Improving lifestyle behaviors during chemotherapy for breast cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis (LEANer) Trial.

BACKGROUND: Little is known about improving physical activity (PA) and diet during and after chemotherapy for breast cancer. This secondary analysis examines changes in PA and diet quality during a yearlong intervention for patients with breast cancer undergoing chemotherapy and evaluates factors associated with these changes. METHODS: Newly diagnosed patients with breast cancer (N = 173) undergoing chemotherapy were randomized to a year-long nutrition and exercise intervention (n = 87) or usual care (UC, n = 86). Mixed models compared 1-year changes in PA and diet quality via the Healthy Eating Index (HEI)-2015 by study arm. Among the intervention group, baseline factors associated with change in PA and diet were assessed with multivariable linear and logistic regression. RESULTS: At 1 year, compared with UC, the intervention arm increased PA more (mean difference = 136.1 minutes/week; 95% CI, 90.2-182.0), participated in more strength training (56% vs. 15%; p < .001), and had suggestive improvements in HEI-2015 (mean difference = 2.5; 95% CI, -0.3 to 5.3; p = .08). In the intervention arm, lower fatigue was associated with improved PA (p = .04) and higher education was associated with improved HEI-2015 (p = .001) at 1 year. Higher HEI-2015 (p = .04) and married/living with someone (p = .05) were associated with higher odds of participating in strength training at 1 year. CONCLUSIONS: This year-long lifestyle intervention for patients with breast cancer undergoing chemotherapy resulted in increases in PA and suggestive improvements in diet quality. Behavior change was associated with baseline fatigue, diet quality, education, and married/living with someone. Addressing these factors in interventions may improve uptake of lifestyle behaviors in trials during and after chemotherapy.

Barriers to and facilitators of improving physical activity and nutrition behaviors during chemotherapy for breast cancer: a sequential mixed methods study.

PURPOSE: Use qualitative and quantitative methods to explore factors influencing the adoption of guideline-based physical activity (PA) and dietary recommendations among participants enrolled in a lifestyle intervention during and after chemotherapy for breast cancer. METHODS: Among women with stage I-III breast cancer who participated in the intervention arm of the Lifestyle, Exercise, and Nutrition early after diagnosis (LEANer) trial, we used stratified, purposeful sampling to interview women who met both, one, or neither intervention goal after the 1-year intervention: (1) 150 min/week moderate-to-vigorous intensity exercise via a self-reported PA questionnaire and (2) improved self-reported diet quality measured by the Healthy Eating Index-2015. Semi-structured interviews were audio-recorded, transcribed verbatim, and analyzed using thematic content analysis. RESULTS: The 29 women interviewed were 52 ± 11 years old on average, with a mean body mass index of 29.6 ± 7.7 kg/m2. Three themes emerged regarding aspects of the LEANer intervention that facilitated behavior change: (1) providing a conduit of trustworthy, timely, and personalized support and education; (2) shifting mindsets and enhanced understanding of the benefits of PA and nutrition during chemotherapy; and (3) fostering a sense of control and alternative focus. Factors described as hindering adoption of goals included: (1) adverse effects of chemotherapy and (2) competing priorities. CONCLUSIONS: Women reported the external support, tailored education, and experiencing the physical and mental benefits of the LEANer intervention facilitated the adoption of the interventions' behavioral goals. Addressing chemotherapy-related symptoms and competing priorities may facilitate adherence to lifestyle interventions during chemotherapy for breast cancer.

The knowledge, barriers and opportunities to improve nutrition and physical activity amongst young people attending an Australian youth mental health service: a mixed-methods study.

