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Ax, A.-K., Husberg, M., Johansson, B., Demmelmaier, I., Berntsen, S., Sjövall, K., . . . Davidson, T. (2023). Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT. Acta Oncologica, 62(4), 414-421
Open this publication in new window or tab >>Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT
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2023 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 62, no 4, p. 414-421Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Cost-effectiveness is important in the prioritisation between interventions in health care. Exercise is cost-effective compared to usual care during oncological treatment; however, the significance of exercise intensity to the cost-effectiveness is unclear. In the present study, we aimed to evaluate the long-term cost-effectiveness of the randomised controlled trial Phys-Can, a six-month exercise programme of high (HI) or low-to-moderate intensity (LMI) during (neo)adjuvant oncological treatment.

METHODS: A cost-effectiveness analysis was performed, based on 189 participants with breast, colorectal, or prostate cancer (HI: n = 99 and LMI: n = 90) from the Phys-Can RCT in Sweden. Costs were estimated from a societal perspective, and included cost of the exercise intervention, health care utilisation and productivity loss. Health outcomes were assessed as quality-adjusted life-years (QALYs), using EQ-5D-5L at baseline, post intervention and 12 months after the completion of the intervention.

RESULTS: At 12-month follow-up after the intervention, the total cost per participant did not differ significantly between HI (€27,314) and LMI exercise (€29,788). There was no significant difference in health outcome between the intensity groups. On average HI generated 1.190 QALYs and LMI 1.185 QALYs. The mean incremental cost-effectiveness ratio indicated that HI was cost effective compared with LMI, but the uncertainty was large.

CONCLUSIONS: We conclude that HI and LMI exercise have similar costs and effects during oncological treatment. Hence, based on cost-effectiveness, we suggest that decision makers and clinicians can consider implementing both HI and LMI exercise programmes and recommend either intensity to the patients with cancer during oncological treatment to facilitate improvement of health.

Place, publisher, year, edition, pages
Taylor & Francis, 2023
Keywords
Cancer, cost-effectiveness, exercise, health
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-501994 (URN)10.1080/0284186X.2023.2200149 (DOI)000971022300001 ()37074759 (PubMedID)
Available from: 2023-05-17 Created: 2023-05-17 Last updated: 2024-03-18Bibliographically approved
Henriksson, A., Strandberg, E., Stenling, A., Mazzoni, A.-S., Sjövall, K., Börjeson, S., . . . Nordin, K. (2023). Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance- and endurance exercise program?: Results from the Phys-Can trial. BMC Sports Science, Medicine and Rehabilitation, 15(1), Article ID 8.
Open this publication in new window or tab >>Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance- and endurance exercise program?: Results from the Phys-Can trial
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2023 (English)In: BMC Sports Science, Medicine and Rehabilitation, E-ISSN 2052-1847 , Vol. 15, no 1, article id 8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Resistance exercise has a beneficial impact on physical function for patients receiving oncological treatment. However, there is an inter-individual variation in the response to exercise and the tolerability to high-intensity exercise. Identifying potential moderating factors, such as inflammation and treatment type, for changes in muscle strength is important to improve the effectiveness of exercise programs. Therefore, we aimed to investigate if inflammation and type of oncological treatment moderate the effects of exercise intensity (high vs. low-moderate) on muscular strength changes in patients with breast (BRCA) or prostate cancer (PRCA).

METHODS: Participants with BRCA (n = 286) and PRCA (n = 65) from the Physical training and Cancer study (Phys-Can) were included in the present study. Participants performed a combined resistance- and endurance exercise program during six months, at either high or low-moderate intensity. Separate regression models were estimated for each cancer type, with and without interaction terms. Moderators included in the models were treatment type (i.e., neo/adjuvant chemotherapy-yes/no for BRCA, adjuvant androgen deprivation therapy (ADT)-yes/no for PRCA)), and inflammation (interleukin 6 (IL6) and tumor necrosis factor-alpha (TNFα)) at follow-up.

RESULTS: For BRCA, neither IL6 (b = 2.469, 95% CI [- 7.614, 12.552]) nor TNFα (b = 0.036, 95% CI [- 6.345, 6.418]) levels moderated the effect of exercise intensity on muscle strength change. The same was observed for chemotherapy treatment (b = 4.893, 95% CI [- 2.938, 12.724]). Similarly, for PRCA, the effect of exercise intensity on muscle strength change was not moderated by IL6 (b = - 1.423, 95% CI [- 17.894, 15.048]) and TNFα (b = - 1.905, 95% CI [- 8.542, 4.732]) levels, nor by ADT (b = - 0.180, 95% CI [- 11.201, 10.841]).

CONCLUSIONS: The effect of exercise intensity on muscle strength is not moderated by TNFα, IL6, neo/adjuvant chemotherapy, or ADT, and therefore cannot explain any intra-variation of training response regarding exercise intensity (e.g., strength gain) for BRCA or PRCA in this setting.

