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Annually, nearly 2 million people are diagnosed with cancer. Cancer is the second leading cause of death in the United States. Strong evidence supports exercise in the prevention of seven different types of cancers. Among cancer survivors, exercise across the cancer care continuum is effective at reducing various treatment-related adverse effects, such as fatigue, anxiety, and depression, and improves quality of life, physical function, sleep, and bone health. Considering the benefits of exercise for people living with and beyond cancer, there are several models to facilitate the implementation of exercise as part of the cancer care plan. These models span clinically supervised settings to supervised and nonsupervised community-based settings. Barriers such as payment and workforce development prevent the implementation of these programs nationwide. Oncology providers and cancer care team members also play an important role in promoting exercise to cancer survivors. In fact, a salient theme for motivating survivors to engage in exercise is support from their medical oncologist. Resources and tools are available to help the cancer care team motivate survivors to engage in exercise, such as enhancing enjoyment of the activity, goal-setting, self-monitoring, and social support. Together, exercise is beneficial across the cancer care continuum, and action can be taken right now to facilitate patient and survivor engagement in exercise.

Among cancer survivors, there are numerous health benefits of exercise engagement; however, less than 15% of survivors meet current aerobic and strength physical activity guidelines. Exercise programs provided by a cancer hospital are commonly noted as a facilitator and preference to exercise engagement. The study aimed to review the evidence and describe the barriers, facilitators, preferences, and factors associated with cancer survivors' engagement in hospital-based exercise oncology programs. Electronic databases (PubMed and Scopus) were searched to identify relevant papers published before July 1, 2021. Original research papers reporting on barriers, facilitators, preferences, or factors associated with participation in hospital-based exercise oncology programs were included. A total of 300 potentially relevant articles were identified, of which 10 met eligibility criteria. Barriers to participation in hospital-based exercise oncology programs included program accessibility, treatment-related side effects, and uncertainty about exercise. Program individualization, peer support, and staff support were reported as facilitators. Survivors also expressed that they preferred flexibility in the time, location, and mode of exercise programming. Baseline quality of life, fitness, and marital status were all identified as potential factors associated with engagement in hospital-based exercise oncology programs. These findings are useful for the development and implementation of hospital-based exercise oncology programs to optimize exercise program engagement.

Purpose Preclinical evidence suggests that natural killer cell (NK-cell) function and myokines facilitate the protective effects of exercise for breast cancer prevention. Since higher-intensity exercise acutely promotes greater mobilization and larger changes in NK-cell cytotoxicity than lower-intensity, high-intensity interval training (HIIT) might offer increased immune protection compared to moderate-intensity continuous-training (MICT). This study compared a 12-week HIIT program to a 12-week MICT program and usual care on changes in resting NK-cell function and circulating myokines among women at high risk for breast cancer. Methods Thirty-three women were randomized to HIIT, MICT, or usual care, for a supervised exercise intervention. Blood was collected at baseline and end-of-study. The cytotoxic activity of CD3−/CD56+ NK-cells against the K562 target cell line in vitro was determined by flow cytometry. Circulating myokines (IL-15, IL-6, irisin, OSM, osteonectin, IL-7) were assessed with luminex multiplex assays and ELISA. One-way ANOVA and paired sample t-tests assessed between- and within-group differences, respectively. Pearson correlation coefficients determined relationships between baseline fitness and change variables. Results Significant differences were not observed between groups for change in NK-cell function or circulating myokines (p > 0.05). Significant correlations were only observed for baseline peak aerobic capacity (ml/kg/min) and change in NK-cell-specific lysis (r = − 0.43, p = 0.02) and hemacytotoxicity for the total sample (r = − 0.46, p = 0.01). Conclusion Our findings suggest that exercise intensity may not significantly impact change in resting NK-cell function and circulating myokines among women at high risk for breast cancer. Structured exercise training may have a larger impact on NK-cell function in those with lower levels of cardiorespiratory fitness. Clinical trial registration: NCT02923401; Registered on October 4, 2016

Background Immunosenescence is described as age-associated changes within the immune system that are responsible for decreased immunity and increased cancer risk. Physically active individuals have fewer ‘senescent’ and more naïve T-cells compared to their sedentary counterparts, but it is not known if exercise training can rejuvenate ‘older looking’ T-cell profiles. We determined the effects of 12-weeks supervised exercise training on the frequency of T-cell subtypes in peripheral blood and their relationships with circulating levels of the muscle-derived cytokines (i.e. ‘myokines’) IL-6, IL-7, IL-15 and osteonectin in older women at high risk of breast cancer. The intervention involved 3 sessions/week of either high intensity interval exercise (HIIT) or moderate intensity continuous exercise (MICT) and were compared to an untrained control (UC) group. Results HIIT decreased total granulocytes, CD4+ T-cells, CD4+ naïve T-cells, CD4+ recent thymic emigrants (RTE) and the CD4:CD8 ratio after training, whereas MICT increased total lymphocytes and CD8 effector memory (EM) T-cells. The change in total T-cells, CD4+ naïve T-cells, CD4+ central memory (CM) T-cells and CD4+ RTE was elevated after MICT compared to HIIT. Changes in $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\max } $$ V ̇ O 2 max after training, regardless of exercise prescription, was inversely related to the change in highly differentiated CD8+ EMRA T-cells and positively related to changes in β2-adrenergic receptor (β2-AR) expression on CM CD4+ and CM CD8+ T-cells. Plasma myokine levels did not change significantly among the groups after training, but individual changes in IL-7 were positively related to changes in the number of β2-AR expressing CD4 naïve T cells in both exercise groups but not controls. Further, CD4 T-cells and CD4 naive T-cells were negatively related to changes in IL-6 and osteonectin after HIIT but not MICT, whereas CD8 EMRA T-cells were inversely related to changes in IL-15 after MICT but not HIIT. Conclusions Aerobic exercise training alters the frequency of peripheral T-cells associated with immunosenescence in middle aged/older women at high risk of breast cancer, with HIIT (pro-senescent) and MICT (anti-senescent) evoking divergent effects. Identifying the underlying mechanisms and establishing whether exercise-induced changes in peripheral T-cell numbers can alter the risk of developing breast cancer warrants investigation.

