Effect of Exercise on Markers of Inflammation in Breast Cancer Survivors: The Yale Exercise and Survivorship Study A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Endothelial function in long-term survivors of childhood acute lymphoblastic leukemia: effects of a home-based exercise program. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Obesity and physical inactivity are related to impaired physical health of breast cancer survivors. Prehabilitation Influences Exercise-Related Psychological Constructs Such as Self-efficacy and Outcome Expectations to Exercise Surveillance of demographic characteristics and health behaviors among adult cancer survivors--Behavioral Risk Factor Surveillance System, United States, 2009. Internet-Based Physical Activity Intervention Targeting Young Adult Cancer Survivors. Social cognitive influences on physical activity participation in long-term breast cancer survivors.
Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR The objective of this study was to develop a prospect ively applicable method for classifying comorbid conditions which might alter the risk of mortality for use in longitudinal studies . A weighted index that takes into account the number and the seriousness of comorbid disease was developed in a cohort of 559 medical patients . The 1-yr mortality rates for the different scores were : " 0 " , 12 % ( 181 ) ; " 1 - 2 " , 26 % ( 225 ) ; " 3 - 4 " , 52 % ( 71 ) ; and " greater than or equal to 5 " , 85 % ( 82 ) . The index was tested for its ability to predict risk of death from comorbid disease in the second cohort of 685 patients during a 10-yr follow-up . The percent of patients who died of comorbid disease for the different scores were : " 0 " , 8 % ( 588 ) ; " 1 " , 25 % ( 54 ) ; " 2 " , 48 % ( 25 ) ; " greater than or equal to 3 " , 59 % ( 18 ) . With each increased level of the comorbidity index , there were stepwise increases in the cumulative mortality attributable to comorbid disease ( log rank chi 2 = 165 ; p less than 0.0001 ) . In this longer follow-up , age was also a predictor of mortality ( p less than 0.001 ) . The new index performed similarly to a previous system devised by Kaplan and Feinstein . The method of classifying comorbidity provides a simple , readily applicable and valid method of estimating risk of death from comorbid disease for use in longitudinal studies . Further work in larger population s is still required to refine the approach because the number of patients with any given condition in this study was relatively small BACKGROUND The risk for cardiovascular disease ( CVD ) is increased in long-term survivors of childhood acute lymphoblastic leukemia ( ALL ) .  Chemotherapy may have direct toxic effects on vascular endothelium , potentially increasing the significance of endothelial dysfunction in the development of CVD in ALL survivors . Endothelial structure and function can be measured with carotid intima media thickness ( IMT ) and brachial flow mediated dilation ( FMD ) . IMT and FMD are intermediate markers of CVD . We studied endothelial function and the effects of an exercise program on vascular endothelium in long-term survivors of childhood ALL . PROCEDURE Twenty-one 16 - 30 year old long-term survivors of ALL ( age at diagnosis ≤16 years ) and 21 healthy controls were studied at baseline , and 17 of the ALL survivors participated in a 16 week home-based exercise program . IMT and FMD were studied before and after the exercise program . RESULTS At baseline , the ALL survivors had impaired overall FMD response ( FMDauc , P = 0.02 ) . FMDmax(% ) was 22 % lower ( P = 0.06 ) and FMD at 40 seconds 44 % lower ( P = 0.01 ) compared to healthy controls . After the exercise program , FMD at 40 seconds ( P < 0.01 ) and IMT ( P = 0.02 ) improved . The mean overall FMD response increased by 25 % after the exercise program , but this change was not statistically significant ( P = 0.27 ) . CONCLUSIONS Our results show that the excess burden of CVD morbidity in this population may possibly be alleviated by simple means . The importance of physical activity on the health of childhood ALL survivors should be emphasized . Longer , controlled studies are needed to confirm our findings 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 AIM The aim of the present study was to examine the impact of obesity and physical activity on the health and wellbeing of patients with breast cancer shortly after the adjuvant treatments . PATIENTS AND METHODS A total of 537 women aged 35 to 68 years with newly-diagnosed breast cancer were enrolled into the exercise intervention study .  