Moving forward on all fronts: impact, patterns, and barriers to exercise in cancer survivors and patients living with advanced disease

Knowlton, Sasha E.; O’Donnell, Elizabeth; Horick, Nora; Perez, Giselle K.; Park, Elyse R.; Rabin, Julia; Quain, Katharine; Garton, Jessica; Peppercorn, Jeffrey

doi:10.1007/s00520-020-05344-w

Cited by 19 publications

(11 citation statements)

References 32 publications

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“…The problem is that, along with the much larger exercise volume that does not recapitulate human exercise behavior, the running wheel model does not provide a reliable preclinical model on the therapeutic ExTr either. This is particularly relevant considering that, although three out of four patients are willing to start an exercise program, nearly 60% of them do not follow an exercise routine (57).…”

Section: Discussionmentioning

confidence: 99%

Exercise Training Improves Tumor Control by Increasing CD8+ T-cell Infiltration via CXCR3 Signaling and Sensitizes Breast Cancer to Immune Checkpoint Blockade

Gomes‐Santos

Amoozgar

Kumar

et al. 2021

Cancer Immunology Research

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The mechanisms behind the antitumor effects of exercise training (ExTr) are not fully understood. Using mouse models of established breast cancer, we examined here the causal role of CD8 þ T cells in the benefit acquired from ExTr in tumor control, as well as the ability of ExTr to improve immunotherapy responses. We implanted E0771, EMT6, MMTV-PyMT, and MCa-M3C breast cancer cells orthotopically in wild-type or Cxcr3 À/À female mice and initiated intensity-controlled ExTr sessions when tumors reached approximately 100 mm 3 . We characterized the tumor microenvironment (TME) using flow cytometry, transcriptome analysis, proteome array, ELISA, and immunohistochemistry. We used antibodies against CD8 þ T cells for cell depletion. Treatment with immune checkpoint blockade (ICB) consisted of anti-PD-1 alone or in combination with anti-CTLA-4. ExTr delayed tumor growth and induced vessel normalization, demonstrated by increased pericyte coverage and perfusion and by decreased hypoxia. ExTr boosted CD8 þ T-cell infiltration, with enhanced effector function. CD8 þ T-cell depletion prevented the antitumor effect of ExTr. The recruitment of CD8 þ T cells and the antitumor effects of ExTr were abrogated in Cxcr3 À/À mice, supporting the causal role of the CXCL9/CXCL11-CXCR3 pathway. ExTr also sensitized ICB-refractory breast cancers to treatment. Our results indicate that ExTr can normalize the tumor vasculature, reprogram the immune TME, and enhance the antitumor activity mediated by CD8 þ T cells via CXCR3, boosting ICB responses. Our findings and mechanistic insights provide a rationale for the clinical translation of ExTr to improve immunotherapy of breast cancer.

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Section: Discussionmentioning

confidence: 99%

Exercise Training Improves Tumor Control by Increasing CD8+ T-cell Infiltration via CXCR3 Signaling and Sensitizes Breast Cancer to Immune Checkpoint Blockade

Gomes‐Santos

Amoozgar

Kumar

et al. 2021

Cancer Immunology Research

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“…For example, about half of participants in two mixed cancer cross-sectional studies by Quain et al [42] and Blaney et al [43] reported being interested in exercise opportunities and becoming physically active. Likewise, approximately 70-80% of mixed cancer participants in five separate quantitative and qualitative studies reported positive attitudes to PA, expressing a desire for PA program opportunities to increase their PA levels [44][45][46][47][48].…”

