Marco Monaci

Evidence for Adapted Physical Activity as an Effective Intervention for Upper Limb Mobility and Quality of Life in Breast Cancer Survivors

BACKGROUND Physical activity interventions are known to be effective in improving the physical and psychological complaints of breast cancer survivors. PURPOSE To investigate the impact of a specific exercise training program on upper limb mobility and quality of life in breast cancer survivors. METHODS The study included 55 women recruited at the Cancer Rehabilitation Centre in Florence after the completion of breast cancer treatment and rehabilitative physiotherapy. All participants underwent an 8-week specific exercise training to improve upper limb mobility function and quality of life. Anthropometric parameters were measured, and each subject underwent a battery of fitness tests to assess shoulder-arm mobility, range of motion, and back flexibility before and after specific exercise program. All participants filled out the Short Form-12 and numerical rating scale questionnaires to assess the quality of life and to quantify back and shoulder pain intensity. RESULTS The evaluation of shoulder-arm mobility and self-reported questionnaire data revealed a statistically significant improvement after completion of our specific exercise program. CONCLUSION An organized specific program of adapted physical activity can be effective in reducing the main adverse effects of surgery and oncological therapy, and may significantly improve shoulder-arm mobility and quality of life in breast cancer survivors.

Low back pain in healthy postmenopausal women and the effect of physical activity: A secondary analysis in a randomized trial

Epidemiological studies on the prevalence of musculoskeletal pain have consistently shown that this is a relevant health problem, with non-specific low back pain (LBP) being the most commonly reported in adult females. Conflicting data on the association between LBP symptoms and physical activity (PA) have been reported. Here, we investigated the prevalence of LBP and the effect of a 24-month non-specific PA intervention on changes in LBP prevalence in a series of Italian healthy postmenopausal women. We performed a secondary analysis in the frame of the DAMA trial, a factorial randomized intervention trial aimed to evaluate the ability of a 24-month intervention, based on moderate-intensity PA, and/or dietary modification, in reducing mammographic breast density in healthy postmenopausal women. The PA intervention included at least 1 hour/day of moderate PA and a more strenuous weekly activity, collective walks and theoretical group sessions. A self-administered pain questionnaire was administered at baseline and at the end of the intervention. The questionnaire was specifically structured to investigate the occurrence of musculoskeletal pain, the body localization, intensity and duration of the pain. Two hundred and ten women (102 randomized to PA intervention, 108 not receiving the PA intervention) filled out the questionnaires. At baseline LBP was present in 32.9% of the participants. Among women randomized to the PA intervention, LBP prevalence at follow up (21.6%) was lower than at baseline (33.3%) (p = 0.02), while in women who did not receive the PA intervention the LBP prevalence at baseline and follow up were 32.4% and 25.9%, respectively (p = 0.30). Overall, there was no significant between-group effect of PA intervention on LBP. Further studies are needed to understand the role of non-specific PA intervention, aimed to improve overall fitness, on LBP prevalence.

Longitudinal assessment of the impact of adapted physical activity on upper limb disability and quality of life in breast cancer survivors from an Italian cohort

PurposeThe purpose of this study was to evaluate the effectiveness of a specific adapted physical activity (APA) protocol on upper limb disability and quality of life in breast cancer survivors and to assess longitudinally the possible role of APA on long-term benefits.MethodsBreast cancer survivors from an Italian cohort were assessed by fitness tests (shoulder-arm mobility, range of motion, and back flexibility) before and after 8-week APA. Quality of life and back and surgical shoulder pain intensity were evaluated by Short Form-12 and numerical rating scale questionnaires, respectively. At 1.5-year post-APA follow-up, survivors were evaluated as at baseline/post-APA to assess long-term effects.ResultsA statistically significant improvement in shoulder-arm mobility, pain perception, and quality of life was observed in breast cancer survivors after APA intervention. Longitudinal analyses indicated an overall decrease in the achieved benefits at 1.5-year post-APA.ConclusionsThe survivorship phase of breast cancer requires a multidisciplinary collaboration involving either the cancer-care medical team or APA professionals to manage psychophysical outcomes. A specific APA protocol may represent an effective countermeasure to reduce post-treatment upper limb disability and improve the quality of life in breast cancer survivors. Participation in structured APA protocols should be maintained over time to preserve the achieved benefits.

