Rapid Escalation of High-Volume Exercise during Caloric Restriction; Change in Visceral Adipose Tissue and Adipocytokines in Obese Sedentary Breast Cancer Survivors

Abstract

Aerobic exercise reduces risk for breast cancer and recurrence and promotes visceral adipose tissue (VAT) loss in obesity. However, few breast cancer survivors achieve recommended levels of moderate to vigorous physical activity (MVPA) without supervision. In a two-cohort study, feasibility of 12 weeks of partially supervised exercise was started concomitantly with caloric restriction and effects on body composition and systemic risk biomarkers were explored. In total, 22 obese postmenopausal sedentary women (including 18 breast cancer survivors) with median age of 60 and BMI of 37 kg/m2 were enrolled. Using personal trainers twice weekly at area YMCAs, MVPA was escalated to ≥200 min/week over 9 weeks. For cohort 2, maintenance of effect was assessed when study provided trainer services were stopped but monitoring, group counseling sessions, and access to the exercise facility were continued. Median post-escalation MVPA was 219 min/week with median 12-week mass and VAT loss of 8 and 19%. MVPA was associated with VAT loss which was associated with improved adiponectin:leptin ratio. In total, 9/11 of cohort-2 women continued the behavioral intervention for another 12 weeks without trainers. High MVPA continued with median 24-week mass and VAT loss of 12 and 29%. This intervention should be further studied in obese sedentary women.

Preventing ovariectomy-induced weight gain decreases tumor burden in rodent models of obesity and postmenopausal breast cancer

“…Insulin resistance was improved in both lean and obese rats, likely due in part to a reduction in visceral fat which is known to drive systemic insulin resistance. Fabian and colleagues recently reported that weight loss and visceral fat reduction improved both circulating and breast biopsy biomarkers of inflammation that have been tied to breast cancer risk [ 38 ]. Women in this clinical study all had obesity at baseline; thus, it is not clear if the same benefits would be seen in non-obese women.…”

“…It has been clearly established that diet-induced weight loss or weight loss through bariatric surgery both decrease breast cancer risk and improve outcomes in patients with breast cancer [ 24 , 28 – 34 ]. Similarly, preventing weight gain [ 35 , 36 ] and increasing physical activity [ 37 , 38 ] are also known to be beneficial. However, there is overwhelming evidence that weight loss is difficult to sustain [ 39 ], and menopause is a time when women are particularly prone to gaining weight.…”

Understanding Breast Cancer Aggressiveness and Its Implications in Diagnosis and Treatment

“…Since glucose is supporting cancer progression, it has been suggested that controlled calorie intake will reduce oxidative stress and protect cells from becoming oncogenic [ 9 ]. Therefore, caloric restriction could ameliorate the risk factors in breast cancer by reducing blood glucose levels, inflammation, and the onset of angiogenesis [ 10 ].…”

Effects of Combined Interventions of Exercise and Diet or Exercise and Supplementation on Breast Cancer Patients: A Systematic Review

“…Calcium and vitamin D are important nutrients for bone health [ 61 ]. Numerous studies have shown the benefits of combined interventions of exercise plus diet on lipid profile, insulin, adiponectin, leptin and ghrelin [ 50 , 54 , 62 , 63 , 64 ] in breast cancer patients. Combined interventions of exercise plus diet have also found benefits in markers of inflammation, oestrogens, androgens and SHBP in other patient populations [ 65 ].…”