Gro F. Bertheussen

Peak Oxygen Uptake and Cardiovascular Risk Factors in 4631 Healthy Women and Men

INTRODUCTION Many studies suggest that cardiorespiratory fitness, measured as peak oxygen uptake (VO2peak), may be the single best predictor of cardiovascular morbidity and premature cardiovascular mortality. However, current reference values are either estimates of oxygen uptake or come from small studies, mainly of men. Therefore, the aims of this study were to directly measure VO2peak in healthy adult men and women and to assess the association with cardiovascular risk factor levels. METHODS A cross-sectional study of 4631 volunteering, free-living Norwegian men (n = 2368) and women (n = 2263) age 20-90 yr. The data collection was from June 2007 to June 2008. Participants were free from known pulmonary or cardiovascular disease. VO2peak was measured by ergospirometry during treadmill running. Associations (odds ratios, OR) with unfavorable levels of cardiovascular risk factors and a cluster of cardiovascular risk factors were assessed by logistic regression analysis. RESULTS Overall, mean VO2peak was 40.0 ± 9.5 mL·kg(-1)·min(-1). Women below the median VO2peak (<35.1 mL·kg(-1)·min(-1)) were five times (OR = 5.4, 95% confidence interval = 2.3-12.9) and men below the median (<44.2 mL·kg(-1)·min(-1)) were eight times (OR = 7.9, 95% confidence interval = 3.5-18.0) more likely to have a cluster of cardiovascular risk factors compared to those in the highest quartile of VO2peak (≥40.8 and ≥50.5 mL·kg(-1)·min(-1) in women and men, respectively). Each 5-mL·kg(-1)·min(-1) lower VO2peak corresponded to ∼56% higher odds of cardiovascular risk factor clustering. CONCLUSIONS These data represent the largest reference material of objectively measured VO2peak in healthy men and women age 20-90 yr. Even in people considered to be fit, VO2peak was clearly associated with levels of conventional cardiovascular risk factors.

Psychosocial interventions as part of breast cancer rehabilitation programs? Results from a systematic review

Objective: This systematic review aimed to determine the effectiveness of psychoeducation, cognitive behavioural therapy (CBT) and social support interventions used in the rehabilitation of breast cancer (BC) patients.

Associations between Physical Activity and Physical and Mental Health- A HUNT 3 Study

PURPOSE Health-related quality of life (HRQoL) has been characterized as the ultimate goal for health interventions such as physical activity (PA). We assessed how frequency, duration, and intensity of PA were related to HRQoL in younger (<65 yr) and older (≥65 yr) females and males. METHODS This population-based cross-sectional study explored associations between frequency, duration, and intensity of PA and physical and mental health. HRQoL was measured by SF-8 Health Survey. Frequency and duration were assessed by items validated in a previous HUNT study, and intensity was assessed by Borg RPE scale. Associations between PA and physical and mental health were estimated using general linear modeling. RESULTS A total of 4500 participants (56% females), age 19-91 yr, with mean age of 53±15 yr, were included. Of these, 40% were less active than recommended by international guidelines. In general, mean physical health (PCS-8) in females and males was 47.4±9.7 and 48.8±8.9, and mental health (MCS-8) was 50.5±8.0 and 51.9±7.3, respectively. Age-adjusted association between PA and HRQoL was stronger for physical than mental health in both genders and age groups. The largest differences were between no exercise and exercise groups at any level for frequency, duration, and intensity of PA. We found no substantial gender differences in association between PA and HRQoL, but association was stronger in older (≥65 yr) than younger (<65 yr) females and males. Adjusting for socioeconomic factors and factors such as presence of diseases, body mass index, smoking habits, cohabitation, and disablement did not change the results. CONCLUSIONS The study suggests that exercising at any level is associated with better physical and mental health in both genders compared with no exercise, particularly among the older individuals.

Feasibility and changes in symptoms and functioning following inpatient cancer rehabilitation.

Abstract Aim. The aim was to assess feasibility of a 3 + 1 week inpatient rehabilitation program for cancer survivors, to explore characteristics of the attending participants and examine changes in work status, symptoms and functioning, level of fatigue, exercise and physical performance following rehabilitation. Methods. This was an open intervention study involving cancer survivors having completed primary cancer treatment. The multidisiplinary program consisted of physical training, patient education and group sessions. Participant were assessed at primary stay (T0), at follow-up stay 8–12 weeks later (T1), and six months after T1 (T2). Symptoms and functioning were assessed by the European Organization for Research and Treatment Core Quality-of-Life Questionnaire, physical fatigue by Fatigue Questionnaire, physical exercise by The Nord- Trøndelag Health Study Physical Activity Questionnaire and physical performance by aerobic capacity (VO2max), 30 second Sit-to-stand (STS) and Maximum Step Length (MSL). Linear mixed models were used in analyses. Results. One hundred and thirty-four of 163 included participants (82%) completed both rehabilitation stays and returned questionaires at T2. The majority of completers were females (81%), breast cancer survivors (60%), highly educated and with mean age of 52.8 years (SD of 8.1). Participants had higher level of symptoms and fatigue and lower functioning at admission compared to a Norwegian reference population. However, they reported higher physical exercise level and 47% reported improved work status from T0 to T2. Symptoms and functioning, fatigue, physical exercise and physical performance improved significantly from T0 to T1 and were maintained at T2. Conclusions. The rehabilitation program was feasible and symptoms and functioning normalized following rehabilitation. The program mainly recruited well-educated breast cancer survivors, reporting relative high level of physical exercise. More focus should be put on recruiting and selecting those who need comprehensive inpatient rehabilitation and also compare the effects of inpatient with outpatient rehabilitation programs.