INTRODUCTION AND OBJECTIVE:Sarcopenia (low skeletal muscle mass) is a poor prognostic factor in patients undergoing nephrectomy for localized renal cancer. However, little is known about the trajec...

377 Background: Among patients diagnosed with mNSCLC, significant declines in fat and muscle mass are common, yet there is a paucity of data related to body composition, QoL, TD, and survival. Accordingly, we evaluated the relationship between body composition via routine CT scans, patient-reported outcomes (PROs), and overall survival (OS) among a convenience sample of mNSCLC patients. Methods: Data from 80 mNSCLC patients with initial CT scans and NCI PROMIS questionnaires within the first three months of diagnosis were analyzed. Body composition from CT scans (sliceOmatic software) extracted Skeletal muscle (SM), intermuscular adipose tissue (IAT), visceral VAT, and subcutaneous (SAT) in area (cm2) and a discovery set was expressed as HU. PROMIS PROs (pain, fatigue, anxiety, depression, and physical function) were collected in clinic using an iPad as an institutional quality initiative. Results: Median time to OS was 16 months. When stratified by sex, females had longer median survival time (female 25 months, male 14 months). When all body composition variables were considered together, greater amounts of skeletal muscle were linked with a 63% reduction in mortality risk 0.37 (95% CI 0.16, 0.87) in the adjusted model. Per one-unit increase in VAT (area cm2) was linked with a 0.04 unit decrease in pain (95% CI -0.08, -0.01). Associations between HU and clinical were also observed. Greater amount of VAT (mean HU) was linked with 2.57(95% CI 1.10, 6.01) times the odds of death in the crude model. Also, in crude model, one unit of increase in skeletal muscle (mean HU) was associated with 0.3 (95% CI 0.03, 0.57) unit increase in physical functionality, and -0.34(95% CI -0.63, -0.05)) unit decrease in fatigue. Conclusions: Body composition data can be collected from retrospective scans and appears to be prognostic of OS, PRO and TD.

Immunosenescence is described as age-associated changes within the immune system that are responsible for decreased immunity and increased cancer risk. Physically active individuals have fewer 'senescent' and more naïve T-cells compared to their sedentary counterparts, but it is not known if exercise training can rejuvenate 'older looking' T-cell profiles. We determined the effects of 12-weeks supervised exercise training on the frequency of T-cell subtypes in peripheral blood and their relationships with circulating levels of the muscle-derived cytokines (i.e. 'myokines') IL-6, IL-7, IL-15 and osteonectin in older women at high risk of breast cancer. The intervention involved 3 sessions/week of either high intensity interval exercise (HIIT) or moderate intensity continuous exercise (MICT) and were compared to an untrained control (UC) group.HIIT decreased total granulocytes, CD4+ T-cells, CD4+ naïve T-cells, CD4+ recent thymic emigrants (RTE) and the CD4:CD8 ratio after training, whereas MICT increased total lymphocytes and CD8 effector memory (EM) T-cells. The change in total T-cells, CD4+ naïve T-cells, CD4+ central memory (CM) T-cells and CD4+ RTE was elevated after MICT compared to HIIT. Changes in [Formula: see text] after training, regardless of exercise prescription, was inversely related to the change in highly differentiated CD8+ EMRA T-cells and positively related to changes in β2-adrenergic receptor (β2-AR) expression on CM CD4+ and CM CD8+ T-cells. Plasma myokine levels did not change significantly among the groups after training, but individual changes in IL-7 were positively related to changes in the number of β2-AR expressing CD4 naïve T cells in both exercise groups but not controls. Further, CD4 T-cells and CD4 naive T-cells were negatively related to changes in IL-6 and osteonectin after HIIT but not MICT, whereas CD8 EMRA T-cells were inversely related to changes in IL-15 after MICT but not HIIT.Aerobic exercise training alters the frequency of peripheral T-cells associated with immunosenescence in middle aged/older women at high risk of breast cancer, with HIIT (pro-senescent) and MICT (anti-senescent) evoking divergent effects. Identifying the underlying mechanisms and establishing whether exercise-induced changes in peripheral T-cell numbers can alter the risk of developing breast cancer warrants investigation.

Purpose This trial aimed to demonstrate the feasibility of high-intensity interval training (HIIT) in postmenopausal, overweight/obese women at high risk of invasive breast cancer and to explore HIIT on changes in cardiorespiratory fitness (CRF), body weight, and body mass index (BMI) compared with moderate-intensity continuous training (MICT) and usual care (UC). Methods Forty-four women were randomized to HIIT, MICT, or UC for a 12-wk, thrice weekly, supervised exercise intervention. HIIT included a 5-min warm-up at 50%–70% HRpeak, four cycles of 4 min at 90%–100% HRpeak, followed by 3 min at 50%–70% HRpeak. MICT consisted of 41 min at 60%–70% HRpeak. Feasibility was assessed by consent, adherence, compliance, and retention rates. CRF, body weight, and BMI were measured at baseline and end of study. Repeated-measures linear mixed models were used to assess within- and between-group differences. Results Average age was 63.9 ± 8.8 yr. BMI was 30.9 ± 5.7 kg·m−2. Participants completed 90% and 89% of HIIT and MICT workouts, respectively, with 100% compliance to the exercise prescriptions. No serious adverse events were reported. Compared with MICT and UC, HIIT exhibited improvements in change in treadmill time (101 s greater than MICT, and 125 s greater than UC, respectively, P < 0.001). Compared with UC, HIIT exhibited improvement in changes in absolute and relative V˙O2peak (a 0.15-L·min−1 increase, P = 0.005, and a 2.3-mL·kg−1⋅min−1 increase, P = 0.004). There were no significant differences between groups for body weight or BMI (P > 0.05). Conclusions HIIT is feasible, safe, and seems to promote greater improvements in CRF compared with MICT and UC in women at high risk for breast cancer.

