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Wang J, Lv M, Li H, Guo D, Chu X. Effects of Exercise in Adults With Cancer Pain: A Systematic Review and Network Meta-Analysis. J Pain Symptom Manage 2024:S0885-3924(24)00990-4. [PMID: 39218125 DOI: 10.1016/j.jpainsymman.2024.08.033] [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] [Received: 04/10/2024] [Revised: 08/12/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
CONTEXT Pain is one of the most common symptoms of cancer patients, affecting the patient's physical, psychological, behavioral, social relations and other aspects. Previous studies have demonstrated that exercise is effective for cancer pain, and the optimal exercise is still unknown. OBJECTIVES This study aimed to compare the effects of different exercise interventions on cancer pain in adults. METHODS Randomized control trials identified from medical literature databases that reported effects of exercise in adults with cancer pain were included in this study. Literature screening and data extraction were conducted independently by 2 researchers. Cochrane Bias Assessment 2.0 was used to assess the quality of the literature, and Stata 15.0 software was used for Network meta-analysis. RESULTS Forty-one studies were included, involving 3537 patients with cancer pain. The types of exercise involved included aerobic exercise, medium intensity continuous training, high-intensity interval training, resistance exercise, mind-body exercise and comprehensive exercise program (CEP). The results suggested that CEP was more effective than the usual care in relieving pain intensity in cancer patients [SMD = -1.96,95% CI (-3.47, -0.44)] (SUCRA = 97.9%). Mind-body exercise outperformed usual care in reducing pain interference in cancer patients [SMD = -0.65, 95% CI (-1.21, -0.09)] (SUCRA = 83.8%). CONCLUSION Current evidence shows that CEP is the best way to relieve the pain intensity of cancer patients, and mind-body exercise is the best way to reduce pain interference of cancer patients. Due to the limited number and quality of the included studies, the above conclusions need to be further verified by more high-quality studies.
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Affiliation(s)
- Jie Wang
- School of Nursing (J.W., M.L.), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Meiling Lv
- School of Nursing (J.W., M.L.), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hongpeng Li
- School of Sport Science (H.L.), Beijing Sport University, Beijing, China
| | - Dongqing Guo
- School of Nursing (J.W., M.L.), Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Chu
- Department of Nursing (X.C.), Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu , China.
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Kanzawa-Lee GA, Larson JL, Resnicow K, Ploutz-Snyder R, Krauss JC, Smith EML. Home-based aerobic exercise feasibility in oxaliplatin-receiving newly-diagnosed cancer survivors. Eur J Oncol Nurs 2024; 71:102649. [PMID: 38954929 DOI: 10.1016/j.ejon.2024.102649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/01/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE Physical activity (PA) is beneficial but difficult to maintain during chemotherapy. This pilot RCT explored the feasibility of the MI-Walk intervention-an 8-week motivational enhancement therapy- and home-based brisk walking intervention-among gastrointestinal (GI) cancer survivors receiving chemotherapy. METHODS Sixty stage II-IV GI cancer survivors were recruited from 5 sites at their second infusion visit. Participants were randomized to receive PA education alone or the MI-Walk intervention: motivational enhancement therapy consisting of 3 motivational interviewing and self-efficacy-enhancing counseling sessions, a Fitbit Charge 2, exercise diaries, telephone follow-up, scripted motivational email messages, and optional weekly walking groups. RESULTS The enrollment and completion rates were 62% and 90%, respectively. The MI-Walk participants (n = 29; mean age = 56.79, SD = 11.72; 97% white; 79% male) reported a baseline moderate-vigorous PA duration of 250.93 (SD = 636.52) min/wk. The mean MI-Walk Intervention acceptability score was 50.32 (SD = 12.02) on a scale of 14-70. Mean Fitbit and counseling helpfulness scores on a 5-point scale were 3.67 (SD = 1.43) and 3.44 (SD = 1.36), respectively. Participants' Fitbit moderate-vigorous PA 8-week averages ranged from 0 to 716.88 min/wk; 64% of participants adhered to ≥127 min/wk. Several characteristics (e.g., age, comorbidity, PA level, employment status, BMI, education level, gender, symptoms) were associated with enrollment, attrition, and intervention acceptability and adherence (p < 0.05). CONCLUSION Enrollment and retention were adequate. The Fitbit and counseling were the most helpful. Acceptability and adherence varied based on participant characteristics; therefore, intervention tailoring and further research among cancer survivors less physically active at baseline and most in need of complex exercise intervention are needed. CLINICALTRIALS gov NCT03515356.
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Affiliation(s)
- Grace A Kanzawa-Lee
- School of Nursing, University of Michigan, Ann Arbor, MI, USA; Smith's Currently at School of Nursing, University of Alabama, Birmingham, AL, USA.
| | - Janet L Larson
- School of Nursing, University of Michigan, Ann Arbor, MI, USA; Smith's Currently at School of Nursing, University of Alabama, Birmingham, AL, USA
| | - Kenneth Resnicow
- School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | | | - John C Krauss
- Rogel Cancer Center, University of Michigan, Ann Arbor, MI, USA
| | - Ellen M Lavoie Smith
- School of Nursing, University of Michigan, Ann Arbor, MI, USA; Smith's Currently at School of Nursing, University of Alabama, Birmingham, AL, USA
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Austin PD, Lee W, Costa DSJ, Ritchie A, Lovell MR. Efficacy of aerobic and resistance exercises on cancer pain: A meta-analysis of randomised controlled trials. Heliyon 2024; 10:e29193. [PMID: 38623224 PMCID: PMC11016720 DOI: 10.1016/j.heliyon.2024.e29193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 02/19/2024] [Accepted: 04/02/2024] [Indexed: 04/17/2024] Open
Abstract
Purpose To evaluate effects of aerobic and resistance exercises for cancer-related pain in adults with and surviving cancer. Secondary objectives were to a) evaluate the effect of exercise on fatigue, psychological function, physical function, b) assess fidelity to exercise. Design A systematic search of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Central Register of Controlled Trials was conducted to identify randomised controlled trials (RCTs) comparing aerobic and/or resistance exercise to control groups. The primary endpoint were changes in cancer-related pain intensity from baseline to post intervention. Meta-regression analysis evaluated predictors for heterogeneity between study findings. Tolerability was defined as reporting of exercise-induced adverse events while fidelity evaluated by reported intervention dropout. Results Twenty-three RCTs including 1954 patients (age 58 ± 8.5 years; 78 % women); 1087 (56 %) and 867 (44 %) allocated to aerobic/resistance exercise therapy and control group, respectively. Exercise therapy was associated with small to moderate decreases in cancer-related pain compared to controls (SMD = 0.38, 95 % CI: 0.17, 0.58). Although there was significant heterogeneity between individual and pooled study effects (Q = 205.25, p < 0.0001), there was no publication bias. Meta-regression including supervision, age, duration and exercise type as moderators showed no significant differences in reported outcomes. Analysis of secondary outcomes revealed a moderate effect for improvements in physical function, fatigue and psychological symptoms. Conclusions Aerobic and resistance exercises are tolerable and effective adjunct therapies to reduce cancer-related pain while also improving physical function, fatigue and mood. Future RCTs of dose, frequency, compliance and exercise type in specific cancer settings are required.
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Affiliation(s)
- Philip D. Austin
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Wei Lee
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Improving Care for Palliative Aged, and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
- St Vincent's Clinical School, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Daniel SJ. Costa
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
- Kolling Institute, Northern Sydney Local Health District, Sydney, NSW, Australia
- School of Psychology, University of Sydney, Sydney, NSW, Australia
- The University of Sydney, Sydney, NSW, Australia
| | - Alison Ritchie
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
| | - Melanie R. Lovell
- Department of Palliative Care, HammondCare, Greenwich Hospital, Sydney, New South Wales, Australia
- Sydney Medical School-Northern, University of Sydney, Sydney, New South Wales, Australia
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Lally P, Kennedy F, Smith S, Beeken RJ, Buck C, Thomas C, Counsell N, Wyld L, Martin C, Williams S, Roberts A, Greenfield DM, Gath J, Potts HWW, Latimer N, Smith L, Fisher A. The feasibility and acceptability of an app-based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK. Cancer Med 2024; 13:e7124. [PMID: 38529687 DOI: 10.1002/cam4.7124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 03/05/2024] [Accepted: 03/08/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory-driven app-based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH). METHODS Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device-measured brisk walking (activPAL accelerometer) and self-reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non-cancer-specific app to promote brisk walking (National Health Service 'Active 10') augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted. RESULTS Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost-effectiveness of the intervention. CONCLUSIONS This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost-effectiveness of the intervention.
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Affiliation(s)
- Phillippa Lally
- Department of Psychological Sciences, University of Surrey, Guildford, Surrey, UK
| | - Fiona Kennedy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Susan Smith
- Department of Behavioural Science and Health, University College London, London, UK
| | - Rebecca J Beeken
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Caroline Buck
- Department of Behavioural Science and Health, University College London, London, UK
| | - Chloe Thomas
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Nicholas Counsell
- Cancer Research UK & Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Lynda Wyld
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Charlene Martin
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Sarah Williams
- Department of Behavioural Science and Health, University College London, London, UK
| | - Anna Roberts
- Department of Behavioural Science and Health, University College London, London, UK
| | - Diana M Greenfield
- Sheffield Teaching Hospitals NHS FT, Weston Park Hospital, Sheffield, UK
| | - Jacqui Gath
- Independent Cancer Patients' Voice (ICPV), London, UK
| | - Henry W W Potts
- Institute of Health Informatics, University College London, London, UK
| | - Nicholas Latimer
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Lee Smith
- The Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Abi Fisher
- Department of Behavioural Science and Health, University College London, London, UK
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Peters M, Butson G, Mizrahi D, Denehy L, Lynch BM, Swain CTV. Physical activity and pain in people with cancer: a systematic review and meta-analysis. Support Care Cancer 2024; 32:145. [PMID: 38321248 PMCID: PMC10847204 DOI: 10.1007/s00520-024-08343-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024]
Abstract
PURPOSE Physical activity can provide analgesic benefit but its effect on cancer-related pain is unclear. This review synthesised and appraised the evidence for the effect of physical activity on pain in people living with or beyond cancer. METHODS A systematic search of Ovid Medline and Embase was performed to identify randomised controlled trials (RCTs), randomised cross-over studies (RXTs), and prospective observational studies that examined physical activity and pain outcomes in adults living with or beyond cancer. Meta-analyses were performed to generate effect estimates. Risk of bias was assessed, and the GRADE system was used to assess evidence quality. RESULTS One hundred twenty-one studies (n = 13,806), including 102 RCTs, 6 RXTs, and 13 observational studies, met the criteria for inclusion. Meta-analyses of RCTs identified a decrease in pain intensity (n = 3734; standardised mean difference (SMD) - 0.30; 95% confidence interval (CI) - 0.45, - 0.15) and bodily pain (n = 1170; SMD 0.28; 95% CI 0.01, 0.56) but not pain interference (n = 207; SMD - 0.13, 95% CI - 0.42, 0.15) following physical activity interventions. Individual studies also identified a reduction in pain sensitivity but not analgesic use, although meta-analysis was not possible for these outcomes. High heterogeneity between studies, low certainty in some effect estimates, and possible publication bias meant that evidence quality was graded as very low to low. CONCLUSION Physical activity may decrease pain in people living with and beyond cancer; however, high heterogeneity limits the ability to generalise this finding to all people with cancer or to specific types of cancer-related pain.
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Affiliation(s)
- Mitchell Peters
- Cancer Science Unit, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Australia
- Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Grace Butson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - David Mizrahi
- The Daffodil Centre, The University of Sydney, a Joint Venture With Cancer Council NSW, Sydney, NSW, Australia
| | - Linda Denehy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia
| | - Brigid M Lynch
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
- Physical Activity Laboratory, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Christopher T V Swain
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, University of Melbourne, Level 7, Alan Gilbert Building, 161 Barry St, Melbourne, VIC, 3010, Australia.
- Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Australia.
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Martínez-Vizcaíno V, Cavero-Redondo I, Reina-Gutiérrez S, Gracia-Marco L, Gil-Cosano JJ, Bizzozero-Peroni B, Rodriguez-Artalejo F, Ubago-Guisado E. Comparative effects of different types of exercise on health-related quality of life during and after active cancer treatment: A systematic review and network meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:726-738. [PMID: 36736726 PMCID: PMC10658325 DOI: 10.1016/j.jshs.2023.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 06/18/2023]
Abstract
BACKGROUND The positive influence of most types of exercise has been reported repeatedly, but what the most effective exercise approaches are for improving health-related quality of life (HRQoL) in people with cancer remains unknown. The aim of this systematic review and network meta-analysis was to synthesize the evidence from intervention studies to assess the effects of different types of exercise on HRQoL during and after cancer treatment. METHODS MEDLINE, SPORTDiscus, the Cochrane Library, Web of Science, and Scopus were searched for randomized controlled trials aimed at testing the effects of exercise interventions meant to improve HRQoL in people with cancer. Separate analyses were conducted for HRQoL as measured by general and cancer-specific questionnaires. We also evaluated whether the effects of exercise were different during and after cancer treatment in both the physical and mental HRQoL domains. RESULTS In total, 93 studies involving 7435 people with cancer were included. Network effect size estimates comparing exercise intervention vs. usual care were significant for combined exercise (0.35, 95% confidence interval (95%CI): 0.14-0.56) for HRQoL as measured by general questionnaires, and for combined (0.31, 95%CI: 0.13-0.48), mind-body exercise (0.54, 95%CI: 0.18-0.89), and walking (0.39, 95%CI: 0.04-0.74) for HRQoL as measured by cancer-specific questionnaires. CONCLUSION Exercise programs combining aerobic and resistance training can be recommended to improve HRQoL during and after cancer treatment. The scarcity and heterogeneity of these studies prevents us from making recommendations about other exercise modalities due to insufficient evidence.
