Impact of physical activity on insulin levels in breast cancer survivors

555 Background: Accumulating data suggest that body weight and physical activity may affect breast cancer risk and outcomes. Biological mechanisms underlying these relationships are not clear. Studies have demonstrated that high levels of insulin, often seen in obese and sedentary individuals, are also associated with an increased risk of breast cancer recurrence and breast cancer-related death. We sought to analyze whether exercise lowers insulin levels in a population of breast cancer survivors. Methods: Inactive women with early stage breast cancer who had completed adjuvant treatment were randomized to a 16 week, mixed cardiovascular and strength training exercise intervention, or to a normal care control group. Target exercise goals included 2 supervised strength training sessions and 90 minutes of unsupervised cardiovascular exercise each week. Fasting insulin and glucose levels, as well as measurement of weight, body composition, and circumference at the waist and hip, were collected at baseline and after 16 weeks in both groups, and changes in these measures were assessed. Results: One hundred and one women were randomized. Comparison of changes in anthropometric measures are presented in Table 1 . Baseline insulin levels were similar in the 2 groups. After the 16-week exercise or control period, insulin levels decreased by 2.86 μIU/ml in the exercise group (p=0.03), and by 0.27 μIU/ml in the control group (p=0.65). A comparison of the change in insulin levels across time in the 2 groups approached statistical significance (p=0.07). There was also a trend toward improvements in insulin sensitivity in the exercise group (p=0.09), with no change seen in fasting glucose levels. Conclusions: Physical activity was associated with a decrease in insulin levels and in hip circumference in breast cancer survivors. The relationship between physical activity and breast cancer prognosis may be mediated, at least partially, through changes in insulin levels and/or changes in fat mass or deposition. [Table: see text] No significant financial relationships to disclose.

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Impact of a Mixed Strength and Endurance Exercise Intervention on Insulin Levels in Breast Cancer Survivors

Journal of Clinical Oncology ◽

10.1200/jco.2007.12.7357 ◽

2008 ◽

Vol 26 (6) ◽

pp. 907-912 ◽

Cited By ~ 174

Author(s):

Jennifer A. Ligibel ◽

Nancy Campbell ◽

Ann Partridge ◽

Wendy Y. Chen ◽

Taylor Salinardi ◽

...

Keyword(s):

Breast Cancer ◽

Body Composition ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Control Group ◽

Fasting Insulin ◽

Insulin Levels ◽

Glucose Levels

Purpose Accumulating data suggest that exercise may affect breast cancer risk and outcomes. Studies have demonstrated that high levels of insulin, often seen in sedentary individuals, are associated with increased risk of breast cancer recurrence and death. We sought to analyze whether exercise lowered insulin concentrations in breast cancer survivors. Methods One hundred one sedentary, overweight breast cancer survivors were randomly assigned either to a 16-week cardiovascular and strength training exercise intervention or to a usual care control group. Fasting insulin and glucose levels, weight, body composition, and circumference at the waist and hip were collected at baseline and 16 weeks. Results Baseline and 16-week measurements were available for 82 patients. Fasting insulin concentrations decreased by an average of 2.86 μU/mL in the exercise group (P = .03), with no significant change in the control group (decrease of 0.27 μU/mL, P = .65). The change in insulin levels in the exercise group seemed greater than the change in controls, but the comparison did not reach statistical significance (P = .07). There was a trend toward improvement in insulin resistance in the exercise group (P = .09) but no change in fasting glucose levels. The exercise group also experienced a significant decrease in hip measurements, with no change in weight or body composition. Conclusion Participation in an exercise intervention was associated with a significant decrease in insulin levels and hip circumference in breast cancer survivors. The relationship between physical activity and breast cancer prognosis may be mediated, in part, through changes in insulin levels and/or changes in body fat or fat deposition.

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Effects of a personal trainer led exercise intervention on physical activity and physical function of breast cancer survivors.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.15_suppl.e23053 ◽

2019 ◽

Vol 37 (15_suppl) ◽

pp. e23053-e23053

Author(s):

Linda F. Wang ◽

Yvonne L. Eaglehouse ◽

Janette T. Poppenberg ◽

Jill Brufsky ◽

Emily Geramita ◽

...

