSION

Some dimensions of BCRL risk-management behaviors changed over time, and several socio-demographic and clinical factors are related to BCRL risk-management behaviors. It is recommended that health care professionals consider the dynamic nature of BCRL risk-management behaviors and related factors when planning health education and promotion interventions.

Methylation and Expression of the Exercise-Related TLR1 Gene Is Associated With Low Grade Glioma Prognosis and Outcome

Background: Exercise improves function, reduces disability, maintains independence, and improves quality of life for low-grade glioma (LGG) patients. Exercise can also improve the effectiveness of cancer treatment. The goal of this research was to find potential exercise related genes that may be used to predict exercise levels and may be used as a biomarker for cancer outcomes.

Methods: The GSE111551 database was thoroughly examined in this research, and the resulting conclusion of exercise-related genes was reached. The protein interaction network (PPI) was used to examine the differentially expressed genes (DEGs). Then the exercise-related gene TLR1 was chosen. The expression, methylation degree, prognosis, and immune relevance of TLR1 were investigated using bioinformatics. In addition, we verified the role of TLR1 in Glioma cell lines.

Results: LGG patients with reduced TLR1 expression and hypermethylation had a better overall survival (OS) and progression free survival (PFS), using the TCGA database. Low TLR1 expression and hypermethylation of TLR1 were found to be independent biomarkers for OS using Cox regression. Furthermore, the CGGA database was used to confirm the prognostic function of TLR1 in this cancer. Finally, most methylation sites of TLR1 were strongly correlated with immune infiltration and immune checkpoint. Then, reducing TLR1 expression substantially slowed the cell cycle and decreased LGG cell proliferation, emigration, and infiltration in vitro.

Conclusions: Exercise-related gene TLR1 has the potential to be a useful prognostic biomarker, and it is thought to be involved in immune cell infiltration and immunotherapy in LGG.

The Impact of the Characteristics of Exercise on The Risk of Breast Cancer Instructions

Background:

Exercise seems to protect from breast cancer (BC) and this protection is likely mediated through weight control during menopause. Considering that night work is associated with higher risk for BC.

Objective:

The aim of this study was to examine the possible relation of BC risk to daytime or nighttime hours of exercise.

Methods:

The material was taken from primary elements of a doctoral thesis at the Department of Midwifery, University of West Attica that examines the impact of the characteristics of exercising on BC. The data were obtained from relevant questionnaires filled in at a big private hospital, following a relevant permit of the scientific committee, and adjusted Google Forms, ensuring anonymity.

Results:

Almost 3 times more women without a history of BC were exclusively exercising during the daytime compared to the ones with a history of BC who were exclusively exercising during the nighttime (40 vs 15). On the contrary, a smaller number of women without a history of BC were exclusively exercising during the nighttime compared to the ones with a history of BC who were exclusively exercising during the nighttime (17 vs 20) (odds ratio >3 with a confidence interval >1 to >7.5 and p<0.05).

Conclusion:

It seems that the protective impact of exercising on BC is mitigated when the exercise is performed exclusively during night hours.

Effects of Intermittent Pneumatic Compression on Lower Limb Lymphedema in Patients with Type 2 Diabetes Mellitus: A Pilot Randomized Controlled Trial

Background and Objectives: Diabetes mellitus type 2 (T2DM) is a chronic disease associated with fluid accumulation in the interstitial tissue. Manual lymphatic drainage (MLD) plays a role in reducing lymphoedema, like intermittent pneumatic compression (IPC). By the present pilot study, we aimed to evaluate the efficacy of a synergistic treatment with MLD and IPC in reducing lower limb lymphedema in T2DM patients. Materials and Methods: Adults with a clinical diagnosis of T2DM and lower limb lymphedema (stage II-IV) were recruited from July to December 2020. Study participants were randomized into two groups: experimental group, undergoing a 1-month rehabilitative program consisting of MLD and IPC (with a compression of 60 to 80 mmHg); control group, undergoing MLD and a sham IPC (with compression of <30 mmHg). The primary outcome was the lower limb lymphedema reduction, assessed by the circumferential method (CM). Secondary outcomes were: passive range of motion (pROM) of hip, knee, and ankle; quality of life; laboratory exams as fasting plasma glucose and HbA1c. At baseline (T0) and at the end of the 1-month rehabilitative treatment (T1), all the outcome measures were assessed, except for the Hb1Ac evaluated after three months. Results: Out of 66 T2DM patients recruited, only 30 respected the eligibility criteria and were randomly allocated into 2 groups: experimental group (n = 15; mean age: 54.2 ± 4.9 years) and control group (n = 15; mean age: 54.0 ± 5.5 years). At the intra-group analysis, the experimental group showed a statistically significant improvement of all outcome measures (p < 0.05). The between-group analysis showed a statistically significant improvement in pROM of the hip, knee, ankle, EQ-VAS, and EQ5D3L index at T1. Conclusions: A multimodal approach consisting of IPC and MLD showed to play a role in reducing lower limb lymphedema, with an increase of pROM and HRQoL. Since these are preliminary data, further studies are needed.

