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Guo Y, Su J, Jiang S, Xu Y, Dou B, Li T, Zhu J, He K. Transcriptomics and metabonomics study on the effect of exercise combined with curcumin supplementation on breast cancer in mice. Heliyon 2024; 10:e28807. [PMID: 38576560 PMCID: PMC10990956 DOI: 10.1016/j.heliyon.2024.e28807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
Curcumin and exercise have been reported to show good anti-tumour effects. However, relevant research on the combined effects of physical exercise and curcumin supplementation on cancer and the underlying mechanisms is still lacking. The current study aimed to construct an anti-breast tumour mouse model using the combined effects of curcumin treatment and swimming exercise. Transcriptomic and metabolomic techniques were used to screen for differentially expressed genes and metabolites, evaluate the anticancer effects, and analyse the molecular regulatory mechanisms related to metabolism. Observation of the mouse phenotypes, including tumour appearance, in-vivo tumour imaging, and HE staining results of pathological sections, suggested a more obvious inhibitory effect of the combination of curcumin administration and exercise intervention on breast cancer than that of a single treatment. The combination treatment group had a total of 445 differentially expressed (154 upregulated and 291 downregulated) genes. Functional enrichment analysis showed the calcium signalling pathway, Wnt signalling pathway, PI3K Akt signalling pathway, and IL-17 signalling pathway to significantly participate in the anti-breast cancer process of curcumin-exercise combination treatment. Results of the intergroup differential metabolite analysis showed that the combined effect of curcumin and exercise involves two unique pathways, namely the amino sugar and nucleotide sugar metabolism, which includes chitosan, d-glucosamine 6-phosphate, l-fucose, and N-acetyl beta-mannosamine, and the amino acid biosynthesis, which includes dl-isoleucine, dl-tyrosine, and homocysteine. Collectively, the top-ranked genes and metabolites with the highest degree of associations were further revealed by O2PLS analysis. Overall, the study helped reveal the mechanism of action of curcumin-exercise combination treatment on breast cancer at multi-omics level.
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Affiliation(s)
- Yong Guo
- Post-doctoral Research Station, Harbin Sport University, Harbin, Heilongjiang, 150008, China
| | - Jinxing Su
- Center for Stem Cell and Translational Medicine, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
- Traditional Chinese Medicine Research Centre, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
| | - Shangquan Jiang
- Center for Stem Cell and Translational Medicine, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
- Traditional Chinese Medicine Research Centre, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
| | - Yan Xu
- School of Sports Human Science, Harbin Sport University, Harbin, Heilongjiang, 150008, China
| | - Binbin Dou
- Graduate School, Harbin Sport University, Harbin, Heilongjiang, 150008, China
| | - Ting Li
- School of Sports Human Science, Harbin Sport University, Harbin, Heilongjiang, 150008, China
| | - Jiabin Zhu
- Winter Olympics Academy, Harbin Sport University, Harbin, Heilongjiang, 150008, China
| | - Kan He
- Center for Stem Cell and Translational Medicine, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
- Traditional Chinese Medicine Research Centre, School of Life Sciences, Anhui University, Hefei, Anhui, 230600, China
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Li C, Zhong X, Ardekani AM. Numerical studies of the lymphatic uptake rate. Comput Biol Med 2023; 165:107380. [PMID: 37634464 DOI: 10.1016/j.compbiomed.2023.107380] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/29/2023] [Accepted: 08/14/2023] [Indexed: 08/29/2023]
Abstract
Lymphatic uptake is essential for transporting nutrients, wastes, immune cells, and therapeutic proteins. Despite its importance, the literature lacks a quantitative analysis of the factors that affect lymphatic uptake, including interstitial pressure, downstream pressure, and tissue deformation. In this paper, we present a coupled model of a poroelastic tissue with initial lymphatics and quantify the impact of these factors on the rate of lymphatic uptake. Our results indicate that the lymphatic uptake increases with the amplitude of the oscillating downstream pressure when the amplitude exceeds a threshold. Additionally, the cross-sectional area of initial lymphatics increases with the volumetric strain of the tissue, while the interstitial pressure increases when the strain rate becomes negative. Therefore, the lymphatic uptake reaches its maximum when the tissue has positive volumetric strain while being compressed. We have also investigated the effect of intersection angles and positions of two initial lymphatics and concluded that they have minor impacts on lymphatic uptake. However, the lymphatic uptake per unit length of initial lymphatics decreases with their total length. These findings advance our understanding of lymphatic uptake and can guide the development of strategies to accelerate the transport of therapeutics.
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Affiliation(s)
- Chenji Li
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States
| | - Xiaoxu Zhong
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States
| | - Arezoo M Ardekani
- School of Mechanical Engineering, Purdue University, West Lafayette, IN 47906, United States.
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Aguilera-Eguía RA, Gutiérrez-Arias R, Zaror C, Seron P. Effectiveness of physical exercise programmes in reducing complications associated with secondary lymphoedema to breast cancer: a protocol for an overview of systematic reviews. BMJ Open 2023; 13:e071630. [PMID: 37429694 DOI: 10.1136/bmjopen-2023-071630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/12/2023] Open
Abstract
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.
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Affiliation(s)
- Raúl Alberto Aguilera-Eguía
- Departamento de Salud Pública, Facultad de Medicina, Universidad Católica de la Santísima Concepción, Concepcion, Chile
- Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ruvistay Gutiérrez-Arias
- Departamento de Apoyo en Rehabilitación Cardiopulmonar Integral, Instituto Nacional del Tórax, Santiago, Chile
- Exercise and Rehabilitation Sciences Institute, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago 7591538, Santiago, Chile
| | - Carlos Zaror
- Pediatric Dentist and Orthodontic, Universidad de La Frontera, Temuco, Chile
| | - Pamela Seron
- CIGES, Universidad de La Frontera, Temuco, Chile
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Abstract
Wilderness medicine (WM) and lifestyle medicine (LM) both aim to use creative methods to promote health. The purpose of this review is to elucidate the effects of wilderness environments on health and elaborate on the intersections of WM and LM. The three theories describing potential mechanisms of health promotion in the wilderness environment-biophilia theory, stress reduction theory (SRT), and attention restoration theory (ART)-are presented. Activity in the wilderness environment is associated with improved cardiovascular fitness and cognitive performance, better sleep/wake cycles when not at altitude or extremely cold weather, better stress management, positive social interactions, and avoidance of risky substances. Wilderness is medicine and may be used as such to promote vigor and vitality in our patients.
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Affiliation(s)
- Michael S. Moore
- Medical Laboratory Sciences, Weber State University, Ogden, UT, USA (MSM)
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Rose GL, Stewart EM, Clifford BK, Bailey TG, Rush AJ, Abbott CR, Hayes SC, Obermair A, McCarthy AL. Efficacy of exercise interventions for women during and after gynaecological cancer treatment - a systematic scoping review. Support Care Cancer 2023; 31:342. [PMID: 37195433 DOI: 10.1007/s00520-023-07790-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 05/01/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To systematically synthesise evidence of exercise intervention efficacy for physical/psychosocial outcomes that matter to women during/following treatment for gynaecological cancer. METHODS Five databases were searched (PubMed, EMBASE, CINAHL, PsychInfo, Scopus). Exercise-only intervention studies that included women during/ following treatment for any gynaecological cancer, with/ without control comparison, on any physical or psychosocial outcome(s), were included and qualitatively appraised using the Revised Cochrane Risk of Bias tool and a modified Newcastle-Ottawa Scale. RESULTS Seven randomised controlled trials (RCTs), three single-arm pre-post studies, and one prospective cohort study satisfied were included (11 studies). Most studies were completed following treatment (91%), included combined (aerobic and resistance; 36%) and aerobic (36%) training, were fully/mostly (63%) unsupervised, and had a moderate-to-high risk of bias. Overall, 33 outcomes (64% objectively-measured) were assessed. Improvements were observed in aerobic capacity (V̇O2 Peak +1.6 mL/kg/min, 6-minute walk distance +20-27 m), lower- (30-second sit-to-stand +2-4 repetitions) and upper-limb strength (30-second arm curl +5 repetitions; 1RM grip strength/chest press +2.4-3.1 kg), and agility (timed up-and-go -0.6 seconds). However, changes in quality of life, anthropometry/body composition, balance and flexibility were inconsistent. There was no evidence to support worsening of outcomes. CONCLUSION Preliminary research into the role of exercise post-gynaecological cancer suggests an improvement in exercise capacity, muscular strength, and agility which, in the absence of exercise, typically decline following gynaecological cancer. Future exercise trials involving larger and more diverse gynaecological cancer samples will improve understanding of the potential and magnitude of effect of guideline-recommended exercise on outcomes that matter to patients.
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Affiliation(s)
- Grace Laura Rose
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia.
