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PURPOSE The aims of this pilot study were the following : 1 ) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospect i ve , r and omized , controlled experimental design ; 2 ) to examine the influence of disease symptoms and treatment side effects on exercise levels ; and 3 ) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar population s. DESCRIPTION OF STUDY Fifty-two patients with newly diagnosed breast cancer were r and omly assigned to one of two treatment arms : usual care or usual care plus exercise . Those assigned to the exercise group received a st and ardized , self-administered , home-based brisk walking intervention in addition to usual care . Each day subjects completed self-report diary forms that elicited information about activity levels , and the occurrence of symptoms and side effects during cancer treatment . RESULTS Analyses of self-reported daily activity levels revealed a diffusion of treatment effect . Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level , while 33 % of the exercise group did not exercise at the prescribed levels . Analyses of self-reported disease symptoms and treatment side effects did not reveal clinical ly meaningful differences between the two groups . CLINICAL IMPLICATION S The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs . Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors PURPOSE / OBJECTIVES To evaluate the effects of 10 weeks of aerobic exercise on depressive and anxiety symptoms and self-esteem of breast cancer survivors . DESIGN Experimental , crossover . SETTING Midwestern university town . SAMPLE Twenty-four breast cancer survivors ( mean time following surgery 41.8 months ; ranging from 1 to 99 months ) recruited via mail and cancer support groups . The mean age of the sample was 48.9 years . METHODS Subjects were assigned r and omly into exercise ( EX ) , exercise-plus-behavior modification ( EX + BM ) , and control groups . EX and EX + BM groups exercised aerobically four days/week at > or = 60 % of age-predicted maximum heart rate for 10 weeks . Data were collected pretest , post-test , and crossover ( 12 weeks following post-test ) . Because pretest or post-test scores showed no statistical differences between EX and EX + BM groups , data were combined to form one group . MAIN RESEARCH VARIABLES Aerobic exercise ( four days/ week ; 30 - 40 minutes/session ) , depression , ( Beck Depression inventory ) , anxiety ( Speilberger State-Trait Anxiety Inventory ) , and self-esteem ( Rosenberg Self-Esteem Inventory ) . FINDINGS Pre- to post-test analyses revealed that women who exercised had significantly less depression and state and trait anxiety over time compared to controls . After the crossover , the control group demonstrated comparable improvements in both depressive and state anxiety scores . Self-esteem did not change significantly . Subjects who received exercise recommendations from their physicians exercised significantly more than subjects who received no recommendation . CONCLUSIONS Mild to moderate aerobic exercise may be of therapeutic value to breast cancer survivors with respect to depressive and anxiety symptoms but not to self-esteem . A physician 's recommendation to exercise appears to be an important factor in a patient 's exercise adherence . IMPLICATION S FOR NURSING PRACTICE To Improve depressive and anxiety symptoms following breast cancer surgery , healthcare professionals should consider recommending mild to moderate exercise This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors Goals of workOur aim was to compare the effects of l and versus water multimodal exercise programs on body composition and breast cancer-specific quality of life in breast cancer survivors . Patients and methods Ninety-eight breast cancer survivors were assigned to three groups : control , l and exercise , and water exercise . Both exercise groups participated in an 8-week multimodal program . Adiposity was measured by anthropometry ( body mass index , waist circumference ) and bioelectrical impedance ( body fat and muscle lean body mass ) . Incidence of clinical ly significant secondary lymphedema was also assessed . Finally , specific quality of life was assessed using the European Organization for Research and Treatment of Cancer Quality of Life BR-23.Main Results Using ANCOVA , significant group × time interactions for body fat percentage ( F = 3.376 ; P = 0.011 ) and lean body mass ( F = 3.566 ; P = 0.008 ) were found . Breast cancer survivors in the l and exercise group exhibited a greater decrease in percentage of body fat than those in the water exercise ( P < 0.001 ) and control ( P = 0.002 ) groups . The ANCOVA revealed a significant group × time interaction for waist circumference ( F = 4.553 ; P = 0.002 ) : breast cancer survivors in the control group showed a greater waist circumference when compared to water ( P = 0.003 ) and l and ( P < 0.001 ) exercise groups . A significant group × time interaction was also found for breast symptoms ( F = 9.048 ; P < 0.001 ) : participants in the water exercise group experienced a greater decrease of breast symptoms than those in the l and exercise ( P < 0.01 ) and control ( P < 0.05 ) groups . Conclusion L and exercise produced a greater decrease in body fat and an increase in lean body mass , whereas water exercise was better for improving breast symptoms PURPOSE The primary purpose of this study was to examine the effect of aerobic exercise on physiological and psychological function in patients rehabilitating from cancer treatment . A second purpose was to evaluate the differential effects of low- and moderate-intensity exercise on these variables . METHODS Eighteen survivors of breast or colon cancer ( 15 female and 3 male , 40 - 65 yr of age ) served as subjects . The subjects were matched by aerobic capacity and scores on a Quality of Life question naire , and then r and omly assigned to a control , low- ( 25 - 35 % heart rate reserve ( HRR ) ) , or a moderate- ( 40 - 50 % HRR ) intensity exercise group . The exercise groups performed lower-body aerobic exercise three times a week for 10 wk . After the exercise training , there were no statistically significant differences between the two exercise groups on any of the physiological variables . Therefore , the exercise groups were combined into one group for the final analysis . RESULTS The results revealed statistically significant increases in aerobic capacity ( P < 0.001 ) and lower-body flexibility ( P = 0.027 ) , a significant decrease in body fat ( P < 0.001 ) , and a significant increase in quality of life ( P < 0.001 ) and a measure of energy ( P = 0.038 ) in the exercise group when compared with the control group . CONCLUSION Low- and moderate-intensity aerobic-exercise programs were equally effective in improving physiological and psychological function in this population of cancer survivors .  Aerobic exercise appears to be a valuable and well-tolerated component of the cancer-rehabilitation process PURPOSE The purpose of our study was to evaluate the effect of cognitive behavioral therapy ( CBT ) , physical exercise ( PE ) , and of these two interventions combined ( CBT/PE ) on menopausal symptoms ( primary outcome ) , body image , sexual functioning , psychological well-being , and health-related quality of life ( secondary outcomes ) in patients with breast cancer experiencing treatment-induced menopause . PATIENTS AND METHODS Patients with breast cancer reporting treatment-induced menopausal symptoms ( N=422 ) were r and omly assigned to CBT ( n=109 ) , PE ( n=104 ) , CBT/PE ( n=106 ) , or to a waiting list control group ( n=103 ) . Self-report question naires were completed at baseline , 12 weeks , and 6 months . Multilevel procedures were used to compare the intervention groups with the control group over time . RESULTS Compared with the control group , the intervention groups had a significant decrease in levels of endocrine symptoms ( Functional Assessment of Cancer Therapy-Endocrine Symptoms ; P<.001 ; effect size , 0.31 - 0.52 ) and urinary symptoms ( Bristol Female Lower Urinary Tract Symptoms Question naire ; P=.002 ; effect size , 0.29 - 0.33 ) , and they showed an improvement in physical functioning ( 36-Item Short Form Health Survey physical functioning subscale ; P=.002 ; effect size , 0.37 - 0.46 ) . The groups that included CBT also showed a significant decrease in the perceived burden of hot flashes and night sweats ( problem rating scale of the Hot Flush Rating Scale ; P<.001 ; effect size , 0.39 - 0.56 ) and an increase in sexual activity ( Sexual Activity Question naire habit subscale ; P=.027 ; effect size , 0.65 ) . Most of these effects were observed at both the 12-week and 6-month follow-ups . CONCLUSION CBT and PE can have salutary effects on endocrine symptoms and , to a lesser degree , on sexuality and physical functioning of patients with breast cancer experiencing treatment-induced menopause . Future work is needed to improve the design and the planning of these interventions to improve program adherence This study examined the effect of an integrated yoga programme on chemotherapy-related nausea and emesis in early operable breast cancer out patients . Sixty-two subjects were r and omly allocated to receive yoga ( n = 28 ) or supportive therapy intervention ( n = 34 ) during the course of their chemotherapy . Both groups had similar socio-demographic and medical characteristics . Intervention consisted of both supervised and home practice of yoga sessions lasting for 60 min daily , while the control group received supportive therapy and coping preparation during their hospital visits over a complete course of chemotherapy . The primary outcome measure was the Morrow Assessment of Nausea and Emesis ( MANE ) assessed after the fourth cycle of chemotherapy . Secondary outcomes included measures for anxiety , depression , quality of life , distressful symptoms and treatment-related toxicity assessed before and during the course of chemotherapy . Following yoga , there was a significant decrease in post-chemotherapy-induced nausea frequency ( P = 0.01 ) and nausea intensity ( P = 0.01 ) , and intensity of anticipatory nausea ( P = 0.01 ) and anticipatory vomiting ( P = 0.05 ) as compared with the control group . There was a significant positive correlation between MANE scores and anxiety , depression and distressful symptoms . In conclusion , the results suggest a possible use for stress reduction interventions such as yoga in complementing conventional antiemetics to manage chemotherapy-related nausea and emesis PURPOSE Self-directed and supervised exercise were compared with usual care in a clinical trial design ed to evaluate the effect of structured exercise on physical functioning and other dimensions of health-related quality of life in women with stages I and II breast cancer . PATIENTS AND METHODS One hundred twenty-three women with stages I and II breast cancer completed baseline evaluations of generic and disease- and site-specific health-related quality of life , aerobic capacity , and body weight . Participants were r and omly allocated to one of three intervention groups : usual care ( control group ) , self-directed exercise , or supervised exercise .  Quality of life , aerobic capacity , and body weight measures were repeated at 26 weeks . The primary outcome was the change in the Short Form-36 physical functioning scale between baseline and 26 weeks . RESULTS Physical functioning in the control group decreased by 4.1 points , whereas it increased by 5.7 points and 2.2 points in the self-directed and supervised exercise groups , respectively ( P = .04 ) . Post hoc analysis showed a moderately large ( and clinical ly important ) difference between the self-directed and control groups ( 9.8 points ; P = .01 ) and a more modest difference between the supervised and control groups ( 6.3 points ; P = .09 ) . No significant differences between groups were observed for changes in quality of life scores . In a secondary analysis of participants stratified by type of adjuvant therapy , supervised exercise improved aerobic capacity ( + 3.5 mL/kg/min ; P = .01 ) and reduced body weight ( -4.8 kg ; P < .05 ) compared with usual care only in participants not receiving chemotherapy . CONCLUSION Physical exercise can blunt some of the negative side effects of breast cancer treatment , including reduced physical functioning .  Self-directed exercise is an effective way to improve physical functioning compared with usual care . In participants not receiving chemotherapy  , supervised exercise may increase aerobic capacity and reduce body weight compared with usual care Introduction Challenges exist in identifying , recruiting and motivating sedentary patients with cancer to initiate physical activity towards recommended levels . We hypothesise that the onset period of adjuvant chemotherapy can be ‘ the open window of opportunity ’ to identify and motivate sedentary patients with breast and colon cancers , at risk for developing coronary heart disease , to initiate and sustain lifestyle changes . Aims To investigate the feasibility of oncologists/nurses screening for physical inactivity , in order to identify and recruit an at-risk population of sedentary patients with breast or colon cancer at the onset of adjuvant chemotherapy . Furthermore , the study will examine the adherence to one of two multimodal exercise interventions lasting 12 weeks ; ( 1 ) hospital-based , high intensity , group exercise intervention ( 2 ) home-based , low intensity , individual , pedometer intervention . Both arms will be compared with a control group . Methods and analyses All newly referred patients will be screened for sedentary behaviour , using national recommendations . Testing at baseline , 6 , 12 and 39 weeks will include ; ( 1 ) physiological testing ( VO2-peak , one repetition maximum muscle strength and lung function ( 2 ) fasting full body dual-energy X-ray absorptiometry scan ( 3 ) fasting blood glucose , insulin , lipids and cholesterols , ( 4 ) psychometric question naires ( general well-being , quality of life , anxiety and depression , motivational readiness ) . The r and omised controlled trial feasibility design is selected in order to examine barriers for recruitment , programme adherence , safety aspects and potential efficacy to the interventions during adjuvant chemotherapy . Ethics and dissemination The Scientific Committee of the Capital Region ( case No. H-1 - 2011 - 131 ) and the Danish Data Protection Agency ( j. No. 2011 - 41 - 6349 ) approved the study . Data will be entered and locked into a data base hosted by the Copenhagen Trial Unit , Rigshosptialet . Data will be available for analyses to project members and the trial statistician after the 45 included patients have completed the 12-week test . Results will be published in peer- review ed scientific journals . Trial registration Current Controlled Trials IS RCT N24901641 Multiple exercise interventions have shown beneficial effects on fatigue and quality of life ( QoL ) in cancer patients , but various psychosocial interventions as well . It is unclear to what extent the observed effects of exercise interventions are based on physical adaptations or rather on psychosocial factors associated with supervised , group-based programs . It needs to be determined which aspects of exercise programs are truly effective . Therefore , we aim ed to investigate whether resistance exercise during chemotherapy provides benefits on fatigue and QoL beyond potential psychosocial effects of group-based interventions . One-hundred-one breast cancer patients starting chemotherapy  were r and omly assigned to resistance exercise ( EX ) or a relaxation control ( RC ) group . Both interventions were supervised , group-based , 2/week over 12 weeks . The primary endpoint fatigue was assessed with a 20-item multidimensional question naire , QoL with the EORTC QLQ-C30/BR23 . Analyses of covariance for individual changes from baseline to Week 13 were calculated . In RC , total and physical fatigue worsened during chemotherapy , whereas EX showed no such impairments ( between-group p = 0.098 and 0.052 overall , and p = 0.038 and 0.034 among patients without severe baseline depression ) . Differences regarding affective or cognitive fatigue were not significant . Benefits of EX were also seen to affect role and social function . Effect sizes were between 0.43 and 0.48 . Explorative analyses indicated significant effect modification by thyroxin use ( p-interaction = 0.044 ) . In conclusion , resistance exercise appeared to mitigate physical fatigue and maintain QoL during chemotherapy beyond psychosocial effects inherent to supervised group-based setting s. Thus , resistance exercise could be an integral part of supportive care for breast cancer patients undergoing chemotherapy To evaluate the efficacy and economic efficiency of a multimedia , multimodal physical activity program for women undergoing adjuvant therapy following surgery for breast cancer . We conducted a r and omized trial with concurrent incremental cost-effectiveness analysis and blinded baseline , 3 , 6 and 12-month follow-up assessment s amongst women undergoing adjuvant therapy following surgery for breast cancer ( n = 89 ) . The intervention was a multimedia , multimodal exercise program comprising strength , balance and endurance training elements . The control was sham flexibility and relaxation program delivered using similar material s. The primary outcome was health-related quality of life ( EQ-5D & VAS , EORTC C30 , BR23 ) . Economic outcomes included direct health care costs and productivity gains and losses . Participants in the intervention group demonstrated greater improvement in health-related quality of life between baseline and the 3-month assessment [ mean ( sd ) EQ-5D VAS ( 0–100 ) baseline : 72.6 ( 15.6 ) , 3 month : 80.6 ( 11.6 ) ] when compared to control group participants [ baseline : 77.5 ( 13.5 ) , 3 month : 74.1 ( 20.6 ) , P = 0.006 ] and also improved more in terms of physical function [ mean ( sd ) EORTC C30 physical function scale intervention ( 0–100 ) baseline : 84.9 ( 14.8 ) , 3 month : 86.9 ( 10.7 ) , control baseline : 91.3 ( 9.6 ) , 3 month : 86.7 ( 14.9 ) , P = 0.02 ] . These improvements were not sustained beyond this point . Upper limb volumes were also lower amongst intervention group participants . However , there was low probability that the intervention would be both less costly and more effective than the control condition ( range probability = 0.05–50.02 % depending on approach ) . Provision of multimodal exercise programs will improve the short-term health of women undergoing adjuvant therapy for breast cancer but are of question able economic efficiency PURPOSE To determine the effects of breast cancer-specific print material s and step pedometers on  physical activity ( PA ) and quality of life ( QoL ) in breast cancer survivors . PATIENTS AND METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive one of the following : a st and ard public health recommendation for PA , previously developed breast cancer-specific PA print material s , a step pedometer , or a combination of breast cancer-specific print material s and step pedometers . The primary outcome was self-reported moderate/vigorous PA minutes per week . Secondary outcomes were QoL ( Functional Assessment of Cancer Therapy-Breast ) , fatigue , self-reported brisk walking , and objective step counts . Assessment s were conducted at baseline and postintervention ( 12 weeks ) . RESULTS Attrition was 10.3 % ( 39 of 377 ) . On the basis of linear mixed-model analyses , PA increased by 30 minutes/week in the st and ard recommendation group compared with 70 minutes/week in the print material group ( mean difference , 39 minutes/week ; 95 % CI = -10 to 89 ; d = 0.25 ; P = .117 ) , 89 minutes/week in the pedometer group ( mean difference , 59 minutes/week ; 95 % CI , 11 to 108 ; d = 0.38 ; P = .017 ) , and 87 minutes/week in the combined group ( mean difference , 57 minutes/week ; 95 % CI , 8 to 106 ; d = 0.37 ; P = .022 ) . For brisk walking minutes/week , all three intervention groups reported significantly greater increases than the st and ard recommendation group . The combined group also reported significantly improved QoL ( mean difference , 5.8 ; 95 % CI , 2.0 to 9.6 ; d = 0.33 ; P = .003 ) and reduced fatigue ( mean difference , 2.3 ; 95 % CI , 0.0 to 4.7 ; d = 0.25 ; P = .052 ) compared with the st and ard recommendation group . CONCLUSION Breast cancer-specific PA print material s and pedometers may be effective strategies for increasing PA and QoL in breast cancer survivors . A combined approach appears to be optimal . CLINICAL TRIAL REGISTRATION Clinical Trials.gov Identifier Excess body weight at diagnosis and weight gain after breast cancer are associated with poorer long-term prognosis . This study investigated the effects of a lifestyle intervention on body weight and other health outcomes influencing long-term prognosis in overweight women ( BMI > 25.0 kg/m2 ) recovering from early-stage ( stage I – III ) breast cancer . A total of 90 women treated 3–18 months previously were r and omly allocated to a 6-month exercise and hypocaloric healthy eating program ( n = 47 , aged 55.6 ± 10.2 year ) or  control group ( n = 43 , aged 55.9 ± 8.9 year ) . Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice , supplemented by weekly nutrition seminars . Body weight , waist circumference , waist/hip ratio [ WHR ] , cardiorespiratory fitness , blood biomarkers associated with breast cancer recurrence and cardiovascular disease risk , and quality of life ( FACT-B ) were assessed at baseline and 6 months . Three-day diet diaries were used to assess macronutrient and energy intakes . A moderate reduction in body weight in the intervention group ( median difference from baseline of −1.09 kg ; IQR −0.15 to −2.90 kg ; p = 0.07 ) was accompanied by significant reductions in waist circumference ( p < 0.001 ) , WHR ( p = 0.005 ) , total ( p = 0.021 ) and saturated fat ( p = 0.006 ) intakes , leptin ( p = 0.005 ) , total cholesterol ( p = 0.046 ) , and resting diastolic blood pressure ( p = 0.03 ) . Cardiopulmonary fitness ( p < 0.001 ) and FACT-B quality of life ( p = 0.004 ) also showed significant improvements in the intervention group . These findings suggest that an individualized exercise and a hypocaloric healthy eating program can positively impact upon health outcomes influencing long-term prognosis in overweight women recovering from early-stage breast cancer PURPOSE / OBJECTIVES To compare changes in frequency , duration , and intensity of exercise behaviors over time in women with breast cancer between those who started their exercise intervention at the beginning of chemotherapy ( EE ) and those who started at the completion of chemotherapy ( CE ) . DESIGN A secondary data analysis of a r and omized , controlled trial for exercise intervention . SETTING Five cancer centers in the San Francisco Bay Area in California . SAMPLE 66 outpatient women with breast cancer who were receiving chemotherapy .  METHODS Piecewise linear mixed models analysis was used to study changes in  exercise behaviors over time in the EE group during and after treatment . In addition , linear mixed models analysis was used to examine changes between the EE and CE groups after treatment . Participants were in the trial for various length of time ( EE group : 19 - 86 weeks ; CE group : 6 - 43 weeks ) . MAIN RESEARCH VARIABLES Exercise frequency , intensity , and duration . FINDINGS In the EE group , weekly exercise duration increased significantly during treatment ( p = 0.02 ) . In addition , weekly exercise intensity increased significantly during treatment ( p = 0.02 ) and decreased significantly after treatment ( p = 0.003 ) . After treatment , initial weekly exercise duration was significantly lower in the CE group than in the EE group ( p = 0.01 ) . No significant differences existed in frequency and intensity over time between the EE and CE groups . CONCLUSIONS Women with breast cancer can sustain exercise behaviors when they start an exercise intervention in the beginning of chemotherapy treatment . IMPLICATION S FOR NURSING Strategies to support patients in maintaining their exercise habit may be needed during the post-treatment period While physical activity during cancer treatment is found beneficial for breast cancer patients , evidence indicates ambiguous findings concerning effects of scheduled exercise programs on treatment-related symptoms . This study investigated effects of a scheduled home-based exercise intervention in breast cancer patients during adjuvant chemotherapy  , on cancer-related fatigue , physical fitness , and activity level .  