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Purpose: Cancer survivors physical function response to exercise programs at the group level is well-established. However, to advance toward a more personalized approach in exercise oncology, a greater understanding of individual response is needed. This study utilized data from a well-established cancer-exercise program to evaluate the heterogeneity of physical function response and explore characteristics of participants who did vs. did not achieve a minimal clinically important difference (MCID). Methods: Physical function measures (grip strength, 6-min walk test (6MWT), and sit-to-stand) were completed pre/post the 3-month program. Change scores for each participant and the proportion achieving the MCID for each physical function measure were calculated. The independent t-tests, Fisher’s exact test, and decision tree analyses were used to explore differences in age, body mass index (BMI), treatment status, exercise session attendance, and baseline value between participants who achieved the MCID vs. those who did not. Results: Participants (N = 250) were 55 ± 14 years old, majority female (69.2%), white (84.1%), and diagnosed with breast cancer (36.8%). Change in grip strength ranged from − 42.1 to + 47.0 lb, and 14.8% achieved the MCID. Change in 6MWT ranged from − 151 to + 252 m, and 59% achieved the MCID. Change in sit-to-stand ranged from − 13 to + 20 reps, and 63% achieved the MCID. Baseline grip strength, age, BMI, and exercise session attendance were related to achieving MCID. Conclusions: Findings illustrate wide variability in the magnitude of cancer survivors’ physical function response following an exercise program, and that a variety of factors predict response. Further investigation into the biological, behavioral, physiological, and genetic factors will inform tailoring of exercise interventions and programs to maximize the proportion of cancer survivors who can derive clinically meaningful benefits. [ABSTRACT FROM AUTHOR]

Post-treatment weight gain places breast cancer (BCa) survivors at heightened risk for cardiovascular disease, metabolic syndrome, and functional decline. Lifestyle weight management (LWM) interventions combining exercise and dietary weight loss represent an effective approach to mitigating the adverse cardiometabolic and functional effects frequently observed in BCa survivors. Unfortunately, community access to cost-effective, sustainable, LWM interventions among BCa survivors remains limited and this lack of easily accessible programming undermines efforts to integrate behavioral weight management in the supportive care of BCa survivors. PURPOSE: The purpose of this pilot trial is to determine the feasibility and preliminary efficacy of a 6-month community-based LWM intervention implementing a group-mediated cognitive behavioral approach in BCa survivors. In the current study, we evaluated the effects of the LWM intervention on select body composition, physical function, and social cognitive outcomes of the first wave of participants enrolled in the trial. METHODS: A total of 11 BCa survivors (M age = 54 years) participated in the LWM intervention. Assessments of body composition assessed (Dual-energy X-ray Absorptiometry), physical function (400m walk test), and select social cognitive outcomes (satisfaction with function and appearance and perceived competence with exercise and diet intake) were obtained at baseline and 3-months. RESULTS: Analysis of change from baseline in the outcomes using Cohen's d effect sizes revealed clinically meaningful improvements in fat mass (d= -0.46), percent lean mass (d= 0.33), lean mass (d= -0.45), physical function (d= -0.59), satisfaction with function (d= 1.89) and appearance (d= 1.16) and perceived competence for exercise (d= 0.42) and dietary intake (d= 0.47). CONCLUSION: Findings from this study demonstrate the preliminary efficacy of implementing a GMCB-based LWM intervention among overweight or obese BCa survivors. Given the meaningful impact that successful weight management has on reducing risk for chronic diseases, these results highlight the ut ility of implementing a LWM intervention in the community for BCa survivors in an effort to extend the access and reach of supportive care approaches during BCa survivorship. [ABSTRACT FROM AUTHOR]

