Effects of a Clinical Exercise Program on Health-Related Fitness and Quality of Life in Spanish Cancer Patients Receiving Adjuvant Therapy.

OBJECTIVE: To report the feasibility and effectiveness of a newly developed clinical exercise program for improving maximal cardiorespiratory fitness in Spanish cancer patients receiving adjuvant chemotherapy or radiation. We also examined the effectiveness of the exercise program for improving maximal muscular strength, body composition, fatigue, and quality of life, and explored if the effectiveness varied based on selected patient characteristics. DESIGN: The study was a single group implementation feasibility study using a pre-posttest design. METHODS: Participants performed a 12-week, twice-weekly, supervised, multi-component exercise program during adjuvant therapy. Paired t-tests were used to assess pre-post changes, and analyses of covariance were used to compare effectiveness based on selected patient characteristics. RESULTS: We had 100 cancer patients referred to the clinical exercise program of which 85 (85%) initiated the exercise program and 76 (89%) completed the post-intervention fitness assessment. Exercise significantly improved VO2max by 4.8 mL/kg/minutes (P < .001, d = 0.74). Exercise also significantly improved chest strength (P < .001, d = 0.82), leg strength (P < .001, d = 1.27), lean body mass (P < .001, d = 0.11), skeletal muscle mass (P < .001; d = 0.09), fat mass (P < .001; d = 0.10), % body fat (P < .001; d = 0.17), quality of life (P = .0017; d = 0.41), and fatigue (P = .007; d = 0.46). Treatment modality, cancer type, and age affected some exercise responses, especially related to body composition changes. CONCLUSIONS: A 12-week, supervised, multi-component exercise program was effective for improving health-related fitness and quality of life in Spanish cancer patients receiving adjuvant therapy. Our results show the benefits of incorporating clinical exercise programming into the supportive care of cancer patients receiving treatments. REGISTRATION: The study protocol is registered at ClinicalTrials.gov (NCT05078216).

Tai Chi for cancer survivors: A systematic review toward consensus-based guidelines.

To manage acute, long-term, and late effects of cancer, current guidelines recommend moderate-to-vigorous intensity aerobic and resistance exercise. Unfortunately, not all cancer survivors are able or willing to perform higher intensity exercise during difficult cancer treatments or because of other existing health conditions. Tai Chi is an equipment-free, multicomponent mind-body exercise performed at light-to-moderate intensity that may provide a more feasible alternative to traditional exercise programs for some cancer survivors. This systematic review evaluated the therapeutic efficacy of Tai Chi across the cancer care continuum. We searched MEDLINE/PubMed, Embase, SCOPUS, and CINAHL databases for interventional studies from inception to 18 September 2020. Controlled trials of the effects of Tai Chi training on patient-reported and objectively measured outcomes in cancer survivors were included. Study quality was determined by the RoB 2 tool, and effect estimates were evaluated using the Best Evidence Synthesis approach. Twenty-six reports from 14 trials (one non-randomized controlled trial) conducted during (n = 5) and after treatment (after surgery: n = 2; after other treatments: n = 7) were included. Low-level evidence emerged to support the benefits of 40-60 min of thrice-weekly supervised Tai Chi for 8-12 weeks to improve fatigue and sleep quality in cancer survivors. These findings need to be confirmed in larger trials and tested for scaling-up potential. Insufficient evidence was available to evaluate the effects of Tai Chi on other cancer-related outcomes. Future research should examine whether Tai Chi training can improve a broader range of cancer outcomes including during the pre-treatment and end of life phases.

Dose-response effects of exercise on bone mineral density and content in post-menopausal women.

