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Background : Substantial numbers of cancer patients use complementary medicine therapies , even without a supportive evidence base . This study aim ed to evaluate in a r and omized controlled trial , the use of Medical Qigong ( MQ ) compared with usual care to improve the quality of life ( QOL ) of cancer patients . Patients and methods : One hundred and sixty-two patients with a range of cancers were recruited .  QOL and fatigue were measured by Functional Assessment of Cancer Therapy — General and Functional Assessment of Cancer Therapy — Fatigue , respectively , and mood status by Profile of Mood State . The inflammatory marker serum C-reactive protein ( CRP ) was monitored serially . Results : Regression analysis indicated that the MQ group significantly improved overall QOL ( t144 = −5.761 , P < 0.001 ) , fatigue ( t153 = −5.621 , P < 0.001 ) , mood disturbance ( t122 = 2.346 , P = 0.021 ) and inflammation ( CRP ) ( t99 = 2.042 , P < 0.044 ) compared with usual care after controlling for baseline variables . Conclusions : This study indicates that MQ can improve  cancer patients  ’ overall QOL and mood status and reduce specific side-effects of treatment . It may also produce physical benefits in the long term through reduced inflammation 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 Background Women who develop secondary arm lymphoedema subsequent to treatment associated with breast cancer require life-long management for a range of symptoms including arm swelling , heaviness , tightness in the arm and sometimes the chest , upper body impairment and changes to a range of parameters relating to quality of life . While exercise under controlled conditions has had positive outcomes , the impact of yoga has not been investigated . The aim of this study is to determine the effectiveness of yoga in the physical and psycho-social domains , in the hope that women can be offered another safe , holistic modality to help control many , if not all , of the effects of secondary arm lymphoedema . Methods and design A r and omised controlled pilot trial will be conducted in Hobart and Launceston with a total of 40 women receiving either yoga intervention or current best practice care .  Intervention will consist of eight weeks of a weekly teacher-led yoga class with a home-based daily yoga practice delivered by DVD . Primary outcome measures will be the effects of yoga on lymphoedema and its associated symptoms and quality of life . Secondary outcome measures will be range of motion of the arm and thoracic spine , shoulder strength , and weekly and daily physical activity . Primary and secondary outcomes will be measured at baseline , weeks four , eight and a four week follow up at week twelve . Range of motion of the spine , in a self-nominated group , will be measured at baseline , weeks eight and twelve . A further outcome will be the women ’s perceptions of the yoga collected by interview at week eight . Discussion The results of this trial will provide information on the safety and effectiveness of yoga for women with secondary arm lymphoedema from breast cancer treatment . It will also inform methodology for future , larger trials . Trial registration 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 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 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 Observational studies demonstrate an association between physical activity and improved outcomes in breast and colon cancer survivors . To test these observations with a large , r and omized clinical trial , an intervention that significantly impacts physical activity in these patients is needed . The Active After Cancer Trial ( AACT ) was a multicenter pilot study evaluating the feasibility of a telephone-based exercise intervention in a cooperative group setting . Sedentary ( engaging in < 60 min of recreational activity/week ) breast and colorectal cancer survivors were r and omized to a telephone-based exercise intervention or usual care control group . The intervention was delivered through the University of California at San Diego ; participants received ten phone calls over the course of the 16-week intervention . All participants underwent assessment of physical activity , fitness , physical functioning , fatigue and exercise self-efficacy at baseline and after the 16-week intervention . One hundred and twenty-one patients were enrolled through ten Cancer and Leukemia Group B ( CALGB ) institutions ; 100 patients had breast cancer and 21 had colorectal cancer . Participants r and omized to the exercise group increased physical activity by more than 100 versus 22 % in controls ( 54.5 vs. 14.6 min , P = 0.13 ) , and experienced significant increases in fitness ( increased 6-min walk test distance by 186.9 vs. 81.9 feet , P = 0.006 ) and physical functioning ( 7.1 vs. 2.6 , P = 0.04 ) as compared to the control group . Breast and colorectal cancer survivors enrolled in a multicenter , telephone-based physical activity intervention  increased physical activity and experienced significant improvements in fitness and physical functioning . Lifestyle intervention research is feasible in a cooperative group setting BACKGROUND AND OBJECTIVES This pilot project assessed the acceptability of a mixed-type , moderate-intensity exercise programme  following breast cancer treatment , and the impact on presence of lymphoedema , fitness , body composition , fatigue , mood and quality of life . METHODS Ten women completed the programme and measures of fitness ( sub-maximal ergometer test ) , body composition ( bio-electrical impedance ) , lympoedema ( bio-electrical impedance and arm circumferences ) , fatigue ( revised Piper Fatigue Scale ) , mood ( Hospital Anxiety and Depression Scale ) , quality of life ( FACT-B ) and general well-being , at baseline , completion of the programme , and 6-week and 3-month follow-up . RESULTS Participation in the programme caused no adverse effect on the presence of lymphoedema . There was a trend towards reduction in fatigue and improved quality of life across the testing phases . Women rated the programme extremely favourably , citing benefits of the support of other women , trained guidance , and the opportunity to experience different types of exercise . CONCLUSIONS A mixed-type , moderate-intensity exercise program in a group format is acceptable to women following breast cancer treatment , with the potential to reduce fatigue and improve quality of life , without exacerbating or precipitating lymphoedema . This pilot work needs to be confirmed in larger r and omised studies 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 Background Breast cancer survivors suffer physical impairment after oncology treatment . This impairment reduces quality of life ( QoL ) and increase the prevalence of h and icaps associated to unhealthy lifestyle ( for example , decreased aerobic capacity and strength , weight gain , and fatigue ) . Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival . Nowadays , technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional . It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective re source to improve fitness and reduce musculoskeletal disorders of these women . Methods / Design This study will use a two-arm , assessor blinded , parallel r and omized controlled trial design . People will be eligible if : their diagnosis is of stages I , II , or IIIA breast cancer ; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program ; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge ; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence ; and they have an interest in improving lifestyle . Participants will be r and omized into e-CUI DATE or usual care groups . E-CUI DATE give participants access to a range of contents : planning exercise arranged in series with breathing exercises , mobility , strength , and stretching . All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs . The control group will be asked to maintain their usual routine . Study endpoints will be assessed after 8 weeks ( immediate effects ) and after 6 months . The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life question naire . The secondary outcomes : pain ( algometry , Visual Analogue Scale , Brief Pain Inventory short form ) ; body composition ; physical measurement ( abdominal test , h and grip strength , back muscle strength , and multiple sit-to-st and test ) ; cardiorespiratory fitness ( International Fitness Scale , 6-minute walk test , International Physical Activity Question naire-Short Form ) ; fatigue ( Piper Fatigue Scale and Borg Fatigue Scale ) ; anxiety and depression ( Hospital Anxiety and Depression Scale ) ; cognitive function ( Trail Making Test and Auditory Consonant Trigram ) ; accelerometry ; lymphedema ; and anthropometric perimeters . Discussion This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer . If this treatment option is effective , telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase . Trial registration Clinical Trials.gov Identifier : Background The Beck Depression Inventory , 2nd edition ( BDI-II ) is widely used in research on depression . However , the minimal clinical ly important difference ( MCID ) is unknown . MCID can be estimated in several ways . Here we take a patient-centred approach , anchoring the change on the BDI-II to the patient 's global report of improvement . Method We used data collected ( n = 1039 ) from three r and omized controlled trials for the management of depression .  Improvement on a ‘ global rating of change ’ question was compared with changes in BDI-II scores using general linear modelling to explore baseline dependency , assessing whether MCID is best measured in absolute terms ( i.e. difference ) or as percent reduction in scores from baseline ( i.e. ratio ) , and receiver operator characteristics ( ROC ) to estimate MCID according to the optimal threshold above which individuals report feeling ‘ better ’ . Results Improvement in BDI-II scores associated with reporting feeling ‘ better ’ depended on initial depression severity , and statistical modelling indicated that MCID is best measured on a ratio scale as a percentage reduction of score . We estimated a MCID of a 17.5 % reduction in scores from baseline from ROC analyses . The corresponding estimate for individuals with longer duration depression who had not responded to antidepressants was higher at 32 % . Conclusions MCID on the BDI-II is dependent on baseline severity , is best measured on a ratio scale , and the MCID for treatment-resistant depression is larger than that for more typical depression . This has important implication s for clinical trials and practice There was a need to design a question naire that could accurately assess the activity patterns of Native Americans to evaluate the relationship between physical activity and diabetes . Such a question naire was developed and implemented into the data collection scheme of the prospect i ve Pima Indian Study of Arizona . The question naire , which assesses historical , past-year , and past-week leisure and occupational activity , was examined in 29 Pima individuals aged 21–36 yr and was shown to be reliable with test-retest correlations ( rank-order correlations ranged from 0.62 to 0.96 for leisure and occupational activity ) . Reproducibility of the past-year leisure physical-activity estimate was determined in 69 participants aged 10 - 59 yr and was found to be reliable in all age-groups with the exception of the 10- to 14-yr-old age-group ( rank-order correlations were 0.31 in the 10- to 14-yr-old age-group compared to 0.88 to 0.92 in those > 20 yr of age ) . Validity of the current-activity section of the question naire was demonstrated indirectly through comparisons with activity monitors . The past-week leisure-activity estimate was related to the Caltrac activity monitor counts per hour ( p = 0.62 , P > 0.05 , n = 17 ) . In summary , a physical-activity question naire has been developed that is both reliable and feasible to use in the Pima Indian population to evaluate the relationship of physical activity to non-insulin-dependent diabetes mellitus OBJECTIVE Physical activity ( PA ) has been shown to provide health benefits for breast cancer patients . The effects of augmenting oncology healthcare provider ( HCP ) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a r and omized trial . Our goal in this secondary analysis was to examine the amount of PA ( min/week ) needed for psychosocial benefits among both groups . METHODS After receiving brief HCP advice to become physically active , 192 women ( age in years : mean = 60.0 , SD = 9.9 ) who had completed treatment for Stage 0-IV breast cancer were r and omized to  telephone counseling to support PA ( n = 106 ) or contact control ( n = 86 ) . Their PA , fatigue , physical functioning , and quality of life were assessed at baseline ( before receiving HCP advice ) , 3 , 6 , and 12 months . A non-r and omized design was used to examine the dose-response relationship between PA and psychosocial outcomes . RESULTS Exercising for at least 150 min/week at moderate intensity was associated with improved physical functioning ( b = 5.9 , SE = 2.9 , p = 0.04 ) and quality of life ( b = 3.6 , SE = 1.9 , p = 0.05 ) at 3 months . These relationships were not found at 6 and 12 months ( p 's > 0.05 ) . However , women who reported at least 150 min/week of PA at both 3 and 6 months had significantly reduced fatigue ( b = 1.3 , SE = 0.7 , p = 0.05 ) and improved physical functioning ( b = 3.1 , SE = 1.3 , p = 0.02 ) and quality of life ( b = 2.0 , SE = 0.9 , p = 0.02 ) compared with women who did not meet this criterion . CONCLUSION Women who exercised at recommended levels ( at least 150 min/week ) and sustained this level of activity for at least 6 months accrued psychosocial benefits Recovering from cancer treatment can be a difficult experience , both physically and psychologically . This paper describes a r and omized controlled trial that evaluates the effects of exercise therapy upon quality of life in 120 women who have had breast cancer . To facilitate behaviour change , exercise counselling is also included as an integral component in the exercise therapy intervention .  Participants are r and omized to one of three groups : exercise therapy , body conditioning ( placebo control ) or a normal care control group .  The supervised exercise therapy and body conditioning sessions take place 3 times per week for 8 weeks . Outcome measures include quality of life , physical self-perceptions , depression , satisfaction with life , exercise behaviour , aerobic capacity and percentage body fat . All outcomes are assessed at baseline , 4 weeks during the intervention and at the end of the 8-week intervention . Follow-up assessment s of outcomes take place at 3 and 6 months post-intervention . As the number of women surviving breast cancer is increasing and cancer treatment is linked to reduced quality of life , it is critical to evaluate treatments that improve the quality of life of this population or hasten recovery following treatment Few r and omized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy . Breast cancer survivors ( N = 58 ) within 2 years of completing adjuvant therapy were r and omly assigned to an immediate exercise group ( IEG ; n = 29 ) or a delayed exercise group ( DEG ; n = 29 ) . The IEG completed 12 weeks of supervised aerobic and resistance exercise , three times per week . The DEG completed the program during the next 12 weeks . Participants completed patient-rated outcomes at baseline , 6 , 12 , 18 and 24 weeks . The primary endpoint was overall quality of life ( QoL ) measured by the Functional Assessment of Cancer Therapy-Breast scale . Secondary endpoints were fatigue , social physique anxiety , and physical fitness . Follow-up data was obtained on 97 % of participants and exercise adherence was 61.3 % . Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL ( P < 0.001 ) . Specifically , QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points ( mean group difference = 26.1 ; 95 % CI = 18.3–32.7 ; P < 0.001 ) . From 12 to 24 weeks , QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG ( mean group difference = 23.0 ; 95 % CI = 16.3–29.1 ; P < 0.001 ) . Similar results were obtained for the secondary endpoints . Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes 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 Background Due to early detection and advances in treatment , the number of women surviving breast cancer is increasing . Whilst there are many positive aspects of improved survival , breast cancer survival is associated with many long-term health and psychosocial sequelae . Engaging in regular physical activity post-diagnosis can reduce this burden . Despite this evidence , the majority of breast cancer survivors do not engage in regular physical activity . The challenge is to provide breast cancer survivors with appealing and effective physical activity support in a sustainable and cost-effective way . This article describes the protocol for the Move More for Life Study , which aims to assess the relative efficacy of two promising theory-based , print interventions design ed to promote regular physical activity amongst breast cancer survivors . Method and design Breast cancer survivors were recruited from across Australia . Participants will be r and omised into one of three groups : ( 1 ) A tailored-print intervention group , ( 2 ) a targeted-print intervention group , or ( 3 ) a st and ard recommendation control group . Participants in the tailored-print intervention group will receive 3 tailored newsletters in the mail over a three month period . Participants in the targeted-print group will receive a previously developed physical activity guidebook design ed specifically for breast cancer survivors immediately after baseline . Participants in the st and ard recommendation control will receive a brochure detailing the physical activity guidelines for Australian adults . All participants will be assessed at baseline , and at 4 and 10 months post-baseline . Intervention efficacy for changing the primary outcomes ( mins/wk aerobic physical activity ; sessions/exercises per week resistance physical activity ) and secondary outcomes ( steps per day , health-related quality life , compliance with physical activity guidelines , fatigue ) will be assessed . Mediation and moderation analyses will also be conducted . Discussion Given the growing number of cancer survivors , distance-based behaviour change programs addressing physical activity have the potential to make a significant public health impact . Trial registration Australian New Zeal and Clinical Trials Registry ( ANZCTR ) identifier : 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 Exercise is considered to be a key aspect of lymphoedema treatment , although there is little evidence for the therapeutic effect of exercise in managing breast cancer-related lymphoedema ( BCRL ) . This small r and omised controlled trial ( RCT ) was design ed to determine the feasibility , prior to undertaking a larger RCT , of research ing a daily home-based exercise programme to treat stable BCRL . An experimental design compared the exercise intervention combined with st and ard lymphoedema self-care to self-care alone over a 6-month period . Twenty-three women with stable unilateral BCRL of ≥10 % excess limb volume ( ELV )  were r and omly allocated to a daily home-based exercise programme and self-care ( n = 11 ) or self-care measures alone ( n = 12 ) . The primary objective was to determine difference in limb volume reduction for the two groups . Secondary objectives were to monitor change in other areas that impact BCRL : quality of life , arm function and range of shoulder movement . All 23 women completed the trial , providing full data for each time point . The intervention group showed a clinical ly and statistically significant improvement in relative ELV at week 26 ( 95 % confidence interval ( CI ) −26.57 to −5.12 ) , whereas the control group improvement crossed the line of no effect ( 95 % CI −17.71 to 1.1 ) . This study demonstrated the feasibility of conducting a RCT of exercise as a therapeutic intervention in the management of BCRL . Although the sample was small , the results support the findings of other exercise studies which have shown trends towards improvement 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 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 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 . 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 ) Lymphedema is a chronic and progressive long-term adverse effect of breast cancer treatment commonly defined by swelling of the affected arm . Current clinical guidelines indicate that women with and at risk for lymphedema should protect the affected arm from overuse . In clinical practice , this often translates into risk aversive guidance to avoid using the arm . This could lead to a disuse pattern that may increase the likelihood of injury from common activities of daily living . Further , such guidance poses an additional barrier to staying physically active , potentially translating to weight gain , which has been shown to be associated with worse clinical course for women with lymphedema . We hypothesize that a program of slowly progressive strength training with no upper limit on the amount of weight that may be lifted would gradually increase the physiologic capacity of the arm so that common activities represent a decreasing percentage of maximal capacity . Theoretically , this increased capacity should decrease the risk that daily activities put stress on the lymphatic system of the affected side . The Physical Activity and Lymphedema ( PAL ) Trial is a recently completed r and omized controlled exercise intervention trial that recruited 295 breast cancer survivors ( 141 with lymphedema at study entry , 154 at risk for lymphedema at study entry ) . The purpose of this report is to provide detail regarding the study design , statistical design , and protocol of the PAL trial Breast cancer treatment often results in impaired shoulder function , in particular , decrements in muscular endurance and range of motion , which may lead to decreased quality of life . The purpose of this investigation was to determine the effects of walking pole use on shoulder function in female breast cancer survivors . Participants had previously been treated with 1 or a combination of the following : mastectomy , breast conservation therapy , axillary lymph node dissection , chemotherapy , or radiation . Participants were r and omly placed in experimental ( n = 6 ) and control ( n = 6 ) groups and met with a cancer exercise specialist 2 times each week for 8 weeks . The experimental group used walking poles during the 20-minute aerobic portion of their workout , whereas the control group did not use walking poles but performed 20 minutes of aerobic exercise per workout session . Both groups participated in similar resistance training programs . Testing was done pre- and postexercise intervention to determine upper body muscular endurance and active range of motion at the glenohumeral joint . Repeated- measures analysis of variance ( ANOVA ) revealed significant improvements in muscular endurance as measured by the bench press ( P = .046 ) and lat pull down ( P = .013 ) in the walking pole group . No within-group improvements were found in the group that did not use walking poles . The data suggest that using a walking pole exercise routine for 8 weeks significantly improved muscular endurance of the upper body , which would clearly be beneficial in helping breast cancer survivors perform activities of daily living and regain an independent lifestyle Background Short term exercise interventions have been shown to be beneficial for breast cancer survivors soon after treatments but longer term adherence is needed . Purpose To examine the effects of a supervised exercise program on motivational variables in breast cancer survivors using Self-Determination Theory ( SDT ) . MethodS ixty breast cancer survivors were r and omized in a cross-over design to either an immediate exercise group  ( IEG ; n = 30 )  that exercised from baseline to week 12 or a delayed exercise group  ( DEG  ; n = 30 )  that exercised from week 12 to 24 .  