Physical activity, additional breast cancer events, and mortality among early-stage breast cancer survivors: findings from the WHEL Study Recovery of overall exercise ability, quality of life, and continence after 12-week combined exercise intervention in elderly patients who underwent radical prostatectomy: a randomized controlled study. Interaction of Molecular Markers and Physical Activity on Mortality in Patients with Colon Cancer Efficacy of cognitive behavioral therapy and physical exercise in alleviating treatment-induced menopausal symptoms in patients with breast cancer: results of a randomized, controlled, multicenter trial. Physical activity after diagnosis and risk of prostate cancer progression: data from the cancer of the prostate strategic urologic research endeavor. Upper limb progressive resistance training and stretching exercises following surgery for early breast cancer: a randomized controlled trial Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Impact + resistance training improves bone health and body composition in prematurely menopausal breast cancer survivors: a randomized controlled trial Health behaviors of cancer survivors: data from an Australian population-based survey A randomized pilot study with daily walking during adjuvant chemotherapy for patients with breast and colorectal cancer Effects of supervised exercise on progression-free survival in lymphoma patients: an exploratory follow-up of the HELP Trial The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials Main outcomes of the Move More for Life Trial: a randomised controlled trial examining the effects of tailored-print and targeted-print materials for promoting physical activity among post-treatment breast cancer survivors. Physical activity and survival after breast cancer diagnosis. Feasibility and efficacy of speed-feedback therapy with a bicycle ergometer on cognitive function in elderly cancer patients in Japan. The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Influence of weight training on skeletal health of breast cancer survivors with or at risk for breast cancer-related lymphedema Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Physical Activity and Risk of Recurrence and Mortality in Breast Cancer Survivors: Findings from the LACE Study Recreational physical activity, body mass index, and survival in women with colorectal cancer Physical Activity and Survival after Diagnosis of Invasive Breast Cancer Modifiable Lifestyle Factors and Triple-negative Breast Cancer Survival: A Population-based Prospective Study A pooled analysis of post-diagnosis lifestyle factors in association with late estrogen-receptor-positive breast cancer prognosis. Physical Activity and Survival After Prostate Cancer. Exercise maintains sexual activity in men undergoing androgen suppression for prostate cancer: a randomized controlled trial Strength training stops bone loss and builds muscle in postmenopausal breast cancer survivors: a randomized, controlled trial Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12-month randomised controlled trial Physical activity and breast cancer survival: an epigenetic link through reduced methylation of a tumor suppressor gene L3MBTL1 Physical Activity, Tumor PTGS2 Expression, and Survival in Patients with Colorectal Cancer Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. Physical activity and survival after colorectal cancer diagnosis. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. Exercise effects on hip bone mineral density in older, post-menopausal breast cancer survivors are age dependent Effects of physical exercise on survival after allogeneic stem cell transplantation. Hemoglobin and Aerobic Fitness Changes with Supervised Exercise Training in Breast Cancer Patients Receiving Chemotherapy Skeletal response to resistance and impact training in prostate cancer survivors. Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. Effects of strength training on body composition, physical functioning, and quality of life in prostate cancer patients during androgen deprivation therapy Can a Multimodal Mind–Body Program Enhance the Treatment Effects of Physical Activity in Breast Cancer Survivors With Chronic Tumor-Associated Fatigue? A Randomized Controlled Trial Physical activity and survival after cancer diagnosis in men. Significantly greater reduction in breast cancer mortality from post-diagnosis running than walking. Association of CTNNB1 (beta-catenin) alterations, body mass index, and physical activity with survival in patients with colorectal cancer. Do Yoga and Aerobic Exercise Training Have Impact on Functional Capacity, Fatigue, Peripheral Muscle Strength, and Quality of Life in Breast Cancer Survivors? Effects of exercise during adjuvant chemotherapy on breast cancer outcomes.
Objective Research suggests that physical activity is associated with improved breast cancer survival , yet no studies have examined the association between post-diagnosis changes in physical activity and breast cancer outcomes . The aim of this study was to determine whether baseline activity and 1-year change in activity are associated with breast cancer events or mortality . Methods A total of 2,361 post-treatment breast cancer survivors ( Stage I – III ) enrolled in a r and omized controlled trial of dietary change completed physical activity measures  at baseline and one year .  Physical activity variables ( total , moderate – vigorous , and adherence to guidelines )  were calculated for each time point . Median follow-up was 7.1 years . Outcomes were invasive breast cancer events and all-cause mortality . Results Those who were most active at baseline had a 53 % lower mortality risk compared to the least active women ( HR = 0.47 ; 95 % CI : 0.26 , 0.84 ; p = .01 ) . Adherence to activity guidelines was associated with a 35 % lower mortality risk ( HR = 0.65 , 95 % CI : 0.47 , 0.91 ; p < .01 ) . Neither baseline nor 1-year change in activity was associated with additional breast cancer events . Conclusions Higher baseline ( post-treatment ) physical activity was associated with improved survival . However , change in activity over the following year was not associated with outcomes . These data suggest that long-term physical activity levels are important for breast cancer prognosis OBJECTIVE To examine the changes from a combined exercise intervention after radical prostatectomy ( RP ) in elderly patients with prostate cancer , because r and omized controlled trials addressing exercise intervention after RP have been lacking . METHODS From May 2009 to May 2010 , all patients who underwent laparoscopic RP were assessed for eligibility . A total of 66 patients were r and omized to an exercise or a control group . The exercise group received a combined exercise intervention ( resistance , flexibility , and Kegel exercises ) twice a week for 12 weeks , and the control group received only Kegel exercises . The primary outcome was physical function , and the secondary outcomes were continence status and quality of life after the exercise intervention . RESULTS A total of 49 patients completed follow-up to the end of study . After the 12-week exercise intervention , except for grip strength , all physical functions were better in the exercise group than in the control group . The 24-hour pad test results ( 12.2 g in the exercise group , 46.2 g in the control group ) and continence rate ( 73.1 % in exercise group , 43.5 % in the control group ) recovered more promptly in the exercise group . On a question naire study using the International Consultation on Incontinence question naire , Beck Depression Inventory , and Medical Outcomes Study 36-item short-form health survey , only the exercise group showed improvement at the last follow-up visit . CONCLUSION A 12-week combined exercise intervention after RP results in improvement of physical function , continence rate , and quality of life . These results could help with prompt recovery of daily activities Purpose : Physical activity in colon cancer survivors has been associated with lower cancer recurrences and improved survival . Whether molecular features of the tumor portend more or less likelihood for benefit from exercise is unknown . Experimental Design : Using two large prospect i ve cohort studies with physical activity assessment s after colon cancer