Search

Energy balance accounts for an individual’s energy intake, expenditure, and storage. Each aspect of energy balance has implications for the pharmacokinetics of cancer treatments and may impact an individual’s drug exposure and subsequently its tolerance and efficacy. However, the integrated effects of diet, physical activity, and body composition on drug absorption, metabolism, distribution, and excretion are not yet fully understood. This review examines the existing literature on energy balance, specifically the role of dietary intake and nutritional status, physical activity and energy expenditure, and body composition on the pharmacokinetics of cancer therapeutics. As energy balance and pharmacokinetic factors can be influenced by age-related states of metabolism and comorbidities, this review also explores the age-related impact of body composition and physiologic changes on pharmacokinetics among pediatric and older adult populations with cancer.

Cardiovascular diseases (CVD) are the leading cause of death worldwide and the risk of developing CVD is markedly increased following anthracycline chemotherapy treatment. Anthracyclines are an essential component of the cancer treatment regimen used for common forms of cancer in male and female children, adolescents, young adults, and older adults. Increased CVD risk with anthracyclines occurs, in part, due to vascular dysfunction—impaired endothelial function and arterial stiffening. These features of vascular dysfunction also play a major role in other common disorders observed following anthracycline treatment, including chronic kidney disease, dementia, and exercise intolerance. However, the mechanisms by which anthracycline chemotherapy induces and sustains vascular dysfunction are incompletely understood. This budding area of biomedical research is termed cardio-oncology, which presents the unique opportunity for collaboration between physicians and basic scientists. This symposium, presented at Experimental Biology 2022, provided a timely update on this important biomedical research topic. The speakers presented observations made at levels from cells to mice to humans treated with anthracycline chemotherapeutic agents using an array of translational research approaches. The speaker panel included a diverse mix of female and male investigators and unique insight from a cardio-oncology physician-scientist. Particular emphasis was placed on challenges and opportunities in this field as well as mechanisms that could be viewed as therapeutic targets leading to novel treatment strategies.

Sedentary behaviors (SB) after cancer diagnosis are associated with poor prognosis for certain cancers, and cancer patients and survivors report high levels of SB. Reducing SB may be a feasible and effective intervention strategy to improve outcomes. This systematic review aims to identify and evaluate the literature on interventions to reduce SB in cancer patients and survivors.Studies were identified via database searches in December 2020. Two authors evaluated study eligibility. Data were extracted and checked, and risk of bias was assessed by the study team. Of 1401 records identified, nine studies involving 394 cancer patients or survivors were included in this review. Six were randomized trials, three were non-randomized intervention studies, and almost all (n = 8) focused on feasibility with small sample sizes. All studies were conducted within the previous 5 years in Canada, Australia, USA, and South Korea. Cancer types studied were breast (n = 3), prostate (n = 2), colorectal or peritoneal (n = 1), and mixed types (n = 3). Intervention duration of 12 weeks was most common (n = 7). Five studies had multiple intervention components, and six studies included wearable devices to measure and/or prompt behavior change. There was an overall trend where intervention groups reduced SB vs. control groups, often coupled with an increase in moderate-to-vigorous physical activity. This review suggests that there is some promise for intervention strategies to reduce SB in cancer patients and survivors. There is a need for more high-quality randomized controlled trials to understand how to best decrease SB in cancer patients and survivors.

Primer sequences used for rtPCR.

PURPOSE Advances in digital health technology can overcome barriers to measurement of function and mobility for older adults with blood cancers, but little is known about how older adults perceive such technology for use in their homes. METHODS To characterize potential benefits and barriers associated with using technology for home functional assessment, we conducted three semistructured focus groups (FGs) in January 2022. Eligible patients came from the Older Adult Hematologic Malignancies Program at Dana-Farber Cancer Institute (DFCI), which includes adults 73 years and older enrolled during their initial consult with their oncologist. Eligible caregivers were 18 years and older and identified by enrolled patients as their primary caregiver. Eligible clinicians were practicing DFCI hematologic oncologists, nurse practitioners, or physician assistants with ≥2 years of clinical experience. A qualitative researcher led thematic analysis of FG transcripts to identify key themes. RESULTS Twenty-three participants attended the three FGs: eight patients, seven caregivers, and eight oncology clinicians. All participants valued function and mobility assessments and felt that technology could overcome barriers to their measurement. We identified three themes related to potential benefits: making it easier for oncology teams to consider function and mobility; providing standardized, objective data; and facilitating longitudinal data. We also identified four themes related to barriers to home functional assessment: concerns related to privacy and confidentiality, burden of measuring additional patient data, challenges in operating new technology, and concerns related to data improving care. CONCLUSION These data suggest that specific concerns raised by older patients, caregivers, and oncology clinicians must be addressed to improve acceptability and uptake of technology used to measure function and mobility in the home.

