Showing papers by "Kerry S. Courneya published in 2019"

Exercise Guidelines for Cancer Survivors: Consensus Statement from International Multidisciplinary Roundtable

Abstract: PurposeThe number of cancer survivors worldwide is growing, with over 15.5 million cancer survivors in the United States alone—a figure expected to double in the coming decades. Cancer survivors face unique health challenges as a result of their cancer diagnosis and the impact of treatments

Effects and moderators of exercise on muscle strength, muscle function and aerobic fitness in patients with cancer: a meta-analysis of individual patient data

Abstract: Objective: To optimally target exercise interventions for patients with cancer, it is important to identify which patients benefit from which interventions. Design: We conducted an individual patient data meta-analysis to investigate demographic, clinical, intervention-related and exercise-related moderators of exercise intervention effects on physical fitness in patients with cancer. Data sources: We identified relevant studies via systematic searches in electronic databases (PubMed, Embase, PsycINFO and CINAHL). Eligibility criteria: We analysed data from 28 randomised controlled trials investigating the effects of exercise on upper body muscle strength (UBMS) and lower body muscle strength (LBMS), lower body muscle function (LBMF) and aerobic fitness in adult patients with cancer. Results: Exercise significantly improved UBMS (β=0.20, 95% Confidence Interval (CI) 0.14 to 0.26), LBMS (β=0.29, 95% CI 0.23 to 0.35), LBMF (β=0.16, 95% CI 0.08 to 0.24) and aerobic fitness (β=0.28, 95% CI 0.23 to 0.34), with larger effects for supervised interventions. Exercise effects on UBMS were larger during treatment, when supervised interventions included ≥3 sessions per week, when resistance exercises were included and when session duration was >60 min. Exercise effects on LBMS were larger for patients who were living alone, for supervised interventions including resistance exercise and when session duration was >60 min. Exercise effects on aerobic fitness were larger for younger patients and when supervised interventions included aerobic exercise. Conclusion: Exercise interventions during and following cancer treatment had small effects on UBMS, LBMS, LBMF and aerobic fitness. Demographic, intervention-related and exercise-related characteristics including age, marital status, intervention timing, delivery mode and frequency and type and time of exercise sessions moderated the exercise effect on UBMS, LBMS and aerobic fitness.

Community-based exercise for health promotion and secondary cancer prevention in Canada: protocol for a hybrid effectiveness-implementation study.

Abstract: Introduction Cancer care has expanded from a disease-focused, survival-oriented model to an approach that now considers how survivors can live well in the aftermath of intensive therapy, where they may deal with significant changes to their bodies, mental health or emotional well-being. Research evidence supports the benefit of exercise during and following cancer treatments for cancer-related symptoms, physical functioning and fitness, and health-related quality of life. To move this efficacy evidence into practice, we designed and launched a 5-year study to evaluate the relative benefit from implementing a clinic-to-community-based cancer and exercise model of care. Methods and analysis A hybrid effectiveness and implementation trial design is being used to evaluate the effectiveness of delivery of community-based exercise and to collect data on implementation of the programme. The study opened in January 2017, with estimated completion by January 2022. The programme will be delivered in seven cities across the province of Alberta, Canada, with sites including three academic institutions, six YMCA locations, Wellspring Edmonton and Calgary, and six municipal fitness centres. Participants are adult cancer survivors (n=2500) from all tumour groups and stages and at any time point along their cancer treatment trajectory, up to 3 years post treatment completion. Survivors take part in a minimum of 60 min of mild-to-moderate intensity full body exercise twice weekly for a 12-week period. The primary effectiveness outcome is the proportion of participants meeting or exceeding 150 min of moderate intensity exercise per week at 1-year follow-up. The Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework will be utilised to capture individual-level and organizational-level impact of the exercise programme at 12 and 24 weeks and 1-year follow-up. The cohort of survivors participating in the study will allow for long-term (>5-year) evaluation of rates of cancer recurrence and secondary cancers beyond the funding period. Ethics and dissemination The study was approved by the Health Research Ethics Board of Alberta. The study is funded by Alberta Innovates and the Alberta Cancer Foundation. The study will help to answer critical questions on the effectiveness of cancer-specific community-based exercise programming in both the short-term and the long-term. Collectively, the findings will help to inform the acceptability, adoption, feasibility, reach and sustainability of community-based exercise. Trial registration number NCT02984163; Pre-results.

