Gymnastik- och idrottshögskolan, GIH

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Bolam, K., Bojsen-Møller, E., Wallin, P., Paulsson, S., Lindwall, M., Rundqvist, H. & Ekblom Bak, E. (2024). Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57 652 Swedish men.. British Journal of Sports Medicine
Open this publication in new window or tab >>Association between change in cardiorespiratory fitness and prostate cancer incidence and mortality in 57 652 Swedish men.
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2024 (English)In: British Journal of Sports Medicine, ISSN 0306-3674, E-ISSN 1473-0480Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVES: To examine the associations between changes in cardiorespiratory fitness (CRF) in adulthood and prostate cancer incidence and mortality.

METHODS: In this prospective study, men who completed an occupational health profile assessment including at least two valid submaximal CRF tests, performed on a cycle ergometer, were included in the study. Data on prostate cancer incidence and mortality were derived from national registers. HRs and CIs were calculated using Cox proportional hazard regression with inverse probability treatment weights of time-varying covariates.

RESULTS: During a mean follow-up time of 6.7 years (SD 4.9), 592 (1%) of the 57 652 men were diagnosed with prostate cancer, and 46 (0.08%) died with prostate cancer as the primary cause of death. An increase in absolute CRF (as % of L/min) was associated with a reduced risk of prostate cancer incidence (HR 0.98, 95% CI 0.96 to 0.99) but not mortality, in the fully adjusted model. When participants were grouped as having increased (+3%), stable (±3%) or decreased (-3%) CRF, those with increased fitness also had a reduced risk of prostate cancer incidence compared with those with decreased fitness (HR 0.65, 95% CI 0.49 to 0.86), in the fully adjusted model.

CONCLUSION: In this study of employed Swedish men, change in CRF was inversely associated with risk of prostate cancer incidence, but not mortality. Change in CRF appears to be important for reducing the risk of prostate cancer.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2024
Keywords
Physical fitness
National Category
Cardiac and Cardiovascular Systems Urology and Nephrology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-8093 (URN)10.1136/bjsports-2023-107007 (DOI)38290798 (PubMedID)
Projects
HPI-gruppen
Available from: 2024-02-02 Created: 2024-02-02 Last updated: 2024-02-22
Ekblom Bak, E., Bojsen-Møller, E., Wallin, P., Paulsson, S., Lindwall, M., Rundqvist, H. & Bolam, K. (2023). Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men.. JAMA Network Open, 6(6), Article ID e2321102.
Open this publication in new window or tab >>Association Between Cardiorespiratory Fitness and Cancer Incidence and Cancer-Specific Mortality of Colon, Lung, and Prostate Cancer Among Swedish Men.
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2023 (English)In: JAMA Network Open, E-ISSN 2574-3805, Vol. 6, no 6, article id e2321102Article in journal (Refereed) Published
Abstract [en]

IMPORTANCE: Cardiorespiratory fitness (CRF) levels appear to be an important risk factor for cancer incidence and death.

OBJECTIVES: To examine CRF and prostate, colon, and lung cancer incidence and mortality in Swedish men, and to assess whether age moderated any associations between CRF and cancer.

DESIGN, SETTING, AND PARTICIPANTS: A prospective cohort study was conducted in a population of men who completed an occupational health profile assessment between October 1982 and December 2019 in Sweden. Data analysis was performed from June 22, 2022, to May 11, 2023.

EXPOSURE: Cardiorespiratory fitness was assessed as maximal oxygen consumption, estimated using a submaximal cycle ergometer test.

MAIN OUTCOMES AND MEASURES: Data on prostate, colon, and lung cancer incidence and mortality were derived from national registers. Hazard ratios (HRs) and 95% CIs were calculated using Cox proportional hazards regression.