Introduction: There is a scarcity of data on the impact of behavioral habits, such as exercise, on physical health in patients with bladder cancer. We investigated the association of exercise on self-reported physical health status and examined the prevalence of bladder cancer patients with sedentary lifestyle. Methods: We examined cross-sectional data of participants diagnosed with bladder cancer within the Behavioral Risk Factor Surveillance System (BRFSS) from 2016–2020. Patient health status was surveyed using self-reported measures such as the total days per month when their “physical health is not good.” The primary outcome was patient-reported poor physical health for more than 14 days within a one-month period. Results: Out of 2 193 981 survey participants, we identified 936 with a history of bladder cancer. Nearly one in three bladder cancer patients reported being sedentary within the last month, as a total of 307 (32.8%) patients reported no exercise within the last 30 days. The remaining 628 (67.2%) reported exercising for at least one day within the last month. In multivariable logistic regression model analysis, we found that exercise is protective for self-reported poor physical health status (odds ratio 0.37, 95% confidence interval 0.25–0.56, p

The purpose of this study was to determine the effects of an 8-week HIIT intervention on patient-reported outcomes and physical function in breast cancer patients undergoing anthracycline-based chemotherapy. Thirty breast cancer patients were recruited prior to initiating treatment and randomized into the HIIT group (n = 15) or control (CON) group (n = 15). The HIIT group attended HIIT sessions three days per week for eight weeks. The CON group was asked to maintain their current level of physical activity. Patient-reported outcomes were assessed by the Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B), Multidimensional Fatigue Inventory with 20 questions (MFI-20), and the 15-item Five-Facet Mindfulness Questionnaire (FFMQ-15). Physical function was assessed using the timed up and go (TUG), 30-s sit-to-stand (30STS), Margaria-Kalamen stair climb test, and 6-min walk test (6MWT). Repeated measures ANCOVA and paired t-tests were performed to assess group differences. All patients completed the 8-week study with 82.3% adherence to the intervention among the HIIT group. Post-intervention, significant improvements were found for the Margaria-Kalamen stair climb test (− 3.39%; P = 0.013) and 6MWT (+ 11.6%; P = 0.008) in the HIIT group compared to baseline and CON group. No changes in patient-reported outcomes, TUG, and 30STS were observed following the 8-week study period in both groups (P > 0.05). HIIT may be an effective strategy to improve physical function and possibly maintain QOL in breast cancer patients undergoing the anthracycline-based chemotherapy. ClinicalTrials.gov: NCT02454777

Anthracycline chemotherapy is a frequent treatment for breast cancer, whereas it can increase risk of physiologic side-effects, such as metabolic syndrome (MetS). Exercise has been used as a non-pharmacological strategy to decrease MetS. Specifically, high-intensity interval training (HIIT) has been shown to improve MetS in patients with diabetes or cardiac rehabilitation patients; however, the effects of HIIT on MetS and associated biomarkers in patients with breast cancer receiving anthracycline chemotherapy have not been previously explored. Therefore, we purposed to determine the effects of HIIT on MetS in breast cancer patients undergoing anthracycline chemotherapy.In total, 30 patients with breast cancer were recruited prior to initiating treatment and randomized into HIIT (n = 15) or control (n = 15). The HIIT group attended supervised cycling sessions 3 days/week for 8 weeks. MetS was assessed by waist circumference, blood pressure, fasting levels of high-density lipoprotein cholesterol (HDL-C), triglycerides, and glucose. Circulating levels of MetS-related biomarkers were also measured (total cholesterol, insulin, HbA1c, leptin, adiponectin, and c-reactive protein).After 8 weeks, MetS z-score was significantly improved in the HIIT group compared with controls (-7.60, 95% CI: -9.08 to -6.13, p 0.001). MetS variables (HDL-C, glucose, and triglycerides) and circulating levels of MetS-related biomarkers were significantly improved in the HIIT group compared with controls (p 0.001). Non-significant differences were found in body composition outcomes at the end of the study.HIIT may be an effective strategy to improve MetS in breast cancer patients undergoing anthracycline chemotherapy. Furthermore, changes in MetS were independent of changes in body composition.