Effect of Aerobic and Resistance Exercise Intervention on Cardiovascular Disease Risk in Women With Early-Stage Breast Cancer: A Randomized Clinical Trial.

Abstract: Importance The Framingham Risk Score (FRS) is a valid method for predicting the 10-year risk of developing cardiovascular disease. Higher FRS is reported in patients with early-stage breast cancer who are overweight than in healthy, age-matched women, but whether exercise reduces FRS in this patient population is unclear. Objective To examine the effects of a 16-week aerobic and resistance exercise intervention on the FRS in women with early-stage breast cancer and with overweight condition or obesity. Design, Setting, and Participants This single-center, prospective randomized clinical trial included 100 women with stage I to III breast cancer who were sedentary, with overweight condition or obesity (body mass index of ≥25.0 or body fat of ≥30%), and completed cancer treatment within 6 months prior to enrollment. Participants were randomized to either the usual care or exercise group. Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analyses. Data were collected from August 1, 2012, through July 1, 2017. Data analysis, which followed the intention-to-treat approach, was performed from May 24 to October 2, 2018. Interventions The exercise group underwent supervised aerobic and resistance exercise sessions thrice weekly for 16 weeks. Main Outcomes and Measures The FRS was calculated for each participant using preset points for each of the 6 FRS categories: age, systolic blood pressure, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, diabetes presence, and smoking status. Results In total, 100 women were randomized to either the exercise group (n = 50) or usual care group (n = 50). Of these women, 55 (55%) were of Hispanic white race/ethnicity and the mean (SD) age was 53.5 (10.4) years. The mean (SD) total FRS scores postintervention were 2.0 (1.5) in the exercise group and 13.0 (3.0) in the usual care group. The postintervention FRS was significantly reduced in the exercise group compared with the usual care group (mean, −9.5; 95% CI, −13.0 to −6.0), which corresponds to an 11% (95% CI, −15.0 to −5.0) decrease on the FRS-predicted 10-year risk of developing cardiovascular disease. Conclusions and Relevance A 16-week supervised aerobic and resistance exercise intervention appeared to reduce the FRS-predicted 10-year risk of cardiovascular disease in women with early-stage breast cancer with overweight condition or obesity. Clinical Trial Registration ClinicalTrials.gov identifier:NCT01140282

Dose-response effects of exercise on bone mineral density and content in post-menopausal women.

Abstract: Exercise is one of the most widely used non-pharmacological strategies to prevent bone resorption during menopause. Given the detrimental consequences of bone demineralization, the purpose of this study was to examine the effects of prescribing different exercise volumes on bone mineral density and content in previously inactive, post-menopausal women during a 12-month intervention and 1 year after intervention completion. Four hundred post-menopausal women were randomized to either 150 min/wk (MODERATE dose group) or 300 min/wk (HIGH dose group) of aerobic exercise. Total bone mineral density (g/cm2) and bone mineral content (g) were assessed at baseline, 12 months (end of the intervention) and 24 months (follow-up) using whole body dual-energy X-ray absorptiometry. At 12 months, mean bone mineral density among women in the HIGH dose group was estimated to be 0.006 g/cm2 (95% CI: 0.001-0.010; P = 0.02) higher than that of women randomized to the MODERATE dose group. At 24 months, the mean difference between groups remained statistically significant, indicating higher mean bone mineral density among women in the HIGH dose group (0.007 g/cm2; 0.001-0.001; P = 0.04). No significant differences between groups were found at any time point for bone mineral content. In an exploratory analysis, women who completed more min/wk of impact exercises had significantly higher mean levels of bone mineral density at 12 months compared to baseline (0.006 g/cm2, 95% CI: 0.006-0.012; P = 0.03). These findings suggest that higher volumes of exercise, especially impact exercise, lead to a smaller decline in total bone mineral density, which may remain following intervention completion.

Activity Tracker to Prescribe Various Exercise Intensities in Breast Cancer Survivors.