SDT variables were assessed at baseline , 6 , 12 , 18 and 24 weeks using the  Behavioral Regulation for Exercise Question niare-2 and the Basic Psychological Needs Satisfaction Scale . Results Fifty-eight participants completed the follow-up assessment s and achieved a 61.3 % adherence rate . Analyses of variance revealed significant time by group interactions for almost all psychological needs and motivations that favored the exercise intervention time periods . For example , autonomy increased in the IEG from baseline to 12 weeks by 2.0 points compared to the DEG where scores decreased by 0.1 points ( mean group difference = 2.0 , p < 0.001 ) . The cross-over results further supported the main findings . ConclusionS upervised exercise soon after breast cancer treatments may help to develop a positive exercise motivational profile among breast cancer survivors that could portend longer term adherence 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 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 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 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 OBJECTIVE To improve mechanistic underst and ing , this pilot r and omized controlled trial examined mediators of an exercise intervention effects on sleep in breast cancer survivors ( BCS ) . METHODS Forty-six postmenopausal BCS ( ≤Stage II , off primary treatment ) were r and omized to a 3-month exercise intervention or control group . Intervention included 160 min/week of moderate intensity aerobic walking , twice weekly resistance training ( resistance b and s ) , and six discussion groups ( to improve adherence ) . Blinded assessment s at baseline and post-intervention included sleep disturbance ( PSQI and PROMIS ® ) , objective sleep quality ( accelerometer ) , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , body composition , fatigue , and psychosocial factors . Mediation was tested using Freedman-Schatzkin difference-in-coefficients tests . RESULTS When compared with control , the intervention group demonstrated a significant increase in PSQI sleep duration ( i.e. , fewer hours of sleep/night ) ( d = 0.73 , p = .03 ) . Medium to large but non-significant st and ardized effect sizes were noted for PSQI daytime somnolence ( d = -0.63 , p = .05 ) and accelerometer latency ( d = -0.49 , p = .14 ) . No statistically significant mediators were detected for PSQI sleep duration score or accelerometer latency . Daytime somnolence was mediated by tumor necrosis factor-alpha ( mediated 23 % of intervention effect , p < .05 ) , interleukin (IL)-6:IL-10 ( 16 % , p < .01 ) , IL-8:IL-10 ( 26 % , p < .01 ) , and fatigue ( 38 % , p < .05 ) . Mediating or enhancing relationships for several of the sleep outcomes were noted for accelerometer physical activity , PROMIS ® fatigue , exercise social support , and /or physical activity enjoyment . CONCLUSIONS Inflammation and psychosocial factors may mediate or enhance sleep response to our exercise intervention . Further study is warranted to confirm our results and translate our findings into more effective interventions aim ed at improving sleep quality in BCS We describe adherence to a three group r and omised controlled trial that involved aerobic exercise therapy  ( N=34 ) and exercise-placebo intervention  ( N=36 ) or usual care  ( N=38 ) in women treated for breast cancer . We also investigated relationships between routes of trial recruitment , socio-economic characteristics , health behaviours , cancer treatment regimen(s ) and subsequent adherence to the interventions . Women who had completed breast cancer treatment 12 - 36 months previously were r and omised to one of the groups . The intervention groups attended an exercise facility three times per week for eight weeks . A total of 77 % of the aerobic exercise therapy and 88.9 % of the exercise-placebo groups attended at least 70 % of prescribed sessions . The percentage of women achieving 30min of aerobic exercise per session steadily increased during the intervention but many women were not able to achieve this goal . Routes of trial recruitment , socio-economic characteristics , health behaviours and cancer treatment regimen(s ) were not related to intervention . Exercise therapy participants were able to comply with the progressive nature of the aerobic exercise intervention , although some women were not able to achieve 30min of aerobic exercise per session by intervention completion . Research is still required to tease out all the potential determinants of exercise in this population 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 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 1 ) To determine the effect of a home-based walking exercise program on the sleep quality and quality of life of cancer patients , as well as 2 ) to determine if enhanced sleep quality was associated with improvement in quality of life over time . Methods This is a prospect i ve , longitudinal , two-armed , r and omized clinical trial . Participants were recruited from oncology outpatient clinics in two university-based medical centers and were allocated to either usual care ( n = 35 ) or a home-based walking exercise intervention for 8 weeks ( n = 36 ) . Measurements included the Taiwanese version of the Pittsburgh Sleep Quality Index , the Medical Outcomes Study Short Form-36 , the Taiwanese Version Ratings of the Perceived Exertion Scale , and a walking exercise log . This study was analyzed on an intention-to-treat basis . Effects of the walking exercise program  on sleep quality and quality of life were analyzed by the generalized estimating equation method . Results Patients in the exercise group reported significant improvements in sleep quality ( β = −3.54 , p < 0.01 ) and the mental health dimension of quality of life ( β = 10.48 , p < 0.01 ) . Among patients who exercised , enhanced sleep quality also corresponded with reduced bodily pain ( β = 0.98 , p = 0.04 ) and improvements over time in the mental health dimension of quality of life ( β = −3.87 , p < 0.01 ) . Conclusions A home-based walking exercise program can be easily incorporated into care for cancer patients who are suffering from sleep disturbances Background Secondary arm lymphoedema continues to affect at least 20 % of women after treatment for breast cancer requiring lifelong professional treatment and self-management . The holistic practice of yoga may offer benefits as an adjunct self-management option . The aim of this small pilot trial was to gain preliminary data to determine the effect of yoga on women with stage one breast cancer-related lymphoedema ( BCRL ) . This paper reports the results for the primary and secondary outcomes . Methods Participants were r and omised , after baseline testing , to receive either an 8-week yoga intervention ( n = 15 ) , consisting of a weekly 90-minute teacher-led class and a 40-minute daily session delivered by DVD , or to a usual care wait-listed control group  ( n = 13 ) . Primary outcome measures were : arm volume of lymphoedema measured by circumference and extra-cellular fluid measured by bioimpedance spectroscopy . Secondary outcome measures were : tissue in duration measured by tonometry ; levels of sensations , pain , fatigue , and their limiting effects all measured by a visual analogue scale ( VAS ) and quality of life based on the Lymphoedema Quality of Life Tool ( LYMQOL ) . Measurements were conducted at baseline , week 8 ( post-intervention ) and week 12 ( four weeks after cessation of the intervention ) . Results At week 8 , the intervention group had a greater decrease in tissue in duration of the affected upper arm compared to the control group ( p = 0.050 ) , as well as a greater reduction in the symptom sub-scale for QOL ( p = 0.038 ) . There was no difference in arm volume of lymphoedema or extra-cellular fluid between groups at week 8 ; however , at week 12 , arm volume increased more for the intervention group than the control group ( p = 0.032 ) . Conclusions An 8-week yoga intervention reduced tissue in duration of the affected upper arm and decreased the QOL sub-scale of symptoms . Arm volume of lymphoedema and extra-cellular fluid did not increase . These benefits did not last on cessation of the intervention when arm volume of lymphoedema increased . Further research trials with a longer duration , higher levels of lymphoedema and larger numbers are warranted before definitive conclusions can be made BACKGROUND With increased breast cancer survivor rates among older women , the negative outcomes of breast cancer treatment may linger for years . METHOD We design ed and implemented an oncologist referred , exercise self-management program to increase physical activity and health-related quality of life using a pretest-posttest , single group design . We recruited 34 breast cancer survivors seen for a follow-up oncology visit at two university cancer treatment centers . Women with a mean age of 59.6 years ( S.D.=66 ) comprised the sample . Average time since diagnosed was 3.1 years ; 45 % had stage I breast cancer and 55 % had stage II ; 62 % received chemotherapy and 59 % received a mastectomy . Following a baseline assessment on exercise support , self-efficacy , barriers and benefits ; quality of life ; and a functional performance test , subjects participated in self-management classes and received telephone support . Participants ( n=30 ) repeated the assessment at 6-months . We compared scores between time periods using t-tests . RESULTS Older women increased frequency of weekly , moderate physical activities ( p < or=0.04 ) , and weekly caloric expenditure ( p < or=0.02 ) . Perceived exercise barriers ( p < or=0.02 ) , aerobic endurance ( p<0.04 ) and lower body strength ( p<0.03 ) approached significance , and health-related quality of life ( p < or=0.001 ) significantly improved . CONCLUSION An exercise self-management format referred by an oncologist is efficacious for implementing a lifestyle modification change among older breast cancer survivors Background Today , the 5-year relative survival rate for cancer is 65 % and there are 10.5 million survivors . The largest group of survivors are those of breast cancer . Reductions in mortality are occurring at a greater rate for women under age 50 at diagnosis than among older women . Aims Our goal was to design a socio-educational intervention for 5-year survivors aged 50 or younger at diagnosis and test the hypotheses that women in the intervention group would show greater improvement than controls with respect to ( 1 ) knowledge of breast cancer , its treatment , and long-term health concerns ; ( 2 ) lifestyle habits ( i.e. , exercise and diet ) ; and ( 3 ) communication with family and physicians . Methods Using a r and omized controlled trial with a pre-post design , 404 women who were 5 years from diagnosis and cancer-free ( response rate 54 % ) were r and omly assigned to an intervention or delayed intervention ( control ) group and were assessed at pre-test ( baseline ) and 6 months later ( 96 % retention ) . The intervention consisted of three 6-h workshops over a 3 month period . Four series of workshops were held at different geographical areas in the greater San Francisco Bay Area . The workshops included activities and information to promote physical , social , emotional , and spiritual well-being . The intervention design was based on findings from focus groups and a survey of 185 cancer-free 5-year survivors that assessed changes since the early months after diagnosis in physical , social , emotional , and spiritual concerns ( response rate 73 % ) . Results Consistent with our first hypothesis , at post-test , women in the intervention group , on average , had greater knowledge regarding breast cancer , its treatment , and their own future health than did those in the control group ( p = 0.015 ) . Hypothesis 2 was partially supported as women in the intervention group were more likely than the control group to report an increased amount of physical activity ( p = 0.036 ) , but not significant dietary changes . Social support was related to increased self report of physical activity . With the exception of the last series of workshops , the intervention group did not report improved communications with family , friends , and physicians ( hypothesis 3 ) . Conclusions A short-term intervention can affect knowledge levels and physical activity but not diet or communication in the family . Implication s for Cancer SurvivorsThe intervention was related to greater knowledge related to breast cancer , and increased report of physical activity . The program was not related to changes in reported diet or family communication OBJECTIVES To examine predictors of  physical activity ( PA )  6 months after a r and omized controlled trial . METHODS Breast cancer survivors ( N=377 ) completed assessment s at baseline , postintervention , and 6 months after the intervention . Data were collected on demographic , medical , psychosocial , motivational , and behavioral variables at baseline , postintervention , and 6 months . RESULTS Survivors meeting PA guidelines at baseline ( OR = 5.54 , 95 % CI = 2.99 - 9.82 , P < 0.001 ) and postintervention ( OR = 2.92 , 95 % CI = 1.63 - 5.23 , P < 0.001 ) had a greater likelihood of meeting PA guidelines at 6 months follow-up . CONCLUSIONS Interventions promoting PA maintenance should focus on optimizing PA behavior , psychosocial functioning , and motivation Objective This pilot study examined the effects of a self-administered , home-based exercise ( HBE ) rehabilitation programme design ed to help women regain shoulder mobility immediately following surgery for a modified radical mastectomy and axillary node dissection . Methods Twenty-seven women who were scheduled for surgery were r and omly assigned to either a  post-surgical experimental HBE rehabilitation group  ( n = 16 ) or a  usual care group  ( UC ; n = 11 ) . Women assigned to the HBE group followed an 11 day ( days 3–14 post-surgery ) , home-based rehabilitation programme consisting of shoulder flexibility and stretching exercises that were described on videotape . The videotape programme was modelled after the exercises and guidelines described in a brochure produced by the Canadian Cancer Society . Results As a result of the exercise programme intervention , there was a time × group interaction indicating that the HBE group demonstrated a significantly greater increase in shoulder flexion range of motion ( ROM ) ( p = 0.003 ) and abduction ROM ( p = 0.036 ) when compared to the UC . There were no statistical differences in shoulder strength between groups over time . External rotation ( p = 0.036 ) and grip strength ( p = 0.001 ) significantly increased in both groups during the intervention period but there were no interaction effects . With respect to the forearm circumferences , there was a significant decrease over time ( p < 0.001 ) but no interaction between groups . Conclusion This HBE rehabilitation programme is an effective way to improve shoulder mobility and ROM during the immediate 2-week recovery period following surgery Cancer-related fatigue is the most disabling symptom experienced by breast cancer patients following the cancer treatment . The positive effects of physical activity in the rehabilitation of breast cancer patients are documented in several studies . In a r and omized controlled study the effects of a structured physical training program on fatigue and health-related quality of life were evaluated . Patients and Methods : 63 breast cancer patients with cancer-related chronic fatigue were r and omized at the beginning of the inpatient rehabilitation . The control group received the st and ard complex rehabilitation program , the intervention group a structured physical training program and additional muscle strength and aerobic exercises . The effects of the treatment were evaluated by question naires at the start of rehabilitation ( t1 ) , end of rehabilitation ( t2 ) , and 3 months after t2 ( t3 ) . Isometric muscle strength and aerobic capacity were evaluated at t1 and t2 . Results : There was an improvement of muscle strength at the end of rehabilitation for both groups . The increase from t1 to t2 was significantly higher for the training group . The scores for global quality of life , physical well-being , and functionality increased from t1 to t2 , but further improvement in the follow-up ( t3 ) was only observed in the training group . The cancer-related fatigue was significantly reduced in the training group from t1 to t3 , however , not in the control group . Conclusions : Structured physical training programs initiated during inpatient rehabilitation and continuously practice d in the time thereafter can improve symptoms of chronic fatigue and quality of life in breast cancer patients 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 Abstract Endocrine therapy ( ET ) is a common method of treatment in breast cancer patients ; however , its negative impact on body composition , body physique ( physical body shape/ measurements ) , and quality of life ( QoL ) remains controversial . Previous studies have shown physical exercise can have a positive effect on QoL in breast cancer patients , especially premenopausal subjects . Objective . In this feasibility study , we sought to assess the impact that physical exercise had on body composition and QoL in premenopausal breast cancer patients undergoing ET  , and to determine the appropriateness of further testing of this intervention in this patient group . Material and methods . This study involved 41 premenopausal female breast cancer patients before and after six , 12 , and 18 months of ET . Aerobic training began in the 6th month and resistance training was added in the 12th month . Body composition was evaluated using dual-energy x-ray absorptiometry ( DXA ) scans , body physique was evaluated using anthropometric measurement techniques , and QoL was evaluated using question naires from the European Organization for Research and Treatment of Cancer . Results . The initial period of ET with no exercise result ed in a reduction in fat-free body mass ( FFBM ) , an increase in fat body mass ( FBM ) , and a decline in QoL scores . Adding aerobic training result ed in a reduction of FBM and percentage of and roid fat , and improved QoL scores . The introduction of resistance training further reduced percentage of and roid and gynoid fat , increased FFBM , and further improved QoL scores . Conclusion . ET negatively impacts body composition , body physique , and QoL of premenopausal breast cancer patients . This feasibility study shows that physical activity may improve QoL and reduce adverse effects of ET on body composition and body physique , indicating appropriateness for further investigation on the use of exercise programs in premenopausal breast cancer patients to improve the outcomes of therapy 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 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 BACKGROUND Fatigue is a relevant problem of cancer patients during and after treatment . Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy . However , there is a lack of information about the effects of this intervention on persistent cancer-related fatigue . Therefore , we assessed the effects of an exercise program on cancer-related fatigue after treatment . PATIENTS AND METHODS A consecutive series of 32 cancer patients with mild to severe persistent fatigue [ scores on the Brief Fatigue Inventory ( BFI ) > 25 ] participated in a 3-week exercise program consisting of endurance ( 30 min walking on a treadmill ) and resistance/coordination exercises for the major muscle groups .  Fatigue , mood , and anxiety were assessed with question naires and physical performance with a stress test before and after the program . RESULTS At the end of the program , we observed a significant increase of physical performance ( workload at the anaerobic threshold pre 61 + /- 26 W , post 78 + /- 31 W , P < 0.0001 ) and reduction of global fatigue ( Functional Assessment of Cancer Therapy : pre 45.7 + /- 13.4 , post 52.6 + /- 12.4 , P < 0.0001 ; BFI : pre 37.9 + /- 18.3 , post 31.2 + /-17.1 , P < 0.001 ) . However , no significant improvement of cognitive fatigue or reduction of anxiety was observed . CONCLUSIONS A 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment . However , this intervention does not affect depression , anxiety , or cognitive fatigue BACKGROUND Participation in physical activity can improve the health outcomes of breast cancer survivors . To impact public health , broad-reaching sustainable interventions that promote physical activity are needed . PURPOSE To evaluate the efficacy of two distance-based interventions for promoting physical activity among breast cancer survivors compared with a st and ard recommendation control . METHODS Breast cancer survivors who had finished ' active ' cancer treatment were eligible to participate . Participants ( n = 330 ) were r and omly assigned to receive one of the following mail-delivered interventions : three computer-tailored newsletters , a previously developed breast cancer-specific physical activity booklet or a pamphlet detailing the public health recommendations for physical activity ( control ) . Primary outcomes were self-reported moderate to vigorous aerobic activity and participant 's self-reported resistance training activity at 4 months post-baseline . Secondary outcomes were pedometer step counts , whether or not participants were meeting the physical activity guidelines , time spent in sedentary behaviour , fatigue and health-related quality of life . RESULTS Participants r and omised into the tailored-print intervention group were three times more likely to commence resistance training and meet the resistance-training guidelines immediately after the intervention than participants allocated to the control group . There were no other significant intervention effects . CONCLUSION Computer-tailored newsletters may be an effective strategy for enhancing resistance-based physical activity among breast cancer survivors . The null findings relating to other outcomes may be due to ceiling effects ( in the case of aerobic activity , fatigue and health-related quality of life ) or the sensitivity of the measure used ( in the case of sitting time ) . These issues require further exploration We examined prospect ively the association between weight change during adulthood and breast cancer risk , using data on 1358 incident cases that developed during 5.8 years of follow-up among 40 429 premenopausal and 57 923 postmenopausal women from six European countries , taking part in the European prospect i ve investigation into cancer and nutrition study .  Multivariate Cox regression models were used to calculate hazard ratios according to weight change ( kg ) , defined as the weight difference between age at enrolment and age 20 adjusted for other risk factors . Changes in weight were not associated with premenopausal breast cancer risk . In postmenopausal women  , weight gain was positively associated with breast cancer risk only among noncurrent hormone replacement therapy ( HRT ) users ( P-trend ⩽0.0002 ) . Compared to women with a stable weight ( ±2 kg ) , the relative risk for women who gained 15–20 kg was 1.50 ( 95 % confidence interval ( CI ) 1.06–2.13 ) . The pooled RR per weight gain increment of 5 kg was 1.08 ( 95 % CI 1.04–1.12 ) . Weight gain was not associated with breast cancer risk in current HRT users , although , overall , these women experienced a much higher risk of breast cancer compared with nonusers . Our findings suggest that large adult weight gain was a significant predictor of breast cancer in postmenopausal women not taking exogenous hormones PURPOSE Interventions to increase physical activity among breast cancer survivors are needed to improve health and quality of life and possibly to reduce the risk of disease recurrence and early mortality . Therefore , we report the feasibility and preliminary outcomes of a pilot r and omized trial design ed to increase physical activity in sedentary breast cancer survivors receiving hormone therapy . METHODS Forty-one sedentary women on estrogen receptor modulators or aromatase inhibitors for stage I , II , or IIIA breast cancer were r and omly assigned to receive a 12-wk multidisciplinary physical activity behavior change intervention or usual care . RESULTS Recruitment was 34 % , intervention adherence was 99 % , and complete follow-up data were obtained on 93 % . Most participants ( 93 % ) were white with mean age of 53 + /- 9 yr . Differences favoring the intervention group were noted for accelerometer physical activity counts ( mean difference = 72,103 ; 95 % confidence interval ( CI ) = 25,383 - 119,000 ; effect size ( d ) = 1.02 ; P = 0.004 ) , aerobic fitness ( mean difference = 2.9 ; 95 % CI = -0.1 to 5.8 ; d = 0.64 ; P = 0.058 ) , back/leg muscle strength ( mean difference = 12.3 ; 95 % CI = 0.4 - 15.9 ; d = 0.81 ; P = 0.017 ) , waist-to-hip ratio ( mean difference = -0.05 ; 95 % CI = -0.01 to -0.08 ; d = -0.77 ; P = 0.018 ) , and social well-being ( mean difference = 2.0 ; 95 % CI = 0.3 - 3.8 ; d = 0.76 ; P = 0.03 ) . However , the intervention group also reported a greater increase in joint stiffness ( mean difference = 1.1 ; 95 % CI = 0.1 - 2.2 ; d = 0.70 ; P = 0.04 ) . CONCLUSIONS A behavior change intervention for breast cancer survivors based on the social cognitive theory is feasible and results in potentially meaningful improvements in physical activity and selected health outcomes . Confirmation in a larger study is warranted 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 OBJECTIVES Cancer survivors often report cognitive problems . Furthermore , decreases in physical activity typically occur over the course of cancer treatment . Although physical activity benefits cognitive function in noncancer population s , evidence linking physical activity to cognitive function in cancer survivors is limited . In our recent r and omized controlled trial , breast cancer survivors who received a yoga intervention  had lower fatigue and inflammation following the trial compared with a wait list control group . This secondary analysis of the parent trial addressed yoga 's impact on cognitive complaints . METHODS Posttreatment stage 0-IIIA breast cancer survivors ( n = 200 ) were r and omized to a 12-week , twice-weekly Hatha yoga intervention or a wait list control group . Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline , immediately postintervention , and 3-month follow-up . RESULTS Cognitive complaints did not differ significantly between groups immediately postintervention ( p = 0.250 ) . However , at 3-month follow-up , yoga participants ' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23 % lower than wait list participants ' scores ( p = 0.003 ) . These group differences in cognitive complaints remained after controlling for psychological distress , fatigue , and sleep quality . Consistent with the primary results , those who practice d yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practice d less frequently ( p < 0.001 ) . CONCLUSIONS These findings suggest that yoga can effectively reduce breast cancer survivors ' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems Up to 50 % of breast cancer survivors on aromatase inhibitor therapy report musculoskeletal symptoms such as joint and muscle pain , significantly impacting treatment adherence and discontinuation rates . We conducted a secondary data analysis of a nationwide , multi-site , phase II/III r and omized , controlled , clinical trial examining the efficacy of yoga for improving musculoskeletal symptoms among breast cancer survivors currently receiving hormone therapy ( aromatase inhibitors [ AI ] or tamoxifen [ TAM ] ) . Breast cancer survivors currently receiving AI ( N = 95 ) or TAM ( N = 72 ) with no participation in yoga during the previous 3 months were r and omized into 2 arms : ( 1 ) st and ard care monitoring and ( 2 ) st and ard care plus the 4-week yoga intervention ( 2x/week ; 75 min/session ) and included in this analysis . The yoga intervention utilized the UR Yoga for Cancer Survivors ( YOCAS © ® ) program consisting of breathing exercises , 18 gentle Hatha and restorative yoga postures , and meditation .  Musculoskeletal symptoms were assessed pre- and post-intervention . At baseline , AI users reported higher levels of general pain , muscle aches , and total physical discomfort than TAM users ( all P ≤ 0.05 ) . Among all breast cancer survivors on hormonal therapy , participants in the yoga group demonstrated greater reductions in musculoskeletal symptoms such as general pain , muscle aches and total physical discomfort from pre- to post-intervention than the control group ( all P ≤ 0.05 ) . The severity of musculoskeletal symptoms was higher for AI users compared to TAM users . Among breast cancer survivors on hormone therapy , the brief community-based YOCAS © ® intervention significantly reduced general pain , muscle aches , and physical discomfort 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 evaluate yoga 's impact on inflammation , mood , and fatigue . PATIENTS AND METHODS A r and omized controlled 3-month trial was conducted with two post-treatment assessment s of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control . The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 ( IL-6 ) , tumor necrosis factor alpha ( TNF-α ) , and interleukin-1β ( IL-1β ) , and scores on the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) , the vitality scale from the Medical Outcomes Study 36-item Short Form ( SF-36 ) , and the Center for Epidemiological Studies -Depression ( CES-D ) scale . RESULTS Immediately post-treatment , fatigue was not lower ( P > .05 ) but vitality was higher ( P = .01 ) in the yoga group compared with the control group . At 3 months post-treatment , fatigue was lower in the yoga group ( P = .002 ) , vitality was higher ( P = .01 ) , and IL-6 ( P = .027 ) , TNF-α ( P = .027 ) , and IL-1β ( P = .037 ) were lower for yoga participants compared with the control group . Groups did not differ on depression at either time ( P > .2 ) . Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits ( P = .019 ; P < .001 ) , as well as vitality ( P = .016 ; P = .0045 ) , but not depression ( P > .05 ) than simple group assignment ; more frequent practice produced larger changes . At 3 months post-treatment , increasing yoga practice also led to a decrease in IL-6 ( P = .01 ) and IL-1β ( P = .03 ) production but not in TNF-α production ( P > .05 ) . CONCLUSION Chronic inflammation may fuel declines in physical function leading to frailty and disability . If yoga dampens or limits both fatigue and inflammation , then regular practice could have substantial health benefits PURPOSE To examine the effects of aerobic exercise therapy on quality of life ( QoL ) and associated outcomes in women treated for breast cancer . Evidence suggests that exercise may be beneficial , but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients . PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were r and omly assigned to supervised aerobic exercise therapy ( n = 34 ) , exercise-placebo ( body conditioning ; n = 36 ) , or usual care ( n = 38 ) . Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks . Outcomes included QoL , depression , exercise behavior , aerobic fitness ; outcomes were assessed at baseline and at the 8- and 24-week follow-up . RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General ( primary outcome ) favoring aerobic exercise therapy at 8 weeks , relative to usual care . Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast , social/family well-being , functional well-being , and breast cancer subscale scores at 8-week follow-up . Psychological health outcomes improved modestly for both intervention groups ; these improvements were sustained for several end points . CONCLUSION Exercise therapy had large , clinical ly meaningful , short-term beneficial effects on QoL in women treated for breast cancer ; this finding can not be attributable to attention , given that the exercise-placebo group did not report similar effects relative to usual care 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 BACKGROUND The majority of women with breast cancer experience treatment-related fatigue . Fatigue makes patients more inclined to terminate their treatment , which influences patient prognosis and survivorship . PURPOSE This study explores the effects of a walking program on fatigue and exercise capacity in women who have undergone breast cancer surgery . METHODS This was a r and omized control trial study with measures taken 3 times over 5 weeks . Sixty-six women with breast cancer were recruited from a medical center in central Taiwan . The intervention was a moderate-intensity , home-based walking program . The Functional Assessment for Chronic Illness Treatment-Fatigue and distance walked in a 6-minute period  , respectively , were used to score the main outcome measures of fatigue and exercise capacity . RESULTS For those who accepted chemotherapy , fatigue was significantly higher during chemotherapy than after surgery . Although participants in the walking program achieved gradually reduced fatigue and increased exercise capacity , there was no significant difference in fatigue and exercise capacity between the exercise and control groups at any of the three measured times . CONCLUSIONS / IMPLICATION S FOR PRACTICE Nurse collaboration with healthcare providers to promote exercise in the breast cancer population may not only improve the health of post-surgery breast cancer women but also enhance the independent functioning of nurses and advance the nursing profession 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 Purpose This study aim ed to determine whether the Physical Activity and Lymphedema ( PAL ) trial weight training program for breast cancer survivors at risk of or with breast cancer-related lymphedema provided skeletal benefits . Methods Of the 295 participants in the r and omized controlled PAL trial , 258 ( weight training ; N = 128 ; control , N = 130 ) had complete measures of bone mineral density ( BMD ( in grams per square centimeter ) ) of the proximal femur and lumbar spine and were also categorized by T scores . Women in the weight training group performed slowly progressive weight training 2 days/week for 12 months compared to women in the control group who maintained their usual physical activities . Results There were no significant differences in the rate of BMD change at any skeletal site between weight training and control groups , regardless of menopausal status . Distribution of bone health categories was not significantly different between groups at baseline , but became different at 12 months ( p < 0.03 ) among postmenopausal women due to an increase in the percentage of controls who became osteopenic ( 35 to 44 % ) compared to stable bone health in weight lifters . Conclusions The PAL weight training program that increased muscle strength without exacerbating or causing lymphedema among breast cancer survivors was not as efficacious at improving skeletal health . The skeletal loads produced from the PAL program may be insufficient to notably shift BMD , but may have a subtle osteogenic effect . Implication s for cancer survivorsThe safety and efficacy of rigorous weight training programs for improving skeletal health in women at risk for or with breast cancer-related lymphedema remain to be determined In this 12-month RCT , we examined whether aerobic impact exercise training ( 3x/week ) could facilitate breast cancer survivors ' recovery by enhancing their bone structural strength , physical performance and body composition . After the adjuvant chemo- and / or radiotherapy , 86 patients were r and omly assigned into the training or control group . Structural bone traits were assessed with pQCT at the tibia and with DXA at the femoral neck . Agility ( figure-8 running ) , jump force and power ( force platform ) , grip strength and cardiovascular fitness ( 2-km walk test ) were also assessed . Training effects on outcome variables were estimated by two-way factorial ANCOVA using the study group and menopausal status as fixed factors . Bone structural strength was better maintained among the trainees . At the femoral neck , there was a small but significant 2 % training effect in the bone mass distribution ( p=0.05 ) . At the tibial diaphysis , slight 1 % to 2 % training effects ( p=0.03 ) in total cross-sectional area and bone structural strength were observed ( p=0.03 ) among the postmenopausal trainees . Also , 3 % to 4 % training effects were observed in the figure-8 running time ( p=0.03 ) and grip strength ( p=0.01 ) . In conclusion , vigorous aerobic impact exercise training has potential to maintain bone structural strength and improve physical performance among breast cancer survivors BACKGROUND Yoga is a popular mind-body therapy that has demonstrated beneficial effects on psychological , behavioral , and functional outcomes . However , few studies have investigated effects on inflammatory processes . This study tested the hypothesis that an Iyengar yoga intervention specifically design ed for fatigued breast cancer survivors would lead to decreases in inflammation-related gene expression and circulating markers of proinflammatory cytokine activity . METHODS Breast cancer survivors with persistent cancer-related fatigue were r and omized to a 12-week Iyengar yoga intervention  ( n=16 ) or a 12-week health education control condition  ( n=15 ) . Blood sample s were collected at baseline , post-intervention , and at a 3-month follow-up for genome-wide transcriptional profiling and bioinformatic analyses . Plasma inflammatory markers and salivary cortisol were also assessed . RESULTS In promoter-based bioinformatics analyses , the yoga group showed reduced activity of the pro-inflammatory transcription factor nuclear factor kappa B ( NF-κB ) , increased activity of the anti-inflammatory glucocorticoid receptor , and reduced activity of cAMP response element-binding protein ( CREB ) family transcription factors relative to controls ( all ps<.05 ) . There was also a significant intervention effect on the soluble tumor necrosis factor receptor type II ( sTNF-RII ) , a marker of TNF activity ; plasma levels of sTNF-RII remained stable in the yoga group , whereas levels of this marker increased in the health education group ( p=.028 ) . A similar , non-significant trend was observed for the interleukin 1 receptor antagonist ( p=.16 ) . No significant changes in C reactive protein ( CRP ) , interleukin 6 ( IL-6 ) , or diurnal cortisol measures were observed . CONCLUSIONS A 12-week restorative Iyengar yoga intervention reduced inflammation-related gene expression in breast cancer survivors with persistent fatigue . These findings suggest that a targeted yoga program may have beneficial effects on inflammatory activity in this patient population , with potential relevance for behavioral and physical health Background Lymphedema is an adverse effect of breast cancer surgery .  Aqua lymphatic therapy ( ALT ) is a novel treatment for limb volume reduction . Objective The aim of this study was to examine whether ALT is a safe method and whether there are differences in adherence , limb volume , and quality of life between women who perform only self-management treatment and women who participate as well in ALT . Design Design of the study was single-blind r and omized clinical trial . Setting The setting was in a hydrotherapy pool , 1.2 m depth , and a temperature of 32–33 ° С. Patients Forty-eight women ( 56 ± 10 years ) , with a 12.8 % lymphedema relative volume , participated in the study .InterventionThe control group was instructed to perform the self-management treatment . The study group joined a weekly session of ALT for 3 months in addition to the self-management therapy .  Measurements Adherence was assessed by a self-reported diary , limb volume by a water displacement device , quality of life by the Upper Limb Lymphedema Question naire ( ULL27 ) , prior to , and after the intervention period . Results There was no episode of arm infection or aggravation in limb volume during the study period . ALT had a positive , statistically and clinical ly significant immediate effect on limb volume but no long-term effect was noted . The adherence rate to ALT  was significantly higher than the adherence to self-management therapy . QOL improved in the study group . Conclusion ALT was found to be a safe method , with high adherence , in treating women who suffer from mild to moderate lymphedema . A significant immediate and insignificant long-term effect on limb volume was noted Purpose : We previously reported the effectiveness of a 12-week physical activity behavior change intervention for breast cancer survivors postintervention with this report , aim ing to determine delayed and /or persistent effects 3 months after intervention completion . Methods : Forty-one sedentary women with stage I , II , or IIIA breast cancer currently receiving hormonal therapy were r and omly assigned to receive the 12-week Better Exercise Adherence after Treatment for Cancer intervention or usual care . Assessment s occurred at baseline , postintervention , and 3 months postintervention . Results : Weekly minutes of greater than or equal to moderate intensity physical activity measured by accelerometer showed a significant group by time interaction ( F = 3.51 ; P = 0.035 ; between group difference in the mean change from baseline to 3 months postintervention , 100.1 minute , P = 0.012 ) . Significant group by time interactions also showed sustained improvements from baseline to 3 months postintervention in strength ( F = 3.82 ; P = 0.027 ; between group difference , 11.2 kg ; P = 0.026 ) , waist-to-hip ratio ( F = 3.36 ; P = 0.041 ; between group difference , −0.04 ; P = 0.094 ) , and social well-being ( F = 4.22 ; P = 0.023 ; between group difference , 3.9 ; P = 0.039 ) . A delayed reduction in lower extremity dysfunction 3 months postintervention was noted ( F = 3.24 ; P = 0.045 ; between group difference in the mean change from postintervention to 3 months follow-up ; P = −7.6 ; P = 0.015 ) . No group by time effect was noted for fitness , body mass index , percent fat , bone density , total quality of life ( Functional Assessment of Cancer Therapy-General ) , fatigue , endocrine symptoms , cognitive function , or sleep . Conclusions : The intervention result ed in sustained improvements in physical activity , strength , central adiposity , and social well-being with lower extremity function benefits appearing 3 months after intervention completion . Testing translation in a multisite study is warranted . ( Cancer Epidemiol Biomarkers Prev 2009;18(5):1410–8 The purpose of the present paper was to evaluate the effects of an 8-week multimodal program focused on core stability exercises and recovery massage with DVD support for a 6-month period in physical and psychological outcomes in breast cancer survivors . A r and omized controlled clinical trial was performed . Seventy-eight ( n = 78 ) breast cancer survivors were assigned to experimental ( core stability exercises plus massage-myofascial release ) and control ( usual health care ) groups . The intervention period was 8 weeks . Mood state , fatigue , trunk curl endurance , and leg strength were determined at baseline , after the last treatment session , and at 6 months of followup . Immediately after treatment and at 6 months , fatigue , mood state , trunk curl endurance , and leg strength exhibited greater improvement within the experimental group compared to placebo group . This paper showed that a multimodal program focused on core stability exercises and massage  reduced fatigue , tension , depression , and improved vigor and muscle strength after intervention and 6 months after discharge Purpose This study examines the effects of a rehabilitation program on quality of life ( QoL ) , cardiopulmonary function , and fatigue in breast cancer patients . The program included aerobic exercises as well as stretching and strengthening exercises . Methods Breast cancer patients ( n=62 ) who had completed chemotherapy were r and omly assigned to an early exercise group ( EEG ; n=32 ) or a delayed exercise group ( DEG ; n=30 ) . The EEG underwent 4 weeks of a multimodal rehabilitation program for 80 min/day , 5 times/wk for 4 weeks . The DEG completed the same program during the next 4 weeks . The European Organization for Research and Treatment of Cancer-Core Quality of Life Question naire ( EORTC QLQ-C30 ) , EORTC Breast Cancer-Specific Quality of Life Question naire ( EORTC QLQ-BR23 ) , predicted maximal volume of oxygen consumption ( VO2max ) , and fatigue severity scale ( FSS ) were used for assessment at baseline , and at 2 , 4 , 6 , and 8 weeks . Results After 8 weeks , statistically significant differences were apparent in global health , physical , role , and emotional functions , and cancer-related symptoms such as fatigue and pain , nausea , and dyspnea on the EORTC QLQ-C30 ; cancer-related symptoms involving the arm and breast on the EORTC QLQ-BR23 ; the predicted VO2max ; muscular strength ; and FSS ( p<0.050 ) , according to time , between the two groups . Conclusion The results of our study suggest that a supervised multimodal rehabilitation program may improve the physical symptoms , QoL , and fatigue in patients with breast cancer BACKGROUND There are very few r and omized controlled studies on exercise in cancer patients . Consequently , there are no guidelines available with regard to the exercises that can be recommended and difficulties are encountered in the clinical practice as to which exercise is more suitable to the patients . AIM The purpose of this study was to investigate the impact of pilates exercises on physical performance , flexibility , fatigue , depression and quality of life in women who had been treated for breast cancer . DESIGN R and omized controlled trial . SETTING Out patient group , Department of Physical Medicine and Rehabilitation and Medical Oncology Department , University Hospital . POPULATION Fifty-two patients with breast cancer were divided into either pilates exercise ( group 1 ) and control group ( group 2 ) . METHODS Patients in Group 1 performed pilates and home exercises and patients in group 2 performed only home exercises . Pilates exercise sessions were performed three times a week for a period of eight weeks in the rehabilitation unit . MAIN OUTCOME MEASURES Subjects were assessed before and after rehabilitation program , with respect to , 6-min walk test ( 6MWT ) , modified sit and reach test , Brief Fatigue Inventory ( BFI ) , Beck Depression Index ( BDI ) and the European Organisation for Research and Treatment of Cancer Quality of Life C30 ( EORTC QLQ-C30 ) and EORTC QLQ BR23 . RESULTS After the exercise program , improvements were observed in Group 1 in 6-minute walk test , BDI , EORTC QLQ-C30 functional , and EORTC QLQ-C30 BR23 functional scores ( P<0.05 ) . In contrast , no significant improvement was observed in Group 2 after the exercise program in any of parameters in comparison to the pre-exercise period ( P>0.05 ) . When the two exercise groups were compared , there were significant differences in 6MWT in pilates-exercise group ( P<0.05 ) . CONCLUSION Pilates exercises are effective and safe in female breast cancer patients . There is a need for further studies so that its effect can be confirmed . CLINICAL REHABILITATION IMPACT This study addressed the effects of pilates exercise , as a new approach , on functional capacity , fatigue , depression and quality of life in breast cancer patients in whom there are doubts regarding the efficacy and usefulness of the exercise UNLABELLED Movement therapy during the rehabilitation of breast cancer has become more important over the last years . PATIENTS AND METHODS In a r and omized controlled study the feasibility of gentle strenght training was compared to conventional gymnastic exercises during rehabilitation of breast cancer patients . The aim oft this study was to identify alternative sports intervention in the treatment of breast cancer patients . The intervention group ( IG ) was lifting st and ardized weights weekly ( 50 % of h1RM ) , while the control group ( CG ) received conventional gymnastic exercises . A bicycle ergometry adjusted to the WHO system was performed with all participants at study entry ( T0 ) , after three ( T1 ) and six months ( T2 ) . The quality of life was measured by st and ardized report forms ( EORTC QLQ C30 Version 3 and BR23 ) . RESULTS Both methods showed a slight improvement in submaximal endurance performance , a significant improvement in the subjective feeling of effort ( IG : 75 W : < 0.01 , CG : 75 W < 0.01 ) , in psychosocial and psychological parameters like quality of life ( IG : < 0.01 , CG < 0.01 ) and in fatigue ( IG : < 0,01 , CG : < 0.01 ) . CONCLUSION This study shows positive effects for gentle strength lifting in the rehabilitation of breast cancer patients and turned out to be a probate alternative to gymnastic exercises BACKGROUND Breast or chest-wall pain ( BCP ) is prevalent in 20%-50 % of breast cancer survivors , and it affects quality of life ( QOL ) . To determine the feasibility and potential efficacy of an exercise program to improve patient QOL and BCP , such a program was offered to breast cancer patients suffering from BCP . METHODS The study enrolled 10 breast cancer patients with moderate-to-severe BCP at 3 - 6 months after completion of all adjuvant treatments . These patients participated in a 12-week comprehensive health improvement program ( CHIP ) . Intensity was adjusted to reach 65%-85 % of the patient 's maximal heart rate . Before the CHIP and at 1 and 6 months after completion of the CHIP , QOL and pain were measured using question naires [ European Organisation for Research and Treatment of Cancer Quality of Life core and breast cancer modules ( QLQ-C30 , -BR23 ) and the McGill Pain Question naire short form ] completed by the patients . Results were compared with those from case-matched control subjects from another study at McGill University . RESULTS After the CHIP , patients reported significant and clinical ly important improvements in QOL and symptoms . At 1 and 6 months post-CHIP , patients in the study felt , on average , better in overall QOL than did historical control subjects . CONCLUSIONS Our study suggests that patients who experience chronic bcp may benefit from an exercise program . A r and omized controlled trial is warranted Background : With continual improvements in screening uptake and adjuvant cancer treatments , the number of Canadian women surviving breast cancer continues