Despite growing recognition of the importance of lifestyle weight management (LWM) in cancer survivorship, over 65% of breast cancer (BCa) survivors are overweight or obese. Successfully promoting maintenance of lifestyle behavior change and limited community access to cost-effective, sustainable LWM interventions are critical barriers that undermine the utility of integrating LWM approaches in the supportive care of BCa survivors. PURPOSE: The purpose of this pilot trial is to determine the feasibility and preliminary efficacy of a 6-month community-based LWM intervention implementing a group-mediated cognitive behavioral (GMCB) approach in BCa survivors. In the current study, we evaluated select indicants of the feasibility and acceptability of the LWM intervention. METHODS: The 6-month, community-based pilot trial promotes behavioral weight management through an evidence-based exercise and dietary lifestyle intervention program. Feasibility and acceptability were tracked prospectively during the trial and assessed using retention and adherence rates and self-reported indices of intervention satisfaction and acceptability. RESULTS: Retention at 3 month and 6 months was 72.7%, however, only 45% completion of select functional and strength battery components at 6-month. Adherence to the intensive intervention sessions was 66% at 3M and 42.4% at 6M. Average satisfaction of the exercise, dietary, and group based behavioral sessions were 9.5, 8.75, and 8.63 out of 10, respectively. There was strong interest for participation in a longer trial, (M = 9.12, SD = 1.25), along with interest for technology supported delivery (M = 9.12, SD = 1.8). Overall, there was highly favorable patient reported satisfaction with program content, program structure, and perceived benefits reported at both 3 months and 6 months. CONCLUSIONS: The present findings provide support for the initial feasibility and acceptability of implementing a GMCB community-based LWM intervention among overweight or obese BCa survivors. Consequently, further evaluation of the efficacy and impact of a integrating the community-based LWM intervention in the supportive care of BCa survivors is warranted. [ABSTRACT FROM AUTHOR]

Addressing skeletal muscle mass loss is an important focus in oncology research to improve clinical outcomes, including cancer treatment tolerability and survival. Exercise is likely a necessary component of muscle-mass-preserving interventions for people with cancer. However, randomized controlled trials with exercise that include people with cancer with increased susceptibility to more rapid and severe muscle mass loss are limited. The aim of the current review is to highlight features of cancer-related skeletal muscle mass loss, discuss the impact in patients most at risk, and describe the possible role of exercise as a management strategy. We present current gaps within the exercise oncology literature and offer several recommendations for future studies to support research translation, including (1) utilizing accurate and reliable body composition techniques to assess changes in skeletal muscle mass, (2) incorporating comprehensive assessments of patient health status to allow personalized exercise prescription, (3) coupling exercise with robust nutritional recommendations to maximize the impact on skeletal muscle outcomes, and (4) considering key exercise intervention features that may improve exercise efficacy and adherence. Ultimately, the driving forces behind skeletal muscle mass loss are complex and may impede exercise tolerability and efficacy. Our recommendations are intended to foster the design of high-quality patient-centred research studies to determine whether exercise can counteract muscle mass loss in people with cancer and, as such, improve knowledge on this topic. [ABSTRACT FROM AUTHOR]

Objective: To compare the effects of an exercise and dietary intervention with those of standard-of-care management upon change in lift and carry performance and mobility-related self-efficacy beliefs and explore associations in prostate cancer patients undergoing androgen deprivation therapy. Methods: 32 prostate cancer patients (M age = 66.2 years; SD = 7.8) undergoing androgen deprivation therapy were randomly assigned to a 3-month exercise and dietary lifestyle intervention (n = 16) or standard-of-care management (n = 16). Outcome assessments were obtained at baseline, 2- and 3-month follow-up. Results: The lifestyle intervention resulted in significantly greater improvements in lift and carry performance (p = 0.01) at 2 Months (d = 1.01; p < 0.01) and 3 Months (d = 0.95; p < 0.01) and superior improvements in mobility-related self-efficacy at 2 Months (d = 0.38) and 3 Months (d = 0.58) relative to standard-of-care. Mobility-related self-efficacy (r = -.66; p = 0.006) and satisfaction with function (r = -.63; p = 0.01) were significantly correlated with lift and carry performance at 3 Months. Conclusions: The exercise and dietary lifestyle intervention yielded superior improvements in lift and carry performance and mobility-related self-efficacy relative to standard-of-care and key social cognitive outcomes were associated with more favorable mobility performance. [ABSTRACT FROM AUTHOR]

