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Rich66 · 06-21-2011, 01:35 PM

Recent Results Cancer Res. 2011;186:189-215.
Physical activity and breast cancer survivorship.

Schmitz K.
Source

Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 903 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. Schmitz@mail.med.upenn.edu

Abstract

A diagnosis of breast cancer is associated with treatments that have physiologic effects beyond the intended curative therapy. The first section of this chapter provides and integrative physiology review of the effects of breast cancer treatment on the body systems used by and affected by physical activity, including effects of chemotherapy, radiation, and surgery. In later sections, we review the literature on physical activity and breast cancer from the point of diagnosis and for the balance of life. The efficacy of physical activity for supportive cancer care outcomes is reviewed separately from the purported usefulness of physical activity for disease-free and overall survival from breast cancer. The current evidence supports the safety of physical activity during and after breast cancer therapy. The supportive cancer care outcomes for which there is sufficient evidence of efficacy during and after breast cancer treatment include fitness, fatigue, body size, and quality of life. Further, there is growing evidence that upper body exercise does not pose additional risk for negative lymphedema outcomes among survivors with and at risk for lymphedema. For overall survival, the evidence is largely observational, with sufficient evidence that physical activity does confer benefit. Finally, we outline future directions for research on physical activity among breast cancer survivors, including expanding to focus on subsets of the population not included in most prior studies (minority women and older women), tailoring of interventions to stages of cancer most likely to benefit, expanding to study women with metastatic cancer, and new modes of exercise, such as team sports, martial arts, and Pilates.

PMID:: 21113765; [PubMed - indexed for MEDLINE]

Cancer Res. 2011 Jun 1;71(11):3889-95. Epub 2011 May 24.
Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor.

Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM.

LINK

Source

Authors' Affiliations: Departments of Epidemiology and Nutrition, Harvard School of Public Health; The Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Urology and Epidemiology and Biostatistics, School of Medicine; and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California.

Abstract

Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality. However, men with metastatic disease may decrease their activity due to their disease; thus, a causal interpretation is uncertain. We therefore prospectively examined vigorous activity and brisk walking after diagnosis in relation to risk of prostate cancer progression, an outcome less susceptible to reverse causation, among 1,455 men diagnosed with clinically localized prostate cancer. Cox proportional hazards regression was used to examine vigorous activity, nonvigorous activity, walking duration, and walking pace after diagnosis and risk of prostate cancer progression. We observed 117 events (45 biochemical recurrences, 66 secondary treatments, 3 bone metastases, 3 prostate cancer deaths) during 2,750 person-years. Walking accounted for nearly half of all activity. Men who walked briskly for 3 h/wk or more had a 57% lower rate of progression than men who walked at an easy pace for less than 3 h/wk (HR = 0.43; 95% CI: 0.21-0.91; P = 0.03). Walking pace was associated with decreased risk of progression independent of duration (HR brisk vs. easy pace = 0.52; 95% CI: 0.29-0.91; P(trend) = 0.01). Few men engaged in vigorous activity, but there was a suggestive inverse association (HR ≥3 h/wk vs. none = 0.63; 95% CI: 0.32-1.23; P(trend) = 0.17). Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity, respectively. Brisk walking after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinically localized prostate cancer. Cancer Res; 71(11); 3889-95. ©2011 AACR.

PMID:: 21610110; [PubMed - in process]
PMCID: PMC3107352: [Available on 2012/6/1]

Obesity (Silver Spring). 2009 Aug;17(8):1534-41. Epub 2009 Feb 19.
Exercise improves body fat, lean mass, and bone mass in breast cancer survivors.

Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L.
Source

Yale School of Medicine, New Haven, Connecticut, USA. melinda.irwin@yale.edu

Abstract

Given the negative effects of a breast cancer diagnosis and its treatments on body weight and bone mass, we investigated the effects of a 6-month randomized controlled aerobic exercise intervention vs. usual care on body composition in breast cancer survivors. Secondary aims were to examine the effects stratified by important prognostic and physiologic variables. Seventy-five physically inactive postmenopausal breast cancer survivors were recruited through the Yale-New Haven Hospital Tumor Registry and randomly assigned to an exercise (n = 37) or usual care (n = 38) group. The exercise group participated in 150 min/week of supervised gym- and home-based moderate-intensity aerobic exercise. The usual care group was instructed to maintain their current physical activity level. Body composition was assessed at baseline and 6-months through dual-energy X-ray absorptiometry (DXA) by one radiologist blinded to the intervention group of the participants. On an average, exercisers increased moderate-intensity aerobic exercise by 129 min/week over and above baseline levels compared with 45 min/week among usual care participants (P < 0.001). Exercisers experienced decreases in percent body fat (P = 0.0022) and increases in lean mass (P = 0.047) compared with increases in body fat and decreases in lean mass in usual care participants. Bone mineral density (BMD) was also maintained among exercisers compared with a loss among usual care participants (P = 0.043). In summary, moderate-intensity aerobic exercise, such as brisk walking, produces favorable changes in body composition that may improve breast cancer prognosis.