- School of Health, University of the Sunshine Coast, Sippy Downs, Australia.
| | - Elizabeth Mary Stewart
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
| | - Briana Kristine Clifford
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Alexandra Jane Rush
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Claudia Rose Abbott
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Andreas Obermair
- School of Medicine, The University of Queensland, Brisbane, Australia
- Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- Mater Research Institute, Brisbane, Australia
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Donahue PMC, MacKenzie A, Filipovic A, Koelmeyer L. Advances in the prevention and treatment of breast cancer-related lymphedema. Breast Cancer Res Treat 2023; 200:1-14. [PMID: 37103598 DOI: 10.1007/s10549-023-06947-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/06/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Breast cancer-related lymphedema (BCRL) represents a lifelong risk for breast cancer survivors and once acquired becomes a lifelong burden. This review summarizes current BCRL prevention and treatment strategies. FINDINGS Risk factors for BCRL have been extensively studied and their identification has affected breast cancer treatment practice, with sentinel lymph node removal now standard of care for patients with early stage breast cancer without sentinel lymph node metastases. Early surveillance and timely management aim to reduce BCRL incidence and progression, and are further facilitated by patient education, which many breast cancer survivors report not having adequately received. Surgical approaches to BCRL prevention include axillary reverse mapping, lymphatic microsurgical preventative healing (LYMPHA) and Simplified LYMPHA (SLYMPHA). Complete decongestive therapy (CDT) remains the standard of care for patients with BCRL. Among CDT components, facilitating manual lymphatic drainage (MLD) using indocyanine green fluorescence lymphography has been proposed. Intermittent pneumatic compression, nonpneumatic active compression devices, and low-level laser therapy appear promising in lymphedema management. Reconstructive microsurgical techniques such as lymphovenous anastomosis and vascular lymph node transfer are growing surgical considerations for patients as well as liposuction-based procedures for addressing fatty fibrosis formation from chronic lymphedema. Long-term self-management adherence remains problematic, and lack of diagnosis and measurement consensus precludes a comparison of outcomes. Currently, no pharmacological approaches have proven successful. CONCLUSION Progress in prevention and treatment of BCRL continues, requiring advances in early diagnosis, patient education, expert consensus and novel treatments designed for lymphatic rehabilitation following insults.
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Affiliation(s)
- Paula M C Donahue
- Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 2201 21St Children's Way, Suite 1218, Nashville, TN, 37212, USA.
- Dayani Center for Health and Wellness, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - Adrien MacKenzie
- Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Louise Koelmeyer
- Faculty of Medicine, Health, and Human Sciences, Australian Lymphoedema Education, Research, and Treatment (ALERT), Macquarie University, Sydney, Australia
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Jiao X, Xing FZ, Zhai MM, Sun P. Successful treatment of breast metastasis from primary transverse colon cancer: A case report. World J Clin Cases 2023; 11:2559-2566. [PMID: 37123317 PMCID: PMC10130999 DOI: 10.12998/wjcc.v11.i11.2559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 02/13/2023] [Accepted: 03/23/2023] [Indexed: 04/06/2023] Open
Abstract
BACKGROUND The incidence of colon cancer is increasing worldwide. Treatments for colon cancer include surgery and surgery combined with chemotherapy and radiotherapy, but the median survival rate is still poor. Colon cancer most commonly metastasizes to the lymph nodes, lungs, liver, peritoneum, and brain, but breast metastasis is rare. There is no agreement on its treatment.
CASE SUMMARY A 23-year-old woman was admitted to our hospital for further treatment with a history of acute abdominal pain, nausea, and vomiting. Her physical examination and computed tomography scan revealed an abdominal tumor. Transverse colectomy was successfully performed. Histopathological examination revealed that the tumor was a mucosecretory adenocarcinoma with signet ring cells. The patient inadvertently found a mass in the outer upper quadrant of the right breast after four cycles of XELOX chemotherapy [oxaliplatin 130 mg/m2, d1, intravenous (iv) drip for 2 h; capecitabine 1000 mg/m2, po, bid, d1–d14]. After discussion with the patient, we performed a lumpectomy and frozen biopsy. The latter revealed that the breast tumor was intestinal metastasis. Genetic testing showed wild-type RAS and BRAF. So we replaced the original chemotherapy with FOLFIRI [irinotecan 180 mg/m2, d1, iv drip for 3–90 min; leucovorin 400 mg/m2, d1, iv drip for 2 h; 5-fluorouracil (5-FU) 400 mg/m2, d1 and 5-FU 1200 mg/(m2 d) × 2 d, continuous iv drip for 46–48 h] + cetuximab (500 mg/m2, d1, iv drip for 2 h). Serum levels of tumor markers returned to normal after several treatment cycles, and there was no evidence of tumor recurrence or metastasis.
CONCLUSION Breast metastasis from colon cancer is rare. Radical breast surgery should be avoided unless needed for palliation. Chemotherapy combined with targeted therapy should be the first choice.
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Affiliation(s)
- Xin Jiao
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261041, Shandong Province, China
| | - Fang-Zhou Xing
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261041, Shandong Province, China
| | - Mi-Mi Zhai
- Department of Digestive System, Weifang People’s Hospital, Weifang 261041, Shandong Province, China
| | - Peng Sun
- Department of Gastrointestinal Surgery, Affiliated Hospital of Weifang Medical University, Weifang 261041, Shandong Province, China
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Li Y, Meng Q, Luo B, Li M, Fang J, Allred SR, Fu MR. Exercises in activating lymphatic system on fluid overload symptoms, abnormal weight gains, and physical functions among patients with heart failure: A randomized controlled trial. Front Cardiovasc Med 2023; 10:1094805. [PMID: 37113700 PMCID: PMC10126351 DOI: 10.3389/fcvm.2023.1094805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 03/27/2023] [Indexed: 04/29/2023] Open
Abstract
Background Fluid overload remains a vexing problem in management of heart failure. The lymphatic system that plays the central role in fluid homeostasis has recently been explored as a potential target to counteract tissue fluid overload. The goal of the study was to evaluate the preliminary effects of exercises in activating lymphatic system on fluid overload symptoms, abnormal weight gains, and physical functions for patients with heart failure. Methods and results A pilot, pre- and post-test, randomized clinical trial was conducted to recruit a total of 66 patients who were randomized to receive either a 4-week The-Optimal-Lymph-Flow for Heart Failure (TOLF-HF) program or usual care alone. The primary outcome was the prevalence and burden of the fluid overload symptoms. Findings of the trial showed that the TOLF-HF intervention was effective in reducing the prevalence or burden of the majority of fluid overload symptoms. TOLF-HF intervention also demonstrated significant improvement in the outcomes of abnormal weight gains (MD: -0.82; 95% CI: -1.43 to -0.21; P = 0.010) and physical functions (F = 13.792, P < 0.001). Conclusions The TOLF-HF program focusing on activating lymphatic system through the performance of therapeutic lymphatic exercises holds the promise as an adjuvant therapy for patients with heart failure to manage fluid overload symptoms, reduce abnormal weight gains, and improve physical functions. Future larger-scale study with longer duration of follow-up is needed. Clinical Trial Registration http://www.chictr.org.cn/index.aspx, identifier ChiCTR2000039121.
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Affiliation(s)
- Yuan Li
- Department of Neonatology, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Qingtong Meng
- Department of Cardiology, Shenzhen People's Hospital, Shenzhen, China
| | - Biru Luo
- Department of Nursing, West China Second University Hospital, Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China
| | - Minlu Li
- West China School of Nursing, Sichuan University, Chengdu, China
- General Ward of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Jinbo Fang
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Sarah R. Allred
- Department of Psychology and Health Sciences, The State University of New Jersey, Camden, NJ, United States
| | - Mei Rosemary Fu
- School of Nursing, George Washington University, Washington, DC, United States
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Wagoner CW, Capozzi LC, Culos-Reed SN. Tailoring the Evidence for Exercise Oncology within Breast Cancer Care. Curr Oncol 2022; 29:4827-4841. [PMID: 35877243 PMCID: PMC9322354 DOI: 10.3390/curroncol29070383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/24/2022] Open
Abstract
Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels throughout the breast cancer continuum, highlighting the lack of translation from research into practice. In addition, discerning how exercise can be tailored to address breast cancer-related impairments, so that individuals are able to participate safely and effectively, has also not been studied extensively. Thus, we propose that implementing exercise screening, triage, and referral pathways across the breast cancer continuum may allow for increased accessibility and adoption among those living with and beyond breast cancer. This paper provides an overview of exercise prescription tailoring for common breast cancer and treatment-related impairments, proposes a simplified screening tool for identifying physical activity and movement-related impairments, and considers how best to channel evidence into practice via proposed implementation pathways that may better connect individuals living with and beyond breast cancer with exercise oncology resources through screening, triage, and referral.
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Affiliation(s)
- Chad W. Wagoner
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.W.W.); (L.C.C.)
| | - Lauren C. Capozzi
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.W.W.); (L.C.C.)
- Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.W.W.); (L.C.C.)
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Cancer Care, Alberta Health Services, Calgary, AB T2N 4N2, Canada
- Correspondence:
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Ramírez-Parada K, Lopez-Garzon M, Sanchez-Rojel C, Petric-Guajardo M, Alfaro-Barra M, Fernández-Verdejo R, Reyes-Ponce A, Merino-Pereira G, Cantarero-Villanueva I. 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). Front Oncol 2022; 12:850564. [PMID: 35299753 PMCID: PMC8921986 DOI: 10.3389/fonc.2022.850564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 02/01/2022] [Indexed: 01/31/2023] Open
Abstract
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.
