Carolyn J. Peddle

Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions

To determine the effects of preoperative exercise training on cardiorespiratory fitness in patients undergoing thoracic surgery for malignant lung lesions.

Randomized Controlled Trial of the Effects of Aerobic Exercise on Physical Functioning and Quality of Life in Lymphoma Patients

PURPOSE Lymphoma patients commonly experience declines in physical functioning and quality of life (QoL) that may be reversed with exercise training. PATIENTS AND METHODS We conducted a randomized controlled trial in Edmonton, Alberta, Canada, between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and randomly assigned them to usual care (UC; n = 62) or 12 weeks of supervised aerobic exercise training (AET; n = 60). Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia. Secondary end points were overall QoL, psychosocial functioning, cardiovascular fitness, and body composition. RESULTS Follow-up assessment for our primary end point was 96% (117 of 122) at postintervention and 90% (110 of 122) at 6-month follow-up. Median adherence to the supervised exercise program was 92%. At postintervention, AET was superior to UC for patient-rated physical functioning (mean group difference, +9.0; 95% CI, 2.0 to 16.0; P = .012), overall QoL (P = .021), fatigue (P = .013), happiness (P = .004), depression (P = .005), general health (P < .001), cardiovascular fitness (P < .001), and lean body mass (P = .008). Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning. AET did not interfere with chemotherapy completion rate or treatment response. At 6-month follow-up, AET was still borderline or significantly superior to UC for overall QoL (P = .054), happiness (P = .034), and depression (P = .009) without an increased risk of disease recurrence/progression. CONCLUSION AET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response. Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients.

Oncologists’ opinions towards recommending exercise to patients with cancer: a Canadian national survey

RationaleThe goal of this study was to examine oncologists’ attitudes towards recommending exercise to patients with cancer during treatment.Patients and methodsUsing a national survey, all 659 practicing medical and radiation oncologists in Canada were sent a brief questionnaire.ResultsThe response rate was 46% (281/610). The majority of oncologists agreed that exercise was beneficial (62.0%), important (55.8%) and safe (63.1%) for patients with cancer during treatment. Forty-three percent of oncologists reported that they tried to recommend exercise to their patients when appropriate. Moreover, oncologists actually reported recommending exercise to 28% of their patients during the past month. Analyses also indicated significant differences between oncologists, with younger, female, and medical oncologists generally having more favorable attitudes towards exercise for patients with cancer than their older, male, and radiation oncology counterparts.ConclusionsOncologists have a favorable attitude toward recommending exercise to patients with cancer although several important barriers may prevent oncologists from providing exercise advice to their patients. Further research is required evaluating the effectiveness of interventions and strategies designed to improve oncologists’ confidence and ability to advise their patients on exercise during oncology consultations.

Associations between exercise, quality of life, and fatigue in colorectal cancer survivors.

PurposeThis study was designed to examine quality of life and fatigue in colorectal cancer survivors meeting and not meeting public health exercise guidelines.MethodsA Canadian provincial cancer registry identified colorectal cancer survivors who were mailed a questionnaire that assessed self-reported exercise, quality of life (Functional Assessment of Cancer Therapy - Colorectal), fatigue, medical, and demographic variables.ResultsCompleted questionnaires were received from 413 (61.3 percent) eligible colorectal cancer survivors. Only 25.9 percent of colorectal cancer survivors reported meeting exercise guidelines. Colorectal cancer survivors meeting public health exercise guidelines reported clinically and significantly better quality of life (mean difference, 6; 95 percent confidence interval, 2.3–9.8; P = 0.002) and fatigue (mean difference = 5.2; 95 percent confidence interval, 2.9–7.5; P < 0.001). Differences remained after adjusting for medical and demographic factors. Cancer site (i.e., colon vs. rectal) was the only variable to moderate this association (P < 0.05 for interaction).ConclusionsColorectal cancer survivors meeting public health exercise guidelines reported significantly and meaningfully better quality of life and fatigue scores than colorectal cancer survivors who did not meet guidelines. Prospective observational studies and randomized, controlled trials are needed to further assess the causal nature of these relationships.

