Impact of a telephone-based physical activity intervention upon exercise behaviors and fitness in cancer survivors enrolled in a cooperative group setting

Observational studies demonstrate an association between physical activity and improved outcomes in breast and colon cancer survivors. To test these observations with a large, randomized 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 randomized 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 randomized 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.     

The group psychotherapy and home-based physical exercise (group-hope) trial in cancer survivors: physical fitness and quality of life outcomes

Physical exercise has been shown to enhance quality of life (QOL) in cancer survivors using pretest-posttest designs and compared to usual care (i.e. no intervention). In the present study, we conducted a randomized controlled trial to determine if exercise could improve QOL in cancer survivors beyond the known benefits of group psychotherapy (GP). We matched 22 GP classes (N=108) on content and then randomly assigned 11 (n=48) to GP alone and 11 (n=60) to GP plus home-based, moderate-intensity exercise (GP+EX). Participants completed a physical fitness test and QOL measures (e.g. Functional Assessment of Cancer Therapy scales) at the beginning and end of GP classes (about 10 weeks). We had excellent recruitment (81%), retention (89%), and adherence (84%) rates and a modest contamination (22%) rate. Using intention-to-treat repeated measures analyses of variance, we found significant Time by Condition interactions for functional well-being, fatigue, and sum of skinfolds. We also found borderline significant interactions for physical well-being, satisfaction with life, and flexibility. All interactions favored the GP+EX condition. We conclude that a home-based, moderate intensity exercise program may im-prove QOL in cancer survivors beyond the benefits of GP, particularly in relation to physical and functional well-being.     

Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: cardiopulmonary and quality of life outcomes.

PURPOSE: To determine the effects of exercise training on cardiopulmonary function and quality of life (QOL) in postmenopausal breast cancer survivors who had completed surgery, radiotherapy, and/or chemotherapy with or without current hormone therapy use. METHODS: Fifty-three postmenopausal breast cancer survivors were randomly assigned to an exercise (n = 25) or control (n = 28) group. The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide. The control group did not train. The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention. Peak oxygen consumption was assessed by a graded exercise test using gas exchange analysis. Overall QOL was assessed by the Functional Assessment of Cancer Therapy-Breast scale. RESULTS: Fifty-two participants completed the trial. The exercise group completed 98.4% of the exercise sessions. Baseline values for peak oxygen consumption (P =.254) and overall QOL (P =.286) did not differ between groups. Peak oxygen consumption increased by 0.24 L/min in the exercise group, whereas it decreased by 0.05 L/min in the control group (mean difference, 0.29 L/min; 95% confidence interval [CI], 0.18 to 0.40; P <.001). Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group (mean difference, 8.8 points; 95% CI, 3.6 to 14.0; P =.001). Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL (r = 0.45; P <.01). CONCLUSION: Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors.     

A randomized trial of exercise and quality of life in colorectal cancer survivors

We conducted a randomized controlled trial to determine the effects of a home-based exercise intervention on change in quality of life (QOL) in recently resected colorectal cancer survivors, most of whom were receiving adjuvant therapy. Participants were randomly assigned in a 2 : 1 ratio to either an exercise ( n  = 69) or control ( n  = 33) group. The exercise group was asked to perform moderate intensity exercise 3–5 times per week for 20–30 min each time. The primary outcome was change in QOL as measured by the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale. Adherence in the exercise group was good (75.8%) but contamination in the control group was problematic (51.6%). Intention-to-treat analysis revealed no significant differences between groups for change in the FACT-C (mean difference, −1.3; 95% CI, −7.8 to 5.1; P  = 0.679). In an 'on-treatment' ancillary analysis, we compared participants who decreased versus increased their cardiovascular fitness over the course of the intervention. This analysis revealed significant differences in favour of the increased fitness group for the FACT-C (mean difference, 6.5; 95% CI, 0.4–12.6; P  = 0.038). These data suggest that increased cardiovascular fitness is associated with improvements in QOL in colorectal cancer survivors but better controlled trials are needed.     

