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Purpose Colorectal cancer and its treatment are associated with debilitating side effects. Exercise may improve the physical and psychological wellbeing of cancer patients; however, evidence in colorectal cancer patients undergoing adjuvant chemotherapy is limited. This pilot study aimed to explore the effects of supervised aerobic exercise on cardiorespiratory fitness and patient-reported health outcomes in colorectal cancer patients undergoing adjuvant chemotherapy. Methods Patients who had undergone curative resection for colorectal cancer (stages II–III) and were scheduled to receive adjuvant chemotherapy were enrolled into this non-randomized controlled trial. Patients in the intervention group (IG) took part in a 6-month supervised aerobic exercise program, while the control group (CG) received usual care. Cardiorespiratory fitness (measured by peak oxygen consumption) was assessed at baseline and 6 months. Fatigue, quality of life, and physical activity levels were additionally assessed at 3 months. Results In total, 59 patients (33 in IG vs. 26 in CG) were enrolled into this study. Eighteen patients (9 in IG vs. 9 in CG) dropped out of the study prior to the 6-month follow-up. Significant improvements in cardiorespiratory fitness (p = .002) and selected patient-reported health outcomes, such as reduced motivation (p = .015) and mental fatigue (p = .018), were observed in the IG when compared to the CG. Conclusion To our knowledge, this is the first study to investigate the effects of a supervised aerobic exercise program in colorectal cancer patients undergoing adjuvant chemotherapy. The significant and clinically meaningful improvements in CRF warrant further randomized controlled trials to confirm these findings. Trials registration German Clinical Trials Register Identifier: DRKS00005793, 11/03/2014, retrospectively registered.

ZusammenfassungEine der häufigsten Langzeitfolgen bei Krebsüberlebenden ist das Erschöpfungssyndrom, auch als „Cancer-Related Fatigue“ (CRF) bezeichnet. Eine Fatigue kann auch Jahre nach der Erkrankung noch bestehen bleiben und führt bei den Betroffenen zu erheblichen Einschränkungen des täglichen Lebens und der Lebensqualität. Bei der Behandlung einer chronischen Fatigue spielt die onkologische Bewegungstherapie eine entscheidende Rolle und konnte in mehreren Metaanalysen die stärkste Evidenz für eine erfolgreiche Symptombehandlung zeigen. Forschungsbedarf besteht jedoch weiterhin bezüglich einer optimalen Trainingssteuerung und Trainingsart, weshalb die multizentrische FatiGO-Studie konzipiert wurde, die die unmittelbare Wirksamkeit auf die Fatigue untersucht.

Background: Breast cancer is associated with many therapy-induced side effects that impact patients’ lives from diagnosis to long-term survivorship. Physical activity has become an important and proven supportive measure in treating side effects like loss of muscle strength, fatigue, chemotherapy-induced peripheral neuropathy, lymphedema, and loss of quality of life. Resistance training (RT) is an established exercise intervention for breast cancer patients, but the correct type, timing, intensity, and duration of exercise remain unclear. It is necessary to investigate different resistance training interventions and their effects on breast cancer patients by covering all stages of treatment, beginning with prehabilitation, through the period of acute therapy, to long-term survivorship. Conclusion: Upon evaluation of randomized controlled trials (RCTs) from the past decade, RT was found to be feasible and safe. Furthermore, there is evidence on the impact of RT on muscle strength, CRF and QoL amongst other factors. Studies implementing mixes of aerobic and strength exercises are rather common, but RCTs of RT-only protocols remain scarce. Different strength training protocols at distinct stages of breast cancer treatment have been conducted, but with the complexity of treatments and the variety of training styles, a large field of study remains. Key Messages: Although the overall data on RT for breast cancer patients has increased, there are many different methodological approaches and testing measures as well as gaps in study documentation. There is still very little of the evidence that would facilitate the compilation of standardized and individualized guidelines.

Background Rituximab induces a rapid remission in most patients with pemphigus. Objective Our aim was to assess the long-term efficacy of rituximab in this disease. Method We conducted a retrospective study of 59 patients with pemphigus treated with rituximab and observed over a median period of 104 months. Results The rate of complete remission off therapy (CRoff) after the first rituximab cycle was 39%, increasing to 61% with additional rituximab courses. Long-term CRoff was achieved in 27% of patients. The recurrence rate after the first rituximab cycle was 63%, decreasing to approximately 40% with subsequent rituximab cycles. Median time to relapse after the first and subsequent rituximab cycles was 25 months. Renewed rituximab therapy reinduced complete remission in 94% of cases. Baseline anti-desmoglein antibody levels of ≤250 U/mL were significantly associated with the outcome of CRoff. In paired serum samples obtained before the first and six months after the last rituximab therapy, significant reductions of desmoglein-specific autoantibodies were observed. Patients relapsing after a complete remission induced by the first rituximab cycle were more likely to achieve CRoff than patients relapsing after a less favourable outcome and non-responders. There was no significant difference in age, sex, pemphigus subtype, rituximab dosing and disease duration between patients achieving CRoff and those not meeting this end point. Conclusions Lower desmoglein-specific antibody levels at baseline were predictive of CRoff. In patients receiving multiple rituximab cycles, complete remission after the first cycle was associated with a favourable long-term outcome. Repeated rituximab courses were highly effective for relapsed disease and improved the overall outcome.

Background Urinary incontinence is one of the most clinically relevant side effects in the treatment of prostate cancer patients. The aim of this systematic review and meta-analysis was to analyze the specific exercise effects of supervised versus unsupervised pelvic floor muscle exercise (PFME) and exercise volume on urinary incontinence status after radical prostatectomy. Methods A systematic data search was performed for studies published from January 2000 to December 2020 using the following databases: PubMed, Embase, SciSearch, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Database of Abstracts of Reviews and Effects. The review was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A random-effects meta-analysis of urinary incontinence remission was performed. The relation between time since surgery and urinary incontinence remission was analyzed using a non-linear dose-response meta-analysis. Results The meta-analysis included 20 randomized controlled trials involving 2188 men (n = 1105 in intervention groups; n = 1083 in control groups). PFME versus no PFME had a beneficial effect on urinary incontinence remission at 3 months, 3–6 months, and more than 6 months post-surgery, with risk differences ranging from 12 to 25%. These effects were particularly evident for higher volume, supervised PFME in the first 6 months post-surgery. Additional biofeedback therapy appeared to be beneficial but only during the first 3 months post-surgery. Conclusions There is good evidence that the supervised PFME causes a decrease in short-term urinary incontinence rates. Unsupervised PFME has similar effects as no PFME in postoperative urinary incontinence. PFME programs should be implemented as an early rehabilitative measure to improve postoperative short-term urinary incontinence in patients with prostate cancer. IMPLICATIONS FOR REHABILITATION • Prostate cancer, surgery, and urinary incontinence • The surgical treatment of prostate cancer often leads to urinary incontinence. • Pelvic floor training leads to a significant improvement of this situation. • Exercise therapy support is very important in this context and is even more effective than unsupported training.

Introduction Breast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression. Methods Breast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS). Results Analysis of the original data showed a significant difference between both groups regarding the subscale “joy” ( P = .018). Several significant results within the intervention group were seen in self-efficacy ( P = .014), fear ( P = .009) and the overall score for fear and depression ( P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” ( P = .019). Conclusion To summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.