It has been increasingly conceptualized that exercise may be able to suppress cancer progression itself based on the preclinical evidence suggesting various mechanisms. The challenges exist in investigating the effects of exercise on tumor progression in human settings. Circulating or tissue-driven tumor markers can be a useful and cost-effective tool in monitoring the progression of some cancers. This scoping review summarized the current evidence on the use of tumor markers in clinical exercise oncology trials. A total of 14 studies were identified, and tumor markers included prostate-specific antigen for prostate cancer, carcinoembryonic antigen and circulating tumor cells for colorectal cancer, and Ki-67 for breast cancer. Treatment settings and exercise prescriptions were highly heterogeneous, while most studies did not find significant exercise-mediated effects on tumor markers. Nevertheless, we provide an insight into the utility and considerations in using tumor markers in clinical exercise oncology research.

Being overweight or obese (OW/OB) during B-cell acute lymphoblastic leukemia (B-ALL) induction is associated with chemoresistance as quantified by minimal residual disease (MRD). We hypothesized that caloric and nutrient restriction from diet/exercise could lessen gains in fat mass (FM) and reduce postinduction MRD. The Improving Diet and Exercise in ALL (IDEAL) trial enrolled patients 10 to 21 years old, newly diagnosed with B-ALL (n = 40), in comparison with a recent historical control (n = 80). Designed to achieve caloric deficits ≥20% during induction, reduce fat intake/glycemic load, and increase activity, IDEAL’s end points were FM gain (primary), MRD ≥0.01%, and adherence/feasibility. Integrated biology explored biomarkers of OW/OB physiology. IDEAL intervention did not significantly reduce median FM change from baseline overall (+5.1% [interquartile range [IQR], 15.8] vs +10.7% [IQR, 16.0]; P = .13), but stratified analysis showed benefit in those OW/OB (+1.5% [IQR, 6.6] vs +9.7% [IQR, 11.1]; P = .02). After accounting for prognostic factors, IDEAL intervention significantly reduced MRD risk (odds ratio, 0.30; 95% confidence interval, 0.09-0.92; P = .02). The trial exceeded its adherence (≥75% of overall diet) and feasibility (≥80% completed visits) thresholds. Integrated biology found the IDEAL intervention increased circulating adiponectin and reduced insulin resistance. The IDEAL intervention was feasible, decreased fat gain in those OW/OB, and reduced MRD. This is the first study in any hematologic malignancy to demonstrate potential benefit from caloric restriction via diet/exercise to augment chemotherapy efficacy and improve disease response. A prospective, randomized trial is warranted for validation. These trials were registered at www.clinicaltrials.gov as #NCT02708108 (IDEAL trial) and #NCT01317940 (historical control).

Research regarding exercise oncology has progressed to include racial and ethnic minority populations in an effort to identify and address disparities, however sexual and gender minorities remain severely underrepresented. Sexual and gender minorities face unique barriers across the healthcare spectrum and are less likely to engage in clinical trials, limiting information gathered about prevalence of cancer, risk of cancer, and effects of exercise on cancer outcomes. In this narrative we will discuss the gap in oncological literature as it pertains to sexual and gender minorities including introducing and defining sexual and gender minority nomenclature, highlighting elevated cancer risks and survivorship trends, as well as a focus on lifestyle modifiable behaviors like exercise to explore potential targeted outcomes and barriers to participation to date.

While the field of exercise oncology has substantially progressed in recent years, a significant void exists in the inclusion of and focus on minority patients diagnosed with cancer, particularly blacks and Hispanics. Blacks and Hispanics are less physically active, experience higher rates of comorbid conditions, and have poorer cancer prognosis when compared to white counterparts. Exercise prevents and reduces an array of health conditions, including cardiovascular disease, diabetes, obesity, and risk of certain cancers. However, black and Hispanic cancer survivors are underrepresented across exercise intervention trials. In this review, we discuss previous explorations among minority cancer survivors with a focus on exercise prescription, targeted outcomes, patient demographics, and barriers to exercise. We also discuss knowledge gaps and future directions necessary to progress the field of exercise oncology to include a more diverse cancer survivor cohort. In brief, we found few studies have evaluated the effect of exercise on physiologic health outcomes in black and Hispanic cancer survivors, with much research focused on psychosocial health. A majority of minority population-based research specifically targets the black breast cancer survivor population, with reported exercise-induced improvements observed in weekly physical activity, cardiorespira-tory fitness, muscle strength, quality of life, and fatigue. Minority cancer survivors also face unique challenges and barriers to exercise participation despite acknowledgement of the benefits with physical activity. Future investigations warrant explorations of exercise timing across the cancer continuum, inclusion of different types of cancer survivors, and novel exercise strategies with inclusion of culturally tailored educational and behavioral components.