RESULTS: Data on 177 709 men (age range, 18-75 years; mean [SD] age, 42 [11] years; mean [SD] body mass index, 26 [3.8]) were analyzed. During a mean (SD) follow-up time of 9.6 (5.5) years, a total of 499 incident cases of colon, 283 of lung, and 1918 of prostate cancer occurred, as well as 152 deaths due to colon cancer, 207 due to lung cancer, and 141 deaths due to prostate cancer. Higher levels of CRF (maximal oxygen consumption as milliliters per minute per kilogram) were associated with a significantly lower risk of colon (HR, 0.98, 95% CI, 0.96-0.98) and lung cancer (HR, 0.98; 95% CI, 0.96-0.99) incidence, and a higher risk of prostate cancer incidence (HR, 1.01; 95% CI, 1.00-1.01). Higher CRF was associated with a lower risk of death due to colon (HR, 0.98; 95% CI, 0.96-1.00), lung (HR, 0.97; 95% CI, 0.95-0.99), and prostate (HR, 0.95; 95% CI, 0.93-0.97) cancer. After stratification into 4 groups and in fully adjusted models, the associations remained for moderate (>35-45 mL/min/kg), 0.72 (0.53-0.96) and high (>45 mL/min/kg), 0.63 (0.41-0.98) levels of CRF, compared with very low (<25 mL/min/kg) CRF for colon cancer incidence. For prostate cancer mortality, associations remained for low (HR, 0.67; 95% CI, 0.45-1.00), moderate (HR, 0.57; 95% CI, 0.34-0.97), and high (HR, 0.29; 95% CI, 0.10-0.86) CRF. For lung cancer mortality, only high CRF (HR, 0.41; 95% CI, 0.17-0.99) was significant. Age modified the associations for lung (HR, 0.99; 95% CI, 0.99-0.99) and prostate (HR, 1.00; 95% CI, 1.00-1.00; P < .001) cancer incidence, and for death due to lung cancer (HR, 0.99; 95% CI, 0.99-0.99; P = .04).

CONCLUSIONS AND RELEVANCE: In this cohort of Swedish men, moderate and high CRF were associated with a lower risk of colon cancer. Low, moderate, and high CRF were associated with lower risk of death due to prostate cancer, while only high CRF was associated with lower risk of death due to lung cancer. If evidence for causality is established, interventions to improve CRF in individuals with low CRF should be prioritized.

Place, publisher, year, edition, pages
American Medical Association (AMA), 2023
National Category
Cancer and Oncology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-7722 (URN)10.1001/jamanetworkopen.2023.21102 (DOI)001059352200007 ()37382952 (PubMedID)
Projects
HPI-gruppen
Funder
Swedish Cancer Society, 21 1837
Available from: 2023-08-21 Created: 2023-08-21 Last updated: 2024-01-11
Kotte, M., Bolam, K., Mijwel, S., Altena, R., Cormie, P. & Wengström, Y. (2023). Distance-based delivery of exercise for people treated for breast, prostate or colorectal cancer: a study protocol for a randomised controlled trial of EX-MED Cancer Sweden.. Trials, 24(1), 116, Article ID 116.
Open this publication in new window or tab >>Distance-based delivery of exercise for people treated for breast, prostate or colorectal cancer: a study protocol for a randomised controlled trial of EX-MED Cancer Sweden.
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2023 (English)In: Trials, E-ISSN 1745-6215, Vol. 24, no 1, p. 116-, article id 116Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Regular exercise has been shown to have beneficial health effects in cancer survivors, including improving quality of life and other important health outcomes. However, providing people with cancer with easily accessible, high-quality exercise support and programs is a challenge. Therefore, there is a need to develop easily accessible exercise programs that draw upon the current evidence. Supervised, distance-based exercise programs have the benefit of reaching out to many people whilst providing the support of an exercise professional. The aim of the EX-MED Cancer Sweden trial is to examine the effectiveness of a supervised, distance-based exercise program, in people previously treated for breast, prostate, or colorectal cancer, on health-related quality of life (HRQoL), as well as other physiological and patient-reported health outcomes.

