Longitudinal associations of cardiorespiratory fitness and physical activity with changes in cognitive function in breast cancer patients undergoing chemotherapy: a prospective matched-control study.

Previous studies have indicated a connection between resilience and cognitive function, but critical gaps persist regarding limited data exploring the relationship between resilience profiles and cognition using person-centered methodologies, especially in the context of breast cancer patients. While the general correlation between resilience and cognitive function is known, how various resilience profiles impact cognitive function in breast cancer patients remains unclear. The study aimed to identify resilience profiles and explore the relationship with cognitive function in breast cancer (BC) patients. This study was a cross-sectional study in descriptive research. BC patients (n = 425) from a tertiary oncology hospital completed the Functional Assessment of Cancer Therapy-Cognitive Function (FACT-Cog) scale and Connor-Davidson Resilience Scale (CD-RISC- 25). Latent profile analysis was adopted to identify subgroups of patients with distinct resilience profiles according to model fit indices. An ANOVA analysis and Chi-square test were also employed. Three profiles were identified, including Class 3, "High resilience-positive coping group" (n = 187, 44.7%), Class 2, "Medium resilience-effort regulation group" (n = 157, 37.6%), and Class 1, "Low resilience-negative coping" (n = 74, 17.7%). The results demonstrate that perceived cognitive impairment (CogPCI), other people's appraisal (CogOth), perceived cognitive ability (CogPCA), impact on quality of life (CogQOL), and FACT-Cog were significant differences in all three potential latent resilience profiles (P < 0.001). The CogPCI and FACT-Cog scores in Class 3 were the best, while Class 1 was the lowest. The psychological resilience profile contains three classes, and the findings provide evidence that high resilience potentially serves as a crucial protective factor for cognitive function in BC patients. Healthcare providers should improve their ability to recognize and evaluate factors influencing resilience, including social support and physical activity, which will enable the development of precise nursing interventions to mitigate the long-term adverse effects of trauma and reduce the impact of cognitive impairment on BC patients.

The mediating effect of psychosomatic symptoms between physical activity and cognitive function among breast cancer patients: A path analysis.

BackgroundPatients with breast cancer (BC) are at risk for cancer-related cognitive impairment (CRCI) due to BC-related stress and cancer treatment. Optimism and positive health behaviors may mitigate CRCI. This study examined relationships between optimism, health behaviors (sleep quality and physical activity) and CRCI in BC patients during the post-surgical period and whether optimism and health behaviors interacted in this relationship.MethodsWomen with recently diagnosed BC enrolled in a stress management trial following BC surgery. At baseline, participants completed questionnaires that measured CRCI, optimism, sleep quality, and physical activity.Results79 patients were enrolled (M = 61 years; range=50–85). Multiple regression models controlling for patient age, stage, surgery type, body mass index, and comorbidities revealed that optimism was associated with fewer perceived cognitive impairments (β=0.32, p=.01) and greater perceived cognitive abilities (β=0.38, p=.001). Poorer sleep quality was associated with poorer perceived cognitive abilities (β =-0.37, p=.01) and greater impact of cognitive impairments on quality of life (β=-0.39, p=.01). Moderation models revealed an interaction between optimism and sleep quality on perceived cognitive impairments (β=2.06, p=.02), such that among those low in optimism, poorer sleep quality was associated with greater perceived cognitive impairments (b=-2.42, p=.01) but not among those with high optimism (p=.46). No other models were statistically significant.ConclusionsResults suggest that optimism and sleep quality may be associated with better cognitive function in BC patients in the post-surgical period. Interventions that improve optimistic expectancies and sleep quality may help to mitigate CRCI in mid-to-older BC patients initiating treatment.

