Fernando Dimeo

Aerobic exercise as therapy for cancer fatigue

PURPOSE Fatigue and impairment of physical performance are common and severe problems of cancer patients. We describe the effect of an aerobic exercise program designed for cancer patients suffering from these symptoms. METHODS Five cancer patients (4 female, 1 male, age 18 to 55), participated in the training program. Fatigue had been present for a time ranging between 5 wk and 18 months and hindered the patients from carrying out normal daily activities. The training program consisted of walking daily on a treadmill with an intensity corresponding to a lactate concentration of 3 +/- 0.5 mmol.L-1 and was carried out for 6 wk. RESULTS By the end of the exercise program we observed an improvement in maximal physical performance (from 6.4 +/- 0.4 km.h-1 to 7.5 +/- 0.9 km.h-1, P < 0.05) and maximal walked distance (from 1640 +/- 724 m to 3300 +/- 953 m, P < 0.05). Heart rate and lactate concentration by an equivalent submaximal workload (5 km.h-1) were significant reduced (from 138 +/- 21 beats.min-1 to 113 +/- 20 beats.min-1, P < 0.05, and from 2.6 +/- 1.4 mmol.L-1 to 1.3 +/- 0.6 mmol.L-1, P < 0.05); all patients experienced a clear reduction of fatigue and could carry out normal daily activities again without substantial limitations. CONCLUSION We conclude that an aerobic exercise program of precisely defined intensity, duration, and frequency can be prescribed as therapy for primary fatigue in cancer patients.

Aerobic Exercise Reduces Blood Pressure in Resistant Hypertension

Regular physical exercise is broadly recommended by current European and American hypertension guidelines. It remains elusive, however, whether exercise leads to a reduction of blood pressure in resistant hypertension as well. The present randomized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension. Resistant hypertension was defined as a blood pressure ≥140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by ≥4 antihypertensive agents. Fifty subjects with resistant hypertension were randomly assigned to participate or not to participate in an 8- to 12-week treadmill exercise program (target lactate, 2.0±0.5 mmol/L). Blood pressure was assessed by 24-hour monitoring. Arterial compliance and cardiac index were measured by pulse wave analysis. The training program was well tolerated by all of the patients. Exercise significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6±12 and 3±7 mm Hg, respectively (P=0.03 each). Regular exercise reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves. Arterial compliance and cardiac index remained unchanged. Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment. It should be included in the therapeutic approach to resistant hypertension.

Complex Mental and Physical Activity in Older Women and Cognitive Performance: A 6-month Randomized Controlled Trial

BACKGROUND Several reports suggest beneficial impacts of either physical or mental activity on cognitive function in old age. However, the differential effects of complex mental and physical activities on cognitive performance in humans remain to be clarified. METHODS This randomized controlled trial evaluates a cognitive and a physical standardized 6-month activity intervention (3 x 1.5 h/wk) conducted in Berlin (Germany). Two hundred fifty nine healthy women aged 70-93 years were randomized to a computer course (n = 92), an exercise course (n = 91), or a control group (n = 76), of whom 230 completed the 6-month assessment. Group differences in change over a period of 6 months in episodic memory (story recall, possible range, 0-21; word recall, possible range, 0-16), executive control (working memory, ie, time quotient of Trail Making Tests B/A), and verbal fluency were evaluated by analyses of covariance (intention to treat) adjusting for baseline, fluid intelligence, and educational level. RESULTS In contrast to the control group, both the exercise group, DeltaM (SD) = 2.09 (2.66), p < .001, and the computer group, DeltaM (SD) =1.89 (2.88), p < .001, showed improved delayed story recall. They maintained performance in delayed word recall and working memory (time measure) as opposed to the control group that showed a decline, DeltaM (SD) = -0.91 (2.15), p = .001, and DeltaM (SD) = 0.24 (0.68), p = .04, respectively. CONCLUSIONS In healthy older women, participation in new stimulating activities contributes to cognitive fitness and might delay cognitive decline. Exercise and computer classes seem to generate equivalent beneficial effects.

Acute exercise ameliorates reduced brain-derived neurotrophic factor in patients with panic disorder.

The neurotrophin brain-derived neurotrophic factor (BDNF) has been implicated in depression and anxiety. Antidepressants and exercise increase BDNF expression, and both have an antidepressant and anxiolytic activity. To further characterize the association of anxiety, BDNF and exercise, we studied panic disorder patients (n=12) and individually matched healthy control subjects (n=12) in a standardized exercise paradigm. Serum samples for BDNF analyses were taken before and after 30min of exercise (70 VO(2max)) or quiet rest. The two conditions were separated by 1 week and the order was randomized. Non-parametric statistical analyses were performed. There was a negative correlation of BDNF concentrations and subjective arousal at baseline (r=-0.42, p=0.006). Compared to healthy control subjects, patients with panic disorder had significantly reduced BDNF concentrations at baseline and 30min of exercise significantly increased BDNF concentrations only in these patients. Our results suggest that acute exercise ameliorates reduced BDNF concentrations in panic disorder patients and raise the question whether this is also found after long-term exercise training and if it is related to the therapeutic outcome.

