ECSS Paris 2023: CP-MH05
INTRODUCTION: Cancer is acknowledged as the second greatest cause of death globally [1] and has enormous economic and societal impacts. Its treatments significantly impact patients physical and mental health, but it remains unclear how the novel treatment – immunotherapy, influences cardiorespiratory function and perceived levels of fatigue in cancer populations. Studies have shown that cancer-related fatigue (CRF) is associated with decreased cardiopulmonary performance, especially V̇O2 peak [2]. Understanding the relationship between them can be beneficial for future exercise interventions for cancer patients undergoing immunotherapy. METHODS: We conducted a cross-sectional study involving three age-matched groups: immunotherapy cancer patients (IMMU) (n=11; 36.36% females), cancer survivors (SUR) (n=12; 50% females), and healthy controls (HC) (n=16; 37.5% females). Cardiopulmonary exercise testing (CPET) was used to assess V̇O2 peak, V̇CO2, V̇E, maximal heart rate (HRmax), peak power output (PPO), and respiratory exchange ratio (RER). Self-reported fatigue was evaluated using the Multidimensional Fatigue Inventory (MFI-20). This study aimed to compare the CPET performance and fatigue levels among IMMU, SUR, and HC and search for possible correlations between fatigue and CPET parameters. RESULTS: Significant differences (p < 0.05) were found between the IMMU and HC and SUR and HC when comparing the values of CPET (V̇O2 peak, V̇CO2, V̇E, PPO) and fatigue levels (general and physical fatigue, reduced activity). IMMU exhibited descriptively higher V̇O2 peak values (mean: 31.09 ± 4.81 mL·kg−1·min−1) than SUR (mean: 28.33 ± 5.43 mL·kg−1·min−1) but lower than HC (mean: 39.75 ± 7.11 mL·kg−1·min−1). The highest fatigue levels were observed in IMMU compared to SUR, which showed fatigue levels comparable to HC. Increased V̇O2 correlated with higher generalized fatigue (ρ = 0.636; p = 0.048), while V̇CO2 (ρ = 0.793; p = 0.006), V̇E (ρ = 0.652; p = 0.041), and RER (ρ = 0.688; p = 0.028) correlated with higher mental fatigue in IMMU. Lower reduced activity was correlated to a higher V̇O2 peak (ρ = 0.590; p = 0.044) in the SUR group. CONCLUSION: The IMMU group showed tendencies of better CPET performance but significantly higher levels of fatigue than the SUR group, even though they were still receiving ongoing anticancer treatment. These findings indicate that CPET is not the only indicator of chronic fatigue development in cancer-affected populations, especially under immunotherapy treatment. REFERENCES: [1] World Health Organization. (2019). Cancer. World Health Organization; World Health Organization: WHO. https://www.who.int/health-topics/cancer#tab=tab_1 [2] Brownstein, C. G., Twomey, R., Temesi, J., Wrightson, J. G., Martin, T., Medysky, M. E., Culos-Reed, S. N., & Millet, G. Y. (2021). Physiological and psychosocial correlates of cancer-related fatigue. Journal of Cancer Survivorship. https://doi.org/10.1007/s11764-021-01115-6
Read CV Diana KranjcECSS Paris 2023: CP-MH05
INTRODUCTION: Physical activity influences anticancer effects (ACE) indirectly by reducing cancer risk factors like sex hormones, body fat, and inflammation (doi:10.1038/nrc2325). Preclinical studies show direct effects on cancer cells, such as reduced proliferation (doi:10.1016/j.cmet.2017.09.015). These effects may be mediated by myokines like IL-6, which can inhibit proliferation and induce apoptosis in breast cancer (BC) (doi:10.1515/tjb-2020-0508) and colon cancer cells (doi:10.1002/ijc.33982). Oncostatin M (OSM) and SPARC can suppress or promote cancer growth depending on the type of cancer. Exercise also stimulates release of BDNF, and FGF21, which have systemic or direct ACE effects (doi:10.1016/j.bbcan.2022.188761). This pilot study examined effect of acute exercise on serum myokine levels in BC survivors. The focus was on markers associated with cancer progression, immune response, and metabolism, including cytokines. METHODS: Seven women (age 44.7±7.76 years, BMI 24.4 (23.1; 30.3), 6-12 months post-BC treatment). Modified Bruce protocol was used to assess HRpeak and VO2peak (UNCCRI Treadmill Protocol). VO2peak attainment was determined based on modified Borg scale (fatigue rating ≥8), and/or RER ≥1.1, and tester’s confirmation of protocol termination. In the following weeks subjects completed three high-intensity exercise protocols (85–95% heart rate reserve) with different modalities: interval, continuous, and incremental. Blood samples