BACKGROUND: Mental illnesses are the leading cause of disability in young people, and lifestyle interventions in young people at risk of mental illness remain a priority. Opportunities to improve nutrition and physical activity among young people through youth mental health services remain unclear. This study aimed to determine the knowledge and behaviors towards nutrition and physical activity, the barriers and enablers to improving behaviors, and the preferred providers and sources of information for nutrition and physical activity among a sample of young people attending a youth mental health service. METHODS: A mixed-method study was conducted in regional Tasmania, Australia in a sample of young people (15-25 years) attending a youth mental health service (headspace). A quantitative survey (n = 48) determined young people's nutrition and physical activity knowledge, behaviors, barriers and enablers to achieving recommendations, and their preferred providers and sources of information. Structured interviews and a focus group further explored these concepts (n = 8), including the role of the mental health service as a provider of this support. RESULTS: The majority of participants did not meet national recommendations for nutrition and physical activity, despite possessing a high level of knowledge regarding their importance for mental health. Improving mental health was a common enabling factor for participants choosing to alter diet and physical activity habits, but also the leading barrier for participating in physical activity. Young people wanted to receive information from reputable health providers, ideally through social media sources. headspace was seen as an important potential provider of this information. CONCLUSIONS: Our results indicate that there is a clear need to improve diet and physical activity habits to enhance mental and physical health outcomes in this at-risk group, and youth mental health services could provide further interventions to support their clients. Specialized staff (e.g. dietitians and exercise physiologists) may provide additional benefits alongside existing mental health care support.

Elite sprint swimming performance is enhanced by completion of additional warm-up activities.

This study investigated the effect of completing additional warm-up strategies in the transition phase between the pool warm up and the start of a race on elite sprint swimming performance. Twenty-five elite swimmers (12 men, 20 ± 3 years; 13 women, 20 ± 2 years, performance standard ~807 FINA2014 points) completed a standardised pool warm up followed by a 30-min transition phase and a 100-m freestyle time trial. During the transition phase, swimmers wore a tracksuit jacket with integrated heating elements and performed a dry land-based exercise routine (Combo), or a conventional tracksuit and remained seated (Control). Start (1.5% ± 1.0%, P = 0.02; mean ± 90% confidence limits) and 100-m time trial (0.8% ± 0.4%, P < 0.01) performances were improved in Combo. Core temperature declined less (-0.2°C ± 0.1°C versus -0.5°C ± 0.1°C, P = 0.02) during the transition phase and total local (trapezius) haemoglobin concentration was greater before the time trial in Combo (81 µM ± 25 µM versus 30 µM ± 18 µM, P < 0.01; mean ± standard deviation) than in Control. Combining swimmers traditional pool warm up with passive heating via heated jackets and completion of dry land-based exercises in the transition phase improves elite sprint swimming performance by ~0.8%.

Current Warm-Up Practices and Contemporary Issues Faced by Elite Swimming Coaches.

McGowan, CJ, Pyne, DB, Raglin, JS, Thompson, KG, and Rattray, B. Current warm-up practices and contemporary issues faced by elite swimming coaches. J Strength Cond Res 30(12): 3471-3480, 2016-A better understanding of current swimming warm-up strategies is needed to improve their effectiveness. The purpose of this study was to describe current precompetition warm-up practices and identify contemporary issues faced by elite swimming coaches during competition. Forty-six state-international level swimming coaches provided information through a questionnaire on their prescription of volume, intensity, and recovery within their pool and dryland-based competition warm-ups, and challenges faced during the final stages of event preparation. Coaches identified four key objectives of the precompetition warm-up: physiological (elevate body temperature and increase muscle activation), kinesthetic (tactile preparation, increase "feel" of the water), tactical (race-pace rehearsal), and mental (improve focus, reduce anxiety). Pool warm-up volume ranged from ∼1300 to 2100 m, beginning with 400-1000 m of continuous, low-intensity (∼50-70% of perceived maximal exertion) swimming, followed by 200-600 m of stroke drills and 1-2 sets (100-400 m in length) of increasing intensity (∼60-90%) swimming, concluding with 3-4 race or near race-pace efforts (25-100 m; ∼90-100%) and 100-400 m easy swimming. Dryland-based warm-up exercises, involving stretch cords and skipping, were also commonly prescribed. Coaches preferred swimmers complete their warm-up 20-30 minutes before race start. Lengthy marshalling periods (15-20+ minutes) and the time required to don racing suits (>10 minutes) were identified as complicating issues. Coaches believed that the pool warm-up affords athletes the opportunity to gain a tactile feel for the water and surrounding pool environment. The combination of dryland-based activation exercises followed by pool-based warm-up routines seems to be the preferred approach taken by elite swimming coaches preparing their athletes for competition.