PMID:: 19629060; [PubMed - indexed for MEDLINE]
PMCID: PMC2841468

Free PMC Article

J Cancer Surviv. 2008 Dec;2(4):253-61. Epub 2008 Oct 16.
Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors.

Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC.
Source

Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301439, Unit 1330, Houston, TX 77230-1439, USA. kbasenen@mdanderson.org

Abstract

BACKGROUND:

Many breast cancer survivors experience long term sequelae, including fatigue, decreased physical functioning, pain, and psychological distress. Physical activity can ameliorate these problems, but there is little research on how activity should be performed to be most beneficial. This study explores how dimensions of physical activity (total energy expenditure, frequency, and duration) are associated with symptoms among breast cancer survivors.
METHODS:

We conducted a secondary analysis of data on physical activity behavior and symptoms in a cross-sectional study (n = 148) of breast cancer survivors who were off treatment and had been diagnosed within the past 5 years.
RESULTS:

Multivariate analyses showed that total energy expenditure was associated with better general health (p = 0.006) and fewer depressive symptoms (p = 0.014), while frequency of activity was linearly related to physical functioning (p = 0.047), pain (0.057), general health (p < 0.001), and depressive symptoms (p < 0.001). Duration was related to physical functioning, pain, and general health, but the worst outcomes were reported by the participants with the shortest and longest duration of activity (quadratic trend p values = 0.002, 0.003, 0.008, respectively).
DISCUSSION/CONCLUSIONS:

Greater total energy expenditure, higher physical activity frequency, and moderate duration were associated with better outcomes for most symptoms, although there was no relationship between any of the dimensions of physical activity and fatigue. IMPLICATIONS FOR CANCER SURVIVORS: The association of better outcomes with higher energy expenditure, higher frequency of activity, and moderate duration indicates that increasing activity through multiple short bouts may be the most beneficial for breast cancer survivors. However, randomized studies are needed to confirm this finding.

PMID:: 18923906; [PubMed - indexed for MEDLINE]
PMCID: PMC3076788

Free PMC Article

Ger Med Sci. 2010 Nov 18;8

oc31.
Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy.

Guerreiro Godoy Mde F, Oliani AH, Pereira de Godoy JM.

FREE TEXT

Source

Lato Sensu Post Graduation Course on Lymphovenous Rehabilitation of the Medicine School in São José do Rio Preto (FAMERP) and Research CAPES, Brazil.

Abstract

The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient's body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤ 0.05) being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001). In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs.

PMID:: 21139989; [PubMed - indexed for MEDLINE]
PMCID: PMC2996058

Can Fam Physician. 2010 Dec;56(12):1277-84.
Management of secondary lymphedema related to breast cancer.

Cheifetz O, Haley L; Breast Cancer Action.
Source

Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. cheifetz@hhsc.ca

FREE TEXT

Abstract

AbstractOBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer.QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed,and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett's levels of evidence. The literature search focused on primary research and systematic reviews.MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises,previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading.CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral.

