To critically analyze the literature surrounding the efficacy of exercise interventions in patients with advanced cancer.
A literature search was undertaken of health and medical electronic databases ...(PubMED, Medline, CINAHL, Embase, PEDRO, Web of Science, Scopus) until March 1, 2017.
Studies were included if they were published in the English language and met the following criteria: structured exercise as the primary intervention, ≥80% study participants diagnosed with advanced cancer that is unlikely to be cured; reported outcomes concerning physical function, quality of life, fatigue, body composition, psychosocial function, sleep quality pain, and/or survival.
After title and abstract screening, 68 articles were eligible for full-text review, with a total of 25 studies (n=1188; 16 controlled trials, 9 noncontrolled trials) included in the quantitative synthesis. Two reviewers assessed methodological quality using the Cochrane Risk of Bias Tool for controlled trials and a modified Newcastle-Ottawa Scale for noncontrolled trials.
Aerobic exercise was used in 6 studies, resistance training in 3 studies, and combination training (aerobic and resistance) in 15 studies. Significant between- and within-group improvements were reported with exercise in ≥50% of studies assessing physical function (83%), quality of life (55%), fatigue (50%), body composition (56%), psychosocial function (56%), and sleep quality (100%). Improvement within or between groups in pain after exercise was only observed in 2 studies (25%), whereas survival was unaffected in any study.
Most studies reported significant between- and/or within-group improvements in physical function, quality of life, fatigue, body composition, psychosocial function, and sleep quality in patients with advanced cancer, although the effects on pain and survival rates are unclear. Exercise appears to be an effective adjunct therapy in the advanced cancer context, although targeted studies are required to determine the optimal exercise dose to enhance outcomes for specific cancer diagnoses.
Improvements in diet and/or exercise are often advocated during prostate cancer treatment, yet the efficacy of, and optimal nutrition and exercise prescription for managing cancer-related fatigue and ...quality of life remains elusive. The aim of this study is to systematically review the effects of nutrition and/or exercise on cancer-related fatigue and/or quality of life.
A literature search was conducted in six electronic databases. The Delphi quality assessment list was used to evaluate the methodological quality of the literature. The study characteristics and results were summarized in accordance with the review's Population, Intervention, Control, Outcome (PICO) criteria.
A total of 20 articles (one diet only, two combined diet and exercise, and seventeen exercise only studies) were included in the review. Soy supplementation improved quality of life, but resulted in several adverse effects. Prescribing healthy eating guidelines with combined resistance training and aerobic exercise improved cancer-related fatigue, yet its effect on quality of life was inconclusive. Combined resistance training with aerobic exercise showed improvements in cancer-related fatigue and quality of life. In isolation, resistance training appears to be more effective in improving cancer-related fatigue and quality of life than aerobic exercise. Studies that utilised an exercise professional to supervise the exercise sessions were more likely to report improvements in both cancer-related fatigue and quality of life than those prescribing unsupervised or partially supervised sessions. Neither exercise frequency nor duration appeared to influence cancer-related fatigue or quality of life, with further research required to explore the potential dose-response effect of exercise intensity.
Supervised moderate-hard resistance training with or without moderate-vigorous aerobic exercise appears to improve cancer-related fatigue and quality of life. Targeted physiological pathways suggest dietary intervention may alleviate cancer-related fatigue and improve quality of life, however the efficacy of nutrition management with or without exercise prescription requires further exploration.
Goals of work
The beneficial effects of exercise in cancer patients are reasonably well-established, although research in this field has predominantly investigated cancer patients in the earlier ...stages of disease. However, the most recent evidence surrounding exercise interventions in advanced cancer populations has yet to be systematically evaluated. This review critically analyses the safety and feasibility of exercise interventions in patients with advanced cancer.
Methods
All randomised, non-randomised and prospective observational trials of exercise training interventions in patients with advanced cancer were included. ‘Safety’ was defined as the number and severity of reported adverse events during exercise training. ‘Feasibility’ was determined by participant adherence, attendance and/or study completion rates.
Results
A total of 25 studies involving 1088 patients were included: 16 randomised controlled and nine prospective observational cohort trials. Seven studies included advanced lung cancer patients exclusively, while eight involved patients with various cancer diagnoses. Aerobic exercise was investigated in five studies, resistance training in two studies and combination training (aerobic and resistance) in 14 studies. Six minor adverse events were reported due to exercise. All of these were musculoskeletal in nature, resulting in two participants’ withdrawal from the study. Exercise adherence ranged from 65 to 89% but was only described in nine studies. Attendance at each exercise session was described in a further nine studies, ranging from 59 to 100%.