Effects of an endurance and resistance exercise program on persistent cancer-related fatigue after treatment

BACKGROUND Fatigue is a relevant problem of cancer patients during and after treatment. Several studies have shown that exercise can improve quality of life and functional status of cancer patients undergoing chemo- or radiotherapy. However, there is a lack of information about the effects of this intervention on persistent cancer-related fatigue. Therefore, we assessed the effects of an exercise program on cancer-related fatigue after treatment. PATIENTS AND METHODS A consecutive series of 32 cancer patients with mild to severe persistent fatigue [scores on the Brief Fatigue Inventory (BFI) > 25] participated in a 3-week exercise program consisting of endurance (30 min walking on a treadmill) and resistance/coordination exercises for the major muscle groups. Fatigue, mood, and anxiety were assessed with questionnaires and physical performance with a stress test before and after the program. RESULTS At the end of the program, we observed a significant increase of physical performance (workload at the anaerobic threshold pre 61 +/- 26 W, post 78 +/- 31 W, P < 0.0001) and reduction of global fatigue (Functional Assessment of Cancer Therapy: pre 45.7 +/- 13.4, post 52.6 +/- 12.4, P < 0.0001; BFI: pre 37.9 +/- 18.3, post 31.2 +/-17.1, P < 0.001). However, no significant improvement of cognitive fatigue or reduction of anxiety was observed. CONCLUSIONS A 3-week exercise program leads to a substantial improvement of physical performance and reduction of mental and physical fatigue in cancer patients after treatment. However, this intervention does not affect depression, anxiety, or cognitive fatigue.

Too Old to Benefit from Sports? The Cardiovascular Effects of Exercise Training in Elderly Subjects Treated for Isolated Systolic Hypertension

Background: Hypertension in the elderly is commonly characterized by an elevation of pulse pressure. With regard to advanced arteriosclerosis and limited physical fitness, doubt was casted whether elderly patients still achieve relevant cardiovascular benefits by physical exercise. The present work examines the impact of pulse pressure as a footprint of vascular ageing on cardiovascular benefits of endurance training in elderly hypertensives. Methods: 54 patients ≧60 years with systolic 24-hour ambulatory blood pressure (ABP) >140 mm Hg and/or antihypertensive treatment and diastolic ABP ≤90 mm Hg were randomly assigned to sedentary activity or a 12-week treadmill exercise program (target lactate 2.5 ± 0.5 mmol/l). Results: Exercise significantly decreased systolic and diastolic ABP by 8.5 ± 8.2 and 5.1 ± 3.7 mm Hg (p < 0.001 each) and increased physical performance. Arterial compliance remained unchanged, whereas endothelium-dependent vasodilation – measured by flow-mediated dilation – significantly increased from 5.6 ± 1.7 to 7.9 ± 3.0% (p < 0.007). After adjustment for initial systolic ABP, pulse pressure did not affect the change of BP. Conclusion: The exercise-induced reduction of BP, which is mediated by improved endothelial function, is independent of pulse pressure. Thus, physical exercise is a helpful adjunct to control BP even in old hypertensives with markedly increased arterial stiffness.

The acute antipanic and anxiolytic activity of aerobic exercise in patients with panic disorder and healthy control subjects.

Regular physical activity is anxiolytic in both healthy subjects and patients with panic disorder. In contrast, acute exercise may induce acute panic attacks or increase subjective anxiety in patients with panic disorder more than in other people. The effects of quiet rest or an aerobic treadmill exercise (30 min at an intensity of 70% of the maximal oxygen uptake, VO2max) on cholecystokinin tetrapeptide (CCK-4) induced panic attacks were studied in a crossover design in 12 patients with panic disorder and 12 matched healthy subjects. The effects of CCK-4 (25 microg in patients and 50 microg in control subjects) were measured with the Acute Panic Inventory (API) score, comparing panic attack frequencies, total score, and subscores for anxiety and somatic symptoms. CCK-4-induced panic attacks were less frequent after prior exercise: they occurred in 15 (62.5%) subjects after rest (9 patients and 6 control subjects), but only 5 (20.8%) subjects after exercise (4 patients and 1 control subject). In both conditions, CCK-4 administration induced a significant increase in the total API score and the anxiety and somatic symptoms subsores. However, compared to prior rest, exercise resulted in a significantly reduced CCK-4-induced increase of the total API score and the anxiety subscore. In patients with panic disorder exercise increased the total API score and the somatic symptoms subscale but not the anxiety subscore. Patients with panic disorder showed increased somatic but not anxiety symptoms after an acute bout of exercise. Severity of CCK-4-induced panic and anxiety, on the other hand was reduced by exercise. These findings suggest that in addition to exercise training an acute bout of exercise may be used to reduce anxiety and panic attack frequency and intensity in panic disorder patients.

