A remote, fully oriented personalized program of physical exercise for women in follow-up after breast cancer treatment improves body composition and physical fitness

Abstract

This study aimed to evaluate the efficacy of an individualized remote exercise program on the improvement of body composition and physical fitness of a heterogeneous group of patients who completed breast cancer treatment. This prospective study included 107 women aged 18 to 60, shortly after curative treatment for localized breast cancer, at the Erasto Gaertner Cancer Hospital (HEG) in Curitiba, PR, Brazil. Body composition, maximal oxygen consumption, and muscle resistance were evaluated after nine months of intervention while considering adherence to the program, level of physical activity, presence of binge eating disorder, tumor classification, and treatment type. Seventy-eight women (72.8%) adhered to the training program. Adherent participants showed significant changes in body mass ([-4.3 ​± ​3.6] kg; p ​< ​0.000 1), body mass index ([-1.6 ​± ​1.5] kg·m⁻²; p ​< ​0.000 1), body fat (−3.4% ​± ​3.1%; p ​< ​0.000 1), maximal oxygen consumption ([7.5 ​± ​2.0] ml·kg⁻¹·min⁻¹); p ​< ​0.000 1), and abdominal resistance ([11.2 ​± ​2.8] reps; p ​< ​0.000 1). In contrast, these variables did not change significantly in the non-adherent group. Among the adherent participants, those subclassified in the severe binge group showed a more noticeable reduction in body mass, body mass index, and body fat (p ​< ​0.05) than those in the non-binge group. Individualized remotely-guided physical exercise programs can improve the body composition and physical fitness of women undergoing post-breast cancer surveillance, regardless of pathological history or treatment.

Keywords

Breast neoplasm / Exercise training / Physical therapy modalities / Body weight changes / Physical functional performance

References

[[1]] H Sung, J Ferlay, RL Siegel, et al.. Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA A Cancer J Clin, 71 (3) ( 2021), pp. 209-249, DOI: 10.3322/caac.21660

[[2]] SK Clinton, EL Giovannucci, SD. Hursting. The world cancer research fund/American institute for cancer research third expert report on diet, nutrition, physical activity, and cancer: impact and future directions. J Nutr, 150 (4) ( 2020), pp. 663-671, DOI: 10.1093/jn/nxz268

[[3]] M Kawai, A Tomotaki, H Miyata, et al.. Body mass index and survival after diagnosis of invasive breast cancer: a study based on the Japanese National Clinical Database-Breast Cancer Registry. Cancer Med, 5 (6) ( 2016), pp. 1328-1340, DOI: 10.1002/cam4.678

[[4]] A. Engin. Obesity-associated breast cancer: analysis of risk factors. Adv Exp Med Biol, 960 ( 2017), pp. 571-606, DOI: 10.1007/978-3-319-48382-5_25

[[5]] M Picon-Ruiz, C Morata-Tarifa, JJ Valle-Goffin, ER Friedman, JM. Slingerland. Obesity and adverse breast cancer risk and outcome: mechanistic insights and strategies for intervention. CA A Cancer J Clin, 67 (5) ( 2017), pp. 378-397, DOI: 10.3322/caac.21405

[[6]] KM Malinovszky, D Cameron, S Douglas, et al.. Breast cancer patients’ experiences on endocrine therapy: monitoring with a checklist for patients on endocrine therapy (C-PET). Breast, 13 (5) ( 2004), pp. 363-368, DOI: 10.1016/j.breast.2004.02.009

[[7]] LE Inumaru, EA Silveira, MM. Naves. Risk and protective factors for breast cancer: a systematic review. Cad Saúde Pública, 27 (7) ( 2011), pp. 1259-1270, DOI: 10.1590/s0102-311x2011000700002

[[8]] G Ammitzbøll, et al..T Kristina Kjær, C Johansen, Effect of progressive resistance training on health-related quality of life in the first year after breast cancer surgery - results from a randomized controlled trial. Acta Oncol, 58 (5) ( 2019), pp. 665-672, DOI: 10.1080/0284186X.2018.1563718

[[9]] AH Bekhet, AR Abdallah, HM Ismail, et al.. Benefits of aerobic exercise for breast cancer survivors: a systematic review of randomized controlled trials. Asian Pac J Cancer Prev APJCP, 20 (11) ( 2019), pp. 3197-3209, DOI: 10.31557/APJCP.2019.20.11.3197

