No abstract

Cancer patients frequently suffer from fatigue and loss of physical performance. Several biologic, psychologic, and social factors have been suggested as explanations for the origins of fatigue in this context. In most cases, fatigue has a multifactorial genesis. However, recent studies suggest that fatigue may originate from alterations in the muscular energetic systems caused by cancer and its treatment. Furthermore, there is growing evidence that physical exercise programs help prevent the manifestation and reduce the intensity of cancer‐related fatigue. In this article, actual evidence of the relationship between fatigue and impairment of physical performance in cancer patients and suggestions for new directions for research are discussed. Cancer 2001;92:1689–93. © 2001 American Cancer Society.

Abstract-Regular physical exercise is broadly recommended by current European and American hypertension guidelines.It remains elusive, however, whether exercise leads to a reduction of blood pressure in resistant hypertension as well. The present randomized controlled trial examines the cardiovascular effects of aerobic exercise on resistant hypertension. Resistant hypertension was defined as a blood pressure Ն140/90 mm Hg in spite of 3 antihypertensive agents or a blood pressure controlled by Ն4 antihypertensive agents. Fifty subjects with resistant hypertension were randomly assigned to participate or not to participate in an 8-to 12-week treadmill exercise program (target lactate, 2.0Ϯ0.5 mmol/L). Blood pressure was assessed by 24-hour monitoring. Arterial compliance and cardiac index were measured by pulse wave analysis. The training program was well tolerated by all of the patients. Exercise significantly decreased systolic and diastolic daytime ambulatory blood pressure by 6Ϯ12 and 3Ϯ7 mm Hg, respectively (Pϭ0.03 each). Regular exercise reduced blood pressure on exertion and increased physical performance as assessed by maximal oxygen uptake and lactate curves. Arterial compliance and cardiac index remained unchanged. Physical exercise is able to decrease blood pressure even in subjects with low responsiveness to medical treatment. It should be included in the therapeutic approach to resistant hypertension. (Hypertension. 2012;60:653-658.)

Loss of physical performance is a universal problem of cancer patients undergoing chemotherapy. We postulated that this impairment can be partially prevented by aerobic exercise. In a randomized study, 33 cancer patients receiving high-dose chemotherapy followed by autologous peripheral blood stem cell transplantation (training group, T) performed an exercise program consisting of biking on an ergometer in the supine position after an interval-training pattern for 30 minutes daily during hospitalization. Patients in the control group (C, n = 37) did not train. Maximal physical performance was assessed with a treadmill test by admission and discharge. Physical performance of the two groups was not different on admission. The decrement in performance during hospitalization was 27% greater in the control group than in the training group (P = .05); this resulted in a significantly higher maximal physical performance at discharge in the trained patients (P = .04). Duration of neutropenia (P = .01) and thrombopenia (P = .06), severity of diarrhea (P = .04), severity of pain (P = .01), and duration of hospitalization (P = .03) were reduced in the training group. We conclude that aerobic exercise can be safely carried out immediately after high-dose chemotherapy and can partially prevent loss of physical performance. Based on the potential significance of the observed outcomes, further studies are warranted to confirm our results.

Background-Several reports indicate that physical activity can reduce the severity of symptoms in depressed patients. Some data suggest that even a single exercise bout may result in a substantial mood improvement. Objective-To evaluate the short term eVects of a training programme on patients with moderate to severe major depression. Conclusions-Aerobic exercise can produce substantial improvement in mood in patients with major depressive disorders in a short time. (Br J Sports Med 2001;35:114-117) Methods-Twelve patients (mean (SD

on a treadmill, shortly after completing treatment. Sixteen patients who did not train served as controls. Physical performance (maximum speed on the treadmill 1 Department of Rehabilitation, Prevention and test), cardiac function, and hemoglobin concentration were compared at the time Sports Medicine, Freiburg University Medical of discharge from the hospital and 7 weeks later. At the second examination, fatigue Center, Freiburg i. Br., Germany.and limitations in daily activities due to impaired endurance were assessed during 2 Department of Hematology/Oncology, Freipersonal interviews. burg University Medical Center, Freiburg i. Br., RESULTS.At the time of discharge from the hospital, maximum physical perfor- Germany.mance (training group: 6.2 { 1.1 km/hour; controls: 6.2 { 1.3 km/hour) and hemoglobin concentration (training group: 10.1 { 1.4 g/dL; controls: 10.1 { 1.2 g/dL)were similar for both groups. After 7 weeks, improvement in maximum physical performance (training group: 8.3 { 1.6 km/hour; controls 7.5 { 1.3 km/hour) and hemoglobin concentration (training group: 13 { 1 g/dL controls: 12 { 1.4 g/dL) were significantly higher for the training group (P õ 0.05). By the second examination, no patient in the training group but 4 controls (25%) reported fatigue and limitations in daily activities due to low physical performance. CONCLUSIONS.Aerobic exercise improves the physical performance of cancer patients recovering from high dose chemotherapy. To reduce fatigue, this group of patients should be counseled to increase physical activity rather than rest after treatment. changes secondary to disease and treatment, psychosocial factors, and level of activity. 9 However, the causes of this impairment of physi-

In healthy older women, participation in new stimulating activities contributes to cognitive fitness and might delay cognitive decline. Exercise and computer classes seem to generate equivalent beneficial effects.

Objective: To evaluate the short-term effects of exercise in patients with major depression. Design: Prospective, randomised, controlled study. Setting: A university hospital. Patients: A consecutive series of 38 inpatients with a major depression episode undergoing standard clinical antidepressant drug treatment. Interventions: Patients were randomly assigned to an exercise (walking, n = 20) or placebo (low-intensity stretching and relaxation exercises, n = 18) group. Training was carried out for 10 days. Main outcome measurements: Severity of depression assessed with the Bech-Rafaelsen Melancholy Scale (BRMS) and the Center for Epidemiologic Studies Depression scale (CES-D). Results: After 10 days, reduction of depression scores in the exercise group was significantly larger than in the placebo group (BRMS: 36% v 18%; CES-D: 41% v 21%; p for both = 0.01); the proportion of patients with a clinical response (reduction in the BRMS scores by more than six points) was also larger for the exercise group (65% v 22%, p,0.01). Conclusions: Endurance exercise may help to achieve substantial improvement in the mood of selected patients with major depression in a short time.