Lifestyle factors related to energy balance, such as excess body weight, poor diet, and physical inactivity, are associated with risk of sporadic endometrial cancer (EC) and colorectal cancer (CRC). There are limited data on energy balance-related lifestyle factors and EC or CRC risk among individuals with Lynch syndrome, who are at extraordinarily higher risk of developing EC or CRC. We conducted a systematic review of evidence related to weight status, weight change, dietary habits, and physical activity on EC and CRC risk among individuals with Lynch syndrome. Findings are reported narratively. We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to June 14(th), 2018. In total, 1,060 studies were identified and 16 were included. Three studies were related to EC and 13 to CRC. Overall, evidence suggests that weight status/weight change may not be associated with EC risk and multivitamin and folic-acid supplementation may be associated with decreased EC risk. Early-adulthood overweight/obese weight-status and adulthood weight-gain may be associated with increased CRC risk, whereas multivitamin supplementation, tea and high fruit intake, and physical activity may be associated with decreased CRC risk. Current evidence proposes that recommendations related to weight, some dietary habits, and physical activity recommended for the general public are also relevant to individuals with Lynch syndrome. More research is needed, specifically prospective cohorts and randomized controlled trials, to determine if tailored recommendations are needed among individuals with Lynch syndrome.

Objective To assess the relationship between time-of-day of exercise training and changes in relevant cancer health outcomes among cancer survivors. Methods Retrospective analysis of data collected from 2016–2019 from a hospital-based exercise oncology program. Descriptive statistics were calculated for demographic, clinical, and exercise timing characteristics (e.g. AM, PM, or mix) among survivors with available data for exercise training time (n = 233). For the total sample and a breast cancer sub-analysis, univariate analysis of covariance, adjusted for age, was carried out by exercise training time, for change in the following outcomes collected during the program’s assessment sessions: cardiorespiratory fitness and muscular endurance (human performance variables), physical function, anthropometrics, self-reported fatigue, and quality of life (QoL). Change in body mass index (BMI) and body weight was included in the breast cancer analysis. Results Overall, 37.3% of survivors habitually engaged in AM exercise (e.g. ≥ 75% AM training), 34.3% in PM exercise, and 28.3% in a mix of AM and PM exercise training throughout the program. Median time in the program was 17 weeks. Significant improvements in most human performance and physical function variables were observed in the total sample regardless of exercise training time-of-day. Among breast cancer survivors, PM but not AM or mixed was associated with improvements in fitness, and lower-body muscular endurance and function. Mixed exercise timing was linked with greater increase in waist circumference (total sample: 3.02cm, 95%CI 1.55, 4.49; breast cancer: 3.57cm 95%CI 0.96, 6.18), body weight (breast cancer: 1.6kg, 95%CI 0.3, 2.8) and BMI (breast cancer: 0.6kg/m2, 95%CI 0.1, 1.0). AM and PM exercise, but not mixed, was associated with improvements in fatigue and QoL. Conclusion Time-of-day of exercise training may differentially impact changes in human performance and physical function variables. Mixed exercise training time may result in less favorable outcomes related of weight management variables among cancer survivors.

Purpose To assess the impact of the Personal Optimism With Exercise Recovery (POWER) program on cancer treatment–related side effects among rural cancer survivors. Methods In this retrospective study of data collected between 2016 and 2019, we assessed change in cardiorespiratory fitness, whole-body muscular endurance, physical function and strength, anthropometrics, fatigue, and quality of life (QoL), after participation in POWER. Descriptive statistics were calculated for demographic and clinical variables. Univariate analysis of variance was carried out with age and BMI at initial assessment as covariates. Results A total of 239 survivors, 78% rural residents, completed a follow-up assessment. Among rural cancer survivors, the most prevalent cancer sites were breast (42.5%), prostate (12.4%), and lymphoma (5.9%). The majority of survivors were female (70%), non-Hispanic (94.6%), and white (93.5%), with average age and BMI of 62.1 ± 13.2 years and 28.4 ± 6.7 kg/m2, respectively. Rural cancer survivors with cancer stages I–III exhibited significant improvements in fitness (+ 3.07 ml/kg/min, 95% CI 1.93, 4.21; + 0.88 METS, 95% CI 0.55, 1.20), physical function (30-s chair stand: + 2.2 repetitions, 95% CI 1.3, 3.1), muscular endurance (10-repetition maximum: chest press + 4.1 kg, 95% CI 2.0, 6.3; lateral pulldown + 6.6 kg, 95% CI 4.4, 8.9), self-reported fatigue (FACIT-Fatigue score: + 4.9, 95% CI 1.6, 8.1), and QoL (FACT-G7 score + 2.1, 95% CI, 0.9, 3.4). Among stage IV rural and urban cancer survivors, significant improvements were observed in muscular endurance and physical function. Conclusion Participation in POWER was associated with attenuation of cancer treatment–related side effects and may serve as a model exercise oncology program for rural cancer survivors.

Introduction Women with pathogenic germline gene variants in BRCA1 and/or BRCA2 are at increased risk of developing ovarian and breast cancer. While surgical and pharmacological approaches are effective for risk-reduction, it is unknown whether lifestyle approaches such as healthful dietary habits, weight management, and physical activity may also contribute to risk-reduction. We conducted a systematic review of evidence related to dietary habits, weight status/change, and physical activity on ovarian and breast cancer risk among women with BRCA1/2 pathogenic variants. Methods We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to October 3, 2019. We identified 2775 records and included 21. Results There is limited evidence related to these factors and ovarian cancer risk. For breast cancer risk, evidence suggests higher diet quality, adulthood weight-loss of ≥10 pounds, and activity during adolescence and young-adulthood may be linked with decreased risk. Higher meat intake and higher daily energy intake may be linked with increased risk. Conclusions There is not enough evidence to suggest tailored recommendations for dietary habits or weight management among women with BRCA1/2 pathogenic variants compared to the general population for ovarian and breast cancer risk-reduction, and physical activity recommendations should remain the same.