Conclusions
Implementation of exercise interventions appears to be safe and feasible in advanced cancer clinical practice, although targeted studies are required to determine the optimal exercise dose for specific cancer diagnoses.
This study investigated the effects of high-intensity interval training (HIIT) vs. work-matched moderate-intensity continuous exercise (MOD) on metabolism and counterregulatory stress hormones. In a ...randomized and counterbalanced order, 10 well-trained male cyclists and triathletes completed a HIIT session 81.6 ± 3.7% maximum oxygen consumption (V̇o2 max); 72.0 ± 3.2% peak power output; 792 ± 95 kJ and a MOD session (66.7 ± 3.5% V̇o2 max; 48.5 ± 3.1% peak power output; 797 ± 95 kJ). Blood samples were collected before, immediately after, and 1 and 2 h postexercise. Carbohydrate oxidation was higher (P = 0.037; 20%), whereas fat oxidation was lower (P = 0.037; -47%) during HIIT vs. MOD. Immediately after exercise, plasma glucose (P = 0.024; 20%) and lactate (P < 0.01; 5.4×) were higher in HIIT vs. MOD, whereas total serum free fatty acid concentration was not significantly different (P = 0.33). Targeted gas chromatography-mass spectromtery metabolomics analysis identified and quantified 49 metabolites in plasma, among which 11 changed after both HIIT and MOD, 13 changed only after HIIT, and 5 changed only after MOD. Notable changes included substantial increases in tricarboxylic acid intermediates and monounsaturated fatty acids after HIIT and marked decreases in amino acids during recovery from both trials. Plasma adrenocorticotrophic hormone (P = 0.019), cortisol (P < 0.01), and growth hormone (P < 0.01) were all higher immediately after HIIT. Plasma norepinephrine (P = 0.11) and interleukin-6 (P = 0.20) immediately after exercise were not significantly different between trials. Plasma insulin decreased during recovery from both HIIT and MOD (P < 0.01). These data indicate distinct differences in specific metabolites and counterregulatory hormones following HIIT vs. MOD and highlight the value of targeted metabolomic analysis to provide more detailed insights into the metabolic demands of exercise.
Key points
Physical activity is associated with reduced mortality rates for survivors of colorectal cancer.
Acute high intensity interval exercise (HIIE) reduced colon cancer cell number in vitro and ...promoted increases in inflammatory cytokines immediately following exercise.
This acute suppression of colon cancer cell number was transient and not observed at 120 minutes post-acute HIIE.
The acute effects of exercise may constitute an important mechanism by which exercise can influence colorectal cancer outcomes.
Physical activity is associated with significant reductions in colorectal cancer mortality. However, the mechanisms by which exercise mediates this anti‐oncogenic effect are not clear. In the present study, colorectal cancer survivors completed acute (n = 10) or chronic (n = 10) exercise regimes. An acute high intensity interval exercise session (HIIE; 4 × 4 min at 85–95% peak heart rate) was completed with serum samples collected at baseline, as well as 0 and 120 min post‐exercise. For the ‘chronic’ intervention, resting serum was sampled before and after 4 weeks (12 sessions) of HIIE. The effect of serum on colon cancer cell growth was evaluated by incubating cells (CaCo‐2 and LoVo) for up to 72 h and assessing cell number. Serum obtained immediately following HIIE, but not 120 min post‐HIIE, significantly reduced colon cancer cell number. Significant increases in serum interleukin‐6 (P = 0.023), interleukin‐8 (P = 0.036) and tumour necrosis factor‐α (P = 0.003) were found immediately following acute HIIE. At rest, short‐term HIIE training did not promote any changes in cellular growth or cytokine concentrations. The acute effects of HIIE and the cytokine flux may be important mediators of reducing colon cancer cell progression. Repetitive exposure to these acute effects may contribute to the relationship between exercise and improved colorectal cancer survival.
Key points
Physical activity is associated with reduced mortality rates for survivors of colorectal cancer.
Acute high intensity interval exercise (HIIE) reduced colon cancer cell number in vitro and promoted increases in inflammatory cytokines immediately following exercise.
This acute suppression of colon cancer cell number was transient and not observed at 120 minutes post-acute HIIE.
The acute effects of exercise may constitute an important mechanism by which exercise can influence colorectal cancer outcomes.
Purpose:
This study assessed the biological reliability of peripheral human cytokines and adipokines, and the influence of participant characteristics on total error. This has essential application ...to interventional cytokine measurement to ensure that reported results are interpreted with confidence.