diagnosis , we examined expression of fatty acid synthase , p53 , p21 , and p27 and mutational status of K-ras and phosphatidylinositol 3-kinase(PI3KCA ) . We calculated hazard ratios ( HR ) of colon cancer – specific mortality , adjusted for tumor and patient characteristics , and tested for molecular interactions with exercise . Results : In a cohort of 484 men and women with stage I to III colon cancer , patients who engaged in at least 18 metabolic equivalent task (MET)–hours per week after diagnosis had an adjusted HR for colon cancer – specific mortality of 0.64 [ 95 % confidence interval ( 95 % CI ) , 0.33 - 1.23 ] and for overall mortality of 0.60 ( 95 % CI , 0.41 - 0.86 ) . A statistically significant interaction was detected based on p27 expression ( P = 0.03 ) . For tumors with loss of p27 ( n = 195 ) , physical activity of ≥18 MET-hours/week led to a HR for colon cancer mortality of 1.40 ( 95 % CI , 0.41 - 4.72 ) , compared with those with < 18 MET-hours/week . However , for tumors with expression of p27 ( n = 251 ) , the adjusted HR was 0.33 ( 95 % CI , 0.12 - 0.85 ) . Molecular status of fatty acid synthase , K-ras , p53 , p21 , and PI3KCA did not influence the association  between exercise and colon cancer – specific or overall mortality . Conclusion : The benefit of physical activity on outcomes in patients with stage I to III colon cancer may be influenced by p27 status . Further studies are warranted to confirm these findings . ( Clin Cancer Res 2009;15(18):5931–6 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 Vigorous activity after diagnosis was recently reported to be inversely associated with prostate cancer-specific mortality . However , men with metastatic disease may decrease their activity due to their disease ; thus , a causal interpretation is uncertain . We therefore prospect ively examined  vigorous activity and brisk walking  after diagnosis in relation to risk of prostate cancer progression , an outcome less susceptible to reverse causation , among 1,455 men diagnosed with clinical ly localized prostate cancer . Cox proportional hazards regression was used to examine  vigorous activity , nonvigorous activity , walking duration , and walking pace  after diagnosis and risk of prostate cancer progression . We observed 117 events ( 45 biochemical recurrences , 66 secondary treatments , 3 bone metastases , 3 prostate cancer deaths ) during 2,750 person-years .  Walking  accounted for nearly half of all activity . Men who walked briskly for 3 h/wk or more had a 57 % lower rate of progression than men who walked at an easy pace for less than 3 h/wk ( HR = 0.43 ; 95 % CI : 0.21 - 0.91 ; P = 0.03 ) . Walking pace was associated with decreased risk of progression independent of duration ( HR brisk vs. easy pace = 0.52 ; 95 % CI : 0.29 - 0.91 ; P(trend ) = 0.01 ) . Few men engaged in vigorous activity , but there was a suggestive inverse association ( HR ≥3 h/wk vs. none = 0.63 ; 95 % CI : 0.32 - 1.23 ; P(trend ) = 0.17 ) . Walking duration and total nonvigorous activity were not associated with risk of progression independent of pace or vigorous activity , respectively . Brisk walking  after diagnosis may inhibit or delay prostate cancer progression among men diagnosed with clinical ly localized prostate cancer The aim of this study was to determine whether an exercise program , commencing 4–6 weeks post-operatively , reduces upper limb impairments in women treated for early breast cancer . Women ( n = 160 ) were r and omized to either an 8-week exercise program ( n = 81 ) or to a control group ( n = 79 ) following stratification for axillary surgery . The exercise program comprised a weekly session and home program of passive stretching and progressive resistance training for shoulder muscles . The control group attended fortnightly assessment s but no exercises were provided . The primary outcome was self-reported arm symptoms derived from the EORTC breast cancer-specific question naire ( BR23 ) , scored out of 100 with a low score indicative of fewer symptoms . The secondary outcomes included physical measures of shoulder range of motion , strength , and swelling ( i.e. , lymphedema ) . Women were assessed immediately following the intervention and at 6 months post-intervention . The change in symptoms from baseline was not significantly different between groups immediately following the intervention or at 6 m post-intervention . The between group difference immediately following the intervention was 4 ( 95 % CI −1 to 9 ) and 6 months post-intervention was 4 ( −2 to 10 ) . However , the change in range of motion for flexion and abduction was significantly greater in the exercise group immediately following the intervention , as was change in shoulder abductor strength . In conclusion , a supervised exercise program provided some , albeit small , additional benefit at 6 months post-intervention to women who had been provided with written information and reminders to use their arm . Both the groups reported few impairments including swelling immediately following the intervention and 6 months post-intervention . Notably , resistance training in the post-operative period did not precipitate lymphedema BACKGROUND Exercise has been reported to decrease cancer-related fatigue  and to increase quality of life ( QoL ) in various breast cancer ( BC ) population s. However , studies investigating exercise during radiotherapy or resistance training are scarce . We conducted a r and omized , controlled trial ( BEST study ) to assess the efficacy of 12-week resistance training on fatigue beyond possible psychosocial effects of a group-based intervention . PATIENTS AND METHODS One hundred sixty patients with BC stage 0-III were r and omly assigned to a 12-week progressive resistance training ( 2 times/week ) or a 12-week relaxation control ( RC , 2 times/week ) . Both interventions were group-based . The primary end point fatigue was assessed with a 20-item multidimensional question naire , QoL with EORTC question naires . Statistical analyses were based on analysis of covariance models for the individual changes from baseline to week 13 . RESULTS Adherence to the intervention program as well as the completion rate ( 97 % ) for the primary outcome variable fatigue was high . In intention-to-treat analyses for the N = 155 patients , significant between-group mean differences ( MD ) favoring the exercise group ( EX ) were observed for general fatigue ( P = 0.044 ) , especially for the subscale physical fatigue [ MD = -0.8 ; 95 % confidence interval -1.5 to -0.2 , P = 0.013 ] , but not for affective ( P = 0.91 ) or cognitive fatigue ( P = 0.65 ) . For QoL , significantly larger improvements regarding the role function ( P = 0.035 ) and pain ( P = 0.040 ) were noted among exercisers compared with RCs . Future perspective improved significantly stronger in the RC group compared with the EX group ( P = 0.047 ) . CONCLUSIONS The 12-week resistance training program was a safe , feasible and efficacious strategy to improve cancer-related fatigue and components of QoL  in BC patients during adjuvant radiotherapy . As exercise was compared with another group-based intervention , results indicate that resistance training effects on fatigue and QoL go beyond psychosocial benefits , and that the clinical ly relevant overall benefit of resistance exercise compared with usual care can be assumed to be higher . TRIAL REGISTRATION Clinical Trials.gov NCT01468766 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 With increases in cancer survival , promotion of healthy lifestyle behaviors among survivors is receiving considerable attention . This study compared health behaviors among a large sample of Australian adult cancer survivors with an age- and sex-matched cohort of people with no cancer history . Methods Using the Australian National Health Survey , 968 cancer survivors were identified , and r and omly matched by age and sex to 5,808 respondents without a history of cancer . Six health behaviors were compared  ( smoking , physical activity , servings of vegetables , servings of fruit , alcohol use , skin checks )  , along with  overweight and obesity , using polytomous logistic regression analyses controlling for selected chronic conditions . Models were applied across both groups and by tumor site . Results Compared to the non-cancer comparison group , cancer survivors were significantly more likely to be current ( OR = 1.35 ) smokers , particularly those under 40 years ( OR = 1.69 ) , and more likely to have regular skin checks ( OR = 1.76 ) . Although not significant , there was consistent evidence that cancer survivors were slightly more likely to be overweight or obese ( p = 0.065 ) and have higher levels of alcohol consumption ( p = 0.088 ) . There was no evidence of differences between survivors and controls for levels of physical inactivity , vegetable consumption or fruit consumption .  