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Survivors ◽

Physical Function ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Step Test ◽

Control Group ◽

Personal Trainer

e23053 Background: Regular exercise is an important tool to address physical and emotional effects of breast cancer treatment. However, many breast cancer survivors do not meet minimum recommended levels of physical activity. This study examines effects of a personal trainer led exercise intervention on physical activity levels and physical function in breast cancer survivors. Methods: Women who completed active treatment for breast cancer were recruited from oncology clinics and survivorship programs from September 2015-to September 2017. Subjects were randomized to an immediate exercise or a wait-list control group. The intervention included 3 personal training sessions over a period of up to 30 weeks. Physical activity and function were assessed before and after intervention by pedometer (7-day record) and endurance step test (steps in 2 minutes). Results: 60 women were randomized to immediate intervention (n = 31) or wait-list control (n = 29). Subjects were an average of (mean ± SD) 56 ± 10 years old and 2 ± 1 years since breast cancer diagnosis. At baseline, the exercise group averaged (mean ± SD) 5236 ± 2214 steps/day and 101 ± 23 steps on 2-minute step test while the control group averaged 5856 ± 2916 steps/day and 106 ± 23 steps on 2-minute step test. After intervention, change (mean ∆ ± SD) was 143 ± 1842 steps/day in the exercise group and 79 ± 1862 steps/day in the control group ( p= 0.9). On the 2-minute step test, the exercise group increased 18 ± 20 steps and the control group increased 9 ± 12 steps ( p= 0.07). Conclusions: While there was some improvement in physical function after the personal-trainer led intervention, the short duration and intensity of the intervention may have diminished the effects. Our results suggest a multi-faceted approach may be needed to support significant changes in breast cancer survivors’ physical activity. Future efforts employing a multidisciplinary team, which includes a certified personal trainer, and with larger patient samples may help address this possibility. Clinical trial information: NCT02770781.

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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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Polyunsaturated Fatty Acids, Exercise, and Cancer-Related Fatigue in Breast Cancer Survivors

Frontiers in Physiology ◽

10.3389/fphys.2021.759280 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yutaka Matsuoka ◽

Katsunori Tsuji ◽

Eisuke Ochi

Keyword(s):

Breast Cancer ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Group ◽

Control Group ◽

Omega 3 ◽

Pufa Supplementation ◽

Exercise Interventions ◽

Cancer Related Fatigue ◽

Omega 6

Cancer-related fatigue (CRF) is one of the most frequently reported and disabling symptoms in cancer survivors. With its negative impact on the activities of daily living, work, social activities, and mood, CRF causes severe impairment of quality of life. A previous study showed that omega-6 polyunsaturated fatty acid (PUFA) supplementation unexpectedly reduced CRF compared with omega-3 PUFA supplementation and that omega-6 PUFA supplementation reduced pro-inflammatory serum markers in fatigued American breast cancer survivors. Meanwhile, a recent meta-analysis of individual patient data revealed significant benefits of exercise interventions on CRF. Recently, we completed our randomized controlled trial among early-stage Japanese breast cancer survivors, in which we examined the effect of baseline blood PUFA characteristics on change in CRF during the 12-week trial by exercise group and confirmed that increased Cancer Fatigue Scale (CFS) was associated with both docosahexaenoic acid (DHA) (p = 0.06) and omega-3 index (p = 0.08) at baseline in all participants (n = 46, omega-6/omega-3 ratio = 6.79, SD = 1.90). On the contrary, DHA at baseline was positively correlated with change in CRF (r = 0.40, p = 0.06) in the control group (n = 24, omega-6/omega-3 ratio = 7.0). Moreover, eicosapentaenoic acid (EPA) at baseline was positively correlated with leg strength (r = 0.39, p = 0.10) in the exercise group. In conclusion, blood PUFA balance might be associated with the effect of exercise on CRF. In addition, higher EPA in individuals who conducted exercise likely has a beneficial effect on muscle strength. Further investigation is needed to clarify the interaction between PUFAs and exercise for alleviating CRF.