Methods:
Participants (49% female, 18–85 years,
n
= 84) completed two consecutive-day testing sessions. Participants provided a venous blood sample at the same time of day across two consecutive days, under standardized participant presentation, including 24-h rested and 12-h fasted conditions. Multiplex immunoassay was used to assess inflammatory analytes from samples (predominantly plasma). Repeat measurements were conducted between-day for total precision quantification, and technical (technique) error was negated from the total to provide an estimate of biological (attributed to participant presentation) error.
Results:
Whilst there was no evidence of statistically significant biological error, a small amount of biological error was consistently present across most analytes (∼3.3%/0.07 pg/ml), which was largest for measurement of leptin (7.3%/210 pg/ml). There was also an influence of sex on reliability of leptin and adiponectin (total model explained 6–7% of error variation), where females demonstrated the greatest error.
Conclusion:
Biological error reported in this study should be applied to any future study or individual with a repeated measurement of cytokine concentrations over time that maintain best practice procedures (12-h fasted, 24-h rested). In most cases, raw error should be used, with exceptions for women for measurement of leptin and adiponectin. This approach will ensure that results are reported with certainty for improved reporting of intervention efficacy.
Cancer-related fatigue (CRF) is one of the most commonly reported disease- and treatment-related side effects that impede quality of life. This systematic review and meta-analysis describes the ...effects of nutrition therapy on CRF and quality of life in people with cancer and cancer survivors. Studies were identified from four electronic databases until September 2017. Eligibility criteria included randomised trials in cancer patients and survivors; any structured dietary intervention describing quantities, proportions, varieties and frequencies of food groups or energy and macronutrient consumption targets; and measures of CRF and quality of life. Standardised mean differences (SMD) were pooled using random-effects models. The American Dietetic Association’s Evidence Analysis Library Quality Checklist for Primary Research was used to evaluate the methodological quality and risk of bias. A total of sixteen papers, of fifteen interventions, were included, comprising 1290 participants. Nutrition therapy offered no definitive effect on CRF (SMD 0·18 (95 % CI –0·02, 0·39)) or quality of life (SMD 0·07 (95 % CI –0·10, 0·24)). Preliminary evidence indicates plant-based dietary pattern nutrition therapy may benefit CRF (SMD 0·62 (95 % CI 0·10, 1·15)). Interventions using the patient-generated subjective global assessment tool and prescribing hypermetabolic energy and protein requirements may improve quality of life. However, the heterogeneity seen in study design, nutrition therapies, quality-of-life measures and cancer types impede definitive dietary recommendations to improve quality of life for cancer patients. There is insufficient evidence to determine the optimal nutrition care plan to improve CRF and/or quality of life in cancer patients and survivors.
Exercise interventions are typically delivered to people with cancer and survivors via supervised clinical rehabilitation. However, motivating and maintaining activity changes outside of the clinic ...setting remains challenging. This study investigated the feasibility, acceptability and efficacy of an individually-tailored, text message-enhanced intervention that focused on increasing whole-of-day activity both during and beyond a 4-week, supervised clinical exercise rehabilitation program for people with cancer and survivors.
Participants (n = 36; mean ± SD age 64.8 ± 9.6 years; 44.1 ± 30.8 months since treatment) were randomized 1:1 to receive the text message-enhanced clinical exercise rehabilitation program, or the standard clinical exercise rehabilitation program alone. Activity was assessed at baseline, 4-weeks (end of the standard program) and 12-weeks (end of enhanced program) using both device (activPAL accelerometer; sitting, standing, light-stepping, moderate-stepping) and self-report Multimedia Activity Recall for Children and Adults (MARCA); sedentary, light, moderate-to-vigorous physical activity (MVPA) methods. The MARCA also assessed time use domains to provide context to activity changes. Changes and intervention effects were evaluated using linear mixed models, adjusting for baseline values and potential confounders.
The study had high retention (86%) and participants reported high levels of satisfaction 4.3/5 (±0.8) with the intervention. Over the first 4 weeks, MARCA-assessed MVPA increased + 53.2 (95%CI: 2.9, 103.5) min/d between groups, favoring the text message-enhanced program, but there were no significant intervention effects on sedentary behavior. By 12 weeks, relative to the standard group, participants in the text message-enhanced group sat less activPAL overall sitting: - 48.2 (- 89.9, - 5.6) min/16 h awake; MARCA: -80.1 (- 156.5, - 3.8) min/d and were participating in more physical activity activPAL light stepping: + 7.0 (0.4, 13.6: min/16 h awake; MARCA MVPA: + 67.3 (24.0, 110.6) min/d. The time-use domains of Quiet Time - 63.3 (- 110.5, - 16.0) min/d and Screen Time - 62.0 (- 109.7, - 14.2) min/d differed significantly between groups.
