Exercise Training Benefits Health-Related Quality of Life and Functional Capacity during Breast Cancer Chemotherapy: A Randomized Controlled Trial.

PURPOSE: To examine the effectiveness of a supervised exercise training program (SETP) on health-related quality of life (HRQoL) and functional capacity in women with breast cancer (BC) undergoing chemotherapy. METHODS: Ninety-three women with early-stage BC were randomly allocated to a SETP plus usual care (exercise, n = 47) or usual care alone (UC, n = 46). The SETP included three sessions per week, combining aerobic and resistance training, conducted concurrently over the chemotherapy. The EORTC Cancer Quality-of-Life-Questionnaire-Core-30 (QLQ-C30) and the BC-specific module (QLQ-BR23) were used to assess HRQoL. Functional capacity was analyzed by maximum voluntary handgrip strength (MVHS) and by the 30-s chair sit-to-stand test (30-s CST). These endpoints were assessed at baseline (t0); middle (t1; after 8 or 12 wk of t0); and at the end of chemotherapy (t2; after 20 wk of t0). Mean changes from baseline were assessed by an intention-to-treat approach. RESULTS: Mixed linear model analyses showed that Exercise group experienced less deterioration in several domains of QLQ-C30 at t2, including in global health status/QoL (Δ = 9.39 units; P = 0.034), QLQ-C30 summary score (Δ = 8.08 units; P < 0.001), physical (Δ = 15.14 units; P < 0.001), role ( Δ = 21.81 units; P < 0.001), cognitive (Δ = 9.16 units; P = 0.032) and social functioning (Δ = 11.67 units; P = 0.038), compared with the UC group. Similarly, Exercise group exhibited significant lower levels of fatigue (Δ = -20.19 units; P < 0.001) and appetite loss (Δ = -13.69 units; P = 0.034), compared with the UC group. Significant between-group differences were observed on MVHS of the tumor/surgery upper limb side (Δ = 2.64 kg; P < 0.001) and contralateral limb (Δ = 2.22 kg; P < 0.001), and on the 30-s CST score (Δ = 3.56repetitions; P < 0.001), favoring the Exercise group. No differences were observed on QLQ-BR23 domains. CONCLUSIONS: Exercise training was an effective complementary therapy to prevent the deterioration of HRQoL and functional capacity during chemotherapy in women with early-stage BC.

The assessment of the match performance of association football referees: Identification of key variables.

The purpose of this study was to understand the contribution of each performance indicator to evaluate match performance of football referees. Thirty-four elite Referee Match Observers (RMOs) from the Portuguese FA participated voluntarily in the study. From the official assessment sheet of each game, the referee's game score was categorized in two groups according to referee's game score: i) Referees with a Low Score (LFS) and ii) Referees with High Score (HFS). A multivariable binary logistic regression model was used to assess the relationship between the Performance Indicators (PIs) of the dimensions i) game difficulty and game intervention and ii) disciplinary actions and game management in relation to the referee's match assessment score. The model proposed revealed that only the PIs negative application of the laws of the game and referee teamwork, from the dimension disciplinary actions and game management, significantly defined the final game referee's assessment score. This study suggests that the PIs scored by the RMOs contributed in a different way to the referee's game score. The model explains 60.4% of the referee's game score based on the variables referee teamwork and negative application of the laws of the game.

Estimating the relative load from movement velocity in the seated chest press exercise in older adults.