TRIAL REGISTRATION: ClinicalTrials.gov NCT02473003.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Androgen deprivation therapy, Cancer, Chemotherapy, Exercise intensity, Inflammation, Moderators, Resistance training
National Category
Cancer and Oncology Sport and Fitness Sciences
Identifiers
urn:nbn:se:uu:diva-495983 (URN)10.1186/s13102-023-00617-3 (DOI)000914000300001 ()36658635 (PubMedID)
Available from: 2023-02-06 Created: 2023-02-06 Last updated: 2024-03-18Bibliographically approved
Western, B., Demmelmaier, I., Vistad, I., Hansen, B. H., Stenling, A., Henriksen, H. B., . . . Berntsen, S. (2023). How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors. PLOS ONE, 18(4), Article ID e0284881.
Open this publication in new window or tab >>How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors
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2023 (English)In: PLOS ONE, E-ISSN 1932-6203, Vol. 18, no 4, article id e0284881Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Physical activity (PA) monitoring is applied in a growing number of studies within cancer research. However, no consensus exists on how many days PA should be monitored to obtain reliable estimates in the cancer population. The objective of the present study was to determine the minimum number of monitoring days required for reliable estimates of different PA intensities in cancer survivors when using a six-days protocol. Furthermore, reliability of monitoring days was assessed stratified on sex, age, cancer type, weight status, and educational level.

METHODS: Data was obtained from two studies where PA was monitored for seven days using the SenseWear Armband Mini in a total of 984 cancer survivors diagnosed with breast, colorectal or prostate cancer. Participants with ≥22 hours monitor wear-time for six days were included in the reliability analysis (n = 736). The intra-class correlation coefficient (ICC) and the Spearman Brown prophecy formula were used to assess the reliability of different number of monitoring days.

RESULTS: For time in light PA, two monitoring days resulted in reliable estimates (ICC >0.80). Participants with BMI ≥25, low-medium education, colorectal cancer, or age ≥60 years required one additional monitoring day. For moderate and moderate-to-vigorous PA, three monitoring days yielded reliable estimates. Participants with BMI ≥25 or breast cancer required one additional monitoring day. Vigorous PA showed the largest within subject variations and reliable estimates were not obtained for the sample as a whole. However, reliable estimates were obtained for breast cancer survivors (4 days), females, BMI ≥30, and age <60 years (6 days).

CONCLUSION: Shorter monitoring periods may provide reliable estimates of PA levels in cancer survivors when monitored continuously with a wearable device. This could potentially lower the participant burden and allow for less exclusion of participants not adhering to longer protocols.

Place, publisher, year, edition, pages
Public Library of Science (PLoS), 2023
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-501995 (URN)10.1371/journal.pone.0284881 (DOI)000984510200038 ()37093874 (PubMedID)
Available from: 2023-05-17 Created: 2023-05-17 Last updated: 2024-03-19Bibliographically approved
Schauer, T., Henriksson, A., Strandberg, E., Lindman, H., Berntsen, S., Demmelmaier, I., . . . Christensen, J. F. (2023). Pre-treatment levels of inflammatory markers and chemotherapy completion rates in patients with early-stage breast cancer. International Journal of Clinical Oncology, 28(1), 89-98
Open this publication in new window or tab >>Pre-treatment levels of inflammatory markers and chemotherapy completion rates in patients with early-stage breast cancer
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2023 (English)In: International Journal of Clinical Oncology, ISSN 1341-9625, E-ISSN 1437-7772, Vol. 28, no 1, p. 89-98Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Chemotherapy efficacy is largely dependent on treatment adherence, defined by the relative dose intensity (RDI). Identification of new modifiable risk factors associated with low RDI might improve chemotherapy delivery. Here, we evaluated the association between low RDI and pre-chemotherapy factors, including patient- and treatment-related characteristics and markers of inflammation.

METHODS: This exploratory analysis assessed data from 267 patients with early-stage breast cancer scheduled to undergo (neo-)adjuvant chemotherapy included in the Physical training and Cancer (Phys-Can) trial. The association between low RDI, defined as < 85%, patient-related (age, body mass index, co-morbid condition, body surface area) and treatment-related factors (cancer stage, receptor status, chemotherapy duration, chemotherapy dose, granulocyte colony-stimulating factor) was investigated. Analyses further included the association between RDI and pre-chemotherapy levels of interleukin (IL)-6, IL-8, IL-10, C-reactive protein (CRP) and Tumor Necrosis Factor-alpha (TNF-α) in 172 patients with available blood samples.

RESULTS: An RDI of < 85% occurred in 31 patients (12%). Univariable analysis revealed a significant association with a chemotherapy duration above 20 weeks (p < 0.001), chemotherapy dose (p = 0.006), pre-chemotherapy IL-8 (OR 1.61; 95% CI (1.01; 2.58); p = 0.040) and TNF-α (OR 2.2 (1.17; 4.53); p = 0.019). In multivariable analyses, inflammatory cytokines were significant association with low RDI for IL-8 (OR: 1.65 [0.99; 2.69]; p = 0.044) and TNF-α (OR 2.95 [1.41; 7.19]; p = 0.007).

