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Cancer Type Does Not Affect Exercise-Mediated Improvements in Cardiorespiratory Function and Fatigue
OBJECTIVE To improve mechanistic underst and ing , this pilot r and omized controlled trial examined mediators of an exercise intervention effects on sleep in breast cancer survivors ( BCS ) . METHODS Forty-six postmenopausal BCS ( ≤Stage II , off primary treatment ) were r and omized to a 3-month exercise intervention or control group . Intervention included 160 min/week of moderate intensity aerobic walking , twice weekly resistance training ( resistance b and s ) , and six discussion groups ( to improve adherence ) . Blinded assessment s at baseline and post-intervention included sleep disturbance ( PSQI and PROMIS ® ) , objective sleep quality ( accelerometer ) , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , body composition , fatigue , and psychosocial factors . Mediation was tested using Freedman-Schatzkin difference-in-coefficients tests . RESULTS When compared with control , the intervention group demonstrated a significant increase in PSQI sleep duration ( i.e. , fewer hours of sleep/night ) ( d = 0.73 , p = .03 ) . Medium to large but non-significant st and ardized effect sizes were noted for PSQI daytime somnolence ( d = -0.63 , p = .05 ) and accelerometer latency ( d = -0.49 , p = .14 ) . No statistically significant mediators were detected for PSQI sleep duration score or accelerometer latency . Daytime somnolence was mediated by tumor necrosis factor-alpha ( mediated 23 % of intervention effect , p < .05 ) , interleukin (IL)-6:IL-10 ( 16 % , p < .01 ) , IL-8:IL-10 ( 26 % , p < .01 ) , and fatigue ( 38 % , p < .05 ) . Mediating or enhancing relationships for several of the sleep outcomes were noted for accelerometer physical activity , PROMIS ® fatigue , exercise social support , and /or physical activity enjoyment . CONCLUSIONS Inflammation and psychosocial factors may mediate or enhance sleep response to our exercise intervention . Further study is warranted to confirm our results and translate our findings into more effective interventions aim ed at improving sleep quality in BCS BACKGROUND Yoga is a popular mind-body therapy that has demonstrated beneficial effects on psychological , behavioral , and functional outcomes . However , few studies have investigated effects on inflammatory processes . This study tested the hypothesis that an Iyengar yoga intervention specifically design ed for fatigued breast cancer survivors would lead to decreases in inflammation-related gene expression and circulating markers of proinflammatory cytokine activity . METHODS Breast cancer survivors with persistent cancer-related fatigue were r and omized to a 12-week Iyengar yoga intervention  ( n=16 ) or a 12-week health education control condition  ( n=15 ) . Blood sample s were collected at baseline , post-intervention , and at a 3-month follow-up for genome-wide transcriptional profiling and bioinformatic analyses . Plasma inflammatory markers and salivary cortisol were also assessed . RESULTS In promoter-based bioinformatics analyses , the yoga group showed reduced activity of the pro-inflammatory transcription factor nuclear factor kappa B ( NF-κB ) , increased activity of the anti-inflammatory glucocorticoid receptor , and reduced activity of cAMP response element-binding protein ( CREB ) family transcription factors relative to controls ( all ps<.05 ) . There was also a significant intervention effect on the soluble tumor necrosis factor receptor type II ( sTNF-RII ) , a marker of TNF activity ; plasma levels of sTNF-RII remained stable in the yoga group , whereas levels of this marker increased in the health education group ( p=.028 ) . A similar , non-significant trend was observed for the interleukin 1 receptor antagonist ( p=.16 ) . No significant changes in C reactive protein ( CRP ) , interleukin 6 ( IL-6 ) , or diurnal cortisol measures were observed . CONCLUSIONS A 12-week restorative Iyengar yoga intervention reduced inflammation-related gene expression in breast cancer survivors with persistent fatigue . These findings suggest that a targeted yoga program may have beneficial effects on inflammatory activity in this patient population , with potential relevance for behavioral and physical health Background International evidence -based guidelines recommend physical exercise to form part of st and ard care for all cancer survivors . However , at present , the optimum exercise intensity is unclear . Therefore , we aim ed to evaluate the effectiveness of a high intensity ( HI ) and low-to-moderate intensity ( LMI ) resistance and endurance exercise program compared with a wait list control ( WLC ) group on physical fitness and fatigue in a mixed group of cancer survivors who completed primary cancer treatment , including chemotherapy . Methods Overall , 277 cancer survivors were r and omized to 12 weeks of  HI exercise ( n = 91 ) , LMI exercise ( n = 95 ) , or WLC ( n = 91 ) . Both interventions were identical with respect to exercise type , duration and frequency , and only differed in intensity . Measurements were performed at baseline ( 4–6 weeks after primary treatment ) and post-intervention . The primary outcomes were cardiorespiratory fitness ( peakVO2 ) , muscle strength ( grip strength and 30-second chair-st and test ) , and self-reported fatigue ( Multidimensional Fatigue Inventory ; MFI ) . Secondary outcomes included health-related quality of life , physical activity , daily functioning , body composition , mood , and sleep disturbances . Multilevel linear regression analyses were performed to estimate intervention effects using an intention-to-treat principle . Results In the HI and LMI groups , 74 % and 70 % of the participants attended more than 80 % of the prescribed exercise sessions , respectively ( P = 0.53 ) . HI ( β = 2.2 ; 95 % CI , 1.2–3.1 ) and LMI ( β = 1.3 ; 95 % CI , 0.3–2.3 ) exercise showed significantly larger improvements in peakVO2 compared to WLC . Improvements in peakVO2 were larger for HI than LMI exercise ( β = 0.9 ; 95 % CI , −0.1 to 1.9 ) , but the difference was not statistically significant ( P = 0.08 ) . No intervention effects were found for grip strength and the 30-second chair-st and test . HI and LMI exercise significantly reduced general and physical fatigue and reduced activity ( MFI subscales ) compared to WLC , with no significant differences between both interventions . Finally , compared to WLC , we found benefits in global quality of life and anxiety after HI exercise , improved physical functioning after HI and LMI exercise , and less problems at work after LMI exercise . Conclusions Shortly after completion of cancer treatment , both HI and LMI exercise were safe and effective . There may be a dose – response relationship between exercise intensity and peakVO2 , favoring HI exercise . HI and LMI exercise were equally effective in reducing general and physical fatigue . Trial registration This study was registered at the Netherl and s Trial Register [ NTR2153 ] on the 5th of January 2010 PURPOSE This study aim ed to examine mediators of fatigue response to an exercise intervention for breast cancer survivors in a pilot r and omized controlled trial . METHODS Postmenopausal breast cancer survivors ( n = 46 ; ≤stage 2 ) , off primary treatment , and reporting fatigue and /or sleep dysfunction were r and omized to a 3-month exercise intervention ( 160 min·wk of moderate-intensity aerobic walking , twice weekly resistance training with resistance b and s ) or control group . Six discussion group sessions provided behavioral support to improve adherence . Fatigue , serum cytokines , accelerometer physical activity , cardiorespiratory fitness , sleep dysfunction , and psychosocial factors were assessed at baseline and 3 months . RESULTS The exercise intervention effect sizes for fatigue were as follows : fatigue intensity d = 0.30 ( P = 0.34 ) , interference d = -0.38 ( P = 0.22 ) , and general fatigue d = -0.49 ( P = 0.13 ) . Using the Freedman-Schatzkin difference-in-coefficients tests , increase in fatigue intensity was significantly mediated by interleukin 6 ( IL-6 ) ( 82 % ) , IL-10 ( 94 % ) , IL-6/IL-10 ( 49 % ) , and tumor necrosis factor-α (TNF-α):IL-10 ( 78 % ) with reduced sleep dysfunction increasing the relationship between intervention and fatigue intensity rather than mediating intervention effects ( -88 % ) . Decrease in fatigue interference was mediated by sleep dysfunction ( 35 % ) , whereas IL-10 and pro-anti-inflammatory cytokine ratios increased the relationship between intervention and interference ( -25 % to -40 % ) . The reduction in general fatigue was significantly mediated by minutes of physical activity ( 76 % ) , sleep dysfunction ( 45 % ) , and physical activity enjoyment ( 40 % ) , with IL-10 ( -40 % ) and IL-6/IL-10 ( -11 % ) increasing the intervention-fatigue relationship . In the intervention group , higher baseline fatigue , anxiety , depression , and perceived exercise barrier interference predicted a greater decline in fatigue interference and /or general fatigue during the intervention . CONCLUSIONS Biobehavioral factors mediated and enhanced intervention effects on fatigue , whereas psychosocial factors predicted fatigue response . Further study is warranted to confirm our results and to improve underst and ing of relationships that mediate and strengthen the intervention-fatigue association 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 OBJECTIVE The study aim ed at investigating the quality of life ( QoL ) and physical performance and activity , and their interrelations , in Finnish female breast cancer patients shortly after adjuvant treatments . METHODS A total of 537 disease-free breast cancer survivors aged 35 - 68 years were surveyed at the beginning of a one year r and omized exercise intervention . The patients were interviewed using EORTC QLQ-C30 , FACIT-F , RBDI , and WHQ ( for vasomotor symptoms ) question naires . Physical performance  was tested by a 2 km walking test . Physical activity was measured by a question naire and a prospect i ve two-week diary . Multivariate analysis was used to study the factors associated with QoL. RESULTS About 26 % of the patients were rated as depressed , 20.4 % as fatigued , and 82 % suffered from menopausal symptoms . The global QoL was lower than in general population ( 69.4 vs 74.7 , p<0.001 ) . About 62 % of the walking test results were below the population average . Fatigue ( p<0.001 ) , depression ( p<0.001 ) , body mass index ( p = 0.016 ) and comorbidity ( p = 0.032 ) impaired , and physical activity ( p = 0.003 ) improved QoL. Physical activity level correlated positively to physical performance ( r = -0.274 , p<0.0001 ) . CONCLUSIONS The QoL of the patients shortly after adjuvant treatments was impaired and the physical performance poor as compared to general population . In particular , depression and fatigue were related to impaired QoL. Physical performance and activity level were the only factors that correlated positively to QoL. Thus , physical exercise could be useful in rehabilitation of cancer survivors , especially for depressed and fatigued patients This investigation determined the cardiopulmonary function and fatigue alterations in male cancer survivors during treatment as well as following treatment utilizing similar exercise assessment protocol s and individualized , prescriptive exercise interventions . The study included 45 male cancer survivors that were referred by local oncologists . Following a comprehensive screening and physical examination , cardiovascular endurance , pulmonary function , and fatigue were assessed leading to the development of 12-week individualized exercise prescriptions and exercise interventions . The cancer survivors were divided into during treatment ( DTm ) and following treatment ( FTm ) groups . Repeated- measures analysis of variance and analyses of covariance were used to compare pre- versus postintervention and between groups . Cardiopulmonary function was maintained in the DTm , whereas the FTm showed significant reductions in resting heart rate ( P < .05 ) with concurrent increases in predicted VO2max and time on treadmill ( P < .05 ) postexercise intervention . Fatigue levels did not increase in the DTm group , whereas the FTm group showed significant reductions in behavioral fatigue , affective fatigue , sensory fatigue , cognitive/mood fatigue , and total fatigue ( P < .05 ) after the exercise intervention . The results of the current study suggest that moderate intensity , individualized , prescriptive exercise intervention maintains or improves cardiovascular and pulmonary function with concomitant reductions in fatigue in cancer survivors during and following cancer treatment . Exercise appears to be a safe , efficacious strategy for improving physical fitness in cancer survivors during and following treatment Background Fatigue is a major problem of cancer patients . Thirty percent of cancer survivors report serious fatigue three years after finishing treatment . There is evidence that physical exercise during cancer treatment reduces fatigue . This may also lead to an improvement of quality of life . Such findings may result in a decrease of healthcare related expenditures and societal costs due to sick leave . However , no studies are known that investigated these hypotheses . Therefore , the primary aim of our study is to assess the effect of exercise during cancer treatment on reducing complaints of fatigue and on reducing health service utilisation and sick leave . Methods / Design The Physical Activity during Cancer Treatment study is a multicentre r and omised controlled trial in 150 breast and 150 colon cancer patients undergoing cancer treatment . Participants will be r and omised to an  exercise or a control group .  