Physical activity (PA) and cardiorespiratory fitness (CRF) are independently associated with reduced cardiometabolic risk in children, and may affect risk through different pathways. This study aims to examine if CRF moderate the prospective association between PA, sedentary time, and cardiometabolic outcomes in 10-year-old children. In total, 718 children of 1129 (drop out n = 7) had valid measures of PA (accelerometry), CRF (the Andersen running test), and a cardiometabolic risk profile measured at baseline and follow-up 7 months later. Cardiometabolic outcomes were systolic blood pressure, waist circumference (WC), total cholesterol, high-density lipoprotein, triglycerides, glucose, and insulin (HOMA-IR). The cardiometabolic risk factors were analysed individually, and as a clustered risk score (z score). A linear mixed model was used to examine the prospective associations between different PA exposures (overall PA, sedentary time, moderate-to-vigorous PA (MVPA), vigorous PA) and cardiometabolic outcomes, including the interaction term PA × CRF in the model to assess moderation by CRF. CRF modified the association for baseline overall PA (P < 0.039) and MVPA (min/day) with clustered cardiometabolic risk at follow-up (P < 0.023). Moreover, CRF modified the association between overall PA and MVPA with HOMA-IR independent of WC (P < 0.022). When stratified by CRF level (median split; high/low), MVPA predicted lower HOMA-IR [MVPA β -0.133 (95% CI: -0.223, -0.043); P = 0.004] and clustered cardiometabolic risk [MVPA β -0.094 (95% CI: -0.169, -0.019); P = 0.014] in children with low CRF, but not among their fitter peers (P > 0.232). There was neither direct association between sedentary time and cardiometabolic risk factors in any analyses, nor moderation by CRF. CRF significantly moderated the prospective association between PA and the clustered cardiometabolic risk, but not for time spent sedentary. The magnitude of association between MVPA and clustered cardiometabolic risk was stronger in children with low CRF, and no associations appeared present in their high-fit peers.

Chapter 19 - Cognitive Impairment in Breast Cancer Survivors: The Protective Role of Physical Activity, Cardiorespiratory Fitness, and Exercise Training

Introduction: The chemotherapy-related cognitive impairment is common, but the influencing factors and effective intervention measures are not well known. Objective: To investigate the changes of cognitive function in breast cancer patients before and after chemotherapy, identify the influencing factors of cognitive function in chemotherapy patients, and investigate whether there is a mediating effect among multiple factors. Finally, an intervention was implemented for patients experiencing cognitive dysfunction to evaluate its effects on cognitive function. Methods: Using the convenience sampling method, we recruited 380 breast cancer chemotherapy patients at three tertiary hospitals in Xi&amp;rsquo;an from October 2018 to May 2019. The Chinese version of the Functional Assessment of Cancer Therapy-Cognitive Function scale, the Hamilton Anxiety Scale, the Hamilton Depression Scale, and the social support rating scale were used to evaluate the cognitive function of breast cancer patients during chemotherapy, and analyze the influencing factors of cognitive function. Results: The incidence of chemotherapy-related cognitive dysfunction in breast cancer patients was 19.74% (75/380). The results of the univariate analysis showed that the education level, medical expense payment method, family history of breast cancer, disease stage, and presence of comorbidities could impact cognitive functioning in breast cancer patients receiving chemotherapy (p&lt;0.05). Correlation analysis revealed that there was a negative correlation among cognitive function and anxiety and depression (p&lt;0.01), while a positive correlation with social support (p&lt;0.05). Furthermore, multivariate stepwise regression analysis showed that the education level, medical expense payment method, disease stage, depression, and social support were independent influencing factors of cognitive function in breast cancer patients receiving chemotherapy and that depressive symptoms had a mediating effect in the relationship between social support and cognitive function. Cognitive has been shown to have a positive impact on cognitive function. Conclusion: Cognitive dysfunction in breast cancer patients receiving chemotherapy is a multifactorial condition that requires rigorous educational and social support interventions for improvements of patient outcomes.

PURPOSE: To determine the effect of demographic, health, and treatment factors on moderate to vigorous physical activity (MVPA) in breast cancer patients undergoing chemotherapy. METHODS: Breast cancer patients (N=66, Mage= 48.3±10.0 years) undergoing chemotherapy (CT) wore an accelerometer for 24-hours (worn on the hip during the day and wrist while sleeping) for ten consecutive days (3 days pre-, day of, and 6 days post-CT dose) during three treatment phases (beginning, middle and end of chemotherapy). Mixed models were used to assess the effect of demographic, health, and treatment factors on MVPA. We assessed the effect of time point (burst), treatment status (i.e. pre-CT dose v. day of/post-CT dose), burst x treatment status interaction, age, body mass index, education, total number of comorbidities, disease stage, cumulative treatment cycle number, self-reported pre-diagnosis minutes/day of MVPA, weekend v. weekdays, and self-reported health status on daily minutes of MVPA. RESULTS: On average, breast cancer patients engaged in 20.8 minutes/day (95%CI:17.4,24.1) of MVPA across all bursts. Results indicate a significant decrease of 5.0 minutes/day of MVPA(95%CI:-6.5,-3.5) as time point increases, a 4.2 minute/day decrease in MVPA(95%CI:-5.8,-3.2) on day of CT dose or post-CT days compared to pre-CT dose days, a 0.9 minute/day increase in MVPA (95%CI: 0.5,1.3) as treatment cycle number increases, and a 2.2 minute/day increase in MVPA (95%CI:1.1,3.2) on weekends. CONCLUSIONS: Results from the current analysis suggest treatment-related factors, such as treatment day, post-treatment days, and time undergoing chemotherapy, had the greatest effect on MVPA in breast cancer patients, significantly decreasing minutes per day spent in MVPA over time. These results show the importance of tailoring future physical activity interventions to specific treatment factors in order to reduce the decline in MVPA during chemotherapy.