CONCLUSIONS: This exploratory analysis highlights the association of pre-chemotherapy IL-8 and TNF-α with low RDI of chemotherapy for breast cancer. IL-8 and TNF-α may therefore potentially help to identify patients at risk for experiencing dose reductions. Clinical trial number NCT02473003 (registration: June 16, 2015).

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Breast cancer, Chemotherapy, Interleukin-8, Relative dose intensity, Tumor necrosis factor-alpha
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-488595 (URN)10.1007/s10147-022-02255-0 (DOI)000870927000003 ()36269530 (PubMedID)
Available from: 2022-11-18 Created: 2022-11-18 Last updated: 2024-03-18Bibliographically approved
Mazzoni, A.-S., Strandberg, E., Börjeson, S., Sjövall, K., Berntsen, S., Demmelmaier, I. & Nordin, K. (2023). Reallocating sedentary time to physical activity: effects on fatigue and quality of life in patients with breast cancer in the Phys-Can project. Supportive Care in Cancer, 31(2), Article ID 151.
Open this publication in new window or tab >>Reallocating sedentary time to physical activity: effects on fatigue and quality of life in patients with breast cancer in the Phys-Can project
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2023 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 31, no 2, article id 151Article in journal (Refereed) Published
Abstract [en]

PURPOSE: We aimed to investigate the effects of reallocating sedentary time to an equal amount of light (LPA) or moderate-to-vigorous intensity physical activity (MVPA) on cancer-related fatigue and health-related quality of life (HRQoL) in patients with breast cancer. We also aimed to determine the daily amount of sedentary time needed to be reallocated to LPA or MVPA to produce minimal clinically important changes in these outcomes.

METHODS: Pooled baseline data from three studies were used, including women with breast cancer who participated in the Phys-Can project. Fatigue was assessed with the Multidimensional Fatigue Inventory questionnaire (MFI; five dimensions, 4-20 scale) and HRQoL with the European Organisation for Research and Treatment of Cancer quality of life questionnaire (EORTC QLQ-C30; 0-100 scale). Sedentary time and physical activity were measured with accelerometry. Isotemporal substitution modelling was used for the analyses.

RESULTS: Overall, 436 participants (mean age 56 years, fatigue 11 [MFI], HRQoL 66 [EORTC QLQ-C30], LPA 254 min/day, MVPA 71 min/day) were included. Fatigue significantly decreased in two MFI dimensions when reallocating 30 min/day of sedentary time to LPA: reduced motivation and reduced activity (β =  - 0.21). Fatigue significantly decreased in three MFI dimensions when reallocating 30 min/day of sedentary time to MVPA: general fatigue (β =  - 0.34), physical fatigue (β =  - 0.47) and reduced activity (β =  - 0.48). To produce minimal clinically important changes in fatigue (- 2 points on MFI), the amount of sedentary time needed to be reallocated to LPA was ≈290 min/day and to MVPA was ≥ 125 min/day. No significant effects were observed on HRQoL when reallocating sedentary time to LPA or MVPA.

CONCLUSIONS: Our results suggest that reallocating sedentary time to LPA or MVPA has beneficial effects on cancer-related fatigue in patients with breast cancer, with MVPA having the greatest impact. In relatively healthy and physically active breast cancer populations, a large amount of time reallocation is needed to produce clinically important changes. Future studies are warranted to evaluate such effects in broader cancer populations.

TRIAL REGISTRATION: NCT02473003 (10/10/2014) and NCT04586517 (14/10/2020).

Place, publisher, year, edition, pages
Springer Nature, 2023
Keywords
Breast cancer, Fatigue, Isotemporal substitution, Physical activity, Quality of life, Sedentary behaviour
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-495984 (URN)10.1007/s00520-023-07614-9 (DOI)000924462300001 ()36738358 (PubMedID)
Available from: 2023-02-06 Created: 2023-02-06 Last updated: 2024-03-19Bibliographically approved
Jakobsson Larsson, B., Nordin, K. & Nygren, I. (2023). Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory. Journal of the Neurological Sciences, 455, Article ID 122780.
Open this publication in new window or tab >>Symptoms of anxiety and depression in patients with amyotrophic lateral sclerosis and their relatives during the disease trajectory
2023 (English)In: Journal of the Neurological Sciences, ISSN 0022-510X, E-ISSN 1878-5883, Vol. 455, article id 122780Article in journal (Refereed) Published
Abstract [en]

OBJECTS: The aim of this study was to describe the presence of anxiety and depression among patients with Amyotrophic Lateral Sclerosis (ALS) and their relatives from diagnosis and during the disease progression. An additional aim was to explore if the patient's physical function correlated with the patients' or relatives' anxiety and depression.