Childhood cancer survivors show reduced physical activity (PA) levels which may considerably impact child development, quality of life, social participation and sequelae such as functional and cardiovascular health. This study aims to evaluate different aspects of PA behaviour in patients with childhood cancer (PaC) before (bT), during (dT) and after (aT) cancer treatment. In this cross-sectional, multicentre study, 114 PaC and 37 healthy controls between 4 and 20 years of age were enrolled. PA behaviour was assessed using an adapted questionnaire which included items asking about PA level, PA intensity and domains of PA. Patients reported lower PA levels and less minutes of PA at moderate-intensity dT than aT and bT (P ≤ 0.05). Healthy controls reported higher PA levels than patients aT (P ≤ 0.05). At school, 41.7% of PaC did not participate in physical education aT or bT. Lastly, 45.6% of PaC who were engaged in sport club activities bT did no more participate in sport club activities aT. Patients reported different PA behaviours dT and aT than bT. Therefore, monitoring of PA should be considered to increase PA levels in PaC. Future studies also need to examine how PA behaviour can be influenced in a positive way in PaC.

Zusammenfassung Ziel der Arbeit Zahlreiche Studien belegen die ganzheitlich-positiven Effekte bewegungstherapeutischer Interventionen bei Krebspatienten. Auch in der onkologischen Rehabilitationsklinik besitzt die Bewegungstherapie einen hohen Stellenwert, deren Erkenntnisse hier zusammengefasst werden sollen. Methoden Es wurde die Datenbank Pubmed sowie die Publikationen der Rehabilitationswissenschaftlichen Kolloquien nach Interventionsstudien von 2006 bis Januar 2018 durchsucht. Ergebnisse 13 Publikationen wurden identifiziert, die sich auf 8 Studien bezogen, von denen 5 RCTs waren. In erster Linie zeigten Studien den positiven Effekt von Trainingsinterventionen auf das Fatigue-Syndrom und das Bewegungsverhalten. Für viele Parameter liegen jedoch noch keine validen Ergebnisse vor. Schlussfolgerung Zukünftige Studien im Setting der onkologischen Rehabilitationskliniken sollten insbesondere auf die objektive Erfassung von körperlicher Aktivität und körperlicher Fitness, lange Follow-Up-Zeiträume, ein multizentrisches Design, eine Personalisierung des Trainings und eine intensivierte Nachsorge achten.

Zusammenfassung Hintergrund Umfassende Erkenntnisse zu bewegungstherapeutischen onkologischen Versorgungsstrukturen in Deutschland liegen zurzeit nicht vor. Ziel dieser Umfrage war eine Infrastruktur- und Angebotsanalyse der Bewegungsinterventionen an bundesdeutschen Krebszentren. Methoden 2015 wurden alle deutschen zertifizierten Krebszentren (N=756) mittels Fragebogen zu bestehenden bewegungstherapeutischen Angeboten befragt und mit definierten infrastrukturelle Mindestanforderung zur Umsetzung gezielter Bewegungstherapie verglichen. Ergebnisse 132 Krebszentren wurden in die Auswertung eingeschlossen. 90,9% der Zentren (N=120) bieten mindestens eine Form von Physio- oder Sporttherapie an. 22,7% der befragten Zentren erfüllen die infrastrukturellen Mindestanforderungen. Schlussfolgerungen Neueste wissenschaftliche Erkenntnisse im Zuge einer optimalen therapeutischen Trainingssteuerung und damit evidenzbasierten Versorgung scheinen zurzeit schwer umsetzbar, was die Etablierung einer Leitlinie zu onkologischer Sport- und Bewegungstherapie notwendig macht.

Es wird vermutet, dass 20–40 % der krebsbedingten Todesursachen auf eine Kachexie zuruckgefuhrt werden konnen. Bisher mangelt es aber an Therapieansatzen fur die Tumorkachexie. Neben pharmakologischen Masnahmen und spezieller Ernahrungsberatung bzw. -therapie konnte Bewegung und gezieltes Training als Supportivtherapie eine weitere vielversprechende Masnahme sein.

Gezielte Bewegungstherapie kann die physischen, psychischen und psychosozialen Einschrankungen onkologischer Patienten in der Nachsorge positiv beeinflussen. Die Verbesserung der Lebensqualitat, die Reduktion bzw. Verhinderung von Nebenwirkungen sowie die Rezidiv- und Mortalitatsprophylaxe sind zentrale Ansatzpunkte bewegungstherapeutischer Studien. Verschiedene Untersuchungen zeigen den positiven Einfluss auf z. B. das Fatigue-Syndrom, die chemotherapieinduzierte Polyneuropathie und das sekundare Lymphodem. Korperliche Aktivitat kann zudem womoglich nach der Diagnose die krebsspezifische und die allgemeine Mortalitat senken. Aufgrund der positiven Auswirkungen von Bewegungsinterventionen in der Tumornachsorge besteht die Notwendigkeit, Versorgungsangebote zu schaffen, um den individuellen Bedurfnissen zur Steigerung der Lebensqualitat gerecht zu werden. Diese mussen Krebspatienten in der Nachsorge flachendeckend und barrierefrei zur Verfugung gestellt sowie qualitatsgesichert nach Evidenz und den aktuellen Leitlinien umgesetzt werden.

Background Emerging evidence suggests that exercise interventions may improve sexual dysfunction, one of the most common and distressing long-term adverse effects of cancer treatment. Aim The aim of this systematic review is to provide an overview of the effects of exercise on sexual dysfunction in prostate cancer patients. Methods A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement. The systematic literature search was performed on 13th July 2021 using CINAHL, Cochrane Central Register of Controlled Trials, Embase, Medline and Web of Science. Studies were included if they were randomized controlled trials (RCTs) assessing sexual function in prostate cancer patients conducting an exercise intervention alone or in combination with other supportive interventions. The methodological quality was assessed using the Physiotherapy Education Database Score and Jadad scale. Outcomes were reported as between-group differences. Intragroup differences were also reported if significant. Outcomes Positive intervention effects on sexual function were primarily observed in patients following prostatectomy and undergoing anti-hormone treatment and for pelvic floor muscle exercises as well as aerobic and resistance exercise. RESULTS 22 RCTs (n = 1.752 patients) met the eligibility criteria, conducting either an exercise-only intervention (n = 10), a multimodal (exercise plus other supportive therapy) intervention (n = 4), or pelvic floor muscle exercises (n = 8). 6 RCTs assessed sexual dysfunction as a primary endpoint and 8 RCTs used dedicated assessment methods. 9 of the 22 RCTs found significant between-group differences in favor of the intervention group. Clinical Implications The multifaceted etiology of sexual dysfunction provides a strong rationale to further investigate the effects of exercise on sexual dysfunction in prostate cancer patients and also to consider a multidisciplinary approach. Strengths and Limitations A strength is the comprehensive literature search to identify RCTs involving different exercise interventions and a wide range of sexual function assessments. Further, this is the first systematic review on this topic. The main limitations include the difficulty to compare studies due to the heterogeneity of exercise interventions and low questionnaire completion rates in some studies. CONCLUSION Preliminary data from a small number of studies suggest that certain exercise interventions may improve sexual dysfunction in prostate cancer patients, however further trials involving sexual dyfunction as a primary outcome and more comprehensive assessment tools are needed to confirm the rehabilitative and preventive effects of exercise on sexual dysfunction in prostate cancer patients.