Quality of Life Interventions in Breast Cancer Survivors: State of the Art in Targeted Rehabilitation Strategies

Breast cancer is the most common malignant tumor and the most prevalent cause of mortality in women. Advances in early diagnosis and more effective adjuvant therapies have improved the long-term survival of these patients. Pharmacotherapies and intrinsic tumor-related factors may lead to a wide spectrum of treatment-related disabling complications, such as breast cancer-related lymphedema, axillary web syndrome, persistent pain, bone loss, arthralgia, and fatigue. These conditions have a detrimental impact on the health-related quality of life of survivors. Here, we sought to provide a portrait of the role that rehabilitation plays in breast cancer survivors. Particular emphasis has been placed on recovering function, improving independence in activities of daily living, and reducing disability. This complex scenario requires a precision medicine approach to provide more effective decision-making and adequate treatment compliance.

Effect of Aqua Therapy Exercises on Postmastectomy Lymphedema: A Prospective Randomized Controlled Trial

Objective

To investigate the effect of aqua therapy resistance exercise on arm volume, pain, and shoulder range of movements in post-mastectomy lymphedema.

Methods

This was a single-blind randomized controlled trial. Fifty eligible breast cancer survivors (median, 10 years after surgery) with lymphedema (median, 21% inter-limb difference) were assigned randomly to group A (n=25) or control group B (n=25). The study group underwent 60 minutes of aqua therapy exercise comprising of warm-up for 10 minutes, 40 minutes of strengthening exercises, and 10 minutes of cooling down, three times a week for 8 weeks. The control group underwent 60 minutes of land-based exercise three times a week for 8 weeks. Arm volume calculated by measuring the arm circumference, shoulder flexion, and abduction range of motion (ROM), and pain using a visual analog scale (VAS) were assessed at baseline and after 8 weeks of treatment.

Results

There was a statistically significant difference in limb volume, shoulder flexion and abduction ROM, and VAS scores in favor of the study group (p<0.001) after 8 weeks of intervention. The mean±standard deviation for limb volume, shoulder flexion, abduction, and pain score were 2,108.71±200.97 mL, 169.68°±4.54°, 150.44°±3.92°, and 3.16±1.1 in the study group and 2,256.41±186.94 mL, 147.36°±5.32°, 131.32°±4.38°, and 5.68±0.94 in the control group, respectively.

Conclusion

Adding aqua therapy resistance exercise to routine physical therapy might be more effective in decreasing the limb volume and pain intensity and improving ROM of the shoulder in postmastectomy lymphedema.

Different Methods of Physical Training Applied to Women Breast Cancer Survivors: A Systematic Review

Objective: The objective of this systematic review was to identify the effects of different training methods in women who have survived breast cancer (WSBC). Data Sources: Studies were identified by searching SportDiscus, Web of Science, PubMed, Scopus, Scielo, and Bireme. Study Selection: The inclusion criteria were articles that addressed only breast cancer in women, were randomized clinical trials, and interventions involving physical training with Consort ≥80. Data Extraction: The PICO and CONSORT strategies were used for the selection of articles and quality assessment of randomized clinical trials, respectively. Two independent reviewers searched for articles among the databases. Disagreements were discussed, and in the case of an impasse, a third reviewer was consulted. Data Synthesis: Evidence that demonstrated the beneficial effects of physical exercise programs carried out by WSBC. Moderate or high-intensity exercise sessions have been shown to benefit women survivors of breast cancer. Among the modalities, the resistance exercise showed effects from 55% of one-repetition maximum (1 RM), exclusively or associated with other training regimes, such as aerobic (from 48% of heart rate), high-intensity interval training (HIIT), or impact. The main benefits include increased muscle strength, promoted by the practice of resistance exercise in combination with other types of exercises or alone; decreased fatigue; improved quality of life; improved psychosocial effects, and increased leisure time. Conclusions: Physical training performed at a moderate or high intensity (aerobic or anaerobic) can reduce fatigue, improve quality of life, improve sleep quality, and increase bone mineral density in women survivors of breast cancer.

Development and validation of a nomogram to predict the risk of breast cancer-related lymphedema among Chinese breast cancer survivors

PURPOSE

Breast cancer-related lymphedema (BCRL) is a major long-term complication for post-surgery breast cancer survivors. Although several risk factors have been identified, lifestyle characteristics have been neglected in previous studies. The aim of this study was to develop and validate a nomogram for estimating this population's risk of developing lymphedema, taking into consideration their demographic, clinical, and personal lifestyle behaviors.

METHODS

In a cross-sectional study, we collected data from 775 post-operative breast cancer survivors who had attended a follow-up session in the recent 10 years (primary cohort). Lymphedema was assessed using the Norman telephone questionnaire, self-reported by patients. Multiple logistic regression was used to identify risk factors for lymphedema, including demographic, clinical, and lifestyle-related factors. A nomogram was constructed based on those factors and was validated using a separate group of 314 breast cancer patients (validation cohort).