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PO-285 A review of effects of exercise on the quality of life in breast cancer survivors

Exercise Biochemistry Review ◽

10.14428/ebr.v1i5.13103 ◽

2018 ◽

Vol 1 (5) ◽

Author(s):

Feng Hong

Keyword(s):

Breast Cancer ◽

Quality Of Life ◽

Physical Exercise ◽

Cancer Survivors ◽

Aerobic Exercise ◽

Breast Cancer Survivors ◽

Exercise Group ◽

Control Group ◽

Supervised Exercise

Objective Breast cancer is one of the most common malignant tumors in women.The number of women diagnosed with breast cancer each year is also increasing.It is also the leading cause of cancer deaths in women, accounting for 14-23% of cancer deaths.However, with the development of medical technology, the survival rate of breast cancer patients is improving.In general, the treatment of breast cancer mainly includes surgical treatment, adjuvant chemotherapy and radiotherapy，But these treatments can do a lot of damage to breast cancer patients.These injuries can limit some of the physical activity of breast cancer patients, and can be accompanied by significant psychological damage，Therefore, the quality of life of breast survivors is largely destroyed.Physical exercise is one of the important ways to improve the overall health of the human body.It also plays an important role in increasing people's mood and quality of life.So whether physical exercise has a positive impact on improving the quality of life of breast cancer survivors or there is some doubt.Therefore, the main purpose of this study is to explore the impact of physical exercise on the quality of life of breast cancer survivors, and then to prove the impact of supervised exercise and individual exercise on the quality of life of breast cancer survivors. Methods Data bases searched were MEDLINE, EMBASE, CINAHL, PubMed.Keywords were“breast cancer and quality of life” in combination with “exercise”or “physical activity”.At the same time, the references of the included articles were reviewed to obtain more relevant studies.In terms of the criteria for inclusion and exclusion of literature, the paper was initially screened to determine whether the title and abstract of the paper were consistent with the research topic.The criteria for inclusion are ①the subjects were breast cancer survivors,②the type of intervention was physical exercise,③the measured result is quality of life,④the type of experiment is randomized controlled trial.The exclusion criteria of the article are ①the subject's occupation was athlete，②quality of life is not measured on a formal scale，③article type is review or abstract. Results A total of 14 articles are included in our review.Quality of life was measured using scale tools in all included studies, of which two scales were used in all included articles.The two scales used can reflect the real life quality of the subjects, of which FACT-G is a mass life quality scale and FACT-B is a life quality scale designed specifically for breast cancer patients. Both scales are globally recognized by the public.In our review, we found that exercise significantly improved the quality of life of breast cancer survivors, particularly aerobic exercise.In the studies included in our study, except Nanette et al. used aerobic exercise combined with resistance strength training as the intervention method in their study, all the other studies used aerobic exercise as the intervention method for the subjects.Among the 14 included studies, 10 indicated that physical exercise significantly increased the quality of life of breast cancer survivors, and 4 found that compared with the control group, the quality of life of breast cancer survivors did not have significant changes, but there was a trend of improving the quality of life.At the same time, our review found that monitoring breast cancer survivors improved quality of life.In two of the studies we included, subjects were divided into individual exercise groups and supervised exercise groups.In their study, Anne et al. divided the recruited research samples into the supervision intervention group and the routine control group. Among them, the supervision intervention group received physical exercise 5 times a week for 12 weeks, and the quality of life of breast cancer survivors was significantly improved.In the study of Cadmus et al., the subjects recruited were divided into individual exercise group, supervised exercise group and routine control group, and the exercise group performed physical exercise with the same load and frequency. The result was that there was no physical activity in the home individual exercise group or the routine control group that improved the quality of life for breast cancer survivors.However, in the supervised exercise group, breast cancer survivors' scores for FACT-B and SF-36 (a measure reflecting quality of life) were significantly improved. Conclusions Exercise can improve the quality of life for breast cancer survivors, especially aerobic exercise. Supervised exercise intervention for breast cancer survivors can better improve their quality of life and alleviate social and psychological problems than individual exercise.The supervised aerobic exercise can be integrated into the life of breast cancer survivors so as to better promote the recovery of breast cancer survivors.

