Karen Y. Wonders

Acute Exercise Protects Against Doxorubicin Cardiotoxicity

Numerous methods have been used to minimize the cardiotoxic effects of the chemotherapeutic agent doxorubicin (DOX), and most have had limited success. Chronic endurance exercise has been shown to protect against DOX cardiotoxicity, but little is known regarding the effects of acute exercise on DOX-induced cardiac dysfunction. Purpose. The purpose of this study was to determine the effects of a single bout of acute endurance exercise on the cardiac dysfunction associated with DOX treatment. Methods. Male Sprague-Dawley rats either performed an acute exercise bout on a motorized treadmill for 60 minutes at a maximal speed of 25 m/min with a 5% grade (EX) or remained sedentary (SED) 24 hours before receiving either a 15-mg/kg DOX bolus dose or saline (SAL). Cardiac function was then analyzed 5 days post injection using a Langendorff isolated perfused heart model. In addition, myocardial lipid peroxidation was analyzed as an indicator of oxidative stress. Results. Doxorubicin treatment alone (SED+DOX) promoted a significant decline in end-systolic pressure (—35%), left ventricular developed pressure (—59%), and the maximal rate of left ventricular pressure development (—43%) as well as a 45% increase in lipid peroxidation products when compared with SED+SAL (P < .05). Acute exercise 24 hours before DOX treatment, however, had a cardioprotective effect, as end-systolic pressure, left ventricular developed pressure, and the maximal rate of left ventricular pressure development were significantly higher in EX+DOX compared with SED+DOX (P < .05) and EX+DOX had similar levels of lipid peroxidation products as SED+SAL Conclusions. An acute exercise bout performed 24 hours before DOX treatment protected against cardiac dysfunction, and this exercise-induced cardioprotection may partly be explained by a reduction in the generation of reactive oxygen species.

Trastuzumab and Doxorubicin-Related Cardiotoxicity and the Cardioprotective Role of Exercise

Women diagnosed with breast cancer typically undergo a multimodal approach to treating their disease. The treatments used often result in sequelae such as fatigue, hair loss, nausea and vomiting, and functional impairment. Many of these sequelae can be controlled or eliminated with pharmacological, physical, or social interventions. However, 2 effective cytotoxic agents, doxorubicin and trastuzumab, are associated with a potentially life-threatening sequela, cardiotoxicity. Currently, these agents are dosage and duration limited to circumvent cardiac damage. Exercise prior to and during the administration of these agents is emerging as a possible cardioprotective intervention based on the findings of animal model studies. Incorporating exercise into the breast cancer treatment trajectory may eliminate the dosage and duration restrictions of these antineoplastic agents and ultimately affect survival and quality of life. The authors present the pharmacological mechanism for each agent and the exciting results of animal model studies that lay the groundwork for future clinical trials.

Breast Cancer and the Role of Exercise in Women

Cancer of the breast is a significant health problem for women from the time of diagnosis through the treatment and survivorship trajectory. The disease and treatments are an assault to a womans body, resulting in sequelae that can be debilitating. Although women diagnosed with breast cancer are living longer, concerns about functional limitations, recurrence, and survival remain paramount. Physical activity and exercise are preventative and rehabilitative measures that can be employed at various points along the breast cancer trajectory. Current research supports the beneficial role that physical activity and exercise play in reducing the risk for developing breast cancer and preventing or attenuating disease and treatment-related impairments.

Time-course of changes in cardiac function during recovery after acute exercise.