RESULTS

The factors independently associated with lymphedema were higher body mass index (BMI), modified radical mastectomy (MRM), postsurgical infection, chemotherapy, radiotherapy, exercise of the affected arm, and the active participation in physical activity (P<0.05). The area under the curve (AUC) values of the primary and the validation cohorts were 0.721 (95% confidence interval: 0.685-0.756) and 0.702 (95% confidence interval: 0.646-0.759), respectively.

CONCLUSIONS

BCRL risk factors include MRM, radiotherapy, chemotherapy, and higher BMI, while the active physical activity behavior of patients appears to be a factor against lymphedema. The nomogram incorporating the patients' clinical and lifestyle factors might be useful for predicting lymphedema in breast cancer survivors.

Cost-Effectiveness Analysis: Lymph Node Transfer vs Lymphovenous Bypass for Breast Cancer-Related Lymphedema

BACKGROUND

Lymph node transfer (LNT) and lymphovenous bypass (LVB) have been described as 2 major surgical options for patients with breast cancer-related lymphedema (BCRL) who have failed conservative therapy. The objective of our study was to perform a cost-effectiveness analysis comparing LNT and LVB for the treatment of BCRL.

STUDY DESIGN

Rates of infection, lymph leak, and failure of LNT and LVB were obtained from a previously published meta-analysis. Failure of surgery was defined as the inability to cease compression therapy postoperatively. Procedural costs were calculated from Medicare reimbursement rates. Cost of conservative management of postoperative surgical site infection, lymph leak, and continued decongestive physiotherapy after failed surgery were obtained from literature review. Average utility scores for each health state were calculated using a visual analog scale survey, then converted to quality-adjusted life years (QALYs). A decision tree was constructed, and incremental cost-effectiveness ratio was assessed at $50,000/QALY. Deterministic and probabilistic sensitivity analyses were performed to evaluate the robustness of our findings.

RESULTS

LNT was less costly ($22,492 vs $31,927) and more effective (31.82 QALY vs 29.24 QALY) than LVB. One-way (deterministic) sensitivity analysis demonstrated that LNT became cost-ineffective when its failure rate was more than 43.8%. LVB became more cost-effective than LNT when its failure rate was less than 21.4%. Probabilistic sensitivity analysis using Monte-Carlo simulation indicated that even with uncertainty present in the variables analyzed, the majority of simulations (97%) favored LNT as the more cost-effective strategy.

CONCLUSIONS

LNT is a dominant, cost-effective strategy compared to LVB for the treatment of BCRL.

Lymphedema Rehabilitation Using Self-Adaptive Inelastic Compression in Breast Cancer: A Proof-of-Principle Study

Inelastic compression (IC) has been proposed as a therapeutic option in the management of breast cancer-related lymphedema (BCRL). To date, no studies have investigated the reliability of IC in the rehabilitative management of BCRL. Thus, we aimed at evaluating the safety and tolerability of an instantly adjustable IC device for BCRL patients. We included BCRL patients referred to an Oncological Rehabilitation Unit. They were subjected to complex decongestion therapy using a self-adaptive IC device. The primary outcome was safety and tolerability of IC in the rehabilitation treatment of BCRL patients. Secondary outcomes were: BCRL volume modifications; disability; quality of life; IC application time. Outcomes were assessed at the baseline (T0), at the end of the 2-week rehabilitation treatment (T1), and at 1 month (T2). Nine BCRL women, mean aged 56.7 ± 4.4 years, were enrolled. None showed side effects, except for a low discomfort and moderate swelling reported by 1 patient (11.1%). BCRL volume significantly reduced at T1 (p = 0.001) with a positive trend at T2. IC timing was significantly reduced at T1 (p = 0.035) and T2 (p = 0.003). Taken together, these findings suggested that IC could be considered as a safe, well-tolerated, and effective tool in the rehabilitative management of BCRL patients.

Comprehensive Analysis of Aerobic Exercise-Related Genes Identifies CDCA4 That Promotes the Progression of Osteosarcoma

Background

Exercise has a positive impact on patients with osteosarcoma, improving function, reducing disability, maintaining independence and quality of life. Exercise may also directly affect the effectiveness of cancer treatment. Cell division cycle-associated protein 4 (CDCA4) is reported to function importantly during numerous human cancers development. Nevertheless, the details toward CDCA4 function are still to be investigated.

Methods

This study comprehensively analyzed the GSE74194 database and obtained aerobic exercise-related genes. Protein-protein interaction network (PPI) and Gene Ontology (GO) analysis were performed on the differentially expressed genes (DEGs). Quantitative reverse transcription polymerase chain reaction (qRT-PCR) and tumor genome atlas (TCGA) data mining were applied to measure aerobic exercise-related gene CDCA4 level in osteosarcoma tissue. We conducted lots of functional experiments to uncover CDCA4 function and its corresponding mechanism in osteosarcoma.