BackgroundEvidence suggests reallocating daily sedentary time to physical activity or sleep confers important health benefits in cancer survivors. Despite emerging research suggesting physical activity as a treatment for cancer-related cognitive impairment (CRCI), little is known about the interactive effects of behaviors across the 24-h period. The present purpose was to examine the cognitive effects of reallocating sedentary time to light-intensity physical activity, moderate-to-vigorous physical activity (MVPA), or sleep in breast cancer survivors.MethodsBreast cancer survivors (N = 271, Mage = 57.81 ± 9.50 years) completed iPad-based questionnaires and cognitive tasks assessing demographics, health history, executive function, and processing speed (Task-Switch, Trail Making). Participants wore an accelerometer for seven consecutive days to measure their sedentary, physical activity, and sleep behaviors. Single effects (each behavior individually) and partition (controlling for other behaviors) models were used to examine associations among behaviors and cognitive performance. Isotemporal substitution models were used to test the cognitive effects of substituting 30 min of sedentary time with 30 min of light-intensity activity, MVPA, and sleep.ResultsMVPA was associated with faster Task-switch reaction time in the partition models (stay: B = − 35.31, p = 0.02; switch: B = − 48.24, p = 0.004). Replacing 30 min of sedentary time with 30 min of MVPA yielded faster reaction times on Task-Switch stay (B = − 29.37, p = 0.04) and switch (B = − 39.49, p = 0.02) trials. In Trails A single effects models, sedentary behavior was associated with faster completion (B = − 0.97, p = 0.03) and light-intensity activity with slower completion (B = 1.25, p = 0.006). No single effects were observed relative to Trails B completion (all p > 0.05). Only the effect of MVPA was significant in the partition models (Trails A: B = − 3.55, p = 0.03; Trails B: B = − 4.46, p = 0.049). Replacing sedentary time with light-intensity activity was associated with slower Trails A (B = 1.55 p = 0.002) and Trails B (B = 1.69, p = 0.02) completion. Replacing light activity with MVPA yielded faster Trails A (B = − 4.35, p = 0.02) and Trails B (B = − 5.23, p = 0.03) completion.ConclusionsFindings support previous research suggesting MVPA may be needed to improve cognitive function in breast cancer survivors. Trails findings underscore the need to dissect sedentary contexts to better understand the impact of daily behavioral patterns on CRCI. Additional research investigating the cognitive impacts of behaviors across the 24-h period is warranted.Trial registrationThis study is registered with United States ClinicalTrials.gov (NCT02523677; 8/14/2015).

ABSTRACTThe study aims to evaluate the effects and feasibility of a biofeedback device for physical activity (PA) improvement in breast and colon cancer patients. Daily PA of 19 cancer patients was measured by accelerometry (ActiGraph, GT1 M). Additionally, patients wore a motion sensor with real-time visual activity feedback (ActiSmile). Counts per minutes (cpm) and moderate to vigorous physical activity (MVPA) were calculated and patients’ activity data were compared to PA of 20 age-matched healthy controls. Baseline PA of patients was lower compared to controls. Following visual real-time feedback cancer patients increased cpm by 21% (p = .002) and MVPA by 9% (p = .007) compared to baseline measurement. PA levels in cancer patients obtained with visual feedback became almost equal compared to age-matched healthy controls: cpm (301; IQR 170 vs. 299; IQR 111), MVPA (36; IQR 23 vs. 41; IQR 25 min/day). Activity biofeedback seems to be feasible to induce changes in patients’ PA behaviour.