Oestrogen receptor (ER)-positive breast cancer is responsive to a number of targeted therapies used clinically. Unfortunately, the continuous application of any targeted therapy often results in resistance to the therapy. Our ultimate goal is to use mathematical modelling to optimize alternating therapies that not only decrease proliferation but also stave off resistance. Toward this end, we measured levels of key proteins and proliferation over a 7-day time course in ER+ MCF-7 breast cancer cells. Treatments included endocrine therapy, either oestrogen deprivation, which mimics the effects of an aromatase inhibitor, or fulvestrant, an ER degrader. These data were used to calibrate a mathematical model based on key interactions between ER signalling and the cell cycle. We show that the calibrated model is capable of predicting the combination treatment of fulvestrant and oestrogen deprivation. Further, we show that we can add a new drug, palbociclib, to the model by measuring only two key proteins, cMyc and hyperphosphorylated RB1, and adjusting only parameters associated with the drug. The model is then able to predict the combination treatment of oestrogen deprivation and palbociclib. We illustrate the model's potential to explore protocols that limit proliferation and hold off resistance by not depending on any one therapy. Public Health Service grantUnited States Public Health Service [R01-CA201092, 1P30-CA-51008] This work was partly supported by Public Health Service grant R01-CA201092 to W.T.B. and A.N.S.-H. Technical services were provided by shared resources at Georgetown University Medical Center, including the Tissue Culture Core Shared Resource, that were funded through Public Health Service award 1P30-CA-51008 (Lombardi Comprehensive Cancer Center Support Grant).

Objective: In cancer patients, the impairment in muscle function is a frequently observed phenomenon. However, comprehensive evaluation of the effect of exercise training on muscle function in childhood cancer patients (CCPs) is sparse and therefore investigated in the MUCKI trial. Study Design: In the randomized controlled MUCKI trial, CCPs during intensive cancer treatment and aged 4-18 years were recruited. Eligible patients were enrolled soon after diagnosis as long as they were physically and mentally able to participate in exercise testing and training. Patients of the exercise group (n = 16) participated in average 2.7 ± 1.2 times per week in a combined resistance and endurance training with moderate exercise intensity, for a time period of 8.0 ± 2.1 weeks, while patients of the control group (n = 17) received usual care. Leg strength was evaluated as the primary endpoint. Secondary endpoints were 6-min walk performance, arm strength, body composition, fatigue, and health-related quality of life. Results: Comparisons of pre- and post-intervention results were evaluated by baseline and stratification criteria adjusted analysis and showed positive effects for the exercise group regarding leg strength [F (1, 20) = 5.733; p = 0.027*; η p 2 = 0.223], walking performance [F (1, 25) = 4.270; p = 0.049*; η p 2 = 0.146], fatigue [F (1, 13) = 8.353; p = 0.013*; η p 2 = 0.391], self-esteem [F (1, 6) = 6.823; p = 0.040*; η p 2 = 0.532], and self-reported strength and endurance capacity [F (1, 6) = 6.273; p = 0.046*; η p 2 = 0.511]. No significant differences were found for the other parameters. Conclusion: Within one of the first randomized controlled trials, the present study provides evidence for a positive effect of combined training in CCPs during intensive cancer treatment. Further research is needed to confirm these results and to evaluate their clinical impact. Clinical Trial Registration Number: NCT02612025.

Zusammenfassung Fragestellung Die Studie analysierte die bewegungstherapeutischen Interventionen hinsichtlich Infrastruktur, Therapieinhalte und Methoden in onkologischen Rehabilitationskliniken in Deutschland. Methodik Die Querschnittserhebung wurde mittels einer Umfrage in Form eines selbst konzipierten Fragebogens durchgeführt. Für die Auswertung wurden 157 Rehabilitationskliniken nach definierten Einschlusskriterien mit einbezogen. Ergebnisse Es haben 33 Rehakliniken (21,02%) mit insgesamt 44 828 Rehabilitanden (29,4%) geantwortet. 83,6% der Rehabilitanden erhalten Sport- und 82,2% Physiotherapie. Alle Rehakliniken führen eine physiotherapeutische/sportwissenschaftliche Diagnostik vor Beginn der Sport- und Bewegungstherapie durch. Je nach Nebenwirkung arbeiten 44–80% der Kliniken bewegungstherapeutisch nach aktuellen wissenschaftlichen Erkenntnissen. Schlussfolgerung Die Bewegungstherapie spielt eine bedeutende Rolle in der onkologischen Rehabilitationsklinik. Es zeigt sich jedoch ein heterogenes Bild im Kontext der bewegungstherapeutischen Methoden und Inhalte.

Chemotherapy-induced peripheral neuropathy (CIPN) is a common and clinically relevant side effect of chemotherapy. Approximately 50% of all leukemia, lymphoma, colorectal- and breast cancer patients are affected. CIPN is induced by neurotoxic chemotherapeutic agents and can manifest with sensory and/or motor deficits. It is associated with significant disability and poor recovery. Common symptoms include pain, altered sensation, reduced or absent reflexes, muscle weakness, reduced balance control and insecure gait. These symptoms not only affect activities of daily living, subsequently reducing patients’ quality of life, they have far more become a decisive limiting factor for medical therapy, causing treatment delays, dose reductions, or even discontinuation of therapy, which can affect the outcome and compromise survival. To date, CIPN cannot be prevented and its occurrence presents a diagnostic dilemma since approved and effective treatment options are lacking. Promising results have recently been achieved with exercise. We have revealed that sensorimotor training (SMT) or whole body vibration (WBV) can reduce the symptoms of CIPN and attenuate motor and sensory deficits. We furthermore detected a tendency that it may also have a preventive effect on the onset of CIPN. We are therefore conducting a prospective, multicentre, controlled clinical trial involving 236 oncological patients receiving either oxaliplatin (N = 118) or vinca-alkaloid (N = 118) who are randomized to one of two interventions (SMT or WBV) or a treatment as usual (TAU) group. Primary endpoint is the time to incidence of neurologically confirmed CIPN. Secondary endpoints are pain, maintenance of the functionality of sensory as well as motor nerve fibres as well as the level of physical activity. The baseline assessment is performed prior to the first cycle of chemotherapy. Subsequent follow-up assessments are conducted at 12 weeks, after completion of chemotherapy, and at a 3-month follow-up. Patients who develop CIPN receive an additional assessment at this time point, as it represents the primary endpoint. We hypothesize that SMT and WBV prevent the onset or delay the progression of CIPN, decrease the likelihood of dose reductions or discontinuation of cancer treatment and improve patients’ quality of life. Deutsche Register Klinischer Studien ( DRKS00006088 , registered 07.05.2014).

ZusammenfassungDie Evidenz zur Wirksamkeit von Sport- und Bewegungstherapie bei Krebserkrankungen ist im letzten Jahrzehnt stark gestiegen. Daher werden in Deutschland derzeit Strukturen und Konzepte implementiert, die eine qualitativ hochwertige und flächendeckende Versorgung von onkologischen Patientinnen und Patienten anstreben. Das Netzwerk OnkoAktiv zielt mit der Vernetzung und Qualitätssicherung existierender Versorgungsstrukturen auf den einfachen Zugang zu spezifischen Bewegungsangeboten durch Betroffene. Die Initiative der Onkologische Trainings- und Bewegungstherapie (OTT) sichert mit dem entsprechenden Ausbildungskonzept den therapeutischen Standard in der Arbeit mit onkologischen Patienten.

