Targeted Exercise Training for Cancer Patients: Moving beyond Generic Exercise Guidelines in Clinical Oncology
The field of exercise oncology has rapidly evolved over the past 30 years. Initial investigations of safety and feasibility have progressed towards efficacy and effectiveness trials with a variety of health-related outcomes in mind. More recently, it has been recognized that interventions aimed at modifying physical activity behavior (i.e. behavioral interventions to increase participation in un/structured physical activity) are distinctly different from those aiming to target a clinically relevant outcome (using a specific exercise prescription). There is a strong rationale for the latter, where cancer/treatment toxicities can result in musculoskeletal, cardiopulmonary, and/or hematological declines with important prognostic implications. Treatment intolerance, unfavorable tumor response and heightened risk of mortality are all consequences of leaving these impairments unaddressed. Importantly, the control/ reversal of the decline in these systems is more likely to occur through a targeted exercise prescription, specifically designed to target the impairment, rather than interventions trying to change behavior. This requires careful consideration in the study design in exercise oncology in relation to the selection of clinically relevant outcomes, decisions on methods of assessments and ensuring the exercise is targeted to the outcome.
The objective of this review is to 1) conceptualize and provide a clinical rationale for targeted exercise interventions in exercise oncology, and 2) provide a framework for consideration in the design and execution in targeted exercise interventions in oncology. We hope that this framework can encourage research into targeted exercise interventions in oncology and that our framework can be used to inform the design of future trials.
Strengthening the case for cluster set resistance training in aged and clinical settings: Emerging evidence, proposed benefits and suggestions
Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) confgurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and ‘power’ outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifcally, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS ofer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efcacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefts in healthy populations.
Exercise Medicine in the Management of Pancreatic Cancer: A Systematic Review.
The aim of this study was to examine the health-related effects of exercise in patients with pancreatic cancer (PanCa) through a systematic review of current evidence. Studies were obtained through searching PubMed, Web of Science, PsycINFO, Embase, CINAHL Plus, and Cochrane Library databases with additional hand searches. All intervention-based studies were included if it involved (1) adult patients with PanCa, (2) exercise training, and (3) findings in quality of life, cancer-related fatigue, psychological distress, and physical function. The review protocol was registered in PROSPERO: CRD42020154684. Seven trials described in 9 publications were included consisting of 201 patients with early-stage and advanced PanCa. Participants were required to perform supervised and/or home-based, low- to moderate-intensity resistance and/or aerobic exercise for 12 to 35 weeks or duration of neoadjuvant therapy. There were no exercise-related adverse events with a reported retention rate of 71% to 90% and exercise attendance of 64% to 96%. The programs were consistently associated with improvements in cancer-related fatigue, psychological distress, and physical function, with mixed effects on quality of life. Exercise training seems to be safe and feasible and may have a beneficial effect on various physical and psychological outcomes in patients with PanCa. Further work with rigorous study designs is required to consolidate and advance current findings.
Psychological Distress in Men with Prostate Cancer Undertaking Androgen Deprivation Therapy: Modifying Effects of Exercise from a Year-long Randomised Controlled Trial
Objectives To assess the long-term effects of various exercise modes on psychological distress in men with prostate cancer on androgen deprivation therapy (ADT). Patients and methods 135 prostate cancer patients aged 43–90 years on ADT were randomized to twice weekly supervised impact loading and resistance exercise (ImpRes), supervised aerobic and resistance exercise (AerRes), and usual care/ delayed supervised aerobic exercise (DelAer) for 12 months, and completed measures of psychological distress using the Brief Symptom Inventory-18 (BSI-18). BSI-18 provides three subscales for anxiety, depression, and somatisation, as well as the global severity index (GSI) where higher scores indicate higher distress. Results Following the intervention, somatization was not different to baseline, however, there were significant interactions (p < 0.01) for depression, anxiety, and the GSI. In ImpRes, depression was reduced at 12 months compared to baseline and 6 months (0.78 ± 1.39 vs. 1.88 ± 3.24 and 1.48 ± 2.65, p < 0.001), as was the GSI (3.67 ± 4.34 vs. 5.94 ± 7.46 and 4.64 ± 4.73, p < 0.001) with anxiety reduced compared to baseline (1.08 ± 1.54 vs. 1.98 ± 2.56). Depression and the GSI decreased (p < 0.05) in AerRes at 6 months but increased by 12 months, while in DelAer the GSI was reduced at 12 months compared to 6 months (3.78 ± 3.94 vs. 5.25 ± 4.22, p = 0.031). Men with the highest level of anxiety, depression, somatization, and the GSI improved the most with exercise (ptrend < 0.001). Conclusion Various supervised exercise modes (aerobic, resistance and impact loading) are effective in reducing psychological distress in men with prostate cancer on ADT. Those with the highest level of psychological distress improved the most. Supervised exercise should be prescribed to improve psychological health in prostate cancer patients on ADT.
ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer – Study Protocol
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme.
Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank.
Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery.
Evaluation of an Exercise Intervention for Effects on Sexual Function in Men with Advanced Prostate Cancer: A Randomised Controlled Trial.
Objectives Treatments for prostate cancer such as androgen deprivation therapy (ADT), surgery and radiation therapy can adversely affect sexual, urinary and bowel function. Preliminary research has demonstrated the efficacy of exercise to preserve sexual function in men with localised prostate cancer receiving ADT, though this has yet to be investigated in a metastatic setting. We examined the effects of a 12-week exercise programme comprising resistance, aerobic and flexibility training on sexual health and function in men with advanced prostate cancer.
Methods Patients with prostate cancer (70.0±8.4 year; body mass index 28.7±4.0 kg/m2) with bone metastases (rib/thoracic spine, 66.7%; lumbar spine, 43.9%; pelvis, 75.4%; femur, 40.4%; humerus, 24.6%; other sites, 70.2%) were randomly assigned to supervised exercise 3 days/week (n=28) or usual care (n=29). Sexual health and function were assessed using the International Index of Erectile Function, the Expanded Prostate Cancer Index Composite and the EORTC-PR25 at baseline and 12 weeks.
Results Patients attended 89% of planned sessions and there were no adverse events. After adjusting for baseline values, there was no significant difference between groups for any measure of sexual function and activity (p>0.05). Additionally, there was no significant difference between groups for urinary and bowel function assessed by the EORTC-PR25 (p>0.05).
Conclusions A short-term programme of supervised exercise does not appear to enhance indices of sexual health and function in men with advanced prostate cancer. Limitations of the intervention included the conservative modular exercise programme, which deliberately avoided loading bone metastatic sites.
