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Observational epidemiologic data suggest that participation in physical activity after a diagnosi... more Observational epidemiologic data suggest that participation in physical activity after a diagnosis of colon cancer reduces the risk of cancer recurrence, cancer-specific mortality, and all-cause mortality. However, the biologic mechanisms that mediate the relationship between physical activity and disease outcomes among colon cancer survivors have not been characterized. Excess visceral adipose tissue and hyperinsulinemia promote the growth and progression of existing micro-metastases and the development of new distant metastases. Exercise reduces visceral adipose tissue and hyperinsulinemia among non-diabetic persons with obesity. However, it is unknown if exercise alters visceral adipose tissue and hyperinsulinemia among colon cancer survivors. We conducted a phase II, randomized, six month, dose-response exercise trial that compared 150 min•wk-1 or 300 min•wk-1 of moderate-intensity aerobic exercise to a usual care control group among 39 colon cancer survivors. We examined the ef...

Nutrients, 2021

Obesity-associated breast cancer recurrence is mechanistically linked with elevated insulin level... more Obesity-associated breast cancer recurrence is mechanistically linked with elevated insulin levels and insulin resistance. Exercise and weight loss are associated with decreased breast cancer recurrence, which may be mediated through reduced insulin levels and improved insulin sensitivity. This is a secondary analysis of the WISER Survivor clinical trial examining the relative effect of exercise, weight loss and combined exercise and weight loss interventions on insulin and insulin resistance. The weight loss and combined intervention groups showed significant reductions in levels of: insulin, C-peptide, homeostatic model assessment 2 (HOMA2) insulin resistance (IR), and HOMA2 beta-cell function (β) compared to the control group. Independent of intervention group, weight loss of ≥10% was associated with decreased levels of insulin, C-peptide, and HOMA2-IR compared to 0–5% weight loss. Further, the combination of exercise and weight loss was particularly important for breast cancer s...

JNCI Cancer Spectrum, 2019

Background Diabetes is a prognostic factor for some malignancies, but its association with outcom... more Background Diabetes is a prognostic factor for some malignancies, but its association with outcome in patients with advanced or metastatic colorectal cancer (CRC) is less clear. Methods This cohort study was nested within a randomized trial of first-line chemotherapy and bevacizumab and/or cetuximab for advanced or metastatic CRC. Patients were enrolled at 508 community and academic centers throughout the National Clinical Trials Network. The primary exposure was physician-documented diabetes at the time of enrollment. The primary endpoint was overall survival (OS); secondary endpoints were progression-free survival (PFS) and adverse events. Tests of statistical significance were two-sided. Results Among 2326 patients, 378 (16.3%) had diabetes. The median follow-up time was 6.0 years. We observed 1973 OS events and 2173 PFS events. The median time to an OS event was 22.7 months among those with diabetes and 27.1 months among those without diabetes (HR = 1.27, 95% CI = 1.13 to 1.44; ...

