Twenty-five years of research on the effects of exercise training in breast cancer survivors: A systematic review of the literature

The effectiveness of Dragon Boat racing on body image and traumatic symptoms of breast cancer patients

Objective

The present study investigated the effectiveness of a Dragon Boat training program in women with breast cancer body image and traumatic distress processing.

Methods

29 breast cancer patients (M(SD) age= 51 (7.41)) voluntarily participated in a physical activity program. Seventeen (Intervention Group) enrolled in a Dragon Boat racing program, while 12 (the Control Group) individually performed alternative physical activities. Before and after the intervention, patients completed the Body Image Scale (BIS) and the Impact of Event Scale - Revised (IES-R).

Results

The Intervention Group reported a decrease in Body Image negative perception (Pillai's trace = .352, F(1,27) = 14.111, p = .001; partial η2 = .951) and in traumatic symptoms (Pillai's trace = .283, F(1,27) = 10.682, p = .003; partial η2 = .883).

Conclusions

Authors discuss the role of Dragon Boat racing in improving positive body image after the experience of breast cancer.

Adapting an Efficacious Peer-Delivered Physical Activity Program for Survivors of Breast Cancer for Web Platform Delivery: Protocol for a 2-Phase Study

BACKGROUND

Interventions promoting physical activity (PA) among survivors of cancer improve their functioning, reduce fatigue, and offer other benefits in cancer recovery and risk reduction for future cancer. There is a need for interventions that can be implemented on a wider scale than that is possible in research settings. We have previously demonstrated that a 3-month peer-delivered PA program (Moving Forward Together [MFT]) significantly increased the moderate to vigorous PA (MVPA) of survivors of breast cancer.

OBJECTIVE

Our goal is to scale up the MFT program by adapting an existing peer mentoring web platform, Mentor1to1. InquistHealth's web platform (Mentor1to1) has demonstrated efficacy in peer mentoring for chronic disease management. We will partner with InquisitHealth to adapt their web platform for MFT. The adaptation will allow for automating key resource-intensive components such as matching survivors with a coach via the web-based peer mentoring platform and collecting key indexes to prepare for large-scale implementation. The aim is to streamline intervention delivery, assure fidelity, and improve survivor outcomes.

METHODS

In phase 1 of this 2-phase study, we will interview 4 peer mentors or coaches with experience in delivering MFT and use their feedback to create Mentor1to1 web platform adapted for MFT (webMFT). Next, another 4 coaches will participate in rapid, iterative user-centered testing of webMFT. In phase 2, we will conduct a randomized controlled trial by recruiting and training 10 to 12 coaches from cancer organizations to deliver webMFT to 56 survivors of breast cancer, who will be assigned to receive either webMFT or MVPA tracking (control) for 3 months. We will assess effectiveness with survivors' accelerometer-measured MVPA and self-reported psychosocial well-being at baseline and 3 months. We will assess implementation outcomes, including acceptability, feasibility, and program costs from the perspective of survivors, coaches, and collaborating organizations, as guided by the expanded Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) framework.

RESULTS

As of September 2023, phase 1 of the study was completed, and 61 survivors were enrolled in phase 2. Using newer technologies for enhanced intervention delivery, program management, and automated data collection has the exciting promise of facilitating effective implementation by organizations with limited resources. Adapting evidence-based MFT to a customized web platform and collecting data at multiple levels (coaches, survivors, and organizations) along with costs will provide a strong foundation for a robust multisite implementation trial to increase MVPA and its benefits among many more survivors of breast cancer.

CONCLUSIONS

The quantitative and qualitative data collected from survivors of cancer, coaches, and organizations will be analyzed to inform a future larger-scale trial of peer mentoring for PA delivered by cancer care organizations to survivors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05409664; https://clinicaltrials.gov/study/NCT05409664.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/52494.

Fixed-Seat Rowing versus Sliding-Seat Rowing: Effects on Physical Fitness in Breast Cancer Survivors

This study aimed to analyze the effects of a team rowing-based training program on physical fitness and anthropometric parameters in female breast cancer survivors (n = 40; 56.78 ± 6.38 years). The participants were divided into two groups: one rowed in fixed-seat rowing (FSR) boats (n = 20; 56.35 ± 4.89 years), and the other rowed in sliding-seat rowing (SSR) boats (n = 20; 57.20 ± 7.7 years). Both groups engaged in two 75 min sessions per week for 24 weeks. Significant improvements were observed in both groups in terms of weight (FSR: -1.93 kg, SSR: -1.75 kg), body mass index (FSR: -0.73 kg/m2, SSR: -0.67 kg/m2), waist circumference (FSR: -2.83 cm, SSR: -3.66 cm), and hip circumference (FSR: -2.02 cm, SSR: -2.88 cm). Muscle strength improved in the lower extremities (jump test: FSR: 2.99 cm, SSR: 3.11 cm) and upper extremities (dominant: FSR: 4.13 kgf, SSR: 4.34 kgf; non-dominant: FSR: 3.67 kgf, SSR: 3.32 kgf). Aerobic capacity also improved, with the SSR group showing a greater increase (FSR: 63.05 m, SSR: 93.65 m). Flexibility tests revealed better results in the SSR group for both dominant (SSR: 1.75 cm vs. FSR: -5.55 cm) and non-dominant limbs (SSR: 1.72 cm vs. FSR: -3.81 cm). These findings suggest that the type of rowing modality can influence physical fitness outcomes, with the SSR group showing superior improvements compared to the FSR group.

Does resistance training ameliorate cancer-related fatigue in cancer survivors? A systematic review with meta-analysis

PURPOSE

Cancer-related fatigue (CRF) is unrelenting. As neither rest nor sleep ameliorates cognitive, emotional, and physical symptoms, quality of life is diminished. This study examines resistance training (RT) effectiveness on CRF in cancer survivors. The secondary aims were to identify the dose-response relationship of RT frequency, intensity, and volume on CRF in different cancer survivor populations.