The physical activity , physical performance ( 2-km walking test ) , cardiovascular risk factors , quality of life ( EORTC-QoL-C30 ) , co-morbidities and body-mass index ( BMI ) were measured after the adjuvant treatments . RESULTS Overall , 191 ( 39 % ) patients were overweight ( BMI = 25 - 30 ) and 85 ( 17 % ) obese ( BMI ≥ 30 ) . Physical activity and performance ( p<0.001 and p<0.001 ) , QoL ( p<0.001 ) and high density lipoprotein (HDL)-cholesterol decreased ( p<0.001 ) whereas age ( p=0.009 ) , co-morbidities ( p<0.001 ) , hypertension ( p=0.011 ) , metabolic syndrome ( p<0.001 ) , low density lipoprotein (LDL)-cholesterol ( p=0.0043 ) , triglycerides ( p<0.001 ) , glucose ( p<0.001 ) and insulin ( p<0.001 ) increased linearly with BMI . Higher waist circumference ( p=0.0011 ) , triglyceride ( p=0.020 ) , insulin ( p=0.0098 ) , rate of metabolic syndrome ( p=0.028 ) , and lower HDL-cholesterol ( p=0.012 ) and QoL ( p<0.001 ) were associated with low physical activity . Physical activity and BMI were the most important determinants of physical performance ( p<0.001 and p<0.001 , respectively ) . CONCLUSION Obesity and a sedentary lifestyle are related to poor physical performance , increased risk of cardiovascular diseases and impaired QoL , leading to a vicious circle , which impairs patients ' physical health and Abstract Brown , K , Loprinzi , PD , Brosky , JA , and Topp , R. Prehabilitation influences exercise-related psychological constructs such as self-efficacy and outcome expectations to exercise . J Strength Cond Res 28(1 ) : 201–209 , 2014—Osteoarthritis ( OA ) is a clinical condition affecting more than 27 million Americans . There is no known cure for OA other than replacing the diseased joint with a joint prosthesis , a process called total knee arthroplasty ( TKA ) . The TKA projections for the year 2016 are 1,046,000 , and this number is predicted to increase by 600 % to more than 3.4 million cases by 2030 . The purpose of this study was to determine whether knee OA patients who engage in guided exercise ( prehabilitation ) before their TKA report higher levels of self-efficacy to exercise ( SEE ) and higher outcome expectations for exercise ( OEE ) than those who do not . Thirty-one participants were r and omized into 2 groups ( 16 in  prehabilitation group [ PRE  ] and 15 in  control group [ CON ] )  , all participants completed the protocol ( 22 women and 9 men ) . The PRE group participated in an exercise intervention ( prehabilitation ) 3 times per week for 8 weeks before TKA . One-way repeated measures analysis of variance was used to investigate the effects of group ( PRE vs. CON ) , time ( baseline T1 , T2 , T3 , and T4 ) , and the interaction of group and time on the dependent variables of SEE and OEE . This analysis indicated that SEE did not change over time ( p = 0.62 ) or between the groups ( p = 0.86 ) . The analysis of the OEE indicated a significant time effect ( p = 0.008 ) . Post hoc analysis indicated that the CON group significantly declined between T2 and T4 . The PRE group did not significantly change their OEE over the 4 data collection points of the study PROBLEM/CONDITION Approximately 12 million people are living with cancer in the United States . Limited information is available on national and state assessment s of health behaviors among cancer survivors . Using data from the Behavioral Risk Factor Surveillance System ( BRFSS ) , this report provides a descriptive state-level assessment of demographic characteristics and health behaviors among cancer survivors aged ≥18 years . REPORTING PERIOD COVERED 2009 DESCRIPTION OF SYSTEM BRFSS is an ongoing , state-based , r and om-digit-dialed telephone survey of the noninstitutionalized U.S. population aged ≥18 years . BRFSS collects information on health risk behaviors and use of preventive health services related to leading causes of death and morbidity . In 2009 , BRFSS added questions about previous cancer diagnoses to the core module . The 2009 BRFSS also included an optional cancer survivorship module that assessed cancer treatment history and health insurance coverage for cancer survivors . In 2009 , all 50 states , the District of Columbia , Guam , Puerto Rico , and the U.S. Virgin Isl and s administered the core cancer survivorship questions , and 10 states administered the optional supplemental cancer survivorship module . Five states added questions on mammography and Papanicolaou ( Pap ) test use , eight states included questions on colorectal screening , and five states included questions on prostate cancer screening . RESULTS An estimated 7.2 % of the U.S. general population aged ≥18 years reported having received a previous cancer diagnosis ( excluding nonmelanoma skin cancer ) . A total of 78.8 % of cancer survivors were aged ≥50 years , and 39.2 % had received a diagnosis of cancer > 10 years previously . A total of 57.8 % reported receiving an influenza vaccination during the previous year , and 48.3 % reported ever receiving a pneumococcal vaccination  . At the time of the interview , 6.8 % of cancer survivors had no health insurance , and 12 % had been denied health insurance , life insurance , or both because of their cancer diagnosis . The prevalence of cardiovascular disease was higher among male cancer survivors ( 23.4 % ) than female cancer survivors ( 14.3 % ) , as was the prevalence of diabetes ( 19.6 % and 14.7 % , respectively ) . Overall , approximately 15.1 % of cancer survivors were current cigarette smokers , 27.5 % were obese , and 31.5 % had not