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Affiliation(s)
- Vicente Martínez-Vizcaíno
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile
| | - Iván Cavero-Redondo
- Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca 3460000, Chile.
| | - Sara Reina-Gutiérrez
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain
| | - Luis Gracia-Marco
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - José J Gil-Cosano
- PROFITH (PROmoting FITness and Health through physical activity) Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, Sport and Health University Research Institute (iMUDS), University of Granada, Granada 18012, Spain
| | - Bruno Bizzozero-Peroni
- Universidad de Castilla-La Mancha, Health and Social Research Center, Cuenca 16071, Spain; Higher Institute for Physical Education, Universidad de la República, Rivera 40000, Uruguay
| | - Fernando Rodriguez-Artalejo
- Department of Preventive Medicine and Public Health, School of Medicine, Universidad Autónoma de Madrid, Madrid 28029, Spain; IdiPaz (Instituto de Investigación Sanitaria Hospital Universitario La Paz), Madrid 28029, Spain; Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain
| | - Esther Ubago-Guisado
- Epidemiology and Control of Chronic Diseases, CIBER of Epidemiology and Public Health (CIBERESP), Madrid 28029, Spain; Cancer Registry of Granada, Escuela Andaluza de Salud Pública, Granada 18011, Spain; Cancer Epidemiology Group, Instituto de Investigación Biosanitaria, Granada 18012, Spain
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Yang HY, Chou YJ, Shun SC. The Effect of Walking Intervention on Cognitive Function Among Patients With Non-Central Nervous System Cancer: A Systematic Review. Cancer Nurs 2023; 46:375-385. [PMID: 37607373 DOI: 10.1097/ncc.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cognitive impairment is one of the most frequently reported symptoms in patients with non-central nervous system (non-CNS) cancer. Walking has positive effects on cognitive function. However, the effects of walking interventions on cognitive function outcomes in patients with non-CNS cancer are not well synthesized. OBJECTIVE The aim of this study was to explore the characteristics of walking intervention and its effects on cognitive function in patients with non-CNS cancer. METHODS Ten databases were searched to identify eligible randomized controlled trials from each database's inception to June 7, 2021. The Physiotherapy Evidence Database Scale was used to assess the quality of the included studies. RESULTS Five randomized controlled trials involving 242 adults with non-CNS cancer were included. Two studies involving immediate treadmill walking interventions with moderate intensity at 40% to 60% maximal heart rate reported significantly improved objective cognitive domains of processing speed and spatial working memory with small to moderate effect sizes for cancer survivors. One study delivering home-based, moderate-intensity walking intervention had borderline significantly positive effects on perceived cognitive functioning for patients with non-CNS cancer during chemotherapy. CONCLUSION Walking intervention with moderate intensity is a beneficial approach to improve objective cognitive domains of processing speed and spatial working memory and perceived cognitive function. IMPLICATIONS FOR PRACTICE Nurses may provide moderate-intensity walking with 40% to 60% maximal heart rate monitoring to alleviate cognitive problems during the continuous process of cancer care. The modality and dosage of intervention should be adjusted depending on this population's tolerance to better maintain training.
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Affiliation(s)
- Hui-Ying Yang
- Author Affiliations: School of Nursing, College of Medicine, National Taiwan University (Ms Yang), Taipei; School of Nursing, College of Medicine, Chang Gung University (Dr Chou), Taoyuan; and School of Nursing, National Yang Ming Chiao Tung University (Dr Shun), Taipei, Taiwan
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Plinsinga ML, Singh B, Rose GL, Clifford B, Bailey TG, Spence RR, Turner J, Coppieters MW, McCarthy AL, Hayes SC. The Effect of Exercise on Pain in People with Cancer: A Systematic Review with Meta-analysis. Sports Med 2023; 53:1737-1752. [PMID: 37213049 PMCID: PMC10432370 DOI: 10.1007/s40279-023-01862-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2023] [Indexed: 05/23/2023]
Abstract
INTRODUCTION Cancer-related pain is common and undertreated. Exercise is known to have a pain-relieving effect in non-cancer pain. OBJECTIVES This systematic review aimed to evaluate (1) the effect of exercise on cancer-related pain in all cancers, and (2) whether the effect of exercise differed according to exercise mode, degree of supervision, intervention duration and timing (during or after cancer treatment), pain types, measurement tool and cancer type. METHODS Electronic searches were undertaken in six databases to identify exercise studies evaluating pain in people with cancer, published prior to 11 January 2023. All stages of screening and data extraction were conducted independently by two authors. The Cochrane risk of bias tool for randomised trials (RoB 2) was used and overall strength of evidence was assessed using the GRADE approach. Meta-analyses were performed overall and by study design, exercise intervention and pain characteristics. RESULTS In total, 71 studies reported in 74 papers were eligible for inclusion. The overall meta-analysis included 5877 participants and showed reductions in pain favouring exercise (standardised mean difference - 0.45; 95% confidence interval - 0.62, - 0.28). For most (> 82%) of the subgroup analyses, the direction of effect favoured exercise compared with usual care, with effect sizes ranging from small to large (median effect size - 0.35; range - 0.03 to - 1.17). The overall strength of evidence for the effect of exercise on cancer-related pain was very low. CONCLUSION The findings provide support that exercise participation does not worsen cancer-related pain and that it may be beneficial. Better pain categorisation and inclusion of more diverse cancer populations in future research would improve understanding of the extent of benefit and to whom. PROSPERO REGISTRATION NUMBER CRD42021266826.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia.
| | - Ben Singh
- Allied Health and Human Performance, Alliance for Research in Exercise, Nutrition and Activity, University of South Australia, Adelaide, Australia
| | - Grace Laura Rose
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Briana Clifford
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
- School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Tom George Bailey
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Rosalind Renee Spence
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Jemma Turner
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
| | - Michel Willem Coppieters
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
- Faculty of Behavioural and Movement Sciences, Amsterdam Movement Sciences-Musculoskeletal Health Program, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Alexandra Leigh McCarthy
- School of Nursing, Midwifery and Social Work, The University of Queensland, and Mater Research Institute, Brisbane, Australia
| | - Sandra Christine Hayes
- School of Health Sciences and Social Work, Menzies Health Institute Queensland, Griffith University, Brisbane and Gold Coast, Australia
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Brunet J, Sharma S. A scoping review of studies exploring physical activity and cognition among persons with cancer. J Cancer Surviv 2023:10.1007/s11764-023-01441-x. [PMID: 37561316 DOI: 10.1007/s11764-023-01441-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023]
Abstract
PURPOSE This scoping review aimed to identify and synthesize published studies on physical activity (PA) and cognition among persons with cancer and elucidate knowledge gaps. METHODS Articles were identified through electronic and manual searches (02/21 and 03/22) using the following inclusion criteria: (1) empirical, peer-reviewed publication in English, (2) sample comprised persons with cancer, and (3) reported at least one statistical association between PA and cognition. Multiple reviewers independently performed study selection and data extraction, and results were mapped in tabular and narrative form. RESULTS Ninety-seven articles were eligible; these were largely published from 2017 to 2022 (54.6%), conducted in high-income countries (96.9%), and presented (quasi-)experimental studies (73.2%). Samples predominantly comprised women with breast cancer (48.5%), and recruitment often occurred post-treatment (63.9%). PA interventions included: aerobic (32.3%), resistance (4.8%), combined aerobic/resistance (38.7%), mind-body (19.4%), or other PA (4.8%). Most (66%) articles reported inconclusive findings; 32% were positive (in support of PA promoting cognition or vice versa), and 2.1% were negative. Diverse samples and studies with long-term follow-up were scarce. CONCLUSIONS The state of knowledge is insufficient and more rigorous, large-scale studies are required to provide definitive conclusions about the cognitive benefits of PA among persons with cancer. IMPLICATIONS FOR CANCER SURVIVORS Cancer-related cognitive impairment (CRCI) thwarts quality of life. This review summarizes what is known about the association between PA and cognition among persons with cancer and concludes that the evidence is currently equivocal. Hence, it remains uncertain if PA interventions can reduce CRCI, and large-scale PA intervention trials explicitly designed to promote cognition are greatly needed.
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Affiliation(s)
- Jennifer Brunet
- School of Human Kinetics, University of Ottawa, 125 University (MNT 339), Ottawa, ON, K1N 6N5, Canada.
- Institut du savoir Montfort, l'Hôpital Montfort, Ottawa, ON, Canada.
- Cancer Therapeutic Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Sitara Sharma
- School of Human Kinetics, University of Ottawa, 125 University (MNT 339), Ottawa, ON, K1N 6N5, Canada
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Cesnik R, Toohey K, Freene N, Kunstler B, Semple S. Physical Activity Levels in People with Cancer Undergoing Chemotherapy: A Systematic Review. Semin Oncol Nurs 2023; 39:151435. [PMID: 37127520 DOI: 10.1016/j.soncn.2023.151435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 03/22/2023] [Accepted: 03/29/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Physical activity (PA) has been shown to improve chemotherapy side effects, survival rates and treatment adherence in people with cancer. This review aimed to identify whether people undergoing chemotherapy in different exercise interventions meet PA guidelines during chemotherapy. DATA SOURCES Databases searched were CINAHL complete, PubMed, Cochrane Library, EMBASE, AMED, Joanna Briggs Institute, OVID MEDLINE, and Google Scholar. Eligibility and risk-of-bias were reviewed by two authors. PROSPERO registration: CRD42018093839. CONCLUSION Thirty-three studies were eligible (14 randomized controlled trials, six pre-post, and 13 cross-sectional studies), which included 2,722 people with cancer undergoing chemotherapy. Studies (n = 11/13) found PA interventions successfully increased or maintained PA participation levels, whereas PA declined without intervention. This review has identified that due to limited evidence it is not possible to determine the most appropriate intervention to improve PA for people undergoing chemotherapy. Despite the well-documented benefits of PA, most people undergoing chemotherapy do not achieve the PA guidelines. Clinicians should be aware that during treatment, participants may not meet PA guidelines even if they participate in an intervention. However, interventions may prevent PA levels from declining. Further research is required to determine the most effective approaches to increase PA levels while undergoing chemotherapy. IMPLICATIONS FOR NURSING PRACTICE Nurses are well placed to have conversations with patients undergoing chemotherapy regarding PA levels. PA should be considered as part of a treatment regimen. Tailored advice must be provided aiming to improve health outcomes. Referral to an exercise professional is best practice to improve the uptake of PA.
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Affiliation(s)
- Rebecca Cesnik
- PhD Candidate, ACT Health, ACT, Australia; Professor, Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Assistant Professor, Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia
| | - Kellie Toohey
- Professor, Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Assistant Professor, Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, University of Canberra, Bruce, ACT, Australia.
| | - Nicole Freene
- Associate Professor, Physiotherapy, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Associate Professor, Health Research Institute, University of Canberra, Bruce, ACT, Australia
| | - Brea Kunstler
- Research Fellow, BehaviourWorks, Monash University, Victoria, Australia
| | - Stuart Semple
- Professor, Sport and Exercise Science, Faculty of Health, University of Canberra, Bruce, ACT, Australia; Associate Professor, Health Research Institute, University of Canberra, Bruce, ACT, Australia; Professor, Research Institute of Sport and Exercise, University of Canberra, Bruce, ACT, Australia
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Dong B, Qi Y, Lin L, Liu T, Wang S, Zhang Y, Yuan Y, Cheng H, Chen Q, Fang Q, Xie Z, Tian L. Which Exercise Approaches Work for Relieving Cancer-Related Fatigue? A Network Meta-analysis. J Orthop Sports Phys Ther 2023; 53:343–352. [PMID: 36947532 DOI: 10.2519/jospt.2023.11251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVE: To determine the most effective exercise modalities for managing cancer-related fatigue during and after cancer treatment. DESIGN: Network meta-analysis (NMA) of randomized controlled trials. LITERATURE SEARCH: Seven electronic databases were systematically searched from inception to January 2022. STUDY SELECTION CRITERIA: Randomized controlled trials testing the effects of exercise on relieving cancer-related fatigue in adult patients with cancer. DATA SYNTHESIS: An NMA of 56 studies was conducted, and the PRISMA-NMA guidelines were followed when reporting results. To determine the most effective interventions, the surface under the cumulative ranking curve (SUCRA) value was calculated for each exercise modality. RESULTS: Combined aerobic and resistance exercise (standardized mean difference [SMD], 1.57; credible interval [CrI], 1.03-2.10), yoga (SMD, 1.02; CrI: 0.44, 1.60), and regular physical activity (SMD, 1.07; CrI: 0.21, 1.92) could significantly alleviate cancer-related fatigue compared to control groups (usual care, wait-list, and regular physical activity). Combined aerobic and resistance exercise (SUCRA, 97.2%) had the highest probability of efficacy, followed by yoga (SUCRA, 75.5%) and regular physical activity (SUCRA, 74.1%). During cancer treatment, combined aerobic and resistance exercise (SUCRA, 94.5%) ranked first in efficacy, followed by regular physical activity (SUCRA, 82.1%) and yoga (SUCRA, 73.8%). After cancer treatment, only combined aerobic and resistance exercise (SMD, 0.99; CrI: 0.13, 1.84) had a significant effect on cancer-related fatigue. CONCLUSION: Combined aerobic and resistance exercise, yoga, and regular physical activity were the most effective exercise modalities for alleviating cancer-related fatigue. Combined aerobic and resistance exercise is recommended during and after cancer treatment. J Orthop Sports Phys Ther 2023;53(6):1-10. Epub: 23 March 2023. doi:10.2519/jospt.2023.11251.
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Cuthbert C, Twomey R, Bansal M, Rana B, Dhruva T, Livingston V, Daun JT, Culos-Reed SN. The role of exercise for pain management in adults living with and beyond cancer: a systematic review and meta-analysis. Support Care Cancer 2023; 31:254. [PMID: 37039883 PMCID: PMC10088810 DOI: 10.1007/s00520-023-07716-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 03/28/2023] [Indexed: 04/12/2023]
Abstract
BACKGROUND Pain is a common side effect of cancer or cancer treatment that negatively impacts biopsychosocial wellbeing and quality of life. Exercise is a potential intervention to manage pain that is safe and has multiple benefits. The objective was to determine the role of exercise in cancer pain management. METHODS We completed a systematic review and meta-analysis of exercise interventions in adults with any type or stage of cancer by searching Ovid MEDLINE®, Embase, APA PsycInfo, the Cochrane Central Register of Controlled Trials, CINAHL, and SPORTDiscus. We included experimental and quasi-experimental designs where pain was measured as an outcome. Data synthesis included narrative and tabular summary. A meta-analysis was performed on studies powered to detect the effect of exercise on pain. Study quality was evaluated using the Cochrane risk of bias tool and certainty of evidence was evaluated using the GRADE tool. RESULTS Seventy-six studies were included. Studies were predominantly conducted in breast cancer and exercise usually included a combination of aerobic and strength training. Ten studies were included in the meta-analysis demonstrating a significant effect for exercise in decreasing pain (estimated average standard mean difference (SMD) was g = - 0.73 (95% CI: - 1.16 to - 0.30)); however, the overall effect prediction interval was large. Overall risk of bias for most studies was rated as some concerns and the grading of evidence certainty was low. CONCLUSION There are limitations in the evidence for exercise to manage cancer-related pain. Further research is needed to understand the role of exercise in a multimodal pain management strategy.
