Fitness In Cancer Survivors Research Articles

Functional Fitness In Cancer Survivors

Functional Fitness In Cancer Survivors

Interleukin-15 and high-intensity exercise: relationship with inflammation, body composition and fitness in cancer survivors.

Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth. These anti-oncogenic effects of exercise were associated with the exercise-mediated release of myokines such as interleukin (IL)-15. However, no study has quantified the acute IL-15 response in human cancer survivors, and whether physiological adaptations to exercise training (i.e. body composition and cardiorespiratory fitness) influence this response. In the present study breast, prostate and colorectal cancer survivors (n=14) completed a single bout of high-intensity interval exercise (HIIE) [4×4min at 85-95% heart rate (HR) peak, 3min at 50-70% HR peak] before and after 7months of three times weekly high-intensity interval training (HIIT) on a cycle ergometer. At each time point venous blood was sampled before and immediately after HIIE to assess the acute myokine (IL-15, IL-6, IL-10, IL-1ra) responses. Markers of inflammation, cardiorespiratory fitness and measures of body composition were obtained at baseline and 7months. An acute bout of HIIE resulted in a significant increase in IL-15 concentrations (pre-intervention: 113%; P=0.013, post-intervention: 102%; P=0.005). Post-exercise IL-15 concentrations were associated with all other post-exercise myokine concentrations, lean mass (P=0.031), visceral adipose tissue (P=0.039) and absolute peak (P=0.032). There was no significant effect of 7months of HIIT on pre- or post-HIIE IL-15 concentrations (P>0.05). This study demonstrates HIIE is a sufficient stimulus to increase circulating IL-15 and other myokines including IL-6, IL-10 and IL-1ra which may be clinically relevant in the anti-oncogenic effect of exercise and repetitive exposure to these effects may contribute to the positive relationship between exercise and cancer recurrence. KEY POINTS: Exercise has been demonstrated to reduce the risk of cancer recurrence. Pre-clinical murine and in vitro models have demonstrated that exercise suppresses tumour and cancer cell growth, mediated by exercise-induced myokines (IL-6 and IL-15). High-intensity interval exercise significantly increased myokines associated with the anti-oncogenic effect of exercise and the magnitude of response was associated with lean mass, but training did not appear to influence this response. Given IL-15 has been implicated in the anti-oncogenic effect of exercise and is being explored as an immunotherapy agent, high-intensity interval exercise may improve outcomes for people living beyond cancer through IL-15-mediated pathways. Interventions that increase lean mass may also enhance this response.

Balke-Ware Vo2peak Prediction Equations Are Inaccurate For Cancer Survivors

INTRO: Cancer and its treatments may cause cardiotoxicities such as cardiomyopathy, EKG abnormalities, lower left ejection fractions, reduced cardiac output, and decreased blood perfusion in tissues. Physical abatements related to cancer and its treatments can be reduced with an individualized exercise prescription. Proper cardiovascular testing is crucial for an exercise prescription and can result in improved VO2Peak (VO2P) as a measure of cardiovascular health and overall quality of life. Currently, a cancer-specific protocol (CANCER) is the only validated treadmill protocol for cancer survivors. Despite this, the Balke-Ware (BW) protocol is often used in clinical settings but it has only been validated for apparently healthy individuals. It is unknown if the BW is appropriate for cancer survivors. PURPOSE: To determine if (1) measured VO2P from BW and CANCER protocols differ and (2) if predictive VO2P equations for the BW are accurate for testing cardiovascular fitness in cancer survivors. METHODS: Thirty-four subjects participated in the study. Subjects completed the CANCER and BW protocols one week apart in randomized order. Measured VO2P was obtained from gas analysis using a research grade metabolic cart. Predicted VO2P was calculated using BW prediction equations from the completed BW gas analysis test. A paired samples t-test was used to test for significance (p < 0.05) for both comparisons. RESULTS: All subjects completed the CANCER protocol, but one subject could not complete the BW. No significant differences were found in VO2P values (mL·kg-1 ·min-1) between CANCER (28.1 ± 0.65) and BW (26.3 ± 0.76) (p = 0.192). Significant differences were found between predicted and actual VO2P from the BW protocol (19.7 ± 1.33 vs. 26.3 ± 0.76, respectively) (p < 0.001). CONCLUSION: Data indicates if direct gas analysis is available, BW appropriately determines VO2P in cancer survivors. However, if direct gas analysis is unavailable, BW predictive VO2P equations significantly underestimate VO2P in cancer survivors. The CANCER protocol provides accurate VO2P values with or without a metabolic cart. Therefore, in a clinical setting where using direct gas analysis may not be practical, the CANCER protocol remains the current gold standard for assessing cardiovascular fitness in cancer survivors.