The Cardiovascular Effects of Upper- Limb Aerobic Exercise in Hypertensive Patients

Background Aerobic exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Several hypertensive patients, however, are limited by musculoskeletal complaints or vascular occlusive disease from lower-limb exercise such as jogging or cycling. In the present randomized-controlled study, we evaluate whether an aerobic arm-cycling program provides a measurable cardiovascular benefit. Methods Twenty-four probands were randomly assigned to sedentary activity or a heart rate controlled 12 week exercise program, consisting of arm-cycling at target lactate concentrations of 2.0 ± 0.5 mmol/l. Endothelial function was assessed by flow-mediated dilation of the brachial artery. Augmentation index and large/small artery compliance (C1 and C2) were measured by computerized pulse-wave analysis of the radial artery. Results The exercise program led to a significant reduction in systolic (134.0 ± 20.0 to 127.0 ± 16.4 mmHg; P = 0.03) and diastolic blood pressure (73.0 ± 21.6 to 67.1 ± 8.2 mmHg; P = 0.02) accompanied by a significant improvement in C2 (3.5 ± 1.6 to 4.8 ± 2.0 ml/mmHg × 100; P = 0.004). Flow-mediated dilation, augmentation index, and C2 were not significantly affected (P > 0.05). Physical performance as derived from lactate and heart rate curves of lower-limb stress tests was unchanged, whereas maximal workload in an upper-limb ergometry significantly increased (P = 0.005). Blood pressure and vascular parameters remained unchanged in the control group. Conclusion Regular arm aerobic exercise leads to a marked reduction in systolic and diastolic blood pressures and an improvement in small artery compliance. Arm-cycling is a reasonable option for hypertensive patients who want to support blood pressure control by sports despite having coxarthrosis, gonarthrosis, or intermittent claudication.

Beta-blockers do not impair the cardiovascular benefits of endurance training in hypertensives

Aerobic physical exercise is broadly recommended as a helpful adjunct to obtain blood pressure control in hypertension. Beta-blockade interacts with heart rate, sympathetic tone, maximal workload and local lactate production. In the present randomized-controlled study, we compared the cardiovascular effects of an endurance training programme in elderly hypertensives with or without beta-blockers and developed a first approach to determine a lactate-based training heart rate in presence of beta-blockade. Fifty-two patients (23 with beta-blocker, 29 without beta-blocker) ⩾60 years with systolic 24-h ambulatory blood pressure (ABP) ⩾140 mm Hg and/or antihypertensive treatment were randomly assigned to sedentary activity or a heart-rate controlled 12-week treadmill exercise programme (lactate 2.0 mmol/l). In the exercise group, the training significantly decreased systolic and diastolic 24-h ABP, blood pressure on exertion (100 W) and increased endothelium-dependent vasodilation (flow-mediated vasodilation, FMD) and physical performance both in the presence and absence of beta-blockade (P<0.05 each). The extent of ABP reduction did not significantly differ in the presence or absence of beta-blockade (Δ systolic ABP 10.6±10.5 vs 10.6±8.8 mm Hg, Δ diastolic ABP 5.7±8.6 vs 5.8±4.0 mm Hg). Mean training heart rate was significantly lower in the patients on beta-blockers (97.2±7.7 vs 118.3±7.5/min, P<0.001). Lactate-based aerobic endurance training evokes comparable cardiovascular benefits in the presence and absence of beta-blockade including a marked improvement of endothelial function. In the present study, target training heart rate with beta-blockers is about 18% lower than without.

Acute exercise influences reward processing in highly trained and untrained men.

INTRODUCTION Physical activity activates brain regions and transmitter systems that represent the reward system (i.e., the ventral striatum [VS] and dopamine). To date, the effect of training status and acute exercise on reward processing has not been investigated systematically in humans. To address this issue, we examined highly trained (HT) physically inactive (PIA) men with a monetary incentive delay (MID) paradigm. METHODS We used functional magnetic resonance imaging (fMRI) to investigate the neural correlates of monetary incentive processing after acute exercise. HT and PIA subjects were randomized into two groups. Subjects in one group ran on a treadmill (T) for 30 min at 60%-70% of their maximal oxygen uptake (V˙O2max), whereas subjects in the other group performed placebo exercise (P). Approximately 1 h after exercise, the MID task was conducted. Mood was assessed using the Positive and Negative Affect Schedule before and after the exercise intervention. RESULTS The psychological assessment showed that exercise significantly increased mood in HT and PIA men. During gain anticipation and gain feedback of the MID task, the VS was significantly stronger activated in the placebo group than in the treadmill group. No effect of training status and no interactions between training status and acute exercise were found. CONCLUSIONS Acute exercise diminishes sensitivity to monetary rewards in humans. This finding is discussed concerning interactions between tonic and phasic dopamine in the VS.