Exercise is one of the most widely used non-pharmacological strategies to prevent bone resorption during menopause. Given the detrimental consequences of bone demineralization, the purpose of this study was to examine the effects of prescribing different exercise volumes on bone mineral density and content in previously inactive, post-menopausal women during a 12-month intervention and 1 year after intervention completion. Four hundred post-menopausal women were randomized to either 150 min/wk (MODERATE dose group) or 300 min/wk (HIGH dose group) of aerobic exercise. Total bone mineral density (g/cm2 ) and bone mineral content (g) were assessed at baseline, 12 months (end of the intervention) and 24 months (follow-up) using whole body dual-energy X-ray absorptiometry. At 12 months, mean bone mineral density among women in the HIGH dose group was estimated to be 0.006 g/cm2 (95% CI: 0.001-0.010; P = 0.02) higher than that of women randomized to the MODERATE dose group. At 24 months, the mean difference between groups remained statistically significant, indicating higher mean bone mineral density among women in the HIGH dose group (0.007 g/cm2 ; 0.001-0.001; P = 0.04). No significant differences between groups were found at any time point for bone mineral content. In an exploratory analysis, women who completed more min/wk of impact exercises had significantly higher mean levels of bone mineral density at 12 months compared to baseline (0.006 g/cm2 , 95% CI: 0.006-0.012; P = 0.03). These findings suggest that higher volumes of exercise, especially impact exercise, lead to a smaller decline in total bone mineral density, which may remain following intervention completion.

Aerobic and resistance exercise improves physical fitness, bone health, and quality of life in overweight and obese breast cancer survivors: a randomized controlled trial.

BACKGROUND: Exercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors. METHODS: One hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65-85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis. RESULTS: At post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO2max (p < 0.001), muscular strength (p < 0.001), osteocalcin (p = 0.01), and BSAP (p = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (p < 0.01). CONCLUSIONS: A 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.

Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial.

BACKGROUND: Supervised exercise interventions produce the largest improvements in patient-reported outcomes in cancer survivors but their scalability has been questioned. Telephone counseling has been proposed as a more feasible alternative but its impact on exercise behavior and health outcomes have been modest. Basing telephone counseling exercise (TCE) interventions on the theoretical advances described in the multi-process action control framework (M-PAC) may improve these outcomes. PURPOSE: To assess the feasibility and preliminary efficacy of a M-PAC-based TCE intervention for increasing aerobic exercise behavior in hematologic cancer survivors (HCS). METHODS: We recruited 51 HCS who were randomized to either a weekly TCE group (n = 26) or a self-directed exercise (SDE) group (n = 25). Participants completed online measures of self-reported aerobic exercise behavior, quality of life (QoL), fatigue, and program satisfaction at baseline and post-intervention (12 weeks). RESULTS: Adherence to the TCE intervention was 93% and retention was 100%. Participants receiving TCE increased their weekly aerobic exercise by 218 min compared to 93 min in the SDE group [mean-adjusted between-group difference (MBGDadj) = 139, 95%CI = 65 to 213, p < .001, effect size (d) = 2.19]. Clinically meaningful QoL improvements favored the TCE group for mental health (MBGDadj = 3.7, 95%CI = - 0.4 to 7.9, p = .08, d = 0.42) and mental health component (MBGDadj = 3.6, 95%CI = - 0.8 to 8.1, p = .10, d = 0.35) subscales. CONCLUSIONS: The 12-week TCE intervention substantially increased exercise behavior and may have meaningfully improved QoL in HCS. IMPLICATIONS FOR CANCER SURVIVORS: Though more definitive trials are needed, remote TCE interventions based on the M-PAC may improve exercise behavior and QoL in HCS and perhaps other cancer survivor groups. TRIAL REGISTRATION NUMBER: Clinical Trials ID: NCT03052777.

Dose-response Effects of Aerobic Exercise Among Colon Cancer Survivors: A Randomized Phase II Trial.

