Improved Sleep Quality Is Associated with Reduced Insulin Resistance in Cancer Survivors Undertaking Circuit, Interval-Based Exercise

PURPOSE

Cancer patients often experience poor sleep quality, typically induced by cancer-related treatments, a sedentary lifestyle, and psychological distress, leading to an increased risk of metabolic dysregulation such as obesity and insulin resistance. In this novel 16-week pilot study, we examined the effect of a circuit-based aerobic and resistance exercise intervention on self-reported sleep quality in breast, prostate, and colorectal cancer survivors and explored the association between changes in sleep quality and insulin resistance.

METHODS

Survivors of breast, prostate or colorectal cancers who were sedentary, overweight or obese (BMI>25.0 kg/m2) were randomized to exercise (n=60) or usual care (n=30). The 16-week intervention included supervised moderate-vigorous aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise performed in a circuit, interval fashion three times per week. Patient-reported sleep quality and insulin resistance were assessed at baseline and post-intervention using Pittsburgh Sleep Quality Index (PSQI) and Homeostasis Model of Assessment (HOMA-IR), respectively. Mean changes in PSQI score that are negative demonstrate improvements in sleep. Between-group differences were determined using repeated-measures analysis of variance. Associations between changes in PSQI and insulin resistance were computed using Pearson correlations.

RESULTS

Participants were 63.2±10.8 years old, obese (87%), female (55%), and completed chemotherapy + radiation therapy (75%). Adherence to the intervention was 92% and the retention rate was 100%. Post-intervention, the PSQI global score improved significantly in the exercise group when compared to usual care (mean between-group difference, -2.7; 95% CI, -4.2 to -0.6). Change in PSQI was inversely associated with change in HOMA-IR (r=-0.91; p<0.01) among the exercise group.

CONCLUSIONS

A circuit, interval-based aerobic and resistance exercise intervention improved patient-reported sleep quality in breast, prostate, and colorectal cancer survivors. Additionally, this exercise-induced improvement in sleep-quality may result in reduced insulin resistance.

Abstract P5-13-01: Effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome in overweight/Obese Hispanic breast cancer survivors

Purpose. Metabolic syndrome (MetS) is associated with increased risk of cardiovascular disease, type 2 diabetes, and possibly cancer recurrence, and is higher in breast cancer survivors than age-matched postmenopausal women. Further, MetS is 1.5 times more prevalent in Hispanic women (&gt;40 years of age) than in non-Hispanic Whites and African Americans, thereby increasing the need to attenuate MetS in Hispanic breast cancer survivors (HBCS). This study examined the effects of a 16-week combined aerobic and resistance exercise intervention on MetS in overweight and obese HBCS.

Methods. This pre-planned sub-analysis included 60 sedentary HBCS (BMI325 kg/m2) from our larger MetS trial. HBCS were randomized to the exercise intervention (EXE; n=30) or usual care (UC; n=30). The EXE group participated in 3 supervised exercise sessions per week for 16 weeks. Aerobic exercise was performed at 65-85% heart rate maximum for ˜30 minutes. Resistance exercise was performed in circuit-fashion with 3 sets of 10-15 repetitions including upper and lower body exercises at 65-85% 1-repetition maximum. The UC group was asked not to increase their current exercise levels during the study period. Participants were tested for MetS (blood pressure, waist circumference, fasting blood glucose, HDL-C, and triglycerides) at baseline, within one week following the 16-week study period, and at 12-week follow-up for the EXE group only. Fasting blood samples were used to measure glucose, HDL-C, and triglycerides. Waist circumference was measured at the midpoint between the lower margin of the last palpable rib and the top of the iliac crest using a fabric tape measure. Blood pressure was measured with an automated sphygmomanometer. Body composition was assessed via dual energy X-ray absorptiometry.

Results. At baseline, 82% (overall and by group) of the HBCS met the criteria for MetS. There were no significant group differences in the MetS variables between the EXE and UC groups at baseline (p&gt;0.01). Post-intervention, all MetS components were significantly lower in the EXE group than the UC group (p&lt;0.01) and only 15% of participants in the EXE group met the criteria for MetS, representing a 67% absolute decrease. This is in comparison to 84% of participants in the UC group. Body fat mass decreased by 10% during the 16-week EXE period, compared to a 2% increase in the UC group (p&lt;0.01). MetS changes remained significantly improved in the EXE group when fat mass was included as a covariate in the statistical model. At the follow-up assessment in the EXE group, all MetS variables remained significantly improved compared to baseline (p&lt;0.01) and were not significantly different post-intervention (p&gt;0.25) despite slight increases (&lt;2%) in waist circumference and triglyceride levels.

Conclusion. This is one of few exercise trials in minority BCS and the first study to target MetS with exercise in HBCS. This 16-week supervised combined aerobic and resistance exercise intervention reduced MetS in sedentary, overweight and obese HBCS. Reductions in MetS components were maintained after completion of the intervention, suggesting the benefits of the intervention on MetS were sustainable in the absence of a supervised intervention.

Citation Format: Dieli-Conwright CM, Sami N, Lee K, Spicer D, Buchanan TA, Demark-Wahnefried W, Courneya K, Tripathy D, Mortimer J. Effects of a 16-week combined aerobic and resistance exercise intervention on metabolic syndrome in overweight/Obese Hispanic breast cancer survivors [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-13-01.