Results demonstrate feasibility, acceptability and efficacy of a novel, text message-enhanced clinical exercise rehabilitation program to support changes in whole-of-day activity, including both physical activity and sedentary behavior. Changes were largely seen at 12-week follow-up, indicating potential for the intervention to result in continued improvement and maintenance of behavior change following a supervised exercise intervention.
This trial is registered with the Australian New Zealand Clinical Trials Registry ( ACTRN12616000641493 ; date registered 17/5/16).
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Chronic inflammation is independently associated with the incidence and progression of chronic disease. Exercise has been found to reduce chronic inflammation, however the role of exercise intensity ...(work rate) is unknown. This review aimed to determine the pooled effect of higher- compared to lower-intensity aerobic and resistance exercise on chronic inflammation in adults.
Systematic review and meta-analysis.
Five electronic databases were searched. Intervention trials that assessed the effect of ≥2 different exercise intensities on peripheral markers of chronic inflammation c-reactive protein (CRP), interleukin (IL)-6, tumour necrosis factor (TNF)-α and IL-10 in adults were included. Random-effect meta-analyses were conducted to calculate the mean difference in change scores between groups effect size (ES). Sub-group analyses were performed to explore the influence of age, chronic disease, body mass index and intervention duration on inflammation heterogeneity.
Of 3952 studies identified, 27 were included. There were no significant effects of exercise intensity on IL-6 (ES=-0.039, 95%CI=-0.353–0.275; p=0.806), TNF-α (ES=0.296, 95%CI=-0.184–0.777; p=0.227) and IL-10 (ES=0.007, 95%CI=-0.904–0.919; p=0.987). A significant pooled ES was observed for higher- versus lower-intensity exercise on CRP concentrations, in studies of middle-aged adults (ES=-0.412, 95%CI=-0.821– -0.004, p=0.048) or interventions >9 weeks in duration (ES=-0.520, 95%CI=-0.882–-0.159, p=0.005).
Exercise intensity did not influence chronic inflammatory response. However, sub-analyses suggest that higher-intensity training may be more efficacious than lower-intensity for middle-aged adults, or when longer duration interventions are implemented (>9 weeks), in the most commonly-reported analyte (CRP).
Cancer-related fatigue (CRF) is a prevalent and persistent symptom from androgen deprivation therapy (ADT) in prostate cancer. The Mediterranean-style dietary pattern (MED-diet) offers a plausible ...mechanism to mitigate CRF through reducing inflammation and improving body composition. This study aimed to evaluate the effects of a 12-week MED-diet, compared to usual care, on CRF and quality of life in men with prostate cancer treated with ADT.
Twenty-three men (65.9 ± 7.8 years; body mass index: 29.6 ± 2.7 kg/m2; ADT duration: 33.8 ± 35.6 months) receiving ADT for ≥3 months were randomly assigned (1:1) to 12-weeks of usual care or the MED-diet involving six individualised nutrition consults. Primary outcomes included CRF Functional Assessment of Chronic Illness Therapy (FACIT)-Fatigue scale (FACIT-F) and quality of life FACIT-General (FACIT-G), secondary outcomes included body mass/composition and interleukin (IL)-6 and IL-8 concentrations measured at baseline, 8-weeks and 12 weeks. Intervention feasibility was measured by intervention safety, study completion rate, consult attendance, and adherence to the MED-diet through the Mediterranean-diet adherence screener (MEDAS). Intention to treat linear mixed models were used to determine changes in outcomes between the MED-diet and usual care at baseline, 8-weeks and 12-weeks.
The MED-diet improved CRF (FACIT-F) at 8-weeks +4.8 (0.0, 9.8); P = 0.05 and 12-weeks +7.2 (2.2, 12.0); P = 0.005, quality of life (FACIT-G) at 12-weeks +9.2 (2.7, 15.8); P = 0.006, reduced total body mass at 8-weeks −2.51 kg (−4.25, −0.78); P = 0.005 and 12-weeks -2.97 kg (−4.71, −1.25); P = 0.001, lean mass at 8-weeks −1.50 kg (−2.91, −0.10); P = 0.036, and IL-8 at 8-weeks -0.18 ng/ml (−0.34, −0.02); P = 0.029 compared to usual care. The MED-diet demonstrated zero adverse events, 91% study completion, 100% attendance, and 81% adherence to the MEDAS.
The MED-diet is safe and feasible, and has the potential to improve CRF and quality of life in overweight men treated with ADT compared to usual care. Further exploration of the MED-diet is warranted in a larger powered sample size to consolidate these findings.
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