Upper limb physical function and adverse effects after breast cancer surgery: a prospective 2.5-year follow-up study and preoperative measures. Safety and Efficacy of Weight Training in Recent Breast Cancer Survivors to Alter Body Composition, Insulin, and Insulin-Like Growth Factor Axis Proteins Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial Weight lifting in women with breast-cancer-related lymphedema. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial Lymphopenia as a prognostic factor for overall survival in advanced carcinomas, sarcomas, and lymphomas. Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy. Prevalence and prognostic effect of sarcopenia in breast cancer survivors: the HEAL Study Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Physical activity, long-term symptoms, and physical health-related quality of life among breast cancer survivors: A prospective analysis Is it safe and efficacious for women with lymphedema secondary to breast cancer to lift heavy weights during exercise: a randomised controlled trial Decline in physical functioning in first 2 years after breast cancer diagnosis predicts 10-year survival in older women Effect of active resistive exercise on breast cancer-related lymphedema: a randomized controlled trial. Change in physical activity during active treatment in a prospective study of breast cancer survivors Randomized controlled trial of weight training and lymphedema in breast cancer survivors. Long-term quality of life after breast cancer: a French registry-based controlled study Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. Fracture risk among breast cancer survivors: results from the Women's Health Initiative Observational Study. Safety of weightlifting among women with or at risk for breast cancer-related lymphedema: musculoskeletal injuries and health care use in a weightlifting rehabilitation trial. An exercise intervention for breast cancer survivors with bone loss. Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. A study of exercise modality and physical self-esteem in breast cancer survivors. Risk factors for lymphedema in breast cancer survivors, the Iowa Women’s Health Study CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
OBJECTIVE To examine upper limb physical function and adverse effects after axillary lymph node dissection ( ALND ) and sentinel lymph node biopsy ( SLNB ) in patients with breast cancer to identify impairments that can inform rehabilitation strategies . DESIGN Prospect i ve longitudinal cohort . Upper limb measurements were studied preoperatively and 2.5 years after breast cancer treatment . SETTING Hospital setting . PARTICIPANTS Two groups of patients with early-stage primary breast cancer ( N=391 ) : the ALND surgery group ( mean age , 55±10y ) and the SLNB group ( mean age , 57±10y ) . INTERVENTIONS Not applicable . MAIN OUTCOME MEASURES Arm lymphedema ( ≥10 % increased arm volume relative to control arm volume ) , grip strength ( in kilograms ) , shoulder mobility , pain intensity during isometric shoulder abduction ( on a 100-mm visual analog scale ) , and body mass index ( kg/m(2 ) ) . Parametric/nonparametric tests were used for hypothesized changes and differences , and regression analysis was used for confounding factors . RESULTS We observed more adverse effects in women treated with ALND than with SLNB after 2.5 years ( P<.05 ) : arm lymphedema ( 17 % vs 3 % ) , grip strength reduction ( 12 % vs 2 % ) , and shoulder abduction-provoked pain ( increase of 6 % vs decrease of 50 % ) . The adverse effects were similar for affected and control upper limbs for all outcomes except arm lymphedema , which occurred only on the affected side . CONCLUSIONS Adverse effects in both affected and control/unaffected upper limb were observed after 2.5-year follow-up in both ALND and SLNB groups , but a higher prevalence was observed in the ALND group . Thus , women going through ALND surgery may benefit from further postoperative physical therapy , including resistance and strength exercise , focusing on pain management 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 The aim of this study was to determine whether an exercise program , commencing 4–6 weeks post-operatively , reduces upper limb impairments in women treated for early breast cancer . Women ( n = 160 ) were r and omized to either an 8-week exercise program ( n = 81 ) or to a control group ( n = 79 ) following stratification for axillary surgery . The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles . The control group attended fortnightly assessment s but no exercises were provided . The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific question naire ( BR23 ) , scored out of 100 with a low score indicative of fewer symptoms . The secondary outcomes included physical measures of shoulder range of motion , strength , and swelling ( i.e. , lymphedema ) . Women were assessed immediately following the intervention and at 6 months post-intervention . The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention . The between group difference immediately following the intervention was 4 ( 95 % CI −1 to 9 ) and 6 months post-intervention was 4 ( −2 to 10 ) . However , the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention , as was change in shoulder abductor strength . In conclusion , a supervised exercise program provided some , albeit small , additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm . Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention . Notably , resistance training in the post-operative period did not precipitate lymphedema BACKGROUND Weight lifting has generally been proscribed for women with breast-cancer-related lymphedema , preventing them from obtaining the well-established health benefits of weight lifting , including increases in bone density . METHODS We performed a r and omized , controlled trial of twice-weekly progressive weight lifting involving 141 breast-cancer survivors with stable lymphedema of the arm . The primary outcome was the change in arm and h and swelling at 1 year , as measured through displaced water volume of the affected and unaffected limbs . Secondary outcomes included the incidence of exacerbations of lymphedema , number and severity of lymphedema symptoms , and muscle strength . Participants were required to wear a well-fitted compression garment while weight lifting . RESULTS The proportion of women who had an increase of 5 % or more in limb swelling was similar in the weight-lifting group ( 11 % ) and the control group ( 12 % ) ( cumulative incidence ratio , 1.00 ; 95 % confidence interval , 0.88 to 1.13 ) . As compared with the control group , the weight-lifting group had greater improvements in self-reported severity of lymphedema symptoms ( P=0.03 ) and upper- and lower-body strength ( P<0.001 for both comparisons ) and a lower incidence of lymphedema exacerbations as assessed by a certified lymphedema specialist ( 14 % vs. 29 % , P=0.04 ) . There were no serious adverse events related to the intervention . CONCLUSIONS In breast-cancer survivors with lymphedema , slowly progressive weight lifting had no significant effect on limb swelling and result ed in a decreased incidence of exacerbations of lymphedema , reduced symptoms , and increased strength . ( Clinical Trials.gov number , NCT00194363 . Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength Summary Our r and omized controlled trial in prematurely menopausal breast cancer survivors showed that impact + resistance training prevented increases in percentage of body fat compared with controls and also improved BMD at the hip and prevented BMD loss at the spine among exercise-trained women who were menopausal for > 1 year . Introduction Cancer treatment-related menopause worsens bone health and body composition in breast cancer survivors ( BCS ) . We investigated whether impact + resistance training could improve bone mineral density ( BMD ) , reduce bone turnover , build muscle , and decrease fat mass in BCS with premature menopause . Methods We conducted a r and omized controlled trial in 71 BCS ( mean age , 46.5 years ) within 5 years of treatment-related menopause . Women were r and omly assigned to one of two groups : ( 1 ) impact + resistance training ( prevent osteoporosis with impact + resistance ( POWIR ) ) or ( 2 ) exercise placebo ( FLEX ) 3 × /week for 1 year . Outcomes were hip and spine BMD ( in grams per square centimeter ) and body composition ( percent body fat ( % BF ) and lean and fat mass ( in kilograms ) ) by DXA and bone turnover markers ( serum osteocalcin ( in nanograms per milliliter ) and urinary deoxypryrodinoline ( in nanomoles per milliliter ) . Results There were no significant group × time interactions for bone outcomes when using an intent-to-treat approach on the full sample . In analyses restricted to BCS who were menopausal for ≥1 year , POWIR increased BMD at the hip and slowed BMD loss at the spine compared with FLEX ( femoral neck — POWIR , 0.004 ± 0.093 g/cm2 vs. FLEX , −0.010 ± 0.089 g/cm2 ; p < 0.01 ; spine — POWIR , −0.003 ± 0.114 g/cm2 vs. FLEX , −0.020 ± 0.110 g/cm2 ; p = 0.03 ) . POWIR prevented increases in % BF ( POWIR , 0.01 % vs. FLEX , 1.3 % ; p < 0.04 ) . Women with attendance to POWIR at ≥64 % had better improvements in % BF than women attending less often ( p < 0.03 ) . Conclusion Impact + resistance training may effectively combat bone loss and worsening body composition from premature menopause in BCS Lymphopenia is frequent in advanced cancers and predicts the toxicity of chemotherapy . Its effect on relapse and survival is uncertain . Its prognostic value for survival