Decreased interleukin-1 receptor antagonist response following moderate exercise in patients with colorectal carcinoma after primary treatment. Adherence to moderate-intensity exercise during breast cancer therapy. Effects of aerobic exercise training in anemic cancer patients receiving darbepoetin alfa: a randomized controlled trial. Safety and Efficacy of Weight Training in Recent Breast Cancer Survivors to Alter Body Composition, Insulin, and Insulin-Like Growth Factor Axis Proteins The effect of aerobic exercise on self-esteem and depressive and anxiety symptoms among breast cancer survivors. One-year follow-up of the 'Starting Again' group rehabilitation programme for cancer patients. Effects of exercise on physiological and psychological variables in cancer survivors. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial Structured exercise improves physical functioning in women with stages I and II breast cancer: results of a randomized controlled trial. Exercise therapy effect on natural killer cell cytotoxic activity in stomach cancer patients after curative surgery. Randomized controlled trial of the effects of print materials and step pedometers on physical activity and quality of life in breast cancer survivors. Physical Activity and Lymphedema (the PAL trial): assessing the safety of progressive strength training in breast cancer survivors. The Effects of Walking Poles on Shoulder Function in Breast Cancer Survivors Effects of an oncologist’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors: a single-blind, randomized controlled trial Correlates of adherence and contamination in a randomized controlled trial of exercise in cancer survivors: An application of the theory of planned behavior and the five factor model of personality A pilot study of yoga for breast cancer survivors: physical and psychological benefits. Effects of Supervised Exercise Therapy in Patients Receiving Radiotherapy for Breast Cancer Effects of a relaxation breathing exercise on fatigue in haemopoietic stem cell transplantation patients. Intensive lifestyle changes may affect the progression of prostate cancer. A randomized, controlled trial of aerobic exercise for treatment‐related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma Effectiveness of a self-administered, home-based exercise rehabilitation program for women following a modified radical mastectomy and axillary node dissection: a preliminary study Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial. Effect of aerobic exercise and relaxation training on fatigue and physical performance of cancer patients after surgery. A randomised controlled trial Randomized Controlled Trial of Aerobic Exercise on Insulin and Insulin-like Growth Factors in Breast Cancer Survivors: The Yale Exercise and Survivorship Study Exercise effects on bone mineral density in women with breast cancer receiving adjuvant chemotherapy. Effects of an exercise program on muscle performance in patients undergoing allogeneic bone marrow transplantation Effects of aerobic exercise on the physical performance and incidence of treatment-related complications after high-dose chemotherapy. Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. A randomized trial to increase physical activity in breast cancer survivors. Randomized trial of exercise therapy in women treated for breast cancer. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes. A nursing rehabilitation program for women with breast cancer receiving adjuvant chemotherapy. Main outcomes of the FRESH START trial: a sequentially tailored, diet and exercise mailed print intervention among breast and prostate cancer survivors. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Fatigue and quality of life outcomes of exercise during cancer treatment. Effect of upper extremity exercise on secondary lymphedema in breast cancer patients: a pilot study. Dance and Movement Program Improves Quality‐of‐Life Measures in Breast Cancer Survivors Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Physical exercise for cytotoxic drug-induced fatigue A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Feasibility of Exercise During Treatment for Multiple Myeloma Psychological and fitness changes associated with exercise participation among women with breast cancer. Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. A Brief Intervention for Fatigue Management in Breast Cancer Survivors Effect of aerobic exercise on body weight and composition in patients with breast cancer on adjuvant chemotherapy. A cognitive behavioral therapy intervention to promote weight loss improves body composition and blood lipid profiles among overweight breast cancer survivors A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. Feasibility and effectiveness of a lifestyle intervention program in obese endometrial cancer patients: a randomized trial. The effects of an individualized exercise intervention on body composition in breast cancer patients undergoing treatment. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. A randomized trial of exercise and quality of life in colorectal cancer survivors. Aerobic exercise in the rehabilitation of cancer patients after high dose chemotherapy and autologous peripheral stem cell transplantation Cardiopulmonary Responses and Adherence to Exercise in Women Newly Diagnosed With Breast Cancer Undergoing Adjuvant Therapy Evaluation of a 12-week home-based walking intervention for breast cancer survivors Home-based physical activity intervention for breast cancer patients. Combining weight-loss counseling with the weight watchers plan for obese breast cancer survivors. An exercise intervention for breast cancer survivors with bone loss. Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. Changes in the Body Image and Relationship Scale following a one-year strength training trial for breast cancer survivors with or at risk for lymphedema Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. Depression and Anxiety in Women With Breast Cancer and Their Partners Exercise and secondary lymphedema: safety, potential benefits, and research issues. Changes in Hope and Power in Lung Cancer Patients who Exercise Lifestyle intervention development study to improve physical function in older adults with cancer: outcomes from Project LEAD. A pilot study to assess the influence of tai chi chuan on functional capacity among breast cancer survivors. Combined aerobic and resistance training in breast cancer survivors: A randomized, controlled pilot trial. A pilot study of a randomized controlled trial to evaluate the effects of progressive resistance exercise training on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in head and neck cancer survivors. Effect of a vigorous aerobic regimen on physical performance in breast cancer patients — a randomized controlled pilot trial Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Stretching Exercises to Reduce Symptoms of Postoperative Neck Discomfort after Thyroid Surgery: Prospective Randomized Study The effect of a multimodal intervention on treatment-related symptoms in patients undergoing hematopoietic stem cell transplantation: a randomized controlled trial. Immunological changes after cancer treatment and participation in an exercise program. Effects of home-based diet and exercise on functional outcomes among older, overweight long-term cancer survivors: RENEW: a randomized controlled trial. Motivational Interviewing to Increase Physical Activity in Long-Term Cancer Survivors: A Randomized Controlled Trial Results of a diet/exercise feasibility trial to prevent adverse body composition change in breast cancer patients on adjuvant chemotherapy. Exercise and lymphocyte activation following chemotherapy for breast cancer. Randomized pilot test of a lifestyle physical activity intervention for breast cancer survivors. Effects of Aerobic Interval Training on Cancer Patients' Functional Capacity The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Effects of resistive exercise on skeletal muscle in marrow transplant recipients receiving total parenteral nutrition. Recruiting and retaining breast cancer survivors into a randomized controlled exercise trial Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer.
Clinical and experimental studies have shown that a moderately increased physical activity level may have beneficial effects in terms of exercise conditioning , resistance to infection and decreased relative risk of cancer . Modulation of the innate and adaptive components of the immune system with a shift of cytokines and their antagonists to a more pro- and less anti-inflammatory response was found to be a prominent feature in non-tumor patients and healthy volunteers . As quantitative data concerning the cytokine/antagonist response following exercise are not available for tumor patients , we compared the effects of a post-operative rehabilitation program with moderate exercise ( ME ) intensity ( 0.55 - 0.65 x maximal aerobic power ) with a program with low exercise ( LE ) intensity ( 0.30 - 0.40 x maximal aerobic power ) in patients with curatively treated colorectal carcinoma ( UICC II and III ) measuring pro- ( IL-1beta , IL-6 , tumour necrosis factor ( TNF ) ) and anti-inflammatory cytokines ( IL-1 receptor antagonist , sTNF receptors I and II ) . Twenty-three patients participated in this prospect i ve trial , N = 13 in the ME group , N = 10 in the LE group . Exercise was performed daily 30 - 40 min for 2 weeks . Basal ( circulating ) and LPS-stimulated ( phasic ) cytokine and antagonist response was determined before exercise and after 1 and 2 weeks using appropriate ELISA tests . The LPS-stimulated interleukin-1 receptor antagonist ( IL-1ra ) response in the ME group gradually decreased from 31,532.6 ( 160.0 - 70,028.0 ) to 18,033.0 pg/ml ( 5040.0 - 52,570.0 ) after one and to 22,892.0 pg/ml ( 6376.0 - 34,726.0 ) after 2 weeks ( P < 0.05 ) with a concomitant decrease of the corresponding IL-1ra/IL-6 and IL-1ra/IL-1beta ratio : 2.51 - 1.41 and 4.1 - 3.1 , respectively . In contrast , in the LE group LPS-stimulated cytokines and antagonists did not significantly change during exercise . Circulating cytokines and antagonists remained unchanged in both groups . In providing quantitative data in patients with curatively-treated colorectal cancer , we demonstrated that a short-term rehabilitation program with moderate exercise leads to a decreased LPS-induced antagonist response with a shift to a more pro-inflammatory state ( decreased antagonist/cytokine ratio ) . Whether this change of the phasic immune response to moderate exercise may be clinical ly beneficial ( decreased rates of infection , relapses and /or second tumours ) is possible , but has to be investigated in long-term studies PURPOSE The aims of this pilot study were the following : 1 ) to examine patterns of adherence to a brisk walking program in women receiving adjuvant chemotherapy or radiation therapy for newly diagnosed breast cancer using a prospect i ve , r and omized , controlled experimental design ; 2 ) to examine the influence of disease symptoms and treatment side effects on exercise levels ; and 3 ) to suggest methods that may improve future clinical trials of moderate-intensity exercise in similar population s. DESCRIPTION OF STUDY Fifty-two patients with newly diagnosed breast cancer were r and omly assigned to one of two treatment arms : usual care or usual care plus exercise . Those assigned to the exercise group received a st and ardized , self-administered , home-based brisk walking intervention in addition to usual care . Each day subjects completed self-report diary forms that elicited information about activity levels , and the occurrence of symptoms and side effects during cancer treatment . RESULTS Analyses of self-reported daily activity levels revealed a diffusion of treatment effect . Fifty percent of the usual-care group reported maintaining or increasing their physical activity to a moderate-intensity level , while 33 % of the exercise group did not exercise at the prescribed levels . Analyses of self-reported disease symptoms and treatment side effects did not reveal clinical ly meaningful differences between the two groups . CLINICAL IMPLICATION S The results of this study suggest that women who exercised regularly before receiving a breast cancer diagnosis attempted to maintain their exercise programs . Women who lead sedentary lifestyles may benefit from a structured exercise program that includes information and support related to exercise adherence strategies BACKGROUND Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity , increased fatigue , and lower quality of life ( QoL ) . Erythropoiesis-stimulating agents ( ESAs ) have been shown to improve these outcomes ; however , it is unknown if additional benefits can be achieved with aerobic exercise training . METHODS We conducted a single-center , prospect i ve , r and omized , controlled trial in 55 mild-to-moderately anemic patients with solid tumors . Patients were r and omized to either darbepoetin alfa alone ( DAL , n = 29 ) or darbepoetin alfa plus aerobic exercise training ( DEX ; n = 26 ) . The DEX group performed aerobic exercise training three times per week at 60%-100 % of baseline exercise capacity for 12 weeks . The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary endpoints were fatigue , cardiorespiratory fitness ( VO(2peak ) ) , hemoglobin ( Hb ) response , and darbepoetin alfa dosing . RESULTS Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences . The DEX group had a significantly greater VO(2peak ) than the DAL group ( mean group difference , + 3.0 ml/kg per minute ; 95 % confidence interval , 1.2 - 4.7 ; p = .001 ) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing . CONCLUSIONS Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements . Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs Background : This r and omized controlled trial assessed the safety and effects of twice-weekly weight training among recent breast cancer survivors . Outcomes included body size and biomarkers hypothesized to link exercise and breast cancer risk . Methods : A convenience sample of 85 recent survivors was r and omized into immediate and delayed treatment groups . The immediate group trained from months 0 to 12 ; the delayed treatment group served as a no exercise parallel comparison group from months 0 to 6 and trained from months 7 to 12 . Measures at baseline , 6 and 12 months included body weight , height , body fat , lean mass , body fat % , and waist circumference , as well as fasting glucose , insulin , insulin resistance , insulin-like growth factor-I ( IGF-I ) , IGF-II , and IGF-binding protein-1 , IGFBP-2 , and IGFBP-3 . Injury reporting was st and ardized . Results : The intervention result ed in significant increases in lean mass ( 0.88 versus 0.02 kg , P < 0.01 ) , as well as significant decreases in body fat % ( −1.15 % versus 0.23 % , P = 0.03 ) and IGF-II ( −6.23 versus 28.28 ng/mL , P = 0.02 ) comparing immediate with delayed treatment from baseline to 6 months . Within-person changes experienced by delayed treatment group participants during training versus no training were similar . Only one participant experienced a study related injury that prevented continued participation . Conclusion : Twice-weekly weight training is a safe exercise program for recent breast cancer survivors that may result in increased muscle mass , as well as decreased body fat % and IGF-II . The implication s of these results on cancer recurrence or survival may become more evident with longer exercise intervention trials among breast cancer survivors PURPOSE / OBJECTIVES To evaluate the effects of 10 weeks of aerobic exercise on depressive and anxiety symptoms and self-esteem of breast cancer survivors . DESIGN Experimental , crossover . SETTING Midwestern university town . SAMPLE Twenty-four breast cancer survivors ( mean time following surgery 41.8 months ; ranging from 1 to 99 months ) recruited via mail and cancer support groups . The mean age of the sample was 48.9 years . METHODS Subjects were assigned r and omly into exercise ( EX ) , exercise-plus-behavior modification ( EX + BM ) , and control groups . EX and EX + BM groups exercised aerobically four days/week at > or = 60 % of age-predicted maximum heart rate for 10 weeks . Data were collected pretest , post-test , and crossover ( 12 weeks following post-test ) . Because pretest or post-test scores showed no statistical differences between EX and EX + BM groups , data were combined to form one group . MAIN RESEARCH VARIABLES Aerobic exercise ( four days/ week ; 30 - 40 minutes/session ) , depression , ( Beck Depression inventory ) , anxiety ( Speilberger State-Trait Anxiety Inventory ) , and self-esteem ( Rosenberg Self-Esteem Inventory ) . FINDINGS Pre- to post-test analyses revealed that women who exercised had significantly less depression and state and trait anxiety over time compared to controls . After the crossover , the control group demonstrated comparable improvements in both depressive and state anxiety scores . Self-esteem did not change significantly . Subjects who received exercise recommendations from their physicians exercised significantly more than subjects who received no recommendation . CONCLUSIONS Mild to moderate aerobic exercise may be of therapeutic value to breast cancer survivors with respect to depressive and anxiety symptoms but not to self-esteem . A physician 's recommendation to exercise appears to be an important factor in a patient 's exercise adherence . IMPLICATION S FOR NURSING PRACTICE To Improve depressive and anxiety symptoms following breast cancer surgery , healthcare professionals should consider recommending mild to moderate exercise In a r and omised prospect i ve study , a brief structured rehabilitation programme , ' Starting Again ' , was evaluated over a follow-up year . 98 patients were assigned to the programme , and 101 to the control condition . The 11 , 2-h sessions emphasised physical training , information and coping skills . Patients in the programme improved significantly more than the controls with respect to appraisal of having received sufficient information , physical training , physical strength and fighting spirit . Results indicate improvement with respect to the three areas focused on in the ' Starting Again ' programme : physical training , information and coping skills training 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 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 OBJECTIVE To evaluate the effect of early exercise therapy on the natural killer cell cytotoxic activity ( NKCA ) of patients who had undergone curative resection of stomach cancer . DESIGN Prospect i ve study . PATIENTS Thirty-five stomach cancer patients who had undergone curative surgery were r and omly divided into an exercise group ( n = 17 ) and a control group ( n = 18 ) . INTERVENTION From postoperative day 2 , moderated exercise using arm and bicycle ergometers performed twice a day , 5 times a week , for 14 days . The intensity of exercise was 60 % of maximal heart rate . Venous blood sample s were obtained on postoperative days 1 , 7 , and 14 . MAIN OUTCOME MEASURE Mean sequential change of NKCA . RESULTS The mean sequential change of NKCA decreased until postoperative day 7 and then increased . Mean NKCA of day 7 decreased in both groups , compared with that at postoperative day 1 . At day 14 , the mean NKCA of the exercise group demonstrated a significant increase compared with that of the control group ( p < .05 ) . CONCLUSION This study suggests that early moderate exercise has a beneficial effect on the function of in vitro NK cells in stomach cancer patients after curative surgery 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 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 : Increased attention has focused on exercise as a quality of life intervention for breast cancer survivors during and after adjuvant therapy . Purpose : Our objective was to examine the effects of an oncologist ’s recommendation to exercise on self-reported exercise behavior in newly diagnosed breast cancer survivors attending their first adjuvant therapy consultation . Methods : Using a single-blind , 3-armed , r and omized controlled trial , 450 breast cancer survivors were r and omly assigned to receive an oncologist exercise recommendation only , an oncologist exercise recommendation plus referral to an exercise specialist , or usual care . The primary outcome was self-reported total exercise ( in metabolic equivalent [ MET ] hours per week ) at 5 weeks postconsultation . Results : The follow-up assessment rate was 73 % ( 329 of 450 ) . Intention-to-treat analysis based on participants with follow-up data indicated a significant difference in total exercise in favor of the recommendation -only group over the usual care group ( mean difference , 3.4 MET hr per week ; 95 % confidence interval [ CI ] , 0.7–6.1 MET hr per week ; p = .011 ) . There was no significant difference between the recommendation -plus-referral group and the usual care group ( mean difference , 1.5 MET hr per week ; 95 % CI , −1.0 to 4.0 MET hr per week ; p = .244 ) . Ancillary on-treatment analyses showed that participants who recalled an exercise recommendation reported significantly more total exercise than participants who did not recall an exercise recommendation ( mean