BackgroundExercise is an effective strategy to improve quality of life and physical fitness in breast cancer survivors; however, few studies have focused on the early survivorship period, minorities, physically inactive and obese women, or tested a combined exercise program and measured bone health. Here, we report the effects of a 16-week aerobic and resistance exercise intervention on patient-reported outcomes, physical fitness, and bone health in ethnically diverse, physically inactive, overweight or obese breast cancer survivors.MethodsOne hundred breast cancer survivors within 6 months of completing adjuvant treatment were assessed at baseline, post-intervention, and 3-month follow-up (exercise group only) for physical fitness, bone mineral density, serum concentrations of bone biomarkers, and quality of life. The exercise intervention consisted of moderate-vigorous (65–85% heart rate maximum) aerobic and resistance exercise thrice weekly for 16 weeks. Differences in mean changes for outcomes were evaluated using mixed-model repeated measure analysis.ResultsAt post-intervention, the exercise group was superior to usual care for quality of life (between group difference: 14.7, 95% CI: 18.2, 9.7; p < 0.001), fatigue (p < 0.001), depression (p < 0.001), estimated VO2max (p < 0.001), muscular strength (p < 0.001), osteocalcin (p = 0.01), and BSAP (p = 0.001). At 3-month follow-up, all patient-reported outcomes and physical fitness variables remained significantly improved compared to baseline in the exercise group (p < 0.01).ConclusionsA 16-week combined aerobic and resistance exercise program designed to address metabolic syndrome in ethnically-diverse overweight or obese breast cancer survivors also significantly improved quality of life and physical fitness. Our findings further support the inclusion of supervised clinical exercise programs into breast cancer treatment and care.Trial registrationThis trial is registered on ClinicalTrials.gov: NCT01140282 as of June 9, 2010.

BACKGROUND: Metabolic syndrome (MSY) is associated with an increased risk of cardiovascular disease, type 2 diabetes, and recurrence in breast cancer survivors (BCS). MSY is 1.5 times more common in Hispanic women compared with non-Hispanic women. Although exercise mitigates MSY in BCS, to the best of the authors' knowledge, few studies to date have focused on minorities. This secondary analysis examined ethnicity as a moderator of the effects of a 16-week aerobic and resistance exercise intervention on MSY, sarcopenic obesity, and serum biomarkers in BCS. METHODS: A total of 100 eligible BCS were randomized to exercise (50 BCS) or usual care (50 BCS). The exercise intervention promoted moderate to vigorous aerobic and resistance exercise 3 times a week for 16 weeks. MSY z scores, sarcopenic obesity, and serum biomarkers were measured at baseline, after the intervention, and at the 28week follow-up (exercise group only). Linear mixed models adjusted for baseline values of the outcome, age, disease stage, adjuvant treatment, and recent physical activity were used to evaluate effect modification by ethnicity. RESULTS: The study sample was 57% Hispanic BCS (HBCS) and 43% non-Hispanic BCS (NHBCS). HBCS were younger, of greater adiposity, and had been diagnosed with more advanced cancers compared with NHBCS (P<.001). Ethnicity was found to moderate the mean differences in exercise training on triglycerides (-36.4 mg/dL; 95% confidence interval [95% CI],-64.1 to -18.8 mg/dL), glucose (-8.6 mg/dL; 95% CI, -19.1 to -3.0 mg/ dL), and C-reactive protein (-3.3 mg/L; 95% CI, -7.3 to -0.9 mg/L). CONCLUSIONS: HBCS appear to have poorer metabolic profiles and therefore may derive relatively larger metabolic changes from exercise compared with NHBCS. Clinical exercise interventions may attenuate existing health disparities across diverse groups of BCS. Cancer 2019;125:910-920.

