Higher-intensity exercise results in more sustainable improvements for VO2peak for breast and prostate cancer survivors

Purpose/Objectives: To examine peak volume of oxygen consumption (VO2peak) changes after a high- or low-intensity exercise intervention.
 Design: Experimental trial comparing two randomized intervention groups with control. 
 Setting: An exercise clinic at a university in Australia.
 Sample: 87 prostate cancer survivors (aged 47–80 years) and 72 breast cancer survivors (aged 34–76 years).
 Methods: Participants enrolled in an eight-week exercise intervention (n = 84) or control (n = 75) group. Intervention participants were randomized to low-intensity (n = 44, 60%–65% VO2peak, 50%–65% of one repetition maximum [1RM]) or high-intensity (n = 40, 75%–80% VO2peak, 65%–80% 1RM) exercise groups. Participants in the control group continued usual routines. All participants were assessed at weeks 1 and 10. The intervention groups were reassessed four months postintervention for sustainability. 
 Main Research Variables: VO2peak and self-reported physical activity.
 Findings: Intervention groups improved VO2peak similarly (p = 0.083), and both more than controls (p < 0.001). The high-intensity group maintained VO2peak at follow-up, whereas the low-intensity group regressed (p = 0.021). The low-intensity group minimally changed from baseline to follow-up by 0.5 ml/kg per minute, whereas the high-intensity group significantly improved by 2.2 ml/kg per minute (p = 0.01). Intervention groups always reported similar physical activity levels. 
 Conclusions: Higher-intensity exercise provided more sustainable cardiorespiratory benefits than lower-intensity exercise.
 Implications for Nursing: Survivors need guidance on exercise intensity, because a high volume of low-intensity exercise may not provide sustained health benefits.

Improving muscular endurance with the MVe Fitness ChairTM in breast cancer survivors: A feasibility and efficacy study

Objectives To assess the feasibility and efficacy of delivering Pilates exercises for resistance training to breast cancer survivors using the MVe Fitness Chair™. Design Pilot randomized controlled trial. Methods Twenty-six female breast cancer survivors were randomized to use the MVe Fitness Chair™ (n = 8), traditional resistance training (n = 8), or a control group (no exercise) (CO) (n = 10). The MVe Fitness Chair™ and traditional resistance training groups completed 8 weeks of exercise. Muscular endurance was assessed pre and post-test for comparisons within and between groups using push ups, curl ups, and the Dynamic Muscular Endurance Test Battery for Cancer Patients of Various Ages. Results Feasibility of the MVe Fitness Chair™ was good, evidenced by over 80% adherence for both exercise groups and positive narrative feedback. Significant improvements in muscular endurance were observed in the MVe Fitness Chair™ (p < 0.002) and traditional resistance training groups (p < 0.001), but there were no differences in improvement between the MVe Fitness Chair™ and traditional resistance training groups (p < 0.711) indicating that Pilates and traditional resistance training may be equally effective at improving muscular endurance in this population. Conclusions The MVe Fitness Chair™ is feasible for use in breast cancer survivors. It appears to promote similar improvements in muscular endurance when compared to traditional resistance training, but has several advantages over traditional resistance training, including cost, logistics, enjoyment, and ease of learning.

Quantifying physical activity and the associated barriers for women with ovarian cancer