Sixty-seven women were r and omized to an exercise intervention group ( n = 33 , performed strength training 3x/week and 30 minutes brisk walking/day ) and a control group ( n = 34 , performed their regular physical activity level ) . Data collection was performed at baseline , at completion of chemotherapy ( Post1 ) , and 6-month postchemotherapy ( Post2 ) . Exercise levels were slightly higher in the scheduled exercise group than in the control group . In both groups , cancer-related fatigue increased at Post1 but returned to baseline at Post2 . Physical fitness and activity levels decreased at Post1 but were significantly improved at Post2 . Significant differences between intervention and control groups were not found . The findings suggest that generally recommended physical activity levels are enough to relief cancer-related fatigue and restore physical capacity in breast cancer patients during adjuvant chemotherapy , although one can not rule out that results reflect diminishing treatment side effects over time PURPOSE Cancer treatment-related fatigue is the most prevalent and distressing symptom of cancer therapy . Interventions to minimize fatigue are needed . The purpose of this study was to examine the relationship between exercise and fatigue over the first three cycles of chemotherapy in women receiving either cyclophosphamide , methotrexate , and fluorouracil ( CMF ) or doxorubicin and cyclophosphamide ( AC ) for breast cancer . METHODS Seventy-two newly diagnosed women with breast cancer were instructed in a home-based moderate-intensity exercise intervention . Measures of functional ability , energy expenditure , and fatigue were obtained at baseline and posttest . Subjects maintained daily records of four types of fatigue , and exercise duration , intensity , and type . RESULTS Exercise significantly reduced all four levels of fatigue ( P < 0.01 ) . As the duration of exercise increased , the intensity of fatigue declined ( P < 0.01 ) . There was a significant carry-over effect of exercise on fatigue , but the effect lasted only 1 d. The level of fatigue at study entry was not associated with number of days of exercise or amount of exercise a woman engaged in . CONCLUSIONS The impact of exercise on fatigue was significant and suggests the effectiveness of a low- to moderate-intensity regular exercise program in maintaining functional ability and reducing fatigue in women with breast cancer receiving chemotherapy Background Premature menopause is a major concern of younger women undergoing adjuvant therapy for breast cancer . Hormone replacement therapy is contraindicated in women with a history of breast cancer . Non-hormonal medications show a range of bothersome side-effects . There is growing evidence that cognitive behavioral therapy ( CBT ) and physical exercise can have a positive impact on symptoms in naturally occurring menopause . The objective of this study is to investigate the efficacy of these interventions among women with breast cancer experiencing treatment-induced menopause . Methods / design In a r and omized , controlled , multicenter trial , we are evaluating the effectiveness of CBT/relaxation , of physical exercise and of these two program elements combined , in reducing menopausal symptoms , improving sexual functioning , reducing emotional distress , and in improving the health-related quality of life of younger breast cancer patients who experience treatment-induced menopause . 325 breast cancer patients ( aged < 50 ) are being recruited from hospitals in the Amsterdam region , and r and omly allocated to one of the three treatment groups or a ' waiting list ' control group . Self-administered question naires are completed by the patients at baseline , and at 12 weeks ( T1 ) and 6 months ( T2 ) post- study entry . Upon completion of the study , women assigned to the control group will be given the choice of undergoing either the CBT or physical exercise program . Discussion Cognitive behavioral therapy and physical exercise are potentially useful treatments among women with breast cancer undergoing treatment-induced , premature menopause . For these patients , hormonal and non-hormonal therapies are contraindicated or have a range of bothersome side-effects . Hence , research into these interventions is needed , before dissemination and implementation in the current health care system can take place . Trial registration The study is registered at the Netherl and s Trial Register ( NTR1165 ) and Clinical Trials.gov ( NCT00582244 ) Background Exercise adherence is a challenge for breast cancer patients receiving chemotherapy but few studies have identified the key barriers . Purpose In this paper , we report the barriers to supervised exercise in breast cancer patients participating in a r and omized controlled trial . Methods Breast cancer patients initiating adjuvant chemotherapy ( N = 242 ) were r and omly assigned to usual care  ( n = 82 )  or supervised resistance  ( n = 82 ) or aerobic  ( n = 78 ) exercise . Participants r and omized to the two exercise groups ( n = 160 ) were asked to provide a reason for each missed exercise session . Results The two exercise groups attended 70.2 % ( 5,495/7,829 ) of their supervised exercise sessions and provided a reason for missing 89.5 % ( 2,090/2,334 ) of their unattended sessions . The 2,090 reasons represented 36 different barriers . Feeling sick ( 12 % ) , fatigue ( 11 % ) , loss of interest ( 9 % ) , vacation ( 7 % ) , and nausea/vomiting ( 5 % ) accounted for the most missed exercise sessions . Disease/treatment-related barriers ( 19 of the 36 barriers ) accounted for 53 % ( 1,102/2,090 ) of all missed exercise sessions . Demographic and medical variables did not predict the types of exercise barriers reported . Conclusions Barriers to supervised exercise in breast cancer patients receiving chemotherapy are varied but over half can be directly attributed to the disease and its treatments . Behavioral support programs need to focus on strategies to maintain exercise in the face of difficult treatment side effects Background Physical activity is important following breast cancer . Trials of non-face-to-face interventions are needed to assist in reaching women living outside major metropolitan areas . Purpose This study seeks to evaluate the feasibility and effectiveness of a telephone-delivered , mixed aerobic and resistance exercise intervention for non-urban Australian women with breast cancer . Methods A r and omized controlled trial comparing an 8-month intervention delivered by exercise physiologists ( n = 73 ) to usual care  ( n = 70 ) . Results Sixty-one percent recruitment rate and 96 % retention at 12 months ; 79 % of women in the intervention group received at least 75 % of calls ; odds ( OR , 95 % CI ) of meeting intervention targets favored the intervention group for resistance training ( OR 3.2 ; 1.2 , 8.9 ) and aerobic ( OR 2.1 ; 0.8 , 5.5 ) activity . Conclusions Given the limited availability of physical activity programs for non-urban women with breast cancer , results provide strong support for feasibility and modest support for the efficacy of telephone-delivered interventions Background We previously reported that a physical activity ( PA ) behavior change intervention based on the theory of planned behavior ( TPB ) increased PA and quality of life in breast cancer survivors . Purpose To examine the effects of our interventions on TPB variables and to determine if PA at 12 weeks follow-up was mediated by TPB variables at 4 weeks . Methods Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either a st and ard public health recommendation for PA ( SR group ) , a step pedometer alone , or one of two TPB-based behavior change interventions consisting of print material s ( alone or combined with a step pedometer ) . For the purpose of this study , we compared the two TPB-based intervention groups ( INT group ) to the SR group . Results Compared to the SR group , the INT group reported more favorable changes in instrumental attitude ( mean difference = 0.13 ; 95 % CI = −0.01 to 0.23 ; d = 0.19 ; p = 0.077 ) , intention ( mean difference = 0.33 ; 95 % CI = 0.10 to 0.56 ; d = 0.33 ; p = 0.006 ) , and planning ( mean difference = 0.39 ; 95 % CI = 0.04 to 0.73 ; d = 0.26 ; p = 0.027 ) . Mediation analyses indicated that both planning and intention partially mediated the effects of the intervention on PA at 12 weeks . Conclusions Our TPB-based behavior change intervention result ed in small improvements in the TPB constructs that partially mediated the effects of our intervention on PA behavior . Additional research with the TPB is warranted OBJECTIVES This study compares the effects of an integrated yoga program with brief supportive therapy in breast cancer out patients undergoing adjuvant radiotherapy at a cancer centre . METHODS Eighty-eight stage II and III breast cancer out patients were r and omly assigned to receive yoga ( n = 44 ) or brief supportive therapy ( n = 44 ) prior to their radiotherapy treatment . Intervention consisted of yoga sessions lasting 60 min daily while the control group was imparted supportive therapy once in 10 days . Assessment s included European Organization for Research in the Treatment of Cancer- Quality of Life ( EORTCQoL C30 ) functional scales and Positive and Negative Affect Schedule ( PANAS ) . Assessment s were done at baseline and after 6 weeks of radiotherapy treatment . RESULTS An intention to treat GLM repeated measures ANOVA showed significant difference across groups over time for positive affect , negative affect and emotional function and social function . There was significant improvement in positive affect ( ES = 0.59 , p = 0.007 , 95%CI 1.25 to 7.8 ) , emotional function ( ES = 0.71 , p = 0.001 , 95%CI 6.45 to 25.33 ) and cognitive function ( ES = 0.48 , p = 0.03 , 95%CI 1.2 to 18.5 ) , and decrease in negative affect ( ES = 0.84 , p<0.001 , 95%CI -13.4 to -4.4 ) in the yoga group as compared to controls . There was a significant positive correlation between positive affect with role function , social function and global quality of life . There was a significant negative correlation between negative affect with physical function , role function , emotional function and social function . CONCLUSION The results suggest a possible role for yoga to improve quality of life and affect in breast cancer out patients BACKGROUND Exercise has been reported to decrease cancer-related fatigue  and to increase quality of life ( QoL ) in various breast cancer ( BC ) population s. However , studies investigating exercise during radiotherapy or resistance training are scarce . We conducted a r and omized , controlled trial ( BEST study ) to assess the efficacy of 12-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention . PATIENTS AND METHODS One hundred sixty patients with BC stage 0-III were r and omly assigned to a 12-week progressive resistance training ( 2 times/week ) or a 12-week relaxation control ( RC , 2 times/week ) . Both interventions were group-based . The primary end point fatigue was assessed with a 20-item multidimensional question naire , QoL with EORTC question naires . Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week 13 . RESULTS Adherence to the intervention program as well as the completion rate ( 97 % ) for the primary outcome variable fatigue was high . In intention-to-treat analyses for the N = 155 patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = 0.044 ) , especially for the subscale physical fatigue [ MD = -0.8 ; 95 % confidence interval -1.5 to -0.2 , P = 0.013 ] , but not for affective ( P = 0.91 ) or cognitive fatigue ( P = 0.65 ) . For QoL , significantly larger improvements regarding the role function ( P = 0.035 ) and pain ( P = 0.040 ) were noted among exercisers compared with RCs . Future perspective improved significantly stronger in the RC group compared with the EX group ( P = 0.047 ) . CONCLUSIONS The 12-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL  in BC patients during adjuvant radiotherapy . As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinical ly relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher . TRIAL REGISTRATION Clinical Trials.gov NCT01468766 The objective was to determine the effects of exercise training on changes in blood immune function in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n=25 ) or control group ( n=28 ) . The exercise group trained on cycle ergometers three times per week for 15 wk . The control group did not train . The primary end point was change in natural killer cell cytotoxic activity in isolated peripheral blood mononuclear cells . Secondary end points were changes in st and ard hematological variables , whole blood neutrophil function , the phenotypes of isolated mononuclear cells , estimations of unstimulated and phytohemaglutinin-stimulated mononuclear cell function ( rate of [3H]thymidine uptake ) , and the production of proinflammatory [ interleukin (IL)-1alpha , tumor necrosis factor-alpha , IL-6 ] and anti-inflammatory cytokines ( IL-4 , IL-10 , transforming growth factor-beta1 ) . Statistical tests were two-sided ( alpha < 0.05 ) . Fifty-two participants completed the trial . Intention-to-treat analyses , which included the baseline value as a covariate , showed significant differences between groups for change in percent specific lysis of a target natural killer cell at all five effector-to-target ratios ( adjusted mean between-group change over all 5 effector-to-target ratios = + 6.34 % ; P < 0.05 for all comparisons ) , the lytic activity per cell ( adjusted mean between-group change = -2.72 lytic units ; P=0.035 ) , and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes ( adjusted mean between-group change = + 218 per dpm x 10(6 ) cells ; P = 0.007 ) . There were no significant differences between groups for change in any other end point . Exercise training increased natural killer cell cytotoxic activity and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes in postmenopausal breast cancer survivors Background : Few studies have evaluated an individualized home-based exercise prescription during and after cancer treatment . Objective : The purpose of this study was to evaluate the effectiveness of a home-based exercise training intervention , the Pro-self Fatigue Control Program on the management of cancer-related fatigue . Interventions / Methods : Participants ( N = 119 ) were r and omized into 1 of 3 groups : group 1 received the exercise prescription throughout the study ; group 2 received their exercise prescription after completing cancer treatment ; and group 3 received usual care . Patients completed the Piper Fatigue Scale , General Sleep Disturbance Scale , Center for Epidemiological Studies -Depression Scale , and Worst Pain Intensity Scale . Results : All groups reported mild fatigue levels , sleep disturbance , and mild pain , but not depression . Using multilevel regression analysis , significant linear and quadratic trends were found for change in fatigue and pain ( ie , scores increased , then decreased over time ) . No group differences were found in the changing scores over time . A significant quadratic effect for the trajectory of sleep disturbance was found , but no group differences were detected over time . No significant time or group effects were found for depression . Conclusions : Our home-based exercise intervention had no effect on fatigue or related symptoms associated with cancer treatment . The optimal timing of exercise remains to be determined . Implication s for Practice : Clinicians need to be aware that some physical activity is better than none , and there is no harm in exercise as tolerated during cancer treatment . Further analysis is needed to examine the adherence to exercise . More frequent assessment s of fatigue , sleep disturbance , depression , and pain may capture the effect of exercise BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT Purpose This study evaluated the effectiveness of a self-managed home-based moderate intensity walking intervention on psychosocial health outcomes among breast cancer patients undergoing chemotherapy . Methods The r and omised controlled trial compared a self-managed , home-based walking intervention to usual care alone among breast cancer patients receiving chemotherapy . Outcome measures included changes in self-report measures of anxiety , depression , fatigue , self-esteem , mood and physical activity .  Fifty participants were r and omised to either the intervention group ( n = 25 ) , who received 12 weeks of moderate intensity walking , or the control group ( n = 25 ) mid-way through chemotherapy . Participants in the intervention group were provided with a pedometer and were asked to set goals and keep weekly diaries outlining the duration , intensity and exertion of their walking .  Levels of psychosocial functioning and physical activity were assessed pre- and post-intervention in both groups . Results The intervention had positive effects on fatigue ( F = 5.77 , p = 0.02 ) , self-esteem ( F = 8.93 , p ≤ 0.001 ) , mood ( F = 4.73 , p = 0.03 ) and levels of physical activity ( x2 = 17.15 , p = 0.0011 ) but not anxiety ( F = 0.90 , p = 0.35 ) and depression ( F = 0.26 , p = 0.60 ) as assessed using the HADS . We found an 80 % adherence rate to completing the 12-week intervention and recording weekly logs . Conclusion This self-managed , home-based intervention was beneficial for improving psychosocial well-being and levels of physical activity among breast cancer patients treated with chemotherapy . Trial registration Current Controlled Trials IS RCT N50709297 OBJECTIVE To evaluate the effects of an 8-week water physical therapy program on cervical and shoulder pain , pressure sensitivity , and the presence of trigger points ( TrPs ) in breast cancer survivors . DESIGN R and omized , controlled trial . SETTING To date , no study has investigated effects of water therapy in breast cancer . PATIENTS Sixty-six breast cancer survivors were r and omly assigned into two groups : WATER group , who received a water exercise program or CONTROL group who received the usual care treatment for breast cancer . INTERVENTIONS The WATER therapy program consisted of 24 sessions ( 3 times/week over 8 weeks ) of low-intensity exercises in a warm pool ( 32 ° C ) . Each session included 10-minute warm-up period ; 35 minutes of aerobic , low-intensity endurance , and core stability training ; and a 15-minute cool-down period ( stretching and relaxation ) .  OUTCOMES Neck and shoulder pain ( visual analog scale , 0 - 100 mm ) , pressure pain thresholds ( PPTs ) over C5-C6 zygapophyseal joints , deltoid muscles , second metacarpal , and tibialis anterior muscles , and the presence of TrPs in cervical-shoulder muscles were assessed at baseline and after the 8-week program by an assessor blinded to treatment allocation . RESULTS The WATER group demonstrated a between-group improvement for neck pain of -31 mm ( 95 % confidence interval [CI]-49 to -22 , P < 0.001 ; effect size 1.1 , 0.81 - 1.75 ) and for shoulder-axillary of -19 mm ( -40 to -04 , P = 0.046 ; effect size 0.70 , 0.14 - 1.40 ) . Improvements were also noted for PPT levels over C5-C6 joints ( between-group differences , affected side : 27.7 kPa , 95 % CI 3.9 - 50.4 ; unaffected : 18.1 kPa , 95 % CI 6.1 - 52.2 ) . No between-group differences for PPT over the remaining points were observed ( P > 0.05 ) . Finally , patients in the WATER program showed a greater reduction of active TrPs as compared with the CONTROL group ( P < 0.05 ) . CONCLUSIONS An 8-week water therapy program was effective for improving neck and shoulder/axillary pain , and reducing the presence of TrPs in breast cancer survivors as compared with usual care ; however , no significant changes in widespread pressure pain hyperalgesia were found Purpose In an earlier r and omised controlled trial , we showed that early stage breast cancer patients who received a supervised exercise programme , with discussion of behaviour change techniques , had psychological and functional benefits 6 months after the intervention . The purpose of this study was to determine if benefits observed at 6 months persisted 18 and 60 months later . Methods Women who were in the original trial were contacted at 18 and 60 months after intervention . Original measures were repeated . Results Of the 148 women from the original study who agreed to be contacted again , 114 attended for follow-up at 18 months and 87 at 60 months . Women in the original intervention group reported more leisure time physical activity and more positive moods at 60 months than women in the original control group . Irrespective of original group allocation , women who were more active consistently reported lower levels of depression and increased quality of life compared to those who were less active . Conclusions We have shown that there are lasting benefits to an exercise intervention delivered during treatment to breast cancer survivors . Regular activity should be encouraged for women with early stage breast cancer as this can have lasting implication s for physical and psychological functioning Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients . It remains unclear what is the optimal setting , dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients . Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a r and omised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention , with usual care . Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness ( VO2 peak ) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients . The study demonstrated convincing recruitment ( 67 % ) , safety and intervention adherence among breast cancer patients ; while the attendance rate for colon cancer patients was notably lower ( 33 % ) . VO2-peak declined on average 12 % across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention . Pedometer use was well adapted in both breast and colon cancer patients . Conclusions Despite a fair adherence and safety , the current study calls into question whether aerobic exercise , regardless of intensity , is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients . Trial Registration : IS RCT 590 Background : Recent research has demonstrated that obesity increases a woman 's risk of breast cancer recurrence . Although the mechanism is not well understood , it is known that obese women have higher levels of insulin and other hormones related to energy balance . In this study , we sought to explore the impact of an exercise intervention on body composition , fat distribution , weight , and insulin levels in a population of breast cancer survivors . METHODS Inactive women with early stage breast cancer who had completed adjuvant chemotherapy and /or radiation were r and omized to a 16-week exercise intervention or a normal care control group . The exercise intervention consisted of supervised strength training and unsupervised cardiovascular exercise , with a goal of 2 strength training sessions and 90 minutes of cardiovascular exercise each week . Measurement of weight , body composition , and circumference at the waist and hip , were collected at baseline and after 16 weeks in both groups . Fasting blood sample s were also collected at these two time points for insulin and glucose levels , so that changes in these levels between the intervention and control groups could be compared . RESULTS Eighty-five women have been r and omized ; complete anthropometric data are presently available for 51 . Women in the exercise group experienced a nonsignificant decrease in body weight , body fat , and circumference at the waist and hip , as compared to control patients . Participants completed a median of 84 % of scheduled strength training sessions and 80 % of recommended cardiovascular sessions .  Strength increased by an average of 40 % during the exercise intervention . Prior studies have demonstrated significant inter-assay variability in biomarker testing , thus insulin and glucose testing will be performed when all patients have completed the protocol . CONCLUSIONS Compliance with the exercise intervention was good . Women in the exercise group experienced non-significant changes in anthropometric measures , and increased strength during the 16-week intervention . Final strength and anthropometric data from the entire cohort will be available for presentation . This project was supported by an ASCO Career Development Award and funding from the Lance Armstrong Foundation . No significant financial relationships to disclose Purpose Exercise during breast cancer chemotherapy is beneficial but it needs to be maintained into survivorship to optimize long-term benefits . Here , we report the predictors of follow-up exercise behavior 6 months after a r and omized exercise trial in breast cancer patients . Methods Breast cancer patients ( N = 242 ) initiating adjuvant chemotherapy  were r and omly assigned to usual care ( n = 82 ) , supervised resistance exercise ( n = 82 ) , or supervised aerobic exercise ( n = 78 ) for the duration of their chemotherapy . At baseline and postintervention , data were collected on demographic , medical , behavioral , fitness , psychosocial , and motivational variables . At 6-month follow-up , participants were mailed a question naire that assessed exercise behavior over the past 6 months and were categorized as either meeting both aerobic and resistance exercise guidelines , either exercise guideline , or neither exercise guideline . Results Two hundred one ( 83.1 % ) participants provided 6-month follow-up data with 85 ( 42.3 % ) meeting neither exercise guideline , 74 ( 36.8 % ) meeting either exercise guideline , and 42 ( 20.9 % ) meeting both exercise guidelines . In multivariate regression analysis , seven variables independently predicted the likelihood of meeting exercise guidelines at follow-up including higher pretrial exercise ( β = 0.23 ; P = 0.002 ) , younger age ( β = −0.15 ; P = 0.028 ) , breast conserving surgery ( β = 0.15 ; P = 0.033 ) , strength improvements ( β = 0.15 ; P = 0.028 ) , lower postintervention fatigue ( β = 0.13 ; P = 0.067 ) , a more positive attitude ( β = 0.12 ; P = 0.086 ) , and lower postintervention body mass index ( β = −0.11 ; P = 0.105 ) . Conclusion Exercise behavior 6 months after a r and omized trial was predicted by a wide range of demographic , medical , behavioral , fitness , psychosocial , and motivational variables . These findings may help facilitate the uptake of exercise behavior during the transition from breast cancer patient to survivor Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register Introduction Exercise may improve cancer outcomes .  