The RESTORE Randomized Controlled Trial: Impact of a Multidisciplinary Rehabilitative Program on Cardiorespiratory Fitness in Esophagogastric Cancer Survivorship: Erratum.

Background Problem: The integration of interval training programs has emerged as a focal point for enhancing the cardiorespiratory endurance and muscular endurance of players. Research Objectives: The main purpose of the present study is to investigate the effect of interval training program on cardiorespiratory endurance and muscular endurance of football payers. Methods: A total of thirty male football players (age 18-24 year) were selected from Imphal West District, Imphal, Manipur (India) who participated in the national level competition. The subjects were randomly assigned into two equal groups, experimental group (n = 15) and control group (n = 15). Before the intervention featuring a six-week interval training program five days of sessions per week (Monday to Friday) each lasting 60 minutes, groups underwent initial assessments through which Cooper’s 12-minute run/walk test for cardiorespiratory endurance and bent-knee sit-ups for muscular endurance. Pre and post-test scores underwent statistical analysis, utilizing descriptive statistics and the Analysis of Covariance test (ANCOVA). The level of significance was set at 0.05 level of confidence. Findings and Results: The experimental group showed improved scores in the cardiorespiratory endurance and muscular endurance compared to the control group (p < 0.05). The mean of the cardiorespiratory endurance and muscular endurance for pretest and posttest of the experimental group were 25.68 ± 25.85 and 27.82 ± 26.25 respectively. The mean of the cardiorespiratory endurance and muscular endurance for pre-test and post-test of the control group were 28.24 ± 28.42 and 32.58 ± 28.80 respectively. Conclusion: It was concluded that the interval training program group had shown significantly improved cardiorespiratory endurance and muscular endurance and the control group had insignificant improvement. It was confirmed that a six weeks interval training program was effective to improve the cardiorespiratory endurance and muscular endurance of football players.

Steep ramp test protocol for preoperative risk assessment and short-term high-intensity interval training to evaluate, improve, and monitor cardiorespiratory fitness in surgical oncology.

The Rehabilitation Strategies in Esophagogastric cancer (RESTORE) randomized controlled trial evaluated the efficacy of a 12-week multidisciplinary program to increase the cardiorespiratory fitness and health-related quality of life (HRQOL) of esophagogastric cancer survivors. Patients following treatment for esophagogastric cancer are at risk of physical deconditioning, nutritional compromise, and sarcopenia. Accordingly, compelling rationale exists to target these impairments in recovery. Disease-free patients treated for esophagogastric cancer were randomized to either usual care or the 12-week RESTORE program (exercise training, dietary counseling, and multidisciplinary education). The primary outcome was cardiopulmonary exercise testing (VO2peak). Secondary outcomes included body composition (bioimpedance analysis), and HRQOL (EORTC-QLQ-C30). Outcomes were assessed at baseline (T0), postintervention (T1), and at 3-month follow-up (T2). Twenty-two participants were randomized to the control group [mean (standard deviation) age 64.14 (10.46) yr, body mass index 25.67 (4.83) kg/m, time postsurgery 33.68 (19.56) mo], and 21 to the intervention group [age 67.19(7.49) yr, body mass index 25.69(4.02) kg/m, time postsurgery 23.52(15.23) mo]. Mean adherence to prescribed exercise sessions were 94(12)% (supervised) and 78(27)% (unsupervised). Correcting for baseline VO2peak, the intervention arm had significantly higher VO2peak at both T1, 22.20 (4.35) versus 21.41 (4.49) mL · min · kg, P < 0.001, and T2, 21.75 (4.27) versus 20.74 (4.65) mL · min · kg, P = 0.001, compared with the control group. Correcting for baseline values, no changes in body composition or HRQOL were observed. The RESTORE program significantly improved cardiorespiratory fitness of disease-free patients after esophagogastric cancer surgery, without compromise to body composition. This randomized controlled trial provides proof of principle for rehabilitation programs in esophagogastric cancer. NCT03314311.