Physical activity is supposed to decrease mortality of colorectal cancer (CRC) and is suggested to reduce side-effects of the disease and its treatment. However, the knowledge about the influence of exercise interventions on patients suffering from CRC and metastasized CRC (mCRC) is still sparse. One frequently observed side effect in mCRC is chemotherapy-induced peripheral neuropathy (CIPN). This randomized controlled trial investigated the influence of a supervised exercise program on CIPN in mCRC. Thirty patients (stage IV) undergoing outpatient palliative treatment including a median of 23.5 chemotherapy cycles of various regimens were randomly assigned to an intervention or control group (IG, n = 17; CG, n = 13). The IG participated in an eight-week supervised exercise program, including endurance, resistance and balance training (2×/week for 60 min) whereas the CG received written standard recommendations to obtain physical fitness. CIPN was assessed using the FACT/GOG-NTX questionnaire. Moreover, endurance capacity (6MWT), strength (h1RM) and balance (GGT-Reha) were evaluated before (t 0) and after (t 1) the intervention as well as after 4 weeks follow-up (t2). Neuropathic symptoms remained stable in the IG over time, while CIPN significantly worsened in the CG from t 0 to t 1 and t 0 to t 2. In contrast to the CG, the IG significantly improved in strength and balance function. Changes in CIPN correlated with changes in balance. This is the first investigation showing positive effects of a multimodal exercise program on CIPN, balance and strength on mCRC patients in a palliative setting, thereby consequently increasing patients` quality of life. The results support earlier findings stating a positive influence of balance exercise on CIPN.

Purpose. Only one-third of patients with breast cancer reach the recommended activity level of 15 to 25 MET h/wk. The aim of this study was to determine the influence of personalized exercise recommendations during rehabilitation on patients’ physical activity level, fatigue, and self-perceived cognitive function as well as on side effect–associated biomarkers. Methods. Total metabolic rate, physical activity level, mean MET and steps, fatigue, self-perceived cognitive functioning , and biomarkers (C-reactive protein [CRP], interleukin 6, macrophage migration inhibiting factor [MIF], tumor necrosis factor [TNF]-α, brain-derived neurotrophic factor [BDNF], insulin-like growth factor 1 [IGF1]) were assessed in 60 patients with breast cancer in the aftercare phase before ( t0) and 8 months after ( t1) the intervention. The rehabilitation program consisted of an initial 3-week period and a 1-week stay after 4 months. Results. Paired t-test indicated a statistically significant increase in all activity outcomes from t0 to t1. Patients’ mean activity level significantly increased from 14.89 to 17.88 MET h/wk. Fatigue and self-perceived cognitive functioning significantly improved from t0 to t1. CRP levels significantly decreased, and BDNF as well as IGF1 levels significantly increased over time. Correlation analysis revealed statistically significant negative associations between fatigue, physical activity, and markers of inflammation (TNF-α and MIF). Furthermore, significant positive correlations between subjective cognitive functioning and all dimensions of fatigue were observed. Conclusions. The results support the importance of personalized exercise recommendations to increase physical activity levels in patients with breast cancer. Furthermore, the results highlighti an association between physical activity, fatigue, and inflammation.

Die wissenschaftliche Evidenz zur Wirksamkeit bewegungstherapeutischer Interventionen in der Onkologie ist partiell so uberzeugend, dass im nachsten Schritt die Implementierung von qualitatsgesicherten Bewegungsprogrammen in die Versorgungsstrukturen erfolgen muss. Es ist demnach belegt, dass gezielte korperliche Aktivitat das Fatigue-Syndrom, die Harninkontinenz bei Prostatakrebspatienten sowie die korperliche Leistungsfahigkeit positiv beeinflussen kann. Daruber hinaus liegen in diesem Kontext ernst zu nehmende Hinweise fur positive Auswirkungen auf das sekundare Lymphodem sowie die chemotherapieinduzierte Polyneuropathie vor. Im Idealfall sollte die Onkologische Bewegungstherapie schon vor Beginn der medizinischen Therapie einsetzen, um die Patienten zu stabilisieren und auf diese Weise Komplikationen und Nebenwirkungen wahrend der Akutphase abzumildern, wie dies erste Studien aufzeigen (Prahabilitation). Die verfugbaren Daten zu bewegungstherapeutischen Interventionen bei onkologischen Erkrankungen im Kindesalter sind noch relativ heterogen, belegen jedoch allesamt die Realisierbarkeit und Notwendigkeit von Bewegungstherapie und Sport in der onkologischen Padiatrie und schliesen Nebenwirkungen („adverse events“) aus.

Ziel der Studie Um die (Re-)Integration in den Alltag zu erleichtern, konnen krebskranke Kinder und ihre Familien an einer familienorientierten Rehabilitationsmasnahme (FOR) teilnehmen. Die vorliegende Studie untersucht deren Einfluss auf die Motorik, die Lebensqualitat und Fatigue. Methodik 22 krebskranke Kinder und 20 gesunde Geschwister im Alter von 4 – 17 Jahren nahmen zu Beginn, zum Ende sowie 6 Monate nach Ende der FOR an motorischen Testungen teil und fullten Fragebogen zur Lebensqualitat und zum Fatigue-Syndrom aus. Ergebnisse Zu Beginn der FOR konnten signifikante Unterschiede in den Bereichen der motorischen Leistungsfahigkeit und dem korperlichen Wohlbefinden zwischen den Gruppen festgestellt werden. Beide Gruppen verbessern ihre motorische Leistungsfahigkeit, ihre Lebensqualitat und die Fatigue-Symptomatik. Schlussfolgerung Sowohl die Betroffenen als auch ihre gesunden Geschwister profitieren von der FOR. Die unterschiedlichen Voraussetzungen zu Beginn der FOR sollten Beachtung finden.

Cancer related cognitive impairments (CRCI) are frequently reported by patients prior to, during and after medical treatment. Although this cognitive decline severely affects patients' quality of life, little is known about effective treatments. Exercise programs represent a promising supportive strategy in this field. However, evidence is sparse and existing studies display methodological limitations. In the planned study, 83 men and women newly diagnosed with acute myeloid leukemia (AML) or myelodysplastic syndrome (MDS) will be randomized into one of three treatment groups. During 4weeks of induction chemotherapy with Anthracycline and Cytarabin patients allocated to exercise group will cycle 3×/week for 30min at moderate to vigorous intensity on an ergometer. Patients allocated to placebo group will receive a supervised myofascial release training (3×/week, approx. 30min) and patients at control group will get usual care. As primary endpoints a cognitive test battery will be conducted measuring performances depending on verbal/spatial memory and executive functioning. Secondary endpoints will be self-perceived cognitive functioning, as well as neurotrophic and inflammatory serum markers. All assessments will be conducted immediately after hospitalization and before chemotherapy is commenced, immediately before discharge of hospital after 4-5weeks as well as before continuing medical treatment 3-4weeks after discharge. This will be the first study investigating the impact of an aerobic exercise training on CRCI in AML/MDS patients. We hope that the study design and the state-of-the-art assessments will help to increase knowledge about CRCI in general and exercise as potential treatment option in this under investigated population.

Erhalt ein Patient eine Krebsdiagnose, hat er die besten Chancen fur eine erfolgreiche Behandlung, wenn er in einem guten Allgemeinzustand ist — sowohl in physischer als auch in psychischer Hinsicht. In diesem Zusammenhang kann Prahabilitation einen wichtigen Beitrag leisten.