to grow . Preliminary findings suggest yoga can improve quality of life ( QoL ) in breast cancer survivors , but few studies have focused on Iyengar yoga ( IY ) . Objective : The purpose of this pilot study was to evaluate the impact of IY on QoL and psychosocial functioning in a select sample of breast cancer survivors . Methods : Breast cancer survivors ( N = 24 ) participating in IY classes completed a question naire measuring generic and disease-specific QoL and psychosocial functioning , before and after the 12-week classes . Results : Postprogram question naires were completed by 17 participants ( 71 % ) who attended an average of 78.9 % of the IY sessions . Several indicators of generic QoL improved significantly , including mental health ( mean change , + 4.2 ; P = .045 ) , vitality ( mean change , + 4.9 ; P = .033 ) , role-emotional ( mean change , + 6.4 ; P = .010 ) , and bodily pain ( mean change , + 4.4 ; P = .024 ) . Other improvements in QoL and psychosocial functioning were meaningful but were not statistically significant . Findings were further substantiated by participant 's evaluation of the program 's benefits and motivational value . Conclusion : In this pilot study of breast cancer survivors participating in IY , we found improvements in QoL and psychosocial functioning . Moreover , positive program evaluation and motivational profile provide support for the acceptability of IY with breast cancer survivors . R and omized controlled trials comparing IY to usual care and other forms of yoga in breast cancer survivors are warranted . Implication s for Practice : Nurses may consider IY as a possible intervention strategy to help breast cancer survivors improve their QoL and psychosocial functioning 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 BACKGROUND Qigong is highly favoured among Asian breast cancer survivors for enhancing health . This study examined the hypothesis that quality of life ( QoL ) in the Qigong group is better than the placebo ( aerobic ) or usual care group . MATERIAL S AND METHODS A total of 197 participants were r and omly assigned to either the 8-week Kuala Lumpur Qigong Trial or control groups in 2010 - 2011 . Measurement taken at baseline and post- intervention included QoL , distress and fatigue . Analysis of covariance ( ANCOVA ) and Kruskal Wallis were used to examine for differences between groups in the measurements . RESULTS There were 95 consenting participants in this 8week trial . The adherence rates were 63 % for Qigong and 65 % for the placebo group . The Qigong group showed significant marginal improvement in Quality of life scores compared to placebo ( mean difference=7.3 unit ; p=0.036 ) , compared to usual care ( mean difference=6.7 unit ; p=0.048 ) on Functional Assessment Cancer Therapy-Breast measure . There were no significant changes between the placebo and usual care groups in fatigue or distress at post intervention ( 8-week ) . CONCLUSIONS Cancer survivors who participated in the  Qigong intervention showed slightly better QOL . Follow up studies are greatly needed to evaluate which subgroups may best benefit from Qigong . With a steep rise of cancer survivors , there is an urgent need to explore and engage more cultural means of physical activity to fight side effects of treatment and for cancer control in developing countries 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 OBJECTIVE  Physical activity ( PA ) has been shown to provide health benefits for breast cancer patients . The effects of augmenting oncology health care provider ( HCP ) advice for PA with 3 months of telephone counseling versus contact control were evaluated in a r and omized trial . METHODS After receiving brief HCP advice to become physically active , 192 women ( age in years : M = 60.0 , SD = 9.9 ) who had completed treatment for Stage 0-IV breast cancer were r and omized to telephone counseling to support PA ( n = 106 ) or contact control ( n = 86 ) . Their PA , motivational readiness , fatigue , and physical functioning were assessed at baseline ( before receiving HCP advice ) , 3 , 6 , and 12 months . RESULTS Telephone counseling produced significant effects on the primary outcome of moderate-intensity PA of about 30 min/week at both 3 months ( 95 % CI = 0.44 , 57.32 ) and 6 months ( 95 % CI = 3.06 , 61.26 ) . Intervention participants were also more than twice as likely as control participants to report improvements in achieving PA guidelines of at least 150 min/week at 3 ( OR = 2.43 , 95 % CI = 1.18 , 4.98 ) and 6 months ( OR = 2.11 , 95 % CI = 1.00 - 4.48 ) . Telephone counseling was significantly more effective than contact control in increasing motivational readiness for PA at all follow-ups ( ORs = 3.93 - 6.28 , all ps < .003 ) . No between-groups differences were found for fatigue , while differential improvements in physical functioning did not remain significant past 3 months ( p = .01 ) . CONCLUSION HCP advice plus telephone counseling improved PA among breast cancer patients at 3 and 6 months and also differentially improved patients ' motivational readiness at all follow-ups , suggesting the potential for exercise promotion in cancer follow-up care Goals Health-related quality of life ( HRQL ) and self-esteem are often diminished among women diagnosed and treated for breast cancer .  Tai Chi is a moderate form of exercise that may be an effective therapy for improving HRQL and self-esteem among these women . We sought to compare the efficacy of Tai Chi Chuan ( TCC ) and psychosocial support ( PST ) for improving HRQL and self-esteem among breast cancer survivors . Patients and methods A group of 21 women diagnosed with breast cancer , who had completed treatment within the last 30 months were r and omized to receive 12 weeks of TCC or PST . Participants in both groups met three times a week for 60 minutes . HRQL and self-esteem were assessed at baseline , 6 weeks , and 12 weeks . Results The TCC group demonstrated significant improvements in HRQL , while the PST group reported declines in HRQL , with the differences between the two groups approaching significance at week 12 . Additionally , the TCC group exhibited improvements in self-esteem , while the PST group reported declines in self-esteem , with the differences between groups reaching statistical significance at week 12 . These findings , coupled with a visual inspection of the raw change scores , support the plausibility of a dose-response relationship concerning Tai Chi . Conclusions In this pilot investigation , the TCC group exhibited improvements in HRQL and self-esteem from baseline to 6 and 12 weeks , while the support group exhibited declines . R and omized , controlled clinical trials with larger sample sizes are needed 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 Purpose To obtain estimates of time to recruit the study sample , retention , facility-based class attendance and home practice for a study of yoga in breast cancer survivors , and its efficacy on fatigue , quality of life ( QOL ) , and weight change . Methods Sixty-three post-treatment stages 0–III borderline overweight and obese ( body mass index ≥24 kg/m2 ) breast cancer survivors were r and omly assigned to a 6-month , facility- and home-based viniyoga intervention ( n = 32 ) or a waitlist control group ( n = 31 ) . The yoga goal was five practice s per week . Primary outcome measures were changes in QOL , fatigue , and weight from baseline to 6 months . Secondary outcomes included changes in waist and hip circumference . Results It took 12 months to complete recruitment . Participants attended a mean of 19.6 classes and practice d at home a mean of 55.8 times during the 6-month period . At follow-up , 90 % of participants completed question naires and 87 % completed anthropometric measurements . QOL and fatigue improved to a greater extent among women in the yoga group relative to women in the control group , although no differences were statistically significant . Waist circumference decreased 3.1 cm ( 95 % CI , −5.7 and −0.4 ) more among women in the yoga compared with the control group , with no difference in weight change . Conclusions This study provides important information regarding recruitment , retention , and practice levels achieved during a 6-month , intensive yoga intervention in overweight and obese breast cancer survivors .  Yoga may help decrease waist circumference and improve quality of life ; future studies are needed to confirm these results PURPOSE / OBJECTIVES To compare the effectiveness of a prescribed home-based walking exercise intervention with usual care in older women receiving hormonal treatment for breast cancer , and to examine relationships among levels of the cortisol , serotonin , interleukin-6 , and bilirubin biomarkers and fatigue , sleep disturbances , and depressive symptoms . DESIGN Longitudinal r and omized clinical trial . SETTING A National Cancer Institute- design ated cancer center in the southeastern United States . SAMPLE 20 women ( aged 55 years or older ) with breast cancer receiving hormonal treatment . METHODS Participants were r and omized to a walking exercise intervention or usual care . Laboratory sample s and the Pittsburgh Sleep Quality Index ( PSQI ) , the Piper Revised Fatigue Scale , and the Center for Epidemiological Studies -Depression Scale were collected at the initial clinic visit and at 12 weeks from the groups . Question naires also were collected at weeks 2 and 14 . MAIN RESEARCH VARIABLES Fatigue , sleep disturbances , depressive symptoms , biomarkers , and exercise . FINDINGS Effect of the exercise intervention on sleep scores was highly significant between groups . Exercise group scores on the PSQI decreased significantly over time ( indicating improved sleep quality ) , although scores did not change significantly within the control group . Sleep actigraphy also showed significantly shorter actual wake time and less movement in the exercise group . Serotonin levels also were significantly affected by the intervention . CONCLUSIONS Data suggest that a walking exercise intervention improves sleep in older women receiving hormonal treatment for their breast cancer . Serotonin levels may be a useful biomarker when assessing sleep disturbances in this group . IMPLICATION S FOR NURSING Clinicians need to be aware that older women receiving hormonal treatment for their breast cancer may experience fatigue , sleep disturbances , and depressive symptoms . Homebased walking activity may reduce symptom severity in this group Objective To evaluate the effects of an 8-week multidimensional physical therapy program , including strengthening exercises and recovery massage , on neck and shoulder pain , pressure hypersensitivity , and the presence of active trigger points ( TrPs ) in breast cancer survivors . Methods In this r and omized controlled clinical trial , 44 breast cancer survivors were r and omly assigned into 2 groups : CUI DATE group who received a multidimensional physical therapy program ; or CONTROL group who received usual care treatment for breast cancer . CUI DATE program consisted of 24 hours of individual physical training ( aerobic , mobility , stretching , and strengthening exercises ) and 12 hours of physical therapy recovery ( stretching , massage ) interventions ( 3 times/wk , 90 min ) . Outcomes included neck and shoulder pain ( visual analog scale , 0 to 100 ) , pressure pain thresholds over the C5-C6 zygapophyseal joints , deltoid muscles , second metacarpal and tibialis anterior muscles , and the presence of active TrPs in shoulder muscles . Outcomes were assessed at baseline and after the 8-week program by a blinded assessor . Results The CUI DATE group showed an estimated improvement for neck pain of –56 mm [ 95 % confidence interval ( CI ) , −71-–40 , P<0.001 ; effect size 2.72 , 1.94 to 3.44 ] and for shoulder/axillary of –56 mm ( 95 % CI , –74-–38 , P<0.001 ; effect size 2.45 , 1.66 to 3.23 ) . Improvements were also noted for pressure pain thresholds levels : C5-C6 zygapophyseal joints ( between-group differences 101 kPa , 95 % CI , 60 - 143 ; effect size 1.68 , 1.00 to 2.35 ; 92 kPa 55 to 129 ; d : 1.98 , 1.18 to 2.77 ) , deltoid muscles ( 98 kPa , 45 to 149 ; d : 1.34 , 0.62 to 2.04 ; 75 kPa 18 to 132 ; d : 1.12 , 0.27 to 1.96 ) , second metacarpal ( 93 kPa , 45 to 134 ; d : 1.30 , 0.63 to 1.86 ; 99 kPa 59 to 139 ; d : 1.60 , 0.96 to 2.24 ) , and tibialis anterior muscles ( 71 kPa , 40 to 144 ; d : 1.16 , 0.65 to 2.34 ; 118 kPa 57 to 178 ; d : 1.17 , 0.56 to 1.77 ) . Finally , patients within the CUI DATE program showed a greater reduction of active muscle TrPs compared with the CONTROL group ( P<0.01 ) . Conclusions An 8-week multidimensional program including strengthening exercises , and massage as major components was effective for improving neck and shoulder pain and reducing widespread pressure hyperalgesia in breast cancer survivors compared with usual care treatment 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 : 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 The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors . A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres . Patients in the experimental group received a MMPP incorporating DWR , 3 times a week , for an 8-week period . The control group received a leaflet containing instructions to continue with normal activities . Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale-Revised total score ( d = 0.7 , P = 0.001 ) , as well as behavioural/severity ( d = 0.6 , P = 0.05 ) , affective/meaning ( d = 1.0 , P = 0.001 ) and sensory ( d = 0.3 , P = 0.03 ) domains . Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5 , P < 0.05 ) and quality of life ( d = 1.3 , P < 0.05 ) . All participants attended over 80 % of sessions , with no major adverse events reported . The results of this study suggest MMPP incorporating  DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors . Further , the high level of adherence and lack of adverse events indicate such a programme is safe and feasible 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 The purpose of this pilot study was to gather information on the immediate and short-term effects of relaxation training according to Yoga In Daily Life ® ( YIDL ) system on the psychological distress of breast cancer patients . 32 patients at the Institute for Oncology of Ljubljana were r and omized to the experimental ( N = 16 ) and to the control group ( N = 16 ) . 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 YIDL ® system . At discharge the experimental group was issued with audiocassette recordings containing the similar instructions for relaxation training to be practice d individually at home ( for further 3 weeks ) . An experimental repeated measures design was used to investigate the differences over 1 month period in stress levels , changes in mental health and psychological parameters . Measures were obtained at three time points during the study period : baseline , at 1 week , and at 4 weeks , by blinded investigators using st and ardized question naires General Health Question naire-12 ( GHQ-12 ) , Rotterdam Symptom Checklist ( RSCL ) psychological subscale , Perceived Stress Scale ( PSS ) . Patients who received relaxation training reported feeling significantly less distressed during hospitalization and after discharge-period than did the controls that did not receive relaxation training . The results indicate that relaxation training according to Yoga in Daily Life ® system could be useful clinical physiotherapy intervention for breast cancer patients experiencing psychological distress . Although this kind of relaxation training can be applied to clinical oncology in Slovenia , more studies need to be done Background . The goal of this pilot study was to determine the magnitude and direction of intervention effect sizes for inflammatory-related serum markers and relevant health outcomes among breast cancer survivors ( BCSs ) receiving a physical activity behavior change intervention compared with usual care .  Methods . This r and omized controlled trial enrolled 28 stage I , II , or IIIA BCSs who were post– primary treatment and not regular exercisers . Participants were assigned to either a 3-month physical activity behavior change intervention group ( ING ) or usual care group ( UCG ) . Intervention included supervised aerobic ( 150 weekly minutes , moderate-intensity ) and resistance ( 2 sessions per week ) exercise that gradually shifted to home-based exercise . Outcomes were assessed at baseline and 3 months . Results . Cardiorespiratory fitness significantly improved in the ING versus the UCG ( between-group difference = 3.8 mL/kg/min ; d = 1.1 ; P = .015 ) . Self-reported sleep latency was significantly reduced in the ING versus the UCG ( between group difference = −0.5 ; d = −1.2 ; P = .02 ) as was serum leptin ( between-group difference = −9.0 ng/mL ; d = −1.0 ; P = .031 ) . Small to medium nonsignificant negative effect sizes were noted for interleukin (IL)-10 and tumor necrosis factor (TNF)-α and ratios of IL-6 to IL-10 , IL-8 to IL-10 , and TNF-α to IL-10 , whereas nonsignificant positive effect sizes were noted for IL-6 and high-molecular-weight adiponectin . Conclusions . Physical activity behavior change interventions in BCSs can achieve large effect size changes for several health outcomes . Although effect sizes for inflammatory markers were often small and not significant , changes were in the hypothesized direction for all except IL-6 and IL-10 Background : Since physical exercise programs have the potential to help cancer patients regain physical fitness and may exert a range of positive consequences for recovery and psychological well-being , the impact of a physical exercise program was investigated in this prospect i ve study . Patients and Methods : Women with primary nonmetastatic breast cancer after a minimum 4-week period post chemotherapy and /or radiotherapy completion were r and omly assigned to one of 2 groups : intervention group ( IG ) ( n = 30 ) and waiting group ( WG ) ( n = 28 ) . The 10-week twice weekly exercise group program consisted of gymnastics , movement games , relaxation , walking , and jogging .  Anxiety , depression , body image , and quality of life were measured using st and ardized question naires . Maximal oxygen uptake ( VO2max/kg ) was assessed as a measure of physical fitness . Results : Patients in the IG improved significantly over time with regard to anxiety ( p = 0.03 , d = 0.45 ) , depression ( p = 0.05 , d = 0.43 ) , individual body image ( p = 0.006 , d = 0.44 ) , and VO2max/kg ( p < 0.001 , d = 0.50 ) , whereas no improvements were observed in the WG . However , this r and omized controlled trial failed to demonstrate significant intervention effects in quality of life and social body image . Conclusions : This prospect i ve study provided evidence for the effectiveness of a 10-week physical exercise intervention to significantly improve psychosocial wellbeing , individual body image , and physical fitness PURPOSE / OBJECTIVES To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments . DESIGN Pretest and post-test quasiexperimental . SETTING Outpatient oncology rehabilitation center . SAMPLE 96 breast cancer survivors undergoing various clinical treatments . METHODS Subjects were divided into four groups based on the specific type of clinical treatment : surgery alone ( n = 22 ) ; surgery and chemotherapy ( n = 30 ) ; surgery and radiation ( n = 17 ) ; and surgery , chemotherapy , and radiation ( n = 27 ) . Following a comprehensive screening and medical examination , cardiovascular endurance , pulmonary function , and fatigue were assessed , leading to the development of an individualized exercise prescription and a six-month exercise intervention . Repeated- measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups . MAIN RESEARCH VARIABLES Systolic and diastolic blood pressure , resting heart rate , forced vital capacity , forced expiratory volume , predicted oxygen consumption , time on treadmill , and fatigue . FINDINGS Cardiopulmonary function ( predicted maximal oxygen consumption and time on treadmill ) significantly increased in all groups after exercise training . In addition , resting heart rate and forced vital capacity significantly improved in those receiving surgery , chemotherapy , and radiation . Psychologically , the exercise intervention result ed in significant reductions in behavioral , affective , sensory , cognitive and mood , and total fatigue scale scores in all three groups who received treatment with surgery . The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral , affective , and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores . CONCLUSIONS The results suggest that moderate intensity , individualized , prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type . Moreover , cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention . IMPLICATION S FOR NURSING Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments . Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program 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 / OBJECTIVES To investigate the feasibility and preliminary effects of a simultaneous stage-matched exercise and diet ( SSED ) intervention in breast cancer survivors . DESIGN R and omized , controlled trial . SETTING Oncology outpatient treatment clinics at the National Cancer Center in South Korea . SAMPLE 45 women with breast cancer who completed their cancer therapy . METHODS Participants were assigned to the SSED intervention group ( n = 23 ) or a control group ( n = 22 ) . Participants in the SSED group received a 12-week individualized intervention promoting prescribed exercise and a balanced diet through stage-matched telephone counseling and a workbook . MAIN RESEARCH VARIABLES Program feasibility , behavioral outcomes ( stage of motivational readiness for exercise and diet , physical activity , and diet quality ) , and quality -of-life ( QOL ) outcomes ( functioning and global QOL , fatigue , anxiety , and depression ) . FINDINGS Participant evaluations of the SSED intervention indicated that it was feasible and acceptable . All women felt that the overall intervention contents were appropriate , and 95 % believed that the intervention helped to promote healthy behaviors . Objective data also supported the SSED intervention 's feasibility ( i.e. , 91 % completed the trial and 100 % of intervention calls were received ) . When compared to control , the SSED intervention group showed significantly greater improvement in motivational readiness for exercise and diet , emotional functioning , fatigue , and depression . CONCLUSIONS Preliminary results suggest that the SSED intervention delivered via telephone counseling and workbook is feasible and beneficial for positive behavioral and QOL outcomes . IMPLICATION S FOR NURSING Nurse-led lifestyle interventions may improve QOL for cancer survivors PURPOSE Survivors of breast cancer may experience deterioration of physical function . This is important because poor physical function may be associated with premature mortality , injurious falls , bone fracture , and disability . We conducted a post hoc analysis to explore the potential efficacy of slowly progressive weight lifting to reduce the incidence of physical function deterioration among survivors of breast cancer . METHODS Between October 2005 and August 2008 , we conducted a single-blind , 12-month , r and omized controlled trial of twice-per-week slowly progressive weight lifting or st and ard care among 295 survivors of nonmetastatic breast cancer . In this post hoc analysis of data from the Physical Activity and Lymphedema Trial , we examined incident deterioration of physical function after 12 months , defined as a ≥ 10-point decrease in the physical function subscale of the Medical Outcomes Short-Form 36-item question naire . RESULTS The proportion of participants who experienced incident physical function deterioration after 12 months was 16.3 % ( 24/147 ) in the control group and 8.1 % ( 12/148 ) in the weight lifting group ( relative risk , 0.49 ; 95 % CI , 0.25 to 0.96 ; P = .04 ) . No serious or unexpected adverse events occurred that were related to weight lifting . CONCLUSION Slowly progressive weight lifting compared with st and ard care reduced the incidence of physical function deterioration among survivors of breast cancer . These data are hypothesis generating . Future studies should directly compare the efficacy of weight lifting with other modalities of exercise , such as brisk walking , to appropriately inform the development of a confirmatory study design ed to preserve physical function among survivors of breast cancer 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 Abstract Introduction . The aim of cancer rehabilitation is to enable patients to attain and maintain optimal physical , psychological and social functioning . We evaluated the effect on health behavior , BMI and self-rated health of a residential psychosocial rehabilitation course for cancer patients . Material and methods . Patients with