Cardiovascular risk profile of patients with HER2/neu-positive breast cancer treated with anthracycline-taxane-containing adjuvant chemotherapy and/or trastuzumab

Purpose: To evaluate the cardiovascular risk profile of a subset of patients with early-stage breast cancer treated with adjuvant taxane-anthracycline–containing chemotherapy and/or trastuzumab (Herceptin). Experimental Design: Twenty-six patients with breast cancer (mean, 20 months postchemotherapy) and 10 healthy age-matched women were studied. We measured 14 metabolic and vascular established cardiovascular disease (CVD) risk factors, body mass index, cardiorespiratory fitness, and left ventricular systolic function. All assessments were done within a 14-day period. Results: Cardiac abnormalities were suggested by left ventricular ejection fraction (LVEF) <50% in 8% of patients, LVEF remained >10% below pretreatment values in 38%, whereas 50% presented with resting sinus tachycardia. Brain natriuretic peptide was significantly elevated in 40% of patients and was correlated with LVEF (r = −0.72, P = < 0.001). For the majority of CVD risk factors, similar proportions of patients and controls (35-60%) were classified as “undesirable.” A significantly higher proportion of patients were classified with low cardiorespiratory fitness (46% versus 0%, P < 0.01), being overweight/obese (72% versus 50%, P < 0.05), and having resting sinus tachycardia (50% versus 0%, P < 0.01) compared with controls. Cardiorespiratory fitness and body mass index were correlated with CVD risk factors (r = −0.64 to 0.63, P < 0.05; r = −0.63 to 0.67, P < 0.05, respectively). Exploratory analyses revealed several differences between CVD risk factors based on chemotherapy regimen. Conclusion: Breast cancer survivors treated with adjuvant chemotherapy are at a higher risk of developing late-occurring CVD than age-matched controls due to direct and indirect treatment-related toxicity. (Cancer Epidemiol Biomarkers Prev 2007;16(5):1026–31)

Effects of Aerobic Exercise Training in Anemic Cancer Patients Receiving Darbepoetin Alfa: A Randomized Controlled Trial

BACKGROUND Anemia in patients with solid tumors is a common problem that is associated with impaired exercise capacity, increased fatigue, and lower quality of life (QoL). Erythropoiesis-stimulating agents (ESAs) have been shown to improve these outcomes; however, it is unknown if additional benefits can be achieved with aerobic exercise training. METHODS We conducted a single-center, prospective, randomized, controlled trial in 55 mild-to-moderately anemic patients with solid tumors. Patients were randomized to either darbepoetin alfa alone (DAL, n = 29) or darbepoetin alfa plus aerobic exercise training (DEX; n = 26). The DEX group performed aerobic exercise training three times per week at 60%-100% of baseline exercise capacity for 12 weeks. The primary endpoint was QoL assessed by the Functional Assessment of Cancer Therapy-Anemia scale. Secondary endpoints were fatigue, cardiorespiratory fitness (VO(2peak)), hemoglobin (Hb) response, and darbepoetin alfa dosing. RESULTS Intention-to-treat analyses indicated significant improvements in QoL and fatigue in both groups over time but there were no between-group differences. The DEX group had a significantly greater VO(2peak) than the DAL group (mean group difference, +3.0 ml/kg per minute; 95% confidence interval, 1.2-4.7; p = .001) and there were borderline significant differences in favor of the DEX group for Hb response and darbepoetin alfa dosing. CONCLUSIONS Aerobic exercise training did not improve QoL or fatigue beyond the established benefits of DAL but it did result in favorable improvements in exercise capacity and a more rapid Hb response with lower dosing requirements. Our results may be useful to clinicians despite the more recent restrictions on the indications for ESAs.

Conservative and dietary interventions for cancer-related lymphedema: a systematic review and meta-analysis.

The findings support the use of compression garments and compression bandaging for reducing lymphedema volume in upper and lower extremity cancer‐related lymphedema. Specific to breast cancer, a statistically significant, clinically small beneficial effect was found from the addition of manual lymph drainage massage to compression therapy for upper extremity lymphedema volume. Cancer 2011.