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Affiliation(s)
- Colleen Cuthbert
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
| | - Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Mannat Bansal
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Benny Rana
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - Tana Dhruva
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | | | - Julia T Daun
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
| | - S Nicole Culos-Reed
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, AB, Canada
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Akbari PS, Hassan Y, Archibald L, Tajik T, Dunn K, Berris M, Smith-Turchyn J. Effect of Physical Activity During Chemotherapy on Cognitive Function in Cancer Survivors: A Systematic Review and Meta-Analysis. Physiother Can 2023; 75:12-21. [PMID: 37250734 PMCID: PMC10211382 DOI: 10.3138/ptc-2021-0032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 07/21/2021] [Accepted: 07/23/2021] [Indexed: 08/11/2023]
Abstract
Purpose: To determine if cancer survivors who perform physical activity (PA) during chemotherapy have improved levels of cognitive function compared to those who do not. Method: E-databases (Ovid MEDLINE, Embase, CINAHL, PsycINFO, AMED) were searched from inception to February 4, 2020. Quantitative studies that assessed cognitive outcomes for adults with any cancer type who received chemotherapy concurrent with PA were selected. Risk of bias was assessed using Cochrane's RoB 2, ROBINS-I, and Newcastle-Ottawa scales. A meta-analysis was performed using standardized mean difference (SMD). Results: Twenty-two studies (15 randomized controlled trials [RCTs] and 7 non-RCTs) met the inclusion criteria. The meta-analysis demonstrated that combined resistance and aerobic training had a small yet statistically significant effect on social cognition compared to usual care (SMD 0.23 [95% CI: 0.04, 0.42], p = 0.020). Conclusions: Combined resistance and aerobic exercise may benefit social cognition in cancer survivors undergoing chemotherapy. Due to high risk of bias and low quality of evidence of included studies, we recommend further investigation to support these findings and make specific PA recommendations.
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Gutiérrez-Santamaría B, Castañeda-Babarro A, Arietaleanizbeaskoa MS, Mendizabal-Gallastegui N, Grandes G, Coca A. Physiological and mental health changes in cancer patients during the COVID-19 state of emergency. SPORT SCIENCES FOR HEALTH 2023; 19:123-130. [PMID: 36211532 PMCID: PMC9525225 DOI: 10.1007/s11332-022-01008-w] [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: 12/13/2021] [Accepted: 09/15/2022] [Indexed: 11/24/2022]
Abstract
Backgrounds Due to the COVID-19 pandemic that we are currently facing, many governments across the world have declared a state of emergency and even confinements. This stressful situation, in addition to prolonged stays at home, may imply a radical change in lifestyle behavior and physical activity (PA). The aim of this study is to evaluate the physiological and psychological effects in cancer patients who changed their PA habits during the COVID-19 state of emergency in Spain. Methods Thirty-three participants were evaluated pre- and post-state of emergency. A series of questionnaires was used to assess cancer-specific quality of life. Results The most relevant results revealed significantly lower walking time (p < 0.001) and sitting time (p = 0.014). Upper and lower body strength also decreased significantly (p = 0.009 and 0.012, respectively) and oxygen consumption (VO2 peak) (p = 0.023). None of the parameters analysed showed significant differences for psychological aspects (QLQ-C-30 and SF-36) and body composition. Conclusion Lower physical activity leads to negative physiological adaptation, particularly affecting cardiovascular and strength levels. While it is important to maintain the general population's amount and intensity of exercise, this particularly vulnerable group's physical capacity is vital to their health and well-being.
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Affiliation(s)
- Borja Gutiérrez-Santamaría
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bizkaia, Spain
| | - Arkaitz Castañeda-Babarro
- Department of Physical Activity and Sport Sciences, Faculty of Education and Sport, University of Deusto, 48007 Bizkaia, Spain
| | - Maria Soledad Arietaleanizbeaskoa
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay Spain
| | - Nere Mendizabal-Gallastegui
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay Spain
| | - Gonzalo Grandes
- Primary Care Research Unit of Bizkaia, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903 Barakaldo, Biscay Spain
| | - Aitor Coca
- Department of Physical Activity and Sports Sciences, Faculty of Health Sciences, Euneiz University, La Biosfera Ibilbidea, 6, 01013 Vitoria-Gasteiz, Spain
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Bringel MDO, Reis AD, Aguiar LC, Garcia JBS. Ansiedade, Depressão, Dor e Fadiga em Pacientes com Câncer de Mama que Realizaram Treinamento Combinado. REVISTA BRASILEIRA DE CANCEROLOGIA 2022. [DOI: 10.32635/2176-9745.rbc.2022v68n3.2611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
Introdução: Apesar do aumento na sobrevida de pacientes com neoplasias de mama, muitas persistem com ansiedade, depressão, fadiga e dor mesmo após o tratamento anticancerígeno, fatores associados a uma pior qualidade de vida. Objetivo: Avaliar a influencia do treinamento combinado na ansiedade, depressão, dor e fadiga em pacientes com câncer de mama. Método: Ensaio controlado randomizado com 26 pacientes em quimioterapia, radioterapia ou acompanhamento clinico em um centro de referência em tratamento de câncer, com idade 30 a 59 anos, não praticantes de treinamento físico nos últimos três meses. O grupo experimental (GE) (n=13) foi submetido a três sessões por semana de treinamento aeróbico e resistido em 12 semanas, com duração de 60 minutos, e duas sessões de treinamento de flexibilidade por semana com duração de 20 segundos em três series. O grupo controle (GC) (n=13) realizou somente o tratamento hospitalar convencional. Todas as avaliações foram realizadas no tempo basal e após 12 semanas. Resultados: As pacientes do GE apresentaram redução significativa da ansiedade (p=0,0242), intensidade da dor (p=0,0290) e dimensão comportamental da fadiga (0,0033). Não foram observadas diferenças na depressão (p=0,0803), interferência da dor nas atividades habituais (p=0,0933) e dimensões afetiva (p=0,0583) e sensorial/cognitiva/emocional (p=0,5525) da fadiga. O GC permaneceu inalterado em todas as variáveis. Conclusão: O treinamento combinado, envolvendo exercícios aeróbios, de resistência e de flexibilidade durante 12 semanas, apresenta efeitos benéficos na ansiedade, fadiga e dor em pacientes com câncer de mama.
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Andersen HH, Vinther A, Lund CM, Paludan C, Jørgensen CT, Nielsen D, Juhl CB. Effectiveness of different types, delivery modes and extensiveness of exercise in patients with breast cancer receiving systemic treatment - A systematic review and meta-analysis. Crit Rev Oncol Hematol 2022; 178:103802. [PMID: 36031174 DOI: 10.1016/j.critrevonc.2022.103802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/18/2022] [Accepted: 08/23/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Effects of exercise in patients with breast cancer have been thoroughly investigated. The aim was to explore differences in effects regarding type, delivery mode and extensiveness (e.g. intensity; volume) of the interventions. METHODS We searched for randomised controlled trials including patients with breast cancer receiving systemic treatment, exercise-based interventions, and measures on patient reported- and objectively measured outcomes. RESULTS Exercise showed significant and moderate effects on the primary outcomes quality of life and physical function, Standardised Mean Difference: 0.52 (95 % CI 0.38-0.65) and 0.52 (95 % CI 0.38-0.66), respectively. Type of exercise had little influence on the effects, however combined aerobic- and resistance exercise seemed superior for increasing physical function, compared to aerobic or resistance exercise. Supervised interventions were superior to partly and unsupervised. Extensiveness of the intervention only influenced physical function. CONCLUSIONS Supervised interventions, more than type or extensiveness of interventions, seem to increase effects.
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Affiliation(s)
- Høgni Hammershaimb Andersen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark.
| | - Anders Vinther
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark; Hospital Secretariat and Communication, Research, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark.
| | - Cecilia Margareta Lund
- Department of Medicine, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark.
| | - Camilla Paludan
- Department of Sports Science and Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
| | - Claus Thomas Jørgensen
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark.
| | - Dorte Nielsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen N, Denmark; Department of Oncology, Copenhagen University Hospital, Herlev and Gentofte, 2730 Herlev, Denmark.
| | - Carsten Bogh Juhl
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 29, Level 8, 3. Floor, O1, 2730 Herlev, Denmark; Department of Sports Science and Biomechanics, University of Southern Denmark, 5230 Odense, Denmark.
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Lemoine A, Perrier M, Mazza C, Quinquenel A, Brasseur M, Delmer A, Vallerand H, Dewolf M, Bertin E, Barbe C, Botsen D, Bouché O. Feasibility and Impact of Adapted Physical Activity (APA) in Cancer Outpatients Beginning Medical Anti-Tumoral Treatment: The UMA-CHAPA Study. Cancers (Basel) 2022; 14:cancers14081993. [PMID: 35454896 PMCID: PMC9029046 DOI: 10.3390/cancers14081993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 04/12/2022] [Accepted: 04/12/2022] [Indexed: 12/15/2022] Open
Abstract
Simple Summary Physical activity may reduce the risk of overall cancer incidence and improve survival in cancer patients. The beneficial effects of physical activity are also described in cancer survivors but remains poorly known during systemic cancer treatment. Therefore, we studied the feasibility of an adapted physical activity (APA) program in cancer outpatients beginning a medical anti-tumoral treatment for a digestive, lung, hematological, or dermatological cancer. We also studied the impact of APA on fatigue, anxiety, depression, and handgrip strength. Abstract Adapted physical activity (APA) improves quality of life and cancer outcomes. The aim of this study was to assess the feasibility of an APA program in outpatients beginning medical anticancer treatment. The secondary objective was to assess the impact of APA on fatigue, anxiety, depression, and handgrip strength (HGS). This prospective study was conducted between January and July 2017. Among 226 patients beginning treatment in the unit for a digestive, lung, hematological, or dermatological cancer, 163 were included. Adherence to the APA program was defined as more than or equal to one one-hour session per week for 3 months. The first evaluation was conducted at 3 months (M3), and the second evaluation at 6 months (M6). A total of 163 patients were included (mean age 62.5 ± 14.3); 139 (85.3%) agreed to follow the APA program. At M3, 106 of them were evaluated, of which 86 (81.1%) declared that they had followed the program. Improvement in anxiety was observed at M3 (−1.0 ± 3.2; p = 0.002) but there was no significant change in fatigue or depression. HGS decreased significantly (−1.2 ± 5.5; p = 0.04). The APA program was feasible in cancer outpatients beginning medical anticancer treatment. APA should be part of standard support care.
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Affiliation(s)
- Amélie Lemoine
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France; (C.M.); (D.B.)
- Correspondence:
| | - Marine Perrier
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France; (M.P.); (M.B.); (O.B.)
| | - Camille Mazza
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France; (C.M.); (D.B.)
| | - Anne Quinquenel
- Department of Clinical Hematology, CHU Reims, 51100 Reims, France; (A.Q.); (A.D.)
| | - Mathilde Brasseur
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France; (M.P.); (M.B.); (O.B.)
| | - Alain Delmer
- Department of Clinical Hematology, CHU Reims, 51100 Reims, France; (A.Q.); (A.D.)
| | - Hervé Vallerand
- Department of Pulmonary Medicine, CHU Reims, 51100 Reims, France; (H.V.); (M.D.)
| | - Maxime Dewolf
- Department of Pulmonary Medicine, CHU Reims, 51100 Reims, France; (H.V.); (M.D.)
| | - Eric Bertin
- Department of Nutrition, Endocrinology and Diabetology, CHU Reims, 51100 Reims, France;
| | - Coralie Barbe
- Research on Health University Department, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France;
| | - Damien Botsen
- Department of Medical Oncology, Godinot Cancer Institute, 51100 Reims, France; (C.M.); (D.B.)
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France; (M.P.); (M.B.); (O.B.)
| | - Olivier Bouché
- Department of Gastroenterology and Digestive Oncology, CHU Reims, University of Reims Champagne-Ardenne (URCA), 51100 Reims, France; (M.P.); (M.B.); (O.B.)
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Singh B, Zopf EM, Howden EJ. Effect and feasibility of wearable physical activity trackers and pedometers for increasing physical activity and improving health outcomes in cancer survivors: A systematic review and meta-analysis. JOURNAL OF SPORT AND HEALTH SCIENCE 2022; 11:184-193. [PMID: 34314878 PMCID: PMC9068515 DOI: 10.1016/j.jshs.2021.07.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 05/13/2021] [Accepted: 06/24/2021] [Indexed: 05/16/2023]
Abstract
PURPOSE This systematic review and meta-analysis aimed to evaluate the effect of wearable devices for improving physical activity and health-related outcomes in cancer survivors. METHODS CINAHL, Cochrane, Ebscohost, MEDLINE, Pubmed, ProQuest Health and Medical Complete, ProQuest Nursing and Allied Health Source, ScienceDirect, and SPORTDiscus databases were searched for randomized controlled trials published before September 1, 2020, that evaluated interventions involving wearable devices in cancer survivors. Standardized mean differences (SMDs) were calculated to assess effects on physical activity and health-related outcomes. Subgroup analyses were conducted to assess whether the effects differed by interventions and cancer characteristics. Risk of bias was assessed using the Cochrane risk of bias tool. RESULTS Thirty-five trials were included (breast cancer, n = 15, 43%). Intervention durations ranged between 4 weeks and 1 year. Most trials (n = 25, 71%) involved pedometer-based physical activity interventions. Seven (20%) involved Fitbit-based interventions, and 3 (9%) involved other wearable physical activity trackers (e.g., Polar, Garmin). Compared to usual care, wearable devices had moderate-to-large effects (SMD range 0.54-0.87, p < 0.001) on moderate-intensity physical activity, moderate-to-vigorous-intensity physical activity, total physical activity, and daily steps. Compared to usual care, those in the intervention had higher quality of life, aerobic fitness, physical function, and reduced fatigue (SMD range = 0.18-0.66, all p < 0.05). CONCLUSION Wearable physical activity trackers and pedometers are effective tools that increase physical activity and improve health-related outcomes in individuals with cancer. Identifying how these devices can be implemented for longer-term use with other intervention components remains an area for future research.
