Beneficios de la actividad física y su prescripción en mujeres con cáncer de mama

Traballo fin de grao (UDC.FCDEF). Ciencias da actividade física e do deporte. Curso 2012/201

Alteracións neuro-músculo-esqueléticas tras a reconstrución mediante o colgajo do dorsal ancho en mulleres con cancro de mama: unha revisión sistemática

[Resumen] Objetivo: Identificar las alteraciones neuro-músculo-esqueléticas (ANME) tras la reconstrucción mediante el colgajo dorsal ancho en mujeres con cáncer de mama. Material y métodos: Se realizaron búsquedas en las bases de datos Cochrane, PEDro, PubMed, Scopus, Web of Sciences, CINAHL y Google Académico. Los criterios de selección se determinaron según tipo de participantes, tipo de estudios, tipo de ANME evaluada, idioma y cobertura cronológica. Los términos clave utilizados fueron agrupados en 4 bloques: a) cáncer de mama, b) reconstrucción mamaria, c) colgajo del dorsal ancho, d) alteraciones ANME. Las variables analizadas fueron tipo de estudio, características de los sujetos, tratamientos quirúrgicos y oncológicos recibidos, tipo de disfunción y de medidas de resultados de las ANME. Para la gestión bibliográfica se utilizó el programa Mendeley. Se evaluó el factor de impacto de las revistas según el JCR/SJR. Resultados: Se seleccionaron 10 artículos y 5 revisiones. Las ANME identificadas fueron alteraciones del miembro superior, analizadas en 4 revisiones; alteraciones neurales, descritas en 4 estudios; alteraciones de la funcionalidad física, en 4 estudios; y alteraciones del raquis, en 1 estudio. Las medidas de resultados difieren entre estudios, aunque prevalecen unas sobre otras, al igual que el momento de evaluación. Excepto las 3 revisiones críticas todos los artículos indican el tipo de cirugía; y solo 3 analizan el impacto de otros tratamientos oncológicos. La calidad de las revistas de publicación es entre moderada y alta. Conclusiones: Se han identificado ANME relacionadas con la reconstrucción mamaria mediante el colgajo dorsal ancho. Las más descritas en la literatura han sido las referentes a la pérdida de movilidad, de fuerza y funcionalidad del miembro superior; seguidas de la disfunción física relacionada con la calidad de vida; alteraciones neurales correspondientes a la pérdida de sensibilidad, contracciones y deformidades del contorno del pecho reconstruido; así como alteraciones en el raquis.[Abstract] Objetive: To identify the neuro-musculoskeletal disorders after breast reconstruction with the latissimus dorsi flap in breast cancer women. Methods: A literature search was performed using the Cochrane, PEDro, PubMed, Scopus, Web of Sciences, CINAHL and Google Scholar databases. The search was limited by the type of participants, the type of studies, the type of ANME evaluated, the language and the chronological coverage. Key terms were grouped into 4 blocks: a) breast cancer, b) breast reconstruction, c) latissimus dorsi flap, d) ANME disorders. The variables of interest were clasified according to the type of study, participants characteristics, surgical and oncological treatments, type of dysfunction and outcomes measures type. Bybliographic management was performed by the Mendeley program. The impact factor of the journals was evaluated according to the JCR / SJR. Outcomes: 10 articles and 5 reviews were selected. Disorders of the upper extremity were analyzed in 4 reviews; Neural disorders, described in 4 studies; Physical functionality disorders, in 4 studies; And one study of rachis disorders were identified as ANME. Measurements of results differ between studies, although some of them prevail among others, as well as the period of the evaluation. All articles indicate the surgery type except 3 critical reviews; other cancer treatments were analyzed by 3 articles. The quality of the publication magazines is between medium and high. Conclusions: AMNS related to breast reconstruction using the latissimus dorsi flap have been identified. The most described in the literature have been those related to loss of mobility, strength and functionality of the upper limb; Followed by physical dysfunction related to quality of life; Neural disorders corresponding to the loss of sensation, contractions and contour deformities of the reconstructed breast; As well as rachis disorders.Traballo fin de grao (UDC.FCS). Fisioterapia. Curso 2016/201

A Randomized Trial to Evaluate the Impact of Exercise-Based Cardiac Rehabilitation for the Prevention of Chemotherapy-Induced Cardiotoxicity in Patients With Breast Cancer: ONCORE Study Protocol