Cancer prevention is the most cost-effective, long-term strategy for the control of cancer. 1 , 2 It is now well established that approximately one-third to one-half of all adult cancers occurring in Western populations can be prevented through the adoption of “healthy lifestyles.” A comprehensive view of a healthy lifestyle includes adherence to published cancer prevention recommendations that seek to eliminate or minimize exposure to lifestyle risk factors, and the use of screening and early detection tests as well as molecular preventive agents (e.g., aspirin, tamoxifen, human papillomavirus [HPV] vaccine) when warranted. This chapter focuses on the epidemiology of lifestyle risk factors and their associated interventions, as well as on the use of molecular preventive agents. Screening and early detection are addressed in another chapter.

Introduction Women with pathogenic germline gene variants in BRCA1 and/or BRCA2 are at increased risk of developing ovarian and breast cancer. While surgical and pharmacological approaches are effective for risk-reduction, it is unknown whether lifestyle approaches such as healthful dietary habits, weight management, and physical activity may also contribute to risk-reduction. We conducted a systematic review of evidence related to dietary habits, weight status/change, and physical activity on ovarian and breast cancer risk among women with BRCA1/2 pathogenic variants. Methods We searched Medline, EMBASE, CENTRAL, PubMed, and clinicaltrials.gov up to October 3, 2019. We identified 2775 records and included 21. Results There is limited evidence related to these factors and ovarian cancer risk. For breast cancer risk, evidence suggests higher diet quality, adulthood weight-loss of ≥10 pounds, and activity during adolescence and young-adulthood may be linked with decreased risk. Higher meat intake and higher daily energy intake may be linked with increased risk. Conclusions There is not enough evidence to suggest tailored recommendations for dietary habits or weight management among women with BRCA1/2 pathogenic variants compared to the general population for ovarian and breast cancer risk-reduction, and physical activity recommendations should remain the same.

Objectives Abdominal obesity is linked with a higher risk of developing ovarian cancer. However, the link between abdominal obesity and survival after diagnosis of ovarian cancer is unknown. The purpose of this study was to determine the impact of abdominal obesity on progression-free survival in patients with ovarian cancer. Methods Among 258 patients, visceral and subcutaneous adipose tissue volume, along with perirenal adipose tissue thickness (a visceral adiposity proxy measure) was retrospectively measured from abdominal computed tomography (CT) scans obtained within 6 months of ovarian cancer diagnosis. Progression-free survival was computed using the Kaplan-Meier method and log-rank tests. Univariate and multivariate Cox proportional hazards analysis was used to determine relationships between measures of abdominal obesity and clinical variables in relation to progression-free survival. Results Patients with perirenal adipose tissue thickness greater than 5 mm(median) had lower rates of progression-free survival at 5 years compared with patients with perirenal adipose tissue thickness less than 5 mm (45.6% vs 53.8%, respectively). Perirenal adipose tissue thickness less than 5 mm was associated with lower rates of progression-free survival on multivariate analysis (hazard ratio = 1.37; 95% confidence interval, 1.03–1.82). There was no correlation with other metrics of abdominal adiposity on progression-free survival in univariate or multivariate analysis. Conclusions Our data suggest that perirenal adipose, but not body mass index, visceral, or subcutaneous fat volume that were measured within 6 months from diagnosis, is associated with lower rates of progression-free survival in ovarian cancer.

170 Background: Performance status (PS), a physician-based, subjective assessment of a patient’s symptoms and ambulatory state, is an eligibility criterion for most clinical trials and a key clinical decision tool for treatment of NSCLC. Methods: Patients with metastatic NSCLC were asked to participate in a prospective, observational study of potential prognostic factors that includes demographics, laboratory, patient reported outcomes (PROs) by the patient reported outcomes measurement information system (PROMIS), PS reported by patient, PS assessed by physician, FitBit tracker (includes steps, distance, heart rate (HR), calories, METs), physical challenge and proteomics (Veristratâ). Correlation and regression analyses were performed for the initial 55 patients enrolled prior to COVID restrictions. Tracker data was collected and averaged over the first 7 days with wear > 500 minutes/day. Other data were collected at baseline. Results: We enrolled 55 patients with metastatic NSCLC. There were 35 females and 20 males with a median age of 67 years. A majority of patients were never (38%, n = 21) or former smokers (40%, n = 22); adenocarcinoma (83%, n = 83%) was the most common histology. 30% (n = 17) patients were 2nd or greater line of therapy. 52 were included for survival analysis and 21 expired with median survival 226 days (149, NA). There were minimal gender related differences in the study population except a higher incidence of adenocarcinoma in women (94% vs 65%, p = 0.012 and longer FiTBit assessed daily “very active minutes” (defined as METs > = 6) in men compared to women (4.21 vs 0.43, p = 0.036). Patient- and physician assessed PS were not statistically different, although patients tended underestimated their PS relative to physicians. Physician assessed PS, patient assessed PS, two-minute walk distance, proteomics by Veristratâ, total daily steps, total daily distance covered, and heart rate/activity mismatch were independent predictors of survival. Age, gender, smoking, BMI, histology, and various CBC-based indices were not prognostic. Conclusions: Patient- and physician-assessment of PS do not always match, many alternate measures to PS are prognostic of survival and tracker-based methods are objective and feasible in clinical practice.