Background: Changes in body composition during cancer treatments have been linked with poorer outcomes, and increased morbidity and mortality. The effect of resistance training (RT) on body composition in cancer cohorts is debated. Objective: We conducted a systematic review and meta-analysis to determine the effect of RT on body composition during and after treatment. Methods: We searched five electronic databases for articles up to 1 February 2021 and included randomized controlled trials that compared RT with a non-exercise control in adults with cancer. Risk of bias was assessed using the RoB 2 tool. Pairwise, random-effects meta-analysis was used to synthesize the available data. Results: Overall, we included 15 studies (n = 1368). After treatment (11 studies), RT increased lean mass with moderate heterogeneity {0.41 kg [95% confidence interval (CI) 0.05, 0.76], p = 0.029; I2 = 47.1%, p = 0.02} and decreased fat mass with substantial heterogeneity (− 0.59 kg [95% CI − 1.05, − 0.12], p = 0.019; I2 = 69.1%, p < 0.001). During treatment (4 studies), RT did not increase lean mass (0.71 kg [95% CI − 0.04, 1.45], p = 0.05; I2 = 0.0%, p = 0.75) or reduce fat mass (0.00 kg [95% CI − 5.31, 5.30], p = 0.99; I2 = 0.0%, p = 0.62), both with no heterogeneity. Conclusion: Modest improvements in body composition were observed following RT after cancer treatment; however, no changes were observed during treatment. These adaptations are markedly lower than those observed in healthy cohorts but may be clinically meaningful for the cancer survivorship population. At present it is unclear if these diminished adaptations are due to ineffective exercise prescriptions in cancer cohorts or due to an innate anabolic resistance as a result of cancer and its treatments. Study registration: Open Science Framework (osf.io/x6z72). [ABSTRACT FROM AUTHOR]

Resistance training (RT) is a fundamental component of exercise prescription aimed at improving overall health and function. RT techniques such as cluster set (CS) configurations, characterized by additional short intra-set or inter-repetition rest intervals, have been shown to maintain acute muscular force, velocity, and 'power' outputs across a RT session, and facilitate positive longer-term neuromuscular adaptations. However, to date CS have mainly been explored from a human performance perspective despite potential for application in health and clinical exercise settings. Therefore, this current opinion piece aims to highlight emerging evidence and provide a rationale for why CS may be an advantageous RT technique for older adults, and across several neurological, neuromuscular, cardiovascular and pulmonary settings. Specifically, CS may minimize acute fatigue and adverse physiologic responses, improve patient tolerance of RT and promote functional adaptations (i.e., force, velocity, and power). Moreover, we propose that CS may be a particularly useful exercise rehabilitation technique where injury or illness, persistent fatigue, weakness and dysfunction exist. We further suggest that CS offer an alternative RT strategy that can be easily implemented alongside existing exercise/rehabilitation programs requiring no extra cost, minimal upskilling and/or time commitment for the patient and professional. In light of the emerging evidence and likely efficacy in clinical exercise practice, future research should move toward further direct investigation of CS-based RT in a variety of adverse health conditions and across the lifespan given the already demonstrated benefits in healthy populations. [ABSTRACT FROM AUTHOR]

Those with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes. This is a 6-month randomised two-armed feasibility trial. Prostate cancer patients undergoing ADT and radiotherapy will be recruited (n = 24) and randomised to either a resistance- or aerobic-emphasised group. Participants will attend twice-weekly supervised individual or small group sessions, with 75% of exercise time in the primary exercise modality. The primary outcome will be feasibility, determined via assessment of recruitment, retention, adherence, safety, and acceptability. Secondary outcomes will include quality of life, body composition, vascular indices, aerobic and muscular fitness and cardiometabolic health blood biomarkers. It is envisaged that the trial will provide valuable information and preliminary difference data that will aid in the design of an efficacious larger trial that will adopt a major and minor emphasis approach to the scheduling of resistance and aerobic exercise. [ABSTRACT FROM AUTHOR]

