The Role of Exercise in Cancer-Related Sarcopenia and Sarcopenic Obesity

Effects of a strength physical exercise program in chronic lymphocytic leukemia patients on quality of life, mental health, and frailty: a randomized controlled trial study protocol

Background

Chronic lymphocytic leukemia (CLL) is a type of cancer that affects the blood and bone marrow, and it is the most prevalent form of leukemia in adults. Many patients experience symptoms that can significantly impact their quality of life, particularly in terms of physical ability, emotional health, and fatigue. Therapeutic exercise has shown to be an effective intervention for alleviating both physical and psychological symptoms in these patients. Specifically, strength training may help address some common treatment side effects.

Objective

This study aims to evaluate the effects of a therapeutic exercise program, focused on frailty in patients with CLL, along with secondary objectives including impacts on functional capacity, quality of life, psychological status, sleep quality, body composition, anthropometric variables, lipid profile and on proteins related to the immune system and inflammation.

Methods

An open label, randomized controlled trial will be carried out with 36 participants, divided into an intervention group (supervised resistance training twice a week and home exercises) and a control group (home exercise only). The primary outcome measure is fraility, assessed using Short Physical Performance Battery (SPPB). Secondary outcomes include assessments using HADS, FACT-F, EORTC QLQ-C30, EORT QLQ-CLL17.

Results and conclusions

This study will explore how physical exercise can improve quality of life and various health metrics in patients with CLL. By creating customized exercise protocols, the research seeks to boost patient well-being, improve treatment outcomes, and lessen debilitating side effects, ultimately promoting the integration of physical activity into routine care.

Clinical Trial Registration

ClinicalTrials.gov, identifier (NCT06654206).

Effect of adaptive variable-resistance training on chemotherapy-induced sarcopenia, fatigue, and functional restriction in pediatric survivors of acute lymphoblastic leukemia: a prospective randomized controlled trial

PURPOSE

With the rising survival rate among children and adolescents with acute lymphoblastic leukemia (ALL), prioritizing patient-centered care to address the long-term effects of chemotherapy through tailored rehabilitation interventions is essential for optimizing their quality of life. The purpose of this study was to investigate the impact of an 8-week intervention using adaptive variable-resistance training (Adaptive-VRT) on chemotherapy-induced sarcopenia, fatigue, and functional restrictions in pediatric survivors of ALL.

METHODS

A prospective randomized controlled trial included a total of 62 survivors of ALL, aged 12-18 years, and completed maintenance chemotherapy. Participants were randomized into two groups: the Adaptive-VRT group (n = 31), assigned the Adaptive-VRT intervention, and the control group (n = 31), which adhered to the standard exercise protocol. Baseline and post-intervention measurements were undertaken to analyze sarcopenia-related variables (i.e., muscle thickness and muscle strength), fatigue, and functional performance.

RESULTS

The Adaptive-VRT group exhibited more favorable changes in muscle thickness [thigh thickness (P < .001; η2P = 0.32); rectus femoris (P < .001; η2P = 0.21); vastus intermedius (P = .002; η2P = 0.15)], and peak concentric torque of quadriceps [at speed of 90°/s (P = .005; η2P = 0.13), 120°/s (P = .021; η2P = 0.10), or 180°/s (P = .008; η2P = 0.11)] in comparison with the control group. Additionally, the Adaptive-VRT group reported lower fatigue levels (P = .031; η2P = 0.08) and demonstrated better functional performance [6-min walk test (P < .001; η2P = 0.25), 4 × 10-m shuttle running test (P < .001; η2P = 0.24), as well as timed up and down stairs (P < .0006; η2P = 0.18)].

CONCLUSION

The findings suggest that Adaptive-VRT is a promising intervention for ameliorating chemotherapy-induced sarcopenia, fatigue, and functional limitations in pediatric ALL survivors.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT06338020.

Ultrasound for skeletal muscle assessment in surgical oncology: A scoping review

BACKGROUND

Skeletal muscle wasting in cancer patients is associated with adverse outcomes. Ultrasound offers a non-invasive muscle assessment, but no previous review has focused on its application during perioperative period. This scoping review aims to map the current literature on the ultrasound use for skeletal muscle assessment in cancer patients during the perioperative period and identify knowledge gaps for future research.