difference , 4.1 MET hr per week ; 95 % CI , 1.9–6.4 MET hr per week ; p < .001 ) . Conclusions : Our findings suggest that an oncologist recommendation may increase exercise behavior in newly diagnosed breast cancer survivors , particularly if it is recalled 1 week after the recommendation In this study , we examined correlates of adherence and contamination in a r and omized controlled trial ( RCT ) of exercise in cancer survivors using the theory of planned behavior and the Five Factor Model of personality ( FFM ) . We r and omly assigned cancer survivors in group psychotherapy classes to either a waiting-list control group ( n = 45 ) or a home-based , moderate intensity exercise program ( n = 51 ) . At baseline , participants completed  measures  of the theory of planned behavior , the FFM , past exercise , physical fitness , medical variables , and demographics . We then monitored exercise over a 10-week period by weekly self-reports . Hierarchical multiple regression analyses indicated that the independent predictors of overall RCT exercise across both conditions were past exercise ( β = .36 , p > .001 ) , assignment to experimental condition ( β = .34 , p > .001 ) , sex ( β = .30 , p > .001 ) , and intention ( β = .14 , p > .10 ) . For exercise adherence in the exercise condition , the independent predictors were sex ( β = .38 , p > .01 ) , extraversion ( β = .30 , p > .05 ) , normative beliefs ( β = -.27 , p > .05 ) , and perceived behavioral control ( β = .23 , p > .10 ) . Finally , the independent predictors of exercise contamination in the control condition were past exercise ( β = .70 , p > .001 ) , sex ( β = .20 , p > .05 ) , and intention ( β = .17 , p > .10 ) . We conclude that the correlates of exercise adherence and contamination differ in kind as well as in degree . Explanations for these findings and practical implication s for conducting exercise RCTs in this population are offered BACKGROUND Physical activity provides a number of physical and psychological benefits to cancer survivors , including lessening the impact of detrimental cancer-related symptoms and treatment side-effects ( e.g. fatigue , nausea ) , and improving overall well-being and quality of life . The purpose of the present pilot study was to examine the physical and psychological benefits afforded by a 7-week yoga program for cancer survivors . METHOD Eligible participants ( per-screened with PAR-Q/PAR-MED-X ) were r and omly assigned to either the  intervention ( n=20 ) or control group ( n=18 ) . All participants completed pre- and post-testing assessment s immediately before and after the yoga program , respectively . RESULTS The yoga program participants ( M age=51.18 ( 10.33 ) ; 92 % female ) included primarily breast cancer survivors , on average 55.95 ( 54.39 ) months post-diagnosis . Significant differences between the intervention and the control group at post-intervention were seen only in psychosocial ( i.e. global quality of life , emotional function , and diarrhea ) variables ( all p 's < 0.05 ) . There were also trends for group differences , in the hypothesized directions , for the psychosocial variables of emotional irritability , gastrointestinal symptoms , cognitive disorganization , mood disturbance , tension , depression , and confusion ( all p 's < 0.10 ) . Finally , there were also significant improvements in both the program participants and the controls from pre- to post-intervention on a number of physical fitness variables . CONCLUSIONS These initial findings suggest that yoga has significant potential and should be further explored as a beneficial physical activity option for cancer survivors . Future research might attempt to include a broader range of participants ( e.g. other types of cancer diagnoses , male subjects ) , a larger sample size , and a longer program duration in an RCT Purpose Postoperative radiotherapy for breast cancer has a number of associated complications . This study examined whether supervised moderate-intensity exercise could mitigate the complications that occur during radiotherapy . Patients and Methods Forty women were r and omized before radiotherapy after various operations for breast cancer . Seventeen patients who were assigned to the exercise group performed supervised moderate-intensity exercise therapy for 50 min 3 times per week for 5 weeks . Twenty-three patients in the  control group were asked to perform self-shoulder stretching exercise . The World Health Organization Quality of Life-BREF ( WHOQOL-BREF ) , brief fatigue inventory ( BFI ) , range of motion ( ROM ) of the shoulder , and pain score were assessed before and after radiotherapy . Results There were no significant differences noted at baseline between groups . In the exercise group , there was an increase in the WHOQOL-BREF and shoulder ROM and decrease in BFI and pain score after radiotherapy . On the other h and , patients in the control group showed decrease in the WHOQOL-BREF and shoulder ROM and increase in BFI and pain score after radiotherapy . There were statistically significant differences in the changes in the WHOQOL , BFI , shoulder ROM , and pain score between the groups . Conclusion Patients receiving radiotherapy for breast cancer may benefit in physical and psychological aspects from supervised moderate-intensity exercise therapy AIM Our purpose was to investigate the effect of a relaxation breathing exercise on fatigue in allogenic haemopoietic stem cell transplantation patients . BACKGROUND Exercise is a promising approach in ameliorating the fatigue associated with cancer and its treatment . DESIGN A r and omized design with control , experimental groups being assessed pre- and postintervention . METHODS Thirty-five patients were r and omly selected , with 18 assigned to an exercise group and 17 to a control group .  The exercise intervention lasted for 30 minutes every day for six weeks . It consisted of physical exercise combined with relaxation breathing exercise .  Fatigue was measured by the revised version of the Piper Fatigue Scale . RESULTS The exercise group had a greater decrease in fatigue than the control group . CONCLUSION These findings indicate that a relaxation breathing exercise would improve fatigue in allogenic haemopoietic stem cell transplantation patients . RELEVANCE TO CLINICAL PRACTICE A relaxation breathing exercise by a nurse can improve fatigue in allogenic haemopoietic stem cell transplantation patients PURPOSE Men with prostate cancer are often advised to make changes in diet and lifestyle , although the impact of these changes has not been well documented . Therefore , we evaluated the effects of comprehensive lifestyle changes on prostate specific antigen ( PSA ) , treatment trends and serum stimulated LNCaP cell growth in men with early , biopsy proven prostate cancer after 1 year . MATERIAL S AND METHODS Patient recruitment was limited to men who had chosen not to undergo any conventional treatment , which provided an unusual opportunity to have a nonintervention r and omized control group to avoid the confounding effects of interventions such as radiation , surgery or and rogen deprivation therapy . A total of 93 volunteers with serum PSA 4 to 10 ng/ml and cancer Gleason scores less than 7 were r and omly assigned to an experimental group that was asked to make comprehensive lifestyle changes or to a usual care control group . RESULTS None of the experimental group patients but 6 control patients underwent conventional treatment due to an increase in PSA and /or progression of disease on magnetic resonance imaging . PSA decreased 4 % in the experimental group but increased 6 % in the control group ( p = 0.016 ) . The growth of LNCaP prostate cancer cells ( American Type Culture Collection , Manassas , Virginia ) was inhibited almost 8 times more by serum from the experimental than from the control group ( 70 % vs 9 % , p < 0.001 ) . Changes in serum PSA and also in LNCaP cell growth were significantly associated with the degree of change in diet and lifestyle . CONCLUSIONS Intensive lifestyle changes may affect the progression of early , low grade prostate cancer in men . Further studies and longer term followup are warranted Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental . Aerobic walking improves physical functioning and has been an intervention for chemotherapy‐related fatigue . A prospect i ve , r and omized , controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma 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 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 Fatigue is a frequent problem after surgical treatment of solid tumours . Aerobic exercise and psychosocial interventions have been shown to reduce the severity of this symptom in cancer patients . Therefore , we compared the effect of the two therapies on fatigue in a r and omised controlled study . Seventy-two patients who underwent surgery for lung ( n=27 ) or gastrointestinal tumours ( n=42 ) were assigned to an aerobic exercise group ( stationary biking 30 min five times weekly ) or a progressive relaxation training group ( 45 min three times per week ) . Both interventions were carried out for 3 weeks . At the beginning and the end of the study , we evaluated physical , cognitive and emotional status and somatic complaints with the European Organization for Research and Treatment of Cancer Quality of Life Question naire Core Module ( EORTC-QLQ-30 ) question naire , and maximal physical performance with an ergometric stress test . Physical performance of the training group improved significantly during the programme ( 9.4±20 watts , p=0.01 ) but remained unchanged in the relaxation group ( 1.5±14.8 watts , p=0.37 ) . Fatigue and global health scores improved in both groups during the intervention ( fatigue : training group 21 % , relaxation group 19 % ; global health of both groups 19 % , p for all ≤0.01 ) ; however , there was no significant difference between changes in the scores of both groups ( p=0.67 ) . We conclude that a structured aerobic training programme improves the physical performance of patients recovering from surgery for solid tumours . However , exercise is not better than progressive relaxation training for the treatment of fatigue in this setting Background : High insulin and insulin-like growth factor-I ( IGF-I ) levels may be associated with an increased breast cancer risk and /or death . Given the need to identify modifiable factors that decrease insulin , IGF-I , and breast cancer risk and death , we investigated the effects of a 6-month r and omized controlled aerobic exercise intervention versus usual care on fasting insulin , IGF-I , and its binding protein ( IGFBP-3 ) in postmenopausal breast cancer