Abstract: Purpose: To prescribe different physical activity (PA) intensities using activity trackers to increase PA, reduce sedentary time, and improve health outcomes among breast cancer survivors. The maintenance effect of the interventions on study outcomes was also assessed. Methods: The Breast Cancer and Physical Activity Level pilot trial randomized 45 breast cancer survivors to a home-based, 12-wk lower (300 min·wk-1 at 40%–59% of HR reserve) or higher-intensity PA (150 min·wk-1 at 60%–80% of HR reserve), or no PA intervention/control. Both intervention groups received Polar A360® activity trackers. Study outcomes assessed at baseline, 12 and 24 wk included PA and sedentary time (ActiGraph GT3X+), health-related fitness (e.g., body composition, cardiopulmonary fitness/VO2max), and patient-reported outcomes (e.g., quality of life). Intention-to-treat analyses were conducted using linear mixed models and adjusted for baseline outcomes. Results: Increases in moderate-vigorous intensity PA (least squares adjusted group difference [LSAGD], 0.6; 95% confidence interval [CI], 0.1–1.0) and decreases in sedentary time (LSAGD, -1.2; 95% CI, -2.2 to -0.2) were significantly greater in the lower-intensity PA group versus control at 12 wk. Increases in VO2max at 12 wk in both interventions groups were significantly greater than changes in the control group (lower-intensity PA group LSAGD, 4.2; 95% CI, 0.5–8.0 mL·kg-1·min-1; higher-intensity PA group LSAGD, 5.4; 95% CI, 1.7–9.1mL·kg-1·min-1). Changes in PA and VO2max remained at 24wk, but differences between the intervention and control groups were no longer statistically significant. Conclusions: Increases in PA time and cardiopulmonary fitness/VO2max can be achieved with both lower- and higher-intensity PA interventions in breast cancer survivors. Reductions in sedentary time were also noted in the lower-intensity PA group.

Breast cancer survivors’ preferences for mHealth physical activity interventions: findings from a mixed methods study

Abstract: Despite the benefits of physical activity for breast cancer survivors, the majority remain insufficiently active. Mobile health (mHealth) physical activity interventions may be a more scalable strategy to increase activity among survivors. However, little is known about their preferences for mHealth intervention features. This study explored survivors’ preferences for these features. Survivors (N = 96; Mage = 55.8 (SD = 10.2)) self-reported demographic and disease characteristics, physical activity. A subset (n = 28) completed a semi-structured phone interview. Transcribed interviews were evaluated using a thematic content analysis approach and consensus review. Following interviews, the full sample self-reported interests and preferences for intervention features via online questionnaires. Quantitative data were analyzed using descriptive statistics. Five themes emerged from interview data: (1) importance of relevance to breast cancer survivors; (2) easy to use; (3) integration with wearable activity trackers; (4) provide sense of accomplishment; and (5) variability in desired level of structure and personalization. The highest ranked intervention features were: daily and weekly progress feedback (87.5%), newsfeed (86.6%), activity challenges (81.3%), and scheduling tool (79.2%). Survivors were interested in receiving progress feedback (80.2%) and motivational (78.1%) and reminder (75.0%) messages. Breast cancer survivors are interested in mHealth physical activity promotion interventions, but preferences varied around themes of relevance, ease of use, and enhancing personal motivation. Engaging survivors in developing and implementing remotely delivered mHealth activity promotion interventions may enhance their effectiveness.

Hispanic ethnicity as a moderator of the effects of aerobic and resistance exercise in survivors of breast cancer.

Abstract: BACKGROUND Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28-week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS.

Aerobic and Resistance Exercise Improves Shoulder Function in Women Who Are Overweight or Obese and Have Breast Cancer: A Randomized Controlled Trial.

Abstract: Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2-20.7°], external rotation at 0° = 23.4° [95% CI = 31.1-12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9-26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.

Peer support for the maintenance of physical activity and health in cancer survivors: the PEER trial - a study protocol of a randomised controlled trial