Women with a history of gynecological cancers were much more likely to be current smokers ( OR = 2.37 ) , while other differences by sex and cancer site were consistent with overall patterns . Cancer survivors were also significantly more likely to report having a range of co-morbid chronic medical conditions . Conclusion Given their increased risk of second cancers and co-morbid chronic conditions , the lack of difference in behavioral risk factors confirms the need for a focus on improving the health behaviors of cancer survivors . Collaborative chronic disease management models may be particularly appropriate in this regard Abstract Background . Physical activity during chemotherapy has been shown in several studies to reduce fatigue , improve symptoms and impact positively on health-related quality of life ( HRQoL ) . Challenges associated with intervention studies on physical activity during cancer treatment relate to consistent adherence . The primary objective was to study feasibility and adherence of physical activity intervention among patients with cancer during adjuvant chemotherapy treatment . The secondary objective was to investigate the effects of physical activity on health aspects , including HRQoL , symptoms and surrogate markers for cardiovascular disease . Material and methods . This r and omized controlled trial included patients with breast cancer ( BRCA ) and colorectal cancer ( CRC ) during adjuvant chemotherapy .  The intervention continued for 10 weeks and included daily walks of 10 000 steps and a weekly supervised group walk . Adherence was assessed by a pedometer and the number of participants who reported step counts every week and percentage of participants who achieved the target steps every week . Results . Adherence average reached 91 % during the intervention period ; in total 74 % completed the exercise intervention . The majority of the participants achieved an average of 83 % of the target of 10 000 steps per day for 10 weeks . There was a significant increase in daily physical activity ( p = 0.016 ) in the intervention group . Significant differences were also found for some breast cancer-specific symptoms [ swelling , mobility and pain ( p = 0.045 ) ] . The study showed a relatively small weight gain an average of 0.9 kg in the intervention group and 1.3 kg in the control group . Conclusion . Physical activity in the form of walking is feasible during adjuvant chemotherapy treatment despite increasing symptoms . The physical activity increased in the intervention group during the study time and had a positive impact on breast symptoms and the weight gain was lower in comparison to previous studies Purpose Few r and omized controlled trials in exercise oncology have examined survival outcomes . Here , we report an exploratory follow-up of progression-free survival ( PFS ) from the Healthy Exercise for Lymphoma Patients ( HELP ) Trial . Methods The HELP Trial r and omized 122 lymphoma patients between 2005 and 2008 to either control ( n = 62 ) or 12 weeks of supervised aerobic exercise ( n = 60 ) . PFS events were abstract ed from medical records in 2013 . In addition to the r and omized comparison , we explored the effects of exercise adherence ( < 80 % vs. ≥80 % ) and control group crossover ( no vs. yes ) . Results After a median follow-up of 61 months ( interquartile range 36–67 ) , the adjusted 5-year PFS was 64.8 % for the exercise group compared with 65.0 % for the control group ( Hazard ratio [ HR ] 1.01 , 95 % CI 0.51–2.01 , p = 0.98 ) . In the secondary analysis , the adjusted 5-year PFS was 59.0 % in the control group without crossover compared with 69.2 % for the control group with crossover ( HR 0.68 , 95 % CI 0.22–2.06 , p = 0.49 ) , 67.7 % for the exercise group with < 80 % adherence ( HR 0.72 , 95 % CI 0.28–1.85 , p = 0.50 ) , and 68.4 % for the exercise group with ≥80 % adherence ( HR 0.70 , 95 % CI 0.32–1.56 , p = 0.39 ) . In a post hoc analysis combining the three groups that received supervised exercise , the adjusted 5-year PFS for the supervised exercise groups was 68.5 % compared with 59.0 % for the group that received no supervised exercise ( HR 0.70 , 95 % CI 0.35–1.39 , p = 0.31 ) . Conclusions This exploratory follow-up of the HELP Trial suggests that supervised aerobic exercise may be associated with improved PFS in lymphoma patients . Larger trials design ed to answer this question are needed Flaws in the design , conduct , analysis , and reporting of r and omised trials can cause the effect of an intervention to be underestimated or overestimated . The Cochrane Collaboration ’s tool for assessing risk of bias aims to make the process clearer and more 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 CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival OBJECTIVE We conducted this study with the aim of demonstrating the feasibility and efficacy of speed-feedback therapy with a bicycle ergometer on cognitive function  in elderly cancer patients . METHODS The subjects were patients with breast or prostate cancer who were 65 years of age or over . Among 146 patients , 78 were r and omly assigned to the intervention group ( n = 38 ) or the control group ( n = 40 ) . The intervention group received speed-feedback therapy with a bicycle ergometer once a week for four successive weeks . The control group was advised to spend the 4-week period engaged in their routine activities . Evaluations were carried out at the baseline and 4 weeks after the baseline ( week 4 ) using the Frontal Assessment Battery , the Barthel Index , the Lawton and Brody Instrumental Activities of Daily Living , and the Functional Assessment of Cancer Therapy-General ver.4 . Data were analyzed by a two-way repeated- measures analysis of variance . RESULTS The mean score of Frontal Assessment Battery for the intervention group was higher than that for the control group at week 4 . In addition to significant main effects of time and group , we also found a significant interaction between the two groups ( p = 0.006 ) . Moreover , all of the subjects in the intervention group could complete all the four sessions of therapy without any pain or distress . CONCLUSION These results suggest that speed-feedback therapy with a bicycle ergometer may be feasible as well as effective for improving the cognitive function in elderly cancer patients 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 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 PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events Introduction : Identifying modifiable factors that reduce the risk of recurrence and improve survival in breast cancer survivors is a pressing concern . The purpose of this study was to examine the association of physical activity following diagnosis and treatment with the risk of breast cancer recurrence and mortality and all-cause mortality in women with early-stage breast cancer . Material s and Methods : The sample consisted of 1,970 women from the Life After Cancer Epidemiology study , a prospect i ve investigation of behavioral risk factors and health outcomes .  