engaged in any leisure-time physical activity during the past 30 days . Demographic characteristics and health behaviors among cancer survivors varied substantially by state . INTERPRETATION Health behaviors and preventive health care practice s among cancer survivors vary by state and demographic characteristics . A large proportion of cancer survivors have comorbid conditions , currently smoke , do not participate in any leisure-time physical activity , and are obese . In addition , many are not receiving recommended preventive care , including cancer screening and influenza and pneumococcal vaccinations . PUBLIC HEALTH ACTION Health-care providers and patients should be aware of the importance of preventive care , smoking cessation , regular physical activity , and maintaining a healthy weight for cancer survivors . The findings in this report can help public health practitioners , research ers , and comprehensive cancer control programs evaluate the effectiveness of program activities for cancer survivors , assess the needs of cancer survivors at the state level , and allocate appropriate re sources to address those needs Purpose : Young adults who have been treated for cancer face several health and psychosocial risks . To minimize these risks , is it imperative that they address any modifiable risk factors , such as sedentary lifestyle . Unfortunately , more than half of young adult cancer survivors remain sedentary . To facilitate the adoption of physical activity ( PA ) in this population -potentially reducing health and psychosocial risks-we developed and pilot tested an internet-based PA intervention for young survivors . Patients and methods : Eighteen young adults , aged 18 to 39 , who had been diagnosed with cancer in the past 10 years were recruited . Participants were r and omized to receive access to the PA website for 12 weeks or information about other cancer-related websites . Intervention feasibility and acceptability was assessed only among those in the PA website group ; PA and psychosocial outcomes ( mood , fatigue ) were assessed in both groups . Results : Findings revealed that 86 % of participants in the PA website group would recommend the intervention to others and most ( 71 % ) were " satisfied " or " very satisfied " with it . Further , 100 % rated getting onto the website as " very easy " and 86 % rated the information on the site as " very easy " to underst and . The logging feature , followed by the goal - setting feature , were most often accessed by participants . Participants also rated the graphing and stage-matched manual features as helpful . Estimates of effect sizes for between-group differences at 12 weeks were medium for PA outcomes and large for psychosocial outcomes . Conclusions : This internet-based PA intervention targeting young adult cancer survivors is feasible and acceptable and may benefit this population BACKGROUND Although physical activity is beneficial for breast cancer survivors , the majority do not meet public health physical activity recommendations . The purpose of this study was to test a social cognitive theory model of physical activity behavior in a sample of long-term breast cancer survivors using both self-report and objective measures of physical activity . METHODS Participants ( N = 1527 ) completed measures of physical activity , self-efficacy , goals , outcome expectations , fatigue , and social support at baseline and 6-month follow-up . A sub sample ( n = 370 ) was r and omly selected to wear an accelerometer . It was hypothesized that self-efficacy directly and indirectly influences physical activity through goals , social support , fatigue , and outcome expectations . Relationships were examined using panel analysis within a covariance modeling framework . RESULTS The hypothesized model provided a good model- data fit ( χ(2 ) = 1168.73 , df = 271 , p = < 0.001 , CFI = 0.96 , SRMR = 0.04 ) in the full sample when controlling for covariates . At baseline , self-efficacy directly and indirectly , via goals , outcome expectations , and social support , influenced physical activity . These relationships were also supported across time . Additionally , the hypothesized model was supported in the sub sample with accelerometer data ( χ2 = 656.88 , df = 330 , p < 0.001 , CFI = 0.95 , SRMR = 0.05 ) . CONCLUSIONS This study vali date s a social cognitive model for underst and ing physical activity behavior in long-term breast cancer survivors . Future studies should be design ed to replicate this model in other breast cancer survivor population s , and the findings should be applied to the development of future physical activity programs and studies for this population
PURPOSE / OBJECTIVES To review the extant literature on the link between physical activity and health outcomes among cancer survivors ; identify evidence -based strategies to promote physical activity among this population ; and conduct an epidemiologic study based on gaps from the literature review , examining the association between physical activity and various biologic markers .