title: Effect of Exercise on Markers of Inflammation in Breast Cancer Survivors: The Yale Exercise and Survivorship Study Home-based exercise to alleviate fatigue and improve functional capacity among breast cancer survivors. Effects of exercise on physiological and psychological variables in cancer survivors. Physical activity for men receiving androgen deprivation therapy for prostate cancer: benefits from a 16-week intervention Effects of a walking intervention on fatigue-related experiences of hospitalized acute myelogenous leukemia patients undergoing chemotherapy: a randomized controlled trial. Randomized controlled trial of exercise and blood immune function in postmenopausal breast cancer survivors. The effect of resistance training on muscle strength and physical function in older, postmenopausal breast cancer survivors: a randomized controlled trial Feasibility and efficacy of a supervised exercise intervention in de-conditioned cancer survivors during the early survivorship phase: the PEACH trial A randomized, controlled trial of aerobic exercise for treatment‐related fatigue in men receiving radical external beam radiotherapy for localized prostate carcinoma Effect of exercise on the caloric intake of breast cancer patients undergoing treatment. Six-Month Follow-up of Patient-Rated Outcomes in a Randomized Controlled Trial of Exercise Training during Breast Cancer Chemotherapy Effects of exercise on fatigue, physical functioning, and emotional distress during radiation therapy for breast cancer. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: pragmatic randomised controlled trial Physical activity and survival after breast cancer diagnosis. The effectiveness of a deep water aquatic exercise program in cancer-related fatigue in breast cancer survivors: a randomized controlled trial. Randomized trial of exercise therapy in women treated for breast cancer. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. Circulating C-reactive protein concentrations and risks of colon and rectal cancer: a nested case-control study within the European Prospective Investigation into Cancer and Nutrition. Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy. Exercise prevents fatigue and improves quality of life in prostate cancer patients undergoing radiotherapy. Exercise training and cytokines in breast cancer survivors. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Effects of exercise on fatigue, sleep, and performance: a randomized trial. Multimodal exercise training during myeloablative chemotherapy: a prospective randomized pilot trial Pro- and anti-inflammatory cytokine balance in strenuous exercise in humans. Active for Life After Cancer: a randomized trial examining a lifestyle physical activity program for prostate cancer patients. Three independent factors predicted adherence in a randomized controlled trial of resistance exercise training among prostate cancer survivors. A 4-week home-based aerobic and resistance exercise program during radiation therapy: a pilot randomized clinical trial. Physical exercise for cancer patients with advanced disease: a randomized controlled trial. The effect of seated exercise on fatigue and quality of life in women with advanced breast cancer. Elevated biomarkers of inflammation are associated with reduced survival among breast cancer patients. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. Resistance training does not protect against increases in plasma cytokine levels among germ cell cancer patients during and after chemotherapy. A home-based exercise program to improve function, fatigue, and sleep quality in patients with Stage IV lung and colorectal cancer: a randomized controlled trial. Do patients who are treated with stem cell transplantation have a health-related quality of life comparable to the general population after 1 year? Effectiveness of physical activity on cardiorespiratory fitness and health-related quality of life in young and middle-aged cancer patients shortly after chemotherapy. Fatigue in cancer patients treated with cytotoxic drugs Reliability of the PEDro scale for rating quality of randomized controlled trials. Effect of exercise training on C-reactive protein in postmenopausal breast cancer survivors: A randomized controlled trial Effects of exercise dose and type during breast cancer chemotherapy: multicenter randomized trial. Exercise, sleep quality, and mediators of sleep in breast and prostate cancer patients receiving radiation therapy. Physical activity and survival after colorectal cancer diagnosis. Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health, eating, activity, and lifestyle study. Effects of physical activity on cancer survival: a systematic review. Impact of a home-based walking intervention on outcomes of sleep quality, emotional distress, and fatigue in patients undergoing treatment for solid tumors. Randomized controlled trial of the effects of aerobic exercise on physical functioning and quality of life in lymphoma patients. The European Cancer Anaemia Survey (ECAS): a large, multinational, prospective survey defining the prevalence, incidence, and treatment of anaemia in cancer patients. A controlled randomized study examining the effects of exercise therapy on patients undergoing haematopoietic stem cell transplantation Exercise intervention for fatigue-related symptoms in Thai women with breast cancer: A pilot study. Effectiveness of a 12-month exercise program on physical performance and quality of life of breast cancer survivors. A progressive postresection walking program significantly improves fatigue and health-related quality of life in pancreas and periampullary cancer patients. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy Exercise manages fatigue during breast cancer treatment: a randomized controlled trial. Effects of a partly self-administered exercise program before, during, and after allogeneic stem cell transplantation. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. Safety and efficacy of aerobic training in operable breast cancer patients receiving neoadjuvant chemotherapy: A phase II randomized trial
abstract: Physical activity is associated with improved breast cancer survival , but the underlying mechanisms , possibly including modification of the inflammatory state , are not well understood . We analyzed changes in interleukin (IL)-6 , C-reactive protein ( CRP ) , and TNF-α in a r and omized controlled trial of exercise in postmenopausal breast cancer survivors . Seventy-five women , recruited through the Yale-New Haven Hospital Tumor Registry , were r and omized to either a six-month aerobic exercise intervention or usual care . Correlations were calculated between baseline cytokines , adiposity , and physical activity measures . Generalized linear models were used to assess the effect of exercise  on IL-6 , CRP , and TNF-α . At baseline , IL-6 and CRP were positively correlated with body fat and body mass index ( BMI ) and were inversely correlated with daily pedometer steps ( P < 0.001 ) . We found no significant effect of exercise  on changes in inflammatory marker concentrations between women r and omized to exercise versus usual care , though secondary analyses revealed a significant reduction in IL-6 among exercisers who reached 80 % of the intervention goal compared with those who did not . Future studies should examine the effect of different types and doses of exercise and weight loss on inflammatory markers in large-scale trials of women diagnosed with breast cancer . Cancer Prev Res ; 6(2 ) ; 109–18 . © 2012 AACR This pilot study examined the efficacy of two home-based exercise programs on alleviating fatigue and improving functional capacity in breast cancer survivors . Participants were r and omly assigned into one of three groups : aerobic exercise ( AE ) , resistance exercise ( RE ) , or usual care control ( CON ) . After receiving individualized instruction and training , participants assigned to the AE and RE groups were asked to perform the prescribed exercise(s ) 3 times per week for 12 weeks at home . Both groups were instructed to keep their perceived exercise intensity in the " fairly light " to " somewhat hard " range using the Borg Perceived Exertion Scale . All participants completed the revised Piper Fatigue Scale ( PFS ) and the 6-minute walk test ( 6MWT ) at baseline and 12-week post-exercise program . Analysis of pre- and post-training data revealed a significant reduction in fatigue levels on the PFS among participants in the AE group ( Z=2.521 , one-tailed P=0.006 ) , and a significant improvement in the distance of the 6MWT for the RE group ( Z=2.366 , one-tailed P=0.009 ) at the end of 12-week study period . No significant changes in fatigue or functional status were observed in the CON group . Findings provide preliminary support for RE as a viable strategy for improving functional capacity in breast cancer survivors , while AE may be more effective in attenuating cancer-related fatigue . Incorporating RE training for future research may help advance the growing body of knowledge in symptom management for breast cancer survivors PURPOSE The primary purpose of this study was to examine the effect of aerobic exercise on physiological and psychological function in patients rehabilitating from cancer treatment . A second purpose was to evaluate the differential effects of low- and moderate-intensity exercise on these variables . METHODS Eighteen survivors of breast or colon cancer ( 15 female and 3 male , 40 - 65 yr of age ) served as subjects . The subjects were matched by aerobic capacity and scores on a Quality of Life question naire , and then r and omly assigned to a control , low- ( 25 - 35 % heart rate reserve ( HRR ) ) , or a moderate- ( 40 - 50 % HRR ) intensity exercise group . The exercise groups performed lower-body aerobic exercise three times a week for 10 wk . After the exercise training , there were no statistically significant differences between the two exercise groups on any of the physiological variables . Therefore , the exercise groups were combined into one group for the final analysis . RESULTS The results revealed statistically significant increases in aerobic capacity ( P < 0.001 ) and lower-body flexibility ( P = 0.027 ) , a significant decrease in body fat ( P < 0.001 ) , and a significant increase in quality of life ( P < 0.001 ) and a measure of energy ( P = 0.038 ) in the exercise group when compared with the control group . CONCLUSION Low- and moderate-intensity aerobic-exercise programs were equally effective in improving physiological and psychological function in this population of cancer survivors .  Aerobic exercise appears to be a valuable and well-tolerated component of the cancer-rehabilitation process Goals of workProstate cancer patients receiving and rogen deprivation therapy ( ADT )  are vulnerable to a number of potentially debilitating side effects , which can significantly impact quality of life . The role of alternate therapies , such as physical activity ( PA ) , in attenuating these side effects is largely understudied for such a large population . Thus , the purpose of this study was to investigate the effects of PA intervention for men receiving ADT on PA behavior , quality of life , and fitness measures . Patients and methods One hundred participants were r and omized into an intervention ( n = 53 ) or a wait-list control group ( n = 47 ) , with 11 dropping out of the intervention group and 23 dropping out of the wait-list control group prior to post-testing . The intervention consisted of both an individually tailored home-based aerobic and light resistant training program and weekly group sessions .  