Results

We screened a total of 547 DEGs related to aerobic exercise, of which 373 were up-regulated and 174 were down-regulated. PPI analysis revealed 90 genes that might play key roles. GO analysis showed that aerobic exercise-related DEGs were significantly enriched during the mitotic cell cycle, cell division, mitotic nuclear division and sister chromatid segregation, nuclear division, microtubule cytoskeleton organization involved protein, microtubule-based process, spindle organization, G2/M transition of mitotic cell cycle. Our results indicated that CDCA4 was increased in osteosarcoma tissues and cell lines, and its level had association with high mortality of osteosarcoma patients. Further studies revealed that absence of CDCA4 largely hindered osteosarcoma cancer cell proliferation, invasion, and migration.

Conclusion

Comprehensive bioinformatics analysis improves our understanding of the underlying molecular mechanisms of aerobic exercise on osteosarcoma. This provides evidence for the effect of aerobic exercise on CDCA4 expression. Our data suggested that CDCA4 could facilitate osteosarcoma development, and gave a hint that CDCA4 was a candidate target in the treatment of osteosarcoma, aerobic exercise might help the treatment and prognosis of patients with osteosarcoma.

Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training - data from the Phys-Can study

INTRODUCTION

Few studies have systematically evaluated the risk of adverse events (AEs) among persons exercising during oncological treatment. We aimed to describe incidence and types of AEs during exercise for persons undergoing oncological treatment, and associations to exercise intensity, exercise adherence, chemotherapy treatment, initial aerobic fitness. A second aim was to compare incidence of lymphedema, periphery inserted central catheter (PICC) complications, and other new medical conditions (any illness or injury occurred during the exercise trial) between high-intensity vs low-to-moderate exercise and usual care (UC).

METHODS

This descriptive, comparative study was based on data from an observational study including patients in an UC setting (n = 90) and a randomized exercise trial (n = 577) in which participants exercised at high-intensity (HI) or low-moderate intensity (LMI). Persons with breast, prostate, or colorectal cancer undergoing neo/adjuvant treatment were included. AEs were reported by exercise coaches, participants, and identified in medical records, as were lymphedema, PICC-complications, and new medical conditions.

RESULTS

Coaches reported AEs for 20% of the participants, while 28% of participants self-reported AEs. The most common coach- and participant reported AEs were musculoskeletal and the majority (97%) were considered minor. HI had higher likelihood of AEs than LMI, according to both coaches (OR: 1.9 [95%CI 1.16-3.21], p=.011) and participants (OR: 3.36 [95%CI 2.00-5.62], ≤.001). Lymphedema rates were low (4-9%) and PICC complications ranged from 15% in LMI to 23% in UC and there were no statistically significant differences between HI, LMI, and UC. There were no statistically significant differences between HI and LMI regarding new medical conditions.

CONCLUSIONS

Exercise during treatment is safe for these patient groups in this setting, even HI exercise can be recommended if no medical contraindications are present. Similar to healthy populations, a higher risk of having minor AEs when exercising at HI in comparison to LMI may exist.

Low-Intensity Resistance Training and Compression Garment in the Management of Breast Cancer-Related Lymphedema: Single-Blinded Randomized Controlled Trial

There is limited evidence regarding the combined effect of exercise and compression garment on breast cancer-related lymphedema (BCRL). Therefore, we investigate the effect of low-intensity resistance training alone or in combination with a compression garment on lymphedema volume, self-reported lymphedema symptoms, and shoulder mobility and function. A total of 60 women with unilateral BCRL were randomly assigned to low-intensity resistance exercises (Rex group, n = 30) or exercises and compression garment (Rex-Com-group, n = 30). Both groups take part in exercises program consisted of 10-12 repetitions at 50 to 60% of one repetition maximum (IRM), three times weekly, for 8 weeks. The primary outcome was lymphedema volume determined by percentage reduction of excess limb volume (ELV). Secondary outcomes were lymphedema symptoms (pain, heaviness, and tightness) and shoulder mobility and function using the disabilities of the arm, shoulder, and hand (DASH) questionnaire. All measurements were standardized and performed before (week 0, W0), after the intervention (week 8, W8), and at follow-up (week 12, W12). A significant reduction in percentage of ELV (p < 0.01), pain severity (p < 0.05), a sensation of heaviness (p < 0.05) and tightness (p < 0.001), and improvement in shoulder range of motion (p < 0.05) and function on DASH scores (p < 0.05) were observed at W8 and W12 in both groups. However, no between-group differences were observed over time. These findings suggest that low-intensity resistance training, irrespective of garment use, can effectively reduce limb volume and lymphedema symptoms, and increase shoulder mobility and function.

Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis

BACKGROUND

The purpose of this systematic review update and meta-analysis was to analyze resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status and upper and lower extremity strength.

METHODS

Systematic literature search was conducted utilizing PubMed, MEDLINE, and Embase databases. Any exercise intervention studies-both randomized controlled and uncontrolled-which assessed the effects of RE on BCRL in BCS in at least one intervention group published between 1966 and 31st January 2020 were included. Included articles were analyzed regarding their level of evidence and their methodological quality using respective tools for randomized and nonrandomized trials of the Cochrane collaboration. Meta-analysis for bioimpedance spectroscopy (BIS) values as well as upper and lower extremity strength was conducted.