Randomized Trial of Exercise and Nutrition on Chemotherapy Completion and Pathologic Complete Response in Women With Breast Cancer: The Lifestyle, Exercise, and Nutrition Early After Diagnosis Study.

PURPOSE: Successful completion of chemotherapy is critical to improve breast cancer outcomes. Relative dose intensity (RDI), defined as the ratio of chemotherapy delivered to prescribed, is a measure of chemotherapy completion and is associated with cancer mortality. The effect of exercise and eating a healthy diet on RDI is unknown. We conducted a randomized trial of an exercise and nutrition intervention on RDI and pathologic complete response (pCR) in women diagnosed with breast cancer initiating chemotherapy. METHODS: One hundred seventy-three women with stage I-III breast cancer were randomly assigned to usual care (UC; n = 86) or a home-based exercise and nutrition intervention with counseling sessions delivered by oncology-certified registered dietitians (n = 87). Chemotherapy dose adjustments and delays and pCR were abstracted from electronic medical records. T-tests and chi-square tests were used to examine the effect of the intervention versus UC on RDI and pCR. RESULTS: Participants randomly assigned to intervention had greater improvements in exercise and diet quality compared with UC (P < .05). RDI was 92.9% ± 12.1% and 93.6% ± 11.1% for intervention and UC, respectively (P = .69); the proportion of patients in the intervention versus UC who achieved ≥85% RDI was 81% and 85%, respectively (P = .44). The proportion of patients who had at least one dose reduction and/or delay was 38% intervention and 36% UC (P = .80). Among 72 women who received neoadjuvant chemotherapy, women randomly assigned to intervention were more likely to have a pCR than those randomly assigned to UC (53% v 28%; P = .037). CONCLUSION: Although a diet and exercise intervention did not affect RDI, the intervention was associated with a higher pCR in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative and triple-negative breast cancer undergoing neoadjuvant chemotherapy.

High occurrence of food insecurity in young people attending a youth mental health service in regional Australia.

AIM: Despite the relationship between food insecurity and poor mental health, food insecurity in young people attending mental health services in Australia remains understudied. This study aimed to determine the occurrence and predictors of food insecurity, and the relationship with dietary factors in young people attending a mental health service. METHODS: A cross-sectional online survey was conducted in a sample of young people (15-25 years) who attended a mental health service in Launceston, Australia. The survey utilised a single-item food insecurity screening tool and eight demographic, health and service use questions. Five questions determined self-reported intake of fruit, vegetables, breakfast, water, sugar-sweetened beverages and takeaway foods. Binary logistic regression determined predictors of food insecurity. Cross-tabulations determined differences in dietary intake according to food security. RESULTS: Of survey respondents (n = 48; 68% female), 40% (n = 19) were food insecure. Respondents living out of home or in unstable accommodation were at significantly higher risk of food insecurity (odds ratio [OR]: 4.43; SE: 0.696; 95% CI: 1.13-17.34; p = 0.032) compared to those living with their parents. Those receiving government financial assistance (OR: 5.00; SE: 0.676; 95% CI: 1.33-18.81; p = 0.017) were also at significantly higher risk of food insecurity. Regardless of food security status, self-reported intake of fruits, vegetables and breakfast were low, and respondents regularly consumed takeaway foods and sugar-sweetened beverages. CONCLUSIONS: There was a high occurrence of food insecurity and poor dietary intake in young people attending a youth mental health service demonstrating that initiatives to support access to healthy food in this group should be a priority, with potential benefits for mental health outcomes.