was analyzed in three data bases of previously reported prospect i ve multicenter studies : ( a )  FEC chemotherapy in metastatic breast carcinoma ; ( b )  CYVADIC in advanced soft tissue sarcoma ( European Organization for Research and Treatment of Cancer-Soft Tissue and Bone Sarcoma Group 62791 ) ; and ( c ) prospect i ve , consecutive phase III studies of aggressive diffuse large-cell non-Hodgkin 's lymphomas conducted at Centre Léon Bérard between 1987 and 1993 . Univariate and multivariate analyses of prognostic factors for survival were performed . The incidence of lymphopenia of < 1,000/microL before treatment was constant among the series : 25 % , 24 % , and 27 % , respectively . Lymphopenia was significantly more frequent ( P < 0.05 ) in metastatic breast cancer patients with performance status ( PS ) of > 1 , non-Hodgkin 's lymphoma patients with international prognostic index ( IPI ) of > 0 , and advanced soft tissue sarcoma and metastatic breast cancer patients with bone metastases . Inunivariate analysis , lymphopenia of < 1,000/microL significantly correlated to overall survival in patients with metastatic breast cancer ( median , 10 versus 14 mo ; P < 0.0001 ) , advanced soft tissue sarcoma ( median , 5 versus 10 months ; P < 0.01 ) , and non-Hodgkin lymphoma ( median , 11 versus 94 months ; P < 0.0001 ) . In multivariate analysis ( Cox model ) , lymphopenia was an independent prognostic factor for overall survival in metastatic breast cancer [ RR ( relative risk ) , 1.8 ; 95 % CI ( confidence interval ) , 1.3 - 2.4 ] along with liver metastases and PS ; in advanced soft tissue sarcoma ( RR , 1.46 ; 95 % CI , 1.0 - 2.1 ) along with liver metastases , lung metastases , and PS ; and in non-Hodgkin 's lymphoma ( RR , 1.48 ; 95 % CI , 1.03 - 2.1 ) along with IPI . Our findings show that lymphopenia is an independent prognostic factor for overall and progression-free survival in several cancers 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 Purpose This study aim ed to determine the prevalence of sarcopenia and examine whether sarcopenia was associated with overall and breast-cancer-specific mortality in a cohort of women diagnosed with breast cancer ( stages I – IIIA ) . Methods A total of 471 breast cancer patients from western Washington State and New Mexico who participated in the prospect i ve Health , Eating , Activity , and Lifestyle Study were included in this study . Appendicular lean mass was measured using dual X-ray absorptiometry scans at study inception , on average , 12 months after diagnosis . Sarcopenia was defined as two st and ard deviations below the young healthy adult female mean of appendicular lean mass divided by height squared ( < 5.45 kg/m2 ) . Total and breast-cancer-specific mortality data were obtained from Surveillance Epidemiology and End Results registries . Multivariable Cox proportional hazard models assessed the associations between sarcopenia and mortality . Results Median follow-up was 9.2 years ; 75 women were classified as sarcopenic , and among 92 deaths , 46 were attributed to breast cancer . In multivariable models that included age , race-ethnicity/ study site , treatment type , comorbidities , waist circumference , and total body fat percentage , sarcopenia was independently associated with overall mortality ( hazard ratio ( HR ) = 2.86 ; 95 % CI , 1.67–4.89 ) . Sarcopenic women had increased risk of breast-cancer-specific mortality , although the association was not statistically significant ( HR = 1.95 , 95 % CI , 0.87–4.35 ) . ConclusionS arcopenia is associated with an increased risk of overall mortality in breast cancer survivors and may be associated with breast-cancer-specific mortality . The development of effective interventions to maintain and /or increase skeletal muscle mass to improve prognosis in breast cancer survivors warrants further study . Implication s for Cancer SurvivorsSuch interventions may help breast cancer patients live longer 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 Introduction Many breast cancer survivors experience persistent physical symptoms of cancer and treatment that can decrease health-related quality of life ( HRQOL ) . This prospect i ve study investigated  physical activity ( PA )  , occurrence of physical symptoms , and HRQOL in a large , ethnically-diverse cohort of breast cancer survivors . Material s and methods Survivors ( n = 545 ) , on average 6 months post-diagnosis , were assessed in person or by mail at baseline ( retrospective reports of pre-diagnosis PA ) , at 29 months post-diagnosis ( post-diagnosis PA ) , and at 39 months post-diagnosis ( pain , hormone symptoms , sexual interest/dysfunction , fatigue , physical subscales of HRQOL ) . Linear regression and analysis of covariance assessed the relationships between pre- and post-diagnosis PA and PA change after cancer with symptoms and HRQOL . Results Greater pre-diagnosis PA was associated with better physical functioning at 39 months ( βs 1.1–2.3 ; all p < 0.01 ) but was generally unrelated to symptoms . Greater post-diagnosis sports/recreational PA was related to less fatigue and better physical functioning ( βs −0.146 , 2.21 ; both p < 0.01 ) .  