RESULTS

Altogether, 29 studies were included in the systematic review. Results of six studies with altogether twelve RE intervention groups could be pooled for meta-analysis of the BCRL. A significant reduction of BCRL after RE was seen in BIS values (95% CI - 1.10 [- 2.19, - 0.01] L-Dex score). Furthermore, strength results of six studies could be pooled and meta-analysis showed significant improvements of muscular strength in the upper and lower extremities (95% CI 8.96 [3.42, 14.51] kg and 95% CI 23.42 [11.95, 34.88] kg, respectively).

CONCLUSION

RE does not have a systematic negative effect on BCRL and, on the contrary, potentially decreases it.

A Longitudinal Study of a Multicomponent Exercise Intervention with Remote Guidance among Breast Cancer Patients

Purpose: Breast cancer patients in treatment suffer from long-term side effects that seriously influence their physical and mental health. The aim of this study was to examine effectiveness of a 12-week multicomponent exercise (ME) with remote guidance intervention on health-related outcomes after one year among breast cancer patients. Methods: In phases I–III, 60 patients (51.2 ± 7.9 years) with breast cancer (BC) who completed chemotherapy/postoperative radiotherapy within the previous four months to two years were randomly assigned to (1) multicomponent exercise with remote guidance (ME) and (2) usual care (UC). Eligible participants were approached to assess cancer-related quality of life (QOL), muscle strength, cardiorespiratory endurance, and physical activity (PA) barriers after one year. Results: The results demonstrated that, after one year, the ME group reported higher vitality-related QOL (5.776, 95% confidence interval [CI] 0.987, 10.565, effect size [ES] = 0.360), mental health-related QOL (9.938, 95% CI 4.146, 15.729, ES = 0.512), leg strength and endurance (2.880, CI 1.337, 4.423, ES = 0.557), and strength and endurance of upper extremities (2.745, 95% CI 1.076, 4.415, ES = 0.491) and lower physical activity (PA) hindrance (5.120, 95% CI 1.976, 8.264, ES = 0.486) than the UC group. Conclusions: The ME group observed significant differences from the UC group in QOL, muscle strength, cardiopulmonary endurance, and PA participation. These findings suggested that the multicomponent exercise intervention with remote guidance produced long-term health benefits for breast cancer patients.

Exercise and Physical Activity in Patients with Osteosarcoma and Survivors

Exercise has the potential to positively affect patients with osteosarcoma by improvement of function, mitigation of disability, and maintenance of independence and quality of life. Exercise may also directly impact cancer treatment efficacy. This chapter examines the feasibility and use of exercise or physical activity as therapy in the treatment of osteosarcoma and its survivors. It additionally presents the benefits of physical activity as treatment and rehabilitation both preoperatively (prehabilitation) and postoperatively. This chapter will also discuss barriers to exercise and physical activity for patients with osteosarcoma and its survivors, emphasizing the need for a comprehensive and cohesive support system to promote its incorporation into patient treatment plans and ensure compliance.

Heavy-load resistance exercise during chemotherapy in physically inactive breast cancer survivors at risk for lymphedema: a randomized trial

Background: Due to long-standing concerns that heavy-load lifting could increase the risk of developing lymphedema, breast cancer survivors have been advised to refrain from resistance exercise with heavy loads. This study prospectively evaluated the effect of heavy-load resistance exercise on lymphedema development in women receiving chemotherapy for breast cancer.Material and Methods: Physically inactive women receiving adjuvant chemotherapy for breast cancer (n = 153) were randomized to a HIGH (supervised, multimodal exercise including heavy-load resistance exercise: 85-90% 1 repetition maximum [RM], three sets of 5-8 repetitions) versus LOW (pedometer and one-on-one consultations) 12-week intervention. Outcomes (baseline, 12 and 39 weeks) included lymphedema status (extracellular fluid [bioimpedance spectroscopy] and inter-arm volume % difference [dual-energy X-ray absorptiometry], lymphedema symptoms [numeric rating scale 0-10]), upper-extremity strength (1 RM), and quality of life domains (EORTC- BR23). Linear mixed models were used to evaluate equivalence between groups for lymphedema outcomes (equivalence margins for L-Dex, % difference and symptoms scale: ±5, ±3% and ±1, respectively). Superiority analysis was conducted for muscle strength and quality of life domains.Results: Postintervention equivalence between groups was found for extracellular fluid (0.4; 90% CI -2.5 to 3.2) and symptoms of heaviness (-0.2; -0.6 to 0.2), tightness (-0.1; -0.8 to 0.6) and swelling (0.2; -0.4 to 0.8). Nonequivalence was found for inter-arm volume % difference (-3.5%; -17.3 to 10.3) and pain (-0.7; -1.3 to 0), favoring HIGH. Strength gains were superior in the HIGH versus LOW group (3 kg; 1 to 5, p < .05). Further, clinically relevant reductions in breast (-11; -15 to -7) and arm (-6; -10 to -1) symptoms were found in the HIGH group.Conclusion: Findings suggest that physically inactive breast cancer survivors can benefit from supervised heavy-load resistance exercise during chemotherapy without increasing lymphedema risk. Trial registration: ISRCTN13816000.