AIM: This study aimed to i) determine the load-velocity relationship in the seated chest press in older adults, ii) compare the magnitude of the relationship between peak and mean velocity with the relative load, and iii) analyze the differences between sexes in movement velocity for each relative load in the chest press. MATERIAL AND METHODS: Thirty-two older adults (17 women and 15 men; 79.6±7.7 years) performed a chest press progressive loading test up to the one-repetition maximum (1RM). The fastest peak and mean velocity reached with each weight were analyzed. Quadratic equations were developed for both sexes and the effectiveness of the regression model was analyzed through a residual analysis. The equations were cross-validated, considering the holdout method. The independent samples t-test analyzed i) the differences in the magnitude of the relationship between peak and mean velocity with the relative load and ii) the differences between sexes in the peak and mean velocity for each relative load. RESULTS: It was possible to observe very strong quadratic load-velocity relationships in the seated chest press in women (peak velocity: r2 = 0.97, standard error of the estimate (SEE) = 4.5% 1RM; mean velocity: r2 = 0.96, SEE = 5.3% 1RM) and men (peak velocity: r2 = 0.98, SEE = 3.8% 1RM; mean velocity: r2 = 0.98, SEE = 3.8% 1RM) without differences (p>0.05) in the magnitude of the relationship between peak and mean velocity with the relative load. Furthermore, there was no overfitting in the regression models due to the high and positive correlation coefficients (r = 0.98-0.99). Finally, men presented higher (p<0.001) lifting velocities than women in almost all relative loads, except for 95-100% 1RM (p>0.05). CONCLUSION: Measuring repetition velocity during the seated chest press is an objective approach to estimating the relative load in older adults. Furthermore, given the velocity differences between older women and men at submaximal loads, it is recommended to use sex-specific equations to estimate and prescribe the relative loads in older adults.

Effects of exercise training on cardiac toxicity markers in women with breast cancer undergoing chemotherapy with anthracyclines: a randomized controlled trial.

AIMS: Exercise training has been suggested to prevent anthracycline-related cardiac dysfunction, but clinicalbased evidence is scarce. We investigated the effects of a supervised exercise training programme (SETP) on cardiac toxicity markers in women with breast cancer (BC) receiving anthracycline-containing chemotherapy. METHODS AND RESULTS: Ninety-three women with early-stage breast cancer were randomly allocated to a supervised exercise training programme (SETP) plus usual care group (Exercise, n = 47) or usual care alone group (UC, n = 46). The SETP consisted of three sessions per week, combining aerobic and resistance training, conducted concurrently across the anthracycline-containing chemotherapy length. The primary endpoint was the change in left ventricular ejection fraction (LVEF) from baseline to the end of anthracycline cycles. Secondary endpoints included global longitudinal strain (GLS) and other conventional echocardiographic parameters, cardiorespiratory fitness (estimated peak VO2), circulating biomarkers (NT-proBNP, hs-TnT), and safety of the SETP. The study endpoints were also assessed 3 months after the end of anthracycline cycles. All patients were prescribed four cycles of doxorubicin plus cyclophosphamide (AC). No significant between-group differences in LVEF change were seen at the end of AC [mean difference: 0.7%; 95% confidence interval (CI): -0.8, 2.3; P = 0.349] and 3 months after AC (1.1%; 95% CI: -0.5, 2.6; P = 0.196). Compared to the usual care (UC) group, the estimated peak VO2 increased in the Exercise group at the end of AC (1.6 mL O2·kg-1·min-1; 95% CI: 0.06, 3.1; P = 0.041) and 3 months after AC (3.1 mL O2·kg-1·min-1; 95% CI: 1.4, 4.7; P < 0.001). No between-group differences were found in the remaining secondary endpoints. No serious adverse events were observed during SETP. CONCLUSION: Exercise training was safe during chemotherapy and significantly improved cardiorespiratory fitness. No significant effects were seen on cardiac toxicity markers (LVEF or GLS) as compared to the usual care. TRIAL REGISTRATION: Mama Move Gaia on treatment trial ISRCTN32617901.

Breast cancer patients are often treated with chemotherapy. Despite the clinical benefit, some of these drugs increase the risk of cardiac toxicity and impair patients' cardiorespiratory fitness. Exercise training has been proposed as a preventive approach, but clinical-based evidence is scarce. The results of this trial showed that an exercise training programme, combining aerobic training and resistance training, conducted during chemotherapy, did not significantly attenuate the decline in conventional cardiac function parameters when compared to usual care. However, the results of this trial showed that the training programme was safe and significantly improved cardiorespiratory fitness.

Load-power relationship in older adults: The influence of maximal mean and peak power values and their associations with lower and upper-limb functional capacity.