Increased PA  after cancer was related to less fatigue and pain and better physical functioning ( all p < 0.01 ) . Significant positive associations were found for moderate to vigorous and vigorous sports/recreation PA , not household activity . Results were similar for Hispanic and non-Hispanic White women . Discussion / conclusions  Increased PA , especially after cancer , was consistently related to better physical functioning and to reduced fatigue and bodily pain , underscoring the need for PA promotion among survivors . Implication s for cancer survivorsSurvivors may be able to decrease fatigue and bodily pain and be better able to pursue daily activities through increasing recreational PA after cancer Purpose Resistance exercise has great potential to aid in the management of breast cancer-related lymphedema ( BCRL ) ; however , little is known regarding optimal exercise prescription . The pervasive view is that resistance exercise with heavy loads may be contraindicated , disregarding the dose – response relationship that exists between the load utilised in resistance exercise and the magnitude of structural and functional improvements . No previous research has examined various resistance exercise prescriptions for the management of BCRL . This study compared the effects of high load and low load resistance exercise on the extent of swelling , severity of symptoms , physical function and quality of life in women with BCRL . Methods Sixty-two women with a clinical diagnosis of BCRL ( > 5 % inter-limb discrepancy ) were r and omly assigned to a high-load resistance exercise ( n = 22 ) , low-load resistance exercise ( n = 21 ) or usual care ( n = 19 ) group . Participants in the experimental groups completed a 3-month moderate- to high-intensity resistance exercise program in which the load of the exercises was manipulated from 10–6 repetition maximum ( 75–85 % of one repetition maximum [ 1RM ] ) for the high-load group or from 20–15 repetition maximum ( 55–65 % 1RM ) for the low-load group . Outcome measures included the extent of swelling in the affected arm , symptom severity , physical function and quality of life . Results There were no differences between groups in the extent of affected arm swelling or severity of symptoms . The change in muscle strength , muscle endurance and quality of life – physical functioning was significantly greater in both high-load and low-load groups compared with the control group ( p < 0.040 ) . Change in quality of life – physical function was significantly associated with the change in symptom severity and muscle strength . No lymphedema exacerbations or other adverse events occurred during this trial . Conclusion Women with BCRL can safely lift heavy weights during upper body resistance exercise without fear of lymphedema exacerbation or increased symptom severity . Implication s for Cancer SurvivorsWomen with breast cancer-related lymphedema can be informed that appropriately prescribed and supervised upper body resistance exercise is safe and can aid in the management of lymphedema through improvements in physical function and quality of life Purpose Breast cancer patients often experience a decline in physical functioning following cancer diagnosis . Although most patients recover after treatment , some patients do not . These changes may be magnified in older women with comorbid conditions and could impact survival outcomes . Methods We used longitudinal data from a prospect i ve cohort study of women 65 + years of age , recruited shortly after diagnosis of early stage breast cancer , to examine changes in self-reported physical functioning measured with the  Physical Function Index ( PF-10 ) of the Medical Outcomes Study Short Form-36 . Outcomes were constructed for small ( 0.2 SD ) , medium ( 0.5 SD ) , and large ( 0.8 SD ) declines in the PF-10 measurement over two intervals : ( 1 ) 3 to 15 months following cancer diagnosis , encompassing treatment and early recovery , and ( 2 ) 3 to 27 months following cancer diagnosis , in order to detect sustained recovery versus persistent decline . Cox-proportional hazards regression was used to examine association between survival and decline in PF-10 scores . Results A large ( > 0.8 SD ) decline in PF-10 scores from 3 to 27 months predicted shorter 10-year survival ( hazard ratio = 1.34 , 95 % confidence interval 1.1–1.6 ) . Persistent decline at 27 months was associated with less education , higher baseline PF-10 , increased comorbidity , and higher body mass index . Conclusions Older women with breast cancer who experience a large and persistent decline in PF-10 are at increased mortality risk . Future research should examine the value of clinical assessment of physical function as a marker for mortality and test interventions to prevent decline in physical function to improve post-treatment survival outcomes . Implication s for Cancer SurvivorsMany breast cancer survivors experience a decline in physical functioning in the year following their cancer diagnosis . While the majority of patients recover in the year after treatment is completed , individuals who experience a persistent decline in physical functioning without recovery are at risk of functional decline and early mortality . Our results highlight the importance of assessing functional status to identify those at risk for functional decline , and suggest a potential role for early intervention in these individuals OBJECTIVE To investigate the differences between the effects of complex decongestive physiotherapy with and without active resistive exercise for the treatment of patients with breast cancer-related lymphedema ( BCRL ) . DESIGN R and omized control-group study . SETTING An outpatient rehabilitation clinic . PARTICIPANTS Patients ( N=40 ) with diagnosed BCRL . INTERVENTIONS Patients were r and omly assigned to either the active resistive exercise group or the nonactive resistive exercise group . In the active resistive exercise group , after complex decongestive physiotherapy , active resistive exercise was performed for 15min/d , 5 days a week for 8 weeks . The nonactive resistive exercise group performed only complex decongestive physiotherapy . MAIN OUTCOME MEASURES The circumferences of the upper limbs ( proximal , distal , and total ) for the volume changes , and the Short Form-36 version 2 question naire for the quality of life ( QOL ) at pretreatment and 8 weeks posttreatment for each patient . RESULTS The volume of the proximal part of the arm was significantly more reduced in the active resistive exercise group than that of the nonactive resistive exercise group ( P<.05 ) . In the active resistive exercise group , there was significantly more improvement in physical health and general health , as compared with that of the nonactive resistive exercise group ( P<.05 ) . CONCLUSIONS For the treatment of patients with BCRL , active resistive exercise with complex decongestive physiotherapy did not cause additional swelling , and it significantly reduced proximal arm volume and helped improve QOL Physical activity offers many benefits to breast cancer survivors , yet research on physical activity during the immediate period following a breast cancer diagnosis is limited . In a prospect i ve cohort study of 1,696 women diagnosed with invasive breast cancer in the Kaiser Permanente Northern California Medical Care Program from 2006–2009 , we describe change in self-reported physical activity levels from around diagnosis to 6 months post-diagnosis and determine factors associated with change . Participants completed a comprehensive physical activity question naire at baseline ( 2 months post-diagnosis ) and at follow-up ( 8 months post-diagnosis ) . Predictors of physical activity change were determined by multivariable linear regression . Reductions in all physical activity levels were observed ( P < 0.0001 ) ; mean ( SD ) change ( h/week ) of moderate-vigorous physical activity ( MVPA ) was −1.28 ( 4.48 ) and sedentary behavior was −0.83 ( 6.95 ) . In fully-adjusted models , overweight and obesity were associated with greater declines in MVPA of −1.58 h/week ( SD = 0.92 ) and −1.29 h/week ( SD = 0.93 ) , respectively ( P = 0.0079 ) . Receipt of chemotherapy only was also associated with a greater decrease in MVPA ( −2.12 h/week ; SD = 0.92 ; P < 0.0001 ) , specifically for recreational activities ( −1.62 h/week ; SD = 0.64 ; P = 0.0001 ) . These data suggest challenges in maintaining physical activity levels during active treatment among women with breast cancer . Interventions to encourage physical activity in breast cancer survivors should be pursued PURPOSE Lymphedema is a common condition that breast cancer survivors face . Despite a lack of supporting evidence from prospect i ve observational studies , occupational and leisure time physical activity are feared to be possible risk factors for lymphedema onset or exacerbation . We examined effects of supervised upper- and lower-body weight training on the incidence and symptoms of lymphedema in 45 breast cancer survivors who participated in the Weight Training for Breast Cancer Survivors study . METHODS Participants were on average 52 years old , 4 to 36 months post-treatment , and had axillary dissection as part of their treatment . Thirteen women had prevalent lymphedema at baseline . The intervention was twice-a-week weight training over a period of 6 months .  