Polymorphisms in three base excision repair genes and breast cancer risk in Thai women

Few randomized controlled trials have examined the effects of combined aerobic and resistance training in breast cancer survivors soon after completing adjuvant therapy. Breast cancer survivors (N = 58) within 2 years of completing adjuvant therapy were randomly assigned to an immediate exercise group (IEG; n = 29) or a delayed exercise group (DEG; n = 29). The IEG completed 12 weeks of supervised aerobic and resistance exercise, three times per week. The DEG completed the program during the next 12 weeks. Participants completed patient-rated outcomes at baseline, 6, 12, 18 and 24 weeks. The primary endpoint was overall quality of life (QoL) measured by the Functional Assessment of Cancer Therapy-Breast scale. Secondary endpoints were fatigue, social physique anxiety, and physical fitness. Follow-up data was obtained on 97% of participants and exercise adherence was 61.3%. Repeated measures analyses of variance revealed a significant group by time interaction for overall QoL (P < 0.001). Specifically, QoL increased in the IEG from baseline to 12 weeks by 20.8 points compared to a decrease in the DEG of 5.3 points (mean group difference = 26.1; 95% CI = 18.3–32.7; P < 0.001). From 12 to 24 weeks, QoL increased in the DEG by 29.5 points compared to an increase of 6.5 points in the IEG (mean group difference = 23.0; 95% CI = 16.3–29.1; P < 0.001). Similar results were obtained for the secondary endpoints. Combined aerobic and resistance exercise soon after the completion of breast cancer therapy produces large and rapid improvements in health-related outcomes.     

Effects of exercise training on fasting insulin, insulin resistance, insulin-like growth factors, and insulin-like growth factor binding proteins in postmenopausal breast cancer survivors: a randomized controlled trial.

Insulin, insulin-like growth factors (IGFs) I and II, and IGF binding proteins (IGFBPs) 1 and 3 have been implicated in breast cancer outcomes. We conducted a randomized controlled trial to determine the physiological effects of exercise training on changes in these biological markers in postmenopausal breast cancer survivors. Fifty-three postmenopausal breast cancer survivors were randomly assigned to an exercise (n = 25) or control group (n = 28). The exercise group trained on cycle ergometers three times per week for 15 weeks. The control group did not train. End points included changes in fasting insulin, glucose, insulin resistance, IGF-I, IGF-II, IGFBP-1, IGFBP-3, and IGF-I:IGFBP-3 molar ratio between baseline and week 15. All of the statistical tests were two-sided (alpha = 0.05). Fifty-two participants completed the trial. The exercise group completed 44.3 of 45 (98.4%) prescribed exercise sessions. Baseline hormone concentrations did not differ between groups except that IGF-II was higher in the exercise group (P = 0.011). No significant differences between groups were observed for changes in fasting insulin (+6.3 pmol/liter; P = 0.941), glucose (+0.09 mmol/liter; P = 0.824), insulin resistance (+0.4; P = 0.247), IGF-II (-40.7 ng/ml; P = 0.101), or IGFBP-1 (+1.4 ng/ml; P = 0.774). However, significant differences between groups were observed for changes in IGF-I (-7.4 ng/ml; P = 0.045), IGFBP-3 (+180.5 ng/ml; P = 0.021), and IGF-I:IGFBP-3 molar ratio (-0.006; P = 0.017). Exercise training had significant physiological effects on IGF-I, IGFBP-3, and IGF-I:IGFBP-3 molar ratio in postmenopausal breast cancer survivors. The clinical implications of these findings remain to be defined.     

Effects of acute exercise on state anxiety in breast cancer survivors.

PURPOSE/OBJECTIVES: To examine the effects of an acute bout of exercise on state anxiety in breast cancer survivors. DESIGN: A two-group (high and low state anxiety) by two-time (pre- and postexercise) mixed factorial design. SETTING: Exercise physiology lab at the University of Alberta. SAMPLE: 34 stage I or II breast cancer survivors ranging in age from 39-65 (X = 50.50; SD = 6.62). METHODS: Participants completed the State Anxiety Inventory prior to and five minutes following an acute bout of exercise. MAIN RESEARCH VARIABLES: State anxiety. FINDINGS: A main effect resulted for group (p < 0.01) and time showing that state anxiety significantly decreased from pre- to postexercise (p < 0.03). Group by time interaction showed that state anxiety for the low state anxiety group did not change from pre- to postexercise (p > 0.05); however, state anxiety significantly decreased in the high state anxiety group (p < 0.03). CONCLUSION: Acute exercise may be an effective intervention in reducing state anxiety in breast cancer survivors, especially those with high state anxiety. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses should be aware that in addition to other traditional anxiolytic therapies (e.g., relaxation therapy) commonly prescribed, acute exercise is an effective method for reducing state anxiety in breast cancer survivors.     