METHODS: The EX-MED Cancer Sweden trial is a prospective randomised controlled trial including 200 people that have completed curative treatment for breast, prostate, or colorectal cancer. Participants are randomly allocated to an exercise group or a routine care control group. The exercise group will participate in a supervised, distanced-based exercise program delivered by a personal trainer who has undertaken specialised exercise oncology education modules. The intervention consists of a combination of resistance and aerobic exercises with participants completing two 60-min sessions per week for 12 weeks. The primary outcome is HRQoL (EORTC QLQ-C30) assessed at baseline, 3- (end of intervention and primary endpoint) and 6-months post-baseline. Secondary outcomes are physiological (cardiorespiratory fitness, muscle strength, physical function, body composition) and patient-reported outcomes (cancer-related symptoms, fatigue, self-reported physical activity), and self-efficacy of exercise. Furthermore, the trial will explore and describe the experiences of participation in the exercise intervention.

DISCUSSION: The EX-MED Cancer Sweden trial will provide evidence regarding the effectiveness of a supervised, distance-based exercise program for survivors of breast, prostate, and colorectal cancer. If successful, it will contribute to the implementation of flexible and effective exercise programs as part of the standard of care for people following cancer treatment, which is likely to contribute to a reduction in the burden of cancer on the individual, health care system and society.

CLINICALTRIALS: gov NCT05064670. Registered on October 1, 2021.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Cancer, Distance-based, Exercise, Fitness, Home-based
National Category
Cancer and Oncology Physiotherapy
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-7533 (URN)10.1186/s13063-023-07152-z (DOI)000936877900003 ()36800978 (PubMedID)
Available from: 2023-03-10 Created: 2023-03-10 Last updated: 2024-01-17
Thomsen, S. N., Lahart, I. M., Thomsen, L. M., Fridh, M. K., Larsen, A., Mau-Sørensen, M., . . . Simonsen, C. (2023). Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials. eClinicalMedicine, 59, Article ID 101937.
Open this publication in new window or tab >>Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials
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2023 (English)In: eClinicalMedicine, E-ISSN 2589-5370, Vol. 59, article id 101937Article in journal (Refereed) Published
Abstract [en]

Background

Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment.

Methods

This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882).

Findings

129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47–2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11–2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03–3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55–0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14–2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence.

Interpretation

The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population.

Funding

There was no funding for this study.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Exercise, Harms, Adverse events, Oncology, Cancer, Chemotherapy
National Category
Cancer and Oncology
Research subject
Medicine/Technology
Identifiers
urn:nbn:se:gih:diva-7631 (URN)10.1016/j.eclinm.2023.101937 (DOI)001003626600001 ()
Available from: 2023-05-09 Created: 2023-05-09 Last updated: 2023-07-13
Hiensch, A. E., Monninkhof, E. M., Schmidt, M. E., Zopf, E. M., Bolam, K., Aaronson, N. K., . . . May, A. M. (2022). Design of a multinational randomized controlled trial to assess the effects of structured and individualized exercise in patients with metastatic breast cancer on fatigue and quality of life: the EFFECT study.. Trials, 23(1), 610, Article ID 610.
Open this publication in new window or tab >>Design of a multinational randomized controlled trial to assess the effects of structured and individualized exercise in patients with metastatic breast cancer on fatigue and quality of life: the EFFECT study.
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2022 (English)In: Trials, E-ISSN 1745-6215, Vol. 23, no 1, p. 610-, article id 610Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Many patients with metastatic breast cancer experience cancer- and treatment-related side effects that impair activities of daily living and negatively affect the quality of life. There is a need for interventions that improve quality of life by alleviating fatigue and other side effects during palliative cancer treatment. Beneficial effects of exercise have been observed in the curative setting, but, to date, comparable evidence in patients with metastatic breast cancer is lacking. The aim of this study is to assess the effects of a structured and individualized 9-month exercise intervention in patients with metastatic breast cancer on quality of life, fatigue, and other cancer- and treatment-related side effects.