Objective The purpose of this study was to quantify physical activity levels and determine the barriers to physical activity for women with ovarian cancer. Materials and Methods Women with ovarian cancer from 3 oncology clinics enrolled in the cross-sectional study. Physical activity and barriers to physical activity were measured using the International Physical Activity Questionnaire and Perceived Physical Activity Barriers scale, respectively. Demographic, medical, and anthropometric data were obtained from medical records. Results Ninety-five women (response rate, 41%), with a mean (SD) age of 61 (10.6) years, a body mass index of 26.5 (6.8) kg/m2, and 36.6 (28.2) months since diagnosis, participated in the study. The majority of the participants had stage III (32%) or IV (32%) ovarian cancer, were undergoing chemotherapy (41%), and had a history of chemotherapy (93%). The majority of the participants reduced their physical activity after diagnosis, with 19% meeting recommended physical activity guidelines. The participants undergoing treatment reported lower moderate-vigorous physical activity compared with those not undergoing active treatment (mean [SD], 42 [57] vs 104 [119] min/wk; P < 0.001) and less total physical activity barriers (mean [SD], 49 vs 47; P > 0.4). The greatest barriers to physical activity included fatigue (37.8%), exercise not in routine (34.7%), lack of self-discipline (32.6%), and procrastination (27.4%). Conclusions Women with ovarian cancer have low levels of physical activity. There are disease-specific general barriers to physical activity participation. The majority of the participants reduced their physical activity after diagnosis, with these patients reporting a higher number of total barriers. Behavioral strategies are required to increase physical activity adherence in this population to ensure that recommended guidelines are met to achieve the emerging known benefits of exercise oncology.

Australian Association for Exercise and Sport Science position stand : optimising cancer outcomes through exercise

Cancer represents a major public health concern in Australia. Causes of cancer are multifactorial with lack of physical activity being considered one of the known risk factors, particularly for breast and colorectal cancers. Participating in exercise has also been associated with benefits during and following treatment for cancer, including improvements in psychosocial and physical outcomes, as well as better compliance with treatment regimens, reduced impact of disease symptoms and treatment-related side effects, and survival benefits for particular cancers. The general exercise prescription for people undertaking or having completed cancer treatment is of low to moderate intensity, regular frequency (3-5 times/week) for at least 20 minutes per session, involving aerobic, resistance or mixed exercise types. Future work needs to push the boundaries of this exercise prescription, so that we can better understand what constitutes optimal, desirable and necessary frequency, duration, intensity and type, and how specific characteristics of the individual (e.g., age, cancer type, treatment, presence of specific symptoms) influence this prescription. What follows is a summary of the cancer and exercise literature, in particular the purpose of exercise following diagnosis of cancer, the potential benefits derived by cancer patients and survivors from participating in exercise programs, and exercise prescription guidelines and contraindications or considerations for exercise prescription with this special population. This report represents the position stand of the Australian Association of Exercise and Sport Science on exercise and cancer recovery and has the purpose of guiding Accredited Exercise Physiologists in their work with cancer patients.

Exercise and secondary lymphedema : safety, potential benefits, and research issues

Participating in regular physical activity is encouraged following breast cancer (BC) treatment, except for those who have subsequently developed lymphoedema. We designed a randomised controlled trial to investigate the effect of participating in a supervised, mixed-type, moderate-intensity exercise program among women with lymphoedema following breast cancer. Women <76 years who had completed BC treatment at least six months prior and subsequently developed unilateral, upper-limb lymphoedema were randomly allocated to an intervention (n=16) or control (n=16) group. The intervention group (IG) participated in 20 supervised group exercise sessions over 12 weeks, while the control group (CG) was instructed to continue habitual activities. Lymphoedema status was assessed by bioimpedance spectroscopy (impedance ratio between limbs) and perometry (volume difference between limbs). Mean baseline measures were similar for the IG (1.13+0.15 and 337+307ml, respectively) and CG (1.13+0.15 and 377+416ml, respectively) and no changes were observed over time. However, 2 women in the IG no longer had evidence of lymphoedema by study end. Average attendance was over 70% of supervised sessions, and there were no withdrawals. The results indicate that, at worst, exercise does not exacerbate secondary lymphoedema. Women with secondary lymphoedema should be encouraged to be physically active, optimising their physical and psychosocial recovery.