BACKGROUND: Observational studies suggest that higher volumes of physical activity are associated with a lower risk of disease recurrence among survivors of colon cancer. However, the feasibility and safety of prescribing higher volumes of physical activity to survivors of colon cancer are unknown. Furthermore, the pathways through which exercise may reduce disease recurrence are unknown. PATIENTS AND METHODS: Survivors of stage I to III colon cancer were randomized to usual-care control, 150 minutes per week of aerobic exercise (low-dose), or 300 minutes per week of aerobic exercise (high-dose). Changes in soluble intercellular adhesion molecule-1 and vascular adhesion molecule-1 prognostic biomarkers were examined. RESULTS: From January 2015 to February 2016, 39 patients were enrolled (n = 13 usual-care control; n = 14 low-dose; n = 12 high-dose), and 38 participants completed the study (97% follow-up). Over 6 months, the low-dose group completed 142 minutes per week (92.8% adherence), and the high-dose group completed 247 minutes per week (89.0% adherence) of exercise. Compared with the control group, changes in soluble intercellular adhesion molecule-1 were -134.9 ng/mL (95% confidence interval, -238.1 to -31.6 ng/mL) in the low-dose group and -114.8 ng/mL (95% confidence interval, -222.5 to -7.1 ng/mL) in the high-dose group (linear Ptrend = .023; nonlinear Ptrend = .044). No changes were observed for soluable vascular adhesion molecule-1 (linear Ptrend = .791; nonlinear Ptrend = .604). Non-serious adverse events occurred at similar rates among randomized groups. No serious adverse events occurred. CONCLUSION: Higher volumes of moderate-intensity aerobic exercise, up to 300 minutes per week, are feasible, safe, and elicit favorable changes in prognostic biomarkers among patients recently treated for stage I to III colon cancer. These data can be used to guide clinical recommendations for patients, and inform future trials.

Effects of a physical activity behavior change intervention on inflammation and related health outcomes in breast cancer survivors: pilot randomized trial.

BACKGROUND: The goal of this pilot study was to determine the magnitude and direction of intervention effect sizes for inflammatory-related serum markers and relevant health outcomes among breast cancer survivors (BCSs) receiving a physical activity behavior change intervention compared with usual care. METHODS: This randomized controlled trial enrolled 28 stage I, II, or IIIA BCSs who were post-primary treatment and not regular exercisers. Participants were assigned to either a 3-month physical activity behavior change intervention group (ING) or usual care group (UCG). Intervention included supervised aerobic (150 weekly minutes, moderate-intensity) and resistance (2 sessions per week) exercise that gradually shifted to home-based exercise. Outcomes were assessed at baseline and 3 months. RESULTS: Cardiorespiratory fitness significantly improved in the ING versus the UCG (between-group difference = 3.8 mL/kg/min; d = 1.1; P = .015). Self-reported sleep latency was significantly reduced in the ING versus the UCG (between group difference = -0.5; d = -1.2; P = .02) as was serum leptin (between-group difference = -9.0 ng/mL; d = -1.0; P = .031). Small to medium nonsignificant negative effect sizes were noted for interleukin (IL)-10 and tumor necrosis factor (TNF)-α and ratios of IL-6 to IL-10, IL-8 to IL-10, and TNF-α to IL-10, whereas nonsignificant positive effect sizes were noted for IL-6 and high-molecular-weight adiponectin. CONCLUSIONS: Physical activity behavior change interventions in BCSs can achieve large effect size changes for several health outcomes. Although effect sizes for inflammatory markers were often small and not significant, changes were in the hypothesized direction for all except IL-6 and IL-10.

Nutrition and physical activity guidelines for cancer survivors.

Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplements to improve their treatment outcomes, quality of life, and overall survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer survivorship to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information with which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity guidelines during the continuum of cancer care, briefly highlighting important issues during cancer treatment and for patients with advanced cancer, but focusing largely on the needs of the population of individuals who are disease free or who have stable disease following their recovery from treatment. It also discusses select nutrition and physical activity issues such as body weight, food choices, food safety, and dietary supplements; issues related to selected cancer sites; and common questions about diet, physical activity, and cancer survivorship.

A randomized controlled trial on the effectiveness of strength training on clinical and muscle cellular outcomes in patients with prostate cancer during androgen deprivation therapy: rationale and design.

