The Effects of Kinect-Enhanced Lymphatic Exercise Intervention on Lymphatic Pain, Swelling, and Lymph Fluid Level

Background: The-Optimal-Lymph-Flow (TOLF) intervention aims to promote lymph flow through therapeutic lymphatic exercises to relieve lymphatic pain, swelling, lymphedema symptoms, and to decrease lymph fluid levels among breast cancer survivors. To enhance the efficacy of the TOLF intervention, an innovative, intelligent, Kinect-enhanced lymphatic exercise intervention (Kinect-TOLF) was developed to teach patients to perform the lymphatic exercises correctly. Objectives: This feasibility trial aimed to determine the feasibility, usability, and effects of the Kinect-TOLF on lymphatic pain, swelling, lymphedema symptoms, and lymph fluid levels. Methods: A single-arm feasibility trial with a pre- and post-test design was employed to recruit 30 breast cancer survivors with persistent lymphatic pain or swelling. Patients received a single training session to learn how to perform the lymphatic exercises using the Kinect-TOLF program. Descriptive statistics, Wilcoxon signed-rank tests, t-test, Spearman’s rank correlation coefficients, linear regressions, and Cohen’s d were performed for data analysis. Qualitative data were assessed for common themes. Results: The Kinect-TOLF was effective in training patients to perform the lymphatic exercises correctly with high user satisfaction. Significant reductions were found in scores of lymphatic pain ( MedΔ = −1.00, CI = [−1.5, −0.1], P = .004), arm/hand swelling ( MedΔ = −1.00, CI = [−1.5, −0.5], P = .004), total swelling ( MedΔ = −1.5, CI = [−2.0, −1.0], P = .003), number of lymphedema symptoms ( MΔ = −3.8, CI = [−5.5, −2.1], P < .001), and lymphedema symptom severity ( MΔ = −5.3, CI = [−9.5, −1.1], P = .016). A significant reduction in lymph fluid levels was found in mean L-Dex scores ( MΔ = −2.68, CI = [−4.67, −0.69], P = .010). Greater decrease in mean L-Dex scores were found in patients with abnormal lymph fluid levels (L-Dex ≥ 7.1) ( MΔ = −5.19, CI = [−1.75, −8.63], P = .008). Patients’ qualitative feedback supported the results of the study. Conclusions: The Kinect-TOLF is safe, feasible, and effective in reducing lymphatic pain, swelling, lymphedema symptoms, and in decreasing lymph fluid levels. Future research should focus on a randomized clinical trial to confirm the unique or synergistic efficacy of the Kinect-TOLF in comparison with current lymphedema treatment and other forms of exercises or movement therapy. This study was registered in ClinicalTrials.gov with US ClinicalTrials.gov Identifier: NCT03999177.

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Effect of aerobic and resistance exercise on the mitochondrial peptide MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors

Scientific Reports ◽

10.1038/s41598-021-96419-z ◽

2021 ◽

Vol 11 (1) ◽

Cited By ~ 1

Author(s):

Christina M. Dieli-Conwright ◽

Nathalie Sami ◽

Mary K. Norris ◽

Junxiang Wan ◽

Hiroshi Kumagai ◽

...

Keyword(s):

Breast Cancer ◽

Resistance Exercise ◽

Cancer Survivors ◽

Repeated Measures ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Care Group ◽