Anthracycline chemotherapy is commonly used to treat breast cancer yet may increase the level of matrix metalloproteinases (MMP) -2 and -9, which increase the risk of atherosclerosis. While exercise has been shown to reduce the level of MMP in patients with diabetes, high intensity interval training (HIIT) has not been utilized to improve level of MMP in women with breast cancer receiving anthracycline chemotherapy. Thirty women were randomized to either 8-week HIIT or control (CON) group. The CON group was offered the HIIT intervention after 8 weeks. MMP-1, -2 -7, -9, tissue inhibitor of MMP (TIMP) -1, and-2 were measured at baseline and post-intervention. Repeated measures ANCOVA and paired t-test were performed to assess changes in MMP and TIMP. Post-intervention, no significant between-group differences were observed for MMP and TIMP. However, within-group decrease in MMP-9 was observed in the HIIT group [104.3(51.9) to 65.2(69.1); P = 0.01]. MMP-9 in the CON group was not significantly changed [115.5(47.2) to 90.4(67.9);]. MMP-2 significantly increased in both the HIIT group [76.6(11.2) to 83.2(13.1); P = 0.007) and the CON group [69.0(8.9) to 77.6(11.1) P = 0.003). It is unclear whether an 8-week HIIT intervention influences MMP-9 in breast cancer patients undergoing anthracycline chemotherapy. Additional investigations are required to understand the exercise-induced changes in MMP-2 and -9 in women undergoing anthracycline chemotherapy.

Background Breast cancer survivors have approximately double the risk of mortality from cardiovascular disease than age-matched women without a cancer history. Reynolds risk score is a validated algorithm for the assessment of cardiovascular disease, which incorporates high sensitivity C-Reactive Protein (hsCRP), hemoglobin A1c (HbA1c), and parental history of myocardial infarction with traditional biomarkers including cholesterol, systolic blood pressure (SBP), and presence of diabetes. We previously demonstrated that exercise improves Framingham risk score (12.0±2.0 to 2.0±1.5), calculated by traditional risk factors of cardiovascular disease, SBP (132.9±13.0 to 120.7±9.5 mmHg), high-density lipoprotein cholesterol (HDL-C; 43.1±6.6 to 64.7±7.8 mg/dL), and total cholesterol (TC; 196.5 ± 53.4 to 157.5 ± 37.1 mg/dL), in breast cancer survivors. This secondary analysis sought to examine the effects of a 16-week aerobic and resistance exercise intervention on Reynolds risk score in breast cancer survivors. Methods One hundred overweight or obese (BMI>25kg/m2) sedentary breast cancer survivors (stage I-III) who completed cancer treatment within 6 months prior to enrollment were randomized to the Exercise group (EX; n=50) or the Control (CON; n=50). The EX underwent supervised moderate-to-vigorous intensity aerobic and resistance exercise sessions 3 times/week for 16 weeks. The CON was asked to maintain their current level of activity. Reynolds risk score was calculated for each participant by assigning values for each of the following eight categories: age, SBP, TC, HDL-C, presence of diabetes; HbA1c, smoking status, hsCRP; and parental history of myocardial infarction. Within-group and between-group differences in mean change for individual outcomes measured at 16 weeks were evaluated using general linear models repeated-measures analyses of variance and mixed model repeated-measures analysis, respectively. Results Following the 16-week study period, Reynolds risk score was significantly reduced (8.3% to 0.9%), with improvements in hsCRP (3.4±0.6 to 2.3±0.3 mg/L), presence of diabetes (40 to 20%), and HbA1c (7.5±0.9 to 2.9±0.2%) in EX compared to CON (P0.05). Conclusion A 16-week supervised aerobic and resistance exercise intervention is an effective approach to reduce the risk of developing cardiovascular disease by reducing hsCRP, cholesterol, diabetes status, and SBP in breast cancer survivors. Participation in supervised exercise training during cancer survivorship should be considered to reduce the risk for cardiovascular disease mortality in breast cancer survivors. Citation Format: Kyuwan Lee, Debu Tripathy, Wendy Demark-Wahnefried, Kerry Courneya, Joanne Mortimer, Christina Dieli-Conwright. Effect of aerobic and resistance exercise on Reynolds risk score in overweight or obese breast cancer survivors [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-11-01.