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Affiliation(s)
- Benjamin Singh
- Gallipoli Medical Research Foundation, Greenslopes Private Hospital, Greenslopes, QLD 4120, Australia.
| | - Eva M Zopf
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Erin J Howden
- Baker Heart and Diabetes Institute, Melbourne, VIC 3004, Australia
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Larsen RT, Wagner V, Korfitsen CB, Keller C, Juhl CB, Langberg H, Christensen J. Effectiveness of physical activity monitors in adults: systematic review and meta-analysis. BMJ 2022; 376:e068047. [PMID: 35082116 PMCID: PMC8791066 DOI: 10.1136/bmj-2021-068047] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/29/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To estimate the effectiveness of physical activity monitor (PAM) based interventions among adults and explore reasons for the heterogeneity. DESIGN Systematic review and meta-analysis. STUDY SELECTION The electronic databases MEDLINE, Embase, SPORTDiscus, CINAHL, and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched on 4 June 2021. Eligible randomised controlled trials compared interventions in which adults received feedback from PAMs with control interventions in which no feedback was provided. No restrictions on type of outcome measurement, publication date, or language were applied. DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted data and assessed risk of bias. Random effects meta-analyses were used to synthesise the results. The certainty of evidence was rated by the Grading of Recommendations Assessment and Evaluation (GRADE) approach. MAIN OUTCOME MEASURES The three primary outcomes of interest were physical activity, moderate to vigorous physical activity, and sedentary time. RESULTS 121 randomised controlled trials with 141 study comparisons, including 16 743 participants, were included. The PAM based interventions showed a moderate effect (standardised mean difference 0.42, 95% confidence interval 0.28 to 0.55) on physical activity, equivalent to 1235 daily steps; a small effect (0.23, 0.16 to 0.30) on moderate to vigorous physical activity, equivalent to 48.5 weekly minutes; and a small insignificant effect (-0.12, -0.25 to 0.01) on sedentary time, equal to 9.9 daily minutes. All outcomes favoured the PAM interventions. CONCLUSIONS The certainty of evidence was low for the effect of PAM based interventions on physical activity and moderate for moderate to vigorous physical activity and sedentary time. PAM based interventions are safe and effectively increase physical activity and moderate to vigorous physical activity. The effect on physical activity and moderate to vigorous physical activity is well established but might be overestimated owing to publication bias. STUDY REGISTRATION PROSPERO CRD42018102719.
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Affiliation(s)
- Rasmus Tolstrup Larsen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
| | - Vibeke Wagner
- Department of Brain Injury Rehabilitation, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christoffer Bruun Korfitsen
- Parker Institute, Bispebjerg and Frederiksberg Hospital, Capital Region, Frederiksberg, Denmark
- Danish Health Authority, Copenhagen, Denmark
| | - Camilla Keller
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
- Danish Cancer Society Research Center, Danish Cancer Society, Copenhagen, Denmark
| | - Carsten Bogh Juhl
- Research Unit of Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Henning Langberg
- Section of Health Services Research, Department of Public Health, University of Copenhagen, Denmark
| | - Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet Copenhagen, Denmark
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Hirschey R, Nance J, Hoover R, Triglianos T, Coffman E, Horrell LN, Walker J, Leak Bryant A, Valle C. Physical Activity: A Systematic Review to Inform Nurse Recommendations During Treatment for Colorectal Cancer. Clin J Oncol Nurs 2021; 25:697-705. [PMID: 34800098 PMCID: PMC8674841 DOI: 10.1188/21.cjon.697-705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Colorectal cancer (CRC) is the third most common cancer in the world (American Cancer Society [ACS], 2021). Because of increasing survival rates, there is a need improve survivors' quality of life (QOL), physical functioning, recurrence risk, and comorbidity prevalence (ACS, 2020). Many patients with CRC have poor QOL during and after treatment; other common side effects include fatigue, depression, anxiety, and decreased sleep quality (Bourke et al., 2014; Cramer et al., 2014; Gao et al., 2020). Focusing on the treatment period is important because physical activity (PA) may decrease side effects and prevent PA decline and functional decline, both of which can become significant barriers to PA following treatment. In addition, patients with CRC have a higher rate of comorbidities than patients without cancer, making lifestyle changes pre- and post-treatment particularly important for their continued survival and QOL (ACS, 2020).
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21
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Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate. BMC Cancer 2021; 21:1179. [PMID: 34740332 PMCID: PMC8569988 DOI: 10.1186/s12885-021-08701-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. METHODS MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. RESULTS Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p < 0.001) and progression (15 to 37%, p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. CONCLUSION Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.
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Yuan Y, Zhang N, Xie C, Liang J, Qi Y, Dong B, Lin L, Tian L. Effects of home-based walking on cancer-related fatigue in patients with breast cancer: a meta-analysis of randomized controlled trials. Arch Phys Med Rehabil 2021; 103:342-352. [PMID: 34302791 DOI: 10.1016/j.apmr.2021.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/10/2021] [Accepted: 06/15/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study was designed to critically evaluate the effect of home-based walking on cancer-related fatigue (CRF) in patients with breast cancer receiving anti-cancer treatment. DATA SOURCES Eight databases were systematically searched from inception to March 2021 for randomized controlled trials (RCTs) without language restrictions. STUDY SELECTION Two reviewers scanned the titles and abstracts, and then read the full texts of potentially eligible trials to screen the literature. Inclusion criteria were studies of home-based walking (HBW) intervention in adult breast cancer patients, and used fatigue as a primary or secondary outcome and containing extractable fatigue scores. DATA EXTRACTION Two reviewers critically and independently assessed the risk of bias using Cochrane Collaboration criteria and extracted correlated data using the designed extraction form. The standardized mean difference (SMD) was used when the outcome assessment tools were different. All of the analyses were performed using Review Manager 5.3. DATA SYNTHESIS Eight RCTs, including 764 patients (HBW: 377, control: 387) meeting the inclusion criteria for the meta-analysis were identified. HBW had a significant effect on CRF in breast cancer (BC) patients receiving multiple anti-cancer treatments [SMD = -0.61, 95% CI (-0.86, -0.36), p<0.001]. HBW without other exercises [SMD = -0.83, 95% CI (-1.39, -0.27), p = 0.003], walking for a gradually increased duration [SMD = -1.24, 95% CI (-2.20, -0.28), p = 0.010] and no restrictions on walking intensity [SMD = -1.03, 95% CI (-1.75, -0.31), p = 0.005] demonstrated substantial effects on CRF. Of the eight included studies, only three reported adverse events. CONCLUSIONS HBW can be considered as an alternative therapy for relieving CRF in breast cancer patients undergoing anti-cancer treatment.
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Affiliation(s)
- Yang Yuan
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Ning Zhang
- Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Congyan Xie
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Jinghong Liang
- Department of Maternal and Child Health, School of Public Health, Sun Yat-sen University, Guangzhou 510080, China
| | - Yishu Qi
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Bei Dong
- School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China
| | - Lu Lin
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
| | - Li Tian
- The First Affiliated Hospital of Soochow University, Suzhou 215006, People's Republic of China; School of Nursing, Medical College of Soochow University, Suzhou 215006, People's Republic of China.
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Congruence and trajectories of device-measured and self-reported physical activity during therapy for early breast cancer. Breast Cancer Res Treat 2021; 188:351-359. [PMID: 33788134 PMCID: PMC8260526 DOI: 10.1007/s10549-021-06195-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 03/13/2021] [Indexed: 11/12/2022]
Abstract
Purpose This study examines congruence between self-reported and device-measured physical activity data in women with early breast cancer and compares trajectories under different treatments. Methods Women with non-metastatic breast cancer were recruited before primary therapy. In four weeks distributed over six months after treatment start, patients reported time spent on work, transport, chores and sports via diary and wore Garmin® vivofit 3 accelerometers to assess steps taken. Associations between these measures and agreement regarding guideline adherence were tested with Spearman’s Correlation Coefficient and Weighted Kappa statistic. Effects of time and treatment were evaluated using mixed analyses of variance. Results Ninety-nine participants (median age = 50) were treated with adjuvant (N= 23), neoadjuvant (N= 21) or without chemotherapy (N= 55). Coherence between self-report and device data was strong (r = 0.566). Agreement about reaching recommendations was only “fair” (kappa coefficient = 0.321 and 0.249, resp.). Neither treatment or week nor their interaction had effects on step counts (all p > 0.05). Self-reported activity time was lower for patients with chemotherapy than for those without (adjuvant: ∆ = 69min, p= 0.006, neoadjuvant: ∆ = 45min, p= 0.038) and lower in week 18 than in week 3 (∆ = 43min, p= 0.010). Conclusion Results show that consumer-grade activity monitors and self-reports correlate but show different perspectives on physical activity in breast cancer patients. In general, patients perceive some decline regardless of primary treatment regimen. Those affected should be offered assistance to gain the benefits of activity. Accelerometers may help professionals to identify these individuals and patients to verify appraisal of their activity levels. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06195-7.
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LeVasseur N, Cheng W, Mazzarello S, Clemons M, Vandermeer L, Jones L, Joy AA, Barbeau P, Wolfe D, Ahmadzai N, Hersi M, Stober C, Shorr R, Hilton J, Hutton B. Optimising weight-loss interventions in cancer patients-A systematic review and network meta-analysis. PLoS One 2021; 16:e0245794. [PMID: 33539414 PMCID: PMC7861370 DOI: 10.1371/journal.pone.0245794] [Citation(s) in RCA: 12] [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: 06/04/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Excess weight has been associated with increased morbidity and a worse prognosis in adult patients with early-stage cancer. The optimal lifestyle interventions to optimize anthropometric measures amongst cancer patients and survivors remain inconsistent. Objective To conduct a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs) comparing the effects of exercise and dietary interventions alone or in combination on anthropometric measures of adult cancer patients and survivors. Methods A systematic search of Medline, Embase and the Cochrane Trials Registry was performed. Outcomes of interest included changes in weight, body mass index (BMI), and waist circumference. Screening and data collection were performed by two reviewers. Bayesian NMAs were performed. Results Overall, 98 RCTs were included; 75 were incorporated in NMAs (n = 12,199). Groups of intervention strategies included: 3 exercise interventions, 8 dietary interventions, 7 combination interventions of diet and exercise and standard care. Median intervention duration was 26 weeks. NMA suggested that diet alone (mean difference [MD] -2.25kg, 95% CrI -3.43 to -0.91kg) and combination strategies (MD -2.52kg, 95% CrI -3.54 to -1.62kg) were associated with more weight loss compared to standard care. All dietary interventions achieved a similar magnitude of weight loss (MD range from -2.03kg to -2.52kg). Both diet alone and combination strategies demonstrated greater BMI reductions versus standard care, and each of diet alone, exercise alone and combination strategies demonstrated greater reductions in waist circumference than standard care. Conclusion Diet and exercise alone or in combination are effective lifestyle interventions to improve anthropometric measures in cancer patients and survivors. All reputable diets appear to be similarly effective to achieve weight loss.
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Affiliation(s)
- Nathalie LeVasseur
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Wei Cheng
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Sasha Mazzarello
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark Clemons
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Lisa Vandermeer
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - Lee Jones
- Memorial Sloan Kettering Cancer Center, New York, New York, United States of America
- Weill Cornell Medical Center, New York, New York, United States of America
| | - Anil Abraham Joy
- Division of Medical Oncology, Department of Oncology, University of Alberta, Cross Cancer Institute, Edmonton, Canada
| | | | - Dianna Wolfe
- Ottawa Hospital Research Institute, Ottawa, Canada
| | | | - Mona Hersi
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Carol Stober
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | | | - John Hilton
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
- Ottawa Hospital Research Institute, Ottawa, Canada
| | - Brian Hutton
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
- University of Ottawa School of Epidemiology and Public Health, Ottawa, Canada
- * E-mail:
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Physical exercise during adjuvant chemotherapy for colorectal cancer-a non-randomized feasibility study. Support Care Cancer 2020; 29:2993-3008. [PMID: 33030598 PMCID: PMC8062327 DOI: 10.1007/s00520-020-05789-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 09/16/2020] [Indexed: 12/26/2022]
Abstract
Background Colorectal cancer (CRC) is the third most common cancer worldwide, and a large proportion of the patients receive adjuvant oxaliplatin-based chemotherapy. Most of these experience chemotherapy-induced peripheral neuropathy (CIPN), affecting quality of life. Evidence to advise exercise to reduce CIPN is limited. The primary aim of this study was to investigate the feasibility of an exercise intervention and data collection among CRC patients during adjuvant chemotherapy. Material and methods This non-randomized feasibility study included CRC patients admitted to adjuvant chemotherapy to an intervention consisting of supervised aerobic endurance, resistance, and balance exercises twice a week at the hospital in addition to home-based exercise once a week. A physiotherapist supervised the patients, and the intervention lasted throughout the period of adjuvant chemotherapy (12–24 weeks). Participants performed physical tests and filled in questionnaires at baseline, 3, 6, 9, and 12 months. Results and conclusion Nineteen (63%) of 30 invited patients consented. A major barrier to recruit or consent to participation was long travel distance to the hospital. The completion rate of questionnaires and physical tests were near 100%. Seven participants dropped out, five before the intervention started. Median attendance to supervised exercise was 85%. There were no serious adverse events related to the intervention. Except for a planned higher intensity of endurance exercise, we found the intervention feasible and safe. Based on experiences in this study, some adjustments have been made for an upcoming randomized trial, including the supervised exercise taking place close to participants’ homes. Trial registration NCT03885817, March 22, 2019, retrospectively registered.
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Effect of Exercise on Physical Function and Psychological Well-being in Older Patients With Colorectal Cancer Receiving Chemotherapy-A Systematic Review. Clin Colorectal Cancer 2020; 19:e243-e257. [PMID: 32828706 DOI: 10.1016/j.clcc.2020.05.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/14/2020] [Accepted: 05/26/2020] [Indexed: 01/07/2023]
Abstract
The incidence of colorectal cancer (CRC) increases with older age. Cancer and treatment-related side effects often lead to physical decline, poor treatment adherence, and a lower quality of life. The aim of the present systematic review and meta-analysis was to evaluate the effects of exercise reported by randomized controlled trials (RCTs) on physical function, physical fitness (ie, aerobic capacity, muscle strength) physical activity, and psychological well-being in older patients with CRC undergoing chemotherapy. Eight RCTs with 552 participants were included in the meta-analysis. The mean age across the RCTs was 58.5 years, and 2 RCTs excluded patients aged > 80 years. The meta-analyses showed a low level of evidence for a small beneficial effect of exercise on self-reported physical function (standardized mean difference [SMD], 0.26; 95% confidence interval [CI], 0.04-0.48) and global quality of life (SMD, 0.22; 95% CI, 0.02-0.43) and low level of evidence for a moderate effect of exercise reducing fatigue (SMD, -0.49; 95% CI, -0.79 to -0.19) for patients receiving chemotherapy for CRC. We found no evidence for a beneficial effect of exercise on physical fitness. No adverse events related to the exercise interventions were reported. The evidence for the effect of exercise on physical outcomes and psychological well-being during chemotherapy for patients with CRC and especially for older patients is sparse. However, exercise during chemotherapy for patients with CRC is feasible and safe. We found a moderate to high risk of bias in most of the included studies, small sample sizes, and a low number of included patients. Moreover, all studies had excluded patients with comorbidities or walking impairment, a group of patients who would probably benefit the most from exercise. This positive result requires verification in larger trials of older and frail patients receiving chemotherapy for CRC.