Lymphedema was monitored at baseline and 6 months by measuring the circumference of each arm , and by self-report of symptoms and clinical diagnosis . RESULTS None of the intervention-group participants experienced a change in arm circumferences > or = 2.0 cm after a 6-month exercise intervention .  Self-reported incidence of a clinical diagnosis of lymphedema or symptom changes over 6 months did not vary by intervention status ( P = .40 and P = .22 , respectively ) . CONCLUSION This is the largest r and omized controlled trial to examine associations between exercise and lymphedema in breast cancer survivors . The results of this study support the hypotheses that a 6-month intervention of resistance exercise did not increase the risk for or exacerbate symptoms of lymphedema . These results herald the need to start reevaluating common clinical guidelines that breast cancer survivors avoid upper body resistance activity for fear of increasing risk of lymphedema Population -based studies on quality of life ( QOL ) of long-term breast cancer survivors are quite recent and insufficient attention has been paid to the effect of time since diagnosis . We compared long-term QOL of population -based breast cancer survivors 5 , 10 , and 15 years after diagnosis with that of healthy controls . Breast cancer survivors were r and omly selected from three population -based cancer registries ( Bas-Rhin , Calvados and Doubs , France ) along with healthy controls , stratified for age and place of residence , r and omly selected from electoral rolls . Participants completed five self-administered question naires : the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 ( EORTC QLQ-C30 ) ,  Short Form-36 ( SF-36 ) , Spielberger State-Trait Anxiety Inventory ( STAI ) , Multidimensional Fatigue Inventory ( MFI ) and a  life conditions question naire . An analysis of variance was used to compare QOL scores of breast cancer survivors by period ( 5 , 10 , or 15 years ) of diagnosis with those of controls , adjusted for sociodemographic data and comorbidities . Six hundred and fifty-two cases and 1,188 controls participated in the study . For many QOL scales , scores were significantly different between cancer survivors and controls . A clinical ly significant difference was evidence d for the fatigue scales , the SF36 physical functioning , role-physical , and role-emotional scales , with more favorable results for controls . Differences decreased with time and 15-year cancer survivors were generally not different from controls . Scores were particularly influenced by age and mean household income . More efforts should be made , specifically during the first 5 to 10 years after diagnosis , to help women with breast cancer to overcome their impairment in QOL PURPOSE Chronic inflammation is believed to contribute to the development and progression of breast cancer . Systemic C-reactive protein ( CRP ) and serum amyloid A ( SAA ) are measures of low- grade chronic inflammation and potential predictors of cancer survival . PATIENTS AND METHODS We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health , Eating , Activity , and Lifestyle ( HEAL ) Study ( a multiethnic prospect i ve cohort study of women diagnosed with stage 0 to IIIA breast cancer ) . Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival ( approximately 4.1 years of follow-up ) and overall survival ( approximately 6.9 years of follow-up ) in 734 disease-free breast cancer survivors . Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios ( HRs ) and 95 % CIs . Results Elevated SAA and CRP were associated with reduced overall survival , regardless of adjustment for age , tumor stage , race , and body mass index ( SAA P trend < .0001 ; CRP P trend = .002 ) . The HRs for SAA and CRP tertiles suggested a threshold effect on survival , rather than a dose-response relationship ( highest v lowest tertile : SAA HR = 3.15 ; 95 % CI , 1.73 to 5.65 ; CRP HR = 2.27 ; 95 % CI , 1.27 to 4.08 ) . Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths . Elevated CRP and SAA were also associated with reduced disease-free survival , although these associations were of borderline significance ( SAA P trend = .04 ; CRP P trend = .07 ) . CONCLUSION Circulating SAA and CRP  may be important prognostic markers for long-term survival  in breast cancer patients , independent of race , tumor stage , and body mass index BACKGROUND Breast cancer and its treatment may compromise bone health . We tested the hypothesis in the Women 's Health Initiative Observational Study that postmenopausal survivors of breast cancer have a higher risk for fractures compared with women who have no cancer history . METHODS A prospect i ve cohort ( 5.1 years ' follow-up ) study design was used . Breast cancer survivors were women who reported a history of breast cancer ( n = 5298 ) . A reference group included women who had no cancer history at baseline ( n = 80 848 ) .  