Introduction BRAWO is a non-interventional study collecting data of 3000 breast cancer patients treated with everolimus and exemestane (advanced or metastatic, hormone-receptor-positive, HER2-negative breast cancer). We introduce results of the 3rd preplanned interim analysis with data cut-off 08/01/ 2015, including 1300 patients. Since physical activity/exercise was reported to influence side effects as well as quality of life (QoL) of various cancer types and therapies, this analysis focuses on the impact of the physical activity/exercise history, development on adverse effects (AE) of the medical treatment and QoL. Methods Patients were asked to complete the EORTC QLQ-C30 QoL questionnaire and visual analogue scales (VAS-KAS) measuring their present-, past ten year- and lifetime physical activity/exercise level. To differentiate between activity/exercise levels, VAS were divided in three equal components (inactive, somewhat active, very active). Questionnaires and information about AE (e. g. stomatitis, fatigue, nausea, diarrhea, etc.) were collected before starting the medical treatment and were repeated each three months. Logistic regression model was used to estimate the impact of baseline physical activity/exercise on AE at any time point of the therapy. ANOVA models were used to calculate the impact of the baseline activity/exercise level on QoL at the last completed data set of each patient. Results Median age of patients was 66 years, median weight was 70 kg, median BMI was 25.9, median time since primary diagnosis was 6.2 years, and 54.4% had visceral metastases at baseline. The median PFS for the first 1300 patients was 7.1 months (95% CI, 6.5-8.0). Patients who reported to be very active (exercise) at the week prior to baseline (4.4%) showed significant lower numbers of AE compared to patients who indicate to be somewhat (14.8%) or inactive (80.8%). In contrast to the exercise level, physical activity in everyday life did not affect the AE incidence. Neither lifetime nor past ten year activity/exercise level is associated with the occurrence of AE. Regarding QoL, very active as well as somewhat active women (measured at baseline for almost each time period) showed significant higher QoL values compared to inactive women during the last assessment before death/progress. Conclusion Exercise prior to medical treatment with Everolimus and Exemestane may impact AE during therapy. Since physical activity did not show such a relation, this analysis highlights the importance of specific guidelines for preventive/rehabilitative exercise programs. More knowledge about dose-response relationships is needed. Furthermore a livelong healthy, "active" lifestyle may increase QoL, even in patients with advanced and terminal breast cancer disease. Citation Format: Bloch W, Baumann F, Zimmer P, Grischke E-M, Fasching PA, Decker T, Uleer C, Schneeweiss A, Salat C, Wimberger P, Mundhenke C, Förster F, Kluth-Pepper B, Schubert J, Tesch H, Schütz F, Lüftner D, Jackisch C. Impact of physical activity/exercise on adverse events and quality of life during treatment with everolimus and exemestane for ER+ women - Results of the 3rd interim analysis of BRAWO. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-13-07.

Ziel der Arbeit: Korperliche Aktivitat und Sport bei Brustkrebs zahlt zu den grosten Herausforderungen in der Bewegungstherapie. Aufgrund der hohen Anzahl von Veroffentlichungen und der damit einhergehenden Menge an Daten sind regelmasige Ubersichtsarbeiten zur Veranschaulichung der Kernaussagen sinnvoll. Methoden: Die Literaturrecherche zum Einfluss von korperlicher Aktivitat und Sport auf spezifische Nebenwirkungen bei Mammakarzinompatientinnen wurde mit Hilfe der Fachdatenbanken PubMed und Medpilot durchgefuhrt. Dabei wurde die Suche auf Studien aus den Jahren 2013 bis 2015 begrenzt. Berucksichtigt wurden ausschlieslich Interventionsstudien sowie nicht interventionelle Studien mit dem Endpunkt Survival. Ergebnisse: Die bisherigen Ergebnisse zu positiven Effekten korperlicher Aktivitat auf Lebensqualitat und krankheits- und therapiebedingte Nebenwirkungen wie Fatigue wurden bestatigt. Zusatzlich konnte die aktuelle Datenlage positive Effekte auf die Symptome eines Lymphodems und die durch die Antihormontherapie hervorgerufenen Beschwerden festigen. Die Vermutung, dass korperliche Aktivitat auch das Uberleben verlangert, konnte durch die aktuelle Datenlage untermauert werden. Zudem deutet sich in den neusten Untersuchungen die Effektivitat sanfterer Bewegungsformen wie Chi-Gong und Yoga sowie neuartiger Interventionen wie Nia an. Diskussion und Schlussfolgerung: Die Arbeit gibt einen Uberblick uber die aktuelle Datenlage zu Aktivitats- und Bewegungsumfangen fur Mammakarzinompatientinnen, aufgeteilt nach unterschiedlichen Nebenwirkungsprofilen. Es wird angeraten, die beschriebenen Trainingssteuerungen aufgrund der Unterschiede von Krankheits- und Therapieverlaufen individuell an die Patientin anzupassen. Zukunftige Arbeiten sollten verstarkt die Wirkmechanismen korperlicher Aktivitat untersuchen, um die Dosis-Wirkungs-Beziehung besser zu verstehen. Eine weitere Herausforderung stellt die Translation der Forschungsergebnisse in die Praxis dar.

Highlights • Whole-body vibration exercise improves physical performance in MGUS patients. • Muscle strength and endurance are improved after WBV in MGUS. • Whole-body vibration increases cortical bone mineral density in female participants. • Bone biomarkers show an adaptive response of the bone in MGUS after WBV., Objective Monoclonal Gammopathy of Undetermined Significance (MGUS) is a risk factor for reduced physical performance, osteoporosis, and fractures due to compromised musculoskeletal metabolism. In this condition it is unknown whether whole-body vibration (WBV) exercise favorably alters physical performance and bone metabolism. Methods To evaluate the effect of three-months WBV exercise (30 min; 2x/week) including an optional three-month extension on physical performance, bone metabolism and bone mineral density. Endpoints included functional assessments, bone turnover markers and bone mineral density assessed by peripheral quantitative computed tomography of the tibia. Results Fifteen MGUS patients (median age 62.0, nine female) completed the first three months of which ten completed the three-month extension. Measures of physical functioning including chair rise test, timed up and go and 6-minute walk test improved (p = 0.007; p = 0.009; p = 0.005) after three and six months of WBV exercise. Total tibial bone mineral density remained unaltered (p > 0.05). WBV exercise tended to increase levels of sclerostin (p = 0.093) with a transient increase in osteoclast resorption markers (N-terminal telopeptide of collagen type 1, tartrate resistant acid phosphatase 5b) after three months while Dickkopf-1 (p = 0.093), procollagen I N-terminal propeptide (p = 0.074) and total alkaline phosphatase (p = 0.016) appeared to decline. No exercise-related adverse events were reported. Conclusion WBV exercise in MGUS patients improves indicators of physical performance. Observed trends in bone turnover markers and changes in distal tibial bone mineral density may indicate a regulatory effect of WBV exercise on bone metabolism and warrants further evaluation by large scale studies.

