Heart Rate Variability and Cardiovascular Adaptations Among Cancer-Survivors Following a 26-Week Exercise Intervention.

Cardiotoxicity as a result of cancer treatment contributes to autonomic dysfunction and decreased cardiorespiratory fitness among cancer survivors. These deleterious cardiovascular outcomes reduce the survival prognosis for cancer patients and contribute to poor quality of life among survivors. Exercise interventions have been shown as effective in mitigating treatment-related side effects. However, previously published interventions have not explored the potential for improvement in autonomic dysfunction (heart rate variability, HRV). This study examined cardiovascular adaptations in cancer survivors (n = 76) who participated in a 26-week intervention consisting of combined aerobic and resistance training (CART). The most noteworthy improvements occurred during the first 13 weeks of training and were maintained throughout the end of the 26-week period. HRrest improved from baseline (PRE) to the midpoint (MID) (P = .036) and from PRE to POST timepoints (P = .029). HRV and VO2max did not initially appear to change in response to CART. However, after stratification on time since treatment, participants who were 5 or more years from their last treatment experienced improvements (ie increase) in the HRV characteristic of HF power (P = .050) and also in VO2max (P =.043), when compared to those experiencing less than 5 years of time since their last treatment. These findings highlight a need for more attention to address the cardiorespiratory deficits experienced by those who have recently completed cancer treatment. In conclusion, the CART intervention is effective in improving cardiorespiratory fitness and autonomic dysfunction. The structure of the intervention is feasible for cancer survivors to continue with at home, using minimal resources, and without supervision. This at-home model may be even more acceptable to recent survivors that may be homebound immediately following treatment.

Musculoskeletal Flexibility and Quality of Life: A Feasibility Study of Homeless Young Adults in Los Angeles County.

Proper musculoskeletal health is dependent on the efficient inner workings of muscles, tendons, ligaments, joints, and bones. The homeless experience can be physically debilitating to these tissues and anatomical structures. This feasibility study aims to explore how to answer the overarching question: do the lived experiences of homeless young adults negatively affect their musculoskeletal health? Questionnaires were distributed to assess the demographic characteristics, physical activity, health behaviors, and sleep patterns of 40 homeless young adults and 45 university students in Los Angeles County. Participants also completed supervised stretch tests to assess musculoskeletal flexibility. Findings indicate that homeless young adults were less flexible in all four stretch assessments compared to university students. Noteworthy differences were noted with the sit and reach (p=0.050), butterfly (p=0.036), right shoulder (p=0.005), and left trunk twist tests (p=0.041). Analyses of physical activity levels and sleep location within the homeless subgroup suggest a deleterious impact on flexibility. Flexibility assessments are a low cost and sensitive method for measuring degree of musculoskeletal dysfunction of homeless young adults. Preliminary data suggests that the musculoskeletal health of this subgroup is adversely affected by their lived experience. Health services such as yoga or Pilates, in addition to existing case management and mental health services at homeless drop-in centers, may reduce the likelihood of long-term physical disability.

Pilot Study of Dose-Response Effects of Exercise on Change in C-Reactive Protein, Cortisol, and Health-Related Quality of Life Among Cancer Survivors.

Fatigue, stress, and depression contribute to poor health-related quality of life (HRQoL) among cancer survivors. This study examined the effects of combined aerobic and resistance training (CART) on HRQoL and biomarkers of stress. Cancer survivors (n = 76, 91% female, 39% breast cancer, 32% gynecologic cancer) were enrolled in CART for three 60-min sessions, weekly, for 26 weeks. Participants completed the National Institutes of Health's Patient Reported Outcomes Measurement Information System (NIH PROMIS) fatigue assessment and the SF-36. Cortisol and c-reactive protein (CRP) were assessed using volunteered blood specimens. Baseline fatigue scores were worse for participants completing treatment within the last year, compared to long-term survivors [F = (2, 59) = 3.470, p = 0.038]. After 26 weeks, fatigue scores improved by a noteworthy two points [M = 52.72, standard deviation, SD = 10.10 vs. M = 50.67, SD = 10.14; t(48) = 1.7145, p = 0.092]. Pre- to postintervention improvements in bodily pain [M = 50.54, SD = 9.51 vs. M = 48.20, SD = 10.07; t(33) = 2.913, p = 0.006] and limitations in social functioning [M = 50.60, SD = 9.17 vs. M = 47.75, SD = 11.66; t(33) = 2.206, p = 0.034], as well as a mean decrease of 1.64 ± 10.11 mg/L in CRP levels [t(107) = 1.261, p = 5.965], were observed. Participants within 1 year of treatment completion experienced greater improvements in post CRP levels compared to those who had treatment 1-4 years (p = 0.030) and 5 or more years ago (p = 0.023). Physical functioning, fatigue, fear/anxiety, social role satisfaction, and CRP levels improved following participation in this exercise intervention. Oncologists should consider recommending CART as soon as medically feasible following the cessation of cancer treatment.