Self-reported frequency and duration of work-related , household and caregiving , recreational , and transportation-related activities during the six months prior to enrollment were assessed . Outcomes were ascertained from electronic or paper medical charts . Hazard ratios and 95 % confidence intervals were estimated from delayed entry Cox proportional hazards models . Results : Although age-adjusted results suggested that higher levels of physical activity were associated with reduced risk of recurrence and breast cancer mortality ( P for trend = 0.05 and 0.07 , respectively for highest versus lowest level of hours per week of moderate physical activity ) , these associations were attenuated after adjustment for prognostic factors and other confounding variables ( P for trend = 0.36 and 0.26 ) . In contrast , a statistically significant protective association between physical activity and all-cause mortality remained in multivariable analyses ( hazard ratio , 0.66 ; 95 % confidence interval , 0.42 - 1.03 ; P for trend = 0.04 ) . Conclusions : These findings do not support a protective effect of physical activity on breast cancer recurrence or mortality but do suggest that regular physical activity is beneficial for breast cancer survivors in terms of total mortality . ( Cancer Epidemiol Biomarkers Prev 2009;18(1):87–95 Background and purpose Previous studies have shown that physical inactivity and obesity are risk factors for the development of colorectal cancer . However , controversy exists regarding the influence of these factors on survival in colorectal cancer patients . We evaluated the impact of recreational physical activity and body mass index ( BMI )  before and after colorectal cancer diagnosis on disease-specific mortality and all-cause mortality . Patients and methods This prospect i ve cohort study included 1,339 women enrolled in the Women ’s Health Initiative study who were diagnosed with colorectal cancer subsequent to study enrollment .  BMI and recreational physical activity  were measured before cancer diagnosis at study entry ( pre-diagnostic ) and after diagnosis at study follow-up interviews ( post-diagnostic ) . We used Cox regression to estimate the association between pre- and post-diagnostic exposures and survival after colorectal cancer diagnosis . Results Among women diagnosed with colorectal cancer , 265 ( 13 % ) deaths occurred during a median study follow-up of 11.9 years , of which 171 ( 65 % ) were attributed to colorectal cancer . Compared with women reporting no pre-diagnostic recreational physical activity , those reporting activity levels of ≥18 MET-h/week had significantly lower colorectal cancer-specific mortality ( hazard ratio ( HR ) = 0.68 ; 95 % confidence interval ( CI ) : 0.41–1.13 ) and all-cause mortality ( HR = 0.63 ; 95 % CI : 0.42–0.96 ) . Similar inverse associations were seen for post-diagnostic recreational physical activity . Neither pre- nor post-diagnostic BMI were associated with mortality after colorectal cancer diagnosis . Conclusion Recreational physical activity before and after colorectal cancer diagnosis , but not BMI , is associated with more favorable survival Previous studies suggest that increased physical activity may lower the risk of breast cancer incidence , but less is known about whether levels of physical activity after breast cancer diagnosis can influence survival . We prospect ively examined the relation between postdiagnosis recreational physical activity and risk of breast cancer death  in women who had a previous invasive breast cancer diagnosed between 1988 and 2001 ( at ages 20 - 79 years ) . All women completed a question naire on recent  postdiagnosis physical activity and other lifestyle factors . Among 4,482 women without history of recurrence at the time of completing the question naire , 109 died from breast cancer within 6 years of enrollment .  Physical activity was expressed as metabolic equivalent task-hours per week ( MET-h/wk ) ; hazard ratios ( HR ) and 95 % confidence intervals ( 95 % CI ) were estimated using Cox proportional hazards regression . After adjusting for age at diagnosis , stage of disease , state of residence , interval between diagnosis and physical activity assessment , body mass index , menopausal status , hormone therapy use , energy intake , education , family history of breast cancer , and treatment modality compared with women expending < 2.8 MET-h/wk in physical activity , women who engaged in greater levels of activity had a significantly lower risk of dying from breast cancer ( HR , 0.65 ; 95 % CI , 0.39 - 1.08 for 2.8 - 7.9 MET-h/wk ; HR , 0.59 ; 95 % CI , 0.35 - 1.01 for 8.0 - 20.9 MET-h/wk ; and HR , 0.51 ; 95 % CI , 0.29 - 0.89 for ≥21.0 MET-h/wk ; P for trend = 0.05 ) . Results were similar for overall survival ( HR , 0.44 ; 95 % CI , 0.32 - 0.60 for ≥21.0 versus < 2.8 MET-h/wk ; P for trend < 0.001 ) and were similar regardless of a woman ’s age , stage of disease , and body mass index . This study provides support for reduced overall mortality and mortality from breast cancer among women who engage in physical activity  after breast cancer diagnosis . ( Cancer Epidemiol Biomarkers Prev 2008;17(2):379–86 Background : Very little is known about the effect of modifiable lifestyle factors on outcomes of triple-negative breast cancer . We examined this association in a population -based prospect i ve cohort study of patients with triple-negative breast cancer . Methods : A total of 518 women with confirmed triple-negative breast cancer , recruited by the Shanghai Breast Cancer Survival Study , completed 6- , 18- , 36- , and 60-month postdiagnosis surveys . We applied Cox proportional hazard models to evaluate the associations . Results : The mean age at diagnosis was 53.4 ( st and ard deviation = 10.6 ) years old . After a median follow-up of 9.1 years ( range : 0.6–11.8 ) , 128 deaths and 112 recurrences were documented . Exercise during the first 60 months postdiagnosis was inversely associated with total mortality and recurrence/disease-specific mortality with adjusted hazard ratios ( HRs ) of 0.67 ( 95 % confidence interval [ CI ] = 0.46 , 0.96 ) and 0.58 ( 95 % CI = 0.39 , 0.86 ) , respectively . Women with higher exercise-metabolic equivalent scores ( ≥7.6 metabolic equivalent-hours/week ) and longer duration of exercise ( ≥2.5 hours/week ) had lower risk of total and recurrence/disease-specific mortality than did nonexercisers . Compared with nontea drinkers , survival was better among women who were regular tea drinkers during the first 60 months for all cause ( HR = 0.57 , 95 % CI = 0.34 , 0.93 ) and recurrence/disease-specific mortality ( HR = 0.54 , 95 % CI = 0.31 , 0.96 ) . There was no dose – response pattern for tea consumption . No interactions were observed for body mass index , menopausal status , and comorbidity . Conclusions : These findings show that postdiagnosis exercise and tea intake were associated with improved survival among women with triple-negative breast cancer Lifestyle factors have been well studied in relation to breast cancer prognosis overall ; however , associations of lifestyle and late outcomes ( > 5 years after diagnosis ) have been much less studied , and no studies have focused on estrogen receptor-positive ( ER+ ) breast cancer survivors , who may have high risk of late recurrence and mortality . We utilized a large prospect i ve pooling study to evaluate the associations of lifestyle factors with late recurrence and all-cause mortality among 6,295 5-year ER+ Stage I-III breast cancer survivors . Pooled and harmonized data were available on clinical factors and lifestyle factors ( pre- to post-diagnosis weight change , body mass index ( BMI ) ( kg/m(2 ) ) , recreational physical activity , alcohol intake and smoking history ) , measured on average 2.1 years after diagnosis . Up date d information for weight only was available . Study heterogeneity was evaluated by the Q-statistic . Multivariable Cox regression models were stratified by study . Adjusting for clinical factors and potential confounders , ≥ 10 % weight gain and obesity ( BMI , 30 - 34.99 and ≥ 35 ) were associated with increased risk of late recurrence ( hazard ratios ( 95 % confidence intervals ) : 1.24 ( 1.00 - 1.53 ) , 1.40 ( 1.05 - 1.86 ) and 1.41 ( 1.02 - 1.93 ) , respectively ) . Daily alcohol intake was associated with late recurrence , 1.28 ( 1.01 - 1.62  ) . Physical activity was inversely associated with late all-cause mortality ( 0.81 ( 0.71 - 0.93 ) and 0.71 ( 0.61 - 0.82 ) for 4.9 to < 17.4 and ≥ 17.4 metabolic equivalent-hr/week ) . A U-shaped association was observed for late all-cause mortality and BMI using up date d weight ( 1.42 ( 1.15 - 1.74 ) and 1.40 ( 1.09 - 1.81 ) , < 21.5 and ≥ 35 , respectively ) . Smoking was associated with increased risk of late outcomes . In this large prospect i ve pooling project , modifiable lifestyle factors were associated with late outcomes among long-term ER+ breast cancer survivors BACKGROUND Despite the