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.

Physical activity interventions in older adults with a cognitive impairment: A critical review of reviews.

This critical review explores the review material on physical activity combined with cognitive stimulation interventions in older adults with cognitive impairment and/or dementia. A critical, systematic, review of the review method was used, considering four electronic databases: WEB OF SCIENCE, SCOPUS, MEDLINE, and the COCHRANE ELECTRONIC LIBRARY. The search terms "exercise," "physical activity," "cognitive impairment," "dementia," and "systematic review" were used. All available reviews were marked against predetermined inclusion and exclusion criteria. There were 32 reviews that met the inclusion criteria. A combination of various types of training and aerobic exercises were the most frequently reported interventions; meanwhile, dual task training programs (combining physical exercise with cognitive stimulation), functional training programs along with exercises combination, aerobic exercise as well as strength, stretching, or balance workouts were also reported. The evidence is compelling; exercise can improve physical health by ensuring cognitive, psychological, and behavioral benefits. Overall, exercise can improve the physical and mental health of people living with dementia: there is sufficient evidence to recommend multimodal exercise.

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.

Acute Effects of Heavy Strength Training on Mechanical, Hemodynamic, Metabolic, and Psychophysiological Parameters in Young Adult Males.

This study analyzed the acute effects of heavy strength training on mechanical, hemodynamic, metabolic, and psychophysiological responses in adult males. Thirteen recreational level males (23.3 ± 1.5 years) randomly performed two heavy strength training sessions (3 sets of 8 repetitions at 80% of one repetition maximum [1RM]) using the bench press (HST-BP) or full squat (HST-FS)). The repetition velocity was recorded in both sessions. Moreover, before and after the sessions, the velocity attained against the ~1.00 m·s−1 load (V1Load) in the HST-BP, countermovement jump (CMJ) height in the HST-FS, blood pressure, heart rate, blood lactate, and psychophysiological responses (OMNI Perceived Exertion Scale for Resistance Exercise) were measured. There were differences between exercises in the number of repetitions performed in the first and third sets (both <8 repetitions). The velocity loss was higher in the HST-BP than in the HST-FS (50.8 ± 10.0% vs. 30.7 ± 9.5%; p < 0.001). However, the mechanical fatigue (V1Load vs. CMJ height) and the psychophysiological response did not differ between sessions (p > 0.05). The HST-FS caused higher blood pressure and heart rate responses than the HST-BP (p < 0.001 and p = 0.02, respectively) and greater blood lactate changes from pre-training to post-set 1 (p < 0.05). These results showed that the number of maximal repetitions performed in both sessions was lower than the target number and decreased across sets. Moreover, the HST-BP caused a higher velocity loss than the HST-FS. Finally, the HST-FS elicited higher hemodynamic and metabolic demand than the HST-BP.

Quality of life of fitness professionals in Portugal: Comparative and correlation study.

Fitness has been revealing a positive impact on the quality of life (QoL) of practitioners and fitness professionals (FPs) represent a role model for their customers in the fitness industry, emphasizing the need to know their QoL indices. The purpose of this study is to characterize the QoL of FPs in Portugal, compare it between groups and correlate QoL with sociodemographic and work-related variables. A total of 388 FPs answered an online survey about sociodemographic and work-related variables and the Portuguese version of the World Health Organization Bref QoL Assessment. Descriptive analysis, t-test, ANOVA, Kruskal-Wallis, Pearson and Spearman were used for statistical analysis. The results suggest that FPs in Portugal have different levels of QoL, considering the high standard deviation, with lower average indices than other countries. The lowest scores of QoL were verified in the environment domain. The results of the comparison between groups suggest that being male, married and having a master's degree or higher were the characteristics with better indices of QoL. Age, professional experience and net salary reveal a positive relation/association with QoL. Body&mind group classes (GC) per week, maximal GC per day, paid and unpaid working hours per week and annual expenses related to the profession reveal a negative relation/association. Maximal GC per day results could be an important finding to help minimize the physical problems among FPs and body&mind GC per week results could be an indicator of the FPs adaptation that allows them to remain on the profession. Unpaid working hours per week has the highest number of significant relations/associations with QoL. These findings could be important to improve the QoL of FPs. Thus, they could result in better work capacity and, therefore, fewer professionals would abandon the profession. It would also have a positive impact on the fitness industry and on the promotion of physical activity for a healthier society. More research is needed regarding the QoL of FPs.