survivors . Methods : Seventy-five postmenopausal breast cancer survivors were identified from the Yale-New Haven Hospital Tumor Registry and r and omly assigned to an exercise ( n = 37 ) or usual care  ( n = 38 ) group . The exercise group participated in 150 minutes per week of moderate-intensity aerobic exercise . The usual care group was instructed to maintain their current physical activity level . A fasting blood sample was collected on each study participant at baseline and 6 months . Blood levels of insulin and IGF were measured with ELISA . Results : On average , exercisers increased  aerobic exercise  by 129 minutes per week compared with 45 minutes per week among usual care participants ( P < 0.001 ) . Women r and omized to exercise experienced decreases in insulin , IGF-I , and IGFBP-3 , whereas women r and omized to usual care had increases in these hormones . Between-group differences in insulin , IGF-I , and IGFBP-3 were 20.7 % ( P = 0.089 ) , 8.9 % ( P = 0.026 ) , and 7.9 % ( P = 0.006 ) , respectively . Conclusions : Moderate-intensity aerobic exercise , such as brisk walking , decreases IGF-I and IGFBP-3 . The exercise-induced decreases in IGF may mediate the observed association between higher levels of physical activity and improved survival in women diagnosed with breast cancer . ( Cancer Epidemiol Biomarkers Prev 2009;18(1):306–13 PURPOSE / OBJECTIVES To test the effects of aerobic and resistance exercise on changes in bone mineral density ( BMD ) in women newly diagnosed with stage I-III breast cancer receiving chemotherapy . DESIGN R and omized clinical trial . SETTING Two National Cancer Institute- design ated cancer centers in metropolitan areas . SAMPLE 66 women with stage I-III breast cancer beginning adjuvant chemotherapy .  METHODS Participants were r and omized to aerobic or resistance exercise and usual care . At the beginning of chemotherapy and at six months , patients completed exercise testing and BMD assessment of the lumbar spine by dual energy x-ray absorptionetry . MAIN RESEARCH VARIABLES BMD , aerobic capacity , and muscle strength . FINDINGS The average decline in BMD was -6.23 % for usual care , -4.92 % for resistance exercise , and -0.76 % for aerobic exercise . Aerobic exercise preserved BMD significantly better compared to usual care . Premenopausal women demonstrated significantly greater declines in BMD than postmenopausal women .  Aerobic capacity increased by almost 25 % for women in the aerobic exercise group and 4 % for resistance exercise . Participants in the usual care group showed a 10 % decline in aerobic capacity . CONCLUSIONS The data suggest that weight-bearing aerobic exercise attenuates declines in BMD and that aerobic and resistance exercise improve aerobic capacity and muscle strength at a time when women generally show marked declines in functional ability . IMPLICATION S FOR NURSING Exercise may prevent or at least minimize bone loss observed during chemotherapy and may prevent or delay the long-term effects of osteoporosis Summary : Allogeneic bone marrow transplantation ( BMT ) has been successfully used for the treatment of several hematological malignancies ; however , it is associated with transplant-related toxicities such as functional impairment and muscle weakness . In order to analyze how an exercise program may influence muscle strength in patients undergoing BMT  , we carried out a prospect i ve study assessing patients from the pre-BMT phase to 16 weeks post-BMT .  In all , 18 patients underwent three trials : ( 1 ) pre-BMT , ( 2 ) after marrow engraftment , and ( 3 ) 6 weeks after trial 2 . After trial 2 , the patients were r and omized in a control group ( CG ) or treatment group ( TG ) , which received a 6-week exercise program with active exercise , muscle stretching and treadmill walking . The results obtained in trial 1 showed similar values for CG and TG , as both groups had muscle strength lower than normal patterns based on data concerning age , sex and weight . In trial 2 , CG and TG showed similarly decreased values . In trial 3 , TG showed values higher than CG for all muscle groups tested . These results suggest that the exercise program was efficient in promoting an increase of muscle strength after allogeneic BMT Loss of physical performance is a universal problem of cancer patients undergoing chemotherapy .  We postulated that this impairment can be partially prevented by aerobic exercise . In a r and omized study , 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation ( training group , T ) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization . Patients in the  control group ( C , n = 37 )  did not train . Maximal physical performance was assessed with a treadmill test by admission and discharge . Physical performance of the two groups was not different on admission . The decrement in performance during hospitalization was 27 % greater in the control group than in the training group ( P = .05 ) ; this result ed in a significantly higher maximal physical performance at discharge in the trained patients ( P = .04 ) . Duration of neutropenia ( P = .01 ) and thrombopenia ( P = .06 ) , severity of diarrhea ( P = .04 ) , severity of pain ( P = .01 ) , and duration of hospitalization ( P = . 03 ) were reduced in the training group . We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance . Based on the potential significance of the observed outcomes , further studies are warranted to confirm our results PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment 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 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 PURPOSE / OBJECTIVES To examine the effects of a comprehensive rehabilitation program on facilitating physical and psychosocial adaptation of women with breast cancer who are receiving adjuvant chemotherapy . DESIGN Experimental . SETTING Breast evaluation clinics of two New Engl and medical centers with comprehensive cancer treatment programs . SAMPLE 14 women ( mean age = 44 years ) receiving adjuvant chemotherapy for breast cancer ( 86 % stage II ) following surgical treatment . METHODS Subjects were assigned r and omly to the experimental group or the usual care group . Experimental group members began a structured exercise program of walking and attended support group meetings . All subjects were tested before beginning chemotherapy , during the course of chemotherapy , and one month following chemotherapy completion . MAIN RESEARCH VARIABLES Performance status , physical functioning , psychosocial adjustment , self-concept and body image , and 12 symptoms ( e.g. , fatigue , nausea , anxiety ) . FINDINGS Measures of physical performance , psychosocial adjustment , and symptom intensity revealed improved adaptation in subjects who completed the walking/support group program . CONCLUSIONS Physical and psychosocial benefits from a modest walking exercise program and a support group are possible for patients receiving adjuvant chemotherapy . IMPLICATION S FOR NURSING PRACTICE Although more detailed research is necessary to answer some of the questions raised by this study , implementing the walking program and forming a support group are achievable in an outpatient setting PURPOSE Cancer survivors are at increased risk for cardiovascular disease , diabetes , osteoporosis , and second primary tumors . Healthful lifestyle practice s may improve the health and well-being of survivors . The FRESH START trial tested the efficacy of sequentially tailored versus st and ardized mailed material s on improving cancer survivors ' diet and exercise behaviors . METHODS Five hundred forty-three individuals with newly diagnosed locoregional breast or prostate cancer were recruited from 39 states and two provinces within North America . Participants were r and omly assigned either to a 10-month program of tailored mailed print material s promoting fruit and vegetable ( F&V ) consumption , reducing total/saturated fat intake , and /or increasing exercise or to a 10-month program of nontailored mailed material s on diet and exercise available in the public domain . Telephone surveys conducted at baseline and 1 year assessed body mass index ( BMI ) , dietary consumption , physical activity , and other psychosocial/behavioral indices . Clinical assessment s were conducted on a 23 % sub sample ; information was used to vali date self-reports . RESULTS Five hundred nineteen participants completed the 1-year follow-up ( 4.4 % attrition ; sample characteristics : 57 + /- 10.8 years old , 83 % white , 56 % female , 64 % overweight/obese , and 0 % underweight ) . Although both arms significantly improved their lifestyle behaviors ( P < .05 ) , significantly greater gains occurred in the FRESH START intervention versus the control arm ( practice of two or more goal behaviors : + 34 % v + 18 % , P < .0001 ; exercise minutes per week : + 59.3 v + 39.2 minutes , P = .02 ; F&V per day : + 1.1 v + 0.6 servings , P = .01 ; total fat : -4.4 % v -2.1 % , P < .0001 ; saturated fat : -1.3 % v -0.3 % , P < .0001 ; and BMI : -0.3 v + 0.1 kg/m2 , respectively , P = .004 ) . CONCLUSION Mailed material interventions , especially those that are tailored , are effective in promoting healthful lifestyle changes among cancer survivors . Further study is needed to determine sustainability , cost to benefit , and generalizability to other cancer population PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events PURPOSE Despite the recognition of fatigue as a common and distressing symptom during cancer treatment , there are few evidence -based interventions available to manage such fatigue . The purpose of this multi-institutional pilot study was to explore the effects of a home-based moderate walking exercise intervention on fatigue , physical functioning , emotional distress , and quality of life ( QOL ) during breast cancer treatment . DESCRIPTION OF STUDY Fifty-two women were recruited from five university hospital outpatient departments for this pilot study with an experimental design . Subjects were r and omly assigned to the walking program or to usual care during adjuvant chemotherapy or radiation therapy for breast cancer . Symptoms , physical functioning , and QOL were measured at baseline , midtreatment , and at the end of treatment . RESULTS Women who exercised at least 90 minutes per week on 3 or more days reported significantly less fatigue and emotional distress as well as higher functional ability and QOL than women who were less active during treatment . CLINICAL IMPLICATION S A home-based walking exercise program is a potentially effective , low-cost , and safe intervention to manage fatigue and to improve QOL during adjuvant chemotherapy or radiation therapy for breast cancer . This health-promoting self-care activity needs further testing in large r and omized clinical trials 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 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 / 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 Study objectives . Cancer-related fatigue ( CRF ) is frequently reported by cancer patients receiving cytotoxic drugs .  