METHODS: A prospective and longitudinal study, including 33 patients with ALS and their relatives who filled out the Hospital Anxiety and Depression Scale (HADS) at the time of diagnosis and over a period of two years. The patient's physical function was measured with the revised Amyotrophic Lateral Sclerosis Functional and Rating Scale (ALS FRS-R).

RESULTS: The results showed that many patients (45%) and relatives (58%) had symptoms of anxiety and that 13% of the patients and 29% of the relatives had symptoms of depression soon after the patient had been diagnosed with ALS. The prevalence of anxiety decreased over time in the group of patients but remained stable in the group of relatives. Relatives had more symptoms of anxiety compared to patients. There was a correlation between the patient's physical function and HADS in the group of relatives; however, no correlation was found in the group of patients.

CONCLUSION: The results showed that many patients and relatives suffered from symptoms of anxiety quite soon after their diagnosis, and that many relatives had symptoms of anxiety during the disease trajectory. This highlights the need to continuously measure patients' anxiety/depression level but also to pay attention to symptoms among relatives.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
Amyotrophic lateral sclerosis, Anxiety, Depression, Longitudinal, Patients, Relatives
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-517315 (URN)10.1016/j.jns.2023.122780 (DOI)001115478600001 ()37976792 (PubMedID)
Funder
Uppsala UniversityNorrbacka-Eugenia Foundation
Available from: 2023-12-06 Created: 2023-12-06 Last updated: 2023-12-19Bibliographically approved
Mazzoni, A.-S., Bjorke, A. C., Stenling, A., Boerjeson, S., Sjoevall, K., Berntsen, S., . . . Nordin, K. (2023). The Role of Long-Term Physical Activity in Relation to Cancer-Related Health Outcomes: A 12-Month Follow-up of the Phys-Can RCT. Integrative Cancer Therapies, 22, Article ID 15347354231178869.
Open this publication in new window or tab >>The Role of Long-Term Physical Activity in Relation to Cancer-Related Health Outcomes: A 12-Month Follow-up of the Phys-Can RCT
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2023 (English)In: Integrative Cancer Therapies, ISSN 1534-7354, E-ISSN 1552-695X, Vol. 22, article id 15347354231178869Article in journal (Refereed) Published
Abstract [en]

Purpose:While moderate-to-vigorous intensity physical activity (MVPA) is associated with various health improvements shortly after completion of exercise interventions, it remains unclear which health benefits can be expected when MVPA levels are maintained in the long term in cancer survivors. We aimed to assess the associations of (1) MVPA level at 12-month follow-up and (2) long-term MVPA patterns (from immediately post-intervention to 12-month follow-up) with different cancer-related health outcomes. Methods:In the Physical training and Cancer (Phys-Can) RCT, 577 participants diagnosed with breast (78%), prostate (19%), or colorectal (3%) cancer were randomized to 6 months of exercise during curative cancer treatment. Accelerometer-assessed physical activity and outcome data (ie, cancer-related fatigue, health-related quality of life [HRQoL], anxiety and depression, functioning in daily life, cardiorespiratory fitness, sedentary time and sleep) were collected immediately post-intervention and at 12-month follow-up. Based on the sample's median of MVPA immediately post-intervention (65 minutes/day) and the changes between the 2 measurement points, 4 categories with different long-term MVPA patterns were created: High & Increasing, High & Decreasing, Low & Increasing, and Low & Decreasing. Multiple linear regression analyses were performed for the analyses. Results:A total of 353 participants were included in the analyses. At 12-month follow-up, a higher MVPA level was significantly associated with lower fatigue in 3 domains (general fatigue [& beta; = -.33], physical fatigue [& beta; = -.53] and reduced activity [& beta; = -.37]), higher cardiorespiratory fitness (& beta; = .34) and less sedentary time (& beta; = -.35). For long-term MVPA patterns, compared to the participants in the "Low & Decreasing" category, those in the "High & Increasing" category reported significantly lower fatigue in 3 domains (general fatigue [& beta; = -1.77], physical fatigue [& beta; = -3.36] and reduced activity [& beta; = -1.58]), higher HRQoL (& beta; = 6.84) and had less sedentary time (& beta; = -1.23). Conclusion:Our results suggest that long-term physical activity is essential for improving health outcomes post-intervention in cancer survivors. Cancer survivors, including those who reach recommended MVPA levels, should be encouraged to maintain or increase MVPA post-intervention for additional health benefits.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
physical activity patterns, correlates, cancer survivorship, health outcomes, accelerometer
National Category
Cancer and Oncology Pediatrics Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-507436 (URN)10.1177/15347354231178869 (DOI)001013762600001 ()37358262 (PubMedID)
Available from: 2023-07-11 Created: 2023-07-11 Last updated: 2024-03-19Bibliographically approved
Vikmoen, O., Wiestad, T. H., Thormodsen, I., Nordin, K., Berntsen, S., Demmelmaier, I., . . . Raastad, T. (2022). Effects of High and Low-To-Moderate Intensity Exercise During (Neo-) Adjuvant Chemotherapy on Muscle Cells, Cardiorespiratory Fitness, and Muscle Function in Women With Breast Cancer: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 11(11)
Open this publication in new window or tab >>Effects of High and Low-To-Moderate Intensity Exercise During (Neo-) Adjuvant Chemotherapy on Muscle Cells, Cardiorespiratory Fitness, and Muscle Function in Women With Breast Cancer: Protocol for a Randomized Controlled Trial
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2022 (English)In: JMIR Research Protocols, E-ISSN 1929-0748, Vol. 11, no 11Article in journal (Refereed) Published
Abstract [en]