Fracture occurrence was ascertained from annual self-reports .  Hip fractures were confirmed by review ing medical records . RESULTS After adjustment for age , weight , ethnicity , and geographic region of enrollment , the hazard ratios ( HRs ) of breast cancer survivors to women in the reference group were 0.93 ( 95 % confidence interval [ CI ] , 0.64 - 1.33 ) for hip ; 1.36 ( 95 % CI , 1.16 - 1.59 ) for forearm or wrist ; 1.31 ( 95 % CI , 1.19 - 1.43 ) for eligible fractures other than hip , vertebral , and forearm or wrist ; and 1.31 ( 95 % CI , 1.21 - 1.41 ) for these fractures combined . The increased risk for clinical vertebral fracture was statistically significant only among survivors who had a breast cancer diagnosis before age 55 years ( HR , 1.78 ; 95 % CI , 1.28 - 2.46 ) . After adjusting for factors related to hormone levels , risk of fall , fracture history , medication use , comorbidity , and lifestyle , the increased risk for all fractures studied among survivors was reduced to 15 % ( HR , 1.15 ; 95 % CI , 1.05 - 1.25 ) . CONCLUSIONS Postmenopausal survivors of breast cancer are at increased risk for clinical fractures . Preventions and therapeutic interventions are needed to reduce fracture risk in this large and growing population INTRODUCTION It has been noted that only 14 % of all clinical trials are translated into practice . The objective of this paper is to promote translation of an efficacious rehabilitative exercise program for breast cancer survivors by clarifying for clinicians the safety profile of participants ( e.g. , rates of musculoskeletal injury and referral to medical professionals ) , and to use this evidence to make recommendations on the appropriate training of health and fitness staff who would be capable of safely , effectively , and sustainably delivering the program . METHODS Breast cancer survivors with and at risk for lymphedema were r and omized to twice-weekly weightlifting or st and ard care for 1 year . An injury survey and health care evaluation were administered after 1 year and in 3-month intervals , respectively . RESULTS The cumulative incidence and rate of injury were higher in the weightlifting than in the control group . The injury rates were 2.3 and 0.3 per 1,000 bouts of weightlifting among breast cancer survivors with and at risk for lymphedema , respectively . Among breast cancer survivors with or at risk for lymphedema , 20.9 % in the weightlifting group had an encounter with a health care provider that required cessation or dose modification of weightlifting . CONCLUSION Despite the demonstrated efficacy of weightlifting , musculoskeletal injuries and other health problems did occur . Therefore , for the successful translation of this rehabilitative intervention into clinical practice , health and fitness professionals working with breast cancer survivors need the knowledge , skills , and abilities that clarify their scope of practice to address these health care needs 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 The aim of this study was to evaluate the impact of a twice-weekly strength training intervention on perceptions of body image in 234 breast cancer survivors ( 112 with lymphedema ) who participated in the Physical Activity and Lymphedema ( PAL ) trial . The study population included two hundred and thirty-four women r and omly assigned to twice-weekly strength training or control group that completed the 32-item Body Image and Relationships Scale ( BIRS ) at baseline and 12 months . Percent change in baseline to 12-month BIRS total and subscale scores , upper and lower body strength , and general quality of life ( QOL ) were compared by intervention status . A series of multiple linear regression models including indicator variables for subgroups based on age , marital status , race , education , BMI , and strength change were used to examine differential intervention impact by subgroup . Strength and QOL variables were assessed as mediators of the intervention effect on BIRS . Results : Baseline BIRS scores were similar across intervention and lymphedema status . Significantly greater improvement in BIRS total score was observed from baseline to 12 months in treatment vs. control participants ( 12.0 vs. 2.0 % ; P < 0.0001 ) . A differential impact of the intervention on the Strength and Health subscale was observed for older women ( > 50 years old ) in the treatment group ( P = 0.03 ) . Significantly greater improvement was observed in bench and leg press among treatment group when compared to control group participants , regardless of lymphedema . Observed intervention