Background: In postmenopausal women, use of hormone therapy is associated with a lower incidence of diabetes (DM). The association of adjuvant endocrine therapy (AET) with DM has not been well studied among women treated for early stage breast cancer. The objective of this study was to examine the association of AET with risk of developing DM among postmenopausal women who developed breast cancer. Methods: 5,013 postmenopausal women from the Women’s Health Initiative diagnosed with non-metastatic breast cancer who were diabetes-free at cancer diagnosis and who had information on use of AET were included. AET use was gathered using 2 methods: 1) review of medication inventories for use of tamoxifen or aromatase inhibitors (AI) and 2) review of the Life and Longevity after Cancer (LILAC), a supplemental questionnaire used from 2009-2010 to gather treatment information from women who developed cancer. Results from these 2 collection methods were analyzed separately due to the timing of the surveys as well as data granularity (i.e. LILAC queried use of AET, not type). The primary outcome of interest for this study was diabetes-free survival, which was calculated from the date of breast cancer diagnosis to first diagnosis of DM. Participants who did not develop DM after breast cancer were censored at their last follow-up visit or date of death. Cox proportional hazards models were used to compute hazard ratios (HR) and 95% confidence intervals (CI). Results: After 10.4 median year’s follow-up post breast cancer diagnosis, 13% (632/5,013) of participants developed DM. Of the 2,646 who had medication inventory data, 1,352 (51%) reported AI use and 1,449 (55%) reported tamoxifen use. Participants who reported use of AIs were 13% more likely to develop DM than participants who did not use AIs (HR=1.13, CI=0.91-1.39). Participants who reported use of tamoxifen were 11% less likely to develop DM than those who did not use tamoxifen (HR=0.89, CI=0.72-1.11). Of the 3,769 participants with LILAC data from the supplemental questionnaire, 2,543 (67%) reported use of AET; these participants were 25% more likely to develop DM than those who did not use AET (HR=1.25, CI=1.02-1.53). When plotted over time, the risk of diabetes in AET users versus non-users was identical at 5 years (5% v 5%, respectively), was 35% higher at 10 years (12% v 9%, respectively), and 30% higher at 15 years (18% v 14%, respectively) (log-rank p=0.029). Conclusion: DM has not been reported as an adverse event in women on AET. Our data suggest an association of AET with DM among postmenopausal women with early stage breast cancer. When looking at specific types of AETs, the risk was marginally increased for AIs but marginally decreased for tamoxifen, with risk more apparent in subsequent years. These data have significance for survivorship care. Citation Format: Joanne E Mortimer, Rebecca A Nelson, Laura Kruper, Kathy Pan, Christina M Dieli Conwright, Aladdin H Shadyab, Lewis Kuller, Barbara Howard, Rowan T Chlebowski. Association of adjuvant endocrine therapy with diabetes among women with postmenopausal breast cancer in the Women’s Health Initiative (WHI) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P5-12-04.

Background: Higher rates of physical inactivity and comorbid conditions are reported in Hispanic and Black cancer patients receiving chemotherapy, compared to their White counterparts. Despite the beneficial effect of exercise training for cancer patients, rates of participation in clinical cancer trials are low among disadvantaged and racial and ethnic minority groups. This is possibly due to more barriers and less access to exercise training. Therefore, there is a crucial need for better understanding of how to apply exercise interventions using novel, accessible, and cost-effective home-based exercise approaches for Hispanic and Black communities, particularly during chemotherapy. In this study, we will examine the effect of supervised and unsupervised exercise on minutes of physical activity among Hispanic and Black cancer patients undergoing chemotherapy for breast, colorectal, and prostate cancer. Methods: The THRIVE trial is an 8-month prospective, three-arm study of 135 patients who are randomized in a 1:1:1 fashion to a supervised exercise intervention (SUP), unsupervised exercise (UNSUP), or an attention control group. Eligible patients include those with early-stage breast, colorectal, or prostate cancer, planning to receive chemotherapy, are sedentary, overweight or obese, and self-identifying as Hispanic or Black. Patients randomized to the SUP group participate in a home-based 16-week periodized aerobic and resistance exercise program performed three days per week, supervised through video conference technology. Patients randomized to the UNSUP group participate in an unsupervised 16-week, telehealth-based, periodized aerobic and resistance exercise program performed three days per week using the same exercise prescription parameters as the SUP group. The attention control group receive a 16-week home-based stretching program. The primary outcome is changes in minutes of physical activity assessed by 7-day accelerometry at month 4. Secondary outcomes include cardiovascular risk factors, patient-reported outcomes, and physical function. Outcome measures are tested at baseline, post-intervention at month 4, and after a non-intervention follow-up period at month 8. Discussion: The THRIVE trial is the first study to employ a novel and potentially achievable exercise intervention for a minority population receiving chemotherapy. In addition, this study utilizes an intervention approach to investigate the biological and behavioral mechanisms underlying exercise participation in these cancer patients. Results from this study will guide and inform large randomized controlled trials to test the effect of home-based exercise on treatment outcomes and comorbid disease risk in minority patients with cancer undergoing chemotherapy. Citation Format: Huimin Yan, Noelle Merchant, Ashley Desameau, Cherardi NeiraViscue, Paola Gonzalo-Encabo, Dong-Woo Kang, Rebekah L. Wilson, Mary K. Norris, Danny Nguyen, Daniel Gundersen, Laura L. Hayman, Rachel A. Freedman, Timothy Rebbeck, Christina M. Dieli-Conwright. Testing Home-based Exercise Strategies in Underserved Minority Cancer Patients Undergoing Chemotherapy (THRIVE) Trial: A study protocol [abstract]. In: Proceedings of the 15th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2022 Sep 16-19; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr C109.