While commercial dietary weight-loss programs typically advise exercise, few provide actual programing. The goal of this study was to compare the Curves Complete 90-day Challenge (CC, n = 29), which incorporates exercising and diet, to programs advocating exercise (Weight Watchers Points Plus (WW, n = 29), Jenny Craig At Home (JC, n = 27), and Nutrisystem Advance Select (NS, n = 28)) or control (n = 20) on metabolic syndrome (MetS) and weight loss. We randomized 133 sedentary, overweight women (age, 47 ± 11 years; body mass, 86 ± 14 kg; body mass index, 35 ± 6 kg/m2) into respective treatment groups for 12 weeks. Data were analyzed using chi square and general linear models adjusted for age and respective baseline measures. Data are means ± SD or mean change ± 95% confidence intervals (CIs). We observed a significant trend for a reduction in energy intake for all treatment groups and significant weight loss for all groups except control: CC (−4.32 kg; 95% CI, −5.75, −2.88), WW (−4.31 kg; 95% CI, −5.82, −2.96), JC (−5.34 kg; 95% CI, −6.86, −3.90), NS (−5.03 kg; 95% CI, −6.49, −3.56), and control (0.16 kg, 95% CI, −1.56, 1.89). Reduced MetS prevalence was observed at follow-up for CC (35% vs. 14%, adjusted standardized residuals (adjres.) = 3.1), but not WW (31% vs. 28% adjres. = 0.5), JC (37% vs. 42%, adjres. = −0.7), NS (39% vs. 50% adjres. = −1.5), or control (45% vs. 55% adjres. = −1.7). While all groups improved relative fitness (mL·kg−1·min−1) because of weight loss, only the CC group improved absolute fitness (L/min). In conclusion, commercial programs offering concurrent diet and exercise programming appear to offer greater improvements in MetS prevalence and cardiovascular function after 12 weeks of intervention.

Body size is emerging as a novel and clinically-relevant patient factor in bladder cancer research. Historically, a patient’s body mass index (BMI) has been used as a proxy for obesity but it shows inconsistent associations with risk of developing the disease as well as with most clinical outcomes. More specific body composition features can be derived for patients using a variety of methods. To date, skeletal muscle measurements derived from pre-operative computed tomography scans have shown the most consistent associations with clinical outcomes. Importantly, skeletal muscle can potentially be modified through resistance training and/or nutritional interventions. Large scale studies that evaluate the prognostic impact of not only body composition features at baseline but also describe changes in body composition post-treatment are needed to move the field forward to ultimately improve clinical outcomes for bladder cancer patients.

Physical activity (PA) is a known behavior to reduce cancer risk and improve cancer survivorship, yet adherence to PA guidelines is poor among the general population and cancer survivors. The purpose of this study was to determine the extent to which patients referred for exercise consultation within a clinical cancer prevention setting were meeting aerobic and resistance physical activity (PA) guidelines and to identify factors associated with guideline adherence. Between 2013 and 2015, cancer prevention patients and cancer survivors were interviewed by an exercise physiologist within an Integrative Health Program at The University of Texas MD Anderson Cancer Prevention Center. PA adherence was defined as at least 150-minutes of moderate-intensity or 75-minutes of vigorous-intensity PA per week, along with resistance training at least 2 days per week. Logistic regression was used to determine factors associated with meeting or not meeting PA guidelines for aerobic exercise, resistance exercise, and aerobic and resistance exercise combined. Among 1,024 cancer prevention patients and survivors, 9% of patients adhered to guideline-based PA. Adherence to aerobic and resistance guidelines were 20% and 12%, respectively. Overweight or obesity was associated with not meeting guideline-based PA in both cancer prevention patients and cancer survivors. Among breast cancer survivors, combination treatment with surgery, radiation, and chemotherapy ('multimodal therapy') was robustly associated with not meeting aerobic guidelines (OR 2.20, 95% CI: 1.17 to 4.16). BMI and breast cancer treatment history are key determinants of PA behavior among cancer prevention patients and survivors. Poor adherence to PA guidelines is a key issue for cancer prevention patients and survivors, particularly obese patients and women who receive multimodal therapy for breast cancer. Identifying and connecting patients at highest risk of poor PA adherence with exercise programs is needed to improve PA, a key modifiable cancer risk factor.

Dual-energy x-ray absorptiometry (DXA) for visceral adipose tissue (VAT) assessment is used as an alternative to computed tomography (CT) for research purposes in apparently healthy and clinical populations. It is unknown whether DXA is comparable to CT among cancer survivors, especially in cases where VAT assessment may be affected by treatment history and side effects and become more challenging to assess, such as a history of surgical gastrointestinal resection and/or ascites. The purpose of this study was to determine the level of agreement between DXA and CT when assessing VAT area and volume among cancer survivors. One hundred Gastrointestinal and pancreatic cancer survivors underwent abdominal and pelvis CT and whole-body DXA within 48 hours. Bland-Altman analysis revealed that in women and men, DXA VAT-area estimates were larger and smaller, respectively, and was consistently smaller in estimates for VAT-volume. Correlations from linear regression analysis revealed statistically significant positive correlations between measurement methods. Overall, while DXA VAT estimates are highly correlated with CT VAT estimates, DXA estimates show substantial bias which indicates the two methods are not interchangeable in this population. Further research is warranted with a larger, more homogeneous sample to develop better estimates of the bias.

There is a growing body of evidence related to the importance of body composition in cancer survivorship. Current evidence exclusive to the metastatic prostate cancer setting is limited, yet sheds light on the importance of body composition to reduce risk of mortality and disease progression in this patient population. In our commentary we present the current state of evidence related to body composition and metastatic prostate cancer survival among metastatic castration-resistant and castration-sensitive prostate cancer patients among varying treatment modalities. Additionally, we discuss the proposed biological mechanisms that may underpin how favorable changes in body composition may be helpful for survivorship, and review promising lifestyle strategies that can be implemented as part of survivorship care to improve body composition in this patient population.

Objectives To differentiate between rehabilitation and exercise training and propose how rehabilitation professionals and exercise physiologists can collaborate to optimize cancer survivor care. Data Source Professional organizations and peer-reviewed manuscripts. Conclusion Both professions offer complementary skillsets that, when integrated, optimize the ability of the cancer care team to implement more effective survivorship care plans. Future models of care must incorporate efficient communications between the cancer rehabilitation program and oncology team, include various reimbursement/payment/funding options, and continuously assess program efficacy. Implications for Nursing Practice Nurses must be cognizant of physical needs (ie, functional and conditioning status) and cancer-related comorbidities when referring cancer survivors for exercise reconditioning.