Sport Medicine in the Prevention and Management of Cancer
Physical inactivity is a major concern in cancer patients despite the established preventative and therapeutic effects of regular physical exercise for this patient group. Sport not only plays an important role in supporting the development and maintenance of a physically active lifestyle but also is increasingly used as a health promotion activity in various populations. Nevertheless, the potential of sport as an effective strategy in the prevention and management of cancer has gained little attention. Based on the scant evidence to date, participation of cancer patients in supervised, well-tailored sport programs appears to be safe and feasible and is associated with an array of physical and psychological benefits. We propose that sport participation may serve as an alternative strategy in the prevention of cancer and sport medicine in the management of cancer. As with the traditional exercise modes, benefits derived from sport participation will be dependent on the sport undertaken and the physical/physiological, motor, and cognitive demands required. To this end, further work is required to develop a solid evidence base in this field so that targeted sport participation can be recommended for cancer patients
Effects of an Exercise and Dietary Intervention on Select Social Cognitive Outcomes in Prostate Cancer Patients Undergoing Androgen Deprivation Therapy
Objective. To compare the effects of a group-mediated cognitive behavioral (GMCB) exercise and dietary (EX+D) intervention with those of standard-of-care (SC) treatment on select social cognitive outcomes in prostate cancer (PCa) patients undergoing androgen deprivation therapy (ADT). Methods. In the single-blind, 2-arm, randomized controlled Individualized Diet and Exercise Adherence–Pilot (IDEA-P) trial, 32 PCa patients (mean age = 66.2 years; SD = 7.8) undergoing ADT were randomly assigned to a 12-week EX+D intervention (n = 16) or SC treatment (n = 16). The exercise component of the personalized EX+D intervention integrated a combination of supervised resistance and aerobic exercise performed twice per week. The dietary component involved counseling and education to modify dietary intake and composition. Blinded assessments of social cognitive outcomes were obtained at baseline and 2-month and 3-month follow-up. Results. Intent-to-treat analysis of covariance demonstrated that the EX+D intervention resulted in significantly greater improvements in scheduling (P < .05), coping (P < .01), and exercise self-efficacy (P < .05), and satisfaction with function (P < .01) at 3 months relative to SC. Results of partial correlation analysis also demonstrated that select social cognitive outcomes were significantly correlated with primary trial outcomes of mobility performance and exercise participation (P < .05) at 3-month follow-up. Conclusions: The GMCB lifestyle intervention yielded more favorable improvements in relevant social cognitive outcomes relative to SC among PCa patients undergoing ADT. Additionally, more favorable social cognitive outcomes were associated with superior mobility performance and exercise participation following the independent maintenance phase of the EX+D intervention.
The Exercise Oncology Twitter Conference: Disseminating Research in the Age of Social Media
Background: Scientists are using social media to amplify their scientific impact. As such, researchers are looking for novel ways to engage this medium to promote scientific findings and communicate research to a broader audience. Here, we examine the use of a Twitter conference as a means to effectively communicate advances in the field of exercise oncology.
Methods: The Exercise Oncology Twitter Conference (ExOncTC) occurred in October 2018. Each presentation consisted of 6 tweets over 15 min. Attendees were able to interact during a presentation via the conference hashtag (#ExOncTC). Registration data were used to characterize presenters and participants while Twitter Analytics/Union Metrics were used to aggregate data to determine engagement and reach.
Results: The ExOncTC featured 68 presenters from 13 countries and 48 institutions. Presenters varied in academic background (ranging from undergraduate students [1.5%] to terminal degree holders [46%]) and profession (including researchers [42.5%] and physicians [6%]). Participants, including researchers, physicians, students, patients, and organizations could register via the Web site (n = 231), follow the @ExOncTC Twitter handle (n = 805), and/or search the #ExOncTC hashtag. During the conference, #ExOncTC was tweeted 1,501 times by 483 unique users for 4,943 total engagements (number of times a user interacts with a tweet). Collectively, these tweets reached 453,900 distinct users with potential impressions equaling 1.8 million (number of views possible).
Conclusion: Reach of the ExOncTC demonstrates the potential effectiveness of using a Twitter conference as a platform to communicate the field of exercise oncology, suggesting Twitter conferencing should be explored as a tool for scientific dissemination to the broader field of clinical exercise physiology.
Examining the effects of creatine supplementation in augmenting adaptations to resistance training in patients with prostate cancer undergoing androgen deprivation therapy: a randomised, double-blind, placebo-controlled trial
Introduction: Creatine supplementation has consistently been demonstrated to augment adaptations in body composition, muscle strength and physical function in a variety of apparently healthy older adults and clinical populations. The effects of creatine supplementation and resistance training in individuals with cancer have yet to be investigated. This study aims to examine the effects of creatine supplementation in conjunction with resistance training on body composition, muscle strength and physical function in prostate cancer patients undergoing androgen deprivation therapy.
Methods and analysis: This is a randomised, double-blind, placebo-controlled trial designed to examine the effects of creatine supplementation in addition to resistance training in patients with prostate cancer receiving androgen deprivation therapy. Both supplement and placebo groups will receive a 12-week supervised exercise programme comprising resistance training undertaken three times per week. The primary endpoint (fat-free mass) and secondary endpoints (fat mass, per cent body fat, physical fitness, quality of life and blood biomarkers) will be assessed at baseline and immediately following the intervention.
Ethics and dissemination: The Human Research Ethics Committee of Edith Cowan University approved this study (ID: 22243 FAIRMAN). If the results of this trial demonstrate that creatine supplementation can augment beneficial adaptations of body composition, physical function and/or psychosocial outcomes to resistance training, this study will provide effect sizes that will inform the design of subsequent definitive randomised controlled trials. The results of this study will be published in peer-reviewed journals and presented at various national and international conferences.
Reporting of Resistance Training Dose, Adherence, and Tolerance in Exercise Oncology
Purpose: While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence, and tolerance in patients with cancer.
Methods: A total of 47 prostate cancer patients (70.1 ± 8.9 yr, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 wk. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (exercise-relative dose intensity, dose modification, and exercise interruption). Total training volume in kilograms (repetitions × sets × training load (weight)) was calculated for each patient.
Results: Attendance assessed from traditional metrics was 79.5% ± 17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean exercise-relative dose intensity of 77.4% ± 16.6% (range: 19.4% -99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol.
Conclusions: Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence, and tolerance may have important applications for future studies and clinical practice.
Exercise Professionals in the Cancer Center: Experiences, Recommendations, and Future Research.