In addition to the usual care , the exercise group will participate in an 18-week supervised group exercise programme . The control group will be asked to maintain their habitual physical activity pattern . Study endpoints will be assessed after 18 weeks ( short term ) and after 9 months ( long term ) . Vali date d question naires will be used . Primary outcome : fatigue ( Multidimensional Fatigue Inventory and Fatigue Quality List ) and cost-effectiveness , health service utilisation and sick leave . Secondary outcome : health related quality of life ( European Organisation Research and Treatment of Cancer- Quality of Life question naire-C30 , Short Form 36 healthy survey ) , impact on functioning and autonomy ( Impact on functioning and autonomy question naire ) , anxiety and depression ( Hospital Anxiety and Depression Scale ) , physical fitness ( aerobic peak capacity , muscle strength ) , body composition and cognitive-behavioural aspects . To register health service utilisation and sick leave , participants will keep diaries including the EuroQuol-5D . Physical activity level will be measured using the Short Question naire to Assess Health-Enhancing Physical Activity and will be monitored with an exercise log and a pedometer . Discussion This study investigates the (cost)-effectiveness of exercise during adjuvant treatment of patients with breast or colon cancer . If early physical exercise proves to be ( cost ) effective , establishing st and ardised physical exercise programmes during cancer treatment will be planned . Trial registration Current Controlled trials IS RCT N43801571 , Dutch Trial Register Exercise use among patients with cancer has been shown to have many benefits and few notable risks . The purpose of this study was to evaluate the impact of a home-based walking intervention during cancer treatment on sleep quality , emotional distress , and fatigue . Methods . A total of 138 patients with prostate ( 55.6 % ) , breast ( 32.5 % ) , and other solid tumors ( 11.9 % ) were r and omized to a  home-based walking intervention or usual care . Exercise dose was assessed using a five-item subscale of the Cooper Aerobics Center Longitudinal Study Physical Activity Question naire . Primary outcomes of sleep quality , distress , and fatigue were compared between the two study arms . Results . The exercise group ( n = 68 ) reported more vigor ( p = .03 ) than control group participants ( n = 58 ) . In dose response models , greater participation in aerobic exercise was associated with 11 % less fatigue ( p < .001 ) , 7.5 % more vigor ( p = .001 ) , and 3 % less emotional distress ( p = .03 ) , after controlling for intervention group assignment , age , and baseline exercise and fatigue levels . Conclusion . Patients who exercised during cancer treatment experienced less emotional distress than those who were less active . Increasing exercise was also associated with less fatigue and more vigor .  Home-based walking is a simple , sustainable strategy that may be helpful in improving a number of symptoms encountered by patients undergoing active treatment for cancer Goals of the workThe goal of this study was to examine the association between  exercise  and quality of life ( QOL ) in multiple myeloma cancer survivors . Patients and methods Using a retrospective design , 156 multiple myeloma cancer survivors were mailed a question naire that assessed self-reported exercise behavior over three periods ( prediagnosis , active treatment , and off-treatment ) and QOL.Main results The response rate was 56 % ( 88/156 ) . Descriptive analyses indicated that 6.8 % and 20.4 % of survivors met national exercise guidelines during active and off-treatment periods , respectively . Exercise during active treatment and off-treatment were positively associated with overall QOL and all subdomains of QOL ( all P<0.05 ) except physical wellbeing . Conclusions A low percentage of multiple myeloma cancer survivors are exercising regularly either during active or off-treatment periods . Survivors who report more exercise during these periods also report higher QOL . These findings suggest that a r and omized controlled trial is warranted Breast cancer is the most prevalent type of cancer in American women .  Exercise appears to diminish many of the side effects result ing from breast cancer and its treatment . Very little research , however , has compared the outcomes of varying lengths of combined aerobic and resistance training exercise interventions on physiological and psychological parameters in breast cancer survivors . The purpose of this study was to compare the physiological and psychological outcomes following 3 and 6 months of exercise in breast cancer survivors . Breast cancer survivors ( N = 114 ) participated in either 3 months of prescriptive , individualized exercise ( 3 M ; n = 29 ) , 6 months of prescriptive , individualized exercise ( 6 M ; n = 68 ) , or served as sedentary controls  ( C ; n = 17 ) . Cancer survivors completed a medical evaluation and assessment at baseline followed by a predetermined 3- or 6-month exercise intervention .  Cancer survivors in the control group performed no exercise between the initial assessment and 6-month re assessment . Cardiovascular endurance , pulmonary function , muscular endurance , fatigue , and symptoms of depression were assessed at baseline and post intervention . Repeated measures ANCOVA revealed improvements ( P < 0.05 ) in cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors undergoing 3- and 6-month individualized exercise interventions . Breast cancer survivors exercising for 6 months showed additional improvements ( P < 0.05 ) in pulmonary function and muscular endurance . Cancer survivors in the control group did not improve in cardiovascular endurance , pulmonary function , muscular endurance , or fatigue . Three months of individualized , prescriptive exercise leads to improved cardiovascular endurance , fatigue , and symptoms of depression in breast cancer survivors . Additional benefits are seen if exercise is continued for a total of 6 months Purpose Fatigue is a commonly reported symptom by prostate cancer survivors and is associated with significant distress and declines in quality of life . Qigong is a mind – body activity that consists of both physical activity and meditative aspects . This 12-week r and omized controlled trial examined the feasibility and efficacy of a Qigong intervention for improving older prostate cancer survivors '  levels of fatigue and distress . Methods Forty older ( median age = 72 , range = 58–93 ) , fatigued ( cut-off value of ≥1 on the CTCAEv4.0 , > 20 on a fatigue grading scale ) , and sedentary ( < 150 min of moderate exercise/week ) prostate cancer survivors were r and omized to 12 weeks of Qigong or stretching classes . Primary outcomes were feasibility ( i.e. , retention and class attendance rates ) and fatigue [ Functional Assessment of Chronic Illness Therapy — Fatigue ( FACIT-Fatigue ) ] , and secondary outcome was distress [ Brief Symptom Inventory-18 ( BSI-18 ) ] . Results Study retention rates did not significantly differ between study groups ( Qigong = 80 % , stretching = 65 % , p = 0.48 ) . The Qigong group had significantly higher class attendance than the stretching group ( p = 0.04 ) . The Qigong group had significantly greater improvements in the FACIT-Fatigue ( p = 0.02 ) and distress ( i.e. , BSI-18 Somatization , Anxiety , & Global Severity Index , p 's < 0.05 ) , than the Stretching group . Conclusions This 12-week Qigong intervention was feasible and potentially efficacious in improving  senior prostate cancer survivors ' levels of fatigue and distress levels . Future , larger definitive r and omized controlled trials are needed to confirm these benefits in older prostate cancer survivors and in racially and ethnically diverse population s. Implication s for cancer survivorsQigong may be an effective nonpharmacological intervention for the management of senior prostate cancer survivors ' fatigue and distress Aim . The aim of the study was to compare the effects of aerobic exercise training and yoga on the functional capacity , peripheral muscle strength , quality of life ( QOL ) , and fatigue in breast cancer survivors . Material and methods . A total of 52 patients with a diagnosis of breast cancer were included in the study . The patients were r and omly assigned to 2 groups : aerobic exercise ( n = 28 ) and yoga added to aerobic exercise ( n = 24 ) . Both groups participated in submaximal exercise 30 minutes/d , 3 d/wk for 6 weeks . The second group participated in a 1-hour yoga program in addition to aerobic exercise training .  Functional capacity was assessed by the 6-Minute Walk Test ( 6MWT ) . Peripheral muscle strength was evaluated with a h and -held dynamometer . The fatigue severity level was assessed with the Fatigue Severity Scale ( FSS ) . The QOL was determined by the European Organisation for Research and Treatment of Cancer Quality of Life Question naire . Results . There were statistically significant increases in peripheral muscle strength , the 6MWT distance , and the perception of QOL in both groups ( P < .05 ) . Additionally , the group with aerobic exercise and yoga showed marked improvement compared with the aerobic exercise group in fatigue perception ( P < .05 ) . Conclusion . According to the data from this study , aerobic exercise training and yoga improved the functional capacity and QOL of breast cancer patients .  Aerobic exercise programs can be supported by body mind techniques , such as yoga , in the rehabilitation of cancer patients for improving functional recovery and psychosocial wellness BACKGROUND During radiotherapy ( RT ) , prostate cancer ( PCa ) patients may report cancer related fatigue ( CRF ) , which impairs functional capacity , psychological status , and quality of life ( QoL ) . RT can induce cytokine responses that could play a role in mediating radiation toxicity by increasing inflammation . While it is known that physical exercise plays an important anti-inflammatory role in healthy adults , its specific anti-inflammatory effects in PCa patients with CRF have not yet been determined . AIM Previous studies have shown that physical exercise in cancer patients undergoing RT improves cardiac fitness , muscle strength , and QoL , however it is still unknown how physical exercise affects inflammation and its specific consequences in PCa patients . Therefore , the purpose of this trial was to examine the effect of supervised physical exercise on inflammatory blood markers , as well as the relationship of these parameters with functional capacity , fatigue , and QoL in high-risk PCa patients undergoing RT .  