Can intensity in strength training change caloric expenditure? Systematic review and meta-analysis

INTRODUCTION

Strength training (ST) is considered an important strategy for maintaining body weight, as it promotes an increase in total energy expenditure (EE). However, the combination and manipulation of variables (intensity and volume) allow for different training adaptations. However, it remains unclear as to what is the most important variable between volume or intensity for example number of sets, repetitions, or total load for maximizing EE during ST. Several studies have analyzed the EE response in ST, but still unclear the variable is able to increase EE in the ST.

OBJECTIVE

This review aimed to investigate the effect of ST on EE in adults using a systematic literature review and subsequent meta-analysis.

METHODS

The search was performed on the electronic databases using the following keywords: strength training (resistance training; strength training; strength training method) and energy expenditure (energy metabolism; energy expenditure; caloric expenditure, caloric cost) with 'AND' and 'OR' combination. Manual searches of references were also conducted for additional relevant studies. After evaluating the inclusion and exclusion criteria, the selected studies were analysed according to strength training methods and the training variables used to measure EE.

RESULTS

We identified two ST methods from the literature review: circuit training (CT) and traditional training (TT). Meta-analysis showed a significant effect on EE increase, which favour TT when compared with CT [-0·99 (95%CI: -1·96, -0·02), P<0·01] with I² of 89% (P<0·01). After adjusting for bias risk, no significant differences were found in EE associated with intensity [-0·40, 95% CI (0·98, 0·18), P = 0·18).

CONCLUSION

The present review and meta-analysis indicated that the intensity of exercise does not seem to be associated with an increase of EE in ST.

Effects of a 12-week resistance and aerobic exercise program on muscular strength and quality of life in breast cancer survivors: Study protocol for the EFICAN randomized controlled trial

BACKGROUND

The number of people living with the side effects of breast cancer treatment (eg, loss of muscular mass and muscular strength, upper-limb mobility and disability, lymphedema, cardiac toxicity, and reduced quality of life) is increasing yearly. These consequences can be improved through exercise, specially combining resistance and aerobic training. Previous exercise trials have not been consistent in applying training principles and standardized reporting, and this partly explains the variability in obtained results. The aim of this study is to assess the effect of a 12-week supervised resistance exercise program combined with home-based aerobic exercise, compared with home-based aerobic exercise only, on muscular strength and several aspects of health-related quality of life in breast cancer survivors. To maximize transparency, replicability, and clinical applicability, the intervention is described following the consensus on exercise reporting template.

METHODS

This study is a parallel-group randomized controlled trial in which 60 female breast cancer survivors, who have completed central treatments of the disease in the last 5 years, will be randomly assigned to either an experimental group that will perform a total of 24 progressive resistance training sessions for 12 weeks (ie, 2 weeks of individual training and 10 weeks of micro-group training) and will be requested to undertake 10,000 steps/d, or a control group that will be requested to undertake 10,000 steps/d, only. Outcomes will be evaluated at baseline and at week 12. Primary outcome measure is peak isometric muscular strength of the lower- and upper-body, assessed with several exercises through an electromechanical dynamometer. Secondary outcomes include cardiorespiratory fitness, upper-joint mobility and disability, health-related quality of life, cancer-related fatigue, depression, life satisfaction, and presence of lymphedema.

DISCUSSION

This study aims to investigate the extent to which a 12-week supervised and progressive resistance exercise program, in addition to home-based aerobic physical activity, might improve muscular strength and health-related quality of life in breast cancer survivors. The comprehensive description of the intervention will likely contribute to enhancing exercise prescription in this population.

TRIAL REGISTRATION NUMBER

ISRCTN14601208.

Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable

PURPOSE

The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone-a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue.

METHODS

A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes.

RESULTS

Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain.

CONCLUSIONS

The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice.

Survivorship, Version 2.2018, NCCN Clinical Practice Guidelines in Oncology

The NCCN Guidelines for Survivorship provide screening, evaluation, and treatment recommendations for common physical and psychosocial consequences of cancer and cancer treatment to help healthcare professionals who work with survivors of adult-onset cancer in the posttreatment period. This portion of the guidelines describes recommendations regarding the management of anthracycline-induced cardiotoxicity and lymphedema. In addition, recommendations regarding immunizations and the prevention of infections in cancer survivors are included.

The effects of the combined exercise intervention based on internet and social media software (CEIBISMS) on quality of life, muscle strength and cardiorespiratory capacity in Chinese postoperative breast cancer patients:a randomized controlled trial

Background

Breast cancer (BC) patients who undergo surgery followed by radiotherapy and chemotherapy have limitations on physical activity which will lead to a decreased quality of life and poor physical fitness level. The purpose of this study was to investigate the effects of the combined exercise intervention based on internet and social media software (CEIBISMS) on postoperative breast cancer patients by evaluating their quality of life, muscle strength and cardiorespiratory capacity.