Post Exercise ◽

Increased Risk ◽

Hispanic White

AbstractMOTS-c is a mitochondrial derived peptide with exercise mimetic activity that elicits beneficial effects on metabolism and exercise capacity. Furthermore, MOTS-c effects in humans are affected by race, potentially via ethnic-specific mtDNA variations. Women treated for breast cancer are at an increased risk for cardiovascular disease, diabetes and obesity, due to side effects of cancer-treatments. We conducted a secondary analysis of the effects of a 16-week aerobic and resistance exercise intervention on MOTS-c in Hispanic and Non-Hispanic White breast cancer survivors (BCS). BCS (Stage I–III) were randomized to exercise or standard care. The intervention promoted aerobic and resistance exercise for 16 weeks. MOTS-c was analyzed in fasting plasma using an in-house ELISA. Within and between group differences were assessed by paired t-test and repeated measures ANOVA. Pearson’s correlation was computed to assess the association between MOTS-c and metabolic biomarkers at baseline and post-exercise. Twenty-five Hispanic-BCS and 24 non-Hispanic White BCS were included. Hispanic BCS were younger, of greater adiposity, had higher stage cancers, and had worse metabolic profiles at baseline compared to non-Hispanic White BCS (p < 0.001). Post-exercise, MOTS-c levels significantly increased when compared to baseline and the usual care group among non-Hispanic White BCS (p < 0.01) but not among Hispanic breast cancer survivors (p > 0.01). Post-exercise levels of MOTS-c among non-Hispanic White BCS were significantly associated with reductions in fat mass, body weight, HOMA-IR, CRP, and an increase in lean mass (p < 0.01). A 16-week aerobic and resistance intervention increased MOTS-c levels among non-Hispanic White BCS. Trial registration: This trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010. https://clinicaltrials.gov/ct2/show/NCT01140282.

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Effects of exercise in breast cancer patients: implications of the trials within cohorts (TwiCs) design in the UMBRELLA Fit trial

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06363-9 ◽

2021 ◽

Author(s):

Roxanne Gal ◽

Evelyn M. Monninkhof ◽

Carla H. van Gils ◽

Rolf H. H. Groenwold ◽

Sjoerd G. Elias ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Beneficial Effect ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Intervention Group ◽

Control Group ◽

Physical Fatigue ◽

Trials Within Cohorts

Abstract Purpose The Trials within Cohorts (TwiCs) design aims to overcome problems faced in conventional RCTs. We evaluated the TwiCs design when estimating the effect of exercise on quality of life (QoL) and fatigue in inactive breast cancer survivors. Methods UMBRELLA Fit was conducted within the prospective UMBRELLA breast cancer cohort. Patients provided consent for future randomization at cohort entry. We randomized inactive patients 12–18 months after cohort enrollment. The intervention group (n = 130) was offered a 12-week supervised exercise intervention. The control group (n = 130) was not informed and received usual care. Six-month exercise effects on QoL and fatigue as measured in the cohort were analyzed with intention-to-treat (ITT), instrumental variable (IV), and propensity scores (PS) analyses. Results Fifty-two percent (n = 68) of inactive patients accepted the intervention. Physical activity increased in patients in the intervention group, but not in the control group. We found no benefit of exercise for dimensions of QoL (ITT difference global QoL: 0.8, 95% CI = − 2.2; 3.8) and fatigue, except for a small beneficial effect on physical fatigue (ITT difference: − 1.1, 95% CI = − 1.8; − 0.3; IV: − 1.9, 95% CI = − 3.3; − 0.5, PS: − 1.2, 95% CI = − 2.3; − 0.2). Conclusion TwiCs gave insight into exercise intervention acceptance: about half of inactive breast cancer survivors accepted the offer and increased physical activity levels. The offer resulted in no improvement on QoL, and a small beneficial effect on physical fatigue. Trial registration Netherlands Trial Register (NTR5482/NL.52062.041.15), date of registration: December 07, 2015.

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A Web-and-Mobile-Based Intervention for Women Treated for Breast Cancer to Manage Chronic Pain and Symptoms Related to Lymphedema: Results of a Randomized Clinical Trial (Preprint)

10.2196/preprints.29485 ◽

2021 ◽

Author(s):

Mei Rosemary Fu ◽

Deborah Axelrod ◽

Amber A Guth ◽

Joan Scagliola ◽

Kavita Rampertaap ◽

...