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Piringer G, Vormittag L, Öhler L, Grünberger B, Meran J, Moshammer M, Andel J, Eisterer W, Trommet V, Thaler J. REGO-ACT: assessment of physical activity during treatment with regorafenib for metastatic colorectal cancer. Wien Klin Wochenschr 2020; 132:423-430. [PMID: 32643016 DOI: 10.1007/s00508-020-01703-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 06/06/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND A frequent side effect of the multikinase inhibitor regorafenib is fatigue. Physical activity has shown potential in reducing cancer-related fatigue. METHODS This non-interventional pilot study assessed physical activity levels of metastatic colorectal cancer (mCRC) patients treated with regorafenib based on median daily step counts measured at 1‑week intervals using a pedometer. The study further evaluated relations between physical activity levels and fatigue, quality of life (QoL) and progression-free survival. RESULTS Pedometer data were available for 22 out of 25 enrolled patients. The numbers of days with available pedometer data ranged from 6 to 100 days. The overall median daily step count was 2357 (range 10-14,931), with substantial interindividual and intraindividual variations. Interindividual median weekly step counts were in the range of 5000-7000 in some, 2000-3000 in others, and several hundreds or less in a few patients. Intraindividual daily step counts also varied by several thousands of steps. Step counts in weeks in which patients reported fatigue were well within the range of or even higher than step counts in adjacent weeks, indicating a lack of correlation. The risk of disease progression was also independent of median weekly step counts; however, significant correlations were seen between QoL and step counts. CONCLUSION Despite the severity of their disease patients showed remarkable levels of walking activity. In view of the highly individual activity levels, exercise prescriptions for seriously ill patient populations should be personalized to the specific needs and preferences of each individual patient.
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Affiliation(s)
- Gudrun Piringer
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, 4600, Wels, Austria. .,Johannes Kepler University Linz, Linz, Austria.
| | - Laurenz Vormittag
- Department of Internal Medicine I, St. Josef Hospital Vienna, Vienna, Austria
| | - Leopold Öhler
- Department of Internal Medicine I, St. Josef Hospital Vienna, Vienna, Austria
| | - Birgit Grünberger
- Department of Internal Medicine, Hospital of The Merciful Brothers, Vienna, Austria.,Department of Internal Medicine, Landesklinikum Wiener Neustadt, Wiener Neustadt, Austria
| | - Johannes Meran
- Department of Internal Medicine, Hospital of The Merciful Brothers, Vienna, Austria
| | | | - Johannes Andel
- Department of Internal Medicine II, Landeskrankenhaus Steyr, Steyr, Austria
| | - Wolfgang Eisterer
- Department of Internal Medicine V, Innsbruck Medical University, Innsbruck, Austria.,Department of Internal Medicine, Klinikum Klagenfurt, Klagenfurt, Austria
| | - Vera Trommet
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, 4600, Wels, Austria
| | - Josef Thaler
- Department of Internal Medicine IV, Klinikum Wels-Grieskirchen, Grieskirchnerstraße 42, 4600, Wels, Austria.,Johannes Kepler University Linz, Linz, Austria
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Schaffer K, Panneerselvam N, Loh KP, Herrmann R, Kleckner IR, Dunne RF, Lin PJ, Heckler CE, Gerbino N, Bruckner LB, Storozynsky E, Ky B, Baran A, Mohile SG, Mustian KM, Fung C. Systematic Review of Randomized Controlled Trials of Exercise Interventions Using Digital Activity Trackers in Patients With Cancer. J Natl Compr Canc Netw 2020; 17:57-63. [PMID: 30659130 DOI: 10.6004/jnccn.2018.7082] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/07/2018] [Indexed: 12/12/2022]
Abstract
Background: Exercise can ameliorate cancer- and treatment-related toxicities, but poor adherence to exercise regimens is a barrier. Exercise interventions using digital activity trackers (E-DATs) may improve exercise adherence, but data are limited for patients with cancer. We conducted a systematic review examining the feasibility of E-DATs in cancer survivors and effects on activity level, body composition, objective fitness outcomes, health-related quality of life (HRQoL), self-reported symptoms, and biomarkers. Methods: We identified randomized controlled trials (RCTs) of E-DATs in adult cancer survivors published in English between January 1, 2008, and July 27, 2017. Two authors independently reviewed article titles (n=160), removed duplicates (n=50), and reviewed the remaining 110 articles for eligibility. Results: A total of 12 RCTs met eligibility criteria, including 1,450 patients (mean age, 50-70 years) with the following cancers: breast (n=5), colon or breast (n=2), prostate (n=1), acute leukemia (n=1), or others (n=3). Duration of E-DATs ranged from 4 to 24 weeks, and the follow-up period ranged from 4 to 52 weeks, with retention rates of 54% to 95%. The technology component of E-DATs included pedometers (n=8); pedometers with smartphone application (n=1), Wii Fit (n=1), heart rate monitor (n=1); and a wireless sensor with accelerometer, gyroscope, and magnetometer (n=1). Adherence by at least one measure to E-DATs was >70% in 8 of 8 RCTs. Compared with controls, E-DATs significantly improved patients' step count in 3 of 5 RCTs, activity level in 6 of 9 RCTs, and HRQoL in 7 of 9 RCTs (all P≤05), with no significant changes in biomarkers (eg, interleukin 6, tumor necrosis factor α, C-reactive protein, c-peptide, lipid panel) in 3 RCTs. Duration of E-DAT was not significantly correlated with adherence or study retention. Conclusions: This systematic review shows that E-DATs are feasible to implement in cancer survivors. Future research should examine the optimal type, dose, and schedule of E-DATs for cancer survivors.
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McGettigan M, Cardwell CR, Cantwell MM, Tully MA. Physical activity interventions for disease-related physical and mental health during and following treatment in people with non-advanced colorectal cancer. Cochrane Database Syst Rev 2020; 5:CD012864. [PMID: 32361988 PMCID: PMC7196359 DOI: 10.1002/14651858.cd012864.pub2] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Colorectal cancer is the third most commonly diagnosed cancer worldwide. A diagnosis of colorectal cancer and subsequent treatment can adversely affect an individuals physical and mental health. Benefits of physical activity interventions in alleviating treatment side effects have been demonstrated in other cancer populations. Given that regular physical activity can decrease the risk of colorectal cancer, and cardiovascular fitness is a strong predictor of all-cause and cancer mortality risk, physical activity interventions may have a role to play in the colorectal cancer control continuum. Evidence of the efficacy of physical activity interventions in this population remains unclear. OBJECTIVES To assess the effectiveness and safety of physical activity interventions on the disease-related physical and mental health of individuals diagnosed with non-advanced colorectal cancer, staged as T1-4 N0-2 M0, treated surgically or with neoadjuvant or adjuvant therapy (i.e. chemotherapy, radiotherapy or chemoradiotherapy), or both. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; 2019, Issue 6), along with OVID MEDLINE, six other databases and four trial registries with no language or date restrictions. We screened reference lists of relevant publications and handsearched meeting abstracts and conference proceedings of relevant organisations for additional relevant studies. All searches were completed between 6 June and 14 June 2019. SELECTION CRITERIA We included randomised control trials (RCTs) and cluster-RCTs comparing physical activity interventions, to usual care or no physical activity intervention in adults with non-advanced colorectal cancer. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies, performed the data extraction, assessed the risk of bias and rated the quality of the studies using GRADE criteria. We pooled data for meta-analyses by length of follow-up, reported as mean differences (MDs) or standardised mean differences (SMDs) using random-effects wherever possible, or the fixed-effect model, where appropriate. If a meta-analysis was not possible, we synthesised studies narratively. MAIN RESULTS We identified 16 RCTs, involving 992 participants; 524 were allocated to a physical activity intervention group and 468 to a usual care control group. The mean age of participants ranged between 51 and 69 years. Ten studies included participants who had finished active treatment, two studies included participants who were receiving active treatment, two studies included both those receiving and finished active treatment. It was unclear whether participants were receiving or finished treatment in two studies. Type, setting and duration of physical activity intervention varied between trials. Three studies opted for supervised interventions, five for home-based self-directed interventions and seven studies opted for a combination of supervised and self-directed programmes. One study did not report the intervention setting. The most common intervention duration was 12 weeks (7 studies). Type of physical activity included walking, cycling, resistance exercise, yoga and core stabilisation exercise. Most of the uncertainty in judging study bias came from a lack of clarity around allocation concealment and blinding of outcome assessors. Blinding of participants and personnel was not possible. The quality of the evidence ranged from very low to moderate overall. We did not pool physical function results at immediate-term follow-up due to considerable variation in results and inconsistency of direction of effect. We are uncertain whether physical activity interventions improve physical function compared with usual care. We found no evidence of effect of physical activity interventions compared to usual care on disease-related mental health (anxiety: SMD -0.11, 95% confidence interval (CI) -0.40 to 0.18; 4 studies, 198 participants; I2 = 0%; and depression: SMD -0.21, 95% CI -0.50 to 0.08; 4 studies, 198 participants; I2 = 0%; moderate-quality evidence) at short- or medium-term follow-up. Seven studies reported on adverse events. We did not pool adverse events due to inconsistency in reporting and measurement. We found no evidence of serious adverse events in the intervention or usual care groups. Minor adverse events, such as neck, back and muscle pain were most commonly reported. No studies reported on overall survival or recurrence-free survival and no studies assessed outcomes at long-term follow-up We found evidence of positive effects of physical activity interventions on the aerobic fitness component of physical fitness (SMD 0.82, 95% CI 0.34 to 1.29; 7 studies, 295; I2 = 68%; low-quality evidence), cancer-related fatigue (MD 2.16, 95% CI 0.18 to 4.15; 6 studies, 230 participants; I2 = 18%; low-quality evidence) and health-related quality of life (SMD 0.36, 95% CI 0.10 to 0.62; 6 studies, 230 participants; I2 = 0%; moderate-quality evidence) at immediate-term follow-up. These positive effects were also observed at short-term follow-up but not medium-term follow-up. Only three studies reported medium-term follow-up for cancer-related fatigue and health-related quality of life. AUTHORS' CONCLUSIONS The findings of this review should be interpreted with caution due to the low number of studies included and the quality of the evidence. We are uncertain whether physical activity interventions improve physical function. Physical activity interventions may have no effect on disease-related mental health. Physical activity interventions may be beneficial for aerobic fitness, cancer-related fatigue and health-related quality of life up to six months follow-up. Where reported, adverse events were generally minor. Adequately powered RCTs of high methodological quality with longer-term follow-up are required to assess the effect of physical activity interventions on the disease-related physical and mental health and on survival of people with non-advanced colorectal cancer. Adverse events should be adequately reported.
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Affiliation(s)
| | - Chris R Cardwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Marie M Cantwell
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Mark A Tully
- Institute of Mental Health Sciences, School of Health Sciences, Ulster University, Newtownabbey, UK
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Kunnavuttivanich V, Pramyothin P, Ithimakin S. Association between dietary patterns and disease recurrence in Thai colorectal cancer patients. Medicine (Baltimore) 2020; 99:e19522. [PMID: 32176103 PMCID: PMC7440110 DOI: 10.1097/md.0000000000019522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Beside established anti-cancer treatment, dietary modification is one of the most promising approaches for reducing the probability of colorectal cancer (CRC) recurrence. Many Western studies showed a relationship between shortened survival and increased amounts of Western diet (meat and processed meat). Given that Thai food is dissimilar to Western diet, we aimed to explore the association between dietary patterns and disease recurrence among Thai CRC patients.Early-stage CRC patients who were disease-free at the end of a 2-year period or patients with disease recurrence within 2 years were enrolled. Patients were administered a food frequency questionnaire to evaluate their dietary lifestyle. Quantitative comparison within individual food groups among patients who were disease-free and among those with recurrence was performed. Proportion of patients with recurrence and disease-free survival was compared between patients who had consumed the lowest and highest tertile of each dietary pattern.A total of 225 CRC patients were enrolled (151 disease-free and 74 recurrence). There were no significant differences in demographic or tumor parameters between patients with or without disease recurrence. From the questionnaire, 45 food items were assigned to 1 of 12 food groups according to similarity in nutritional profile. Patients who consumed high amounts of pickled fish or chili-paste had significantly lower recurrence rates compared to patients who had never eaten those foods (P < .01). From the factor analysis, meat/wheat, vegetarian, and fast-food/processed fruit patterns were identified as the major dietary patterns. There was no significant association between intakes of individual dietary patterns and CRC recurrence.Among CRC patients with Thai dietary lifestyles there was no association between meat/wheat, fast-food/processed fruit, or vegetarian dietary patterns and CRC recurrence. Greater consumption of some unique Thai foods, such as chili-paste or pickled fish, may relate to better outcomes for CRC patients.
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Affiliation(s)
| | - Pornpoj Pramyothin
- Division of Nutrition, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Campbell KL, Zadravec K, Bland KA, Chesley E, Wolf F, Janelsins MC. The Effect of Exercise on Cancer-Related Cognitive Impairment and Applications for Physical Therapy: Systematic Review of Randomized Controlled Trials. Phys Ther 2020; 100:523-542. [PMID: 32065236 PMCID: PMC8559683 DOI: 10.1093/ptj/pzz090] [Citation(s) in RCA: 65] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 04/11/2019] [Accepted: 07/02/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cancer-related cognitive impairment (CRCI), often called "chemo-brain" or "chemo-fog," is a common side effect among adults with cancer, which can persist well after treatment completion. Accumulating evidence demonstrates exercise can improve cognitive function in healthy older adults and adults with cognitive impairments, suggesting exercise may play a role in managing CRCI. PURPOSE The purpose was to perform a systematic review of randomized controlled trials (RCTs) to understand the effect of exercise on CRCI. DATA SOURCES Relevant literature was retrieved from CINAHL, Medline (Ovid), and EMBASE. STUDY SELECTION Eligible articles were RCTs that prescribed aerobic, resistance, combined aerobic/resistance, or mind-body (eg, yoga or Qigong) exercise during or following cancer treatment and included cognitive function outcome measures. DATA EXTRACTION Descriptive information and Cohen d effect sizes were directly extracted or calculated for included trials. DATA SYNTHESIS Twenty-nine trials were included in the final analysis. A statistically significant effect of exercise on self-reported cognitive function, both during and postadjuvant treatment, was reported in 12 trials (41%) (Cohen d range: 0.24-1.14), most commonly using the EORTC QLQ-C30. Ten trials (34%) performed neuropsychological testing to evaluate cognitive function; however, only 3 trials in women with breast cancer reported a significant effect of exercise (Cohen d range: 0.41-1.47). LIMITATIONS Few RCTs to date have evaluated the effect of exercise on CRCI as a primary outcome. Twenty-six trials (90%) in this review evaluated CRCI as secondary analyses. CONCLUSIONS Evidence supporting exercise as a strategy to address CRCI is limited. Future research evaluating CRCI as a primary outcome, including self-reported and objective measures, is needed to confirm the possible role of exercise in preventing and managing cognitive impairments in adults with cancer.