METHODS

A systematic literature search was conducted in the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Embase, Medline, and Web of Science. Two independent reviewers screened studies for eligibility and extracted relevant data, including study characteristics, population, ultrasound protocols, and outcomes. Inclusion criteria were primary studies involving adults undergoing cancer surgery with ultrasound used for skeletal muscle assessment during the perioperative period.

RESULTS

Thirteen studies were included. The majority assessed quantitative parameters, with the rectus femoris muscle being the most evaluated. Muscle thickness and cross-sectional area were the most frequently reported parameters. Studies validated ultrasound parameters against established tools and clinical indicators, including sarcopenia, frailty, muscle strength, and biomarker. Ultrasound was also used to predict postoperative outcomes and assess perioperative interventions. However, variability in ultrasound protocols highlights the need for standardized practices, and the lack of consensus on cutoffs warrants future research.

CONCLUSIONS

This review demonstrated the validity and the applications of ultrasound for skeletal muscle assessment in cancer patients during the perioperative period. Significant variability in ultrasound protocols and the absence of standardized cutoffs highlight the need for further research.

Prognostic Impact of Sarcopenic Obesity on Postoperative Outcomes in Colorectal Cancer Patients Undergoing Surgery: A Systematic Review and Meta-Analysis

Sarcopenic obesity is a condition in which the coexistence of sarcopenia and obesity may have unfavorable prognostic implications in cancer. This meta-analysis aims to evaluate the effects of sarcopenic obesity on postoperative outcomes in patients undergoing colorectal cancer surgery. A systematic literature search was conducted in the Scopus, PubMed, and Web of Science databases for articles up to February 8, 2024. The primary outcomes were overall and major complications and overall survival. A random- or fixed-effects model was used in each case based on heterogeneity, and both subgroup and sensitivity analyses were performed. Twenty studies with 11,264 patients were included. The prevalence of sarcopenic obesity was 14.5%. Sarcopenic obesity was found to be a risk factor for overall complications [pooled OR: 1.69 (95% CI: 1.26-2.26); p < 0.001] and major complications [pooled OR: 1.64 (95% CI: 1.06-2.55); p = 0.028]. The effect on overall survival was not significant [pooled HR: 1.24 (95% CI: 0.98-1.56); p = 0.076], but significance varied in some subgroups. Furthermore, sarcopenic obesity was associated with an increased risk of 30-day mortality, but not with prolonged hospitalization. In conclusion, sarcopenic obesity is associated with unfavorable outcomes after colorectal cancer surgery; therefore, it may be useful to include a diagnosis of sarcopenic obesity when formulating the disease prognosis.

Global consensus on optimal exercise recommendations for enhancing healthy longevity in older adults (ICFSR)