A review of clinical effects associated with metabolic syndrome and exercise in prostate cancer patients

Androgen deprivation therapy (ADT), a primary treatment for locally advanced or metastatic prostate cancer, is associated with the adverse effects on numerous physiologic parameters, including alterations in cardiometabolic variables that overlap with components of the metabolic syndrome (MetS). As MetS is an established risk factor for cardiovascular mortality and treatment for prostate cancer has been associated with the development of MetS, interventions targeting cardiometabolic factors have been investigated in prostate cancer patients to attenuate the detrimental effects of ADT. Much support exists for exercise interventions in improving MetS variables in insulin-resistant adults, but less evidence is available in men with prostate cancer. Regular exercise, when performed at appropriate intensities and volumes, can elicit improvements in ADT-related adverse effects, including MetS, and contributes to the growing body of literature supporting the role of exercise in cancer survivorship. This review (1) discusses the biologic inter-relationship between prostate cancer, ADT and MetS, (2) evaluates the current literature in support of exercise in targeting MetS and (3) describes the physiological mechanisms by which exercise may favorably alter MetS risk factors in prostate cancer patients on ADT.

Abstract P4-10-05: Changes in metabolic syndrome components in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy

Purpose. We sought to determine the impact of (neo)adjuvant chemotherapy on metabolic syndrome (MetS) components and related anthropometric and metabolic biomarkers among premenopausal and postmenopausal early stage breast cancer patients.

Methods. Eighty-six women with early stage (I-III) breast cancer who were free from clinically diagnosed MetS (defined as 3 out of 5 components of MetS) and were planning to undergo chemotherapy, enrolled in the study. Participants were tested for MetS (blood pressure; BP, waist circumference; WC, fasting blood glucose; FBG, high-density lipoprotein cholesterol; HDL-C, and triglycerides; TG), anthropometrics (body weight; BW, percent body fat; BF, fat mass; FM), lipid profile (total cholesterol; TC, low-density lipoprotein cholesterol; LDL-C), glucose metabolism (insulin, homeostatic model- insulin resistance; HOMA-IR, glycosylated hemoglobin; HbA1c), and inflammation (C-reactive protein; CRP) within one week before and following the completion of chemotherapy. Fasting (12-hour) venous blood samples of the antecubital vein were drawn to measure glucose, insulin, lipid profile (TC, HDL-C, LDL-C, and TRI), HbA1c, and CRP. Blood samples were analyzed at the City of Hope Clinical Pathology Laboratory. Insulin resistance was calculated using the HOMA index: [(fasting glucose (mg/dL) x fasting insulin (mg/dL)/405]. Height, BW, and BP measurements were obtained by the nursing staff during pre-chemotherapy physical exams. Body composition (BF and FM) was measured using a portable hand-held bioelectrical impedance device (Omron®; Hoffman Estates, IL). WC was measured, using a fabric measuring tape, as the distance around the waist using the umbilicus as the reference point.

One-way analysis of covariance (ANCOVA) using SPSS version 18.0 was used to compare means adjusting for covariates such as age, race, type of chemotherapy, duration of chemotherapy, BMI at baseline, and menopausal status.

Results. The majority of the 86 women enrolled were Caucasian (44%) or Hispanic (30%), nonsmoking (96%), employed (84%), and well-educated (90%), with a mean age of 48.2 years. Women were most commonly undergoing Cytoxan/Adriamycin + Taxol (42%) or Taxotere/Cytoxan (36%) chemotherapy regimens, lasting on average 15.3 (±2.7) weeks. Overall the population was sedentary, averaging 7.2 (±5.8) minutes of physical activity/week.

Following chemotherapy, all MetS components and overall MetS score (out of 5) significantly increased (p&lt;0.01). Additionally, BW, BF, FM, lipids (TC, LDL), glucose metabolism (HOMA-IR, insulin, HbA1c), and inflammation (CRP) significantly increased (p&lt;0.01).

Conclusion. In women without MetS, (neo)adjuvant chemotherapy negatively altered MetS components, related anthropometrics, and biomarkers of glucose metabolism and inflammation, within 12 -18 weeks. Studies that test the impact of lifestyle interventions, such as diet and exercise, should be explored in this population of breast cancer patients to reduce the onset of MetS.

Citation Format: Dieli-Conwright CM, Wong L, Waliany S, Bernstein L, Salehian B, Mortimer JE. Changes in metabolic syndrome components in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-10-05.

Oestradiol and SERM treatments influence oestrogen receptor coregulator gene expression in human skeletal muscle cells

AIM

Oestrogen receptors (ER) are present in human skeletal muscle (hSkM) cells; however, the function of the receptor is currently unknown. We investigated the influence of oestradiol and selective ER modulators [tamoxifen (TAM), raloxifene (RAL)] on ER coregulator mRNA expression in hSkM.

METHODS

Human skeletal muscle cells were treated with 10 nm oestradiol, 5 microm TAM and 10 microm RAL over a 24-h period. Following the treatment period, mRNA expression was quantified using real-time PCR to detect changes in ER-alpha, ER-beta, steroid receptor coactivator (SRC), silencing mediator for retinoid and thyroid hormone receptors (SMRT), MyoD, GLUT4 and c-fos.

RESULTS

ER-alpha mRNA expression increased with all three drug treatments (P < 0.05) while there was no change in mRNA expression of ER-beta in hSkM cells. mRNA expression of SRC increased and SMRT decreased with oestradiol, TAM and RAL in hSkM cells (P < 0.05). Importantly, mRNA expression of MyoD increased with oestradiol and decreased with TAM and RAL in hSkM cells (P < 0.05). mRNA expression of GLUT4 increased with oestradiol and RAL and decreased with TAM in hSkM cells (P < 0.05).

CONCLUSIONS

These findings are novel in that they provide the first evidence that oestradiol and selective ER modulators influence ER-alpha function in hSkM cells. This demonstrates the importance of the ER and alterations in its coregulators, to potentially prevent sarcopenia and promote muscle growth in postmenopausal women using these forms of hormone replacement therapy.