Associations between Symptoms and Exercise Barriers in Breast Cancer Survivors.

Despite exercise benefits for cancer survivor health, most breast cancer survivors do not meet exercise recommendations. Few studies have examined associations between psychosocial symptoms and exercise barriers in this population. To improve physician exercise counseling by identifying survivors with high barriers in a clinical setting, associations between breast cancer symptoms (fatigue, mood, sleep quality) and exercise barriers were investigated. Physically inactive survivors (N = 320; average age 55 ± 8 years, 81% White, 77% cancer stage I or II) completed a baseline survey for a randomized physical activity trial and secondary analyses were performed. Potential covariates, exercise barriers interference score, Fatigue Symptom Inventory, Hospital Anxiety and Depression Scale (HADS), and Pittsburgh Sleep Quality Index were assessed. Based on multiple linear regression analyses, only HADS Global (B = 0.463, p < 0.001) and number of comorbidities (B = 0.992, p = 0.01) were independently associated with total exercise barriers interference score, explaining 8.8% of the variance (R2 = 0.088, F(2,317) = 15.286, p < 0.001). The most frequent barriers to exercise for survivors above the HADS clinically important cut point included procrastination, routine, and self-discipline. These results indicate greater anxiety levels, depression levels, and comorbidities may be independently associated with specific exercise barriers. Health professionals should consider mood and comorbidities when evaluating survivors for exercise barriers, and tailoring exercise counseling.

Exercise during chemotherapy: Friend or foe?

BACKGROUND: A higher chemotherapy completion rate is associated with better outcomes including treatment efficacy and overall survival. Exercise may have the potential to improve relative dose intensity (RDI) by reducing the frequency and severity of chemotherapy-related toxicities. We examined the association between exercise adherence and RDI and possible clinical- and health-related fitness predictors of RDI. METHODS: Chemotherapy records were extracted from the electronic medical record for patients enrolled in the ENACT trial (n = 105). Chemotherapy completion was assessed using average RDI. A threshold of 85% was established for "high" versus "low" RDI. Logistic regression analyses were used to estimate the associations between the clinical- and health-related fitness predictors of RDI. RESULTS: Patients with breast cancer (BC) had a significantly higher average RDI (89.8% ± 17.6%) compared with gastrointestinal cancer (GI) (76.8% ± 20.9%, p = 0.004) and pancreatic cancer (PC) (65.2% ± 20.1%, p < 0.001). Only 25% of BC patents required a dose reduction compared to 56.3% of GI and 86.4% of PC patients. Cancer site was significantly associated with RDI. Compared with BC, patients with GI (ß = -0.12, p = 0.03) and PC (ß = -0.22, p = 0.006) achieved significantly lower RDI. Every 2.72 unit increase in overall exercise adherence led to a significant 7% decrease in RDI (p = 0.001) in GI patients. Metastatic GI patients had a 15% RDI increase for every 2.72 unit increase in exercise adherence (p = 0.04). CONCLUSION: Exercise is a supportive therapy that has potential to enhance chemotherapy tolerance and completion. The relationship between exercise adherence and RDI is influenced by factor such as cancer site and treatment type. Special attention must be paid to how exercise is prescribed to ensure that exercise adherence does not negatively affect RDI. Cancer site, exercise dosage, and multimodal interventions to address toxicities are key areas identified for future research.

The exercise in all chemotherapy trial.

BACKGROUND: Multiple international organizations have called for exercise to become standard practice in the setting of oncology care. The feasibility of integrating exercise within systemic chemotherapy has not been investigated. METHODS: Patients slated to receive infusion therapy between April 2017 and October 2018 were screened for possible inclusion. The study goal was to establish the acceptability and feasibility of embedding an exercise professional into the chemotherapy infusion suite as a method of making exercise a standard part of cancer care. The exercise prescriptions provided to patients were individualized according to results of brief baseline functional testing. RESULTS: In all, 544 patients were screened, and their respective treating oncologists deemed 83% of them to be medically eligible to participate. After further eligibility screening, 226 patients were approached. Nearly 71% of these patients (n = 160) accepted the invitation to participate in the Exercise in All Chemotherapy trial. Feasibility was established because 71%, 55%, 69%, and 63% of the aerobic, resistance, balance, and flexibility exercises prescribed to patients were completed. Qualitative data also supported the acceptability and feasibility of the intervention from the perspective of patients and clinicians. The per-patient cost of the intervention was $190.68 to $382.40. CONCLUSIONS: Embedding an exercise professional into the chemotherapy infusion suite is an acceptable and feasible approach to making exercise standard practice. Moreover, the cost of the intervention is lower than the cost of other common community programs. Future studies should test whether colocating an exercise professional with infusion therapy could reach more patients in comparison with not colocating. LAY SUMMARY: Few studies have tested the implementation of exercise for patients with cancer by embedding an exercise professional directly into the chemotherapy infusion suite. The Exercise in All Chemotherapy trial shows that this approach is both acceptable and feasible from the perspective of clinicians and patients.

Effects of Resistance Training and Protein Supplementation in Breast Cancer Survivors.

PURPOSE: This study aimed to evaluate 12 wk of resistance training (RT; n = 16) and protein supplementation (RT + protein; n = 17) on muscular strength, body composition, and blood biomarkers of muscle (insulin-like growth factor 1 [IGF-1]), fat (adiponectin), and inflammation (human C-reactive protein [CRP]) in breast cancer survivors (BCS). METHODS: Thirty-three BCS (59 ± 8 yr) were measured pre- and posttraining for one-repetition maximum (1-RM) muscular strength (chest press and leg extension), body composition (lean mass [LM] and fat mass [FM]) via dual-energy x-ray absorptiometry, and serum concentrations of IGF-1, adiponectin, and CRP. RT consisted of 2 d·wk using 10 exercises for two sets of 10-12 repetitions and a third set to failure at ~65%-85% of 1-RM. RT + protein consumed 20 g of protein twice a day. ANOVA was used for analyses. Significance was set at P ≤ 0.05. RESULTS: Average RT intensity was 65%-81% of 1-RM and was not different between RT and RT + protein. There were no group-time interactions for strength, LM, FM, and biomarkers. Both groups significantly increased upper (+31 ± 18 kg) and lower (+19 ± 12 kg) body strength, LM (+0.9 ± 1.0 kg) and decreased FM (-0.5 ± 1.2 kg), and percent body fat (-1.0% ± 1.2%). Serum levels of IGF-1 significantly increased from baseline to 12 wk in both RT (102 ± 34 to 115 ± 33 ng·mL) and RT + protein (110 ± 40 to 119 ± 37 ng·mL); adiponectin and CRP did not change. CONCLUSIONS: Twelve weeks of RT at 65%-81% of 1-RM, 2 d·wk in BCS, was well tolerated and significantly improved strength, body composition, and IGF-1. Supplemental protein (40 g·d) did not induce a change in any variable. However, on the basis of food logs, reductions in total calories and dietary protein intake from whole foods resulted in only a net protein increase of 17 g·d for RT + protein, which may have influenced the results.