Neoadjuvant chemotherapy ( NC ) for breast cancer provides a unique setting to evaluate intervention effects . Treatments leading to decreased post-neoadjuvant Ki-67 levels , smaller tumor size , and higher pathologic response are associated with improved survival and lower recurrence . This r and omized , prospect i ve pilot trial evaluates the feasibility of supervised exercise during NC for breast cancer . Methods Stage II-III , ER positive , cancer patients with BMI > 25 receiving NC were r and omized to st and ard NC with supervised bootcamp ( NC + BC ) or NC alone .  Ki-67 , C-peptide , BMI , and tumor size were measured before chemotherapy and at time of surgery . Results There were no initial differences between groups in regards to tumor size , C-peptide , BMI , and Ki-67 . The NC + BC ( n = 5 ) group had a lower mean BMI at the conclusion of NC compared with those ( n = 5 ) in the NC group ( 28.0 versus 35.8 , P = 0.03 ) . Final tumor size was 2.59 cm in the NC + BC group versus 3.16 cm for NC ( P = 0.76 ) Mean Ki-67 for NC + BC was 7 % versus 29 % with NC ( P = 0.14 ) . C-peptide ( ng/mL ) was equivalent between the two groups ( 4.55 NC + BC versus 4.74 NC , P = 0.85 ) . Conclusions Adding a supervised exercise program to NC is feasible , decreases BMI , and may lead to lower Ki-67 levels and improved survival PURPOSE Exercise adherence is difficult during cancer treatments , but few studies have examined the predictors of such exercise . Here , we report the predictors of adherence to supervised exercise training during breast cancer chemotherapy . METHODS Breast cancer patients ( N = 242 ) initiating adjuvant chemotherapy in Edmonton , Ottawa , and Vancouver were r and omly assigned to usual care  ( n = 82 ) ,  supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise ( n = 78 ) for the duration of their chemotherapy . Baseline data on st and ard demographic , medical , behavioral , fitness , and psychosocial variables as well as motivational variables from the Theory of Planned Behavior were collected . Adherence was assessed by objective attendance records . RESULTS Adherence to supervised exercise was 70.2 % . Univariate analyses indicated significant or borderline significant associations between  exercise adherence  and location/center ( r = 0.30 ; P < 0.001 ) , V[spacing dot above]O2peak ( r = 0.21 ; P = 0.008 ) , muscular strength ( r = 0.21 ; P = 0.008 ) , percent body fat ( r = -0.21 ; P = 0.012 ) , disease stage ( r = 0.17 ; P = 0.031 ) , education ( r = 0.15 ; P = 0.053 ) , depression ( r = -0.14 ; P = 0.073 ) , and smoking ( r = -0.14 ; P = 0.081 ) . In multivariate analysis , location/center ( beta = 0.28 ; P = 0.001 ) , V[spacing dot above]O2peak ( [ beta ] = 0.19 ; P = 0.016 ) , disease stage ( beta = 0.18 ; P = 0.015 ) , and depression ( beta = -0.16 ; P = 0.033 ) remained significant and explained 21 % of the variance in exercise adherence . Participants in Vancouver , with higher aerobic fitness , more advanced disease stage , and lower depression , achieved better adherence . CONCLUSION Adherence to supervised exercise training was predicted by unique aspects of the location/center , disease stage , aerobic fitness , and depression but not motivational variables . Location/center in our trial may have been a proxy for the amount of one-on-one attention received during supervised exercise . These findings may have implication s for improving adherence during breast cancer chemotherapy The purpose of this study was to examine the effects of an exercise intervention on the total caloric intake ( TCI ) of breast cancer patients undergoing treatment . A secondary purpose was to determine whether or not a relationship existed between changes in TCI , body fat composition ( % BF ) , and fatigue during the study , which lasted 6 months . Twenty females recently diagnosed with breast cancer , scheduled to undergo chemotherapy or radiation , were assigned r and omly to an experimental ( N = 10 ) or control group ( N = 10 ) . Outcome measures included TCI ( 3-day food diary ) , % BF ( skinfolds ) , and fatigue ( revised Piper Fatigue Scale ) . Each exercise session was conducted as follows : initial cardiovascular activity ( 6 - 12 min ) , followed by stretching ( 5 - 10 min ) , resistance training ( 15 - 30 min ) , and a cool-down ( approximately 8 min ) . Significant changes in TCI were observed among groups ( F1,18 = 8.582 ; P = 0.009 ) , at treatments 2 and 3 , and at the end of the study [ experimental ( 1973 + /- 419 ) , control ( 1488 + /- 418 ) ; experimental ( 1946 + /- 437 ) , control ( 1436 + /- 429 ) ; experimental ( 2315 + /- 455 ) , control ( 1474 + /- 294 ) , respectively ] . A significant negative correlation was found ( Spearman rho(18 ) = -0.759 ; P < 0.001 ) between TCI and % BF and between TCI and fatigue levels ( Spearman rho(18 ) = -0.541 ; P = 0.014 ) at the end of the study . In conclusion , the results of this study suggest that an exercise intervention administered to breast cancer patients undergoing medical treatment may assist in the mitigation of some treatment side effects , including decreased TCI , increased fatigue , and negative changes in body composition Exercise for Health was a r and omized , controlled trial design ed to evaluate two modes of delivering ( face-to-face [ FtF ] and over-the-telephone [ Tel ] ) an 8-month translational exercise intervention , commencing 6-weeks post-breast cancer surgery ( PS ) . Outcomes included quality of life ( QoL ) , function ( fitness and upper body ) and treatment-related side effects ( fatigue , lymphoedema , body mass index , menopausal symptoms , anxiety , depression and pain ) . Generalised estimating equation modelling determined time ( baseline [ 5 weeks PS ] , mid-intervention [ 6 months PS ] , post-intervention [ 12 months PS ] ) , group ( FtF , Tel , Usual Care [ UC ] ) and time-by-group effects . 194 women representative of the breast cancer population were r and omised to the FtF ( n = 67 ) , Tel ( n = 67 ) and UC ( n = 60 ) groups . There were significant ( p < 0.05 ) interaction effects on QoL , fitness and fatigue with differences being observed between the treatment groups and the UC group . Trends observed for the treatment groups were similar . The treatment groups reported improved QoL , fitness and fatigue over time and changes observed between baseline and post-intervention were clinical ly relevant . In contrast , the UC group experienced no change , or worsening QoL , fitness and fatigue , mid-intervention . Although improvements in the UC group occurred by 12-months post-surgery , the change did not meet the clinical ly relevant threshold . There were no differences in other treatment-related side effects between groups . This translational intervention trial , delivered either FtF or Tel , supports exercise as a form of adjuvant breast cancer therapy that can prevent declines in fitness and function during treatment and optimise recovery post-treatment Background Cancer chemotherapy is frequently associated with a decline in general physical condition , exercise tolerance , and muscle strength and with an increase in fatigue . While accumulating evidence suggests that physical activity and exercise interventions during chemotherapy treatment may contribute to maintaining cardiorespiratory fitness and strength , the results of studies conducted to date have not been consistent . Additional research is needed to determine the optimal intensity of exercise training programs in general and in particular the relative effectiveness of supervised , outpatient ( hospital- or physical therapy practice -based ) versus home-based programs . Methods This multicenter , prospect i ve , r and omized trial will evaluate the effectiveness of a low to moderate intensity , home-based , self-management physical activity program , and a high intensity , structured , supervised exercise program , in maintaining or enhancing physical fitness ( cardiorespiratory fitness and muscle strength ) , in minimizing fatigue and in enhancing the health-related quality of life ( HRQoL ) .  Patients receiving adjuvant chemotherapy for breast or colon cancer ( n = 360 ) are being recruited from twelve hospitals in the Netherl and s , and r and omly allocated to one of the two treatment groups or to a  ' usual care ' control group .  Performance-based and self-reported outcomes are assessed at baseline , at the end of chemotherapy and at six month follow-up . Discussion This large , multicenter , r and omized clinical trial will provide additional empirical evidence regarding the effectiveness of physical exercise during adjuvant chemotherapy in enhancing physical fitness , minimizing fatigue , and maintaining or enhancing patients ' quality of life . If demonstrated to be effective , exercise intervention programs will be a welcome addition to the st and ard program of care offered to patients with cancer receiving chemotherapy . Trial registration This study is registered at the Netherl and s Trial Register ( NTR 2159 Insulin , insulin-like growth factors ( IGFs ) I and II , and IGF binding proteins ( IGFBPs ) 1 and 3 have been implicated in breast cancer outcomes . We conducted a r and omized controlled trial to determine the physiological effects of exercise training on changes in these biological markers in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control group ( n = 28 ) . The exercise group trained on cycle ergometers three times per week for 15 weeks . The control group did not train . End points included changes in fasting insulin , glucose , insulin resistance , IGF-I , IGF-II , IGFBP-1 , IGFBP-3 , and IGF-I : IGFBP-3 molar ratio between baseline and week 15 . All of the statistical tests were two-sided ( alpha = 0.05 ) . Fifty-two participants completed the trial . The exercise group completed 44.3 of 45 ( 98.4 % ) prescribed exercise sessions . Baseline hormone concentrations did not differ between groups except that IGF-II was higher in the exercise group ( P = 0.011 ) . No significant differences between groups were observed for changes in fasting insulin ( + 6.3 pmol/liter ; P = 0.941 ) , glucose ( + 0.09 mmol/liter ; P = 0.824 ) , insulin resistance ( + 0.4 ; P = 0.247 ) , IGF-II ( -40.7 ng/ml ; P = 0.101 ) , or IGFBP-1 ( + 1.4 ng/ml ; P = 0.774 ) . However , significant differences between groups were observed for changes in IGF-I ( -7.4 ng/ml ; P = 0.045 ) , IGFBP-3 ( + 180.5 ng/ml ; P = 0.021 ) , and IGF-I : IGFBP-3 molar ratio ( -0.006 ; P = 0.017 ) . Exercise training had significant physiological effects on IGF-I , IGFBP-3 , and IGF-I : IGFBP-3 molar ratio in postmenopausal breast cancer survivors . The clinical implication s of these findings remain to be defined PURPOSE / OBJECTIVES To evaluate the relationship between nausea and exercise during and after adjuvant cancer  treatment ( chemotherapy and radiation therapy or chemotherapy alone ) . DESIGN Secondary data analysis from a longitudinal , single-blinded , three-arm , r and omized controlled trial . The trial failed to show a significant effect of an exercise intervention on nausea control ( by intent to treat analysis ) ; therefore , patients were analyzed together to evaluate the relationship between nausea and actual exercise behavior . SETTING Outpatient cancer treatment clinics . SAMPLE 112 female patients with breast cancer who were receiving adjuvant cancer treatment .  METHODS Actual exercise behavior-based analysis was conducted with nausea intensity and the participant 's exercise status measured three times during and after adjuvant cancer treatment . Participants were considered exercisers if actual exercise behaviors corresponded to the recommendation of the American College of Sports Medicine : aerobic exercise at a minimum of moderate intensity , 20 minutes per session , and three times per week . Mann-Whitney U tests evaluated the difference in nausea intensity depending on actual exercise status . MAIN RESEARCH VARIABLES Nausea intensity and exercise status . FINDINGS Exercisers experienced significantly less intense nausea than nonexercisers at the completion of adjuvant cancer treatment . CONCLUSIONS A moderate level of aerobic exercise is related to less intense nausea at the completion of adjuvant cancer treatment . IMPLICATION S FOR NURSING A moderate level of aerobic exercise is recommended during adjuvant cancer treatment because of the possibility of reducing nausea intensity as well as alleviating other symptoms from adjuvant cancer treatment OBJECTIVE To determine the effect of exercise on quality of life in ( a ) a r and omized controlled trial of exercise among recently diagnosed breast cancer survivors undergoing adjuvant therapy and ( b ) a similar trial among post-treatment survivors . METHODS Fifty newly diagnosed breast cancer survivors were recruited through a hospital-based tumor registry and r and omized to a 6-month , home-based exercise program ( n=25 ) or a usual care group ( n=25 ) . In a separate trial , 75 post-treatment survivors were r and omized to a 6-month , supervised exercise intervention ( n=37 ) or to usual care ( n=38 ) . Participants in both studies completed measures of happiness , depressive symptoms , anxiety , stress , self-esteem , and quality of life at baseline and 6 months . RESULTS Forty-five participants completed the trial for newly diagnosed survivors and 67 completed the trial for post-treatment survivors . Good adherence was observed in both studies . Baseline quality of life was similar for both studies on most measures . Exercise was not associated with quality of life benefits in the full sample of either study ; however exercise was associated with improved social functioning among post-treatment survivors who reported low social functioning at baseline ( p<0.05 ) . CONCLUSIONS Exercise did not affect quality of life in either recently diagnosed or post-treatment breast cancer survivors ; however this may be due in part to relatively high baseline functioning among participants in both studies . Strategies for future research include limiting enrollment to survivors who report reduced quality of life on screening question naires and targeting survivor subgroups known to be at particular risk for quality of life impairment Background : High insulin and insulin-like growth factor-I ( IGF-I ) levels may be associated with an increased breast cancer risk and /or death . Given the need to identify modifiable factors that decrease insulin , IGF-I , and breast cancer risk and death , we investigated the effects of a 6-month r and omized controlled aerobic exercise intervention versus usual care on fasting insulin , IGF-I , and its binding protein ( IGFBP-3 ) in postmenopausal breast cancer survivors . Methods : Seventy-five postmenopausal breast cancer survivors were identified from the Yale-New Haven Hospital Tumor Registry and r and omly assigned to an exercise ( n = 37 ) or usual care  ( n = 38 ) group . The exercise group participated in 150 minutes per week of moderate-intensity aerobic exercise . The usual care group was instructed to maintain their current physical activity level . A fasting blood sample was collected on each study participant at baseline and 6 months . Blood levels of insulin and IGF were measured with ELISA . Results : On average , exercisers increased  aerobic exercise  by 129 minutes per week compared with 45 minutes per week among usual care participants ( P < 0.001 ) . Women r and omized to exercise experienced decreases in insulin , IGF-I , and IGFBP-3 , whereas women r and omized to usual care had increases in these hormones . Between-group differences in insulin , IGF-I , and IGFBP-3 were 20.7 % ( P = 0.089 ) , 8.9 % ( P = 0.026 ) , and 7.9 % ( P = 0.006 ) , respectively . Conclusions : Moderate-intensity aerobic exercise , such as brisk walking , decreases IGF-I and IGFBP-3 . The exercise-induced decreases in IGF may mediate the observed association between higher levels of physical activity and improved survival in women diagnosed with breast cancer . ( Cancer Epidemiol Biomarkers Prev 2009;18(1):306–13 PURPOSE / OBJECTIVES To test the effects of aerobic and resistance exercise on changes in bone mineral density ( BMD ) in women newly diagnosed with stage I-III breast cancer receiving chemotherapy . DESIGN R and omized clinical trial . SETTING Two National Cancer Institute- design ated cancer centers in metropolitan areas . SAMPLE 66 women with stage I-III breast cancer beginning adjuvant chemotherapy .  METHODS Participants were r and omized to aerobic or resistance exercise and usual care . At the beginning of chemotherapy and at six months , patients completed exercise testing and BMD assessment of the lumbar spine by dual energy x-ray absorptionetry . MAIN RESEARCH VARIABLES BMD , aerobic capacity , and muscle strength . FINDINGS The average decline in BMD was -6.23 % for usual care , -4.92 % for resistance exercise , and -0.76 % for aerobic exercise . Aerobic exercise preserved BMD significantly better compared to usual care . Premenopausal women demonstrated significantly greater declines in BMD than postmenopausal women .  Aerobic capacity increased by almost 25 % for women in the aerobic exercise group and 4 % for resistance exercise . Participants in the usual care group showed a 10 % decline in aerobic capacity . CONCLUSIONS The data suggest that weight-bearing aerobic exercise attenuates declines in BMD and that aerobic and resistance exercise improve aerobic capacity and muscle strength at a time when women generally show marked declines in functional ability . IMPLICATION S FOR NURSING Exercise may prevent or at least minimize bone loss observed during chemotherapy and may prevent or delay the long-term effects of osteoporosis Background : Few exercise trials in cancer patients have reported longer-term follow-up . Here , we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients . Methods : Breast cancer patients initiating adjuvant chemotherapy ( n = 242 ) were r and omly assigned to usual care ( n = 82 ) , resistance exercise training ( RET ; n = 82 ) , or aerobic exercise training ( AET ; n = 78 ) for the duration of their chemotherapy . At 6-month follow-up , participants were mailed a question naire that assessed quality of life , self-esteem , fatigue , anxiety , depression , and exercise behavior . Results : Two hundred one ( 83.1 % ) participants provided 6-month follow-up data . Adjusted linear mixed-model analyses showed that , at 6-month follow-up , the RET group reported higher self-esteem [ adjusted mean difference , 1.6 ; 95 % confidence interval ( 95 % CI ) , 0.1 - 3.2 ; P = 0.032 ] and the AET group reported lower anxiety ( adjusted mean difference , −4.7 ; 95 % CI , −0.0 to −9.3 ; P = 0.049 ) compared with the usual care group . Moreover , compared with participants reporting no regular exercise during the follow-up period , those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes , including quality of life ( adjusted mean difference , 9.5 ; 95 % CI , 1.2 - 17.8 ; P = 0.025 ) . Conclusions : Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up . Moreover , adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes . Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes . ( Cancer Epidemiol Biomarkers Prev 2007;16(12):2572–8 OBJECTIVES The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to the Yoga In Daily Life ( ® ) system on the self-esteem of patients with breast cancer . DESIGN This is a parallel-groups design . SETTING S/LOCATION Baseline interventions took place at the Institute for Oncology of Ljubljana ( Slovenia ) . At discharge , the experimental group was issued with audiocassette recordings containing the instructions for relaxation training to be practice d individually at home for an additional 3 weeks . SUBJECTS The convenience sample of 32 patients with breast cancer was recruited from an accessible population of hospitalized women . Patients were r and omized to the experimental ( n=16 ) and to the control group ( n=16 ) . INTERVENTIONS Both groups received the same st and ard physiotherapy for 1 week , while the experimental group additionally received a group relaxation training sessions according to the Yoga in Daily Life ( ® ) system . At discharge , the experimental group was issued with audiocassette recordings containing similar instructions for relaxation training to be practice d individually at home for an additional 3 weeks . OUTCOME MEASURES Outcome measures were obtained by blinded investigators ( physiotherapists ) using st and ardized question naires ( Rosenberg Self-Esteem Scale ) at baseline ( after the surgery ) ; at 1 week ( 1 week postattendance ; at discharge ) ; and at 4 weeks ( 4 weeks postattendance ) ; prior the commencement of radiation . RESULTS Analysis of variance showed that there were statistically significant differences between the experimental and control group in all measuring self-esteem scores over the study period ( p<0.0005 ) . At the same time , the control group 's scores remained unchanged over the study period ( p>0.05 ) . CONCLUSIONS The results indicate that relaxation training according to the Yoga in Daily Life system could be a useful clinical physiotherapy intervention for patients who have breast cancer and who are experiencing low self-esteem . Although this kind of relaxation training can be applied to clinical oncology in Slovenia , more studies need to be done PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment OBJECTIVE Evidence of the benefits of exercise for those treated for cancer has led to exercise interventions for this population . Some have question ed whether cancer patients offered a home-based intervention  adhere to the exercise prescribed . METHOD We examined exercise adherence in a r and omized controlled trial of a 12-week ,  home-based exercise trial for breast cancer patients . Three adherence outcomes were examined : minutes of exercise participation/week , number of steps taken during planned exercise/week  , and whether the participant met her weekly exercise goal . Predictors of adherence ( e.g. demographic and medical variables , Transtheoretical Model variables , history of exercise ) were examined . RESULTS Findings indicate that participants significantly increased their minutes of exercise and steps taken during planned exercise from Week 1 to 12 . The percentage of participants achieving exercise goals was highest in the first few weeks . Exercise self-efficacy significantly predicted each adherence outcome . Baseline PA predicted mean exercise session steps over the 12 weeks . CONCLUSION Adherence to a home-based exercise intervention for breast cancer patients changes over time and may be related to baseline levels of exercise self-efficacy Individuals treated for cancer often experience higher levels of emotional distress than the general population . Previous research has shown that exercise can have an ameliorating effect on these problems . This 12-month prospect i ve longitudinal study investigated mood , quality of life , cancer-related symptoms , and exercise behavior of 69 women who had completed treatment for Stage 0 - 2 breast cancer . We studied the natural progression of exercise participation after cancer treatment . Effects on mood , quality of life , and cancer-related symptoms were assessed after controlling for demographic variables , disease variables , social support , and baseline values to test the hypothesis that women who exercised were more likely to report better mood , higher quality of life , and fewer cancer-related symptoms . Results indicated that women did not increase their  exercise participation over time and that overall mean minutes of exercise participation were below recommended levels . Baseline demographic predictors of exercise participation included younger age , having a spouse or partner , increased time since diagnosis , higher social support , and higher depression .  Exercise participation was associated with improved physical functioning , but not overall mood or cancer-related symptoms . We discuss implication s of these findings towards the well-being of breast cancer survivors Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer , with six month follow-up . Design Pragmatic r and omised controlled prospect i ve open trial . Setting Three National Health Service oncology clinics in Scotl and and community exercise facilities . Participants 203 women entered the study ; 177 completed the six month follow-up . Interventions Supervised 12 week group exercise programme in addition to usual care , compared with usual care . Main outcome measures Functional assessment of cancer therapy ( FACT ) question naire , Beck depression inventory , positive and negative affect scale , body mass index , seven day recall of physical activity , 12 minute walk test , and assessment of shoulder mobility . Results Mixed effects models with adjustment for baseline values , study site , treatment at baseline , and age gave intervention effect estimates ( intervention minus control ) at 12 weeks of 129 ( 95 % confidence interval 83 to 176 ) for metres walked in 12 minutes , 182 ( 75 to 289 ) for minutes of moderate intensity activity reported in a week , 2.6 ( 1.6 to 3.7 ) for shoulder mobility , 2.5 ( 1.0 to 3.9 ) for breast cancer specific subscale of quality of life , and 4.0 ( 1.8 to 6.3 ) for positive mood . No significant effect was seen for general quality of life ( FACT-G ) , which was the primary outcome . At the six month follow-up , most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged . No adverse effects were noted . Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later . Clinicians should encourage activity for their patients . Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services . Trial registration Current controlled trials IS RCT N12587864 OBJECTIVE To investigate the effectiveness of an 8-week aquatic program on  cancer-related fatigue , as well as physical and psychological outcomes in breast cancer survivors . DESIGN A r and omized controlled trial . SETTING Outpatient clinic , urban , academic medical center , and a sport university swimming pool . PARTICIPANTS Breast cancer survivors ( N=68 ) were r and omly assigned to either an experimental ( aquatic exercise group in deep water pool ) group or a control ( usual care ) group . INTERVENTIONS The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool . Sessions lasted 60 minutes in duration : 10 minutes of warm-up , 40 minutes of aerobic and endurance exercises , and 10 minutes of cool-down exercises . Patients allocated to the usual care group followed the oncologist 's recommendations in relation to a healthy lifestyle . MAIN OUTCOME MEASURES Values for fatigue ( Piper Fatigue Scale ) , mood state ( Profile of Mood States ) , and abdominal ( trunk curl static endurance test ) and leg ( multiple sit-to-st and test ) strength were collected at baseline , after the last treatment session , and at a 6-month follow-up . RESULTS Immediately after discharge , the aquatic exercise group showed a large effect size in total fatigue score ( d=.87 ; 95 % confidence interval , .48 - 1.26 ) , trunk curl endurance ( d=.92 ; 95 % confidence interval , 1.97 - 3.83 ) , and leg strength ( d=1.10 ; .55 - 2.76 ) , but negligible effects in vigor , confusion , and disturbance of mood ( d<.25 ) . At the 6-month follow-up period , the aquatic exercise group maintained large to small effect sizes in fatigue scores , multiple sit-to-st and test , and trunk curl static endurance ( .25>d>.90 ) and negligible effects for the fatigue-severity dimension and different scales of the Profile of Mood States ( d<.25 ) . CONCLUSION An aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors PURPOSE To determine the effects of exercise training on cardiopulmonary function and quality of life ( QOL ) in postmenopausal breast cancer survivors who had completed surgery , radiotherapy , and /or chemotherapy with or without current hormone therapy use . METHODS Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control ( n = 28 ) group . The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide . The control group did not train . The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention . Peak oxygen consumption was assessed by a grade d exercise test using gas exchange analysis . Overall QOL was assessed by the Functional Assessment of Cancer Therapy-Breast scale . RESULTS Fifty-two participants completed the trial . The exercise group completed 98.4 % of the exercise sessions . Baseline values for peak oxygen consumption ( P = .254 ) and overall QOL ( P = .286 ) did not differ between groups . Peak oxygen consumption increased by 0.24 L/min in the exercise group , whereas it decreased by 0.05 L/min in the control group ( mean difference , 0.29 L/min ; 95 % confidence interval [ CI ] , 0.18 to 0.40 ; P < .001 ) . Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group ( mean difference , 8.8 points ; 95 % CI , 3.6 to 14.0 ; P = .001 ) . Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL ( r = 0.45 ; P < .01 ) . CONCLUSION Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors PURPOSE / OBJECTIVES To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy . DESIGN Experimental . SETTING Breast evaluation clinics of two New Engl and medical centers with comprehensive cancer treatment programs . SAMPLE 14 women ( mean age = 44 years ) receiving adjuvant chemotherapy for breast cancer ( 86 % stage II ) following surgical treatment . METHODS Subjects were assigned r and omly to the experimental group or the usual care group . Experimental group members began a structured exercise program of walking and attended support group meetings . All subjects were tested before beginning chemotherapy , during the course of chemotherapy , and one month following chemotherapy completion . MAIN RESEARCH VARIABLES Performance status , physical functioning , psychosocial adjustment , self-concept and body image , and 12 symptoms ( e.g. , fatigue , nausea , anxiety ) . FINDINGS Measures of physical performance , psychosocial adjustment , and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program . CONCLUSIONS Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy . IMPLICATION S FOR NURSING PRACTICE Although more detailed research is necessary to answer some of the questions raised by this study , implementing the walking program and forming a support group are achievable in an outpatient setting The aim of this study was to explore the effects of exercise on angiogenesis and apoptosis-related molecules , quality of life , fatigue and depression in patients who completed breast cancer treatment . Sixty breast cancer patients were r and omised into three groups , as supervised exercise group , home exercise group and education group .  Angiogenesis and apoptosis-related cytokine levels and quality of life ( EORTC QOL-C30 : European Organisation for Research and Treatment of Cancer Quality of Life C30 ) , fatigue ( Brief Fatigue Inventory ) and depression ( BDI : Beck Depression Inventory ) scores were compared before and after a 12-week exercise programme . After the exercise programme , statistically significant decreases were found in interleukin-8 and neutrophil activating protein-78 levels in the home exercise group ( P < 0.05 ) . The education group showed a statistically significant increase in monocyte chemoattractant protein-1 level ( P < 0.05 ) . Functional score and global health score of EORTC QOL-C30 in the supervised exercise group and functional score of EORTC QOL-C30 in the home exercise group increased significantly after exercise programme ( P < 0.05 ) . BDI score was significantly lower in the supervised exercise group after the exercise programme ( P < 0.05 ) . Changes in angiogenesis and apoptosis-related molecules in the study groups suggest a possible effect of exercise on these parameters . Exercise programmes are safe and effective on quality of life and depression in breast cancer patients whose treatments are complete Purpose Although physical activity ( PA ) adoption improves fitness and psychological well-being among cancer survivors , PA maintenance has not been examined . This paper presents follow-up of a home-based PA program for women treated for early-stage breast cancer . Material s and methods Eighty-six sedentary women ( mean age = 53.14 years , SD = 9.70 ) were r and omly assigned to a  PA or contact control group . The PA group received a 12-week telephone counseling program to adopt PA . Assessment s were conducted at baseline , end-of-intervention ( 12 weeks ) , 6 , and 9 months post-baseline . Results When comparing change from end-of-intervention ( 12 weeks ) between groups , a significant reduction was observed in minutes of PA at 6 months ( t = −2.10 , p < 0.05 ) , but there was no decrease in intervention effect at 9 months ( t = −0.19 , p = 0.84 ) . Similarly , post-intervention reductions in fatigue were lost at 6 months ( t = 3.27 , p < 0.01 ) , but remained present at 9 months ( t = 1.65 , p = 0.10 ) . PA group ’s fitness improvements were maintained at both follow-ups ( t = 1.04 , p = 0.30 and t = 0.05 , p = 0.96 ) . The previously significant intervention effect on vigor was maintained at 6 months ( t = 1.32 , p = 0.19 ) but was significantly reduced at 9 months ( t = −2.15 , p < 0.05 ) . PA participants were more likely to progress in motivational readiness at 6 ( OR = 5.95 , 95 % CI = 2.30 , 15.36 ) and 9 months ( OR = 4.09 , 95 % CI = 1.69 , 9.87 ) ; however , group differences in meeting PA guidelines were not maintained . ConclusionS ome positive effects of a home-based PA intervention for breast cancer patients were maintained at 6 and 9 months AIM This paper is a report of a study analysing the effect of a home-based walking exercise program on symptoms and mood distress among breast cancer women receiving chemotherapy postoperatively . BACKGROUND Treatment-related symptoms , mood distress and decline in physical activity have been identified as major complaints among cancer patients . Studies on the efficacy of home-based walking exercise for symptoms and mood did not fully describe the exercise prescriptions that could be safe and beneficial for women with breast cancer , especially these receiving adjuvant chemotherapy . METHOD This is a prospect i ve , r and omized clinical trial . In 2008 - 2009 , participants were recruited from the oncology outpatient clinic of a medical center in Taiwan , and were assigned to either the  exercise group ( n=19 ) or the  control group ( n=21 ) . Women in the exercise group participated in a moderate-intensity home-based walking program for 12 weeks during their chemotherapy treatments .  Symptoms , mood status and physical activity level were measured at baseline , 6- and 12-week follow-up . Data were analysed by two-way repeated- measures analysis of variance . RESULTS Women in the exercise group reported significantly lower symptom severity scores and mood disturbance compared with those in the control group throughout the study period . CONCLUSION Regular moderate-intensity exercise can play an important role in improving treatment-related symptoms and mood in women with breast cancer . A home-based walking exercise program can be easily incorporated into care for women with breast cancer undergoing chemotherapy PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care activity needs further testing in large r and omized clinical trials Background Cancer-related fatigue ( CRF ) is one of the most common and distressing side effects of cancer and its treatment . During and after radiotherapy breast cancer patients often suffer from CRF which frequently impairs quality of life ( QoL ) . Despite the high prevalence of CRF in breast cancer patients and the severe impact on the physical and emotional well-being , effective treatment methods are scarce . Physical activity for breast cancer patients has been reported to decrease fatigue , to improve emotional well-being and to increase physical strength . The pathophysiological and molecular mechanisms of CRF and the molecular-biologic changes induced by exercise , however , are poorly understood . In the BEST trial we aim to assess the effects of resistance training on fatigue , QoL and physical fitness as well as on molecular , immunological and inflammatory changes in breast cancer patients during adjuvant radiotherapy . Methods / design The BEST study is a prospect i ve r and omized , controlled intervention trial investigating the effects of a 12-week supervised progressive resistance training compared to a 12-week supervised muscle relaxation training in 160 patients with breast cancer undergoing adjuvant radiotherapy .  To determine the effect of exercise itself beyond potential psychosocial group effects , patients in the control group perform a group-based progressive muscle relaxation training . Main inclusion criterion is histologically confirmed breast cancer stage I-III after lumpectomy or mastectomy with indication for adjuvant radiotherapy . Main exclusion criteria are acute infectious diseases , severe neurological , musculosceletal or cardiorespiratory disorders . The primary endpoint is cancer-related fatigue ; secondary endpoints include immunological and inflammatory parameters analyzed in peripheral blood , saliva and urine . In addition , QoL , depression , physical performance and cognitive capacity will be assessed . Discussion The BEST study is the first r and omized controlled trial comparing progressive resistance training with muscle relaxation training in breast cancer patients during adjuvant radiotherapy . Based on the analysis of physiological , immunological and inflammatory parameters it will contribute to a better underst and ing of the physiological and psychosocial effects and the biological mechanisms of resistance training . The ultimate goal is the implementation of optimized intervention programs to reduce fatigue , improve quality of life and potentially the prognosis after breast cancer . Trial registration Clinical Trials.gov Objective To assess the effect of a multimodal group exercise intervention , as an adjunct to conventional care , on fatigue , physical capacity , general wellbeing , physical activity , and quality of life in patients with cancer who were undergoing adjuvant chemotherapy or treatment for advanced disease . Design R and omised controlled trial . Setting Two university hospitals in Copenhagen , Denmark . Participants 269 patients with cancer ; 73 men , 196 women , mean age 47 years ( range 20 - 65 ) representing 21 diagnoses . Main exclusion criteria were brain or bone metastases . 235 patients completed follow-up . Intervention Supervised exercise comprising high intensity cardiovascular and resistance training , relaxation and body awareness training , massage , nine hours weekly for six weeks in addition to conventional care , compared with conventional care . Main outcome measures European Organization for Research and Treatment of Cancer Quality of Life Question naire ( EORTC QLQ-C30 ) , Medical Outcomes Study Short Form ( MOS SF-36 ) , Leisure Time Physical Activity Question naire , muscular strength ( one repetition maximum ) , maximum oxygen consumption ( Vo2max ) . Statistical methods The general linear model was used for continuous outcome while analysis of associates between categorical outcomes was performed as analysis of marginal homogeneity in contingency tables . Results Adjusted for baseline score , disease , and demographic covariates , the intervention group showed an estimated improvement at six weeks for the primary outcome , fatigue , of −6.6 points ( 95 % confidence interval −12.3 to −0.9 , P=0.02 ; effect size=0.33 , 0.04 to 0.61 ) . Significant effects were seen on vitality ( effect size 0.55 , 95 % CI 0.27 to 0.82 ) , physical functioning ( 0.37 , 0.09 to 0.65 ) , role physical ( 0.37 , 0.10 to 0.64 ) , role emotional ( 0.32 , 0.05 to 0.59 ) , and mental health ( 0.28 , 0.02 to 0.56 ) scores . Improvement was noted in physical capacity : estimated mean difference between groups for maximum oxygen consumption was 0.16 l/min ( 95 % CI 0.1 to 0.2 , P<0.0001 ) and for muscular strength ( leg press ) was 29.7 kg ( 23.4 to 34.9 , P<0.0001 ) . No significant effect was seen on global health status/ quality of life . Conclusion A supervised multimodal exercise intervention including high and low intensity components was feasible and could safely be used in patients with various cancers who were receiving adjuvant chemotherapy or treatment for advanced disease . The intervention reduced fatigue and improved vitality , aerobic capacity , muscular strength , and physical and functional activity , and emotional wellbeing , but not quality of life . Trial registration Current Controlled trials IS RCT N05322922 Reporting harms may cause more trouble and discredit than the fame and glory associated with successful reporting of benefits ( 1 ) . The CONSORT ( Consoli date d St and ards of Reporting Trials ) statement , a checklist ( Table 1 ) flow diagram first published in 1996 and revised 5 years later ( 2 , 3 ) , is an effort to st and ardize , and thereby improve , published reports of r and omized , controlled trials ( RCTs ) . One of the additions to the 2001 revision was an item about reporting adverse events . This single item did not do full justice to the importance of harms-related issues . The CONSORT Group met in September 2001 to discuss how to correct this deficiency . We aim ed to provide evidence -based guidance on the reporting of harms in RCTs . First , we search ed MEDLINE , EMBASE , Web of Science , and the Cochrane Library using a wide array of terms related to harms and identified pertinent evidence . We also communicated with experts and review ed bibliographies of identified articles to find additional studies . At a meeting in Montebello , Quebec , Canada , in May 2003 , CONSORT Group members , including several journal editors and additional experts in related fields , held a structured discussion of recommendations about reporting of harms-related issues in RCTs . The discussion s led to a written document that we circulated among the team members for comment . The present manuscript describes our recommendations on the appropriate reporting of harms in RCTs . Table 1 . Original CONSORT Checklist The terminology of harms-related issues in RCTs is confusing and often misleading or misused ( see Glossary ) ( 4 , 5 ) . Safety is a reassuring term that may obscure the real and potentially major harms that drugs and other interventions may cause . We encourage authors to use the term harms instead of safety . In addition to misused terminology , reporting of harms in RCTs has received less attention than reporting of efficacy and effectiveness and is often inadequate ( 6 - 14 ) . In short , both scientific evidence and ethical necessity call for action to improve the quality of reporting of harms in RCTs ( 15 , 16 ) . Here , we present a set of recommendations and accompanying explanations for the proper reporting of harms in RCTs . These recommendations should complement the existing CONSORT statement ( Table 2 ) . Examples are presented on the Annals and CONSORT ( www.consort-statement.org ) Web sites . Table 2 . Checklist of Items To Include When Reporting Harms in R and omized , Controlled Trials Recommendations Title and Abstract Recommendation 1 . If the study collected data on harms and benefits , the title or abstract should so state . The title should mention harms if the study of harms was a key trial objective . Many phase I and phase II trials , some phase II/III trials , and most phase IV trials ( 17 , 18 ) target harms as primary outcomes . Yet , the title and abstract seldom contain the word harm . Among 375143 entries in the Cochrane Central Register of Controlled Trials ( Cochrane Library , issue 3 , 2003 ) , search ing titles with the search terms harm or harms yielded 337 references ( compared with 55374 for efficacy and 23415 for safety ) . Of the 337 , excluding several irrelevant articles on self-harm or harm reduction , only 3 trial reports and 2 abstract s contained the word harm in their titles . Authors should present information on harms in the abstract . If no important harms occurred , authors should so state . Explicit reference to the reporting of adverse events in the title or abstract is also important for appropriate data base indexing and information retrieval ( 19 ) . Introduction Background Recommendation 2 . If the trial addresses both harms and benefits , the introduction should so state . The introduction states the scientific background and rationale of an RCT . This requires a balanced presentation whereby the possible benefits of the intervention under investigation are outlined along with the possible harms associated with the treatment . R and omized , controlled trials that focus primarily on harms should clearly state this interest when describing the study objectives in the Introduction and in defining these objectives in the Methods . Methods Outcomes Recommendation 3 . List addressed adverse events with definitions for each ( with attention , when relevant , to grading , expected vs. unexpected events , reference to st and ardized and vali date d definitions , and description of new definitions ) . The Methods section should succinctly define the recorded adverse events ( clinical and laboratory ) . Authors should clarify whether the reported adverse events encompass all the recorded adverse events or a selected sample . They should explain how , why , and who selected adverse events for reporting . In trials that do not mention harms-related data , the Methods section should briefly explain the reason for the omission ( for example , the design did not include the collection of any information on harms ) . Authors should also be explicit about separately reporting anticipated and unexpected adverse events . Expectation may influence the incidence of reported or ascertained adverse events . Making participants aware in the consent form of the possibility of a specific adverse event ( priming ) may increase the reporting rate of the event ( 20 ) . Another example of priming is the finding that the rates of withdrawals due to adverse events and the rates of specific adverse events were significantly higher in trials of aspirin , diclofenac , or indomethacin with comparator drugs compared with placebo-controlled trials ( 21 ) . Presumably , participants were more eager to come forth and report an adverse event or to withdraw from treatment when they knew they could not be receiving inactive placebo . Authors should report whether they used st and ardized and vali date d measurement instruments for adverse events . Several medical fields have developed st and ardized scales ( 22 - 32 ) . Use of nonvali date d scales is common . The source document for well-established definitions and scales should be referenced . New definitions for adverse events should be explicit and clear . Authors should describe how they developed and vali date d new scales . For interventions that target healthy individuals ( for example , many preventive interventions ) , any harm , however minor , may be important to capture and report because the balance of harms and benefits may easily lean toward harms in a low-risk population . For other population s and for interventions that improve major outcomes ( for example , survival ) , severe and life-threatening adverse events may be the only ones that are important in the balance of benefits and harms . Recommendation 4 . Clarify how harms-related information was collected ( mode of data collection , timing , attribution methods , intensity of ascertainment , and harms-related monitoring and stopping rules , if pertinent ) . It is important to describe the question naires , interviews , and tests used to collect information on harms , as well as their timing during follow-up . Passive surveillance of harms leads to fewer recorded adverse events than active surveillance ( 4 ) . Open-ended questions may yield different information , both quantitatively and qualitatively , than structured question naires ( 33 ) . Studies of nonsteroidal , anti-inflammatory drugs ( NSAIDs ) exemplify how data collection methods can affect the detection and reporting of harms . When selective NSAIDs with fewer gastrointestinal adverse events became available , trials reported more than 10 times as many ulcers when comparing these drugs with older NSAIDs as when older NSAIDs were compared with placebo . In the newer trials , more ulcers were detected because participants had regular endoscopy , and the case definition of ulcers was more sensitive ( 34 ) . Authors should specify the time frame of surveillance for adverse events . Some investigators stop recording adverse events at the end of the intervention period or a certain number of days afterward ( for example , 30 days after discontinuation of drug therapy ) and miss events with long latency ( 35 ) . Surgical trials often capture only the adverse events that occur intraoperatively . Several important surgical complications are likely to occur later . Finally , in crossover trials , delayed events might occur while the patient is taking a subsequent assigned treatment . Attribution is the process of deciding whether an adverse event is related to the intervention . Whenever authors filter events through an attribution process , they should state who makes the attribution ( investigators , participants , sponsors , or combinations ) , whether the process is blinded to assigned treatment , and what definitions of adverse events they use ( 4 ) . Discontinuations and withdrawals due to adverse events are especially important because they reflect the ultimate decision of the participant and /or physician to discontinue treatment . Although treatment may occasionally be discontinued for mild or moderate adverse events , attributing discontinuation to a specific reason ( to toxicity , lack of efficacy , other reasons , or combinations of reasons ) may be difficult . For example , in psychopharmacology , dropouts may reflect treatment ineffectiveness as much as toxicity-related intolerance ( 36 ) . Trial reports should specify who gave the reasons for discontinuation ( participants or physicians ) and whether attribution was blinded to the assigned treatment . For example , even in blinded trials , participants and their clinicians are often unblinded before they decide whether to discontinue the intervention . It is important to report participants who are nonadherent or lost to follow-up because their actions may reflect their inability to tolerate the intervention . Moreover , authors should specify how they h and led withdrawals in the analyses of the data . R and omized , controlled trials should report any plan for monitoring for harms and rules for stopping the trial because of harms ( 37 ) . They should clarify whether stopping guidelines examine benefits and harms Background Patient preference for group assignment may affect outcomes in unblinded trials but few studies have attempted to underst and such preferences . The purpose of the present study was to examine factors associated with breast cancer patients ' preference for two types of exercise training during chemotherapy .  