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Perceived physical fatigability improves after an exercise intervention among breast cancer survivors: A pilot randomized clinical trial.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.12050 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 12050-12050

Author(s):

Yujia (Susanna) Qiao ◽

G J. Van Londen ◽

Jill Brufsky ◽

Janette T. Poppenberg ◽

Rebecca W. Cohen ◽

...

Keyword(s):

Breast Cancer ◽

Clinical Trial ◽

Cancer Survivors ◽

Randomized Clinical Trial ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Whole Body ◽

Control Group ◽

Patient Reported

12050 Background: Among breast cancer populations, exercise interventions resulted in positive but relatively small improvements on fatigue, which may have been masked by using single-item, non-specific measures of global fatigue. Perceived fatigability – whole-body tiredness anchored to standardized tasks/activities of specific intensity and duration – accounts for self-pacing bias as an individual likely titrates their usual activities and exertion level to avoid exhaustion. We examined whether this novel fatigability measure could replace global fatigue in an exercise intervention trial in breast cancer survivors. Methods: This pilot single-center randomized clinical trial of 49 breast cancer survivors was conducted from 2015-17, among which 41 participants (exercise = 22, control = 19) completed the trial and reported their perceived physical fatigability and global fatigue at the first (V1) and the last visit (V3). Perceived physical fatigability was measured using the 10-item, self-administered Pittsburgh Fatigability Scale (PFS) scored 0-50, higher PFS Physical scores = greater fatigability. Global fatigue was assessed with a single question “I have a lack of energy” scored 0 “not at all” to 4 “very much” from the Functional Assessment of Cancer Therapy-Endocrine Subscale (FACT-ES). The exercise intervention consisted of three one-on-one training sessions over 6-14 weeks, plus two optional email/phone consultations. The trainer developed a personalized, home-based exercise program with a goal of achieving the recommended ≥150 minutes/week of moderate to vigorous exercise based on ACSM guidelines. Those randomized to the control group met the trainer for V1 and again 6-14 weeks later at V3, but no exercise prescription was provided. We computed mean differences in perceived physical fatigability and global fatigue between V3 and V1 and compared by intervention groups. Results: Among the 41 women in the study (mean age = 54.9±9.8 years; 80% white), sociodemographic and clinical characteristics were similar by intervention groups, except for antiestrogen use. Post-intervention changes (mean ± SE) in PFS Physical scores were -4.4±1.4 (-22.5%) in the exercise group and 0.2±1.4 (+1.0%) in the control group (p =.022), whereas change in global fatigue scores were -0.64±0.23 in the exercise group and 0.00±0.22 in the control group (p =.054). Conclusions: These findings add to mounting evidence that an exercise intervention reduces fatigue among breast cancer survivors. Importantly, the PFS showed a clinically meaningful reduction after the exercise intervention that was masked when using global fatigue as the measurement. Therefore, the PFS serves as a more sensitive instrument to measure perceived physical fatigability and can better evaluate patient-reported outcomes in future cancer trials, especially those focused on cancer survivorship. Clinical trial information: NCT 02770781.

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Randomized Controlled Trial of Exercise Training in Postmenopausal Breast Cancer Survivors: Cardiopulmonary and Quality of Life Outcomes

Journal of Clinical Oncology ◽

10.1200/jco.2003.04.093 ◽

2003 ◽

Vol 21 (9) ◽

pp. 1660-1668 ◽

Cited By ~ 480

Author(s):

Kerry S. Courneya ◽

John R. Mackey ◽

Gordon J. Bell ◽

Lee W. Jones ◽

Catherine J. Field ◽

...