Severity of Fatigue is Associated with Cardiorespiratory Fitness in Cancer Survivors

Severity of Fatigue is Associated with Cardiorespiratory Fitness in Cancer Survivors

Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting

Observational studies demonstrate an association between physical activity and improved outcomes in breast and colon cancer survivors. To test these observations with a large, randomized clinical trial, an intervention that significantly impacts physical activity in these patients is needed. The Active After Cancer Trial (AACT) was a multicenter pilot study evaluating the feasibility of a telephone-based exercise intervention in a cooperative group setting. Sedentary (engaging in <60 min of recreational activity/week) breast and colorectal cancer survivors were randomized to a telephone-based exercise intervention or usual care control group. The intervention was delivered through the University of California at San Diego; participants received ten phone calls over the course of the 16-week intervention. All participants underwent assessment of physical activity, fitness, physical functioning, fatigue and exercise self-efficacy at baseline and after the 16-week intervention. One hundred and twenty-one patients were enrolled through ten Cancer and Leukemia Group B (CALGB) institutions; 100 patients had breast cancer and 21 had colorectal cancer. Participants randomized to the exercise group increased physical activity by more than 100 versus 22% in controls (54.5 vs. 14.6 min, P = 0.13), and experienced significant increases in fitness (increased 6-min walk test distance by 186.9 vs. 81.9 feet, P = 0.006) and physical functioning (7.1 vs. 2.6, P = 0.04) as compared to the control group. Breast and colorectal cancer survivors enrolled in a multicenter, telephone-based physical activity intervention increased physical activity and experienced significant improvements in fitness and physical functioning. Lifestyle intervention research is feasible in a cooperative group setting.

Normalization of Cardiovascular Fitness in Cancer Survivors Following an Exercise Intervention

Research has consistently shown that exercise improves cardiovascular function in cancer survivors. However, this improvement has yet to be compared against the general population. PURPOSE: To evaluate cardiovascular fitness pre and post exercise intervention in cancer survivors against the normative data for a cancer population and the general US population. A secondary purpose was to compare the percent change in cardiovascular fitness in cancer survivors to that of an apparently healthy population. METHODS: Exercise treadmill test performance was evaluated in a cancer population of 543 subjects. Subjects ranged in age from 19 to 70+ years with 79% representing females. Normal distributions for VO2 peak and treadmill time (Bruce protocol) were created for the cancer population at baseline (intake) and following a 3 or 6-month exercise intervention. Cardiovascular values for ten age and gender groups were compared against the normative classifications of a cancer population and the general US population according to ACSM norms. RESULTS: Four age groups improved in cardiovascular classification (from very poor to poor) when evaluated with the US population norms. All but one age group improved its cardiovascular classification (5 groups: average to above average; 3 groups: average to excellent; 1 group: above average to excellent) when evaluated with cancer population norms. Average VO2 peak values improved from 21.6 ± 6.3 mL·kg-1·min-1 to 24.84 ± 6.18 mL·kg-1·min-1. This 15% improvement mirrored the increase in aerobic capacity seen in healthy individuals following a similar exercise intervention. Mean treadmill time improved from 5:52 ± 2:38 minutes to 7:09 ± 2:22 minutes. Prior to the exercise intervention, distinctive peaks in the treadmill time distribution occurred at stage changes at 3:00 and 6:00 minutes. The 3:00 minute peak was not present following the intervention, while 6:00 and 9:00 minute peaks were observed. CONCLUSION: Although all age groups remained in a "very poor or poor" classification based upon US norms, when evaluated using cancer specific norms the data indicated substantial improvement. These improvements parallel the response seen in healthy individuals. This emphasizes the importance of cancer specific normative data.