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Affiliation(s)
- Karol Ramírez-Parada
- Carrera de Kinesiología, Departamento Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Maria Lopez-Garzon
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Cesar Sanchez-Rojel
- Departamento de Hematología-Oncología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Militza Petric-Guajardo
- Department of Surgery Dr Sótero del Río Hospital, Santiago, Chile
- Department of Surgery Davila Clinic, Santiago, Chile
| | - Margarita Alfaro-Barra
- Centro de Cáncer, Red de Salud U- Christus, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Rodrigo Fernández-Verdejo
- Laboratorio de Fisiología del Ejercicio y Metabolismo (LABFEM), Escuela de Kinesiología, Facultad de Medicina, Universidad Finis Terrae, Santiago, Chile
| | - Alvaro Reyes-Ponce
- Escuela de Kinesiología, Facultad de Ciencias de la Rehabilitación, Universidad Andrés Bello, Viña del Mar, Chile
| | - Gina Merino-Pereira
- Departamento Manejo Integral del Cáncer y Otros Tumores, Subsecretaria de Salud Pública, Ministerio de Salud de Chile, Santiago, Chile
- Escuela de Medicina, Facultad de Ciencias, Universidad Mayor, Santiago, Chile
- Instituto de Investigación y Postgrado, Facultad de Ciencias de la Salud, Universidad Central de Chile, Santiago, Chile
| | - Irene Cantarero-Villanueva
- 'Cuídate' From Biomedical Group (BIO277), Instituto de Investigación Biosanitaria (ibs.GRANADA), Granada, Spain
- Department of Physical Therapy, Faculty of Health Sciences, University of Granada, Granada, Spain
- Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
- Sport and Health Research Center (iMUDS), Granada, Spain
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Bruce J, Mazuquin B, Mistry P, Rees S, Canaway A, Hossain A, Williamson E, Padfield EJ, Lall R, Richmond H, Chowdhury L, Lait C, Petrou S, Booth K, Lamb SE, Vidya R, Thompson AM. Exercise to prevent shoulder problems after breast cancer surgery: the PROSPER RCT. Health Technol Assess 2022; 26:1-124. [PMID: 35220995 DOI: 10.3310/jknz2003] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Upper limb problems are common after breast cancer treatment. OBJECTIVES To investigate the clinical effectiveness and cost-effectiveness of a structured exercise programme compared with usual care on upper limb function, health-related outcomes and costs in women undergoing breast cancer surgery. DESIGN This was a two-arm, pragmatic, randomised controlled trial with embedded qualitative research, process evaluation and parallel economic analysis; the unit of randomisation was the individual (allocated ratio 1 : 1). SETTING Breast cancer centres, secondary care. PARTICIPANTS Women aged ≥ 18 years who had been diagnosed with breast cancer and were at higher risk of developing shoulder problems. Women were screened to identify their risk status. INTERVENTIONS All participants received usual-care information leaflets. Those randomised to exercise were referred to physiotherapy for an early, structured exercise programme (three to six face-to-face appointments that included strengthening, physical activity and behavioural change strategies). MAIN OUTCOME MEASURES The primary outcome was upper limb function at 12 months as assessed using the Disabilities of Arm, Hand and Shoulder questionnaire. Secondary outcomes were function (Disabilities of Arm, Hand and Shoulder questionnaire subscales), pain, complications (e.g. wound-related complications, lymphoedema), health-related quality of life (e.g. EuroQol-5 Dimensions, five-level version; Short Form questionnaire-12 items), physical activity and health service resource use. The economic evaluation was expressed in terms of incremental cost per quality-adjusted life-year and incremental net monetary benefit gained from an NHS and Personal Social Services perspective. Participants and physiotherapists were not blinded to group assignment, but data collectors were blinded. RESULTS Between 2016 and 2017, we randomised 392 participants from 17 breast cancer centres across England: 196 (50%) to the usual-care group and 196 (50%) to the exercise group. Ten participants (10/392; 3%) were withdrawn at randomisation and 32 (8%) did not provide complete baseline data. A total of 175 participants (89%) from each treatment group provided baseline data. Participants' mean age was 58.1 years (standard deviation 12.1 years; range 28-88 years). Most participants had undergone axillary node clearance surgery (327/392; 83%) and 317 (81%) had received radiotherapy. Uptake of the exercise treatment was high, with 181 out of 196 (92%) participants attending at least one physiotherapy appointment. Compliance with exercise was good: 143 out of 196 (73%) participants completed three or more physiotherapy sessions. At 12 months, 274 out of 392 (70%) participants returned questionnaires. Improvement in arm function was greater in the exercise group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 16.3 (standard deviation 17.6)] than in the usual-care group [mean Disabilities of Arm, Hand and Shoulder questionnaire score of 23.7 (standard deviation 22.9)] at 12 months for intention-to-treat (adjusted mean difference Disabilities of Arm, Hand and Shoulder questionnaire score of -7.81, 95% confidence interval -12.44 to -3.17; p = 0.001) and complier-average causal effect analyses (adjusted mean difference -8.74, 95% confidence interval -13.71 to -3.77; p ≤ 0.001). At 12 months, pain scores were lower and physical health-related quality of life was higher in the exercise group than in the usual-care group (Short Form questionnaire-12 items, mean difference 4.39, 95% confidence interval 1.74 to 7.04; p = 0.001). We found no differences in the rate of adverse events or lymphoedema over 12 months. The qualitative findings suggested that women found the exercise programme beneficial and enjoyable. Exercise accrued lower costs (-£387, 95% CI -£2491 to £1718) and generated more quality-adjusted life years (0.029, 95% CI 0.001 to 0.056) than usual care over 12 months. The cost-effectiveness analysis indicated that exercise was more cost-effective and that the results were robust to sensitivity analyses. Exercise was relatively cheap to implement (£129 per participant) and associated with lower health-care costs than usual care and improved health-related quality of life. Benefits may accrue beyond the end of the trial. LIMITATIONS Postal follow-up was lower than estimated; however, the study was adequately powered. No serious adverse events directly related to the intervention were reported. CONCLUSIONS This trial provided robust evidence that referral for early, supported exercise after breast cancer surgery improved shoulder function in those at risk of shoulder problems and was associated with lower health-care costs than usual care and improved health-related quality of life. FUTURE WORK Future work should focus on the implementation of exercise programmes in clinical practice for those at highest risk of shoulder problems. TRIAL REGISTRATION This trial is registered as ISRCTN35358984. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 15. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Julie Bruce
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Bruno Mazuquin
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Pankaj Mistry
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sophie Rees
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Alastair Canaway
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Anower Hossain
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Institute of Statistical Research and Training (ISRT), University of Dhaka, Dhaka, Bangladesh
| | - Esther Williamson
- Centre for Rehabilitation Research, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Emma J Padfield
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Ranjit Lall
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Helen Richmond
- Primary Healthcare Research Unit, Faculty of Medicine, Memorial University of Newfoundland, St John's, NL, Canada
| | - Loraine Chowdhury
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Clare Lait
- Gloucestershire Care Services NHS Trust, Gloucester, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Katie Booth
- Warwick Clinical Trials Unit, Division of Health Sciences, University of Warwick, Coventry, UK
| | - Sarah E Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
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12
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Lee DG, Lee S, Kim KT. Computed Tomography-Based Quantitative Analysis of Fibrotic Changes in Skin and Subcutaneous Tissue in Lower Extremity Lymphedema Following Gynecologic Cancer Surgery. Lymphat Res Biol 2022; 20:488-495. [PMID: 35012367 DOI: 10.1089/lrb.2021.0069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Lymphedema produces protein-rich fluids that aggravate inflammation in the skin and subcutaneous tissue. Inflammation then induces fibroadipose tissue deposition and fibrosis. However, few methods have been developed to evaluate the severity of fibrosis. Therefore, we aimed to evaluate the subcutaneous fibrotic changes in lower extremity lymphedema following gynecologic cancer surgery using an image analysis tool, the FIJI software. Methods and Results: Seventy-four patients with lymphedema following gynecologic surgery were enrolled in this study. We quantitatively analyzed the cross-sectional area (CSA) of soft tissue compartments, including subcutaneous tissue with the skin, muscle volume, fibrotic changes in subcutaneous tissue, and the perimeter of skin boundaries. The limb circumference and the CSA of the subcutaneous tissue and skin on the affected side were significantly larger than those on the unaffected side. Fibrotic changes showed the same trend. However, muscle volume patterns were different from those of the other compartments. Some patients showed lower muscle volume on the unaffected side than on the affected side. Circumference and cellulitis significantly affected the extent of fibrotic changes in the skin and subcutaneous tissues. Age and duration of lymphedema did not affect fibrosis. Conclusion: Fibrosis of subcutaneous regions with the skin can be quantitatively calculated using an image analysis tool in lower extremity lymphedema following gynecologic cancer surgery. Edema and cellulitis increase fibrotic changes in the subcutaneous tissue with the skin.
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Affiliation(s)
- Dong Gyu Lee
- Department of Physical Medicine and Rehabilitation, Yeungnam University College of Medicine, Daegu, Korea
| | - Soyoung Lee
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Kyoung Tae Kim
- Department of Rehabilitation Medicine, Keimyung University School of Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
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13
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Korsholm-Rosfort T, Larsen S, Aagaard T, Ammitzbøll G, Dalton SO. Interrater Reliability of Dynamic Muscle Testing After Breast Cancer Surgery in Women at High Risk of Lymphedema: To Improve Quality in Clinical Practice. Integr Cancer Ther 2021; 19:1534735420903801. [PMID: 32108545 PMCID: PMC7052446 DOI: 10.1177/1534735420903801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The purpose of this study is to determine the interrater reliability of dynamic muscle tests in the early rehabilitation phase in women after breast cancer surgery with axillary lymph node dissection (ALND) based on the "preventive intervention against lymphedema after breast cancer" (LYCA) randomised controlled trial. Methods: Fifteen women treated with breast cancer surgery including ALND were recruited from participants in the LYCA trial. In this interrater reliability study, women were tested in 4 dynamic muscle tests by 2 physiotherapists at a Capital Hospital in Denmark. Intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs) was used to assess the relative reliability between raters. A Bland-Altman plot and limits of agreement were calculated to describe the absolute reliability. Results: All 6 subtests displayed high interrater reliability. ICC values were: leg press 0.96 (95% CI = 0.87-0.99), elbow flexion (contralateral) 0.94 (0.83-0.98), elbow flexion (affected arm) 0.93 (0.80-0.98), elbow extension 0.80 (0.41-0.93), shoulder abduction (contralateral) 0.89 (0.68-0.96), and shoulder abduction (affected arm) 0.91 (0.74-0.97). Cumulated interrater reliability for the test battery was very high (ICC = 0.99, 95% CI = 0.990-1.0). The absolute reliability of this study was considered high, and the absence of large shifts between mean and the line of 0 difference suggest no systematic bias that could influence clinical interpretation. Conclusions: The dynamic muscle tests evaluated in this study had high interrater reliability and can be used reliably in women in the postoperative phase after breast cancer surgery with ALND.