[[10]] AK Swisher, J Abraham, D Bonner, et al.. Exercise and dietary advice intervention for survivors of triple-negative breast cancer: effects on body fat, physical function, quality of life, and adipokine profile. Support Care Cancer, 23 (10) ( 2015), pp. 2995-3003, DOI: 10.1007/s00520-015-2667-z

[[11]] CN Holick, PA Newcomb, A Trentham-Dietz, et al.. Physical activity and survival after diagnosis of invasive breast cancer. Cancer Epidemiol Biomarkers Prev, 17 (2) ( 2008), pp. 379-386, DOI: 10.1158/1055-9965.EPI-07-0771

[[12]] Silva DaS, MS Tremblay, MFM Souza, et al.. Mortality and years of life lost due to breast cancer attributable to physical inactivity in the Brazilian female population (1990-2015). Sci Rep, 8 (1) ( 2018), Article 11141, DOI: 10.1038/s41598-018-29467-7

[[13]] KH Schmitz, KS Courneya, C Matthews, et al.. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc, 42 (7) ( 2010), pp. 1409-1426, DOI: 10.1249/MSS.0b013e3181e0c112

[[14]] HE Erskine HA. Whiteford. Epidemiology of binge eating disorder. Curr Opin Psychiatr, 31 (6) ( 2018), pp. 462-470, DOI: 10.1097/YCO.0000000000000449

[[15]] C Desmedt, M Fornili, F Clatot, et al.. Differential benefit of adjuvant docetaxel-based chemotherapy in patients with early breast cancer according to baseline body mass index. J Clin Oncol, 38 (25) ( 2020), pp. 2883-2891, DOI: 10.1200/JCO.19.01771

[[16]] T Iwase, X Wang, TV Shrimanker, MG Kolonin, NT. Ueno. Body composition and breast cancer risk and treatment: mechanisms and impact. Breast Cancer Res Treat, 186 (2) ( 2021), pp. 273-283, DOI: 10.1007/s10549-020-06092-5

[[17]] AE Lohmann, PJ Goodwin, RT Chlebowski, K Pan, V Stambolic, RJ. Dowling. Association of obesity-related metabolic disruptions with cancer risk and outcome. J Clin Oncol, 34 (35) ( 2016), pp. 4249-4255, DOI: 10.1200/JCO.2016.69.6187

[[18]] LFM Rezende, M Arnold, FM Rabacow, et al.. The increasing burden of cancer attributable to high body mass index in Brazil. Cancer Epidemiol, 54 ( 2018), pp. 63-70, DOI: 10.1016/j.canep.2018.03.006

[[19]] KL Dittus, JR Harvey, JY Bunn, et al.. Impact of a behaviorally-based weight loss intervention on parameters of insulin resistance in breast cancer survivors. BMC Cancer, 18 (1) ( 2018), p. 351, DOI: 10.1186/s12885-018-4272-2

[[20]] SB Santagnello, FM Martins, et al..GN De Oliveira Junior, Improvements in muscle strength, power, and size and self-reported fatigue as mediators of the effect of resistance exercise on physical performance breast cancer survivor women: a randomized controlled trial. Support Care Cancer, 28 (12) ( 2020), pp. 6075-6084, DOI: 10.1007/s00520-020-05429-6

[[21]] CC Schag, RL Heinrich, PA. Ganz. Karnofsky performance status revisited: reliability, validity, and guidelines. J Clin Oncol, 2 (3) ( 1984), pp. 187-193, DOI: 10.1200/JCO.1984.2.3.187

[[22]] RR Townsend, IB Wilkinson, EL Schiffrin, et al.. Recommendations for improving and standardizing vascular research on arterial stiffness: a scientific statement from the American heart association. Hypertension, 66 (3) ( 2015), pp. 698-722, DOI: 10.1161/HYP.0000000000000033

[[23]] PT Katzmarzyk CL. Craig. Musculoskeletal fitness and risk of mortality. Med Sci Sports Exerc, 34 (5) ( 2002), pp. 740-744, DOI: 10.1097/00005768-200205000-00002