Abstract: Despite an overwhelming body of evidence showing the benefits of physical activity (PA) and exercise for cancer survivors, few survivors meet the exercise oncology guidelines. Moreover, initiating, let alone maintaining exercise programs with cancer survivors continues to have limited success. The aim of this trial is to evaluate the influence of peer support on moderate-to-vigorous PA (MVPA) and various markers of health 12 months following a brief supervised exercise intervention in cancer survivors. Men and women previously diagnosed with histologically-confirmed breast, colorectal or prostate cancer (n = 226), who are >1-month post-treatment, will be invited to participate in this trial. Once enrolled, participants will complete 4 weeks (12 sessions) of supervised high intensity interval training (HIIT). On completion of the supervised phase, both groups will be provided with written recommendations and verbally encouraged to achieve three HIIT sessions per week, or equivalent exercise that meets the exercise oncology guidelines. Participants will be randomly assigned to receive 12 months of peer support, or no peer support (control). Primary and secondary outcomes will be assessed at baseline, after the 4-week supervised HIIT phase and at 3-, 6- and 12-months. Primary outcomes will include accelerometry-derived MVPA and prescribed HIIT session adherence; whilst secondary outcomes will include cardiorespiratory fitness ( $$ \dot{\mathrm{V}}{\mathrm{O}}_{2\mathrm{peak}} $$ ), body composition, quality of life and select cytokines, myokines and inflammatory markers. Random effects mixed modelling will be used to compare mean changes in outcomes between groups at each time point. A group x time interaction will be used to formally test for differences between groups (alpha =0.05); utilising intention-to-treat analyses. If successful, peer support may be proposed, adopted and implemented as a strategy to encourage cancer survivors to maintain exercise beyond the duration of a short-term, supervised intervention. A peer support-exercise model has the long-term potential to reduce comorbidities, improve physical and mental wellbeing, and significantly reduce the burden of disease in cancer survivors. Human Research Ethics Committee of Bellberry Ltd. (#2015–12-840). Australian New Zealand Clinical Trial Registry 12618001855213 . Retrospectively registered 14 November 2018. Trial registration includes all components of the WHO Trial Registration Data Set, as recommended by the ICMJE.

Comparing docosahexaenoic acid (DHA) concomitant with neoadjuvant chemotherapy versus neoadjuvant chemotherapy alone in the treatment of breast cancer (DHA WIN): protocol of a double-blind, phase II, randomised controlled trial.

Abstract: Introduction Neoadjuvant chemotherapy for breast cancer treatment is prescribed to facilitate surgery and provide confirmation of drug-sensitive disease, and the achievement of pathological complete response (pCR) predicts improved long-term outcomes. Docosahexaenoic acid (DHA) has been shown to reduce tumour growth in preclinical models when combined with chemotherapy and is known to beneficially modulate systemic immune function. The purpose of this trial is to investigate the benefit of DHA supplementation in combination with neoadjuvant chemotherapy in patients with breast cancer. Methods and analysis This is a double-blind, phase II, randomised controlled trial of 52 women prescribed neoadjuvant chemotherapy to test if DHA supplementation enhances chemotherapy efficacy. The DHA supplementation group will take 4.4 g/day DHA orally, and the placebo group will take an equal fat supplement of vegetable oil. The primary outcome will be change in Ki67 labelling index from prechemotherapy core needle biopsy to definitive surgical specimen. The secondary endpoints include assessment of (1) DHA plasma phospholipid content; (2) systemic immune cell types, plasma cytokines and inflammatory markers; (3) tumour markers for apoptosis and tumour infiltrating lymphocytes; (4) rate of pCR in breast and in axillary nodes; (5) frequency of grade 3 and 4 chemotherapy-associated toxicities; and (6) patient-perceived quality of life. The trial has 81% power to detect a significant between-group difference in Ki67 index with a two-sided t-test of less than 0.0497, and accounts for 10% dropout rate. Ethics and dissemination This study has full approval from the Health Research Ethics Board of Alberta - Cancer Committee (Protocol #: HREBA.CC-18-0381). We expect to present the findings of this study to the scientific community in peer-reviewed journals and at conferences. The results of this study will provide evidence for supplementing with DHA during neoadjuvant chemotherapy treatment for breast cancer. Trial registration number NCT03831178

The impact of exercise on growth factors (VEGF and FGF2): results from a 12-month randomized intervention trial.

Abstract: Vascular endothelial growth factor (VEGF) and Fibroblast growth factor-2 (FGF2) are angiogenic cytokines in normal tissues and tumors. Evidence suggests that increased growth factor expression in adipose tissue leads to improved vascularity and decreased hypoxia, fibrosis, and inflammation, which may, in turn, reduce post-menopausal breast cancer risk. We investigated whether or not exercise had dose-response effects on levels of plasma VEGF and FGF2 in postmenopausal women. Four hundred previously inactive but healthy postmenopausal women aged 50–74 years of age were randomized to 150 or 300 min per week of aerobic exercise in a year-long exercise intervention. VEGF and FGF2 were measured from fasting serum samples with a custom-plex multiplex assay. A high compared to moderate volume of aerobic exercise did not cause chronic changes in plasma VEGF or FGF2 levels in intention-to-treat or per-protocol analyses. We did not detect differences in growth factor levels related to increasing doses of exercise. It is unlikely that changes in VEGF and FGF2 levels mediate the reduction in risk of post-menopausal breast cancer development in associated with increased levels of exercise. Clinicaltrials.gov identifier: NCT01435005.