High-intensive interval training (HIIT) is indicated as a means of improving cardiorespiratory fitness (CRF) and musculoskeletal fitness (MSF). The relationship between CRF and MSF was examined too. Little is known about gaining CRF from HIIT independence of MSF in adolescents. Therefore, this study is aimed at investigating whether MSF mediated the relationship between HIIT and CRF and whether sex moderate this relation. The study sample included 122 individuals (45 boys, 77 girls) 16.12 ± 0.38 years of secondary school age. Participants were assigned to the HIIT intervention or control groups. The intervention lasted 14 minutes during one physical education lesson per week for ten weeks. Outcome and potential mediator were residual changes calculated from pre- and postintervention results of MSF components: handgrip (HG), sit-ups (ABS), sit-and-reach (FL), vertical jump (VJ), and Harvard step-test representing cardiorespiratory fitness (CRF). MSF index (MSFI) was calculated as a construct, agglomerating all MSF, and tested its usefulness. HIIT significantly impacted CRF in boys and girls (B = 2.32, p = 0.032; B = 2.28, p = 0.005, respectively). The impact of the HIIT program on the ABS and FL was observed only in girls. The moderation effect of sex was confirmed. Significant effect of HIIT on CRF decreased (Bdirect < Btotal) and was no significant after including FL (B = 1.46, p = 0.62)—complete mediation, but no ABS (B = 2.97, p = 0.001)—partial mediation. CRF was mediated by changes in ABS (B = 2.28, p < 0.001) and FL (4.18, p < 0.001). MSFI was not mediating; its usefulness was limited. HIIT is an effective tool in the development of CRF in both sexes. MSF played a limited role in the relationship between HIIT and CRF. It suggested different mechanisms in both sexes: girls who performed better to the HIIT had better values of FL and ABS, but not boys. HIIT intervention involved modifications in ABS or FL, which also influenced the increase of CRF.

Impaired quality of life (QOL) is commonly experienced by breast cancer survivors (BCS) due to direct effects of cancer or associated treatments. BCS are more predisposed to compromised QOL components in the physical, emotional, social, and cognitive well being domains than the general population. QOL may be affected by cardiorespiratory fitness (CRF); CRF refers to the ability of the circulatory and respiratory systems to supply oxygen to skeletal muscles during sustained physical activity. Higher levels of CRF, measured by maximal oxygen uptake (VO2max), are associated with higher QOL in healthy and diabetic populations, as improved CRF presumably eases activities of daily living and subsequently improves QOL. Limited research has examined the association between CRF and QOL in BCS. Purpose: The purpose of this study was to investigate the association between CRF, measured by estimated VO2max values (relative to body weight), and QOL, assessed by the FACT-B questionnaire, in BCS. Methods: Eligible participants (n = 45) were sedentary women diagnosed with stage I-III breast cancer, and who completed cancer-related treatments within 6 months prior to study enrollment in a larger ongoing exercise intervention trial. Baseline data were collected prior to initiating the exercise intervention. CRF was determined by estimated VO2max value (mL/kg/min) derived from the Single Stage Submaximal Treadmill Test, a 4-minute treadmill walking test where the treadmill speed is self-selected by the participant. Heart rate was obtained upon completion of the test and used to generate an estimated VO2max value using a validated equation. QOL was determined by the FACT-B questionnaire, a validated breast cancer specific questionnaire measuring four dimensions of QOL; physical well-being, social/family well-being, emotional well-being, and functional well-being. Each QOL dimension score was summed to yield an overall QOL score. The FACT-B questionnaire is scored out of a total 144 points from 0 (low QOL) to 144 (high QOL). A Spearman ranked-difference correlation test was used to determine the association between CRF and QOL. Independent t-tests were used to compare mean CRF and QOL between premenopausal and postmenopausal BCS. Results: Among BCS, mean estimated VO2max values were 29.13 ± 6.37 mL/kg/min, classified as average (45th percentile) according to the American College of Sports Medicine. Mean VO2max values for premenopausal BCS (n=24) was 31.01 ± 7.52 mL/kg/min and 27.22 ± 3.79 mL/kg/min for postmenopausal BCS (n=21); however these differences by menopausal status were not statistically significant (p&amp;gt;0.05). Mean FACT-B scores for BCS was 99.79 ± 21.02 (69th percentile). FACT-B mean scores for premenopausal BCS were 97.22 ± 21.23 (67th percentile) and 102.41 ± 21.75 (71st percentile) for postmenopausal BCS; however these differences by menopausal status were not statistically significant (p&amp;gt;0.05). Overall, there was a weak positive correlation between CRF and QOL (rs = 0.27, p&amp;lt;0.05). When stratified by menopausal status, we found a moderate positive correlation between CRF and QOL (rs = 0.48, p&amp;lt;0.05) in postmenopausal BCS. However, in premenopausal BCS, there was a weak non-significant correlation between CRF and QOL (rs = 0.36, p&amp;gt;0.05). Conclusion: In summary, QOL and CRF were weakly related, which differs from the stronger association between CRF and QOL in healthy and diabetic populations. However, this association between CRF and QOL was stronger in postmenopausal BCS, thus it may be valuable to further investigate the effect of menopausal status on CRF and QOL. Both CRF and QOL values were average and above average, respectively, in our sample which may explain the weak-moderate association between CRF and QOL. Nonetheless, due to the possible association between CRF and QOL, it may be necessary to consider investigating this association in a larger sample of BCS. Citation Format: Christina M. Dieli-Conwright, Breanna Orozco, Joanne Mortimer, Debu Tripathy, Darcy Spicer, Leslie Bernstein. Association between cardiorespiratory fitness and quality of life in breast cancer survivors. [abstract]. In: Proceedings of the Thirteenth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2014 Sep 27-Oct 1; New Orleans, LA. Philadelphia (PA): AACR; Can Prev Res 2015;8(10 Suppl): Abstract nr B09.