With improved survival rates in pediatric oncology, the detection of adverse side- and late-effects is gaining increased interest. This cross-sectional study investigated walking abilities and ankle dorsiflexion function in children with cancer.Study participants included 16 children with various cancers (4-20 years, patient group) after completion of the intense treatment and 16 age- and gender-matched healthy peers (comparison group).Walking speed (10-meter-walking-test, treadmill test assessing preferred transition speed), walking capacity (2-minute-walk-test), walking balance (Timed-Up-And-Go-Test), active/passive ankle dorsiflexion range of motion (ROM) (goniometer) and ankle dorsiflexion strength (hand-held dynamometer) were comprehensively assessed.Significant lower values in the patient group were found for walking capacity, maximum walking speed, ankle dorsiflexion ROM and strength. No significant differences between the groups were found for preferred walking speed and walking balance.Limited walking abilities and ankle dorsiflexion dysfunctions are prominent in children with cancer; having the potential to impact children's community mobility and physical activity.To provide holistic care, the development of specific supportive strategies such as exercise interventions and its translation into clinical practice needs to be accelerated.Mit verbesserten Überlebensraten in der Kinderonkologie wird es immer wichtiger, Nebenwirkungen und Spätfolgen zu identifizieren. In dieser Querschnittsstudie wurden die Gehfähigkeit und die Funktion der Sprunggelenksdorsalflexion bei onkologisch erkrankten Kindern untersucht.Insgesamt nahmen 16 Kinder verschiedener Krebserkrankungen (4–20 Jahre), die ihre intensive Krebstherapie abgeschlossen hatten (Patientengruppe), sowie 16 gesunde Kinder, die in Alter und Geschlecht einem onkologisch erkrankten Kind entsprachen (Kontrollgruppe), an der Studie teil.In verschiedenen Gehtests wurden die Parameter Geschwindigkeit (10Meter-Gehttest, Laufbandtest zur Erfassung der Geschwindigkeit beim Übergang vom Gehen ins Laufen), Distanz (2 Min-Gehtest) sowie das Gleichgewicht im Gehen (Timed-Up-And-Go-Test) erfasst. Zudem wurden das aktive/passive Bewegungsausmaß im Sprunggelenk (Goniometer) und die Kraft der Sprunggelenksdorsalflexoren (Dynamometer) umfassend analysiert.In der Patientengruppe wurden signifikant niedrigere Werte für die Gehdistanz, die maximale Gehgeschwindigkeit, das Bewegungsausmaß im Sprunggelenk sowie in der Kraft der Sprunggelenksdorsalflexoren festgestellt. Für die frei gewählte Gehgeschwindigkeit und das Gleichgewicht im Gehen wurden keine signifikanten Unterschiede zwischen den Gruppen identifiziert.Einschränkungen in der Gehfähigkeit und der Sprunggelenksdorsalflexion stellen relevante Spätfolgen bei Kindern mit Krebs dar, die das Potential haben, die Alltagsmobilität und körperliches Aktivitätsverhalten negativ zu beeinflussen.Um eine ganzheitliche Versorgung gewährleisten zu können, müssen die Entwicklung von spezifischen supportiven Therapiemaßnahmen wie Bewegungsinterventionen sowie deren Translation in die klinische Praxis vorangetrieben werden.

Background: Secondary lymphedema (SL) is a possible side effect of breast cancer treatment. Current data describe a positive influence of exercise on upper lymphedema. This systematic review evaluates studies examining a potential preventive effect of exercise on SL incidence. Methods: A systematic literature search of PubMed, LIVIVO, and the Cochrane Library was performed. Results: 8 randomized controlled trials were included in the review. 3 studies investigated the effect of strength training, and 5 the effect of combined exercise therapy. 5 studies included participants without lymphedema at study entry, and 3 studies included both patients with and without lymphedema. The partly significant results showed that progressive strength training as well as combined dynamic exercise therapies consisting of physiotherapy, physical therapy, and/or kinesiotherapy are safe and can prevent SL. Onset as well as diagnosis of lymphedema were significantly decreased in 5 studies in the exercise group. Conclusion: All 8 studies included indicate a potential preventive effect of exercise on SL; however, further research is needed.

Purpose To assess a whole-body vibration (WBV) intervention for children after cancer treatment. Methods Eleven children after inpatient anticancer therapy participated in a 12-week supervised WBV intervention, which consisted of one 9- to 13-minute WBV session per week, with 5 to 9 minutes' overall vibration time. Feasibility was defined as the ability to participate in WBV training without reporting adverse events. The number of offered and completed training sessions, program acceptance, and measures of function were assessed. Results Nine participants completed the WBV intervention without any WBV-related adverse events. The adherence rate was 87.96%. Only minor side effects were reported and there was general program acceptance. We found indications that WBV has positive effects on knee extensor strength and active ankle dorsiflexion range of motion. Conclusions WBV was feasible, safe, and well received among children after inpatient anticancer therapy. No health deteriorations were observed. Positive effects need to be confirmed in future trials.

Background/aim Breast cancer survivors often report a decrease in physical activity levels and quality of life. The aim of this study was to explore whether a "Kyusho Jitsu" martial arts intervention is feasible and can improve general well-being and physical activity levels in breast cancer survivors. Materials and methods Breast cancer survivors (N=51) were randomly assigned to the intervention or control group. The intervention group participated in a 24-week Kyusho Jitsu intervention. Both groups were assessed at baseline, 3, and 6 months. Results Analysis of original data showed several significant improvements in favor of the intervention group, but also some of the control group. Sensitivity analysis supports these findings. No adverse events were observed. Conclusion To our knowledge this is the first study showing that a holistic Kyusho Jitsu martial arts intervention can be feasible and effective for breast cancer survivors.

Chemotherapy-induced peripheral neuropathy (CIPN) is a prevalent and clinically relevant side effect of chemotherapy. The symptoms diminish patients’ quality of life and represent a decisive limiting factor for medical therapy. To date, effective treatment options are lacking. Specific exercise interventions have proven promising to target relevant symptoms. We conducted a prospective, four-armed, randomized, controlled trial, to evaluate the effects of sensorimotor training (SMT) and whole-body vibration training (WBV) on patients with CIPN. Participants (N = 40) were randomized to either one of two intervention groups (SMT N = 10 or WBV N = 10) or oncological control group (N = 10) and matched by gender and age with a healthy control (N = 10). The intervention groups exercised twice a week for 6 weeks. Primary endpoint was the reduction of CIPN-related symptoms (improve peripheral deep sensitivity, Achilles tendon reflex (ASR) and patellar tendon reflex (PSR), light-touch perception, sense of position, and lower leg strength). Secondary endpoints were nerve conduction velocity and amplitude, balance control, quality of life, and CIPN-related pain. Patients exercising improved sensory and associated motor symptoms. Significant intergroup differences were found for the tendon reflexes (ASR P = .017 and PSR P = .020), peripheral deep sensitivity (P = .010), and pain (P = .043). Furthermore, tendencies were found regarding the subjective improvement of symptoms (P = .075) and two subscales of the EORTC-QLQ-C30 questionnaire: pain (P = .054) and dyspnea (P = .054). The results for the SMT group were superior regarding the tendon reflexes, and a tendency regarding the subjective report of symptoms, while WBV was superior regarding pain. SMT and WBV behold a large potential to reduce CIPN-related symptoms and can be considered feasible and safe for patients with CIPN (compliance 97.5%, no adverse events). Registration: DRKS00013027

The current scientific field of exercise interventions in breast cancer is very large. Rehabilitation focuses on restoring or improving quality of life and thus on independence and participation in life. Hence, it is important to investigate exercise interventions in the setting of rehabilitation and aftercare. It is also necessary to determine the influence of physical activity or exercise therapy on the prevention of recurrence and mortality as well as on certain side effects of the disease and its medical treatment in rehabilitation. Physical activity in rehabilitation and aftercare is feasible and safe and can be used for various purposes. Against the background of reduced fatigue, chemotherapy-induced peripheral neuropathy, cancer-related cognitive impairment, arthralgia, lymphedema, recurrence, and mortality, as well as improved quality of life, different methodological approaches and evidence can be seen. Although the overall data availability has increased, there are gaps in study documentation as well as inadequate verification of scientific approaches in rehabilitation clinics and in everyday life.