Fall-related Comorbidity and Health Beliefs among Cancer Survivors Participating in a Community-based Exercise Intervention.

OBJECTIVES: Health beliefs (HB) and fall and balance-related outcomes were examined following a 26-week community-based exercise intervention among cancer survivors (CS). METHODS: Fall and balance-related measures and HB were quantitatively and qualitatively examined during a 26-week intervention among CS (N = 33). Of the 33 participants, 28 consented to an interview about their physical activity (PA) behavior. RESULTS: Participants scored high on balance efficacy (median ± range = 8.68 ± 1.53) and reported high perception of having barriers to PA (mean ± SD = 4.66 ± 0.59). Fall-related measures improved after the 26-week intervention (p = .002). Most cues to action to engage in PA were delivered by a healthcare professional (N = 18). Once enrolled in the intervention, social benefits and access to a program tailored toward CS emerged as motivating factors to engage in PA (N = 12, N = 11, respectively). CONCLUSIONS: There is a need to design fall risk reduction programs tailored to CS and to offer these programs in an environment that fits the unique physical and social needs of CS.

Cardiometabolic Health Among Cancer Survivors: A 13-Week Pilot Study of a Combined Aerobic and Resistance Training Program.

PURPOSE/OBJECTIVES: To explore the feasibility of combined aerobic and resistance training (CART) as a safe method of improving cardiometabolic health among cancer survivors.
. DESIGN: Descriptive and longitudinal pilot study for exercise intervention.
. SETTING: University campus in Los Angeles, California.
. SAMPLE: A multiethnic population of cancer survivors (N = 11) was recruited by convenience sampling and physician referral. 
. METHODS: Consenting participants were prescribed CART for one hour per day, three days per week for 13 weeks.
. MAIN RESEARCH VARIABLES: Components of cardiometabolic health were measured, including resting heart rate (HRrest), blood pressure, body mass index, waist circumference, body fat percentage, and android fat percentage at baseline and after 13 weeks of training. Fasting blood glucose, insulin, adiponectin, leptin, tumor necrosis factor alpha, and C-reactive protein (CRP) also were assessed at baseline and after 13 weeks of training.
. FINDINGS: More than half of the participants reported living with at least two other chronic diseases or conditions in addition to a cancer diagnosis. Five of six African American and Hispanic participants reported the presence of at least two risk factors for metabolic syndrome, compared to one of five Caucasian participants. After 13 weeks of training, participants experienced an average decrease in waist circumference. Decrease in waist circumference was associated with a decrease in CRP. A relationship also was suggested between number of exercise sessions attended and improvement in HRrest. 
. CONCLUSIONS: A CART intervention among cancer survivors should continue to be explored in a larger sample to establish efficacy and effectiveness at improving cardiometabolic health. Because of the higher risk of comorbidity among cancer survivors in comparison to cancer-free adults, improving cardiometabolic health is as important as monitoring cancer recurrence. A need exists for increased attention to the post-treatment cardiometabolic health of cancer survivors and also for examining potential cardiometabolic health disparities among non-Caucasian cancer survivors.
. IMPLICATIONS FOR NURSING: CART may be a plausible alternative to reduce the risk of metabolic syndrome and improve cardiometabolic health among cancer survivors. Additional studies that continue to explore the efficacy and effectiveness of CART may provide more information to help nurses and physicians determine whether the cancer survivorship care plan should include an exercise-based alternative to intervene on cardiometabolic health.