Identifying the relative loads (%1RM) that maximize power output (Pmax-load) in resistance exercises can help design interventions to optimize muscle power in older adults. Moreover, examining the maximal mean power (MPmax) and peak power (PPmax) values (Watts) would allow an understanding of their differences and associations with functionality markers in older adults. Therefore, this research aimed to 1) analyze the load-mean and peak power relationships in the leg press and chest press in older adults, 2) examine the differences between mean Pmax-load (MPmax-load) and peak Pmax-load (PPmax-load) within resistance exercises, 3) identify the differences between resistance exercises in MPmax-load and PPmax-load, and 4) explore the associations between MPmax and PPmax in the leg press and chest press with functional capacity indicators. Thirty-two older adults (79.3 ± 7.3 years) performed the following tests: medicine ball throw (MBT), five-repetition sit-to-stand (STS), 10-m walking (10 W), and a progressive loading test in the leg press and chest press. Quadratic regressions analyzed 1) the load-mean and peak power relationships and identified the MPmax-load, MPmax, PPmax-load, and PPmax in both exercises, 2) the associations between MPmax and PPmax in the chest press with MBT, and 3) the associations between MPmax and PPmax in the leg press with STSpower and 10Wvelocity. In the leg press, the MPmax-load was ∼66% 1RM, and the PPmax-load was ∼62% 1RM, both for women and men (p > 0.05). In the chest press, the MPmax-load was ∼62% 1RM, and the PPmax-load was ∼56% 1RM, both for women and men (p > 0.05). There were differences between MPmax-load and PPmax-load within exercises (p < 0.01) and differences between exercises in MPmax-load and PPmax-load (p < 0.01). The MPmax and PPmax in the chest press explained ∼48% and ∼52% of the MBT-1 kg and MBT-3 kg variance, respectively. In the leg press, the MPmax and PPmax explained ∼59% of STSpower variance; however, both variables could not explain the 10Wvelocity performance (r 2 ∼ 0.02). This study shows that the Pmax-load is similar between sexes, is resistance exercise-specific, and varies within exercises depending on the mechanical power variable used in older adults. Furthermore, this research demonstrates the influence of the MBT as an upper-limb power marker in older adults.

Body composition and grip strength constraints in elite male rink-hockey players of contrasting ethnicity.

Rink hockey is a highly specialized and physiological demanding sport with sparse research regarding the game and athletes' characteristics. A cross-sectional study was developed to characterize the body composition and grip strength of elite male rink hockey players and to establish the relationship between ethnicity on body composition and grip strength. A sample of 100 elite rink-hockey athletes aged 26.59 ± 6.02 participated in the study, comprised of 69 Caucasian male adults aged 27.58 ± 6.44 years and 31 Black African male adults aged 24.39 ± 4.27. Body composition was assessed by anthropometric measurements. Static grip strength was assessed with an adjustable dynamometer. Multiple regression analysis was applied to understand which variables constraints body fat percentage (BF) and grip strength. Body mass showed an average of 76.36 ± 9.18 kg for 175.80 ± 5.87 cm of height and BF% of 10.82 ± 5.07%. Maximal right grip strength was 50.91 ± 6.26 kg and 50.27 ± 6.23 kg for left grip strength. Four predictors accounted for 70.01% of the variance of BF%: abdominal circumference (p < 0.001), right thigh circumference (p < 0.001), right calf circumference (p = 0.001) and ethnicity (p = 0.016). Three predictors accounted for 13.1% of the variance of right grip strength: ethnicity (p = 0.013), chronological age (p = 0.024) and right distal thigh circumference (p = 0.014). Results suggest that elite rink hockey athletes have a specific anthropometric identity, which at the elite level may lead to reduced body fat and greater handgrip strength. Ethnicity seems to predict body fat and grip strength in elite rink hockey athletes.

Educação física escolar em unidades prisionais: elementos para se pensar sobre a educação "por entre as grades" / School physical education in prison units: elements to think about education "through the grates" / Educación física escolar en unidades prisioneras: elementos para pensar sobre la educación "a través de las rejillas"

O objetivo do estudo foi identificar e analisar aspectos que caracterizam as aulas de Educação Física em unidades prisionais da Região dos Inconfidentes, MG. Para tal, foi realizada uma pesquisa qualitativa, a partir da entrevista semiestruturada com professores licenciados em Educação Física atuantes em escolas prisionais. Foi identificado que, devido às regras impostas pelas unidades prisionais, as aulas passam por adaptações e acontecem em salas de aula, com a proibição e/ou restrição do uso de materiais pedagógicos e de determinadas metodologias de ensino. Segundo os participantes, acresce a quase ausência dos movimentos corporais, o que acaba por subverter a lógica e os preceitos da Educação Física escolar, alicerçadas no conceito de Cultura Corporal de Movimento e nos objetivos definidos pelos documentos legais (AU).