Efficacy of a specific program of adapted physical activity in breast cancer survivors: a 5-year single center experience in Florence

Physical activity has been proposed as a nonpharmacological intervention to improve the quality of life in breast cancer survivors. Breast cancer is the most commonly diagnosed malignancy among women worldwide. Recently, earlier detection and advances in therapies have substantially improved the survival rate of breast cancer patients, many of which will have a normal life expectancy. However, cancer treatments can produce negative short- and/or long-term physical and psychological effects (i.e. shoulder and arm decresed mobility, pain, mood disturbance), which heavily contribute to the reduction of life quality. In previous study, we carefully described the exercise methodology of a planned and personalized program of adapted physical activity (APA) demonstrating its efficacy in reducing the shoulderarm complications and improving the quality of life in breast cancer survivors (1). In the present study, we evaluted a higher numbers of breast cancer survivors and a long-time follow up to verify the effectiveness of our protocol. For this pourpose, 140 breast cancer survivors (mean age 56.8±10.2) were recruited by Cancer Rehabilitation Center in Florence between February 2009 and November 2014. The women were evaluated at the baseline and after the 8-week physical activity. The anthropometric parameters were measured and the subjects underwent a battery of fitness tests to assess shoulder-arm mobility and range of motion (ROM), and back flexibility (sit and reach test). All partecipants filled out numerical rating scale and Short-Form 12 questionnaires to quantify the pain intensity to back and the shoulder of the operated arm, and to assess the quality of life, respectively. The evaluation of shoulderarm mobility and self-reported questionnaire data revealed a statistically significant improvement after completion of our specific exercise program. After one year from APA, participants were subjected again to this evaluation protocol. Moreover, to evaluate the APA long-term effects (i.e. physically active lifestyle and shoulder-arm disability), a structured questionnaire was administered to all participants.

Effects of a specific adapted exercise on chronic cancerrelated arm lymphedema: a pilot study

Secondary arm lymphedema (LE) is among the most dreaded chronic complications in cancer patients that occurs when axillary lymphatic drainage from the arm is interrupted because of axillary lymph node dissection and/or axillary radiation (Ikeda et al., 2014). LE is characterized by accumulation of protein-rich interstitial fluid in the arm, resulting in tissue swelling. Subsequent swelling can cause pain, discomfort, heaviness, distortion, and reduced mobility and function, thereby affecting quality of life. With increased survival rates there is greater emphasis on enhancing quality of life after treatments (Armer et al., 2003), but the secondary LE remains a problem even with modern treatment modalities. Many treatment options for lymphedema are available, but none offer a permanent reduction or elimination of arm swelling (McKenzie and Kalda, 2003). Recent researches support the positive effects deriving from the regular participation in structured adapted physical activity programs in preventing or attenuating cancer treatment-related impairments improving the quality of life (Mirandola et al., 2013). In this context, the aim of our study was to propose and evaluate a specific exercise, planned by an adapted exercise specialist, to reduce LE and improve strenght and mobility of the arm, as well as quality of life in cancers survivors. We recruited by Cancer Rehabilitation Center of Florence 20 cancer survivors with chronic moderate-severe arm lymphedema, divided randomly into 4 groups according to the different protocol for duration, frequency and intensity of proposed exercise. Outcome measures, included the arm circumference, ROM of arm and hand-wrist, strenght (hand grip test) and quality of life (ULL27 questionaire), were assessed at baseline, in itinere (1, 2 and 3 months) and post-intervention (6 months). Our preliminary results demonstrated that a structured exercise (10 repetitions x 3 with 1 minute break once a day for 3 times per week) improved shoulder function, reduced and managed LE cancer survivors.

Musculoskeletal pain in women from DAMA Trial: role of a physical activity intervention

Epidemiological studies showed that prevalence of musculoskeletal pain is higher in women than in men (Bracci et al. 2007; Salaffi et al. 2005) and low back pain is the most commonly reported whereas conflicting evidence exists for the association between physical activity and low back pain symptoms (Heneweer et al. 2011; Sitthipornvorakul et al. 2011). In this study, we investigated the prevalence of musculoskeletal pain and the role of a non-specific physical activity (PA) intervention in prevention/reduction of pain in the frame of the DAMA Trial. DAMA (n° ISRCTN28492718, funded by Istituto Toscano Tumori and Ministry of Health ) is a 24-month factorial randomized trial in post-menopausal women with high-Mammographic Breast Density (MBD), a risk factor for breast cancer (Masala et al. 2006), aimed to evaluate the ability of a structured intervention based on a moderate-intensity physical exercise and/or specific dietary modification, to reduce MBD. Participants were post-menopausal women, 50-69 yrs, with MBD>50%. Exclusion criteria were: current/recent HRT; current smokers; diabetes and/or other co-morbidities contraindicating dietary and PA intervention. After the baseline visit in which blood and urine samples, anthropometry, dietary and lifestyle information were collected, participants (234 women) were randomized by age- and BMI-stratified blocks, to one of the four arms: dietary intervention, PA intervention, dietary+PA intervention or control. The PA intervention included one hour/week exercise program carried out by exercise specialist, individual and group sessions to explain PA benefits, group walks and at least 1 hour/day of individual moderate PA (i.e. walking, biking, home exercise). The control arm received general advice on healthy diet and PA. To evaluate physical fitness of all participants, at baseline and follow-up (FU), specific visits were performed and a specific questionnaire on pain was self-administered to investigate body site of pain, pain intensity and duration. Baseline and FU pain questionnaires were completed by 210 women (102 randomised to PA intervention*, 108 to control arm§). At baseline pain was reported by 154 women (73%), among them 75% reported back, 29% shoulder and 29% leg pain. After the 24-month intervention a significant effect emerged for low back pain in women randomised to PA intervention, in term of reduced prevalence of women with pain and prevention of new cases (p=0.02 in PA arm, 0.30 in control arm) suggesting also a beneficial effect of non-specific PA.