METHODS: The EFFECT study is a multinational, randomized controlled trial including 350 patients with metastatic breast cancer. Participants are randomly allocated (1:1) to an exercise or control group. The exercise group participates in a 9-month multimodal exercise program, starting with a 6-month period where participants exercise twice a week under the supervision of an exercise professional. After completing this 6-month period, one supervised session is replaced by one unsupervised session for 3 months. In addition, participants are instructed to be physically active for ≥30 min/day on all remaining days of the week, while being supported by an activity tracker and exercise app. Participants allocated to the control group receive standard medical care, general written physical activity advice, and an activity tracker, but no structured exercise program. The primary outcomes are quality of life (EORTC QLQ-C30, summary score) and fatigue (EORTC QLQ-FA12), assessed at baseline, 3, 6 (primary endpoint), and 9 months post-baseline. Secondary outcomes include physical fitness, physical performance, physical activity, anxiety, depression, pain, sleep problems, anthropometric data, body composition, and blood markers. Exploratory outcomes include quality of working life, muscle thickness, urinary incontinence, disease progression, and survival. Additionally, the cost-effectiveness of the exercise program is assessed. Adherence and safety are monitored throughout the intervention period.

DISCUSSION: This large randomized controlled trial will provide evidence regarding the (cost-) effectiveness of exercise during treatment of metastatic breast cancer. If proven (cost-)effective, exercise should be offered to patients with metastatic breast cancer as part of standard care.

TRIAL REGISTRATION: ClinicalTrials.gov NCT04120298 . Registered on October 9, 2019.

Keywords
Exercise, Fatigue, Metastatic breast cancer, Quality of life, Randomized controlled trial
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7687 (URN)10.1186/s13063-022-06556-7 (DOI)35906659 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2024-01-17
Campbell, K. L., Cormie, P., Weller, S., Alibhai, S. M., Bolam, K., Campbell, A., . . . Goulart, J. (2022). Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals.. JCO oncology practice, 18(5), e697-e709
Open this publication in new window or tab >>Exercise Recommendation for People With Bone Metastases: Expert Consensus for Health Care Providers and Exercise Professionals.
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2022 (English)In: JCO oncology practice, ISSN 2688-1535, Vol. 18, no 5, p. e697-e709Article in journal (Refereed) Published
Abstract [en]

PURPOSE: Exercise has been underutilized in people with advanced or incurable cancer despite the potential to improve physical function and reduce psychosocial morbidity, especially for people with bone metastases because of concerns over skeletal complications. The International Bone Metastases Exercise Working Group (IBMEWG) was formed to develop best practice recommendations for exercise programming for people with bone metastases on the basis of published research, clinical experience, and expert opinion.

METHODS: The IBMEWG undertook sequential steps to inform the recommendations: (1) modified Delphi survey, (2) systematic review, (3) cross-sectional survey to physicians and nurse practitioners, (4) in-person meeting of IBMEWG to review evidence from steps 1-3 to develop draft recommendations, and (5) stakeholder engagement.

RESULTS: Recommendations emerged from the contributing evidence and IBMEWG discussion for pre-exercise screening, exercise testing, exercise prescription, and monitoring of exercise response. Identification of individuals who are potentially at higher risk of exercise-related skeletal complication is a complex interplay of these factors: (1) lesion-related, (2) cancer and cancer treatment-related, and (3) the person-related. Exercise assessment and prescription requires consideration of the location and presentation of bone lesion(s) and should be delivered by qualified exercise professionals with oncology education and exercise prescription experience. Emphasis on postural alignment, controlled movement, and proper technique is essential.

CONCLUSION: Ultimately, the perceived risk of skeletal complications should be weighed against potential health benefits on the basis of consultation between the person, health care team, and exercise professionals. These recommendations provide an initial framework to improve the integration of exercise programming into clinical care for people with bone metastases.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7688 (URN)10.1200/OP.21.00454 (DOI)34990293 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
de Boniface, J., Altena, R., Haddad Ringborg, C., Bolam, K. & Wengström, Y. (2022). Physical exercise during neoadjuvant chemotherapy for breast cancer as a mean to increase pathological complete response rates: Trial protocol of the randomized Neo-ACT trial.. PLOS ONE, 17(10), e0274804, Article ID e0274804.
Open this publication in new window or tab >>Physical exercise during neoadjuvant chemotherapy for breast cancer as a mean to increase pathological complete response rates: Trial protocol of the randomized Neo-ACT trial.
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2022 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 17, no 10, p. e0274804-, article id e0274804Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: In early breast cancer, neoadjuvant chemotherapy (NACT) is increasingly used. The proof of efficacy is pathologically complete response (pCR), i.e. the absence of invasive tumour in breast and lymph nodes at surgery. Today, pCR is a common endpoint in pharmaceutical trials since it is significantly associated with survival especially in triple-negative and HER2-positive subtypes. Apart from the mitigation of treatment-related toxicity and symptoms, physical exercise mediates anti-tumoral systemic effects associated with tumour regression in preclinical and clinical models. The aim of Neo-ACT is to test the hypothesis that physical exercise can improve pCR rates in breast cancer patients receiving NACT.