Sarcopenia refers to the age-related reduction in strength, muscle mass and functionality which increases the risk for falls, injuries and fractures. Sarcopenia is associated with other age-related conditions such as osteoporosis, frailty and cachexia. Identifying treatments to overcome sarcopenia and associated conditions is important from a global health perspective. There is evidence that creatine monohydrate supplementation, primarily when combined with resistance training, has favorable effects on indices of aging muscle and bone. These musculoskeletal benefits provide some rationale for creatine being a potential intervention for treating frailty and cachexia. The purposes of this narrative review are to update the collective body of research pertaining to the effects of creatine supplementation on indices of aging muscle and bone (including bone turnover markers) and present possible justification and rationale for its utilization in the treatment of frailty and cachexia in older adults. • The combination of creatine supplementation and resistance training increases lean mass and muscle strength in aging adults. • Creatine supplementation decreases measures of bone catabolism which may help explain some of the preliminary increases in bone area and strength. • Creatine supplementation poses no adverse effect on kidney or liver function. • Creatine supplementation as the potential to be an effective intervention for treating frailty and cachexia. [ABSTRACT FROM AUTHOR]

Changes in body composition during multimodal treatment for cancer patients are characterised by decreases in lean muscle mass and increases in fat mass. These changes, in particular loss of lean muscle mass, have been linked with poorer treatment outcomes and increased morbidity and mortality in some cancer populations. While the effect of resistance training (RT) on body composition in healthy and elite athlete populations is well characterised, the capacity for RT to modify body composition in cancer cohorts is less clear. PURPOSE: This study aimed to determine the effect of RT on body composition (fat mass and lean mass) in patients with cancer undergoing treatment and survivors of cancer. METHODS: We conducted a systematic review and meta-analysis conforming to PRISMA guidelines. MEDLINE, Embase, SportDiscus, CINAHL and Cochrane Library were searched up to June 2020. Randomized controlled trials that compared RT to a non-exercise control arm in adults with a diagnosis of cancer (undergoing or completed cancer treatment) were included. Article screening and data extraction was performed independently by two reviewers and study quality was assessed using the TESTEX scale. Separate pairwise random-effects meta-analyses were performed for 'on treatment' and 'survivorship' studies. RESULTS: When RT was performed during survivorship, significant differences between the RT and control groups were found for changes in muscle size (0.38 kg [95% CI 0.06, 0.71], p = 0.02; I² = 50.7%, p = 0.01) and fat mass (-0.55 kg [95% CI -0.97, -0.13], p = 0.01; I² = 71.3%, p = <0.001). When RT was performed during treatment, there was a significant difference between RT and control groups for changes in muscle size (0.86 kg [95% CI 0.25, 1.47], p = 0.005; I² = 0.0%, p = 0.63), however there was no difference between groups for changes in fat mass (-0.00 kg [95% CI -0.82, 0.81], p = 0.99; I² = 0.0%, p = 0.62). CONCLUSION: Modest improvements in body composition were observed following RT in cancer survivors on treatment and throughout survivorship. These changes are smaller than those observed following similar programs in the general population. The reason for these differences warrants further investigation. [ABSTRACT FROM AUTHOR]