The aim of the study was to identify and analyze aspects that characterize Physical Education classes in prison units in the Inconfidentes Region, MG. To this end, a qualitative research was carried out, based on a semi-structured interview with teachers licensed in Physical Education working in prison schools. It was identified that, due to the rules imposed by the prison units, classes undergo adaptations and take place in clas-srooms, with the prohibition and / or restriction of the use of teaching materials and certain teaching methodologies. According to the partici-pants, there is an almost absence of body movements, which ends up subverting the logic and precepts of school Physical Education, based on the concept of Body Culture of Movement and objectives defined by legal documents (AU).

El objetivo del estudio fue identificar y analizar aspectos que caracterizan las clases de Educación Física en unidades penitenciarias de la Región de los Inconfidentes, MG. Para ello, se llevó a cabo una investi-gación cualitativa, basada en una entrevista semiestructurada a profeso-res titulados en Educación Física que laboran en escuelas penitenciarias. Se identificó que, debido a las normas impuestas por las unidades peni-tenciarias, las clases sufren adaptaciones y se desarrollan en las aulas, con la prohibición y / o restricción del uso de materiales didácticos y determinadas metodologías de enseñanza. Según los participantes, hay una casi ausencia de movimientos corporales, lo que acaba subvirtiendo la lógica y los preceptos de la Educación Física escolar, basada en el con-cepto de Cultura Corporal del Movimiento y objetivos definidos por los documentos legales (AU).

Load-velocity relationship in the horizontal leg-press exercise in older women and men.

This study analyzed the predictive ability of movement velocity to estimate the relative load (i.e., % of one-repetition maximum [1RM]) during the horizontal leg-press exercise in older women and men. Twenty-four women and fourteen men living in community-dwelling centers volunteered to participate in this study. All participants performed a progressive loading test up to 1RM in the horizontal leg-press. The fastest peak velocity (PV) and mean velocity (MV) attained with each weight were collected for analysis. Linear regression equations were modeled for women and men. We observed very strong linear relationships between both velocity variables and the relative load in the horizontal leg-press in women (PV: r2 = 0.93 and standard error of the estimate (SEE) = 5.96% 1RM; MV: r2 = 0.94 and SEE = 5.59% 1RM) and men (PV: r2 = 0.93 and SEE = 5.96% 1RM; MV: r2 = 0.94 and SEE = 5.97% 1RM). The actual 1RM and the estimated 1RM using both the PV and MV presented trivial differences and very strong relationships (r = 0.98-0.99) in both sexes. Men presented significantly higher (p < 0.001-0.05) estimated PV and MV against all relative loads compared to women (average PV = 0.81 vs. 0.69 m·s-1 and average MV = 0.44 vs. 0.38 m·s-1). Our data suggest that movement velocity accurately estimates the relative load during the horizontal leg-press in older women and men. Coaches and researchers can use the proposed sex-specific regression equations in the horizontal leg-press to implement velocity-monitored resistance training with older adults.

The effects of dry-land strength training on competitive sprinter swimmers.

BACKGROUND/OBJECTIVE: This study aimed to examine the effects of eight weeks of dry-land strength combined with swimming training on the development of upper and lower body strength, jumping ability, and swimming performance in competitive sprinter swimmers. METHODS: Twenty (14 men and 6 women) university swimmers of national-level (age: 20.55 ± 1.76 years, body mass: 68.86 ± 7.69 kg, height: 1.77 ± 0.06 m, 100 m front crawl: 71.08 ± 6.71s, 50 m front crawl: 31.70 ± 2.45s) were randomly divided into two groups: experimental group (EG: 11) and control group (CG: 9). In addition to the usual in-water training (3-4 sessions per week of ∼80 min), the EG performed 8 weeks (one session per week) of strength-training (ST). The ST included bench press, full squat, countermovement jumping, countermovement jumping with free-arm movement, and the medical ball throwing. Stroke length, stroke frequency, stroke index, and swimming velocity were recorded during 50 and 100 m front crawl time-trials. Strength and swimming performance were evaluated before and after 8 weeks of training. RESULTS: The results showed a significant improvement in sprint performance (50 m: p < 0.01, d = 0.47; 100 m: p < 0.05, d = 0.42), stroke frequency (50 m: p < 0.01, d = 0.90) and stroke index (100 m: p < 0.01, d = 0.29) in the EG. Despite both groups' increased strength performance, increases in bench press were higher in the EG (p < 0.001, d = 0.75) than CG (p = 0.05, d = 0.34). CONCLUSIONS: Complementing in-water training with strength training seems to be relevant to improve upper body strength and to optimize 50 m and 100 m swimming performance, adapting technical patterns used during all-out swimming.