Aging, a universal and inevitable process, is characterized by a progressive accumulation of physiological alterations and functional decline over time, leading to increased vulnerability to diseases and ultimately mortality as age advances. Lifestyle factors, notably physical activity (PA) and exercise, significantly modulate aging phenotypes. Physical activity and exercise can prevent or ameliorate lifestyle-related diseases, extend health span, enhance physical function, and reduce the burden of non-communicable chronic diseases including cardiometabolic disease, cancer, musculoskeletal and neurological conditions, and chronic respiratory diseases as well as premature mortality. Physical activity influences the cellular and molecular drivers of biological aging, slowing aging rates-a foundational aspect of geroscience. Thus, PA serves both as preventive medicine and therapeutic agent in pathological states. Sub-optimal PA levels correlate with increased disease prevalence in aging populations. Structured exercise prescriptions should therefore be customized and monitored like any other medical treatment, considering the dose-response relationships and specific adaptations necessary for intended outcomes. Current guidelines recommend a multifaceted exercise regimen that includes aerobic, resistance, balance, and flexibility training through structured and incidental (integrated lifestyle) activities. Tailored exercise programs have proven effective in helping older adults maintain their functional capacities, extending their health span, and enhancing their quality of life. Particularly important are anabolic exercises, such as Progressive resistance training (PRT), which are indispensable for maintaining or improving functional capacity in older adults, particularly those with frailty, sarcopenia or osteoporosis, or those hospitalized or in residential aged care. Multicomponent exercise interventions that include cognitive tasks significantly enhance the hallmarks of frailty (low body mass, strength, mobility, PA level, and energy) and cognitive function, thus preventing falls and optimizing functional capacity during aging. Importantly, PA/exercise displays dose-response characteristics and varies between individuals, necessitating personalized modalities tailored to specific medical conditions. Precision in exercise prescriptions remains a significant area of further research, given the global impact of aging and broad effects of PA. Economic analyses underscore the cost benefits of exercise programs, justifying broader integration into health care for older adults. However, despite these benefits, exercise is far from fully integrated into medical practice for older people. Many healthcare professionals, including geriatricians, need more training to incorporate exercise directly into patient care, whether in settings including hospitals, outpatient clinics, or residential care. Education about the use of exercise as isolated or adjunctive treatment for geriatric syndromes and chronic diseases would do much to ease the problems of polypharmacy and widespread prescription of potentially inappropriate medications. This intersection of prescriptive practices and PA/exercise offers a promising approach to enhance the well-being of older adults. An integrated strategy that combines exercise prescriptions with pharmacotherapy would optimize the vitality and functional independence of older people whilst minimizing adverse drug reactions. This consensus provides the rationale for the integration of PA into health promotion, disease prevention, and management strategies for older adults. Guidelines are included for specific modalities and dosages of exercise with proven efficacy in randomized controlled trials. Descriptions of the beneficial physiological changes, attenuation of aging phenotypes, and role of exercise in chronic disease and disability management in older adults are provided. The use of exercise in cardiometabolic disease, cancer, musculoskeletal conditions, frailty, sarcopenia, and neuropsychological health is emphasized. Recommendations to bridge existing knowledge and implementation gaps and fully integrate PA into the mainstream of geriatric care are provided. Particular attention is paid to the need for personalized medicine as it applies to exercise and geroscience, given the inter-individual variability in adaptation to exercise demonstrated in older adult cohorts. Overall, this consensus provides a foundation for applying and extending the current knowledge base of exercise as medicine for an aging population to optimize health span and quality of life.

Examination of Sarcopenia with Obesity as a Prognostic Factor in Patients with Colorectal Cancer Using the Psoas Muscle Mass Index

Background: Sarcopenia, the age-related loss of muscle mass, is a negative prognostic factor in gastrointestinal cancer. Sarcopenia combined with visceral obesity (sarcopenic obesity) is associated with poor outcomes. We explored the influence of obesity and other factors on the prognosis of patients with colorectal cancer diagnosed with sarcopenia. Methods: We enrolled 211 patients with colorectal cancer diagnosed with preoperative sarcopenic obesity who underwent radical resection at Osaka University Hospital between January 2009 and January 2012. Muscle mass was assessed using the psoas muscle mass index. Obesity was evaluated by measuring the visceral fat area in the umbilical region. Patients were categorized into two groups: sarcopenia with obesity (SO) and sarcopenia without obesity (non-SO). Overall survival, cancer-specific survival, and cancer-related relapse-free survival (CRRFS) were compared between the two groups. Patient characteristics, including age, sex, body mass index, serum albumin, C-reactive protein, tumor markers, prognostic nutritional index (PNI), modified Glasgow prognostic score (mGPS), and geriatric nutritional risk index (GNRI), were also analyzed. Results: CRRFS was significantly shorter in the SO group than in the non-SO group (p = 0.028). PNI, mGPS, and GNRI were not identified as significant prognostic factors for CRRFS. Multivariate analysis highlighted sarcopenic obesity, elevated carcinoembryonic antigen levels, and unfavorable histological types as significant predictors of poor CRRFS outcomes. Conclusions: Sarcopenic obesity is an independent predictor of poor prognosis in patients with CRC. Thus, interventions aimed at increasing muscle mass and reducing visceral fat could potentially improve the prognosis of these patients.