BackgroundPatients with psoriatic arthritis (PsA) have a remarkable increased risk for cardiometabolic comorbidities impacting their disease management and functioning. Studies in the general population have demonstrated that higher levels of...

Determinants of Exercise Capacity in CKD Patients Treated With Hemodialysis

Physical Activity and Diabetes.

Children tend to be sedentary during the after-school hours, and this has deleterious effects on their health. The objective of the present study was to determine the effects of a 3-year after-school physical activity (PA) program, without restriction of dietary energy intake, on percent body fat (%BF), cardiorespiratory fitness (CRF), and cardiometabolic markers in children. A cluster randomization design was employed. A total of 574 3rd grade children from 18 elementary schools in the southeastern United States participated. The intervention consisted of 80 minutes of age-appropriate moderate-to-vigorous PA each school day. The main outcomes of interest were %BF measured by dual-energy X-ray absorptiometry; CRF measured by heart rate in response to a submaximal step test; nonfasting total and high-density lipoprotein cholesterol (HDL-C); and resting blood pressure (BP). Intent-to-treat analyses showed significant treatment by time interactions for %BF (p = 0.009) and CRF (p = 0.0003). The change pattern of the means suggested that %BF and CRF in intervention children improved relative to control children during the school months, rebounding to the levels of control children over the summers following years 1 and 2. Year-by-year analyses of what occurred during the months when the program was offered revealed dose–response relations for %BF and CRF, such that the clearest beneficial effects were seen for those youth who attended at least 60% of the after-school sessions. No significant intervention effects were seen for cholesterol or BP. An after-school PA program was effective in reducing adiposity and improving CRF, especially in the children who attended the sessions at least 3 days/week. However, the favorable effects on %BF and CRF were lost over the summer. Thus, it is critical to incorporate strategies that attract and retain the children to receive an adequate dose of PA year-round.

Poor cardiorespiratory fitness (CRF) is associated with a higher symptom burden and an increased prevalence of long-term treatment-related cardiovascular disease risk factors in cancer survivors. However, the magnitude of systemic therapy-related CRF impairment remains unclear. The aim of this study was to evaluate the effects of systemic anticancer treatment on CRF and identify physiological determinants underpinning CRF impairment. A systematic literature search was performed in PubMed, Embase, CINAHL, SPORTDiscus, and the Cochrane Library. The primary endpoint was the change in CRF, measured by peak oxygen consumption (Vo2peak), from before to after systemic treatment. Secondary endpoints included post-treatment differences in Vo2peak between cancer survivors and noncancer control subjects, along with physiological determinants of Vo2peak. Two meta-regressions were conducted to examine the association between CRF and cardiac output and arteriovenous oxygen difference. A total of 44 studies were included, comprising 27 prospective trials (61%; n=1,234 cancer survivors, median age 52.4 years) and 17 cross-sectional studies (39%; n=1,372 cancer survivors, median age 54.0 years; n=1,923 noncancer control subjects, median age 56.0 years). Systemic anticancer treatment was associated with a significant decrease in Vo2peak (weighted mean difference-2.13mL·kg-1·min-1; 95% CI:-2.76 to-1.50mL·kg-1·min-1). No significant differences were observed between patient subgroups (esophagogastric, breast, and colon or rectal cancers). At a median follow-up of 2 years (range: 6weeks to 12 years) post-therapy, cancer survivors had a significantly lower Vo2peak (weighted mean difference-6.39mL·kg-1·min-1; 95% CI:-7.60 to-5.18mL·kg-1·min-1) compared with noncancer control subjects. Reduced arteriovenous oxygen difference was associated with lower Vo2peak (β=2.55; 95% CI: 2.05-3.06; P< 0.001). Systemic anticancer treatment leads to substantial and sustained impairments in CRF.

Examining the impact of a summer learning program on children’s weight status and cardiorespiratory fitness: A natural experiment