Background We previously reported that (neo)adjuvant chemotherapy adversely altered metabolic syndrome (MetS) components, body composition, and related biomarkers after a 12 to 18-week chemotherapy treatment course in women. Here, we sought to determine whether these measures worsened within 4–5 years post-chemotherapy among the same sample of early stage breast cancer survivors. Methods Twenty-eight breast cancer survivors were reassessed within 4–5 years post-chemotherapy. Participants were tested for MetS, lipid profile (total cholesterol; TC, low-density lipoprotein cholesterol; LDL-C), glucose metabolism (insulin, homeostatic model- insulin resistance; HOMA-IR, glycosylated hemoglobin; HbA1c), inflammation (C-reactive protein; CRP) and body composition (body weight; BW, percent body fat; BF, fat mass; FM) during follow-up physical exams. A comparison of measurements between post-chemotherapy and follow-up periods was performed using repeated measures analysis of covariance. Results Most study patients were Caucasian (44%) or Hispanic (30%) with a mean age of 48.2 years. Average time from completion of chemotherapy was 4.75 years. At follow-up, MetS components significantly increased (p Conclusion MetS components, body composition, and biomarkers continued to worsen within 4–5 years post-chemotherapy in breast cancer survivors. Energy balance interventions should target breast cancer patients to reduce the exacerbation of MetS.

In the Women's Health Initiative (WHI) Dietary Modification (DM) randomized trial, dietary intervention significantly reduced breast cancer mortality (P = 0.02). In observational studies, physical activity is associated with lower breast cancer incidence. Currently, dietary intervention influence on other health-related behaviors is unknown. Therefore, we evaluated whether the WHI dietary intervention influenced self-directed physical activity.Of 48,835 postmenopausal women, 19,541 were randomized to dietary intervention (18 nutritionist-led group sessions first year, then quarterly sessions throughout 8.5 years [median] intervention) and 29,294 to a usual diet comparison (written health-related materials only). Neither randomization group received specific or ongoing instructions to increase physical activity. Episodes per week of moderate or vigorous recreational physical activity (MVPA) were serially reported. Marginal longitudinal logistic regression models were used to assess physically inactive (MVPA = 0) or physically active (MVPA 0) participants by randomization group. Marginal Poisson regression models estimated mean weekly MVPA.At entry, 45.6% of all participants reported physical inactivity (MVPA = 0). In 43,760 women with MVPA information, throughout 15.9 years (median) cumulative follow-up, dietary intervention group participation was associated with 7% lower physical inactivity rate (odds ratio [OR] 0.93, 95% confidence interval [CI] 0.91, 0.95, P 0.001) and a 4% higher mean MVPA (ratio of means [RM] 1.04 95% CI 1.02, 1.06, P 0.001), relative to the comparison group.In a randomized trial setting, a low-fat dietary pattern intervention was associated with a long-term, favorable influence on self-directed recreational physical activity.NCT00000611.