Background: (Neo-)adjuvant chemotherapy for breast cancer is effective but has deleterious side effects on muscle tissue, resulting in reduced skeletal muscle mass, muscle function, and cardiorespiratory fitness. Various exercise regimens during cancer treatment have been shown to counteract some of these side effects. However, no study has compared the effect of high-intensity training versus low-to-moderate intensity training on muscle tissue cellular outcomes and physical function in patients with breast cancer during chemotherapy.

Objective: The aim of this substudy within the Physical Training in Cancer (Phys-Can) consortium is to evaluate and compare the effects of high and low-to-moderate intensity exercise on muscle cellular outcomes, muscle function, and cardiorespiratory fitness in women with breast cancer undergoing (neo-)adjuvant chemotherapy. We further aim to investigate if the effects of chemotherapy including taxanes on muscles will be different from those of taxane-free chemotherapy.

Methods: Eighty women recently diagnosed with breast cancer scheduled to start (neo-)adjuvant chemotherapy will be randomized to a combination of strength and endurance training, either at high intensity or at low-to-moderate intensity. Testing of muscle function and cardiorespiratory fitness and collection of muscle biopsies from the vastus lateralis muscle will be performed before the first cycle of chemotherapy (or after 1 week, when not possible) (T0), halfway through chemotherapy (T1), and after completion of chemotherapy (T2). It is estimated that approximately 50% of the participants will be willing to undergo muscle biopsies. To separate the effect of the treatment itself, a usual care group with no supervised training will also be included, and in this group, testing and collection of muscle biopsies will be performed at T0 and T2 only.

Results: This study is funded by Active Against Cancer (Aktiv mot kreft) (May 2013) and the Norwegian Cancer Society (December 2018). Inclusion started in December 2016 and the last participant is expected to be recruited in December 2022. As of June 2022, we enrolled 38 (19 with biopsies) participants to the high-intensity training group, 36 (19 with biopsies) participants to the low-to-moderate intensity training group, and 17 (16 with biopsies) participants to the usual care group. Data analyses will start in fall 2022. The first results are expected to be published in spring 2024.

Conclusions: This study will generate new knowledge about the effects of different training intensities for women with breast cancer during chemotherapy treatment. It will give further insight into how chemotherapy affects the muscle tissue and how physical training at different intensities may counteract the treatment side effects in muscles. The results of this study will inform

Place, publisher, year, edition, pages
JMIR Publications Inc., 2022
Keywords
resistance training, endurance training, muscle strength, muscle endurance, anthracyclines, taxanes
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:uu:diva-498965 (URN)10.2196/40811 (DOI)000917774000016 ()36367769 (PubMedID)
Available from: 2023-03-28 Created: 2023-03-28 Last updated: 2024-03-19Bibliographically approved
Helgesen Bjørke, A. C., Buffart, L. M., Raastad, T., Demmelmaier, I., Stenling, A., Nordin, K. & Berntsen, S. (2022). Exploring Moderators of the Effect of High vs. Low-to-Moderate Intensity Exercise on Cardiorespiratory Fitness During Breast Cancer Treatment - Analyses of a Subsample From the Phys-Can RCT. Frontiers in Sports and Active Living, 4, Article ID 902124.
Open this publication in new window or tab >>Exploring Moderators of the Effect of High vs. Low-to-Moderate Intensity Exercise on Cardiorespiratory Fitness During Breast Cancer Treatment - Analyses of a Subsample From the Phys-Can RCT
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2022 (English)In: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 4, article id 902124Article in journal (Refereed) Published
Abstract [en]

Introduction: The results from the physical training and cancer randomized controlled trial (Phys-Can RCT) indicate that high intensity (HI) strength and endurance training during (neo-)adjuvant cancer treatment is more beneficial for cardiorespiratory fitness (CRF, measured as peak oxygen uptake [VO(2)peak]) than low-to-moderate intensity (LMI) exercise. Adherence to the exercise intervention and demographic or clinical characteristics of patients with breast cancer undergoing adjuvant treatment may moderate the exercise intervention effect on VO(2)peak. In this study, the objective was to investigate whether baseline values of VO(2)peak, body mass index (BMI), time spent in moderate- to vigorous-intensity physical activity (MVPA), physical fatigue, age, chemotherapy treatment, and the adherence to the endurance training moderated the effect of HI vs. LMI exercise on VO(2)peak.