PA , quality of life , fitness , and physiological outcomes were assessed pre and post the 16-week intervention . Results Significant increases in PA , supported by changes in girth measures and blood pressure , support the beneficial impact of the intervention . Positive trends were also evident for depression and fatigue . However , due to the high dropout rate , these results must be interpreted with caution . Conclusions PA effectively attenuates many of the side effects of ADT and should be recommended to prostate survivors as an alternate therapy . Determining the maintenance of this behavior change will be important for underst and ing how the long-term benefits of increased activity levels may alleviate the late effects of ADT The purpose of this r and omized , controlled clinical trial was to preliminarily examine the effects of a three-week walking exercise program ( WEP ) on fatigue-related experiences of acute myelogenous leukemia ( AML ) patients receiving chemotherapy . Eligible AML patients were r and omly assigned to either an experimental group ( n=11 ) , which received 12 minutes of WEP per day , five days per week for three consecutive weeks , or to a control group ( n=11 ) , which received st and ard ward care . Effects of the WEP were assessed by seven indicators : worst and average fatigue intensities , fatigue interference with patients ' daily life , 12-minute walking distance , overall symptom distress , anxiety , and depressive status . All patients were evaluated four times : before chemotherapy ( baseline or Day 1 ) , Day 7 , Day 14 , and Day 21 of chemotherapy . Data were analyzed by Generalized Estimating Equation and revealed that AML patients in the three-week WEP group had a significantly greater increase in 12-minute walking distance than the control group . Patients in the WEP also had lower levels of fatigue intensity and interference , symptom distress , anxiety , and depressive status than the control group . Although preliminary , our results strongly suggest that three weeks of systematic walking exercise is clinical ly feasible for AML patients undergoing chemotherapy and can effectively improve their fatigue-related experiences The objective was to determine the effects of exercise training on changes in blood immune function in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n=25 ) or control group ( n=28 ) . The exercise group trained on cycle ergometers three times per week for 15 wk . The control group did not train . The primary end point was change in natural killer cell cytotoxic activity in isolated peripheral blood mononuclear cells . Secondary end points were changes in st and ard hematological variables , whole blood neutrophil function , the phenotypes of isolated mononuclear cells , estimations of unstimulated and phytohemaglutinin-stimulated mononuclear cell function ( rate of [3H]thymidine uptake ) , and the production of proinflammatory [ interleukin (IL)-1alpha , tumor necrosis factor-alpha , IL-6 ] and anti-inflammatory cytokines ( IL-4 , IL-10 , transforming growth factor-beta1 ) . Statistical tests were two-sided ( alpha < 0.05 ) . Fifty-two participants completed the trial . Intention-to-treat analyses , which included the baseline value as a covariate , showed significant differences between groups for change in percent specific lysis of a target natural killer cell at all five effector-to-target ratios ( adjusted mean between-group change over all 5 effector-to-target ratios = + 6.34 % ; P < 0.05 for all comparisons ) , the lytic activity per cell ( adjusted mean between-group change = -2.72 lytic units ; P=0.035 ) , and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes ( adjusted mean between-group change = + 218 per dpm x 10(6 ) cells ; P = 0.007 ) . There were no significant differences between groups for change in any other end point . Exercise training increased natural killer cell cytotoxic activity and unstimulated [3H]thymidine uptake by peripheral blood lymphocytes in postmenopausal breast cancer survivors Introduction Older breast cancer survivors ( BCS ) report more falls and functional limitations than women with no cancer history .  Exercise training could reduce risk factors for future falls and disability . Methods We conducted a r and omized , controlled trial in 106 early-stage , postmenopausal BCS who were ≥50 years old at diagnosis and post-treatment . Women were r and omly assigned to a 1-year resistance + impact exercise program or a stretching placebo program . Endpoints were one repetition maximum bench press and leg press strength , timed five chair st and s , 4 m usual walk speed , timed stance tests , h and grip strength , self-report physical function , and fatigue . We also examined the influence of age , adjuvant hormone therapy use , and exercise adherence on study outcomes . Results Women in the resistance + impact training program significantly improved maximal leg ( p < 0 .02 ) and bench ( p < 0 .02 ) press strength compared to the stretching group . Women who attended 50 % or more of prescribed resistance training sessions had significantly better changes in maximal strength measures compared to less adherent women . Conclusions Resistance + impact exercise is superior to stretching at improving maximal muscle strength and exercise adherence contributes to the degree of improvement . Implication s for cancer survivorsOlder BCS can safely engage in resistance exercise that improves lower and upper body strength , thereby reducing a risk factor for falls and future disability . However , the ability of resistance training to shift other indices of fall and disability risk , i.e. , balance and function , is unclear . Strategies to promote adherence to resistance training could lead to greater improvements in strength Purpose This study aims to evaluate the feasibility and efficacy of an 8-week supervised exercise program in de-conditioned cancer survivors within 2–6 months of chemotherapy completion . Methods Participants were r and omly assigned to an 8-week , twice-weekly , supervised aerobic exercise training regime ( n = 23 ) or a usual care group ( n = 20 ) .  Feasibility was assessed by recruitment rate , program adherence and participant feedback . The primary outcome was aerobic fitness assessed by the Modified Bruce fitness test at baseline ( 0 weeks ) , post-intervention ( 8 weeks ) and at 3-month follow-up . Secondary outcomes included physical activity , waist circumference , fatigue and quality of life . Results The recruitment rate was 81 % and adherence to the supervised exercise was 78.3 % . Meaningful differences in aerobic fitness between the exercise and usual care groups at both the 8-week [ mean 3.0 mL kg−1 min−1 ( 95 % CI −1.1–7.0 ) ] and 3-month follow-up [ 2.1 mL kg−1 min−1 ( −2.3–6.6 ) ] were found , although these differences did not achieve statistical significance ( p values > 0.14 ) . Self-reported physical activity increased in the exercise group ( EG ) compared to the usual care group at both 8-week ( p = 0.01 ) and 3-month follow-up ( p = 0.03 ) and significant differences in favour of the EG were found for physical well-being at both the 8-week ( p = 0.03 ) and 3-month follow-up ( p = 0.04 ) . Improvements in fatigue ( p = 0.01 ) , total quality of life plus fatigue ( p = 0.04 ) , and a composite physical functioning score ( p = 0.01 ) at the 3-month follow-up were also found . Conclusion The PEACH trial suggests that 8 weeks of supervised aerobic exercise training was feasible and may improve aerobic fitness , fatigue and quality of life in de-conditioned cancer survivors during the early survivorship phase . Implication s for Cancer SurvivorsExercise interventions commenced in the early survivorship phase appear safe , feasible and may lead to improvements in QOL and fatigue Advice to rest and take things easy if patients become fatigued during radiotherapy may be detrimental . Aerobic walking improves physical functioning and has been an intervention for chemotherapy‐related fatigue . A prospect i ve , r and omized , controlled trial was performed to determine whether aerobic exercise would reduce the incidence of fatigue and prevent deterioration in physical functioning during radiotherapy for localized prostate carcinoma The purpose of this study was to examine the effects of an exercise intervention on the total caloric intake ( TCI ) of breast cancer patients undergoing treatment . A secondary purpose was to determine whether or not a relationship existed between changes in TCI , body fat composition ( % BF ) , and fatigue during the study , which lasted 6 months . Twenty females recently diagnosed with breast cancer , scheduled to undergo chemotherapy or radiation , were assigned r and omly to an experimental ( N = 10 ) or control group ( N = 10 ) . Outcome measures included TCI ( 3-day food diary ) , % BF ( skinfolds ) , and fatigue ( revised Piper Fatigue Scale ) . Each exercise session was conducted as follows : initial cardiovascular activity ( 6 - 12 min ) , followed by stretching ( 5 - 10 min ) , resistance training ( 15 - 30 min ) , and a cool-down ( approximately 8 min ) . Significant changes in TCI were observed among groups ( F1,18 = 8.582 ; P = 0.009 ) , at treatments 2 and 3 , and at the end of the study [ experimental ( 1973 + /- 419 ) , control ( 1488 + /- 418 ) ; experimental ( 1946 + /- 437 ) , control ( 1436 + /- 429 ) ; experimental ( 2315 + /- 455 ) , control ( 1474 + /- 294 ) , respectively ] . A significant negative correlation was found ( Spearman rho(18 ) = -0.759 ; P < 0.001 ) between TCI and % BF and between TCI and fatigue levels ( Spearman rho(18 ) = -0.541 ; P = 0.014 ) at the end of the study . In conclusion , the results of this study suggest that an exercise intervention administered to breast cancer patients undergoing medical treatment may assist in the mitigation of some treatment side effects , including decreased TCI , increased fatigue , and negative changes in body composition Background : Few exercise trials in cancer patients have reported longer-term follow-up . Here , we report a 6-month follow-up of exercise behavior and patient-rated outcomes from an exercise trial in breast cancer patients . Methods : Breast cancer patients initiating adjuvant chemotherapy ( n = 242 ) were r and omly assigned to usual care ( n = 82 ) , resistance exercise training ( RET ; n = 82 ) , or aerobic exercise training ( AET ; n = 78 ) for the duration of their chemotherapy . At 6-month follow-up , participants were mailed a question naire that assessed quality of life , self-esteem , fatigue , anxiety , depression , and exercise behavior . Results : Two hundred one ( 83.1 % ) participants provided 6-month follow-up data . Adjusted linear mixed-model analyses showed that , at 6-month follow-up , the RET group reported higher self-esteem [ adjusted mean difference , 1.6 ; 95 % confidence interval ( 95 % CI ) , 0.1 - 3.2 ; P = 0.032 ] and the AET group reported lower anxiety ( adjusted mean difference , −4.7 ; 95 % CI , −0.0 to −9.3 ; P = 0.049 ) compared with the usual care group . Moreover , compared with participants reporting no regular exercise during the follow-up period , those reporting regular aerobic and resistance exercise also reported better patient-rated outcomes , including quality of life ( adjusted mean difference , 9.5 ; 95 % CI , 1.2 - 17.8 ; P = 0.025 ) . Conclusions : Improvements in self-esteem observed with RET during breast cancer chemotherapy were maintained at 6-month follow-up whereas reductions in anxiety not observed with AET during breast cancer chemotherapy emerged at 6-month follow-up . Moreover , adopting a combined aerobic and resistance exercise program after breast cancer chemotherapy was associated with further improvements in patient-rated outcomes . Exercise training during breast cancer chemotherapy may result in some longer-term and late effects for selected patient-rated outcomes . ( Cancer Epidemiol Biomarkers Prev 2007;16(12):2572–8 PURPOSE S/ OBJECTIVES To test the hypothesis that women participating in a walking exercise program during radiation therapy treatment for breast cancer would demonstrate more adaptive responses as evidence d by higher levels of physical functioning and lower levels of symptom intensity than women who did not participate . DESIGN Experimental , two-group pretest , post-test . SETTING Two university teaching hospital outpatient radiation therapy departments . SAMPLE 46 women beginning a six-week program of radiation therapy