a primary cancer of the breast , prostate , colon or rectum were r and omized to either a six-day multi-focus psychosocial residential rehabilitation intervention that included lectures , discussion s and peer group discussion s on issues related to treatment and life with cancer or to usual care . The end points were changes in smoking , alcohol consumption , physical activity , body mass index and self-rated health between baseline and follow-up after one and six months . The primary analyses included all participants who received their allocated condition . The two follow-up times were analyzed separately in general linear and logistic regression models for continuous and dichotomous outcomes , respectively . The analyses were adjusted for baseline outcome score , cancer site , time since diagnosis , age and education . Results . Of the 507 participants who were r and omly assigned , 452 were included in the analysis , of whom 404 completed the one month and 394 completed the six month assessment . The intervention group showed slightly more positive changes in health behavior , BMI and self-rated health than the usual care group , but the differences between the groups were small and not significant . Discussion . Participation in a six-day cancer rehabilitation course did not significantly influence health behavior , BMI or self-rated health among cancer patients 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 The purpose of this r and omized control trial was to verify the effectiveness of a brief group intervention that combines stress management psycho-education and physical activity ( ie , independent variable ) intervention in reducing fatigue and improving energy level , quality of life ( mental and physical ) , fitness ( VO2submax ) , and emotional distress ( ie , dependent variables ) in breast cancer survivors . This study applied Lazarus and Folkman stress-coping theoretical framework , as well as Salmon 's unifying theory of physical activity . Eighty-seven French-speaking women who had completed their treatments for nonmetastatic breast cancer at a university hospital in Quebec City , Canada , were r and omly assigned to either the group intervention ( experimental ) or the usual-care ( control ) condition . Data were collected at baseline , postintervention , and at 3-month follow-up . The 4-week group intervention was cofacilitated by 2 nurses . Results showed that participants in the intervention group showed greater improvement in fatigue , energy level , and emotional distress at 3-month follow-up , and physical quality of life at postintervention , compared with the participants in the control group . These results suggest that a brief psycho-educational group intervention focusing on active coping strategies and physical activity is beneficial to cancer survivors after breast cancer treatments OBJECTIVE Physical activity ( PA ) adoption can improve quality of life ( QOL ) and related outcomes among breast cancer survivors . To disseminate a telephone-based PA intervention to cancer survivors , we partnered with the American Cancer Society 's Reach To Recovery program ( RTR ) whose volunteers ( breast cancer survivors ) provide information and emotional support to breast cancer survivors . METHOD This r and omized controlled trial compared the effects of PA telephone counseling delivered by RTR volunteers ( PA Plus RTR )  versus a contact control condition ( RTR Control )  in six New Engl and states . RTR volunteers ( n = 18 ; mean age = 54.9 years , mean years since breast cancer diagnosis = 7.0 ) delivered a 12-week PA program to help participants adopt 30 min of moderate-intensity activity ≥5 days/week . Breast cancer survivors ( n = 76 ; mean age = 55.62 years , mean years since diagnosis = 1.11 , Stage 0 = 6.58 % , Stage 1 = 38.16 % , Stage 2 = 44.74 % , Stage 3 = 10.53 % ) were r and omized to a study group . RESULTS Using a series of generalized linear models , we assessed intervention effects on physical health , physical functioning , mental health , fatigue , and QOL at 12 and 24 weeks , and examined whether these effects were moderated by age , marital status , chemotherapy use , and baseline values of the outcomes . There were no significant intervention effects on the outcomes but there were significant moderator effects of age , chemotherapy use , and baseline physical functioning , physical health , and breast cancer-specific symptoms ( all p 's < .05 ) . CONCLUSIONS Specific demographic and treatment variables and baseline psychosocial health moderate the impact of PA interventions on QOL . Copyright © 2015 John Wiley & Sons , Overweight or obesity is an established negative prognostic factor in breast cancer . Co-morbidities associated with obesity , including cardiovascular disease ( CVD ) , may negatively impact quality of life and survival in this population . Our purpose was to determine the effect of a cognitive behavioral therapy ( CBT ) intervention for weight loss through exercise and diet modification on risk factors for recurrence of breast cancer , and risks for CVD associated with obesity . Eighty-five overweight or obese breast cancer survivors were r and omly assigned to a once weekly , 16-week intervention or wait-list control group . The intervention incorporated elements of CBT for obesity , addressing a reduction in energy intake , as well exercise , with a goal of an average of 1 h a day of moderate to vigorous activity .  Body weight , total and regional body fat ( by dual energy X-ray absorptiometry ) , waist and hip circumference , and blood lipids were assessed at baseline and following 16 weeks of intervention . Results : Seventy six women ( 89.4 % ) completed the intervention . Independent t-test to evaluate group differences at 16 weeks showed significant differences in weight , body mass index , percent fat , trunk fat , leg fat , as well as waist and hip circumference between intervention and control groups ( P ≤ 0.05 ) . Furthermore , levels of triglycerides and total cholesterol/high density lipoprotein cholesterol levels were also significantly reduced following the intervention . These results indicate that 16 weeks of a CBT program for weight management may reduce obesity and CVD risk in overweight breast cancer survivors 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 Objectives This study aim ed to determine the effect of a moderate , tailored exercise program on health-related quality of life , physical function , and arm volume in women receiving treatment for nonmetastatic breast cancer . Methods Women who were within 4–12 weeks of surgery for stage I – III breast cancer were r and omized to center-based exercise and lymphedema education intervention or patient education .  Functional Assessment of Cancer Therapy – Breast Cancer ( FACT-B ) , 6-min walk , and arm volume were performed at 3-month intervals through 18 months . Repeated measures analysis of covariance was used to model the total meters walked over time , FACT-B scores , and arm volume . Models were adjusted for baseline measurement , baseline affected arm volume , number of nodes removed , age , self-reported symptoms , baseline SF-12 mental and physical component scores , visit , and treatment group . Results Of the recruited 104 women , 82 completed all 18 months . Mean age ( range ) was 53.6 ( 32–82 ) years ; 88 % were Caucasian ; 45 % were employed full time ; 44 % were overweight ; and 28 % obese . Approximately , 46 % had breast-conserving surgery ; 79 % had axillary node dissection ; 59 % received chemotherapy ; and 64 % received radiation . The intervention result ed in an average increase of 34.3 ml ( SD = 12.8 ) versus patient education ( p = 0.01 ) . Changes in FACT-B scores and arm volumes were not significantly different . Conclusions With this early exercise intervention after breast cancer diagnosis , a significant improvement was achieved in physical function , with no decline in health-related quality of life or detrimental effect on arm volume . Implication s for cancer survivorsStarting a supervised exercise regimen that is tailored to an individual 's strength and stamina within 3 months following breast cancer surgery appears safe and may hasten improvements in physical functioning BACKGROUND Adjuvant treatment for breast cancer may result in long-lasting , adverse emotional and physical side effects , and reduce quality of life ( QOL ) . This pilot study examined the effects of a home-based walking program on QOL and fatigue in early stage breast cancer survivors and whether changes in walking behavior were associated with changes in outcomes . METHODS Participants ( n = 32 ) were r and omized to a 12-week  home-based walking intervention plus brief telephone counseling  ( n = 20 ) or a wait-list control group  ( n = 12 ) . Self-reported fatigue , QOL , and walking were assessed at baseline and 12-weeks . Results are presented as effect sizes . RESULTS Participants in the intervention had improvements in a majority of fatigue and QOL outcomes , whereas the control group had no change or worsened in many ; effect sizes were generally in the small to medium range . Changes in fatigue/QOL outcomes were associated with changes in walking behavior , with effects generally in the small to medium range . CONCLUSION Home-based physical activity ( walking ) programs may be an appropriate avenue for alleviating the adverse side effects that often accompany adjuvant treatment for breast cancer . These programs have potential for widespread dissemination , which may have considerable impact on the quality of life of women recently completing breast cancer treatment The lymphedema diagnostic method used in descriptive or intervention studies may influence results found . The purpose s of this work were to compare baseline lymphedema prevalence in the physical activity and lymphedema ( PAL ) trial cohort and to subsequently compare the effect of the weight-lifting intervention on lymphedema , according to four st and ard diagnostic methods . The PAL trial was a r and omized controlled intervention study , involving 295 women who had previously been treated for breast cancer , and evaluated the effect of 12 months of weight lifting on lymphedema status . Four diagnostic methods were used to evaluate lymphedema outcomes : ( i ) interlimb volume difference through water displacement , ( ii ) interlimb size difference through sum of arm circumferences , ( iii ) interlimb impedance ratio using bioimpedance spectroscopy , and ( iv ) a vali date d self-report survey . Of the 295 women who participated in the PAL trial , between 22 and 52 % were considered to have lymphedema at baseline according to the four diagnostic criteria used . No between-group differences were noted in the proportion of women who had a change in interlimb volume , interlimb size , interlimb ratio , or survey score of ≥5 , ≥5 , ≥10 % , and 1 unit , respectively ( cumulative incidence ratio at study end for each measure ranged between 0.6 and 0.8 , with confidence intervals spanning 1.0 ) . The variation in proportions of women within the PAL trial considered to have lymphoedema at baseline highlights the potential impact of the diagnostic criteria on population surveillance regarding prevalence of this common morbidity of treatment . Importantly though , progressive weight lifting was shown to be safe for women following breast cancer , even for those at risk or with lymphedema , irrespective of the diagnostic criteria used Most breast cancer survivors ( BCS ) are not meeting recommended physical activity guidelines . Here , we report the effects of the Better Exercise Adherence after Treatment for Cancer ( BEAT Cancer ) behavior change intervention on physical activity , aerobic fitness , and quality of life ( QoL ) . We r and omized 222 post- primary treatment BCS to the 3-month intervention ( BEAT Cancer ) or usual care ( UC ) . BEAT Cancer combined supervised exercise , face-to-face counseling , and group discussion s with tapering to home-based exercise . Assessment s at baseline , immediately post-intervention ( month 3 ; M3 ) , and 3 months post-intervention ( month 6 ; M6 ) included accelerometer and self-reported physical activity , submaximal treadmill test , and QoL [ Functional Assessment of Cancer Therapy (FACT)-Breast scale ] . Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer compared to UC on weekly minutes of ≥moderate intensity physical activity at M3 by accelerometer [ mean between group difference ( M ) = + 41 ; 95 % confidence interval ( CI ) = 10–73 ; p = 0.010 ] and self-report ( M = + 93 ; CI = 62–123 ; p < 0.001 ) . Statistical significance remained at M6 for self-reported physical activity ( M = + 74 ; CI = 43–105 ; p < 0.001 ) . BEAT  Cancer participants were significantly more likely to meet physical activity recommendations at both time points [ accelerometer M3 adjusted odds ratio ( OR ) = 2.2 ; CI = 1.0–4.8 and M6 adjusted OR = 2.4 ; CI = 1.1–5.3 ; self-report M3 adjusted OR = 5.2 ; CI = 2.6–10.4 and M6 adjusted OR = 4.8 ; CI = 2.3–10.0 ] . BEAT Cancer significantly improved fitness at M6 ( M = + 1.8 ml/kg/min ; CI = 0.8–2.8 ; p = 0.001 ) and QoL at M3 and M6 ( M = + 6.4 ; CI = 3.1–9.7 ; p < 0.001 and M = + 3.8 ; CI = 0.5–7.2 ; p = 0.025 , respectively ) . The BEAT Cancer intervention  significantly improved physical activity , fitness , and QoL with benefits continuing 3 months post-intervention BACKGROUND Physical exercise can improve cancer patients ' functioning and reduce their symptom levels . A r and omized , controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease . METHODS Cancer patients ( n = 231 ) with a life expectancy ≤2 years were r and omized to a physical exercise group ( PEG , n = 121 ) or a control usual care group ( UCG , n = 110 ) . The PEG exercised under supervision 60 minutes twice a week for 8 weeks . Assessment s were performed before and after the intervention . The primary outcome was physical fatigue ( PF ) measured by the Fatigue Question naire . Physical performance was a secondary outcome measured by the Shuttle Walk Test ( SWT ) and h and grip strength ( HGS ) test . Analyses were performed after multiple imputations for missing data . The trial is registered with Clinical Trials.gov ( identifier , NCT00397774 ) . FINDINGS Thirty-six percent of the PEG were lost to follow-up compared with 23 % of the UCG , primarily as a result of disease progression . Seventy-eight PEG and 85 UCG patients completed the intervention . Analyses showed no significant between-group effects in PF . However , clinical ly and statistically significant between-group effects were found for the SWT and HGS test . INTERPRETATION Fatigue was not reduced but physical performance ( SWT and HGS test ) was significantly improved after 8 weeks of physical exercise . Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease OBJECTIVE To determine distribution- and anchor-based minimal important difference ( MID ) estimates for four scores from the Functional Assessment of Cancer Therapy-Breast ( FACT-B ) : the breast cancer subscale ( BCS ) , Trial Outcome Index ( TOI ) , FACT-G ( the general version ) , and FACT-B. STUDY DESIGN AND SETTING We used data from a Phase III clinical trial in metastatic breast cancer ( ECOG study 1193 ; n=739 ) and a prospect i ve observational study of pain in metastatic breast cancer ( n=129 ) . One third and one half of the st and ard deviation and 1 st and ard error of measurement were used as distribution-based criteria . Clinical indicators used to determine anchor-based differences included ECOG performance status , current pain , and response to treatment . RESULTS FACT-B scores were responsive to performance status and pain anchors , but not to treatment response . By combining the results of distribution- and anchor-based methods , MID estimates were obtained : BCS=2 - 3 points , TOI=5 - 6 points , FACT-G=5 - 6 points , and FACT-B=7 - 8 points . CONCLUSION Distribution- and anchor-based estimates of the MID do show convergence . These estimates can be used in combination with other measures of efficacy to determine meaningful benefit and provide a basis for sample size estimation in clinical trials Background : Breast cancer is one of the most common cancers amongst women in developed and developing countries . It is associated with the highest mortality rate in low to average-income countries . Breast cancer investigation amongst Iranian women reveals that the number of its incidence is yet the highest in all cancer types . Despite recent longer survival time of women with breast cancer , most of the patients suffer from long term physical and mental distress due to combined treatments . Exercise interventions are among new approaches to promote the better quality of life of the patients , which has only recently been considered by research ers . This study aim ed to investigate the effect of exercise intervention on the quality of life of breast cancer survivors . Material s and Methods : This is a clinical trial conducted on 80 women with I-III breast cancer , at 18 - 55 years of age mostly two years after the completion of their treatment in Seyed al Shohada hospital in Isfahan . They were r and omly divided into two groups of study and control . Exercise intervention went on for 8 weeks in the study group ( three sessions a week , 60 minutes ) . Quality of life in both groups was measured a day before , and at the end of the eight weeks period by the instrument of the National Medical Center and Beckman Research Institute . The data were analyzed by descriptive and inferential statistical tests of X2 , t-test and Mac Hammer test . Findings : Results showed that there was no significant difference in the mean score of the physical dimension of quality of life in the study group before and after intervention while the score of physical health was significantly better in the control group ( p < 0.00).The mean score of mental dimension had increased in the study group , while it had decreased in the control group . The mean score of social health showed no significant difference before and after intervention . The mean score of spiritual health had significantly decreased in the control group , while it had significantly increased in the study group ( p = 0.004 ) . Generally , the total mean score of the quality of life showed no significant difference before and after intervention . However , the percentage of the quality of life score increased in the study group , but decreased in the control group . Conclusions : The results of this study showed that exercise interventions can promote a better quality of life for the patients , and increase the total score of quality of life . Although , the total score of quality of life was not significantly different , it was concluded that exercise can promote the quality of life amongst patients with breast cancer 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 OBJECTIVE Although studies have shown that physical activity ( PA ) can reduce some treatment-related side effects of breast cancer , there is a need to offer PA programs outside of research setting s to reach more cancer survivors . We partnered with the American Cancer Society 's Reach to Recovery ( RTR ) program to train their volunteers ( breast cancer survivors ) to deliver a 12-week PA intervention to other breast cancer survivors . METHOD We conducted a r and omized controlled trial to compare the PA intervention delivered by  RTR volunteers ( PA plus RTR ) with contact control ( RTR control ) .  Eighteen RTR volunteers/coaches ( Mage = 54.9 years ; Mtime since diagnosis = 7.0 years ) delivered the contact control condition or the PA intervention .  Seventy-six breast cancer survivors in New Engl and ( Mage = 55.6 years ; Mtime since diagnosis = 1.1 years ) were r and omized to 1 of the 2 groups . At baseline , 12 weeks ( postintervention ) , and at 24 weeks , participants wore an  accelerometer  for 7 days , were interviewed about their PA , and reported their motivational readiness for PA . RESULTS Adjusted , mixed-effects longitudinal regression models showed significant group differences favoring the PA plus RTR group in minutes of moderate to vigorous PA at 12 weeks ( Mdifference = 103 min/week , p < .001 ) and at 24 weeks ( Mdifference = 34.7 min/week , p = .03 ) . Results were corroborated with significant group differences in accelerometer data favoring the PA plus RTR group at both time points . CONCLUSION Peer volunteers were able to significantly increase PA among cancer survivors relative to contact control . Partnerships with existing volunteer programs can help to widen the reach of behavioral interventions among cancer survivors . ( PsycINFO Data base PURPOSE / OBJECTIVES To examine the effects of a seated exercise program on fatigue and quality of life ( QOL ) in women with metastatic breast cancer . DESIGN R and omized , controlled , longitudinal trial . SETTING Outpatient clinic of a comprehensive cancer center . SAMPLE Convenience sample of 38 women who were beginning outpatient chemotherapy . METHODS Subjects were r and omized to a control or intervention group ; the intervention was performance of a seated exercise program using home videotape three times per week for four cycles of chemotherapy . All subjects completed the Functional Assessment of Chronic Illness Therapy Fatigue Version IV ( FACIT F ) at baseline and at the time of the next three cycles . Subjects were asked to document the frequency , duration , and intensity of all exercise participation on monthly calendars . MAIN RESEARCH VARIABLES Exercise , fatigue , and QOL . FINDINGS 32 subjects , 16 per group , completed the study follow-up . With a mixed modeling approach , total FACIT F scores for the entire sample declined at a significant rate ( p = 0.003 ) beginning with cycle 3 but at a slower rate for the experimental group ( p = 0.02 ) . Fatigue scores indicated less increase and physical well-being subscale scores showed less decline for the experimental group ( p = 0.008 and p = 0.02 , respectively ) . CONCLUSIONS Women with advanced breast cancer r and omized to the seated exercise intervention had a slower decline in total and physical well-being and less increase in fatigue scores starting with the third cycle of chemotherapy . IMPLICATION S FOR NURSING Seated exercise may be a feasible exercise program for women with advanced cancer for controlling fatigue and improving physical well-being Targeted exercise training could reduce risk factors for fracture and obesity-related diseases that increase from breast cancer treatment , but has not been sufficiently tested . We hypothesized that progressive , moderate-intensity resistance + impact training would increase or maintain hip and spine bone mass , lean mass and fat mass and reduce bone turnover compared to controls who participated in a low-intensity , non-weight bearing stretching program . We conducted a r and omized , controlled trial in 106 women with early stage breast cancer who were > 1 year post-radiation and /or chemotherapy , ≥50 years of age at diagnosis and postmenopausal , free from osteoporosis and medications for bone loss , resistance and impact exercise naïve , and cleared to exercise by a physician . Women were r and omly assigned to participate in 1 year of thrice-weekly progressive , moderate-intensity resistance + impact ( jump ) exercise or in a similar frequency and length control program of progressive , low-intensity stretching . Primary endpoints were bone mineral density ( BMD ; g/cm2 ) of the hip and spine and whole body bone-free lean and fat mass ( kg ) determined by DXA and biomarkers of bone turnover — serum osteocalcin ( ng/ml ) and urinary deoxypyrodiniline cross-links ( nmol/mmolCr ) . Women in the resistance + impact training program  preserved BMD at the lumbar spine ( 0.47 vs. −2.13 % ; P = 0.001 ) compared to controls . The resistance + impact group had a smaller increase in osteocalcin ( 7.0 vs. 27 % , P = 0.03 ) and a larger decrease in deoxypyrodinoline ( −49.9 vs. −32.6 % , P = 0.06 ) than controls . Increases in lean mass from resistance + impact training were greatest among women currently taking aromatase inhibitors compared to controls not on this therapy ( P = 0.01 ) . Our combined program of resistance + impact exercise  reduced risk factors for fracture among postmenopausal breast cancer survivors ( BCS ) and may be particularly relevant for BCS on aromatase inhibitors ( AIs ) because of the additional benefit of exercise on muscle mass that could reduce falls Breast cancer patients suffer impairment in cardiorespiratory fitness after treatment for primary disease , affecting patients ’ health and survival . The aim of this study was to evaluate the ability of a pragmatic exercise intervention to improve cardiorespiratory fitness of breast cancer patients after primary treatment . Between February 2013 and December 2014 , 94 women with early stage ( I – III ) breast cancer , 1–36 months post-chemotherapy , and radiotherapy were r and omly assigned to an intervention program ( EX ) combining supervised aerobic and resistance exercise ( n = 44 ) or usual care ( CON ) ( n = 45 ) for 12 weeks . Primary study endpoint was VO2max . Secondary endpoints were muscle strength , shoulder range of motion , body composition , and quality of life ( QoL ) . Assessment s were undertaken at baseline , 12-week , and 6-month follow-ups . Eighty-nine patients aged 29–69 years were assessed at baseline and 12 weeks . The EX group showed significant improvements in VO2max , muscle strength , percent fat , and lean mass ( p ≤ 0.001 in all cases ) and QoL compared with usual care ( CON ) . Apart from body composition , improvements were maintained for the EX at 6-month follow-up . There were no adverse events during the testing or exercise intervention program . A combined exercise intervention produced considerable improvement in cardiorespiratory fitness , physical function , and quality of life in breast cancer patients previously treated with chemotherapy and radiation therapy . Importantly , most of these benefits were maintained 6 months after ceasing the supervised exercise intervention 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 Purpose Many breast cancer patients experience ( severe ) menopausal symptoms after an early onset of menopause caused by cancer treatment . The aim of this study was to assess the cost-effectiveness of cognitive behavioral therapy ( CBT ) and physical exercise ( PE ) , compared to a waiting list control group ( WLC ) . Methods We performed a cost-effectiveness analysis from a healthcare system perspective , using a Markov model . Effectiveness data came from a recent r and omized controlled trial that evaluated the efficacy of CBT and PE .  