Methods Breast cancer patients ( N = 242 ) completed a battery of tests including a question naire that assessed patient preference and the theory of planned behavior ( TPB ) prior to being r and omized to usual care , resistance exercise training ( RET ) , or aerobic exercise training ( AET ) . Results 99 ( 40.9 % ) participants preferred RET , 88 ( 36.4 % ) preferred AET , and 55 ( 22.7 % ) reported no preference . Past exercisers ( p = 0.023 ) , smokers ( p = 0.004 ) , and aerobically fitter participants ( p = 0.005 ) were more likely to prefer RET . As hypothesized , participants that preferred AET had more favorable TPB beliefs about AET whereas participants that preferred RET had more favorable TPB beliefs about RET . In multivariate modeling , patient preference for RET versus AET was explained ( R2 = .46 ; p < 0.001 ) by the difference in motivation for RET versus AET ( β = .56 ; p < 0.001 ) , smoking status ( β = .13 ; p = 0.007 ) , and aerobic fitness ( β = .12 ; p = 0.018 ) . Motivational difference between RET versus AET , in turn , was explained ( R2 = .48 ; p < 0.001 ) by differences in instrumental attitude ( β = .27 ; p < 0.001 ) , affective attitude ( β = .25 ; p < 0.001 ) , and perceived behavioral control ( β = .24 ; p < 0.001 ) . Conclusion Breast cancer patients ' preference for RET versus AET during chemotherapy was predicted largely by a difference in motivation for each type of exercise which , in turn , was based on differences in their beliefs about the anticipated benefits , enjoyment , and difficulty of performing each type of exercise during chemotherapy . These findings may help explain patient preference effects in unblinded behavioral trials . Trial Registration Clinical Trials.gov Identifier NCT00115713 Background Exercise started shortly after breast cancer diagnosis might prevent or diminish fatigue complaints . The Physical Activity during Cancer Treatment ( PACT ) study was design ed to primarily examine the effects of an 18-week exercise intervention , offered in the daily clinical practice setting and starting within 6 weeks after diagnosis , on preventing an increase in fatigue . Methods This multi-centre controlled trial r and omly assigned 204 breast cancer patients to usual care ( n = 102 ) or supervised aerobic and resistance exercise ( n = 102 ) . By design , all patients received chemotherapy  between baseline and 18 weeks . Fatigue ( i.e. , primary outcome at 18 weeks ) , quality of life , anxiety , depression , and physical fitness were measured at 18 and 36 weeks . Results Intention-to-treat mixed linear model analyses showed that physical fatigue increased significantly less during cancer treatment in the intervention group compared to control ( mean between-group differences at 18 weeks : −1.3 ; 95 % CI −2.5 to −0.1 ; effect size −0.30 ) . Results for general fatigue were comparable but did not reach statistical significance ( -1.0 , 95%CI -2.1 ; 0.1 ; effect size -0.23 ) . At 18 weeks , submaximal cardiorespiratory fitness and several muscle strength tests ( leg extension and flexion ) were significantly higher in the intervention group compared to control , whereas peak oxygen uptake did not differ between groups . At 36 weeks these differences were no longer statistically significant . Quality of life outcomes favoured the exercise group but were not significantly different between groups . Conclusions A supervised 18-week exercise programme offered early in routine care during adjuvant breast cancer treatment showed positive effects on physical fatigue , submaximal cardiorespiratory fitness , and muscle strength . Exercise early during treatment of breast cancer can be recommended . At 36 weeks , these effects were no longer statistically significant . This might have been caused by the control participants ’ high physical activity levels during follow-up . Trial registration Current Controlled Trials IS RCT N43801571 , Dutch Trial Register NTR2138 . Trial registered on December 9th , 2009 PURPOSE To examine the effect of a progressive upper-body exercise program on  lymphedema secondary to breast cancer treatment . METHODS Fourteen breast cancer survivors with unilateral upper extremity lymphedema were r and omly assigned to an exercise ( n = 7 ) or control group ( n = 7 ) . The exercise group followed a progressive , 8-week upper-body exercise program consisting of resistance training plus aerobic exercise using a Monark Rehab Trainer arm ergometer . Lymphedema was assessed by arm circumference and measurement of arm volume by water displacement . Patients were evaluated on five occasions over the experimental period . The Medical Outcomes Trust Short-Form 36 Survey was used to measure quality of life before and after the intervention . Significance was set at alpha < or = 0.01 . RESULTS No changes were found in arm circumference or arm volume as a result of the exercise program . Three of the quality -of-life domains showed trends toward increases in the exercise group : physical functioning ( P = .050 ) , general health ( P = .048 ) , and vitality ( P = .023 ) . Mental health increased , although not significantly , for all subjects ( P = .019 ) . Arm volume measured by water displacement was correlated with calculated arm volume ( r = .973 , P < .001 ) , although the exercise and control group means were significantly different ( P < .001 ) . CONCLUSIONS Participation in an upper-body exercise program caused no changes in arm circumference or arm volume in women with lymphedema after breast cancer , and they may have experienced an increase in quality of life . Additional studies should be done in this area to determine the optimum training program To better underst and mechanisms of physical activity ( PA ) behavior change in breast cancer survivors , we examined mediation of a successful PA behavior change intervention by social cognitive theory ( SCT ) constructs . Our exploratory study r and omized 41 breast cancer survivors to receive the 3-month intervention ( INT ) or usual care ( UC ) .  We used the Freedman and Schatzkin approach to examine mediation of intervention effect on PA 3 months postintervention by changes in SCT constructs from baseline to immediately postintervention . Compared with UC , the INT group reported lower barriers interference ( mean difference = -7.8 , 95 % CI [ -15.1 , -0.4 ] , d = -0.67 , p = .04 ) and greater PA enjoyment ( mean difference = 0.7 , 95 % CI [ 0 , 1.5 ] , d = 0.61 , p = .06 ) . Barriers interference mediated 39 % ( p = .004 ) of the intervention effect on PA 3 months postintervention . PA enjoyment was not a significant mediator . Reducing barriers to PA partially explained our intervention effect A pilot research study was conducted at 2 cancer centers in Connecticut to determine the effect of a dance and movement program on quality of life and shoulder function in breast cancer survivors treated within the prior 5 years . Thirty-five women completed the trial that included a 12-week intervention , using The Lebed Method , Focus on Healing Through Movement and Dance . The study design was a r and omized control trial with a wait list control group crossover to active treatment in weeks 13 to 25 , with the treatment group receiving the program in weeks 1 to 12 , and no program in weeks 13 to 25 . Outcome measures were the Breast Cancer Quality of Life ( FACT-B ) , Shoulder range of motion ( ROM ) , and Body Image Scale . FACT-B significantly improved in the intervention group at 13 weeks from 102.0 ± 15.8 to 116.7 ± 16.9 , compared to the wait list group 108.1 ± 16.4 to 107.1 ± 21.3 ( time × group effect , P = .008 ) . During the crossover phase , the FACT-B score increased in the wait list group and was stable in the treatment group . The overall effect of the training at 26 weeks was significant ( time effect , P = .03 ) , and the order of training was also significant ( P = .015 ) . Shoulder ROM increased in both groups at 13 weeks —15 ° and 8 ° in the intervention and wait list groups ( Time effect , P = .03 ; time × group , P = .58 ) . Body Image improved similarly in both groups at 13 weeks ( time effect , P = .001 ; time × group , P = .25 ) , and at 26 weeks . There was no significant effect of the order of training for these outcome measures . A dance movement program that addressed the physical and emotional needs of women following treatment for breast cancer substantially improved a breast cancer – specific quality -of-life measure . Larger studies are justified to determine the acceptability of this therapy as part of the continuum of care for breast cancer survivors Fatigue is one of the most frequent side effects of cancer treatments . According to a number of studies , the incidence of fatigue as a side effect of radiation therapy ( RT ) ranges from 65 % to 100 % depending on which instruments were used ( Greenberg et al. , 1992 ; Jacobsen-Thors , 2003 ) . For many cancer patients , cancer-related fatigue is severe and imposes limitations on normal daily activities ( JereczekFossa et al. , 2002 ) . Patients often report that cancerrelated fatigue differs from fatigue experienced before initiation of cancer . They describe it as severe , chronic and frustrating , effects that fail to be relieved by rest . In many studies in the past , patients have felt that fatigue has adversely affected their quality of life more than pain and sexual dysfunction or other treatment-related side effects ( Stone et al. , 1998 ) . Fatigue has negative impact on various aspects of quality of life , so it is imperative to find non-invasive and nonpharmacological solutions for managing it . There is little however known as to which techniques can help alleviate fatigue .  Physical exercise has been shown to be effective , convenient and a low-cost self-care method for reducing anxiety and sleep difficulties , and increasing adaptation during radiotherapy . Aerobic exercises ( e.g. walking ) have been suggested for the rehabilitation of cancer patients affected by energy loss but this is not a fully accepted approach as yet . Nevertheless , exercise has been shown BACKGROUND Breast cancer treatment is associated with a decline in measured cardiorespiratory fitness and increased fatigue . There is accumulating evidence that exercise training during adjuvant chemotherapy may contribute to prevent these changes . Additional studies are needed to explore the effectiveness of home-based walking interventions among this population . AIM The aim of this study was to investigate the effects of a 12-week adapted home-based walking training program ( WTP ) on clinical rehabilitation in breast cancer patients receiving adjuvant chemotherapy . DESIGN This was a pilot study using a single-group design . SETTING Unit Department of Physiology and Medical Oncology , Limoges University Hospital , France . POPULATION Thirty-nine out patients predominantly with stage II breast cancer . METHODS Participants performed 3 home ambulatory aerobic walking sessions per week at 50 - 60 % of their maximum heart rate for 12 weeks . Functional capacity was assessed with an incremental cardiopulmonary exercise test during which peak oxygen consumption ( VO(2peak ) ) was measured . A six-minute walking test ( 6 MWT ) was performed to evaluate physical function . The revised Piper Fatigue Scale ( PFS-R ) was used to measure self-reported fatigue . RESULTS Thirty-four patients ( 87 % ) completed all study procedures . Per Protocol ( PP ) analysis indicated that VO(2peak ) recorded both before and after a 12-week adapted home-based WTP increased significantly by 2.21 mL.kg-1.min-1 ( P=0.008 ) and 6 MWT distance increased significantly by 42 m ( P=0.04 ) . PFS-R score increased by 0.4 points , but not significantly . CONCLUSION In breast cancer patients receiving adjuvant chemotherapy  , home-based WTP is feasible and associated with significant improvements in VO(2peak ) , with no significant effect on fatigue score . Larger r and omized trials are necessary to confirm these findings Purpose : Fatigue is a common side effect of cancer treatment that impacts quality of life .  Exercise is one approach suggested to improve fatigue . The purpose of this study was to explore the relationship of exercise to fatigue and quality of life . Methods : Thirty-one subjects with breast cancer were enrolled prior to beginning chemotherapy and 27 completed the study . All baseline measures were obtained before the first chemotherapy treatment . Subjects were instructed on a home-based , 8-week exercise program . Results : Women who adopted the exercise program ( 60 % ) showed significant increases in functional ability and less weight gain . Exploratory , stepwise multiple regression analyses suggested that the maximum effect of exercise on quality of life outcomes may be mediated by fatigue . Conclusions : The low-to-moderate intensity , home-based exercise program was feasible for some women with breast cancer receiving chemotherapy .  The results suggest that exercise may affect quality of life and that this effect may be mediated by the effects of exercise on fatigue . Better retention of functional ability and better weight control are additional possible benefits of exposing breast cancer patients to increased exercise . A r and omized , controlled clinical trial is needed to establish confidence in these observed relationships 8504 Background : Cancer-related fatigue ( CRF ) is reported in up to 97 % of cancer patients during RTH . 60 % rate it as moderate to severe . Fatigue can significantly reduce functional capacity ( FC ) , treatment compliance , and QOL . Although there is no st and ard treatment for CRF , aerobic exercise has demonstrated a positive influence on CRF and FC during RTH , but the influence of combined resistance and aerobic exercise is not clear . We explored the efficacy of a low to moderate home-based exercise intervention , including resistance and aerobic training , to SC on CRF and domains of FC ( aerobic capacity and strength ) , in a sample of BC and PC patients during RTH . METHODS BC and PC patients ( N=38 ; ξ age=56 ; 71 % BC ) , beginning at least 28 sessions of RTH were r and omized to a 4wk HBEX  ( 7 days/wk ) or SC condition , with CRF ( FACT subscale ) , aerobic capacity ( 6-min . walk ) , and strength ( h and grip dynamometry ) assessment s pre and post-intervention . RESULTS Change scores indicated improvements in the HBEX group ( N=19 ) in CRF ( ξ=3.6 , SE=2.1 ) and aerobic capacity ( ξ=43.6 , SE=52.3 ) , while the SC group declined in CRF ( ξ=-1.1 , SE=1.1 ) and aerobic capacity ( ξ=-28.5 SE=71.6 ) . Change scores revealed declines in strength among both groups , however the HBEX group showed smaller declines in strength ( ξ=-.05 , SE=0.7 ) compared to the SC group ( ξ=-.80 , SE=.91 ) . T-tests using intent-to-treat indicated statistically significant between group differences on changes in CRF ( ES=.63 ; p=.05 ) from pre to post-intervention , as well as significantly higher aerobic capacity ( ES=1.3 ; p<.001 ) with a statistical trend toward lower CRF ( ES=.51 ; p=.09 ) between groups post-intervention . CONCLUSIONS HBEX improved CRF and aerobic capacity , while SC result ed in  declines  . HBEX reduced declines in strength compared to SC . Future phase III r and omized controlled trials are needed with larger sample s to fully investigate the influence of this HBEX intervention on CRF , aerobic capacity and strength . Funded by NCI grant 1R25CA102618 . No significant financial relationships to disclose Objective : To provide information and recommendations to assist women with breast cancer and their physicians in making decisions regarding the use of locoregional post-mastectomy radiotherapy ( PMRT ) . Outcomes : Locoregional control , disease-free survival , overall survival and treatment-related toxicities . Evidence : This guideline is based on a review of all meta-analyses , consensus statements and other guidelines published between 1966 and November 2002 . Search es of MEDLINE and CANCERLIT for English- language r and omized controlled trials published between 1995 and November 2002 were also conducted to supplement the literature previously review ed by the American Society of Clinical Oncology ( ASCO ) Health Services Research Committee panel in its published guideline . A non systematic review of the literature was continued through June 2003 . Recommendations : Locoregional PMRT is recommended for women with an advanced primary tumour ( tumour size 5 cm or greater , or tumour invasion of the skin , pectoral muscle or chest wall ) . Locoregional PMRT is recommended for women with 4 or more positive axillary lymph nodes . The role of PMRT in women with 1 to 3 positive axillary lymph nodes is unclear . These women should be offered the opportunity to participate in clinical trials of PMRT . Locoregional PMRT is generally not recommended for women who have tumours that are less than 5 cm in diameter and who have negative axillary nodes . Other patient , tumour and treatment characteristics , including age , histologic grade , lymphovascular invasion , hormone receptor status , number of axillary nodes removed , axillary extracapsular extension and surgical margin status , may affect locoregional control , but their use in specifying additional indications for PMRT is currently unclear . PMRT should encompass the chest wall and the supraclavicular , infraclavicular and axillary apical lymph node areas . To reduce the risk of lymphedema , radiation of the entire axilla should not be used routinely after complete axillary dissection of level I and II lymph nodes . A definite recommendation regarding the inclusion of the internal mammary lymph nodes in PMRT can not be made because of limited and inconsistent data . The use of modern techniques in radiotherapy planning is recommended to minimize excessive normal tissue exposure , particularly to the cardiac and pulmonary structures . Common short-term side effects of PMRT , including fatigue and skin erythema , are generally tolerable and not dose-limiting . Severe long-term side effects , including lymphedema , cardiac and pulmonary toxicities , brachial plexopathy , rib fractures and secondary neoplasms , are relatively rare . The optimal sequencing of PMRT and systemic therapy is currently unclear . Regimens containing anthracyclines or taxanes should not be administered concurrently with radiotherapy because of the potential for increased toxicity . Validation : The authors ' original text was su bmi tted for review , revision and approval by the Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer . Subsequently , feedback was provided by 11 oncologists from across Canada . The final document was approved by the steering committee . Sponsor : The Steering Committee on Clinical Practice Guidelines for the Care and Treatment of Breast Cancer was convened by Health Canada . Completion date : November 2003 The purpose of this r and omized controlled trial was to determine the effects of an 8-week ( aerobic+strength ) exercise training program ( 3 sessions/week ) on the circulating cytokine levels of breast cancer survivors . We r and omly allocated 16 female survivors of breast cancer ( mean±SD age : 50±5 years ) to an intervention or usual care ( control ) group ( N=8 in each group ) . The intervention group followed an 8-week exercise program consisting of 3 sessions/week ( session duration : 90 min ) . We measured the levels of the following cytokines before and after the intervention : beta-NGF , CTACK , eotaxin , FGF basic , G-CSF , gmCSFα , HGF , ICAM1 , IFNα2 , IFNγ , IL1α , IL1ß , IL1ra , IL2 , IL2ra , IL3 , IL4 , IL6 , IL7 , IL8 , IL9 , IL10 , IL12 , IL13 , IL15 , IL16 , IL17 , IL18 , IP10 , LIF , MCS-F , MIP1α , MIP1β , MIF , MCP1 , MCP3 , MIG , PDGF bb , SCF , SCGFβ , SDF1α , TRAIL , TNFα , TNFβ , VCAM1 , and VEGF . We only observed a significant interaction ( group*time ) effect for CTACK ( P=0.016 ) , with mean values remaining stable in the intervention group but increasing over time in controls . The intervention program did not induce a significant decrease in the main breast cancer-related cytokines such as IL6 and IL8 . A combined ( aerobic+strength ) 8-week exercise training intervention did not induce major changes in the basal cytokine levels of breast cancer survivors This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy . The study was design ed as a r and omised controlled trial ( RCT ) . Physical functioning , fatigue and Quality of Life ( QoL ) outcomes were evaluated pre and post a 12-week intervention . The results showed that after 12 weeks the women who participated in the exercise programme ( n = 12 ) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls ( n = 10 ) . Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance . These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe , well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer . Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women . Future studies need to address these issues and determine if these short-term benefits can be sustained After surgery , breast cancer patients are offered adjuvant chemotherapy to avoid cancer cell spread . During chemotherapy process , neutrophils could fall relatively , and side effects could spike to the peak . Therefore , the medical care personnel should prevent the progression of the side effects . This study aim ed to examine the effects of Chan-Chuang qi-gong therapy on complete blood counts in breast cancer patients treated with chemotherapy .  This study used a quasi-experimental design . The experiment group ( n = 32 ) received a 21-day Chan-Chuang qi-gong therapy , whereas the control group ( n = 35 )  did not . White blood cells , platelet , and hemoglobin were measured on the day before chemotherapy and on days 8 , 15 , and 22 during chemotherapy . According to this study , there were significant differences in white blood cells ( F = 115.76 , P < .001 ) , platelets ( F = 25.29 , P < .001 ) , and hemoglobin ( F = 15.39 , P < .001 ) over the 3-week therapy between the experiment and control groups . Chan-Chuang qi-gong therapy may decrease leukopenia in breast cancer patients treated with chemotherapy .  