Keyword(s):

Breast Cancer ◽

Oxygen Consumption ◽

Exercise Training ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Postmenopausal Breast Cancer ◽

Exercise Group ◽

Peak Oxygen Consumption ◽

Control Group

Purpose: To determine the effects of exercise training on cardiopulmonary function and quality of life (QOL) in postmenopausal breast cancer survivors who had completed surgery, radiotherapy, and/or chemotherapy with or without current hormone therapy use. Methods: Fifty-three postmenopausal breast cancer survivors were randomly assigned to an exercise (n = 25) or control (n = 28) group. The exercise group trained on cycle ergometers three times per week for 15 weeks at a power output that elicited the ventilatory equivalent for carbon dioxide. The control group did not train. The primary outcomes were changes in peak oxygen consumption and overall QOL from baseline to postintervention. Peak oxygen consumption was assessed by a graded exercise test using gas exchange analysis. Overall QOL was assessed by the Functional Assessment of Cancer Therapy–Breast scale. Results: Fifty-two participants completed the trial. The exercise group completed 98.4% of the exercise sessions. Baseline values for peak oxygen consumption (P = .254) and overall QOL (P = .286) did not differ between groups. Peak oxygen consumption increased by 0.24 L/min in the exercise group, whereas it decreased by 0.05 L/min in the control group (mean difference, 0.29 L/min; 95% confidence interval [CI], 0.18 to 0.40; P < .001). Overall QOL increased by 9.1 points in the exercise group compared with 0.3 points in the control group (mean difference, 8.8 points; 95% CI, 3.6 to 14.0; P = .001). Pearson correlations indicated that change in peak oxygen consumption correlated with change in overall QOL (r = 0.45; P < .01). Conclusion: Exercise training had beneficial effects on cardiopulmonary function and QOL in postmenopausal breast cancer survivors.

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Metabolic syndrome and breast cancer: Effects of a 16-week combined exercise intervention.

Journal of Clinical Oncology ◽

10.1200/jco.2013.31.15_suppl.tps9648 ◽

2013 ◽

Vol 31 (15_suppl) ◽

pp. TPS9648-TPS9648

Author(s):

Christina Marie Dieli-Conwright ◽

Debu Tripathy ◽

E. Todd Schroeder ◽

Joanne E. Mortimer ◽

Leslie Bernstein

Keyword(s):

Breast Cancer ◽

Metabolic Syndrome ◽

Cancer Survivors ◽

Breast Cancer Survivors ◽

Exercise Intervention ◽

Exercise Group ◽

Current Evidence ◽

Comprehensive Cancer Center ◽

Increased Risk ◽

Risk Of Cancer

TPS9648 Background: Current evidence suggests that breast cancer treatments such as chemotherapy lead to excessive weight gain, fatigue, physical inactivity, and negative alterations in components of metabolic syndrome (MetS). MetS is associated with increased risk of cancer recurrence, cardiovascular diseases and type 2 diabetes, and is defined by visceral adiposity, insulin resistance, hyperglycemia, hyperinsulinemia, low serum high-density lipoprotein cholesterol, and hypertension. MetS is highly prevalent and present in 25% of American and European adults and higher in minorities. Given that chemotherapy for breast cancer induces many of the components of MetS, an effort to offset these consequences of cancer therapy using exercise/lifestyle intervention could improve breast cancer, cardiovascular and endocrine outcomes. Methods: Our study seeks to determine whether a 16-week exercise intervention induces changes in prognostic components of MetS (waist circumference, blood pressure, serum levels of glucose, insulin, lipids, C-reactive protein and HbA1c) among breast cancer survivors if initiated within 3 months of completion of chemotherapy or radiation therapy. We are currently recruiting women diagnosed with Stage I-III breast cancer from the USC Norris Comprehensive Cancer Center and Los Angeles County Hospital, which cares for a high proportion of minority/underserved patients. Participants are randomized to either the Control (usual care) or the Exercise group. The Exercise group participates in aerobic and resistance exercise sessions 3 times a week for 16 weeks supervised by an exercise specialist at the USC Clinical Exercise Research Center. At baseline and following the study period, all participants are tested for MetS components, muscle strength, body composition, bone density, cardiorespiratory fitness, quality of life, fatigue and shoulder function. We will recruit an additional 85 patients (at present time n=15) over the next 3 years. It is expected that this intervention will improve components of MetS and physical fitness in breast cancer survivors when compared to the Control group, thus defining intervention and biomarker variables for more definitive trials. Clinical trial information: NCT01140282.

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