MATERIALS AND METHODS

Systematic searches via numerous databases for RCTs were performed in June 2022. Patient-reported outcome measures (PROM), were analysed, pre-to-post intervention, using a random-effects model. The Physiotherapy Evidence Database (PEDro) scale informed methodological quality assessment.

RESULTS

Eight studies were included (cancer survivors: breast (BCS) = 5; endometrial (ECS) = 1; prostate (PCS) = 2). Overall, RT interventions ≥ 6 weeks elicited large significant reductions in CRF for FACIT-F (SMD = 0.932, p = <0.001) and moderate significant reductions in CRF for PFS-R (SMD = -0.622, p = 0.004).

CONCLUSION

Main findings indicate that RT ameliorates CRF, especially in BCS; however, individualised approaches should be advocated. Supervised training elicited the greatest positive outcomes, thus should be a pivotal part of the cancer rehabilitation pathway. Future studies should be adequately powered, undertake discrete analyses of different cancer types, and investigate chronic RT effects.

Resistance Training-Induced Gains in Muscle Strength and Power Mediate the Improvement in Walking Speed in Middle-Aged Women Who Are Breast Cancer Survivors

ABSTRACT

Santagnello, SB, Martins, FM, de Oliveira Junior, GN, de Sousa, JdeFR, Nomelini, RS, Murta, EFC, and Orsatti, FL. Resistance training-induced gains in muscle strength and power mediate the improvement in walking speed in middle-aged women who are breast cancer survivors. J Strength Cond Res 38(4): 773-782, 2024-(a) Ascertain whether lower muscle mass, strength (1 repetition maximum [1RM]), and power (Pmax) in middle-aged women who are breast cancer survivors (BCS), when compared with women of a similar age never diagnosed with cancer (WNC), are related with lower walking speed (WS). (b) Ascertain whether changes in WS are associated with changes in muscle mass, 1RM, and (or) Pmax after resistance training (RT) in middle-aged BCS. A cross-section study was performed. Twenty WNC and 21 BCS were evaluated for lean mass of legs (LLM), 1RM (knee extension), muscle quality index (MQI = 1RM/LLM), Pmax (maximum muscle power-knee extension), and fast WS (10 and 400-meters). Randomized clinical trial was performed. The BCS were randomly divided into the control group ( n = 9) and the RT group ( n = 11). Breast cancer survivors exhibited lower 1RM (24.2%, p ˂ 0.001), Pmax (30.6%, p ˂ 0.001), MQI (22.2%, p = 0.001), and WS (10-m = 17.0%, p ˂ 0.001 and 400-m = 10.5%, p = 0.002) than WNC. Resistance training increased 1RM (31.6%, p = 0.001), MP (29.0%, p = 0.012), MQI (28.5%, p = 0.008), and WS (10-m = 9.4%, p = 0.009 and 400-m = 6.2%, p = 0.006) in BCS. The changes in WS were positively associated with 1RM (10-m = 68%, p = 0.001 and 400-m = 37%, p = 0.036) and Pmax (10-m = 56%, p = 0.005 and 400-m = 40%, p = 0.027) and MQI (10-m = 63%, p = 0.043 and 400-m = 37%, p = 0.035). Resistance training-induced gains in muscle strength and power mediate the improvement in WS in middle-aged BCS. Resistance training is an effective strategy to improve WS in middle-aged BCS.

Effects of Physical Activity on Quality of Life, Anxiety and Depression in Breast Cancer Survivors: A Systematic Review and Meta-analysis

PURPOSE

Anxiety, depression, and poor quality of life (QOL) were considered important concerns that hindered the rehabilitation of breast cancer survivors. A number of studies have investigated the effects of physical activity, but they have not reached the same conclusions. This review aimed to identify the effects of physical activity on QOL, anxiety, and depression in breast cancer survivors.

METHODS

PubMed, Embase, Web of Science, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, SinoMed, CNKI, Vip, and WanFang databases were searched for the time period between January 1, 2012, and April 30, 2022. Studies were included if they were randomized controlled trials of the effects of physical activity on QOL, anxiety, or depression in breast cancer survivors. The tools of the Joanna Briggs Institute were used to assess the quality of the included studies. R software version 4.3.1 was used for meta-analysis.

RESULTS

A total of 26 studies, involving 2105 participants, were included in the systematic review. Among these, 20 studies involving 1228 participants were included in the meta-analysis. Compared with the control group, the results indicated that physical activity can significantly improve QOL(Hedges' g = 0.67; 95% CI 0.41-0.92) and reduce anxiety (Hedges' g = -0.28; 95% CI -0.46 to -0.10) in breast cancer survivors. However, the effect of physical activity on depression (Hedges' g = -0.46; 95% CI -0.99 to 0.06) was not statistically significant.

CONCLUSIONS

Physical activity was an effective intervention to improve QOL and reduce anxiety in breast cancer survivors, as well as showed positive trends in depression, although without statistical significance. More well-designed studies are required to clarify the effects of different types of physical activities on the QOL, anxiety, and depression among breast cancer survivors.

REGISTERED NUMBER ON PROSPERO

CRD42022363094. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=363094.

Exercise as Medicine in Cardio-Oncology: Reducing Health Disparities in Hispanic and Latina Breast Cancer Survivors

PURPOSE OF REVIEW

This review aims to access the current state of the evidence in exercise as medicine for cardio-oncology in Hispanic and Latina breast cancer survivors and to provide our preliminary data on the effects of supervised aerobic and resistance training on cardiovascular disease (CVD) risk in this population.

RECENT FINDINGS

Breast cancer survivors have a higher risk of CVD; particularly Hispanic and Latina breast cancer survivors have a higher burden than their White counterparts. Exercise has been shown to reduce CVD risk in breast cancer survivors; however, evidence in Hispanic and Latina breast cancer survivors is scarce. Our review highlights a clear need for exercise oncology clinical trials in Hispanic and Latina breast cancer survivors targeting CVD risk factors. Moreover, our exploratory results highlight that 16 weeks of aerobic and resistance training may reduce the 10-year risk of developing CVD by 15% in Hispanic and Latina breast cancer survivors.