Background Symptom burden and adverse treatment effects can negatively impact physical function, health-related outcomes, and quality of life in cancer survivors. Resistive exercise that improves skeletal muscle function can ameliorate these complications, but the central role of the skeletal muscle in mediating improvements in patient-related outcomes has not been explored. This protocol describes the rationale and methods for a systematic review that aims to determine the effects of resistive exercise on the skeletal muscle hypertrophy, muscle performance, and muscle-related biomarkers in cancer survivors. Methods A systematic review will be conducted on peer-reviewed randomized controlled trials (RCTs) that employ resistive exercise interventions for cancer survivors. The following electronic databases will be searched: AMED, CENTRAL, CINAHL, CIRRIE, EMBASE, MEDLINE, PEDro, REHABDATA, Scopus, and SPORTDiscus. Studies will be considered for inclusion if they present quantitative data in adult cancer survivors on skeletal muscle characteristics (e.g., muscle mass), muscle performance (e.g., strength), or skeletal muscle-related biomarkers (e.g., myocellular satellite cells). Secondary outcomes will be physical function (e.g., stair climb) and patient-reported outcomes (e.g., fatigue). Data will be reported through a narrative that describes study design, participants, interventions, and outcome characteristics. Discussion This systematic review will help clarify the influence of resistive exercise on factors relating to the skeletal muscle in adult cancer survivors. Findings may provide insight into optimal exercise selection for evidence-based practice. Systematic review registration PROSPERO: #277791 [under review]

Nutrition and exercise interventions are strongly recommended for most cancer patients; however, much debate exists about the best prescription. Combining fasting with exercise is relatively untouched within the oncology setting. Separately, fasting has demonstrated reductions in chemotherapy-related side effects and improved treatment tolerability and effectiveness. Emerging evidence suggests fasting may have a protective effect on healthy cells allowing chemotherapy to exclusively target cancer cells. Exercise is commonly recommended and attenuates treatment- and cancer-related adverse changes to body composition, quality of life, and physical function. Given their independent benefits, in combination, fasting and exercise may induce synergistic effects and further improve cancer-related outcomes. In this narrative review, we provide a critical appraisal of the current evidence of fasting and exercise as independent interventions in the cancer population and discuss the potential benefits and mechanisms of combined fasting and exercise on cardiometabolic, body composition, patient-reported outcomes, and cancer-related outcomes. Our findings suggest that within the non-cancer population combined fasting and exercise is a viable strategy to improve health-related outcomes, however, its safety and efficacy in the oncology setting remain unknown. Therefore, we also provide a discussion on potential safety issues and considerations for future research in the growing cancer population.

Few trials have examined the effect of lifestyle behavioral interventions on tissue markers in patients with cancer. The purpose of this study was to examine the feasibility and impact of a 6-month weight loss intervention on breast tissue and serum biomarkers in women with breast cancer. Fifty-one women who completed breast cancer treatment and had a BMI ≥ 25.0 kg/m2 were randomized to a weight loss intervention or usual care. Breast tissue biopsies, fasting blood draw and body composition were collected at baseline and 6 months, with between-group changes examined using analysis of covariance method. Baseline and post-intervention biopsies were conducted in 49 and 42 women, respectively, with pre- and post-epithelial tissue available from 25 tissue samples. Average 6-month weight loss was 6.7% for the weight loss group and 2.0% increase for the usual care group (p p p

There are well-known racial/ethnic disparities in the prevalence of obesity and physical inactivity, as well as breast cancer risk and survival. However, most of the current scientific evidence that serves as a foundation for nutrition and physical activity guidelines is based on studies conducted in predominantly non-Hispanic White populations. Similarly, exercise, diet, or lifestyle intervention trials for breast cancer prevention and survivorship are scarce in racial/ethnic minority populations. We review the current evidence for racial/ethnic disparities in obesity and breast cancer risk and survival (we are focusing on obesity, because this is considered an ASCO priority, and studies conducted in the United States), discuss the evolution of nutrition/physical activity guidelines for cancer prevention and control, and provide an overview of lifestyle interventions, including barriers and facilitators in implementation and dissemination science among minority populations underrepresented in research. There is a critical need to include racially/ethnically diverse populations in cancer prevention and control research or to specifically target minority populations in which disparities are known to exist to achieve much needed health equity.

Abtract Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2–20.7°], external rotation at 0° = 23.4° [95% CI = 31.1–12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9–26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.