The aim of this systematic review is to assess the effect of different types of exercise on breast cancer-related lymphedema (BCRL) in order to elucidate the role of exercise in this patient group. A systematic data search was performed using PubMed (December 2016). The review is focused on the rehabilitative aspect of BCRL and undertaken according to the PRISMA statement with Levels of Evidence (LoE) assessed. 11 randomized controlled trials (9 with LoE 1a and 2 with LoE 1b) that included 458 women with breast cancer in aftercare were included. The different types of exercise consisted of aqua lymph training, swimming, resistance exercise, yoga, aerobic, and gravity-resistive exercise. Four of the studies measured a significant reduction in BCRL status based on arm volume and seven studies reported significant subjective improvements. No study showed adverse effects of exercise on BCRL. The evidence indicates that exercise can improve subjective and objective parameters in BCRL patients, with dynamic, moderate, and high-frequency exercise appearing to provide the most positive effects.

Low levels of physical activity often observed in pediatric oncology might be attributed to various functional deficits, especially those of the lower limbs as these affect gait, mobility, and, consequently, physical activity. In the past few years, whole-body vibration (WBV) has emerged as a new therapy modality for improving physical functioning. Although WBV is increasingly applied in children with disabilities, its impact on lower limb function in pediatric cancer patients and survivors has not yet been investigated. To establish whether there is evidence that WBV may be beneficial for pediatric cancer patients and survivors, this review summarizes current data on WBV studies among children with disabilities and extracts relevant information for the pediatric cancer population. Two independent reviewers performed a systematic literature search following the PRISMA guidelines. Nine studies were included in the analysis. Results demonstrate that WBV is a safe, highly compliant, and effective approach in cohorts of children with disabilities. The largest effects of WBV were observed in lower extremity muscle mass and strength, balance control, gait, and walking ability. Furthermore, we were able to develop first recommendations for WBV protocols. WBV seems to be feasible and effective for improving parameters that may be relevant to the pediatric cancer population. Efforts are needed to conduct first WBV interventions in children with cancer proving the effects. The developed recommendations for WBV protocols might help to implement these intervention studies.

© 2017 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American College of Sports Medicine. Purpose The presence of bone metastases has excluded participation of cancer patients in exercise interventions and is a relative contraindication to supervised exercise in the community setting because of concerns of fragility fracture. We examined the efficacy and safety of a modular multimodal exercise program in prostate cancer patients with bone metastases. Methods Between 2012 and 2015, 57 prostate cancer patients (70.0 ± 8.4 yr; body mass index, 28.7 ± 4.0 kg·m -2) with bone metastases (pelvis, 75.4%; femur, 40.4%; rib/thoracic spine, 66.7%; lumbar spine, 43.9%; humerus, 24.6%; other sites, 70.2%) were randomized to multimodal supervised aerobic, resistance, and flexibility exercises undertaken thrice weekly (EX; n = 28) or usual care (CON; n = 29) for 3 months. Physical function subscale of the Medical Outcomes Study Short-Form 36 was the primary end point as an indicator of patient-rated physical functioning. Secondary end points included objective measures of physical function, lower body muscle strength, body composition, and fatigue. Safety was assessed by recording the incidence and severity of any adverse events, skeletal complications, and bone pain throughout the intervention. Results There was a significant difference between groups for self-reported physical functioning (3.2 points; 95% confidence interval, 0.4-6.0 points; P = 0.028) and lower body muscle strength (6.6 kg; 95% confidence interval, 0.6-12.7; P = 0.033) at 3 months favoring EX. However, there was no difference between groups for lean mass (P = 0.584), fat mass (P = 0.598), or fatigue (P = 0.964). There were no exercise-related adverse events or skeletal fractures and no differences in bone pain between EX and CON (P = 0.507). Conclusions Multimodal modular exercise in prostate cancer patients with bone metastases led to self-reported improvements in physical function and objectively measured lower body muscle strength with no skeletal complications or increased bone pain.

Eine medizinisch-onkologische Therapie, aber auch die Krebserkrankung selbst verursacht zahlreiche akute wie auch chronische Nebenwirkungen. Vermehrt bestatigen Studien die validen Effekte von Bewegungstherapie zur bio-psycho-sozialen Regeneration. Doch fehlen in der onkologischen Versorgung bislang patientenorientierte Bewegungskonzepte, die die Translation wissenschaftlicher Erkenntnisse in die Therapie und Praxis ermoglichen. Reviews und RCT-Studien zu den Effekten von korperlicher Aktivitat auf krebsspezifische Defizite zeigen, dass spezifische Bewegungsprogramme einen positiven Einfluss auf Fatigue-Syndrom, Harninkontinenz, Lymphodem, Polyneuropathie, Arthralgie und den Nebenwirkungen einer Hormontherapie haben. Mit der zunehmend aussagekraftigeren Evidenz zur korperlichen Aktivitat in der Onkologie konnen im nachsten Schritt die aus den Studien resultierenden Empfehlungen in Praxis und Therapie ubertragen werden. Dazu wurde das personalisierte Behandlungskonzept „Onkologische Trainings- und Bewegungstherapie“ (OTT) entwickelt.

Background Exercise interventions in pediatric oncology are feasible and safe. However, scarce data are available with regard to the effectiveness of outpatient, group-based exercise interventions. As well, the potential role of exercise to improve motor performance has not been adequately explored despite being a meaningful outcome during childhood with important implications for physical activity behavior. No study has yet demonstrated significant changes in motor performance after an exercise intervention. Procedures This explorative, prospective study was designed to evaluate the effects of a 6-month, group-based, therapeutic exercise program for a mixed childhood cancer population on motor performance, level of activity, and quality of life. After cessation of inpatient medical treatment, childhood cancer outpatients aged 4–17 years exercised once a week during a 6-month period (IG). Comparison groups included childhood cancer outpatients receiving care as usual (CG1), as well as healthy peers (matched to IG by age and gender) (CG2). Results Overall motor performance, various motor dimensions, activity in sport clubs and school sports, as well as physical and emotional well-being were significantly reduced in the IG at baseline. Significant differences between the IG and CG1 and/or CG2 were identified in the change of overall motor performance, single motor dimensions, overall level of activity, and emotional well-being from baseline to post-intervention. Conclusions The exercise intervention was beneficial in terms of motor performance, level of activity, and emotional well-being. As such, this study provides support for group-based exercise as a potential strategy to improve these outcomes after inpatient medical treatment. Pediatr Blood Cancer © 2015 Wiley Periodicals, Inc.

