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C-16 Thematic Poster - Exercise in Cancer Patients (Clinical Exercise Physiology Association)

Medicine & Science in Sports & Exercise: May 2013 - Volume 45 - Issue 5S - p 213–215
doi: 10.1249/01.mss.0000433654.36207.73

May 30, 2013, 8:00 AM - 10:00 AM

Room: 206

990 Chair: Katharina Schmidt. Department of Sports Medicine, Goethe University Frankfurt/Main, Frankfurt, Germany.

(No relationships reported)

991 Board #1 May 30, 8:00 AM - 10:00 AM

Examination Of Balance In Early-stage Female Breast Cancer Survivors Who Have Undergone Chemotherapy

Charlotte Shatten, Claudio L. Battaglini, J. Troy Blackburn, Johna Register-Mihalik, Anthony C. Hackney, FACSM. UNC-Chapel Hill, Chapel Hill, NC.

(No relationships reported)

PURPOSE: To compare breast cancer survivors (BCS) and apparently healthy, sedentary age-matched controls (CNT) on clinical and laboratory measures of static balance.

METHODS: Balance was assessed during single leg stance (SLS) with the eyes open and closed. Laboratory (center of pressure sway speed (SS) and sway path (SP)) and clinical (timed SLS) measures of balance were assessed simultaneously in 10 BCS and 10 CNT. The NeuroCom Sensory Organization Test and vibratory sensation were assessed to identify vestibular and somatosensory contributions to potential balance deficits. Dependent t-tests were used to compare each variable between groups.

RESULTS: : No significant group differences were identified between clinical and laboratory balance measures (p>0.05). However, vibration sensation threshold of the first metatarsophalangeal joint was greater in BCS vs. CNT for the right foot (19.43 ± 11.34 vs. 10.16 ± 2.32 V, p=0.03) and approached significance on left foot (16.86 ± 8.26 vs. 11.53 ± 4.22 V, p=0.07).

CONCLUSIONS: Although no significant differences in static balance were observed between groups, significant differences in vibration sensation, an assessment of peripheral sensory function, suggest that neuromuscular dysfunction is present in BCS patients. Future research is necessary to determine if the lack of an influence on balance is due to compensatory mechanisms and if balance deficits in these individuals, which are frequently anecdotally reported, are more evident during assessments of dynamic balance (e.g. during walking).

992 Board #2 May 30, 8:00 AM - 10:00 AM

Predicted Vs. Measured Vo2 Peak In Overweight And Obese Hormone-negative Breast Cancer Survivors

Daniel Bonner, Anne Swisher, Diana Gilleland, Jame Abraham, Jessica Garcia, Gerald Hobbs, Sobha Kurian, Alexandra Reynolds, Brittany Watts, Mary Anne Yanosik, Linda Vona-Davis. West Virginia University, Morgantown, WV. (Sponsor: William T. Stauber, FACSM)

(No relationships reported)

PURPOSE: Obesity and physical inactivity have been linked to higher risk of developing breast cancer as well as poorer outcomes of treatment.

These risks may be especially high for women with hormone-receptor negative cancers. Unlike other forms of cancer, breast cancer treatment often leads to weight gain, thus weight management is a critical issue for survivors. We developed a program, Get Fit for the Fight ® that aims to reduce obesity through adoption of regular physical activity and healthy eating behaviors. One outcome of the program is maximal aerobic capacity. The purpose of this study was to determine the relationship between predicted and measured peak oxygen consumption (VO2peak) in overweight and obese breast cancer survivors.

METHODS: To date, 23 women (mean age 53.6 yrs) who were at least 12 months after completion of treatment for hormone-receptor negative breast cancer with a BMI > 25 (mean 31.3 kg/m2) have been enrolled into the study. At baseline, all women underwent full cardiopulmonary exercise testing to volitional maximal levels using a modified Balke treadmill protocol with measured expired gas analysis. Measured VO2peak was compared to VO2peak predicted from standard equations utilizing treadmill speed and grade. A t-test was performed to determine difference and significance was set at p < 0.05.

RESULTS:: At baseline, mean measured VO2 peak was 19.9 ml/kg/min (SD = 4.9), which was significantly (p<0.01) higher than predicted values (mean 16.7 ml/kg/min; SD = 1.7). Measured VO2peak values were higher than predicted in 19 of 23 subjects (83%). Mean exercise time on the test was 13.2 min (SD = 3.3 min). Mean maximal respiratory exchange ratio (RER) was 1.05 (SD = 0.7) and mean maximal heart rate was 163 beats/min (SD = 24.5), both of which were indicators of maximal effort on the test.