Determinants of changes in physical activity from pre-diagnosis to post-diagnosis in a cohort of prostate cancer survivors.

Abstract: Physical activity (PA) has been shown to improve quality of life and survival in cancer survivors; however, a cancer diagnosis may change PA patterns. We examine determinants of changes in meeting the PA guidelines (150 min/week of moderate aerobic PA) before and after a prostate cancer diagnosis. Eight hundred and thirty prostate cancer survivors who participated in a population-based case–control study between 1997 and 2000 in Alberta, Canada, enrolled in a prospective cohort study. Past year activity levels were self-reported at diagnosis (pre-diagnosis measure) and again 2 years post-diagnosis. Determinants were collected by questionnaires and medical chart abstractions. Four PA patterns were created: non-exercisers (fail to meet guidelines pre-diagnosis and post-diagnosis), adopters (fail to meet guidelines pre-diagnosis, meet guidelines post-diagnosis), maintainers (meet guidelines pre-diagnosis and post-diagnosis) and relapsers (meet guidelines pre-diagnosis, fail to meet guidelines post-diagnosis). Multinomial logistic regression analyses identified that being a non-exerciser compared to maintainer was associated with being employed, rural location, high PSA, smoking status, not attending support groups and less than average physical quality of life (QoL). Being a relapser compared to maintainer was associated with rural location and lack of friend support. Finally, being a non-exerciser compared to adopter was associated with urinary incontinence, smoking status and less than average physical and mental QoL. Demographic, health and lifestyle variables are associated with changes in meeting PA guidelines from pre-diagnosis to post-diagnosis in prostate cancer survivors. Programming should be aimed at offering interventions to help inactive survivors adopt PA and active survivors to maintain PA.

Exercise duRing Active Surveillance for prostatE cancer-the ERASE trial: a study protocol of a phase II randomised controlled trial

Abstract: Introduction Active surveillance (AS) is the preferred primary treatment strategy for men with low-risk clinically localised prostate cancer (PCa); however, the majority of these men still receive radical treatment within 10 years due to disease progression and/or fear of cancer progression. Interventions designed to suppress tumour growth, mitigate fear of cancer progression and precondition men for impending radical treatments are an unmet clinical need. Exercise has been shown to delay the progression of prostate tumours in animal models, improve physical and functional health and manage psychological outcomes in cancer patients; however, these outcomes have not been demonstrated in PCa patients undergoing AS. Methods and analysis This phase II randomised controlled trial will randomise 66 men undergoing AS to either an exercise group or a usual care group. The exercise group will perform a 12-week, supervised, high-intensity interval training programme, consisting of 3 sessions/week for 28–40 min/session. The primary outcome will be cardiorespiratory fitness. Secondary outcomes will include immunosurveillance and cancer-related biomarkers, psychosocial outcomes including fear of cancer progression and quality of life and physical function. Exploratory outcomes will include clinical indicators of disease progression. The trial has 80% power to detect a significant between-group difference in VO2peak of 3.5 mL/kg/min with a two-tailed alpha level Ethics and dissemination The study has received full ethical approval from the Health Research Ethics Board of Alberta – Cancer Committee (Protocol Number: HREBA.CC-17–0248). The findings of the study will be disseminated through public and scientific channels. Trial registration number NCT03203460; Pre-results.

Long-term Effects of Moderate versus High Durations of Aerobic Exercise on Biomarkers of Breast Cancer Risk: Follow-up to a Randomized Controlled Trial

Abstract: Background: The optimal lifestyle for breast cancer prevention over the long term is unclear. We aimed to determine whether or not the amount of exercise prescribed in a year-long exercise intervention influences breast cancer biomarker levels 1 year later. Methods: We conducted a 24-month follow-up study (2012–2014) to the Breast Cancer and Exercise Trial in Alberta (BETA), a 12-month, two-armed (1:1), two-center randomized controlled trial of exercise in 400 cancer-free, postmenopausal women. The exercise prescription was moderate–vigorous aerobic exercise, 5 days/week (3 days/week supervised) for 30 minutes/session (MODERATE) or 60 minutes/session (HIGH). Participants were asked not to change their usual diet. We used linear mixed models to compare biomarker concentrations (C-reactive protein, insulin, glucose, HOMA-IR, estrone, sex hormone binding globulin, total estradiol, and free estradiol) over time (0, 12, and 24 months) by group (MODERATE, HIGH), using group–time interactions. Results: After 12 months of no intervention, 24-month fasting blood samples were available for 84.0% and 82.5% of MODERATE and HIGH groups, respectively (n = 333/400). We found no evidence that 0 to 24– or 12 to 24–month biomarker changes differed significantly between randomized groups (HIGH:MODERATE ratio of mean biomarker change ranged from 0.97 to 1.06, P values >0.05 for all). We found more favorable biomarker profiles among participants who experienced greater than the median fat loss during the trial. Conclusions: Prescribing aerobic exercise for 300 versus 150 minutes/week for 12 months to inactive, postmenopausal women had no effects on longer-term biomarkers. Impact: Exercise may lead to larger improvements in breast cancer biomarkers after intervention among women who also experience fat loss with exercise.