Improved physical fitness of cancer survivors: A randomised controlled trial comparing physical training with physical and cognitive-behavioural training

We compared the effect of a group-based 12-week supervised exercise programme, i.e. aerobic and resistance exercise, and group sports, with that of the same programme combined with cognitive-behavioural training on physical fitness and activity of cancer survivors. One hundred and forty seven cancer survivors (all cancer types, medical treatment ≥3 months ago) were randomly assigned to physical training (PT, n=71) or PT plus cognitive-behavioural training (PT+CBT, n=76). Maximal aerobic capacity, muscle strength and physical activity were assessed at baseline and post-intervention. Analyses using multilevel linear mixed-effects models showed that cancer survivors’ physical fitness increased significantly in PT and PT+CBT from baseline to post-intervention. Changes did not differ between PT and PT+CBT. Physical fitness of cancer survivors was improved following an intensive physical training programme. Adding a structured cognitive-behavioural intervention did not enhance the effect.

Exercise Training Manages Cardiopulmonary Function and Fatigue During and Following Cancer Treatment in Male Cancer Survivors

This investigation determined the cardiopulmonary function and fatigue alterations in male cancer survivors during treatment as well as following treatment utilizing similar exercise assessment protocols and individualized, prescriptive exercise interventions. The study included 45 male cancer survivors that were referred by local oncologists. Following a comprehensive screening and physical examination, cardiovascular endurance, pulmonary function, and fatigue were assessed leading to the development of 12-week individualized exercise prescriptions and exercise interventions. The cancer survivors were divided into during treatment (DTm) and following treatment (FTm) groups. Repeated-measures analysis of variance and analyses of covariance were used to compare pre- versus postintervention and between groups. Cardiopulmonary function was maintained in the DTm, whereas the FTm showed significant reductions in resting heart rate (P < .05) with concurrent increases in predicted VO2max and time on treadmill ( P < .05) postexercise intervention. Fatigue levels did not increase in the DTm group, whereas the FTm group showed significant reductions in behavioral fatigue, affective fatigue, sensory fatigue, cognitive/mood fatigue, and total fatigue (P < .05) after the exercise intervention. The results of the current study suggest that moderate intensity, individualized, prescriptive exercise intervention maintains or improves cardiovascular and pulmonary function with concomitant reductions in fatigue in cancer survivors during and following cancer treatment. Exercise appears to be a safe, efficacious strategy for improving physical fitness in cancer survivors during and following treatment.

Fitness and quality of life in endometrial cancer survivors and controls

19502 Background: It has been suggested that sedentary behavior during cancer treatment or effects of the treatment itself may decrease cardiorespiratory fitness in cancer survivors. However, few studies have tested whether cancer survivors actually have impaired cardiorespiratory fitness compared to similarly aged individuals who have not had cancer. We investigated whether endometrial cancer survivors had poorer fitness than women of similar age and activity level with no cancer history. Methods: The sample included endometrial cancer survivors in a pilot exercise study; all had been diagnosed with Stage I-IIIa disease and were at least 6 months post- treatment. Controls were recruited from a local multi-speciality clinic. Both groups had no contraindications to exercise and were sedentary. Cardiorespiratory fitness was measured by predicted maximal myocardial oxygen carrying capacity (MV02 max) on a submaximal ramped cycle ergometer test. Quality of life was measured using the SF-36 (physical and mental component scores). Results: The study accrued 20 survivors (Mean age=58.6, SD=7.9; Mean BMI=30.5, SD=7.7) and 13 controls (Mean age=55.8, SD=7.6; Mean BMI=30.3, SD=7.0). In t-tests comparing survivors and controls, there were significant differences in predicted MV02 max (p=0.044) and physical aspects of quality of life (p=0.004), but not mental aspects of quality of life. After adjusting for age and BMI using ANCOVA, the p value for predicted MV02 max increased to 0.068, but differences in physical quality of life remained significant (see Table 1 ). Conclusions: Endometrial cancer survivors have diminished quality of life in the physical domain compared to women who have not had cancer; similar results were found for cardiorespiratory fitness, although the effect was attenuated after adjusting for BMI and age. The results suggest endometrial cancer survivors could benefit from exercise interventions to improve fitness and physical functioning. Table 1 : Fitness and quality of life of endometrial cancer survivors and controls. [Table: see text] No significant financial relationships to disclose.