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Purpose: Data from large randomized controlled trials confirming sleep quality improvements with aerobic physical activity have heretofore been lacking for post-primary treatment breast cancer survivors. Our primary purpose for this report was to determine the effects of a physical activity behavior change intervention, previously reported to significantly increase physical activity behavior, on sleep quality in post-primary treatment breast cancer survivors. Methods: Post-primary treatment breast cancer survivors (n = 222) were randomized to a 3-month physical activity behavior change intervention (Better Exercise Adherence after Treatment for Cancer [BEAT Cancer]) or usual care. Self-report (Pittsburgh Sleep Quality Index [PSQI]) and actigraphy (latency and efficiency) sleep outcomes were measured at baseline, 3 months (M3), and 6 months (M6). Results: After adjusting for covariates, BEAT Cancer significantly improved PSQI global sleep quality when compared with usual care at M3 (mean between-group difference [M] = -1.4, 95% confidence interval [CI] = -2.1 to -0.7, P < 0.001) and M6 (M = -1.0, 95% CI = -1.7 to -0.2, P = 0.01). BEAT Cancer improved several PSQI subscales at M3 (sleep quality M = -0.3, 95% CI = -0.4 to -0.1, P = 0.002; sleep disturbances M = -0.2, 95% CI = -0.3 to -0.03, P = 0.016; daytime dysfunction M = -0.2, 95% CI = -0.4 to -0.02, P = 0.027) but not M6. A nonsignificant increase in percent of participants classified as good sleepers occurred. No significant between-group difference was noted for accelerometer latency or efficiency. Conclusion: A physical activity intervention significantly reduced perceived global sleep dysfunction at 3 and 6 months, primarily because of improvements in sleep quality aspects not detected with accelerometer. [ABSTRACT FROM AUTHOR]

Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes; however, no randomized data are available. Here, we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training (START). Methods: The START was a Canadian multicenter trial that randomized 242 breast cancer patients between 2003 and 2005 to usual care (n = 82), supervised aerobic (n = 78), or resistance (n = 82) exercise during chemotherapy. The primary end point for this exploratory analysis was disease-free survival (DFS). Secondary end points were overall survival, distant DFS, and recurrence-free interval. The two exercise arms were combined for analysis (n = 160), and selected subgroups were explored. Results: After a median follow-up o f 89 months, there were 25/160 (15.6%) DFS events in the exercise groups and 18/82 (22.0%) in the control group. Eight-year DFS was 82.7% for the exercise groups compared with 75.6% for the control group (HR, 0.68; 95% confidence interval (Cl), 0.37-1.24; log-rank, P = 0.21). Slightly stronger effects were observed for overall survival (HR, 0.60; 95% Cl, 0.27-1.33; log-rank, P = 0.21), distant DFS (HR, 0.62; 95% Cl, 0.32—1.19; log-rank, P = 0.15), and recurrence-free interval (HR, 0.58; 95% Cl, 0.30-1.11; Gray test, P = 0.095). Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese (HR, 0.59; 95% Cl, 0.27-1.27), had stage II/III cancer (HR, 0.61; 95% Cl, 0.31-1.20), estrogen receptor-positive tumors (HR, 0.58; 95% Cl, 0.26-1.29), human epidermal growth factor receptor 2-positive tumors (HR, 0.21; 95% Cl, 0.04-1.02), received taxane-based chemotherapies (HR, 0.46; 95% Cl, 0.19-1.15), and ≥85% o f their planned chemotherapy (HR, 0.50; 95% Cl, 0.25-1.01). Conclusions: This exploratory follow-up o f the START provides the first randomized data to suggest that adding exercise to standard chemotherapy may improve breast cancer outcomes. A definitive phase III trial is warranted. [ABSTRACT FROM AUTHOR]

The article reports on research which was conducted to investigate the effects supervised aerobic exercise had on the motivational outcomes and longer-term behavior of lymphoma patients. Researchers evaluated 60 patients. They found that supervised exercise has motivational effects in lymphoma patients and improves longer-term exercise behavior. They concluded that strategies to further enhance the motivational value of supervised exercise in lymphoma patients are warranted and should be developed.