Combined aerobic and resistance training improves bone health of female cancer survivors.

INTRODUCTION: Cancer pathogenesis and resulting treatment may lead to bone loss and poor skeletal health in survivorship. The purpose of this investigation was to evaluate the influence of 26 weeks of combined aerobic and resistance-training (CART) exercise on bone mineral density (BMD) in a multi-racial sample of female cancer survivors. METHODS: Twenty-six female cancer survivors volunteered to undergo CART for 1 h/day, 3 days/week, for 26 weeks. The Improving Physical Activity After Cancer Treatment (IMPAACT) Program involves supervised group exercise sessions including 20 min of cardiorespiratory training, 25 min of circuit-style resistance-training, and 15 min of abdominal exercises and stretching. BMD at the spine, hip, and whole body was assessed using dual-energy X-ray absorptiometry (DXA) before and after the intervention. Serum markers of bone metabolism (procollagen-type I N-terminal propeptide, P1NP, and C-terminal telopeptides, CTX) were measured at baseline, 13 weeks, and at study completion. RESULTS: Eighteen participants, with the average age of 63.0 ± 10.3 years, completed the program. Mean duration since completion of cancer treatment was 6.2 ± 10.6 years. Paired t-tests revealed significant improvements in BMD of the spine (0.971 ± 0.218 g/cm2 vs. 0.995 ± 0.218 g/cm2, p = 0.012), hip (0.860 ± 0.184 g/cm2 vs. 0.875 ± 0.191 g/cm2, p = 0.048), and whole body (1.002 ± 0.153 g/cm2 vs. 1.022 ± 0.159 g/cm2, p = 0.002). P1NP declined 22% at 13 weeks and 28% at 26 weeks in comparison to baseline (p < 0.01) while CTX showed a non-significant decrease of 8% and 18% respectively. CONCLUSIONS: We report significant improvements in BMD at the spine, hip, and whole body for female cancer survivors who completed 26 weeks of CART. This investigation demonstrates the possible effectiveness of CART at improving bone health and reducing risk of osteoporosis for women who have completed cancer treatment. The IMPAACT Program appears to be a safe and feasible way for women to improve health after cancer treatment.

Mind the gaps: missed opportunities to promote bone health among cancer survivors.

INTRODUCTION: Many cancer treatments have a negative effect on bone health and can lead to osteoporosis. Additionally, the risk of osteoporosis during cancer survivorship may differ by racial and ethnic group. Overall, cancer survivors may be poorly informed about the risk of bone loss due to treatment. EXERCISE PRESCRIPTION: Exercise can be prescribed to improve bone health and reduce risk of fracture. Women participating in the Improving Physical Activity After Cancer Treatment pilot study (IMPAACT) experienced significant improvements in bone health. The pilot work also suggests that cancer survivors of diverse racial/ethnic profiles may not fit the normal risk profile for osteoporosis and could be overlooked during screening. IN SUMMARY: The lack of awareness of poor bone health in cancer survivors needs to be addressed, especially for those who do not fit the normal osteoporosis risk profile. Exercise is a safe and effective part of a cancer survivorship plan and is useful in promoting bone health.

Chronic disease burden among cancer survivors in the California Behavioral Risk Factor Surveillance System, 2009-2010.

PURPOSE: The California Behavioral Risk Factor Surveillance System estimates that 56.6 % of cancer survivors report ever being diagnosed with a chronic disease. Few studies have assessed potential variability in comorbidity by cancer type. METHODS: We used data collected from a representative sample of adult participants in the 2009 and 2010 California Behavioral Risk Factor Surveillance System (n = 18,807). Chronic diseases were examined with cancer survivorship in case/non-case and case/case analyses. Prevalence ratios (PR) and corresponding 95 % confidence intervals (95 % CI) were estimated using Cox proportional hazards models, with adjustment on race, sex, age, education, smoking, and drinking. RESULTS: Obesity was associated with gynecological cancers (PR 1.74; 95 % CI 1.26-2.41), and being overweight was associated with gynecological (PR 1.40; 95 % CI 1.05-1.86) and urinary (PR 2.19; 95 % CI 1.21-3.95) cancers. Arthritis was associated with infection-related (PR 1.78; 95 % CI 1.12-2.83) and hormone-related (PR 1.20; 95 % CI 1.01-1.42) cancers. Asthma was associated with infection- (PR 2.26; 95 % CI 1.49-3.43), hormone- (PR 1.46; 95 % CI 1.21-1.77), and tobacco- (PR 1.86; 95 % CI 1.25-2.77) related cancers. Chronic obstructive pulmonary disease (COPD) was associated with infection- (PR 2.16; 95 % CI 1.22-3.83) and tobacco-related (PR 2.24; 95 % CI 1.37-3.66) cancers and with gynecological cancers (PR 1.60; 95 % 1.00-2.56). CONCLUSIONS: This is the first study to examine chronic disease burden among cancer survivors in California. Our findings suggest that the chronic disease burden varies by cancer etiology. IMPLICATIONS FOR CANCER SURVIVORS: A clear need has emerged for future biological and epidemiological studies of the interaction between chronic disease and cancer etiology in survivors.