Dance to enhance the cognitive and physical abilities in elderly individuals

for measures preserving the independence and maintaining the quality of life in elderly individuals. Numerous researches have shown that regular and structured physical activity is associated with successful aging (Vogel et al., 2009). Physical activity appropriated for older adults should include a multicomponent exercise program of moderate aerobic activities, strength training, balance and flexibility exercises. In particular, the physical activity should be personalized and adapted to the specific needs of each subject. Structured specific program of Adapted Physical Activity can prevent and/or reduce the functional decline correlated with aging. Among the various physical activities, recent studies suggest that dancing is a type of physical activity that may allow elderly adults to improve their physical function, health and well-being, and to maintain cognitive function (Hui et al., 2009; Kattenstroth et al., 2010). We investigated the potential cognitive and physical benefits deriving from practice of Dance respect to Adapted Physical Activity participation and not practice of physical activity in leisure time, in 150 healthy elderly subjects (80 women and 70 men; mean age 68,4 ± 0,25). All participants were assessed with a battery of cognitive tests using Attention and Concentration Software by Erickson and underwent fitness tests as Tinetti test and sit and reach. Moreover, subjects filled out the SF-12 questionnaire to assess their quality of life and structured questionnaire to evaluate the participation in leisure cognitive activities (reading books or newspapers, doing crossword puzzles, etc.). Our results demonstrated that subjects practicing Dance or Adapted Physical Activity are statistically better in all proposed tests than the sedentary individuals. In particular, subjects who practice dance, show results significantly better in cognitive tests compared with Adapted Physical Activity. Dance, given its peculiar characteristics, results an effective physical activity in maintaining the cognitive and physical functions and an alternatively training feasible in elderly subjects. Increased self-esteem, social contact and psychophysical wellness significantly ameliorate the quality of life during aging.

Role of physical activity program in the tertiary prevention of female breast cancer: a pilot study

Physical activity is recognised internationally as a key factor in breast cancer prevention that is worldwide the major cause of cancer incidence and mortality in women. It is likely that physical activity is associated with decreased breast cancer risk via multiple interrelated biologic pathway that may involve adiposity, sex hormones, insulin resistence, adipokines and chronic inflammation (Recent Results Cancer Res, 2011). Although women diagnosed with breast cancer are living longer for treatment improvements, concerns about functional limitations, recurrence and survival remain paramount. Recent researches support the beneficial role that physical activity plays in reducing the risk for developing breast cancer and preventing or attenuating disease and treatment-related impairments (Methods Mol Biol, 2009). Post-diagnosis physical activity has been associated with improved quality of life and survivors should be encouraged to initiate and maintain a program of physical activity (Cancer Prev Res, 2011). However, actually it is not yet clear which duration, frequency and intensity of physical activities provide the benefits in primary or tertiary prevention; studies are also limited by incomplete reporting and methodological limitations (Cancer Treat Rev, 2010). We provided a physical activity program in breast cancer survivors (60 women; mean age 59,5 ± 9,8) recruited by Cancer Rehabilitation Center in Florence to investigate the role of physical activity on psychophysical wellness. The subjects were evaluated at the baseline and after the 8-week study period. The anthropometric parameters were measured and the subjects underwent a battery of fitness tests to assess shoulder-arm mobility and range of motion, and back flexibility. All partecipants filled out numerical rating scale and Short-Form 12 questionnaires to quantify the pain intensity to back and the shoulder of the operated arm, and to assess the quality of life, respectively. Our results demonstrated that an organized specific program of adapted physical activity may be an effective countermeasure to reduce the adverse effects after surgery and oncological therapy.