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Affiliation(s)
- Kristin L Campbell
- Department of Physical Therapy, University of British Columbia 212-2177
Wesbrook Mall, Vancouver, British Columbia, Canada V7J 3K6,Address all correspondence to Dr Campbell at:
| | | | - Kelcey A Bland
- Mary MacKillop Institute for Health Research, Australian Catholic
University, Melbourne, Victoria, Australia
| | | | - Florian Wolf
- Institute for Cardiovascular Research and Sports Medicine, German Sport
University, Cologne, Germany
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Albergoni A, Hettinga FJ, La Torre A, Bonato M, Sartor F. The Role of Technology in Adherence to Physical Activity Programs in Patients with Chronic Diseases Experiencing Fatigue: a Systematic Review. SPORTS MEDICINE - OPEN 2019; 5:41. [PMID: 31512075 PMCID: PMC6739434 DOI: 10.1186/s40798-019-0214-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 08/19/2019] [Indexed: 12/29/2022]
Abstract
BACKGROUND The beneficial role of physical activity (PA) to manage the health condition of patients with chronic diseases is well known. However, adherence to PA guidelines in this group is still low. Monitoring and user-interface technology could represent a significant tool to increase exercise adherence to those particular groups who experience difficulties in adhering to regular and substantial physical activity, and could be supportive in increasing the success of PA programs and interventions. This systematic review aimed at evaluating the effect of physical activity monitoring technology in improving adherence to a PA program in patients with chronic diseases experiencing fatigue. METHODS This systematic review was conducted according to PRISMA guidelines. The literature search was performed in Embase, Medline, Biosis, Scopus, and SPORTDiscus. We filtered the literature according to the question: "Does monitoring technology affect adherence to physical activity and exercise programs in patients with chronic diseases perceiving fatigue?". RESULTS The search resulted in 1790 hits; finally, eight studies were included, with a total number of 205 patients. Study quality was moderate except for one study of high quality. Only three disease types emerged, COPD, HF, and cancer. PA programs were rather short (from 8 to 13 weeks) except for one 3-year-long study. Five studies employed pedometers and two an activity monitor. Three studies based their adherence on steps, the remaining studies focused on active minutes. Adherence was explicitly reported in two studies, and otherwise derived. Four studies showed high adherence levels (85% week-10, 89% week-8, 81% week-13, 105% week-13, 83% average week-1-12) and three low levels (56% week-12, 41% year-2, 14 year-3). CONCLUSION The small number of studies identified did not allow to establish whether the use of monitoring technology could improve adherence to PA programs in patients with chronic diseases experiencing fatigue, but the current evidence seems to suggest that this is a field warranting further study, particularly into how monitoring technology can help to engage patients to adhere to PA programs.
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Affiliation(s)
- Andrea Albergoni
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
| | - Florentina J. Hettinga
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle, UK
| | - Antonio La Torre
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | | | - Francesco Sartor
- Department of Patient Care & Measurements, Philips Research, Eindhoven, The Netherlands
- School of Sport Rehabilitation and Exercise Sciences, University of Essex, Colchester, UK
- College of Health & Behavioural Science, Bangor University, Bangor, UK
- Philips Electronics Nederland B.V, HTC 34 1.011, P.O. Box WB61, 5656 AE Eindhoven, The Netherlands
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Foucaut AM, Morelle M, Kempf-Lépine AS, Baudinet C, Meyrand R, Guillemaut S, Metzger S, Bourne-Branchu V, Grinand E, Chabaud S, Pérol D, Carretier J, Berthouze SE, Reynes E, Perrier L, Rebattu P, Heudel PE, Bachelot T, Bachmann P, Fervers B, Trédan O, Touillaud M. Feasibility of an exercise and nutritional intervention for weight management during adjuvant treatment for localized breast cancer: the PASAPAS randomized controlled trial. Support Care Cancer 2019; 27:3449-3461. [DOI: 10.1007/s00520-019-4658-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Accepted: 01/16/2019] [Indexed: 01/05/2023]
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Rammant E, Fonteyne V, Decaestecker K, Bultijnck R, Deforche B, Pieters R, Ost P, Verhaeghe S, Van Hecke A. Understanding physical activity behavior in patients with bladder cancer before and after radical cystectomy: a qualitative interview study. Clin Rehabil 2018; 33:750-761. [PMID: 30514109 DOI: 10.1177/0269215518815531] [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: 11/17/2022]
Abstract
OBJECTIVE: To explore the determinants of physical activity in patients with bladder cancer before and after radical cystectomy. DESIGN: A qualitative research design using semi-structured face-to-face interviews. SETTING AND SUBJECTS: A total of 30 interviews were conducted with people diagnosed with bladder cancer and treated with radical cystectomy at Ghent University Hospital. MAIN MEASURES: The interviews were audiotaped and transcribed verbatim. Framework analysis with constant comparison between and within interviews was applied until final topics were derived from interpreting the data. RESULTS: Physical activity behavior in patients with bladder cancer is determined multifactorial with condition-related (e.g. urinary symptoms, comorbidities), therapy-related (e.g. fatigue, diarrhea), patient-related (e.g. outcome expectations, coping skills, definitions of physical activity), social/economic-related (e.g. social support, attractive environment) and health system-related (e.g. physicians' advice, information) factors. CONCLUSION: The results of this study can guide the development of theory-based behavior change interventions to increase physical activity in bladder cancer patients.
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Affiliation(s)
- Elke Rammant
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Valérie Fonteyne
- 2 Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | | | - Renée Bultijnck
- 1 Department of Radiation Oncology and Experimental Cancer Research, Ghent University, Ghent, Belgium
| | - Benedicte Deforche
- 4 Unit Health Promotion, Department of Public Health, Ghent University, Ghent, Belgium.,5 Physical Activity, Nutrition and Health Research Unit, Department of Movement and Sport Sciences, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ronny Pieters
- 3 Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Piet Ost
- 2 Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Sofie Verhaeghe
- 6 Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Ann Van Hecke
- 6 Department of Public Health, University Centre for Nursing and Midwifery, Ghent University, Ghent, Belgium
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Gupta A, Stewart T, Bhulani N, Dong Y, Rahimi Z, Crane K, Rethorst C, Beg MS. Feasibility of Wearable Physical Activity Monitors in Patients With Cancer. JCO Clin Cancer Inform 2018; 2:1-10. [PMID: 30652571 PMCID: PMC6873942 DOI: 10.1200/cci.17.00152] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
PURPOSE The feasibility of using physical activity monitors (PAMs) to measure functional status in patients with cancer is unclear. We aimed to determine the feasibility of using PAMs to longitudinally assess physical activity and performance status (PS) in patients with cancer. METHODS Patients with cancer who had Eastern Cooperative Oncology Group (ECOG) PS of 0 to 2 and were receiving systemic therapy were enrolled in a prospective pilot trial of PAM use. Feasibility was defined as patients using the PAM for > 50% of the observation period. We correlated PAM-reported measures with scores from ECOG PS and quality-of-life tools (Functional Assessment of Cancer Therapy-General [FACT-G], Quick Inventory of Depressive Symptoms-Self-Rated 16 [QIDS-SR16], and Brief Fatigue Inventory [BFI]) using Pearson's correlation test. Patients were surveyed regarding their experience with PAMs at study completion. RESULTS In all, 24 patients were enrolled; mean age was 54 years, 16 (67%) were women, and 19 (79%) were white. Twenty-three patients (96%) met the primary end point of feasibility. The median duration of follow-up was 69 days. Mean PAM-measured steps for ECOG PS of 0, 1, and 2 were 5,911, 1,890, and 845 steps per day, respectively ( P = .002). Minimum steps per day correlated with BFI ( r = -0.53; P < .01), FACT-G ( r = 0.45; P = .02), and QIDS-SR16 ( r = -0.57; P < .01). Eighteen patients (75%) reported a positive experience with the PAM. CONCLUSION PAMs are a feasible tool for measuring long-term physical activity in patients with cancer who are receiving systemic therapy. PAM-derived measures correlated with clinician-assessed PS.
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Affiliation(s)
- Arjun Gupta
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Tyler Stewart
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Nizar Bhulani
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Ying Dong
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Zain Rahimi
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Kimberli Crane
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Chad Rethorst
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
| | - Muhammad S. Beg
- Arjun Gupta, Nizar Bhulani, Ying Dong, Zain Rahimi, Kimberli Crane, Chad Rethorst, and Muhammad S. Beg, University of Texas Southwestern Medical Center, Dallas, TX; and Tyler Stewart, Yale University, New Haven, CT
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The effect of training interventions on physical performance, quality of life, and fatigue in patients receiving breast cancer treatment: a systematic review. Support Care Cancer 2018; 27:109-122. [PMID: 30302542 DOI: 10.1007/s00520-018-4490-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 10/02/2018] [Indexed: 01/28/2023]
Abstract
OBJECTIVES The primary purpose of this systematic review is to structure the available evidence concerning physical exercise programs and their effects on (1) physical performance outcomes, (2) experienced fatigue, and (3) quality of life (QoL) in patients during the initial treatment for breast cancer. DATA SOURCES A systematic literature search, based upon the PRISMA guideline, up to January 1, 2018, was performed using four databases (Web of Science, Cochrane Library for Clinical Trials, PubMed, and Medline). STUDY SELECTION Inclusion criteria were as follows: (1) adults > 18 years; (2) patients with breast cancer undergoing initial treatment; (3) interventions with the aim to influence the patient's physical activity, QoL, or fatigue; (4) randomized controlled trials (RCTs) of all ages. The selected studies were scored for methodological quality, and data concerning physical performance, QoL, and fatigue were extracted. Twenty-eight RCTs were included. DATA EXTRACTION Different treatment modalities during initial treatment were identified (radiation therapy, chemotherapy, and combination therapy), as well as different types of physical training interventions (cardiovascular endurance exercise, strengthening programs, or a combination of both). Therefore, the results were clustered with regard to the above-mentioned grouping; extracting every relevant outcome related to physical performance (6 MWT or VO2peak; grip/muscle strength), QoL (questionnaires), and fatigue (questionnaires). DATA SYNTHESIS Different training programs (endurance, resistance, or a combination of both) were found. These programs were applied during different phases of initial treatment. Some programs were supervised while others were home based. Overall, most training interventions provided an improvement in physical performance and a decrease in perceived fatigue. QoL was the outcome variable least susceptible to improvement. CONCLUSION Different types of exercise programs are available for rehabilitation purposes of breast cancer patients during adjuvant therapy. Overall resistance training or resistance training in combination with CV endurance training provides the best results, especially on physical performance and perceived fatigue.
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Cave J, Paschalis A, Huang CY, West M, Copson E, Jack S, Grocott MPW. A systematic review of the safety and efficacy of aerobic exercise during cytotoxic chemotherapy treatment. Support Care Cancer 2018; 26:3337-3351. [PMID: 29936624 DOI: 10.1007/s00520-018-4295-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 05/27/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Aerobic exercise improves prognosis and quality of life (QoL) following completion of chemotherapy. However, the safety and efficacy of aerobic exercise during chemotherapy is less certain. A systematic review was performed of randomised trials of adult patients undergoing chemotherapy, comparing an exercise intervention with standard care. METHOD From 253 abstracts screened, 33 unique trials were appraised in accordance with PRISMA guidance, including 3257 patients. Interventions included walking, jogging or cycling, and 23 were of moderate intensity (50-80% maximum heart rate). RESULTS Aerobic exercise improved, or at least maintained fitness during chemotherapy. Moderately intense exercise, up to 70-80% of maximum heart rate, was safe. Any reported adverse effects of exercise were mild and self-limiting, but reporting was inconsistent. Adherence was good (median 72%). Exercise improved QoL and physical functioning, with earlier return to work. Two out of four studies reported improved chemotherapy completion rates. Four out of six studies reported reduced chemotherapy toxicity. There was no evidence that exercise reduced myelosuppression or improved response rate or survival. CONCLUSIONS Exercise during chemotherapy is safe and should be encouraged because of beneficial effects on QoL and physical functioning. More research is required to determine the impact on chemotherapy completion rates and prognosis.
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Affiliation(s)
- J Cave
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, MP 307, Tremona Road, Southampton, SO16 6YD, UK.
| | - A Paschalis
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, MP 307, Tremona Road, Southampton, SO16 6YD, UK
| | - C Y Huang
- Department of Acute Internal Medicine, Chelsea and Westminster Hospital NHS Foundation Trust, London, UK
| | - M West
- Department of Surgery, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Copson
- Department of Medical Oncology, University Hospital Southampton NHS Foundation Trust, MP 307, Tremona Road, Southampton, SO16 6YD, UK
| | - S Jack
- Department of Critical Care Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - M P W Grocott
- Department of Critical Care Research, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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Reis AD, Pereira PTVT, Diniz RR, de Castro Filha JGL, Dos Santos AM, Ramallo BT, Filho FAA, Navarro F, Garcia JBS. Effect of exercise on pain and functional capacity in breast cancer patients. Health Qual Life Outcomes 2018; 16:58. [PMID: 29625622 PMCID: PMC5889570 DOI: 10.1186/s12955-018-0882-2] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 03/25/2018] [Indexed: 01/12/2023] Open
Abstract
PURPOSE To assess the influence of combined training on pain, fatigue, maximal oxygen uptake (VO2 max), body mass index (BMI), flexibility, and strength in patients with breast cancer. METHODS A controlled pilot study with 28 patients undergoing chemotherapy, radiation therapy, and clinical observation in a renowned cancer treatment center; the patients were aged from 30 to 59 years old and were not engaged in physical training for three months previously. The Study Group (SG) underwent 12 weeks of training, including three 60-min sessions of aerobic exercise and resistance training, and two sessions of flexibility training per week; each flexibility exercise lasted 20 s and was performed in sets of three repetitions. The Control Group (CG) received only the standard hospital treatment. Participants were evaluated at the beginning of the study to establish a baseline and reevaluated at the end of 12 weeks. RESULTS Patients in the SG showed a significant decrease in total pain points (p = 0.0047), pain intensity (p = 0.0082), and the extent to which pain interfered with their daily life (p = 0.0047). There was an increase in maximum oxygen uptake (p = 0.0001), flexibility (p = 0.0001), and strength on both sides (right p = 0.0001 and left p = 0.0008). No significant differences were observed in fatigue (p = 0.0953) or BMI (p = 0.6088). CONCLUSION Combined training was effective in decreasing pain and increasing VO2 max, flexibility and static strength in patients with breast cancer. TRIAL REGISTRATION NCT03061773 . Registered on February 19, 2017, 'retrospectively registered'.