Keyword(s):

Breast Cancer ◽

Chronic Pain ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Flow System ◽

Bodily Pain ◽

Intervention Group ◽

Lymph Flow ◽

Limb Volume ◽

The Web

BACKGROUND The-Optimal-Lymph-Flow is a patient-centered, web-and-mobile-based mHealth system that delivers safe, easy and feasible digital therapy of lymphatic exercises and limb mobility exercises. The purpose of this randomized clinical trial (RCT) was to evaluate the effectiveness of the web-and-mobile-based The-Optimal-Lymph-Flow system for managing chronic pain and symptoms related to lymphedema. OBJECTIVE The primary objective of this study was to determine the effectiveness of the web-and-mobile-based The-Optimal-Lymph-Flow system for managing chronic pain, aching, soreness, and tenderness among breast cancer survivors and quality of life related to pain. The secondary objective was to evaluate the effectiveness of the web-and-mobile-based The-Optimal-Lymph-Flow system for managing symptoms related to lymph fluid accumulation, limb volume differences, and body mass index (BMI). METHODS A parallel randomized controlled trial (RCT) with a control-experimental, pre- and post-test, repeated-measures design. A total of 120 patients were recruited and randomized according to pain with 1:1 ratio into either Arm Precaution (AP) control focusing on limb mobility and protection or The-Optimal-Lymph flow (TOLF) intervention focusing promoting lymph flow and limb mobility. Trial outcomes were evaluated at baseline and week 12 post intervention. Descriptive statistics, Fisher’s Exact tests, Wilcoxon rank-sum tests, t-test, and generalized linear mixed-effects models were performed for data analysis. RESULTS At the study endpoint of week 12 post intervention, significantly fewer patients in the TOLF intervention group compared to AP control group reported chronic pain (49% vs. 71%; OR=0.39, CI=[0.17, 0.90], p=0.021). Patients in TOLF intervention group were significantly more likely to experience a complete reduction in chronic pain (50% vs 22%; OR=3.56, CI = [1.39, 9.76], p=0.005), and soreness (43% vs 22%; OR=2.60, CI = [1.03, 6.81], p=0.034). Significantly lower median severity scores were found in TOLF group for chronic pain (〖Med〗_LE=0, IQR=0-1 vs 〖Med〗_AP=1, IQR=0-2; p=0.024) and general bodily pain (〖Med〗_LE=1, IQR=0-1.5 vs 〖Med〗_AP=1, IQR=1-3; p=0.040). Compared to AP control, significantly fewer patients in TOLF group reported arm/hand swelling (p=0.038); heaviness (p=0.027), redness (p=0.033), limited movement in shoulder (p=0.015) and arm (p=0,025). No significant differences between TOLF and AP groups were found in complete reduction of aching and tenderness, mean numbers of lymphedema symptom reported, > 5% limb volume differences, and BMI. CONCLUSIONS TOLF intervention had significant benefits for breast cancer survivors to manage chronic pain, soreness, general bodily pain, limb swelling, heaviness, and impaired limb mobility. TOLF intervention resulted in a 13% reduction in proportions of patients who took pain medications compared to AP group which had a 5% increase. A 12% reduction in proportions of patients with > 5% limb volume differences were found in the TOLF group while a 5% increase in the AP group. Taking together, TOLF intervention can be a better choice for breast cancer survivors to reduce chronic pain and limb volume. CLINICALTRIAL US Clinicaltrials.gov NCT02462226, https://clinicaltrials.gov/ct2/show/NCT02462226

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A Behavior-Modification, Clinical-Grade Mobile Application to Improve Breast Cancer Survivors' Accountability and Health Outcomes

JCO Clinical Cancer Informatics ◽

10.1200/cci.18.00054 ◽

2018 ◽

pp. 1-11 ◽

Cited By ~ 6

Author(s):