DESIGN This was a prospect i ve , two-arm r and omized controlled clinical trial . SETTING The study was performed in our out patients center . POPULATION Fifty-four high-risk PCa men were r and omly allocated to two groups prior to undergoing RT . METHODS Twenty-seven patients performed supervised , moderate-intensity physical exercise ( exercise group ; EG )  and the other 27 formed a control group that carried out normal daily physical activity ( usual group ; UG ) . The following parameters were assessed before and after RT : functional capacity , changes in blood count variables and production of pro-inflammatory cytokines ( interleukin [IL]-1β , IL-6 , tumor necrosis factor [TNF]-α ) , fatigue , and QoL ( using FACT-F score and EORTC question naires ) . RESULTS No significant differences existed between the study groups at baseline assessment . After RT , there was a significant improvement in functional capacity ( P<0.05 ) and a decrease in pro-inflammatory cytokine levels ( P>0.05 ) and fatigue ( P<0.05 ) in the EG compared to the UG . Fatigue level was significantly higher in the UG ( F[2.126 ] ; P<0.05 ) after RT than before . Physical exercise had no effect on the correlation between inflammatory blood markers and functional capacity and fatigue scores provided by study participants . CONCLUSIONS Regular , moderate-intensity physical exercise improves functional capacity , decreases the production of inflammatory markers and fatigue , and has a positive influence on QoL in high-risk PCa patients during RT . CLINICAL REHABILITATION IMPACT This is one of the first studies to examine the effects of supervised exercise training on pro-inflammatory cytokine levels during RT in PCa patients by measuring functional capacity , fatigue , and AIM The study aim ed at determining whether physical exercise training improves the quality of life ( QoL ) and physical fitness of breast cancer survivors . PATIENTS AND METHODS A total of 573 breast cancer survivors were r and omized into an exercise or a control group , 12-months after adjuvant treatments . EORTC QLQ-C30 and BR-23 question naires were used for evaluation of QoL , FACIT-F for fatigue and the Finnish modified version of Beck 's 13-item depression scale ( RBDI ) for depression . Physical fitness was assessed by a 2-km walking test , and a figure-8 running test and physical activity ( PA )  by metabolic equivalent ( MET ) hours per week ( MET-h/wk ) . RESULTS Figure-8 running time improved significantly among the patients of the intervention group compared with the controls ( p<0.001 ) . No significant between-group differences were observed in 2-km walking time , in PA , EORTC-QLQ-C30 , BR-23 , FACIT-F or BDI . However , there was a linear relationship between increased PA and improved QoL ( p=0.006 ) , irrespective of the intervention . CONCLUSION Increase in physical activity was associated with improved QoL , but no effect of the exercise intervention was observed Cancer treatments have serious physiological and psychological side effects in cancer survivors . This investigation examined cardiopulmonary function and fatigue in breast cancer survivors during and after treatment by using similar exercise assessment s , prescriptions , individualized interventions , and re assessment Background The quality of life for breast cancer survivors has become increasingly important because of their high survival rate and prolonged life expectancy . The purpose of this study was to examine the association of physical activity following diagnosis and health-related quality of life ( HRQOL ) in breast cancer survivors . Methods We conducted a cross-sectional study of breast cancer survivors . A total of 231 women aged 21–78 years who had been diagnosed with stages I to III breast cancer and had breast cancer surgery at least 6 months prior were recruited from three hospitals between September 2012 and April 2015 and were included in this study . We asked participants about their HRQOL and engagement in physical activity using structured question naires . We examined the association between HRQOL levels and physical activity using a generalized linear model . Results Breast cancer survivors in the high physical activity group ( 3rd tertile ) were more likely to have lower scores for fatigue ( p for trend = 0.001 ) and pain ( p for trend = 0.02 ) and higher scores for sexual function ( p for trend = 0.007 ) than those in the low physical activity group ( 1st tertile ) . When we stratified participants by stage , we found increasing scores for physical functioning ( p for trend = 0.01 ) and decreasing scores for fatigue ( p for trend = 0.02 ) with increasing levels of physical activity in breast cancer survivors with stage I breast cancer . In survivors with stages II and III , we found statistically significant associations with fatigue ( p for trend = 0.02 ) and sexual functioning ( p for trend = 0.001 ) . Conclusions In conclusion , engagement in physical activity was related to better health-related quality of life among breast cancer survivors . Our findings may warrant further prospect i ve and intervention studies to support the benefit of physical activity in improving the quality of life and survival of Korean breast cancer survivors OBJECTIVES Cancer survivors often report cognitive problems . Furthermore , decreases in physical activity typically occur over the course of cancer treatment . Although physical activity benefits cognitive function in noncancer population s , evidence linking physical activity to cognitive function in cancer survivors is limited . In our recent r and omized controlled trial , breast cancer survivors who received a yoga intervention  had lower fatigue and inflammation following the trial compared with a wait list control group . This secondary analysis of the parent trial addressed yoga 's impact on cognitive complaints . METHODS Posttreatment stage 0-IIIA breast cancer survivors ( n = 200 ) were r and omized to a 12-week , twice-weekly Hatha yoga intervention or a wait list control group . Participants reported cognitive complaints using the Breast Cancer Prevention Trial Cognitive Problems Scale at baseline , immediately postintervention , and 3-month follow-up . RESULTS Cognitive complaints did not differ significantly between groups immediately postintervention ( p = 0.250 ) . However , at 3-month follow-up , yoga participants ' Breast Cancer Prevention Trial Cognitive Problems Scale scores were an average of 23 % lower than wait list participants ' scores ( p = 0.003 ) . These group differences in cognitive complaints remained after controlling for psychological distress , fatigue , and sleep quality . Consistent with the primary results , those who practice d yoga more frequently reported significantly fewer cognitive problems at 3-month follow-up than those who practice d less frequently ( p < 0.001 ) . CONCLUSIONS These findings suggest that yoga can effectively reduce breast cancer survivors ' cognitive complaints and prompt further research on mind-body and physical activity interventions for improving cancer-related cognitive problems Purpose . To determine which mode of exercise is preferred by breast cancer survivors and to evaluate this response between grade d exercise testing on a treadmill and on a cycle ergometer . Methods . Twelve breast cancer survivors completed 2 maximal aerobic stress tests on separate days . The women completed a ramp protocol on an electronically braked cycle ergometer and an incremental step protocol on a treadmill to volitional fatigue . Test order was r and omized . Expired gases were collected for the determination of peak aerobic capacity ( Vo2peak ) . Results . Exercise mode had a significant effect on the grade d exercise response in breast cancer survivors , P = .003 . Treadmill Vo2peak was significantly greater than bike Vo2peak ( 28.7 ± 4.7 vs 23.9 ± 4.7 mL/min/kg , respectively , P = .003 ) and VEmax was equivalent between exercise modes ( P = .731 ) . Maximal heart rate was significantly higher by 11 bpm during the treadmill protocol ( P = .004 ) , and Ve/VCo2 exhibited possible mode dependency ( P = .018 ) . Conclusion . This patient population felt more comfortable and produced significantly greater Vo2peak values using the treadmill protocol . These results discuss the potential implication s concerning the design and interpretation of exercise interventions for breast cancer survivors PURPOSE / OBJECTIVES To investigate the effects of supervised exercise training on cardiopulmonary function and fatigue in cancer survivors undergoing various clinical treatments . DESIGN Pretest and post-test quasiexperimental . SETTING Outpatient oncology rehabilitation center . SAMPLE 96 breast cancer survivors undergoing various clinical treatments . METHODS Subjects were divided into four groups based on the specific type of clinical treatment : surgery alone ( n = 22 ) ; surgery and chemotherapy ( n = 30 ) ; surgery and radiation ( n = 17 ) ; and surgery , chemotherapy , and radiation ( n = 27 ) . Following a comprehensive screening and medical examination , cardiovascular endurance , pulmonary function , and fatigue were assessed , leading to the development of an individualized exercise prescription and a six-month exercise intervention . Repeated- measures analysis of variance and covariance were used to compare the effectiveness of the intervention and differences among treatment groups . MAIN RESEARCH VARIABLES Systolic and diastolic blood pressure , resting heart rate , forced vital capacity , forced expiratory volume , predicted oxygen consumption , time on treadmill , and fatigue . FINDINGS Cardiopulmonary function ( predicted maximal oxygen consumption and time on treadmill ) significantly increased in all groups after exercise training . In addition , resting heart rate and forced vital capacity significantly improved in those receiving surgery , chemotherapy , and radiation . Psychologically , the exercise intervention result ed in significant reductions in behavioral , affective , sensory , cognitive and mood , and total fatigue scale scores in all three groups who received treatment with surgery . The breast cancer survivors in the surgery-alone group showed significant reductions in behavioral , affective , and total fatigue scale scores but not in sensory and cognitive and mood fatigue scale scores . CONCLUSIONS The results suggest that moderate intensity , individualized , prescriptive exercise maintains or improves cardiopulmonary function with concomitant reductions in fatigue regardless of treatment type . Moreover , cancer survivors receiving combination chemotherapy and radiotherapy following surgery appear to benefit to a greater extent as a result of an individualized exercise intervention . IMPLICATION S FOR NURSING Clinicians need to be aware of adjuvant therapies such as moderate exercise that attenuate negative side effects of cancer treatments . Symptom management recommendations should be given to cancer survivors concerning the effectiveness of exercise throughout the cancer continuum and the importance of participating in a cancer rehabilitation exercise program This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors Background Breast cancer survivors suffer physical impairment after oncology treatment . This impairment reduces quality of life ( QoL ) and increase the prevalence of h and icaps associated to unhealthy lifestyle ( for example , decreased aerobic capacity and strength , weight gain , and fatigue ) . Recent work has shown that exercise adapted to individual characteristics of patients is related to improved overall and disease-free survival . Nowadays , technological support using telerehabilitation systems is a promising strategy with great advantage of a quick and efficient contact with the health professional . It is not known the role of telerehabilitation through therapeutic exercise as a support tool to implement an active lifestyle which has been shown as an effective re source to improve fitness and