BackgroundC-reactive protein (CRP) concentrations are associated with morbidity and mortality in breast cancer patients and moderate-vigorous physical activity (MVPA) may help regulate CRP levels.PurposeThe purpose of this prospective study was to examine intraindividual and interindividual changes in MVPA on changes in CRP levels among early posttreatment breast cancer patients.MethodsDuring five data collections over the first year posttreatment for breast cancer, women (N = 138, Mage = 55.3, standard deviation = 11.1 years) completed a questionnaire, wore an accelerometer for seven consecutive days to measure MVPA, and provided blood samples to measure CRP concentrations. Intraindividual and interindividual associations between MVPA on CRP were tested using hierarchical linear modeling.ResultsBased on the intraindividual associations, lower concentrations of CRP were evident when participants engaged in more, as compared to their average, MVPA (β = −.02, p < .021). In addition, interindividual analyses showed that women who engaged in more MVPA across the study period had lower concentrations of CRP compared to women who engaged in less MVPA (β = −.24, p = .006).ConclusionsMVPA in breast cancer patients is consistently associated with lower CRP concentrations over time. Interventions may target individual MVPA early after diagnosis to mitigate CRP levels in breast cancer patients.

IntroductionEvidence in the general population suggests that predictors of cardiovascular health such as moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure are associated with cognitive function. Studies supporting these associations in adults with Down syndrome (DS) are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS.MethodsThis is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO2 Peak), and cognitive function (CANTAB® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes.ResultsComplete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ± 14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO2 Peak was correlated with simple movement time (rho = − 0.28, p = 0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: β = − 0.11, p = 0.002; total errors: β = 0.58, p = 0.001) and reaction time (five-choice movement time: β = 4.11, p = 0.03; simple movement time: β = 6.14, p = 0.005) using age- and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time.ConclusionPredictors of cardiovascular health, including cardiorespiratory fitness and systolic blood pressure, were associated with some aspects of cognition in adults with DS. While future research should examine the role of improved cardiovascular health on delaying decreases in cognitive function and dementia in adults with DS, we recommend that health care providers convey the importance of exercise and cardiovascular health to their patients with DS.Trial registrationNCT04048759, registered on August 7, 2019.

Physical activity is related with academic achievement in children. This cross-sectional study aimed to assess whether cardiorespiratory fitness (CRF) and executive function act as mediators of the association between moderate to vigorous physical activity (MVPA) and academic achievement. This study included 186 schoolchildren (9-11 years) from Cuenca, Spain. Sociodemographic variables, anthropometric variables, academic achievement, executive function (inhibition, cognitive flexibility and working memory), CRF (20-m shuttle run) and physical activity (by accelerometry) were measured. Serial mediation models were estimated using the Hayes´ PROCESS macro. The significant paths in the model mediating this relationship between MVPA and academic achievement were as follows: MVPA → CRF → academic achievement (IE = 0.068, 95% CI: [0.018; 0.127]; IE = 0.079, 95% CI: [0.029; 0.144]; and IE = 0.090, 95% CI: [0.032; 0.165], controlling for inhibition, cognitive flexibility and working memory, respectively), MVPA → CRF → inhibition → academic achievement (0.018, 95% CI: [0.001; 0.047]) and MVPA → cognitive flexibility → academic achievement (0.087, 95% CI: [0.012; 0.169]). The relationship between MVPA and academic achievement may not be direct but mediated by CRF, cognitive flexibility, and inhibition via CRF. Physical activity interventions to improve AA should be focused on improvements in CRF and executive function.

PurposeOver the past four decades, the worldwide prevalence of obesity has nearly tripled, with childhood obesity being now more common than ever. Furthermore, children and adolescents with overweight or obesity are at a higher risk of retaining this condition into adulthood (Lobstein et al., 2015). Previous studies have shown that larger increase in body mass index (BMI) during adolescence is associated with less improvements in cardiorespiratory fitness (CRF) and steeper decline in moderate to vigorous physical activity (MVPA) (Kolunsarka et al., 2021). However, the trajectories of these three variables during adolescence are diverse. Therefore, this study aimed to identify and investigate adolescents with similar concurrent changes in MVPA, CRF and BMI throughout adolescence.MethodsIn this four-year longitudinal study (2017-2021), device-measured MVPA, BMI and CRF data were collected annually from 1157 participants (Mage = 11.37 ± 0.37). A multivariate trajectory analysis was used to identify adolescents who share similar BMI, MVPA and CRF trajectories over four years.ResultsThree distinct groups were identified and labelled according to BMI trajectories. The ‘persistently normal’ group (86%) exhibited the highest baseline levels of CRF and MVPA, with significant increases in CRF and a concurrent decrease in MVPA. Conversely, the ‘improving from high’ group (5%) demonstrated a significant increase in CRF and a non-significant (p = 0.07) increase in MVPA. In contrast, the ‘progressing to very high’ group (9%) showed no significant changes in either MVPA or CRF.ConclusionThese findings underscore the critical importance of early identification and targeted interventions to mitigate the risk of accelerated weight gain, insufficient physical activity and declining fitness during adolescence.Funding SourceThis study was funded by the Strategic Research Council within the Academy of Finland within the project SchoolWell, and the Finnish Ministry of Education and Culture.