Exercise-induced cardiac dysfunction (EICD) has been observed immediately following exhaustive exercise in trained individuals, but limited and conflicting data are available regarding EICD in a previously untrained population days after an exhaustive exercise bout. The purpose of this study was to examine the effects of a single bout of acute exercise on cardiac function during the 72 h after exercise and identify potential contributing mechanisms. After completing an acute exercise bout on a motorized treadmill (25 m/min, 5% grade, 60 min), rats were sacrificed immediately, 24 h, 48 h, or 72 h after the exercise bout. At the scheduled time of sacrifice, hearts were isolated and perfused for determination of ex vivo cardiac function, and examined for malondialdehyde (MDA), a lipid peroxidation index, and antioxidant potential (AOP). During the 48 h post exercise, left ventricular developed pressure decreased by 30%, dP/dtmax declined by 37%, and dP/dtmin showed a 34% decrease (p<0.05). By 72 h, cardiac function had returned to control levels. MDA was increased immediately after the exercise bout and at the 24 and 48 h intervals (p<0.05). Conversely, AOP progressively decreased at the 24 and 48 h intervals. As with cardiac function, MDA and AOP had returned to control levels by 72 h post-exercise. These data indicate that a single bout of prolonged, moderately intense exercise performed by previously sedentary rats impaired cardiac function for up to 48 h. This decrement in cardiac function was associated with increased lipid peroxidation and decreased antioxidant potential.

Ten weeks of home-based exercise attenuates symptoms of chemotherapy-induced peripheral neuropathy in breast cancer patients

The purpose of this investigation was to determine if a structured, home-based exercise program was beneficial to reduce symptoms of chemotherapy-induced peripheral neuropathy and improve quality of life (QOL). A total of 50 women who are breast cancer survivors and are listed in the Breast Cancer Registry of Greater Cincinnati database were recruited by mail. Participants were initially asked to complete the McGill QOL questionnaire and the Leeds Assessment of Neuropathic Symptoms and Signs, before beginning a 10-week home-based exercise program. At the completion of the exercise program, subjects were asked again to complete the same two questionnaires. Pre- and post-intervention data were analyzed using a repeated measures ANOVA, at a significance level of α<0.05. Six individuals completed the investigation. Prior to the 10-week exercise program, participants described their pain as unpleasant skin sensations (Pre-HBEx, N=6), abnormally sensitive to touch (Pre-HBEx, N=6), and coming on suddenly in bursts for no apparent reason (Pre-HBEx, N=5). Following 10-weeks of exercise, participants reported experiencing less of these symptoms (Post-HBEx, N=3, 1, and 4 respectively; P=0.05). It was also determined that troublesome symptoms were significantly reduced after 10-weeks of home-based exercise (P=0.05).

The Effect of Supervised Exercise Training on Symptoms of Chemotherapy- Induced Peripheral Neuropathy

Chemotherapy-Induced Peripheral Neuropathy is a common, dose-limiting effect of chemotherapy treatment. Pharmacological therapies are largely uneffective, making the investigation of other interventions warranted. Homebased exercise programs have produced promising improvements in quality of life and pain symptoms, yet compliance to programs is low. Thus, the purpose of this investigation was to examine the outcomes of a structured, supervised exercise program in reducing symptoms of CIPN and improving physical fitness and overall QOL. A total of 38 individuals actively in chemotherapy treatment participated in this investigation. The McGill QOL and Leeds Assessment of Neuropathic Symptoms and Signs questionnaires, followed by a comprehensive fitness evaluation was administered both before and after the 12-week supervised exercise program. Results revealed that 12-weeks of supervised exercise training helped attenuate symptoms of CIPN. Overall QOL was significantly improved, and troublesome symptoms related to CIPN significantly decreased (p<0.05). Thus, we assert that exercise is an effective tool in managing symptoms of CIPN.