effects were independent of observed strength and QOL changes . Twice-weekly strength training positively impacted self-perceptions of appearance , health , physical strength , sexuality , relationships , and social functioning . Evidence suggests the intervention was beneficial regardless of prior diagnosis of lymphedema . Strength and QOL improvements did not mediate the observed intervention effects BACKGROUND Exercise improves physical functioning and symptom management during breast cancer chemotherapy , but the effects of different doses and types of exercise are unknown . METHODS A multicenter trial in Canada r and omized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy  consisting of either a st and ard dose of 25 to 30 minutes of aerobic exercise ( STAN ; n = 96 ) , a higher dose of 50 to 60 minutes of aerobic exercise ( HIGH ; n = 101 ) , or a combined dose of 50 to 60 minutes of aerobic and resistance exercise ( COMB ; n = 104 ) . The primary endpoint was physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)-36 . Secondary endpoints were other physical functioning scales , symptoms , fitness , and chemotherapy completion . All statistical tests were linear mixed model analyses , and the P values were two-sided . RESULTS Follow-up assessment of patient-reported outcomes was 99.0 % . Adjusted linear mixed-model analyses showed that neither HIGH ( + 0.8 ; 95 % confidence interval [ CI ] = -0.8 to 2.4 ; P = .30 ) nor COMB ( + 0.5 ; 95 % CI = -1.1 to 2.1 ; P = .52 ] were superior to STAN for the primary outcome . In secondary analyses not adjusted for multiple comparisons , HIGH was superior to STAN for the SF-36 physical component summary ( P = .04 ) , SF-36 bodily pain ( P = .02 ) , and endocrine symptoms ( P = .02 ) . COMB was superior to STAN for endocrine symptoms ( P = .009 ) and superior to STAN ( P < .001 ) and HIGH ( P < .001 ) for muscular strength . HIGH was superior to COMB for the SF-36 bodily pain ( P = .04 ) and aerobic fitness ( P = .03 ) . No differences emerged for body composition or chemotherapy completion . CONCLUSIONS A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than st and ard volumes 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 Risk factors for lymphedema and related arm symptoms in breast cancer ( BC ) survivors have not been examined using a large prospect i ve population -based cohort . The Iowa Women ’s Health Study ( IWHS ) collected self-reported data for diagnosed lymphedema in 2004 , and data for cancer diagnosis , treatment , behavioral and health characteristics between 1986 and 2003 . We studied 1,287 women , aged 55–69 at baseline , who developed unilateral BC : n = 104 ( 8 % ) with diagnosed lymphedema , n = 475 ( 37 % ) with arm symptoms but without diagnosed lymphedema , and n = 708 without lymphedema . Age- and multivariate-adjusted logistic regression models examined risk factors for lymphedema and related arm symptoms ( OR [ 95 % confidence interval ] ) . The mean time between BC and the 2004 survey was 8.1 ± 5.0 ( mean ± SD ) years . After multivariate adjustment , the following cancer characteristics were positively associated with lymphedema : tumor stage ( regional vs. in situ : 3.92 [ 1.61–9.54 ] ) , number of excised nodes ( highest vs. lowest quintile : 3.52 [ 1.32–9.34 ] , Ptrend = 0.003 ) , tumor-positive nodes ( yes vs. no 2.12 [ 1.19 , 3.79 ] ) , and adjuvant chemotherapy ( yes vs. no : 3.05 [ 1.75–5.30 ] ) . Several health characteristics were positively associated with lymphedema : baseline body mass index ( highest vs. lowest tertile : 3.24 [ 1.70–6.21 ] ) , waist and hip circumference , and general health ( fair/poor vs. excellent : 3.44 [ 1.30–9.06 ] ) . Positive associations with arm symptoms were number of excised nodes ( highest vs. lowest quintile : 2.38 [ 1.41–4.03 ] , Ptrend = 0.007 ) , axillary radiation ( yes vs. no : 1.72 [ 1.15–2.57 ] ) , and baseline general health ( fair/poor vs. excellent : 4.27 [ 2.60–7.00 ] ) . In the IWHS , obesity , poorer general health , and markers of more advanced cancer were risk factors for lymphedema and related arm symptoms in BC survivors The CONSORT statement is used worldwide to improve the reporting of r and omised controlled trials . Kenneth Schulz and colleagues describe the latest version , CONSORT 2010 , which up date s the reporting guideline based on new method ological evidence and accumulating experience . To encourage dissemination of the CONSORT 2010 Statement , this article is freely accessible on bmj.com and will also be published in the Lancet , Obstetrics and Gynecology , PLoS Medicine , Annals of Internal Medicine , Open Medicine , Journal of Clinical Epidemiology , BMC Medicine , and Trials
The purpose of this study was to assess the safety and efficacy of progressive resistance training ( PRT ) in breast cancer .