PMID:: 21375063; [PubMed - indexed for MEDLINE]
PMCID: PMC3001918

06-21-2011, 01:35 PM	#1
Rich66 Senior Member Join Date: Feb 2008 Location: South East Wisconsin Posts: 3,431	Excercise/activity Recent Results Cancer Res. 2011;186:189-215. Physical activity and breast cancer survivorship. Schmitz K. Source Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, 903 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021, USA. Schmitz@mail.med.upenn.edu Abstract A diagnosis of breast cancer is associated with treatments that have physiologic effects beyond the intended curative therapy. The first section of this chapter provides and integrative physiology review of the effects of breast cancer treatment on the body systems used by and affected by physical activity, including effects of chemotherapy, radiation, and surgery. In later sections, we review the literature on physical activity and breast cancer from the point of diagnosis and for the balance of life. The efficacy of physical activity for supportive cancer care outcomes is reviewed separately from the purported usefulness of physical activity for disease-free and overall survival from breast cancer. The current evidence supports the safety of physical activity during and after breast cancer therapy. The supportive cancer care outcomes for which there is sufficient evidence of efficacy during and after breast cancer treatment include fitness, fatigue, body size, and quality of life. Further, there is growing evidence that upper body exercise does not pose additional risk for negative lymphedema outcomes among survivors with and at risk for lymphedema. For overall survival, the evidence is largely observational, with sufficient evidence that physical activity does confer benefit. Finally, we outline future directions for research on physical activity among breast cancer survivors, including expanding to focus on subsets of the population not included in most prior studies (minority women and older women), tailoring of interventions to stages of cancer most likely to benefit, expanding to study women with metastatic cancer, and new modes of exercise, such as team sports, martial arts, and Pilates. PMID: 21113765 [PubMed - indexed for MEDLINE] Cancer Res. 2011 Jun 1;71(11):3889-95. Epub 2011 May 24. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Richman EL, Kenfield SA, Stampfer MJ, Paciorek A, Carroll PR, Chan JM. LINK Source Authors' Affiliations: Departments of Epidemiology and Nutrition, Harvard School of Public Health; The Channing Laboratory, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Departments of Urology and Epidemiology and Biostatistics, School of Medicine; and Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California. Abstract Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality. However, men with metastatic disease may decrease their activity due to their disease; thus, a causal interpretation is uncertain. We therefore prospectively examined vigorous activity and brisk walking after diagnosis in relation to risk of prostate cancer progression, an outcome less susceptible to reverse causation, among 1,455 men diagnosed with clinically localized prostate cancer. Cox proportional hazards regression was used to examine vigorous activity, nonvigorous activity, walking duration, and walking pace after diagnosis and risk of prostate cancer progression. We observed 117 events (45 biochemical recurrences, 66 secondary treatments, 3 bone metastases, 3 prostate cancer deaths) during 2,750 person-years. Walking accounted for nearly half of all activity. Men who walked briskly for 3 h/wk or more had a 57% lower rate of progression than men who walked at an easy pace for less than 3 h/wk (HR = 0.43; 95% CI: 0.21-0.91; P = 0.03). Walking pace was associated with decreased risk of progression independent of duration (HR brisk vs. easy pace = 0.52; 95% CI: 0.29-0.91; P(trend) = 0.01). Few men engaged in vigorous activity, but there was a suggestive inverse association (HR ≥3 h/wk vs. none = 0.63; 95% CI: 0.32-1.23; P(trend) = 0.17). Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity, respectively. Brisk walking after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinically localized prostate cancer. Cancer Res; 71(11); 3889-95. ©2011 AACR. PMID: 21610110 [PubMed - in process] PMCID: PMC3107352 [Available on 2012/6/1] Obesity (Silver Spring). 2009 Aug;17(8):1534-41. Epub 2009 Feb 19. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Irwin ML, Alvarez-Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L. Source Yale School of Medicine, New Haven, Connecticut, USA. melinda.irwin@yale.edu Abstract Given the negative effects of a breast cancer diagnosis and its treatments on body weight and bone mass, we investigated the effects of a 6-month randomized controlled aerobic exercise intervention vs. usual care on body composition in breast cancer survivors. Secondary aims were to examine the effects stratified by important prognostic and physiologic variables. Seventy-five physically inactive postmenopausal breast cancer survivors were recruited through the Yale-New Haven Hospital Tumor Registry and randomly assigned to an exercise (n = 37) or usual care (n = 38) group. The exercise group participated in 150 min/week of supervised gym- and home-based moderate-intensity aerobic exercise. The usual care group was instructed to maintain their current physical activity level. Body composition was assessed at baseline and 6-months through dual-energy X-ray absorptiometry (DXA) by one radiologist blinded to the intervention group of the participants. On an average, exercisers increased moderate-intensity aerobic exercise by 129 min/week over and above baseline levels compared with 45 min/week among usual care participants (P < 0.001). Exercisers experienced decreases in percent body fat (P = 0.0022) and increases in lean mass (P = 0.047) compared with increases in body fat and decreases in lean mass in usual care participants. Bone mineral density (BMD) was also maintained among exercisers compared with a loss among usual care participants (P = 0.043). In summary, moderate-intensity aerobic exercise, such as brisk walking, produces favorable changes in body composition that may improve breast cancer prognosis. PMID: 19629060 [PubMed - indexed for MEDLINE] PMCID: PMC2841468 Free PMC Article J Cancer Surviv. 