Cost data were obtained from relevant Dutch sources . Outcome measures were incremental treatment costs ( ITCs ) per patient with a clinical ly relevant improvement on a measure of endocrine symptoms , the Functional Assessment of Cancer Therapy question naire ( FACT-ES ) , and on a measure of hot flushes , the Hot Flush Rating Scale ( HFRS ) , and costs per quality -adjusted life years ( QALY ) gained over a 5-year time period . Results ITCs for achieving a clinical ly relevant decline on the FACT-ES for one patient were € 1,051 for CBT and € 1,315 for PE , compared to the WLC . The corresponding value for the HFRS was € 1,067 for CBT , while PE was not more effective than the WLC . Incremental cost-utility ratios were € 22,502/QALY for CBT and € 28,078/QALY for PE . Conclusion CBT is likely the most cost-effective strategy for alleviating treatment-induced menopausal symptoms in this population , followed by PE . The outcomes are sensitive to a reduction of the assumed duration of the treatment effect from 5 to 3 and 1.5 years . Implication s for Cancer Survivors Patients can be prescribed CBT or , based on individual preferences , PE 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 BACKGROUND The purpose of this study was to determine the effectiveness of different recruitment strategies used to recruit patients into the Sheffield Exercise and Breast Cancer Trial ( SHERBERT ) , which involved exercise as a therapy , in sedentary women treated for breast cancer . We also evaluated whether the routes of recruitment distinguished patients participating in the trial in terms of socio-economic characteristics , lifestyle behaviours , cancer treatment(s ) , treatment side effects , length of treatment and time since treatment was completed . METHODS SHERBERT aim ed to recruit at least 114 sedentary women , aged 18 - 65 years , who had been treated for breast cancer between 1 and 3 years previously , to receive exercise therapy , an equal contact exercise-placebo intervention or usual care .  Potentially eligible patients were recruited by postal invitation letters from their treating clinician ( i.e. oncologist/surgeon ) or by a range of community strategies . RESULTS We identified 572 potentially eligible patients via our various recruitment strategies . The response rate to clinician invitation letters was 39.3 % ( N=148/377 ) , of patients who responded and remained available and interested ( N=112 ) 46.4 % ( N=52 ) were eligible to be r and omised . The community strategies derived a total of 195 interested responses , of these 66 patients ( 33.8 % ) were eligible to be r and omised . On the basis of recruitment via clinician invitation letter we estimated the trial recruitment rate amongst eligible patients to be 28.6 % . A total of 108 patients were eventually r and omised . Responders to clinician invitation letters were more affluent compared to non-responders . R and omised patients recruited via different strategies did not vary significantly in terms of their socio-economic characteristics , lifestyle behaviours or variables related to cancer treatment . CONCLUSIONS The number of patients r and omised was marginally lower than anticipated . We were able to identify and highlight valuable information for planning the recruitment of future trials involving similar 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 Sixteen female breast cancer patients who had been diagnosed ( 3.0 + /- 1.2 years previous to the study ) and undergone surgery , chemotherapy , and /or radiation treatment were r and omly assigned to exercise and nonexercise groups . Pre- and post- study measurements were taken for aerobic performance , leg strength , and concentrations of circulating lymphocyte subsets and natural killer cell cytotoxic activity ( NKCA ) .  Exercise training consisted of 60 minutes of supervised weight training and aerobic activity three times each week for eight weeks . Although subjects in the exercise groups demonstrated some modest improvement in the various aerobic and strength tests , NKCA and concentrations of circulating T and NK cells were not significantly altered relative to the nonexercise group . This study suggests that moderate exercise over an eight-week period has no significant effect on the function of in vitro natural killer cells in breast cancer patients Pilates has been advocated for rehabilitation of breast cancer survivors despite little scientific evidence . The authors of this article have examined the feasibility of a Pilates program in postmastectomy breast cancer survivors and the impact on physical and psychological parameters .  Fifteen breast cancer survivors were recruited in a one-arm study of 12 weeks of Pilates exercises . The authors assessed recruitment , adherence , and attrition , and measured changes in shoulder and neck range of motion , posture , height , arm volume , quality of life , mood , and body image from pre- to postintervention . Of 26 eligible patients , 15 enrolled , 13 completed the study , and 10 performed more than 50 % of the recommended sessions . Statistically significant improvements emerged for shoulder abduction and internal rotation on the affected side , neck rotation toward the unaffected side , and neck flexion . The affected side arm volume and the interlimb volume discrepancy increased . Significant improvements were reported in quality of life , mood , and body image . The improvements in physical and psychological outcomes are promising and deserve further evaluation in a r and omized , controlled study . The increase in affected arm volume also warrants additional investigation Summary The ability of combined step aerobic- and circuit-training to prevent bone loss after breast cancer treatments was related to skeletal site and patients ’ menopausal status . Among premenopausal breast cancer survivors , a 12-month exercise intervention completely prevented bone loss at the femoral neck , whereas no exercise effect was seen at lumbar spine or at neither site in postmenopausal women . Introduction The primary objective of this r and omised clinical trial was to determine the preventive effect of supervised weight-bearing jumping exercises and circuit training on bone loss among breast cancer patients . Methods Of 573 breast cancer survivors aged 35–68 years r and omly allocated into  exercise  or  control group after adjuvant treatments , 498 ( 87 % ) were included in the final analysis . The 12-month exercise intervention comprised weekly supervised step aerobic- and circuit-exercises and similar home training . Bone mineral density ( BMD ) at lumbar spine and femoral neck were measured by dual-energy X-ray absorptiometry . Physical performance was assessed by 2-km walking and figure-8 running tests , and the amount of physical activity was estimated in metabolic equivalent-hours/week . Results In premenopausal women  , bone loss at the femoral neck was prevented by exercise , the mean BMD changes being −0.2 % among the trainees vs. −1.4 % among the controls ( p = 0.01 ) . Lumbar bone loss could not be prevented ( −1.9 % vs. −2.2 % ) . In postmenopausal women , no significant exercise-effect on BMD was found either at the lumbar spine ( −1.6 % vs. −2.1 % ) or femoral neck ( −1.1 % vs. −1.1 % ) . Conclusions This 12-month aerobic jumping and circuit training intervention completely prevented femoral neck bone loss in premenopausal breast cancer patients , whereas no effect on BMD was seen in postmenopausal women Introduction . Cancer rehabilitation programs mainly involve endurance training , and little attention is paid to strength training .  Cancer survivors are generally advised to train at much lower workloads than the st and ard guidelines for strength training suggest . The purpose of this study is to evaluate the effectiveness of an 18-week high-intensity strength training program in cancer survivors . Methods . Fifty-seven patients ( age 24 to 73 years ) who had received chemotherapy for lymphomas , breast , gynecologic , testicular , or colorectal cancer completed the program . Outcome measures were changes in muscular strength ( one-repetition maximum ) , cardiopulmonary function ( VO2 max ) , maximal short exercise capacity ( MSEC ) , body composition and health-related quality of life ( HRQOL ) between baseline and follow-up . Discussion . The high-intensity strength training was well tolerated by all patients . Significant improvements in muscle strength were found , with effect sizes varying from 1.32 to 2.68 . VO2 max increased significantly by 10 % in men and by 13 % in women . Different functional scales of HRQOL improved ( p < 0.01 ) , with effect sizes varying from 0.47 to 0.82 . Muscle strength correlated significantly with physical functioning before and after the training program . Conclusion . We conclude that a supervised , high-intensity strength training program seems to be an effective means to improve muscle strength , cardiopulmonary function , and HRQOL and should be incorporated in cancer rehabilitation programs . Further r and omized trials are needed to confirm the results OBJECTIVES To describe changes in physical activity levels related to health-enhancing physical activity guidelines during and after adjuvant chemotherapy in a cohort of Swedish patients with breast cancer . DESIGN Exploratory clinical prospect i ve longitudinal study with 6 and 12 months of follow-up . PARTICIPANTS Forty women treated for breast cancer with adjuvant chemotherapy were included , and 33 women completed the study . MAIN OUTCOME MEASURES The primary outcome was the proportion of participants meeting the health-enhancing physical activity guidelines , both in relative terms ( perceived exertion using Borg 's rate of perceived exertion scale ) and absolute terms ( metabolic equivalent ) . RESULTS The proportion of participants meeting the guidelines when leisure-time physical activity was measured in terms of absolute intensity was 81 ( 25/31 ) to 94 % ( 31/33 ) during chemotherapy , 93 % ( 29/31 ) at 6-month follow-up and 87 % ( 26/30 ) at 12-month follow-up . Women who had been physically active before their cancer diagnosis and women who had received information about physical activity were more physically active during chemotherapy . CONCLUSIONS Swedish patients with breast cancer are generally more physically active during adjuvant chemotherapy than has been reported previously in international studies . Physical activity habits prior to cancer diagnosis and information about the benefits of physical activity appear to be important factors for higher levels of physical activity during and after chemotherapy Goals of workTo evaluate a 12-week home-based walking intervention among breast cancer survivors and to quantify changes in  physical activity ( PA ) behaviors , body weight , and body composition in response to the intervention . Patients and methods Breast cancer survivors that were in the posttreatment period were r and omized to intervention ( n=23 ) or wait-list usual care ( n=13 ) .  PA was assessed by self-report , and in a study sub sample ( n=23 ) , by an accelerometer . Intention to treat principles were employed to estimate the intervention effect on PA behaviors , body weight , and body composition . Intervention adherence was calculated as the proportion of exercise sessions completed relative to the number of exercise sessions recommended , as reported each week on walking logs . Main results Thirty-four of 36 women r and omized ( 94 % ) completed the study . Average intervention adherence over 12 weeks was 94 % . Intervention participants reported a significantly greater increase in walking for exercise [ + 11.9 metabolic equivalent (MET)-h/week ] over time than did usual care participants ( + 1.7 MET-h/week , p=0.01 ) . Objective measures of activity also indicated that intervention participants increased their activity levels over time as compared to usual care participants [ i.e. , counts/min/day and steps/day ( p≤0.04 ) ] . No significant changes in body weight or composition were observed . Conclusion We found that a 12-week home-based walking intervention was safe and effective for increasing short-term PA levels in breast cancer survivors . Future studies are needed to assess the ability of brief interventions to facilitate the maintenance of increased activity levels and to produce favorable quality of life and risk factor outcomes OBJECTIVES This study aim ed to identify demographic , psychological , health-related , and geographic predictors of adherence to home-based and supervised components of a yoga intervention in breast cancer survivors . METHODS Participants were the 32 post-treatment breast cancer survivors who were r and omized to the Viniyoga intervention arm of a controlled trial . Participants were asked to practice yoga 5 times per week for 6 months , including at least one weekly facility-based session . Adherence was monitored using sign-in sheets and logs . Height and weight were measured ; other potential predictors of adherence were obtained from baseline question naires . RESULTS Participants attended 19.6±13.0 yoga classes and performed 55.8±32.8 home-based yoga sessions . Participants adhered to 58 % of the overall yoga practice goal ( 75 % of the goal for yoga classes and 54 % of the goal for home based-sessions ) . Higher class attendance and home practice were predicted by greater self-efficacy for yoga ( p=0.004 and 0.06 , respectively ) . Additionally , employment outside the home was associated with greater class attendance ( p=0.004 ) , while higher waist circumference was marginally associated with lower adherence to home-based yoga ( p=0.05 ) . CONCLUSIONS High levels of facility- and home-based yoga practice were achieved . Breast cancer survivors who have lower self-efficacy for yoga or who have a higher waist circumference may benefit from additional support or intervention tailoring . Adherence may also be improved by ensuring that class times are convenient to both working and nonworking women PURPOSE The efficacy of a home-based physical activity ( PA ) intervention for early-stage breast cancer patients was evaluated in a r and omized controlled trial . PATIENTS AND METHODS Eighty-six sedentary women ( mean age , 53.14 years ; st and ard deviation , 9.70 years ) who had completed treatment for stage 0 to II breast cancer were r and omly assigned to a PA or contact control group . Participants in the PA group received 12 weeks of PA counseling ( based on the Transtheoretical Model ) delivered via telephone , as well as weekly exercise tip sheets . Assessment s were conducted at baseline , after treatment ( 12 weeks ) , and 6 and 9 month after baseline follow-ups . The post-treatment outcomes are reported here . RESULTS Analyses showed that , after treatment , the PA group reported significantly more total minutes of PA , more minutes of moderate-intensity PA , and higher energy expenditure per week than controls . The PA group also out-performed controls on a field test of fitness . Changes in PA were not reflected in objective activity monitoring . The PA group was more likely than controls to progress in motivational readiness for PA and to meet PA guidelines . No significant group differences were found in body mass index and percent body fat . Post-treatment group comparisons revealed significant improvements in vigor and a reduction in fatigue in the PA group . There was a positive trend in intervention effects on overall mood and body esteem . CONCLUSION The intervention successfully increased PA and improved fitness and specific aspects of psychological well-being among early-stage breast cancer patients . The success of a home-based PA intervention has important implication s for promoting recovery in this population OBJECTIVE The objective was to develop effective weight-loss methods for women who have had breast cancer , because obesity may result in an adverse prognosis . RESEARCH METHODS AND PROCEDURES This r and omized pilot study tested an individualized approach toward weight loss in obese women who have had a diagnosis of breast cancer . An individualized approach was applied either alone or combined with the commercial Weight Watchers program .  Forty-eight women ( body mass index of 30 to 44 kg/m(2 ) ) were enrolled . RESULTS Weight change after 12 months of intervention was as follows ( mean + /- SD ) : 0.85 + /- 6.0 kg in the control group , -2.6 + /- 5.9 kg in the Weight Watchers group , -8.0 + /- 5.5 kg in the individualized group , and -9.4 + /- 8.6 kg in the comprehensive group that used both individualized counseling and Weight Watchers .  Weight loss relative to control was statistically significant in the comprehensive group 3 , 6 , and 12 months after r and omization , whereas weight loss in the individualized group was significant only at 12 months . Weight loss of 10 % or more of initial body weight was observed in 6 of 10 women in the comprehensive group at 12 months . In the comprehensive and Weight Watchers-only groups , weight loss was significantly related to frequency of attendance at Weight Watchers meetings , and attendance was more frequent in the comprehensive group . DISCUSSION These data indicate that the most weight loss was achieved when the counseling approach combined both Weight Watchers and individualized contacts . This was effective even though most of the individualized contacts were by telephone 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 To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness ( CRF ) , mental distress , and health-related quality of life ( HRQOL ) parameters in young and middle-aged cancer patients shortly after curative chemotherapy . PATIENTS AND METHODS One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast , gynecologic , or testicular cancer completed the trial . These patients were r and omly allocated to either an intervention group ( n = 59 ) , which underwent a 14-week training program , or a control group ( n = 52 ) that received st and ard care . Primary outcome was change in CRF , as determined by Astr and -Rhyming indirect bicycle ergometer test ( maximum oxygen uptake [ VO(2max ) ] ) , between baseline ( T0 ) and follow-up ( T1 ) . Secondary outcomes were mental distress , as assessed by the Hospital Anxiety and Depression Scale , and HRQOL , as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Question naire . Two-way analysis of covariance was used to analyze changes from T0 to T1 . RESULTS VO(2max ) increased by 6.4 mL/kg(-1)/min(-1 ) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1 ) in patients in the control group ( P < .01 ) . The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group ( P < .01 ) . There were no intergroup differences in mental distress or HRQOL . CONCLUSION A supervised , home-based , flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy , but it has no favorable effect on patients ' experience of fatigue , mental distress , or HRQOL 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 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 233 Background : Excess weight is one of the few modifiable risk factors for incident breast cancer . Many programs can achieve a 7 % weight loss but few can maintain it over time . Training women to use self-help re sources over the internet has potential for reducing intervention costs and ensuring program maintenance . METHODS 50 overweight/obese ( BMI ≥27.5 kg/m2 ) women at increased risk of breast cancer ( Gail score≥1.7 ) were identified from a mammography registry and enrolled in the HELP pilot study and r and omized with 2:1 probability to a 12-week lifestyle intervention or a comparison group .  Twelve telephone-based coaching calls trained participants to use a free , publicly available website to set goals and track performance for dietary intake and physical activity . The comparison group received information but no training . At baseline and 12 weeks , participants were weighed , fitted with an accelerometer for physical activity pattern , and completed question naires . RESULTS At baseline , participants were 60.9±0.79 years of age with a BMI of 33.1±0.60 kg/m2 ; 39 % were daily internet users . Thirty-three were r and omized to the intervention group with 91 % completing follow-up . Fifty-four percent were able to use the website reliably and found it to be helpful , including 44 % of previously nondaily internet users . At 12 weeks , intervention group participants who found the website helpful had lost 5.6±0.7 kg , or 6.7 % of initial weight , intervention participants who did not find it helpful lost 0.8±0.9 kg or 1.1 % of initial weight and the comparison group gained 1.0±0.94 kg ( 89 % follow-up ) The between-group difference weight change was 4.2 kg ( p<.0001 ) . 74 % of intervention group participants lost weight , compared to only 34 % of women assigned to the comparison group . CONCLUSIONS A 12-session telephone coaching program to train women to use publicly available web-based weight loss programs effectively achieved a large short-term weight loss among the majority of participants . Further follow-up is needed to identify how well the initial weight loss is maintained without further intervention assistance 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 Background Exercise therapy is being explored in a variety of cancer population s to counteract treatment-related deconditioning . Higher intensity interval protocol s are being prescribed to improve physical function and attenuate surrogates of comorbidity in non-cancer population s. The purpose of this study is to explore the safety of higher intensity exercise stimuli on cardiorespiratory fitness ( VO2peak ) in breast cancer survivors . Methods Postmenopausal breast cancer survivors were r and omized into three groups : supervised aerobic interval training ( AIT ) , supervised continuous moderate exercise training ( CMT ) , and an unsupervised control group ( CON ) . For 6 weeks , AIT exercised between 70 and 100 % VO2peak , while CMT exercised between 60 and 70 % VO2peak . Both groups followed a matched-work design . Results Thirty-three participants completed the study ( age , 57.2 ( 9 ) years ; weight , 67.6 ( 12 ) kg ) with no adverse advents . Between-group baseline values were non-significant . VO2peak at baseline ( 25.3 ( 5.4 ) mL·kg−1·min−1 ) was below population norms . Compared to CON , cardiorespiratory fitness improved in AIT and CMT by 12 % ( P < 0.001 ) with no significant difference between exercise groups . AIT had a greater influence on lower extremity strength ( P = 0.026 ) and body weight ( P = 0.031 ) . Conclusion This pilot study provides evidence that similar to CMT , AIT can safely increase VO2peak in a small group of breast cancer survivors . Further exploration of the benefits of implementing higher intensity training protocol s is warranted AIM The aim of the study was to investigate how tailored exercise is experienced by cancer survivors . PATIENTS AND METHODS Twenty-five breast cancer survivors who were recently treated with systemic adjuvant treatments attended tailored exercise classes as a part of a r and omized controlled exercise intervention study ( Breast Cancer and Exercise , BREX ) . Focus group discussion s with a median of four ( range 3 - 6 ) participants in each group were conducted to capture their individual experiences of their course of illness , taking part in the exercise trial , the personal meaning of tailored exercise classes and the group . RESULTS Attending the intervention in which the focus of attention was on physical rehabilitation was highly valued , since the participants experienced both improved physical fitness and improved coping . Due to altered physical appearance and poor physical fitness , the participants felt that tailored exercise for patients with breast cancer reduced their barrier to start exercising . Peer support from the group was valued , especially that of sharing experiences , receiving psychological support and gaining a sense of normality . A sense of mastery over their disease through participating in the intervention , i.e. better psychological functioning and improved mood , was a consequence of better physical fitness and of meeting other breast cancer survivors . Also participating in the study per se increases a sense of comfort and security with extra medical examinations and follow-up . CONCLUSION Participating in the tailored exercise group for breast cancer survivors helped patients gain a sense of mastery , restoring their self-esteem and constructing a meaning for their cancer experience and its impact on their lives 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 Recruitment of participants was a challenging issue for a statewide , 4-site , r and omized , longitudinal trial for osteoporosis prevention . The accrual goal was 273 healthy breast cancer survivors . This federally funded study included a home-based followed by a fitness center-based 24-month intervention with follow-up at 36 months . In this report , recruitment planning , monitoring , and modifications are described , and the cost per enrolled participant is identified . Monthly monitoring of accrual numbers per recruitment strategy at each of 4 catchment areas allowed for early identification of necessary changes in recruitment strategies . Modifications were necessary when only 39 % of the overall accrual goal had been attained at the 66 % time point into the 18-month recruitment phase . Successful recruitment strategies were intensified , and new strategies were implemented , addressing motivators and deterrents for participation in clinical trials . Because approximately 81 % of women were demonstrating bone loss via free dual energy x-ray absorptiometry screening , prevalence of the bone loss problem in survivors was incorporated into the recruitment information . Of 708 women screened via telephone and laboratory/dual energy x-ray absorptiometry testing , 249 were enrolled with 67 % at 2 metropolitan sites and 33 % at 2 rural sites .  