The purpose of this study was to determine the effects of an 8-week high-intensity interval training (HIIT) intervention on vascular endothelial function, measured as brachial artery flow-mediated dilation (baFMD), and vascular wall thickness measured by carotid intima media thickness (cIMT) in breast cancer patients undergoing anthracycline-based chemotherapy. Thirty women were randomized to either HIIT or non-exercise control groups (CON). The HIIT group participated in an 8-week HIIT intervention occurring three times per week on a cycle ergometer. The CON group was offered the HIIT intervention after 8 weeks. baFMD was measured from the brachial artery diameter at baseline (D0) and 1 min after cuff deflation (D1); percent change was calculated by measuring brachial artery diameter after cuff deflation relative to the baseline [baFMD = (D1 − D0)/D0 × 100]. The cIMT was obtained from the posterior wall of common carotid artery 10 mm below the carotid bulb. Paired t test and repeated measures ANCOVA were performed to assess changes in baFMD and cIMT. At baseline, the HIIT (n = 15) and CON (n = 15) groups did not differ by age (46.9 ± 9.8 years), BMI (31.0 ± 7.5 kg/m2), and blood pressure (123.4 ± 16.8/72.3.9 ± 5.6 mmHg). Post-exercise, baFMD significantly increased [4.3; 95% confidence interval (CI): (1.5, 7.0), p = 0.005] in HIIT versus CON group. cIMT did not significantly change [0.003, 95% CI − 0.004, 0.009), p = 0.40] in HIIT group, while IMT significantly increased from baseline to post-intervention (0.009, 95% CI 0.004, 0.010, p = 0.003) in CON group. This study may suggest that HIIT improved vascular endothelial function and maintained wall thickness in breast cancer patients undergoing anthracycline-based chemotherapy. Trial registration: ClinicalTrials.gov: NCT02454777.

Introduction: Obesity and a lack of physical activity lead to systemic and chronic inflammation among cancer survivors, which are highly associated with various comorbidities (e.g., type 2 diabetes, hypertension, and metabolic syndrome) and poor oncologic prognosis. Exercise, optimized to benefit physiological responses, can be an effective strategy to reduce systemic inflammation. The objective of the study was to investigate the effects of a 16-week circuit, interval-based exercise training program on proinflammatory cytokines in cancer survivors who are obese and sedentary. Methods: This study was a single center, pilot randomized controlled trial in 90 survivors of breast, prostate, and colorectal cancers who were sedentary ( 25.0 kg/m2). Participants were randomly assigned to either the exercise group (n=60) or the usual care group (n=30). The exercise intervention was moderate to vigorous intensity aerobic (65-85% of VO2max) and resistance (65-85% of 1-repetition maximum) exercise training in a supervised, circuit, interval-based format performed thrice-weekly for 16 weeks. Blood samples were obtained at baseline and post-intervention to measure serum levels of proinflammatory cytokines, including interleukin (IL)-6, IL-8, tumor necrosis factor-α (TNF-α), and high-sensitive c-reactive protein (hsCRP). Paired t-test and repeated measure ANOVA were used to determine the between-group differences. Results: Participants were aged 63.2±10.8 years and diagnosed with breast (35%), prostate (30%), and colorectal (35%) cancers. 55% were female and mean BMI was 34.7±5.9. 75% completed chemotherapy and/or radiation therapy. Retention and adherence rates to the exercise intervention was high (100% and 92%, respectively). Compared to usual care, circuit, interval-based exercise significantly reduced IL-6 (between group mean difference, -1.2 pg/mL; p Conclusions: A 16-week circuit, interval-based aerobic and resistance exercise training program induced a reduction in systemic levels of proinflammatory cytokines among sedentary and obese breast, prostate, and colorectal cancer survivors. Our findings suggest that combined aerobic and resistance exercise may be an effective strategy to offset elevated systemic inflammation associated with obesity and sedentary behavior in cancer survivors. Citation Format: Dong-Woo Kang, Cami N. Christopher, Amber J. Normann, Mary K. Norris, Christina M. Dieli-Conwright. A 16-week circuit interval-based exercise intervention reduces systemic inflammation in obese, sedentary cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr CT531.

During the COVID-19 pandemic, new challenges are presented in clinical research settings to increase exercise levels, particularly in vulnerable populations such as cancer survivors. While in-person supervised exercise is an effective format to improve patient-reported outcomes and physical function for cancer survivors, the COVID-19 pandemic limited this form of exercise as a feasible option within research and cancer care. As such, exercise oncology interventions were adapted to home-based instruction. In this review, we examine the current evidence of exercise interventions in cancer populations during and beyond the COVID-19 pandemic. We identified that group-based virtually supervised home-based exercise was the most used format among exercise oncology interventions during the pandemic. Preliminary results support feasibility and effectiveness of this emerging exercise setting in cancer survivors; however, it needs to be further investigated in adequately designed larger trials. Additionally, we provide recommendations and perspective for the implementation of virtually supervised home-based exercise.