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Affiliation(s)
- Tina Korsholm-Rosfort
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Denmark
| | - Simone Larsen
- Department of Physiotherapy and Occupational Therapy, Faculty of Health and Technology, University College Copenhagen, Denmark
| | - Thomas Aagaard
- Department of Physio- and Occupational Therapy, Holbaek Hospital, Denmark.,Department of Orthopedic Surgery, Holbaek Hospital, Denmark.,4Department of Orthopedic Surgery, Zealand University Hospital, Denmark
| | - Gunn Ammitzbøll
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.,Survivorship and Equality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
| | - Susanne O Dalton
- Danish Research Center for Equality in Cancer (COMPAS), Zealand University Hospital, Naestved, Denmark.,Survivorship and Equality in Cancer, Danish Cancer Society Research Center, Copenhagen, Denmark
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14
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Hayes S, Singh B, Bloomquist K, Johansson K. Do Women with Breast Cancer–related Lymphoedema Need to Wear Compression While Exercising?: Results from a Systematic Review and Meta-analysis. CURRENT BREAST CANCER REPORTS 2020. [DOI: 10.1007/s12609-020-00373-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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15
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Edwick DO, Hince DA, Rawlins JM, Wood FM, Edgar DW. Bioimpedance Spectroscopy Is a Valid and Reliable Measure of Edema Following Hand Burn Injury (Part 1-Method Validation). J Burn Care Res 2020; 41:780-787. [PMID: 32386214 DOI: 10.1093/jbcr/iraa071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
The assessment of swelling following burn injury is complicated by the presence of wounds and dressings and due to patients experiencing significant pain and impaired movement. There remains a lack of sensitive objective measures for edema in patients presenting with hand burn injury. Bioimpedance spectroscopy (BIS) is a measure of body composition that has been demonstrated by our group to be reliable for measuring whole body and limb edema during resuscitation and to be sensitive to edema changes within healing wounds. The aim of this study was to determine the reliability and validity of BIS as a measure of edema following hand burn injury specifically. One hundred patients presenting with burn injury including a portion of a hand were recruited to this trial. Repeated measures of the hand were recorded using a novel application of BIS and in parallel with water displacement volumetry (WDV). The results were analyzed using mixed-effects regressions. Paired repeated measures were obtained for 195 hands, using four electrode configurations. BIS demonstrated high reliability in measuring hand BIS-Intraclass Correlation Coefficient 0.995 to 0.999 (95% CI 0.992-1.000) and sensitivity-Minimum Detectable Difference 0.74 to 3.86 Ω (0.09-0.48 Ω/cm). A strong correlation was shown with WDV, Pearson's r = -0.831 to -0.798 (P < .001). BIS is a sensitive and reliable measure of edema following acute hand burn injury.
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Affiliation(s)
- Dale O Edwick
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia.,School of Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
| | - Dana A Hince
- Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia
| | - Jeremy M Rawlins
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Department of Plastic and Maxillofacial Surgery, Royal Perth Hospital, Australia
| | - Fiona M Wood
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, Australia
| | - Dale W Edgar
- State Adult Burns Unit, Fiona Stanley Hospital, Murdoch, Australia.,Fiona Wood Foundation, Fiona Stanley Hospital, Murdoch, Australia.,Burn Injury Research Node, The University of Notre Dame Australia, Fremantle, Australia.,Institute of Health Research, The University of Notre Dame Australia, Fremantle, Australia.,Burn Injury Research Unit, University of Western Australia, Perth, Australia
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16
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Bohn-Goldbaum E, Pascoe A, Singh MF, Singh N, Kok J, Dwyer DE, Mathieson E, Booy R, Edwards KM. Acute exercise decreases vaccine reactions following influenza vaccination among older adults. Brain Behav Immun Health 2020; 1:100009. [PMID: 38377422 PMCID: PMC8474530 DOI: 10.1016/j.bbih.2019.100009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 10/13/2019] [Indexed: 11/30/2022] Open
Abstract
Although valuable and effective in decreasing disease burden, influenza vaccination has low rates of efficacy, especially in those at most risk. Studies have shown that acute exercise can improve vaccine responses, most consistently with weaker antigens. Here we examined the effect of resistance exercise on the acute and longer-term responses to influenza vaccination among healthy older adults. Forty-six participants (47.8% male, mean 73.4 ± 6.6 years) were randomised to perform one 45-min moderate-intensity resistance exercise session or sit quietly prior to the receipt of influenza vaccination. Acute exercise reduced vaccine reactions but had no effect on either antibody responses or development of influenza-like symptoms during six months of follow-up. Psychosocial and behavioural characteristics were examined for potential associations with the responses to vaccination. Participants (n = 36) vaccinated in the previous year had higher baseline antibody titres but not follow-up titres nor more frequent experience of influenza-like symptoms over 6 months compared to those unvaccinated in the previous year. These findings provide further support for the ability of acute exercise to reduce vaccine reactions and suggest risk factors for vaccine responses for future exploration.
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Affiliation(s)
- Erika Bohn-Goldbaum
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
| | - April Pascoe
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
| | - Maria Fiatarone Singh
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
- The University of Sydney, Faculty of Health Sciences, Physical Activity, Lifestyle, Ageing and Wellbeing Research Group, Lidcombe, Australia
- Hebrew SeniorLife and Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University, Boston, MA, USA
| | - Nalin Singh
- The Centre for STRONG Medicine, Pymble, NSW, Australia
| | - Jen Kok
- Institute for Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital and University of Sydney, Sydney, Australia
| | - Dominic E. Dwyer
- Institute for Clinical Pathology and Medical Research, NSW Health Pathology, Westmead Hospital and University of Sydney, Sydney, Australia
| | | | - Robert Booy
- The University of Sydney, National Centre for Immunisation Research and Surveillance of Vaccine Preventable Diseases, Sydney, Australia
| | - Kate M. Edwards
- The University of Sydney, Faculty of Health Sciences and Charles Perkins Centre, Sydney, Australia
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17
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Swift LA, Christensen BW, Samocha MB, le Jeune SS, Millares-Ramirez EM, Dujovne GA. Randomized Comparative Trial of Acupuncture and Exercise Versus Uterine Ecbolics in the Treatment of Persistent Postbreeding Endometritis in Mares. J Equine Vet Sci 2019; 86:102821. [PMID: 32067656 DOI: 10.1016/j.jevs.2019.102821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 08/28/2019] [Accepted: 10/28/2019] [Indexed: 10/25/2022]
Abstract
Although exercise and acupuncture are frequently used therapies to treat persistent postbreeding endometritis, their efficacy to date is unproven. The objective of this study was to determine if exercise and acupuncture are effective methods to reduce intrauterine fluid and compare the effectiveness of these treatments to the use of uterine ecbolics. Twelve mares susceptible to postbreeding endometritis were enrolled in the study with a randomized cross-over design using both positive and negative controls. During each estrous cycle, mares were randomized into one of six treatment groups, including stall rest (SR), oxytocin, cloprostenol, exercise, electroacupuncture, and oxytocin and exercise. Each mare was challenged with an insemination dose of 500 × 106 dead sperm at time 0 hours. Intrauterine fluid measurements were taken at 0, 4, 24, 48, 72, and 96 hours postbreeding. Associations between treatment efficacy and fluid clearance were investigated using a random-effects logistic regression model that controlled for positive uterine culture. Compared with the SR negative control, exercise was the most effective treatment and had 29.7 times increased odds of fluid clearance. The second most effective treatment was oxytocin alone, with 16.9 times increased odds of fluid clearance. This was followed by cloprostenol that had 10.6 greater odds of fluid clearance, and finally, the treatment that combined exercise with oxytocin had 8.4 times greater odds of fluid clearance. Results from this study confirm that exercise and exercise combined with oxytocin are effective methods to clear intrauterine fluid.
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Affiliation(s)
- Laura A Swift
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Bruce W Christensen
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Mollie B Samocha
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA
| | - Sarah S le Jeune
- Department of Surgical and Radiological Sciences, University of California-Davis, Davis, CA
| | | | - Ghislaine A Dujovne
- Department of Population Health and Reproduction, School of Veterinary Medicine, University of California-Davis, Davis, CA.
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18
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Bloomquist K, Oturai P, Steele ML, Adamsen L, Møller T, Christensen KB, Ejlertsen B, Hayes SC. Heavy-Load Lifting: Acute Response in Breast Cancer Survivors at Risk for Lymphedema. Med Sci Sports Exerc 2018; 50:187-195. [PMID: 28991039 PMCID: PMC5770105 DOI: 10.1249/mss.0000000000001443] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
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.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Peter Oturai
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Megan L Steele
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Karl Bang Christensen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Bent Ejlertsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
| | - Sandra C Hayes
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Copenhagen, DENMARK
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Obinu A, Gavini E, Rassu G, Maestri M, Bonferoni MC, Giunchedi P. Lymph node metastases: importance of detection and treatment strategies. Expert Opin Drug Deliv 2018; 15:459-467. [PMID: 29504430 DOI: 10.1080/17425247.2018.1446937] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Lymphatic vessels are the preferential route of most solid tumors to spread their metastases in the body. The onset of metastatic nests in draining lymph nodes (LNs) are a significant indicator of cancer progression and a dismaying sign of worsen staging. Therefore, the individuation and elimination of cancer cells within the lymphatic system (LS) are an important goal. Nevertheless, the targeting of the LS with traditional contrast agents and/or chemotherapeutics is difficult, due to its anatomical structure. For this reason, many studies on new lymphatic delivery systems have been carried out, both to improve lymphatic imaging and to selectively carry chemotherapeutics to LNs, reducing the exposure of healthy tissues to the cytotoxic substances. This is an overview of the present situation in the field of detection and treatment strategies of lymphatic metastases, taking into account the use of nano-drug delivery systems. Nanocarriers, thanks to their small size and other physicochemical characteristics, are suitable vectors for imaging and chemotherapy of the LS. AREAS COVERED The role of the LS in tumor progression and importance of treatment and imaging strategies of lymphatic metastases. EXPERT OPINION The nanoparticles are a promising approach for treatment and detection of lymphatic metastases. However further studies are necessary in order to evaluate their efficacy in human clinical application.