Understanding physical activity in adolescent cancer survivors: an application of the theory of planned behavior

Notwithstanding the remarkable achievements in survival, there is a growing recognition that pediatric cancer survivors are faced with a variety of chronic health problems that may be exacerbated by maladaptive health behaviors. The purpose of the present study was to examine the utility of the theory of planned behavior (TPB) in understanding adolescent survivors' motivation to engage in physical activity. A group of adolescent cancer survivors recalled their beliefs, attitudes, norms, perceptions of control, intentions and post-treatment physical activity behaviors using a self-administered, mailed questionnaire in a retrospective design. Multiple regression analyses revealed that the TPB explained 29.1% of the variance in physical activity behavior, with the significant independent correlates being intention (beta=0.31,p=0.023) and self-efficacy (beta=0.42,p=0.04). For intention, 33.7% of the variance was explained by the TPB, with affective attitude (beta=0.32,p=0.016) and instrumental attitude (beta=0.31, p=0.037) making significant unique contributions. The present study has provided some of the first data toward understanding physical activity behavior in adolescent cancer survivors. Specifically, the results suggest that interventions designed to promote physical activity in this population should focus on the development of a positive attitude as well as fostering an enhanced sense of self-efficacy.     

Exercise use as complementary therapy among breast and prostate cancer survivors receiving active treatment: examination of exercise intention

BACKGROUND: Exercise is associated with an improved quality of life among cancer survivors. Previous research has highlighted the utility of the theory of planned behavior in understanding cancer survivors' intention to exercise. The purpose of this study was to extend the research on the theory of planned behavior in relation to exercise intention in breast cancer survivors and to provide preliminary evidence supporting its application with prostate cancer survivors during treatment. METHODS: Participants consisted of 126 breast and 82 prostate cancer survivors receiving active treatment. Participants completed self-administered, mail-in questionnaires that assessed demographic and medical variables, past exercise, and the theory of planned behavior. RESULTS: For breast cancer survivors, the results revealed that attitudes, subjective norm, and perceived behavioral control explained 66% of the variance in exercise intention with the instrumental component of attitude, subjective norm, and perceived behavioral control making significant unique contributions to intention. For prostate cancer survivors, attitudes, subjective norm, and perceived behavioral control explained 57% of the variance in exercise intention, with subjective norm and perceived behavioral control making significant unique contributions to intention. CONCLUSIONS: The results provide further support that the theory of planned behavior is a useful framework for understanding determinants of exercise intention in breast cancer survivors undergoing active treatment and preliminary support for prostate cancer survivors undergoing active treatment. When designing exercise interventions, differences in breast and prostate cancer survivors' exercise intention merit consideration.     

The implementation of an oncologist referred, exercise self-management program for older breast cancer survivors

BACKGROUND: With increased breast cancer survivor rates among older women, the negative outcomes of breast cancer treatment may linger for years. METHOD: We designed and implemented an oncologist referred, exercise self-management program to increase physical activity and health-related quality of life using a pretest-posttest, single group design. We recruited 34 breast cancer survivors seen for a follow-up oncology visit at two university cancer treatment centers. Women with a mean age of 59.6 years (S.D.=66) comprised the sample. Average time since diagnosed was 3.1 years; 45% had stage I breast cancer and 55% had stage II; 62% received chemotherapy and 59% received a mastectomy. Following a baseline assessment on exercise support, self-efficacy, barriers and benefits; quality of life; and a functional performance test, subjects participated in self-management classes and received telephone support. Participants (n=30) repeated the assessment at 6-months. We compared scores between time periods using t-tests. RESULTS: Older women increased frequency of weekly, moderate physical activities (p相似文献   

Effect of exercise on upper extremity pain and dysfunction in head and neck cancer survivors: a randomized controlled trial