Background Cancer treatment–related cardiotoxicity (CTrCD) is commonly associated with anthracyclines and anti-HER2 agents which are widely used for the treatment of breast cancer. In order to mitgate CTrCD, exercise-based cardio-oncology rehabilitation (COR) involving a structured exercise program has been proposed. Objectives To evaluate the impact of a cardiac-rehabilitation program in breast cancer patients submitted to chemotherapy with known cardiotoxicity. Methods A systematic review was performed. Two databases were searched, PubMed and SCOPUS. All randomized or controlled trials and other prospective studies published between 2000 and March 2020 which evaluate the impact of an aerobic exercise program on cardiorespiratory fitness (CRF), health-related quality of life (QOL), vascular/endothelial function as well as cardiac assessment namely through the evaluation of left ventricular function and cardiac biomarkers in patients undergoing anthracycline and/or anti-HER2 treatments were included. Main results Fourteen studies were included enrolling 578 breast cancer patients with a mean age of 48.80 years. Regarding the impact of exercise in CRF, 5 studies (n=176) reported a significant improvement of VO2 max. and 4 studies of VO2max./kg (n=137). The peak power output was also improved in 4 studies (n=95) in the exercise-group. Considering the assessment of QOL, 3 studies (n=180) revealed significant differences favoring the exercise-group. The results regarding the evaluation of the LVEF were not clear: 2 studies (n=48) reported a significant decrease on LVEF when compared to baseline at the end of the intervention in both groups, despite the exercise program. However, 2 studies (n=97) showed a significant increase on LVEF in the exercise-group. Three studies (n=82) did not found significant differences in global longitudinal strain between groups. Limited evidence was found in vascular and endothelial functon. In 2 studies (n=50), endothelial function measured by brachial artery flow-mediated dilatation significantly improved in the exercise-group. Two studies (n=98) reported no significant impact of exercise on atenuating the increase of cTnI and BNP levels in the course of chemotherapy. On the other hand, when considering NT-proBNP, an increase in its levels was attenuated in the exercise-group. Conclusions This study confirms that exercise-based COR seems to be an effective approach to improve several cardiovascular outcomes and quality of life in breast cancer patients. Funding Acknowledgement Type of funding sources: None.

Cancer frequently leads to reduced cardiorespiratory fitness (CRF), altered body composition, and increased fatigue, negatively impacting quality of life. This study aimed to evaluate the effects of a multimodal oncological exercise program on CRF, body composition, functional capacity, fatigue, and quality of life in breast cancer survivors. Seventy-four breast cancer survivors (stages IA-IIIB) were randomized to either an intervention group (n = 40), participating in a 16-week, twice-weekly multimodal exercise program (in-person or online), or a control group (n = 34). CRF was the primary outcome. Measurements were taken at baseline and post-intervention. The intervention group showed significant improvements in CRF (+22.4%), fat mass (-10%), and lean mass (+5.24%). Functional capacity and physical activity levels also increased. No significant differences were found between in-person and online delivery formats, suggesting the effectiveness of remote interventions. A 16-week structured, multimodal exercise program significantly improved CRF, body composition, and physical function in breast cancer survivors. Comparable outcomes between in-person and online formats support the feasibility and utility of remote exercise programs in oncology care.

Changes in cardiorespiratory fitness in cardiac rehabilitation patients: A meta-analysis

Purpose: Cancer survivors’ exposure to chemotherapeutic agents leads to multiple long-term side effects with a decrease in their cardiorespiratory fitness. The first aim was to determine whether cardiorespiratory fitness and physical activity levels were lower among survivors than healthy Canadians, while the second aim was to report associations between genetic variants and cardiorespiratory fitness in survivors. Methods: Cardiorespiratory fitness (VO2peak) and moderate to vigorous physical activity (MVPA) were compared between childhood ALL survivors (N=221) and healthy Canadians (N=825). We performed whole-exome sequencing in survivors. Germline variants (both common and rare) in a selected set of trainability genes were analyzed for an association with cardiorespiratory fitness. Results: Survivors’ VO2 peak was found to be 22% lower than healthy Canadians. The cardiorespiratory fitness level was different between survivors and healthy Canadians despite a clinically equivalent level of MVPA. Positive associations between the cardiorespiratory fitness level and trainability genes (TTN, LEPR, IGFBPI, and ENO3 genes) were reported, especially in female survivors with a low cardiorespiratory fitness level. Conclusion: The cardiorespiratory fitness was significantly lower in survivors, which can be associated with variants in genes related to subjects’ trainability. At this time, it appears that more physical activity would be beneficial to survivors to achieve the same benefits as the healthy population. However, the optimal amount of physical activity needed to reach these benefits is not yet clear. The survivors’ responder or nonresponder status several years after the end of the treatments is unknown. This study has important implications for the field of exercise in oncology. Citation Format: Maxime Caru, Kateryna Petrykey, Mariia Samoilenko, Simon Drouin, Valérie Lemay, Laurence Kern, Lucia Romo, Patrick Beaulieu, Pascal St-Onge, Laurence Bertout, Geneviéve Lefebvre, Gregor Andelfinger, Maja Krajinovic, Caroline Laverdière, Daniel Sinnett, Daniel Curnier. The need to improve exercise prescriptions to support care in pediatric oncology [abstract]. In: Proceedings of the AACR Special Conference on the Advances in Pediatric Cancer Research; 2019 Sep 17-20; Montreal, QC, Canada. Philadelphia (PA): AACR; Cancer Res 2020;80(14 Suppl):Abstract nr B62.