Obesity increases risk of endometrial cancer through dysregulation of estrogen and insulin signaling. The primary aim of this study was to evaluate the impact of metformin or lifestyle intervention on endometrial proliferation in postmenopausal obese women. Secondary aims included evaluating obesity-related biomarkers and adverse events experienced. Obese, postmenopausal women with prediabetes were randomized into four groups for a 16-week intervention using a 2 (metformin 1700 mg/day vs. placebo) × 2 (lifestyle intervention vs. no lifestyle intervention) factorial design. Pre- and postintervention endometrial proliferation, anthropometrics, body composition, and serum biomarkers (sex hormones, sex hormone binding globulin, IGF-I, adiponectin, omentin, insulin, glucose, and others) were assessed. Data were analyzed with linear regression models and false-discovery rate correction. Of 576 women approached for the study, 52 attended initial screening, 29 were eligible and randomized, and 26 completed the study. Lifestyle intervention resulted in significant loss of weight (−4.23 kg, P = 0.006) and total fat mass (−3.23 kg, P < 0.001). Participants receiving metformin lost 3.43 kg of weight (P = 0.023), but this was not statistically significant after multiple comparisons adjustment controlling false-discovery rate to 10%. Endometrial proliferation was low at baseline (mean 7.1%) and remained unchanged by 16 weeks, but included substantial variability. Metformin and lifestyle intervention produced minor changes to serum biomarkers. Lifestyle intervention produced the most significant changes in weight and body composition. While it is known that obese postmenopausal women are at increased risk for endometrial cancer, improved biomarkers are needed to stratify risk and test prevention strategies, particularly at the endometrial tissue level. Cancer Prev Res; 11(8); 477–90. ©2018 AACR.

In a double-blind, crossover, randomized and placebo-controlled trial; 28 men and women ingested a placebo (PLA), 3 g of creatine nitrate (CNL), and 6 g of creatine nitrate (CNH) for 6 days. Participants repeated the experiment with the alternate supplements after a 7-day washout. Hemodynamic responses to a postural challenge, fasting blood samples, and bench press, leg press, and cycling time trial performance and recovery were assessed. Data were analyzed by univariate, multivariate, and repeated measures general linear models (GLM). No significant differences were found among treatments for hemodynamic responses, clinical blood markers or self-reported side effects. After 5 days of supplementation, one repetition maximum (1RM) bench press improved significantly for CNH (mean change, 95% CI; 6.1 [3.5, 8.7] kg) but not PLA (0.7 [−1.6, 3.0] kg or CNL (2.0 [−0.9, 4.9] kg, CNH, p = 0.01). CNH participants also tended to experience an attenuated loss in 1RM strength during the recovery performance tests following supplementation on day 5 (PLA: −9.3 [−13.5, −5.0], CNL: −9.3 [−13.5, −5.1], CNH: −3.9 [−6.6, −1.2] kg, p = 0.07). After 5 days, pre-supplementation 1RM leg press values increased significantly, only with CNH (24.7 [8.8, 40.6] kg, but not PLA (13.9 [−15.7, 43.5] or CNL (14.6 [−0.5, 29.7]). Further, post-supplementation 1RM leg press recovery did not decrease significantly for CNH (−13.3 [−31.9, 5.3], but did for PLA (−30.5 [−53.4, −7.7] and CNL (−29.0 [−49.5, −8.4]). CNL treatment promoted an increase in bench press repetitions at 70% of 1RM during recovery on day 5 (PLA: 0.4 [−0.8, 1.6], CNL: 0.9 [0.35, 1.5], CNH: 0.5 [−0.2, 0.3], p = 0.56), greater leg press endurance prior to supplementation on day 5 (PLA: −0.2 [−1.6, 1.2], CNL: 0.9 [0.2, 1.6], CNH: 0.2 [−0.5, 0.9], p = 0.25) and greater leg press endurance during recovery on day 5 (PLA: −0.03 [−1.2, 1.1], CNL: 1.1 [0.3, 1.9], CNH: 0.4 [−0.4, 1.2], p = 0.23). Cycling time trial performance (4 km) was not affected. Results indicate that creatine nitrate supplementation, up to a 6 g dose, for 6 days, appears to be safe and provide some ergogenic benefit.

In a double-blind, randomized and crossover manner, 25 resistance-trained participants ingested a placebo (PLA) beverage containing 12 g of dextrose and a beverage (RTD) containing caffeine (200 mg), β-alanine (2.1 g), arginine nitrate (1.3 g), niacin (65 mg), folic acid (325 mcg), and Vitamin B12 (45 mcg) for 7-days, separated by a 7–10-day. On day 1 and 6, participants donated a fasting blood sample and completed a side-effects questionnaire (SEQ), hemodynamic challenge test, 1-RM and muscular endurance tests (3 × 10 repetitions at 70% of 1-RM with the last set to failure on the bench press (BP) and leg press (LP)) followed by ingesting the assigned beverage. After 15 min, participants repeated the hemodynamic test, 1-RM tests, and performed a repetition to fatigue (RtF) test at 70% of 1-RM, followed by completing the SEQ. On day 2 and 7, participants donated a fasting blood sample, completed the SEQ, ingested the assigned beverage, rested 30 min, and performed a 4 km cycling time-trial (TT). Data were analyzed by univariate, multivariate, and repeated measures general linear models (GLM), adjusted for gender and relative caffeine intake. Data are presented as mean change (95% CI). An overall multivariate time × treatment interaction was observed on strength performance variables (p = 0.01). Acute RTD ingestion better maintained LP 1-RM (PLA: −0.285 (−0.49, −0.08); RTD: 0.23 (−0.50, 0.18) kg/kgFFM, p = 0.30); increased LP RtF (PLA: −2.60 (−6.8, 1.6); RTD: 4.00 (−0.2, 8.2) repetitions, p = 0.031); increased BP lifting volume (PLA: 0.001 (−0.13, 0.16); RTD: 0.03 (0.02, 0.04) kg/kgFFM, p = 0.007); and, increased total lifting volume (PLA: −13.12 (−36.9, 10.5); RTD: 21.06 (−2.7, 44.8) kg/kgFFM, p = 0.046). Short-term RTD ingestion maintained baseline LP 1-RM (PLA: −0.412 (−0.08, −0.07); RTD: 0.16 (−0.50, 0.18) kg/kgFFM, p = 0.30); LP RtF (PLA: 0.12 (−3.0, 3.2); RTD: 3.6 (0.5, 6.7) repetitions, p = 0.116); and, LP lifting volume (PLA: 3.64 (−8.8, 16.1); RTD: 16.25 (3.8, 28.7) kg/kgFFM, p = 0.157) to a greater degree than PLA. No significant differences were observed between treatments in cycling TT performance, hemodynamic assessment, fasting blood panels, or self-reported side effects.