The article investigates the predictors of supervised exercise adherence in breast cancer patients initiating adjuvant chemotherapy in Edmonton, Ottawa and Vancouver, Canada. Objective attendance records were used to evaluate the adherence of the patients. Findings of univariate and multivariate analysis reveal that supervised exercise adherence has significant relations to the training location, disease stage and depression as well as patients' muscular strength, percent body fat and education. It was concluded that breast cancer patients' exercise adherence was not driven by motivational variables but by unique factors such as location, fitness and depression.

Supplemental digital content is available in the text. Purpose: Fatigue is a common and potentially disabling symptom in patients with cancer. It can often be effectively reduced by exercise. Yet, effects of exercise interventions might differ across subgroups. We conducted a meta-analysis using individual patient data of randomized controlled trials (RCT) to investigate moderators of exercise intervention effects on cancer-related fatigue. Methods: We used individual patient data from 31 exercise RCT worldwide, representing 4366 patients, of whom 3846 had complete fatigue data. We performed a one-step individual patient data meta-analysis, using linear mixed-effect models to analyze the effects of exercise interventions on fatigue (z score) and to identify demographic, clinical, intervention- and exercise-related moderators. Models were adjusted for baseline fatigue and included a random intercept on study level to account for clustering of patients within studies. We identified potential moderators by testing their interaction with group allocation, using a likelihood ratio test. Results: Exercise interventions had statistically significant beneficial effects on fatigue (β = −0.17; 95% confidence interval [CI], −0.22 to −0.12). There was no evidence of moderation by demographic or clinical characteristics. Supervised exercise interventions had significantly larger effects on fatigue than unsupervised exercise interventions (βdifference = −0.18; 95% CI −0.28 to −0.08). Supervised interventions with a duration ≤12 wk showed larger effects on fatigue (β = −0.29; 95% CI, −0.39 to −0.20) than supervised interventions with a longer duration. Conclusions: In this individual patient data meta-analysis, we found statistically significant beneficial effects of exercise interventions on fatigue, irrespective of demographic and clinical characteristics. These findings support a role for exercise, preferably supervised exercise interventions, in clinical practice. Reasons for differential effects in duration require further exploration. [ABSTRACT FROM AUTHOR]

Purpose: The number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone—a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments on their physical and mental well-being. For example, cancer survivors often experience declines in physical functioning and quality of life while facing an increased risk of cancer recurrence and all-cause mortality compared with persons without cancer. The 2010 American College of Sports Medicine Roundtable was among the first reports to conclude that cancer survivors could safely engage in enough exercise training to improve physical fitness and restore physical functioning, enhance quality of life, and mitigate cancer-related fatigue. Methods: A second Roundtable was convened in 2018 to advance exercise recommendations beyond public health guidelines and toward prescriptive programs specific to cancer type, treatments, and/or outcomes. Results: Overall findings retained the conclusions that exercise training and testing were generally safe for cancer survivors and that every survivor should "avoid inactivity." Enough evidence was available to conclude that specific doses of aerobic, combined aerobic plus resistance training, and/or resistance training could improve common cancer-related health outcomes, including anxiety, depressive symptoms, fatigue, physical functioning, and health-related quality of life. Implications for other outcomes, such as peripheral neuropathy and cognitive functioning, remain uncertain. Conclusions: The proposed recommendations should serve as a guide for the fitness and health care professional working with cancer survivors. More research is needed to fill remaining gaps in knowledge to better serve cancer survivors, as well as fitness and health care professionals, to improve clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to examine mediators of fatigue response to an exercise intervention for breast cancer survivors in a pilot randomized controlled trial. Methods: Postmenopausal breast cancer survivors (n = 46; ≤stage 2), off primary treatment, and reporting fatigue and/or sleep dysfunction were randomized to a 3-month exercise intervention (160 min•wk-1 of moderate-intensity aerobic walking, twice weekly resistance training with resistance bands) or control group. Six discussion group sessions provided behavioral support to improve adherence. Fatigue, serum cytokines, accelerometer physical activity, cardiorespiratory fitness, sleep dysfunction, and psychosocial factors were assessed at baseline and 3 months. Results: The exercise intervention effect sizes for fatigue were as follows: fatigue intensity d = 0.30 (P = 0.34), interference d = -0.38 (P = 0.22), and general fatigue d = -0.49 (P = 0.13). Using the Freedman-Schatzkin difference-in-coefficients tests, increase in fatigue intensity was significantly mediated by interleukin 6 (IL-6) (82%), IL-10 (94%), IL-6/IL-10 (49%), and tumor necrosis factor-α (TNF-α):IL-10 (78%) with reduced sleep dysfunction increasing the relationship between intervention and fatigue intensity rather than mediating intervention effects (-88%). Decrease in fatigue interference was mediated by sleep dysfunction (35%), whereas IL-10 and pro-anti-inflammatory cytokine ratios increased the relationship between intervention and interference (-25% to -40%). The reduction in general fatigue was significantly mediated by minutes of physical activity (76%), sleep dysfunction (45%), and physical activity enjoyment (40%), with IL-10 (-40%) and IL-6/IL-10 (-11%) increasing the intervention-fatigue relationship. In the intervention group, higher baseline fatigue, anxiety, depression, and perceived exercise barrier interference predicted a greater decline in fatigue interference and/or general fatigue during the intervention. Conclusions: Biobehavioral factors mediated and enhanced intervention effects on fatigue, whereas psychosocial factors predicted fatigue response. Further study is warranted to confirm our results and to improve understanding of relationships that mediate and strengthen the intervention-fatigue association. [ABSTRACT FROM AUTHOR]