It is recommended conducting more studies on qi-gong and then introducing it in clinical nursing practice at an appropriate time to promote quality of nursing care and quality of patient life PURPOSE / OBJECTIVES To compare a 12-week nontraditional exercise Nia program practice d at home to usual care on fatigue , quality of life ( QOL ) , aerobic capacity , and shoulder flexibility in women with breast cancer undergoing radiation therapy . DESIGN R and omized clinical trial . SETTING Large community-based hospital in the midwestern United States . SAMPLE 41 women with stage I , II , or III breast cancer starting radiation therapy . METHODS 22 women were r and omized to the Nia group and 19 to the usual care group . Those in the Nia group were instructed to practice Nia 20 - 60 minutes three times per week for 12 weeks . Those in the usual care group were instructed to continue normal activities . MAIN RESEARCH VARIABLES Fatigue , QOL , aerobic capacity , and shoulder flexibility . FINDINGS Controlling for baseline scores , change over time between groups was significantly different for the women who practice d Nia at least 13 times during the 12-week period ; those in the Nia intervention reported significantly less fatigue between weeks 6 and 12 , as compared to control group ( p = 0.05 ) . No statistical differences in QOL , aerobic capacity , or shoulder flexibility were found , but trends favoring Nia were identified . CONCLUSIONS For women undergoing radiation therapy for breast cancer , Nia can help relieve fatigue . Additional research in arm and shoulder mobility and preservation also may be beneficial . IMPLICATION S FOR NURSING Oncology nurses are in a unique position to offer suggestions to help manage fatigue , and Nia could be considered as part of a cancer survivorship program . KNOWLEDGE TRANSLATION Exercise is beneficial for women with breast cancer , and interest is growing in nontraditional exercise options . Nia can benefit women with breast cancer undergoing radiation therapy Exercise participation has been shown to improve cardiovascular fitness and reduce psychological distress  among women receiving chemotherapy and /or radiation . The purpose of this pilot study was to examine the changes in distress and body image , and fitness following exercise participation among 24 women who had been diagnosed with breast cancer within the previous 3 years . The women were r and omly assigned to participate in a 12-week supervised aerobic exercise program in a hospital setting or a wait-list control group . Assessment s of distress and body image were conducted at pre- and post-treatment . Data showed that the women in the exercise group improved significantly in body image ( Physical Condition and Weight Concerns subscales ) vs control group participants at post-treatment . Reductions in distress were also noted in the exercise group , but these were nonsignificant . At post-treatment , there were modest improvements in fitness in the exercise group Purpose To examine predictors of exercise adherence in breast cancer survivors . Methods Seventy-five breast cancer survivors were r and omly assigned  to exercise ( n = 37 ) or usual care ( n = 38 ) . Demographic , prognostic , physiologic , and psychosocial information was collected at baseline and 6 months . The exercise goal was 30 min of exercise 5 days/week for 6 months . Results Women r and omized to exercise participated in moderate-intensity recreational exercise for 123 ± 52 min/week ( 81 % of the prescribed 150 min/week ) over 6 months . Baseline variables associated with better adherence were lower body mass index ( BMI ) , smaller waist circumference , higher amounts of physical activity 6 months prior to enrollment , being in the preparation vs. contemplation Stage of Change and higher FACT-B breast cancer subscale score . After adjusting for these variables , lower BMI and higher Stage of Change continued to be associated with better adherence ( p < 0.05 ) . Conclusions Future studies of exercise and breast cancer prognosis should target obese women for participation , as well as women just beginning to contemplate participation and its benefits after a cancer diagnosis OBJECTIVES Restorative yoga ( RY ) is a gentle type of yoga that may be beneficial for cancer patients and post-treatment survivors . Study goals were : to determine the feasibility of implementing a RY intervention for women with breast cancer ; and to examine group differences in self-reported emotional , health-related quality of life , and symptom outcomes . METHODS Women with breast cancer ( n=44 ; mean age 55.8 years ) enrolled in this study ; 34 % were actively undergoing cancer treatment . Study participants were r and omized to the intervention ( 10 weekly 75-minute RY classes ) or a waitlist control group . Participants completed question naires at Week 0 ( baseline ) and Week 10 ( immediately post-intervention for the yoga group ) . RESULTS Group differences favoring the yoga group were seen for mental health , depression , positive affect , and spirituality ( peace/meaning ) . Significant baseline*group interactions were observed for negative affect and emotional well-being . Women with higher negative affect and lower emotional well-being at baseline derived greater benefit from the yoga intervention compared to those with similar values at baseline in the control group . The yoga group demonstrated a significant within-group improvement in fatigue ; no significant difference was noted for the control group . CONCLUSIONS Although limited by sample size , these pilot data suggest potential benefit of RY on emotional outcomes and fatigue in cancer patients . This study demonstrates that a RY intervention is feasible for women with breast cancer ; implication s for study design and implementation are noted with an emphasis on program adoption and participant adherence This study examined the effect of a supervised , aerobic exercise program on change in body weight and composition ( multi-site subcutaneous skinfold measures , percent body fat , and lean body weight ) of women undergoing adjuvant chemotherapy for breast cancer . Stage II patients with breast cancer ( N = 24 ) were r and omized to an exercise treatment group ( EG , n = 12 ) and a control group ( CG , n = 12 ) . The EG participated in the individualized Winningham Aerobic Interval Training ( WAIT ) exercise program with exertional levels set at 60%-85 % of maximal heart rate for 20 - 30 minutes , 3 times per week , for 10 - 12 weeks . The CG received no exercise treatment , but were asked to continue with their daily activities . Subjects were asked to maintain their customary eating patterns throughout their participation . Data were analyzed using covariate analysis , adjusting for age and pre-test values . Comparisons of pre- and post-test results indicated that exercise had a moderating effect on gain in body fat and altered the subcutaneous body fat profile in both obese ( OB ) and nonobese ( NOB ) subjects . Exercising OB subjects showed a greater increase in lean body weight than NOB subjects , indicating an increase in muscle tissue . Results from this study may be useful in design ing safe and effective weight-control programs for patients with breast cancer on chemotherapy PURPOSE Short-term physical activity ( PA ) has beneficial effects on symptom management and quality of life , however , longer-term adherence is likely needed for improved disease outcomes in breast cancer survivors ( BCS ) . This study examined the effects of a supervised group exercise program on motivational outcomes and PA among BCS at 5-year follow-up . METHODS The original study was a two-armed , r and omized controlled trial comparing a 12-week supervised group exercise program to usual care among 203 BCS . BCS for this follow-up study were contacted at 60 months postintervention and asked to complete assessment s of motivational outcomes from the Theory of Planned Behavior and PA behavior using the Scottish Physical Activity Question naire . RESULTS Overall , 87 participants provided 5-year follow-up data with no differences in participation by group . Analyses of covariance ( ANCOVAs ) revealed that supervised exercise had a significant positive effect on descriptive norm at 5-year follow-up ( mean = + 0.6 ; 95 % CI = + 0.1 to + 1.1 ; d = + 0.48 ; p = 0.021 ) . Small positive effects were also noted for perceived behavioral control ( d = + 0.18 ) , instrumental attitude ( d = + 0.26 ) , and injunctive norm ( d = + 0.35 ) , although they were not statistically significant . Moreover , BCS who were more active at 5-year follow-up also reported more favorable perceived behavioral control ( d = + 0.16 ) , instrumental attitude ( d = + 0.28 ) , injunctive norm ( d = + 0.24 ) , and descriptive norm ( d = + 0.31 ) , although these differences were not statistically significant . CONCLUSIONS This trial provides suggestive evidence that a supervised exercise program has positive effects on motivational outcomes even after 5 years . Additional intervention strategies during follow-up may further improve long-term adherence and health outcomes in BCS The purpose of this secondary analysis was to examine the nutritional symptoms and body composition outcomes of aerobic exercise in women with breast cancer . A single-blind clinical trial , r and omized to tailored Pro-Self © exercise during and after chemotherapy , after chemotherapy only , or no Pro-Self ( usual care ) .  One hundred women , average age 49.9 years ( SD = 9.6 ) , participated .  Mild taste changes , nausea , constipation , and anorexia were experienced by 47 % to 55 % at baseline and end of treatment but diminished post treatment . No group differences were found in total nutritional symptoms or symptom severity . Intervention group participants maintained lean body mass ; control group participants had nonsignificant lean body mass loss . Issues related to self-report , protocol adherence , and generalizability limit findings . Aerobic exercise is useful in achieving healthy weight and body composition , but the intensity and duration achieved during cancer treatment and recovery did not produce significant changes CONTEXT AND OBJECTIVE Changes in metabolism have been reported in the majority of patients undergoing cancer treatment , and these are usually characterized by progressive change in body composition . The effects of aerobic exercise programs to combat the cancer and cancer treatment-related side effects , which include the negative changes in body composition , have been extensively reported in the literature . However , few resistance exercise intervention studies have hypothesized that breast cancer patients might benefit from this type of exercise . The purpose of this study was to determine whether exercise protocol s that emphasize resistance training would change body composition and strength in breast cancer patients undergoing treatment . DESIGN AND SETTING R and omized controlled trial , at the Campus Recreation Center and Rocky Mountain Cancer Rehabilitation Institute of the University of Northern Colorado , and the North Colorado Medical Center . METHODS Twenty inactive breast cancer patients were r and omly assigned to a 21-week exercise group ( n = 10 ) or a control group ( n = 10 ) . The exercise group trained at low to moderate intensity for 60 minutes on two days/week . The primary outcome measurements included body composition ( skinfold method ) and muscle strength ( one repetition maximum ) . RESULTS Significant differences in lean body mass , body fat and strength ( p = 0.004 , p = 0.004 , p = 0.025 , respectively ) were observed between the groups at the end of the study . CONCLUSION The results suggest that exercise emphasizing resistance training promotes positive changes in body composition and strength in breast cancer patients undergoing treatment PURPOSE / OBJECTIVES Through a r and omized clinical trial , to compare patients undergoing an initial course of chemotherapy who report pain and fatigue at baseline and who are receiving conventional care alone with those receiving conventional care plus a nursing intervention  on outcomes reported at 20 weeks . SETTING Chemotherapy clinics of two comprehensive and two community cancer centers . METHODS Interviews were conducted at baseline and 10 and 20 weeks . An 18-week , 10-contact nursing intervention utilizing problem-solving approaches to symptom management and improving physical functioning and emotional health  was implemented . SAMPLE The sample consisted of 53 patients in the experimental arm and 60 in the control arm who reported pain and fatigue at baseline . VARIABLES Pain and fatigue , numbers of other symptoms , and physical role impact and social-functioning subscales from the Medical Outcomes Study 36 Short Form . FINDINGS Patients who received the intervention reported a significant reduction in the number of symptoms experienced and improved physical and social functioning . Fewer patients in the experimental arm reported both pain and fatigue at 20 weeks . CONCLUSIONS Behavioral interventions targeted to patients with pain and fatigue can reduce symptom burden , improve the quality of the daily life of patients , and demonstrate the " value-added " role of nursing care for patients undergoing chemotherapy . IMPLICATION S FOR NURSING These data support the " value-added " role of nursing interventions for symptom management and improved quality of life during the course of cancer treatment Summary This study examined whether 24 months of weight training exercises enhanced the effectiveness of risedronate , calcium , and vitamin D in maintaining or improving bone mineral density ( BMD ) in 223 postmenopausal breast cancer survivors . Subjects who were ≥50 % adherent to exercise had no improvement in BMD but were less likely to lose BMD . Introduction This study examined whether ( 1 ) postmenopausal breast cancer survivors ( BCS ) with bone loss taking 24 months of risedronate , calcium , and vitamin D had increased bone mineral density ( BMD ) at the total hip , femoral neck , L1-L4 spine , total radius and 33 % radius , and decreased bone turnover ; ( 2 ) subjects who also participated in strength/weight training ( ST ) exercises had greater increases in BMD and greater decreases in bone turnover ; and ( 3 ) subjects who also exercised were more likely to preserve ( at least maintain ) BMD . Methods Postmenopausal BCS ( 223 ) were r and omly assigned to exercise plus medication or medication only groups . Both groups received 24 months of 1,200 mg of calcium and 400 IU of vitamin D daily and 35 mg of risedronate weekly , and the exercise group additionally had ST exercises twice weekly . Results After 24 months , women who took medications without exercising had significant improvements in BMD at the total hip ( + 1.81 % ) and spine ( + 2.85 % ) and significant decreases in Alkphase B ( −8.7 % ) and serum NTx ( −16.7 % ) . Women who also exercised had additional increases in BMD at the femoral neck ( + 0.29 % ) , total hip ( + 0.34 % ) , spine ( + 0.23 % ) , total radius ( + 0.30 % ) , and additional decreases in Alkphase B ( −2.4 % ) and Serum NTx ( −6.5 % ) . Additional changes in BMD and bone turnover with exercise were not significant . Subjects who were ≥50 % adherent to exercise were less likely to lose BMD at the total hip ( chi-square [ 1 ] = 4.66 , p = 0.03 ) and femoral neck ( chi-square [ 1 ] = 4.63 , p = 0.03 ) . ConclusionS trength/weight training exercises may prevent loss of BMD in postmenopausal BCS at risk for bone loss Purpose : To examine the effect of regular Iyengar yoga practice on measures of self‐perceived psychosocial function and diurnal salivary cortisol secretion in stage II – IV breast cancer survivors ( n = 18 ) . Data sources : Women were r and omly assigned to attend yoga practice for 90 min twice weekly for 8 weeks ( n = 9 ) or to a wait‐listed , noninterventional control group ( n = 9 ) . Traditional Iyengar yoga routines that progressively increased in difficulty as participants gained strength and flexibility were used . At baseline and after the 8‐week study period , women completed self‐report instruments to document various aspects of psychosocial and physical functioning , and collected salivary sample s for cortisol analysis four times during the day for two consecutive days . Conclusions : The yoga group had lower morning and 5 p.m. salivary cortisol and improved emotional well‐being and fatigue scores . Implication s for practice : Breast cancer survivors are at risk for chronic psychosocial distress that may alter activity of the hypothalamic – pituitary – adrenal axis , result ing in aberrant regulation of cortisol secretion and increased risk of immune dysfunction and cancer progression . Regular yoga practice may be a low‐risk , cost‐effective way to improve psychosocial functioning , fatigue , and regulation of cortisol secretion in breast cancer survivors . These findings require validation with a larger r and omized study The purpose of this study was to examine the exercise beliefs of breast cancer survivors before and after participation in a r and omized trial . Prior to r and omization , 52 breast cancer survivors completed exercise belief measures based on the theory of planned behavior . After the trial , participants assigned to the  exercise group ( n = 24 ) completed the belief measures again . Results show that there was significant variability in the expected benefits of exercise prer and omization , ranging from 40 % for a reduced risk of breast cancer recurrence to 94 % for an improved energy level . Moreover , attitudes toward exercise and perceptions of control were higher in the exercise group after the exercise program . The findings are discussed in terms of the veracity of the exercise beliefs held by breast cancer survivors as well as the aspects of the program that may have contributed to the positive changes in exercise beliefs Goal of workBreast cancer survivors have limited options for the treatment of hot flashes and related symptoms . Further , therapies widely used to prevent recurrence in survivors , such as tamoxifen , tend to induce or exacerbate menopausal symptoms . The aim of this preliminary , r and omized controlled trial was to evaluate the effects of a yoga intervention on menopausal symptoms in a sample of survivors of early-stage breast cancer ( stages IA – IIB ) . Material s and methods Thirty-seven disease-free women experiencing hot flashes were r and omized to the 8-week Yoga of Awareness program ( gentle yoga poses , meditation , and breathing exercises ) or to wait-list control . The primary outcome was daily reports of hot flashes collected at baseline , posttreatment , and 3 months after treatment via an interactive telephone system . Data were analyzed by intention to treat . Main results At posttreatment , women who received the yoga program showed significantly greater improvements relative to the control condition in hot-flash frequency , severity , and total scores and in levels of joint pain , fatigue , sleep disturbance , symptom-related bother , and vigor . At 3 months follow-up , patients maintained their treatment gains in hot flashes , joint pain , fatigue , symptom-related bother , and vigor and showed additional significant gains in negative mood , relaxation , and acceptance . Conclusions This pilot study provides promising support for the beneficial effects of a comprehensive yoga program for hot flashes and other menopausal symptoms in early-stage breast cancer survivors The purpose of this study was to explore the effect of Chan-Chuang qigong on symptoms distress and psychological distress of breast cancer patients who underwent chemotherapy .  A quasi-experimental design was adopted . Subjects were recruited from breast cancer out patients receiving chemotherapy at an 1800-bed medical center in Taipei , Taiwan . Of these subjects , 35 were assigned to the control group and 32 to the experimental group in which Chan-Chuang qigong was administered . Assignment was not r and om . The instruments included a 21-item symptom distress scale and psychological distress with the symptom checklist-90-revised . Data of the symptoms and psychological distress were collected on the day before chemotherapy as baseline values , and also collected on days 8 , 15 and 22 of chemotherapy . The results showed that the overall severity of symptom distress in the experimental group was significantly lower than the control group on day 22 ( p < 0.05 ) . The symptoms with significant improvement included pain , numbness , heartburn and dizziness ( p < 0.05 ) . With regard to psychological distress , the difference of overall severity between the two groups was not statistically significant ( p > 0.05 ) . However , the items of " unwillingness to live " ( p < 0.05 ) and " hopelessness about the future " ( p < 0.05 ) were significantly improved in the experimental group . In conclusion , Chan-Chuang qigong had the effect of attenuating the symptom distress and probably some part of the psychological distress of chemotherapy patients Cardiopulmonary responses to an 8-week moderate-intensity aerobic exercise intervention and adherence to exercise during and after intervention were assessed in 41 women newly diagnosed with breast cancer undergoing adjuvant therapy .  The intervention was primarily aim ed at minimizing deconditioning . Women were r and omly assigned to the intervention or control group , completed grade d exercise tests before and after intervention , and encouraged to continue their exercise postintervention . Over time , only the intervention group showed significant decreases in resting heart rate , resting systolic blood pressure ( SBP ) , P < .05 each , and maximum SBP , P < .02 , and an increase in VO2 peak , P < .001 , although resting SBP was higher in the intervention group at both timepoints , P < .05 . The adherence rate to 8-week exercise intervention was 78.3 % with average weekly attendance of 2.4 sessions and 42.7 minutes ( 27.8 minutes within target heart rate ) exercise per session . Overall physical activity levels over 16 weeks postintervention did not differ between 2 groups . However , the within-group analysis indicated that only the intervention group showed a significant increase in voluntary activity , P < .02 , and energy expenditure , P < .02 , and a decrease in sedentary activity , P < .02 . These findings indicate that moderate-intensity aerobic exercise is beneficial in reducing deconditioning of cardiopulmonary responses in newly diagnosed breast cancer women undergoing adjuvant therapy The U.S. population is aging , bringing with it an increased prevalence of chronic disease and concomitant declines in physical function . The risk of developing cancer increases significantly with age , and functional decline is much more likely once a cancer diagnosis is rendered . Thus , functional status in later life is a key concern , one that is heightened among elders who have been diagnosed with cancer . To date , however , there have been few trials that have exclusively addressed issues related to cancer survivorship among older cancer patients , and to our knowledge , none has focused on preserving or enhancing physical functioning . This paper describes the study design and method ological considerations of a r and omized controlled trial to determine if a personally tailored workbook and telephone counseling program can positively affect physical activity and dietary behaviors and ultimately the physical functioning of up to 420 older men and women newly diagnosed with breast or prostate cancer . This trial is unique because the cancer diagnosis is used not only as a marker of risk for functional decline , but also as a " teachable moment " - an opportune time when elders may be more receptive to making beneficial lifestyle changes . Undoubtedly , as cure rates for cancer increase and intersect with ever-growing numbers of elderly , there will be numerous opportunities to provide and test interventions within this vulnerable population and to target functional status as a primary outcome . In reporting our methods , we hope to give others " a leg up , " so that they can hurdle with greater ease the barriers we experienced , and thus advance the field more rapidly Purpose Adherence to prescribed exercise is a challenge for cancer patients undergoing treatment . The changing pattern of exercise adherence over time can not be fully understood by an overall measure of adherence . This study was aim ed to identify the trajectory of exercise adherence and its predictors for women with breast cancer during their chemotherapy . Methods Participants were 78 women with breast cancer assigned to the exercise arm of a r and omized control trial . Based on the weekly adherence rates in time and intensity , patients were classified as good ( > 100 % ) , acceptable ( 80–100 % ) , and poor ( < 80 % ) adherents . Data were analyzed using ordinal logistic hierarchical linear modeling . Results The trajectories for both time and intensity adherence declined significantly . The decline in  exercise-time adherence  was significantly slower in women who reported higher interest in exercise . Women with higher perceived importance of exercise , early disease stage , and employed were more likely to be classified as good intensity adherents . Poorer weekly adherence for both exercise time and intensity was associated with higher fatigue level for that week . Conclusions  Adherence to exercise adherence in breast cancer patients declined as the dose of exercise prescription increased . Factors influencing overall adherence and adherence trend were identified PURPOSE ( a ) to determine if 110 postmenopausal breast cancer survivors ( BCS ) with bone loss who participated in 24 months of strength and weight training ( ST ) exercises  had improved muscle strength and balance and had fewer falls compared to BCS who did not exercise ; and ( b ) to describe type and frequency of ST exercises ; adverse effects of exercises ; and participants ' adherence to exercises at home , at fitness centers , and at 36-month follow up . DESIGN Findings reported are from a federally funded multicomponent intervention study of 223 postmenopausal BCS with either osteopenia or osteoporosis who were r and omly assigned to an exercise ( n=110 ) or comparison ( n=113 ) group . METHODS Time points for testing outcomes were baseline , 6 , 12 , and 24 months into intervention . Muscle strength was tested using Biodex Velocity Spectrum Evaluation , and dynamic balance using Timed Backward T and em Walk . Adherence to exercises was measured using self-report of number of prescribed sessions attended and participants ' reports of falls . FINDINGS Mean adherence over 24 months was 69.4 % . Using generalized estimating equation ( GEE ) analyses , compared to participants not exercising , participants who exercised for 24 months had significantly improved hip flexion ( p=0.011 ) , hip extension ( p=0.0006 ) , knee flexion ( p<0.0001 , knee extension ( p=0.0018 ) , wrist flexion ( p=0.031 ) , and balance ( p=0.010 ) . Gains in muscle strength were 9.5 % and 28.5 % for hip flexion and extension , 50.0 % and 19.4 % for wrist flexion and extension , and 21.1 % and 11.6 % for knee flexion and extension . Balance improved by 39.4 % . Women who exercised had fewer falls , but difference in number of falls between the two groups was not significant . CONCLUSIONS Many postmenopausal BCS with bone loss can adhere to a 24 month ST exercise intervention , and exercises can result in meaningful gains in muscle strength and balance . CLINICAL RELEVANCE More studies are needed for examining relationships between muscle strength and balance in postmenopausal BCS with bone loss and their incidence of falls and fractures PURPOSE Accumulating data suggest that exercise may affect breast cancer risk and outcomes . Studies have demonstrated that high levels of insulin , often seen in sedentary individuals , are associated with increased risk of breast cancer recurrence and death . We sought to analyze whether exercise lowered insulin concentrations in breast cancer survivors . METHODS One hundred one sedentary , overweight breast cancer survivors were r and omly assigned either to a 16-week cardiovascular and strength training exercise intervention or to a usual care control group .  