Methods

This study was a randomized control trial with an intervention period of 12 weeks. Sixty participants (30 in each group, 42–60 years old, female) were recruited through an outpatient department. Procedure of exercise in the intervention group included: via phone step-recording app, ask the individuals to complete the target number of steps within a specified period of exercise, four times per week; face-to-face remote video instruction of individuals on muscle training, three times per week; via social media apps daily push common knowledge of physical exercise BC rehabilitation. The control group received traditional treatment and rehabilitation according to daily specifications of the hospital. The primary outcome was quality of life and the secondary outcomes were muscle strength and cardiorespiratory capacity.

Results

Experiments using a Short Form 36 showed that the CEIBISMS yielded significantly better results than traditional methods, in vitality (p = 0.009), mental health (p = 0.001) and reported health transition (p = 0.048) by week 12. The CEIBISMS resulted in significant improvement in the stand-up and sit-down chair test (p < 0.0001), arm lifting test (p = 0.017).

Conclusion

The CEIBISMS offered rehabilitative effects in quality of life (QOL) and muscle strength of postoperative patients with breast cancer (BC) in China.

Trial registration

ChiCTR-IPR-17012368. Trial registered on 14 August, 2017.

Effect of individualised physical rehabilitation programmes on the functional state of the cardiovascular system in women with post-mastectomy syndrome

Background/Aims

The purpose of this study was to determine the effectiveness of individualised physical rehabilitation programmes aimed at improving cardiovascular function in women with post-mastectomy syndrome.

Methods

The following methods were applied: theoretical analysis of scientific and methodologic literature data, impedance cardiography, and mathematical statistical methods. A total of 115 women with late symptoms of post-mastectomy syndrome who completed the interventions were included in this study. The participants were randomly enrolled into three groups for the first individualised programme (Group 1, n=45), for the second individualised programme (Group 2, n=40) and for the third individualised programme (Group 3, n=30). The first programme included aqua aerobics (aqua jogging, aqua building, aqua stretching), conditional swimming and recreational aerobics; the second programme included conditional swimming and Pilates exercises; the third programme included yoga-based exercises and stretching. The study was conducted during the ambulatory rehabilitation stage and lasted for 12 months.

Results

It was found that most of the investigated hemodynamic parameters in all groups steadily improved during the year of rehabilitation. The average values of stroke volume, cardiac output, left ventricular work, left ventricular power after 12 months of rehabilitation were statistically better (P<0.05) in the first main group compared with the second and third main groups.

Conclusions

Individualised programmes of physical rehabilitation were effective in improvement of cardiovascular function of all studied patients with post-mastectomy syndrome.

Resistance exercise and breast cancer related lymphedema - a systematic review update

Background: Purpose of this systematic review update was analyzing resistance exercise (RE) intervention trials in breast cancer survivors (BCS) regarding their effect on breast cancer-related lymphedema (BCRL) status. Articles published until 31 September 2017 were included.Methods: A systematic literature search was conducted utilizing PubMed, MEDLINE, and EMBASE databases. Included articles were analyzed regarding their level of evidence and their methodological quality using the Cochrane risk of bias tool.Results: Altogether, 23 articles could be included of which 16 were independent RE intervention studies and seven additional articles. Lymphedema assessment was so heterogeneous that conduction of a thorough meta-analysis regarding lymphedema status was still impossible. In all but one study, which reported a small but methodologically weak increase in arm volume, no negative effects of RE on BCRL was recorded.Conclusions: RE seems to be a safe exercise intervention for BCS and not to be harmful concerning the risk of lymphedema. Lymphedema assessment methods that allow for a qualitative analysis of arm tissue composition should be favored.Implications for rehabilitationBreast cancer-related lymphedema affects a considerable proportion of breast cancer patients and is debilitating on the physical, functional, social, and psychological domain.At the current time breast cancer related lymphedema is incurable but well manageable by a number of physical therapy modalities, especially complete decongestive therapy (CDT).One of the encouraging treatment methods is resistance exercise.

Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema

Purpose

Despite a paucity of evidence, prevention guidelines typically advise avoidance of heavy lifting in an effort to protect against breast cancer–related lymphedema. This study compared acute responses in arm swelling and related symptoms after low- and heavy-load resistance exercise among women at risk for lymphedema while receiving adjuvant taxane-based chemotherapy.

Methods

This is a randomized, crossover equivalence trial. Women receiving adjuvant taxane-based chemotherapy for breast cancer who had undergone axillary lymph node dissection (n = 21) participated in low-load (60%–65% 1-repetition maximum, two sets of 15–20 repetitions) and heavy-load (85%–90% 1-repetition maximum, three sets of 5–8 repetitions) upper-extremity resistance exercise separated by a 1-wk wash-out period. Swelling was determined by bioimpedance spectroscopy and dual-energy x-ray absorptiometry, with breast cancer–related lymphedema symptoms (heaviness, swelling, pain, tightness) reported using a numeric rating scale (0–10). Order of low- versus heavy-load was randomized. All outcomes were assessed before, immediately after, and 24 and 72 h after exercise. Generalized estimating equations were used to evaluate changes over time between groups, with equivalence between resistance exercise loads determined using the principle of confidence interval inclusion.

Results

The acute response to resistance exercise was equivalent for all outcomes at all time points irrespective of loads lifted, with the exception of extracellular fluid at 72 h after exercise with less swelling after heavy loads (estimated mean difference, −1.00; 95% confidence interval, −3.17 to 1.17).