Exercise for health : a breast cancer recovery program - quality of life benefits [Conference Abstract]

Introduction: Five-year survival from breast cancer in Australia is 87%. Hence, ensuring a good quality of life (QOL) has become a focal point of cancer research and clinical interest. Exercise during and after treatment has been identified as a potential strategy to optimise QOL of women diagnosed with breast cancer.----- Methods: Exercise for Health is a randomised controlled trial of an eight-month, exercise intervention delivered by Exercise Physiologists. An objective of this study was to assess the impact of the exercise program during and following treatment on QOL. Queensland women diagnosed with unilateral breast cancer in 2006/07 were eligible to participate. Those living in urban-Brisbane (n=194) were allocated to either the face-to-face exercise group, the telephone exercise group, or the usual-care group, and those living in rural Queensland (n=143) were allocated to the telephone exercise group or the usual-care group. QOL, as assessed by the Functional Assessment of Cancer Therapy-Breast (FACT-B+4) questionnaire, was measured at 4-6 weeks (pre-intervention), 6 months (mid-intervention) and 12 months (three months post-intervention) post-surgery.----- Results: Significant (P<0.01) increases in QOL were observed between pre-intervention and three months post-intervention 12 months post-surgery for all women. Women in the exercise groups experienced greater mean positive changes in QOL during this time (+10 points) compared with the usual-care groups (+5 to +7 points) after adjusting for baseline QOL. Although all groups experienced an overall increase in QOL, approximately 20% of urban and rural women in the usual-care groups reported a decline in QOL, compared with 10% of women in the exercise groups.----- Conclusions: This work highlights the potential importance of participating in physical activity to optimise QOL following a diagnosis of breast cancer. Results suggest that the telephone may be an effective medium for delivering exercise counselling to newly diagnosed breast cancer patients.

Preliminary Results from Exercise for Health : A Breast Cancer Recovery Project [Abstract]

The Exercise for Health program is a telephone-delivered exercise intervention for women with breast cancer (BC) living in regional Queensland. The effect of the program is being evaluated in the context of a randomised controlled trial. Consenting, newly diagnosed BC patients, treated in one of 8 regional Queensland hospitals, were randomly allocated to telephone-based exercise counselling (EC) or usual care (UC) at 6-weeks post-surgery. EC participants received an exercise workbook and 16 calls from an exercise physiologist over 8 months. Physical activity levels (PA) (Active Australia & CHAMPS), quality-of-life (FACTB+4), upper-body function (DASH) and fatigue (FACIT-Fatigue) were assessed at baseline (4-6 weeks post-surgery), 6- and 12-months post-surgery. Preliminary analyses of available 6-month data were conducted using t-tests and repeated measures ANCOVAs. Participating women (n=143; EC n=73, UC n=70) were aged 53±9 years and 30% met PA guidelines at baseline. Up to two thirds of the women received adjuvant therapy during the first 6 months following surgery. Greater improvements (mean change+SD) occurred for the EC vs UC group in weekly sessions of walking (1.83±4.3 vs -0.5±5.5, p=0.029) moderate-vigorous PA (5.0±6.5 vs -1.1±6.1, p=0.005) and strength training (1.9±2.9 vs -0.5±4.2 p<0.001), and in upper-body function, reflected by lower log-transformed disability scores (-0.34±0.44 vs -0.17±0.28, p=0.038). More EC than UC participants met PA guidelines at 6 months (46.3% vs 32.7%). Preliminary findings from this ongoing trial suggest that the telephone is a feasible and effective medium for delivering exercise counselling to newly diagnosed BC patients living in regional areas.