reduce musculoskeletal disorders of these women . Methods / Design This study will use a two-arm , assessor blinded , parallel r and omized controlled trial design . People will be eligible if : their diagnosis is of stages I , II , or IIIA breast cancer ; they are without chronic disease or orthopedic issues that would interfere with ability to participate in a physical activity program ; they had access to the Internet and basic knowledge of computer use or living with a relative who has this knowledge ; they had completed adjuvant therapy except for hormone therapy and not have a history of cancer recurrence ; and they have an interest in improving lifestyle . Participants will be r and omized into e-CUI DATE or usual care groups . E-CUI DATE give participants access to a range of contents : planning exercise arranged in series with breathing exercises , mobility , strength , and stretching . All of these exercises will be assigned to women in the telerehabilitation group according to perceived needs . The control group will be asked to maintain their usual routine . Study endpoints will be assessed after 8 weeks ( immediate effects ) and after 6 months . The primary outcome will be QoL measured by The European Organization for Research and Treatment of Cancer Quality of Life Question naire Core 30 version 3.0 and breast module called The European Organization for Research and Treatment of Cancer Breast Cancer-Specific Quality of Life question naire . The secondary outcomes : pain ( algometry , Visual Analogue Scale , Brief Pain Inventory short form ) ; body composition ; physical measurement ( abdominal test , h and grip strength , back muscle strength , and multiple sit-to-st and test ) ; cardiorespiratory fitness ( International Fitness Scale , 6-minute walk test , International Physical Activity Question naire-Short Form ) ; fatigue ( Piper Fatigue Scale and Borg Fatigue Scale ) ; anxiety and depression ( Hospital Anxiety and Depression Scale ) ; cognitive function ( Trail Making Test and Auditory Consonant Trigram ) ; accelerometry ; lymphedema ; and anthropometric perimeters . Discussion This study investigates the feasibility and effectiveness of a telerehabilitation system during adjuvant treatment of patients with breast cancer . If this treatment option is effective , telehealth systems could offer a choice of supportive care to cancer patients during the survivorship phase . Trial registration Clinical Trials.gov Identifier : Purpose This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2–6 months of chemotherapy completion . Methods Participants were r and omly assigned to an 8-week , twice-weekly , supervised aerobic exercise training regime ( n = 23 ) or a usual care group ( n = 20 ) .  Feasibility was assessed by recruitment rate , program adherence and participant feedback . The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline ( 0 weeks ) , post-intervention ( 8 weeks ) and at 3-month follow-up . Secondary outcomes included physical activity , waist circumference , fatigue and quality of life . Results The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 % . Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [ mean 3.0 mL kg−1 min−1 ( 95 % CI −1.1–7.0 ) ] and 3-month follow-up [ 2.1 mL kg−1 min−1 ( −2.3–6.6 ) ] were found , although these differences did not achieve statistical significance ( p values > 0.14 ) . Self-reported physical activity increased in the exercise group ( EG ) compared to the usual care group at both 8-week ( p = 0.01 ) and 3-month follow-up ( p = 0.03 ) and significant differences in favour of the EG were found for physical well-being at both the 8-week ( p = 0.03 ) and 3-month follow-up ( p = 0.04 ) . Improvements in fatigue ( p = 0.01 ) , total quality of life plus fatigue ( p = 0.04 ) , and a composite physical functioning score ( p = 0.01 ) at the 3-month follow-up were also found . Conclusion The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness , fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase . Implication s for Cancer SurvivorsExercise interventions commenced in the early survivorship phase appear safe , feasible and may lead to improvements in QOL and fatigue Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR PURPOSE This study aim ed to examine the acute effect of caffeine on exercise capacity , exercise-related fatigue , and functional performance in prostate cancer survivors . METHODS In this r and omized , placebo-controlled , double-blind crossover study , 30 prostate cancer survivors ( age , 70.3 ± 7.7 yr ; body mass , 80.5 ± 13.0 kg ; mean ± SD ) consumed 6.04 ± 0.16 mg·kg(-1 ) of anhydrous caffeine or a placebo 1 h before completing a battery of exercise capacity and functional performance tests . Testing sessions were separated by 3 - 4 wk . Immediate fatigue and perceived exertion were measured directly pre- and postexercise at both testing sessions . RESULTS Caffeine  increased exercise capacity by 7.93 s ( + 3.0 % ; P = 0.010 ) ; however , postexercise fatigue and perception of exertion were comparable with the placebo session ( P = 0.632 and P = 0.902 , respectively ) . Increases in isometric grip strength trended toward significance in both dominant ( + 2.9 % ; P = 0.053 ) and nondominant ( + 2.1 % ; P = 0.061 ) h and s in the caffeine trial compared with placebo . Caffeine ingestion did not result in improvements in performance for any of the remaining functional measures , including the timed up- and -go test , repeated chair st and s , 6-m fast walk , and 6-m backward t and em walk . Systolic blood pressure and HR were significantly increased ( P = 0.006 and P = 0.040 , respectively ) upon completion of the testing battery when compared with placebo . CONCLUSIONS Consumption of caffeine 1 h before exercise induced improvements in exercise capacity and muscular strength in prostate cancer survivors . However , there was no change in exercise-related fatigue when compared with placebo despite reduction in timed performance of the 400-m walk . Caffeine seems to enhance exercise tolerance through improved performance with no subsequent increase in fatigue or perception of exertion and may be an appropriate strategy to promote exercise participation in prostate cancer survivors Observational studies demonstrate an association between physical activity and improved outcomes in breast and colon cancer survivors . To test these observations with a large , r and omized clinical trial , an intervention that significantly impacts physical activity in these patients is needed . The Active After Cancer Trial ( AACT ) was a multicenter pilot study evaluating the feasibility of a telephone-based exercise intervention in a cooperative group setting . Sedentary ( engaging in < 60 min of recreational activity/week ) breast and colorectal cancer survivors were r and omized to a telephone-based exercise intervention or usual care control group . The intervention was delivered through the University of California at San Diego ; participants received ten phone calls over the course of the 16-week intervention . All participants underwent assessment of physical activity , fitness , physical functioning , fatigue and exercise self-efficacy at baseline and after the 16-week intervention . One hundred and twenty-one patients were enrolled through ten Cancer and Leukemia Group B ( CALGB ) institutions ; 100 patients had breast cancer and 21 had colorectal cancer . Participants r and omized to the exercise group increased physical activity by more than 100 versus 22 % in controls ( 54.5 vs. 14.6 min , P = 0.13 ) , and experienced significant increases in fitness ( increased 6-min walk test distance by 186.9 vs. 81.9 feet , P = 0.006 ) and physical functioning ( 7.1 vs. 2.6 , P = 0.04 ) as compared to the control group . Breast and colorectal cancer survivors enrolled in a multicenter , telephone-based physical activity intervention  increased physical activity and experienced significant improvements in fitness and physical functioning . Lifestyle intervention research is feasible in a cooperative group setting OBJECTIVE To investigate the effectiveness of an 8-week aquatic program on  cancer-related fatigue , as well as physical and psychological outcomes in breast cancer survivors . DESIGN A r and omized controlled trial . SETTING Outpatient clinic , urban , academic medical center , and a sport university swimming pool . PARTICIPANTS Breast cancer survivors ( N=68 ) were r and omly assigned to either an experimental ( aquatic exercise group in deep water pool ) group or a control ( usual care ) group . INTERVENTIONS The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool . Sessions lasted 60 minutes in duration : 10 minutes of warm-up , 40 minutes of aerobic and endurance exercises , and 10 minutes of cool-down exercises . Patients allocated to the usual care group followed the oncologist 's recommendations in relation to a healthy lifestyle . MAIN OUTCOME MEASURES Values for fatigue ( Piper Fatigue Scale ) , mood state ( Profile of Mood States ) , and abdominal ( trunk curl static endurance test ) and leg ( multiple sit-to-st and test ) strength were collected at baseline , after the last treatment session , and at a 6-month follow-up . RESULTS Immediately after discharge , the aquatic exercise group showed a large effect size in total fatigue score ( d=.87 ; 95 % confidence interval , .48 - 1.26 ) , trunk curl endurance ( d=.92 ; 95 % confidence interval , 1.97 - 3.83 ) , and leg strength ( d=1.10 ; .55 - 2.76 ) , but negligible effects in vigor , confusion , and disturbance of mood ( d<.25 ) . At the 6-month follow-up period , the aquatic exercise group maintained large to small effect sizes in fatigue scores , multiple sit-to-st and test , and trunk curl static endurance ( .25>d>.90 ) and negligible effects for the fatigue-severity dimension and different scales of the Profile of Mood States ( d<.25 ) . CONCLUSION An aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors OBJECTIVES To determine the effects of the 3-month multicomponent Better Exercise Adherence after Treatment for Cancer ( BEAT Cancer ) physical activity behavior change intervention on fatigue , depressive symptomatology , and anxiety . METHODS Post primary treatment breast cancer survivors ( n = 222 ) were r and omized to BEAT Cancer or usual care .  Fatigue Symptom Inventory and Hospital Anxiety and Depression Scale were assessed at baseline , postintervention ( month 3 ; M3 ) , and follow-up ( month 6 ; M6 ) . RESULTS Adjusted linear mixed-model analyses demonstrated significant effects of BEAT Cancer vs usual care on fatigue intensity ( M3 mean between group difference [ M ] = -0.6 ; 95 % confidence interval [ CI ] = -1.0 to -0.2 ; effect size [ d ] = -0.32 ; P = .004 ) , fatigue interference ( M3 M = -0.8 ; CI = -1.3 to -0.4 ; d = -0.40 ; P < .001 ) , depressive symptomatology ( M3 M = -1.3 ; CI = -2.0 to -0.6 ; d = -0.38 ; P < .001 ) , and anxiety ( M3 M = -1.3 ; CI = -2.0 to -0.5 ; d = -0.33 ; P < .001 ) . BEAT Cancer effects remained significant at M6 for all outcomes ( all P values < .05 ; d = -0.21 to -.35 ) . Clinical ly meaningful effects were noted for fatigue intensity , fatigue interference , and depressive symptomatology . CONCLUSIONS BEAT Cancer  reduces fatigue , depressive symptomatology , and anxiety up to 3 months postintervention in post primary treatment breast cancer survivors . Further study is needed to determine sustainable methods for disseminating and implementing the beneficial intervention components BACKGROUND Sixty percent of cancer survivors are 65years of age or older . Cancer and its treatments lead to cancer-related fatigue and many other side effects , in turn , creating substantial global side-effect burden ( total burden from all side effects ) which , ultimately , compromises functional independence and quality of life . Various modes of exercise , such as yoga , reduce cancer-related fatigue and global side-effect burden in younger cancer survivors , but no studies have specifically examined the effects of yoga on older cancer survivors . OBJECTIVES The purpose of this study was to assess the effects of a 4-week yoga intervention ( Yoga for Cancer Survivors : YOCAS © ® ) on overall cancer-related fatigue , and due to its multidimensional nature , the subdomains of cancer-related fatigue ( general , physical , emotional , and mental ) and global side-effect burden in older cancer survivors . MATERIAL S AND METHODS We conducted a secondary analysis on data from a multicenter phase III r and omized controlled clinical trial with 2 arms ( st and ard care and st and ard care plus a 4-week YOCAS © ® intervention ) . The sample for this secondary analysis was 97 older cancer survivors ( ≥60years of age ) , between 2months and 2years post-treatment , who participated in the original trial . RESULTS Participants in the YOCAS © ® intervention arm reported significantly lower cancer-related fatigue , physical fatigue , mental fatigue , and global side-effect burden than participants in the st and ard care arm following the 4-week intervention period ( p<0.05 ) . CONCLUSIONS YOCAS © ® is an effective st and ardized yoga intervention for reducing cancer-related fatigue , physical fatigue , mental fatigue , and global side-effect burden among older cancer survivors Background Prostate cancer can negatively impact quality of life of the patient and his spouse caregiver , but interventions rarely target the health of both partners simultaneously . We tested the feasibility and preliminary efficacy of a partnered strength training program on the physical and mental health of prostate cancer survivors ( PCS ) and spouse caregivers . Methods Sixty-four couples were r and omly assigned to 6 months of partnered strength training ( Exercising Together , N = 32 ) or usual care ( UC , N = 32 ) . Objective measures included body composition ( lean , fat and trunk fat mass ( kg ) , and % body fat ) by DXA , upper and lower body muscle strength by 1-repetition maximum , and physical function by the physical performance battery ( PPB ) . Self-reported measures included the physical and mental health summary scales and physical function and fatigue subscales of the SF-36 and physical activity with the CHAMPS question naire . Results Couple retention rates were 100 % for Exercising Together and 84 % for UC . Median attendance of couples to Exercising Together sessions was 75 % . Men in Exercising Together became stronger in the upper body ( p < 0.01 ) and more physically active ( p < 0.01 ) than UC . Women in Exercising Together increased muscle mass ( p = 0.05 ) and improved upper ( p < 0.01 ) and lower body ( p < 0.01 ) strength and PPB scores ( p = 0.01 ) more than UC . Conclusions Exercising Together is a novel couples-based approach to exercise that was feasible and improved several health outcomes for both PCS and their spouses . Implication s for cancer survivorsA couples-based approach should be considered in cancer survivorship programs so that outcomes can mutually benefit both partners . Trial registration Clinical Trials.gov PURPOSE To evaluate yoga 's impact on inflammation , mood , and fatigue . PATIENTS AND METHODS A r and omized controlled 3-month trial was conducted with two post-treatment assessment s of 200 breast cancer survivors assigned to either 12 weeks of 90-minute twice per week hatha yoga classes or a wait-list control . The main outcome measures were lipopolysaccharide-stimulated production of proinflammatory cytokines interleukin-6 ( IL-6 ) , tumor necrosis factor alpha ( TNF-α ) , and interleukin-1β ( IL-1β ) , and scores on the Multidimensional Fatigue Symptom Inventory-Short Form ( MFSI-SF ) , the vitality scale from the Medical Outcomes Study 36-item Short Form ( SF-36 ) , and the Center for Epidemiological Studies -Depression ( CES-D ) scale . RESULTS Immediately post-treatment , fatigue was not lower ( P > .05 ) but vitality was higher ( P = .01 ) in the yoga group compared with the control group . At 3 months post-treatment , fatigue was lower in the yoga group ( P = .002 ) , vitality was higher ( P = .01 ) , and IL-6 ( P = .027 ) , TNF-α ( P = .027 ) , and IL-1β ( P = .037 ) were lower for yoga participants compared with the control group . Groups did not differ on depression at either time ( P > .2 ) . Planned secondary analyses showed that the frequency of yoga practice had stronger associations with fatigue at both post-treatment visits ( P = .019 ; P < .001 ) , as well as vitality ( P = .016 ; P = .0045 ) , but not depression ( P > .05 ) than simple group assignment ; more frequent practice produced larger changes . At 3 months post-treatment , increasing yoga practice also led to a decrease in IL-6 ( P = .01 ) and IL-1β ( P = .03 ) production but not in TNF-α production ( P > .05 ) . CONCLUSION Chronic inflammation may fuel declines in physical function leading to frailty and disability . If yoga dampens or limits both fatigue and inflammation , then regular practice could have substantial health benefits The purpose of the present paper was to evaluate the effects of an 8-week multimodal program focused on core stability exercises and recovery massage with DVD support for a 6-month period in physical and psychological outcomes in breast cancer survivors . A r and omized controlled clinical trial was performed . Seventy-eight ( n = 78 ) breast cancer survivors were assigned to experimental ( core stability exercises plus massage-myofascial release ) and control ( usual health care ) groups . The intervention period was 8 weeks . Mood state , fatigue , trunk curl endurance , and leg strength were determined at baseline , after the last treatment session , and at 6 months of followup . Immediately after treatment and at 6 months , fatigue , mood state , trunk curl endurance , and leg strength exhibited greater improvement within the experimental group compared to placebo group . This paper showed that a multimodal program focused on core stability exercises and massage  reduced fatigue , tension , depression , and improved vigor and muscle strength after intervention and 6 months after discharge Recent research has applied the theory of planned behavior ( TPB ) to underst and ing exercise after a cancer diagnosis , but studies are few and have been limited by retrospective design s , self-report measures of exercise and varied results . In the present study , we extended this research by using a prospect i ve design and an objective measure of exercise adherence . Participants were a convenience sample of 24 breast cancer survivors attending a twice weekly , 12-week training program in preparation for a dragon boat race competition . Participants completed a baseline question naire that assessed demographic and medical variables  , past exercise , and the TPB ( i.e. beliefs , subjective norm , attitude , perceived behavioral control and intention ) . Program attendance was monitored over a 12-week period by the class instructor . Overall , participants attended 66 % of the training sessions . Multiple regression analyses indicated that : ( a ) intention was the sole determinant of program attendance and explained 35 % of the variance ; ( b ) the TPB constructs explained 49 % of the variance in intention with subjective norm being the most important determinant ; and ( c ) the key underlying beliefs were support from physician , spouse , and friends , and confidence in being able to attend the training class when having limited time , no one to exercise with , fatigue , and other health problems . Based on this preliminary study , it was concluded that the TPB may provide a good framework on which to base interventions design ed to promote exercise in breast cancer survivors PURPOSE / OBJECTIVES To investigate the feasibility and preliminary effects of a simultaneous stage-matched exercise and diet ( SSED ) intervention in breast cancer survivors . DESIGN R and omized , controlled trial . SETTING Oncology outpatient treatment clinics at the National Cancer Center in South Korea . SAMPLE 45 women with breast cancer who completed their cancer therapy . METHODS Participants were assigned to the SSED intervention group ( n = 23 ) or a control group ( n = 22 ) . Participants in the SSED group received a 12-week individualized intervention promoting prescribed exercise and a balanced diet through stage-matched telephone counseling and a workbook . MAIN RESEARCH VARIABLES Program feasibility , behavioral outcomes ( stage of motivational readiness for exercise and diet , physical activity , and diet quality ) , and quality -of-life ( QOL ) outcomes ( functioning and global QOL , fatigue , anxiety , and depression ) . FINDINGS Participant evaluations of the SSED intervention indicated that it was feasible and acceptable . All women felt that the overall intervention contents were appropriate , and 95 % believed that the intervention helped to promote healthy behaviors . Objective data also supported the SSED intervention 's feasibility ( i.e. , 91 % completed the trial and 100 % of intervention calls were received ) . When compared to control , the SSED intervention group showed significantly greater improvement in motivational readiness for exercise and diet , emotional functioning , fatigue , and depression . CONCLUSIONS Preliminary results suggest that the SSED intervention delivered via telephone counseling and workbook is feasible and beneficial for positive behavioral and QOL outcomes . IMPLICATION S FOR NURSING Nurse-led lifestyle interventions may improve QOL for cancer survivors And rogen-deprivation therapy ( ADT ) for prostate cancer ( PCa ) has side effects that significantly impair health-related quality of life ( HRQOL ) . Exercise ameliorates many side effects of ADT , but different modalities , particularly in the home-based setting , have not been well studied . In this study the authors r and omly assigned 66 PCa survivors receiving ADT to 6 mo of home-based aerobic or resistance training .  Psychosocial well-being and physical fitness were measured at baseline , 3 and 6 mo , and then 6 mo postintervention . Intention-to-treat analyses showed that fatigue and HRQOL were not significantly different between groups ; however , in a per- protocol analysis the resistance-exercise training group demonstrated clinical ly significant improvements in HRQOL . Differential within-group effects on physical fitness were also observed at various time points . At all time points , the aerobic-training group engaged in significantly more physical activity than the resistance-training group , a finding that should be further examined given evidence -based guidelines for activity volume in cancer survivors OBJECTIVE To determine the feasibility and efficacy of a physical activity behavioural change intervention in managing cancer-related fatigue among gynaecological cancer survivors during and post anti-cancer treatments . METHODS A two arm , single blind , r and omised controlled trial was conducted within the Northern Irel and regional Cancer Centre . Thirty three sedentary gynaecological cancer survivors ( stage I-III ; ≤3 years post diagnosis ) , experiencing cancer-related fatigue ( mild-severe ) took part . Participants were r and omly assigned to a behavioural change , moderate intensity physical activity intervention ( n=16 ) or a Contact Control group ( n=17 ) . The primary outcome was fatigue ( Multidimensional Fatigue Symptom Inventory-Short Form and Functional Assessment in Chronic Illness Therapy-Fatigue subscale ) . Secondary outcomes included quality of life , physical functioning , positive and negative affect , depression , body composition , sleep dysfunction and self-reported physical activity . Feasibility was assessed based on the recruitment rate , programme and physical activity adherence and participants ' programme evaluation , including optional focus groups ( n=16 ) . RESULTS Twenty five percent of eligible women took part ( 33/134 ) . Participants were 8.7 ( SD=9.1 ) months post diagnosis , with a mean age of 53 ( SD=10.3 ) years . The majority of the sample had a diagnosis of ovarian ( n=12 ) or endometrial cancer ( n=11 ) . Significant differences favouring the intervention group were observed for fatigue at 12 weeks and 6 months follow-up ( 12 week : mean difference=-11.06 ; 95 % confidence interval (CI)=-21.89 to -0.23 ; effect size (d)=0.13 ; p=0.046 ; 6 month : mean difference=-19.48 ; 95 % CI=-19.67 to -19.15 ; effect size (d)=0.20 ; p=0.01 ) . A mean of 10 calls ( SD=1.2 calls ) were delivered to the Physical Activity Group , and 10 ( SD=1.6 calls ) to the CC group . The intervention was positively perceived based on exit question naire and focus group findings . CONCLUSIONS A physical activity behavioural change intervention for gynaecological cancer survivors is feasible in terms of participants ' programme adherence and evaluation , and the intervention demonstrates improvements in fatigue . However , confirmation in the form of a larger fully powered RCT is warranted Purpose Patients suffering from postcancer fatigue have both an inferior physical activity and physical fitness compared to non-fatigued cancer survivors . The aims of this study were ( 1 ) to examine the effect of cognitive behavior therapy , an effective treatment for postcancer fatigue , on physical activity and physical fitness and ( 2 ) to examine whether the effect of cognitive behavior therapy on postcancer fatigue is mediated by physical activity and /or physical fitness . Methods Severely fatigued cancer survivors were r and omly assigned to either the intervention ( cognitive behavior therapy ) or the waiting list condition . After assigning 23 patients in the intervention condition and 14 patients in the waiting list condition  , they were assessed both at baseline and 6 months later . Physical activity was assessed via actigraphy and physical fitness was assessed by a maximal exercise test . A nonparametric bootstrap approach was used to test the statistical significance of the mediation effects . Results A significant increase in physical activity was observed in the intervention group from baseline to follow-up , whereas physical activity did not change from baseline to follow-up in the waiting list group . Physical fitness did not significantly change after cognitive behavior therapy or after 6 months of waiting for therapy .  Fatigue decreased more significantly in the intervention group than in the waiting list group . The mediation hypotheses were rejected . Conclusions Cognitive behavior therapy effectively reduced postcancer fatigue and increased physical activity but did not change physical fitness . The effect of cognitive behavior therapy on postcancer fatigue is not mediated by a change in physical activity or physical fitness PURPOSE Increased physical activity in patients with colorectal cancer is related to improved recurrence-free and overall survival . Psychological distress after cancer may place patients at risk of reduced physical activity , but paradoxically may also act as a motivator for lifestyle change . The relationship between psychological distress and physical activity after cancer over time has not been described . METHODS A prospect i ve survey of 1,966 ( 57 % response ) colorectal cancer survivors assessed the psychological distress variables of anxiety , depression , somatization , and cancer threat appraisal  as predictors of  physical activity  at 5 , 12 , 24 , and 36 months postdiagnosis ; 978 respondents had valid data for all time points . RESULTS Higher somatization was associated with greater physical inactivity ( relative risk ratio [ RRR ] = 1.12 ; 95 % CI , 1.1 to 1.2 ) and insufficient physical activity ( RRR = 1.05 ; 95 % CI , 0.90 to 1.0 ) . Respondents with a more positive appraisal of their cancer were significantly ( P = .031 ) less likely to be inactive ( RRR = 0.95 ; 95 % CI , 0.90 to 1.0 ) or insufficiently active ( RRR = 0.96 ) . Fatigued and obese respondents and current smokers were more inactive . Respondents whose somatization increased between two time periods were less likely to increase their physical activity over the same period ( P < .001 ) . Respondents with higher anxiety at one time period were less likely to have increased their activity at the next assessment ( P = .004 ) . There was no association between depression and physical activity . CONCLUSION Cancer survivors who experience somatization and anxiety are at greater risk of physical inactivity . The lack of a clear relationship between higher psychological distress and increasing physical activity argues against distress as a motivator to exercise in these patients Purpose The purpose of the study was to compare the quality of life ( QoL ) , fatigue and mental distress in survivors of malignant extremity bone tumours ( EBT survivors ) with age and gender-matched survivors of Hodgkin ’s disease ( HD survivors ) and testicular cancer ( TC survivors ) as well as normative sample s from the general population . Patients and methods Five years or more after end of treatment , 75 EBT survivors were mailed a question naire containing Short Form-36 ( SF-36 ) , the Hospital Anxiety and Depression Scale , the Fatigue Question naire and questions about demography .  Fifty-eight EBT survivors responded . TC survivors , HD survivors and normative sample s ( NORMs ) had earlier on filled in the same question naire . For EBT survivors , gender and age-matched controls were r and omly selected among TC survivors , HD survivors and NORMs . Results No significant differences in the fatigue or mental distress scores were observed between the survivor groups . The EBT survivors had significantly higher fatigue scores and lower depression scores than NORMs and significantly lower scores on all physical dimensions of QoL than TC survivors , HD survivors and NORMs . In multivariate analysis , a low level of education and lack of employment were significantly associated with caseness of mental distress . Older age at survey , female gender , being an EBT survivor and lack of employment were associated with caseness on the SF-36 Physical Component Summary Scale . Conclusion At long-term follow-up , EBT survivors did not show impaired mental health or fatigue at the group level , although their post-treatment status was characterised by reduced QoL dimensions on physical function compared to TC survivors , HD survivors and NORMs The aim of the study was to assess the feasibility and effectiveness of aquatic-based exercise in the form of deep water running ( DWR ) as part of a multimodal physiotherapy programme ( MMPP ) for breast cancer survivors . A controlled clinical trial was conducted in 42 primary breast cancer survivors recruited from community-based Primary Care Centres . Patients in the experimental group received a MMPP incorporating DWR , 3 times a week , for an 8-week period . The control group received a leaflet containing instructions to continue with normal activities . Statistically significant improvements and intergroup effect size were found for the experimental group for Piper Fatigue Scale-Revised total score ( d = 0.7 , P = 0.001 ) , as well as behavioural/severity ( d = 0.6 , P = 0.05 ) , affective/meaning ( d = 1.0 , P = 0.001 ) and sensory ( d = 0.3 , P = 0.03 ) domains . Statistically significant differences between the experimental and control groups were also found for general health ( d = 0.5 , P < 0.05 ) and quality of life ( d = 1.3 , P < 0.05 ) . All participants attended over 80 % of sessions , with no major adverse events reported . The results of this study suggest MMPP incorporating  DWR decreases cancer-related fatigue and improves general health and quality of life in breast cancer survivors . Further , the high level of adherence and lack of adverse events indicate such a programme is safe and feasible PURPOSE S/ OBJECTIVES To compare sleep quality and disturbance , fatigue , and depressive symptoms between breast cancer survivors and healthy women experiencing hot flashes and to examine relationships among sleep and remaining variables ( fatigue , depressive symptoms , and frequency of hot flashes ) . DESIGN Cross-sectional , descriptive , comparative pilot study . SETTING University-based outpatient setting . SAMPLE 15 breast cancer survivors and 15 healthy women matched on age , race , and menopausal status . All women had untreated hot flashes ( no hormone replacement therapy or other hot flash treatments ) . METHODS Question naires ( sleep quality and disturbance , fatigue , and depression ) ; two ambulatory , 24-hour sternal skin conductance monitoring sessions ( hot flash frequency ) ; and medical records review . MAIN RESEARCH VARIABLES Sleep quality and disturbance , fatigue , depressive symptoms , and objective hot flash frequency . FINDINGS The majority of participants evidence d poor sleep quality and high sleep disturbance ( 73 % of breast cancer survivors and 67 % of healthy women above a cutoff score of 5 ) . Sleep duration was significantly shorter for breast cancer survivors in contrast to healthy women . Nighttime flashes were experienced by 67 % of breast cancer survivors and 37 % of healthy women . No group differences were found in fatigue , depressive symptoms , or objective hot flash frequency . Global sleep scores were significantly positively correlated with fatigue and depression but not with hot flash frequency . CONCLUSIONS Findings suggest that sleep disturbance is common in menopausal breast cancer survivors and healthy women , is not necessarily related to hot flashes , and may stem from a multifactorial etiology . IMPLICATION S FOR NURSING Menopausal breast cancer survivors who present with any one of these symptoms should be screened for all symptoms both during and after treatment OBJECTIVES To determine the feasibility of an eccentric resistance exercise training protocol in men with prostate cancer and to assess whether men with prostate cancer who are receiving and rogen deprivation therapy ( ADT ) have a blunted effect from the training as compared with prostate cancer survivors not receiving ADT . DESIGN Prospect i ve pilot study . SETTING Academic medical center . PARTICIPANTS Sixteen men with prostate cancer ( Gleason scores 3 + 3 to 4 + 4 ) were initially enrolled . Ten men ( mean age 66 , range 48 - 86 ) completed the study , 5 were currently receiving ADT . Analysis was performed on these 10 men . INTERVENTIONS Subjects were evaluated at baseline . All men underwent a 12-week resistance exercise training protocol using a recumbent , high-force eccentric , leg cycle ergometer 3 times per week at a " somewhat hard " perceived exertion for 12 to 15 minutes . Preexercise and postexercise training changes were examined within and between groups . MAIN OUTCOME MEASURES Quadriceps muscle volume ( magnetic resonance imaging ) , isometric knee extension strength , functional mobility ( Timed Up and Go Test [ TUG ] and 6-minute walk [ 6MW ] ) , health-related quality of life ( FACT-P ) , and fatigue ( FACIT-fatigue scale ) . RESULTS The ADT group demonstrated significant within-group improvements in the 6MW ( P = .01 ) and isometric knee extension strength ( P = .03 ) . This group also demonstrated a clinical ly relevant change in the FACT-P ; however , this did not meet statistical significance . The  non-ADT  group demonstrated significant within-group improvements in the physical subscale of the FACT-P ( P = .03 ) and an increase in muscle volume ( P = .04 ) . Their improvements in the TUG approached significance ( P = .08 ) . No between-group differences existed . CONCLUSIONS Eccentric resistance exercise was well tolerated , and both groups derived some benefits in strength and functional mobility .  Men receiving ADT  did not appear to have a blunted response to the exercise as compared with prostate cancer survivors not receiving ADT Abstract Minority recruitment to cancer trials is low and there are limited data on minority adherence to lifestyle modification interventions . We examined factors related to recruitment and adherence to a pilot weight loss intervention among Hispanic and black breast cancer survivors . Participants completed a detailed screening interview to assess barriers to enrollment . An index was created to assess adherence at 6 months . 