Genetic variation at 8q24, family history of cancer, and upper gastrointestinal cancers in a Chinese population.

Genetic variation at 8q24 is associated with prostate, bladder, breast, colorectal, thyroid, lung, ovarian, UADT, liver and stomach cancers. However, a role for variation at 8q24 in familial clustering of upper gastrointestinal cancers has not been studied. In order to explore potential inherited susceptibility, we analyzed epidemiologic data from a population-based case-control study of upper gastrointestinal cancers from Taixing, China. The study population includes 204 liver, 206 stomach, and 218 esophageal cancer cases and 415 controls. Associations between 8q24 rs1447295, rs16901979, rs6983267 and these cancers were stratified by family history of cancer. Odds ratios and 95% confidence intervals were adjusted for potential confounders: age, sex, education, tobacco smoking, alcohol consumption, and BMI at interview. We also adjusted for hepatitis B and aflatoxin (liver cancer) and Helicobacter pylori (stomach cancer). In a dominant model, among those with a family history of cancer, rs1447295 was positively associated with liver cancer (OR(adj) 2.80; 95% CI 1.15-6.80). Heterogeneity was observed (P(heterogeneity) = 0.029) with rs6983267 and liver cancer, with positive association in the dominant model among those with a family history of cancer and positive association in the recessive model among those without a family history of cancer. When considered in a genetic risk score model, each additional 8q24 risk genotype increased the odds of liver cancer by two-fold among those with a family history of cancer (OR(adj) 2.00; 95% CI 1.15-3.47). These findings suggest that inherited susceptibility to liver cancer may exist in the Taixing population and that variation at 8q24 might be a genetic component of that inherited susceptibility.

Utility of anthropometric measures in a multiethnic population: their association with prevalent diabetes, hypertension and other chronic disease comorbidities.

Body mass index (BMI) and waist circumference (WC) are two common anthropometric measures of obesity in clinical and public health practice. Consensus, however, remains elusive regarding their utility for predicting cardiovascular disease risk in multiethnic populations. We address this gap in the literature by analyzing cross-sectional data from the first round of the Los Angeles County Health and Nutrition Examination Survey, 2011. We characterized the relationships between BMI, WC, waist-to-hip ratios, waist-to-height ratios, and chronic disease extent, as confirmed by the presence of hypertension, diabetes, and/or two or more other chronic conditions as defined by a composite indicator 'comorbidity'. To account for race/ethnicity, age, gender, and cigarette smoking frequency, adjusted odds ratios (aOR) were generated and reported for each of the regression analyses. Whereas being overweight was associated with hypertension alone (aOR 2.10; 95% CI 1.12-3.94), obesity was associated with hypertension (aOR 5.04; 95% CI 2.80-9.06) as well as diabetes (aOR 5.28; 95% CI 2.25-12.3) and comorbidity (aOR 3.69; 95% CI 2.02-6.77). In whites and African-Americans, BMI and WC were positively related to diabetes, hypertension and comorbidity. In Hispanics, BMI and WC were also positively related to diabetes and comorbidity, but only the former measure was associated with hypertension (p < 0.050). In Asians, BMI was not a significant predictor of diabetes, hypertension and/or comorbidity. Collectively, the findings suggest that BMI is not universally informative and waist circumference and its derivatives may represent a viable, more racially/ethnically appropriate alternative for use with selected minority groups.