Age-related differences in exercise and quality of life among breast cancer survivors

Purpose: Physical activity has become a focus of cancer recovery research as it has the potential to reduce treatment-related burden and optimize health-related quality of life (HRQoL). However, the potential for physical activity to influence recovery may be age-dependent. This paper describes physical activity levels and HRQoL among younger and older women after surgery for breast cancer and explores the correlates of physical inactivity. Methods: A population-based sample of breast cancer patients diagnosed in South-East Queensland, Australia, (n=287) were assessed once every three months, from 6 to 18 months post-surgery. The Functional Assessment of Cancer Therapy-Breast questionnaire (FACTB+4) and items from the Behavioral Risk Factor Surveillance System (BRFSS) questionnaire were used to measure HRQoL and physical activity, respectively. Physical activity was assigned metabolic equivalent task (MET) values, and categorized as < 3, 3 to 17.9 and 18+ MET-hours/weeks. Descriptive statistics, generalized linear models with age stratification (<50 years versus 50+ years), and logistic regression were used for analyses (p=0.05, two-tailed). Results: Younger women who engaged in 3 or more MET-hours/week of physical activity reported a higher HRQoL at 18 months compared to their more sedentary counterparts (p<0.05). Older women reported similar HRQoL irrespective of activity level and consistently reported clinically higher HRQoL than younger women. Increasing age, being overweight or obese, and restricting use of the treated side at six months post-surgery increased the likelihood of sedentary behavior (OR>3, p<0.05). Conclusions: Age influences the potential to observe HRQoL benefits related to physical activity participation. These results also provide relevant information for the design of exercise interventions for breast cancer survivors and highlights that some groups of women are at greater risk of long-term sedentary behavior.

Role of exercise in the prevention and management of lymphedema after breast cancer

Swelling or lymphedema of the limb, trunk, or breast is considered the most problematic and dreaded concern after treatment for breast cancer and has significant physical, psychological, and social ramifications. Conservative incidence estimates suggest that 20%-30% of breast cancer survivors will experience lymphedema, with the majority of cases (up to 80%) occurring within the first year after surgery. The etiology of secondary lymphedema seems to be multifactorial, with acquired abnormalities as well as preexisting conditions being contributory factors.

Colorectal cancer survivors’ exercise experiences and preferences : qualitative findings from an exercise rehabilitation programme immediately after chemotherapy

Little is known about cancer survivors’ experiences with and preferences for exercise programmes offered during rehabilitation (immediately after cancer treatment). This study documented colorectal cancer survivors’ experiences in an exercise rehabilitation programme and their preferences for programme content and delivery. At the completion of 12-weeks of supervised exercise, 10 participants took part in one-on-one semi-structured interviews. Data from these interviews were coded, and themes were identified using qualitative software. Key findings were that most participants experienced improvements in treatment symptoms, including reduced fatigue and increased energy and confidence to do activities of daily living. They also reported that interactions with the exercise trainer and a flexible programme delivery were important aspects of the intervention. Most participants reported that they preferred having a choice of exercise, starting to exercise within a month after completing treatment, having supervision and maintaining a one-on-one format. Frustrations included scheduling conflicts and a lack of a transition out of the programme. The findings indicate that colorectal cancers experience benefits from exercise offered immediately after treatment and prefer individual attention from exercise staff. They further indicate directions for the implementation of future exercise programmes with this population.

Randomised controlled trial of a supervised exercise rehabilitation program for colorectal cancer survivors immediately after chemotherapy: study protocol

Background Colorectal cancer (CRC) diagnosis and the ensuing treatments can have a substantial impact on the physical and psychological health of survivors. As the number of CRC survivors increases, so too does the need to develop viable rehabilitation programs to help these survivors return to good health as quickly as possible. Exercise has the potential to address many of the adverse effects of CRC treatment; however, to date, the role of exercise in the rehabilitation of cancer patients immediately after the completion of treatment has received limited research attention. This paper presents the design of a randomised controlled trial which will evaluate the feasibility and efficacy of a 12-week supervised aerobic exercise program (ImPACT Program) on the physiological and psychological markers of rehabilitation, in addition to biomarkers of standard haematological outcomes and the IGF axis. Methods/Design Forty CRC patients will be recruited through oncology clinics and randomised to an exercise group or a usual care control group. Baseline assessment will take place within 4 weeks of the patient completing adjuvant chemotherapy treatment. The exercise program for patients in the intervention group will commence a week after the baseline assessment. The program consists of three supervised moderate-intensity aerobic exercise sessions per week for 12 weeks. All participants will have assessments at baseline (0 wks), mid-intervention (6 wks), post-intervention (12 wks) and at a 6-week follow-up (18 wks). Outcome measures include cardio-respiratory fitness, biomarkers associated with health and survival, and indices of fatigue and quality of life. Process measures are participants' acceptability of, adherence to, and compliance with the exercise program, in addition to the safety of the program. Discussion The results of this study will provide valuable insight into the role of supervised exercise in improving life after CRC. Additionally, process analyses will inform the feasibility of implementing the program in a population of CRC patients immediately after completing chemotherapy.