Background Visceral adiposity is a risk factor for many chronic diseases. Existing methods to quantify visceral adipose tissue volume using computed tomographic (CT) images often use a single slice, are manual, and are time consuming, making them impractical for large population studies. We developed and validated a method to accurately, rapidly, and robustly measure visceral adipose tissue volume using CT images. Methods In-house software, Medical Executable for the Efficient and Robust Quantification of Adipose Tissue (MEERQAT), was developed to calculate visceral adipose tissue volume using a series of CT images within a manually identified region of interest. To distinguish visceral and subcutaneous adipose tissue, ellipses are drawn through the rectus abdominis and transverse abdominis using manual and automatic processes. Visceral and subcutaneous adipose tissue volumes are calculated by counting the numbers of voxels corresponding to adipose tissue in the region of interest. MEERQAT’s ellipse interpolation method was validated by comparing visceral adipose volume from 10 patients’ CT scans with corresponding results from manually delineated scans. Accuracy of visceral adipose quantification was tested using a phantom consisting of animal fat and tissues. Robustness of the method was tested by determining intra-observer and inter-observer coefficients of variation (CV). Results The mean difference in visceral adipose tissue volume between manual and elliptical delineation methods was -0.54 ± 4.81%. In the phantom, our measurement differed from the known adipose volume by ≤ 7.5% for all scanning parameters. Mean inter-observer CV for visceral adipose tissue volume was 0.085, and mean intra-observer CV for visceral adipose tissue volume was 0.059. Conclusions We have developed and validated a robust method of accurately and quickly determining visceral adipose tissue volume in any defined region of interest using CT imaging.

Methods Fifty sedentary, obese women (41.6 ± 12 yrs, 35.4 ± 8 kg/ m) were assigned to diet groups based on five obesityrelated genetic variants from four genes prominently associated with obesity (FABP2, PPARG, ADRB2, ADRB3). Participants were either truly matched (T) to their diet group based on genotype (n = 28) or falsely matched (F) based on genotype (n = 22). Prescribed diets consisted of 1,500 kcal/d and included carbohydrate:fat: protein percentages of 30:25:45 (H) or 20:35:45 (L). Participants performed a supervised circuit-style resistanceexercise program four days/week and a walking program consisting of 10,000 steps/day, three days/week. Body weight and duel energy X-ray absorptiometry (DXA) body composition measures were obtained at baseline, 4, 8, 12, 16, 20, and 24 weeks. Data were analyzed by MANOVA, with baseline body weight and body composition values used as covariates to normalize baseline differences between groups. Data are presented as changes from baseline at each time point, respectively. Results MANOVA revealed an overall Wilks’ Lamda time effect (p < 0.001) with no significant time by diet (p = 0.51), time × gene type (0.84), or time × diet × gene type (0.81) effects observed. Univariate analysis revealed that the exercise and diet interventions promoted significant reductions in weight (-5.36 ± 5.0 kg, p < 0.001), fat mass (-4.53 ± 3.6 kg, p < 0.001), and body fat (-2.88 ± 2.7 %, p < 0.001) with a trend toward a reduction in fat free mass (-0.65 ± 2.3 kg, p < 0.071). When baseline body weight and DXA body composition variables were used as covariates, Wilks’ Lambda time × diet (p = 0.098) tended to differ, a time × gene type interaction was observed (p = 0.011), while no differences were seen in time × diet × gene type (p = 0.18). Univariate analyses revealed some trends in time × diet changes in weight (H -2.03 ± 1.7, -3.13 ± 2.6, -4.17 ± 3.3, -4.62 ± 4.0, -4.75 ± 4.6, -4.41 ± 5.1; L -2.47 ± 1.8, -3.66 ± 2.4, -4.56 ± 3.1, -5.49 ± 3.9, -5.89 ± 4.5, -6.17 ± 4.8 kg, pq = 0.02), fat mass (H -1.53 ± 1.4, -2.67 ± 2.3, -3.63 ± 2.5, -3.73 ± 2.8, -4.14 ± 3.6, -3.95 ± 3.6; L -1.31 ± 1.6, -2.66 ± 2.2, -3.22 ± 2.5, -4.32 ± 2.9, -4.60 ± 3.0, -5.03 ± 3.7 kg, pq = 0.10), FFM (H -0.49 ± 1.2, -0.58 ± 1.5, -0.52 ± 1.8, -0.68 ± 2.4, -0.51 ± 2.2, -0.31 ± 2.3; L -0.95 ± 1.5, -0.73 ± 1.9, -1.20 ± 1.9, -0.86 ± 2.0, -1.03 ± 2.6, -0.94 ± 2.4 kg, p = 0.14), or body fat (H -0.50 ± 1.9, -1.51 ± 1.8, -2.32 ± 2.2, -2.22 ± 2.0, -2.68 ± 2.5, -2.65 ± 2.3; L -0.46 ± 1.5, -1.55 ± 2.1, -1.67 ± 2.4, -2.56 ± 2.5, -2.78 ± 2.7, -3.08 ± 3.0 %, pq = 0.13) generally in favor of the more carbohydrate restricted diet. Some trends were also seen in time × gene type changes in weight (T -2.06 ± 1.8, -2.91 ± 2.6, -3.99 ± 3.3, -4.83 ± 4.0, -5.07 ± 4.6, -5.15 ± 5.1; F -2.54 ± 1.7, -4.05 ± 2.2, -4.88 ± 2.9, -5.43 ± 3.8, -5.73 ± 4.6, -5.62 ± 5.0 kg, p = 0.20), Exercise & Sport Nutrition Lab, Texas A&M University, College Station, TX, USA Full list of author information is available at the end of the article Coletta et al. Journal of the International Society of Sports Nutrition 2015, 12(Suppl 1):P16 http://www.jissn.com/content/12/S1/P16

Diagnosing insulin resistance via an OGTT can be costly and impractical. However, this information can be useful in recommending proper diet for individuals interested in losing weight. This study ...

