Creatine supplementation and resistance training to preserve muscle mass and attenuate cancer progression (CREATINE-52): a protocol for a double-blind randomized controlled trial.

BACKGROUND: Muscle mass is important for metastatic prostate cancer survival and quality of life (QoL). The backbone of treatment for men with metastatic castration sensitive prostate cancer (mCSPC) is androgen deprivation therapy (ADT) with an androgen signaling inhibitor. ADT is an effective cancer treatment, but it facilitates significant declines in muscle mass and adverse health outcomes important to mCSPC survivors, such as fatigue, and reductions in physical function, independence, insulin sensitivity, and QoL. In non-metastatic CSPC survivors, resistance training (RT) preserves muscle mass and improves these related health outcomes, but the biggest barrier to RT in CSPC survivors of all stages is fatigue. Creatine monohydrate supplementation coupled with RT (Cr + RT) may address this barrier since creatine plays a critical role in energy metabolism. Cr + RT in cancer-free older adults and other clinical populations improves muscle mass and related health outcomes. Evidence also suggests that creatine supplementation can complement cancer treatment. Thus, Cr + RT is a strategy that addresses gaps in survivorship needs of people with mCSPC. The purpose of this parallel, double-blind randomized controlled trial is to test the effects of 52-weeks of Cr + RT compared with placebo (PLA) and RT (PLA + RT) on muscle mass, other related health outcomes, and markers of cancer progression. METHODS: We will carry out this trial with our team's established, effective, home-based, telehealth RT program in 200 mCSPC survivors receiving ADT, and evaluate outcomes at baseline, 24-, and 52-weeks. RT will occur twice weekly with elastic resistance bands, and an established creatine supplementation protocol will be used for supplementation delivery. Our approach addresses a major facilitator to RT in mCSPC survivors, a home-based RT program, while utilizing a supervised model for safety. DISCUSSION: Findings will improve delivery of comprehensive survivorship care by providing a multicomponent, patient-centered lifestyle strategy to preserve muscle mass, improve health outcomes, and complement cancer treatment (NCT06112990).

Clinical and Demographic Factors Associated With Follow-Up in a Hospital-Based Exercise Oncology Program.

OBJECTIVE: Despite the numerous benefits of regular exercise participation for cancer survivors, nearly 60% of survivors do not meet current guidelines. Hospital-based exercise oncology programs may be one strategy to promote exercise engagement as survivors have expressed a preference for exercise programs associated with a cancer hospital. However, follow-up rates in hospital-based exercise oncology programs can be low. Follow-up assessments are a critical component of exercise oncology programs as they determine survivor progress, allow for revision of exercise prescriptions, and demonstrate the effectiveness of the exercise program. Therefore, the purpose of this study was to identify clinical and demographic factors associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. METHODS: We analyzed data collected from 2016 to 2019 (n = 849) from the Huntsman Cancer Institute's hospital-based exercise oncology program, the Personal Optimism with Exercise Recovery (POWER) program. Cancer survivors completed an assessment at the start of POWER and were encouraged to attend a 12-week follow-up assessment. Factors associated with not attending a 12-week follow-up assessment were identified using logistic regression. RESULTS: Multiple myeloma cancer survivors were more likely (OR 2.33; 95% CI 1.09, 4.98) to not attend a 12-week follow-up assessment, whereas endometrial cancer survivors were less likely (OR 0.39; 95% CI 0.18, 0.87). Greater travel time (OR 2.69; 95% CI: 1.83, 3.96) and distance (OR 2.37; 95% CI: 1.61, 3.49) were associated with not attending a 12-week follow-up assessment. Immunotherapy (OR 1.66; 95% CI 1.02, 2.72), waist circumference (OR 1.01; 95% CI 1.00, 1.02), overweight status per body mass index (OR 1.62; 95% CI 1.11, 2.38), and male sex (OR 1.70; 95% CI 1.23, 2.35) were associated with an increased likelihood of not attending a 12-week follow-up assessment. Survivors with a higher baseline quality of life (OR 0.96; 95% CI 0.93, 0.99) and peak oxygen consumption (OR 0.97; 95% CI 0.95, 0.99) were less likely not to attend a 12-week follow-up assessment. CONCLUSIONS: Both clinical and demographic factors were associated with not attending a 12-week follow-up assessment in a hospital-based exercise oncology program. Understanding factors related to follow-up assessment attendance in exercise oncology programs can inform the development of targeted interventions to improve follow-up rate thus maximizing exercise support for cancer survivors.

Mindfulness-Oriented Recovery Enhancement Restructures Reward Processing and Promotes Interoceptive Awareness in Overweight Cancer Survivors: Mechanistic Results From a Stage 1 Randomized Controlled Trial.

INTRODUCTION: The primary aims of this Stage I pilot randomized controlled trial were to establish the feasibility of integrating exercise and nutrition counseling with Mindfulness-Oriented Recovery Enhancement (MORE), a novel intervention that unites training in mindfulness, reappraisal, and savoring skills to target mechanisms underpinning appetitive dysregulation a pathogenic process that contributes to obesity among cancer survivors; to identify potential therapeutic mechanisms of the MORE intervention; and to obtain effect sizes to power a subsequent Stage II trial. METHODS: Female overweight and obese cancer survivors (N = 51; mean age = 57.92 ± 10.04; 88% breast cancer history; 96% white) were randomized to one of two 10-week study treatment conditions: ( a) exercise and nutrition counseling or ( b) exercise and nutrition counseling plus the MORE intervention. Trial feasibility was assessed via recruitment and retention metrics. Measures of therapeutic mechanisms included self-reported interoceptive awareness, maladaptive eating behaviors, and savoring, as well as natural reward responsiveness and food attentional bias, which were evaluated as psychophysiological mechanisms. RESULTS: Feasibility was demonstrated by 82% of participants who initiated MORE receiving a full dose of the intervention. Linear mixed models revealed that the addition of MORE led to significantly greater increases in indices of interoceptive awareness, savoring, and natural reward responsiveness, and, significantly greater decreases in external eating behaviors and food attentional bias-the latter of which was significantly associated with decreases in waist-to-hip ratio. Path analysis demonstrated that the effect of MORE on reducing food attentional bias was mediated by increased zygomatic electromyographic activation during attention to natural rewards. CONCLUSIONS AND IMPLICATIONS: MORE may target appetitive dysregulatory mechanisms implicated in obesity by promoting interoceptive awareness and restructuring reward responsiveness.