Exercise Improves Body Fat, Lean Mass, and Bone Mass in Breast Cancer Survivors

Article · September 2009with68 Reads
DOI: 10.1038/oby.2009.18 · Source: PubMed
Abstract
Given the negative effects of a breast cancer diagnosis and its treatments on body weight and bone mass, we investigated the effects of a 6-month randomized controlled aerobic exercise intervention vs. usual care on body composition in breast cancer survivors. Secondary aims were to examine the effects stratified by important prognostic and physiologic variables. Seventy-five physically inactive postmenopausal breast cancer survivors were recruited through the Yale-New Haven Hospital Tumor Registry and randomly assigned to an exercise (n = 37) or usual care (n = 38) group. The exercise group participated in 150 min/week of supervised gym- and home-based moderate-intensity aerobic exercise. The usual care group was instructed to maintain their current physical activity level. Body composition was assessed at baseline and 6-months through dual-energy X-ray absorptiometry (DXA) by one radiologist blinded to the intervention group of the participants. On an average, exercisers increased moderate-intensity aerobic exercise by 129 min/week over and above baseline levels compared with 45 min/week among usual care participants (P < 0.001). Exercisers experienced decreases in percent body fat (P = 0.0022) and increases in lean mass (P = 0.047) compared with increases in body fat and decreases in lean mass in usual care participants. Bone mineral density (BMD) was also maintained among exercisers compared with a loss among usual care participants (P = 0.043). In summary, moderate-intensity aerobic exercise, such as brisk walking, produces favorable changes in body composition that may improve breast cancer prognosis.
    • Therefore, feelings of guilt may be used as a motivational tool to engage in strategies, such as MVPA, that may mitigate the physical changes resulting from breast cancer. MVPA has been shown to help women lose weight and body fat, circumvent weight gain, and build muscle tone (Irwin et al., 2009). BCS might be motivated by feelings of guilt to engage in MVPA to improve their physical fitness.
    [Show abstract] [Hide abstract] ABSTRACT: Purpose/Objectives: To test body-related shame and guilt as predictors of breast cancer survivors' (BCS') moderate to vigorous intensity physical activity (MVPA) during six months and to examine motivational regulations as mediators of this association. Design: Prospective study. Setting: Survivors were recruited through advertisements and oncologist referrals from medical clinics and hospitals in Montreal, Quebec, Canada. Sample: 149 female BCS. Methods: Self-reports of body-related shame and guilt, motivational regulations, and MVPA were measured among BCS at baseline. MVPA was assessed a second time six months later. Residual change scores were used. Main Research Variables: Body-related shame and guilt; external, introjected, and autonomous (identifed and intrinsic) motivational regulations; MVPA. Findings: In the multiple mediation models, body-related shame was associated with low levels of MVPA, as well as external, introjected, and autonomous motivational regulations. Guilt was related to high levels of MVPA and introjected and autonomous motivational regulations. Indirect effects linked shame, guilt, and MVPA via autonomous motivation. Only body-related shame was a signifcant predictor of six-month changes in MVPA. Conclusions: Based on these results, the specifc emotions of shame and guilt contextualized to the body differentially predict BCS' health motivations and behavior over time. Implications for Nursing: Survivorship programs may beneft from integrating intervention strategies aimed at reducing body-related shame and helping women manage feelings of guilt to improve physical activity.
    Full-text · Article · Jul 2017
    • Additional benefits due to exercise without bisphosphonate medication use were not observed [25]. Other investigations involving walking [27], aerobic exercise [28], and resistance-training with a jumping protocol [29][30][31]have demonstrated that exercise may help maintain bone health in cancer survivors.
    [Show abstract] [Hide abstract] ABSTRACT: Introduction Cancer pathogenesis and resulting treatment may lead to bone loss and poor skeletal health in survivorship. The purpose of this investigation was to evaluate the influence of 26 weeks of combined aerobic and resistance-training (CART) exercise on bone mineral density (BMD) in a multi-racial sample of female cancer survivors. Methods Twenty-six female cancer survivors volunteered to undergo CART for 1 h/day, 3 days/week, for 26 weeks. The Improving Physical Activity After Cancer Treatment (IMPAACT) Program involves supervised group exercise sessions including 20 min of cardiorespiratory training, 25 min of circuit-style resistance-training, and 15 min of abdominal exercises and stretching. BMD at the spine, hip, and whole body was assessed using dual-energy X-ray absorptiometry (DXA) before and after the intervention. Serum markers of bone metabolism (procollagen-type I N-terminal propeptide, P1NP, and C-terminal telopeptides, CTX) were measured at baseline, 13 weeks, and at study completion. Results Eighteen participants, with the average age of 63.0 ± 10.3 years, completed the program. Mean duration since completion of cancer treatment was 6.2 ± 10.6 years. Paired t-tests revealed significant improvements in BMD of the spine (0.971 ± 0.218 g/cm² vs. 0.995 ± 0.218 g/cm², p = 0.012), hip (0.860 ± 0.184 g/cm² vs. 0.875 ± 0.191 g/cm², p = 0.048), and whole body (1.002 ± 0.153 g/cm² vs. 1.022 ± 0.159 g/cm², p = 0.002). P1NP declined 22% at 13 weeks and 28% at 26 weeks in comparison to baseline (p < 0.01) while CTX showed a non-significant decrease of 8% and 18% respectively. Conclusions We report significant improvements in BMD at the spine, hip, and whole body for female cancer survivors who completed 26 weeks of CART. This investigation demonstrates the possible effectiveness of CART at improving bone health and reducing risk of osteoporosis for women who have completed cancer treatment. The IMPAACT Program appears to be a safe and feasible way for women to improve health after cancer treatment.