The effect of prescribed exercise volume on biomarkers of chronic stress in postmenopausal women: Results from the Breast Cancer and Exercise Trial in Alberta (BETA)

Abstract: There is epidemiologic and biologic evidence for a role of stress in breast cancer etiology and physical activity mitigates the negative effects of stress. We examined the potential for a dose-response relationship between two volumes of aerobic exercise and biomarkers of chronic stress in post-menopausal women. The Breast Cancer and Exercise Trial in Alberta is a randomized controlled trial with post-menopausal women randomized to either a MODERATE (150 min per week) or HIGH (300 min per week) volume of exercise over a one year intervention period. Fasting serum concentrations of cortisol, cortisone, corticosterone and 11-deoxycortisol at baseline, 12 months (the end of the intervention), and 24 months. Intention-to-treat analyses were performed using general linear models, adjusted for baseline biomarker concentrations. There were modest but non-statistically significant decreases in cortisol (HIGH: −4%, 95% CI: −7%, 2%; MODERATE: −1%, 95%: CI: −14%, 4%) and corticosterone (HIGH: −4%, 95% CI: −12%, 6%; MODERATE: −5%, 95% CI: −14%, 4%) concentrations for both exercise groups between baseline and 12 months, and no difference in cortisone concentrations. Intention-to-treat analysis of 386 (97%) participants showed no statistically significant group differences for changes in biomarker levels at 12 months. Between baseline and 12 months, there were no differences in cortisol or cortisone and, at 24 months all stress hormone levels increased to near-baseline levels with no significant differences between the two intervention groups.

Social Cognitive Effects and Mediators of a Pilot Telephone Counseling Intervention to Increase Aerobic Exercise in Hematologic Cancer Survivors

Abstract: Background Theory-based telephone counseling exercise (TCE) interventions can increase aerobic exercise behavior in cancer survivors. Few studies, however, assess intervention effects on social cognitive variables. Here, the authors examined changes in social cognitive variables from a TCE intervention based on the multi-process action control framework in hematologic cancer survivors. Methods A total of 51 hematologic cancer survivors were randomized to weekly TCE (n = 26) or self-directed exercise (n = 25) for 12 weeks. Participants self-reported on demographic and cancer variables, as well as motivational, regulatory, and reflexive ratings pertaining to aerobic exercise at baseline and post-intervention. Results Small-to-large between-group differences in all variables favored the TCE group. The most prominent effects were noted for differences in coping planning (adjusted mean between-group difference [MBGDadj] = 1.4, 95% confidence interval [CI], 0.7 to 2.2, d = 1.04), instrumental attitude (MBGDadj = 0.5, 95% CI, 0.1 to 1.0, d = 1.11), affective attitude (MBGDadj = 0.6, 95% CI, 0.1 to 1.2, d = 0.71), and perceived opportunity (MBGDadj = 0.4, 95% CI, -0.3 to 1.2, d = 0.50). Changes in coping planning (b = 24.98, β = 0.18, 95% CI, -0.03 to 0.56), perceived opportunity (b = 17.95, β = 0.13, 95% CI, 0.01 to 0.36), exercise identity (b = 17.43, β = 0.12, 95% CI, -0.05 to 0.41), and habit (b = 14.64, β = 0.10, 95% CI, -0.01 to 0.42) accounted for the largest mediating effects on aerobic exercise behavior. Conclusions Multi-process action control framework-based TCE interventions may strengthen motivational, regulatory, and reflexive profiles that translate into increased aerobic exercise behavior in hematologic cancer survivors.

Physical activity levels and preferences of patients with breast cancer receiving chemotherapy in Chile.