Fasting insulin and glucose levels , weight , body composition , and circumference at the waist and hip were collected at baseline and 16 weeks . RESULTS Baseline and 16-week measurements were available for 82 patients .  Fasting insulin concentrations decreased by an average of 2.86 microU/mL in the exercise group ( P = .03 ) , with no significant change in the control group ( decrease of 0.27 microU/mL , P = .65 ) . The change in insulin levels in the exercise group seemed greater than the change in controls , but the comparison did not reach statistical significance ( P = .07 ) . There was a trend toward improvement in insulin resistance in the exercise group ( P = .09 ) but no change in fasting glucose levels . The exercise group also experienced a significant decrease in hip measurements , with no change in weight or body composition . CONCLUSION Participation in an exercise intervention was associated with a significant decrease in insulin levels and hip circumference in breast cancer survivors . The relationship between physical activity and breast cancer prognosis may be mediated , in part , through changes in insulin levels and /or changes in body fat or fat deposition Six hundred forty-six women with node-positive breast cancer from two prospect i ve , r and omized , adjuvant breast cancer trials were evaluated for changes in weight during and after receiving 60 weeks of chemotherapy , chemohormonal therapy , or observation . The median weight change in the 545 patients remaining on protocol at 60 weeks for observed postmenopausal patients was + 1.8 kg , for treated postmenopausal patients + 3.6 kg , and for treated premenopausal patients + 5.9 kg ( P less than .001 ) . After a median follow-up of 6.6 years , premenopausal women who gained more than the median weight at 60 weeks had a risk of relapse 1.5 times greater ( covariate P = .17 ) and a risk of death 1.6 times greater ( covariate P = .04 ) than premenopausal women who had gained less than the median weight . In the postmenopausal patients , the trend for inferior relapse-free and overall survival in those who gained more than the median weight at 60 weeks was not significant ( P = .05 ) . We conclude that , relative to observation , adjuvant chemotherapy is associated with greater weight gain in node-positive , postmenopausal breast cancer patients ; the amount of weight gain appears greater for premenopausal than postmenopausal women , and in premenopausal women , excessive weight gain may be associated with an increase in relapse and cancer-related deaths in the selected patients who show no evidence of recurrence during 60 weeks of adjuvant chemotherapy . This last point must be interpreted with caution because of the exploratory nature of the analyses Evidence suggests that exercise affects breast cancer risk and outcomes , but little is known about the mechanisms through which this effect may be mediated . This study examines the impact of exercise upon levels of adiponectin , high molecular weight adiponectin ( HMWA ) , and leptin in breast cancer survivors . Methods One hundred and one sedentary , overweight breast cancer survivors were r and omized to a 16-week exercise intervention or usual care control group . Anthropometric measurements were taken and fasting levels of adiponectin , HMWA and leptin were collected at baseline and 16 weeks . Results Baseline and week-16 measurements were available for 81 patients . The exercise group experienced a significant decrease in hip measurements , with no change in weight or body composition . There were no significant changes in adiponectin , HMWA , or leptin in either group . Modeling analyses demonstrated a significant inverse relationship between changes in leptin and adiponectin , but no relationship between changes in BMI , waist or hip circumference , or body fat percentage and change in leptin or adiponectin . Conclusions This study did not demonstrate a significant change in adipocytokine levels in breast cancer survivors participating in an exercise intervention  , suggesting that further work is needed to explore the mechanisms through which exercise may impact breast cancer The objective of this study was to determine the effects of exercise training on changes in C-reactive protein ( CRP ) and other cardiovascular risk factors in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control group ( n = 28 ) . The exercise group trained on cycle ergometers 3 times per week for 15 weeks . The control group did not train . The primary end point was change in CRP between baseline and week 15 . Secondary end points were changes in RHR , HRR , SBP , DBP , TC , LDL-C , HDL-C , TG , and TC : HDL-C ratio .  Fifty-two participants completed the trial . Baseline values did not differ between groups except that TG ( p = .007 ) and TC : HDL-C ratio ( p = .023 ) were higher in the exercise group . Intention-to-treat analysis showed that CRP decreased by 1.39 mg/L in the exercise group whereas it increased by 0.10 mg/L in the control group ( mean between group change , -1.49 mg/L ; 95 % CI , -3.09 to 0.10 mg/L ; p = .066 ) . Intention-to-treat analysis also showed a clinical ly and statistically significant difference between groups for change in HRR ( mean change , + 10.6 beats/min ; 95 % CI , + 3.4 to + 17.7 beats/min ; p = .004 ) and clinical ly but not statistically significant differences between groups for change in RHR ( mean change , -5.5 beats/min ; 95 % CI , -11.5 to + 0.5 beats/min ; p = .073 ) , SBP ( mean change , -5.5 mmHg ; 95 % CI , -14.5 to + 3.4 mmHg ; p = .218 ) , DBP ( mean change,-3.6 mmHg ; 95 % CI , -9.3 to + 2.1 mmHg ; p = .214 ) , and HDL-C ( mean change , + 0.05 mmol/L ; 95 % CI , -0.03 to 0.14 mmol/L ; p = .214 ) . These data suggest that exercise training may have beneficial effects on CRP and other cardiovascular risk factors in postmenopausal breast cancer survivors . Larger r and omized controlled trials are warranted PURPOSE This study , theoretically based on the Exercise Self-Esteem Model , EXSEM , examined effects of exercise modality on physical and global self-esteem ( PSE , GSE ) in breast cancer survivors . The EXSEM posits GSE at the apex with PSE feeding into GSE . PSE has three subdomains : physical condition ( PC ) , attractive body ( AB ) , and physical strength ( PS ) . The goals were to compare the effect of combination modality versus single-modality exercise on PSE and GSE and to explore the relationship between exercise modality and the subdomains of PSE . METHODS Survivors were r and omly allocated to flexibility ( F ) , aerobic ( A ) , resistance ( R ) , or aerobic plus resistance ( AR ) , 12-wk , individualized , home-based exercise program . Pre/posttesting included submaximal treadmill test , six-repetition maximum chest press and leg press , YMCA bench press , shoulder/hip flexibility , and bioelectric impedance analysis body composition . Esteem measures were the Physical Self-Perception Profile and the Rosenberg Self-Esteem Scale . RESULTS Forty-two women completed the study ( F = 12 , A = 10 , R = 9 , and AR = 11 ) . Fitness improvements congruent with exercise modality were seen in all groups . PSE and GSE outcomes did not reveal a greater effect from the combination modality program , AR , compared with the single-modality programs A and R. The relationships between the single-modality groups and the subdomains of PC , PS , and AB were supported in the R group ( PS and AB increased ) and were partially supported in the A group ( PC , not AB , increased ) . CONCLUSIONS A single-modality R program significantly improved all domains of PSE , and participation in the A program improved the PC subdomain . The combination exercise program did not enhance PSE greater than the single-modality programs . EXSEM was a useful framework for exploring esteem in breast cancer survivors OBJECTIVES This study compares the anxiolytic effects of a yoga program and supportive therapy in breast cancer out patients undergoing conventional treatment at a cancer centre . METHODS Ninety-eight stage II and III breast cancer out patients were r and omly assigned to receive yoga ( n=45 ) or brief supportive therapy ( n=53 ) prior to their primary treatment i.e. , surgery . Only those subjects who received surgery followed by adjuvant radiotherapy and six cycles of chemotherapy were chosen for analysis following intervention ( yoga , n=18 , control , n=20 ) . Intervention consisted of yoga sessions lasting 60min daily while the control group was imparted supportive therapy during their hospital visits as a part of routine care . Assessment s included Speilberger 's State Trait Anxiety Inventory and symptom checklist . Assessment s were done at baseline , after surgery , before , during , and after radiotherapy and chemotherapy . RESULTS A GLM-repeated measures ANOVA showed overall decrease in both self-reported state anxiety ( p<0.001 ) and trait anxiety ( p=0.005 ) in yoga group as compared to controls . There was a positive correlation between anxiety states and traits with symptom severity and distress during conventional treatment intervals . CONCLUSION The results suggest that yoga can be used for managing treatment-related symptoms and anxiety in breast cancer out patients PURPOSE Declines in physical functioning ( PF ) among elderly cancer patients threaten quality of life and the ability to maintain independence . Adherence to healthy lifestyle behaviors may prevent functional decline . PATIENTS AND METHODS Project Leading the Way in Exercise and Diet ( LEAD ) , an intervention development study of the Pepper Older Americans Independence Center , aim ed to determine whether breast and prostate cancer survivors ( age 65 + years ) assigned to a 6-month home-based diet and exercise intervention  experienced improvements in PF when compared with an attention control arm receiving general health information . An accrual target was set at 420 , and PF ( Short Form-36 subscale ) , physical activity ( Community Healthy Activities Models Program for Seniors ) , and diet quality ( index from 3-day recalls ) were assessed at baseline and at 6 and 12 months ( 6 months after intervention ) . RESULTS This developmental project did not achieve its accrual target ( N = 182 ) ; however , PF change scores were in the direction and of the magnitude projected . Baseline to 6-month change scores in the intervention versus the control arms were as follows : PF , + 3.1 v -0.5 ( P = .23 ) ; physical activity energy expenditure , + 111 kcal/wk v -400 kcal/wk ( P = .13 ) ; and diet quality index , + 2.2 v -2.9 ( P = .003 ) , respectively . Differences between arms diminished during the postintervention period . CONCLUSION These findings suggest that home-based diet and exercise interventions hold promise in improving lifestyle behaviors among older cancer survivors , changes that trend toward improved PF . Future studies should incorporate larger sample sizes and interventions that sustain long-term effects and also take into account secular trends ; these efforts will require adequate planning and re sources to overcome the numerous barriers to intervening in this difficult to reach yet vulnerable population PURPOSE The purpose of this study was to examine the longer-term effects of pedometers and print material s on changes in physical activity ( PA ) and health-related quality of life ( HRQoL ) in breast cancer survivors who participated in a 3-month behavior change intervention . METHODS Breast cancer survivors ( N = 377 ) were r and omly assigned to receive either ( a ) a st and ard public health recommendation for PA ( SR ) , ( b ) previously developed breast cancer-specific PA print material s ( PM ) , ( c ) a step pedometer ( PED ) , or ( d ) a combination of the two ( COM ) . The primary endpoint was self-reported moderate/vigorous PA minutes per week at 6-month follow-up after the initial 3-month intervention period . RESULTS Seventy-one percent ( 266/377 ) of participants completed the 6-month follow-up assessment . According to intention-to-treat linear mixed-model analyses , self-reported moderate to vigorous PA increased by 9 min x wk(-1 ) in the SR group compared with 39 min x wk(-1 ) in the PM group ( mean difference = 30 min x wk(-1 ) ; 95 % CI = -44 to 104 ; P = 0.425 ) , 69 min x wk(-1 ) in the PED group ( mean difference = 60 min x wk(-1 ) ; 95 % CI = -13 to 132 ; P = 0.107 ) , and 56 min x wk(-1 ) in the COM group ( mean difference = 47 min x wk(-1 ) ; 95 % CI = -26 to 119 ; P = 0.210 ) . The same pattern was observed for self-reported , brisk walking . No differences were found for HRQoL or fatigue . CONCLUSION ( S ) Breast cancer-specific PM and PED did not maintain significantly higher PA or HRQoL at 6-month follow-up in breast cancer survivors , but the magnitude of the effect on PA ( 30 - 60 min x wk(-1 ) ) was consistent with the immediate postintervention effect observed at the 3-month postintervention time point . Issues of power result ing from additional loss to follow-up may account for the failure to achieve statistical significance . Additional research with larger sample sizes and more complete follow-up is warranted Numerous studies have reported that exercise is safe and beneficial for breast cancer survivors ; however , long-term adherence to exercise programs is not easy to accomplish . This secondary analysis examined the demographic and clinical characteristics , adherence to exercise , and cognitive — behavioral intervention components data collected on 120 postmenopausal women with a history of breast cancer and bone loss who had been r and omized to the exercise group in a 24-month study . Hierarchical regression was used to identify variables that predicted adherence to  exercise . Mean adherence to  exercises  was 61.89 % .  Feedback and support were the most frequently used cognitive — behavioral intervention components . In hierarchical regression , predictors for adherence to exercise were feedback ( β = .40 , p < .001 ) and adherence to exercise  in the previous time period ( β = .31 , p < .001 ) . Participants receiving more frequent feedback had higher adherence to exercise The purpose of this pilot study was to examine the effects of a combined cardiorespiratory and resistance exercise training program of short duration on the cardiorespiratory fitness , strength endurance , task specific functional muscle capacity , body composition and quality of life ( QOL ) in women breast cancer survivors . Sixteen subjects were r and omly assigned to either a training ( n = 8 ; age : 50 + /- 5 yrs ) or control non-exercising group ( n = 8 ; age : 51 + /- 10 yrs ) . The training group followed an 8-week exercise program consisting of 3 weekly sessions of 90-min duration , supervised by an experienced investigator and divided into resistance exercises and aerobic training . Before and after the intervention period , all of the subjects performed a cardiorespiratory test to measure  peak oxygen uptake ( VO2peak ) , a dynamic strength endurance test ( maximum number of repetitions for chest and leg press exercise at 30 - 35 % and 100 - 110 % of body mass , respectively ) and a sit-st and test . Quality of life was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 ( EORTC-C30 ) question naire . In response to training , QOL , VO2peak ( mean 3.9 ml/kg/min ; 95 % CI , 0.93 , 6.90 ) performance in leg press ( 17.9 kg ; 95 % CI , 12.8 , 22.4 ) and sit-st and test ( - 0.67 s ; 95 % CI , - 0.52 , - 1.2 ) improved ( p < or = 0.05 ) . We observed no significant changes in the control group . Combined cardiorespiratory and resistance training , even of very brief duration , improves the QOL and the overall physical fitness of women breast cancer survivors BACKGROUND Exercise for Health was a pragmatic , r and omised , controlled trial comparing the effect of an eight-month exercise intervention on function , treatment-related side effects and quality of life following breast cancer , compared with usual care . The intervention commenced six weeks post-surgery , and two modes of delivering the same intervention was compared with usual care . The purpose of this paper is to describe the study design , along with outcomes related to recruitment , retention and representativeness , and intervention participation . METHODS Women newly diagnosed with breast cancer and residing in a major metropolitan city of Queensl and , Australia , were eligible to participate . Consenting women were r and omised to a face-to-face-delivered exercise group  ( FtF , n = 67 ) , telephone-delivered exercise group ( Tel , n = 67 ) or usual care group ( UC , n = 60 ) and were assessed pre-intervention ( 5-weeks post-surgery ) , mid-intervention ( 6 months post-surgery ) and 10 weeks post-intervention ( 12 months post-surgery ) . Each intervention arm entailed 16 sessions with an Exercise Physiologist . RESULTS Of 318 potentially eligible women , 63 % ( n = 200 ) agreed to participate , with a 12-month retention rate of 93 % . Participants were similar to the Queensl and breast cancer population with respect to disease characteristics , and the r and omisation procedure was mostly successful at attaining group balance , with the few minor imbalances observed unlikely to influence intervention effects given balance in other related characteristics . Median participation was 14 ( min and max : 0 and 16 ) and 13 ( min and max : 3 and 16 ) intervention sessions for the FtF and Tel , respectively , with 68 % of those in Tel and 82 % in FtF participating in at least 75 % of sessions . DISCUSSION Participation in both intervention arms during and following treatment for breast cancer was feasible and acceptable to women . Future work , design ed to inform translation into practice , will evaluate the quality of life , clinical , psychosocial and behavioural outcomes associated with each mode of delivery The effect of physiotherapy on shoulder function in patients surgically treated for breast cancer was examined through a r and omized controlled trial . One hundred and thirty-nine patients with newly diagnosed breast cancer were enrolled in the study . Sixty-two ( 45 % ) had Breast Conserving Therapy and 77 ( 55 % ) had Modified Radical Mastectomy ( Axillary dissection of level I and II was included in both procedures ) . Enrolled patients were r and omized to either group A or group B. Group A was offered , team instructed physiotherapy consisting of 12 sessions of 60 min , two sessions a week . The treatment was instituted between the sixth and eight postoperative week . Group B was also offered team instructed physiotherapy , consisting of 12 sessions of 60 minute two sessions a week , but not until the 26th postoperative week . The patients were seen for follow-up examinations four times during the first postoperative year ( after 7 , 13 , 26 and 56 weeks ) . Shoulder function was assessed by the Constant Shoulder Score preoperatively and at the four follow-up examinations . Team instructed physiotherapy was found to improve the shoulder function significantly in patients treated surgically for breast cancer . The effect of the treatment was influenced by the type of surgery performed , and in mastectomised patients , also by the application of radiation therapy .  Compromised shoulder function is a less frequent and less severe side effect to breast conserving therapy as compared to modified radical mastectomy 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 r and omized 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 r and omly 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 BACKGROUND The purpose of this study was to determine the feasibility of using a tumor registry to recruit newly diagnosed survivors into a r and omized controlled exercise trial and to discuss issues related to this recruitment strategy . METHODS A tumor registry-based rapid ascertainment system was used to recruit breast cancer survivors into a 6-month home-based , telephone-administered intervention of moderate-to-vigorous intensity exercise or a usual care group . RESULTS 468 newly diagnosed cases were identified . Of these , 50 women ( 15.4 % of those for which screening calls were made ) were enrolled in the study . Women were r and omized , on average , 11 weeks after diagnosis ( SD = 4.8 ) . Sixty-four percent were r and omized before beginning treatment or within the first week of treatment . Time required to obtain physician consent was the primary determinant of diagnosis-to-r and omization latency . Enrolled women were more likely than nonenrolled women to be non-Hispanic White and to have a college degree ( P < .05 ) . CONCLUSION Tumor registries present a feasible means of recruiting breast cancer survivors before or early in adjuvant treatment . The success of recruiting survivors promptly after diagnosis is largely dependent on ability to rapidly obtain physician consent . Specific effort is needed to counteract self- selection effects that may lead to under-representation of minorities Exercise use among patients with cancer has been shown to have many benefits and few notable risks . The purpose of this study was to evaluate the impact of a home-based walking intervention during cancer treatment on sleep quality , emotional distress , and fatigue . Methods . A total of 138 patients with prostate ( 55.6 % ) , breast ( 32.5 % ) , and other solid tumors ( 11.9 % ) were r and omized to a  home-based walking intervention or usual care . Exercise dose was assessed using a five-item subscale of the Cooper Aerobics Center Longitudinal Study Physical Activity Question naire . Primary outcomes of sleep quality , distress , and fatigue were compared between the two study arms . Results . The exercise group ( n = 68 ) reported more vigor ( p = .03 ) than control group participants ( n = 58 ) . In dose response models , greater participation in aerobic exercise was associated with 11 % less fatigue ( p < .001 ) , 7.5 % more vigor ( p = .001 ) , and 3 % less emotional distress ( p = .03 ) , after controlling for intervention group assignment , age , and baseline exercise and fatigue levels . Conclusion . Patients who exercised during cancer treatment experienced less emotional distress than those who were less active . Increasing exercise was also associated with less fatigue and more vigor .  Home-based walking is a simple , sustainable strategy that may be helpful in improving a number of symptoms encountered by patients undergoing active treatment for cancer OBJECTIVE To determine the effect of moderate-intensity aerobic exercise on the quality of life ( QOL ) and physical functioning in breast cancer survivors . MATERIAL S AND METHODS We r and omly assigned 62 breast cancer survivors to an  exercise ( N = 30 ) or control group ( N = 32 ) . The exercise group trained at a moderate intensity progressing from 25 to 40 min over a 10-week period . The control group did not train . Outcomes were assessed at baseline and postintervention . The primary outcomes were overall QOL -- as assessed by the functional assessment of cancer therapy-breast ( FACT-B ) scale . Secondary outcomes were changes in various subscales of overall QOL , and changes in body composition outcomes : body weight , body mass index , and changes in performance in a 12 min walk test ( 12MWT ) . RESULTS Sixty-two of 73 women r and omized ( 84.9 % ) completed the study . There were no significant differences amongst the two groups at baseline for any variable . In the exercise group significant improvements were demonstrated for the FACT-B ( 13.4 points , P < 0.003 ) , functional assessment of cancer therapy-general ( FACT-G ) ( 9.16 points , P < 0.008 ) , the functional well-being subscale ( P < 0.010 ) , and the emotional well-being subscale ( P < 0.035 ) compared to the control group . No significant changes in body weight or BMI were observed . Exercise group showed a significant increase in 12MWT ( P < 0.009 ) . CONCLUSION We conclude that 10 week of moderate-intensity aerobic exercise program significantly improves QOL and physical functioning in breast cancer survivors . Future studies are needed to evaluate the effectiveness of similar exercise programs over longer periods of time and involving a greater number of breast cancer survivors Background : Aerobic exercise training ( AET ) is known to increase RBC production ; however , this has not been evaluated in breast cancer patients undergoing adjuvant chemotherapy . The purpose of this study was to examine the changes in hemoglobin ( Hb ) levels in the Supervised Trial of Aerobic versus Resistance Training ( START ) and to determine its association with changes in VO2peak . Methods : Two hundred and forty-two breast cancer patients initiating chemotherapy were r and omized to usual care ( n = 82 ) , resistance exercise ( RET , n = 82 ) , or AET ( n = 78 ) groups for the duration of their chemotherapy ( median , 17 weeks ) . Supervised exercise was thrice weekly based on st and ard AET and RET prescriptions .  