Multicomponent exercise program effects on fitness and cognitive function of elderlies with mild cognitive impairment: Involvement of oxidative stress and BDNF.

Regular exercise has been shown to be one of the most important lifestyle influences on improving functional performance, and decreasing morbidity and all-cause mortality among older people. However, although there is some evidence on the effects of aerobic training on oxidative stress, there is little information regarding the effects of multicomponent exercise (dual-task training) and combination of exercise with cognitive stimulation on oxidative stress. In this context, the aim of this study was to verify the effects of a multicomponent exercise program on physical fitness and cognitive function in the elderly with mild cognitive impairment and determine the role of oxidative stress and brain-derived neurotrophic factor (BDNF). At baseline, 37 elderly nursing home residents with mild cognitive impairment were divided into two groups: the control group (CG, n = 12, 81.8 years) and the experimental group (EG, n = 25, 83.2 years). These elderlies followed multicomponent exercise training for 24 weeks, with two sessions per week and 45-50 min per session. The exercises included both aerobic and strength exercises, considering functional movements and light to moderate intensity. Cognitive stimulation comprehended exercises based on word games, puzzles, mathematical calculations, forward and backward counting, computer exercises, exergames, and games on a balanced platform. Physical assessments (weight, height, and body mass index), health and functional parameters (fitness tests: chair stand, arm curls, chair sit-and-reach, eight feet up-and-go, back scratch, 6-min walking, feet together, semi-tandem, and full tandem), lipid profile (total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and triglycerides), measures of lipid peroxidation damage, thiobarbituric acid reactive substances (TBARS), total antioxidant capacity (TAC), and BDNF were measured in plasma, based on which analyses were performed before and after the 24 weeks of the multicomponent exercise intervention. The results showed an overall improvement in physical and functional performance. Regarding biochemical measures, multicomponent exercises lead to a significant decrease in oxidative damage. The results indicate that multicomponent exercise training induces benefits in functional capacity and reduces damage due to oxidative stress.

Development of a Combined Exercise and Cognitive Stimulation Intervention for People with Mild Cognitive Impairment-Designing the MEMO_MOVE PROGRAM.

Dementia patients are at high risk for the decline of both physical and cognitive capacities, resulting in an increased risk of the loss of autonomy. Exercise is regarded as a non-pharmacological therapy for dementia, considering the potential benefits of preventing cognitive decline and improving physical fitness. In this paper, we aim to describe the different design stages for an exercise program combined with cognitive stimulation for a population with mild cognitive impairment, i.e., the MEMO_MOVE program. METHODS: The intervention design followed the Medical Research Council's guidelines for complex interventions and was structured according to the six steps in quality intervention development (6SQuID). The intervention was described considering the Template for Intervention Description and Replication (TIDieR). In order to establish the intervention characteristics, a literature review was conducted to collate and analyze previous work, which provided a summary the type of exercise that should be implemented among this population. RESULTS: The MEMO_MOVE program was structured and described, regarding (i) inclusion of a cognitive stimulation component; (ii) the kind of cognitive stimulation; and (iii) the type of exercise, duration, frequency, intensity, and program length. CONCLUSIONS: A systematic step-by-step process design was followed to create a specific intervention to promote physical fitness and cognitive stimulation in individuals with mild dementia.

Job Satisfaction of Fitness Professionals in Portugal: A Comparative Study of Gender, Age, Professional Experience, Professional Title, and Educational Qualifications.