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Affiliation(s)
- Andréa Dias Reis
- Post-Graduate Program in Adult and Child Health, Federal University of Maranhão (Universidade Federal do Maranhão - UFMA), unit 203, street 4, n° 8, Cidade Operária, São Luis, MA, Brazil.
| | - Paula Tamara Vieira Teixeira Pereira
- Post-Graduate Program in Adult and Child Health, Federal University of Maranhão (Universidade Federal do Maranhão - UFMA), unit 203, street 4, n° 8, Cidade Operária, São Luis, MA, Brazil
| | | | | | - Alcione Miranda Dos Santos
- Post-Graduate Program in Health Sciences (Federal University of Maranhão - UFMA), São Luís, Brazil.,Post-Graduate Program in Collective Health (Federal University of Maranhão - UFMA), São Luís, Brazil
| | | | | | - Francisco Navarro
- Post-Graduate Program in Adult and Child Health, Federal University of Maranhão (Universidade Federal do Maranhão - UFMA), unit 203, street 4, n° 8, Cidade Operária, São Luis, MA, Brazil.,Department of Physical Education (Federal University of Maranhão - UFMA), São Luís, Brazil
| | - João Batista Santos Garcia
- Post-Graduate Program in Adult and Child Health, Federal University of Maranhão (Universidade Federal do Maranhão - UFMA), unit 203, street 4, n° 8, Cidade Operária, São Luis, MA, Brazil.,Post-Graduate Program in Health Sciences (Federal University of Maranhão - UFMA), São Luís, Brazil
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Cormie P, Zopf EM, Zhang X, Schmitz KH. The Impact of Exercise on Cancer Mortality, Recurrence, and Treatment-Related Adverse Effects. Epidemiol Rev 2018; 39:71-92. [PMID: 28453622 DOI: 10.1093/epirev/mxx007] [Citation(s) in RCA: 362] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 02/16/2017] [Indexed: 12/15/2022] Open
Abstract
The combination of an increasing number of new cancer cases and improving survival rates has led to a large and rapidly growing population with unique health-care requirements. Exercise has been proposed as a strategy to help address the issues faced by cancer patients. Supported by a growing body of research, major health organizations commonly identify the importance of incorporating exercise in cancer care and advise patients to be physically active. This systematic review comprehensively summarizes the available epidemiologic and randomized controlled trial evidence investigating the role of exercise in the management of cancer. Literature searches focused on determining the potential impact of exercise on 1) cancer mortality and recurrence and 2) adverse effects of cancer and its treatment. A total of 100 studies were reviewed involving thousands of individual patients whose exercise behavior was assessed following the diagnosis of any type of cancer. Compared with patients who performed no/less exercise, patients who exercised following a diagnosis of cancer were observed to have a lower relative risk of cancer mortality and recurrence and experienced fewer/less severe adverse effects. The findings of this review support the view that exercise is an important adjunct therapy in the management of cancer. Implications on cancer care policy and practice are discussed.
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Mangia AS, Coqueiro NLDO, Azevedo FC, Araujo HTDS, Amorim EDO, Alves CNR, Camargo C, Fonseca AJD. What clinical, functional, and psychological factors before treatment are predictors of poor quality of life in cancer patients at the end of chemotherapy? ACTA ACUST UNITED AC 2018; 63:978-987. [PMID: 29451662 DOI: 10.1590/1806-9282.63.11.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To correlate physical activity level (PAL), functional capacity and psychological state with quality of life (QoL) in cancer patients undergoing chemotherapy (CT). METHOD Observational cohort study. Patients (n=121) with any primary cancer site with indications of chemotherapy with palliative or curative intent were evaluated at three moments: 1) patient admission (week 0), before chemotherapy; 2) week 8; 3) end of CT. Data were collected regarding QoL, PAL, clinical data, functional capacity (short walking distance test, sitting-rising test, isometric manual gripping force), and anxiety and depression tests. RESULTS There was significant improvement at the end of CT for: level of physical activity; walk test (> 500 meters); sitting-rising test (> 20x). There was a significant reduction in the prevalence of moderate/severe depression. The prevalence of high QoL showed a significant increase in evaluation 3 (42.4% vs. 40.0% vs. 59.2%, p=0.02). Education up to high school level, low PAL, walking < 300 meters, sitting and rising < 20 times, having depression (moderate to severe) and QoL that was not high at the start of treatment (week 0) all proved to be risk factors for low quality of life at week 16. Conversely, early staging, curative intent chemotherapy and low-grade symptoms were shown to be protective factors. CONCLUSION Performing less than 20 movements in the sitting-rising test and low PAL at the start of chemotherapy represent independent risk factors for low quality of life at the end of chemotherapy.
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Affiliation(s)
- Ariella Sebastião Mangia
- Physical Educator. MSc in Health Sciences from Universidade Federal de Roraima (UFRR), Boa Vista, RR, Brazil
| | - Nara Lisiane de Oliveira Coqueiro
- Psychologist at the Oncology High Complexity Assistance Unit in Roraima. MSc Student, Health Sciences Graduate Program, UFRR, Boa Vista, RR, Brazil
| | - Fernanda Cabral Azevedo
- Oncology Physiotherapist at the Oncology High Complexity Assistance Unit, Boa Vista, RR, Brazil
| | | | | | - Cibelli Navarro Rodrigues Alves
- MD, Clinical Oncologist at the Oncology High Complexity Assistance Unit. MSc in Health Sciences from UFRR, Boa Vista, RR, Brazil
| | - Calvino Camargo
- Psychologist. PhD in Social Psychology from Universidade de São Paulo. Professor in the Health Sciences Graduate Program, UFRR, Boa Vista, RR, Brazil
| | - Allex Jardim da Fonseca
- MD, Clinical Oncologist. PhD in Medicine from Universidade do Estado do Amazonas. Professor in the Health Sciences Graduate Program, UFRR, Boa Vista, RR, Brazil
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Kiechle M, Dukatz R, Yahiaoui-Doktor M, Berling A, Basrai M, Staiger V, Niederberger U, Marter N, Lammert J, Grill S, Pfeifer K, Rhiem K, Schmutzler RK, Laudes M, Siniatchkin M, Halle M, Bischoff SC, Engel C. Feasibility of structured endurance training and Mediterranean diet in BRCA1 and BRCA2 mutation carriers - an interventional randomized controlled multicenter trial (LIBRE-1). BMC Cancer 2017; 17:752. [PMID: 29126396 PMCID: PMC5681801 DOI: 10.1186/s12885-017-3732-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 10/30/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Women with pathogenic BRCA germline mutations have an increased risk for breast and ovarian cancer that seems to be modified by life-style factors. Though, randomized trials investigating the impact of lifestyle interventions on cancer prevention and prognosis in BRCA carriers are still missing. METHODS We implemented a multicenter, prospective randomized controlled trial in BRCA1/2 patients, comparing a lifestyle intervention group (IG) with a control group (CG) with the primary aim to prove feasibility. Intervention comprised a structured, individualized endurance training alongside nutrition education based on the Mediterranean diet (MD) for 3 months, plus monthly group training and regular telephone contact during the subsequent 9 months. The CG attended one session on healthy nutrition and the benefits of physical activity. Primary endpoints were feasibility, acceptance and satisfaction over 12 months. Furthermore, effects on physical fitness, diet profile, body mass index (BMI), quality of life and perceived stress were investigated. RESULTS Sixty-eight participants (mean age 41, mean BMI 23.2 kg/m2) were enrolled, of whom 55 (81%, 26 IG, 29 CG) completed 12 months. 73% (n = 26) participated in at least 70% of all intervention sessions. Predictors for drop-outs (19%; n = 13) or non-adherence (27%; n = 7) were not found. 73% rated the program highly and 80% would participate again. Severe adverse events did not occur. Positive effects in the IG compared to the CG were observed for secondary endpoints: BMI, MD eating pattern and stress levels. CONCLUSIONS This lifestyle intervention was feasible, safe and well accepted. Positive results on eating habits, physical fitness and stress levels warrant a larger randomized trial. TRIAL REGISTRATION The study has been retrospectively registered at ClinicalTrials.gov (reference: NCT02087592 ) on March 12, 2014. The first patient was included on February 24, 2014.
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Affiliation(s)
- Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany.
| | - Ricarda Dukatz
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Maryam Yahiaoui-Doktor
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
| | - Anika Berling
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Georg-Brauchle Ring 56, 80638, Munich, Germany
| | - Maryam Basrai
- Institute for Nutritional Medicine, University Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany
| | - Vera Staiger
- Institute for Nutritional Medicine, University Hohenheim, Fruwirthstr. 12, 70593, Stuttgart, Germany
| | - Uwe Niederberger
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1 - 9, 24105, Kiel, Germany
| | - Nicole Marter
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1 - 9, 24105, Kiel, Germany
| | - Jacqueline Lammert
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Katharina Pfeifer
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Rita K Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, 50931, Cologne, Germany
| | - Matthias Laudes
- Department of Internal Medicine 1, University Hospital Schleswig-Holstein, Campus Kiel, Arnold-Heller-Strasse 3, 24105, Kiel, Germany
| | - Michael Siniatchkin
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1 - 9, 24105, Kiel, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Georg-Brauchle Ring 56, 80638, Munich, Germany.,Else Kroener-Fresenius Prevention Center, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675, Munich, Germany
| | - Stephan C Bischoff
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1 - 9, 24105, Kiel, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107, Leipzig, Germany
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Nyrop KA, Deal AM, Choi SK, Wagoner CW, Lee JT, Wood WA, Anders C, Carey LA, Dees EC, Jolly TA, Reeder-Hayes KE, Muss HB. Measuring and understanding adherence in a home-based exercise intervention during chemotherapy for early breast cancer. Breast Cancer Res Treat 2017; 168:43-55. [PMID: 29124455 DOI: 10.1007/s10549-017-4565-1] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 11/01/2017] [Indexed: 12/26/2022]
Abstract
PURPOSE Ensuring and measuring adherence to prescribed exercise regimens are fundamental challenges in intervention studies to promote exercise in adults with cancer. This study reports exercise adherence in women who were asked to walk 150 min/week throughout chemotherapy treatment for early breast cancer. Participants were asked to wear a FitbitTM throughout their waking hours, and Fitbit steps were uploaded directly into study computers. METHODS Descriptive statistics are reported, and both unadjusted and multivariable linear regression models were used to assess associations between participant characteristics, breast cancer diagnosis, treatment, chemotherapy toxicities, and patient-reported symptoms with average Fitbit steps/week. RESULTS Of 127 women consented to the study, 100 had analyzable Fitbit data (79%); mean age was 48 and 31% were non-white. Mean walking steps were 3956 per day. Nineteen percent were fully adherent with the target of 6686 steps/day and an additional 24% were moderately adherent. In unadjusted analysis, baseline variables associated with fewer Fitbit steps were: non-white race (p = 0.012), high school education or less (p = 0.0005), higher body mass index (p = 0.0024), and never/almost never drinking alcohol (p = 0.0048). Physical activity variables associated with greater Fitbit steps were: pre-chemotherapy history of vigorous physical activity (p = 0.0091) and higher self-reported walking minutes/week (p < 0.001), and higher outcome expectations from exercise (p = 0.014). Higher baseline anxiety (p = 0.03) and higher number of chemotherapy-related symptoms rates "severe/very severe" (p = 0.012) were associated with fewer steps. In multivariable analysis, white race was associated with 12,146 greater Fitbit steps per week (p = 0.004), as was self-reported walking minutes prior to start of chemotherapy (p < 0.0001). CONCLUSIONS Inexpensive commercial-grade activity trackers, with data uploaded directly into research computers, enable objective monitoring of home-based exercise interventions in adults diagnosed with cancer. Analysis of the association of walking steps with participant characteristics at baseline and toxicities during chemotherapy can identify reasons for low/non-adherence with prescribed exercise regimens.
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Affiliation(s)
- K A Nyrop
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA. .,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - A M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S K Choi
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C W Wagoner
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J T Lee
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - W A Wood
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Anders
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - L A Carey
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - E C Dees
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T A Jolly
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Reeder-Hayes
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H B Muss
- Division of Hematology/Oncology, School of Medicine, University of North Carolina at Chapel Hill, 170 Manning Drive, Campus, PO Box 7305, Chapel Hill, NC, 27599-7305, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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43
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Gresham G, Schrack J, Gresham LM, Shinde AM, Hendifar AE, Tuli R, Rimel BJ, Figlin R, Meinert CL, Piantadosi S. Wearable activity monitors in oncology trials: Current use of an emerging technology. Contemp Clin Trials 2017; 64:13-21. [PMID: 29129704 DOI: 10.1016/j.cct.2017.11.002] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/16/2017] [Accepted: 11/01/2017] [Indexed: 01/05/2023]
Abstract
BACKGROUND Physical activity is an important outcome in oncology trials. Physical activity is commonly assessed using self-reported questionnaires, which are limited by recall and response biases. Recent advancements in wearable technology have provided oncologists with new opportunities to obtain real-time, objective physical activity data. The purpose of this review was to describe current uses of wearable activity monitors in oncology trials. METHODS We searched Pubmed, Embase, and the Cochrane Central Register of Controlled Trials for oncology trials involving wearable activity monitors published between 2005 and 2016. We extracted details on study design, types of activity monitors used, and purpose for their use. We summarized activity monitor metrics including step counts, sleep and sedentary time, and time spent in moderate-to-vigorous activity. RESULTS We identified 41 trials of which 26 (63%) involved cancer survivors (post-treatment) and 15 trials (37%) involved patients with active cancer. Most trials (65%) involved breast cancer patients. Wearable activity monitors were commonly used in exercise (54%) or behavioral (29%) trials. Cancer survivors take between 4660 and 11,000 steps/day and those undergoing treatment take 2885 to 8300steps/day. CONCLUSION Wearable activity monitors are increasingly being used to obtain objective measures of physical activity in oncology trials. There is potential for their use to expand to evaluate and predict clinical outcomes such as survival, quality of life, and treatment tolerance in future studies. Currently, there remains a lack of standardization in the types of monitors being used and how their data are being collected, analyzed, and interpreted. PRECIS Recent advancements in wearable activity monitor technology have provided oncologists with new opportunities to monitor their patients' daily activity in real-world settings. The integration of wearable activity monitors into cancer care will help increase our understanding of the associations between physical activity and the prevention and management of the disease, in addition to other important cancer outcomes.