JAMA, 2019

studies, higher plasma 25-hydroxyvitamin D (25[OH]D) levels have been associated with improved su... more studies, higher plasma 25-hydroxyvitamin D (25[OH]D) levels have been associated with improved survival in metastatic colorectal cancer (CRC). OBJECTIVE To determine if high-dose vitamin D 3 added to standard chemotherapy improves outcomes in patients with metastatic CRC. DESIGN, SETTING, AND PARTICIPANTS Double-blind phase 2 randomized clinical trial of 139 patients with advanced or metastatic CRC conducted at 11 US academic and community cancer centers from March 2012 through November 2016 (database lock: September 2018). INTERVENTIONS mFOLFOX6 plus bevacizumab chemotherapy every 2 weeks and either high-dose vitamin D 3 (n = 69) or standard-dose vitamin D 3 (n = 70) daily until disease progression, intolerable toxicity, or withdrawal of consent. MAIN OUTCOMES AND MEASURES The primary end point was progression-free survival (PFS) assessed by the log-rank test and a supportive Cox proportional hazards model. Testing was 1-sided. Secondary end points included tumor objective response rate (ORR), overall survival (OS), and change in plasma 25(OH)D level. RESULTS Among 139 patients (mean age, 56 years; 60 [43%] women) who completed or discontinued chemotherapy and vitamin D 3 (median follow-up, 22.9 months), the median PFS for high-dose vitamin D 3 was 13.0 months (95% CI, 10.1 to 14.7; 49 PFS events) vs 11.0 months (95% CI, 9.5 to 14.0; 62 PFS events) for standard-dose vitamin D 3 (log-rank P = .07); multivariable hazard ratio for PFS or death was 0.64 (1-sided 95% CI, 0 to 0.90; P = .02). There were no significant differences between high-dose and standard-dose vitamin D 3 for tumor ORR (58% vs 63%, respectively; difference, −5% [95% CI, −20% to 100%], P = .27) or OS (median, 24.3 months vs 24.3 months; log-rank P = .43). The median 25(OH)D level at baseline for high-dose vitamin D 3 was 16.1 ng/mL vs 18.7 ng/mL for standard-dose vitamin D 3 (difference, −2.6 ng/mL [95% CI, −6.6 to 1.4], P = .30); at first restaging, 32.0 ng/mL vs 18.7 ng/mL (difference, 12.8 ng/mL [95% CI, 9.0 to 16.6], P < .001); at second restaging, 35.2 ng/mL vs 18.5 ng/mL (difference, 16.7 ng/mL [95% CI, 10.9 to 22.5], P < .001); and at treatment discontinuation, 34.8 ng/mL vs 18.7 ng/mL (difference, 16.2 ng/mL [95% CI, 9.9 to 22.4], P < .001). The most common grade 3 and higher adverse events for chemotherapy plus high-dose vs standard-dose vitamin D 3 were neutropenia (n = 24 [35%] vs n = 21 [31%], respectively) and hypertension (n = 9 [13%] vs n = 11 [16%]). CONCLUSIONS AND RELEVANCE Among patients with metastatic CRC, addition of high-dose vitamin D 3 , vs standard-dose vitamin D 3 , to standard chemotherapy resulted in a difference in median PFS that was not statistically significant, but with a significantly improved supportive hazard ratio. These findings warrant further evaluation in a larger multicenter randomized clinical trial.

Journal of Cachexia, Sarcopenia and Muscle, 2019

There is growing interest from the oncology community to understand how body composition measures... more There is growing interest from the oncology community to understand how body composition measures can be used to improve the delivery of clinical care for the 18.1 million individuals diagnosed with cancer annually. Methods that distinguish muscle from subcutaneous and visceral adipose tissue, such as computed tomography (CT), may offer new insights of important risk factors and improved prognostication of outcomes over alternative measures such as body mass index. In a meta-analysis of 38 studies, low muscle area assessed from clinically acquired CT was observed in 27.7% of patients with cancer and associated with poorer overall survival [hazard ratio: 1.44, 95% CI: 1.32-1.56]. Therapeutic interventions such as lifestyle and pharmacotherapy that modify all aspects of body composition and reduce the incidence of poor clinical outcomes are needed in patients with cancer. In a metaanalysis of six randomized trials, resistance training exercise increased lean body mass assessed from dual-energy X-ray absorptiometry [mean difference (MD): +1.07 kg, 95% CI: 0.76-1.37; P < 0.001] and walking distance [MD: +143 m, 95% CI: 70-216; P < 0.001] compared with usual care control in patients with non-metastatic cancer. In a meta-analysis of five randomized trials, anamorelin (a ghrelin agonist) significantly increased lean body mass [MD: +1.10 kg, 95% CI: 0.35-1.85; P = 0.004] but did not improve handgrip strength [MD: 0.52 kg, 95% CI: À0.09-1.13; P = 0.09] or overall survival compared with placebo [HR: 0.99, 95% CI: 0.85-1.14; P = 0.84] in patients with advanced or metastatic cancer. Early screening to identify individuals with occult muscle loss, combined with multimodal interventions that include lifestyle therapy with resistance exercise training and dietary supplementation combined with pharmacotherapy, may be necessary to provide a sufficient stimulus to prevent or slow the cascade of tissue wasting. Rapid, cost-efficient, and feasible methods to quantify muscle and adipose tissue distribution are needed if body composition assessment is to be integrated into large-scale clinical workflows. Fully automated analysis of body composition from clinically acquired imaging is one example. The study of body composition is one of the most provocative areas in oncology that offers tremendous promise to help patients with cancer live longer and healthier lives.