1-Deoxysphingolipids, Early Predictors of Type 2 Diabetes, Compromise the Functionality of Skeletal Myoblasts.

Metabolic dysfunction, dysregulated differentiation, and atrophy of skeletal muscle occur as part of a cluster of abnormalities associated with the development of Type 2 diabetes mellitus (T2DM). Recent interest has turned to the attention of the role of 1-deoxysphingolipids (1-DSL), atypical class of sphingolipids which are found significantly elevated in patients diagnosed with T2DM but also in the asymptomatic population who later develop T2DM. In vitro studies demonstrated that 1-DSL have cytotoxic properties and compromise the secretion of insulin from pancreatic beta cells. However, the role of 1-DSL on the functionality of skeletal muscle cells in the pathophysiology of T2DM still remains unclear. This study aimed to investigate whether 1-DSL are cytotoxic and disrupt the cellular processes of skeletal muscle precursors (myoblasts) and differentiated cells (myotubes) by performing a battery of in vitro assays including cell viability adenosine triphosphate assay, migration assay, myoblast fusion assay, glucose uptake assay, and immunocytochemistry. Our results demonstrated that 1-DSL significantly reduced the viability of myoblasts in a concentration and time-dependent manner, and induced apoptosis as well as cellular necrosis. Importantly, myoblasts were more sensitive to the cytotoxic effects induced by 1-DSL rather than by saturated fatty acids, such as palmitate, which are critical mediators of skeletal muscle dysfunction in T2DM. Additionally, 1-DSL significantly reduced the migration ability of myoblasts and the differentiation process of myoblasts into myotubes. 1-DSL also triggered autophagy in myoblasts and significantly reduced insulin-stimulated glucose uptake in myotubes. These findings demonstrate that 1-DSL directly compromise the functionality of skeletal muscle cells and suggest that increased levels of 1-DSL observed during the development of T2DM are likely to contribute to the pathophysiology of muscle dysfunction detected in this disease.

Dietary Supplement Use and Interactions with Tamoxifen and Aromatase Inhibitors in Breast Cancer Survivors Enrolled in Lifestyle Interventions.

The use of dietary supplements is common in the general population and even more prevalent among cancer survivors. The World Cancer Research Fund/American Institute for Cancer Research specifies that dietary supplements should not be used for cancer prevention. Several dietary supplements have potential pharmacokinetic and pharmacodynamic interactions that may change their clinical efficacy or potentiate adverse effects of the adjuvant endocrine therapy prescribed for breast cancer treatment. This analysis examined the prevalence of self-reported dietary supplement use and the potential interactions with tamoxifen and aromatase inhibitors (AIs) among breast cancer survivors enrolled in three randomized controlled trials of lifestyle interventions conducted between 2010 and 2017. The potential interactions with tamoxifen and AIs were identified using the Natural Medicine Database. Among 475 breast cancer survivors (2.9 (mean) or 2.5 (standard deviation) years from diagnosis), 393 (83%) reported using dietary supplements. A total of 108 different types of dietary supplements were reported and 36 potential adverse interactions with tamoxifen or AIs were identified. Among the 353 women taking tamoxifen or AIs, 38% were taking dietary supplements with a potential risk of interactions. We observed a high prevalence of dietary supplement use among breast cancer survivors and the potential for adverse interactions between the prescribed endocrine therapy and dietary supplements was common.

Effect of healthy diet and exercise on chemotherapy completion rate in women with breast cancer: The Lifestyle, Exercise and Nutrition Early after Diagnosis (LEANer) study: Study protocol for a randomized clinical trial.