CONCLUSIONS: Predicting VO2peak from peak workload on a treadmill test significantly underestimates measured VO2 peak in overweight/obese survivors of triple-negative breast cancer. This lack of agreement may reflect changes in exercise metabolism due to either breast cancer or its treatment. Measured, not predicted, values should be used in this population. Funding: WV EPSCoR # EPS08-07; Oncology Section, American Physical Therapy Association Clinical Trial Registration: NCT01498536

993 Board #3 May 30, 8:00 AM - 10:00 AM

Does Cardiorespiratory Fitness Influence Cognitive Function In Breast Cancer Survivors Reporting Cancer-associated Cognitive Changes?

Kristin L. Campbell, Julia W.Y. Kam, Sherri Hayden, Sarah E. Neil, Amy A. Kirkham, Todd C. Handy, Lara A. Boyd, Teresa Y.L. Liu-Ambrose. University of British Columbia, Vancouver, BC, Canada. (Sponsor: Kerri Winters-Stone, FACSM)

(No relationships reported)

Many cancer survivors report changes in their ability to remember, think and problem solve associated with cancer treatment; commonly called “chemo brain”. Recent evidence suggests a positive relationship between cardiorespiratory fitness and cognitive function. We investigated whether cardiorespiratory fitness is associated with cognitive function in women reporting cognitive changes following treatment for breast cancer and in women who have not had cancer.

METHODS: Breast cancer survivors (BCS) reporting cognitive changes up to 3 years following treatment for breast cancer (N=12) and healthy controls (CON) (N=8) completed a maximal graded treadmill test with expired gas collection (VO2peak) as well as a battery of neuropsychological tests for verbal learning and memory (Hopkins Verbal Learning Test) (HVLT), information processing speed and executive function (Trails Making A & B), verbal fluency (FAS test and animal naming). The impact of cognitive function on quality of life using a cancer-specific self-report questionnaire (FACT-Cog) was administered to BCS only.

RESULTS: BCS were younger than CON; BSC 53.4 (6.5) vs. 59.8 (3.7) yrs, p=0.02. There was no difference between groups in VO2peak; BCS 26.5 (6.9) vs. CON 27.8 (4.9) ml/kg/min, p=0.64. Compared to CON, BCS had a significantly lower performance on both the first learning trial (LT1) (6.67 vs. 8.75, p=0.02) and total recall (23.5 vs. 30.1, p=0.01) of the HVLT. In BCS, there was no association between FACT-Cog and VO2peak. There was no association between VO2peak and neuropsychological test performance in all participants combined or in either group alone. When controlling for VO2peak or age, group remained significant for performance on LT1 (p=0.04 and 0.02, respectively) and total recall (p=0.01 and 0.03, respectively).

CONCLUSION: Breast cancer survivors reporting cognitive changes following treatment for breast cancer had lower performance on tasks of verbal memory compared to women who have not had breast cancer. However, there was no association between cardiorespiratory fitness and neuropsychological test performance.

994 Board #4 May 30, 8:00 AM - 10:00 AM

Effect of Exercise on Physical Capacity and Quality of Life Outcomes in Breast Cancer Patients

Eduardo M. Oliveira1, Maria João Cardoso2, André Seabra3, Sofia Magalhães1, Sara Oliveira1, Diana Carvalho1, José Soares3. 1Mama Help-Support Centre for Breast Cancer Patients, Porto, Portugal. 2Breast Unit, Champalimaud Fundation, Lisbon, Portugal. 3Sports Faculty of University of Porto, Porto, Portugal.

(No relationships reported)

With 1.3 milion new breast cancer cases reported every year and improved survival, it is important to develop interventions to maintain quality of life (QOL) during and after cancer treatment. Aerobic and strength training is an intervention that can enhance QOL and physical components during treatment.

With 1.3 milion new breast cancer cases reported every year and improved survival, it is important to develop interventions to maintain quality of life (QOL) during and after cancer treatment. Aerobic and strength training is an intervention that can enhance QOL and physical components during treatment.

PURPOSE: To examine the effect of 12 weeks of supervised exercise in physical capacity measurement, strength and QOL in breast cancer patients during treatment compared to a control group.

METHODS: Fifty-four cancer patients aged 30 to 70 years were alllocated to a multidimensional exercise intervention program (n=43) and to a control group that received standard care (n=11). The intervention comprised cardiovascular training at 70-85% of VO2max in cycle ergometer, resistence training, and specific rehabilitation arm exercises. The patients trained during 60 minutes, twice a week, during 12 weeks. Physical capacity (VO2max), strenght (maximal isometric force in leg extension) and health related quality of life EORTC QLQ-C30 were assessed pre- and post intervention. General linear model for repeated measures was used to compare (baseline and 12-week follow-up) with group assignment and time x group interaction included as fixed effects (p≤.05 for significance).