In 2018, the Clinical Oncology Society of Australia published a landmark position statement calling for exercise to be integrated as standard practice in cancer care. Efforts to implement this directive in the years ahead will come with many practical challenges. We suggest that for the successful integration of exercise therapy to occur, exercise professionals and their services will have to become a respected, visible, and promoted part of the cancer treatment center itself (i.e., “part of the woodwork”). However, we are aware of no report in the literature documenting the role or experiences of an exercise professional working within a cancer center, or practical recommendations for the implementation and evaluation of exercise services in this setting. Therefore, we detail the experiences of an accredited exercise physiologist, to our knowledge, one of the first to be employed on a full-time basis within a cancer center in Australia (M.M.). On the basis of this case study, we provide practical recommendations for exercise professionals seeking to integrate exercise services within the cancer treatment setting. In addition, we present a model of care involving a key role for the exercise professional, which could be implemented to improve patient care and health outcomes throughout cancer treatment and beyond. Although our article is written from an Australian perspective, our recommendations may be relevant to and/or adapted for health care systems in other countries.
The Potential Therapeutic Effects of Creatine Supplementation on Body Composition and Muscle Function in Cancer.
independence and is associated with greater treatment toxicity and poorer prognosis. Exercise interventions are regularly being investigated as a means to ameliorate treatment-related adverse effects, and nutritional/supplementation strategies to augment adaptations to exercise are highly valuable. Creatine (Cr) is a naturally-occurring substance in the human body that plays a critical role in energy provision during muscle contraction. Given the beneficial effects of Cr supplementation on lean body mass, strength, and physical function in a variety of clinical populations, there is therapeutic potential in individuals with cancer at heightened risk for muscle loss. Here, we provide an overview of Cr physiology, summarize the evidence on the use of Cr supplementation in various aging/clinical populations, explore mechanisms of action, and provide perspectives on the potential therapeutic role of Cr in the exercise oncology setting.
Effects of a Group-Mediated Exercise and Dietary Intervention in the Treatment of Prostate Cancer Patients Undergoing Androgen Deprivation Therapy: Results From the IDEA-P Trial
Background: Although androgen-deprivation therapy (ADT) is the foundation of treatment for prostate cancer, the physiological impacts of ADT result in functional decline and enhanced risk of chronic disease and metabolic syndrome.
Purpose: The Individualized Diet and Exercise Adherence Pilot Trial (IDEA-P) is a single-blind, randomized, pilot trial comparing the effects of a group-mediated, cognitive-behavioral (GMCB) exercise and dietary intervention (EX+D) with those of a standard-of-care (SC) control during the treatment of prostate cancer patients undergoing ADT.
Methods: A total of 32 prostate cancer patients (M age = 66.28, SD = 7.79) undergoing ADT were randomly assigned to the 12-week EX+D intervention (n = 16) or control (n = 16). The primary outcome in IDEA-P was change in mobility performance with secondary outcomes including body composition and muscular strength. Blinded assessment of outcomes were obtained at baseline and at 2- and 3-month follow-ups.
Results: Favorable adherence and retention rates were observed, and no serious intervention-related adverse events were documented. Intent-to-treat ANCOVA controlling for baseline value and ADT duration demonstrated that EX+D resulted in significantly greater improvements in mobility performance (p < .02), muscular strength (p < .01), body fat percentage (p < .05), and fat mass (p < .03) at 3-month follow-up, relative to control.
Conclusion: Findings from the IDEA-P trial suggest that a GMCB-based EX+D intervention resulted in significant, clinically meaningful improvements in mobility performance, muscular strength, and body composition, relative to controls. Collectively, these results suggest that the EX+D was a safe and well-tolerated intervention for prostate cancer patients on ADT. The utility of implementing this approach in the treatment of prostate cancer patients on ADT should be evaluated in future large-scale efficacy trials.
Monitoring Resistance Exercise Intensity Using Ratings of Perceived Exertion in Previously Untrained Patients With Prostate Cancer Undergoing Androgen Deprivation Therapy
Exercise has been shown to be safe and effective for patients with prostate cancer (PrCa). The monitoring of resistance exercise (RE) intensity is an emerging area of interest in RE prescription. Rating of perceived exertion (RPE) is one of the most commonly used methods but has not yet been validated in this population. Thus, the purpose of this study was to examine the relationship between RPE and RE intensity in PrCa. Data for this study were abstracted from baseline upper- and lower-body strength assessments from 2 previous trials (Individual Diet and Exercise Adherence Pilot Trial; Livestrong, Austin, TX, USA) in our laboratory investigating functional outcomes in patients with PrCa undergoing androgen deprivation therapy (ADT). A total of 75 participants from both trials were included in this study. Ratings of perceived exertion corresponding to 50, 70, and 90% 1 repetition maximum (1RM) were extracted from the results of participants' upper- and lower-body 1RM strength tests. The changes in RPE across increasing intensities were assessed using separate univariate analysis of variance (ANOVA). For each ANOVA, RPE was used as the dependent variable and intensity (50, 70, and 90%) used as the fixed factor. A univariate ANOVA revealed a significant difference (p ≤ 0.05) among the RPE values for each intensity for both upper- and lower-body lifts. The results of our analyses suggest that RPE values rise linearly in response to increases in exercise intensity. Our study supports the concept that RPE may be a practical training tool to accurately estimate RE intensity in PrCa survivors undergoing ADT. Practitioners may consider using RPE to monitor and adjust RE intensity in this population.
A group-mediated physical activity intervention in older knee osteoarthritis patients: effects on social cognitive outcomes
The objective of the present study was to compare a group-mediated cognitive behavioral (GMCB) physical activity intervention with traditional exercise therapy (TRAD) upon select social cognitive outcomes in sedentary knee osteoarthritis (knee OA) patients. A total of 80 patients (mean age = 63.5 years; 84% women) were recruited using clinic and community-based strategies to a 12-month, single-blind, two-arm, randomized controlled trial. Mobility-related self-efficacy, self-regulatory self-efficacy (SRSE), and satisfaction with physical function (SPF) were assessed at baseline, 3, and 12 months. Results of intent-to-treat 2 (Treatment: GMCB and TRAD) × 2 (Time: 3 and 12 month) analyses of covariance yielded significantly greater increases in SRSE and SPF (P < 0.01) relative to TRAD. Partial correlations revealed that changes in SRSE and SPF were significantly related (P < 0.05) to improvements in physical activity and mobility at 3 and 12- months. The GMCB intervention yielded more favorable effects on important social cognitive outcomes than TRAD; these effects were related to improvements in physical activity and mobility
A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology.