Renee Stubbins ◽

Tiancheng He ◽

Xiaohui Yu ◽

Mamta Puppala ◽

Chika F. Ezeana ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Survivors ◽

Behavior Modification ◽

Technology Use ◽

Breast Cancer Survivors ◽

Health Care Team ◽

Care Team ◽

Feasibility Trial ◽

System Usability Scale

Purpose Only 34% of breast cancer survivors engage in the recommended level of physical activity because of a lack of accountability and motivation. Methodist Hospital Cancer Health Application (MOCHA) is a smartphone tool created specifically for self-reinforcement for patients with cancer through the daily accounting of activity and nutrition and direct interaction with clinical dietitians. We hypothesize that use of MOCHA will improve the accountability of breast cancer survivors and help them reach their personalized goals. Patients and Methods Women with stages I to III breast cancer who were at least 6 months post–active treatment with a body mass index (BMI) greater than 25 kg/m2 were enrolled in a 4-week feasibility trial. The primary objective was to demonstrate adherence during weeks 2 and 3 of the 4-week study period (14 days total). The secondary objective was to determine the usability of MOCHA according to the system usability scale. The exploratory objective was to determine weight loss and dietitian-participant interaction. Results We enrolled 33 breast cancer survivors who had an average BMI of 31.6 kg/m2. Twenty-five survivors completed the study, and the average number of daily uses was approximately 3.5 (range, 0 to 12) times/day; participants lost an average of 2 lbs (+4 lbs to −10.6 lbs). The average score of usability (the second objective) was 77.4, which was greater than the acceptable level. More than 90% of patients found MOCHA easy to navigate, and 84% were motivated to use MOCHA daily. Conclusion This study emphasizes the importance of technology use to improve goal adherence for patients by providing real-time feedback and accountability with the health care team. MOCHA focuses on the engagement of the health care team and is integrated into clinical workflow. Future directions will use MOCHA in a long-term behavior modification study.

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Can Counseling Add Value to an Exercise Intervention for Improving Quality of Life in Breast Cancer Survivors? A Feasibility Study

The Journal of Supportive Oncology ◽

10.1016/j.suponc.2011.09.004 ◽

2012 ◽

Vol 10 (5) ◽

pp. 188-194 ◽

Cited By ~ 12

Author(s):

Fiona Naumann ◽

Eric Martin ◽

Martin Philpott ◽

Cathie Smith ◽

Diane Groff ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Cancer Survivors ◽

Feasibility Study ◽

Breast Cancer Survivors ◽

Exercise Intervention

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A Group Dynamics-Based Exercise Intervention to Improve Physical Activity Maintenance in Breast Cancer Survivors

Journal of Physical Activity and Health ◽

10.1123/jpah.2018-0667 ◽

2019 ◽

Vol 16 (9) ◽

pp. 785-791

Author(s):

Heather J. Leach ◽

Katie B. Potter ◽

Mary C. Hidde

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Group Dynamics ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Intervention Group ◽

Group Cohesion ◽

Self Report

Background: To maintain increases in physical activity (PA), interventions that implement group dynamics principles and strategies with the intent of enhancing group cohesion may be advantageous. This study examined group cohesion and PA following a group dynamics-based PA intervention among breast cancer survivors. Methods: The study was designed as a pilot randomized controlled trial comparing an 8-week group dynamics-based intervention with an individually supervised intervention. Group cohesion was measured by the Physical Activity Group Environment Questionnaire, and PA was measured at baseline, post-intervention, and 3-month follow-up using a self-report questionnaire and pedometer. Results: Group cohesion levels were high following the intervention and positively associated with PA at 3-month follow-up (ranger = .182–.555). At 3-month follow-up, 91.7% of participants in the group-dynamics-based intervention (n = 12) were classified as moderately active or greater, compared with 54.5% in the individually supervised intervention (n = 11). Conclusions: These results suggest that, for breast cancer survivors, peer support and fostering group cohesion as part of an exercise program may help to support PA following the completion of a structured intervention. A larger trial with longer follow-up is needed to establish comparative efficacy for a group-dynamics-based exercise intervention to enhance long-term PA adherence in breast cancer survivors.

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The effect of aerobic exercise on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2011.29.27_suppl.244 ◽

2011 ◽

Vol 29 (27_suppl) ◽

pp. 244-244

Author(s):

E. M. Guinan ◽

J. M. Hussey ◽

J. M. Walsh ◽

M. J. Kennedy ◽

E. M. Connolly

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Aerobic Exercise ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Risk Profile ◽