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Affiliation(s)
- Antonella Obinu
- a PhD in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy
| | - Elisabetta Gavini
- b Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Giovanna Rassu
- b Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
| | - Marcello Maestri
- a PhD in Experimental Medicine, Department of Clinical-Surgical, Diagnostic and Paediatric Sciences , University of Pavia , Pavia , Italy.,c Department of Surgery , IRCCS Policlinico San Matteo Foundation , Pavia , Italy
| | | | - Paolo Giunchedi
- b Department of Chemistry and Pharmacy , University of Sassari , Sassari , Italy
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20
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de Oliveira MMF, Gurgel MSC, Amorim BJ, Ramos CD, Derchain S, Furlan-Santos N, dos Santos CC, Sarian LO. Long term effects of manual lymphatic drainage and active exercises on physical morbidities, lymphoscintigraphy parameters and lymphedema formation in patients operated due to breast cancer: A clinical trial. PLoS One 2018; 13:e0189176. [PMID: 29304140 PMCID: PMC5755747 DOI: 10.1371/journal.pone.0189176] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 11/15/2017] [Indexed: 01/01/2023] Open
Abstract
PURPOSE evaluate whether manual lymphatic drainage (MLD) or active exercise (AE) is associated with shoulder range of motion (ROM), wound complication and changes in the lymphatic parameters after breast cancer (BC) surgery and whether these parameters have an association with lymphedema formation in the long run. METHODS Clinical trial with 106 women undergoing radical BC surgery, in the Women's Integrated Healthcare Center-University of Campinas. Women were matched for staging, age and body mass index and were allocated to performed AE or MLD, 2 weekly sessions during one month after surgery. The wound was evaluated 2 months after surgery. ROM, upper limb circumference measurement and upper limb lymphoscintigraphy were performed before surgery, and 2 and 30 months after surgery. RESULTS The incidence of seroma, dehiscence and infection did not differ between groups. Both groups showed ROM deficit of flexion and abduction in the second month postoperative and partial recovery after 30 months. Cumulative incidence of lymphedema was 23.8% and did not differ between groups (p = 0.29). Concerning the lymphoscintigraphy parameters, there was a significant convergent trend between baseline degree uptake (p = 0.003) and velocity visualization of axillary lymph nodes (p = 0.001) with lymphedema formation. A reduced marker uptake before or after surgery predicted lymphedema formation in the long run (>2 years). None of the lymphoscintigraphy parameters were shown to be associated with the study group. Age ≤39 years was the factor with the greatest association with lymphedema (p = 0.009). In women with age ≤39 years, BMI >24Kg/m2 was significantly associated with lymphedema (p = 0.017). In women over 39 years old, women treated with MLD were at a significantly higher risk of developing lymphedema (p = 0.011). CONCLUSION Lymphatic abnormalities precede lymphedema formation in BC patients. In younger women, obesity seems to be the major player in lymphedema development and, in older women, improving muscle strength through AE can prevent lymphedema. In essence, MLD is as safe and effective as AE in rehabilitation after breast cancer surgery.
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Affiliation(s)
| | - Maria Salete Costa Gurgel
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Bárbara Juarez Amorim
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Celso Dario Ramos
- Department of Nuclear Medicine and Radiology, University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Sophie Derchain
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Natachie Furlan-Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - César Cabello dos Santos
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
| | - Luís Otávio Sarian
- Department of Obstetrics and Gynecology- University of Campinas, School of Medicine, Campinas, São Paulo, Brazil
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Evaluation of the Upper Limb Lymphatic System: A Prospective Lymphoscintigraphic Study in Melanoma Patients and Healthy Controls. Plast Reconstr Surg 2017; 138:1321-1331. [PMID: 27537229 DOI: 10.1097/prs.0000000000002763] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Current research on the upper limb lymphatic system mainly studies breast cancer patients with unilateral lymphedema. Without preoperative lymphoscintigraphy, the contralateral limb is used as a control, assuming that it is functionally intact. Few lymphoscintigraphic studies investigate patients before any axillary surgery. The purpose of this study was to evaluate, through lymphoscintigraphy, the preoperative condition of the upper limb lymphatic system in melanoma patients and healthy controls. METHODS Two groups were studied: the study group (16 patients with trunk/upper limb melanoma candidates for axillary sentinel lymph node biopsy) and the control group (10 healthy volunteers). All subjects underwent upper limb lymphoscintigraphy. Lymphoscintigraphic images were classified into three patterns based on the tracer appearance time in the axillary nodes. Type I, 20 minutes; type II, 60 minutes; and type III, 120 minutes. Statistical analysis was used to assess the relationship between lymphoscintigraphic patterns and clinical variables and to compare patterns of distribution. RESULTS Lymphoscintigraphic patterns were asymmetric in 37.5 percent (study group) and 50 percent (control group). Type III was the most common pattern. There was no significant association between lymphoscintigraphic patterns and considered clinical variables. There was no significant difference in the lymphoscintigraphic pattern distribution of the two groups (p = 0.870). CONCLUSION The authors' findings show wide differences and an often "slow" tracer appearance time in patients with intact lymphatic system, questioning the use of contralateral limb as control and transportation time greater than 30 minutes as criteria for identification of lymphatic alterations. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, IV.
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Manual Lymphatic Drainage and Active Exercise Effects on Lymphatic Function Do Not Translate Into Morbidities in Women Who Underwent Breast Cancer Surgery. Arch Phys Med Rehabil 2016; 98:256-263. [PMID: 27519926 DOI: 10.1016/j.apmr.2016.06.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/01/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate manual lymphatic drainage (MLD) and active exercise effects on lymphatic alterations of the upper limb (UL), range of motion (ROM) of shoulder, and scar complications after breast cancer surgery. DESIGN Clinical trial. SETTING Health care center. PARTICIPANTS Women (N=105) undergoing radical breast cancer surgery who were matched for staging, age, and body mass index. INTERVENTIONS Women (n=52) were submitted to MLD and 53 to active exercises for UL for 1 month and followed up. MAIN OUTCOME MEASURES Shoulder ROM, surgical wound inspection and palpation, UL circumference measurements, and lymphoscintigraphy were performed in preoperative and postoperative periods. RESULTS There was no significant difference between groups with regard to wound healing complications, ROM, and UL circumferences. After surgery, 25 (48.1%) of the MLD group and 19 (35.8%) of the active exercise group showed worsening in radiopharmaceutical uptake velocity, whereas 9 (17.3%) of the MLD group and 11 (20.8%) of the active exercise group showed improved velocity (P=.445). With regard to uptake intensity, 27 (51.9%) of the MLD group and 21 (39.6%) of the active exercise group showed worsening whereas 7 (13.5%) of the MLD group and 7 (13.2%) of the active exercise group showed some improvement (P=.391). The presence of collateral circulation was similar in both groups at both time points evaluated. The active exercise group had a significant increase in postoperative liver absorption (P=.005), and the MLD group had a significant increase in postoperative dermal backflow (P=.024). CONCLUSIONS MLD and active exercise effects are equivalent with regard to morbidity. Minor changes in lymphatic function associated with either MLD or active exercises were not related to patients' symptoms or signs.
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Bloomquist K, Hayes S, Adamsen L, Møller T, Christensen KB, Ejlertsen B, Oturai P. A randomized cross-over trial to detect differences in arm volume after low- and heavy-load resistance exercise among patients receiving adjuvant chemotherapy for breast cancer at risk for arm lymphedema: study protocol. BMC Cancer 2016; 16:517. [PMID: 27449067 PMCID: PMC4957879 DOI: 10.1186/s12885-016-2548-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/11/2016] [Indexed: 11/22/2022] Open
Abstract
Background In an effort to reduce the risk of breast cancer-related arm lymphedema, patients are commonly advised to avoid heavy lifting, impacting activities of daily living and resistance exercise prescription. This advice lacks evidence, with no prospective studies investigating arm volume changes after resistance exercise with heavy loads in this population. The purpose of this study is to determine acute changes in arm volume after a session of low- and heavy-load resistance exercise among women undergoing adjuvant chemotherapy for breast cancer at risk for arm lymphedema. Methods/Design This is a randomized cross-over trial. Participants: Women receiving adjuvant chemotherapy for breast cancer who have undergone axillary lymph node dissection will be recruited from rehabilitation centers in the Copenhagen area. Intervention: Participants will be randomly assigned to engage in a low- (two sets of 15–20 repetition maximum) and heavy-load (three sets of 5–8 repetition maximum) upper-extremity resistance exercise session with a one week wash-out period between sessions. Outcome: Changes in extracellular fluid (L-Dex score) and arm volume (ml) will be assessed using bioimpedance spectroscopy and dual-energy x-ray absorptiometry, respectively. Symptom severity related to arm lymphedema will be determined using a visual analogue scale (heaviness, swelling, pain, tightness). Measurements will be taken immediately pre- and post-exercise, and 24- and 72-hours post-exercise. Sample size: A sample size of 20 participants was calculated based on changes in L-Dex scores between baseline and 72-hours post exercise sessions. Discussion Findings from this study are relevant for exercise prescription guidelines, as well as recommendations regarding participating in activities of daily living for women following surgery for breast cancer and who may be at risk of developing arm lymphedema. Trial registration Current Controlled Trials ISRCTN97332727. Registered 12 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2548-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kira Bloomquist
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Sandi Hayes
- Institute of Health and Biomedical Innovation, Queensland University of Technology, 60 Musk Avenue, Kelvin Grove Urban Village, Kelvin Grove, Queensland, 4059, Australia
| | - Lis Adamsen
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Tom Møller
- University Hospitals Centre for Health Research (UCSF), Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Karl Bach Christensen
- Department of Public Health; Section of Biostatistics, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
| | - Bent Ejlertsen
- DBCG, Afsnit 2501, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET, Copenhagen University Hospital, Blegdamsvej 9, 2100, Copenhagen, Denmark
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Oliveira RR, Nascimento SL, Amaral MTPD, Silva MPPE, Oliveira MMF. Influence of body mass index on the frequency of lymphedema and other complications after surgery for breast cancer. FISIOTERAPIA E PESQUISA 2016. [DOI: 10.1590/1809-2950/14743623012016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
ABSTRACT Objective: this study assessed the influence of pre-operative body mass index (BMI) has upon lymphedema, scar tissue adhesion, pain, and heaviness in the upper limb at two years after surgery for breast cancer. Methods: retrospective analysis of 631 medical records of women who underwent surgery for breast cancer and were referred to the Physiotherapy Program at Prof. Dr. José Aristodemo Pinotti Women's Hospital of the Center for Integral Women's Health Care, CAISM/UNICAMP between January 2006 and December 2007. Results: mean age of women was 56.5 years (±13.7 years) and the most part (55%) were overweight or obese, surgical stages II and III were present in 63% of women studied. Radical mastectomy was the most frequent surgery (54.4%), followed by quadrantectomy (32.1%). In the first year after surgery, there was no significant association between BMI categories and incidence of scar tissue adhesion, pain, heaviness and lymphedema. In the second year, overweight and obese women had higher rates of heaviness in the upper limb and lymphedema. For lymphedema, there was a significant difference among BMI categories (p=0.0268). Obese women are 3.6 times more likely to develop lymphedema in the second year after surgery (odds ratio 3.61 95% CI 1.36 to 9.41). Conclusion: BMI ≥25kg/m2 prior to treatment for breast cancer can be considered a risk factor for developing lymphedema in the two years after surgery. There was no association between BMI and the development of other complications.