To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies. However, despite research progression and international recognition, current exercise oncology-based exercise prescriptions remain relatively basic and underdeveloped, particularly in regards to resistance training. Recent publications have called for a more precise manipulation of training variables such as volume, intensity, and frequency (i.e., periodization), given the large heterogeneity of a cancer population, to truly optimize clinically relevant patient-reported outcomes. Indeed, increased attention to integrating fundamental principles of exercise physiology into the exercise prescription process could optimize the safety and efficacy of resistance training during cancer care. The purpose of this article is to give an overview of the current state of resistance training prescription and discuss novel methods that can contribute to improving approaches to exercise prescription. We hope this article may facilitate further evaluation of best practice regarding resistance training prescription, monitoring, and modification to ultimately optimize the efficacy of integrating resistance training as a supportive care intervention for survivors or and patients with cancer.
Resistance training interventions across the cancer control continuum: a systematic review of the implementation of resistance training principles
Objectives: The primary purpose of this systematic review is to examine the extant resistance training (RT) cancer research to evaluate the proportion of RT interventions that: (1) implemented key RT training principles (specificity, progression, overload) and (2) explicitly reported relevant RT prescription components (frequency, intensity, sets, reps).
Design: A qualitative systematic review was performed by two reviewers (CMF and PNH) who inspected the titles and abstracts to determine eligibility for this systematic review. Identified papers were obtained in full and further reviewed. Data were extracted to evaluate the application of principles of training, along with specific RT components.
Data sources: Electronic databases (PubMed, EMBASE, CINAHL, Cochrane, PEDro, PsychInfo, Cancer Lit, Sport Discus, AMED, Cochrane Central Register of Controlled Trials) and reference lists of included articles from inception to May 2016.
Results: 37 studies were included. The principle of specificity was used appropriately in all of the studies, progression in 65% and overload in 76% of the studies. The most common exercise prescription (∼50%) implemented in the studies included in this review were 2-3 days/week, focusing on large muscle groups, 60-70% 1 repetition maximum (RM), 1-3 sets of 8-12 repetitions.
Conclusions: Reporting of RT principles in an oncology setting varies greatly, with often vague or non-existent references to the principles of training and how the RT prescription was designed.
Effects of exercise interventions during different treatments in breast cancer
Previous findings suggest that exercise is a safe and efficacious means of improving physiological and psychosocial outcomes in female breast cancer survivors. To date, most research has focused on post-treatment interventions. However, given that the type and severity of treatment-related adverse effects may be dependent on the type of treatment, and that the effects are substantially more pronounced during treatment, an assessment of the safety and efficacy of exercise during treatment is warranted. In this review, we present and evaluate the results of randomized controlled trials (RCTs) conducted during breast cancer treatment. We conducted literature searches to identify studies examining exercise interventions in breast cancer patients who were undergoing chemotherapy or radiation. Data were extracted on physiological and psychosocial outcomes. Cohen’s d effect sizes were calculated for each outcome. A total of 17 studies involving 1,175 participants undergoing active cancer therapy met the inclusion criteria. Findings revealed that, on average, exercise interventions resulted in moderate to large improvements in muscular strength: resistance exercise (RE, d = 0.86), aerobic exercise (AE, d = 0.55), small to moderate improvements in cardiovascular functioning (RE, d = 0.45; AE, d = 0.17, combination exercise (COMB, d = 0.31) and quality of life (QoL; RE, d = 0.30; AE, d = 0.50; COMB, d = 0.63). The results of this review suggest that exercise is a safe, feasible, and efficacious intervention in breast cancer patients who are undergoing different types of treatment. Additional research addressing the different modes of exercise during each type of treatment is warranted to assess the comparable efficacy of the various exercise modes during established breast cancer treatments.
Affective Responses to Acute Resistance Exercise Performed at Self-Selected and Imposed Loads in Trained Women. Journal
The purpose of this study was to examine the affective responses to acute resistance exercise (RE) performed at self-selected (SS) and imposed loads in recreationally trained women. Secondary purposes were to (a) examine differences in correlates of motivation for future participation in RE and (b) determine whether affective responses to RE were related to these select motivational correlates of RE participation. Twenty recreationally trained young women (mean age = 23 years) completed 3 RE sessions involving 3 sets of 10 repetitions using loads of 40% of 1 repetition maximum (1RM), 70% 1RM, and an SS load. Affective responses were assessed before, during, and after each RE session using the Feeling Scale. Self-efficacy and intention for using the imposed and SS loads for their regular RE participation during the next month were also assessed postexercise. Results revealed that although the SS and imposed load RE sessions yielded different trajectories of change in affect during exercise (p < 0.01), comparable improvements in affect emerged after RE. Additionally, the SS condition was associated with the highest ratings of self-efficacy and intention for future RE participation (p < 0.01), but affective responses to acute RE were unrelated to self-efficacy or intention. It is concluded that acute bouts of SS and imposed load RE resulted in comparable improvements in affect; recreationally trained women reported the highest self-efficacy and intention to use the load chosen in SS condition in their own resistance training; and affective responses were unrelated to motivational correlates of resistance training.
Women Exercise and Aging
Aging is associated with physiological declines, notably a decrease in bone mineral density (BMD) and lean body mass, with a concurrent increase in body fat and central adiposity. Interest in women and aging is of particular interest partly as a result of gender specific responses to aging, particularly as a result of menopause. It is possible that the onset of menopause may augment the physiological decline associated with aging and inactivity. More so, a higher incidence of metabolic syndrome (an accumulation of cardiovascular disease risk factors including obesity, low-density lipoprotein cholesterol, high blood pressure, and high fasting glucose) has been shown in middle-aged women during the postmenopausal period. This is due in part to the drastic changes in body composition, as previously discussed, but also a change in physical activity (PA) levels. Sarcopenia is an age related decrease in the cross-sectional area of skeletal muscle fibers that consequently leads to a decline in physical function, gait speed, balance, coordination, decreased BMD, and quality of life. PA plays an essential role in combating physiological decline associated with aging. Maintenance of adequate levels of PA can result in increased longevity and a reduced risk for metabolic disease along with other chronic diseases. The aim of this paper is to review relevant literature, examine current PA guidelines, and provide recommendations specific to women based on current research
Functional Performance in Older Adults After a Combination Multicomponent Exercise Program and Bingo Game
Inexpensive exercise interventions are needed to attract and retain older adults to participate in sufficient amounts of exercise to improve functional performance (FP). This study examined the addition of a program enhancing game, bingo, to a multicomponent exercise program (BingocizeTM). Older adults (18 women, M age = 75.1 (8.63) years, participated 2 days per week (45- 60 minute sessions) for 10 weeks. Participants sat at tables with bingo cards, balance pads, and exercise bands. Exercises were alternated with rolls of bingo until a participant won the bingo game. Pre and post body weight (BW), body mass index (BMI), and FP were measured. FP was assessed using the Senior Fitness Test battery. Using paired-sample t-tests, significant improvements were found in all FP measures, but not in BW or BMI (p ˂ .05). The low-cost, sustainability, and ease of implementation suggest BingocizeTM may be a novel and enjoyable alternative to traditional older adult group exercise interventions. Our results should be interpreted with caution due to the lack of a control group and small sample size. Future research could examine changes in activities of daily living, quality of life, and other measures of functional fitness in this and other populations.