high global prevalence of prostate cancer ( PCa ) , few epidemiologic studies have assessed physical activity in relation to PCa survival . OBJECTIVE To evaluate different types , intensities , and timing of physical activity relative to PCa survival . DESIGN , SETTING , AND PARTICIPANTS A prospect i ve study was conducted in Alberta , Canada , in a cohort of 830 stage II-IV incident PCa cases diagnosed between 1997 and 2000 with follow-up to 2014 ( up to 17 yr ) . Prediagnosis lifetime activity was self-reported at diagnosis . Postdiagnosis activity was self-reported up to three times during follow-up . OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Cox proportional hazards models related  physical activity to all-cause and PCa-specific deaths and to first recurrence/progression of PCa . RESULTS AND LIMITATIONS A total of 458 deaths , 170 PCa-specific deaths , and , after first follow-up , 239 first recurrences/progressions occurred . Postdiagnosis  total  activity ( > 119 vs ≤42 metabolic equivalent [MET]-hours/week per year ) was associated with a significantly lower all-cause mortality risk ( hazard ratio [ HR ] : 0.58 ; 95 % confidence interval [ CI ] , 0.42 - 0.79 ; p value for trend < 0.01 ) . Postdiagnosis recreational activity ( > 26 vs ≤4 MET-hours/week per year ) was associated with a significantly lower PCa-specific mortality risk ( HR : 0.56 ; 95 % CI , 0.35 - 0.90 ; p value for trend = 0.01 ) .  Sustained recreational activity before and after diagnosis ( > 18 - 20 vs < 7 - 8 MET-hours/week per year ) was associated with a lower risk of all-cause mortality ( HR : 0.66 ; 95 % CI , 0.49 - 0.88 ) . Limitations included generalisability to healthier cases and an observational study design . CONCLUSIONS These findings support emerging recommendations to increase physical activity after the diagnosis of PCa and would inform a future exercise intervention trial examining PCa outcomes . PATIENT SUMMARY In a 17-yr prostate cancer ( PCa ) survival study , men who survived at least 2 yr who were more physically active postdiagnosis or  performed more recreational physical activity  before and after diagnosis survived longer . Recreational physical activity  after diagnosis was associated with a lower risk of PCa death Background : Previous research has shown exercise to be an effective method to mitigate many adverse treatment-related effects of and rogen suppression therapy ( AST ) but the potential impact of exercise on sexual activity remains unknown . The purpose of this investigation was to report the effect of a 12-week exercise program on sexual activity in prostate cancer patients undergoing AST . Methods : Fifty-seven prostate cancer patients undergoing AST were r and omly assigned to an exercise program ( resistance and aerobic modes ; n=29 ) or usual care control ( n=28 ) . Sexual activity was assessed by the European Organization for Research and Treatment of Cancer prostate cancer-specific quality of life question naire ( QLQ-PR25 ) . Results : QLQ-PR25 data were log transformed and analysis of covariance was used to compare sexual activity between groups following the intervention adjusted for baseline activity . No differences in sexual activity were observed between the exercise and control groups before the intervention . There was a significant ( P=0.045 ) adjusted group difference in sexual activity following the 12-week intervention . Patients undergoing usual care decreased sexual activity while patients in the exercise program maintained their level of sexual activity . At baseline , 20.6 and 22.2 % of participants in the exercise and control groups reported a major interest in sex ( that is , high libido ) . Following the intervention , the exercise group had a significantly higher percentage of participants reporting a major interest in sex ( exercise=17.2 % vs control=0 % ; P=0.024 ) . Conclusions : Participation in a short-term exercise program result ed in the maintenance of sexual activity in prostate cancer patients undergoing AST 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 PURPOSE Regular physical activity reduces the risk of developing colon cancer , however , its influence on patients with established disease is unknown . PATIENTS AND METHODS We conducted a prospect i ve observational study of 832 patients with stage III colon cancer enrolled in a r and omized adjuvant chemotherapy trial . Patients reported on various recreational physical activities approximately 6 months after completion of therapy and were observed for recurrence or death . To minimize bias by occult recurrence , we excluded patients who experienced recurrence or died within 90 days of their physical activity assessment . RESULTS Compared with patients engaged in less than three metabolic equivalent task ( MET ) -hours per week of physical activity , the adjusted hazard ratio for disease-free survival was 0.51 ( 95 % CI , 0.26 to 0.97 ) for 18 to 26.9 MET-hours per week and 0.55 ( 95 % CI , 0.33 to 0.91 ) for 27 or more MET-hours per week . The adjusted P for trend was .01 . Postdiagnosis activity was associated with similar improvements in recurrence-free survival ( P for trend = .03 ) and overall survival ( P for trend = .01 ) . The benefit associated with physical activity was not significantly modified by sex , body mass index , number of positive lymph nodes , age , baseline performance status , or chemotherapy received . Moreover , the benefit remained unchanged even after excluding participants who developed cancer recurrence or died within 6 months of activity assessment . CONCLUSION Beyond surgical resection and postoperative adjuvant chemotherapy for stage III colon cancer , for patients who survive and are recurrence free approximately 6 months after adjuvant chemotherapy , physical activity appears to reduce the risk of cancer recurrence and mortality 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 The study was conducted to determine the effect of physical activity on DNA methylation and to predict the consequence of this effect concerning gene expression and breast cancer survival . Blood sample s , collected from 12 breast cancer patients who participated in a r and omized clinical trial of exercise , were examined for exercise-related changes in DNA methylation using a methylation microarray . Tumor sample s of 348 breast cancer patients were analyzed with qRT-PCR and qMSP to determine gene expression and methylation identified in the microarray analysis . Cox regression models were developed to predict survival outcomes in association with gene expression and methylation . After 6 months of moderate-intensity aerobic exercise , changes in DNA methylation ( P < 5 × 10−5 ) in peripheral blood leukocytes were detected in 43 genes from a panel of 14 495 . Based on the list , we analyzed gene expression in association with overall survival in breast tumors and found three genes whose methylation was reduced after exercise were favorably in association with overall survival , i.e. , higher expression associated with better survival . Of the three genes , L3MBTL1 was a putative tumor suppressor gene with known function to repress chromatin for transcription , which is activated mainly in germline stem cells . Further analyses of tumor features among patients indicated that high expression of L3MBTL1 was associated with low grade and hormone receptor – positive tumors , as well as low risk of disease recurrence and breast cancer death . In conclusion , the study suggests that increasing physical activity after a breast cancer diagnosis may affect epigenetic regulation of tumor suppressor genes , which have favorable impacts on survival outcomes of breast cancer patients Background : Higher levels of physical activity are associated with lower colorectal carcinoma incidence and mortality , perhaps through influencing energy balance , cellular prosta7 systemic inflammation . Although evidence suggests interactive effects of energetics , sedentary lifestyle , and tumor CTNNB1 ( β-catenin ) or CDKN1B ( p27 ) status on colon cancer prognosis , interactive effects of physical activity and tumor PTGS2 ( the official symbol for COX-2 ) status on clinical outcome remain unknown . Methods : Using molecular pathological epidemiology data base of 605 stage I – III colon and rectal cancers in two prospect i ve