Social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in newly diagnosed women with breast cancer

PURPOSE

Identifying correlates of physical activity and sedentary behaviour allows for the identification of factors that may be targeted in future behaviour change interventions. This study sought to determine the social-cognitive, demographic, clinical, and health-related correlates of physical activity and sedentary behaviour in individuals recently diagnosed with breast cancer.

METHODS

Data were collected from 1381 participants within 90 days of diagnosis in the Alberta Moving Beyond Breast Cancer (AMBER) Cohort Study. Physical activity and sedentary behaviour were measured with ActiGraph GT3X+® and activPALTM devices, respectively, for seven consecutive days. Correlates were collected via a self-reported questionnaire, medical record extraction, or measured by staff.

RESULTS

Multivariable models were fitted for sedentary behaviour, light physical activity, and moderate-to-vigorous physical activity. Greater sedentary behaviour was associated with higher body fat percentage (BF%) (ß=0.044; p<0.001) and being single (ß=0.542; p<0.002). Lower light physical activity was associated with higher BF% (ß=-0.044; p<0.001), higher body mass index (ß=-0.039; p<0.001), greater disease barrier influence (ß=-0.006; p<0.001), a HER2-positive diagnosis (ß=-0.278; p=0.001), and being single (ß=-0.385; p= 0.001). Lower moderate-to-vigorous physical activity was associated with higher BF% (ß =-0.011; p=0.001), greater disease barrier influence (ß=-0.002; p<0.001), and being of Asian (ß=-0.189; p=0.002) or Indian/South American (ß=-0.189; p=0.002) descent. Greater moderate-to-vigorous physical activity was associated with having greater intentions (ß=0.049; p=0.033) and planning (ß=0.026; p=0.015) towards physical activity.

CONCLUSION

Tailoring interventions to increase physical activity for individuals recently diagnosed with breast cancer may improve long-term outcomes across the breast cancer continuum.

"My Body, My Rhythm, My Voice": a community dance pilot intervention engaging breast cancer survivors in physical activity in a middle-income country

BACKGROUND

Interventions to promote physical activity among women breast cancer survivors (BCS) in low- to middle-income countries are limited. We assessed the acceptability and preliminary effectiveness of a theory-driven, group-based dance intervention for BCS delivered in Bogotá, Colombia.

METHODS

We conducted a quasi-experimental study employing a mixed-methods approach to assess the 8-week, 3 times/week group dance intervention. The effect of the intervention on participants' physical activity levels (measured by accelerometry), motivation to engage in physical activity, and quality of life were evaluated using generalized estimating equation analysis. The qualitative method included semi-structured interviews thematically analyzed to evaluate program acceptability.

RESULTS

Sixty-four BCS were allocated to the intervention (n = 31) or the control groups (n = 33). In the intervention arm, 84% attended ≥ 60% of sessions. We found increases on average minutes of moderate-to-vigorous physical activity per day (intervention: +8.99 vs control: -3.7 min), and in ratings of motivation (intervention change score = 0.45, vs. control change score= -0.05). BCS reported improvements in perceived behavioral capabilities to be active, captured through the interviews.

CONCLUSIONS

The high attendance, behavioral changes, and successful delivery indicate the potential effectiveness, feasibility, and scalability of the intervention for BCS in Colombia.

TRIAL REGISTRATION

ClinicalTrial.gov NCT05252780, registered on Dec 7th, 2021-retrospectively registered unique protocol ID: P20CA217199-9492018.

CORE-CERT Items as a Minimal Requirement for Replicability of Exercise Interventions: Results From Application to Exercise Studies for Breast Cancer Patients

ABSTRACT

Hacke, C, Knuth, J, Bucher, M, Weisser, B, and Schmidt, T. CORE-CERT items as a minimal requirement for replicability of exercise interventions: results from application to exercise studies for breast cancer patients. J Strength Cond Res XX(X): 000-000, 2022-Exercise interventions have been demonstrated to be useful in the prevention and therapy for multiple different diseases. The Consensus on Exercise Reporting Template (CERT) has been developed as the reporting guideline for exercise studies. The main goals of CERT are to ensure completeness of reporting, to enable interpretation of exercise programs, and to allow extraction of data for meta-analyses and the development of guidelines. However, for clinicians, the most important aspect of good reporting might be the replicability of protocols for their patients. This study was designed to determine the core components of exercise interventions for breast cancer, which are considered as minimal requirement for replicability in practice. The original items of CERT were specified, subdivided, or extended by additional key items to develop a "CORE-CERT checklist." The original CERT and our CORE-CERT were then applied to 29 exercise RCTs for breast cancer obtained from the most frequently cited and most recent meta-analyses in current guidelines. The reporting quality using both templates were examined. Mean original CERT score was 11 of 19 (59%) of completed items and 13 of 19 (68%) of reporting completeness for CORE-CERT. Reporting quality using CORE-CERT items was approximately 8% higher, indicating a more precise description of items in CORE-CERT. Differences concerned exercise dosage, nonexercise components, supervision, and description of each exercise. We propose a novel CORE-CERT guideline necessary for the replicability of exercise interventions in clinical practice. The application of CORE-CERT demonstrated a slightly better but still insufficient reporting quality of exercise interventions for breast cancer.