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Singh B, Disipio T, Peake J, Hayes SC. Systematic Review and Meta-Analysis of the Effects of Exercise for Those With Cancer-Related Lymphedema. Arch Phys Med Rehabil 2016; 97:302-315.e13. [DOI: 10.1016/j.apmr.2015.09.012] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Revised: 09/07/2015] [Accepted: 09/11/2015] [Indexed: 11/28/2022]
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Oliveira MMFD, Amaral MTPD, Gurgel MSC. Lymphatic compensation during the postoperative period after breast cancer treatment with axillary dissection. J Vasc Bras 2015. [DOI: 10.1590/1677-5449.0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Lymphedema secondary to breast cancer causes physical and psychological morbidity and compromises quality of life. The objective of this literature review was to study lymphatic compensation after surgery for breast cancer and the factors that influence this process, with a view to understanding the etiopathogenesis of lymphedema. Articles indexed on Pubmed published from 1985 to 2012 were reviewed. According to the literature, lymphangiogenesis reduces damage to lymph vessels; there is little evidence that Vascular Endothelial Growth Factor is elevated in women with lymphedema; lymphovenous communications can be observed 60 days after surgery; women without lymphedema have acquired alternative mechanisms for removal of proteins from the interstitial space; and active exercise stimulates lymphatic and venous pumping. Health professionals should teach these patients about the risk factors for lymphedema. The effects of lymphangiogenesis, proteolysis and lymphovenous communications on development of lymphedema should be studied, since these events are intimately related.
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Association between lymphedema self-care adherence and lymphedema outcomes among women with breast cancer-related lymphedema. Am J Phys Med Rehabil 2015; 94:288-96. [PMID: 25171662 DOI: 10.1097/phm.0000000000000178] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether adherence to self-care modalities for breast cancer-related lymphedema (BCRL) predicts BCRL outcomes among 128 breast cancer survivors who participated in the 12-mo physical activity and lymphedema trial. DESIGN This was a prospective cohort study. Adherence to ten BCRL self-care modalities, as recommended in the clinical practice guidelines for the management of BCRL, was assessed by a questionnaire at baseline. BCRL outcomes assessed at baseline and 12 mos included volumetry, circumferences, bioimpedence spectroscopy, the Norman lymphedema survey, and therapist-defined lymphedema exacerbations requiring treatment. Generalized linear models were used to estimate the relationship between adherence to BCRL self-care modalities and the likelihood of experiencing a BCRL outcome. RESULTS Adherence to BCRL self-care activities did not predict experiencing any BCRL outcomes at 12 mos. Levels of adherence to BCRL self-care modalities did not predict a 5% or greater decrease in interlimb volume (Ptrend = 0.79), 5% or greater decrease in the sum of interlimb arm circumferences (Ptrend = 0.47), 10% or greater decrease in bioimpedence spectroscopy (Ptrend = 0.83), 1 or greater decrease in self-reported lymphedema symptoms (Ptrend = 0.91), or therapist-defined lymphedema exacerbation requiring treatment (Ptrend = 0.84). CONCLUSIONS Our findings suggest that levels of BCRL self-care adherence do not predict BCRL outcomes among breast cancer survivors with stable lymphedema who were followed for 12 mos.
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O'Toole JA, Ferguson CM, Swaroop MN, Horick N, Skolny MN, Brunelle CL, Miller CL, Jammallo LS, Specht MC, Taghian AG. The impact of breast cancer-related lymphedema on the ability to perform upper extremity activities of daily living. Breast Cancer Res Treat 2015; 150:381-8. [PMID: 25749734 DOI: 10.1007/s10549-015-3325-3] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 01/15/2023]
Abstract
We sought to assess the association of breast cancer-related lymphedema (BCRL) with the ability to perform upper extremity activities of daily living (ADL) in our patient population. 324 breast cancer patients who had received treatment for unilateral breast cancer at our institution between 2005 and 2014 were prospectively screened for lymphedema. Bilateral arm measurements were performed pre-operatively and during post-operative follow-up using a Perometer. Patients completed an extensive quality of life (QOL) questionnaire at the time of each study assessment. Lymphedema was defined as a relative volume change (RVC) of ≥10% from the patient's pre-operative baseline measurement. Linear regression models were used to evaluate the relationship between post-operative arm function score (as a continuous variable) and RVC, demographic, clinical, and QOL factors. By multivariate analysis, greater fear of lymphedema (p < 0.0001), more pain (p < 0.0001), body mass index >25 (p = 0.0015), mastectomy (p = 0.0001), and having an axillary node dissection (p = 0.0045) were all associated with lower functional scores. Higher emotional well-being score (p < 0.0001) and adjuvant chemotherapy (p = 0.0005) were associated with higher post-operative functional score. Neither low-level volume changes (5-10 % RVC) nor BCRL (RVC ≥10 %) were associated with ability to perform upper extremity ADL as measured by self-report (p = 0.99, p = 0.79). This prospective study demonstrates that low-level changes in arm volume (RVC 5-10 %) as well as clinically significant BCRL (RVC ≥10 %) did not impact the self-reported ability to use the affected extremity for ADL. These findings may help to inform clinicians and patients on the importance of prospective screening for lymphedema and QOL which enables early detection and intervention.
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Affiliation(s)
- Jean A O'Toole
- Department of Physical & Occupational Therapy, Massachusetts General Hospital, Harvard Medical School, Boston, MA, 02114, USA
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Lymphedema Quality of Life Inventory (LyQLI)-Development and investigation of validity and reliability. Qual Life Res 2015; 24:427-39. [PMID: 25633655 DOI: 10.1007/s11136-014-0783-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE The purpose of this study was to reduce the 188-item Swedish Lymphedema Quality of Life Inventory (SLQOLI) to an abbreviated, clinically useful version (phase 1) and to test it for reliability and validity (phase 2). METHODS In phase 1 correlation analysis, factor analysis, content validity assessment and expert panels were used to reduce the number of items in SLQOLI to 45 items, which was named, Lymphedema Quality of Life Inventory (LyQLI). In phase 2, LyQLI was sent to 200 patients with lymphedema. 126 patients completed the questionnaire twice to determine stability of the instrument over time. SF-36 was sent to the patients once, correlations between the three domains in LyQLI and the two sum scores Physical Health (PCS) and Mental Health (MCS) in SF-36 were used to assess concurrent validity. RESULTS The 188-item SLQOLI was reduced to 45-item LyQLI. Four domains were reduced to three: physical, psychosocial and practical. Reliability estimates using ICC for the physical and psychosocial domains were 0.88 (p < 0.01) and 0.87 (p < 0.01), for the practical domain 0.87 (p < 0.01). Cronbach's alpha coefficients for the three domains were 0.88, 0.92 and 0.88, respectively. The physical domain correlated highly significantly with PCS, psychosocial highly significantly with MCS and practical equally highly significantly to both PCS and MCS. Using skewness coefficients, small floor effects in the items were found. CONCLUSION The shorter LyQLI demonstrated good reliability and validity with potential use to assess quality of life in clinic settings and in further cross-sectional studies of patients with lymphedema.