Ultimate Full Contact: Fight Outcome Characterization Concerning Their Methods, Occurrence Times and Technical-Tactical Developments.

Fight analysis produces relevant technical-tactical information. However, this knowledge is limited in hybrid full-contact combat sports. Therefore, this study aimed to characterize the results of the fights' outcomes through the winners at the World Ultimate Full Contact (WUFC) Championships between 2008 and 2017. Methods: 170 combats between senior male fighters (master class) from 38 countries were observed; all fight outcome methods, their occurrence times, inherent skills and their development forms were analyzed through frequencies, percentages, crosstabs and chi-square test, considering a Fisher's exact value of p < 0.05. The fight outcome methods were, in decreasing order, as follows: submission; decision and technical knockout (TKO); knockout (KO); and doctor stoppage. Only 19.4% fights completed the regular time 10 min (600 s), and 68.8% fight outcomes occurred in the first 5 min (300 s). Chokes were more used than joint locks, primarily developed in single actions. Head punches and kicks were the skills most responsible for KO, developed more in combinations and counter-attacks, while TKO was always through combination attacks and mostly by ground and pound. Ground fighting is most effective. In stand-up fighting, combination attacks and counter-attack are most effective. It is important to increase the technical-tactical capacities and adjustable decision-making to perform the regular fight time.

Estimation in additive models and ANOVA-like applications.

A well-known property of cumulant generating function is used to estimate the first four order cumulants, using least-squares estimators. In the case of additive models, empirical best linear unbiased predictors are also obtained. Pairs of independent and identically distributed models associated with the treatments of a base design are used to obtain unbiased estimators for the fourth-order cumulants. An application to real data is presented, showing the good behaviour of the least-squares estimators and the great flexibility of our approach.

Considering the sample sizes as truncated Poisson random variables in mixed effects models.

When applying analysis of variance, the sample sizes may not be previously known, so it is more appropriate to consider them as realizations of random variables. A motivating example is the collection of observations during a fixed time span in a study comparing, for example, several pathologies of patients arriving at a hospital. This paper extends the theory of analysis of variance to those situations considering mixed effects models. We will assume that the occurrences of observations correspond to a counting process and the sample dimensions have Poisson distribution. The proposed approach is applied to a study of cancer patients.

Balanced prime basis factorial fixed effects model with random number of observations.

Factorial designs are in general more efficient for experiments that involve the study of the effects of two or more factors. In this paper we consider a p U factorial model with U factors, each one having a p prime number of levels. We consider a balanced (r replicates per treatment) prime factorial with fixed effects. Our goal is to extend these models to the case where it is not possible to known in advance the number of treatments replicates, r. In these situations is more appropriate to consider r as a realization of a random variable R, which will be assumed to be geometrically distributed. The proposed approach is illustrated through an application considering simulated data.

Heart Rate Variability Changes From Traditional vs. Ultra-Short-Term Recordings in Relation to Preseason Training Load and Performance in Futsal Players.