BACKGROUND: Shoulder pain and disability are well recognized complications associated with surgery for head and neck cancer. This study was designed to examine the effects of progressive resistance exercise training (PRET) on upper extremity pain and dysfunction in postsurgical head and neck cancer survivors. METHODS: Fifty-two head and neck cancer survivors were assigned randomly to PRET (n = 27) or a standardized therapeutic exercise protocol (TP) (n = 25) for 12 weeks. The primary endpoint was change in patient-rated shoulder pain and disability from baseline to postintervention. Secondary endpoints were upper extremity strength and endurance, range of motion, fatigue, and quality of life. RESULTS: Follow-up assessment for the primary outcome was 92%, and adherence to the supervised PRET and TP programs were 95% and 87%, respectively. On the basis of intention-to-treat analyses, PRET was superior to TP for improving shoulder pain and disability (-9.6; 95% confidence interval [95% CI], -16.4 to -4.5; P = .001), upper extremity strength (+10.8 kg; 95% CI, 5.4-16.2 kg; P < .001), and upper extremity endurance (+194 repetitions x kg; 95% CI, 10-378 repetitions x kg; P = .039). Changes in neck dissection impairment, fatigue, and quality of life favored the PRET group but did not reach statistical significance. CONCLUSIONS: The PRET program significantly reduced shoulder pain and disability and improved upper extremity muscular strength and endurance in head and neck cancer survivors who had shoulder dysfunction because of spinal accessory nerve damage. Clinicians should consider the addition of PRET in the rehabilitation of postsurgical head and neck cancer survivors.     

Exercise Barriers in Korean Colorectal Cancer Patients

Background: It has been proved that participating in exercise improves colorectal cancer patients’ prognosis.This study is to identify barriers to exercise in Korean colorectal cancer patients and survivors. Materialsand Methods: A total of 427 colorectal cancer patients and survivors from different stages and medical statuscompleted a self-administered questionnaire that surveyed their barriers to exercise and exercise participation.Results: The greatest perceived exercise barriers for the sampled population as a whole were fatigue, low levelof physical fitness, and poor health. Those under 60-years old reported lack of time (p=0.008), whereas thoseover 60 reported low level of physical fitness (p=0.014) as greater exercise barriers than their counterparts.Women reported fatigue as a greater barrier than men (p<0.001). Those who were receiving treatment ratedpoor health (p=0.0005) and cancer-related factors as greater exercise barriers compared to those who were notreceiving treatment. A multivariate model found that other demographic and medical status were not potentialfactors that may affect exercise participation. Further, for those who were not participating in physical activity,tendency to be physically inactive (p<0.001) and lack of exercise skill (p<0.001) were highly significant barriers,compared to those who were participating in physical activity. Also, for those who were not meeting ACSMguidelines, cancer-related exercise barriers were additionally reported (p<0.001), compared to those who were.Conclusions: Our study suggests that fatigue, low level of physical fitness, and poor health are most reportedexercise barriers for Korean colorectal cancer survivors and there are differences in exercise barriers by age,sex, treatment status, and physical activity level. Therefore, support for cancer patients should be providedconsidering these variables to increase exercise participation.     

Medical, demographic and social cognitive correlates of physical activity in a population-based sample of colorectal cancer survivors

Physical activity (PA) improves quality of life in colorectal cancer survivors (CRC) and may reduce the risk of disease recurrence and early death. Few studies, however, have examined the correlates of PA in CRC survivors. Using the Alberta Cancer Registry, 2000 randomly selected CRC survivors were mailed a self-reported questionnaire assessing medical, demographic, behavioural and social cognitive variables from the theory of planned behaviour (TPB). Of the 600 survivors who responded, 33% were meeting public health PA guidelines and almost half were completely sedentary. Higher PA was reported by survivors who were younger, unmarried, better educated, wealthier, employed, non-smokers, social drinkers, not treated with radiation therapy, disease-free, in better health and less comorbidity. In multivariate path analysis, these variables were not directly associated with PA after controlling for the TPB variables. The TPB explained 34% (P < 0.001) of the variance in PA behaviour with direct associations for intention (β= 0.22; P= 0.015) and planning (β= 0.18; P= 0.001). Intention, in turn, had 62% (P < 0.001) of its variance explained by perceived behavioural control (β= 0.43; P < 0.001), affective attitude (β= 0.25; P < 0.001) and instrumental attitude (β= 0.15; P < 0.001). The TPB may be a useful framework for developing population-based interventions to increase PA in CRC survivors.     

The Kuala Lumpur Qigong Trial for Women in the Cancer Survivorship Phase-Efficacy of a Three-Arm RCT to Improve QOL