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Fisher MI, Donahoe-Fillmore B, Leach L, O'Malley C, Paeplow C, Prescott T, Merriman H. Effects of yoga on arm volume among women with breast cancer related lymphedema: A pilot study. J Bodyw Mov Ther 2014; 18:559-65. [DOI: 10.1016/j.jbmt.2014.02.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 01/28/2014] [Accepted: 02/19/2014] [Indexed: 10/25/2022]
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de Oliveira MMF, de Rezende LF, do Amaral MTP, Pinto e Silva MP, Morais SS, Gurgel MSC. Manual lymphatic drainage versus exercise in the early postoperative period for breast cancer. Physiother Theory Pract 2014; 30:384-9. [PMID: 24410411 DOI: 10.3109/09593985.2013.876695] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the effect of active exercise and manual lymphatic drainage (MLD) on postoperative wound healing complications, shoulder range of motion (ROM) and upper limb (UL) perimetry in women undergoing radical mastectomy for breast cancer. METHODS Controlled non-randomized clinical trial with 89 women undergoing breast cancer surgery with axillary lymph node dissection (Brazilian Registry of Clinical Trials: 906). Women were matched for staging, age and body mass index, with 46 women allocated to the exercise group and 43 in the MLD group, receiving 2 weekly sessions during one month. Assessments were performed in the preoperative and 60 d after surgery, including inspection, palpation, goniometry and perimetry. RESULTS No significant difference existed between groups relative to individual and clinical surgical characteristics. The incidence of seroma, number of punctures performed, dehiscence and infection was similar in both groups. A comparison of shoulder ROM and UL perimetry between groups, obtained in the preoperative and postoperative period, did not show any significant difference. CONCLUSION The performance of active exercise or MLD did not demonstrate difference in wound healing complications, shoulder ROM and UL perimetry at 60 d after surgery, suggesting that these techniques may be employed, according to the complaints or symptoms of each woman and physical therapist experience.
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Affiliation(s)
- Mariana Maia Freire de Oliveira
- Physical Therapy Section-Prof. Dr. José Arostodemo Pinotti Women's Hospital-Integral Healthcare Center (CAISM), Universidade Estadual de Campinas (Unicamp) , Campinas , Brazil
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Fong SSM, Ng SSM, Luk WS, Chung JWY, Ho JSC, Ying M, Ma AWW. Effects of qigong exercise on upper limb lymphedema and blood flow in survivors of breast cancer: a pilot study. Integr Cancer Ther 2013; 13:54-61. [PMID: 23749481 DOI: 10.1177/1534735413490797] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
HYPOTHESIS Qigong exercise is a popular method for relieving the side effects of conventional cancer treatments in survivors of breast cancer, yet its effects are not empirically assessed. This study aimed to investigate the effects of qigong exercise on upper limb lymphedema, arterial resistance, and blood flow velocity in survivors with breast cancer and mastectomy. STUDY DESIGN This study was conducted as a prospective clinical trial. METHODS Eleven survivors of breast cancer with qigong experience (mean age = 58.3 ± 10.1 years) were assigned to the experimental group and 12 survivors of breast cancer without qigong experience (mean age = 53.8 ± 4.2 years) were assigned to the control group. They all had breast cancer-related lymphedema. All procedures were completed within one session. After baseline measurements were taken, the experimental group performed 18 Forms Tai Chi Internal Qigong for approximately 6 minutes while the control group rested for similar duration in a sitting position. Both groups were then reassessed. All participants were measured on their affected upper limb circumference (by using tape measures), peripheral arterial resistance, and blood flow velocities (using a Doppler ultrasound machine). RESULTS The between-group differences were not significant for all outcome measures at baseline (P > .05). The circumferences of the affected upper arm, elbow, forearm and wrist decreased after qigong exercise (P < .05). However, no significant difference was found in the circumference measures between the 2 groups posttest (P > .0125). In terms of vascular outcomes, the resistance index decreased and the maximum systolic arterial blood flow velocity (SV) and minimum diastolic arterial blood flow velocity (DV) increased significantly after qigong exercise (P < .05). The between-group difference was close to significant for SV (P = .018) and was significant for DV (P < .001) posttest. CONCLUSION Qigong exercise could reduce conventional cancer therapy side effects such as upper limb lymphedema and poor circulatory status in survivors of breast cancer. However, such effects may be temporary, and further studies must be conducted to explore longer term effects.
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Affiliation(s)
- Shirley S M Fong
- Institute of Human Performance, The University of Hong Kong, Pokfulam, Hong Kong
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Edema: a silent but important factor. J Hand Ther 2012; 25:153-61; quiz 162. [PMID: 22212492 DOI: 10.1016/j.jht.2011.09.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/13/2011] [Accepted: 09/27/2011] [Indexed: 02/03/2023]
Abstract
Edema is a normal response to injury. Even the smallest injury is associated with some inflammation, and initial edema is part of the normal inflammatory process. However, edema becomes a concern when it persists beyond the inflammatory phase. Once we have progressed into the rebuilding, or fibroplastic phase of healing, edema will delay healing and contribute to complications such as pain and stiffness. Early prevention and management to prevent this progression are therefore critical. This article discusses edema in relation to stages of healing and presents the research behind techniques available to the clinician to manage localized extracellular upper extremity edema in the patient with an intact lymphatic system.
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Desai P, Williams AG, Prajapati P, Downey HF. Lymph flow in instrumented dogs varies with exercise intensity. Lymphat Res Biol 2011; 8:143-8. [PMID: 20863266 DOI: 10.1089/lrb.2009.0029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Although it is generally accepted that exercise accelerates lymph flow, no study has directly measured lymph flow as a function of exercise intensity. In this study, we have measured flow in the thoracic lymph duct of five instrumented dogs while they ran on a treadmill. METHODS AND RESULTS Dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and a catheter in the descending thoracic aorta. After recovery from surgery, the dogs ran on a treadmill at speeds which varied stepwise from 0 to 10 mph and from 10 to 0 mph. Dogs ran for 1 min at each speed with 15 min rest between each exercise. Heart rate increased significantly during exercise, whereas mean aortic pressure did not change. Resting lymph flow was 1.7+/-0.2 ml/min. Exercise at 1.5 mph significantly increased lymph flow to 3.9 +/- 0.6 ml/min (P < 0.01), 121% higher than resting flow. Lymph flow was further elevated at higher treadmill speeds, reaching 9.0 +/-1.6 ml/min (P < 0.01) at 10 mph, 419% higher than resting flow. Regression analysis demonstrated a linear relationship between treadmill speed and the percent increase in lymph flow. Lymph flow returned to the resting rate 1-2 min post-exercise. CONCLUSION Lymph flow in the thoracic duct is positively correlated with exercise intensity.
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Affiliation(s)
- Pratikkumar Desai
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, Texas 76107, USA
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Prajapati P, Shah P, King HH, Williams AG, Desai P, Downey HF. Lymphatic pump treatment increases thoracic duct lymph flow in conscious dogs with edema due to constriction of the inferior vena cava. Lymphat Res Biol 2011; 8:149-54. [PMID: 20863267 DOI: 10.1089/lrb.2009.0032] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Osteopathic lymphatic pump treatments (LPT) are used to treat edema, but their direct effects on lymph flow have not been studied. In the current study, we examined the effects of LPT on lymph flow in the thoracic duct of instrumented conscious dogs in the presence of edema produced by constriction of the inferior vena cava (IVC). METHODS AND RESULTS Six dogs were surgically instrumented with an ultrasonic flow transducer on the thoracic lymph duct and catheters in the descending thoracic aorta and in IVC. After postoperative recovery, lymph flow and hemodynamic variables were measured 1) pre-LPT, 2) during 4 min LPT, 3) post-LPT, in the absence and presence of edema produced by IVC constriction. This constriction increased abdominal girth from 60 +/-2.6 to 75 +/- 2.9 cm. Before IVC constriction, LPT increased lymph flow (P < 0.05) from 1.9 +/- 0.2 ml/min to a maximum of 4.7 +/-1.2 ml/min, whereas after IVC constriction, LPT increased lymph flow (P < 0.05) from 7.9 +/-2.2 to a maximum of 11.7 +/-2.2 ml/min. The incremental lymph flow mobilized by 4 min of LPT (ie, the flow that exceeded 4 min of baseline flow), was 10.6 ml after IVC constriction. This incremental flow was not significantly greater than that measured before IVC constriction. CONCLUSIONS Edema caused by IVC constriction markedly increased lymph flow in the thoracic duct. LPT increased thoracic duct lymph flow before and after IVC constriction. The lymph flow mobilized by 4 min of LPT in presence of edema was not significantly greater than that mobilized prior to edema.
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Affiliation(s)
- Parna Prajapati
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, Texas 76107, USA
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Chan DNS, Lui LYY, So WKW. Effectiveness of exercise programmes on shoulder mobility and lymphoedema after axillary lymph node dissection for breast cancer: systematic review. J Adv Nurs 2010; 66:1902-14. [PMID: 20626480 DOI: 10.1111/j.1365-2648.2010.05374.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This article is a report of a review of the effectiveness of exercise programmes on shoulder mobility and lymphoedema in postoperative patients with breast cancer having axillary lymph node dissection, as revealed by randomized controlled trials. BACKGROUND Breast cancer is the most common malignancy in women. After surgery, the most common postoperative complications are reduced range of motion in the shoulder, muscle weakness in the upper extremities, lymphoedema, pain and numbness. To reduce these impairments, shoulder exercises are usually prescribed. However, conflicting results regarding the effect and timing of such exercises have been reported. Data sources. Studies were retrieved from a systematic search of published works over the period 2000-2009 indexed in the Cumulative Index to Nursing and Allied Health Literature, Ovid Medline, the British Nursing Index, Proquest, Science Direct, Pubmed, Scopus and the Cochrane Library, using the combined search terms 'breast cancer', 'breast cancer surgery', 'exercise', 'lymphoedema', 'shoulder mobility' and 'randomized controlled trials'. METHODS A quantitative review of effectiveness was carried out. Studies were critically appraised by three independent reviewers, and categorized according to levels of evidence defined by the Joanna Briggs Institute. RESULTS Six studies were included in the review. Early rather than delayed onset of training did not affect the incidence of postoperative lymphoedema, but early introduction of exercises was valuable in avoiding deterioration in range of shoulder motion. CONCLUSION Further studies are required to investigate the optimal time for starting arm exercises after this surgery. Nurses have an important role in educating and encouraging patients to practise these exercises to speed up recovery.
