Background Exercise during neoadjuvant chemoradiotherapy(NCRT)has potential to mitigate treatment-related declines in physical fitness,and to improve clinical outcomes,including toxicity and tumor response.However,opt...Background Exercise during neoadjuvant chemoradiotherapy(NCRT)has potential to mitigate treatment-related declines in physical fitness,and to improve clinical outcomes,including toxicity and tumor response.However,optimal frequency and timing of exercise remains to be determined.Therefore,this pilot trial aimed to assess feasibility of 2 different exercise interventions during NCRT in patients with esophageal and rectal cancer and to evaluate potential clinical effects.Methods Patients were randomized into 1 of 3 study arms during NCRT:(a)30-min aerobic exercise in-hospital within 1 h prior to each radiotherapy fraction(ExPR),(b)two 60-min supervised combined aerobic and resistance exercise sessions per week(AE+RE),and(c)usual care(UC).Feasibility was assessed by examining participation rate and exercise adherence.Intervention effects on physical fitness,health-related quality of life,treatment-related toxicity,and tumor response in patients with esophageal cancer were explored using regression analyses and 85%confidence intervals(85%CIs).Results Thirty-seven patients with esophageal cancer(participation rate=45%)and 2 patients with rectal cancer(participation rate=14%)were included.Median session attendance was 98%(interquartile range(IQR):96%–100%)in the ExPR and 78%(IQR:33%–100%)in the AE+RE group.We found clinically relevant benefits of exercise on maximal oxygen uptake(VO2_(max),mL/kg/min)(ExPR:β=9.7,85%CI:6.9–12.6;AE+RE:β=5.6,85%CI:2.6–8.5)and treatment-related toxicity(ExPR:β=–2.8,85%CI:–5.4 to–0.2;AE+RE:β=–2.6,85%CI:–5.3 to 0.0).Additionally,good tumor response was found in 70%in AE+RE and ExPR vs.55%in UC(odds ratio(OR)=1.9,85%CI:0.5–7.7).Conclusion Starting prehabilitation during NCRT is feasible,can increase starting fitness of traditional pre-surgical programs,and has potential to improve clinical outcomes.展开更多
Purpose A priori cardiovascular(CV)health status may impact reductions in risk factors and CV mortality and morbid-ity following exercise training,although this is not fully understood.Therefore,the purpose of the stu...Purpose A priori cardiovascular(CV)health status may impact reductions in risk factors and CV mortality and morbid-ity following exercise training,although this is not fully understood.Therefore,the purpose of the study was to examine if endothelial function(assessed via flow mediated dilation;FMD%),predicts the magnitude of change in CV risk factors or fitness following exercise training.Methods We pooled data from 338 individuals who underwent supervised exercise training(8-26 weeks).Using recent sex-and age-specific reference values for flow-mediated dilation(FMD%),we categorised participants as having preserved endothelial function(P-EF)(>50th percentile of reference value,56 females,67 males,46±17 years)or reduced endothelial function(R-EF)(<50th percentile of reference value,67 females,148 males,48±17 years).The effects of exercise training on cardiovascular risk factors(BMI,cholesterol,glucose and triglycerides),cardiorespiratory fitness(VO_(2peak))and vascular function(FMD%)were examined using a two-way mixed design general linear model.Results Exercise training significantly improved physical fitness(P<0.001),with no difference in the magnitude of improvement between P-EF and R-EF.Modest but significant reductions were present in BMI,blood pressure and total cholesterol(all P<0.005),with no difference between P-EF and R-EF groups in the magnitude of changes in these variables with training.Exercise training did not significantly alter glucose,triglycerides,high density lipoprotein(HDL)and low-density lipoprotein(LDL)(all P>0.05).Conclusion Individuals with reduced and preserved a priori endothelial function status can obtain benefits from exercise in terms of risk factor modification and fitness change.Therefore,exercise has the potential to be beneficial in all clinical groups.展开更多
基金supported by the Hypatia Fellowship grant from Radboudumc awarded to LB.
文摘Background Exercise during neoadjuvant chemoradiotherapy(NCRT)has potential to mitigate treatment-related declines in physical fitness,and to improve clinical outcomes,including toxicity and tumor response.However,optimal frequency and timing of exercise remains to be determined.Therefore,this pilot trial aimed to assess feasibility of 2 different exercise interventions during NCRT in patients with esophageal and rectal cancer and to evaluate potential clinical effects.Methods Patients were randomized into 1 of 3 study arms during NCRT:(a)30-min aerobic exercise in-hospital within 1 h prior to each radiotherapy fraction(ExPR),(b)two 60-min supervised combined aerobic and resistance exercise sessions per week(AE+RE),and(c)usual care(UC).Feasibility was assessed by examining participation rate and exercise adherence.Intervention effects on physical fitness,health-related quality of life,treatment-related toxicity,and tumor response in patients with esophageal cancer were explored using regression analyses and 85%confidence intervals(85%CIs).Results Thirty-seven patients with esophageal cancer(participation rate=45%)and 2 patients with rectal cancer(participation rate=14%)were included.Median session attendance was 98%(interquartile range(IQR):96%–100%)in the ExPR and 78%(IQR:33%–100%)in the AE+RE group.We found clinically relevant benefits of exercise on maximal oxygen uptake(VO2_(max),mL/kg/min)(ExPR:β=9.7,85%CI:6.9–12.6;AE+RE:β=5.6,85%CI:2.6–8.5)and treatment-related toxicity(ExPR:β=–2.8,85%CI:–5.4 to–0.2;AE+RE:β=–2.6,85%CI:–5.3 to 0.0).Additionally,good tumor response was found in 70%in AE+RE and ExPR vs.55%in UC(odds ratio(OR)=1.9,85%CI:0.5–7.7).Conclusion Starting prehabilitation during NCRT is feasible,can increase starting fitness of traditional pre-surgical programs,and has potential to improve clinical outcomes.
文摘Purpose A priori cardiovascular(CV)health status may impact reductions in risk factors and CV mortality and morbid-ity following exercise training,although this is not fully understood.Therefore,the purpose of the study was to examine if endothelial function(assessed via flow mediated dilation;FMD%),predicts the magnitude of change in CV risk factors or fitness following exercise training.Methods We pooled data from 338 individuals who underwent supervised exercise training(8-26 weeks).Using recent sex-and age-specific reference values for flow-mediated dilation(FMD%),we categorised participants as having preserved endothelial function(P-EF)(>50th percentile of reference value,56 females,67 males,46±17 years)or reduced endothelial function(R-EF)(<50th percentile of reference value,67 females,148 males,48±17 years).The effects of exercise training on cardiovascular risk factors(BMI,cholesterol,glucose and triglycerides),cardiorespiratory fitness(VO_(2peak))and vascular function(FMD%)were examined using a two-way mixed design general linear model.Results Exercise training significantly improved physical fitness(P<0.001),with no difference in the magnitude of improvement between P-EF and R-EF.Modest but significant reductions were present in BMI,blood pressure and total cholesterol(all P<0.005),with no difference between P-EF and R-EF groups in the magnitude of changes in these variables with training.Exercise training did not significantly alter glucose,triglycerides,high density lipoprotein(HDL)and low-density lipoprotein(LDL)(all P>0.05).Conclusion Individuals with reduced and preserved a priori endothelial function status can obtain benefits from exercise in terms of risk factor modification and fitness change.Therefore,exercise has the potential to be beneficial in all clinical groups.