Nakamura, FY, Antunes, P, Nunes, C, Costa, JA, Esco, MR, and Travassos, B. Heart rate variability changes from traditional vs. ultra-short-term recordings in relation to preseason training load and performance in futsal players. J Strength Cond Res 34(10): 2974-2981, 2020-The aims of this study were to analyze heart rate variability (HRV) changes in futsal players during preseason training using both "criterion" (10-minute) and ultra-shortened (2-minute) measures, and to determine whether they were related to changes in the Yo-Yo Intermittent Recovery Test, level 1 (Yo-Yo IR1) performance and accumulated training load (TL). Eleven male competitive futsal players (age = 25.19 ± 4.70 years; body mass = 73.15 ± 11.70 kg; and height = 176.90 ± 5.01 cm) volunteered for the study. Data collection took place during the first to the fourth weeks of preseason training. Training load was monitored with session ratings of perceived exertion. The total distance (TD) covered during the Yo-Yo IR1 was recorded during week 1 and week 4. Heart rate variability was measured through the log-transformed root mean square of successive normal-to-normal interval differences using the ultra-short analysis, with its weekly mean (lnRMSSDM) and coefficient of variation (lnRMSSDCV) recorded, and by means of the criterion method (weeks 1 and 4). lnRMSSDM was likely higher at week 4 compared with week 1 using both criterion and ultra-short recordings. Moderate-to-large correlations were found between changes in the lnRMSSDM and lnRMSSDCV values and changes in TL and TD (r values ranged from -0.48 to 0.65). Changes in ultra-short HRV measures (i.e., increase in lnRMSSDM and decrease in lnRMSSDCV) during futsal preseason were associated with increased performance. The players who accumulated higher perceived TLs displayed smaller improvements in the Yo-Yo IR1 performance and HRV.

Modeling Fitness Variable Responses to Training in Prepubescent Children.

Alves, AR, Marta, C, Neiva, HP, Nunes, C, Izquierdo, M, and Marques, MC. Modeling fitness variable responses to training in prepubescent children. J Strength Cond Res 34(8): 2352-2359, 2020-The aim of this study was to determine strength and oxygen uptake (V[Combining Dot Above]O2max) performances according to different training program intervention design with 8-week duration in prepubescent children through a multiple linear regression models. Two hundred forty-five healthy prepubescent children (aged 10.9 ± 0.5 years) were randomly assigned to a specific training program (strength training only-S; aerobic training only-A; intrasession aerobic and strength training-AS; intrasession strength and aerobic training-SA; or concurrent training performed in different sessions-CT) or a control group (no training regimen-C). It was possible to develop indirect predictive models for each training method, by including each variable pretraining, body fat percentage and body mass index. The models provided explained 82% of variance in the V[Combining Dot Above]O2max, 98% in the 1 kg ball-throw, 96% in the 3 kg ball-throw, 92% in the countermovement jump, 93% in the standing long jump and 98% in the 20 m sprint performances. This novel approach to training evaluation and control aims to provide a tool to allow professionals to calculate changes with a high confidence level (CI 95%), to control gains and to choose the best training methodology to apply according to the defined purposes. The results of this study could be a great support to teachers, coaches, and professionals providing important tools to improve the efficacy and individualization of training.

Effects of physical exercise on outcomes of cardiac (dys)function in women with breast cancer undergoing anthracycline or trastuzumab treatment: study protocol for a systematic review.

BACKGROUND: Cardiotoxicity is a known complication and one of the most adverse effects from the use of conventional treatments such as anthracyclines and trastuzumab in breast cancer (BC) care. This phenomenon has been associated with the restriction of therapeutic options and the increase of cardiovascular complications, which may compromise the survival of patients. Implementation of preventive strategies is an important approach for the management of this issue. Physical exercise has been proposed as a non-pharmacological strategy to counteracting cardiotoxicity. The aim of this protocol is to describe the rationale and methods for a systematic review of published randomized controlled trials (RCTs) that have analysed the effects of physical exercise on outcomes of cardiac (dys)function in women with BC undergoing neoadjuvant or adjuvant treatment containing anthracyclines and/or trastuzumab. METHODS AND ANALYSIS: This is a protocol for a systematic review reported according to the PRISMA-P 2015 checklist. Randomized controlled trials (RCTs) will be included. The literature will be screened on MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials, ISI Web of Science and Scopus. The risk of bias of the included RCTs will be assessed using the Cochrane Collaboration's tool. The primary outcomes will be systolic function (left ventricular ejection fraction), diastolic function (E/A' ratio, deceleration time of early left ventricular filling, isovolumetric relaxation time, E/E' septal and lateral ratio) and myocardial deformation imaging outcomes (strain and strain rate [measured in longitudinal, radial, or circumferential directions]). Secondary outcomes will be cardiac biomarkers (troponin I or T, high-sensitivity troponin I or T, brain natriuretic peptide, amino terminal of B-type natriuretic peptide). Data will be descriptively reported, and quantitative synthesis will also be considered if the included studies are sufficiently homogenous. DISCUSSION: This systematic review will help to understand the effectiveness of physical exercise on counteracting cardiotoxicity related to anticancer therapies in women with BC. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018096060.