Conclusions

Low- and heavy-load resistance exercise elicited similar acute responses in arm swelling and breast cancer–related lymphedema symptoms in women at risk for lymphedema receiving adjuvant taxane-based chemotherapy. These represent important preliminary findings, which can be used to inform future prospective evaluation of the long-term effects of repeated exposure to heavy-load resistance exercise.

Interdisciplinary Screening, Diagnosis, Therapy and Follow-up of Breast Cancer. Guideline of the DGGG and the DKG (S3-Level, AWMF Registry Number 032/045OL, December 2017) - Part 2 with Recommendations for the Therapy of Primary, Recurrent and Advanced Breast Cancer

Purpose The aim of this official guideline coordinated and published by the German Society for Gynecology and Obstetrics (DGGG) and the German Cancer Society (DKG) was to optimize the screening, diagnosis, therapy and follow-up care of breast cancer. Method The process of updating the S3 guideline published in 2012 was based on the adaptation of identified source guidelines. They were combined with reviews of evidence compiled using PICO (Patients/Interventions/Control/Outcome) questions and with the results of a systematic search of literature databases followed by the selection and evaluation of the identified literature. The interdisciplinary working groups took the identified materials as their starting point and used them to develop suggestions for recommendations and statements, which were then modified and graded in a structured consensus process procedure. Recommendations Part 2 of this short version of the guideline presents recommendations for the therapy of primary, recurrent and metastatic breast cancer. Loco-regional therapies are de-escalated in the current guideline. In addition to reducing the safety margins for surgical procedures, the guideline also recommends reducing the radicality of axillary surgery. The choice and extent of systemic therapy depends on the respective tumor biology. New substances are becoming available, particularly to treat metastatic breast cancer.

The effects of combined exercise intervention based on Internet and social media software for postoperative patients with breast cancer: study protocol for a randomized controlled trial

BACKGROUND

Many randomized controlled trials have investigated the effects of exercise on the rehabilitation of patients with breast cancer. However, the exercise forms used in most previous studies were monotonous. Therefore, we designed a protocol to estimate the effects of combined exercise intervention using Internet and social media software on the rehabilitation of postoperative patients with BC.

METHODS/DESIGN

This study protocol is a randomized control trial with an intervention time of 12 weeks. After completing baseline questionnaire and physical fitness tests, the participants are randomized to the study group or the control group. Procedure contents of exercise intervention in the study group include: via phone step-recording app, ask the individuals to complete the target number of steps within a specified period of exercise, four times per week; face-to-face remote video guidance of individuals on muscle training, three times per week; common knowledge of physical exercise BC rehabilitation will be pushed regularly by social media apps every day. The control group will receive normal treatment and rehabilitation according to daily specifications of the hospital. The primary outcome will be the quality of life. The secondary outcomes are physical fitness and social cognitive indicators.

DISCUSSION

This study is a clinical trial to estimate the effects of combined exercise intervention based on the Internet and social media software for postoperative patients with breast cancer (BC). If expected results are achieved in this study, measures and methods of BC rehabilitation will be enriched.

TRIAL REGISTRATION

Chinese Clinical Trial Register, ChiCTR-IPR-17012368 . Registered on 14 August 2017.

Does Exercise Have a Preventive Effect on Secondary Lymphedema in Breast Cancer Patients Following Local Treatment? - A Systematic Review

Background

Secondary lymphedema (SL) is a possible side effect of breast cancer treatment. Current data describe a positive influence of exercise on upper lymphedema. This systematic review evaluates studies examining a potential preventive effect of exercise on SL incidence.

Methods

A systematic literature search of PubMed, LIVIVO, and the Cochrane Library was performed.

Results

8 randomized controlled trials were included in the review. 3 studies investigated the effect of strength training, and 5 the effect of combined exercise therapy. 5 studies included participants without lymphedema at study entry, and 3 studies included both patients with and without lymphedema. The partly significant results showed that progressive strength training as well as combined dynamic exercise therapies consisting of physiotherapy, physical therapy, and/or kinesiotherapy are safe and can prevent SL. Onset as well as diagnosis of lymphedema were significantly decreased in 5 studies in the exercise group.

Conclusion

All 8 studies included indicate a potential preventive effect of exercise on SL; however, further research is needed.

Exercise in the Prevention and Treatment of Breast Cancer: What Clinicians Need to Tell Their Patients

In 2016, nearly a quarter-million women were diagnosed with invasive breast cancer, the second deadliest cancer type. Lifestyle behaviors are well-established risk factors for both the development of, and negative outcomes from, breast cancer. New findings demonstrate that engaging in even minimal amounts of exercise is protective against breast cancer. Further, numerous studies have identified the role of exercise in the treatment of breast cancer and improvement in treatment side effects, quality of life, and overall survival. Unfortunately, few patients are physically active due to multiple barriers. Physicians may be helpful in engaging patients in being more active. Further research is necessary to identify programs and approaches to help patients both with, and at-risk for, breast cancer to engage in exercise.