The effects of home-based exercise therapy for breast cancer-related fatigue induced by radical radiotherapy

Background Radiotherapy (RT) can lead to cancer-related fatigue (CRF) and decreased health-related quality of life (HRQoL) in breast cancer patients. The purpose of this trial was to examine the feasibility and efficacy of a home-based resistance and aerobic exercise intervention for reducing CRF and improving HRQoL in breast cancer patients during RT. Methods Women with breast cancer (N = 106) commencing RT were randomized to 12 weeks of home-based resistance and aerobic exercise (EX) or usual care/control (CON). The primary endpoint was CRF, with secondary endpoints of HRQoL, sleep duration and quality, and physical activity. Measurements were undertaken prior to RT, at completion of RT (~ 6 weeks), at completion of the intervention (12 weeks), and 6 and 12 months after RT completion, while CRF was also measured weekly during RT. Results Eighty-nine women completed the study (EX = 43, CON = 46). Over the 12-week intervention, EX completed 1–2 resistance training sessions and accumulated 30–40 min of aerobic exercise weekly. For CRF, EX had a quicker recovery both during and post-RT compared to CON (p < 0.05). Moreover, there was a significant difference in HRQoL between groups at RT completion, with HRQoL unchanged in CON and higher in EX (p < 0.05). There was no change in sleep duration or quality for either group and there were no exercise-related adverse effects. Conclusions Home-based resistance and aerobic exercise during RT is safe, feasible, and effective in accelerating CRF recovery and improving HRQoL. Improvements in CRF and HRQoL for these patients can be achieved with smaller exercise dosages than stated in the generic recommendations for breast cancer

Associations of physical activity and quality of life in parapneumonic effusion patients

Introduction Little is known about activity behaviours and quality of life (QoL) of patients with parapneumonic pleural effusions (PPE) after hospital discharge. This study is a secondary analysis of a randomised trial (dexamethasone versus placebo) for hospitalised patients with PPE. We: 1) described the patients’ activity behaviour patterns and QoL measured at discharge and at 30 days post-discharge; and 2) examined the association between activity behaviours and QoL scores. Methods Activity behaviour (7-day accelerometry; Actigraph GT3X+) and QoL (Medical Outcomes Study Short-Form 36) were assessed. Repeated measures analysis of covariance controlling for baseline values and a series of linear regression models were undertaken. Results 36 out of 53 eligible participants completed accelerometry assessments. Despite modest increases in light physical activity (+7.5%) and some domains of QoL ( \u3e 2 points) from discharge to 30 days post-discharge, patients had persistently high levels of sedentary behaviour ( \u3e 65% of waking wear time) and poor QoL ( ⩽ 50 out of 100 points) irrespective of treatment group ( p=0.135–0.903). Increasing moderate-to-vigorous physical activity was associated with higher scores on most QoL domains ( p=0.006–0.037). Linear regression indicates that a clinically important difference of 5 points in physical composite QoL score can be achieved by reallocating 16.1 min·day−1 of sedentary time to moderate-to-vigorous physical activity. Conclusion Patients with PPE had low levels of physical activity and QoL at discharge and 30 days post-discharge irrespective of treatment. Moderate-to-vigorous physical activity participation was associated with higher QoL scores. Increasing moderate-to-vigorous physical activity following discharge from the hospital may be associated with improvements in QoL. © The authors 2023

Study protocol: Investigating the feasibility of a hybrid delivery of home-based cluster set resistance training for individuals previously treated for lung cancer

Background: Symptom burden remains a critical concern for individuals with non-small cell lung cancer (NSCLC) following the completion of treatment. The most common symptom clusters, dyspnea (shortness of breath) and fatigue, can contribute to physical decline, reductions in quality of life, and a higher risk of comorbidities and mortality. Dyspnea is a primary limiter of exercise capacity in individuals with lung cancer, resulting in exercise avoidance and an accelerated physical decline. As such, designing resistance training with cluster sets to mitigate symptoms of dyspnea and fatigue may result in improved exercise tolerance. Thus, maintaining the exercise stimulus via cluster sets, combined with improved tolerance of the exercise, could result in the maintenance of physical function and quality of life. The purpose of this study is to investigate the feasibility and preliminary efficacy of a hybrid-delivery home-based cluster-set resistance training program in individuals with NSCLC. Methods: Individuals with NSCLC (n = 15), within 12 months of completion of treatment, will be recruited to participate in this single-arm feasibility trial. Participants will complete 8 weeks of home-based resistance training designed to minimize dyspnea and fatigue. The hybrid delivery of the program will include supervised sessions in the participants’ home and virtual supervision via video conferencing. The primary outcome of feasibility will be quantified by recruitment rates, retention, acceptability, and intervention fidelity. Exploratory outcomes (dyspnea, fatigue, quality of life, physical function, and body composition) will be assessed pre- and post-intervention. Discussion: This study will provide important data on the feasibility of delivering this intervention and inform procedures for a future randomized controlled trial. Trial registration: Record not yet publi