Background: Qigong is highly favoured among Asian breast cancer survivors for enhancing health. Thisstudy examined the hypothesis that quality of life (QoL) in the Qigong group is better than the placebo (aerobic)or usual care group. Materials and Methods: A total of 197 participants were randomly assigned to either the8-week Kuala Lumpur Qigong Trial or control groups in 2010-2011. Measurement taken at baseline and postinterventionincluded QoL, distress and fatigue. Analysis of covariance (ANCOVA) and Kruskal Wallis were usedto examine for differences between groups in the measurements. Results: There were 95 consenting participantsin this 8week trial. The adherence rates were 63% for Qigong and 65% for the placebo group. The Qigong groupshowed significant marginal improvement in Quality of life scores compared to placebo (mean difference=7.3unit; p=0.036), compared to usual care (mean difference=6.7 unit; p=0.048) on Functional Assessment CancerTherapy-Breast measure. There were no significant changes between the placebo and usual care groups infatigue or distress at post intervention (8-week). Conclusions: Cancer survivors who participated in the Qigongintervention showed slightly better QOL. Follow up studies are greatly needed to evaluate which subgroups maybest benefit from Qigong. With a steep rise of cancer survivors, there is an urgent need to explore and engagemore cultural means of physical activity to fight side effects of treatment and for cancer control in developingcountries.     

Effects of baseline comorbidities on cancer screening trial adherence among older African American men.

BACKGROUND: The purpose of this study was to examine the effects of baseline comorbidities on screening adherence in a sample of older African American men (ages >or=55 years) enrolled in a case management intervention in a cancer screening trial. METHODS: Baseline comorbidity data were obtained from 683 African American men who were randomly assigned to a case management intervention group (n = 344) or to a case management control group (n = 339). The effects of comorbidities on the screening adherence rates of each group were then assessed. RESULTS: No statistically significant interactions were found between each health history characteristic and the intervention. Therefore, analyses were not stratified by intervention status. In general, participants with comorbidities were no less likely to adhere to trial screening than participants without comorbidities. Exceptions were current smokers and participants with chronic bronchitis. Current smokers were less likely than others to adhere to the prostate-specific antigen test (P = 0.02) and the digital rectal examination for prostate cancer screening (P = 0.01), to the chest X-ray for lung cancer screening (P < 0.01), and to the flexible sigmoidoscopy for colorectal cancer screening (P = 0.04). Participants with chronic bronchitis had lower rates of adherence to the chest X-ray (P = 0.06). Having a relative with cancer positively influenced adherence to the digital rectal examination (P = 0.05). CONCLUSIONS: Overall, older African American men with comorbidities appear to be very good candidates for participation in longitudinal cancer screening trials. However, smoking had a statistically significant and deleterious effect on adherence to all types of screening.     

Exercise adherence in breast cancer survivors training for a dragon boat race competition: a preliminary investigation

Recent research has applied the theory of planned behavior (TPB) to understanding exercise after a cancer diagnosis, but studies are few and have been limited by retrospective designs, self-report measures of exercise and varied results. In the present study, we extended this research by using a prospective 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 questionnaire 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 designed to promote exercise in breast cancer survivors.     

Effects of a Structured Weight-Bearing Exercise Program on Bone Metabolism Among Breast Cancer Survivors: A Feasibility Trial

PurposeTreatments for breast cancer, specifically hormonal therapy, accelerate bone loss (BL) among breast cancer survivors, leading to osteoporosis and an increase in fracture risk. Tai Chi Chuan (TCC) is a moderate form of weight-bearing exercise, equivalent to walking, and it has been shown to improve aerobic capacity and strength among breast cancer survivors and might also be effective in slowing bone loss in breast cancer survivors. This pilot study compared the influence of TCC with that of standard support therapy (ST; exercise control) on BL biomarkers among breast cancer survivors.Patients and MethodsRandomly assigned breast cancer survivors (N = 16; median age, 53 years; < 30 months after treatment) completed 12 weeks (3 times per week, 60 minutes per session) of TCC or ST. Serum levels of N-telopeptides of type I collagen (NTx), a marker of bone resorption, and bone-specific alkaline phosphatase (BSAP), a marker of bone formation, were determined according to enzyme-linked immunosorbent assay at baseline and after the intervention.ResultsUsing analysis of covariance, survivors in the TCC group experienced a greater increase in levels of bone formation (BSAP [μg/L]: before, 8.3; after, 10.2; change, 1.9 μg/L and 22.4%), compared with survivors in ST (BSAP [μg/L]: before, 7.6; after, 8.1; change, 0.5 μg/L [6.3%]). Survivors in the TCC group also experienced a significant decrease in bone resorption (NTx [nanomoles bone collagen equivalent; nmBCE]: before, 17.6; after, 11.1; change, ?6.5 nmBCE; ?36.9%), whereas women in the ST group did not (NTx [nmBCE]: before, 20.8; after, 18.8; change, ?2.0 nmBCE; ?9.6%).ConclusionThis pilot study suggests that weight-bearing exercise exerts positive effects on BL, through increased bone formation and decreased bone resorption. Further examinations of the influence of TCC on bone health are warranted.     