Dietary interventions to improve body composition in men treated with androgen deprivation therapy for prostate cancer: A solution for the growing problem?
Androgen deprivation therapy (ADT) has adverse effects on body composition, including muscle wasting and body fat accumulation, which may be attenuated by nutrition therapy. This systematic review summarises available evidence on the effects of dietary interventions on lean mass, fat mass and body mass index (BMI) in men treated with ADT for prostate cancer. MEDLINE, Embase, Web of Science and ClinicalTrials.org were searched from inception through December 2020. We included all controlled trials evaluating effects of supplementation or dietary interventions on body composition in men with prostate cancer receiving continuous ADT. Methodological quality of the studies was assessed using the Cochrane Collaboration’s risk of bias tool. Meta-analysis was performed using a random effects model to calculate standardised mean differences between intervention and comparator groups. (PROSPERO; CRD42020185777). Eleven studies (n = 536 participants) were included. Seven studies investigated the effects of dietary advice interventions, e.g. individual or group counselling, and four studies included a nutritional supplement. Eight studies combined the dietary intervention with exercise. Nine studies reported sufficient data for inclusion in the meta-analysis. Dietary advice and supplementation interventions combined were not associated with significant changes in lean mass (0.05 kg; 95% CI: −0.17, 0.26; p = 0.674; n = 355), fat mass (−0.22 kg; 95% CI: −0.45, 0.01; p = 0.064; n = 336) or BMI (−0.16 kg*m−2; 95% CI: −0.37, 0.04; p = 0.121; n = 399). Dietary advice interventions alone were associated with a significant fat mass reduction (−0.29 kg; 95% CI: −0.54, −0.03; p = 0.028; n = 266). Most studies were dietary advice interventions targeting caloric restriction, which showed the potential to reduce fat mass but did not increase lean mass in men treated with ADT. Future interventions should investigate whether a combination of dietary advice and protein supplementation with concomitant resistance exercise could counteract ADT-induced muscle wasting.
Does androgen deprivation for prostate cancer affect normal adaptation to resistance exercise?
Loss of muscle mass and muscle function is a common side effect from androgen deprivation therapy (ADT) for prostate cancer (PCa). Here, we explored effects of heavy-load resistance training (RT) on lean body mass and muscle strength changes reported in randomized controlled trials (RCTs) among PCa patients on ADT and in healthy elderly men (HEM), by comparison of results in separate meta-analysis. Methods: RCTs were identified through databases and reference lists.
Results: Seven RCTs in PCa patients (n = 449), and nine in HEM (n = 305) were included. The effects of RT in lean body mass change were similar among PCa patients (Standardized mean difference (SMD): 0.4, 95% CI: 0.2, 0.7) and HEM (SMD: 0.5, 95% CI: 0.2, 0.7). It is noteworthy that the within-group changes showed different patterns in PCa patients (intervention: 0.2 kg; control: -0.6 kg) and HEM (intervention: 1.2 kg; control: 0.2 kg). The effects of RT on change in muscle strength (measured as 1 RM) were similar between PCa patients and HEM, both for lower body- (PCa: SMD: 1.9, 95% CI: 1.2, 2.5; HEM: SMD: 2.2, 95% CI: 1.0, 3.4), and for upper body exercises (PCa: SMD: 2.0, 95% CI: 1.3, 2.7; HEM: SMD: 1.9, 95% CI: 1.3, 2.6).
Conclusions: The effects of RT on lean body mass and 1 RM were similar in PCa patients on ADT and HEM, but the mechanism for the intervention effect might differ between groups. It seems that RT counteracts loss of lean body mass during ADT in PCa patients, as opposed to increasing lean body mass in HEM.
Study protocol: Investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer.
Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre-and post-intervention. This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial.
Creatine Supplementation for Older Adults: Focus on Sarcopenia, Osteoporosis, Frailty and Cachexia
Sarcopenia refers to the age-related reduction in strength, muscle mass and functionality which increases the risk for falls, injuries and fractures. Sarcopenia is associated with other age-related conditions such as osteoporosis, frailty and cachexia. Identifying treatments to overcome sarcopenia and associated conditions is important from a global health perspective. There is evidence that creatine monohydrate supplementation, primarily when combined with resistance training, has favorable effects on indices of aging muscle and bone. These musculoskeletal benefits provide some rationale for creatine being a potential intervention for treating frailty and cachexia. The purposes of this narrative review are to update the collective body of research pertaining to the effects of creatine supplementation on indices of aging muscle and bone (including bone turnover markers) and present possible justification and rationale for its utilization in the treatment of frailty and cachexia in older adults.
The impact of a cancer exercise program located within a health system on body composition, fatigue, and physical function in adults with cancer.
Background Despite exercise being regularly recommended for individuals with cancer, notable and consistent gaps remain in the design, utilization and uptake of cancer exercise services embedded into healthcare. The purpose of this study was to examine the effectiveness of a longstanding, cancer center-embedded, cancer exercise program (the Moving On Program) within the Prisma Health Cancer Institute, on body composition, fatigue, and physical function in adult survivors of cancer. Materials and Methods Moving On, is a 12-week, thrice weekly, aerobic and resistance exercise program designed for adults who complete their primary treatment for any cancer diagnosis at Prisma Health. In a retrospective analysis of data collected between 2014 and 2020, we assessed changes in body composition, fatigue and physical function (6-minute walk test (6MWT)) at baseline and follow-up using paired t-tests. A Bonferroni adjustment (α=0.05/10=0.005) was used to reduce the chance of committing a type I error. Results Participants who completed both baseline and follow up assessments were included in our analyses (n=369, mean=60.3 10.6 years, male=111, female=258). The most prevalent cancer sites were breast cancer (32%) and blood/lymphoma (9.7%). Individuals exhibited signi cant improvements in body composition variables (arm lean mass (p=0.003, ES=0.158), total % fat (p<0.001, ES=0.199), total fat mass (p<0.001, ES=0.203), and total lean mass (p=0.005, ES=0.148)), fatigue (p<0.001, ES=0.605), and 6MWT (p<0.001, ES=1.032). Conclusions Though statistically signi cant improvements were exhibited in a variety of body composition variables; the small effect sizes accompanying these changes suggest that improvements made across 12-weeks are trivial. The medium and large effect sizes accompanying improvements in fatigue and physical function
Implementation during a pandemic: Findings, successes, and lessons learned from community grantees.