BACKGROUND: The World Cancer Research Fund and the American Cancer Society provide nutrition and physical activity guidelines for cancer survivors. Many women with breast cancer do not follow these guidelines and delay efforts toward following them until active treatment is complete. However, adoption of these recommended lifestyle behaviors soon after diagnosis may prevent adverse treatment-related side effects and may improve adherence to treatment, resulting in improved breast cancer prognosis. The Lifestyle, Exercise, and Nutrition Early after Diagnosis (LEANer) study is testing the effect of a nutrition and physical activity intervention on chemotherapy completion rates. METHODS: 172 women with stage I-III breast cancer undergoing chemotherapy will be randomized 1:1 to a yearlong, 16 session, nutrition and exercise intervention or usual care control group. The intervention is delivered by registered dietitians specializing in oncology nutrition and exercise training. The intervention includes goal setting to meet nutrition and physical activity guidelines for cancer survivors. After each chemotherapy session, date and dose of each drug administered, and reason for dose-adjustments and/or dose-delays are abstracted from the electronic medical record or obtained from the treating oncologist. Chemotherapy completion rate is assessed as the average relative dose-intensity (RDI) for the originally planned regimen based on standard formulas. Secondary endpoints of endocrine therapy adherence, treatment-related side effects, and changes in inflammatory and metabolic biomarkers, body composition, and patient reported outcomes are assessed at four timepoints. DISCUSSION: If successful, this study has the potential to make healthy lifestyle interventions a standard component of breast cancer treatment.

Morning Exercise: Enhancement of Afternoon Sprint-Swimming Performance.

CONTEXT: An exercise bout completed several hours prior to an event may improve competitive performance later that same day. PURPOSE: To examine the influence of morning exercise on afternoon sprint-swimming performance. METHODS: Thirteen competitive swimmers (7 male, mean age 19 ± 3 y; 6 female, mean age 17 ± 3 y) completed a morning session of 1200 m of variedintensity swimming (SwimOnly), a combination of varied-intensity swimming and a resistance-exercise routine (SwimDry), or no morning exercise (NoEx). After a 6-h break, swimmers completed a 100-m time trial. RESULTS: Time-trial performance was faster in SwimOnly (1.6% ± 0.6, mean ± 90% confidence limit, P < .01) and SwimDry (1.7% ± 0.7%, P < .01) than in NoEx. Split times for the 25- to 50-m distance were faster in both SwimOnly (1.7% ± 1.2%, P = .02) and SwimDry (1.5% ± 0.8%, P = .01) than in NoEx. The first 50-m stroke rate was higher in SwimOnly (0.70 ± 0.21 Hz, mean ± SD, P = .03) and SwimDry (0.69 ± 0.18 Hz, P = .05) than in NoEx (0.64 ± 0.16 Hz). Before the afternoon session, core (0.2°C ± 0.1°C [mean ± 90% confidence limit], P = .04), body (0.2°C ± 0.1°C, P = .02), and skin temperatures (0.3°C ± 0.3°C, P = .02) were higher in SwimDry than in NoEx. CONCLUSIONS: Completion of a morning swimming session alone or together with resistance exercise can substantially enhance sprint-swimming performance completed later the same day.

Evaluating Warm-Up Strategies for Elite Sprint Breaststroke Swimming Performance.

PURPOSE: Targeted passive heating and completion of dryland-based activation exercises within the warm-up can enhance sprint freestyle performance. The authors investigated if these interventions would also elicit improvements in sprint breaststroke swimming performance. METHODS: Ten national and internationally competitive swimmers (~805 FINA (Fédération internationale de natation) 2014 scoring points; 6 men, mean ± SD 20 ± 1 y; 4 women, 21 ± 3 y) completed a standardized pool warm-up (1550 m) followed by a 30-min transition phase and a 100-m breaststroke time trial. In the transition phase, swimmers wore a conventional tracksuit and remained seated (control) or wore tracksuit pants with integrated heating elements and performed a 5-min dryland-based exercise routine (combo) in a crossover design. RESULTS: Performance in the 100-m time trial (control: 68.6 ± 4.0 s, combo: 68.4 ± 3.9 s, P = .55) and start times to 15 m (control: 7.3 ± 0.6 s; combo: 7.3 ± 0.6 s; P = .81) were not different between conditions. It was unclear (P = .36) whether combo (-0.12°C ± 0.19°C [mean ± 90% confidence limits]) elicited an improvement in core temperature maintenance in the transition phase compared with control (-0.31°C ± 0.19°C). Skin temperature immediately before commencement of the time trial was higher (by ~1°C, P = .01) within combo (30.13°C ± 0.88°C [mean ± SD]) compared with control (29.11°C ± 1.20°C). Lower-body power output was not different between conditions before the time trial. CONCLUSIONS: Targeted passive heating and completion of dryland-based activation exercises in the transition phase does not enhance sprint breaststroke performance despite eliciting elevated skin temperature immediately before time trial commencement.