Impact of exercise training on cardiotoxicity and cardiac health outcomes in women with breast cancer anthracycline chemotherapy: a study protocol for a randomized controlled trial.

BACKGROUND: Anthracyclines are chemotherapeutic agents frequently used in breast cancer (BC) treatment. Although it improves disease-free and overall survival, the use of anthracyclines is associated with a cumulative risk of cardiac toxicity. Preventive strategies to optimize cardiac health are needed and exercise is proposed as a potential non-pharmacological approach for counteracting anthracycline-related cardiotoxicity (ARC). Most of the data on the effects of exercise to reduce ACT are from animal studies, with only a few studies in a limited number of patients indicating beneficial effects. To better understand the effectiveness of exercise in the mitigation of ARC, clinical, real-world trials claim require a larger sample size and more accurate and valuable clinical biomarkers. In this study, we intend to include a large sample and investigate cardiac function through serial measures of biomarkers and imaging techniques. METHODS: This protocol describes a two-arm, prospective, randomized controlled trial that will explore the cardioprotective effect of a structured exercise program in women with BC undergoing anthracycline-containing chemotherapy (ACT). Ninety adult women with early BC and recommended to receive ACT will be randomly assigned (1:1) to an intervention group or a control group. Patients allocated to the intervention group will perform a supervised exercise program three times per week, consisting of a combination of aerobic and resistance training with progressive intensity and volume, during the time period they receive ACT. The control group will receive standard BC care. Primary outcomes related to cardiac (dys)function will be circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, resting left ventricular (LV) longitudinal strain, and resting LV ejection fraction. Secondary outcomes will include the assessment of resting blood pressure, resting heart rate (HR), resting HR variability (HRV), recovery HR, physical function outcomes, self-reported physical activity level, health-related quality of life, and fatigue. Data will be obtained at baseline (t0), after the end of anthracycline-treatment (t2), and 3 months after t2 (t3). Additionally, NT-proBNP will be measured 1-24 h prior to each anthracycline-treatment cycle (t1). DISCUSSION: The implementation of the present study design, using novel clinical biomarkers, will determine the effect of structured exercise interventions at mitigating ARC, with the overall aim of finding means to further improve BC care. TRIAL REGISTRATION: ISRCTN, ISRCTN32617901 . Registered on 24 October 2018. Last updated on 11 January 2019.

Health-related quality of life and physical fitness in breast cancer patients: the impact of a supervised physical exercise program in women with no exercise experience.

After breast cancer diagnosis (BCD), localized breast cancer (BC) patients are treated with curative intent by several therapeutic modalities. Despite the benefit of those therapies, the induction of side effects is acommon consequence affecting psychosocial and physiological outcomes. This quasi-experimental study compared physical fitness in recent-term (14-30 months; n= 11) and later-term (74-92 months; n= 8) BCD patients. After inclusion, recent-term BCD patients were engaged in asupervised exercise program and was explored its impact on physical fitness, health-related quality of life (HR-QOL) and fatigue. At baseline (M1) and after 8 (M2) and 16 weeks (M3) of this period, HR-QOL and fatigue were evaluated by the EORTC QLQ-C30 questionnaire and physical fitness through the estimation of maximum oxygen consumption (VO2max,ml.kg.min-1), handgrip force (kg) and sit-stand test. At baseline, women with later-term BCD have revealed better VO2max (p < 0.05) than recent-term BCD patients. There was asignificant time*group interaction for physical fitness outcomes and only the patients who have participated in the exercise program reported significant changes between baseline and at 16 weeks. The observed results demonstrated that performing regular exercise is associated with effective psychosocial and physiological recovery after BCD.