Being overweight or obese is a primary modifiable risk factor that exacerbates disease progression and mobility disability in older knee osteoarthritis (OA) patients. Lifestyle interventions combining exercise with dietary weight loss (EX+DWL) yield meaningful improvements in mobility and weight loss that are superior to EX or DWL alone. Unfortunately, community access to practical, sustainable weight management interventions remains limited and places knee OA patients at increased risk of mobility disability. The Collaborative Lifestyle Intervention Program in Knee Osteoarthritis patients (CLIP-OA), was a two-arm, 18 month randomized-controlled, comparative effectiveness trial designed to contrast the effects of an evidence-based, theory-driven EX+DWL intervention, personalized to patient needs and delivered by our community partners, with those of the Arthritis Foundation's Walk With Ease (WWE) standard of care self-management program in the treatment of knee OA patients with overweight or obesity. The primary outcome of the CLIP-OA trial was mobility performance assessed using the 400-m walk test (400MWT). Secondary outcomes included weight loss, pain, select quality of life and social cognitive variables, and cost-effectiveness of intervention delivery. Findings from the CLIP-OA trial will determine the comparative and cost-effectiveness of the EX+DWL and WWE interventions on key clinical outcomes and has the potential to offer a sustainable medium for intervention delivery that can promote widely accessible weight management among knee OA patients with overweight or obesity. Trial Registration: NCT02835326. [ABSTRACT FROM AUTHOR]

[Display omitted] • Epidemiological studies indicate that physical activity/exercise has a protective effect against colon cancer progression. • Changes in shear pressure, systemic milieu, extracellular vesicles, and immune system by exercise may impact colon cancer. • Research into mechanisms will enhance development of targeted exercise prescription for patients with colon cancer. Numerous epidemiological studies indicate that physical activity has a protective effect against colon cancer development and progression. Further, the relevant biological mechanisms where physical activity or exercise may improve survival have also been initially examined. In this review, we provide an overview of the epidemiological evidence to date which comprises 16 cohort studies of the effects of physical activity on colon cancer outcomes including cancer recurrence, cancer-specific and overall survival. Moreover, we present four potential mechanisms involving shear pressure, systemic milieu alteration, extracellular vesicles, and immune function by which physical activity and exercise may favorably impact colon cancer. Research currently in progress will provide definitive evidence of survival benefits resulting from exercise and future work will help clarify the role of targeted exercise and the relevant mechanisms involved. [ABSTRACT FROM AUTHOR]

Breast cancer survivors (BCS) commonly exhibit post-treatment declines in muscular strength and physical function. These adverse effects place BCS at heightened risk for chronic disease and functional decline. Theory-based exercise and dietary (EX+D) lifestyle interventions, promoting both regular resistance training and mastery of EX+D self-regulatory strategies, consistently yield meaningful improvements in clinically-relevant outcomes. However, little is known regarding the feasibility or utility of integrating these approaches in community settings among BCS. PURPOSE: The purpose of the Healthy New Albany Breast Cancer (HNABC) pilot study was to determine the feasibility and preliminary efficacy of a community-based group-mediated cognitive behavioral (GMCB) lifestyle intervention in the supportive care of BCS. METHODS: The pilot trial was a 6-month, single-group feasibility study examining the effects of a novel GMCB intervention on EX+D behavior delivered to a cohort of BCS (n = 11; M age = 54 years). Objectively determined chest press (CP) and leg extension (LE) one-repetition maximum (1RM; kg) was assessed using a standardized protocol. Self-reported resistance training volume (RTV; kg) and ratings of perceived exertion (RPE; 0-10 scale) were extracted individual training logs and averaged across the cohort for the CP and leg press (LP) exercises, respectively. Balance was assessed in the medial-lateral direction via root mean square excursion (RMSE; mm) using a balance plate. Baseline to 3-month mean change was calculated and effect size was estimated using Hedge's g. RESULTS: Modest improvement in average 1RM was observed for both CP (3.12 kg; g = 0.54) and LE (4.21 kg; g = 0.44). Self-reported average RTV also increased for both CP (429.37 kg; g = 1.09) and LP (1807.93 kg; g = 0.98). Notably, both CP and LP RPE remained stable with modest average changes despite large increases in RTV (< 0.61). No differences were observed for RMSE. CONCLUSION: Improvements in strength and training volume together with stability of average RPE indicate successful self-management of training variables. Findings from this pilot study support the feasibility and preliminary efficacy of implementing a community-based GMCB EX+D intervention in the supportive care of BCS. [ABSTRACT FROM AUTHOR]