Materials and Methods: We used data collected from a subsample from the Phys-Can RCT; women who were diagnosed with breast cancer and had a valid baseline and post-intervention VO(2)peak test were included (n = 255). The exercise interventions from the RCT included strength and endurance training at either LMI, which was continuous endurance training at 40-50% of heart rate reserve (HRR), or at HI, which was interval training at 80-90% of HRR, with similar exercise volume in the two groups. Linear regression analyses were used to investigate moderating effects using a significance level of p < 0.10. Statistically significant interactions were examined further using the Johnson-Neyman (J-N) technique and regions of significance (for continuous variables) or box plots with adjusted means of post-intervention VO(2)peak (for binary variables).

Results: Age, as a continuous variable, and adherence, dichotomized into < or > 58% based on median, moderated the effect of HI vs. LMI on CRF (B = -0.08, 95% CI [-0.16, 0.01], p(interaction) = 0.06, and B = 1.63, 95% CI [-0.12, 3.38], p(interaction) = 0.07, respectively). The J-N technique and regions of significance indicated that the intervention effect (HI vs. LMI) was positive and statistically significant in participants aged 61 years or older. Baseline measurement of CRF, MVPA, BMI, physical fatigue, and chemotherapy treatment did not significantly moderate the intervention effect on CRF.

Conclusion: Women with breast cancer who are older and who have higher adherence to the exercise regimen may have larger effects of HI exercise during (neo-)adjuvant cancer treatment on CRF.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
cardiorespiratory fitness (CRF), breast cancer, moderators, intensity, age, exercise adherence, endurance and strength training
National Category
Sport and Fitness Sciences
Identifiers
urn:nbn:se:uu:diva-481907 (URN)10.3389/fspor.2022.902124 (DOI)000831767600001 ()35903402 (PubMedID)
Available from: 2022-08-17 Created: 2022-08-17 Last updated: 2024-03-18Bibliographically approved
Ax, A.-K., Husberg, M., Johansson, B., Demmelmaier, I., Berntsen, S., Sjövall, K., . . . Davidson, T. (2022). Long-term resource utilisation and associated costs of exercise during (neo)adjuvant oncological treatment: the Phys-Can project. Acta Oncologica, 61(7), 888-896
Open this publication in new window or tab >>Long-term resource utilisation and associated costs of exercise during (neo)adjuvant oncological treatment: the Phys-Can project
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2022 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 61, no 7, p. 888-896Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Exercise during oncological treatment is beneficial to patient health and can counteract the side effects of treatment. Knowledge of the societal costs associated with an exercise intervention, however, is limited. The aims of the present study were to evaluate the long-term resource utilisation and societal costs of an exercise intervention conducted during (neo)adjuvant oncological treatment in a randomised control trial (RCT) versus usual care (UC), and to compare high-intensity (HI) versus low-to-moderate intensity (LMI) exercise in the RCT.

METHODS: We used data from the Physical Training and Cancer (Phys-Can) project. In the RCT, 577 participants were randomised to HI or to LMI of combined endurance and resistance training for 6 months, during oncological treatment. The project also included 89 participants with UC in a longitudinal observational study. We measured at baseline and after 18 months. Resource utilisation and costs of the exercise intervention, health care, and productivity loss were compared using analyses of covariance (RCT vs. UC) and t test (HI vs. LMI).

RESULTS: Complete data were available for 619 participants (RCT HI: n = 269, LMI: n = 265, and UC: n = 85). We found no difference in total societal costs between the exercise intervention groups in the RCT and UC. However, participants in the RCT had lower rates of disability pension days (p < .001), corresponding costs (p = .001), and pharmacy costs (p = .018) than the UC group. Nor did we find differences in resource utilisation or costs between HI and LMI exercise int the RCT.

CONCLUSION: Our study showed no difference in total societal costs between the comprehensive exercise intervention and UC or between the exercise intensities. This suggests that exercise, with its well-documented health benefits during oncological treatment, produces neither additional costs nor savings.