The specific mechanism of CRF in cancer patients is not completely known . In recent years , convincing evidence supports the management of fatigue with physical exercise . This study investigated a recommendation that physical activity , eg , a 30-minute daily walk , would decrease fatigue in cancer patients receiving cytotoxic drugs at an outpatient ward . Method . In total , 89 patients were interviewed about their fatigue and were asked to complete a question naire , the  Fatigue Symptom Inventory ( FSI )  , once a week over several treatment cycles of cytotoxic drugs . On inclusion , all patients received similar information about fatigue . After r and omization , information about the positive effects of exercise was given to half of the patients after one cycle of cytotoxic drugs , and to the remaining patients after two cycles of cytotoxic drugs . Results . A total of 74 patients completed the study and returned useable question naires . The fatigue prevalence was 89 % after one cytotoxic drug cycle . According to the FSI ratings , the group who received information about physical exercise after one cycle scored significantly lower ratings than the other group throughout the study ( P=0.034 ) . The patient interviews confirmed that physical activity helped them to better battle fatigue . Intensity of other symptoms and side effects from cytotoxic drugs closely paralleled the fatigue ratings . Conclusion . Fatigue was commonly found in the study population . Though small improvements followed physical exercise , results pointed towards the fact that information and exercise may support patients to combat fatigue . Early and frequent information would probably support patients to better combat fatigue by physical exercise This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy . The study was design ed as a r and omised controlled trial ( RCT ) . Physical functioning , fatigue and Quality of Life ( QoL ) outcomes were evaluated pre and post a 12-week intervention . The results showed that after 12 weeks the women who participated in the exercise programme ( n = 12 ) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls ( n = 10 ) . Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance . These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe , well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer . Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women . Future studies need to address these issues and determine if these short-term benefits can be sustained Fatigue and insomnia are problems for patients with cancer . Research findings show that aerobic exercise decreases cancer-related fatigue . Because patients with cancer who have skeletal muscle wasting may not obtain maximum benefit from aerobic exercise training , exercise programs may need to include resistance training . Thus far , testing exercise as an intervention for fatigue has focused on patients with breast cancer and excluded patients with bone metastasis . There is a need to test the feasibility and effectiveness of exercise for patients with other types of cancer and with bone involvement . The effect of aerobic and strength resistance training on the sleep of patients with cancer has not been tested . A pilot/feasibility study with a r and omized controlled design was conducted to investigate homebased exercise therapy for 24 patients receiving high-dose chemotherapy and autologous peripheral blood stem cell transplantation as treatment for multiple myeloma . None of the patients injured themselves . Because of the small sample size in the feasibility study , the effect of exercise on lean body weight was the only end point that obtained statistical significance . However , the results suggest that an individualized exercise program for patients receiving aggressive treatment for multiple myeloma is feasible and may be effective for decreasing fatigue and mood disturbance , and for improving sleep 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 BACKGROUND Active for Life After Cancer is a r and omized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program ( Lifestyle ) for prostate cancer patients to improve quality of life ( QOL ) including physical and emotional functioning compared to a group-based Educational Support Program and a St and ard Care Program ( no group ) . METHOD A total of 134 prostate cancer patients receiving continuous and rogen-ablation were r and omly assigned to one of the three study conditions . RESULTS Results indicated no significant improvements in QOL at 6 or 12 months . Both group-based programs were positively received and yielded good attendance and retention . Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity . Despite these improvements , no significant changes were found for most physical activity measures . CONCLUSIONS Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these 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 This study examined the effect of a supervised , aerobic exercise program on change in body weight and composition ( multi-site subcutaneous skinfold measures , percent body fat , and lean body weight ) of women undergoing adjuvant chemotherapy for breast cancer . Stage II patients with breast cancer ( N = 24 ) were r and omized to an exercise treatment group ( EG , n = 12 ) and a control group ( CG , n = 12 ) . The EG participated in the individualized Winningham Aerobic Interval Training ( WAIT ) exercise program with exertional levels set at 60%-85 % of maximal heart rate for 20 - 30 minutes , 3 times per week , for 10 - 12 weeks . The CG received no exercise treatment , but were asked to continue with their daily activities . Subjects were asked to maintain their customary eating patterns throughout their participation . Data were analyzed using covariate analysis , adjusting for age and pre-test values . Comparisons of pre- and post-test results indicated that exercise had a moderating effect on gain in body fat and altered the subcutaneous body fat profile in both obese ( OB ) and nonobese ( NOB ) subjects . Exercising OB subjects showed a greater increase in lean body weight than NOB subjects , indicating an increase in muscle tissue . Results from this study may be useful in design ing safe and effective weight-control programs for patients with breast cancer on chemotherapy 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 During radiation therapy , cancer patients may report  cancer-related fatigue ( CRF ) , which impairs aerobic capacity , strength , muscle mass , and , ultimately , quality of life ( QOL ) . The purpose of this pilot clinical trial was to examine the feasibility and initial efficacy of a home-based aerobic and progressive resistance exercise intervention for aerobic capacity , strength , muscle mass , CRF , and QOL . Daily steps walked ( DSW ) , daily minutes of resistance exercise ( MRE ) , and number of resistance exercise days ( RED ) were assessed to evaluate intervention adherence . Breast and prostate cancer patients ( n = 38 ) beginning radiation therapy  were r and omized to undergo 4 weeks of exercise or no exercise . Participants in the exercise group demonstrated good adherence to the exercise intervention , with significantly more DSW , MRE , and RED at post intervention and 3 month follow-up than controls . Participants in the exercise intervention exhibited significantly higher QOL and significantly lower CRF post intervention and at 3-month follow-up than controls . Results of this pilot study provide positive preliminary evidence that exercise during radiation may be beneficial for cancer patients OBJECTIVE The majority of endometrial cancer survivors ( ECS ) are obese and at risk for premature death . The purpose of this study was to assess feasibility of a lifestyle intervention program for promoting weight loss , change in eating behaviors , and increased physical activity in obese ECS . STUDY DESIGN Early stage ECS ( n=45 ) were r and omized to a  6-month lifestyle intervention  ( LI ; n=23 ) or usual care ( UC ; n=22 ) . The LI group received group and individual counseling for 6 months . The primary endpoint was weight change . Secondary endpoints were physical activity , [ Leisure score index ( LSI ) ] and nutrient intake ( 3-day food records ) . Quantitative vitamin C and folate intake were used to assess fruit/vegetable intake . RESULTS Recruitment was 29 % , adherence ( LI group ) was 73 % and 84 % of participants completed follow-up assessment s. At 12 months , the intervention group lost 3.5 kg compared to a 1.4 kg gain in the control group [ mean difference=-4.9 kg ; 95 % CI : -9.0 to -0.9 kg ; p=.018 ] and had an increased LSI score of 16.4 versus -1.3 in the control group from baseline [ mean group difference=17.8 ; 95 % CI=7.1 to 28.4 ; p=.002 ] . There were no differences in vitamin C and folate intake . The LI group had lower intake of kilocalories , although differences were not significant . CONCLUSION ( S ) A lifestyle intervention program in obese ECS is feasible and can result in sustained behavior change and weight loss over a 1-year period CONTEXT AND OBJECTIVE Changes in metabolism have been reported in the majority of patients undergoing cancer treatment , and these are usually characterized by progressive change in body composition . The effects of aerobic exercise programs to combat the cancer and cancer treatment-related side effects , which include the negative changes in body composition , have been extensively reported in the literature . However , few resistance exercise intervention studies have hypothesized that breast cancer patients might benefit from this type of exercise . The purpose of this study was to determine whether exercise protocol s that emphasize resistance training would change body composition and strength in breast cancer patients undergoing treatment . DESIGN AND SETTING R and omized controlled trial , at the Campus Recreation Center and Rocky Mountain Cancer Rehabilitation Institute of the University of Northern Colorado , and the North Colorado Medical Center . METHODS Twenty inactive breast cancer patients were r and omly assigned to a 21-week exercise group ( n = 10 ) or a control group ( n = 10 ) . The exercise group trained at low to moderate intensity for 60 minutes on two days/week . The primary outcome measurements included body composition ( skinfold method ) and muscle strength ( one repetition maximum ) . RESULTS Significant differences in lean body mass , body fat and strength ( p = 0.004 , p = 0.004 , p = 0.025 , respectively ) were observed between the groups at the end of the study . CONCLUSION The results suggest that exercise emphasizing resistance training promotes positive changes in body composition and strength in breast cancer patients undergoing treatment PURPOSE / OBJECTIVES 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 We conducted a r and omized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life ( QOL ) in recently resected colorectal cancer survivors , most of whom were receiving adjuvant therapy . Participants were r and omly assigned in a 2:1 ratio to either an  exercise ( n = 69 ) or control ( n = 33 ) group . The exercise group was asked to perform moderate intensity exercise 3 - 5 times per week for 20 - 30 min each time . The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal ( FACT-C ) scale . Adherence in the exercise group was good ( 75.8 % ) but contamination in the control group was problematic ( 51.6 % ) . Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C ( mean difference , -1.3 ; 95 % CI , -7.8 to 5.1 ; P = 0.679 ) . In an ' on-treatment ' ancillary analysis , we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention . This analysis revealed significant differences in favour of the increased fitness group for the FACT-C ( mean difference , 6.5 ; 95 % CI , 0.4 - 12.6 ; P = 0.038 ) . These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed Fatigue and loss of physical performance are frequent problems of cancer patients . In a pilot study , the authors evaluated the feasibility and effects of  aerobic training  in the rehabilitation of cancer patients after completing high dose chemotherapy Cardiopulmonary responses to an 8-week moderate-intensity aerobic exercise intervention and adherence to exercise during and after intervention were assessed in 41 women newly diagnosed with breast cancer undergoing adjuvant therapy .  The intervention was primarily aim ed at minimizing deconditioning . Women were r and omly assigned to the intervention or control group , completed grade d exercise tests before and after intervention , and encouraged to continue their exercise postintervention . Over time , only the intervention group showed significant decreases in resting heart rate , resting systolic blood pressure ( SBP ) , P < .05 each , and maximum SBP , P < .02 , and an increase in VO2 peak , P < .001 , although resting SBP was higher in the intervention group at both timepoints , P < .05 . The adherence rate to 8-week exercise intervention was 78.3 % with average weekly attendance of 2.4 sessions and 42.7 minutes ( 27.8 minutes within target heart rate ) exercise per session . Overall physical activity levels over 16 weeks postintervention did not differ between 2 groups . However , the within-group analysis indicated that only the intervention group showed a significant increase in voluntary activity , P < .02 , and energy expenditure , P < .02 , and a decrease in sedentary activity , P < .02 . These findings indicate that moderate-intensity aerobic exercise is beneficial in reducing deconditioning of cardiopulmonary responses in newly diagnosed breast cancer women undergoing adjuvant therapy 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 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 Background : Psychosocial interventions can improve psychological quality of life ( symptoms of depression and anxiety ) of both women with breast cancer and their partners , but are not offered routinely to women and their partners . Objective : To test the hypotheses that telephone-delivered psychosocial interventions decrease depression and anxiety in women with breast cancer and their partners . Methods : The design of the study was a three-wave repeated measures with a between-subjects factor ( treatment group ) . Ninety-six women and their 96 partners were assigned r and omly to participate in one of three different 6-week programs : ( a ) telephone interpersonal counseling ( TIP-C ) ; ( b ) self-managed exercise ; or ( c ) attention control ( AC ) . Results : The mixed-model analysis of variance for symptoms of depression among women with breast cancer revealed  women 's depressive symptom scores decreased over time in all groups . For anxiety , women 's symptoms of anxiety decreased in the TIP-C and exercise groups over time , but not in the AC group . A parallel set of analyses was conducted on  partners ' depression and anxiety data . Symptoms of depression and anxiety among the partners decreased substantially over the course of the investigation . Similar to the women , partners '  symptoms of anxiety decreased significantly in the TIP-C and exercise groups , but not in the AC group . Discussion : Findings from this study support that these telephone-delivered psychosocial interventions were effective for decreasing symptoms of depression and anxiety to improve psychological quality of life when compared to an AC group PURPOSE Participating in regular physical activity is encouraged after treatment for breast cancer , with exception of those who have subsequently developed lymphedema . The purpose of this project was to investigate , in a r and omized controlled trial , the effect of participating in a supervised , mixed-type exercise program on lymphedema status among women with lymphedema after breast cancer . METHODS Women younger than 76 yr , who completed breast cancer treatment at least 6 months prior and had subsequently developed unilateral , upper-limb lymphedema , were r and omly allocated to an intervention ( n = 16 ) or control ( n = 16 ) group . The intervention group ( IG ) participated in 20 supervised , group , aerobic and resistance exercise sessions over 12 wk , whereas the control group ( CG ) was instructed to continue habitual activities .  Lymphedema status was assessed by bioimpedance spectroscopy ( impedance ratio between limbs ) and perometry ( volume difference between limbs ) , and independent t-tests ( two-tailed P < 0.05 ) were used to determine statistical significance of observed changes . RESULTS Mean ratio and volume measures at baseline were similar for the IG ( 1.13 + /- 0.15 and 337 + /- 307 mL , respectively ) and the CG ( 1.13 + /- 0.19 and 377 + /- 416 mL , respectively ) , and no changes were observed over time for either group . Although no group change was observed between preintervention and 3-month follow-up for the IG ( ratio and volume change = 0.02 + /- 0.07 and 2 + /- 71 mL , respectively ) , two women in this group no longer had evidence of lymphedema by study end . Average attendance was more than 70 % of supervised sessions , there were no withdrawals , and several qualitative comments from participants support the program acceptability . CONCLUSIONS The results from this pilot study indicate that , at minimum , exercise does not exacerbate secondary lymphedema .  Women with secondary lymphedema should be encouraged to be physically active , optimizing their physical and psychosocial recovery Using Rogers ’ science of unitary human beings , changes in hope and power among 104 lung cancer patients were examined in relation to participation in a preoperative exercise program . Participants were r and omly assigned to exercise or no-exercise and a repeated measures ANOVA was employed . The exercise group ’s power increased while the no-exercise group ’s power decreased . No differences in hope emerged . Positive correlations between hope and power were observed . Findings suggest that exercise is a form of knowing participation in change and illustrate a relation between one ’s ability to envision a better future and one ’s potential to actualize options through choice 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 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 The purpose of this pilot study was to examine the effects of a combined cardiorespiratory and resistance exercise training program of short duration on the cardiorespiratory fitness , strength endurance , task specific functional muscle capacity , body composition and quality of life ( QOL ) in women breast cancer survivors . Sixteen subjects were r and omly assigned to either a training ( n = 8 ; age : 50 + /- 5 yrs ) or control non-exercising group ( n = 8 ; age : 51 + /- 10 yrs ) . The training group followed an 8-week exercise program consisting of 3 weekly sessions of 90-min duration , supervised by an experienced investigator and divided into resistance exercises and aerobic training . Before and after the intervention period , all of the subjects performed a cardiorespiratory test to measure  peak oxygen uptake ( VO2peak ) , a dynamic strength endurance test ( maximum number of repetitions for chest and leg press exercise at 30 - 35 % and 100 - 110 % of body mass , respectively ) and a sit-st and test . Quality of life was assessed using the European Organization for Research and Treatment of Cancer QLQ-C30 ( EORTC-C30 ) question naire . In response to training , QOL , VO2peak ( mean 3.9 ml/kg/min ; 95 % CI , 0.93 , 6.90 ) performance in leg press ( 17.9 kg ; 95 % CI , 12.8 , 22.4 ) and sit-st and test ( - 0.67 s ; 95 % CI , - 0.52 , - 1.2 ) improved ( p < or = 0.05 ) . We observed no significant changes in the control group . Combined cardiorespiratory and resistance training , even of very brief duration , improves the QOL and the overall physical fitness of women breast cancer survivors BACKGROUND Shoulder dysfunction remains a frequent complication after neck dissection procedures for head and neck cancer . METHODS We conducted a pilot study to evaluate the effects of progressive resistance exercise training ( PRET ) on shoulder dysfunction caused by spinal accessory neurapraxia/neurectomy in patients with head and neck cancer . Twenty patients ( mean age , 61 + /- 7.7 years ) were r and omly assigned to PRET or st and ard care intervention . Subjects assigned to the PRET group exercised three times per week for 12 weeks . The goal of the exercise program was to enhance scapular stability and strength of the upper extremity . The resistance-training program was progressive in terms of number of sets and repetitions performed , as well as the amount of weight lifted , depending on performance status . RESULTS The completion rate for the trial was 85 % ( 17 of 20 ) . The exercise group completed 93 % of scheduled exercise sessions . Significant improvements were found in favor of the PRET group in active shoulder external rotation ( p = .001 ) , shoulder pain ( p = .038 ) , and overall