RESULTS: Highly significant increases were achieved with an increase of 17.5 vs 7.7% in VO2max, and 46,6 vs 4.9% in power at VO2max, respectively, in the intervention group compared to the control group (p≤.05). A gain in strength occurred only the intervention group with and increase in leg extension by 13,4% (p≤.05). Intervention and control groups improved global health status (10.2 vs 9.3 points) but emotional status (16.6 vs 11.0 points) and role function (14.9 vs -0.1 points) were significantly higher in the intervention group (p≤.05).

CONCLUSIONS: A supervised, individualized, prescriptive results in an improvement in functional ability and QOL functions in women with breast cancer.

995 Board #5 May 30, 8:00 AM - 10:00 AM

Outpatient Phases in Cancer Rehabilitation

Jessica M. Brown, Daniel Y.K. Shackelford, Carole M. Schneider, FACSM. Rocky Mtn Cancer Rehab, Univ Northern Colorado, Greeley, CO.

(No relationships reported)

Cancer detection and treatment methods have improved significantly, which has in turn led to an estimated 12 million cancer survivors living with negative treatment-associated side effects. Rehabilitation of cancer survivors has become a problem of increasing significance with the surge in the incidence of cancer. A plethora of research investigations have shown that exercise is beneficial for cancer survivors. Yet there is not an orderly plan or system to rehabilitate cancer survivors with varying levels of acuity following diagnosis.

PURPOSE: To establish appropriate phases in cancer rehabilitation that address the individual needs of cancer survivors. The phases should be built upon goals addressing varying levels of acuity and establish appropriate exercise recommendations.

METHODS: Seven hundred-twenty-eight cancer survivors were grouped according to cancer history and treatment status yielding four distinct categories of care. Patient files and exercise logs from previous cancer rehabilitation participation were examined to develop exercise prescriptions and the orderly phase plan.

RESULTS: Following analysis of exercise logs, the phase system includes four phases corresponding to the four distinct categories of treatment status found in cancer survivors. Each phase consists of its own goals and appropriate exercise recommendations of intensity, duration, and frequency for the exercise prescription.

CONCLUSIONS: Rehabilitation of cancer patients should follow an orderly plan that includes varying levels of patient acuity and appropriate exercise recommendations throughout the cancer continuum. Outpatient phases should be an essential component of cancer rehabilitation.

996 Board #6 May 30, 8:00 AM - 10:00 AM

Relationship Of Strength And Cardiovascular Training On Cancer-related Fatigue

Trista L. Manikowske1, Brent M. Peterson1, Andrew R. Smith1, Jessica M. Brown1, Daniel Y.K. Shackelford1, Trent L. Lalonde1, Kurt Dallow, FACSM2, Reid Hayward1, Carole M. Schneider, FACSM1. 1Rocky Mtn Cancer Rehab, Univ Northern Colorado, Greeley, CO. 2North Colorado Family Medicine, Greeley, CO.

(No relationships reported)

Cancer survivors are negatively affected by fatigue both during and following treatment. Interventions consisting of cardiovascular and strength training both independently and in combination have been shown to attenuate the deleterious effects of cancer-related fatigue (CRF).

PURPOSE: To examine whether strength or cardiovascular training has a greater effect on CRF in cancer survivors following an individualized 3-month training intervention.

METHODS: Nineteen cancer survivors (ages 58 ± 13 years) completed initial assessments of cardiovascular (VO2peak), strength (chest and leg press), and CRF (Piper Fatigue Scale). Participants then completed 3-months of supervised exercise training at 60 minutes a day; 3 days per week. The intervention consisted of progressive cardiovascular and whole-body strength training. Participants were then reassessed following the intervention.

RESULTS: There were significant increases in pre to post VO2peak[[Unsupported Character - Codename &shy;]] (19.1 to 23.4 mLkg-1min-1; p=.006), chest press (50.3 to 62.0 lbs.; p=.016), and leg press (143.2 to 190.8 lbs.; p=.000). CRF significantly decreased (4.37 to 2.97; p=.006) from pre to post exercise. A negative correlation was observed between CRF and leg press (p= .07, r= -.430) and VO2peak (p = .36, r= -.23), however, a positive correlation was seen with chest press (p=.55, r= .15). This suggests that lower body exercises may have a greater effect on the reduction of CRF than cardiovascular fitness.

CONCLUSIONS: Cancer treatment-related side-effects lengthen the recovery process post treatment for cancer survivors. The results of this study demonstrate that exercise interventions increase strength and cardiovascular fitness while decreasing CRF. Cardiovascular fitness and lower body strength correlate with a reduction in CRF. Lower body strength was shown to have a higher correlation with decreased CRF than upper body strength or cardiovascular fitness. Therefore, rehabilitation programs for cancer survivors with a goal of reducing CRF should incorporate lower body strength training.