Place, publisher, year, edition, pages
Taylor & Francis, 2022
Keywords
Cancer, cost analysis, costs, exercise, health care costs, sick leave
National Category
Physiotherapy Cancer and Oncology
Identifiers
urn:nbn:se:uu:diva-477208 (URN)10.1080/0284186X.2022.2075238 (DOI)000799825800001 ()35607981 (PubMedID)
Available from: 2022-06-15 Created: 2022-06-15 Last updated: 2024-03-18Bibliographically approved
Projects
How can health care help femal breastcancer patients reduce their stress symptoms? A randomized intervention study with stepped-care [2009-03129_VR]; Uppsala UniversityPhysical training and cancer (Phys-Can) - effects and understanding of mechanisms for minimizing cancer related fatigue, improve quality of life and disease outcome - a multicenter clinical trial [2013-02734_VR]; Uppsala University; Publications
Ax, A.-K., Johansson, B., Carlsson, M. E., Nordin, K. & Börjeson, S. (2020). Exercise: A positive feature on functioning in daily life during cancer treatment — Experiences from the Phys-Can study. European Journal of Oncology Nursing, 44, Article ID 101713. Mazzoni, A.-S., Brooke, H. L., Berntsen, S., Nordin, K. & Demmelmaier, I. (2020). Exercise Adherence and Effect of Self-Regulatory Behavior Change Techniques in Patients Undergoing Curative Cancer Treatment: Secondary Analysis from the Phys-Can Randomized Controlled Trial. Integrative Cancer Therapies, 19, Article ID 1534735420946834. Henriksson, A. (2020). Physical activity and exercise during curative oncological treatment: exploring the effects of exercise intensity and behaviour change support, safety, and patients’ and exercise professionals’ experiences. (Doctoral dissertation). Uppsala: Acta Universitatis UpsaliensisWiestad, T. H., Raastad, T., Nordin, K., Igelström, H., Henriksson, A., Demmelmaier, I. & Berntsen, S. (2020). The Phys-Can observational study: adjuvant chemotherapy is associated with a reduction whereas physical activity level before start of treatment is associated with maintenance of maximal oxygen uptake in patients with cancer. BMC Sports Science, Medicine and Rehabilitation, 12(1), Article ID 53. Johnsson, A., Demmelmaier, I., Sjövall, K., Wagner, P., Olsson, H. & Tornberg, Å. B. (2019). A single exercise session improves side-effects of chemotherapy in women with breast cancer: an observational study. BMC Cancer, 19, Article ID 1073. Mazzoni, A.-S., Carlsson, M., Berntsen, S., Nordin, K. & Demmelmaier, I. (2019). "Finding my own motivation" - A Mixed Methods Study of Exercise and Behaviour Change Support During Oncological Treatment. International Journal of Behavioral Medicine, 26(5), 499-511Bjorke, A. C., Sweegers, M. G., Buffart, L. M., Raastad, T., Nygren, P. & Berntsen, S. (2019). Which exercise prescriptions optimize V̇O2max during cancer treatment?: a systematic review and meta-analysis. Scandinavian Journal of Medicine and Science in Sports, 29(9), 1274-1287Mazzoni, A.-S., Nordin, K., Berntsen, S., Demmelmaier, I. & Igelström, H. (2017). Comparison between logbook-reported and objectively-assessed physical activity and sedentary time in breast cancer patients: an agreement study. BMC Sports Science, Medicine and Rehabilitation, 9(1), Article ID 8. Berntsen, S., Aaronson, N. K., Buffart, L., Börjeson, S., Demmelmaier, I., Hellbom, M., . . . Nordin, K. (2017). Design of a randomized controlled trial of physical training and cancer (Phys-Can) - the impact of exercise intensity on cancer related fatigue, quality of life and disease outcome. BMC Cancer, 17(1), Article ID 218. Igelström, H., Berntsen, S., Demmelmaier, I., Johansson, B. & Nordin, K. (2017). Exercise during and after curative oncological treatment: a mapping review. Physical Therapy Reviews, 22(3/4), 103-115
The Phys-Can (Physical training and Cancer) Study: Long-term Follow-up [2019-01324_VR]; Uppsala University; Publications
Helgesen Bjørke, A. C., Buffart, L. M., Raastad, T., Demmelmaier, I., Stenling, A., Nordin, K. & Berntsen, S. (2022). Exploring Moderators of the Effect of High vs. Low-to-Moderate Intensity Exercise on Cardiorespiratory Fitness During Breast Cancer Treatment - Analyses of a Subsample From the Phys-Can RCT. Frontiers in Sports and Active Living, 4, Article ID 902124. Ax, A.-K., Husberg, M., Johansson, B., Demmelmaier, I., Berntsen, S., Sjövall, K., . . . Davidson, T. (2022). Long-term resource utilisation and associated costs of exercise during (neo)adjuvant oncological treatment: the Phys-Can project. Acta Oncologica, 61(7), 888-896Ax, A.-K., Johansson, B., Lyth, J., Nordin, K. & Börjeson, S. (2022). Short- and long-term effect of high versus low-to-moderate intensity exercise to optimise health-related quality of life after oncological treatment-results from the Phys-Can project. Supportive Care in Cancer, 30(7), 5949-5963Henriksson, A., Igelström, H., Arving, C., Nordin, K., Johansson, B. & Demmelmaier, I. (2022). The Phys-Can study: meaningful and challenging - supervising physical exercise in a community-based setting for persons undergoing curative oncological treatment. Physiotherapy Theory and Practice, 38(1), 141-150Strandberg, E., Bean, C., Vassbakk-Svindland, K., Brooke, H. L., Sjövall, K., Börjeson, S., . . . Demmelmaier, I. (2022). Who makes it all the way?: Participants vs. decliners, and completers vs. drop-outs, in a 6-month exercise trial during cancer treatment. Results from the Phys-Can RCT. Supportive Care in Cancer, 30(2), 1739-1748Demmelmaier, I., Brooke, H. L., Henriksson, A., Mazzoni, A.