Abstract: In Chilean patients with breast cancer (BC) receiving chemotherapy we aimed to (a) report the levels of physical activity (PA), (b) compare clinical/socio-demographic parameters among patients with different levels of PA, and (c) explore exercise preferences. Patients (n = 112) completed a questionnaire regarding their PA habits, and another questionnaire regarding their preferences for an exercise program. Patients were then divided into three groups based on the exercise guidelines for patients with BC (150 min/week of moderate exercise, or 75 min/week of vigorous exercise). The groups were (i) not engaging in any moderate-to-vigorous PA (MVPA), (ii) engaging in some MVPA, but not meeting the guidelines, and (iii) meeting the guidelines. Clinical/socio-demographic parameters and preferences for exercise were compared between groups. Only 13% of patients with BC met the exercise guidelines. These patients were younger, had been diagnosed more recently, and had fewer children than patients not engaging in MVPA. There were no differences in the preferences for exercise between groups. Overall, patients preferred to exercise with other patients (76%), at moderate intensity (67%), performing different activities (94%), supervised (94%), with a fixed schedule (69%), and to do group activities (90%). Most patients with BC receiving chemotherapy did not meet the exercise guidelines. Patients > 50 years old and with > 2 children were the most inactive. Efforts to increase PA levels should focus especially on these patients. The preferences for exercise reported here will help to increase adherence to exercise programs and improve outcomes for these patients in Chile.

Exercise Dose Effects on Body Fat 12 Months after an Exercise Intervention: Follow-up from a Randomized Controlled Trial

Abstract: Background. Exercise interventions can result in weight loss, which is associated with reductions in disease risk. It is unknown how the volume of exercise prescribed in a one-time exercise intervention impacts long-term body fatness. We compared 24-month body fat changes among postmenopausal women previously prescribed 300 versus 150 minutes/week of exercise in a year-long exercise intervention trial. Methods. The Breast Cancer and Exercise Trial in Alberta (BETA) was a two-centred randomized controlled trial in Alberta, Canada. The trial consisted of a 12-month intervention and 12-month observation period. For the intervention, participants were randomized to either a moderate-volume exercise group (150 min/week) or a high-volume exercise group (300 min/week). Participants in this study were 334 inactive postmenopausal women who had been followed-up to 24 months. The primary outcome for this study was 24-month change in total body fat using dual energy X-ray absorptiometry scans. Other measures included weight, waist and hip circumferences, subcutaneous and intra-abdominal fat from computed tomography scans, and lean mass. Researchers were blinded to randomization group when measuring body fat. Results. Both groups self-reported ∼180 minutes/week moderate–vigorous activity at 24 months. No statistically significant difference was found in total body fat at 24 months between the two groups. Statistically significant effects (comparing high versus moderate groups) were found for BMI (least-square mean change (95% CI): −0.66 (−0.97, −0.36) versus −0.25 (−0.55, 0.05) kg/m2, ), waist-to-hip ratio (−0.033 (−0.040, −0.026) versus −0.023 (−0.030, −0.016), ), and subcutaneous abdominal fat area (−32.18 (−39.30, −25.06) versus −22.20 (−29.34, −15.05) cm2, ). Conclusion. Prescribing 300 versus 150 minutes/week of exercise to inactive postmenopausal women resulted in some long-term greater decreases in measures of body composition but no overall differences in total body fat loss. This trail is registered with NCT01435005 .

Predictors of Adherence to Different Volumes of Exercise in the Breast Cancer and Exercise Trial in Alberta

Abstract: BACKGROUND Exercise demonstrates a dose-response effect on many health outcomes; however, adhering to higher doses of exercise can be challenging, and the predictors of adherence may differ based on exercise volume. PURPOSE To examine the predictors of adherence to two different volumes of aerobic exercise within the Breast Cancer and Exercise Trial in Alberta (BETA). METHODS In BETA, we randomized 400 inactive but healthy postmenopausal women to either a moderate volume (150 min/week) or a high volume (300 min/week) of aerobic exercise for 1 year. We collected data on several predictors of exercise adherence at baseline and used linear and mixed-effect models to determine predictors of exercise adherence to exercise volume and overall. RESULTS Adherence was higher in the moderate-volume group (84.5%) compared with the high-volume group (75.2%; p < .001). There were no statistically significant interactions between predictors of exercise adherence and exercise volume. Overall, we found that exercise adherence was predicted by randomization group, body mass index (BMI), employment status, and physical health. Adherence was 8.6% lower in the high-volume versus moderate-volume group, 6.7% lower for women working full time versus not, 0.8% lower per BMI increase of 1 kg/m2, and 0.5% higher per unit of physical health. CONCLUSIONS Adherence to high-volume aerobic exercise was more challenging than for moderate-volume aerobic exercise, but the predictors of adherence were similar. Moreover, few factors were major predictors of exercise adherence in this setting suggesting that well-controlled efficacy trials that produce high adherence rates may reduce the influence of individual characteristics on exercise adherence. TRIAL REGISTRATION NCT1435005.