cohort studies ( the Nurse 's Health Study and the Health Professionals Follow-up Study ) , we examined patient survival according to postdiagnosis physical activity and tumor PTGS2 status  ( with 382 PTGS2-positive and 223 PTGS2-negative tumors by immunohistochemistry ) . Cox proportional hazards models were used to calculate colorectal cancer-specific mortality HR , adjusting for clinical and other tumor variables including microsatellite instability status . Results : Among PTGS2-positive cases , compared with the least active first quartile , the multivariate HRs ( 95 % confidence interval ) were 0.30 ( 0.14–0.62 ) for the second , 0.38 ( 0.20–0.71 ) for the third , and 0.18 ( 0.08–0.41 ) for the fourth quartile of physical activity level ( Ptrend = 0.0002 ) . In contrast , among PTGS2-negative cases , physical activity level was not significantly associated with survival ( Ptrend = 0.84 ; Pinteraction = 0.024 , between physical activity and tumor PTGS2 status ) . Conclusions : Postdiagnosis physical activity is associated with better survival among patients with PTGS2-positive tumors but not among patients with PTGS2-negative tumors . Impact : Immunohistochemical PTGS2 expression in colorectal carcinoma may serve as a predictive biomarker in pathology practice , which may predict stronger benefit from exercise . Cancer Epidemiol Biomarkers Prev ; 22(6 ) ; 1142–52 . © 2013 AACR BACKGROUND Exercise improves physical functioning and symptom management during breast cancer chemotherapy , but the effects of different doses and types of exercise are unknown . METHODS A multicenter trial in Canada r and omized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy  consisting of either a st and ard dose of 25 to 30 minutes of aerobic exercise ( STAN ; n = 96 ) , a higher dose of 50 to 60 minutes of aerobic exercise ( HIGH ; n = 101 ) , or a combined dose of 50 to 60 minutes of aerobic and resistance exercise ( COMB ; n = 104 ) . The primary endpoint was physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)-36 . Secondary endpoints were other physical functioning scales , symptoms , fitness , and chemotherapy completion . All statistical tests were linear mixed model analyses , and the P values were two-sided . RESULTS Follow-up assessment of patient-reported outcomes was 99.0 % . Adjusted linear mixed-model analyses showed that neither HIGH ( + 0.8 ; 95 % confidence interval [ CI ] = -0.8 to 2.4 ; P = .30 ) nor COMB ( + 0.5 ; 95 % CI = -1.1 to 2.1 ; P = .52 ] were superior to STAN for the primary outcome . In secondary analyses not adjusted for multiple comparisons , HIGH was superior to STAN for the SF-36 physical component summary ( P = .04 ) , SF-36 bodily pain ( P = .02 ) , and endocrine symptoms ( P = .02 ) . COMB was superior to STAN for endocrine symptoms ( P = .009 ) and superior to STAN ( P < .001 ) and HIGH ( P < .001 ) for muscular strength . HIGH was superior to COMB for the SF-36 bodily pain ( P = .04 ) and aerobic fitness ( P = .03 ) . No differences emerged for body composition or chemotherapy completion . CONCLUSIONS A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than st and ard volumes PURPOSE Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown . PATIENTS AND METHODS By a prospect i ve , observational study of 573 women with stage I to III colorectal cancer , we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis . To minimize bias by occult recurrences , we excluded women who died within 6 months of their postdiagnosis physical activity assessment . RESULTS Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality ( P for trend = .008 ) and overall mortality ( P for trend = .003 ) . Compared with women who engaged in less than 3 metabolic equivalent task [ MET ] -hours per week of physical activity , those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 ( 95 % CI , 0.18 to 0.82 ) and an adjusted hazard ratio for overall mortality of 0.43 ( 95 % CI , 0.25 to 0.74 ) . These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment . Prediagnosis physical activity was not predictive of mortality . Women who increased their activity ( when comparing prediagnosis to postdiagnosis values ) had a hazard ratio of 0.48 ( 95 % CI , 0.24 to 0.97 ) for colorectal cancer deaths and a hazard ratio of 0.51 ( 95 % CI , 0.30 to 0.85 ) for any-cause death , compared with those with no change in activity . CONCLUSION Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality PURPOSE To investigate the association between pre- and postdiagnosis physical activity ( as well as change in prediagnosis to postdiagnosis physical activity ) and mortality among women with breast cancer . PATIENTS AND METHODS This was a prospect i ve observational study of 933 women enrolled onto the Health , Eating , Activity , and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004 , whichever came first . The primary outcomes measured were total deaths and breast cancer deaths . The primary exposures were  physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity . RESULTS Compared with inactive women , the multivariable hazard ratios ( HRs ) for total deaths for women expending at least 9 metabolic equivalent hours per week ( approximately 2 to 3 h/wk of brisk walking ) were 0.69 ( 95 % CI , 0.45 to 1.06 ; P = .045 ) for those active in the year before diagnosis and 0.33 ( 95 % CI , 0.15 to 0.73 ; P = .046 ) for those active 2 years after diagnosis . Compared with women who were inactive both before and after diagnosis , women who increased physical activity  after diagnosis had a 45 % lower risk of death ( HR = 0.55 ; 95 % CI , 0.22 to 1.38 ) , and women who decreased physical activity  after diagnosis had a four-fold greater risk of death ( HR = 3.95 ; 95 % CI , 1.45 to 10.50 ) . CONCLUSION Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis 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 Observational studies have suggested that physical activity may be associated with improved survival after cancer treatment . However , data from controlled clinical trials are required . We analyzed survival data of 103 patients from a previously published r and omized controlled trial in allogeneic stem cell transplant patients who were r and omized to either an exercise intervention ( EX ) or to a social contact control group . EX patients trained prior to hospital admission , during inpatient treatment , and for 6 - 8 weeks after discharge .  Survival analyses were used to compare both total mortality ( TM ) and non-relapse mortality ( NRM ) after discharge and transplantation during an observation period of 2 years after transplantation . Analyses were corroborated with Cox and Fine & Gray regression models adjusting for potential confounders . After discharge , EX patients had a significantly lower TM rate than controls ( 12.0 vs. 28.3 % , p = 0.030 ) and a numerically lower NRM rate ( 4.0 vs. 13.5 % , p = 0.086 ) . When the inpatient period was included , absolute risk reductions were similar but not significantly different ( TM : 34.0 vs. 50.9 % , p = 0.112 ; NRM : 26.0 vs. 36.5 % , p = 0.293 ) . The number needed to treat ( NNT ) to prevent one death with EX was about 6 . Furthermore , regression analyses revealed that baseline fitness was protective against mortality . The data suggest that exercise might improve survival in patients undergoing allo-HCT . However , the results should be interpreted with caution as the study was not design ed to detect differences in survival rates , and as no stratification on relevant prognostic factors was carried out Background : Aerobic exercise training ( AET ) is known to increase RBC production ; however , this has not been evaluated in breast cancer patients undergoing adjuvant chemotherapy . The purpose of this study was to examine the changes in hemoglobin ( Hb ) levels in the Supervised Trial of Aerobic versus Resistance Training ( START ) and to determine its association with changes in VO2peak . Methods : Two hundred and forty-two breast cancer patients initiating chemotherapy were r and omized to usual care ( n = 82 ) , resistance exercise ( RET , n = 82 ) , or AET ( n = 78 ) groups for the duration of their chemotherapy ( median , 17 weeks ) . Supervised exercise was thrice weekly based on st and ard AET and RET prescriptions .  