Funding communities through mini-grant programs builds community capacity by fostering leadership among community members, developing expertise in implementing evidence-based practices, and increasing trust in partnerships. The South Carolina Cancer Prevention and Control Research Network (SC-CPCRN) implemented the Community Health Intervention Program (CHIP) mini-grants initiative to address cancer-related health disparities among high-risk populations in rural areas of the state. One community-based organization and one faith-based organization were funded during the most recent call for proposals. The organizations implemented National Cancer Institute evidence-based strategies and programs focused on health and cancer screenings and physical activity and promotion of walking trails. Despite the potential for the COVID-19 pandemic to serve as a major barrier to implementation, grantees successfully recruited and engaged community members in evidence-based activities. These initiatives added material benefits to their local communities, including promotion of walking outdoors where it is less likely to contract the virus when socially distanced and provision of COVID-19 testing and vaccines along with other health and cancer screenings. Future mini-grants programs will benefit from learning from current grantees' flexibility in program implementation during a pandemic as well as their intentional approach to modifying program aspects as needed.
The collaborative lifestyle intervention program in knee osteoarthritis patients (CLIP-OA) Trial: design and methods
Being overweight or obese is a primary modifiable risk factor that exacerbates disease progression and mobility disability in older knee osteoarthritis (OA) patients. Lifestyle interventions combining exercise with dietary weight loss (EX+DWL) yield meaningful improvements in mobility and weight loss that are superior to EX or DWL alone. Unfortunately, community access to practical, sustainable weight management interventions remains limited and places knee OA patients at increased risk of mobility disability. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis patients (CLIP-OA), was a two-arm, 18 month randomized-controlled, comparative effectiveness trial designed to contrast the effects of an evidence-based, theory-driven EX+DWL intervention, personalized to patient needs and delivered by our community partners, with those of the Arthritis Foundation's Walk With Ease (WWE) standard of care self-management program in the treatment of knee OA patients with overweight or obesity. The primary outcome of the CLIP-OA trial was mobility performance assessed using the 400-m walk test (400MWT). Secondary outcomes included weight loss, pain, select quality of life and social cognitive variables, and cost-effectiveness of intervention delivery. Findings from the CLIP-OA trial will determine the comparative and cost-effectiveness of the EX+DWL and WWE interventions on key clinical outcomes and has the potential to offer a sustainable medium for intervention delivery that can promote widely accessible weight management among knee OA patients with overweight or obesity.
Social cognitive outcomes are associated with improvements in mobility performance following a lifestyle intervention in prostate cancer patients undergoing androgen deprivation therapy.
To compare the effects of an exercise and dietary intervention with those of standard-of-care management upon change in lift and carry performance and mobility-related self-efficacy beliefs and explore associations in prostate cancer patients undergoing androgen deprivation therapy.
Methods: 32 prostate cancer patients (M age = 66.2 years; SD = 7.8) undergoing androgen deprivation therapy were randomly assigned to a 3-month exercise and dietary lifestyle intervention (n = 16) or standard-of-care management (n = 16). Outcome assessments were obtained at baseline, 2- and 3-month follow-up.
Results: The lifestyle intervention resulted in significantly greater improvements in lift and carry performance (p = 0.01) at 2 Months (d = 1.01; p < 0.01) and 3 Months (d = 0.95; p < 0.01) and superior improvements in mobility-related self-efficacy at 2 Months (d = 0.38) and 3 Months (d = 0.58) relative to standard-of-care. Mobility-related self-efficacy (r = -.66; p = 0.006) and satisfaction with function (r = -.63; p = 0.01) were significantly correlated with lift and carry performance at 3 Months.
Conclusions: The exercise and dietary lifestyle intervention yielded superior improvements in lift and carry performance and mobility-related self-efficacy relative to standard-of-care and key social cognitive outcomes were associated with more favorable mobility performance.
Exercise to counteract skeletal muscle mass loss in people with cancer: can we overcome the odds?
Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic.
Protective effects of physical activity in colon cancer and underlying mechanisms: a review of epidemiological and biological evidence.
Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved.
Therapeutic potential of emodin for gastrointestinal cancers
Gastrointestinal (GI) cancers cause one-third of all cancer-related deaths worldwide. Natural compounds are emerging as alternative or adjuvant cancer therapies given their distinct advantage of manipulating multiple pathways to both suppress tumor growth and alleviate cancer comorbidities; however, concerns regarding efficacy, bioavailability, and safety are barriers to their development for clinical use. Emodin (1,3,8-trihydroxy-6-methylanthraquinone), a Chinese herb-derived anthraquinone, has been shown to exert anti-tumor effects in colon, liver, and pancreatic cancers. While the mechanisms underlying emodin’s tumoricidal effects continue to be unearthed, recent evidence highlights a role for mitochondrial mediated apoptosis, modulated stress and inflammatory signaling pathways, and blunted angiogenesis. The goals of this review are to (1) highlight emodin’s anti-cancer properties within GI cancers, (2) discuss the known anti-cancer mechanisms of action of emodin, (3) address emodin’s potential as a treatment complementary to standard chemotherapeutics, (4) assess the efficacy and bioavailability of emodin derivatives as they relate to cancer, and (5) evaluate the safety of emodin.
Exercise Intervention and Sexual Function in Advanced Prostate Cancer: A Randomised Controlled Trial
Background: Sexual dysfunction is a common, distressing, and persistent adverse effect of prostate cancer treatment and current management strategies do not adequately address physical and psychological effects. Exercise is emerging as potential therapy in the management of sexual health. The purpose of this study was to investigate the effects of supervised, clinic-based, resistance and aerobic exercise with and without psychosexual therapy self-management on sexual health in men with prostate cancer. Methods: A 3-arm, parallel group, multi-center randomized clinical trial was undertaken between 2014 and 2018. The study was conducted at university-affiliated exercise clinics. Eligible participants were men with prostate cancer who had previously or were currently undergoing treatment and concerned about sexual dysfunction. One-hundred and twelve participants were randomized to: 1) 6 months of supervised, group-based resistance and aerobic exercise (n=39), 2) the same exercise program plus psychosexual therapy (n=36), or 3) usual care (n=37). Exercise was undertaken 3 days per week at university-affiliated exercise clinics. Psychosexual therapy consisted of a brief self-management intervention that addressed psychological and sexual wellbeing. The primary outcome was sexual health assessed with the International Index of Erectile Function. Secondary outcomes included body composition, physical function, and muscle strength. Analyses were undertaken using an intention-to-treat approach. Results: Erectile function increased by 5.1 points (exceeds MICD) with exercise and 1.0 point with usual care (P interaction=.010) while intercourse satisfaction increased by 2.2 points with exercise and 0.2 points with usual care (P interaction=.026). Self-managed psychosexual therapy did not result in additional improvements. Compared with usual care, exercise prevented an increase in fat mass (P interaction=.028) and improved physical function outcomes, as well as upper and lower body muscle strength. Conclusions: Supervised resistance and aerobic exercise improved erectile function and intercourse satisfaction in men with prostate cancer; however, self-managed psychosexual therapy resulted in no additional improvements. Men with prostate cancer concerned about sexual dysfunction should be encouraged to undertake exercise as a potential countermeasure.