112 potentially eligible women were identified ; 66 consented and completed a screening interview . After screening , 9 were ineligible ; 15 opted to not enroll ; and 42 were r and omized . Among eligible women , earlier stage at diagnosis , treatment type , and negative beliefs related to exercise and diet after diagnosis were negatively associated with study enrollment ( P < 0.05 ) . Self-reported barriers to adherence included fatigue , family responsibilities , illness , work , transportation , and negative perceptions of exercise and diet . Results from this study emphasize the need to adapt recruitment and adherence strategies to address these factors The purpose of this review is to summarize literature that describes the impact of exercise on health and physical function among children during and after treatment for cancer . Relevant studies were identified by entering the following search terms into Pubmed : aerobic training ; resistance training ; stretching ; pediatric ; children ; AND cancer . Reference lists in retrieved manuscripts were also review ed to identify additional trials . We include fifteen intervention trials published between 1993 and 2011 that included children younger than age 21 years with cancer diagnoses . Nine included children with an acute lymphoblastic leukemia ( ALL ) diagnosis , and six children with mixed cancer diagnoses . Generally , interventions tested were either in-hospital supervised exercise training or home based programs design ed to promote physical activity . Early evidence from small studies indicates that the effects of exercise include increased cardiopulmonary fitness , improved muscle strength and flexibility , reduced fatigue and improved physical function . Generalizations to the entire childhood cancer and childhood cancer survivor population s are difficult as most of the work has been done in children during treatment for and among survivors of ALL . Additional r and omized studies are needed to confirm these benefits in larger population s of children with ALL , and in population s with cancer diagnoses other than ALL Background Research suggests that cancer rehabilitation reduces fatigue in survivors of cancer . To date , it is unclear what type of rehabilitation is most beneficial . Objective This r and omized controlled trial compared the effect on cancer-related fatigue of physical training combined with cognitive behavioral therapy with physical training alone and with no intervention . Design In this multicenter r and omized controlled trial , 147 survivors of cancer were r and omly assigned to a group that received physical training combined with cognitive-behavioral therapy ( PT+CBT group , n=76 ) or to a group that received physical training alone ( PT group , n=71 ) . In addition , a nonintervention control group ( WLC group ) consisting of 62 survivors of cancer who were on the waiting lists of rehabilitation centers elsewhere was included . Setting The study was conducted at 4 rehabilitation centers in the Netherl and s. Patients All patients were survivors of cancer . Intervention Physical training consisting of 2 hours of individual training and group sports took place twice weekly , and cognitive-behavioral therapy took place once weekly for 2 hours . Measurements Fatigue was assessed with the Multidimensional Fatigue Inventory before and immediately after intervention ( 12 weeks after enrollment ) . The WLC group completed question naires at the same time points . Results Baseline fatigue did not differ significantly among the 3 groups . Over time , levels of fatigue significantly decreased in all domains in all groups , except in mental fatigue in the WLC group . Analyses of variance of postintervention fatigue showed statistically significant group effects on general fatigue , on physical and mental fatigue , and on reduced activation but not on reduced motivation . Compared with the WLC group , the PT group reported significantly greater decline in 4 domains of fatigue , whereas the PT+CBT group reported significantly greater decline in physical fatigue only . No significant differences in decline in fatigue were found between the PT+CBT and PT groups . Conclusions Physical training combined with cognitive-behavioral therapy and physical training alone had significant and beneficial effects on fatigue compared with no intervention . Physical training was equally effective as or more effective than physical training combined with cognitive-behavioral therapy in reducing cancer-related fatigue , suggesting that cognitive-behavioral therapy did not have additional beneficial effects beyond the benefits of physical training Objective : To investigate the impact of aquatic exercise on pressure pain threshold in breast cancer survivors with hormone therapy-associated arthralgia . Design : Single-blind , controlled trial . Setting : Two major metropolitan hospitals and a Sport and Spa Club in Granada , Spain . Subjects : Forty women aged 29–71 years with stage I – III breast cancer who reported arthralgia . Intervention : Patients were allocated alternately to either aquatic exercise in a chest-high pool or usual care while on the waiting list ; control patients received treatment later . The two-month hydrotherapy intervention consisted of 24 sessions 3 days per week . Each session included 5 minutes of warm-up , 15–20 minutes of aerobic exercise , 15 minutes of mobility exercise and 20 minutes of recovery techniques . Main measures : Pressure pain threshold at neck , shoulder , h and and leg were evaluated as primary outcomes . Cancer-related fatigue , as measured by the Piper Fatigue Scale , body mass index and waist circumference were secondary outcomes . A 2 × 2 repeated-measure ANCOVA was used in this study . Results : No adverse events or development of worsening of pain was observed . Almost all the participants in the intervention group ( 89 % ) adhered to the hydrotherapy programme . Participants experienced a decrease in pressure pain threshold measured in neck , h and , shoulder and leg , as measured by algometry pressure , and waist circumference ; all P < 0.05 . Cancer-related fatigue ( P = 0.06 ) and body mass index ( P = 0.42 ) did not show significant improvement . Conclusions : These data suggest that hydrotherapy in a chest-high pool may reduce the pain threshold and waist circumference in breast cancer survivors with hormone therapy-associated arthralgia PURPOSE Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles , but few studies have developed translatable health behavior change interventions . This study aim ed to determine the effects of a telephone-delivered multiple health behavior change intervention ( CanChange ) on health and behavioral outcomes among colorectal cancer survivors . METHODS In this two-group r and omized controlled trial , 410 colorectal cancer survivors were r and omly assigned to the health coaching intervention ( 11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity , weight management , dietary habits , alcohol , and smoking ) or usual care . Assessment of primary ( ie , physical activity [ Godin Leisure Time Index ] , health-related quality of life [ HRQoL ; Short Form-36 ] , and cancer-related fatigue [ Functional Assessment of Chronic Illness Therapy Fatigue Scale ] ) and secondary outcomes ( ie , body mass index [ kg/m(2 ) ] , diet and alcohol intake [ Food Frequency Question naire ] , and smoking ) were conducted at baseline and 6 and 12 months . RESULTS At 12 months , significant intervention effects were observed for moderate physical activity ( 28.5 minutes ; P = .003 ) , body mass index ( -0.9 kg/m(2 ) ; P = .001 ) , energy from total fat ( -7.0 % ; P = .006 ) , and energy from saturated fat ( -2.8 % ; P = .016 ) . A significant intervention effect was reported for vegetable intake ( 0.4 servings per day ; P = .001 ) at 6 months . No significant group differences were found at 6 or 12 months for HRQoL , cancer-related fatigue , fruit , fiber , or alcohol intake , or smoking . CONCLUSION The CanChange intervention was effective for improving physical activity , dietary habits , and body mass index in colorectal cancer survivors . The intervention is translatable through existing telephone cancer support and information services in Australia and other countries Background : Physical activity is associated with reductions in fatigue in breast cancer survivors . However , mechanisms underlying this relationship are not well-understood . The purpose of this study was to longitudinally test a model examining the role of self-efficacy and depression as potential mediators of the relationship between physical activity and fatigue in a sample of breast cancer survivors using both self-report and objective measures of physical activity . Methods : All participants ( N = 1,527 ) completed self-report measures of physical activity , self-efficacy , depression , and fatigue at baseline and 6 months . A sub sample was r and omly selected to wear an accelerometer at both time points . It was hypothesized that physical activity indirectly influences fatigue via self-efficacy and depression . Relationships among model constructs were examined over the 6-month period using panel analysis within a covariance modeling framework . Results : The hypothesized model provided a good model- data fit ( χ2 = 599.66 , df = 105 , P ≤ 0.001 ; CFI = 0.96 ; SRMR = 0.02 ) in the full sample when controlling for covariates . At baseline , physical activity indirectly influenced fatigue via self-efficacy and depression . These relationships were also supported across time . In addition , the majority of the hypothesized relationships were supported in the sub sample with accelerometer data ( χ2 = 387.48 , df = 147 , P ≤ 0.001 , CFI = 0.94 , SRMR = 0.04 ) . Conclusions : This study provides evidence to suggest the relationship between physical activity and fatigue in breast cancer survivors may be mediated by more proximal , modifiable outcomes of physical activity participation . Impact : Recommendations are made relative to future applications and research concerning these relationships . Cancer Epidemiol Biomarkers Prev ; 22(5 ) ; 773–81 . © 2013 AACR Background . In the earlier stages of prostate cancer , effective treatments have created a need for research to focus on practice s that may improve quality of life throughout survivorship . Physical activity is a significant supportive care management strategy for prostate cancer survivors , though the optimal modality is not yet understood . Hypotheses . The authors hypothesized that yoga would be a feasible physical activity option for prostate cancer survivors and their support persons and that the incorporation of social support would increase physical activity adherence . Methods . This 14-week feasibility study involved a 7-week class-based yoga program ( adherence phase ) , followed by 7 weeks of self-selected physical activity ( maintenance phase ) . Demographic information , physical activity behavior , quality of life , fatigue , stress , mood , and fitness variables were assessed at 3 time points . Prostate cancer survivors ’  perceived social support was rated during yoga and after yoga . Results . Class attendance was 6.1 and 5.8 for prostate cancer survivors ( n = 15 ) and their support persons ( n = 10 ) , respectively , for the 7 classes . Levels of perceived social support were higher for those who brought a support person . Significant improvements with regard to stress , fatigue , and mood before and after yoga class ( all Ps < .05 ) were reported by all participants . No clinical ly significant changes were noted on prostate cancer survivor ’s quality of life or fatigue over the course of the 14-week study . Conclusions . Yoga is a feasible physical activity option for prostate cancer survivors . The program had a promising uptake rate , high program adherence rate , and there were acute program benefits with regard to stress , fatigue , and mood for all participants . Future examination is warranted with regard to chronic benefits and group cohesion influences on levels of perceived social support Background Loss of lean body mass ( LBM ) is a common occurrence after treatment for breast cancer and is related to deleterious metabolic health outcomes [ Clin Oncol , 22(4):281–288 , 2010 ; Appl Physiol Nutr Metab , 34(5):950–956 , 2009 ] . The aim of this research is to determine the effectiveness of long chain omega-3 fatty acids ( LCn-3s ) and exercise training alone , or in combination , in