Aerobic fitness ( VO2peak ) and Hb concentration were measured at baseline and end of chemotherapy . Results : Regardless of the exercise group , Hb declined over the course of chemotherapy ( 13.4 ± 10.0 to 11.8 ± 11.5 g/dL , P < 0.01 ) . Both AET and RET groups had significant , moderate correlations between the change in VO2peak and Hb ( AET : r = 0.49 , P < 0.001 ; RET : r = 0.39 , P = 0.001 ) . Conclusion : The results indicate that regular exercise does not protect against the decline in Hb associated with chemotherapy in breast cancer patients , but result ed in a stronger association between Hb and VO2peak . Impact : Even with the chemotherapy-induced decline in Hb , breast cancer patients can maintain their aerobic capacity by participating in regular aerobic exercise . Further studies are required to determine safe intensity levels that may stimulate the maintenance of Hb levels in breast cancer patients . Cancer Epidemiol Biomarkers Prev ; 19(11 ) ; 2826–32 . © 2010 AACR INTRODUCTION And rogen deprivation therapy ( ADT ) is associated with significant bone loss and an increase in fracture risk among prostate cancer survivors ( PCS ) . We investigated whether impact + resistance training could stop ADT-related declines in bone mineral density ( BMD ) among PCS on ADT . METHODS We r and omized 51 PCS ( mean age , 70.2 yr ) currently prescribed ADT to participate in 1 yr of impact + resistance training ( Prevent Osteoporosis with Impact + Resistance ( POWIR ) )  or in an exercise placebo program of stretching exercise ( FLEX ) . Outcomes were proximal femur ( total hip , femoral neck , and greater trochanter ) and spine ( L1-L4 ) BMD ( g·cm ) and bone turnover markers ( serum osteocalcin ( ng·mL ) and urinary deoxypyrodinoline cross-links ( nmol·mmol Cr ) ) . RESULTS Retention in the 1-yr study was 84 % and median attendance to supervised classes was 84 % in POWIR and 74 % in FLEX . No study -related injuries were reported . There were no significant differences between groups for average L1-L4 BMD or for BMD at any hip site . When examining individual vertebrae , POWIR has a significant effect on preservation of BMD ( -0.4 % ) at the L4 vertebrae compared with losses ( -3.1 % ) in FLEX ( P = 0.03 ) . CONCLUSION Impact + resistance training was a safe and acceptable form of exercise for older PCS on ADT . Among our limited sample , POWIR did not appear to have a clinical ly meaningful effect on hip or spine BMD , but some evidence of skeletal adaptation to resistance + impact training in an and rogen-deprived state was apparent . Future studies need to be conducted on a larger sample of patients and should consider modifications to POWIR that could further enhance loading across the spine and at the hip to preserve BMD at these clinical ly relevant sites 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 Background . And rogen deprivation therapy ( ADT ) increases survival rates in prostate cancer ( PCa ) patients with locally advanced disease , but is associated with side effects that may impair daily function . Strength training may counteract several side effects of ADT , such as changes in body composition and physical functioning , which in turn may affect health-related quality of life ( HRQOL ) . However , additional r and omised controlled trials are needed to exp and this knowledge . Material and methods . Fifty-eight PCa patients on ADT were r and omised to either 16 weeks of high-load strength training ( n = 28 ) or usual care ( n = 30 ) . The primary outcome was change in total lean body mass ( LBM ) assessed by dual x-ray absorptiometry ( DXA ) . Secondary outcomes were changes in regional LBM , fat mass , and areal bone mineral density ( aBMD ) measured by DXA ; physical functioning assessed by 1-repetition maximum ( 1RM ) tests , sit-to-st and test , stair climbing test and Shuttle walk test ; and HRQOL as measured by the European Organization for the Research and Treatment of Cancer Quality of Life Question naire Core 30 . Results and Conclusion . No statistically significant effect of high-load strength training was demonstrated on total LBM ( p = 0.16 ) , but significant effects were found on LBM in the lower and upper extremities ( 0.49 kg , p < 0.01 and 0.15 kg , p < 0.05 , respectively ) . Compared to usual care , high-load strength training showed no effect on fat mass , aBMD or HRQOL , but beneficial effects were observed in all 1RM tests , sit-to-st and test and stair climbing tests . Adherence to the training program was 88 % for lower body exercises and 84 % for upper body exercises . In summary , high-load strength training improved LBM in extremities and physical functioning , but had no effect on fat mass , aBMD , or HRQOL in PCa patients on ADT Background . Chronic fatigue is one of the most restricting symptoms following primary breast cancer treatment , but clinical studies on symptom management are rare . The objective was to evaluate the impact of a multimodal mind – body program ( MMMT ) , including moderate physical activity as compared with a walking intervention alone , on chronic fatigue symptoms of women with stage I to IIIA breast cancer . Patients and Methods . Sixty-four women ( mean age = 56.7 years ) suffering from chronic fatigue after active tumor treatment were r and omly assigned to either an experimental or a control ( n = 32 each ) intervention ( 10 weeks ) . Fatigue , quality of life ( QoL ) , functional well-being , anxiety , and depression were measured with st and ard question naires at baseline , after 10 weeks , and after 3 months . Results . Compared with baseline , both groups had reduced fatigue scores after treatment without any significant difference between groups ( posttreatment , Δ = −0.3 , confidence interval = −1.6 to 1.0 , P = .678 ; follow-up , Δ = −0.4 , confidence interval = −1.8 to 0.9 , P = .510 ) . All patients also improved regarding QoL and general functional well-being . Conclusion . Since both interventions reduced fatigue symptoms and enhanced QoL to a similar extent , we observed no verifiable add-on effect of the MMMT  regarding fatigue symptoms . Considering the higher costs with additional expenditure related to MMMT , home-based walking intervention is recommended BACKGROUND The number of cancer survivors is increasing rapidly ; however , little is known about whether engaging in physical activity after a cancer diagnosis is associated with lower mortality rates in men . METHODS We conducted a prospect i ve cohort study of 1021 men ( mean age , 71.3 years ) who were diagnosed with cancer ( other than nonmelanoma skin cancer ) . Men reported their physical activities ( walking , stair climbing , and participation in sports and recreational activities ) on question naires in 1988 , a median of 6 years after their cancer diagnosis .  Physical activity was up date d in 1993 and men were followed until 2008 , with mortality follow-up > 99 % complete , during which 777 men died ( 337 from cancer , 190 from cardiovascular disease ) . RESULTS In multivariate analyses , the relative risks for all-cause mortality associated with expending < 2100 , 2100 - 4199 , 4200 - 8399 , 8400 - 12,599 , and ≥ 12,600 kJ/week in physical activity were 1.00 ( referent ) , 0.77 , 0.74 , 0.76 , and 0.52 , respectively ( P-trend < 0.0001 ) . Higher levels of physical activity also were associated with lower rates of death from cancer and cardiovascular disease ( P- trend = 0.01 and 0.002 , respectively ) . CONCLUSIONS Engaging in physical activity after cancer diagnosis is associated with better survival among men The purpose of these analyses is to test prospect ively whether post-diagnosis running and walking differ significantly in their association with breast cancer mortality .  