997 Board #7 May 30, 8:00 AM - 10:00 AM

Moderate Intensity Acute Aerobic Exercise Effect on Natural Killer Cell Counts in Breast Cancer Survivors

Claudio Battaglini, Elizabeth Evans, Robert McMurray, FACSM, Scott Randell, Hyman Muss, A.C. Hackney, FACSM. University of North Carolina at Chapel Hill, Chapel Hill, NC.

(No relationships reported)

Current research examining the effect of acute aerobic exercise on immune responses in cancer survivors is limited.

PURPOSE: To examine the effect of one acute bout of aerobic exercise on natural killer (NK) cell counts in breast cancer survivors (BCS) and healthy controls (C).

METHODS: Participants included 9 women who had completed major treatments for Stage I-III invasive breast cancer within 3-6 months of enrollment and 9 sedentary women without a history of cancer. Subjects completed a 30-minute bout of exercise on the cycle ergometer at 60% of VO2peak. Blood samples were taken pre-exercise, immediately post-exercise, 2 hours post-exercise, and 24 hours post-exercise. Complete blood counts were obtained at each time point. Proportions of lymphocytes that carry the NK cell phenotype (CD3-CD16+CD56+) were obtained via flow cytometric analysis. NK cell counts were compared between groups across time points using a 2x4 mixed model ANOVA.

RESULTS: NK cell counts rose significantly from pre-exercise to immediately post-exercise in both the BCS and C groups (70.3 ± 37.9 cells/μL to 214.3 ± 132.0 cells/μL, p = 0.003 and 108.9 ± 51.7 cells/μL to 357.5 ± 171.1 cells/μL, p = 0.001). At 2 hours post-exercise, NK cell counts tended to remain elevated in the BCS group (92.1 ± 62.4 cells/μL) relative to pre-exercise (p = 0.096). At 24 hours post-exercise, NK cell counts also tended to be elevated in the BCS group (106.3 ± 66.8 cells/μL, p = 0.052) and in the C group (142.3 ± 74.6, p = 0.097) relative to pre-exercise. When comparing between groups, NK cell counts were somewhat lower in the BCS group compared to the C group pre-exercise (p = 0.09) and immediately post-exercise (p = 0.064).

CONCLUSIONS: Although some lower in NK cell counts, recent BCS seem to exhibit a normal NK cell response to acute moderate intensity aerobic exercise as compared with similar women without a history of cancer.

Supported by UNC Lineberger Comprehensive Cancer Center and Petro Kulynych Foundation

998 Board #8 May 30, 8:00 AM - 10:00 AM

The Utility of Exercise or Pharmacological Stress in Identifying Cardiac Damage in Breast Cancer Survivors

Amy A. Kirkham, Kristin L. Campbell. University of British Columbia, Vancouver, BC, Canada.

(No relationships reported)

The addition of myocardial stress to cardiac imaging techniques may increase sensitivity in identifying breast cancer treatment (BCT) related cardiac damage.

PURPOSE: To systematically review whether cardiac imaging with exercise or pharmacologic stress (SI) can better identify cardiac damage in breast cancer survivors (BCS) than imaging at rest (RI).

METHODS: Medline, Embase and CINAHL were searched using (breast cancer) AND (keywords related to cardiac imaging) AND (keywords related to cardiotoxic BCT or related cardiac issues). All experimental or observational studies including ≥2 cardiac imaging techniques/parameters and BCS only, were searched to identify studies that used both SI and RI. Studies were also excluded if they did not report the SI data for ≥10 BCS or included cancer treatments no longer used for BCS. Ten studies were included in the review and relevant data extracted. The results of SI were compared to those of RI, and each study was labeled as “no benefit,” “some benefit,” or “benefit,” based on whether the SI identified cardiac damage that was not detected by the RI.

RESULTS: Overall, 3 studies showed “no benefit”, 2 showed “some benefit” and 5 showed a “benefit” of SI over RI. The use of exercise or pharmacologicals to induce myocardial stress was evenly split amongst the studies showing “benefit” or “some benefit” (1 study used both). Six of the 7 studies showing at least some benefit were long-term follow-up (LTFU) studies of 34 months to 18 years post-treatment (chemotherapy and/or radiation), and the other followed patients through chemotherapy up to 18 months later. All of the studies with LTFU of radiation treatment (n=5) (some included chemotherapy as well), showed at least some benefit of SI over RI, with the exception of one study reporting no damage with SI or RI. These studies all used myocardial perfusion imaging (MPI) techniques. Other techniques showing the benefit of SI were echocardiography (n=2, 1 during and 1 LTFU to chemotherapy) and ECG (n=2, both LTFU to radiation and/or chemotherapy).

CONCLUSIONS: MPI with exercise or pharmacological stress appears to be beneficial for detection of cardiac damage in LTFU to radiation treatment for breast cancer. Both ECG and echocardiography with stress merit further research to determine their utility in identifying BCT-induced cardiac damage.

© 2013 American College of Sports Medicine