for early stage breast cancer . METHODS Following r and om assignment , subjects in the exercise group maintained an individualized , self-paced , home-based walking exercise program throughout treatment . The control group received usual care . Dependent variables were measured prior to and at the end of radiation therapy . In addition , symptoms were assessed at the end of three weeks of treatment . MAIN RESEARCH VARIABLES Participation in the walking exercise program , physical functioning fatigue , emotional distress , and difficulty sleeping . FINDINGS Hypothesis testing by multivariate analysis of covariance , with pretest scores as covariates , indicated significant differences between groups on outcome measures ( p < 0.001 ) . The exercise group scored significantly higher than the usual care group on physical functioning ( p = 0.003 ) and symptom intensity , particularly fatigue , anxiety , and difficulty sleeping . Fatigue was the most frequent and intense subjective symptom reported . CONCLUSIONS A self-paced , home-based walking exercise program can help manage symptoms and improve physical functioning during radiation therapy . IMPLICATION S FOR NURSING PRACTICE Nurse-prescribed and -monitored exercise is an effective , convenient , and low-cost self-care activity that reduces symptoms and facilitates adaptation to breast cancer diagnosis and treatment Objectives To determine functional and psychological benefits of a 12 week supervised group exercise programme during treatment for early stage breast cancer , with six month follow-up . Design Pragmatic r and omised controlled prospect i ve open trial . Setting Three National Health Service oncology clinics in Scotl and and community exercise facilities . Participants 203 women entered the study ; 177 completed the six month follow-up . Interventions Supervised 12 week group exercise programme in addition to usual care , compared with usual care . Main outcome measures Functional assessment of cancer therapy ( FACT ) question naire , Beck depression inventory , positive and negative affect scale , body mass index , seven day recall of physical activity , 12 minute walk test , and assessment of shoulder mobility . Results Mixed effects models with adjustment for baseline values , study site , treatment at baseline , and age gave intervention effect estimates ( intervention minus control ) at 12 weeks of 129 ( 95 % confidence interval 83 to 176 ) for metres walked in 12 minutes , 182 ( 75 to 289 ) for minutes of moderate intensity activity reported in a week , 2.6 ( 1.6 to 3.7 ) for shoulder mobility , 2.5 ( 1.0 to 3.9 ) for breast cancer specific subscale of quality of life , and 4.0 ( 1.8 to 6.3 ) for positive mood . No significant effect was seen for general quality of life ( FACT-G ) , which was the primary outcome . At the six month follow-up , most of these effects were maintained and an intervention effect for breast cancer specific quality of life emerged . No adverse effects were noted . Conclusion Supervised group exercise provided functional and psychological benefit after a 12 week intervention and six months later . Clinicians should encourage activity for their patients . Policy makers should consider the inclusion of exercise opportunities in cancer rehabilitation services . Trial registration Current controlled trials IS RCT N12587864 CONTEXT Physical activity has been shown to decrease the incidence of breast cancer , but the effect on recurrence or survival after a breast cancer diagnosis is not known . OBJECTIVE To determine whether physical activity among women with breast cancer decreases their risk of death from  breast cancer  compared with more sedentary women . DESIGN , SETTING , AND PARTICIPANTS Prospect i ve observational study based on responses from 2987 female registered nurses in the Nurses ' Health Study who were diagnosed with stage I , II , or III breast cancer between 1984 and 1998 and who were followed up until death or June 2002 , whichever came first . MAIN OUTCOME MEASURE Breast cancer mortality risk according to  physical activity  category ( <3 , 3 - 8.9 , 9 - 14.9 , 15 - 23.9 , or > or = 24 metabolic equivalent task [ MET ] hours per week ) . RESULTS Compared with women who engaged in less than 3 MET-hours per week of physical activity , the adjusted relative risk ( RR ) of death from breast cancer was 0.80 ( 95 % confidence interval [ CI ] , 0.60 - 1.06 ) for 3 to 8.9 MET-hours per week ; 0.50 ( 95 % CI , 0.31 - 0.82 ) for 9 to 14.9 MET-hours per week ; 0.56 ( 95 % CI , 0.38 - 0.84 ) for 15 to 23.9 MET-hours per week ; and 0.60 ( 95 % CI , 0.40 - 0.89 ) for 24 or more MET-hours per week ( P for trend = .004 ) . Three MET-hours is equivalent to walking at average pace of 2 to 2.9 mph for 1 hour . The benefit of physical activity was particularly apparent among women with hormone-responsive tumors . The RR of breast cancer death for women with hormone-responsive tumors who engaged in 9 or more MET-hours per week of activity compared with women with hormone-responsive tumors who engaged in less than 9 MET-hours per week was 0.50 ( 95 % CI , 0.34 - 0.74 ) . Compared with women who engaged in less than 3 MET-hours per week of activity , the absolute unadjusted mortality risk reduction was 6 % at 10 years for women who engaged in 9 or more MET-hours per week . CONCLUSIONS Physical activity after a breast cancer diagnosis may reduce the risk of death from this disease . The greatest benefit occurred in women who performed the equivalent of walking 3 to 5 hours per week at an average pace , with little evidence of a correlation between increased benefit and greater energy expenditure . Women with breast cancer who follow US physical activity recommendations may improve their survival OBJECTIVE To investigate the effectiveness of an 8-week aquatic program on  cancer-related fatigue , as well as physical and psychological outcomes in breast cancer survivors . DESIGN A r and omized controlled trial . SETTING Outpatient clinic , urban , academic medical center , and a sport university swimming pool . PARTICIPANTS Breast cancer survivors ( N=68 ) were r and omly assigned to either an experimental ( aquatic exercise group in deep water pool ) group or a control ( usual care ) group . INTERVENTIONS The intervention group attended aquatic exercise sessions 3 times per week for 8 weeks in a heated deep swimming pool . Sessions lasted 60 minutes in duration : 10 minutes of warm-up , 40 minutes of aerobic and endurance exercises , and 10 minutes of cool-down exercises . Patients allocated to the usual care group followed the oncologist 's recommendations in relation to a healthy lifestyle . MAIN OUTCOME MEASURES Values for fatigue ( Piper Fatigue Scale ) , mood state ( Profile of Mood States ) , and abdominal ( trunk curl static endurance test ) and leg ( multiple sit-to-st and test ) strength were collected at baseline , after the last treatment session , and at a 6-month follow-up . RESULTS Immediately after discharge , the aquatic exercise group showed a large effect size in total fatigue score ( d=.87 ; 95 % confidence interval , .48 - 1.26 ) , trunk curl endurance ( d=.92 ; 95 % confidence interval , 1.97 - 3.83 ) , and leg strength ( d=1.10 ; .55 - 2.76 ) , but negligible effects in vigor , confusion , and disturbance of mood ( d<.25 ) . At the 6-month follow-up period , the aquatic exercise group maintained large to small effect sizes in fatigue scores , multiple sit-to-st and test , and trunk curl static endurance ( .25>d>.90 ) and negligible effects for the fatigue-severity dimension and different scales of the Profile of Mood States ( d<.25 ) . CONCLUSION An aquatic exercise program conducted in deep water was effective for improving cancer-related fatigue and strength in breast cancer survivors PURPOSE To examine the effects of aerobic exercise therapy on quality of life ( QoL ) and associated outcomes in women treated for breast cancer . Evidence suggests that exercise may be beneficial , but no trial has included an exercise-placebo and a usual-care group to control for the attention effects that might be associated with aerobic exercise interventions in cancer patients . PATIENTS AND METHODS A total of 108 women who had been treated for breast cancer 12 to 36 months previously were r and omly assigned to supervised aerobic exercise therapy ( n = 34 ) , exercise-placebo ( body conditioning ; n = 36 ) , or usual care ( n = 38 ) . Exercise therapy and exercise-placebo sessions took place three times per week for 8 weeks . Outcomes included QoL , depression , exercise behavior , aerobic fitness ; outcomes were assessed at baseline and at the 8- and 24-week follow-up . RESULTS Analyses of covariance revealed a significant mean difference of 9.8 units in Functional Assessment of Cancer Therapy-General ( primary outcome ) favoring aerobic exercise therapy at 8 weeks , relative to usual care . Significant differences that favored aerobic exercise therapy relative to usual care were recorded for Functional Assessment of Cancer Therapy-Breast , social/family well-being , functional well-being , and breast cancer subscale scores at 8-week follow-up . Psychological health outcomes improved modestly for both intervention groups ; these improvements were sustained for several end points . CONCLUSION Exercise therapy had large , clinical ly meaningful , short-term beneficial effects on QoL in women treated for breast cancer ; this finding can not be attributable to attention , given that the exercise-placebo group did not report similar effects relative to usual care PURPOSE Breast cancer chemotherapy  may cause unfavorable changes in physical functioning , body composition , psychosocial functioning , and quality of life ( QOL ) . We evaluated the relative merits of aerobic and resistance exercise in blunting these effects . PATIENTS AND METHODS We conducted a multicenter r and omized controlled trial in Canada between 2003 and 2005 that r and omly assigned 242 breast cancer patients initiating adjuvant chemotherapy to usual care ( n = 82 ) , supervised resistance exercise  ( n = 82 ) , or supervised aerobic exercise  ( n = 78 ) for the duration of their chemotherapy ( median , 17 weeks ; 95 % CI , 9 to 24 weeks ) . Our primary end point was cancer-specific QOL assessed by the Functional Assessment of Cancer Therapy-Anemia scale . Secondary end points were fatigue , psychosocial functioning , physical fitness , body composition , chemotherapy completion rate , and lymphedema . RESULTS The follow-up assessment rate for our primary end point was 92.1 % , and adherence to the supervised exercise was 70.2 % . Unadjusted and adjusted mixed-model analyses indicated that aerobic exercise was superior to usual care for improving self-esteem ( P = .015 ) , aerobic fitness ( P = .006 ) , and percent body fat ( adjusted P = .076 ) . Resistance exercise was superior to usual care for improving self-esteem ( P = .018 ) , muscular strength ( P < .001 ) , lean body mass ( P = .015 ) , and chemotherapy completion rate ( P = .033 ) . Changes in cancer-specific QOL , fatigue , depression , and anxiety favored the exercise groups but did not reach statistical significance . Exercise did not cause lymphedema or adverse events . CONCLUSION Neither aerobic nor resistance exercise significantly improved cancer-specific QOL  in breast cancer patients receiving chemotherapy , but they did improve self-esteem , physical fitness , body composition , and chemotherapy completion rate without causing lymphedema or significant adverse events The authors investigated associations between serum  C-reactive protein ( CRP ) concentrations and colon and rectal cancer risk in a nested case-control study within the European Prospect i ve Investigation into Cancer and Nutrition ( 1992 - 2003 ) among 1,096 incident cases and 1,096 controls selected using risk-set sampling and matched on study center , age , sex , time of blood collection , fasting status , menopausal status , menstrual cycle phase , and hormone replacement therapy . In conditional logistic regression with adjustment for education , smoking , nutritional factors , body mass index , and waist circumference , CRP showed a significant nonlinear association with colon cancer risk but not rectal cancer risk . Multivariable-adjusted relative risks for CRP concentrations of > or = 3.0 mg/L versus < 1.0 mg/L were 1.36 ( 95 % confidence interval ( CI ) : 1.00 , 1.85 ; P-trend = 0.01 ) for colon cancer and 1.02 ( 95 % CI : 0.67 , 1.57 ; P-trend = 0.65 ) for rectal cancer . Colon cancer risk was significantly increased in men ( relative risk = 1.74 , 95 % CI : 1.11 , 2.73 ; P-trend = 0.01 ) but not in women ( relative risk = 1.06 , 95 % CI : 0.67 , 1.68 ; P-trend = 0.13 ) . Additional adjustment for C-peptide , glycated hemoglobin , and high density lipoprotein cholesterol did not attenuate these results . These data provide evidence that elevated CRP concentrations are related to a higher risk of colon cancer but not rectal cancer , predominantly among men and independently of obesity , insulin resistance , and dyslipidemia PURPOSE / OBJECTIVES To compare the effectiveness of a prescribed home-based walking exercise intervention with usual care in older women receiving hormonal treatment for breast cancer , and to examine relationships among levels of the cortisol , serotonin , interleukin-6 , and bilirubin biomarkers and fatigue , sleep disturbances , and depressive symptoms . DESIGN Longitudinal r and omized clinical trial . SETTING A National Cancer Institute- design ated cancer center in the southeastern United States . SAMPLE 20 women ( aged 55 years or older ) with breast cancer receiving hormonal treatment . METHODS Participants were r and omized to a walking exercise intervention or usual care . Laboratory sample s and the Pittsburgh Sleep Quality Index ( PSQI ) , the Piper Revised Fatigue Scale , and the Center for Epidemiological Studies -Depression Scale were collected at the initial clinic visit and at 12 weeks from the groups . Question naires also were collected at weeks 2 and 14 . MAIN RESEARCH VARIABLES Fatigue , sleep disturbances , depressive symptoms , biomarkers , and exercise . FINDINGS Effect of the exercise intervention on sleep scores was highly significant between groups . Exercise group scores on the PSQI decreased significantly over time ( indicating improved sleep quality ) , although scores did not change significantly within the control group . Sleep actigraphy also showed significantly shorter actual wake time and less movement in the exercise group . Serotonin levels also were significantly affected by the intervention . CONCLUSIONS Data suggest that a walking exercise intervention improves sleep in older women receiving hormonal treatment for their breast cancer . Serotonin levels may be a useful biomarker when assessing sleep disturbances in this group . IMPLICATION S FOR NURSING Clinicians need to be aware that older women receiving hormonal treatment for their breast cancer may experience fatigue , sleep disturbances , and depressive symptoms . Homebased walking activity may reduce symptom severity in this group OBJECTIVE To show fatigue prevention and quality of life ( QOL ) improvement from cardiovascular exercise during  radiotherapy .  DESIGN Prospect i ve enrollment ( n=21 ) , r and omized to exercise ( n=11 ) and control groups ( n=10 ) , with pre- and post-radiotherapy between- and within-group comparisons . SETTING Academic medical center . PARTICIPANTS Localized prostate cancer patients undergoing radiotherapy . INTERVENTIONS The interventional group received radiotherapy plus aerobic exercise 3 times a week for 8 weeks whereas the control group received radiotherapy without exercise . MAIN OUTCOME MEASURES Pre- and post-radiotherapy differences in cardiac fitness , fatigue , depression , functional status , physical , social , and functional well-being , leg strength , and flexibility were examined within and between 2 groups . RESULTS No significant differences existed between 2 groups at pre-radiotherapy assessment . At post-radiotherapy assessment , the exercise group showed significant within group improvements in : cardiac fitness ( P<.001 ) , fatigue ( P=.02 ) , Functional Assessment of Cancer Therapy-Prostate ( FACT-P ) ( P=.04 ) , physical well-being ( P=.002 ) , social well-being ( P=.02 ) , flexibility ( P=.006 ) , and leg strength ( P=.000 ) . Within the control group , there was a significant increase in fatigue score ( P=.004 ) and a decline in social well-being ( P<.05 ) at post-radiotherapy assessment . Between-group differences at post-radiotherapy assessment were significant in cardiac fitness ( P=.006 ) , strength ( P=.000 ) , flexibility ( P<.01 ) , fatigue ( P<.001 ) , FACT-P ( P=.006 ) , physical well-being ( P<.001 ) , social well-being ( P=.002 ) , and functional well-being ( P=.04 ) . CONCLUSIONS An 8-week cardiovascular exercise program in patients with localized prostate cancer undergoing radiotherapy improved cardiovascular fitness , flexibility , muscle strength , and overall QOL and prevented fatigue The purpose of this r and omized controlled trial was to determine the effects of an 8-week ( aerobic+strength ) exercise training program ( 3 sessions/week ) on the circulating cytokine levels of breast cancer survivors . We r and omly allocated 16 female survivors of breast cancer ( mean±SD age : 50±5 years ) to an intervention or usual care ( control ) group ( N=8 in each group ) . The intervention group followed an 8-week exercise program consisting of 3 sessions/week ( session duration : 90 min ) . We measured the levels of the following cytokines before and after the intervention : beta-NGF , CTACK , eotaxin , FGF basic , G-CSF , gmCSFα , HGF , ICAM1 , IFNα2 , IFNγ , IL1α , IL1ß , IL1ra , IL2 , IL2ra , IL3 , IL4 , IL6 , IL7 , IL8 , IL9 , IL10 , IL12 , IL13 , IL15 , IL16 , IL17 , IL18 , IP10 , LIF , MCS-F , MIP1α , MIP1β , MIF , MCP1 , MCP3 , MIG , PDGF bb , SCF , SCGFβ , SDF1α , TRAIL , TNFα , TNFβ , VCAM1 , and VEGF . We only observed a significant interaction ( group*time ) effect for CTACK ( P=0.016 ) , with mean values remaining stable in the intervention group but increasing over time in controls . The intervention program did not induce a significant decrease in the main breast cancer-related cytokines such as IL6 and IL8 . A combined ( aerobic+strength ) 8-week exercise training intervention did not induce major changes in the basal cytokine levels of breast cancer survivors This pilot study examined whether exercise as an adjunctive rehabilitation therapy could benefit women who have early stage breast cancer and are currently receiving chemotherapy/radiotherapy . The study was design ed as a r and omised controlled trial ( RCT ) . Physical functioning , fatigue and Quality of Life ( QoL ) outcomes were evaluated pre and post a 12-week intervention . The results showed that after 12 weeks the women who participated in the exercise programme ( n = 12 ) displayed significantly higher levels of physical functioning and reported higher QoL scores than the controls ( n = 10 ) . Changes in fatigue and satisfaction with life favoured the intervention group but did not reach significance . These results are encouraging and suggest that a structured group exercise programme during adjuvant treatment is a safe , well tolerated and effective way of providing physical and psychological health benefits to women during treatment for early stage breast cancer . Since this was a pilot study the numbers did not allow appropriately powered analyses of some variables of interest and favoured relatively young and socio-economically advantaged women . Future studies need to address these issues and determine if these short-term benefits can be sustained PURPOSE / OBJECTIVES To compare usual care with a home-based individualized exercise program ( HBIEP ) in patients receiving intensive treatment for multiple myeloma ( MM ) and epoetin alfa therapy .  DESIGN R and omized trial with repeated measures of two groups ( one experimental and one control ) and an approximate 15-week experimental period . SETTING Outpatient setting of the Myeloma Institute for Research and Therapy at the Rockfellow Cancer Center at the University of Arkansas for Medical Sciences . SAMPLE 187 patients with newly diagnosed MM enrolled in a separate study evaluating effectiveness of the Total Therapy regimen , with or without thalidomide . METHODS Measurements included the Profile of Mood States fatigue scale , Functional Assessment of Cancer Therapy-Fatigue , ActiGraph ® recordings , 6-Minute Walk Test , and hemoglobin levels at baseline and before and after stem cell collection . Descriptive statistics were used to compare demographics and treatment effects , and repeated measures analysis of variance was used to determine effects of HBIEP . MAIN RESEARCH VARIABLES Fatigue , nighttime sleep , performance ( aerobic capacity ) as dependent or outcome measures , and HBIEP combining strength building and aerobic exercise as the independent variable . FINDINGS Both groups were equivalent for age , gender , race , receipt of thalidomide , hemoglobin levels , and type of treatment regimen for MM . No statistically significant differences existed among the experimental and control groups for fatigue , sleep , or performance ( aerobic capacity ) . Statistically significant differences ( p < 0.05 ) were found in each of the study outcomes for all patients as treatment progressed and patients experienced more fatigue and poorer nighttime sleep and performance ( aerobic capacity ) . CONCLUSIONS The effect of exercise seemed to be minimal on decreasing fatigue , improving sleep , and improving performance ( aerobic capacity ) . IMPLICATION S FOR NURSING Exercise is safe and has physiologic benefits for patients undergoing MM treatment ; exercise combined with epoetin alfa helped alleviate anemia Purpose Cancer and its treatment-related side effects induce loss of physical performance . This study evaluated the effects of multimodal aerobic and strength exercises on physical performance in hospitalized cancer patients while receiving myeloablative chemotherapy . Methods In this prospect i ve pilot study , 48 evaluable patients were r and omly assigned to a training ( TG , n = 24 ) or control ( CG , n = 24 ) group . The TG performed an individually supervised exercise program five times a week with ergometer training and strength exercises for 20 min each during the hospitalization period for chemotherapy . The CG received st and ard physiotherapy .  Physical performance was evaluated using spiroergometry , lung function , and muscle strength testing . Treatment-related side effects were assessed by daily interviews , quality of life by EORTC-QLQ-C30 , and fatigue using the Modified Fatigue Impact Scale ( MFIS ) question naire . Results Physical performance significantly increased in the TG ( 8.96 ± 24 W ) and decreased in the CG ( −7.24 ± 20 W , p = 0.02 ) . At 2-mmol/ml blood lactate concentration , the TG achieved significantly increased oxygen consumption ( p = 0.03 ) and expiratory minute ventilation ( p = 0.04 ) compared to the CG . Furthermore , physical functioning increased significantly in the TG ( p = 0.04 ) . Patients in the TG required less antiemetics ( p = 0.01 ) and experienced significantly less fatigue ( p = 0.04 ) , although MFIS analysis was not able to detect this beneficial effect . Patients of the CG displayed higher impairments of cognitive ( p = 0.02 ) and psychosocial function ( p = 0.03 ) after chemotherapy . No adverse events due to the study intervention were observed . Conclusions Multimodal exercise has beneficial effects on physical performance , physical functioning , and treatment-related symptoms even during myeloablative chemotherapy . We suggest an enhanced physical activity intervention program during hospitalization of cancer patients 1 . The present study investigates to what extent and by which time course prolonged strenuous exercise influences the plasma concentration of pro-inflammatory and inflammation responsive cytokines as well as cytokine inhibitors and anti-inflammatory cytokines . 