BACKGROUND: Studies indicate that strength training has beneficial effects on clinical health outcomes in prostate cancer patients during androgen deprivation therapy. However, randomized controlled trials are needed to scientifically determine the effectiveness of strength training on the muscle cell level. Furthermore, close examination of the feasibility of a high-load strength training program is warranted. The Physical Exercise and Prostate Cancer (PEPC) trial is designed to determine the effectiveness of strength training on clinical and muscle cellular outcomes in non-metastatic prostate cancer patients after high-dose radiotherapy and during ongoing androgen deprivation therapy. METHODS/DESIGN: Patients receiving androgen deprivation therapy for 9-36 months combined with external high-dose radiotherapy for locally advanced prostate cancer are randomized to an exercise intervention group that receives a 16 week high-load strength training program or a control group that is encouraged to maintain their habitual activity level. In both arms, androgen deprivation therapy is continued until the end of the intervention period.Clinical outcomes are body composition (lean body mass, bone mineral density and fat mass) measured by Dual-energy X-ray Absorptiometry, serological outcomes, physical functioning (muscle strength and cardio-respiratory fitness) assessed with physical tests and psycho-social functioning (mental health, fatigue and health-related quality of life) assessed by questionnaires. Muscle cellular outcomes are a) muscle fiber size b) regulators of muscle fiber size (number of myonuclei per muscle fiber, number of satellite cells per muscle fiber, number of satellite cells and myonuclei positive for androgen receptors and proteins involved in muscle protein degradation and muscle hypertrophy) and c) regulators of muscle fiber function such as proteins involved in cellular stress and mitochondrial function. Muscle cellular outcomes are measured on muscle cross sections and muscle homogenate from muscle biopsies obtained from muscle vastus lateralis. DISCUSSION: The findings from the PEPC trial will provide new knowledge on the effects of high-load strength training on clinical and muscle cellular outcomes in prostate cancer patients during androgen deprivation therapy. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00658229.

Predictors of adherence to an Iyengar yoga program in breast cancer survivors.

CONTEXT: Despite the known health benefits of physical activity, participation rates in cancer survivor groups remain low. Researchers have attempted to identify alternative modes of nontraditional physical activities that may increase participation and adherence rates. This study investigated the determinants of yoga in breast cancer survivors. AIM: To examine predictors of Iyengar yoga adherence in breast cancer survivors using the theory of planned behaviour. SETTINGS AND DESIGN: Classes were held either in Campus Recreation facilities or at the Behavioral Medicine Fitness Center at the University of Alberta in Edmonton, Canada. The study was an evaluation of an existing yoga program. MATERIALS AND METHODS: Twenty-three post adjuvant therapy breast cancer survivors participating in a community-based, twice weekly, 12 week Iyengar yoga program were asked to complete baseline measures of the theory of planned behavior, demographic, medical, health/fitness, and psychosocial variables. Adherence was measured by objective attendance to the classes. STATISTICAL ANALYSIS: We analyzed univariate associations between predictors and yoga adherence with independent t-tests. RESULTS: Adherence to the Iyengar yoga program was 63.9% and was predicted by stronger intention (P<0.001), greater self-efficacy (P=0.003), more positive instrumental attitude (Ps=0.025), higher disease stage (P=0.018), yoga experience in the past year, (P=0.044), diagnosis of a second cancer (P=0.008), lower fatigue (P=0.037), and greater happiness (P=0.023). CONCLUSIONS: Adherence to Iyengar yoga in breast cancer survivors was strongly related to motivational variables from the theory of planned behaviour. Researchers attempting to improve yoga adherence in breast cancer survivors may benefit from targeting the key constructs in the theory of planned behaviour.

Risk of endometrial cancer in relation to individual nutrients from diet and supplements.