Recruitment media costs were approximately US$ 35 per enrolled participant . When combined with skeletal and laboratory screening , costs were approximately US$ 480 per enrolled participant . Tracking recruitment efforts in large clinical trials should be ongoing , site-specific , and cost-effective . Changes incorporated early in the recruitment phase addressed unique aspects of rural versus metropolitan areas and result ed in near achievement of accrual goals 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 As the number of women surviving breast cancer increases , with implication s for the health system , research into the physical and psychosocial sequelae of the cancer and its treatment is a priority . This research estimated self-reported health-related quality of life ( HRQoL ) associated with two rehabilitation interventions for breast cancer survivors , compared to a non-intervention group . Women were selected if they received an early home-based physiotherapy intervention ( DAART , n = 36 ) or a group-based exercise and psychosocial intervention ( STRETCH , n = 31 ) . Question naires on HRQoL , using the Functional Assessment of Cancer Therapy – Breast Cancer plus Arm Morbidity module , were administered at pre- , post-intervention , 6- and 12-months post-diagnosis . Data on a  non-intervention group ( n = 208 ) were available 6- and 12-months post-diagnosis . Comparing pre/post-intervention measures , benefits were evident for functional well-being , including reductions in arm morbidity and upper-body disability for participants completing the DAART service at one-to-two months following diagnosis . In contrast , minimal changes were observed between pre/post-intervention measures for the STRETCH group at approximately 4-months post-diagnosis . Overall , mean HRQoL scores ( adjusted for age , chemotherapy , hormone therapy , high blood pressure and occupation type ) improved gradually across all groups from 6- to 12-months post-diagnosis , and no prominent differences were found . However , this obscured declining HRQoL scores for 20–40 % of women at 12 months post-diagnosis , despite receiving supportive care services . Greater awareness and screening for adjustment problems among breast cancer survivors is required throughout the disease trajectory . Early physiotherapy after surgery has the potential for short-term functional , physical and overall HRQoL benefits To evaluate the effect of age on quality of life ( QOL ) in breast cancer survivors after resistance training , 20 women were assigned to 1 of 2 groups based on age ( YRT 40 - 59 yr , ORT 60 - 80 yr ) . Both groups completed 3 sets of 8 exercises twice a week for 8 wk . Measurements were obtained before and after the training program . QOL was measured using the Body Image and Relationship Scale ( BIRS ) . Both groups improved in chest press ( p < .001 ) , leg press ( p < .001 ) , arm curls ( p < .05 ) , and chair st and s ( p < .001 ) . For QOL , YRT reported greater improvements compared with ORT in BIRS total score ( Group × Time interaction , p = .002 ) and strength and health subscale score ( Group × Time interaction , p = .001 ) , and greater age was related to greater perceived impairment ( BIRS total : r = .61 , p = .004 ; strength and health subscale : r = .69 , p = .001 ) . Despite significant improvements in strength and function , older women perceived relatively little improvement in QOL compared with younger women , and age had a differential negative influence on improvements in QOL 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 Cancer patients often report impaired sleep quality . Impaired sleep quality may be due to increased levels of sleep-mediating cytokines result ing from cancer treatment . Exercise may have a positive influence on sleep-mediating cytokines , such as interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-α ) , and soluble tumor necrosis factor-alpha receptor ( sTNF-R ) , which may improve sleep quality . This two-arm pilot study compared the influence of a home-based exercise intervention with st and ard care/control on sleep quality and mediators of sleep . Breast and prostate cancer patients ( n = 38 ) beginning radiation therapy were r and omized to a 4-week exercise program or no exercise arm . Global sleep quality , subjective sleep quality , sleep latency , sleep duration , sleep efficiency , sleep disturbances , use of sleep medication , and daytime dysfunction were assessed with the Pittsburgh Sleep Quality Index . IL-6 , TNF-α , and sTNF-R were measured before and after intervention . There was a greater improvement in sleep quality in the exercise  group from pre- to postintervention , although the difference was not significant . Additionally , there were associations between IL-6 and sleep efficiency and duration , suggesting that regulation of sleep-mediating cytokines by exercise may mediate improvements in sleep- quality components Treatment of breast cancer can significantly diminish functional capacity in patients months and even years after the completion of treatments . Tai chi chuan ( TCC ) is a moderate form of exercise that may be an effective therapy for improving functional capacity among breast cancer survivors . We sought to provide pilot data comparing the efficacy of TCC and psychosocial therapy ( PST ; physical activity control ) for improving functional capacity among breast cancer survivors post treatment . Twenty-one women who had completed treatment of breast cancer were r and omized to receive TCC or PST 3 times/wk for 12 weeks . Functional capacity was assessed at baseline and at 12 weeks . The TCC group demonstrated significant improvement in functional capacity ( specifically aerobic capacity , muscular strength , and flexibility ) whereas the PST group showed significant improvement in flexibility only . These data suggest that TCC may be an efficacious intervention for enhancing functional capacity among breast cancer survivors and may support the need for larger r and omized , controlled clinical trials to further eluci date these relationships 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 BACKGROUND Aromatase inhibitors ( AIs ) have improved the prognosis for breast cancer survivors and are now st and ard of care for postmenopausal women with hormone receptor positive early stage breast cancer . One side-effect , however , is a decrease in bone mineral density ( BMD ) and increased fracture risk . Since hormone replacement therapy ( HRT ) is contraindicated in these women , one prevention option is exercise combined with vitamin D and calcium . The effect of this intervention on drug-induced osteoporosis is unknown . METHODS A single-blind r and omized controlled trial will be undertaken to test the hypothesis that exercise combined with vitamin D and calcium can prevent the decrease in BMD associated with the use of AIs . Sixty postmenopausal women prescribed an AI for the treatment of breast cancer will be r and omized into either an exercise or control group . Participants r and omized to the exercise group will undertake a 12-month gym-based exercise program , 3 times per week involving resistance and impact training . Participants in the control group will be advised on the benefits of exercise for preventing osteoporosis , but not prescribed exercise . Both groups will receive vitamin D and calcium supplements . The primary outcome will be total hip bone mineral density measured via dual energy X-ray absorptiometry ( DXA ) . Study outcomes will be compared between groups at baseline , 6months and 12months . SUMMARY This study will investigate the effect of exercise in combination with vitamin D and calcium on prevention of drug-induced osteoporosis in postmenopausal women prescribed AIs for the treatment of breast cancer 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 This r and omized , controlled pilot trial was carried out to assess the feasibility and efficacy of an aerobic exercise in enhancing physical performance of breast cancer patients after adjuvant treatments . The potential of the training regimen to prevent accompanying bone loss was also assessed . Thirty patients , 41–65 years of age , were r and omly assigned into training or control  groups shortly after adjuvant chemo- or radiotherapy . The 12-week training included a guided aerobic exercise session once a week ( the effective part being either step aerobic- or circuit-training in alternate weeks ) and similar home exercise sessions twice a week . Adherence to the guided sessions was 78 % , while home training was performed an average 2.1 times per week . Agility assessed with figure-8 running test and peak jumping power showed significant between-group treatment-effects ( ∼5 % and ∼10 % , respectively ) . Judged from the accelerometer data , reaction forces up to six times body weight occurred during the training , which implies that the training could also have potential to affect bone mass . The present exercise regimen turned out to be feasible and effective among breast cancer patients in terms of physical performance . Large controlled trials are necessary to confirm these findings 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 OBJECTIVE A multidimensional rehabilitation program for cancer survivors was developed to overcome cancer-related problems and to improve quality of life . The two purpose s of the study were to describe the effectiveness of the program and to obtain information about patient preferences for multi or mono dimensional rehabilitation programs . METHODS SUBJECTS cancer survivors with different diagnoses , and cancer-related physical and psychosocial problems . INTERVENTION a 15-week rehabilitation program including individual exercise , sports , psycho-education , and information . Group-wise r and omization was implemented by assigning one half of the patients to the complete program while the other half were allowed to choose which program components they considered relevant . MEASURES Health-Related Quality of Life [ R AND -36 and Rotterdam Symptom Check List ( RSCL ) ] , exercise capacity ( symptom limited bicycle ergometry ) , muscle force ( h and -held dynamometry ) , and patient preferences . Measurements were performed before ( T0 ) and after the rehabilitation program ( T1 ) , and at a 3-month follow-up ( T2 ) . RESULTS After the rehabilitation program , cancer survivors ( n=63 ) displayed statistically significant improvements on health-related quality of life with effect sizes ( ES ) varying from 0.38 to 0.99 ( R AND -36 ) and from -0.34 to -0.57 ( RSCL ) , most persistent at 3-month follow-up . Furthermore , statistically significant improvements in exercise capacity and muscle force of upper and lower extremities were displayed after rehabilitation . If offered a choice , 80 % of the patients prior to start and 58 % of the patients after completion of the program indicated that they preferred the entire multidimensional program . CONCLUSION A multidimensional rehabilitation program has statistically and clinical ly relevant beneficial effects on health-related quality of life , exercise capacity , and muscle force in cancer patients with different diagnoses . Furthermore , if offered the choice , the majority of cancer survivors seem to prefer multidimensional programs to programs with only one component Summary We evaluated whether age moderated the effect of impact + resistance exercise on hip BMD in older post-menopausal breast cancer survivors ( BCS ) .  Exercise was more beneficial among younger than older women within our sample , suggesting that much older BCS may require different training programs to improve hip health . Purpose Previously , we reported that a program of resistance + impact training stopped bone loss at the spine in older , post-menopausal BCS but had no effect on bone mineral density ( BMD ) at the hip . Aging may blunt the responsiveness of the hip to mechanical loading , so we conducted a secondary data analysis to evaluate whether age moderated the effect of exercise on hip BMD . Methods We analyzed data from our r and omized , controlled trial in older ( ≥ 50 years of age at diagnosis ) , post-menopausal , post-adjuvant treatment BCS ( n = 106 ) comparing women assigned to impact + resistance exercise ( POWIR ) or  to a control program of low-intensity stretching ( FLEX ) . We examined effect modification by age on BMD at three hip sites ( greater trochanter , femoral neck , and total hip ) using hierarchical linear modeling adjusting for time since diagnosis and use of adjuvant hormone therapy . Results Age moderated the effect of exercise on total hip BMD such that younger women in POWIR were more likely to see a positive net benefit than FLEX compared to older women where there was little difference between groups ( p = 0.02 ) . Conclusions The skeletal response to loading at the hip within post-menopausal BCS diminishes with age . Whether more vigorous exercise programs and /or longer training periods are required to favorably change hip health in older BCS will require future study and careful thought about the risks and benefits of tougher training programs Purpose Physical activity benefits cancer survivors , but the comparative effectiveness of a team-based delivery approach remains unexplored . The hypothesis tested was that a team-based physical activity intervention delivery approach has added physical and psychological benefits compared to a group-based approach . A team-based sport accessible to survivors is dragon boating , which requires no previous experience and allows for diverse skill levels . Methods In a non-r and omized trial , cancer survivors chose between two similarly structured 8-week programs , a dragon boat paddling team ( n = 68 ) or group-based walking program ( n = 52 ) . Three separate intervention rounds were carried out in 2007–2008 . Pre – post testing measured physical and psychosocial outcomes . Results Compared to walkers , paddlers had significantly greater ( all p < 0.01 ) team cohesion , program adherence/attendance , and increased upper-body strength . For quality -of-life outcomes , both interventions were associated with pre – post improvements , but with no clear-cut pattern of between-intervention differences . Conclusions These hypothesis-generating findings suggest that a short-term , team-based physical activity program ( dragon boat paddling ) was associated with increased cohesion and adherence/attendance . Improvements in physical fitness and psychosocial benefits were comparable to a traditional , group-based walking program . Compared to a group-based intervention delivery format , the team-based intervention delivery format holds promise for promoting physical activity program adherence/attendance in cancer survivors 9610 Background : Weight-bearing exercise may slow the rate of bone loss associated with breast cancer treatment . The purpose of this study is to determine the effect of tai chi chuan ( TCC ) on bone health , as measured by the changes in the levels of bone resorption and bone formation . This study also aim ed to investigate whether changes in bone health were correlated with growth and inflammation markers that serve as regulators of bone cell function . METHODS Female patients ( N=16 ) who completed treatment for breast cancer within the past 30 months were r and omly assigned to either the TCC group or the psycho-educational support group without exercise ( ST ) for 60 minutes , three times a week for a period of 12 weeks . Serum levels of bone resorption ( N-telopeptides of type I collagen ; NTx ) and bone formation ( bone specific alkaline phosphatase ; BAP ) were determined by ELISA at baseline and post-intervention . Using vali date d methods , a bone remodeling index ( BRI ) was calculated from levels of NTx and BAP . In addition , pre- and post-intervention levels of insulin-like growth factor binding protein 1 ( IGFBP-1 ) and interleukin-2 ( IL-2 ) , markers associated with excessive bone resorption , were measured . Lastly , levels of interleukin-6 ( IL-6 ) , believed to enhance bone formation , were measured at both pre- and post-intervention . RESULTS ANCOVA analyses demonstrated that survivors in the TCC group experienced a greater increase in bone remodeling than those in the ST group ( Δ BRITCC=1.6 vs Δ BRIST=0.2 ; p=0.04 ) . All correlations were determined by Pearson 's correlation coefficients . IGFBP-1 was negatively correlated with increasing bone remodeling levels ( r=-0.43 , p=0.14 ) . IL-2 was also negatively correlated with increasing bone remodeling levels ( r=-0.35 , p=0.24 ) . IL-6 was positively correlated with increasing bone remodeling levels ( r=0.69 , p=0.01 ) . CONCLUSIONS This pilot study suggests that TCC has positive effects on bone remodeling through changes in growth and inflammation factors that regulate bone cell function . A larger , more definitive trial examining the influence of TCC on bone remodeling is warranted . FUNDING Sally Schindel Cone and R25 CA102618 No significant financial relationships to disclose 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 Objective : To investigate the impact of aquatic exercise on pressure pain threshold in breast cancer survivors with hormone therapy-associated arthralgia . Design : Single-blind , controlled trial . Setting : Two major metropolitan hospitals and a Sport and Spa Club in Granada , Spain . Subjects : Forty women aged 29–71 years with stage I – III breast cancer who reported arthralgia . Intervention : Patients were allocated alternately to either aquatic exercise in a chest-high pool or usual care while on the waiting list ; control patients received treatment later . The two-month hydrotherapy intervention consisted of 24 sessions 3 days per week . Each session included 5 minutes of warm-up , 15–20 minutes of aerobic exercise , 15 minutes of mobility exercise and 20 minutes of recovery techniques . Main measures : Pressure pain threshold at neck , shoulder , h and and leg were evaluated as primary outcomes . Cancer-related fatigue , as measured by the Piper Fatigue Scale , body mass index and waist circumference were secondary outcomes . A 2 × 2 repeated-measure ANCOVA was used in this study . Results : No adverse events or development of worsening of pain was observed . Almost all the participants in the intervention group ( 89 % ) adhered to the hydrotherapy programme . Participants experienced a decrease in pressure pain threshold measured in neck , h and , shoulder and leg , as measured by algometry pressure , and waist circumference ; all P < 0.05 . Cancer-related fatigue ( P = 0.06 ) and body mass index ( P = 0.42 ) did not show significant improvement . Conclusions : These data suggest that hydrotherapy in a chest-high pool may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia Cancer treatments have serious physiological and psychological side effects in cancer survivors . This investigation examined cardiopulmonary function and fatigue in breast cancer survivors during and after treatment by using similar exercise assessment s , prescriptions , individualized interventions , and re assessment 636 Background : Musculoskeletal symptoms , for which there is no st and ard therapy , are common in women on aromatase inhibitors ( AIs ) for PEBC . A phase III r and omized study explored whether exercise improves arthralgias / myalgias ( A/M ) . METHODS Eligible women with EPBC had A/M related to A and were r and omized to an exercise ( E ) or a control ( C ) group  . E patients exercised 3x weekly for 48 weeks ; for the first 12 weeks in a supervised setting ; for second 12 weeks , supervised once weekly and twice independently , and for the last 24 weeks independently , using aerobic and resistance programs tailored to their fitness . The primary endpoint was change in SF36 bodily pain domain scores at week 12 ( W12 ) . Secondary endpoints included change in bone density ( BMD ) , change in body mass ( BMI ) , strength , and in hot flash ( HF ) index . RESULTS The study closed due to poor accrual after 3 years with 22 ( 11C 11E ) of the planned 72 subjects enrolled at two sites among 98 screened . Among 20 evaluable subjects , baseline median age was 62 ; BMI was 26 kg/m2 in the E and C arms ; median number of A/M sites was 5 , with a median worst score of 2 ( CTC-version 2 criteria ) . In the E and C arms , respectively , mean baseline SF36 physical domain scores were 7 and 8 ( best possible score 12 , worst 2 ) . At W12 the score improved in 6 ( 55 % ) E and 7 ( 64 % ) C subjects . Median weight dropped 4 kg in the E and rose 4 kg in the C groups by W48 . W12 bench press and leg strength did not significantly change in either groups . At W48 , there was minimal change in BMD in both groups compared to baseline , with only 1 C subject evolving from osteopenia to osteoporosis . Median baseline HF scores were low in both groups and did not differ significantly at any time point . CONCLUSIONS A 48 week supervised exercise intervention did not have a measurable improvement in A related A/M symptoms as measued by 12W SF36 bodily pain scores . Weight dropped in the E group by a median of 4 kg ( 8 kg difference compared to C group ) . Recruitment is an important consideration in exercise trials and may be challenging among patients more distant from their initial diagnosis of cancer The purpose of this pilot study was to preliminarily examine the effects of an exercise program on the symptoms of fatigue , sleep disturbance , mood disturbance , symptom distress , and physical fitness for Thai women with breast cancer . Twenty-three eligible women were r and omly assigned to either an experimental group ( n = 11 ) or to a control group ( n = 12 ) . Data were collected and analyzed at baseline and again at 4 , 7 , and 10 weeks . At each time point , fatigue was measured at an expected high point during treatment . Participants in the exercise group demonstrated a trend toward improving the symptoms with mean score changes . Using generalized estimating equations analysis , a significant decrease in mood disturbance was found in the exercise group compared with control at 10 weeks ( β = 0.03 , P = 0.04 ) . The participants exhibited significantly longer 12-minute walk distance at 10 weeks than those in the control group ( t = 2.28 , P = 0.04 ) . These results indicate that exercise during adjuvant chemotherapy may be beneficial for Thai women with breast cancer AIM The study aim ed at determining whether physical exercise training improves the quality of life ( QoL ) and physical fitness of breast cancer survivors . PATIENTS AND METHODS A total of 573 breast cancer survivors were r and omized into an exercise or a control group , 12-months after adjuvant treatments . EORTC QLQ-C30 and BR-23 question naires were used for evaluation of QoL , FACIT-F for fatigue and the Finnish modified version of Beck 's 13-item depression scale ( RBDI ) for depression . Physical fitness was assessed by a 2-km walking test , and a figure-8 running test and physical activity ( PA )  by metabolic equivalent ( MET ) hours per week ( MET-h/wk ) . RESULTS Figure-8 running time improved significantly among the patients of the intervention group compared with the controls ( p<0.001 ) . No significant between-group differences were observed in 2-km walking time , in PA , EORTC-QLQ-C30 , BR-23 , FACIT-F or BDI . However , there was a linear relationship between increased PA and improved QoL ( p=0.006 ) , irrespective of the intervention . CONCLUSION Increase in physical activity was associated with improved QoL , but no effect of the exercise intervention was observed 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 This study aim ed to examine mediators of fatigue response to an exercise intervention for breast cancer survivors in a pilot r and omized controlled trial . METHODS Postmenopausal breast cancer survivors ( n = 46 ; ≤stage 2 ) , off primary treatment , and reporting fatigue and /or sleep dysfunction were r and omized to a 3-month exercise intervention ( 160 min·wk of moderate-intensity aerobic walking , twice weekly resistance training with resistance b and s ) or control group . Six discussion group sessions provided behavioral support to improve adherence . Fatigue , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , sleep dysfunction , and psychosocial factors were assessed at baseline and 3 months . RESULTS The exercise intervention effect sizes for fatigue were as follows : fatigue intensity d = 0.30 ( P = 0.34 ) , interference d = -0.38 ( P = 0.22 ) , and general fatigue d = -0.49 ( P = 0.13 ) . Using the Freedman-Schatzkin difference-in-coefficients tests , increase in fatigue intensity was significantly mediated by interleukin 6 ( IL-6 ) ( 82 % ) , IL-10 ( 94 % ) , IL-6/IL-10 ( 49 % ) , and tumor necrosis factor-α (TNF-α):IL-10 ( 78 % ) with reduced sleep dysfunction increasing the relationship between intervention and fatigue intensity rather than mediating intervention effects ( -88 % ) . Decrease in fatigue interference was mediated by sleep dysfunction ( 35 % ) , whereas IL-10 and pro-anti-inflammatory cytokine ratios increased the relationship between intervention and interference ( -25 % to -40 % ) . The reduction in general fatigue was significantly mediated by minutes of physical activity ( 76 % ) , sleep dysfunction ( 45 % ) , and physical activity enjoyment ( 40 % ) , with IL-10 ( -40 % ) and IL-6/IL-10 ( -11 % ) increasing the intervention-fatigue relationship . In the intervention group , higher baseline fatigue , anxiety , depression , and perceived exercise barrier interference predicted a greater decline in fatigue interference and /or general fatigue during the intervention . CONCLUSIONS Biobehavioral factors mediated and enhanced intervention effects on fatigue , whereas psychosocial factors predicted fatigue response . Further study is warranted to confirm our results and to improve underst and ing of relationships that mediate and strengthen the intervention-fatigue association 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 Background : Depression , anxiety , and fatigue are among the most significant problems that influence the quality of life of patients with breast cancer who receive adjuvant chemotherapy . Although evidence has shown yoga to decrease anxiety , depression , and fatigue in patients with cancer , few studies on the effects of yoga have targeted patients with breast cancer .  Yoga interventions should be tested to promote the psychological and physical health of women with breast cancer . Purpose : This study examines the effectiveness of an 8-week yoga exercise program in promoting the psychological and physical health of women with breast cancer undergoing adjuvant chemotherapy in terms of depression , anxiety , and fatigue . Methods : A sample of 60 women with nonmetastatic breast cancer was recruited . Participants were r and omly assigned into either the experimental group ( n = 30 ) or the control group ( n = 30 ) . A 60-minute , twice-per-week yoga exercise was implemented for 8 weeks as the intervention for the participants in the experimental group . The control group received st and ard care only . Results : Analysis using the Johnson – Neyman procedure found that the yoga exercise  reduced overall fatigue and the interference of fatigue in everyday life for the experimental group participants . Significant reductions were obtained after 4 weeks of intervention participation for those experimental group patients with relatively low starting baseline values ( baseline item mean value < 3.31 and 3.22 , respectively ) and after 8 weeks for most patients ( approximately 75 % ) with moderate starting baseline values ( baseline item mean value < 7.30 and 5.34 , respectively ) . The 8-week intervention did not significantly improve the levels of depression ( F = 1.29 , p > .05 ) or anxiety ( F = 2.7 , p > .05 ) . Conclusions / Implication s for Practice : The 8-week yoga exercise program developed in this study effectively reduced fatigue in patients with breast cancer but did not reduce depression or anxiety . Oncology nurses should strengthen their clinical health education and apply yoga to reduce the fatigue experienced by patients with breast cancer who undergo adjuvant chemotherapy PURPOSE To determine whether exercise training would increase lymphocyte activation in patients with breast cancer following chemotherapy . Activation was determined by the presence of CD4(+)CD69(+ ) T-helper lymphocytes , mitogen-induced proliferation , and levels of cytokines produced by mitogen-stimulated lymphocytes and in the patients ' plasma . METHODS Patients with breast cancer ( N = 28 ) who participated in a 6-month exercise program were compared with patients ( N = 21 ) who did not exercise .  Following chemotherapy , and 3 and 6 months later , patients underwent fitness evaluations and had blood drawn . The exercise program consisted of resistance training and aerobic activity at 60 - 75 % functional capacity three times a week with a personal trainer . Immunochemistry and flow cytometry were used to measure the number of CD4(+)CD69(+ ) blood lymphocytes . Whole blood was stimulated with concanavalin A ( ConA ) , phytohemagglutin ( PHA ) , or pokeweed mitogen ( PWM ) to determine proliferation potential . Enzyme-linked immunosorbent assays ( ELISA ) were used to determine the concentration of interferon-gamma ( IFN-gamma ) and interleukin-6 ( IL-6 ) in the culture medium of mitogen-stimulated lymphocytes as well as the plasma concentrations of IL-6 , soluble IL-6 receptor , soluble gp130 , and IFN-gamma . Analysis of groups across time was done using the Wilcoxon signed rank test , and comparisons of groups were done using the Mann-Whitney U test . RESULTS The exercising patients showed increases in maximal oxygen uptake and upper body strength . This group also showed a greater percentage of CD4(+)CD69(+ ) cells and a greater level of tritiated thymidine incorporation ( DNA synthesis ) when stimulated with ConA , PHA , and PWM at the end of the intervention . Plasma and mitogen-stimulated IL-6 and IFN-gamma production were similar in both groups . CONCLUSION Exercise may improve immune function by increasing lymphocyte activation in patients with breast cancer following treatment Objective : To examine the effects of a scapula-oriented exercise on upper limb dysfunction in breast cancer survivors . Study design : A prospect i ve r and omized , controlled pilot trial with historical control . Setting : Rehabilitation department at a university hospital . Subjects : Thirty-two women with breast cancer were r and omly assigned to  scapula-oriented exercise group ( n = 16 ) and general exercise group ( n = 16 ) . An historical control group ( n = 18 ) without exercise was enrolled from breast cancer survivors . Interventions : The scapula-oriented exercises were design ed focusing on scapulothoracic movement . The general exercise group performed body conditioning exercise . Exercise therapies were performed for one session per week for eight weeks . Main outcome measures : Pain and physical disabilities related to upper limb dysfunction , quality of life and depression were used as subjective outcomes . Objective outcome measures included shoulder range of motion and strength . Outcomes were assessed at baseline and post exercise . Results : At baseline , no significant difference was observed among the three groups . The scapula-oriented exercise group showed improvements in pain , physical function , social function , and global quality of life compared with baseline , whereas the general exercise group showed improved fatigue and range of motion . The change in global quality of life ( P = 0.067 ; effect size , 0.33 ) and strength of external rotation ( P = 0.001 ; effect size , 0.55 ) were significantly greater in the scapula-oriented exercise group than in the general exercise and control group . Conclusion : Scapula-oriented exercise had beneficial effects on pain , quality of life and aspects of strength . The sample size required in a larger definitive study is 32 subjects per group OBJECTIVE This study sought to investigate the effects of yoga on the quality of life in patients with breast cancer . DESIGN Twenty patients between 30 and 50 years of age presently under treatment for breast cancer were included in the study . The physical characteristics of the patients were recorded and general physiotherapy assessment s performed . Eight sessions of a yoga program including warming and breathing exercises , asanas , relaxation in supine position , and meditation were applied to participants . MAIN OUTCOME MEASURES The pre- and post-yoga quality of life assessment s for the patients were conducted using the Nottingham Health Profile ( NHP ) . Patients ' stress levels were assessed using the STAI-I and STAI-II anxiety inventory . Their satisfaction levels about the yoga program was evaluated using the visual analog scale ( VAS ) . RESULTS It was found that patients ' quality of life scores after the yoga program were better than scores obtained before the yoga program ( p < 0.05 ) . After sessions , there was a statistically significant decrease in their STAI-I ( measuring the reactions of anxiety ) scores and STAI-II ( measuring the permanence of anxiety ) scores ( p < 0.05 ) . It was found out that the satisfaction score concerning the yoga program was considerably increased after the yoga program ( p < 0.05 ) . CONCLUSIONS It can be concluded that yoga is valuable in helping to achieve relaxation and diminish stress , helps cancer patients perform daily and routine activities , and increases the quality of life in cancer patients . This result was positively reflected in patients satisfaction with the yoga program Clinical trials of the effect of physical exercise on breast cancer related arm lymphedema ( ALE ) are very rare . The aim of this study was to examine if controlled low intensity arm exercises with weights , with or without a compression sleeve , influence breast cancer related ALE . Thirty-one breast cancer treated patients with small or moderate ALE were included in the study . A specifically design ed arm exercise program was performed with or without compression sleeve on different days and in a r and omized order . Measurements were performed before , directly after and 24 hours after the exercise intervention , with water displacement method and multiple frequency bioelectrical impedance analysis ( n=10 ) for volume of the arms and Borg 's scale for perceived exertion during training . There was an increase of total arm volume of the lymphedema arm immediately after the exercise intervention for both with and without sleeve conditions ( p < 0.01 ) . At 24 hours , no volume increase was found compared to pre-exercise and both groups showed tendency towards reduced lymphedema relative volume ( p < 0.05 ) . The patient 's rating of perceived exertion was low regardless of whether a sleeve was worn , but was significantly higher when exercising with the sleeve . We conclude that low intensity exercises can be performed by patients with arm lymphedema without risk of worsening the edema . Exercises without the sleeve may be of benefit provided compression sleeve is worn regularly The majority of patients with cancer use some form of complementary or alternative medicine . External qigong treatment ( EQT ) , classified as a bioenergy therapy , is one such approach that patients combine with conventional medicine or , in some cases , use in place of conventional medicine . This study aim ed to determine whether EQT could shrink breast cancer tumors and improve quality of life ( QOL ) in women with pathologically confirmed breast cancer awaiting surgery . A total of 9 women with pathologically confirmed breast cancer were recruited from large cancer centers in the United States ( n = 5 ) and China ( n = 4 ) . A single-arm pre/post design was used . Each patient underwent 5 consecutive days of EQT , with each treatment lasting from 2 to 5 minutes . All treatments were performed by the same qigong master . Tumor measurements were made before and after the EQT sessions . Tumor assessment s were conducted prior to study initiation and following the last EQT . Patients underwent both an ultrasound and mammogram ( United States ) or an ultrasound and magnetic resonance imaging ( China ) . All patients also underwent physical breast examinations ( PBEs ) and completed QOL question naires before and after the last EQT . No clinical changes in tumor measurements from pre- to post-EQT were noted . There was also no suggestion of change in tumor size by PBE or change in QOL . Using the current study design , EQT did not have any effect on tumor size . EQT also does not appear to have any effect on patient QOL . Because of the small sample size and working with only one qigong practitioner , to definitively determine the efficacy or lack of efficacy of EQT , a larger study with multiple qigong practitioners would need to be conducted 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 Hypothesis . Qigong exercise is a popular method for relieving the side effects of conventional cancer treatments in survivors of breast cancer , yet its effects are not empirically assessed . This study aim ed to investigate the effects of qigong exercise on upper limb lymphedema , arterial resistance , and blood flow velocity in survivors with breast cancer and mastectomy . Study Design . This study was conducted as a prospect i ve clinical trial . Methods . Eleven survivors of breast cancer with qigong experience ( mean age = 58.3 ± 10.1 years ) were assigned to the experimental group and 12 survivors of breast cancer without qigong experience ( mean age = 53.8 ± 4.2 years ) were assigned to the control group . They all had breast cancer – related lymphedema . All procedures were completed within one session . After baseline measurements were taken , the experimental group performed 18 Forms Tai Chi Internal Qigong for approximately 6 minutes while the control group rested for similar duration in a sitting position . Both groups were then reassessed . All participants were measured on their affected upper limb circumference ( by using tape measures ) , peripheral arterial resistance , and blood flow velocities ( using a Doppler ultrasound machine ) . Results . The between-group differences were not significant for all outcome measures at baseline ( P > .05 ) . The circumferences of the affected upper arm , elbow , forearm and wrist decreased  after qigong exercise ( P < .05 ) . However , no significant difference was found in the circumference measures between the 2 groups posttest ( P > .0125 ) . In terms of vascular outcomes , the resistance index decreased and the maximum systolic arterial blood flow velocity ( SV ) and minimum diastolic arterial blood flow velocity ( DV ) increased significantly after qigong exercise ( P < .05 ) . The between-group difference was close to significant for SV ( P = .018 ) and was significant for DV ( P < .001 ) posttest . Conclusion . Qigong exercise could reduce conventional cancer therapy side effects such as upper limb lymphedema and poor circulatory status in survivors of breast cancer . However , such effects may be temporary , and further studies must be conducted to explore longer term effects We compared the effect of a group-based 12-week supervised exercise programme , i.e. aerobic and resistance exercise , and group sports , with that of the same programme combined with cognitive-behavioural training on physical fitness and activity of cancer survivors . One hundred and forty seven cancer survivors ( all cancer types , medical treatment ≥3 months ago ) were r and omly assigned to physical training ( PT , n=71 ) or PT plus cognitive-behavioural training ( PT+CBT , n=76 ) . Maximal aerobic capacity , muscle strength and physical activity were assessed at baseline and post-intervention . Analyses using multilevel linear mixed-effects models showed that cancer survivors ’ physical fitness increased significantly in PT and PT+CBT from baseline to post-intervention . Changes did not differ between PT and PT+CBT . Physical fitness of cancer survivors was improved following an intensive physical training programme . Adding a structured cognitive-behavioural intervention did not enhance the effect Evidence -based exercise and relaxation recommendations for people with breast cancer-related lymphedema ( BCRL ) are needed . We report a r and omized controlled study of one program , design ed to achieve synergistic improvements in physical and emotional BCRL symptoms . People in the treatment group received an exercise and relaxation program , The Breast Cancer Recovery Program ( N=16 ) . The  control participants ( N=16 )  continued with health professionals ' recommendations .  Participants were tested at entry , 2.5 weeks , 5 weeks , and 3 months . Treatment group participants , compared with control participants , demonstrated significant treatment effects for improved bioimpedance z , arm flexibility , quality of life , mood at 3 months , and weight loss . Adherence was high for this safe and effective program , which improved lymphedema physical and emotional symptoms CONTEXT Clinical guidelines for breast cancer survivors without lymphedema advise against upper body exercise , preventing them from obtaining established health benefits of weight lifting . OBJECTIVE To evaluate lymphedema onset after a 1-year weight lifting intervention vs no exercise ( control ) among survivors at risk for breast cancer-related lymphedema ( BCRL ) . DESIGN , SETTING , AND PARTICIPANTS A r and omized controlled equivalence trial ( Physical Activity and Lymphedema trial ) in the Philadelphia metropolitan area of 154 breast cancer survivors 1 to 5 years postunilateral breast cancer , with at least 2 lymph nodes removed and without clinical signs of BCRL at study entry . Participants were recruited between October 1 , 2005 , and February 2007 , with data collection ending in August 2008 . INTERVENTION Weight lifting intervention included a gym membership and 13 weeks of supervised instruction , with the remaining 9 months unsupervised , vs no exercise . MAIN OUTCOME MEASURES Incident BCRL determined by increased arm swelling during 12 months ( ≥5 % increase in interlimb difference ) . Clinician-defined BCRL onset was also evaluated . Equivalence margin was defined as doubling of lymphedema incidence . RESULTS A total of 134 participants completed follow-up measures at 1 year . The proportion of women who experienced incident BCRL onset was 11 % ( 8 of 72 ) in the weight lifting intervention group and 17 % ( 13 of 75 ) in the control group ( cumulative incidence difference [ CID ] , -6.0 % ; 95 % confidence interval [ CI ] , -17.2 % to 5.2 % ; P for equivalence = .04 ) . Among women with 5 or more lymph nodes removed , the proportion who experienced incident BCRL onset was 7 % ( 3 of 45 ) in the weight lifting intervention group and 22 % ( 11 of 49 ) in the control group ( CID , -15.0 % ; 95 % CI , -18.6 % to -11.4 % ; P for equivalence = .003 ) . Clinician-defined BCRL onset occurred in 1 woman in the weight lifting intervention group and 3 women in the control group ( 1.5 % vs 4.4 % , P for equivalence = .12 ) . CONCLUSION In breast cancer survivors at risk for lymphedema , a program of slowly progressive weight lifting compared with no exercise did not result in increased incidence of lymphedema . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00194363 PURPOSE Exercise is commonly recommended to women after breast cancer surgery , yet it is difficult for patients and health professionals to adopt safe and beneficial types and modes of exercise . Thus studies on exercise interventions targeting women with breast cancer treatment were systematic ally review ed . METHODS The review process and quality assessment of the studies followed the guideline of the National Evidence -based Healthcare Collaborating Agency . Relevant studies were obtained from electronic data bases , and two trained review ers independently analyzed the studies . Of the 902 articles sorted , 11 were selected . Then , quality assessment for each study was carried out with the Scottish Intercollegiate Guideline Network ( SIGN ) checklist . RESULTS Seven different types of  exercise interventions were identified from 3 quasi-experimental and 8 r and omized controlled trial studies . The interventions varied in duration from several days to 13 weeks , and tended to show significant effects on psychological outcomes and upper body functions within a short-term period and were effective in alleviating lymphedema at a longer 1-year point . Supervised , professional intervention had significant effects on health indicators and a higher adherence rate . CONCLUSION Well- design ed exercises are effective and beneficial for improving women 's physical , physiological , and psychological health outcomes after breast cancer treatment as well as to facilitate changes in exercise behaviors . The feasibility of applying intervention protocol s , efficiency of interventions , and strengths of exercise protocol s should be further examined 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 PURPOSE Arthralgia occurs in up to 50 % of breast cancer survivors treated with aromatase inhibitors ( AIs ) and is the most common reason for poor AI adherence . We conducted , in 121 breast cancer survivors receiving an AI and reporting arthralgia , a yearlong r and omized trial of the impact of exercise versus usual care on arthralgia severity . PATIENTS AND METHODS Eligibility criteria included receiving an AI for at least 6 months , reporting ≥ 3 of 10 for worst joint pain on the Brief Pain Inventory ( BPI ) , and reporting < 90 minutes per week of aerobic exercise and no strength training . Participants were r and omly assigned to exercise ( 150 minutes per week of aerobic exercise and supervised strength training twice per week ) or usual care . The BPI , Western Ontario and McMaster Universities Osteoarthritis ( WOMAC ) index , and Disabilities of the Arm , Shoulder and H and ( DASH ) question naire were completed at baseline and at 3 , 6 , 9 , and 12 months . Intervention effects were evaluated using mixed-model repeated measures analysis , with change at 12 months as the primary end point . RESULTS Over 12 months , women r and omly assigned to exercise ( n = 61 ) attended 70 % ( ± st and ard deviation [ SD ] , 28 % ) of resistance training sessions and increased their exercise by 159 ( ± SD , 136 ) minutes per week . Worst joint pain scores decreased by 1.6 points ( 29 % ) at 12 months among women r and omly assigned to exercise versus a 0.2-point increase ( 3 % ) among those receiving usual care ( n = 60 ; P < .001 ) . Pain severity and interference , as well as DASH and WOMAC pain scores , also decreased significantly at 12 months in women r and omly assigned to exercise , compared with increases for those receiving usual care ( all P < .001 ) . CONCLUSION Exercise led to improvement in AI-induced arthralgia in previously inactive breast cancer survivors
BACKGROUND Women with a diagnosis of breast cancer may experience short- and long-term disease and treatment-related adverse physiological and psychosocial outcomes .
These outcomes can negatively impact prognosis , health-related quality of life ( HRQoL ) , and psychosocial and physical function .
Physical activity may help to improve prognosis and may alleviate the adverse effects of adjuvant therapy .
OBJECTIVES To assess effects of physical activity interventions after adjuvant therapy for women with breast cancer .