Exercise for breast cancer survivors: bridging the gap between evidence and practice

Evidence supporting the benefits of exercise following the diagnosis of breast cancer is overwhelming and compelling. Exercise reduces the severity and number of treatment-related side effects, optimizes quality of life during and following treatment, and may optimize survival. Yet, exercise does not uniformly form part of the standards of care provided to women following a breast cancer diagnosis. This commentary summarizes the evidence in support of exercise as a form of adjuvant treatment and identifies and discusses potential issues preventing the formal integration of exercise into breast cancer care. Proposed within the commentary is a model of breast cancer care that incorporates exercise prescription as a key component but also integrates the need for surveillance and management for common breast cancer treatment-related morbidities, as well as education. While future research evaluating the potential cost savings through implementation of such amodel is required, a committed, collaborative approach by clinicians, allied health professionals, and researchers will be instrumental in bridging the gap between research and practice.

A randomized trial of a telephone-delivered exercise intervention for non-urban dwelling women newly diagnosed with breast cancer : exercise for health

Physical activity is important following breast cancer. Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas. This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered, mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer. A randomized controlled trial comparing an 8-month intervention delivered by exercise physiologists (n = 73) to usual care (n = 70). Sixty-one percent recruitment rate and 96% retention at 12 months; 79% of women in the intervention group received at least 75% of calls; odds (OR, 95% CI) of meeting intervention targets favored the intervention group for resistance training (OR 3.2; 1.2, 8.9) and aerobic (OR 2.1; 0.8, 5.5) activity. Given the limited availability of physical activity programs for non-urban women with breast cancer, results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions.

Water-based exercise for patients with chronic arm lymphedema : a randomized controlled pilot trial

Objective: To evaluate the feasibility and effect of a water-based exercise (WBE) program on lymphedema status and shoulder range of motion (ROM) among women with breast cancer related lymphedema. Design: Single-blinded, randomized controlled pilot trial. Twenty-nine eligible breast cancer survivors (median 10 years after surgery) with arm lymphedema (median 21% inter limb difference) were included and randomized into intervention (n= 15) or control (n=14). Twenty-five participants completed the study. The intervention was at least twice weekly WBE for 8 weeks; supervised initially but performed independently during the study period. Outcomes of interest were feasibility as measured by retention and adherence, lymphedema status as measured by optoelectronic perometry, bioimpedance spectroscopy and tissue dielectric constant, and shoulder range of motion (ROM) as measured by goniometer. Results: Four participants were not measured at post-intervention and were not included in the analysis (retention). Four participants in the intervention group did not perform the minimum WBE criteria set (adherence). No effect was found on lymphedema status. Compared to the control group, median ROM change for flexion was 6 (1-10) degrees (p<0.001) and 6 (0-15.5) degrees (p=0,07) for external rotation. Clinically relevant increase in the intervention group was found for 36% in flexion (p≤0.05) and (57%) in external rotation (p≤0.05) compared to controls. Conclusions: This study shows WBE is feasible for breast cancer survivors with arm lymphedema and that shoulder ROM can be improved years after cancer treatment has been completed.