[[24]] CK Blair, K Robien, M Inoue-Choi, W Rahn, D. Lazovich. Physical inactivity and risk of poor quality of life among elderly cancer survivors compared to women without cancer: the Iowa Women’s Health Study. J Cancer Surviv, 10 (1) ( 2016), pp. 103-112, DOI: 10.1007/s11764-015-0456-9

[[25]] M Piñeros, DM Parkin, K Ward, et al.. Essential TNM: a registry tool to reduce gaps in cancer staging information. Lancet Oncol, 20 (2) ( 2019), pp. e103-e111, DOI: 10.1016/S1470- 2045(18)30897-0

[[26]] CL Craig, AL Marshall, M Sjostrom, et al.. International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc, 35 (8) ( 2003), pp. 1381-1395, DOI: 10.1249/01.MSS.0000078924.61453.FB

[[27]] C Duarte, J Pinto-Gouveia, C. Ferreira. Expanding binge eating assessment: validity and screening value of the Binge Eating Scale in women from the general population. Eat Behav, 18 ( 2015), pp. 41-47, DOI: 10.1016/j.eatbeh.2015.03.007

[[28]] BA Dolezal, EV Neufeld, DM Boland, JL Martin, CB. Cooper. Interrelationship between sleep and exercise: a systematic review. Adv Prev Med ( 2017), Article 1364387, DOI: 10.1155/2017/1364387

[[29]] A Murtezani, Z Ibraimi, A Bakalli, S Krasniqi, ED Disha, I. Kurtishi. The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial. J Cancer Res Therapeut, 10 (3) ( 2014), pp. 658-664, DOI: 10.4103/0973-1482.137985

[[30]] B Stubbs, D Vancampfort, S Rosenbaum, et al.. An examination of the anxiolytic effects of exercise for people with anxiety and stress-related disorders: a meta-analysis. Psychiatr Res, 249 ( 2017), pp. 102-108, DOI: 10.1016/j.psychres.2016.12.020

[[31]] H Hoppeler, H Howald, K Conley, et al.. Endurance training in humans: aerobic capacity and structure of skeletal muscle. J Appl Physiol ( 1985), 59 (2) ( 1985), pp. 320-327, DOI: 10.1152/jappl.1985.59.2.320

[[32]] R Cešeiko, SN Thomsen, S Tomsone, et al.. Heavy resistance training in breast cancer patients undergoing adjuvant therapy. Med Sci Sports Exerc, 52 (6) ( 2020), pp. 1239-1247, DOI: 10.1249/MSS.0000000000002260

[[33]] T Moritani, M Muro, A. Nagata. Intramuscular and surface electromyogram changes during muscle fatigue. J Appl Physiol ( 1985), 60 (4) ( 1986), pp. 1179-1185, DOI: 10.1152/jappl.1986.60.4.1179

[[34]] JR Vallerand, RE Rhodes, GJ Walker, KS. Courneya. Feasibility and preliminary efficacy of an exercise telephone counseling intervention for hematologic cancer survivors: a phase II randomized controlled trial. J Cancer Surviv, 12 (3) ( 2018), pp. 357-370, DOI: 10.1007/s11764-018-0675-y

[[35]] J Kerr, C Anderson, SM. Lippman. Physical activity, sedentary behaviour, diet, and cancer: an update and emerging new evidence. Lancet Oncol, 18 (8) ( 2017), pp. e457-e471, DOI: 10.1016/S1470- 2045(17)30411-4

[[36]] BM. Lynch. Sedentary behavior and cancer: a systematic review of the literature and proposed biological mechanisms. Cancer Epidemiol Biomarkers Prev, 19 (11) ( 2010), pp. 2691-2709, DOI: 10.1158/1055-9965.EPI-10-0815

[[37]] DSM Chan, L Abar, M Cariolou, et al.. World Cancer Research Fund International: continuous Update Project-systematic literature review and meta-analysis of observational cohort studies on physical activity, sedentary behavior, adiposity, and weight change and breast cancer risk. Cancer Causes Control, 30 (11) ( 2019), pp. 1183-1200, DOI: 10.1007/s10552-019-01223-w

We thank the Erasto Gaertner Hospital for the structure and team of professionals throughout the intervention; special thanks to the physical therapy, psychology, and nutrition sectors. We also thank Dr. Keith Mary de Souza Sato Urbinati for the project's initial phase contributions. Finally, we thank the patients who participated in this study.