Aerobic fitness ( VO2peak ) and Hb concentration were measured at baseline and end of chemotherapy . Results : Regardless of the exercise group , Hb declined over the course of chemotherapy ( 13.4 ± 10.0 to 11.8 ± 11.5 g/dL , P < 0.01 ) . Both AET and RET groups had significant , moderate correlations between the change in VO2peak and Hb ( AET : r = 0.49 , P < 0.001 ; RET : r = 0.39 , P = 0.001 ) . Conclusion : The results indicate that regular exercise does not protect against the decline in Hb associated with chemotherapy in breast cancer patients , but result ed in a stronger association between Hb and VO2peak . Impact : Even with the chemotherapy-induced decline in Hb , breast cancer patients can maintain their aerobic capacity by participating in regular aerobic exercise . Further studies are required to determine safe intensity levels that may stimulate the maintenance of Hb levels in breast cancer patients . Cancer Epidemiol Biomarkers Prev ; 19(11 ) ; 2826–32 . © 2010 AACR Chemotherapy for breast cancer causes early-onset menopause for most women older than age 40 and is associated with accelerated bone loss . The primary objective of this study was to compare the effects of intravenous ( IV ) zoledronic acid versus prescribed physical activity ( PA ) on changes in bone mineral density ( BMD ) for women between the ages of 40 and 55 years receiving chemotherapy for breast cancer . A r and omized controlled trial of 62 patients with breast cancer during chemotherapy compared IV zoledronic acid and oral calcium/vitamin D ( ZO group ) versus a PA program and oral calcium/vitamin D ( PA group ) . ZO group participants received zoledronic acid IV every 3 months for 5 treatments . PA group participants were enrolled in a home-based exercise program and received motivational counseling , pedometers , and exercise tapes .  BMD measurements from dual-energy x-ray absorptiometry ( DEXA ) scanning were completed at baseline and at 12 months . BMD significantly decreased in the PA group but not in the ZO group . Although spine , total hip , and total body BMD increased in the ZO group by 1.6 % , 0.8 % , and 0.8 % , respectively , BMD decreased in the PA group by 6.0 % , 3.4 % , and 3.3 % , respectively ( P values < 0.0001 for all group comparisons ) . Zoledronic acid protected patients with breast cancer against bone loss during initial treatment , whereas home-based PA interventions were less effective in preventing bone loss ABSTRACT The primary objective of this pilot study was to explore the feasibility of implementing two exercise programs for female patients who are breast cancer survivors and residents of the metropolitan area of San Juan , Puerto Rico . Potential benefits and complications of participating in a gym‐exercise program or a home‐exercise program , as opposed to st and ard care , were identified . Participants were r and omly assigned to 1 of 3 groups : a gym‐exercise group , a home‐exercise group , or a non‐exercise group . Interventions consisted of exercise programs with both aerobic and strengthening components , offered for a 26‐week period . Outcome measures consisted of functional evaluation , shoulder range of motion , 12‐minute walk test , h and grip strength , body mass index , and quality of life . The results of this study showed that it is feasible for Puerto Rican women to participate in a moderate intensity exercise program without developing complications . Participation in the exercise programs studied here minimized the side effects after cancer treatment , such as reduced physical functional ability and restricted shoulder mobility . Improvements were found in the measures of shoulder range of motion , upper extremity related physical function , and distance walked PURPOSE This study examined the effects of aerobic exercise using a flex b and on the improvement of physical functions & body image in breast cancer women undergoing radiation therapy after a mastectomy . METHOD Women with breast cancer(n = 26 ) were assigned to an experimental group(EG , n = 15 ) and control group(CG , n = 11 ) . The E.G. participated in an aerobic exercise program with a 60 % to 80 % intensity of maximal heart rate for 25 minutes during the main exercise , 3 times per week , for 6 weeks . The EG did not exercise regularly for 3 months before participating in this program . The CG received no exercise treatment during the research period . Data were analyzed using the chi(2)-test and Mann-Whitney U test by the SPSS version 11.0 program at a 5 % significant level . RESULTS Group analysis revealed that the EGwomen had significantly more improved cardiopulmonary functions , ROM of the affected shoulder joint , and body image compared to the CG . CONCLUSION Aerobic exercise using a flex b and may be an effective rehabilitative measure for mastectomy women with respect to cardio-pulmonary functions , ROM , & body image . Further studies are recommended to study early rehabilitation programs within 10 days post-operatively This study aims to test the effects of yoga on health-related quality of life , life satisfaction , cancer-related fatigue , mindfulness , and spirituality compared to conventional therapeutic exercises during (neo)adjuvant cytotoxic and endocrine therapy in women with breast cancer . In a r and omized controlled trial 92 women with breast cancer undergoing oncological treatment were r and omly enrolled for a yoga intervention ( YI ) ( n = 45 ) or for a physical exercise intervention ( PEI ) ( n = 47 ) . Measurements were obtained before ( t 0 ) and after the intervention ( t 1 ) as well as 3 months after finishing intervention ( t 2 ) using st and ardized question naires . Life satisfaction and fatigue improved under PEI ( p < 0.05 ) but not under YI ( t 0 to t 2 ) . Regarding quality of life ( EORTC QLQ-C30 ) a direct effect ( t 0 to t 1 ; p < 0.001 ) of YI was found on role and emotional functioning , while under PEI only emotional functioning improved . Significant improvements ( p < 0.001 ) were observed at both t 1 and t 2 also for symptom scales in both groups : dyspnea , appetite loss , constipation , and diarrhea . There was no significant difference between therapies for none of the analyzed variables neither for t 1 nor for t 2 . During chemotherapy , yoga was not seen as more helpful than conventional therapeutic exercises . This does not argue against its use in the recovery phase Introduction Breast cancer survivors experience diminished health-related quality of life ( HRQOL ) . We report on the influence of tai chi chuan exercise ( TCC ) on HRQOL and explore associations between changes in HRQOL and biomarkers . Methods Breast cancer survivors ( N = 21 ) were r and omly assigned to TCC or st and ard support therapy ( SST ) for 12 weeks ( three times/week ; 60 min/session ) . Interleukin-6 , interleukin-8 ( IL-8 ) , insulin-like growth factor-1 ( IGF-1 ) , insulin-like growth factor-binding protein (IBFBP)-1 , IGFBP-3 , glucose , insulin , and cortisol were measured pre- and postintervention . Overall HRQOL and subdomains were assessed at preintervention ( T1 ) , midintervention ( T2 ) and postintervention ( T3 ) and biomarkers at T1 and T3 . Results The TCC group improved in total HRQOL ( T1–T2:CS = 8.54 , P = 0.045 ) , physical functioning ( T1–T2:CS = 1.89 , P = 0.030 ) , physical role limitations ( T1–T2 CS = 1.55 , P = 0.023 ) , social functioning ( T1–T3:CS = 1.50 , P = 0.020 ) , and general mental health ( T1–T2:CS = 2.67 , P = 0.014 ; T1–T3:CS = 2.44 , P = 0.019 ) . The SST  improved in social functioning ( T1–T2:CS = 0.64 , P = 0.043 ) and vitality ( T1–T2:CS = 0.90 , P = 0.01 ) . There were relationships between changes in IGF-1 and overall HRQOL ( r = −0.56 ; P < 0.05 ) , physical role limitation ( r = −0.68 ; P < 0.05 ) , and social functioning ( r = −0.56 ; P < 0.05 ) . IGFBP-1 changes were associated with physical role limitations changes ( r = 0.60 ; P < 0.05 ) . IGFBP-3 changes were associated with physical functioning changes ( r = 0.46 ; P ≤ 0.05 ) . Cortisol changes were associated with changes in physical role limitations ( r = 0.74 ; P < 0.05 ) and health perceptions ( r = 0.46 ; P < 0.05 ) . Glucose changes were associated with emotional role limitation changes ( r = −0.70 ; P < 0.001 ) . IL-8 changes were associated with emotional role limitation changes ( r = 0.59 ; P < 0.05 ) . Discussion / conclusions TCC may improve HRQOL by regulating inflammatory responses and other biomarkers associated with side effects from cancer and its treatments . Implication s for cancer survivorsTCC may be an intervention capable of improving HRQOL in breast cancer survivors PURPOSE Patients with breast cancer on adjuvant chemotherapy can experience weight gain and concurrent losses in muscle mass .  Exercise interventions can prevent these changes , but time and travel pose barriers to participation . The Survivor Training for Enhancing Total Health ( STRENGTH ) trial assessed the feasibility and impact of 2 home-based interventions . PATIENTS AND METHODS Ninety premenopausal patients with breast cancer on adjuvant chemotherapy were r and omized to a calcium-rich diet ( CA ) intervention ( attention control ) or to 2 experimental arms : a CA + exercise ( EX ) arm or a CA + EX and high fruit and vegetable , low-fat diet ( FVLF ) arm . Exercise arms included aerobic and strength-training exercises .  Body composition , weight status , waist circumference , dietary intake , physical activity , quality of life , anxiety , depression , serum lipids , sex hormone binding globulin , insulin , proinsulin , C-reactive protein , interleukin-1B , and tumor-necrosis factor receptor-II were measured at baseline and at 6-month follow-up . RESULTS Accrual targets were achieved and modest attrition was observed ( 8.8 % ) . Self-reports suggest increased calcium intakes in all arms , and higher fruit and vegetable and lower fat intake in the CA + EX + FVLF arm ; no differences in physical activity were observed . While measures of adiposity were generally lower in the CA + EX + FVLF arm , the only significant difference was in percentage of body fat ( arms and legs ) ; change in scores ( mean + /- st and ard deviation ) were + 0.7 % + /- 2.3 % ( CA ) ; + 1.2 % + /- 2.7 % ( CA + EX ) ; and + 0.1 % + /- 2 % ( CA + EX + FVLF ; P = .047 ) . Lean body mass was largely preserved , even in the control arm ( net gain of 452 g + /- 2395 g ) . No differences were observed in other endpoints . CONCLUSION Diet and exercise interventions can prevent weight gain and adverse body composition changes , but more research is needed to determine optimally effective interventions that can be implemented during active treatment and that promote adherence PURPOSE This study examines the impact of yoga , including physical poses , breathing , and meditation exercises , on quality of life ( QOL ) , fatigue , distressed mood , and spiritual well-being among a multiethnic sample of breast cancer patients . PATIENTS AND METHODS One hundred twenty-eight patients ( 42 % African American , 31 % Hispanic ) recruited from an urban cancer center were r and omly assigned ( 2:1 ratio ) to a 12-week yoga intervention ( n = 84 ) or a 12-week waitlist control group ( n = 44 ) . Changes in QOL ( eg , Functional Assessment of Cancer Therapy ) from before r and om assignment ( T1 ) to the 3-month follow-up ( T3 ) were examined ; predictors of adherence were also assessed . Nearly half of all patients were receiving medical treatment . RESULTS Regression analyses indicated that the control group had a greater decrease in social well-being compared with the intervention group after controlling for baseline social well-being and covariates ( P < .0001 ) . Secondary analyses of 71 patients not receiving chemotherapy during the intervention period indicated favorable outcomes for the intervention group compared with the control group in overall QOL ( P < .008 ) , emotional well-being ( P < .015 ) , social well-being ( P < .004 ) , spiritual well-being ( P < .009 ) , and distressed mood ( P < .031 ) . Sixty-nine percent of intervention participants attended classes ( mean number of classes attended by active class participants = 7.00 + /- 3.80 ) , with lower adherence associated with increased fatigue ( P < .001 ) , radiotherapy ( P < .0001 ) , younger age ( P < .008 ) , and no  antiestrogen therapy  ( P < .02 ) . CONCLUSION Despite limited adherence , this intent-to-treat analysis suggests that yoga is associated with beneficial effects on social functioning among a medically diverse sample of breast cancer survivors . Among patients not receiving chemotherapy , yoga appears to enhance emotional well-being and mood and may serve to buffer deterioration in both overall and specific domains of QOL OBJECTIVES To assess the feasibility and efficacy of delivering Pilates exercises for resistance training to breast cancer survivors using the MVe Fitness Chair ™ . DESIGN Pilot r and omized controlled trial . METHODS Twenty-six female breast cancer survivors were r and omized to use the MVe Fitness Chair ™ ( n=8 ) , traditional resistance training ( n=8 ) , or a control group ( no exercise ) ( CO ) ( n=10 ) . The MVe Fitness Chair ™ and traditional resistance training groups completed 8 weeks of exercise . Muscular endurance was assessed pre and post-test for comparisons within and between groups using push ups , curl ups , and the Dynamic Muscular Endurance Test Battery for Cancer Patients of Various Ages . RESULTS Feasibility of the MVe Fitness Chair ™ was good , evidence d by over 80 % adherence for both exercise groups and positive narrative feedback . Significant improvements in muscular endurance were observed in the MVe Fitness Chair ™ ( p<0.002 ) and traditional resistance training groups ( p<0.001 ) , but there were no differences in improvement between the MVe Fitness Chair ™ and traditional resistance training groups ( p<0.711 ) indicating that Pilates and traditional resistance training may be equally effective at improving muscular endurance in this population . CONCLUSIONS The MVe Fitness Chair ™ is feasible for use in breast cancer survivors . It appears to promote similar improvements in muscular endurance when compared to traditional resistance training , but has several advantages over traditional resistance training , including cost , logistics , enjoyment , and ease of learning OBJECTIVE This paper will report the results of a pilot test of a 6-month , 21-session intervention to increase breast cancer survivors ' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines ( lifestyle intervention ) . The effect of the intervention on physical performance , quality of life , and physical activity are reported . METHODS Sixty breast cancer survivors were r and omized to either a  lifestyle intervention  or a  st and ard care control group .  Physical performance , quality of life ( Medical outcomes study short form-36 [ SF-36 ] ) , and physical activity ( 7-day recall and motivation readiness ) , were assessed at baseline and 6 months . RESULTS The lifestyle group had significantly better performance in the 6-min walk task than the controls ( p=0.005 ) at 6 months . The intervention had positive effects on the bodily pain ( p=0.020 ) and general health ( p=0.006 ) subscales from the SF-36 . The lifestyle group had a greater motivational readiness for physical activity at 6-month than st and ard care , but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or = 30 min of moderate or more intense activity . CONCLUSIONS Despite the small sample size , the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity , and should be tested in a larger r and omized trial . PRACTICE IMPLICATION S If the lifestyle approach is shown to be effective in a larger trial , it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity ( VO2Lmax ) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied . Subjects were stratified by baseline functional capacity ( ± 1 MET ) and r and omized to experimental ( EX ) , placebo ( PL ) , and control ( CO ) groups . EX subjects completed a 10-week , 3 times/week exercise training program ; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises ; the CO group maintained normal activities . The EX group showed significant , p < .05 , improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups . The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy Physical exercise has been shown to enhance quality of life ( QOL ) in cancer survivors using pretest-posttest design s and compared to usual care ( i.e. no intervention ) . In the present study , we conducted a r and omized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy ( GP ) . We matched 22 GP classes ( N=108 ) on content and then r and omly assigned 11 ( n=48 ) to GP alone and 11 ( n=60 ) to GP plus home-based , moderate-intensity exercise ( GP+EX ) . Participants completed a physical fitness test and QOL measures ( e.g. Functional Assessment of Cancer Therapy scales ) at the beginning and end of GP classes ( about 10 weeks ) . We had excellent recruitment ( 81 % ) , retention ( 89 % ) , and adherence ( 84 % ) rates and a modest contamination ( 22 % ) rate . Using intention-to-treat repeated measures analyses of variance , we found significant Time by Condition interactions for functional well-being , fatigue , and sum of skinfolds . We also found borderline significant interactions for physical well-being , satisfaction with life , and flexibility . All interactions favored the GP+EX condition . We conclude that a home-based , moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP , particularly in relation to physical and functional well-being Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy .  The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence -based treatments are available to manage this distressing side-effect . The purpose of this multi-institutional r and omized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer . Sedentary women ( N=119 ) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were r and omized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment . Of participants r and omized to exercise , 72 % adhered to the exercise prescription ; 61 % of the usual care group adhered . The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39 % of the usual care group exercised and 28 % of the exercise group did not . When exercise participation was considered using the data analysis method of instrumental variables with principal stratification , a clinical ly important and statistically significant ( p=0.03 ) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated . Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment PURPOSE / OBJECTIVES To describe and predict adherence to a physical activity protocol for patients with breast cancer receiving chemotherapy .  DESIGN Longitudinal , observational study . SETTING Cancer center in the upper Midwestern region of the United States . SAMPLE 36 patients with breast cancer aged 40 - 55 years who were receiving adjuvant treatment . METHODS A longitudinal study was conducted within a r and omized clinical trial comparing the effects of physical activity versus bisphosphonates on bone mineral density . Participants r and omized to physical activity were advised to walk 10,000 steps per day and received initial physical therapy consultation and ongoing motivational interviewing . Multilevel modeling was used to identify variables that predict adherence . MAIN RESEARCH VARIABLES Adherence to the 10,000-step protocol was estimated with total steps and mean steps per day . FINDINGS Thirty-six women were enrolled in the physical activity group ; 29 provided step data . The mean total steps per participant for the first six weeks was 280,571 ( SD = 111,992 ) , which is 67 % of the prescribed steps . Excluding days when no steps were recorded , the mean steps per day for the initial six-week period was 7,363 ( SD = 2,421 ) , a 74 % adherence rate . A significant linear increase occurred in steps per day after chemotherapy in a treatment cycle ( p < 0.0001 ) . Baseline inactivity predicted adherence . CONCLUSIONS Adherence to the walking program was compromised during chemotherapy but improved after chemotherapy completion . IMPLICATION S FOR NURSING Knowing that chemotherapy predicts adherence to a walking protocol is useful for selecting the type , timing , and intensity of physical activity interventions Given observational findings that physical activity reduces breast cancer risk , improves survival , and improves quality of life in breast cancer survivors , a need has been identified for r and omized controlled trials that testthe efficacy of exercise on biological mechanisms associated with breast cancer survival . The primary aims of the Yale Exercise and Survivorship Study were to 1 ) determine the feasibility of recruiting breast cancer survivors into a r and omized controlled trial of the effects of exercise on biological markers and /or mechanisms associated with survival , 2 ) compare the effectiveness of various recruitment strategies on accrual rates and baseline characteristics , and 3 ) report adherence to the exercise trial BACKGROUND AND RATIONALE Cancer-related fatigue is a common severe symptom in breast cancer patients , especially during chemotherapy . Exercise appears to be promising in prevention or treatment of fatigue .  Resistance training as an accompanying treatment to chemotherapy has been minimally investigated , yet might counteract muscle degradation and inflammation caused by many chemotherapeutics , and thus forestall or reduce fatigue . Previous exercise trials mostly compared the intervention with ' usual care ' . Therefore , it is unclear to what extent the observed effects on fatigue are based on physical adaptations by exercise itself , or rather on psycho-social factors linked to the group support or attention by the trainer . METHODS AND DESIGN The BEATE study is a r and omized , controlled intervention trial comparing a 12-week supervised progressive resistance training program with a supervised group-based progressive muscle relaxation training in 100 patients with breast cancer under adjuvant chemotherapy .  The primary endpoint is cancer-related fatigue ; secondary endpoints include quality of life , depression , and cognitive capacity . In addition , isokinetic and isometric muscle strength , cardiorespiratory fitness , and body composition are measured , and biomarkers , such as inflammatory parameters , cortisol , and oxidative stress are analyzed in blood , saliva and urine . Safety of the resistance training during chemotherapy is monitored . DISCUSSION Strengths of the BEATE study include the investigation of progressive resistance training parallel with chemotherapy , the choice of a control group that enables an evaluation of the physiological effects of exercise beyond potential psycho-social effects , and the comprehensive and high- quality assessment of physiological factors and biomarkers potentially related to fatigue Abstract Background . To evaluate the safety and efficacy of moderate-to-high intensity aerobic training in breast cancer patients receiving neoadjuvant chemotherapy . Methods . Twenty patients with stage IIB – IIIC operable breast cancer were r and omly assigned to receive doxorubicin plus cyclophosphamide ( AC ) or AC in combination with aerobic training ( AC + AET ) ( n = 10/group ) for 12 weeks . The AC+ AET group performed three supervised aerobic cycle ergometry sessions per week at 60%–100 % of exercise capacity ( VO2peak ) . Safety outcomes included exercise testing as well as treatment- and exercise training-related adverse events ( AEs ) , whereas efficacy outcomes included cardiopulmonary function and patient-reported outcomes ( PROs ) as measured by a cardiopulmonary exercise test ( CPET ) and Functional Assessment of Cancer Therapy-Breast ( FACT-B ) scale . Results . Twelve non-significant ECG abnormalities and three non-life threatening events occurred during CPET procedures . One AE was reported during aerobic training . There were no significant between group differences for clinician-documented events ( e.g. pain , nausea ) or hematological parameters ( p 's > 0.05 ) . Attendance and adherence rates to aerobic training were 82 % and 66 % , respectively . Intention-to-treat analysis indicated that VO2peak increased by 2.6 ± 3.5 ml/kg/min ( + 13.3 % ) in the AC + AET group and decreased by 1.5 ± 2.2 ml/kg/min ( −8.6 % ) in the AC group ( between group difference , p = 0.001 ) . FACT-B increased 11.1 points in the AC + AET group compared to a 1.5 point decrease in the AC group ( between group difference , p = 0.685 ) . Conclusion . Moderate-to-high intensity aerobic training when conducted with one-on-one supervision is a safe adjunct therapy associated with improvements in cardiopulmonary function and select PROs during neoadjuvant chemotherapy
BACKGROUND A huge clinical research data base on adjuvant cancer treatment has verified improvements in breast cancer outcomes such as recurrence and mortality rates .
On the other h and , adjuvant and neoadjuvant therapy with chemotherapy and radiotherapy impacts on quality of life due to substantial short- and long-term side effects .
A number of studies have evaluated the effect of exercise interventions on those side effects .
The original review identified some benefits of physical activity on physical fitness and the result ing capacity for performing activities of daily life .
It also identified a lack of evidence for other outcomes , providing clear justification for an up date d review .
OBJECTIVES To assess the effect of aerobic or resistance exercise interventions during adjuvant treatment for breast cancer on treatment-related side effects such as physical deterioration , fatigue , diminished quality of life , depression , and cognitive dysfunction .