addressing LBM loss in breast cancer survivors . Methods / design A total of 153 women who have completed treatment for breast cancer in the last 12 months , with a Body Mass Index ( BMI ) of 20 to 35 kg/m2 , will be r and omly assigned to one of 3 groups : 3g/d LCn-3s ( N-3 ) , a 12-week nutrition and exercise education program plus olive oil ( P-LC ) or the education program plus LCn-3s ( EX+N-3 ) . Participants r and omised to the education groups will be blinded to treatment , and will receive either olive oil placebo ( OO+N-3 ) or LCn-3 provision , while the N-3 group will be open label . The education program includes nine 60 - 75min sessions over 12 weeks that will involve breast cancer specific healthy eating advice , plus a supervised exercise session run as a resistance exercise circuit . They will also be advised to conduct the resistance training and aerobic training 5 to 7 days per week collectively . Outcome measures will be taken at baseline , 12-weeks and 24-weeks . The primary outcome is % change in LBM as measured by the air displacement plethysmograhy . Secondary outcomes include quality of life ( FACT-B + 4 ) and inflammation ( C-Reactive protein : CRP ) . Additional measures taken will be erythrocyte fatty acid analysis , fatigue , physical activity , menopausal symptoms , dietary intake , joint pain and function indices . Discussion This research will provide the first insight into the efficacy of LCn-3s alone or in combination with exercise in breast cancer survivors with regards to LBM and quality of life . In addition , this study is design ed to improve evidence -based dietetic practice , and how specific dietary prescription may link with appropriate exercise interventions .Trials registration ACTRN12610001005044 ; and World Health Organisation Universal trial number : U1111 - 1116 - 8520 The lifestyle recommendations of the World Cancer Research Fund (WCRF)/American Institute for Cancer Research ( AICR ) are primarily intended for cancer prevention . In the absence of specific recommendations for cancer survivors , we investigated adherence of colorectal cancer ( CRC ) survivors to the WCRF/AICR lifestyle recommendations and associations with health-related quality of life ( HRQoL ) . The cross-sectional part of the Energy for life after ColoRectal cancer ( EnCoRe ) study was conducted in 155 CRC survivors ( stage I-III ) , 2 - 10 years post diagnosis .  Dietary intake , physical activity and general body fatness  were measured by 7-d food diaries , by question naires and accelerometers and BMI , respectively . Adherence to each of the ten WCRF/AICR recommendations was scored as 0 ( no/low adherence ) , 0·5 ( moderate adherence ) or 1 point ( complete adherence ) , and summed into an overall adherence score ( range : 0 - 10 ) . HRQoL , disability and distress were assessed by vali date d question naires . Associations of the overall WCRF/AICR adherence score with HRQoL outcomes were analysed by confounder-adjusted linear regression . The mean adherence score was 5·1 ( sd 1·4 , range : 1·5 - 8·5 ) . In confounder-adjusted models , a higher adherence score was significantly associated with the HRQoL dimension better physical functioning ( β per 1 point difference in score : 2·6 ; 95 % CI 0·2 , 5·1 ) and with less fatigue ( β : -3·3 ; 95 % CI -6·4 , -0·1 ) . In conclusion , higher adherence of CRC survivors to WCRF/AICR lifestyle recommendations for cancer prevention was associated with better physical functioning and with less fatigue . This study adds to the limited knowledge on adherence to lifestyle behaviours in CRC survivors and relationships with quality of life . Prospect i ve studies are needed to investigate longitudinal associations 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 Introduction Many breast cancer survivors experience persistent physical symptoms of cancer and treatment that can decrease health-related quality of life ( HRQOL ) . This prospect i ve study investigated  physical activity ( PA )  , occurrence of physical symptoms , and HRQOL in a large , ethnically-diverse cohort of breast cancer survivors . Material s and methods Survivors ( n = 545 ) , on average 6 months post-diagnosis , were assessed in person or by mail at baseline ( retrospective reports of pre-diagnosis PA ) , at 29 months post-diagnosis ( post-diagnosis PA ) , and at 39 months post-diagnosis ( pain , hormone symptoms , sexual interest/dysfunction , fatigue , physical subscales of HRQOL ) . Linear regression and analysis of covariance assessed the relationships between pre- and post-diagnosis PA and PA change after cancer with symptoms and HRQOL . Results Greater pre-diagnosis PA was associated with better physical functioning at 39 months ( βs 1.1–2.3 ; all p < 0.01 ) but was generally unrelated to symptoms . Greater post-diagnosis sports/recreational PA was related to less fatigue and better physical functioning ( βs −0.146 , 2.21 ; both p < 0.01 ) .  Increased PA  after cancer was related to less fatigue and pain and better physical functioning ( all p < 0.01 ) . Significant positive associations were found for moderate to vigorous and vigorous sports/recreation PA , not household activity . Results were similar for Hispanic and non-Hispanic White women . Discussion / conclusions  Increased PA , especially after cancer , was consistently related to better physical functioning and to reduced fatigue and bodily pain , underscoring the need for PA promotion among survivors . Implication s for cancer survivorsSurvivors may be able to decrease fatigue and bodily pain and be better able to pursue daily activities through increasing recreational PA after cancer BACKGROUND Mind-body therapies such as Tai Chi are widely used by breast cancer survivors , yet effects on inflammation are not known . This study hypothesized that Tai Chi Chih ( TCC ) would reduce systemic , cellular , and genomic markers of inflammation as compared with cognitive behavioral therapy for insomnia ( CBT-I ) . METHODS In this r and omized trial for the treatment of insomnia , 90 breast cancer survivors with insomnia were assigned to TCC or CBT-I for 2-hour sessions weekly for 3 months . At baseline and postintervention , blood sample s were obtained for measurement of C-reactive protein and toll-like receptor-4-activated monocyte production of interleukin-6 ( IL-6 ) and tumor necrosis factor-α ( TNF ) , with a r and om sub sample ( n = 48 ) analyzed by genome-wide transcriptional profiling . RESULTS Levels of C-reactive protein did not change in the TCC and CBT-I groups . Levels of toll-like receptor-4-activated monocyte production of IL-6 and TNF combined showed an overall reduction in TCC versus CBT-I ( P < .02 ) , with similar effects for IL-6 ( P = .07 ) and TNF ( P < .05 ) alone . For genome-wide transcriptional profiling of circulating peripheral blood mononuclear cells , expression of genes encoding proinflammatory mediators showed an overall reduction in TCC versus CBT-I ( P = .001 ) . TELiS promoter-based bioinformatics analyses implicated a reduction of activity of the proinflammatory transcription factor , nuclear factor-κB , in structuring these differences . CONCLUSIONS Among breast cancer survivors with insomnia , 3 months of TCC reduced cellular inflammatory responses , and reduced expression of genes encoding proinflammatory mediators . Given the link between inflammation and cancer , these findings provide an evidence -based molecular framework to underst and the potential salutary effects of TCC on cancer survivorship OBJECTIVE To evaluate a patient education program that aims at reducing perceived fatigue in cancer survivors . METHODS In ten German centres , 261 patients with cancer-related fatigue were r and omly assigned to a patient education program consisting of 6 sessions à 90 min or st and ard care . The primary outcome measure was cancer-related fatigue . Data were analysed using analysis of variance ( ANOVA ) with repeated measures . RESULTS Patients in the intervention group showed statistically significant reduction in cancer-related fatigue ( F = 76.510 , p < 0.001 , η(2 ) = 0.248 ) . Secondary outcomes also showed significant improvements in all measures , including quality of life ( F = 29.607 , p < 0.001 , η(2 ) = 0.113 ) , general self-efficacy ( F = 27.680 , p < 0.001 , η(2 ) = 0.107 ) , exercise self-efficacy ( F = 49.230 , p < 0.001 , η(2 ) = 0.175 ) , physical activity ( F = 8.036 , p < 0.001 , η(2 ) = 0.033 ) , anxiety ( F = 33.194 , p < 0.001 , η(2 ) = 0.125 ) , depression ( F = 24.604 , p < 0.001 , η(2 ) = 0.096 ) , and fatigue knowledge ( F = 55.157 , p < 0.001 , η(2 ) = 0.192 ) . CONCLUSION The program was effective in reducing perceived fatigue as well as further outcomes . PRACTICE IMPLICATION S This newly developed education program has the potential to fill a gap in the care of cancer survivors . The program needs further evaluation in other countries employing a control group of patients receiving equal time and attention as the intervention group Purpose . Despite mounting evidence indicating that exercise training has a positive effect on cancer recovery , the influence of cancer type on the response to exercise training remains uncharacterized . Therefore , the adaptations to exercise training were compared between groups composed of 7 different forms of cancer . Methods . A total of 319 cancer survivors completed fatigue inventories and participated in assessment s of cardiorespiratory function , which encompassed aerobic capacity ( VO2peak ) , pulmonary function ( forced vital capacity [ FVC ] and forced expiratory volume in 1 second [ FEV1 ] ) , and resting blood pressure and heart rate . Participants were divided into 7 groups based on cancer type , including breast cancer ( BC , n = 170 ) , prostate cancer and other male urogenital neoplasia ( PC , n = 38 ) , hematological malignancies ( HM , n = 34 ) , colorectal cancer ( CC , n = 25 ) , gynecological cancers ( GC , n = 20 ) , gl and ular and epithelial neoplasms ( GEN , n = 20 ) , and lung cancer ( LC , n = 12 ) . All participants completed an individualized , multimodal exercise intervention consisting of cardiorespiratory , flexibility , balance , and muscular strength training 3 days per week for 3 months . Following the intervention , all subjects were reassessed . Generalized Estimating Equations with exchangeable working correlation structure was used to model each response ; the group by time interaction effect represented the effect of cancer type on exercise-associated improvements . Results . No significant ( P > .05 ) group by time interaction effects were observed between different types of cancer for any parameter . Pre- to postexercise contrasts revealed significant improvements in VO2peak in BC , PC , HM , and GEN at the Bonferroni adjusted significance level ( .00714 ) . Heart rate was significantly lowered in the BC and CC groups . Mean fatigue indices decreased by at least 17 % in all groups , but these changes were only significant in the BC , HM , CC , and GC groups . Systolic blood pressure decreased significantly in BC and GC , and diastolic blood pressure decreased significantly only in the BC group while pulmonary function remained unchanged in all cancer types . Conclusion . Although trends toward improved cardiorespiratory and fatigue parameters only reached significance in some groups , there were no significant differences between cancer types . This suggests that cardiorespiratory and fatigue improvements following rehabilitative exercise are not dependent on cancer type . Further research investigating alternative physiological parameters are needed to confirm the relationship between cancer type and exercise-mediated rehabilitation
A significant negative association was found between aerobic exercise intensity and fatigue reduction .
A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance .
No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes .
Rates of adherence were typically high and few adverse events were reported .
Exercise is safe , reduces fatigue and increases endurance in cancer survivors .
QUESTION Is there a dose-response effect of exercise on inflammation , fatigue and activity in cancer survivors ?