METHOD: The Neo-ACT trial is a prospective clinical trial, randomising T1-3N0-2 breast cancer patients planned for NACT to either a home-based physical exercise intervention supported by a mobile application or routine care. The primary endpoint is pCR; secondary endpoints are patient-reported quality of life, toxicity-related outcomes, and oncological outcomes such as Residual Cancer Burden, objective radiological tumour response, as well as overall, breast cancer-specific and disease-free survival at 2, 5 and 10 years. The intervention consists of a combination of high-intensity interval and resistance training of progressing intensity, and includes at least 150 min of moderate to vigorous physical activity per week, inclusive of two weekly 60-min exercise sessions. In order to show an improvement in pCR of 10%, a total of 712 participants need to be included in the analysis. The Neo-ACT has been registered at clinicaltrials.gov on January 11, 2022 (NCT05184582).

EXPECTED RESULTS: If Neo-ACT can prove the oncological efficacy of physical exercise, implementation of training programmes into NACT schedules will be pursued. The use of a digitally led exercise intervention aims to test the potential of such a strategy for use in rural areas and areas of limited resources.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7686 (URN)10.1371/journal.pone.0274804 (DOI)36227931 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
Rose, G. L., Skinner, T. L., Keating, S. E., Friedrich, N. K. & Bolam, K. (2022). The effects of exercise on the bone health of people with cancer: a systematic review and meta-analysis.. Osteoporosis International, 33(2), 327-338
Open this publication in new window or tab >>The effects of exercise on the bone health of people with cancer: a systematic review and meta-analysis.
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2022 (English)In: Osteoporosis International, ISSN 0937-941X, E-ISSN 1433-2965, Vol. 33, no 2, p. 327-338Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To determine the pooled effect of exercise on the bone health of people diagnosed with cancer.

METHODS: Four electronic databases were systematically searched. Controlled trials that assessed the effect of exercise on the bone mineral density (BMD) or content (BMC) measured by dual-energy x-ray absorptiometry or peripheral quantitative computed tomography in people who had been diagnosed with cancer were included in the study. Random-effect meta-analyses of effect size (ES) were conducted. Sub-group analyses were performed to explore the influence of intervention duration, prescription and participant characteristics.

RESULTS: Of 66 full-text articles screened, 22 studies, from 21 interventions, were included (primarily breast/prostate cancer, sample range n = 36-498). When all interventions were grouped, a significant pooled ES was observed for exercise on hip (ES = 0.112, 95% CI: 0.026 to 0.198; p = 0.011) and lumbar spine BMD (ES = 0.269, 95% CI: 0.036 to 0.501; p = 0.024) compared to control. There was also an influence of sex, where females had greater improvements in hip (ES = 0.120, 95% CI: 0.017 to 0.223; p = 0.022) and spine BMD (ES = 0.415, 95% CI: 0.056 to 0.774; p = 0.23) compared to males.

CONCLUSION: Overall, exercise regimens of studies included in this review appear to improve bone health at the hip and spine in people diagnosed with cancer. Sub-analyses suggest some influence of sex, where females had greater improvements in BMD compared to males. It is essential that future studies evaluate the dose-response of exercise training on bone health and create exercise protocols that better align with the laws of bone modelling to enhance osteogenic potential.