Supervised, Individualized Exercise Programs Help Mitigate Costs during Cancer Treatment

Background: Cancer and its associated treatments often result in long-term physical and psychological side effects that negatively impact the cancer survivors quality of life. In addition, the financial costs of cancer are substantial and are projected to reach

The Role of Nutrition and Exercise in the Prevention of the Onset ofCancer

158 billion by the year 2020. Research indicates that endurance exercise training is helpful in attenuating the deleterious effects of cancer treatments by increasing survival, attenuating myocardial lesions and myocyte disarray, increasing levels of antioxidants, decreasing lipid peroxidation induced by oxidative stress and markers of apoptosis, and preserving cardiac function. However, nationally less than 5% of patients are ever referred to a cancer rehabilitation exercise program. Cost is a barrier to these programs, as they often are not reimbursable under most insurance plans. Purpose: Therefore, the purpose of this investigation was to determine if exercise training during cancer treatment helped to minimize side effects and reduce health care costs. Specifically, treatment tolerance, length of hospital stay, hospital readmits, ER visits, and treatment compliance were measured. Methods: This was a retrospective, two-group study which ascertained the protective effect of an exercisetraining program during cancer treatment. All oncology patients who received cancer treatment at Kettering Medical Center in Dayton, Ohio between January-December 2016 were identified by office staff. Their medical records were pulled and patients were placed in one of two groups: those who exercised during treatment, and those who remained sedentary. The medical records were reviewed to determine outcome data for length of hospital stays, hospital readmits, ER visits, treatment compliance, fatigue, and anxiety/depression related to oncology conditions. The age range of the patients was 21-93 years. Patients were excluded if they had pre-existing cardiac, liver, and bone marrow conditions prior to treatment. Individuals in the exercise group (EX, n=672) completed 12 weeks of prescribed, individualized exercise that included cardiovascular, strength training, and flexibility components. The intensity level for the cardiovascular exercise ranged from 30%-45% of the individual’s predicted VO2max. The strength training involved a full body workout, with emphasis on all major muscle groups. Individuals in the sedentary group (SED, n=728) did not participate in an exercise program during treatment. Results: Patients in the EX group had significantly lower reports of fatigue, pain, and cardiac problems (p<0.05), as well as fewer notes of depression and anxiety than their SED group counterparts. In addition, the EX group tolerated their treatment significantly better than the SED group (p<0.05). Finally, the EX group had a significantly lower number of ER visits (EX=2, SED=14, p<0.05), 30-day readmits (EX=2, SED=53, p<0.05) as well as a shorter length of stay (EX=0.75, SED=3 p<0.05). Conclusion: Results from this investigation point to a protective effect of moderate-intensity exercise that translated to reductions in ER visits, 30-day readmits, and length of hospital stay, which translated into cost savings for the payer, provider, and patients, alike.

A Comprehensive Cancer Care Plan: Examining the Role of Exercise,Nutrition, and Emotional Support in Cancer Recovery

With cancer being the second leading cause of death in the United States, it is imperative to take as many precautions as possible to its onset. Studies have shown that sound nutrition practices and regular exercise create changes in the body that facilitate the prevention of cancer. This paper presents a comprehensive review of these topics, as well as some practical tips that will enhance the health of an individual and help prevent the onset of cancer.

Exercise Intensity As A Determinant Of Exercise Induced Hypoalgesia: 2301

At present, approximately 1 in 30 Americans are cancer survivors. The 5-year survival rate for all cancers is approaching 65%, and reaches as high as 90% for certain cancers, such as cancer of the breast. As advances in early detection, therapy, and supportive care diffuse into the community, the number of cancer survivors is only expected to continue to increase in the decades to come. More than ever before, cancer survivors are living long enough to be troubled by the persistent and late effects of their illness and its treatment. However, a growing body of research indicates that the long-term health care needs of cancer survivors are not being sufficiently met, highlighting a need for more health care resources to be directed towards this unique group of survivors. It is becoming increasingly clear that in order to meet the long-term needs of cancer survivors, a cancer care plan must be developed. Integral to this survivorship care plan are resources addressing palliative care, focusing on behavior change, and lifestyle interventions such as exercise, nutrition, and emotional support. This paper focuses on the current guidelines and benefits of exercise training, nutrition guidance, and emotional support, three aspects of cancer care that have been shown to greatly improve the quality of life for cancer patients.