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Affiliation(s)
- Gillian Gresham
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States; Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States.
| | - Jennifer Schrack
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | | | - Arvind M Shinde
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Andrew E Hendifar
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Richard Tuli
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - B J Rimel
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Robert Figlin
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
| | - Curtis L Meinert
- Johns Hopkins Bloomberg School of Public Health, Department of Epidemiology, United States
| | - Steven Piantadosi
- Cedars-Sinai Medical Center, Samuel Oschin Comprehensive Cancer Institute, United States
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Abbott L, Hooke MC. Energy Through Motion©: An Activity Intervention for Cancer-Related Fatigue in an Ambulatory Infusion Center. Clin J Oncol Nurs 2017; 21:618-626. [DOI: 10.1188/17.cjon.618-626] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Sweegers MG, Altenburg TM, Chinapaw MJ, Kalter J, Verdonck-de Leeuw IM, Courneya KS, Newton RU, Aaronson NK, Jacobsen PB, Brug J, Buffart LM. Which exercise prescriptions improve quality of life and physical function in patients with cancer during and following treatment? A systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2017; 52:505-513. [PMID: 28954800 DOI: 10.1136/bjsports-2017-097891] [Citation(s) in RCA: 143] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Certain exercise prescriptions for patients with cancer may improve self-reported quality of life (QoL) and self-reported physical function (PF). We investigated the effects of exercise on QoL and PF in patients with cancer and studied differences in effects between different intervention-related and exercise-related characteristics. DESIGN We searched four electronic databases to identify randomised controlled trials investigating exercise effects on QoL and PF in patients with cancer. Pooled effects (Hedges' g) were calculated using Comprehensive Meta-Analysis software. Subgroup analyses were conducted based on intervention dimensions, including timing, duration and delivery mode, and exercise dimensions, including frequency, intensity, type and time (FITT factors). RESULTS We included 74 exercise arms. Patients who were randomised to exercise interventions had significantly improved QoL (g=0.15, 95% CI (0.10 to 0.20), n=67 exercise arms) and PF (g=0.21, 95% CI (0.15 to 0.27), n=59 exercise arms) compared with patients in control groups. We found a significant between-group difference for exercise delivery mode, with significant beneficial effects for supervised exercise interventions (g=0.20, 95% CI (0.14 to 0.26) for QoL and g=0.27, 95% CI (0.20 to 0.33) for PF), but not for unsupervised interventions (g=0.04, 95% CI (-0.06 to 0.13) for QoL and g=0.09, 95% CI (-0.01 to 0.19) for PF). No statistically significant differences in intervention effects were found for variations in intervention timing, duration or exercise FITT factors. Unsupervised exercise with higher weekly energy expenditure was more effective than unsupervised exercise with lower energy expenditure (z=2.34, p=0.02). CONCLUSIONS Exercise interventions, especially when supervised, have statistically significant and small clinical benefit on self-reported QoL and PF in patients with cancer. Unsupervised exercise intervention effects on PF were larger when prescribed at a higher weekly energy expenditure.
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Affiliation(s)
- Maike G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Teatske M Altenburg
- Department of Public and Occupational Health, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Mai J Chinapaw
- Department of Public and Occupational Health, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Joeri Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center, Amsterdam, The Netherlands.,Department of Clinical Psychology, Vrije Universiteit, Amsterdam, The Netherlands
| | - Kerry S Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul B Jacobsen
- Division of Population Science, Moffitt Cancer Center and Research Institute, Amsterdam, The Netherlands
| | - Johannes Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Institute, VU University Medical Center, Amsterdam, The Netherlands.,Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Medical Oncology, VU University Medical Center, Amsterdam, The Netherlands
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Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T. Exercise for people with cancer: a systematic review. ACTA ACUST UNITED AC 2017; 24:e290-e315. [PMID: 28874900 DOI: 10.3747/co.24.3619] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND This systematic review was completed by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario's Program in Evidence-Based Care (pebc). It provides background and guidance for clinicians with respect to exercise for people living with cancer in active and post treatment. It focuses on the benefits of specific types of exercise, pre-screening requirements for new referrals, safety concerns, and delivery models. METHODS Using the pebc's standardized approach, medline and embase were systematically searched for existing guidelines, systematic reviews, and primary literature. RESULTS The search identified two guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present review provides conclusions about the duration, frequency, and intensity of exercise appropriate for people living with cancer. CONCLUSIONS The evidence shows that exercise is safe and provides benefit in quality of life and in muscular and aerobic fitness for people with cancer both during and after treatment. The evidence is sufficient to support the promotion of exercise for adults with cancer, and some evidence supports the promotion of exercise in group or supervised settings and for a long period of time to improve quality of life and muscular and aerobic fitness. Exercise at moderate intensities could also be sustainable for longer periods and could encourage exercise to be continued over an individual's lifetime. It is important that a pre-screening assessment be conducted to evaluate the effects of disease, treatments, and comorbidities.
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Affiliation(s)
- R Segal
- Medical Oncology, The Ottawa Hospital, Ottawa
| | - C Zwaal
- McMaster University, Hamilton
| | - E Green
- Canadian Partnership Against Cancer, Toronto
| | | | - A Loblaw
- Odette Cancer Research Program, Sunnybrook Hospital, Toronto; and
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Segal R, Zwaal C, Green E, Tomasone JR, Loblaw A, Petrella T. Exercise for people with cancer: a clinical practice guideline. ACTA ACUST UNITED AC 2017; 24:40-46. [PMID: 28270724 DOI: 10.3747/co.24.3376] [Citation(s) in RCA: 165] [Impact Index Per Article: 23.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Development of this guideline was undertaken by the Exercise for People with Cancer Guideline Development Group, a group organized by Cancer Care Ontario's Program in Evidence-Based Care (pebc). The purpose of the guideline was to provide guidance for clinicians with respect to exercise for patients living with cancer, focusing on the benefits of specific types of exercise, recommendations about screening requirements for new referrals, and safety concerns. METHODS Consistent with the pebc's standardized approach, a systematic search was conducted for existing guidelines, and systematic literature searches were performed in medline and embase for both systematic reviews and primary literature. Content and methodology experts performed an internal review, which was followed by an external review by targeted experts and intended users. RESULTS The search identified three guidelines, eighteen systematic reviews, and twenty-nine randomized controlled trials with relevance to the topic. The present guideline provides recommendations for the duration, frequency, and intensity of exercise appropriate for people living with cancer. It also provides recommendations for pre-exercise assessment, safety concerns, and delivery models. CONCLUSIONS There is sufficient evidence to show that exercise provides benefits in quality of life and muscular and aerobic fitness for people with cancer both during and after treatment, and that it does not cause harm. The present guideline is intended to support the Canadian Society for Exercise Physiology's Canadian physical activity guidelines. The recommendations are intended for clinicians and institutions treating cancer patients in Ontario, and for policymakers and program planners involved in the delivery of exercise programs for cancer patients.
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Affiliation(s)
- R Segal
- Medical Oncology, The Ottawa Hospital, Ottawa
| | - C Zwaal
- McMaster University, Hamilton
| | - E Green
- Canadian Partnership Against Cancer, Toronto
| | | | - A Loblaw
- Evaluative Clinical Sciences, Odette Cancer Research Program, Sunnybrook Hospital, Toronto; and
| | - T Petrella
- ncic Melanoma Clinical Trials Group, Sunnybrook Hospital, Toronto, ON
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Vitamin D and Physical Activity in Patients With Colorectal Cancer: Epidemiological Evidence and Therapeutic Implications. Cancer J 2017; 22:223-31. [PMID: 27341603 DOI: 10.1097/ppo.0000000000000197] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Colorectal cancer (CRC) is a leading cause of cancer incidence and mortality in the United States. Notwithstanding major improvements in the early detection and treatment of CRC, an important proportion of patients who received a diagnosis of localized disease ultimately have a recurrence and die, underscoring the need of new therapeutic approaches. Vitamin D and physical activity (PA) have emerged as 2 potential interventions for both prevention and treatment of CRC. Plausible biological mechanisms have been described for the antineoplastic effects of vitamin D and PA, and a wealth of epidemiological evidence indicates that 25(OH)D (the main circulating form of vitamin D) and PA levels are inversely associated with CRC risk. Recent efforts have now focused on the role of vitamin D and PA as adjunct treatments after a CRC diagnosis. Observational studies evaluating prediagnosis and postdiagnosis circulating 25(OH)D levels among patients with CRC of all stages have found that subjects with levels in the highest quantiles have improved overall and CRC-specific survival compared with those with levels in the lowest quantiles. Similarly, prospective studies of PA have found that higher levels of postdiagnosis PA are associated with lower overall and CRC-specific mortality in patients with nonmetastatic CRC. Meta-analyses of the observational studies of 25(OH)D and postdiagnosis PA have confirmed significant protective associations against overall and CRC-specific mortality, as well as significant dose-response relationships. No randomized controlled trial of vitamin D or PA using survival outcomes as endpoints has been completed to date. Two randomized, placebo-controlled trials of vitamin D in patients with metastatic CRC assessing patient survival as an endpoint are underway: the first is a phase II trial comparing high-dose vitamin D3 (8000 IU/d for 2 weeks followed by 4000 IU/d) versus standard dose (400 IU/d), and the second is a phase I-II trial comparing customized oral doses of vitamin D3 titrated to raise serum 25(OH)D levels to 80 to 100 ng/mL versus 2000 IU/d. For PA, the ongoing phase III CHALLENGE (Colon Health and Life-Long Exercise Change) study is the first randomized controlled trial using survival as an endpoint among patients with stage II-III colon cancer. The results of these trials will pave the way to more conclusive phase III trials that will provide more definitive answers about the role of these interventions in the treatment of CRC. Lastly, the advent of genomic technologies will allow identifying molecular signatures in CRC associated with improved response to vitamin D and PA and will usher in a precision medicine approach to these therapies.
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Kiechle M, Engel C, Berling A, Hebestreit K, Bischoff S, Dukatz R, Gerber WD, Siniatchkin M, Pfeifer K, Grill S, Yahiaoui-Doktor M, Kirsch E, Niederberger U, Marter N, Enders U, Löffler M, Meindl A, Rhiem K, Schmutzler R, Erickson N, Halle M. Lifestyle intervention in BRCA1/2 mutation carriers: study protocol for a prospective, randomized, controlled clinical feasibility trial (LIBRE-1 study). Pilot Feasibility Stud 2016; 2:74. [PMID: 28031860 PMCID: PMC5165708 DOI: 10.1186/s40814-016-0114-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 11/23/2016] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Women with highly penetrant BRCA mutations have a 55-60% lifetime risk for breast cancer and a 16-59% lifetime risk for ovarian cancer. However, penetrance differs interindividually, indicating that environmental and behavioral factors may modify this risk. These include lifestyle factors such as physical activity status, dietary habits, and body weight. The modification of penetrance by changing lifestyle factors has not thus far been investigated in a randomized trial in BRCA mutation carriers. METHODS Therefore, we intend to enroll 60 BRCA1/2 mutation carriers in a pilot feasibility study (Lifestyle Intervention Study in Women with Hereditary Breast and Ovarian Cancer (LIBRE) pilot). This multi-center, prospective, controlled trial aims to randomize (1:1) participants into a (1) multi-factorial lifestyle intervention group (IG) versus (2) the control group with usual care (CG). The primary endpoint is feasibility and acceptance of a structured interdisciplinary lifestyle intervention program over 12 months (at least 70% of the patients to complete the 1-year intervention). Furthermore, the effects on physical fitness, BMI, quality of life, and stress coping capacity will be investigated. During the first 3 months, women in the IG will receive structured, individualized and mainly supervised endurance training of ≥18 MET*h/week (MET = metabolic equivalent task) and personal nutritional counseling based on the Mediterranean diet. During the subsequent 9 months, the IG will receive monthly group training sessions and regular telephone contacts for motivation, whereas the CG will only receive usual care (one general counseling on healthy nutrition and benefits of regular physical activity on health status). At randomization and subsequent time points (3, 6, 12 months), cardiopulmonary fitness will be assessed by spiroergometry and nutritional and psychological status by validated questionnaires. DISCUSSION This pilot study will investigate the optimal strategy to improve physical fitness, nutritional habits, and psychological factors in women at high risk for developing breast or ovarian cancer. The results of this pilot feasibility study will be the basis for a larger prospective randomized trial including clinical events (LIBRE). TRIAL REGISTRATION ClinicalTrials.gov, NCT02087592.
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Affiliation(s)
- Marion Kiechle
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Christoph Engel
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Anika Berling
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
- Else Kroener-Fresenius Prevention Center, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Katrin Hebestreit
- Institute for Nutritional Medicine, University Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany
| | - Stephan Bischoff
- Institute for Nutritional Medicine, University Hohenheim, Fruwirthstr. 12, 70593 Stuttgart, Germany
| | - Ricarda Dukatz
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Wolf-Dieter Gerber
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1-9, 24105 Kiel, Germany
| | - Michael Siniatchkin
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1-9, 24105 Kiel, Germany
| | - Katharina Pfeifer
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Sabine Grill
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Maryam Yahiaoui-Doktor
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Ellen Kirsch
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1-9, 24105 Kiel, Germany
| | - Uwe Niederberger
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1-9, 24105 Kiel, Germany
| | - Nicole Marter
- Institute for Medical Psychology and Sociology, University Hospital Schleswig-Holstein, Campus Kiel, Preusserstr. 1-9, 24105 Kiel, Germany
| | - Ute Enders
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Markus Löffler
- Institute for Medical Informatics, Statistics and Epidemiology, University of Leipzig, Haertelstrasse 16-18, 04107 Leipzig, Germany
| | - Alfons Meindl
- Department of Gynecology and Center for Hereditary Breast and Ovarian Cancer, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Kerstin Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, 50931 Cologne, Germany
| | - Rita Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Kerpener Str. 34, 50931 Cologne, Germany
| | - Nicole Erickson
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
- Else Kroener-Fresenius Prevention Center, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
- Else Kroener-Fresenius Prevention Center, Klinikum rechts der Isar, Technical University Munich (TUM), Ismaninger Str. 22, 81675 Munich, Germany
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Helm J, McBrearty A, Fontaine S, Morrison R, Yam P. Use of accelerometry to investigate physical activity in dogs receiving chemotherapy. J Small Anim Pract 2016; 57:600-609. [PMID: 27709617 DOI: 10.1111/jsap.12587] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/07/2016] [Accepted: 07/21/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To perform a preliminary study to assess whether single-agent palliative or adjuvant chemotherapy has an impact on objectively measured physical activity in dogs. METHODS Fifteen dogs with neoplasia (treatment group) wore ActiGraph™ accelerometers for 5-day periods before, during and after receiving single-agent adjuvant or palliative chemotherapy. Mean 5-day total physical activity and time spent in three different intensities of activity (sedentary, light-moderate and vigorous) before, during and after receiving chemotherapy were compared to a group of 15 healthy dogs (control group). Results were also compared within the treatment group across time. RESULTS Prior to chemotherapy, treated dogs tended to be less active than control dogs. Treatment group dogs were slightly more active at restaging than they were prior to treatment but had similar activity levels to control dogs. Marked effects of chemotherapy on physical activity were not detected. Physical activity was slightly lower in treated dogs during chemotherapy when compared to control dogs but there was a slight increase in physical activity of treated dogs during chemotherapy when compared with pretreatment recordings. There was little change in the mean 5-day total physical activity between treated dogs during chemotherapy and at restaging but a mild decrease in time spent sedentary and increase in time spent in light-moderate activity at this comparison of time points. CLINICAL SIGNIFICANCE Single-agent adjuvant or palliative chemotherapy had minimal impact on physical activity levels in dogs with neoplasia.
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Affiliation(s)
- J Helm
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH.
| | - A McBrearty
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - S Fontaine
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - R Morrison
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
| | - P Yam
- School of Veterinary Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, G61 1QH
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