Body mass index change in adulthood and lung and upper aerodigestive tract cancers.

Body mass index (BMI) has been inversely associated with lung and upper aerodigestive tract (UADT) cancers. However, only a few studies have assessed BMI change in adulthood in relation to cancer. To understand the relationship between BMI change and these cancers in both men and women, we analyzed data from a population-based case-control study conducted in Los Angeles County. Adulthood BMI change was measured as the proportional change in BMI between age 21 and 1 year before interview or diagnosis. Five categories of BMI change were included, and individuals with no more than a 5% loss or gain were defined as having a stable BMI (reference group). Adjusted odds ratios (ORs) and their 95% confidence intervals (CIs) were estimated using logistic regression models. Potential confounders included age, gender, ethnicity, education, tobacco smoking and energy intake. For UADT cancers, we also adjusted for alcohol drinking status and frequency. A BMI gain of 25% or higher in adulthood was inversely associated with lung cancer (OR 0.53, 95% CI 0.33-0.84) and UADT cancers (OR 0.44, 95% CI 0.27-0.71). In subgroup analyses, a BMI gain of ≥25% was inversely associated with lung and UADT cancers among current and former smokers, as well as among current and former alcohol drinkers. The inverse association persisted among moderate and heavy smokers (≥20 pack-years). The observed inverse associations between adulthood BMI gain and lung and UADT cancers indicate a potential role for body weight-related biological pathways in the development of lung and UADT cancers.

Green tea consumption, inflammation and the risk of primary hepatocellular carcinoma in a Chinese population.

OBJECTIVE: Green tea has been found to possess anti-inflammatory, anti-oxidative and anti-carcinogenic properties. The present study examines the association between green tea drinking and hepatocellular carcinoma (HCC) and its interactions with other risk or protective factors and single nucleotide polymorphisms (SNP) of inflammation and oxidative stress related genes. METHODS: A population-based case-control study with 204 primary HCC cases and 415 healthy controls was conducted in Taixing, China. Epidemiological data were collected using a standard questionnaire. SNPs of genes of the inflammation and metabolic pathways were genotyped at the UCLA Molecular Epidemiology Laboratory. Logistic regression was performed to estimate adjusted odds ratios and 95% confidence intervals. RESULTS: Longer duration and larger quantities of green tea consumption were inversely associated with primary HCC. Individuals who drank green tea longer than 30 years were at lowest risk (adjusted OR=0.44, 95% CI: 0.19-0.96) compared with non-drinkers. A strong interaction was observed between green tea drinking and alcohol consumption (adjusted OR for interaction=3.40, 95% CI: 1.26-9.16). Green tea drinking was also observed to have a potential effect modification on HBV/HCV infection, smoking and polymorphisms of inflammation related cytokines, especially for IL-10. CONCLUSION: Green tea consumption may protect against development of primary HCC. Potential effect modifications of green tea on associations between primary HCC and alcohol drinking, HBV/HCV infection, and inflammation-related SNPs were suggested.

Delayed differentiation in embryonic stem cells and mesodermal progenitors in the absence of CtBP2.

Mammalian embryonic stem cells (ESCs) are characterized by an ability to self-renew and give rise to each of the three germ layers. ESCs are a pluripotential source of numerous primitive progenitors and committed lineages and can make stoichiometric decisions leading to either asymmetric or symmetric cell division. Several genes have been identified as essential for maintenance of self-renewal, but few non-lineage specific genes have been identified as essential for differentiation. We selected the chromatin factor Ctbp2 from microarray data for its enriched expression in stem cells, in comparison to committed progenitors. RNA interference (RNAi) was used to knockdown gene expression in mouse ESCs and the potential for transduced cells to self-renew and differentiate was assessed in ESC and mesodermal assays. Here, we demonstrate an important role for Ctbp2 in stem cell maintenance and regulation of differentiation using an in vitro system. The knockdown of Ctbp2 increases the prevalence of ESCs in culture, delays differentiation induced by LIF withdrawal, and introduces developmental changes in mesodermal differentiation. A model is presented for the importance of Ctbp2 in maintaining a balance in decisions to self-renewal and differentiate.