-S., Helgesen Björke, A. C., Igelström, H., . . . Nordin, K. (2021). Does exercise intensity matter for fatigue during (neo)adjuvant cancer treatment?: The PhysCan randomized clinical trial. Scandinavian Journal of Medicine and Science in Sports, 31(5), 1144-1159Mazzoni, A.-S., Brooke, H. L., Berntsen, S., Nordin, K. & Demmelmaier, I. (2021). Effect of self-regulatory behaviour change techniques and predictors of physical activity maintenance in cancer survivors: a 12-month follow-up of the Phys-Can RCT.. BMC Cancer, 21, Article ID 1272. Schauer, T., Mazzoni, A.-S., Henriksson, A., Demmelmaier, I., Berntsen, S., Raastad, T., . . . Christensen, J. F. (2021). Exercise intensity and markers of inflammation during and after (neo-) adjuvant cancer treatment. Endocrine-Related Cancer, 28(3), 191-201Henriksson, A., Johansson, B., Radu, C., Berntsen, S., Igelström, H. & Nordin, K. (2021). Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training - data from the Phys-Can study.. Acta Oncologica, 60(1), 96-105Mazzoni, A.-S. (2021). Promoting physical activity during and after curative cancer treatment: Assessment, experiences and effect of behaviour change support. (Doctoral dissertation). Uppsala: Acta Universitatis Upsaliensis
How to stay physically active during and after cancer treatment? Long term follow-up of an exercise intervention and feasibility of a tailored digital app to support physical activity [2022-00607_VR]; Uppsala University; Publications
Western, B., Ivarsson, A., Vistad, I., Demmelmaier, I., Aaronson, N. K., Radcliffe, G., . . . Buffart, L. M. (2024). Dropout from exercise trials among cancer survivors: An individual patient data meta-analysis from the POLARIS study. Scandinavian Journal of Medicine and Science in Sports, 34(2), Article ID e14575. Ax, A.-K., Husberg, M., Johansson, B., Demmelmaier, I., Berntsen, S., Sjövall, K., . . . Davidson, T. (2023). Cost-effectiveness of different exercise intensities during oncological treatment in the Phys-Can RCT. Acta Oncologica, 62(4), 414-421Henriksson, A., Strandberg, E., Stenling, A., Mazzoni, A.-S., Sjövall, K., Börjeson, S., . . . Nordin, K. (2023). Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance- and endurance exercise program?: Results from the Phys-Can trial. BMC Sports Science, Medicine and Rehabilitation, 15(1), Article ID 8. Western, B., Demmelmaier, I., Vistad, I., Hansen, B. H., Stenling, A., Henriksen, H. B., . . . Berntsen, S. (2023). How many days of continuous physical activity monitoring reliably represent time in different intensities in cancer survivors. PLOS ONE, 18(4), Article ID e0284881. Schauer, T., Henriksson, A., Strandberg, E., Lindman, H., Berntsen, S., Demmelmaier, I., . . . Christensen, J. F. (2023). Pre-treatment levels of inflammatory markers and chemotherapy completion rates in patients with early-stage breast cancer. International Journal of Clinical Oncology, 28(1), 89-98Mazzoni, A.-S., Strandberg, E., Börjeson, S., Sjövall, K., Berntsen, S., Demmelmaier, I. & Nordin, K. (2023). Reallocating sedentary time to physical activity: effects on fatigue and quality of life in patients with breast cancer in the Phys-Can project. Supportive Care in Cancer, 31(2), Article ID 151. Mazzoni, A.-S., Bjorke, A. C., Stenling, A., Boerjeson, S., Sjoevall, K., Berntsen, S., . . . Nordin, K. (2023). The Role of Long-Term Physical Activity in Relation to Cancer-Related Health Outcomes: A 12-Month Follow-up of the Phys-Can RCT. Integrative Cancer Therapies, 22, Article ID 15347354231178869. Vikmoen, O., Wiestad, T. H., Thormodsen, I., Nordin, K., Berntsen, S., Demmelmaier, I., . . . Raastad, T. (2022). Effects of High and Low-To-Moderate Intensity Exercise During (Neo-) Adjuvant Chemotherapy on Muscle Cells, Cardiorespiratory Fitness, and Muscle Function in Women With Breast Cancer: Protocol for a Randomized Controlled Trial. JMIR Research Protocols, 11(11)Johnsson, A., Sjövall, K., Demmelmaier, I., Wagner, P., Olsson, H. & Tornberg, Å. B. (2022). Immediate increase in perceived energy after exercise during the course of chemotherapy treatment for breast cancer. European Journal of Oncology Nursing, 58, Article ID 102149. Brooke, H. L., Mazzoni, A.-S., Buffart, L. M., Berntsen, S., Nordin, K. & Demmelmaier, I. (2022). Patterns and determinants of adherence to resistance and endurance training during cancer treatment in the Phys-Can RCT. BMC Sports Science, Medicine and Rehabilitation, 14(1), Article ID 155.
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-8685-3722

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