2008 Dec;2(4):253-61. Epub 2008 Oct 16. Dimensions of physical activity and their relationship to physical and emotional symptoms in breast cancer survivors. Basen-Engquist K, Hughes D, Perkins H, Shinn E, Taylor CC. Source Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, P.O. Box 301439, Unit 1330, Houston, TX 77230-1439, USA. kbasenen@mdanderson.org Abstract BACKGROUND: Many breast cancer survivors experience long term sequelae, including fatigue, decreased physical functioning, pain, and psychological distress. Physical activity can ameliorate these problems, but there is little research on how activity should be performed to be most beneficial. This study explores how dimensions of physical activity (total energy expenditure, frequency, and duration) are associated with symptoms among breast cancer survivors. METHODS: We conducted a secondary analysis of data on physical activity behavior and symptoms in a cross-sectional study (n = 148) of breast cancer survivors who were off treatment and had been diagnosed within the past 5 years. RESULTS: Multivariate analyses showed that total energy expenditure was associated with better general health (p = 0.006) and fewer depressive symptoms (p = 0.014), while frequency of activity was linearly related to physical functioning (p = 0.047), pain (0.057), general health (p < 0.001), and depressive symptoms (p < 0.001). Duration was related to physical functioning, pain, and general health, but the worst outcomes were reported by the participants with the shortest and longest duration of activity (quadratic trend p values = 0.002, 0.003, 0.008, respectively). DISCUSSION/CONCLUSIONS: Greater total energy expenditure, higher physical activity frequency, and moderate duration were associated with better outcomes for most symptoms, although there was no relationship between any of the dimensions of physical activity and fatigue. IMPLICATIONS FOR CANCER SURVIVORS: The association of better outcomes with higher energy expenditure, higher frequency of activity, and moderate duration indicates that increasing activity through multiple short bouts may be the most beneficial for breast cancer survivors. However, randomized studies are needed to confirm this finding. PMID: 18923906 [PubMed - indexed for MEDLINE] PMCID: PMC3076788 Free PMC Article Ger Med Sci. 2010 Nov 18;8oc31. Active exercises utilizing a facilitating device in the treatment of lymphedema resulting from breast cancer therapy. Guerreiro Godoy Mde F, Oliani AH, Pereira de Godoy JM. FREE TEXT Source Lato Sensu Post Graduation Course on Lymphovenous Rehabilitation of the Medicine School in São José do Rio Preto (FAMERP) and Research CAPES, Brazil. Abstract The aim of this study was to evaluate the reduction in volume of arm lymphedema secondary to breast cancer therapy utilizing an exercise facilitating device. Twenty-one women with arm lymphedema resulting from the surgical and radiotherapeutic treatment of breast cancer were randomly selected. Evaluation was made by water-displacement volumetry before and after each session. The patients were submitted to a series of active exercises using a facilitating device for four 12-minute sessions with intervals of 3 minutes between sessions in the sitting position with alignment of the spinal column. The lymphedematous arm was maintained under compression using a cotton-polyester sleeve. The active exercising device used was a mobile flexion bar fixed on a metal base at a height of 30 cm from the tabletop and at a distance of 10 cm from the patient's body. The paired t-test was utilized for statistical analysis with an alpha error of 5% (p-value ≤ 0.05) being considered significant. The initial mean volume of the arms was 2,089.9 and the final volume was 2,023.0 mL with a mean loss of 66.9 mL (p-value <0.001). In conclusion, active exercises utilizing facilitating devices can contribute to a reduction in size of lymphedematous limbs. PMID: 21139989 [PubMed - indexed for MEDLINE] PMCID: PMC2996058 Can Fam Physician. 2010 Dec;56(12):1277-84. Management of secondary lymphedema related to breast cancer. Cheifetz O, Haley L; Breast Cancer Action. Source Hamilton Health Sciences, 711 Concession St, Hamilton, ON L8V 1C3. cheifetz@hhsc.ca FREE TEXT Abstract AbstractOBJECTIVE To review recent literature on the management of secondary lymphedema following breast cancer.QUALITY OF EVIDENCE MEDLINE, EMBASE, AMED, PubMed,and the Internet were searched for articles published between 2005 and 2009. Articles were evaluated using Sackett's levels of evidence. The literature search focused on primary research and systematic reviews.MAIN MESSAGE Secondary lymphedema related to breast cancer is an ongoing challenge. Evidence suggests that there are several safe and beneficial treatments, including complex decongestive therapy, physiotherapy, and exercise. Furthermore, resistive exercises,previously contraindicated on the affected side, have been found to be both beneficial and safe with careful progression and monitoring. Exercise guidelines and patient education topics are presented with a comprehensive reference list for further reading.CONCLUSION Advances in cancer treatment, cancer and exercise research, and lymphedema management require that physicians have a basic understanding of the current evidence to provide appropriate patient education and referral. PMID: 21375063 [PubMed - indexed for MEDLINE] PMCID: PMC3001918