Control Group ◽

Metabolic Risk ◽

Model Assessment ◽

Supervised Exercise

244 Background: Current literature suggests that weight gain during treatment for breast cancer is associated with a poorer prognosis and an increased risk of developing secondary health problems such as the metabolic syndrome (MetSyn). Physical activity (PA) can alter features of the MetSyn and improve body composition by reducing abdominal adiposity. We report metabolic results of a prospective randomized controlled trial (PEACH trial; Walsh JM, et al. [2010] BMC Cancer. 10[42]) which examines the effect of an exercise intervention on the metabolic risk profile of breast cancer survivors 2-6 months post chemotherapy. Methods: All subjects gave written informed consent and were randomized to an 8-week, twice weekly aerobic exercise intervention programme or a usual care control group consisting of routine medical advice about PA. The five clinical features of the MetSyn were measured: waist circumference (WC), resting blood pressure (BP), triglycerides, high-density lipoprotein cholesterol (HDL-C) and fasting glucose. Insulin resistance was estimated by the homeostatic model assessment (HOMA). Statistical analysis was carried out using independent sample t-tests with significance set at p < 0.05. Results: Twenty-six breast cancer survivors participated (mean (± SD) age 48.13 (8.75) years). At baseline, 50% (n = 13) of subjects were overweight and 23.1% (n = 6) were obese, with 73.1% (n = 19) centrally obese. 34.6% (n = 9) of subjects were classified with the MetSyn. There were no significant differences between groups at baseline. Intention-to-treat analysis showed no significant changes, however, analysis of those who adhered to > 70% of the supervised exercise intervention showed a significant improvement in WC when compared to the control group (p < 0.05). Conclusions: Results show that an 8-week aerobic exercise intervention significantly reduced WC but did not modify other features of the MetSyn. The decrease in WC demonstrated by this short intervention may have important implications in terms of improving survival and the metabolic risk profile of breast cancer survivors. Final follow-up assessments are ongoing and will enable change in WC over time to be evaluated further.

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Evaluation of an interactive portal for breast cancer survivors: Use, satisfaction, and preliminary effects.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.200 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 200-200

Author(s):

Wilma Kuijpers ◽

Wim G Groen ◽

Hester SA Oldenburg ◽

Michel W.J.M. Wouters ◽

Neil K Aaronson ◽

...

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Physical Activity ◽

Cancer Survivors ◽

User Satisfaction ◽

Breast Cancer Survivors ◽

Vigorous Physical Activity ◽

Sf 36 ◽

Patient Reported

200 Background: MijnAVL is an interactive portal that includes patient education, an overview of appointments, access to the electronic medical record (EMR), patient-reported outcomes plus feedback and physical activity support. The aim of this feasibility study was to evaluate use, satisfaction and preliminary effects among breast cancer survivors. Methods: We included women currently or recently treated for breast cancer with curative intent. At baseline, they completed a questionnaire on sociodemographics, expectations of MijnAVL and three effect measures: patient activation (PAM), quality of life (SF-36), and physical activity (IPAQ). MijnAVL could be used noncommittally for 4 months. Log data were collected retrospectively and participants completed questions on satisfaction and effect measures. This process was conducted twice, to be able to improve MijnAVL iteratively. Results: We included 92 women (mean age 49.5 years, 59% on-treatment). Mean number of logins was 8.7 and mean duration 13.1 minutes. Overview of appointments (80% of participants) and access to the EMR (90%) were most frequently used and most appreciated. Website user satisfaction was rated 3.8 on a 1-5 scale on average and participants were primarily positive about the accessibility of information. We did not find an effect on the PAM. For the SF-36, we found significant improvements on the role functioning – emotional (65.3 to 78.5, p< .01), mental health (69.8 to 76.5, p< .01) and social functioning (71.2 to 80.5, p< .01) domains. Median vigorous physical activity significantly increased from 0 to 360 MET-minutes per week (p< .05); levels of walking and moderate physical activity did not change significantly over time. These effects were not related to the intensity of use of MijnAVL. Conclusions: This study showed that user experiences were positive and that exposure to MijnAVL resulted in improvements on three quality of life domains and vigorous physical activity. More tailored, interactive features might be needed to substantially change empowerment, quality of life and physical activity. Research with a controlled design and possibly a more sensitive measure for patient empowerment are needed to substantiate our findings.

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