were obtained before and immediately after each exercise session. Levels of IL-6, OSM, FGF-21, SPARC, and BDNF were analyzed using the Human Myokine Magnetic Bead Panel (HMYOMAG-56K, Millipore, Billerica, MA, USA) on a Magpix analyzer (Austin, TX, USA). After checking normality mixed-design ANOVA and Post-hoc comparisons were used for data analysis. RESULTS: During VO2peak estimation RER reached 1.14±0.0698, ventilation (VE) was 77±7.47 L/min and VO2peak 29.1±2.93 ml/kg/min. Data analysis revealed no significant interaction between intervention and time for any of the evaluated biomarkers (p>0.05). Furthermore, post-hoc comparisons showed no significant differences between interventions or time points for any biomarker (all p > 0.05). However, each patient showed a different intra-individual response to various high-intensity exercise modalities, with varying trends and magnitudes of change. For example, BDNF values before vs after the training session for one of the patients were as follows: interval training - 18,914.8 vs 6,689.3 pg/mL; continuous exercise - 13,551.4 vs 14,891.5 pg/mL; incremental exercise - 6,813.5 vs 11,788.1 pg/mL, correspondingly. CONCLUSION: None of the high-intensity exercise modalities resulted in significant systemic changes of myokines in breast cancer patients. However, intra- and inter- individual variability in response to different exercise modalities should be considered for development of proper research design and for personalized interventions in this patient population.
Read CV Linda LaizaneECSS Paris 2023: CP-MH05
INTRODUCTION: The ability to walk safely and engage in daily activities and social interactions without restrictions relies on the coordinated interplay of sufficient muscle strength, ankle flexibility, and the effective acquisition and utilisation of sensory information essential for motor control and balance during walking. It is well-documented that cancer and its associated treatments can have a detrimental effect on physical performance, potentially resulting in limitations in parameters needed for normal gait, including balance. Therefore, this study hypothesises that balance impairments significantly influence gait variability in children with cancer, a factor recognised as a crucial contributor to increased fall risk in children. The present research aims to examine the relationship between balance and gait variability in children and adolescents with cancer. METHODS: A total of 62 patients aged 4 to 20 years (mean age: 9.68 ± 4.02 years) during and after cancer treatment participated in the study. Spatio-temporal gait parameters (step length, base of support, step duration, velocity, step frequency) were measured using a 10 m OPTOGait walkway (Microgate S.r.l., Bolzano) and intra-individual gait variability was calculated using the coefficient of variance (CV). Balance was measured using the static stand test according to Bös et al. (2009), a balance test in which subjects maintain a one-legged stance on a thin T-bar for one minute and ground contacts are counted. Correlations between balance and gait variability were analysed using Spearmans correlation. The significance level was set at p < 0.05 and Spearman correlation coefficients were interpreted according to Cohen (ρ = 0.1 - 0.3: small correlation, ρ = 0.3 - 0.5: moderate correlation, ρ > 0.5: strong correlation). RESULTS: The findings indicate moderate to strong significant correlations between balance performance and intra-individual variability in all gait parameters assessed, except for step frequency where only small significant correlations can be observed. Children with poorer balance ability in the static stand test had significantly greater variability in step length (ρ = .402, p = .002), base of support (ρ = .305, p = .022), step duration (ρ = .375, p = .004), velocity (ρ = .353, p = .008) and step frequency (ρ = .263, p = .05). CONCLUSION: The findings of this study highlight the significant relationship between balance ability and gait variability in children and adolescents with cancer. Given the critical role of balance in maintaining stable and efficient gait, targeted interventions aimed at improving balance may help reduce gait variability. Future research should further explore the underlying mechanisms of balance deficits in childhood cancer patients and assess the effectiveness of tailored rehabilitation strategies to enhance mobility and overall quality of life.
Read CV Mareike KuehnECSS Paris 2023: CP-MH05