Moderator Effects in a Randomized Controlled Trial of Exercise Training in Lymphoma Patients

Background: The Healthy Exercise for Lymphoma Patients trial showed that aerobic exercise training improved important health outcomes in lymphoma patients. Here, we examine potential moderators of the exercise training response. Methods: Lymphoma patients were stratified by major disease type and current treatment status and randomly assigned to usual care (n = 62) or aerobic exercise training (n = 60) for 12 weeks. Endpoints were quality of life, cardiovascular fitness, and body composition. Moderators were patient preference for group assignment, age, sex, marital status, disease stage, body mass index, and general health. Results: Patient preference did not statistically moderate the effects of exercise training on quality of life (P for interaction = 0.36), but the interaction effect of 7.8 points favoring patients with no preference was clinically meaningful. Marital status (P for interaction = 0.083), general health (P for interaction = 0.012), and body mass index (P for interaction = 0.010) moderated the effects of aerobic exercise training on quality of life with better outcomes for unmarried versus married patients, patients in poor/fair health versus good-to-excellent health, and normal weight/obese versus overweight patients. Disease stage (P for interaction = 0.056) and general health (P for interaction = 0.012) moderated the effects of aerobic exercise training on body composition with better outcomes for patients with advanced disease versus early disease/no disease and patients in good health versus very good-to-excellent health. No variables moderated intervention effects on cardiovascular fitness. Findings were not explained by differences in adherence. Conclusions: Clinically available variables predicted quality of life and body composition responses to aerobic exercise training in lymphoma patients. If replicated, these results may inform future randomized trials and clinical practice. (Cancer Epidemiol Biomarkers Prev 2009;18(10):2600–7)

Medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors: an application of self-determination theory

ObjectivesThe purpose of the present study was to evaluate medical, demographic, and psychosocial correlates of exercise in colorectal cancer survivors (CRC-S) using self-determination theory (SDT).MethodsParticipants were 414 CRC-S who completed a mailed survey that assessed self-reported exercise, medical and demographic variables, and SDT constructs consisting of behavioral regulation for exercise, psychological needs satisfaction in exercise (PNSE), and perceived autonomy support (PAS).ResultsCRC-S with less education were significantly less likely to meet exercise guidelines (21 vs 31%; p < 0.001). Path analysis indicated that SDT and education explained 16% of the variance in exercise behavior with identified regulation (β = 0.17, p = 0.031), introjected regulation (β = 0.14, p = 0.006), and education (β = 0.16, p < 0.001) each making a significant independent contribution.ConclusionsFew medical and demographic factors are correlates of regular exercise in CRC-S, but SDT provided a good understanding of exercise behavior in this population. Exercise behavior change interventions incorporating principles of SDT may have utility for promoting exercise and improving outcomes in this important population of cancer survivors.

Effects of presurgical exercise training on quality of life in patients undergoing lung resection for suspected malignancy: a pilot study.

The aim of this study was to explore the effects of presurgical exercise training on quality of life (QOL) in patients with malignant lung lesions. Using a single-group prospective design, patients were enrolled in supervised aerobic exercise training for the duration of surgical wait time (mean 59.7 days). Participants completed assessments of cardiorespiratory fitness (peak oxygen consumption) and QOL using the Functional Assessment of Cancer Therapy-Lung scales, including the trial outcome index (TOI) and the lung cancer subscale (LCS) at baseline, immediately presurgery, and postsurgery (mean, 57 days). 9 participants provided complete data. Repeated-measures analysis indicated a significant effect for time on TOI (P = .006) and LCS (P = .009). Paired analysis revealed that QOL was unchanged after exercise training (ie, baseline to presurgery), but there were significant and clinically meaningful declines from presurgery to postsurgery in the LCS (−3.6, P = .021) and TOI (−8.3, P = .018). Change in peak oxygen consumption from presurgery to postsurgery was significantly associated with change in the LCS (r = 0.70, P = .036) and TOI (r = 0.70, P = .035). Exercise training did not improve QOL from baseline to presurgery. Significant declines in QOL after surgery seem to be related to declines in cardiorespiratory fitness. A randomized controlled trial is needed to further investigate these relationships.