score for shoulder pain and disability ( p = .045 ) . CONCLUSIONS The study results demonstrate a high rate of completion and adherence with our PRET program among patients with head and neck cancer . The preliminary findings , although limited , also suggest a potential therapeutic role for resistance exercise as an adjunct to st and ard physical therapy treatment 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 Patients who undergo thyroid surgery frequently suffer from unpleasant symptoms such as a stretching , choking , or pressing feeling or discomfort in the neck for a long time . The usefulness of rehabilitation ( i.e. , a stretching exercise ) for reducing these symptoms after surgery has never been studied . In the present study , attempts were made to evaluate the usefulness of the stretching exercise in reducing disagreeable postoperative symptoms in the patients who had undergone thyroid surgery . A total of 409 patients , including 234 thyroid cancer patients , were r and omly divided into a stretching group ( n = 204 ) and a control group ( n = 205 ) . Patients in the stretching group were instructed that the stretching exercise was to be performed three times a day beginning the morning following surgery . A question naire survey was performed before surgery and then 1 week , 1 month , 6 months , and 1 year after surgery . Total symptom scores obtained from the question naire survey from the control group and the stretching group were compared . The use of analgesics was also investigated . Postoperative neck symptoms declined gradually over the course of a year , and the total symptom scores were significantly ( p < 0.001 ) lower in the stretching group than in the control group at all points throughout the year ( 1 week , 1 month , 6 months , and 1 year ) . The mean requirement for the use of analgesics during hospitalization was significantly ( p < 0.0001 ) less in the stretching group ( 1.6 ± 2.3 tablets , mean ± SD ) than in the control group ( 3.1 ± 3.8 tablets ) . The stretching exercise had effectively reduced postoperative neck symptoms and also reduced the use of analgesics after thyroid surgery Studies applying exercise , relaxation training , and psychoeducation have each indicated a positive impact on physical performance and /or psychological factors in patients diagnosed with cancer . We explored the longitudinal effect of a combination of these interventions on treatment-related symptoms in patients undergoing myeloablative allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) . Forty-two patients ( 18 - 65 years ) were r and omized either to an intervention or a control group . The intervention group received st and ard treatment and care , and a supervised four- to six-week structured exercise program , progressive relaxation , and psychoeducation during hospitalization , one hour per day for five days per week . The control group received st and ard treatment , care , and physiotherapy . A 24-item symptom assessment question naire was completed weekly during hospitalization , and at three and six months after allo-HCST . Through principal component analysis with varimax rotation , individual symptoms were grouped into five symptom clusters : mucositis , cognitive , gastrointestinal , affective , and functional symptom clusters . Then , a subsequent general estimate equation analysis revealed similar longitudinal patterns of intensity in all symptom clusters for intervention and control groups , but in the intervention group , there was an overall significant reduction ( P<0.05 ) in symptom intensity over time for all clusters except the affective symptom cluster . This study provides beginning evidence for the efficacy of an exercise-based multimodal intervention in reducing the intensity of a spectrum of symptoms in this small sample of patients undergoing allo-HSCT PURPOSE The purpose of this investigation was to evaluate the impact of undertaking peripheral blood stem cell transplantation ( PBST ) on T-cell number and function , and to determine the role of a mixed type , moderate intensity exercise program in facilitating the recovery of T-cell number and function . METHODS Immunological measures of white blood cell , lymphocyte , CD3 , CD4 , and CD8 counts , and CD3 cell function were assessed pretransplant ( PI ) , immediately posttransplant ( PII ) , and 1 month ( I1 ) , 2 months ( I2 ) and 3 months ( PIII ) posttransplant . After PII , 12 patients were divided equally into a control group ( CG ) or exercise intervention group ( EG ) . RESULTS Lower total T-cell , helper T-cell , and suppressor T-cell counts ( P < 0.01 ) , as well as lower T-cell function ( P < 0.01 ) , when compared with normative data , were found at PI . More specifically , 88 % of the group had CD3 , CD4 , and CD8 counts that were more than 40 % , 20 % , and 50 % below normal at PI , respectively . Undertaking a PBST caused further adverse changes to the total leukocyte , lymphocyte , CD3 , CD4 and CD8 count , and the helper/suppressor ratio . Although CD8 counts had returned to normal by PIII , CD3 , CD4 , and the CD4 /CD8 ratio remained significantly lower than normative data ( P < 0.01 ) , with 66 % , 100 % , and 100 % of the subject group reporting counts and ratios , respectively , below the normal range . CONCLUSION The PBST patients were immunocompromised before undertaking the transplant , and the transplant procedure imposed further adverse changes to the leukocyte and lymphocyte counts . The leukocyte and CD8 counts returned to normal within 3 months posttransplant ; however , the other immunological parameters assessed demonstrated a delayed recovery . Although participation in the exercise program did not facilitate a faster immune cell recovery , neither did the exercise program hinder or delay recovery CONTEXT Five-year survival rates for early stage colorectal , breast , and prostate cancer currently exceed 90 % and are increasing . Cancer survivors are at greater risk for second malignancies , other comorbidities , and accelerated functional decline . Lifestyle interventions may provide benefit , but it is unknown whether long-term cancer survivors can modify their lifestyle behaviors sufficiently to improve functional status . OBJECTIVE To determine whether a telephone counseling and mailed print material -based diet and exercise intervention is effective in reorienting functional decline in older , overweight cancer survivors . DESIGN , SETTING , AND PARTICIPANTS R and omized controlled trial of 641 overweight ( body mass index > or = 25 and < 40 ) , long-term ( > or = 5 years ) survivors ( aged 65 - 91 years ) of colorectal , breast , and prostate cancer , who were r and omly assigned to an intervention group ( n = 319 ) or delayed intervention ( control ) group ( n = 322 ) in Canada , the United Kingdom , and 21 US states . Individuals were recruited for the Reach out to Enhance Wellness ( RENEW ) trial from July 1 , 2005 , through May 17 , 2007 . INTERVENTION A 12-month , home-based tailored program of telephone counseling and mailed material s promoting exercise , improved diet quality , and modest weight loss . The control group was wait-listed for 12 months . MAIN OUTCOME MEASURES Change in self-reported physical function on the Short-Form 36 physical function subscale ( score range , 0 - 100 ; a high score indicates better functioning ) from baseline to 12 months was the primary end point . Secondary outcomes included changes in function on the basic and advanced lower extremity function subscales of the Late Life Function and Disability Index ( score range , 0 - 100 ) , physical activity , body mass index , and overall health-related quality of life . RESULTS The mean baseline Short-Form 36 physical function score was 75.7 . At the 12-month follow-up , the mean function scores declined less rapidly in the intervention group ( -2.15 ; 95 % confidence interval [ CI ] , -0.36 to -3.93 ) compared with the control group ( -4.84 ; 95 % CI , -3.04 to -6.63 ) ( P = .03 ) . The mean baseline basic lower extremity function score was 78.2 . The mean changes in basic lower extremity function were 0.34 ( 95 % CI , -0.84 to 1.52 ) in the intervention group compared with -1.89 ( 95 % CI , -0.70 to -3.09 ) in the control group ( P = .005 ) . Physical activity , dietary behaviors , and overall quality of life increased significantly in the intervention group compared with the control group , and weight loss also was greater ( 2.06 kg [ 95 % CI , 1.69 to 2.43 kg ] vs 0.92 kg [ 95 % CI , 0.51 to 1.33 kg ] , respectively ; P < .001 ) . CONCLUSION Among older , long-term survivors of colorectal , breast , and prostate cancer , a diet and exercise intervention reduced the rate of self-reported functional decline compared with no intervention . TRIAL REGISTRATION clinical trials.gov Identifier : NCT00303875 Background : Physical activity can confer many benefits on cancer survivors , including relief of persistent symptoms related to cancer treatment . Objectives : To evaluate the effect of a motivational interviewing ( MI ) intervention on increasing physical activity ( Community Healthy Activities Model Program for Seniors question naire ) and improving aerobic fitness ( 6-minute walk ) , health ( Medical Outcomes Study Short-Form 36 ) , and fatigue ( Schwartz Cancer Fatigue Scale ) in cancer survivors . A secondary purpose was to evaluate whether the effect of MI on physical activities depended on self-efficacy . Methods : Fifty-six physically inactive adult cancer survivors ( mean = 42 months since completion of treatment ) were assigned r and omly to intervention and control groups . The MI intervention consisted of one in-person counseling session followed by two MI telephone calls over 6 months . Control group participants received two telephone calls without MI content . Outcomes were measured at baseline , 3 months , and 6 months , and were analyzed using multilevel modeling . Results : The results of the MI intervention explained significant group differences in regular physical activities ( measured in caloric expenditure per week ) , controlling for time since completion of cancer treatment ( p < .05 ) . Aerobic fitness , physical and mental health , and fatigue were not different between groups . In the intervention group , individuals with high self-efficacy for exercise at baseline increased their physical activity more than those with low self-efficacy ( p < .05 ) . In the control group , increases in physical activity did not depend on self-efficacy . Discussion : Use of MI may increase physical activity in long-term cancer survivors , especially in persons with high self-efficacy for exercise . Multilevel modeling analysis revealed individual changes that would not have been shown by analysis of group means . Future studies with larger sample s or more intense MI interventions may show changes in aerobic fitness , physical and mental health , and fatigue PURPOSE Patients with breast cancer on adjuvant chemotherapy can experience weight gain and concurrent losses in muscle mass .  