    Full-text · Article · Sep 2016
    • A recent study reports that men, who walk briskly for 3 h/wk or more, demonstrate a 57% lower rate of progression of prostatic cancer compared to those who walked at an easy pace for less than 3 h/wk [134]. The positive effects of brisk walking observed in breast cancer patients include: reduced risk of breast cancer [135], significant reductions in insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP-3) [136], decreased body fat, increased lean mass and maintained bone mineral density (BMD) [137]. Similar positive effects are reported in, for example, common diseases such as Alzheimer's disease [138], cardiovascular disease [139], diabetes [140] and obesity [141], all diseases associated with endotoxemia and consequently also with deranged microbiota and dysbiosis [31,43].
    File · Data · Feb 2016 · BMC Medicine
    • A recent study reports that men, who walk briskly for 3 hours/week or more, demonstrate a 57% lower rate of progression of prostatic cancer compared to those who walked at an easy pace [119]. The positive effects of brisk walking observed in breast cancer patients include: reduced risk of breast cancer [120], significant reductions in insulin-like growth factor-I (IGF-I) and its binding protein (IGFBP- 3)[121] , decreased body fat, increased lean mass and maintenance bone mineral density (BMD) [122]. Similar positive effects were reported in for Alzheimer´s disease [123] , cardiovascular disease [124], diabetes [125] and obesity [126] meaning all diseases associated with endotoxemia and consequently with deranged microbiota and dysbiosis [127, 128].
    File · Data · Feb 2016 · BMC Medicine
    • Since the initiation of the Yale FIT trial, 7 exercise studies have been published that identified bone outcomes [30]. Of those, one was only 6 months duration [31], two were aerobic exercise [32, 33], one included a bisphosphonate in the exercise arm of the study [34], leaving three studies for comparison353637 . Winters- Stone and colleagues [35, 36] conducted the same study in two groups of BCS, specifically a 12-month resistance ?
    [Show abstract] [Hide abstract] ABSTRACT: Bone loss is a significant clinical problem for female cancer survivors (FCS) and increases fracture risk. The aim of the Yale Fitness Intervention Trial (Yale FIT) was to determine the effects of a 12-month aerobic-resistance exercise intervention compared to a home-based physical activity group on bone outcomes [bone mineral density (BMD)] and biomarkers bone turnover). Early postmenopausal FCS (N = 154) were randomized to the exercise intervention (3 times/week) or to a home-based physical activity group. Calcium (1200 mg) and Vitamin D (400 IU) supplements were provided to both groups. BMD was measured at baseline and 12 months. No significant difference in BMD was observed for the exercise vs home-based group. However, subjects on Tamoxifen or no endocrine therapy did not significantly lose BMD, with the exception of the femoral neck (FN). In contrast subjects on aromatase inhibitors (AIs) had significant BMD loss at all sites. The majority of subjects had sufficient serum levels of Vitamin D (>20 ng/mL) but there was significantly less bone loss in subjects in the 20-29 ng/mL range at the LS (p = 0.01), hip (p = 0.03), and GT (p = 0.008) compared to lower or higher levels. Exercise stimulates bone remodeling but the intervention was not superior for BMD outcomes at one year. The dose of the osteogenic stimulus in the intervention has been effective in preserving BMD in healthy postmenopausal women but it may be inadequate for survivors with chemotherapy-induced menopause and for those on adjuvant AI therapy.
    Article · Feb 2016
    • However, our interventions included only a small component of behavioral motivation counseling and accomplishing behavior change may require more specific PA promotion strategies [41]. Finally, the lack of significant reductions in body fat was consistent with previous research [42] and not unanticipated, because both interventions focused on physical exercise only and did not aim at losing body weight by including a dietary component. Strengths of this study include the direct comparison between HI and LMI, a well-designed (e.g.
    [Show abstract] [Hide abstract] ABSTRACT: BACKGROUND: International evidence-based guidelines recommend physical exercise to form part of standard care for all cancer survivors. However, at present, the optimum exercise intensity is unclear. Therefore, we aimed 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 randomized 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-stand 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-stand 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 Netherlands Trial Register [ NTR2153 ] on the 5th of January 2010.
    Full-text · Article · Oct 2015
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