The Dietary Inflammatory Index® and Alternative Healthy Eating Index 2010 in relation to leucocyte telomere length in postmenopausal women: a cross-sectional study

Abstract: Telomeres are nucleoprotein complexes that form the ends of eukaryotic chromosomes where they protect DNA from genomic instability, prevent end-to-end fusion and limit cellular replicative capabilities. Increased telomere attrition rates, and relatively shorter telomere length, is associated with genomic instability and has been linked with several chronic diseases, malignancies and reduced longevity. Telomeric DNA is highly susceptible to oxidative damage and dietary habits may make an impact on telomere attrition rates through the mediation of oxidative stress and chronic inflammation. The aim of this study was to examine the association between leucocyte telomere length (LTL) with both the Dietary Inflammatory Index® 2014 (DII®) and the Alternative Healthy Eating Index 2010 (AHEI-2010). This is a cross-sectional analysis using baseline data from 263 postmenopausal women from the Alberta Physical Activity and Breast Cancer Prevention (ALPHA) Trial, in Calgary and Edmonton, Alberta, Canada. No statistically significant association was detected between LTL z-score and the AHEI-2010 (P = 0·20) or DII® (P = 0·91) in multivariable adjusted models. An exploratory analysis of AHEI-2010 and DII® parameters and LTL revealed anthocyanidin intake was associated with LTL (P < 0·01); however, this association was non-significant after a Bonferroni correction was applied (P = 0·27). No effect modification by age, smoking history, or recreational physical activity was detected for either relationship. Increased dietary antioxidant and decreased oxidant intake were not associated with LTL in this analysis.

Behavioral Predictors of Weight Regain in Postmenopausal Women: Exploratory Results From the Breast Cancer and Exercise Trial in Alberta

Abstract: Objective: This secondary analysis assessed associations between changes in energy balance and sleep behaviors and the risk of weight regain following exercise-induced weight loss. Methods: Of 400 participants initially randomized in the Breast Cancer and Exercise Trial in Alberta (BETA), 227 lost weight following the moderate- to vigorous-intensity exercise intervention (-4.2±3.6 kg) and were included in this analysis. Self-reported energy intake (EI), sleep duration, quality and timing, and objective measurements of physical activity (PA) and sedentary time were collected at the end of the intervention and the end of follow-up. Linear regression models assessed associations between changes in these behaviors and risk of weight regain during follow-up. Results: Participants regained 43% of the weight lost during follow-up. Reductions in moderate to vigorous PA (s=-1.00; 95% CI=-1.74 to -0.25 h/d; P=0.01) and steps per day (s=-0.0003; 95% CI=-0.0005 to -0.0001 steps/d; P=0.004); increases in sedentary time (s=0.54; 95% CI=0.67 to 1.02 h/d; P=0.03), EI (s=0.001; 95% CI=0.0003 to 0.002 kcal; P=0.01), and fat intake (s=0.004; 95% CI=0.001 to 0.006 kcal; P=0.002); and delayed sleep timing midpoint (s=0.02; 95% CI=0.004 to 0.03 min; P=0.01) were associated with weight regain during follow-up. Conclusions: These exploratory results suggest that reductions in moderate to vigorous PA; increases in EI, fat intake, and sedentary time; and delayed sleep timing midpoint were significantly associated with risk of weight regain.

Comprehensive lifestyle improvement program for prostate cancer (CLIPP): Protocol for a feasibility and exploratory efficacy study in men on androgen deprivation therapy

Abstract: American Cancer Society [128749-IRG-16-124-37-IRG]; Clinical Research Oversight Council through the University of Arizona Cancer Center; University of Arizona Cancer Center Behavioral Measurement and Interventions Shared Resource; NIH-NCI Cancer Center [P30 CA023074]

Automatic associations of breast cancer and heart disease with fruit and vegetables and physical activity

Abstract: Objectives:This exploratory research examined if breast cancer or heart disease is automatically associated with physical activity compared to fruit and vegetable stimuli; if reading messages about...