A Review of Accelerometer-based Activity Monitoring in Cancer Survivorship Research

Background In the cancer survivorship context, physical activity and sedentary behavior have been measured using different methods. Purpose To conduct a narrative review of published research in cancer survivor populations to summarize the quality and identify gaps in reporting on accelerometer data collection, data processing, and outcome measures in cancer survivors. Methods An initial PubMed® search of articles published in English was conducted in January 2017, and a final search was conducted in May 2017. Variables extracted included study characteristics, methods for accelerometry data collection (e.g., device used), data processing (e.g., cut points used), and data reporting (e.g., time spent in different activity intensities). Results A total of 46 articles were eligible for inclusion in the review. The majority of studies (34 of 46) targeted a single cancer group and 18 of these 34 studies were in survivors of breast cancer. Half (54%) of the studies used an ActiGraph® accelerometer. Methods of accelerometer data processing varied across studies. Definitions of non-wear time, vectors used during processing, and filters applied during processing were reported by 51%, 60%, and 8% of studies, respectively. Most studies reported moderate and vigorous physical activity (78%), 50% reported sedentary time, and 43% reported light-intensity activity. Cut points to categorize these activities varied between studies. Conclusions This narrative review highlights inconsistency in the methods used to collect, process, and report accelerometry data across cancer survivor studies. Accelerometry has potential to add detailed knowledge of the levels and patterns of physical activities and sedentary behaviors across the cancer spectrum. Recommendations are made to improve data processing and reporting methods to maximize the scientific validity of future accelerometer research in this field

Exercise and cancer survivorship

Exercise has been identified as an integral component of comprehensive survivorship care and a promising adjuvant therapy to aid in the management of cancer. Leading organisations worldwide now advocate exercise for cancer survivors. Here we briefly review the existing evidence for exercise and survivorship, as well as current research endeavours in Australia. Discussion extends to identify the gaps between research and practice, as well as future research directions needed to drive the field forward. With continued efforts by scientists, clinicians and consumers, there is real potential to strengthen the nexus between scientific evidence and clinical practice and integrate exercise into standard cancer care

A randomized trial of aerobic exercise and sleep quality in lymphoma patients receiving chemotherapy or no treatments

Background: Patients with lymphoma experience sleep problems that may be managed with aerobic exercise but no previous study has examined this issue.Methods: We randomized 122 patients with lymphoma to usual care (n = 62) or 12 weeks of supervised aerobic exercise training (AET; n = 60). Our primary sleep endpoint was global sleep quality assessed by the Pittsburgh Sleep Quality Index (PSQI). Secondary endpoints were the PSQI component scores. Planned subgroup analyses were also conducted.Results: Intention-to-treat analyses indicated that AET resulted in a nonsignificant (P = 0.16) improvement in global sleep quality compared with usual care [mean group difference = −0.64; 95% confidence interval (CI), −1.56 to +0.27]. In planned subgroup analyses, statistically significant or borderline significant interactions were identified for type of lymphoma (Pinteraction = 0.006), current treatment status (Pinteraction = 0.036), time since diagnosis (Pinteraction = 0.010), body mass index (Pinteraction = 0.075), and baseline sleep quality (Pinteraction = 0.041). Specifically, AET improved global sleep quality in patients with lymphoma who had indolent non–Hodgkin lymphoma (P = 0.001), were receiving chemotherapy (P = 0.013), were less than 2 years post-diagnosis (P = 0.005), were obese (P = 0.025), and were poor sleepers at baseline (P = 0.007).Conclusions: AET did not significantly improve sleep quality in this heterogeneous sample of patients with lymphoma; however, clinically identifiable subgroups appeared to benefit. Future exercise trials targeting these responsive subgroups are needed to confirm these findings.Impact: If replicated in larger and more focused trials, aerobic exercise may be an attractive option to manage sleep dysfunction in patients with cancer because of its favorable safety profile and other documented health benefits