Heated jackets and dryland-based activation exercises used as additional warm-ups during transition enhance sprint swimming performance.

OBJECTIVES: The lengthy competition transition phases commonly experienced by competitive swimmers may mitigate the benefits of the pool warm-up. To combat this, we examined the impact of additional passive and active warm-up strategies on sprint swimming performance. DESIGN: Counterbalanced, repeated-measures cross-over study. METHODS: Sixteen junior competitive swimmers completed a standardised pool warm-up followed by a 30min transition and 100m freestyle time-trial. Swimmers completed four different warm-up strategies during transition: remained seated wearing a conventional tracksuit top and pants (Control), wore an insulated top with integrated heating elements (Passive), performed a 5min dryland-based exercise circuit (Dryland), or a combination of Passive and Dryland (Combo). Swimming time-trial performance, core and skin temperature and perceptual variables were monitored. Time variables were normalised relative to Control. RESULTS: Both Combo (-1.05±0.26%; mean±90% confidence limits, p=0.00) and Dryland (-0.68±0.34%; p=0.02) yielded faster overall time-trial performances, with start times also faster for Combo (-0.37±0.07%; p=0.00) compared to Control. Core temperature declined less during transition with Combo (-0.13±0.25°C; p=0.01) and possibly with Dryland (-0.24±0.13°C; p=0.09) compared to Control (-0.64±0.16°C), with a smaller reduction in core temperature related to better time-trial performance (R(2)=0.91; p=0.04). CONCLUSIONS: Dryland-based exercise circuits completed alone and in combination with the application of heated tracksuit jackets during transition can significantly improve sprint swimming performance. Attenuation in the decline of core temperature and a reduction in start time appear as likely mechanisms.

Warm-Up Strategies for Sport and Exercise: Mechanisms and Applications.

It is widely accepted that warming-up prior to exercise is vital for the attainment of optimum performance. Both passive and active warm-up can evoke temperature, metabolic, neural and psychology-related effects, including increased anaerobic metabolism, elevated oxygen uptake kinetics and post-activation potentiation. Passive warm-up can increase body temperature without depleting energy substrate stores, as occurs during the physical activity associated with active warm-up. While the use of passive warm-up alone is not commonplace, the idea of utilizing passive warming techniques to maintain elevated core and muscle temperature throughout the transition phase (the period between completion of the warm-up and the start of the event) is gaining in popularity. Active warm-up induces greater metabolic changes, leading to increased preparedness for a subsequent exercise task. Until recently, only modest scientific evidence was available supporting the effectiveness of pre-competition warm-ups, with early studies often containing relatively few participants and focusing mostly on physiological rather than performance-related changes. External issues faced by athletes pre-competition, including access to equipment and the length of the transition/marshalling phase, have also frequently been overlooked. Consequently, warm-up strategies have continued to develop largely on a trial-and-error basis, utilizing coach and athlete experiences rather than scientific evidence. However, over the past decade or so, new research has emerged, providing greater insight into how and why warm-up influences subsequent performance. This review identifies potential physiological mechanisms underpinning warm-ups and how they can affect subsequent exercise performance, and provides recommendations for warm-up strategy design for specific individual and team sports.