BackgroundExercise has been shown to facilitate cognitive function; however, data on changes in cognitive function in response to exercise interventions among breast cancer patients and survivors, who frequently experience cognitive impairment, have not been comprehensively synthesized. Therefore, this study aims to examine the impact of exercise interventions on cognitive function among breast cancer patients and survivors.MethodsElectronic databases including PubMed, Scopus, and Web of Science were searched from inception to December 25, 2024. A three-level meta-analysis was performed in R utilizing the standard mean difference. Moderators including cognitive function domains, sample characteristics (i.e., age and timing of exercise), and exercise regimen (i.e., frequency, intensity, type, session time, and length) were examined for subgroup analysis. The methodological quality and the certainty of evidence were evaluated using criteria of the Physiotherapy Evidence Database (PEDro) scale and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, respectively.ResultsA total of 21 identified studies comprising 114 effect sizes were included in the final analysis. Overall, exercise demonstrated a positive small effect size on cognitive function in breast cancer patients and survivors (g = 0.22; 95% confidence interval [CI] 0.07–0.36; p < .001).ConclusionsExercise demonstrated a facilitative effect on various cognitive functions among breast cancer patients during both treatment and survivorship. The non-significant moderation effects further suggest that diverse exercise regimens offer cognitive benefits. However, limited research highlights the need to identify optimal exercise modalities for cognitive enhancement in this population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12282-025-01757-9.

Introduction: Most adults with Down Syndrome (DS) will develop Alzheimer's disease. Evidence in the general population suggests that factors associated with cardiovascular health including, moderate to vigorous physical activity (MVPA), cardiorespiratory fitness, and systolic blood pressure, are associated with better cognitive outcomes and decreased risk of Alzheimer's disease. Studies supporting these associations in adults with DS are limited. The purpose of this study was to examine the associations between systolic blood pressure, cardiorespiratory fitness, and MVPA on cognition in adults with DS. Methods: This is a cross-sectional analysis using baseline data from a trial in adults with DS. Participants attended a laboratory visit where resting blood pressure, cardiorespiratory fitness (VO 2 Peak ) and cognitive function (CANTAB ® DS Battery) were obtained. The cognitive battery included tests measuring multitasking, episodic memory, and reaction time. Physical activity (accelerometer) was collected over the week following the laboratory visit. Pearson correlations and linear regressions were used to measure the impact of systolic blood pressure, cardiorespiratory fitness, and MVPA on cognitive outcomes. Results: Complete data was available for 72 adults with DS (26.8 ± 9.3 years of age, 57% female). At baseline, VO 2 Peak (21.1 ± 4.2 ml/kg/min) and MVPA were low (14.4 ±14.4 min/day), and systolic blood pressure was 118.3 ± 13.3 mmHg. VO 2 Peak was correlated with simple movement time (rho = -0.28, p=0.03) but was not significant using a linear regression controlling for age and sex. Systolic blood pressure was significantly associated with episodic memory (first attempt memory score: β = -0.11, p=0.002; total errors: β = 0.58, p = 0.001) and reaction time (five-choice movement time: β = 4.11, p = 0.03; simple movement time: β = 6.14, p = 0.005) using age-and sex-adjusted linear regressions. No associations were observed between MVPA and multitasking, episodic memory, or reaction time. Conclusion: Cardiovascular risk factors, including cardiorespiratory fitness and systolic blood pressure, were associated with cognition in adults with DS. Given the high prevalence of Alzheimer's disease in adults with DS, future research examining cardiovascular health and Alzheimer's disease risk is warranted.