2 . Ten male subjects ( median age 27.5 years , range 24 - 37 ) completed the Copenhagen Marathon 1997 ( median running time 3 : 26 ( h : min ) , range 2 : 40 - 4 : 20 ) . Blood sample s were obtained before , immediately after and then every 30 min in a 4 h post-exercise recovery period . 3 . The plasma concentrations of tumour necrosis factor (TNF)alpha , interleukin (IL)-1beta , IL-6 , IL-1ra , sTNF-r1 , sTNF-r2 and IL-10 were measured by enzyme-linked immunosorbent assay ( ELISA ) . The highest concentration of IL-6 was found immediately after the race , whereas IL-1ra peaked 1 h post exercise ( 128-fold and 39-fold increase , respectively , as compared with the pre-exercise values ) . The plasma level of IL-1beta , TNFalpha , sTNF-r1 and sTNF-r2 peaked in the first hour after the exercise ( 2 . 1- , 2.3- , 2.7- and 1.6-fold , respectively ) . The plasma level of IL-10 showed a 27-fold increase immediately post exercise . 4 . In conclusion , strenuous exercise induces an increase in the pro-inflammatory cytokines TNFalpha and IL-1beta and a dramatic increase in the inflammation responsive cytokine IL-6 . This is balanced by the release of cytokine inhibitors ( IL-1ra , sTNF-r1 and sTNF-r2 ) and the anti-inflammatory cytokine IL-10 . The study suggests that cytokine inhibitors and anti-inflammatory cytokines restrict the magnitude and duration of the inflammatory response to exercise BACKGROUND Active for Life After Cancer is a r and omized trial evaluating the efficacy of a 6-month group-based lifestyle physical activity program ( Lifestyle ) for prostate cancer patients to improve quality of life ( QOL ) including physical and emotional functioning compared to a group-based Educational Support Program and a St and ard Care Program ( no group ) . METHOD A total of 134 prostate cancer patients receiving continuous and rogen-ablation were r and omly assigned to one of the three study conditions . RESULTS Results indicated no significant improvements in QOL at 6 or 12 months . Both group-based programs were positively received and yielded good attendance and retention . Lifestyle participants demonstrated significant improvements in most theoretical mediators proposed by the Transtheoretical Model and Social Cognitive Theory to affect physical activity . Despite these improvements , no significant changes were found for most physical activity measures . CONCLUSIONS Results suggest a lifestyle program focusing on cognitive-behavioral skills training alone is insufficient for promoting routine physical activity in these patients OBJECTIVE To examine predictors of adherence in a r and omized controlled trial of resistance exercise training ( RET ) in prostate cancer survivors receiving and rogen deprivation therapy . STUDY DESIGN AND SETTING A r and omized controlled trial conducted at fitness centers in Ottawa and Edmonton , Canada . Prostate cancer survivors ( n=155 ) completed measures of social cognitive variables , quality of life ( QOL ) , behavior , and fitness before being r and omized to either an exercise ( n=82 ) or control ( n=73 ) group . The exercise group was asked to perform supervised RET three times per week for 12 weeks . RESULTS The exercise group attended 28.2 of the 36 ( 78.3 % ) RET sessions . Univariate analyses revealed eight different significant ( Ps < .05 ) predictors of exercise adherence including exercise stage of change , intention , age , QOL , fatigue , subjective norm , leg-press test , and perceived behavioral control . A multivariate analysis indicated that there were three independent predictors of adherence that explained 20.4 % of the variance : exercise stage of change ( beta=0.26 ; P=.013 ) , age ( beta=-0.22 ; P=.037 ) , and intention ( beta=0.19 ; P=.073 ) . CONCLUSION Exercise adherence in the trial was very good but not optimal . Adherence was predicted by variables from many different categories including social cognitive , QOL , behavioral , fitness , and demographic . These findings may have important implication s for maximizing adherence during clinical trials of exercise in prostate cancer survivors During radiation therapy , cancer patients may report  cancer-related fatigue ( CRF ) , which impairs aerobic capacity , strength , muscle mass , and , ultimately , quality of life ( QOL ) . The purpose of this pilot clinical trial was to examine the feasibility and initial efficacy of a home-based aerobic and progressive resistance exercise intervention for aerobic capacity , strength , muscle mass , CRF , and QOL . Daily steps walked ( DSW ) , daily minutes of resistance exercise ( MRE ) , and number of resistance exercise days ( RED ) were assessed to evaluate intervention adherence . Breast and prostate cancer patients ( n = 38 ) beginning radiation therapy  were r and omized to undergo 4 weeks of exercise or no exercise . Participants in the exercise group demonstrated good adherence to the exercise intervention , with significantly more DSW , MRE , and RED at post intervention and 3 month follow-up than controls . Participants in the exercise intervention exhibited significantly higher QOL and significantly lower CRF post intervention and at 3-month follow-up than controls . Results of this pilot study provide positive preliminary evidence that exercise during radiation may be beneficial for cancer patients BACKGROUND Physical exercise can improve cancer patients ' functioning and reduce their symptom levels . A r and omized , controlled trial was launched to test the hypothesis that physical exercise reduces fatigue and improves physical performance in cancer patients with advanced and incurable disease . METHODS Cancer patients ( n = 231 ) with a life expectancy ≤2 years were r and omized to a physical exercise group ( PEG , n = 121 ) or a control usual care group ( UCG , n = 110 ) . The PEG exercised under supervision 60 minutes twice a week for 8 weeks . Assessment s were performed before and after the intervention . The primary outcome was physical fatigue ( PF ) measured by the Fatigue Question naire . Physical performance was a secondary outcome measured by the Shuttle Walk Test ( SWT ) and h and grip strength ( HGS ) test . Analyses were performed after multiple imputations for missing data . The trial is registered with Clinical Trials.gov ( identifier , NCT00397774 ) . FINDINGS Thirty-six percent of the PEG were lost to follow-up compared with 23 % of the UCG , primarily as a result of disease progression . Seventy-eight PEG and 85 UCG patients completed the intervention . Analyses showed no significant between-group effects in PF . However , clinical ly and statistically significant between-group effects were found for the SWT and HGS test . INTERPRETATION Fatigue was not reduced but physical performance ( SWT and HGS test ) was significantly improved after 8 weeks of physical exercise . Physical exercise might therefore be a suitable approach for maintaining physical capacity in cancer patients with incurable and advanced disease PURPOSE / OBJECTIVES To examine the effects of a seated exercise program on fatigue and quality of life ( QOL ) in women with metastatic breast cancer . DESIGN R and omized , controlled , longitudinal trial . SETTING Outpatient clinic of a comprehensive cancer center . SAMPLE Convenience sample of 38 women who were beginning outpatient chemotherapy . METHODS Subjects were r and omized to a control or intervention group ; the intervention was performance of a seated exercise program using home videotape three times per week for four cycles of chemotherapy . All subjects completed the Functional Assessment of Chronic Illness Therapy Fatigue Version IV ( FACIT F ) at baseline and at the time of the next three cycles . Subjects were asked to document the frequency , duration , and intensity of all exercise participation on monthly calendars . MAIN RESEARCH VARIABLES Exercise , fatigue , and QOL . FINDINGS 32 subjects , 16 per group , completed the study follow-up . With a mixed modeling approach , total FACIT F scores for the entire sample declined at a significant rate ( p = 0.003 ) beginning with cycle 3 but at a slower rate for the experimental group ( p = 0.02 ) . Fatigue scores indicated less increase and physical well-being subscale scores showed less decline for the experimental group ( p = 0.008 and p = 0.02 , respectively ) . CONCLUSIONS Women with advanced breast cancer r and omized to the seated exercise intervention had a slower decline in total and physical well-being and less increase in fatigue scores starting with the third cycle of chemotherapy . IMPLICATION S FOR NURSING Seated exercise may be a feasible exercise program for women with advanced cancer for controlling fatigue and improving physical well-being PURPOSE Chronic inflammation is believed to contribute to the development and progression of breast cancer . Systemic C-reactive protein ( CRP ) and serum amyloid A ( SAA ) are measures of low- grade chronic inflammation and potential predictors of cancer survival . PATIENTS AND METHODS We evaluated the relationship between circulating markers of inflammation and breast cancer survival using data from the Health , Eating , Activity , and Lifestyle ( HEAL ) Study ( a multiethnic prospect i ve cohort study of women diagnosed with stage 0 to IIIA breast cancer ) . Circulating concentrations of CRP and SAA were measured approximately 31 months after diagnosis and tested for associations with disease-free survival ( approximately 4.1 years of follow-up ) and overall survival ( approximately 6.9 years of follow-up ) in 734 disease-free breast cancer survivors . Cox proportional hazards models were used with adjustment for potential confounding factors to generate hazard ratios ( HRs ) and 95 % CIs . Results Elevated SAA and CRP were associated with reduced overall survival , regardless of adjustment for age , tumor stage , race , and body mass index ( SAA P trend < .0001 ; CRP P trend = .002 ) . The HRs for SAA and CRP tertiles suggested a threshold effect on survival , rather than a dose-response relationship ( highest v lowest tertile : SAA HR = 3.15 ; 95 % CI , 1.73 to 5.65 ; CRP HR = 2.27 ; 95 % CI , 1.27 to 4.08 ) . Associations were similar and still significant after adjusting for self-reported history of cardiovascular events and censoring cardiovascular disease deaths . Elevated CRP and SAA were also associated with reduced disease-free survival , although these associations were of borderline significance ( SAA P trend = .04 ; CRP P trend = .07 ) . CONCLUSION Circulating SAA and CRP  may be important prognostic markers for long-term survival  in breast cancer patients , independent of race , tumor stage , and body mass index PURPOSE Regular physical activity reduces the risk of developing colon cancer , however , its influence on patients with established disease is unknown . PATIENTS AND METHODS We conducted a prospect i ve observational study of 832 patients with stage III colon cancer enrolled in a r and omized adjuvant chemotherapy trial . Patients reported on various recreational physical activities approximately 6 months after completion of therapy and were observed for recurrence or death . To minimize bias by occult recurrence , we excluded patients who experienced recurrence or died within 90 days of their physical activity assessment . RESULTS Compared with patients engaged in less than three metabolic equivalent task ( MET ) -hours per week of physical activity , the adjusted hazard ratio for disease-free survival was 0.51 ( 95 % CI , 0.26 to 0.97 ) for 18 to 26.9 MET-hours per week and 0.55 ( 95 % CI , 0.33 to 0.91 ) for 27 or more MET-hours per week . The adjusted P for trend was .01 . Postdiagnosis activity was associated with similar improvements in recurrence-free survival ( P for trend = .03 ) and overall survival ( P for trend = .01 ) . The benefit associated with physical activity was not significantly modified by sex , body mass index , number of positive lymph nodes , age , baseline performance status , or chemotherapy received . Moreover , the benefit remained unchanged even after excluding participants who developed cancer recurrence or died within 