Aerobic exercise training resets the human skeletal muscle methylome 10 years after breast cancer treatment and survival

Cancer survivors suffer impairments in skeletal muscle in terms of reduced mass and function. Interestingly, human skeletal muscle possesses an epigenetic memory of earlier stimuli, such as exercise. Long-term retention of epigenetic changes in skeletal muscle following cancer survival and/or exercise training has not yet been studied. We, therefore, investigated genome-wide DNA methylation (methylome) in skeletal muscle following a 5-month, 3/week aerobic-training intervention in breast cancer survivors 10-14 years after diagnosis and treatment. These results were compared to breast cancer survivors who remained untrained and to age-matched controls with no history of cancer, who undertook the same training intervention. Skeletal muscle biopsies were obtained from 23 females before(pre) and after(post) the 5-month training period. InfiniumEPIC 850K DNA methylation arrays and RT-PCR for gene expression were performed. The breast cancer survivors displayed a significant retention of increased DNA methylation (i.e., hypermethylation) at a larger number of differentially methylated positions (DMPs) compared with healthy age-matched controls pre training. Training in cancer survivors led to an exaggerated number of DMPs with a hypermethylated signature occurring at non-regulatory regions compared with training in healthy age-matched controls. However, the opposite occurred in important gene regulatory regions, where training in cancer survivors elicited a considerable reduction in methylation (i.e., hypomethylation) in 99% of the DMPs located in CpG islands within promoter regions. Importantly, training was able to reverse the hypermethylation identified in cancer survivors back toward a hypomethylated signature that was observed pre training in healthy age-matched controls at 300 (out of 881) of these island/promoter-associated CpGs. Pathway enrichment analysis identified training in cancer survivors evoked a predominantly hypomethylated signature in pathways associated with cell cycle, DNA replication/repair, transcription, translation, mTOR signaling, and the proteosome. Differentially methylated region (DMR) analysis also identified genes: BAG1, BTG2, CHP1, KIFC1, MKL2, MTR, PEX11B, POLD2, S100A6, SNORD104, and SPG7 as hypermethylated in breast cancer survivors, with training reversing these CpG island/promoter-associated DMRs toward a hypomethylated signature. Training also elicited a largely different epigenetic response in healthy individuals than that observed in cancer survivors, with very few overlapping changes. Only one gene, SIRT2, was identified as having altered methylation in cancer survivors at baseline and after training in both the cancer survivors and healthy controls. Overall, human skeletal muscle may retain a hypermethylated signature as long as 10-14 years after breast cancer treatment/survival. Five months of aerobic training reset the skeletal muscle methylome toward signatures identified in healthy age-matched individuals in gene regulatory regions.

The Practice of Physical Activity on Psychological, Mental, Physical, and Social Wellbeing for Breast-Cancer Survivors: An Umbrella Review

(1) Background: The number of breast-cancer patients and survivors is increasing in the last years. Physical activity seems to be a feasible and useful complementary intervention to improve the physical, psychological, and social spheres and decrease some symptoms, especially for survivors. Consequently, the objective of the present umbrella review was to analyze the efficacy of different physical-activity interventions in the physical, mental, and social spheres of breast-cancer survivors. (2) Methods: Systematic reviews and meta-analyses of randomized controlled trials on breast-cancer survivors and physical-activity effects were searched on the electronic databases PubMed, Web of Science, and Scopus till 9 August 2022. The quality of the studies included was evaluated, and the results were narratively analyzed. (3) Results: Physical-activity intervention generally improves the physical, mental, and social spheres of breast-cancer survivors, but the studies included present heterogeneity in the protocols adopted. (4) Conclusions: A well-structured and planned physical-activity intervention is useful for improvements in the physical, mental, and social spheres of breast-cancer survivors, but the studies presented high heterogeneity. Yoga seems to be the most effective physical intervention to complement medical therapy.

Alestad J, Santali EY, Arshad S, Ahmed N, Afolabi HA. Effectiveness of physical activity on immunity markers and quality of life in cancer patient: a systematic review

Background

Cancer is a huge group of diseases that can affect various body parts of humans but also has a psychological, societal, and economic impact. Physical activity can improve the quality of life (QOL) and immunity, while moderate intensity exercise can reduce the probability of this lethal disease. The current study aimed to determine the effect of physical activity on immune markers and QOL in cancer patients as well as to evaluate cancer-related fatigue (CRF) and its association with physical activity.

Methodology

Before starting the study, the study protocol was registered in PROSPERO (registration number CRD42021273292). An electronic literature search was performed by combining MeSH terminology and keywords used with the Boolean operators "OR" and "AND" to find relevant published studies on PubMed, Scopus, Cochrane, and ScienceDirect databases. The Joanna Briggs Institute (JBI) critical evaluation checklist was used to assess the quality of selected studies, while the GRADE approach was used to see the quality of evidence.

Results

A total of 13,931 studies were retrieved after the search on databases. After the scrutiny of studies by reading the title of articles and the inclusion/exclusion criteria, a total of 54 studies were selected for further screening by reading the full texts. In the final, a total of nine studies were selected for the current systematic review and proceeded for data extraction. The patients who were doing different exercises showed improvements in immunity, QOL, and reduction in CRF. A significant reduction in tumour necrosis factor-α (TNF-α), C reactive protein (CRP), interleukin-8 (IL-8), IL-6, and an increase in natural killer (NK) cells levels was also observed.

Conclusions

The exercise program is safe and beneficial to improve the quality of life and immunity markers before, during, and after cancer treatment. Physical exercise may also help patients to overcome the adverse effects of the treatment and to reduce the chance of developing new tumours in the future.

Tailoring the Evidence for Exercise Oncology within Breast Cancer Care

Exercise is safe and effective for those living with and beyond breast cancer, with evidence supporting exercise guidelines, and position statements from international organizations. Despite the clearly recognized benefits of exercise for these individuals, many do not participate or maintain recommended exercise levels throughout the breast cancer continuum, highlighting the lack of translation from research into practice. In addition, discerning how exercise can be tailored to address breast cancer-related impairments, so that individuals are able to participate safely and effectively, has also not been studied extensively. Thus, we propose that implementing exercise screening, triage, and referral pathways across the breast cancer continuum may allow for increased accessibility and adoption among those living with and beyond breast cancer. This paper provides an overview of exercise prescription tailoring for common breast cancer and treatment-related impairments, proposes a simplified screening tool for identifying physical activity and movement-related impairments, and considers how best to channel evidence into practice via proposed implementation pathways that may better connect individuals living with and beyond breast cancer with exercise oncology resources through screening, triage, and referral.