Section: Attitudes Towards Pamentioning

confidence: 99%

Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review

Elshahat

Treanor

Donnelly

2021

Int J Behav Nutr Phys Act

125

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Background It has been posited that physical activity (PA) has the potential to improve health outcomes and the health-related quality of life of people living with or beyond cancer. Despite the well-documented health benefits of PA, there is a low level of PA among cancer patients. A systematic scoping review was conducted to investigate attitudes, perceptions, preferences and barriers vs. facilitators to cancer patients’ PA participation. Methods A systematic search was performed across four automated databases (PubMed, Embase, PsycINFO and Medline) in keeping with the PRISMA guideline. All cancer types were included, and any age/gender groups were eligible. Both qualitative and quantitative studies were included. The Health Belief Model provided a conceptual framework for the conduct of the scoping review as well as guiding thinking to inform evidence-based interventions. Results Ninety-eight articles were included in this review. Nearly half of the studies focused on mixed cancer sites; breast cancer was the most commonly examined cancer type (19%). Post-treatment was the most commonly investigated stage (33%), followed by studies of mixed stages of the cancer trajectory (27%), the acute treatment stage (23%) and pre-treatment stage (1%). Patient treatment stage was not reported in 16% of studies. Cancer patients reported positive attitudes to PA and recognized its benefits for health and wellbeing. Cancer-related side effects (e.g. fatigue) were a leading physiological barrier to PA participation, whereas effective symptom management techniques/tools acted as a powerful facilitator. Psychosocial barriers included low motivation and kinesiophobia, and perceived health benefits and social support/guidance by healthcare providers were significant facilitators. Inaccessible fitness facilities hindered cancer patients’ PA engagement though the availability of tailored amenities appeared to be a strong facilitator. PA preferences varied in terms of type, place, time, company and source of information and pointed to the need for individualized PA programs. Conclusions There is a need for further research to identify barriers and facilitators to PA that are faced by patients with particular cancer types. Recommended PA promoting-strategies involve including exercise science professionals in healthcare teams and ensuring that fitness facilities are accessible.

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“…Research exploring patient perspectives via the use of questionnaires and focus groups have highlighted several barriers to PA for cancer patients, for example, the inability to set achievable goals resulting in lowered motivation compared to pre-cancer status [ 20 ], and a lack of PA facilities and readily available information [ 21 ]. Furthermore, Knowlton et al [ 22 ] found that patients believed the burden of their illness prevented them from undertaking PA, as their body would not let them take part. These studies highlight the need for cancer patients to receive education on PA and the benefits it can provide to help them improve their quality of life.…”

Section: Introductionmentioning

confidence: 99%

The Role of Physical Activity in Cancer Recovery: An Exercise Practitioner’s Perspective

Roscoe

Pringle

Chandler

et al. 2022

IJERPH

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Less than 20% of cancer patients meet the recommended physical activity (PA) guidelines, partially due to poor knowledge and enforcement/encouragement amongst health-care professionals (HCPs). The primary aim of this study was to explore the perceptions of exercise practitioners on the role of PA and the physiological and psychological benefits to recovering cancer patients; the secondary aim was to understand the barriers and facilitators of promoting PA to cancer survivors. The third aim was to, seek the perspectives on the effectiveness of referral systems between the hospitals and PA structures. A purposive sample of five exercise practitioners’ (four male and one female) with experience with cancer patients participated in a semi-structured interview (45–60 min). Interviews addressed five key topics: intervention procedures, patient well-being, patient education on PA, effectiveness of referrals from hospitals, and post-intervention PA. Interviews were transcribed verbatim and analysed via thematic analysis. The participants believed that recovering cancer patients possess a knowledge of the physiological benefits of PA, yet psychological understanding remains unknown. Social environments are key to participation in PA and most HCPs lacked knowledge/awareness of the benefits of engaging in PA. There is a need to improve HCPs knowledge of the benefits of PA, whilst providing standardised training on how PA can improve cancer patients’ outcomes.

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Moving forward on all fronts: impact, patterns, and barriers to exercise in cancer survivors and patients living with advanced disease

Cited by 19 publications

References 32 publications

Exercise Training Improves Tumor Control by Increasing CD8+ T-cell Infiltration via CXCR3 Signaling and Sensitizes Breast Cancer to Immune Checkpoint Blockade

Exercise Training Improves Tumor Control by Increasing CD8+ T-cell Infiltration via CXCR3 Signaling and Sensitizes Breast Cancer to Immune Checkpoint Blockade

Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review

The Role of Physical Activity in Cancer Recovery: An Exercise Practitioner’s Perspective

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