6 months of activity assessment . CONCLUSION Beyond surgical resection and postoperative adjuvant chemotherapy for stage III colon cancer , for patients who survive and are recurrence free approximately 6 months after adjuvant chemotherapy , physical activity appears to reduce the risk of cancer recurrence and mortality CONTEXT Testicular germ cell cancer ( GCC ) patients treated with cisplatin-etoposide-bleomycin chemotherapy ( BEP )  have excellent prognosis but have an increased risk of late-occurring morbidities , which may be associated with changes in the inflammatory profile . OBJECTIVE The objective of the study was to explore plasma cytokine concentrations in GCC patients r and omized to resistance training or usual care during BEP , in comparison with healthy controls . DESIGN / SETTING This was a r and omized controlled trial in GCC patients enrolled from an oncology clinic , including a healthy reference group for comparison purpose s. OUTCOME MEASURES Plasma granulocyte macrophage colony-stimulating factor , interferon-γ , IL-1β , IL-2 , IL-6 , IL-8 , IL-10 , IL-12 , and TNF-α were measured in fasting blood sample s from GCC patients r and omized to resistance training ( INT ; n = 15 ) or usual care ( CON ; n = 15 ) and healthy age-matched controls ( REF ; n = 19 ) . Clinical toxicity assessment s and patient-reported end points were also recorded . RESULTS CON and INT were balanced at baseline . Compared with REF , CON had higher concentrations of IL-10 , IL-6 , and interferon-γ , and INT had higher concentrations of IL-6 , IL-8 and TNF-α ( all P < .05 ) . At the end of therapy , concentrations of IL-6 , IL-8 , and IL-10 increased in both GCC groups ( all P < .01 ) . Three months after therapy , all cytokine concentrations were comparable with the pretreatment levels in both GCC-groups but remained elevated compared with REF ( P < .05 ) . Changes in TNF-α correlated with pulmonary toxicity ( P < .01 ) . At the end of therapy , IL-6 concentrations correlated with quality of life ( P < .05 ) and fatigue ( P < .01 ) . CONCLUSION GCC patients treated with BEP display consistently elevated levels of systemic inflammatory markers compared with healthy controls . Resistance training during therapy has no impact on plasma cytokine concentrations CONTEXT Exercise benefits patients with cancer , but studies of home-based approaches , particularly among those with Stage IV disease , remain small and exploratory . OBJECTIVES To conduct an adequately powered trial of a home-based exercise intervention that can be facilely integrated into established delivery and reimbursement structures . METHODS Sixty-six adults with Stage IV lung or colorectal cancer were r and omized , in an eight-week trial , to usual care or incremental walking and home-based strength training . The exercising participants were instructed during a single physiotherapy visit and subsequently exercised four days or more per week ; training and step-count goals were advanced during bimonthly telephone calls . The primary outcome measure was mobility assessed with the Ambulatory Post Acute Care Basic Mobility Short Form . Secondary outcomes included ratings of pain and sleep quality as well as the ability to perform daily activities ( Ambulatory Post Acute Care Daily Activities Short Form ) , quality of life ( Functional Assessment of Cancer Therapy-General ) , and fatigue ( Functional Assessment of Cancer Therapy-Fatigue ) . RESULTS Three participants dropped out and seven died ( five in the intervention and two in the control group , P=0.28 ) . At Week 8 , the intervention group reported improved mobility ( P=0.01 ) , fatigue ( P=0.02 ) , and sleep quality ( P=0.05 ) compared with the usual care group , but did not differ on the other measures . CONCLUSION A home-based exercise program seems capable of improving the mobility , fatigue , and sleep quality of patients with Stage IV lung and colorectal cancer Health-related quality of life ( HRQOL ) in leukemia and lymphoma patients treated with high-dose chemotherapy followed by allogeneic ( SCT ) and autologous ( ASCT ) stem cell transplantation or receiving combination chemotherapy ( CT )  was prospect ively assessed by the EORTC QLQ-C30 and compared with reference data from a general population sample . One year after transplant , the SCT group had functional scores which were close to population values except for lower social ( P < 0.0001 ) and role function ( P = 0.0004 ) . More symptoms and problems were reported , especially appetite loss ( P = 0.001 ) and financial difficulties ( P = 0.0001 ) . The ASCT patients reported a less than optimal HRQOL relative to the population 1 year post transplant . Cognitive , physical , role , and social function , dyspnoea , financial difficulties and global quality of life were most impaired ( P < 0.001 ) . in the ct group , physical , role and social function , dyspnoea and financial difficulties were impaired 1 year after start of chemotherapy , compared with the general population ( P < 0.001 ) . the eortc qlq-c30 was supplemented by a high-dose chemotherapy module , the hdc-19 , at the 1-year assessment , but no consistent differences were found across groups . fifteen to 34 % of the patients expressed fears of relapse and worries about future health , while 24–30 % indicated no participation in sexual activities PURPOSE To evaluate the effectiveness of a supervised home-based flexible training program on cardiorespiratory fitness ( CRF ) , mental distress , and health-related quality of life ( HRQOL ) parameters in young and middle-aged cancer patients shortly after curative chemotherapy . PATIENTS AND METHODS One hundred eleven patients age 18 to 50 years who had received chemotherapy for lymphomas or breast , gynecologic , or testicular cancer completed the trial . These patients were r and omly allocated to either an intervention group ( n = 59 ) , which underwent a 14-week training program , or a control group ( n = 52 ) that received st and ard care . Primary outcome was change in CRF , as determined by Astr and -Rhyming indirect bicycle ergometer test ( maximum oxygen uptake [ VO(2max ) ] ) , between baseline ( T0 ) and follow-up ( T1 ) . Secondary outcomes were mental distress , as assessed by the Hospital Anxiety and Depression Scale , and HRQOL , as assessed by the European Organisation for Research and Treatment of Cancer Core Quality of Life Question naire . Two-way analysis of covariance was used to analyze changes from T0 to T1 . RESULTS VO(2max ) increased by 6.4 mL/kg(-1)/min(-1 ) in patients in the intervention group and by 3.1 mL/kg(-1)/min(-1 ) in patients in the control group ( P < .01 ) . The fatigue score decreased by 17.0 points in the control group compared with only 5.8 points in the intervention group ( P < .01 ) . There were no intergroup differences in mental distress or HRQOL . CONCLUSION A supervised , home-based , flexible training program has significant effect on CRF in young and middle-aged cancer patients shortly after curative chemotherapy , but it has no favorable effect on patients ' experience of fatigue , mental distress , or HRQOL Study objectives . Cancer-related fatigue is a significant and distressing problem for the cancer patient , affecting their physical and psychosocial function negatively , and reducing their quality of life . The aims of this study were to assess frequency , severity , and the consequence of fatigue in cancer out patients receiving cytotoxic drugs  , using an existing international fatigue scale applied for Swedish use . Methods . The study used a non-r and omized , prospect i ve design to evaluate fatigue and its impact on quality of life in out patients receiving cytotoxic drugs .  Once a week , 147 cancer patients , in an outpatient ward for cytotoxic drug administration , filled out question naires containing 13 items from the Fatigue Symptom Inventory ( FSI ) , and five additional questions . Results . Prevalence of fatigue was 92 % in the week after all patients had received cytotoxic drugs , and patients were statistically significantly more fatigued during than before treatment . The degree of fatigue was highest the week after treatment , and declined over the following week . Other symptoms , especially depressed mood , showed a strong correlation with cancer and cytotoxic-induced fatigue . Lung and breast cancer patients experienced the highest degree of fatigue . Some cytotoxic drug regimens were , apart from the underlying disease , associated with high fatigue scores , eg , those with cyclophosphamide or gemcitabine . Patients not receiving first line treatment scored significantly higher fatigue with more influence on daily living . Conclusion . The study verified that fatigue is a common side effect , and affects quality of life negatively , even for out patients receiving cytotoxic drugs . The clinical oncology pharmacist must inform patients that a severe tiredness , fatigue , may follow cytotoxic drug administration BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . The objective of this study was to determine the effects of exercise training on changes in C-reactive protein ( CRP ) and other cardiovascular risk factors in postmenopausal breast cancer survivors . Fifty-three postmenopausal breast cancer survivors were r and omly assigned to an exercise ( n = 25 ) or control group ( n = 28 ) . The exercise group trained on cycle ergometers 3 times per week for 15 weeks . The control group did not train . The primary end point was change in CRP between baseline and week 15 . Secondary end points were changes in RHR , HRR , SBP , DBP , TC , LDL-C , HDL-C , TG , and TC : HDL-C ratio .  Fifty-two participants completed the trial . Baseline values did not differ between groups except that TG ( p = .007 ) and TC : HDL-C ratio ( p = .023 ) were higher in the exercise group . Intention-to-treat analysis showed that CRP decreased by 1.39 mg/L in the exercise group whereas it increased by 0.10 mg/L in the control group ( mean between group change , -1.49 mg/L ; 95 % CI , -3.09 to 0.10 mg/L ; p = .066 ) . Intention-to-treat analysis also showed a clinical ly and statistically significant difference between groups for change in HRR ( mean change , + 10.6 beats/min ; 95 % CI , + 3.4 to + 17.7 beats/min ; p = .004 ) and clinical ly but not statistically significant differences between groups for change in RHR ( mean change , -5.5 beats/min ; 95 % CI , -11.5 to + 0.5 beats/min ; p = .073 ) , SBP ( mean change , -5.5 mmHg ; 95 % CI , -14.5 to + 3.4 mmHg ; p = .218 ) , DBP ( mean change,-3.6 mmHg ; 95 % CI , -9.3 to + 2.1 mmHg ; p = .214 ) , and HDL-C ( mean change , + 0.05 mmol/L ; 95 % CI , -0.03 to 0.14 mmol/L ; p = .214 ) . These data suggest that exercise training may have beneficial effects on CRP and other cardiovascular risk factors in postmenopausal breast cancer survivors . Larger r and omized controlled trials are warranted BACKGROUND Exercise improves physical functioning and symptom management during breast cancer chemotherapy , but the effects of different doses and types of exercise are unknown . METHODS A multicenter trial in Canada r and omized 301 breast cancer patients to thrice-weekly supervised exercise during chemotherapy  consisting of either a st and ard dose of 25 to 30 minutes of aerobic exercise ( STAN ; n = 96 ) , a higher dose of 50 to 60 minutes of aerobic exercise ( HIGH ; n = 101 ) , or a combined dose of 50 to 60 minutes of aerobic and resistance exercise ( COMB ; n = 104 ) . The primary endpoint was physical functioning assessed by the Medical Outcomes Survey-Short Form (SF)-36 . Secondary endpoints were other physical functioning scales , symptoms , fitness , and chemotherapy completion . All statistical tests were linear mixed model analyses , and the P values were two-sided . RESULTS Follow-up assessment of patient-reported outcomes was 99.0 % . Adjusted linear mixed-model analyses showed that neither HIGH ( + 0.8 ; 95 % confidence interval [ CI ] = -0.8 to 2.4 ; P = .30 ) nor COMB ( + 0.5 ; 95 % CI = -1.1 to 2.1 ; P = .52 ] were superior to STAN for the primary outcome . In secondary analyses not adjusted for multiple comparisons , HIGH was superior to STAN for the SF-36 physical component summary ( P = .04 ) , SF-36 bodily pain ( P = .02 ) , and endocrine symptoms ( P = .02 ) . COMB was superior to STAN for endocrine symptoms ( P = .009 ) and superior to STAN ( P < .001 ) and HIGH ( P < .001 ) for muscular strength . HIGH was superior to COMB for the SF-36 bodily pain ( P = .04 ) and aerobic fitness ( P = .03 ) . No differences emerged for body composition or chemotherapy completion . CONCLUSIONS A higher volume of aerobic or combined exercise is achievable and safe during breast cancer chemotherapy and may manage declines in physical functioning and worsening symptoms better than st and ard volumes Cancer patients often report impaired sleep quality . Impaired sleep quality may be due to increased levels of sleep-mediating cytokines result ing from cancer treatment . Exercise may have a positive influence on sleep-mediating cytokines , such as interleukin-6 ( IL-6 ) , tumor necrosis factor-alpha ( TNF-α ) , and soluble tumor necrosis factor-alpha receptor ( sTNF-R ) , which may improve sleep quality . This two-arm pilot study compared the influence of a home-based exercise intervention with st and ard care/control on sleep quality and mediators of sleep . Breast and prostate cancer patients ( n = 38 ) beginning radiation therapy were r and omized to a 4-week exercise program or no exercise arm . Global sleep quality , subjective sleep quality , sleep latency , sleep duration , sleep efficiency , sleep disturbances , use of sleep medication , and daytime dysfunction were assessed with the Pittsburgh Sleep Quality Index . IL-6 , TNF-α , and sTNF-R were measured before and after intervention . There was a greater improvement in sleep quality in the exercise  group from pre- to postintervention , although the difference was not significant . Additionally , there were associations between IL-6 and sleep efficiency and duration , suggesting that regulation of sleep-mediating cytokines by exercise may mediate improvements in sleep- quality components PURPOSE Physically active individuals have a lower risk of developing colorectal cancer but the influence of exercise on cancer survival is unknown . PATIENTS AND METHODS By a prospect i ve , observational study of 573 women with stage I to III colorectal cancer , we studied colorectal cancer-specific and overall mortality according to predefined physical activity categories before and after diagnosis and by change in activity after diagnosis . To minimize bias by occult recurrences , we excluded women who died within 6 months of their postdiagnosis physical activity assessment . RESULTS Increasing levels of exercise after diagnosis of nonmetastatic colorectal cancer reduced cancer-specific mortality ( P for trend = .008 ) and overall mortality ( P for trend = .003 ) . Compared with women who engaged in less than 3 metabolic equivalent task [ MET ] -hours per week of physical activity , those engaging in at least 18 MET-hours per week had an adjusted hazard ratio for colorectal cancer-specific mortality of 0.39 ( 95 % CI , 0.18 to 0.82 ) and an adjusted hazard ratio for overall mortality of 0.43 ( 95 % CI , 0.25 to 0.74 ) . These results remained unchanged even after excluding women who died within 12 and 24 months of activity assessment . Prediagnosis physical activity was not predictive of mortality . Women who increased their activity ( when comparing prediagnosis to postdiagnosis values ) had a hazard ratio of 0.48 ( 95 % CI , 0.24 to 0.97 ) for colorectal cancer deaths and a hazard ratio of 0.51 ( 95 % CI , 0.30 to 0.85 ) for any-cause death , compared with those with no change in activity . CONCLUSION Recreational physical activity after the diagnosis of stages I to III colorectal cancer may reduce the risk of colorectal cancer-specific and overall mortality PURPOSE To investigate the association between pre- and postdiagnosis physical activity ( as well as change in prediagnosis to postdiagnosis physical activity ) and mortality among women with breast cancer . PATIENTS AND METHODS This was a prospect i ve observational study of 933 women enrolled onto the Health , Eating , Activity , and Lifestyle Study who were diagnosed with local or regional breast cancer between 1995 and 1998 and observed until death or September 2004 , whichever came first . The primary outcomes measured were total deaths and breast cancer deaths . The primary exposures were  physical activity in the year before and 2 years after diagnosis and the pre- to postdiagnosis change in physical activity . RESULTS Compared with inactive women , the multivariable hazard ratios ( HRs ) for total deaths for women expending at least 9 metabolic equivalent hours per week ( approximately 2 to 3 h/wk of brisk walking ) were 0.69 ( 95 % CI , 0.45 to 1.06 ; P = .045 ) for those active in the year before diagnosis and 0.33 ( 95 % CI , 0.15 to 0.73 ; P = .046 ) for those active 2 years after diagnosis . Compared with women who were inactive both before and after diagnosis , women who increased physical activity  after diagnosis had a 45 % lower risk of death ( HR = 0.55 ; 95 % CI , 0.22 to 1.38 ) , and women who decreased physical activity  after diagnosis had a four-fold greater risk of death ( HR = 3.95 ; 95 % CI , 1.45 to 10.50 ) . CONCLUSION Moderate-intensity physical activity after a diagnosis of breast cancer may improve prognosis PURPOSE Physical activity ( PA ) has been suggested to help increase the survival of individuals with cancer . The objective of this review was to systematic ally evaluate and summarize the available evidence investigating the effect of PA on the survival of individuals with cancer . METHODS Electronic data bases ( CINAHL , EMBASE , and MEDLINE ) were systematic ally search ed for r and omized controlled trials and cohort studies . Selected studies were assessed by two independent investigators for method ological quality , using the PEDro scale . RESULTS Ten prospect i ve cohort studies met the inclusion criteria . Quality - assessment scores averaged 5/10 on the PEDro scale , with two articles obtaining a score of 6/10 . The majority of studies found that individuals participating in higher levels of physical activity had a reduced risk of cancer-related mortality . This trend was observed specifically for breast , colon , and colorectal cancers . On average , it appears that engaging in higher levels of metabolic equivalent hours per week may help to improve survival rates among individuals diagnosed with cancer . CONCLUSION Patients diagnosed with cancer demonstrated a trend toward increased survival with greater levels of PA . However , because only prospect i ve cohort studies were included in the study , the conclusions drawn should be regarded with caution Exercise use among patients with cancer has been shown to have many benefits and few notable risks . The purpose of this study was to evaluate the impact of a home-based walking intervention during cancer treatment on sleep quality , emotional distress , and fatigue . Methods . A total of 138 patients with prostate ( 55.6 % ) , breast ( 32.5 % ) , and other solid tumors ( 11.9 % ) were r and omized to a  home-based walking intervention or usual care . Exercise dose was assessed using a five-item subscale of the Cooper Aerobics Center Longitudinal Study Physical Activity Question naire . Primary outcomes of sleep quality , distress , and fatigue were compared between the two study arms . Results . The exercise group ( n = 68 ) reported more vigor ( p = .03 ) than control group participants ( n = 58 ) . In dose response models , greater participation in aerobic exercise was associated with 11 % less fatigue ( p < .001 ) , 7.5 % more vigor ( p = .001 ) , and 3 % less emotional distress ( p = .03 ) , after controlling for intervention group assignment , age , and baseline exercise and fatigue levels . Conclusion . Patients who exercised during cancer treatment experienced less emotional distress than those who were less active . Increasing exercise was also associated with less fatigue and more vigor .  Home-based walking is a simple , sustainable strategy that may be helpful in improving a number of symptoms encountered by patients undergoing active treatment for cancer PURPOSE Lymphoma patients commonly experience declines in physical functioning and quality of life ( QoL )  that may be reversed with exercise training . PATIENTS AND METHODS We conducted a r and omized controlled trial in Edmonton , Alberta , Canada , between 2005 and 2008 that stratified 122 lymphoma patients by major disease type and current treatment status and r and omly assigned them to usual care ( UC ; n = 62 ) or 12 weeks of supervised aerobic exercise training ( AET ; n = 60 ) . Our primary end point was patient-rated physical functioning assessed by the Trial Outcome Index-Anemia . Secondary end points were overall QoL , psychosocial functioning , cardiovascular fitness , and body composition . RESULTS Follow-up assessment for our primary end point was 96 % ( 117 of 122 ) at postintervention and 90 % ( 110 of 122 ) at 6-month follow-up . Median adherence to the supervised exercise program was 92 % . At postintervention , AET was superior to UC for patient-rated physical functioning ( mean group difference , + 9.0 ; 95 % CI , 2.0 to 16.0 ; P = .012 ) , overall QoL ( P = .021 ) , fatigue ( P = .013 ) , happiness ( P = .004 ) , depression ( P = .005 ) , general health ( P < .001 ) , cardiovascular fitness ( P < .001 ) , and lean body mass ( P = .008 ) . Change in peak cardiovascular fitness mediated the change in patient-rated physical functioning . AET did not interfere with chemotherapy completion rate or treatment response . At 6-month follow-up , AET was still borderline or significantly superior to UC for overall QoL ( P = .054 ) , happiness ( P = .034 ) , and depression ( P = .009 ) without an increased risk of disease recurrence/progression . CONCLUSION AET significantly improved important patient-rated outcomes and objective physical functioning in lymphoma patients without interfering with medical treatments or response . Exercise training to improve cardiovascular fitness should be considered in the management of lymphoma patients The European Cancer Anaemia Survey ( ECAS ) was conducted to prospect ively evaluate the prevalence , incidence and treatment of anaemia ( haemoglobin < 12.0 g/dL ) in European cancer patients , including the relationship of mild , moderate and severe anaemia to performance status . Patients were evaluated for up to 6 months . Data ( N=15367 ) included demographics , tumour type , performance status , haemoglobin levels , cancer treatments and anaemia treatments . Prevalence of anaemia at enrollment was 39.3 % ( haemoglobin < 10.0 g/dL , 10 % ) , and 67.0 % during the survey ( haemoglobin < 10.0 g/dL , 39.3 % ) . Low haemoglobin levels correlated significantly with poor performance status . Incidence of anaemia was 53.7 % ( haemoglobin < 10.0 g/dL , 15.2 % ) . Anaemia was treated in 38.9 % of patients ( epoetin , 17.4 % ; transfusion , 14.9 % ; and iron , 6.5 % ) . Mean haemoglobin to initiate anaemia treatment was 9.7 g/dL. Anaemia prevalence and incidence in cancer patients are high . Anaemia significantly correlates with poor performance status and many anaemic patients are not treated A haematopoietic SCT ( HSCT ) can cause severe side effects , which may have a profound impact on a patient 's life both physically and psychologically . Some studies have shown that physical activity has positive effects for in patients after an HSCT .  Therefore , the question arises whether a controlled exercise programme right from the beginning of the conditioning phase could help contribute to a patient 's physical and psychological recovery . To evaluate the different effects of specific , moderate physical activities on the physical and psychological condition of HSCT  patients we performed a controlled r and omized study with 64 in patients undergoing an allogeneic or autologous HSCT .  