Impact of community-based exercise on fatigue in early breast cancer survivors: identifying potential determinants of change

BACKGROUND

Exercise has been shown to reduce fatigue in early breast cancer survivors (EBCS), though it is unclear if these results translate to community-based exercise settings. Mechanisms that influence changes in fatigue seen after exercise are also poorly understood. This study sought to evaluate the impact of community-based exercise and identify associations of fatigue in EBCS.

METHODS

Twenty-nine EBCS and 13 non-cancer controls (CON) enrolled. Pre/post-intervention measurements included measures of fitness/function, balance, and adherence/compliance as well as self-reported measures of fatigue, health-related quality of life (HRQOL), well-being, self-efficacy, and physical activity. Both groups participated in a supervised 16-week aerobic + resistance exercise intervention. A mixed model ANOVA and Cohen's D effect size assessed fatigue changes, and univariable linear regressions identified fatigue associations.

RESULTS

Fatigue improved for EBCS (- 2.6, Cohen's D = 0.51) but not CON (0.0, Cohen's D = 0.02); no interaction effect was observed. Post-intervention fatigue in EBCS was associated with better QOL (R² = 0.387; p < 0.01), depression (R² = 0.251; p < 0.01), self-efficacy, (R² = 0.453; p < 0.01), outcome expectations from exercise (R² = 0.254; p < 0.01), balance (R² = 0.167; p < 0.05), and the 6-minute walk test (R² = 0.193; p < 0.05). EBCS improvements in fatigue were associated with improvements in self-reported physical health (R² = 0.425; p < 0.01), depression (R² = 0.233; p < 0.01), pain (R² = 0.157; p < 0.05), outcome expectations from exercise (R² = 0.420; p < 0.01), and the 6-minute walk test (R² = 0.172; p < 0.05). Less fatigue in the CON group was shown be associated with better sleep quality (R² = 0.309; p < 0.05) and pain (R² = 0.259; p < 0.05).

CONCLUSION

Community-based exercise appears beneficial for alleviating fatigue in EBCS. These improvements may be driven by parallel improvements in psychosocial outcomes and objectively measured functional outcomes.

The Impact of Therapeutic Exercises on the Quality of Life and Shoulder Range of Motion in Women After a Mastectomy, an RCT

Breast cancer ranks highest in incidence and mortality among females and second among both genders. Lebanon has the second highest rate of breast cancer worldwide for those 35-39 years old and the highest for those 40-49. Mastectomy often results in deceased shoulder and arm mobility and decreased quality of life. The objective of this study was to assess the effect of an educational program of therapeutic exercises on the quality of life and functional ability in women after a mastectomy. Sixty women undergoing a mastectomy were randomly assigned to either an intervention or control group. The intervention group received extensive pre-surgery education as well as training on therapeutic exercises. Follow-up phone calls to the intervention group were made to ensure that the exercises were being done. Both groups were visited at home at two and four weeks to obtain the outcome variables. The Breast Cancer Patient Version was used to assess quality of life, and the "Goniometer" was used to assess the range of motion of the affected shoulder. At two and four weeks after surgery, women in the intervention group had significant improvements in their shoulder range of motion: flexion, extension, and abduction were significantly different between the control and intervention group at p = 0.04-0.00. For quality of life, physical, psychological, psychological, social, and spiritual well-being were significantly higher for the intervention group at both two and four weeks after surgery, p < 0.001. In a middle-income country, one-to-one education provided by a nurse, which included demonstrations, back demonstrations, and weekly phone calls had a positive impact on women's shoulder range of motion and quality of life. NCT04184102.

Cross-sector co-creation of a community-based physical activity program for breast cancer survivors in Colombia

Benefits of physical activity (PA) in breast cancer survivors (BCS) are well established. However, programs to promote PA among BCS tailored to real-world contexts within low- to middle-income countries are limited. Cross-sector co-creation can be key to effective and scalable programs for BCS in these countries. This study aimed to evaluate the networking process to engage multisector stakeholders in the co-creation of a PA program for Colombian BCS called My Body. We employed a mixed-methods design including semistructured interviews, workshops and a social network analysis of centrality measures to assess stakeholders' engagement, resources and skills enabling the collaborative work, challenges, outcomes and lessons learned. The descriptive analysis and the centrality measures of the network revealed that 19 cross-sector stakeholders engaged in the My Body collaborative network. Through ongoing communication and cooperation, My Body built relationships between the academic lead institutions (local and international), and local and national public, private and academic institutions working in public health, sports and recreation, social sciences and engineering fields. The outcomes included the co-creation of the community-based PA program for BCS, its implementation through cross-sector synergies, increased relationships and communications among stakeholders, and successful dissemination of evidence and project results to the collaboration partners and other relevant stakeholders and community members. The mixed-methods assessment enabled understanding of ways to advance cross-sector co-creation of health promotion programs. The findings can help to enable continued development of sustainable cross-sector co-creation processes aimed at advancing PA promotion.

Reducing Metabolic Dysregulation in Obese Latina and/or Hispanic Breast Cancer Survivors Using Physical Activity (ROSA) Trial: A Study Protocol

Background

Latina and Hispanic breast cancer survivors (LHBCS) are at increased risk for long-term complications and poorer metabolic health, including metabolic dysregulation (MetD) before and following breast cancer diagnosis. MetD can increase risk of cancer recurrence, death, and comorbid conditions by increasing inflammation and cancer cell proliferation. While exercise improves physical fitness and metabolic outcomes in breast cancer survivors, there is a lack of studies including underrepresented and disadvantaged minority groups such as LHBCS.