[Abstract] Background. Anthracyclines and monoclonal antibodies against human epidermal growth factor receptor-2 (HER2) are frequently used to treat breast cancer but they are associated with risk of developing cardiotoxicity. Implementation of cardioprotective strategies as part of breast cancer treatment are needed. To date, a limited number of studies have examined the effectiveness of cardiac rehabilitation programs or exercise programs in the prevention of cardiotoxicity through an integral assessment of cardiac function. The ONCORE study proposes an exercise-based cardiac rehabilitation program as a non-pharmacological tool for the management of chemotherapy-induced cardiotoxicity. Methods. The study protocol describes a prospective, randomized controlled trial aimed to determine whether an intervention through an exercise-based CR program can effectively prevent cardiotoxicity induced by anthracyclines and/or anti-HER2 antibodies in women with breast cancer. Three hundred and forty women with breast cancer at early stages scheduled to receive cardiotoxic chemotherapy will be randomly assigned (1:1) to participation in an exercise-based CR program (intervention group) or to usual care and physical activity recommendation (control group). Primary outcomes include changes in left ventricular ejection fraction and global longitudinal strain as markers of cardiac dysfunction assessed by transthoracic echocardiography. Secondary outcomes comprise levels of cardiovascular biomarkers and cardiopulmonary function through peak oxygen uptake determination, physical performance and psychosocial status. Supervised exercise program-related outcomes including safety, adherence/compliance, expectations and physical exercise in- and out-of-hospital are studied as exploratory outcomes. Transthoracic echocardiography, clinical test and questionnaires will be performed at the beginning and two weeks after completion of chemotherapy. Discussion. The growing incidence of breast cancer and the risk of cardiotoxicity derived from cancer treatments demand adjuvant cardioprotective strategies. The proposed study may determine if an exercise-based CR program is effective in minimizing chemotherapy-induced cardiotoxicity in this population of women with early-stage breast cancer. The proposed research question is concrete, with relevant clinical implications, transferable to clinical practice and achievable with low risk.Instituto de Salud Carlos III; PI17/0168

Thirty-Second Sit-To-Stand Test as an Alternative for Estimating Peak Oxygen Uptake and 6-Min Walking Distance in Women With Breast Cancer: A Cross-Sectional Study

[Abstract] Purpose: To determine whether the 30-s sit-to-stand (30STS) test can be a valid tool for estimating and stratifying peak oxygen uptake (VO2peak) and 6-min walking distance (6MWD) in women with breast cancer. Methods: This cross-sectional study uses data from the ONCORE randomized controlled trial, including 120 women aged 18-70 years with early-stage breast cancer under treatment with anthracycline and/or anti-HER2 antibodies. Participant characteristics were collected at baseline and pooled data from functional assessment (30STS test, relative and absolute VO2peak, and 6MWD) were collected at baseline and post-intervention (comprehensive cardio-oncology rehabilitation program vs. usual care). Bivariate correlations and multivariate linear regression analyses were performed to study the relationship between functional test variables. Results: The number of repetitions in the 30STS test showed (i) a moderate correlation with relative VO2peak (ml/kg/min) (r = 0.419; p < 0.001; n = 126), (ii) a weak correlation with absolute VO2peak (ml/min) (r = 0.241; p = 0.008; n = 120), and (iii) a moderate correlation with the 6MWD (r = 0.440; p < 0.001; n = 85). The ONCORE equations obtained from the multivariate regression models allowed the estimation of VO2peak and 6MWD (r2 = 0.390; r2 = 0.261, respectively) based on the 30STS test, and its stratification into tertiles (low, moderate, and high). Conclusion: The 30STS test was found to be a useful tool to estimate VO2peak and/or 6MWD in women with early-stage breast cancer. Its use may facilitate the assessment and stratification of functional capacity in this population for the implementation of therapeutic exercise programs if cardiopulmonary exercise testing (CPET) or 6MWT are not available.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature. This work was supported by a competitive grant from the Asociación Española Contra el Cáncer (AECC) Scientific Foundation — PRDLC21480DÍAZ — and by a competitive grant of the Spanish Health Research Fund of the Carlos III Health Institute (ISCIII) — PI17/01687, co-funded FEDER, through Strategic Action in Healthcare, 2017. The ISCIII is the national and international reference in biomedical research and public health in Spain. The AECC Scientific Foundation and the ISCIII had no role in study design, data collection, data analysis, data interpretation, or writing of the report. Funding for open access charge will be supported by Universidade da Coruña/CISUGFundación Científica Asociación Española Contra el Cáncer; PRDLC21480DÍA