This study examined whether genetic profile influences response to a diet and exercise intervention. 53 sedentary women (38±12 yrs, 80.8±13.9 kg) were randomized to a control group (C) or exercise + diet groups. Those in exercise groups performed circuit resistance-exercise (4 d/wk) and walked (10,000 steps, 3 d/wk). Diets were 1,500 kcal/d with 20:35:45 (CI), 30:25:45 (CII) or 55:30:15 (AHA) percentages of CHO:FAT: PRO. Buccal cheek swabs were obtained at baseline and analyzed for FABP2, PPARG, ADRB-79, ADRB3, and ADRB-46 genes to determine true (T) or false (F) genetic matches to higher CHO or CHO restricted diets. Body weight and DEXA body composition measurements were obtained at 0, 4, 8, 12, 16, 20, and 24 wks. Data were analyzed by MANOVA and are presented as changes from baseline. An overall Wilk's Lambda time x diet (p=0.085) and time x diet x genotype (p=0.102) trend was observed. Univariate analysis revealed significant interaction trends in fat mass (C: 0.39±1.26; CI: T -6.16±5.04, F -1.58±2.22...

This study examined whether genotype of some obesity-related genes (FABP2, PPARG, ADRB2-79, ADRB2-46, ADRB3) influences success to different diets while participating in an exercise program. 40 sed...

Background: Genome wide association studies have provided valuable information pertaining to a potential link between certain genetic polymorphisms and the prevalence of obesity. These findings have led to the assessment of obesity-related genes in relation to health outcomes after participation in a weight loss intervention. Few studies to date have taken these findings one-step further regarding use of these genes as part of a genetic profile to dictate dietary prescription for optimization of weight loss and health outcomes. The purpose of this review to explain how genetic profiling may be useful within a weight loss intervention to promote weight loss and improved health outcomes, and identify potential candidate genes for use in genetic profiling. Methods: A literature search was conducted using PubMed Central since this search engine’s primary focus is within the biomedical discipline, including literature from MEDLINE, life science journals, and related online books. Results and conclusions: To date, candidate genes selected within weight loss interventions utilizing a genetic profile are relatively inconsistent. One investigation demonstrated clear, significant results in favor of dietary prescription based on the profile used and thus warrants further investigation with use of the candidate genes selected. This genetic profile is further supported by investigations assessing each candidate gene in relation to health outcomes from weight loss interventions. Therefore, weight loss interventions genotyping for FABP2 (rs1799883), PPARG2 (rs1801282), ADRB3 (rs4994C3), and ADRB2 (rs1042713 and rs1042714) together to dictate dietary intervention, while including an exercise component, may be useful in optimizing success from participation in a weight loss intervention.

Background Consumption of tart cherry juice has been reported to effectively reduce inflammation, muscle damage, and muscle soreness following bouts of exercise. The purpose of this study was to determine if consumption of a powdered form of tart cherries derived from tart cherry skins prior to and following intense endurance exercise promotes similar positive results as seen with tart cherry juice consumption.

Background Consumption of tart cherry juice has been reported to effectively reduce inflammation, muscle damage, and muscle soreness following bouts of exercise. The purpose of this study was to determine if consumption of a powdered form of tart cherries derived from tart cherry skins prior to and following intense resistance exercise promotes similar positive results as seen with tart cherry juice consumption.

Background A number of nutritional strategies have been developed to optimize nutrient delivery prior to exercise. As a result, a number of pre-workout supplements have been developed to increase energy availability, promote vasodilation, and/ or positively affect exercise capacity. The purpose of this study was to examine the acute effects of ingesting a preworkout dietary supplement with and without synephrine on energy metabolism and cardiovascular hemodynamics. Methods

The OGTT is a gold standard in assessing carbohydrate intolerance (CI) and insulin resistance. However, the test is costly and time consuming. This study examined whether a CI survey could predict response to an OGTT. 108 women (31.6±13 yr, 34.7±7% body fat, 25.3±4 kg/m2) donated fasting blood samples, completed a CI inventory, had body composition and health measures determined, and underwent a 75 g OGTT in which glucose samples and perceptions of CI symptoms were obtained at 0, 30, 60, 90, and 120 minutes. Pearson product correlations were performed to determine which factors correlated with OGTT glucose AUC. Results revealed significant correlations (p

The purpose of this study was to examine the relationship of responses to a carbohydrate intolerance (CI) questionnaire to body composition and markers of health. 108 women (31.6±13 yrs, 34.7±7% bo...

The OGTT is a gold standard in assessing carbohydrate intolerance (CI) and insulin resistance. However, the test is costly and time consuming. This study examined whether responses to a carbohydrat...

The fasting homeostatic model assessment (HOMA) is a gold standard in assessing insulin resistance. However, the test is costly and time consuming. This study examined whether responses to a carbohydrate intolerance survey (CI) correlate to HOMA, an OGTT, body composition and/or markers of health. 108 women (31.6±13 yrs, 34.7±7% body fat, 25.3±4 kg/m2) donated fasting blood samples, completed a CI inventory, had body composition and health measures determined, and underwent a 75g, 2-hr OGTT. Pearson product correlations were performed to determine which factors correlated with HOMA. Results revealed significant correlations (p

The purpose of this study was to determine if different types of exercise and diet interventions promote greater changes in visceral adipose tissue (VAT). 54 sedentary women (34±8 yrs, BMI 35±6) we...