Methods

Our 12-month randomized (exercise or attention control) controlled trial (the ROSA trial) aims to utilize a progressive combined aerobic and resistance exercise program to improve MetD, insulin resistance, and visceral adiposity among obese LHBCS. We aim to recruit 160 women with Stage I-III breast cancer who are sedentary, centrally obese, and have completed treatment (e.g., surgery, radiation, chemotherapy) prior to enrollment. Participants randomized to the exercise group receive 16-weeks of virtually supervised aerobic and resistance training, followed by 16-weeks of unsupervised home-based aerobic and resistance exercise, and 16-weeks of follow-up. The attention control group receive a 12-month home-based stretching program. Primary and secondary outcomes are measured every 4-weeks during study visits.

Discussion

The ROSA trial is the first exercise oncology trial targeting high-risk sedentary, obese LHBCS to improve MetD-related outcomes. Results of this trial will help illuminate how exercise impacts health-related outcomes, survivorship, and recurrence, and inform future exercise oncology guidelines to reduce health disparities among minority cancer survivors.

The Effect of Exercise Training on Lean Body Mass in Breast Cancer Patients: A Systematic Review and Meta-analysis

PURPOSE

Reduced lean body mass (LBM) is common during and after treatment for breast cancer, and it is associated with increased treatment-induced toxicity, shorter time to tumor progression, and decreased survival. Exercise training is a potential intervention for maintaining or increasing LBM. We conducted a systematic review and a meta-analysis to investigate the effects of exercise training on LBM in breast cancer.

METHODS

A comprehensive search was performed to November 2020 for randomized controlled trials reporting the effects of structured exercise training on LBM compared with control in women with breast cancer during or after cancer treatment. A random-effects meta-analysis was completed using the absolute net difference in the change in LBM between intervention and control groups as the outcome measure. Sensitivity and subgroup analyses were also performed.

RESULTS

Data from 17 studies involving 1743 breast cancer survivors were included in the meta-analysis. Overall, there was a significant benefit of exercise training compared with control on LBM (0.58 kg, 95% confidence interval = 0.27 to 0.88, P < 0.001). Subgroup analysis showed positive effects for resistance training (0.59 kg) and aerobic training (0.29 kg), and for exercise training conducted during (0.47 kg) or after (0.66 kg) cancer treatment. Exercise training was beneficial in studies enrolling postmenopausal women (0.58 kg) as well as in those with participants of mixed menopausal status (1.46 kg).

CONCLUSIONS

Compared with usual care, exercise training has a beneficial effect on LBM in women with breast cancer, both during and after cancer treatment. Given the physiological and functional importance of LBM in women with breast cancer, oncologists should encourage their patients to engage in regular exercise training, with particular emphasis on resistance training.

Peer mentoring for physical activity adoption and maintenance among breast cancer survivors: moderators of physical activity outcomes

PURPOSE

We aimed to identify the moderators of maintenance strategies' effects to assist cancer care organizations that offer peer mentoring physical activity programs.

METHODS

A total of 161 inactive breast cancer survivors participated in a 12-month study and were randomized to one of three conditions at baseline. American Cancer Society's Reach to Recovery coaches delivered weekly calls to participants for the first 3 months. During Months 4-9, participants self-monitored PA and received feedback (Reach Plus) or additionally received monthly calls from coaches (Reach Plus Phone) or weekly text/email messages (Reach Plus Message). Moderate-to-vigorous PA (MVPA) was assessed using self-report and accelerometry at baseline, 3, 6, 9, and 12 months. We examined baseline demographics, cancer-specific, and social cognitive variables as potential moderators of MVPA. Using Latent Class Models, we identified three participant profiles. The profile was used as a moderator in longitudinal mixed-effects models of MVPA.

RESULTS

Profile 1 (44%) were married, White, in preparation, with higher income and higher social support. Profile 2 (41%) were older, office employees, African American, with higher PA self-efficacy. Profile 3 (15%) were diagnosed with stage 1 cancer, in contemplation, with higher MVPA and lower social support. At follow-ups, among those with Profile 1, Reach Plus participants had higher MVPA than other groups (f² [Formula: see text].10). Among those with Profile 2, Reach Plus Message participants had higher mean MVPA than other groups (f² [Formula: see text].11). Among those with Profile 3, Reach Plus Phone participants had higher MVPA than other groups, f² [Formula: see text].11 (all ps < .05).

CONCLUSIONS

Organizations can choose PA maintenance strategies that are most effective for survivors with specific profiles.

IMPLICATIONS FOR CANCER SURVIVORS

Breast cancer survivors with specific profiles increase PA when receiving certain PA maintenance programs.

TRIAL REGISTRATION

ClinicalTrials.gov ID: NCT02694640 (Feb. 26, 2016).

An organizational approach to exploring the determinants of community-based exercise program implementation for breast cancer survivors

BACKGROUND

The majority of breast cancer survivors do not engage in sufficient levels of exercise. Community-based exercise programs (CBEP) may mitigate low rates of exercise participation; however, few programs exist. Previous research exploring the determinants of CBEP implementation for cancer survivors is limited in that it has predominantly focused on cancer survivor perspectives or it has failed to rely on a theoretical framework to explore determinants to implementation across various implementation domains. An organizational exploration of the determinants of CBEP implementation for breast cancer survivors is warranted to guide future program implementation.

PURPOSE

The purpose of this study was to apply the Consolidated Framework for Implementation Research (CFIR) to explore the determinants of CBEP implementation for breast cancer survivors from a program provider perspective.

METHODS

Data collection and analysis were guided by the CFIR. Program providers completed an online questionnaire and an interview. Transcripts were analyzed using inductive content analysis. Resulting codes were deductively mapped onto the CFIR.

RESULTS

Seven barriers and seven facilitators were identified, with three key influencers (e.g., program awareness, financial support, and knowledge regarding the benefits of exercise for breast cancer survivors) cited as both barriers and facilitators to program implementation. Barriers primarily operated within the outer setting (e.g., needs and resources) domain of the CFIR, whereas facilitators and key influencers operated across multiple CFIR domains (e.g., culture and planning).