A number of rehabilitation strategies are available that have the potential to improve the identification of and outcomes for children with disabilities in low and middle income countries. Future research ought to advance the development, implementation, and evaluation of training programs for non-rehabilitation specialists (e.g., doctors, nurses, and teachers), non-specialist community members (e.g., community health workers), and caregivers in the area of rehabilitation, and evaluate the effectiveness of rehabilitation interventions in improving participatory outcomes and quality of life for children with disabilities. Implications for Rehabilitation Additional research is needed to understand the influence of rehabilitation on personal factors (e.g., self-efficacy and quality of life) and participation for children with disabilities. There is limited availability of experienced rehabilitation service providers, especially in rural areas, warranting additional research into the development and evaluation of non-specialist training programs, and the integration of rehabilitation concepts across health workforce education programs. Researchers from low and middle income countries appear to be underrepresented in published rehabilitation research, indicating a need to further promote the inclusion of this group through community-based participatory research.

Abtract Background Adverse upper limb musculoskeletal effects occur after surgical procedures and radiotherapy for breast cancer and can interfere with activities of daily living. Objective The objective of this study was to examine the effects of a 16-week exercise intervention on shoulder function in women who are overweight or obese and have breast cancer. Design This study was a randomized controlled trial. Setting The study was performed at the Division of Biokinesiology and Physical Therapy at the University of Southern California. Participants One hundred women with breast cancer were randomly allocated to exercise or usual-care groups. The mean (SD) age of the women was 53.5 (10.4) years, 55% were Hispanic white, and their mean (SD) body mass index was 33.5 (5.5) kg/m2. Intervention The 16-week exercise intervention consisted of supervised, progressive, moderate to vigorous aerobic and resistance exercise 3 times per week. Measurements Shoulder active range of motion, isometric muscular strength, and patient-reported outcome measures (including Disabilities of the Arm, Shoulder, and Hand and the Penn Shoulder Scale) were assessed at baseline, after the intervention, and at the 3-month follow-up (exercise group only). Differences in mean changes for outcomes were evaluated using mixed-model repeated-measures analysis. Results Compared with the usual-care group, the exercise group experienced significant increases in shoulder active range of motion (the mean between-group differences and 95% confidence intervals (CIs) were as follows: shoulder flexion = 36.6° [95% CI = 55.2–20.7°], external rotation at 0° = 23.4° [95% CI = 31.1–12.5°], and external rotation at 90° = 34.3° [95% CI = 45.9–26.2°]), improved upper extremity isometric strength, and improved Disabilities of the Arm, Shoulder, and Hand and Penn Shoulder Scale scores. Limitations Limitations include a lack of masking of assessors after the intervention, an attention control group, and statistical robustness (shoulder function was a secondary end point). Conclusions A 16-week exercise intervention effectively improved shoulder function following breast cancer treatment in women who were overweight or obese, who were ethnically diverse, and who had breast cancer.

Background: Because obesity is an independent risk factor for breast cancer recurrence, assessment of body composition is crucial to guide weight management in breast cancer survivors (BCS). This study assessed whether dual-energy x-ray absorptiometry (DXA) and bioelectrical impedance analysis (BIA) yield similar results for body composition in BCS. Methods: Body fat percentage, lean body mass, and fat mass were estimated using DXA and BIA under fasting conditions in 89 BCS. BMI categories included normal (18-24.99 kg/m 2 ; n = 28), overweight (25.0-29.9 kg/m 2 ; n = 21), obese (>30 kg/m 2 ; n = 23), and severely obese BCS (>35 kg/m 2 ; n = 17). Agreement between the devices was assessed by Bland-Altman analysis. Results: There was no agreement between the 2 devices for body fat percentage (DXA: 44.2 ± 6.2% vs BIA: 40.4 ± 7.8%), lean body mass (DXA: 39.1 ± 7.6 kg vs BIA: 42.9 ± 5.9 kg), and fat mass (DXA: 32.4 ± 10.8 kg vs BIA: 30.6 ± 11.0 kg; P < .001). These findings were consistent in normal, overweight, and obese BCS. There was agreement between the 2 devices for fat mass (DXA: 48.7 ± 7.2 kg vs BIA: 47.9 ± 5.7 kg) in severely obese BCS (P = .102), possibly due to small sample size. Conclusions: BIA may underestimate body fat percentage and fat mass and overestimate lean body mass, compared with DXA. Future studies are warranted to assess the use of these 2 devices in a larger cohort of BCS within BMI categories. (Nutr Clin Pract. 2019;34:421-427)