Muscle wasting in cancer: opportunities and challenges for exercise in clinical cancer trials.
Low muscle in cancer is associated with an increase in treatment-related toxicities and is a predictor of cancer-related and all-cause mortality. The mechanisms of cancer-related muscle loss are multifactorial, including anorexia, hypogonadism, anaemia, inflammation, malnutrition, and aberrations in skeletal muscle protein turnover and metabolism. In this narrative review, we summarise relevant literature to (i) review the factors influencing skeletal muscle mass regulation, (ii) provide an overview of how cancer/treatments negatively impact these, (iii) review factors beyond muscle signalling that can impact the ability to participate in and respond to an exercise intervention to counteract muscle loss in cancer, and (iv) provide perspectives on critical areas of future research. Despite the well-known benefits of exercise, there remains a paucity of clinical evidence supporting the impact of exercise in cancer-related muscle loss. There are numerous challenges to reversing muscle loss with exercise in clinical cancer settings, ranging from the impact of cancer/treatments on the molecular regulation of muscle mass, to clinical challenges in responsiveness to an exercise intervention. For example, tumour-related/treatment-related factors (e.g. nausea, pain, anaemia, and neutropenia), presence of comorbidities (e.g. diabetes, arthritis, and chronic obstructive pulmonary disease), injuries, disease progression and bone metastases, concomitant medications (e.g., metformin), can negatively affect an individual’s ability to exercise safely and limit subsequent adaptation. This review identifies numerous gaps and oppportunities in the area of low muscle and muscle loss in cancer. Collaborative efforts between preclinical and clinical researchers are imperative to both understanding the mechanisms of atrophy, and develop appropriate therapeutic interventions.
Key takeaways for knowledge expansion of early-career scientists conducting Transdisciplinary Research in Energetics and Cancer (TREC): a report from the TREC Training Workshop 2022.
The overall goal of the annual Transdisciplinary Research in Energetics and Cancer (TREC) Training Workshop is to provide transdisciplinary training for scientists in energetics and cancer and clinical care. The 2022 Workshop included 27 early-to-mid career investigators (trainees) pursuing diverse TREC research areas in basic, clinical, and population sciences. The 2022 trainees participated in a gallery walk, an interactive qualitative program evaluation method, to summarize key takeaways related to program objectives. Writing groups were formed and collaborated on this summary of the 5 key takeaways from the TREC Workshop. The 2022 TREC Workshop provided a targeted and unique networking opportunity that facilitated meaningful collaborative work addressing research and clinical needs in energetics and cancer. This report summarizes the 2022 TREC Workshop's key takeaways and future directions for innovative transdisciplinary energetics and cancer research.
Considerations for Designing Exercise Trials for Cancer Related Muscle Dysfunction
Individuals diagnosed with cancer commonly experience a significant decline in muscle mass and physical function collectively referred to as cancer related muscle dysfunction. This is concerning because impairments in functional capacity are associated with an increased risk for the development of disability and subsequent mortality. Notably, exercise offers a potential intervention to combat cancer related muscle dysfunction. Despite this, research is limited on the efficacy of exercise when implemented in such a population. Thus, the purpose of this mini review is to offer critical considerations for researchers seeking to design studies pertaining to cancer related muscle dysfunction. Namely, 1) defining the condition of interest, 2) determining the most appropriate outcome and methods of assessment, 3) establishing the best timepoint (along the cancer continuum) to intervene, and 4) understanding how exercise prescription can be configured to optimize outcomes.
Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials
Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47–2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11–2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03–3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55–0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14–2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence.
Design and Methods of a Translational, Community-Based, Lifestyle Weight Management Pilot Intervention Trial in Breast Cancer Survivors with Overweight or Obesity
Breast cancer survivors (BCS) with overweight or obesity are at heightened risk of cancer recurrence, cardiometabolic disease, and compromised quality of life. Given the prevalence of significant weight gain during and following breast cancer treatment, there is growing recognition of the need to develop efficacious, widely-accessible, weight management programs for BCS. Unfortunately, access to evidence-based weight management resources for BCS remains limited and little is known of the optimal theoretical basis, program components, and mode of delivery for community-based interventions. The primary aim of the Healthy New Albany Breast Cancer (HNABC) pilot trial was to determine the safety, feasibility, and preliminary efficacy of delivering a translational, evidence-based, and theory-driven lifestyle weight management intervention to BCS with overweight or obesity in the community setting. HNABC was a single-arm, pilot trial evaluating a 24-week, multi-component intervention leveraging exercise, dietary modification, and group-mediated cognitive behavioral (GMCB) counseling components designed to facilitate lifestyle behavior change and promote sustained independent adherence. Assessments of various objectively-determined and patient-reported outcomes and theory-derived determinants of behavioral adoption and maintenance were obtained at baseline, 3- and 6-month follow-up. Measures of trial feasibility were calculated prospectively throughout the study. Findings from the HNABC pilot trial will provide evidence demonstrating the feasibility and preliminary efficacy of a multi-component, community-based, GMCB lifestyle weight management intervention for BCS. Results will inform the design of a future, large-scale, randomized controlled efficacy trial. If successful, this approach could offer a widely accessible, community-based intervention model for weight management programs in BCS.
Evaluating Individual Level Change in Physical Function Response Following an Exercise Program for Cancer Survivors.
Cancer survivors physical function response to exercise programs at the group level is well-established. However, to advance toward a more personalized approach in exercise oncology, a greater understanding of individual response is needed. This study utilized data from a well-established cancer-exercise program to evaluate the heterogeneity of physical function response and explore characteristics of participants who did vs. did not achieve a minimal clinically important difference (MCID). Physical function measures (grip strength, 6-min walk test (6MWT), and sit-to-stand) were completed pre/post the 3-month program. Change scores for each participant and the proportion achieving the MCID for each physical function measure were calculated. The independent t-tests, Fisher's exact test, and decision tree analyses were used to explore differences in age, body mass index (BMI), treatment status, exercise session attendance, and baseline value between participants who achieved the MCID vs. those who did not. Participants (N = 250) were 55 ± 14 years old, majority female (69.2%), white (84.1%), and diagnosed with breast cancer (36.8%). Change in grip strength ranged from - 42.1 to + 47.0 lb, and 14.8% achieved the MCID. Change in 6MWT ranged from - 151 to + 252 m, and 59% achieved the MCID. Change in sit-to-stand ranged from - 13 to + 20 reps, and 63% achieved the MCID. Baseline grip strength, age, BMI, and exercise session attendance were related to achieving MCID. Findings illustrate wide variability in the magnitude of cancer survivors' physical function response following an exercise program, and that a variety of factors predict response. Further investigation into the biological, behavioral, physiological, and genetic factors will inform tailoring of exercise interventions and programs to maximize the proportion of cancer survivors who can derive clinically meaningful benefits.