Age-related and cancer-related sarcopenia: is there a difference?

PURPOSE OF REVIEW

The aim of this review is the attempt to differentiating the pathophysiologic and clinical features of the aging-related sarcopenia from cancer-related sarcopenia. In fact, there is some controversy among the experts mainly regarding two points: is always sarcopenia, even that aging-related one, the expression of a generalized disease or may exist independently and without major alteration of the muscle function? Are always aging-related and cancer-related sarcopenia completely separated entities?

RECENT FINDINGS

Literature shows that sarcopenia, defined as simple skeletal muscle mass loss, may range from a mainly focal problem which is common in many healthy elderly people, to a component of a complex multiorgan syndrome as cancer cachexia. Disuse, malnutrition and (neuro)degenerative processes can account for most of the aging-related sarcopenias while systemic inflammation and secretion of cancer-and immune-related molecules play an additional major role in cachexia.

SUMMARY

A multimodal approach including physical exercise and optimized nutritional support are the key measures to offset sarcopenia with some contribution by the anti-inflammatory drugs in cancer patients. Results are more promising in elderly patients and are still pending for cancer patients where a more specific approach will only rely on the identification and contrast of the key mediators of the cachectic process.

Predictive impact of sarcopenia in advanced non-small cell lung cancer patients treated with immune checkpoint inhibitors: A retrospective study

Background

Sarcopenia, characterised by an ongoing loss of skeletal muscle mass and reduced strength and function, is frequently observed in patients with non-small cell lung cancer (NSCLC). However, the relationship between sarcopenia and the prognosis of NSCLC treated with immune checkpoint inhibitors (ICIs) remains unclear. This aimed to assess whether sarcopenia is an independent prognostic factor for survival in patients with advanced NSCLC receiving ICIs.

Methods

For this retrospective cohort study, we analysed the medical records of patients attending our hospital aged 18-75 years who were newly diagnosed with stage IIIB to stage IV NSCLC, and who had received ICIs as first- or second-line therapy between May 2019 and April 2022. The skeletal muscle index (SMI) was calculated from computed tomography (CT) images and relevant clinical characteristics within 4 weeks of initiating treatment and used to diagnose sarcopenia status. The Kaplan-Meier method and log-rank test were used to calculate and compare patients' progression-free survival (PFS). Cox proportional hazard regression was used to examine the associations between sarcopenia and survival outcomes. The chi-square test was used to compare treatment response outcomes, such as the objective response rate (ORR), disease control rate (DCR), and immunotherapy-related adverse events (irAEs), between individuals with and without sarcopenia. Additionally, the Student's t-test was utilised to compare SMI values between patients by their objective response (OR) and disease control (DC). Finally, the Mann-Whitney U test was used to compare nutritional and inflammatory indicators between the sarcopenia groups.

Results

The study enrolled 70 patients, of whom 34 (48.6%) were diagnosed with sarcopenia. The median PFS of patients with and without sarcopenia was 7.5 vs. 13.4 months, respectively (p = 0.006). The proportional hazards regression analysis showed sarcopenia to be an independent prognostic factor for shorter PFS (hazard ratio (HR): 0.504, 95% CI: 0.265-0.962, p = 0.038). Using chi square tests, we found significant differences in the ORR (20.59% vs. 58.33%, p = 0.001) and occurrence of any irAEs (44.1% vs. 22.2%, p = 0.028) between the sarcopenia and the non-sarcopenia groups, respectively. The Student's t-test showed a significant difference in SMI between the ORR group and the non-ORR group (49.99 ± 7.00 vs. 42.98 ± 2.18 cm2/m2, p = 0.0015). While the sarcopenia group were with significantly a lower CD4+/CD8+ ratios and a higher C-reactive protein (CRP) level (p = 0.026, p = 0.011, respectively). Conclusions: This study found that sarcopenia is a significant predictor of a poor prognosis for patients with advanced NSCLC receiving ICIs. Multiple inflammatory and immune functions related to prognosis also differ by sarcopenia status.