The patients were r and omly assigned to two groups . Although the training group took part in a specific programme of exercise therapy twice a day throughout the entire hospitalization phase , patients in the control group were offered the hospital 's st and ard mobilization programme . The results of this study showed significant differences in favour of the training group regarding strength , endurance , lung function and quality of life . However , further studies are needed to confirm these results The purpose of this pilot study was to preliminarily examine the effects of an exercise program on the symptoms of fatigue , sleep disturbance , mood disturbance , symptom distress , and physical fitness for Thai women with breast cancer . Twenty-three eligible women were r and omly assigned to either an experimental group ( n = 11 ) or to a control group ( n = 12 ) . Data were collected and analyzed at baseline and again at 4 , 7 , and 10 weeks . At each time point , fatigue was measured at an expected high point during treatment . Participants in the exercise group demonstrated a trend toward improving the symptoms with mean score changes . Using generalized estimating equations analysis , a significant decrease in mood disturbance was found in the exercise group compared with control at 10 weeks ( β = 0.03 , P = 0.04 ) . The participants exhibited significantly longer 12-minute walk distance at 10 weeks than those in the control group ( t = 2.28 , P = 0.04 ) . These results indicate that exercise during adjuvant chemotherapy may be beneficial for Thai women with breast cancer AIM The study aim ed at determining whether physical exercise training improves the quality of life ( QoL ) and physical fitness of breast cancer survivors . PATIENTS AND METHODS A total of 573 breast cancer survivors were r and omized into an exercise or a control group , 12-months after adjuvant treatments . EORTC QLQ-C30 and BR-23 question naires were used for evaluation of QoL , FACIT-F for fatigue and the Finnish modified version of Beck 's 13-item depression scale ( RBDI ) for depression . Physical fitness was assessed by a 2-km walking test , and a figure-8 running test and physical activity ( PA )  by metabolic equivalent ( MET ) hours per week ( MET-h/wk ) . RESULTS Figure-8 running time improved significantly among the patients of the intervention group compared with the controls ( p<0.001 ) . No significant between-group differences were observed in 2-km walking time , in PA , EORTC-QLQ-C30 , BR-23 , FACIT-F or BDI . However , there was a linear relationship between increased PA and improved QoL ( p=0.006 ) , irrespective of the intervention . CONCLUSION Increase in physical activity was associated with improved QoL , but no effect of the exercise intervention was observed BACKGROUND As patients with pancreas and periampullary cancer ( PPC ) experience improved survival rates and longevity , the focus shifts toward living life while surviving cancer . Fatigue is the most commonly reported symptom in all cancer patients .  Exercise has been found to effectively decrease fatigue levels and improve physical functioning in cancer patients . STUDY DESIGN One hundred two patients with resected PPC consented to participate in this study and were r and omized to either an intervention group ( IG ) or a usual care group ( UCG ) . Subjects completed visual analog scales , the FACIT-Fatigue Scale and the Short Form-36v2 after surgery and again 3 to 6 months after hospital discharge . RESULTS Patients in the IG and UCG were comparable with regard to demographics , comorbidities , cancer type and staging , type of resection , preoperative fatigue and pain levels , adjuvant therapy , and baseline walking distance . Patients in the IG had significantly improved scores on the FACIT-Fatigue Scale at study completion , improved fatigue and pain scores , as well as overall physical functioning and mental health composite scores . At study completion , participants in the IG were walking twice as far and were significantly more likely to have continued walking or another form of exercise as compared with the UCG . Using hierarchical cluster analysis , 3 mutually exclusive symptom groupings were identified in the cohort . Kaplan-Meier survival analysis did not indicate an overall survival benefit for the IG . CONCLUSIONS This is the first prospect i ve , r and omized controlled trial to report that participation in a home walking program confers a significant benefit in resected PPC patients with regard to fatigue levels , physical functioning , and health-related quality of life Fatigue is a common and often severe problem in cancer patients undergoing chemotherapy .  The authors postulated that physical activity training can reduce the intensity of fatigue in this group of patients Fatigue is the most prevalent and debilitating symptom experienced by breast cancer patients receiving adjuvant chemotherapy or radiation therapy and few evidence -based treatments are available to manage this distressing side-effect . The purpose of this multi-institutional r and omized controlled trial was to determine the effects of exercise on fatigue levels during treatment for breast cancer . Sedentary women ( N=119 ) with Stage 0-III breast cancer receiving outpatient adjuvant chemotherapy or radiation therapy were r and omized to a home-based moderate-intensity walking exercise program or to usual care for the duration of their cancer treatment . Of participants r and omized to exercise , 72 % adhered to the exercise prescription ; 61 % of the usual care group adhered . The intention-to-treat analysis revealed no group differences in part because of a dilution of treatment effect as 39 % of the usual care group exercised and 28 % of the exercise group did not . When exercise participation was considered using the data analysis method of instrumental variables with principal stratification , a clinical ly important and statistically significant ( p=0.03 ) effect of exercise on pretest-to-posttest change in fatigue levels was demonstrated . Adherence to a home-based moderate-intensity walking exercise program may effectively mitigate the high levels of fatigue prevalent during cancer treatment Before , during , and after allogeneic hematopoietic stem cell transplantation ( allo-HSCT ) , patients experience considerable physical and psychologic distress . Besides graft-versus-host disease and infections , reduced physical performance and high levels of fatigue affect patients ' quality of life . This multicenter r and omized controlled trial examined the effects of a partly self-administered exercise intervention before , during , and after allo-HSCT on these side effects . After r and omization to an exercise and a social contact control group  105 patients trained in a home-based setting before hospital admission , during inpatient treatment and a 6- to 8-week period after discharge .  Fatigue , physical performance , quality of life , and physical/psychologic distress were measured by st and ardized instruments at baseline , admission to , and discharge from hospital and 6 to 8 weeks after discharge . The exercise group showed significantly improvement in fatigue scores ( up to 15 % improvement in exercise group vs up to 28 % deterioration in control ; P<.01-.03 ) , physical fitness/functioning ( P=.02-.03 ) and global distress ( P=.03 ) . All effects were at least detectable at one assessment time point after hospitalization or repeatedly . Physical fitness correlated significantly with all reported symptoms/variables . In conclusion , this partly supervised exercise intervention is beneficial for patients undergoing allo-HSCT . Because of low personnel requirements , it might be valuable to integrate such a program into st and ard medical care PURPOSE Radiotherapy for prostate cancer ( PCa ) may cause unfavorable changes in fatigue , quality of life ( QOL ) , and physical fitness . We report results from the Prostate Cancer Radiotherapy and Exercise Versus Normal Treatment study examining the effects of 24 weeks of resistance or aerobic training versus usual care on fatigue , QOL , physical fitness , body composition , prostate-specific antigen , testosterone , hemoglobin , and lipid levels in men with PCa receiving radiotherapy . PATIENTS AND METHODS Between 2003 and 2006 , we conducted a r and omized controlled trial in Ottawa , Canada , where 121 PCa patients initiating radiotherapy with or without and rogen deprivation therapy  were r and omly assigned to usual care ( n = 41 ) , resistance ( n = 40 ) , or aerobic exercise ( n = 40 ) for 24 weeks . Our primary end point was fatigue assessed by the Functional Assessment of Cancer Therapy-Fatigue scale . RESULTS The follow-up assessment rate for our primary end point of fatigue was 92.6 % . Median adherence to prescribed exercise was 85.5 % . Mixed-model repeated measures analyses indicated both resistance ( P = .010 ) and aerobic exercise ( P = .004 ) mitigated fatigue over the short term . Resistance exercise also produced longer-term improvements ( P = .002 ) . Compared with usual care , resistance training improved QOL ( P = .015 ) , aerobic fitness ( P = .041 ) , upper- ( P < .001 ) and lower-body ( P < .001 ) strength , and triglycerides ( P = .036 ) , while preventing an increase in body fat ( P = .049 ) . Aerobic training also improved fitness ( P = .052 ) . One serious adverse event occurred in the group that performed aerobic exercise . CONCLUSION In the short term , both resistance and aerobic exercise mitigated  fatigue in men with PCa receiving radiotherapy  . Resistance exercise generated longer-term improvements and additional benefits for QOL , strength , triglycerides , and body fat Abstract Background . To evaluate the safety and efficacy of moderate-to-high intensity aerobic training in breast cancer patients receiving neoadjuvant chemotherapy . Methods . Twenty patients with stage IIB – IIIC operable breast cancer were r and omly assigned to receive doxorubicin plus cyclophosphamide ( AC ) or AC in combination with aerobic training ( AC + AET ) ( n = 10/group ) for 12 weeks . The AC+ AET group performed three supervised aerobic cycle ergometry sessions per week at 60%–100 % of exercise capacity ( VO2peak ) . Safety outcomes included exercise testing as well as treatment- and exercise training-related adverse events ( AEs ) , whereas efficacy outcomes included cardiopulmonary function and patient-reported outcomes ( PROs ) as measured by a cardiopulmonary exercise test ( CPET ) and Functional Assessment of Cancer Therapy-Breast ( FACT-B ) scale . Results . Twelve non-significant ECG abnormalities and three non-life threatening events occurred during CPET procedures . One AE was reported during aerobic training . There were no significant between group differences for clinician-documented events ( e.g. pain , nausea ) or hematological parameters ( p 's > 0.05 ) . Attendance and adherence rates to aerobic training were 82 % and 66 % , respectively . Intention-to-treat analysis indicated that VO2peak increased by 2.6 ± 3.5 ml/kg/min ( + 13.3 % ) in the AC + AET group and decreased by 1.5 ± 2.2 ml/kg/min ( −8.6 % ) in the AC group ( between group difference , p = 0.001 ) . FACT-B increased 11.1 points in the AC + AET group compared to a 1.5 point decrease in the AC group ( between group difference , p = 0.685 ) . Conclusion . Moderate-to-high intensity aerobic training when conducted with one-on-one supervision is a safe adjunct therapy associated with improvements in cardiopulmonary function and select PROs during neoadjuvant chemotherapy
target: A significant negative association was found between aerobic exercise intensity and fatigue reduction .
  A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance .
  No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes .
  Rates of adherence were typically high and few adverse events were reported .
  Exercise is safe , reduces fatigue and increases endurance in cancer survivors .
background: QUESTION Is there a dose-response effect of exercise on inflammation , fatigue and activity in cancer survivors ?