OBJECTIVE: Intake of nutrients may influence the risk of endometrial cancer (EC). We aimed to estimate the association of intake of individual nutrients from food and from food plus supplements with EC occurrence. DESIGN: A population-based case-control study conducted in Canada (2002-2006). SETTING: Nutrient intakes from food and supplements were assessed using an FFQ. Logistic regression was used to estimate EC risk within quartile levels of nutrient intakes. SUBJECTS: Incident EC cases (n 506) were identified from the Alberta Cancer Registry, and population controls were frequency- and age-matched to cases (n 981). RESULTS: There existed little evidence of an association with EC for the majority of macronutrients and micronutrients examined. We observed a statistically significant increased risk associated with the highest, compared with the lowest, quartile of intake of dietary cholesterol (multivariable-adjusted OR = 1·51, 95 % CI 1·08, 2·11; P for trend = 0·02). Age-adjusted risk at the highest level of intake was significantly reduced for Ca from food sources (OR = 0·73, 95 % CI 0·54, 0·99) but was attenuated in the multivariable model (OR = 0·82, 95 % CI 0·59, 1·13). When intake from supplements was included in Ca intake, risk was significantly reduced by 28 % with higher Ca (multivariable-adjusted OR = 0·72, 95 % CI 0·51, 0·99, P for trend = 0·04). We also observed unexpected increased risks at limited levels of intakes of dietary soluble fibre, vitamin C, thiamin, vitamin B6 and lutein/zeaxanthin, with no evidence for linear trend. CONCLUSIONS: The results of our study suggest a positive association between dietary cholesterol and EC risk and an inverse association with Ca intake from food sources and from food plus supplements.

Pilot evaluation of an Iyengar yoga program for breast cancer survivors.

BACKGROUND: With continual improvements in screening uptake and adjuvant cancer treatments, the number of Canadian women surviving breast cancer continues to grow. Preliminary findings suggest yoga can improve quality of life (QoL) in breast cancer survivors, but few studies have focused on Iyengar yoga (IY). OBJECTIVE: The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors. METHODS: Breast cancer survivors (N = 24) participating in IY classes completed a questionnaire measuring generic and disease-specific QoL and psychosocial functioning, before and after the 12-week classes. RESULTS: Postprogram questionnaires were completed by 17 participants (71%) who attended an average of 78.9% of the IY sessions. Several indicators of generic QoL improved significantly, including mental health (mean change, +4.2; P = .045), vitality (mean change, +4.9; P = .033), role-emotional (mean change, +6.4; P = .010), and bodily pain (mean change, +4.4; P = .024). Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant. Findings were further substantiated by participant's evaluation of the program's benefits and motivational value. CONCLUSION: In this pilot study of breast cancer survivors participating in IY, we found improvements in QoL and psychosocial functioning. Moreover, positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors. Randomized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted. IMPLICATIONS FOR PRACTICE: Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning.

Nutrition and physical activity during and after cancer treatment: an American Cancer Society guide for informed choices.

Cancer survivors are often highly motivated to seek information about food choices, physical activity, and dietary supplement use to improve their treatment outcomes, quality of life, and survival. To address these concerns, the American Cancer Society (ACS) convened a group of experts in nutrition, physical activity, and cancer to evaluate the scientific evidence and best clinical practices related to optimal nutrition and physical activity after the diagnosis of cancer. This report summarizes their findings and is intended to present health care providers with the best possible information from which to help cancer survivors and their families make informed choices related to nutrition and physical activity. The report discusses nutrition and physical activity issues during the phases of cancer treatment and recovery, living after recovery from treatment, and living with advanced cancer; select nutrition and physical activity issues such as body weight, food choices, and food safety; issues related to select cancer sites; and common questions about diet, physical activity, and cancer survivorship.

A comparison of physical activity of posttreatment breast cancer survivors and noncancer controls.

The authors obtained data from 335 breast cancer survivors and 6,880 noncancer controls. They proposed (1) to determine whether, after treatment, the survivors were meeting the Center for Disease Control and Prevention/American College of Sports Medicine recommendations for physical activity and were similar to the controls in physical activity and (2) to compare the modes of activity of the 2 groups in frequency, min/session, and sessions/wk. Adjusted logistic regression analyses revealed that the breast cancer survivors engaged in as much moderate, vigorous, and combined physical activity as the noncancer controls did. However, chi-square analyses showed that survivors engaged in more yard work than the controls did, whereas independent-sample t tests showed that the frequency and the total min/wk of stretching were significantly higher in breast cancer survivors compared with noncancer controls. Findings from the study suggest that breast cancer survivors engage in as much physical activity as controls do, but that the groups differ in specific activities.