CONCLUSIONS

Study findings provide insight into the current challenges to CBEP implementation experienced by program providers and highlight potential avenues for future exercise program development and implementation.

Effects of Short-Term Unsupervised Exercise, Based on Smart Bracelet Monitoring, on Body Composition in Patients Recovering from Breast Cancer

OBJECTIVE

We aimed to investigate the effects of exercise, monitored and managed using smart bracelets, on body composition, and quality of life in breast cancer survivors.

METHODS

A before-and-after study was conducted in 109 patients who were in the recovery phase of breast cancer and attended the Breast Surgery Department of the Cancer Hospital of Fudan University up to December 2017. Patients were advised to adhere to at least 150 minutes of moderate-intensity exercise per week, and a smart bracelet was issued to each participant to record their daily exercise data for 3 months. Bioelectrical impedance analysis was used to observe the effects of short-term unsupervised exercise intervention on body composition in patients recovering from breast cancer. Patients completed the Functional Assessment of Cancer Therapy-Breast to assess health-related quality of life.

RESULTS

Weight, body mass index (BMI), body fat mass (BFM), fat mass index (FMI), percent body fat (PBF), arm circumference (AC), arm muscle circumference (AMC), and visceral fat area (VFA) were lower than baseline after exercising for 3 months based on data from the wearable devices (P < .05). The only significant improvement was found in the "additional concerns about breast cancer" category among the quality-of-life assessments (P < .05). The average walking time was negatively associated with BFM, PBF, and FMI, while the average calorie consumption due to running was positively associated with fat free mass (FFM).

CONCLUSION

In this study, we demonstrated that short-term exercise may be beneficial for postoperative breast cancer survivors. A wearable device could help patients track physical data easily and promote a healthier and more positive life.

Effect of exercise on neuromuscular toxicity in oxaliplatin-treated mice

INTRODUCTION/AIMS

Clinically, the chemotherapeutic agent oxaliplatin can cause peripheral neuropathy, impaired balance, and muscle wastage. Using a preclinical model, we investigated whether exercise intervention could improve these adverse conditions.

METHODS

Mice were chronically treated with oxaliplatin alone or in conjunction with exercise. Behavioral studies, including mechanical allodynia, rotarod, open-field, and grip-strength tests, were performed. After euthanasia, multiple organs and four different muscle types were dissected and weighed. The cross-sectional area (CSA) of muscle fibers in the gastrocnemius muscle was assessed and gene expression analysis performed on the forelimb triceps muscle.

RESULTS

Oxaliplatin-treated mice displayed reduced weight gain, mechanical allodynia, and exploratory behavior deficits that were not significantly improved by exercise. Oxaliplatin-treated exercised mice showed modest evidence of reduced muscle wastage compared with mice treated with oxaliplatin alone, and exercised mice demonstrated evidence of a mild increase in CSA of muscle fibers.

DISCUSSION

Exercise intervention did not improve signs of peripheral neuropathy but moderately reduced the negative impact of oxaliplatin chemotherapy related to muscle morphology, suggesting the potential for exploring the impact of exercise on reducing oxaliplatin-induced neuromuscular toxicity in cancer patients.

Comparison of fatigue and fatigability correlates in Korean breast cancer survivors and differences in associations with anxiety, depression, sleep disturbance, and endocrine symptoms: a randomized controlled trial

BACKGROUND

Fatigue is one of the most common and burdensome symptoms experienced by cancer patients. In interventions intended to reduce fatigue in such patients, fatigability, or perception of fatigue contextualized to activities of fixed intensity and duration, may also be measured. This study investigated the effects of a 15-month intervention on fatigue and fatigability in breast cancer survivors (BCS); explored the fatigue-fatigability relationship; and evaluated the impacts of fatigue and fatigability on anxiety, depression, sleep disturbance, and endocrine symptoms.

METHODS

A randomized controlled trial design was applied to an exercise program called BLESS (Better Life after cancer, Energy, Strength, and Support). The intervention included this 12-week exercise program and four follow-up contacts intended to promote exercise adherence over the following year. Participants were women aged 20 to 69 who had been diagnosed with stage I, II, or III breast cancer; had completed active treatment; and had moderate or higher fatigue. At the completion of the intervention, the survey responses of 40 BCS were evaluated using the chi-square test and multiple regression analysis. The Korean versions of the Revised Piper Fatigue Scale and Pittsburgh Fatigability Scale were used to measure fatigue and fatigability, respectively.

RESULTS

There was no significant difference in fatigue or fatigability between the experimental and control groups at intervention completion. However, the control group showed a stronger association than the experimental group between fatigue and physical fatigability. In the control group, fatigue and fatigability were significantly associated with anxiety, depression, sleep disturbance, and endocrine symptoms. In the experimental group, only the cognitive/mood fatigue score and depression were significantly associated. Only endocrine symptoms influenced mental fatigability (B = - 0.185, P < 0.05), and only depression influenced cognitive/mood fatigue (B = 1.469, P < 0.05).

CONCLUSIONS

Fatigue and fatigability showed different correlations with cancer-related symptoms after the exercise intervention. Future assessments of fatigability in intervention studies will allow measurement of the spectrum of patients' abilities to overcome fatigue at various physical activity levels while capturing different aspects of cancer-related symptoms.

TRIAL REGISTRATION

This study was retrospectively registered on Clinical Research Information Service ( KCT0005763 ; date of registration: 31/12/2020).

Exercise effects on fatigue in breast cancer survivors after treatments: A systematic review and meta-analysis

AIM

The aim of this study is to explore the effects of exercise interventions by type, duration and intensity of exercise for fatigue in breast cancer survivors who had completed their treatment.

BACKGROUND

Most studies found that exercise has valuable outcomes for cancer survivors. This meta-analysis comprehensively summarizes the benefits of exercise intervention for fatigue in breast cancer patients who had completed their adjuvant treatments.