No effect of exercise on colon mucosal prostaglandin concentrations: a 12-month randomized controlled trial.

BACKGROUND: Epidemiologic studies provide evidence that exercise is associated with reduced risk of colon cancer. Exercise may exert protective effects on the colon by influencing prostaglandin production. We hypothesized that an exercise intervention would decrease prostaglandin E(2) concentrations and increase prostaglandin F(2alpha) in colon biopsies compared with controls. METHODS: A 12-month randomized controlled trial testing the effects of exercise on colon mucosal prostaglandin concentrations was conducted in men (n=95) and women (n=89). The exercise intervention included moderate-to-vigorous aerobic activity, 60 min/d, 6 days/wk versus controls. Prostaglandin E(2) and F(2alpha) concentrations were measured in colon biopsies using an enzyme-linked immunoassay at baseline and at 12 months to assess changes in mean concentration for each group. RESULTS: Baseline colon prostaglandin E(2) and F(2alpha) concentrations were not correlated with age, race, education, family history of colon cancer, previous polyps, body size, diet, smoking, nonsteroidal antiinflammatory drug use, metabolic factors, or sex hormone levels. For both men and women, the exercise and control groups showed no change in mean prostaglandin E(2) or F(2alpha) between the baseline and 12-month biopsies. There was no difference in mean prostaglandin concentrations between exercisers and controls when exercisers were grouped by level of intervention adherence. Results were not modified by baseline age, body mass index, percentage of body fat, nonsteroidal antiinflammatory drug use, history of adenomatous polyps, or family history of colon cancer. CONCLUSION: A 12-month moderate-to-vigorous intensity aerobic exercise intervention did not result in significant changes in colon mucosal prostaglandin concentrations.     

A multimodal physiotherapy programme plus deep water running for improving cancer‐related fatigue and quality of life in breast cancer survivors

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.     

Serum 25-hydroxy Vitamin D Status is Not Related to Osteopenia/Osteoporosis Risk in Colorectal Cancer Survivors

Background: The incidence of colorectal cancer increases with vitamin D deficiency as shown in recentlypublished studies. In addition, prospective investigations have indicated that low vitamin D levels may beassociated with increased mortality of colorectal cancer, especially in stage III and IV cases. However, the exactincidence of vitamin D deficiency and the relation between vitamin D deficiency and osteopenia/osteporosis isstill not known. The aim of this study is to identify severity of vitamin D deficiency and absolute risk factors ofosteopenia/osteoporosis in colorectal cancer survivors. Materials and Methods: A total of 113 colorectal cancersurvivors treated with surgery and/or chemotherapy ± radiotherapy were recruited from medical oncologyoutpatient clinics during routine follow-up visits in 2012-2013. Bone mineral densitometry (BMD) was performed,and serum 25-OH vitamin D levels were also checked on the same day of the questionnaire. The patients wasdivided into 2 groups, group A with normal BMD and group B with osteopenia/osteoporosis. Results: Themedian age of the study population was 58 (40-76). Thirty (30.0%) were female, whereas 79 (70.0%) were male.The median follow-up was 48 months (14-120 months). Vitamin D deficiency was found in 109 (96.5%); milddeficiency (20-30 ng/ml) in 19 (16.8%), moderate deficiency (10-20 ng/ml) in 54 (47.8%) and severe deficiency(<10 ng/ml) in 36 (31.9%). Osteopenia was evident in 58 (51.4%) patients whereas osteoporosis was noted in 17(15.0%) . Normal BMD was observed in 38 (33.6%). No apparent effects of type of surgery, presence of stoma,chemotherapy, radiotherapy and TNM stage were found regarding the risk of osteopenia and osteoporosis.Also, the severity of the vitamin D deficiency had no effect in the risk of osteopenia and osteporosis (p=0.93). Infemale patients, osteopenia/osteoporosis were observed in 79.5% patients as compared to 60.7% of male patients(p=0.04). Conclusions: In our study, vitamin D deficiency and osteopenia/osteoporosis was observed in 96.5%and 66.4% of colorectal cancer survivors, respectively. There is no defined absolute risk factor of osteopeniaand osteoporosis in colorectal cancer survivors. To our knowledge, in the literature, our study is the first toevaluateall the risk factors of osteopenia and osteoporosis in colorectal cancer survivors.