Cox proportional hazard analyses were used to compare breast cancer mortality to baseline exercise energy expenditure ( METs , 1 MET-hour ≅1 km run ) in 272 runners and 714 walkers previously diagnosed with breast cancer from the National Runners ' and Walkers ' Health Studies when adjusted for age , race , menopause , family history , breastfeeding and oral contraceptive use . Diagnosis occurred ( mean ± SD ) 7.9 ± 7.3 years before baseline . Forty-six women ( 13 runners and 33 walkers ) died from breast cancer during 9.1-year mortality surveillance . For the 986 runners and walkers  combined , breast cancer mortality decreased an average of 23.9 % MET-hours/day [ 95 % confidence interval ( CI ) : 7.9 - 38.3 % ; p = 0.004 ] . There was a significantly greater decrease in risk for running than walking ( risk per MET-hours/day run vs. walked : p = 0.03 ) . For the 272 runners analyzed separately , breast cancer mortality decreased an average of 40.9 % per MET-hours/day run ( 95 % CI : 19.3 - 60.0 % , p = 0.0004 ) . When analyzed by categories of running energy expenditure , breast cancer mortality was 87.4 % lower for the 1.8 - 3.6 MET-hours/day category ( 95 % CI : 41.3 - 98.2 % lower , p = 0.008 ) and 95.4 % lower for the ≥3.6 MET-hours/day category ( 95 % CI : 71.9 - 100 % lower , p = 0.0004 ) compared to the < 1.07 MET-hours/day category . In contrast , the 714 walkers showed a nonsignificant 4.6 % decrease in breast cancer mortality per MET-hours/day walked ( 95 % CI : 27.3 % decreased risk to 21.3 % increased risk , p = 0.71 ) . These results suggest that post-diagnosis running is associated with significantly lower breast cancer mortality than post-diagnosis walking CONTEXT Alterations of the WNT signaling pathway and cadherin-associated protein β 1 ( CTNNB1 or β-catenin ) have been implicated in colorectal carcinogenesis and metabolic diseases . OBJECTIVE To test the hypothesis that CTNNB1 activation in colorectal cancer modifies prognostic associations of body mass index ( BMI ) and level of postdiagnosis physical activity . DESIGN , SETTING , AND PATIENTS Two US prospect i ve cohort studies ( Nurses ' Health Study and the Health Professionals Follow-up Study ) were used to evaluate CTNNB1 localization by immunohistochemistry in 955 patients with stage I , II , III , or IV colon and rectal cancer from 1980 through 2004 . A Cox proportional hazards model was used to compute the hazard ratio ( HR ) for mortality , adjusting for clinical and tumor features , including microsatellite instability , CpG isl and methylator phenotype , level of long interspersed nucleotide element 1 methylation , mutations in KRAS , BRAF , or PIK3CA , and tumor protein p53 . MAIN OUTCOME MEASURES Colorectal cancer-specific mortality and overall mortality through June 30 , 2009 . RESULTS In obese patients ( BMI ≥30 ) , positive status for nuclear CTNNB1 was associated with significantly better colorectal cancer-specific survival ( adjusted HR , 0.24 [ 95 % confidence interval { CI } , 0.12 - 0.49 ] , P < .001 for interaction ; 5-year survival : 0.85 for patients with positive nuclear CTNNB1 status vs 0.78 for those with negative status ) and overall survival ( adjusted HR , 0.56 [ 95 % CI , 0.35 - 0.90 ] , P = .03 for interaction ; 5-year survival : 0.77 for patients with positive nuclear CTNNB1 status vs 0.74 for those with negative status ) , while CTNNB1 status was not associated with prognosis among nonobese patients ( BMI < 30 ) . Among patients with negative status for nuclear CTNNB1 and cancer in stages I , II , or III , postdiagnosis physical  activity was associated with better colorectal cancer-specific survival ( adjusted HR , 0.33 [ 95 % CI , 0.13 - 0.81 ] , P = .05 for interaction ; 5-year survival : 0.97 for ≥18 vs 0.89 for < 18 metabolic equivalent task hours/week ) , while postdiagnosis physical  activity was not associated with colorectal cancer-specific survival among patients with positive status for nuclear CTNNB1 ( adjusted HR , 1.07 [ 95 % CI , 0.50 - 2.30 ] ) . CONCLUSIONS Among obese patients only , activation of CTNNB1 was associated with better colorectal cancer-specific survival and overall survival . Postdiagnosis physical activity was associated with better colorectal cancer-specific survival only among patients with negative status for nuclear CTNNB1 . These molecular pathological epidemiology findings suggest that the effects of alterations in the WNT-CTNNB1 pathway on outcome are modified by BMI and physical activity Aim . The aim of the study was to compare the effects of aerobic exercise training and yoga on the functional capacity , peripheral muscle strength , quality of life ( QOL ) , and fatigue in breast cancer survivors . Material and methods . A total of 52 patients with a diagnosis of breast cancer were included in the study . The patients were r and omly assigned to 2 groups : aerobic exercise ( n = 28 ) and yoga added to aerobic exercise ( n = 24 ) . Both groups participated in submaximal exercise 30 minutes/d , 3 d/wk for 6 weeks . The second group participated in a 1-hour yoga program in addition to aerobic exercise training .  Functional capacity was assessed by the 6-Minute Walk Test ( 6MWT ) . Peripheral muscle strength was evaluated with a h and -held dynamometer . The fatigue severity level was assessed with the Fatigue Severity Scale ( FSS ) . The QOL was determined by the European Organisation for Research and Treatment of Cancer Quality of Life Question naire . Results . There were statistically significant increases in peripheral muscle strength , the 6MWT distance , and the perception of QOL in both groups ( P < .05 ) . Additionally , the group with aerobic exercise and yoga showed marked improvement compared with the aerobic exercise group in fatigue perception ( P < .05 ) . Conclusion . According to the data from this study , aerobic exercise training and yoga improved the functional capacity and QOL of breast cancer patients .  Aerobic exercise programs can be supported by body mind techniques , such as yoga , in the rehabilitation of cancer patients for improving functional recovery and psychosocial wellness UNLABELLED Observational studies suggest that physical activity after a breast cancer diagnosis is associated with improved cancer outcomes ; however , no r and omized data are available . Here , we report an exploratory follow-up of cancer outcomes from the Supervised Trial of Aerobic versus Resistance Training ( START ) . METHODS The START was a Canadian multicenter trial that r and omized 242 breast cancer patients between 2003 and 2005 to usual care ( n = 82 ) , supervised aerobic ( n = 78 ) , or resistance ( n = 82 ) exercise during chemotherapy .  The primary end point for this exploratory analysis was disease-free survival ( DFS ) . Secondary end points were overall survival , distant DFS , and recurrence-free interval . The two exercise arms were combined for analysis ( n = 160 ) , and selected subgroups were explored . RESULTS After a median follow-up of 89 months , there were 25/160 ( 15.6 % ) DFS events in the exercise groups and 18/82 ( 22.0 % ) in the control group . Eight-year DFS was 82.7 % for the exercise groups compared with 75.6 % for the control group ( HR , 0.68 ; 95 % confidence interval ( CI ) , 0.37 - 1.24 ; log-rank , P = 0.21 ) . Slightly stronger effects were observed for overall survival ( HR , 0.60 ; 95 % CI , 0.27 - 1.33 ; log-rank , P = 0.21 ) , distant DFS ( HR , 0.62 ; 95 % CI , 0.32 - 1.19 ; log-rank , P = 0.15 ) , and recurrence-free interval ( HR , 0.58 ; 95 % CI , 0.30 - 1.11 ; Gray test , P = 0.095 ) . Subgroup analyses suggested potentially stronger exercise effects on DFS for women who were overweight/obese ( HR , 0.59 ; 95 % CI , 0.27 - 1.27 ) , had stage II/III cancer ( HR , 0.61 ; 95 % CI , 0.31 - 1.20 ) , estrogen receptor-positive tumors ( HR , 0.58 ; 95 % CI , 0.26 - 1.29 ) , human epidermal growth factor receptor 2-positive tumors ( HR , 0.21 ; 95 % CI , 0.04 - 1.02 ) , received taxane-based chemotherapies ( HR , 0.46 ; 95 % CI , 0.19 - 1.15 ) , and ≥85 % of their planned chemotherapy ( HR , 0.50 ; 95 % CI , 0.25 - 1.01 ) . CONCLUSIONS This exploratory follow-up of the START provides the first r and omized data to suggest that adding exercise to st and ard chemotherapy may improve breast cancer outcomes . A definitive phase III trial is warranted
The combination of an increasing number of new cancer cases and improving survival rates has led to a large and rapidly growing population with unique health-care requirements .
Exercise has been proposed as a strategy to help address the issues faced by cancer patients .
Supported by a growing body of research , major health organizations commonly identify the importance of incorporating exercise in cancer care and advise patients to be physically active .
This systematic review comprehensively summarizes the available epidemiologic and r and omized controlled trial evidence investigating the role of exercise in the management of cancer .