Exercise interventions can prevent these changes , but time and travel pose barriers to participation . The Survivor Training for Enhancing Total Health ( STRENGTH ) trial assessed the feasibility and impact of 2 home-based interventions . PATIENTS AND METHODS Ninety premenopausal patients with breast cancer on adjuvant chemotherapy were r and omized to a calcium-rich diet ( CA ) intervention ( attention control ) or to 2 experimental arms : a CA + exercise ( EX ) arm or a CA + EX and high fruit and vegetable , low-fat diet ( FVLF ) arm . Exercise arms included aerobic and strength-training exercises .  Body composition , weight status , waist circumference , dietary intake , physical activity , quality of life , anxiety , depression , serum lipids , sex hormone binding globulin , insulin , proinsulin , C-reactive protein , interleukin-1B , and tumor-necrosis factor receptor-II were measured at baseline and at 6-month follow-up . RESULTS Accrual targets were achieved and modest attrition was observed ( 8.8 % ) . Self-reports suggest increased calcium intakes in all arms , and higher fruit and vegetable and lower fat intake in the CA + EX + FVLF arm ; no differences in physical activity were observed . While measures of adiposity were generally lower in the CA + EX + FVLF arm , the only significant difference was in percentage of body fat ( arms and legs ) ; change in scores ( mean + /- st and ard deviation ) were + 0.7 % + /- 2.3 % ( CA ) ; + 1.2 % + /- 2.7 % ( CA + EX ) ; and + 0.1 % + /- 2 % ( CA + EX + FVLF ; P = .047 ) . Lean body mass was largely preserved , even in the control arm ( net gain of 452 g + /- 2395 g ) . No differences were observed in other endpoints . CONCLUSION Diet and exercise interventions can prevent weight gain and adverse body composition changes , but more research is needed to determine optimally effective interventions that can be implemented during active treatment and that promote adherence PURPOSE 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 This paper will report the results of a pilot test of a 6-month , 21-session intervention to increase breast cancer survivors ' physical activity by teaching them to incorporate short periods of moderate activity into their daily routines ( lifestyle intervention ) . The effect of the intervention on physical performance , quality of life , and physical activity are reported . METHODS Sixty breast cancer survivors were r and omized to either a  lifestyle intervention  or a  st and ard care control group .  Physical performance , quality of life ( Medical outcomes study short form-36 [ SF-36 ] ) , and physical activity ( 7-day recall and motivation readiness ) , were assessed at baseline and 6 months . RESULTS The lifestyle group had significantly better performance in the 6-min walk task than the controls ( p=0.005 ) at 6 months . The intervention had positive effects on the bodily pain ( p=0.020 ) and general health ( p=0.006 ) subscales from the SF-36 . The lifestyle group had a greater motivational readiness for physical activity at 6-month than st and ard care , but no significant differences were seen between the two in terms of number of minutes of moderate or more intense physical activity or number of days on which they did > or = 30 min of moderate or more intense activity . CONCLUSIONS Despite the small sample size , the lifestyle intervention showed promise for improving physical functioning and quality of life and increasing physical activity , and should be tested in a larger r and omized trial . PRACTICE IMPLICATION S If the lifestyle approach is shown to be effective in a larger trial , it represents a highly feasible intervention that it can be delivered to cancer survivors by health care institutions or community organizations without dedicated exercise facilities and equipment The effect of a 10-week aerobic interval-training cycle ergometer protocol on the functional capacity ( VO2Lmax ) of 45 women receiving chemotherapy for treatment of Stage II breast cancer was studied . Subjects were stratified by baseline functional capacity ( ± 1 MET ) and r and omized to experimental ( EX ) , placebo ( PL ) , and control ( CO ) groups . EX subjects completed a 10-week , 3 times/week exercise training program ; PL subjects participated in 10 weeks of nonaerobic stretching and flexibility exercises ; the CO group maintained normal activities . The EX group showed significant , p < .05 , improvement on pre- to posttest VO2Lmax as well as workload and test time compared to the PL and CO groups . The interval-training exercise intervention was effective in improving the functional capacity of Stage II breast cancer patients on adjuvant chemotherapy Physical exercise has been shown to enhance quality of life ( QOL ) in cancer survivors using pretest-posttest design s and compared to usual care ( i.e. no intervention ) . In the present study , we conducted a r and omized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy ( GP ) . We matched 22 GP classes ( N=108 ) on content and then r and omly assigned 11 ( n=48 ) to GP alone and 11 ( n=60 ) to GP plus home-based , moderate-intensity exercise ( GP+EX ) . Participants completed a physical fitness test and QOL measures ( e.g. Functional Assessment of Cancer Therapy scales ) at the beginning and end of GP classes ( about 10 weeks ) . We had excellent recruitment ( 81 % ) , retention ( 89 % ) , and adherence ( 84 % ) rates and a modest contamination ( 22 % ) rate . Using intention-to-treat repeated measures analyses of variance , we found significant Time by Condition interactions for functional well-being , fatigue , and sum of skinfolds . We also found borderline significant interactions for physical well-being , satisfaction with life , and flexibility . All interactions favored the GP+EX condition . We conclude that a home-based , moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP , particularly in relation to physical and functional well-being Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy .  The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence -based treatments are available to manage this distressing side-effect . The purpose of this multi-institutional r and omized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer . Sedentary women ( N=119 ) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were r and omized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment . Of participants r and omized to exercise , 72 % adhered to the exercise prescription ; 61 % of the usual care group adhered . The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39 % of the usual care group exercised and 28 % of the exercise group did not . When exercise participation was considered using the data analysis method of instrumental variables with principal stratification , a clinical ly important and statistically significant ( p=0.03 ) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated . Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment Skeletal muscle protein loss occurs during marrow transplantation despite total parenteral nutrition . To determine if muscle atrophy could be minimized with exercise therapy , 30 patients undergoing marrow transplantation for acute leukemia completed a prospect i ve r and omized trial to receive : ( 1 ) no therapy ( controls ) , ( 2 ) physical therapy thrice weekly ( PT3 ) , or ( 3 ) physical therapy five times weekly ( PT5 ) . Patients were studied through 35 days posttransplant . Muscle protein status and turnover was assessed by weekly nitrogen balance , and creatinine and 3-methylhistidine excretion . Results favored a muscle protein-sparing effect of exercise , as a significant decrease in creatinine excretion in controls only suggested muscle protein loss associated with inactivity . Changes in arm muscle area correlated with energy , but not protein intake . Large individual variation , inadequate nutritional support and differences in admission arm muscle area may have clouded these results 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 Radiotherapy for prostate cancer ( PCa ) may cause unfavorable changes in fatigue , quality of life ( QOL ) , and physical fitness . We report results from the Prostate Cancer Radiotherapy and Exercise Versus Normal Treatment study examining the effects of 24 weeks of resistance or aerobic training versus usual care on fatigue , QOL , physical fitness , body composition , prostate-specific antigen , testosterone , hemoglobin , and lipid levels in men with PCa receiving radiotherapy . PATIENTS AND METHODS Between 2003 and 2006 , we conducted a r and omized controlled trial in Ottawa , Canada , where 121 PCa patients initiating radiotherapy with or without and rogen deprivation therapy  were r and omly assigned to usual care ( n = 41 ) , resistance ( n = 40 ) , or aerobic exercise ( n = 40 ) for 24 weeks . Our primary end point was fatigue assessed by the Functional Assessment of Cancer Therapy-Fatigue scale . RESULTS The follow-up assessment rate for our primary end point of fatigue was 92.6 % . Median adherence to prescribed exercise was 85.5 % . Mixed-model repeated measures analyses indicated both resistance ( P = .010 ) and aerobic exercise ( P = .004 ) mitigated fatigue over the short term . Resistance exercise also produced longer-term improvements ( P = .002 ) . Compared with usual care , resistance training improved QOL ( P = .015 ) , aerobic fitness ( P = .041 ) , upper- ( P < .001 ) and lower-body ( P < .001 ) strength , and triglycerides ( P = .036 ) , while preventing an increase in body fat ( P = .049 ) . Aerobic training also improved fitness ( P = .052 ) . One serious adverse event occurred in the group that performed aerobic exercise . CONCLUSION In the short term , both resistance and aerobic exercise mitigated  fatigue in men with PCa receiving radiotherapy  . Resistance exercise generated longer-term improvements and additional benefits for QOL , strength , triglycerides , and body fat
Introduction Approximately 11.1 million cancer survivors are alive in the United States .
Activity prescriptions for cancer survivors rely on evidence as to whether exercise during or after treatment results in improved health outcomes .
This systematic review and meta- analysis evaluates the extent to which physical activity during and post treatment is appropriate and effective across the cancer control continuum .