Feasibility of a Hybrid Delivery of Cluster Set Resistance Training for Individuals Previously Treated for Lung Cancer
Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial.
Designing effective exercise intervention trials for prostate cancer cohorts: A qualitative study on experiences and views of exercise oncology researchers.
Exercise intervention research has shown promising results in preventing and reversing the side effects caused by prostate cancer and its' treatment. However, there are still unanswered questions and the need for additional research. As the field of exercise oncology in the context of prostate cancer presents unique challenges and complexities, seeking the advice of experienced exercise oncology researchers before initiating a similar trial could help to design more effective and efficient studies and help avoid pitfalls.
Methods: A qualitative descriptive study design and a nonprobability, purposive sampling method was employed. An interview guide was developed and included topics such as recruitment, retention, programme goals, research design, health considerations, treatment considerations, adverse events, exercise prescription and outcome tools. Individual semi-structured interviews were conducted and interviews were transcribed and analysed using thematic analysis.
Results: Eight individuals with extensive experience working with prostate cancer patients in exercise oncology research settings were interviewed. Four main themes and seven subthemes were generated and supported by the data. Theme 1 highlighted the critical role of recruitment, with associated subthemes on recruitment barriers and recruitment methods. Theme 2 explored the positives and negatives of home-based programmes. Theme 3 focused on specific health characteristics, exercise prescription and outcome measure factors that must be considered when working with prostate cancer cohorts. Finally, theme 4 centered around the emotional dimensions present in exercise oncology trials, relating to both researchers and study participants.
Conclusion: Exercise oncology remains a challenging area in which to conduct research. Learning from experienced personnel in the field offers valuable information and guidance that could impact the success of future trials.
An Early Career Researcher’s guide to using social media.
Social media usage has soared in the last decade, with the majority of adults having an account on at least one platform. Sites such as LinkedIn, X, and TikTok allow users to share content using different forms, for example, written or video, long form or short form. Social media can be used by researchers to forge collaborations, rapidly disseminate new research, and demonstrate societal impact. This opinion piece aims to highlight the value of social media, in particular for early career researchers, and offer suggestions on how early career researchers can strategically use social media to build a network and an online presence. We reflect on our own experiences of social media and include some of the reasons we have been deterred from it in the past, such as fear of making a mistake, being misunderstood, or painted as being an overconfident "know it all." As the demonstration of impact and engagement becomes ever more important in grant applications and job security, social media competency is a powerful professional skill that will be important for all scientists.
A Proposal for the Comprehensive Care of Men on Androgen Deprivation Therapy:
Introduction:To promote comprehensive care of patients throughout the androgen deprivation therapy (ADT) prescribing process, the Prostate Cancer 360 (PC360) Working Group developed monitoring and management recommendations intended to mitigate or prevent ADT-Associated adverse events.Methods:The PC360 Working Group included 14 interdisciplinary experts with a dedicated clinical interest in prostate cancer and ADT management. The working group defined challenges associated with ADT adverse event management and then collaboratively developed comprehensive care recommendations intended to be practical for ADT prescribers.Results:The PC360 Working Group developed both overarching recommendations for ADT adverse event management and specific recommendations across 5 domains (cardiometabolic, bone, sexual, psychological, and lifestyle). The working group recommends an interdisciplinary, team-based approach wherein the ADT prescriber retains an oversight role for ADT management while empowering patients and their primary and specialty care providers to manage risk factors. The PC360 recommendations also emphasize the importance of proactive patient education that involves partners or other support providers. Recommended monitoring and assessment tools, risk factor management, and patient counseling points are also included for the 5 identified domains, with an emphasis on lifestyle and behavioral interventions that can improve quality of life and reduce the risk for ADT-Associated complications.Conclusions:Comprehensive care of patients receiving ADT requires early and ongoing coordinated management of a variety of health domains, including cardiometabolic, bone, sexual, psychological health. Patient education and primary care provider involvement should begin prior to ADT initiation and continue throughout treatment to improve patient and partner quality of life.
A comparison of aerobic- and resistance-emphasised exercise on cardiometabolic health and quality of life in men receiving androgen deprivation therapy for prostate cancer: Protocol for a pilot feasibility trial
Those with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes.
Examining Provider Perceptions and Practices for Comprehensive Geriatric Assessment amo
Introduction: Cancer rates increase with age, and older cancer survivors have unique medical care needs, making assessment of health status and identification of appropriate supportive resources key to delivery of optimal cancer care. Comprehensive geriatric assessments (CGAs) help determine an older person’s functional capabilities as cancer care providers plan treatment and follow-up care. Despite its proven utility, research on implementation of CGA is lacking. Methods: Guided by a qualitative description approach and through interviews with primary care providers and oncologists, our goal was to better understand barriers and facilitators of CGA use and identify training and support needs for implementation. Participants were identified through Cancer Prevention and Control Research Network partner listservs and a national cancer and aging organization. Potential interviewees, contacted via email, were provided with a description of the study purpose. Eight semi-structured interviews were conducted via Zoom, recorded, and transcribed verbatim by a professional transcription service. The interview guide explored providers’ knowledge and use of CGAs. For codebook development, three representative transcripts were independently reviewed and coded by four team members. The interpretive process involved reflecting, transcribing, coding, and searching for and identifying themes. Results: Providers shared that, while it would be ideal to administer CGAs with all new patients, they were not always able to do this. Instead, they used brief screening tools or portions of CGAs, or both. There was variability in how CGA domains were assessed; however, all considered CGAs useful and they communicated with patients about their benefits. Identified facilitators of implementation included having clinic champions, an interdisciplinary care team to assist with implementation and referrals for intervention, and institutional resources and buy-in. Barriers noted included limited staff capacity and competing demands on time, provider inexperience, and misaligned institutional priorities. Discussion: Findings can guide solutions for improving the broader and more systematic use of CGAs in the care of older cancer patients. Uptake of processes like CGA to better identify those at risk of poor outcomes and intervening early to modify treatments are critical to maximize the health of the growing population of older cancer survivors living through and beyond their disease.