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Affiliation(s)
- Dorothy N S Chan
- Department of Surgery, Ruttonjee and Tang Shiu Kin Hospital, Hong Kong SAR, China
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Wiggins MS, Simonavice EM. Cancer prevention, aerobic capacity, and physical functioning in survivors related to physical activity: a recent review. Cancer Manag Res 2010; 2:157-64. [PMID: 21188106 PMCID: PMC3004575 DOI: 10.2147/cmar.s7461] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2010] [Indexed: 11/23/2022] Open
Abstract
According to recent published reports, over 12 million new cases of cancer were estimated worldwide for 2007. Estimates from 2008 predict that cancer will account for 22.8% of all deaths in the US. Another report stated 50% to 75% of cancer deaths in the US are related to smoking, poor dietary choices, and physical inactivity. A 2004 report indicated obesity and/or a sedentary lifestyle increases the risk of developing several types of cancer. Conversely, several large-scale cohort studies point to the positive relationship between physical activity and a reduction in cancer risk. In addition, research over the last few years has clearly shown cardiorespiratory benefits, increases in quality of life (QOL), and increases in physical functioning for cancer survivors who engage in exercise programs. Thus, the purpose of this review is to highlight three areas related to cancer and physical activity. First, information concerning the prevention of cancer through physical activity is addressed. Second, recent studies identifying changes in volume of oxygen uptake (VO(2)) and/or cardiorespiratory functioning involving exercise with cancer survivors is presented. Third, studies identifying changes in cancer survivors' physical functional capacity and QOL are presented. Finally, a summary of the review is offered.
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Affiliation(s)
- Matthew S Wiggins
- Department of Kinesiology, University of Wisconsin-Eau Claire, Eau Claire, WI, USA
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Devoogdt N, Van Kampen M, Geraerts I, Coremans T, Christiaens MR. Different physical treatment modalities for lymphoedema developing after axillary lymph node dissection for breast cancer: A review. Eur J Obstet Gynecol Reprod Biol 2010; 149:3-9. [DOI: 10.1016/j.ejogrb.2009.11.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2009] [Revised: 11/18/2009] [Accepted: 11/19/2009] [Indexed: 10/20/2022]
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Kärki A, Anttila H, Tasmuth T, Rautakorpi UM. Lymphoedema therapy in breast cancer patients: a systematic review on effectiveness and a survey of current practices and costs in Finland. Acta Oncol 2010; 48:850-9. [PMID: 19235573 DOI: 10.1080/02841860902755251] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND This study systematically evaluates the effects and harms of physiotherapy methods and explores current treatment practices and costs in relation to lymphoedema in breast cancer patients in Finland. MATERIAL AND METHODS A systematic review of randomized controlled trials (RCTs) on physiotherapy interventions for breast cancer patients with lymphoedema. A postal survey to lymph therapists, a telephone and register survey for therapy costs. RESULTS We identified 14 RCTs, of which two had moderate and the others high risk of bias. There was moderate evidence that compression bandages decreased lymphoedema, and that pneumatic pumps had no effect on lymphoedema. In Finland lymph therapy practice is a combination of manual lymph drainage (MLD), compression bandages, therapeutic exercises and guidance for self-treatment, with an annual average cost of EUR 799 per patient. CONCLUSIONS Compression bandages are likely to reduce upper limb lymphoedema in breast cancer patients. Evidence on other physiotherapy methods and their combinations is limited due to the poor quality of the trials. No evidence was found on any outcomes other than upper limb volume. We call for well-designed trials with patient-related outcomes on the effectiveness of MLD, guidance and therapeutic exercises.
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Affiliation(s)
- Anne Kärki
- Satakunta University of Applied Sciences, Research and Development, Pori, Finland
| | - Heidi Anttila
- Finnish Office for Health Technology Assessment (Finohta), National Institute for Health and Welfare (THL), Helsinki, Finland
| | - Tiina Tasmuth
- Department of Oncology, Helsinki University Central Hospital, Helsinki, Finland
| | - Ulla-Maija Rautakorpi
- Finnish Office for Health Technology Assessment (Finohta), National Institute for Health and Welfare (THL), Helsinki, Finland
- Hämeenlinna City Health Centre, Hämeenlinna, Finland
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A multicentre cross-sectional study of arm lymphedema four or more years after breast cancer treatment in Iranian patients. Breast Cancer 2009; 17:281-5. [DOI: 10.1007/s12282-009-0165-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2009] [Accepted: 07/20/2009] [Indexed: 10/20/2022]
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Jönsson C, Johansson K. Pole walking for patients with breast cancer-related arm lymphedema. Physiother Theory Pract 2009; 25:165-73. [DOI: 10.1080/09593980902776621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Paskett ED. Breast cancer-related lymphedema: attention to a significant problem resulting from cancer diagnosis. J Clin Oncol 2008; 26:5666-7. [PMID: 19001317 DOI: 10.1200/jco.2008.19.0850] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Nielsen I, Gordon S, Selby A. Breast cancer-related lymphoedema risk reduction advice: A challenge for health professionals. Cancer Treat Rev 2008; 34:621-8. [DOI: 10.1016/j.ctrv.2007.11.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2007] [Revised: 11/19/2007] [Accepted: 11/20/2007] [Indexed: 11/29/2022]
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Downey HF, Durgam P, Williams AG, Rajmane A, King HH, Stoll ST. Lymph flow in the thoracic duct of conscious dogs during lymphatic pump treatment, exercise, and expansion of extracellular fluid volume. Lymphat Res Biol 2008; 6:3-13. [PMID: 18361766 DOI: 10.1089/lrb.2007.1017] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This investigation examined interactions between expansion of the extracellular fluid volume (ECE), osteopathic lymphatic pump treatment (LPT), and exercise on lymph flow in the thoracic duct of eight instrumented, conscious dogs. METHODS AND RESULTS After recovery from surgery, LPT was performed for 8 min before and after ECE with normal saline, i.v., 4.4+/-0.3% of body weight. Baseline lymph flow was 1.7+/-0.5 mL/min. LPT rapidly increased lymph flow to 5.0+/-1.1 mL/min at 1 min, and lymph flow remained above baseline for 4 min (p<0.05). LPT produced a net increase in lymph flow of 15.4+/-1.1 mL. Following ECE, baseline lymph flow was 4.8+/-0.6 mL/min (p<0.05). LPT increased lymph flow to 9.9+/-1.1 mL/min at 1 min (p<0.05), and lymph flow remained above baseline for 4 min (p<0.05); all flow values after ECE were greater than corresponding values before ECE. However, the net increase in lymph flow produced by 8 min of LPT (18.3+/-3.8 mL) was not significantly greater than that observed before ECE. Moderate treadmill exercise increased lymph flow for 4 min before ECE and for 6 min after ECE. All lymph flows during exercise were greater after ECE than before ECE. The net increase in lymph flow produced by 8 min of exercise was 24.9+/-5.5 mL before ECE and 39.6+/-5.1 mL after ECE (p<0.05). CONCLUSIONS Expansion of the extracellular fluid volume produced large increases in thoracic duct lymph flow, that were further augmented by lymphatic pump treatment and by moderate treadmill exercise.
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Affiliation(s)
- H Fred Downey
- Department of Integrative Physiology, University of North Texas Health Science Center, Fort Worth, Texas 76107, USA.
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Kivelä R, Silvennoinen M, Lehti M, Kainulainen H, Vihko V. Effects of acute exercise, exercise training, and diabetes on the expression of lymphangiogenic growth factors and lymphatic vessels in skeletal muscle. Am J Physiol Heart Circ Physiol 2007; 293:H2573-9. [PMID: 17766486 DOI: 10.1152/ajpheart.00126.2007] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Blood and lymphatic vessels together form the circulatory system, allowing the passage of fluids and molecules within the body. Recently we showed that lymphatic capillaries are also found in the capillary bed of skeletal muscle. Exercise is known to induce angiogenesis in skeletal muscle, but it is not known whether exercise has effects on lymphangiogenesis or lymphangiogenic growth factors. We studied lymphatic vessel density and expression of the main lymphangiogenic growth factors VEGF-C and VEGF-D and their receptor VEGFR-3 in response to acute running exercise and endurance exercise training in the skeletal muscle of healthy and diabetic mice. VEGF-C mRNA expression increased after the acute exercise bout (P < 0.05) in healthy muscles, but there was no change in diabetic muscles. VEGF-C levels were not changed either in healthy or in diabetic muscle after the exercise training. Neither acute exercise nor exercise training had an effect on the mRNA expression of VEGF-D or VEGFR-3 in healthy or diabetic muscles. Lymphatic vessel density was similar in sedentary and trained mice and was >10-fold smaller than blood capillary density. Diabetes increased the mRNA expression of VEGF-D (P < 0.01). Increased immunohistochemical staining of VEGF-D was found in degenerative muscle fibers in the diabetic mice. In conclusion, the results suggest that acute exercise or exercise training does not significantly affect lymphangiogenesis in skeletal muscle. Diabetes increased the expression of VEGF-D in skeletal muscle, and this increase may be related to muscle fiber damage.
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Affiliation(s)
- Riikka Kivelä
- LIKES Research Center for Sport and Health Sciences, University of Jyväskylä, Rautpohjankatu 8a, FIN-40700 Jyväskylä, Finland.
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Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Exercise for women with or at risk for breast cancer-related lymphedema. Phys Ther 2006; 86:1398-405. [PMID: 17012644 DOI: 10.2522/ptj.20050328] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Affiliation(s)
- Deanna Bicego
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Rockson SG. Literature watch. A genetic Xenopus laevis tadpole model to study lymphangiogenesis. Lymphat Res Biol 2005; 3:263-7. [PMID: 16379598 DOI: 10.1089/lrb.2005.3.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stanley G Rockson
- Stanford Center for Lymphatic and Venous Disorders, Division of Cardiovascular Medicine, Stanford University School of Medicine, Falk Cardiovascular Research Center, Stanford, CA 94305, USA.
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