This research characterizes and compares the job satisfaction of fitness professionals in Portugal between genders, ages, professional experience, professional title, and educational qualifications. A total of 401 fitness professionals answered the online questionnaire Job Satisfaction Scale, which has 16 factors rated on a Likert scale with seven levels. The statistical analysis comprises descriptive and statistical tests to compare the results of two (t-test) or more (ANOVA) groups. Overall, the results demonstrated that fitness professionals were moderately satisfied with their work. The lower degrees of job satisfaction were concerning salary, opportunities for promotion, and stability at work. The highest levels of job satisfaction were related to the freedom to choose their work method, their work colleagues, the physical conditions of their workplace, and the opportunity to use their competencies. There were no differences in job satisfaction in terms of gender and a few differences between professional title and between educational levels. Regarding age and professional experience, the results showed significant differences in almost all factors, suggesting that, as fitness professionals get older and more experienced, their job satisfaction is greater. The results of this study suggest that even though fitness professionals are, in general, moderately satisfied with their work, some aspects can be improved by employers to increase their satisfaction levels. Such findings would assist employers in guiding the job satisfaction of their employees with consequent enhancements in the services provided by fitness professionals, which can increase participants' retention in exercise fitness activities.

Effects of Backpacks on Ground Reaction Forces in Children of Different Ages When Walking, Running, and Jumping.

Backpacks for transporting school loads are heavily utilized by children, and their mechanical advantages have been allowing children to transport heavy loads. These heavy loads may increase ground reaction forces (GRFs), which can have a negative effect on joints and bone health. The aim of this study was to investigate the effect of backpacks on the GRFs generated by children during walking, running, and jumping. Twenty-one children from the fifth (G-5, n = 9) and ninth (G-9, n = 12) grades walked, ran, and jumped over a force plate. When walking, the G-5 had GRF increments in the first (17.3%; p < 0.001) and second (15.4%; p < 0.001) peak magnitude, and in the total integral of the vertical force (20%; p < 0.001), compared to the control condition (i.e., no backpack), and the G-9 had increments of 10.4%, 9%, and 9% (p < 0.001), respectively. The G-9 did not prolong their total stance time (p > 0.05), unlike the G-5 (p = 0.001). When running, total stance time increased 15% (p < 0.001) and 8.5% (p < 0.001) proportionally to the relative load carried, in the G-5 and G-9, respectively. Peak GRF did not increase in any group when running or landing from a jump over an obstacle. It was found that GRF was affected by the backpack load when walking and running. However, when landing from a jump with the backpack, schoolchildren smoothed the landing by prolonging the reception time and thus avoiding GRF peak magnitudes.

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.

Gender's Effect on a School-Based Intervention in The Prepubertal Growth Spurt.

Children aged 10-11 years pass through a dynamic developmental period marked by rapid changes in body size, shape, and composition, all of which are sexually dimorphic. The purpose of this study was to analyze the effects of gender on a school-based intervention in the prepubertal growth spurt. One hundred twenty-five healthy children (58 boys, 67 girls), fifth and sixth grade students from an urban public elementary school in Portugal (10.8 ± 0.4 years), were randomly assigned into two experimental groups: a strength training group (19 boys, 22 girls), and an endurance training group (21 boys, 24 girls); and a control group (18 boys, 21 girls; no training program). Training program for the two experimental groups was conducted twice a week for 8 weeks. Compared with the values at the beginning of the protocol, both strength and endurance training programs produced significant improvements (p< 0.05) in vertical and horizontal jumps, a 1 kg and 3 kg medicine ball throw, a 20 m sprint and VO2max, for both boys and girls. No significant changes were observed related to gender in training-induced strength (p> 0.05, η_p^2= 0.16, Power= 0.29) and aerobic (p> 0.05, η_p^2= 0.05, Power= 0.28) capacity. The results of the present study should be taken into consideration in order to optimize strength training school-based programs.