METHODS

We conducted a meta-analysis on randomized control trials published during 1 January 2000 through 31 December 2019, from PubMed, Cochrane Library databases, EMBASE, Medline (ProQuest), CINAHL, PsycINFO, Chinese Electronic Periodical Service and Wan Fan Data with prespecified searching criteria. Breast cancer patients earlier than stage IIIc and completing adjuvant treatments were included, and the effects of exercise on fatigue were investigated.

RESULTS

Nine randomized controlled trials (RCTs) were included (N = 581). Patients receiving exercise interventions showed reduced fatigue comparing with those without exercise. Exercise with low-moderate intensity, 20 min/day, three times per week and lasting up to 12 weeks had a significant effect on reducing fatigue for breast cancer survivors.

CONCLUSION

Our study suggested that exercise interventions can reduce fatigue for this group of cancer survivors. The duration and intensity of exercise intervention could be prescribed for this specific group of cancer patients as a basic requirement to handle their reported fatigue.

Both "Vitamin L for Life" and "One Milligram of Satan": A Multi-Perspective Qualitative Exploration of Adjuvant Endocrine Therapy Use after Breast Cancer

Adjuvant endocrine therapy (AET) is recommended after hormone receptor-positive breast cancer to reduce risk of recurrence, but adherence is sub-optimal in many women. Behavioral interventions have been ineffective in improving adherence rates to AET. This qualitative descriptive study investigates factors that support women in AET use and suggestions for interventions to improve AET use and management. Interviews with women who persisted with AET (n = 23), women who discontinued AET (n = 15), and healthcare providers (HCPs; oncologists, oncology residents, and pharmacists; n = 9) were conducted, transcribed, and described using thematic analysis. Data collection stopped once saturation occurred (i.e., no new codes or themes emerged during interviews). Two researchers created codes and developed themes in an iterative process; a third researcher verified the representativeness of final themes. This study was approved by the Health Research Ethics Board of Alberta (ID: HREBA.CC-17-0513). Women who persisted described being prepared for side effects and having self-management strategies, strong rationale for AET use, supportive HCPs, and available resources as relevant factors. Women who discontinued described feeling overwhelmed by side effects, information needs, drawbacks of AET, helpful/unhelpful experiences with HCPs, and contextual factors as relevant to their discontinuation. HCPs described health system-related and patient-related barriers, side effect management, and patient-provider interactions as relevant to supporting AET use. The considerable overlap in themes among the three groups suggests broad recognition of salient factors relevant to AET use and that associated strategies to improve use may be acceptable to patients and providers alike. Factors supporting AET use could include the following: education (which may be necessary but insufficient), developing a strong personal rationale for use, being prepared for side effects, having side effect management strategies, reciprocal communication between patients and HCPs, and accessible resources.

Impact of community-based exercise program participation on aerobic capacity in women with and without breast cancer

BACKGROUND

Evidence for exercise as an efficacious strategy to improve aerobic capacity of breast cancer survivors (BCS) has come largely from intervention studies conducted in laboratory settings. There is an increasing need to translate to community-type settings, but the efficacy of those interventions using gold standard evaluation is not well-established.

AIM

To investigate whether similar improvement in aerobic capacity (maximal oxygen consumption [VO₂]) measured with gold standard testing can be achieved through a community-based setting in BCS.

METHODS

A peak cardiopulmonary exercise test (VO_2peak), 6-min walk test (6MWT), and timed up and go test (TUG) were assessed pre- and post-16 wk of progressive intensity aerobic and strength training exercise at a community center.

RESULTS

The sample consisted of 31 early BCS (< 1 year since treatment completion) and 15 controls (CTLs). Both groups significantly improved VO_2peak (+1.2 mL/kg/min; P = 0.030), 6MWT (+35 meters; P < 0.001), and TUG (-0.44 s; P < 0.01) following training. Both groups improved peak cycling power during the cardiopulmonary exercise test with BCS improving by +10 watts more than the CTLs (P = 0.020). Average exercise attendance was 71% (34 of 48 possible days), but compliant days averaged only 60% of total days for aerobic, and < 40% for strength in both groups.

CONCLUSION

Community-based exercise programs can be an effective strategy to improve aerobic capacity and physical function for early-stage BCS but potentially not to the same extent observed in laboratory-based randomized controlled trials. Further research is needed to explore barriers and facilitators of exercise engagement in community-based centers to maximize training benefits for adults with cancer.

Knowledge and perceived benefits of exercise among women with breast cancer in tertiary hospitals in Delta State

BACKGROUND

Knowledge of exercise is of paramount importance in improving and reclaiming the health of women with breast cancer and also enables them to reap the enormous benefits associated with healthy physical activity.

AIM

To assess the knowledge and perceived benefits of exercise among women with breast cancer in Delta State.

METHOD

Sample of 94 eligible consenting women who are still maintaining follow up with the two tertiary hospitals in Delta state, Federal Medical Center (FMC) Asaba and Delta State University Teaching Hospital (DELSUTH) Oghara were enlisted for the study.

RESULT

Findings from the study revealed knowledge of the recommended exercise was poor among the women with breast cancer, as only 21(22.3%) had good knowledge. For those knowledgeable, their knowledge source was mainly through the mass media 5(23.8%) and the internet 4(19.0%). On the benefits of exercise as perceived by the women with breast cancer, the result shows that 88 (93.6%) of the women with breast cancer perceived exercise as beneficial. The principal exercise perceived to be beneficial was walking 43(45.7) and treatment of discomfort 25(26.6%) was the main benefit they hoped to gain from exercise. Also demographic profiles of the women were not significantly related to their knowledge about the recommended exercise asp > 0.05.

CONCLUSION

Knowledge of the recommended exercise was low among women with breast cancer despite their awareness of the benefits. It is therefore essential for health care providers, especially those involved in the care of these patients, to use every avenue to health-educate, counsel and help them in implementing the recommended exercise to enhance their survival.