Measurement of physical activity in cancer survivors—a comparison of the HUNT 1 Physical Activity Questionnaire (HUNT 1 PA-Q) with the International Physical Activity Questionnaire (IPAQ) and aerobic capacity

PurposePhysical activity (PA) is an important adjuvant component in all phases of the cancer disease and PA is important for better functioning, coping with the situation and overall quality of life (QoL). In order to achieve better scientific knowledge of the effect of PA in cancer survivors, it is of paramount importance to have validated and feasible assessment tools for PA.MethodsThis validation study, which was part of an open intervention study, used a cross-sectional and a longitudinal design. The HUNT 1 physical activity questionnaire (HUNT 1 PA-Q) was compared to the International Physical Activity Questionnaire (IPAQ) and aerobic capacity. The participants were cancer survivors with different diagnoses attending an inpatient rehabilitation program partly focusing on physical training.ResultsThe correlations between HUNT 1 PA-Q and IPAQ were 0.41 at pre-test and 0.57 at post-test, and sensitivity to change (effect size) was 0.42 for both questionnaires. VO2max demonstrated high sensitivity to change (0.68) and low correlations with HUNT 1 PA-Q (0.30 at pre-test and 0.21 at post-test). There were 13 incomplete HUNT 1 PA-Q forms and 48 incomplete IPAQ forms during the study period.ConclusionsHUNT 1 PA-Q is considered suitable for use in cancer survivors and should be preferred to IPAQ because it was easier to fill in and provided more complete data. Aerobic capacity measures other aspect of PA and should be used as a supplement to PA questionnaire when the aim is to capture health effects related to aerobic capacity.

Metabolite and lipoprotein responses and prediction of weight gain during breast cancer treatment

BackgroundBreast cancer treatment has metabolic side effects, potentially affecting risk of cardiovascular disease (CVD) and recurrence. We aimed to compare alterations in serum metabolites and lipoproteins during treatment between recipients and non-recipients of chemotherapy, and describe metabolite profiles associated with treatment-related weight gain.MethodsThis pilot study includes 60 stage I/II breast cancer patients who underwent surgery and were treated according to national guidelines. Serum sampled pre-surgery and after 6 and 12 months was analysed by MR spectroscopy and mass spectrometry. In all, 170 metabolites and 105 lipoprotein subfractions were quantified.ResultsThe metabolite and lipoprotein profiles of chemotherapy recipients and non-recipients changed significantly 6 months after surgery (p < 0.001). Kynurenine, the lipid signal at 1.55–1.60 ppm, ADMA, 2 phosphatidylcholines (PC aa C38:3, PC ae C42:1), alpha-aminoadipic acid, hexoses and sphingolipids were increased in chemotherapy recipients after 6 months. VLDL and small dense LDL increased after 6 months, while HDL decreased, with triglyceride enrichment in HDL and LDL. At baseline, weight gainers had less acylcarnitines, phosphatidylcholines, lyso-phosphatidylcholines and sphingolipids, and showed an inflammatory lipid profile.ConclusionChemotherapy recipients exhibit metabolic changes associated with inflammation, altered immune response and increased risk of CVD. Altered lipid metabolism may predispose for treatment-related weight gain.

Abstract P6-08-37: Cardiorespiratory fitness (VO2max) before, during and after adjuvant treatment in breast cancer patients

Background: Breast cancer treatment may result in reduced exercise capacity that may in turn lead to reduced maximum oxygen consumption (VO 2max ). However, whether physical exercise can counteract any observed decline in VO 2max in breast cancer patients undergoing adjuvant breast cancer treatment, is less known. Material & methods: The women participating in the Norwegian Energy Balance and Breast Cancer Aspect (EBBA)-II pilot study, were aged 35-75 years and diagnosed with stage I-II breast cancer. Performing a maximum exercise test on a treadmill (modified Balke protocol), VO 2max was assessed at four times; preoperative, 6, 12 and 24 months postoperative. The patients were randomized postoperative to a control group (n=31) or an intervention group (n=29) stratified by menopausal status. The 12 months exercise intervention program consisted of group-based exercise, 60 minutes twice a week and a minimum of 60 minutes of individual exercise. Regression models were used to study the associations between treatment regime and VO 2max . Results: Breast cancer patients (n=60) with a mean age at diagnosis of 55.3 years (38.0-69.0 years), had a mean body mass index of 25.1 kg/m2, and a mean preoperative VO 2max of 32.4 ml/min/kg. Comparing the intervention group to the control group, the intervention group maintained VO 2max throughout the treatment period, and improved their VO 2max with 7.8 % from 12 to 24 months postoperative (p=0.117), while the control group had a 15% reduction in VO 2max 6 months after surgery (p 2max of 22.9 % (p 2max at 6 months postoperative (p = 0.159). Thereafter, in the control group, VO 2max improved with 21.6 % at 12 months postoperative (p=0.006), while in the intervention group VO 2max improved with 13.4 % 24 months postoperative (p=0.038). Patients in the intervention group who did not receive any chemotherapy increased their VO 2max by 6% 6 months postoperative (p=0.174), while patients in the control group who did not receive any chemotherapy had a reduction in VO 2max of 2.1 % at 6 month postoperative (p=0.630). Conclusion: Our findings suggest that systematic physical training may counteract a decline in VO 2max in breast cancer patients receiving adjuvant treatment, including chemotherapy, and is of clinical interest, but needs to be replicated in larger studies. Citation Format: Hanne Frydenberg, Tora J Bettum, Trygve Lofterod, Elisabeth Edvardsen, Vidar G Flote, Sissi E Finstad, Gro F Bertheussen, Ellen Schlichting, Anne McTiernan, Inger Thune. Cardiorespiratory fitness (VO 2max ) before, during and after adjuvant treatment in breast cancer patients [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-37.