Keywords
Bone density [MESH], Exercise [MESH], Impact-loading, Meta-analysis [MESH], Neoplasms [MESH]
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7689 (URN)10.1007/s00198-021-06131-x (DOI)34532766 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
Weller, S., Hart, N. H., Bolam, K., Mansfield, S., Santa Mina, D., Winters-Stone, K. M., . . . Campbell, K. L. (2021). Exercise for individuals with bone metastases: A systematic review.. Critical reviews in oncology/hematology, 166, 103433, Article ID 103433.
Open this publication in new window or tab >>Exercise for individuals with bone metastases: A systematic review.
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2021 (English)In: Critical reviews in oncology/hematology, ISSN 1040-8428, E-ISSN 1879-0461, Vol. 166, p. 103433-, article id 103433Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Exercise has the potential to improve physical function and quality of life in individuals with bone metastases but is often avoided due to safety concerns. This systematic review summarizes the safety, feasibility and efficacy of exercise in controlled trials that include individuals with bone metastases.

METHODS: MEDLINE, Embase, Pubmed, CINAHL, PEDro and CENTRAL databases were searched to July 16, 2020.

RESULTS: A total of 17 trials were included incorporating aerobic exercise, resistance exercise or soccer interventions. Few (n = 4, 0.5%) serious adverse events were attributed to exercise participation, with none related to bone metastases. Mixed efficacy results were found, with exercise eliciting positive changes or no change. The majority of trials included an element of supervised exercise instruction (n = 16, 94%) and were delivered by qualified exercise professionals (n = 13, 76%).

CONCLUSIONS: Exercise appears safe and feasible for individuals with bone metastases when it includes an element of supervised exercise instruction.

Keywords
bone neoplasms, exercise, neoplasm metastasis, neoplasms, rehabilitation, sports, systematic review
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7690 (URN)10.1016/j.critrevonc.2021.103433 (DOI)34358650 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
Ansund, J., Mijwel, S., Bolam, K., Altena, R., Wengström, Y., Rullman, E. & Rundqvist, H. (2021). High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT.. Cardio-oncology (London, England), 7(1), 7, Article ID 7.
Open this publication in new window or tab >>High intensity exercise during breast cancer chemotherapy - effects on long-term myocardial damage and physical capacity - data from the OptiTrain RCT.
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2021 (English)In: Cardio-oncology (London, England), ISSN 2057-3804, Vol. 7, no 1, p. 7-, article id 7Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Adjuvant systemic breast cancer treatment improves disease specific outcomes, but also presents with cardiac toxicity. In this post-hoc exploratory analysis of the OptiTrain trial, the effects of exercise on cardiotoxicity were monitored by assessing fitness and biomarkers over the intervention and into survivorship. Methods; Women starting chemotherapy were randomized to 16-weeks of resistance and high-intensity interval training (RT-HIIT), moderate-intensity aerobic and high-intensity interval training (AT-HIIT), or usual care (UC). Outcome measures included plasma troponin-T (cTnT), Nt-pro-BNP and peak oxygen uptake (VO2peak), assessed at baseline, post-intervention, and at 1- and 2-years.

RESULTS: For this per-protocol analysis, 88 women met criteria for inclusion. Plasma cTnT increased in all groups post-intervention. At the 1-year follow-up, Nt-pro-BNP was lower in the exercise groups compared to UC. At 2-years there was a drop in VO2peak for patients with high cTnT and Nt-pro-BNP. Fewer patients in the RT-HIIT group fulfilled biomarker risk criteria compared to UC (OR 0.200; 95% CI = 0.055-0.734).

CONCLUSIONS: In this cohort, high-intensity exercise was associated with lower levels of NT-proBNP 1-year post-baseline, but not with cTnT directly after treatment completion. This may, together with the preserved VO2peak in patients with low levels of biomarkers, indicate a long-term cardioprotective effect of exercise.

TRIAL REGISTRATION: Clinicaltrials. govNCT02522260 , Registered 13th of august 2015 - Retrospectively Registered.

Keywords
Biomarkers, Cardiotoxicity, Exercise oncology
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:gih:diva-7691 (URN)10.1186/s40959-021-00091-1 (DOI)33588948 (PubMedID)
Available from: 2023-06-27 Created: 2023-06-27 Last updated: 2023-06-27
Projects
The WORK TOGETHER program: Using a systems approach to update an occupational health service and reduce the health gap [2023-01126]; Swedish School of Sport and Health Sciences, GIH
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5140-9098

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