The article presents a report on the feasibility study aimed at increasing physical activity in sedentary breast cancer survivors who were receiving hormone therapy. Considerations concerning the participants of the study are provided, along with the discussion and interpretation of the results. Accordingly, 41 sedentary breast cancer survivors were assigned randomly for multidisciplinary physical activity behavior change intervention. Base on the results, the study concludes for the feasibility of behavior change intervention for breast cancer survivors and, potential for physical activity improvements.

PURPOSE: Prostate cancer (PCa) patients undergoing active surveillance often experience psychological distress such as anxiety or fear or cancer progression. This study was to investigate the impacts of a 12-week exercise program on patient-reported outcomes in PCa patients undergoing active surveillance. METHODS: 52 PCa patients on active surveillance were randomized to high-intensity interval training (HIIT; n=26) or usual care (UC; n=26). The HIIT group performed a 12-week, thriceweekly, supervised, aerobic HIIT intervention. Patient-reported outcomes were assessed at baseline and postintervention (12-weeks), including PCa-specific anxiety (Memorial Anxiety Scale for Prostate Cancer; MAX-PC), fear of cancer progression (Fear of Cancer Recurrence Inventory; FCRI), PCa-related symptoms (Expanded Prostate Cancer Index Composite-26; EPIC-26), cancer-related quality of life (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30-item; EORTC QLQ-C30), and generic psychosocial outcomes (e.g., fatigue, stress, and self-esteem). Analysis of covariance was used to compare between-group differences. RESULTS: 50/52 (96%) participants completed patient-reported outcome assessments at 12-weeks and adherence to the HIIT program was 96%. Compared to UC, HIIT significantly reduced total PCa-specific anxiety (adjusted between-group mean difference, -2.7; 95% confidence interval [CI], -5.0 to -0.4; p=0.024; d=0.28) and fear of recurrence (adjusted between-group mean difference, -2.0; 95% CI, -3.5 to -0.4; p=0.013; d=0.67) in MAX-PC; hormonal dysfunction (p=0.005) in EPIC-26; and perceived stress (p=0.037), fatigue (p=0.029), and self-esteem (p=0.007). CONCLUSIONS: A 12-week supervised HIIT program reduced PCa-specific anxiety, fear of cancer progression, hormone symptoms, stress, and fatigue, and increased self-esteem in men with PCa on active surveillance. Larger trials are warranted to determine the longer-term effects of exercise on patient-reported outcomes and whether such effects influence willingness to continue on active surveillance. [ABSTRACT FROM AUTHOR]

The article cites a study that identifies key demographic and health factors associated with physical activity (PA) participation in adults diagnosed with type 1 or type 2 diabetes recruited from the Canadian Diabetes Association of Alberta, Canada. The study uses multiple and logistic regression models to identify demographic and health factors related to PA levels, and the analyses were conducted separately for type 1 and type 2 groups. The study shows that a 63.7% of those with type 1 and 71.9% for those with type 2 diabetes were not achieving recommended PA levels.