Bewegungstherapeutische Masnahmen sind mittlerweile integraler Bestandteil der onkologischen (Fruh-)Rehabilitation. Neben dem Ausdauer- und Koordinationstraining ist das Krafttraining ein essenzieller Bestandteil der Bewegungstherapie, um beispielsweise den Nebenwirkungen eines Lymphodems, einer Antiandrogentherapie oder einer Kachexie entgegenzuwirken. Um das Outcome von Bewegungsprogrammen vor dem Hintergrund von verschiedensten Nebenwirkungen von onkologischen Erkrankungen und deren Therapien zu optimieren, sind zwingend weitere Studien notwendig. In der vorliegenden Studie sollte untersucht werden, inwieweit ein intensives Krafttraining einem moderaten Krafttraining hinsichtlich des Kraftzuwachses uberlegen ist. Zu diesem Zweck wurden 31 Tumorpatienten ohne Krafttrainingserfahrung (unterschiedlichster Entitaten und Therapiestatus) in eine moderate Trainingsgruppe (MT, n=17) und eine Hypertrophietrainingsgruppe randomisiert (HT, n=14). Alle Patienten trainierten zunachst uber 8 Wochen 2-mal wochentlich in einem Kraftausdauerzirkel (je 2 Durchgange), der 6 Kraftgerate (je 20 Wiederholungen [Wdh]) fur die grosen Muskelgruppen beinhaltete. In den folgenden 8 Wochen trainierte die MT weiter bei 20 Wdh, wohingegen fur die HT der Widerstand so erhoht wurde, dass lediglich 8–12 Wdh moglich waren. Die Maximalkraft der Patienten wurde vor Beginn der Intervention (t0), nach 8 Wochen (t1) und nach 16 Wochen (t2) mittels eines hypothetischen One-Repition-Maximum- (h1RM-)Tests erfasst. Die Ergebnisse zeigten bei ahnlichem Ausgangsniveau der beiden Gruppen einen signifikant erhohten Kraftzuwachs fur fast alle Muskelgruppen von t1 zu t2 in der HT. Der Mehrwert dieser Ergebnisse ist weniger die Feststellung, dass ein HT hinsichtlich des Kraftzuwachses einem MT uberlegen ist, sondern vielmehr, dass ein HT auch fur Tumorpatienten gut durchfuhrbar ist. Insofern keine Kontraindikationen bestehen, kann somit intensives Krafttraining v. a. fur den Muskelaufbau empfohlen werden. Ob der reine Kraftzuwachs fur Nebenwirkungen wie das Fatigue-Syndrom eine zentrale oder eher untergeordnete Rolle spielt, mussen weitere Untersuchungen zeigen.

Introduction Exercise has beneficial effects on cancer prevention as well as on prognosis of patients with cancer. To optimize the outcomes of exercise programs, more knowledge about the underlying mechanisms is needed. This study investigates the short-term effects of a half marathon on immune cell proportions, pro-inflammatory cytokine levels, and recovery behavior of patients with breast cancer in the aftercare compared to healthy controls. Methods Nine patients with breast cancer in the aftercare and 9 healthy age-matched controls participated in a half marathon. Blood samples were collected before, after, and 24 h after the run. Immune status was measured by flow cytometer analysis, while serum levels of the pro-inflammatory cytokines TNF-α, IL-6, and MIF were assessed using ELISA. Recovery behavior was determined using an ADL monitor. Results Both groups showed a similar recovery behavior and time courses in changes of granulocytes, monocytes, lymphocytes, and cytokine serum levels. Patients revealed increased proportions of cytotoxic and memory T cells, whereas helper and naive T cells were decreased compared to healthy controls. Naive and memory T-cell proportions were not affected by the intervention. Conclusions Patients with breast cancer in the aftercare and healthy subjects show a similarly recovery behavior and immune response to the intervention. The detected differences in T-cell subsets need further investigation. Based on the results of the study, we hypothesize that immune cell subsets with known relevance in cancer were mobilized through the intervention. We confirm that the hypothesis of a midterm anti-inflammatory effect of exercise is also valid for patients with breast cancer in the aftercare.

Purpose. Although physical activity has been demonstrated to increase cancer survival in epidemiological studies, breast cancer patients tend toward inactivity after treatment. Methods Breast cancer patients were quasi-randomly allocated to two different groups, intervention (IG) and control (CG) groups. The intervention group (n = 111) received an individual 3-week exercise program with two additional 1-week inpatient stays after 4 and 8 months. At the end of the rehabilitation, a home-based exercise program was designed. The control group (n = 83) received a 3-week rehabilitation program and did not obtain any follow-up care. Patients from both groups were measured using questionnaires on physical activity, fatigue, and quality of life (QoL) at five time points, 4 months (t1), 8 months (t2), 12 months (t3), 18 months (t4), and 24 months (t5) after the beginning of the rehabilitation. Results After 2 years, the level of physical activity (total metabolic rate) increased significantly from 2733.16 ± 2547.95 (t0) to 4169.71 ± 3492.27 (t5) metabolic equivalent (MET)- min/week in the intervention group, but just slightly changed from 2858.38 ± 2393.79 (t0) to 2875.74 ± 2590.15 (t5) METmin/ week in the control group (means ± standard deviation). Furthermore, the internal group comparison showed significant differences after 2 years as well. These results came along with a significantly reduced fatigue syndrome and an increased health-related quality of life. Conclusions The data indicate that an individual, according to their preferences, and physical-resource-adapted exercise program has a more sustainable impact on the physical activity level in breast cancer patients than the usual care. It is suggested that the rehabilitation program should be personalized for all breast cancer patients.

To assess the effects of chemoimmunotherapy on post-chemotherapy cognitive impairments (PCCI) in patients with B-cell non-Hodgkin lymphoma (NHL), we used objective and subjective measures of cognitive functions in combination with serum parameters and neuroelectric recordings. Self-perceived status of cognition, fatigue and emotional functioning were reduced in patients (n=30) compared to healthy controls (n=10). Cognitive performance was impaired in patients with NHL compared to controls and a norm sample (n=1179). PCCI was more severe in patients treated with rituximab and bendamustine (BR) than in patients who received R in combination with CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) polychemotherapy (R-CHOP). Individual alpha peak frequency and serum brain-derived neurotrophic factor (BDNF) levels in patients with NHL correlated with accuracy in the objective cognition test. Higher serum interleukin-6 (IL-6) concentrations were associated with higher fatigue levels. Patients with NHL and especially those who were treated with BR were affected by PCCI. BDNF and IL-6 might be involved in the pathogenesis of PCCI and fatigue.

BACKGROUND Lymphoma patients undergoing therapy must cope with the side-effects of the disease itself, therapy and associated immobility. Peripheral neuropathy (PNP), loss of balance control and weakness not only diminishes patients' quality of life (QOL), it can also affect planning and the dosage of therapy. Exercise may enable patients to reverse these declines, improving their performance level and QOL. PATIENTS AND METHODS We carried out a randomized, controlled trial, assigning 61 lymphoma patients either to a control group (CG; N=31) or to a 36-week intervention (IG; N=30), consisting of sensorimotor-, endurance- and strength training twice a week. Primary end point was QOL; secondary end points included movement coordination, endurance, strength and therapy-induced side-effects. RESULTS Intergroup comparison revealed improved QOL- (ΔT1-T0; P=0.03) and PNP-related deep sensitivity in the IG: 87.5% were able to reduce the symptom, compared with 0% in the CG (P

Klinisches/methodisches Problem Die Befundung in der Radiologie steht vor einem Wandel, der von einem umfassenderen Verstandnis der Befunderhebung und den zunehmenden technischen Moglichkeiten gepragt sein wird.

Entwickeln Krebspatienten eine chemotherapieinduzierte Polyneuropathie (CIPN), verringert dies nicht nur deren Lebensqualitat, sondern es kann auch die medizinische Therapie negativ beeinflussen. Bisher gibt es keine zufriedenstellende praventive oder symptomatische Behandlung. Vielversprechend erweisen sich nach neuesten wissenschaftlichen Erkenntnissen jedoch bewegungstherapeutische Ansatze wie Sensomotorik- und Vibrationstraining.