Endocrine-related cancer, 2018

Physical activity is associated with a lower risk of disease recurrence among colon cancer surviv... more Physical activity is associated with a lower risk of disease recurrence among colon cancer survivors. The pathways through which physical activity may alter disease outcomes are unknown, but may include changes in metabolic growth factors, such as insulin. Between January 2015 and August 2015, 39 stage I-III colon cancer survivors were randomized to one of the three groups: usual care control, 150 min/week of aerobic exercise (low-dose) and 300 min/week of aerobic exercise (high-dose) for six months. The pre-specified key metabolic growth factor outcome was fasting insulin. Insulin resistance was quantified using the homeostatic model assessment. Mean age was 56.5 ± 10.0 years, 51% had stage III disease, 72% were treated with chemotherapy and the mean time since finishing treatment was 10.9 ± 6.1 months. Over six months, the low-dose group completed 141.5 ± 9.9 min/week of aerobic exercise, and the high-dose group completed 247.2 ± 10.7 min/week of aerobic exercise. Fasting insulin ...

Journal of cachexia, sarcopenia and muscle, Jan 15, 2018

Muscle abnormalities such as low muscle mass and low muscle radiodensity are well known risk fact... more Muscle abnormalities such as low muscle mass and low muscle radiodensity are well known risk factors for unfavourable cancer prognosis. However, little is known in regard to the degree and impact of longitudinal changes in muscle mass and radiodensity within the context of cancer. Here, we explore the relationship between muscle wasting and mortality in a large population-based study of patients with non-metastatic colorectal cancer (CRC). A total of 1924 patients with stage I-III CRC who underwent surgical resection in the Kaiser Permanente Northern California Health System were included. Muscle mass and radiodensity were quantified using computed tomography images obtained at diagnosis and after approximately 14 months. Cox proportional-hazards models were used to estimate hazard ratios for all-cause mortality. The hazard ratio for all-cause mortality among patients with the largest deterioration in muscle mass (≥2 SD; ≥11.4% loss from baseline), as compared with those who remaine...

JNCI cancer spectrum, 2018

Energy balance-related risk factors for colon cancer recurrence and mortality-type II diabetes, h... more Energy balance-related risk factors for colon cancer recurrence and mortality-type II diabetes, hyperinsulinemia, inflammation, and visceral obesity-are positively correlated with consumption of refined grains and negatively correlated with consumption of whole grains. We examined the relationship between the consumption of refined and whole grains with cancer recurrence and mortality in a cohort of patients with colon cancer. We conducted a prospective observational study of 1024 patients with stage III colon cancer who participated in a randomized trial of postoperative chemotherapy. Patients reported consumption of refined and whole grains using a food frequency questionnaire during and six months after chemotherapy. The primary outcome was disease-free survival (DFS). Multivariable-adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using Cox regression models. All values are two-sided. During a median follow-up of 7.3 years, 394 patients experienced a...

British Journal of Cancer, 2017

Background: Physical activity is associated with a lower risk of disease recurrence among colon c... more Background: Physical activity is associated with a lower risk of disease recurrence among colon cancer survivors. Excess visceral adipose tissue is associated with a higher risk of disease recurrence among colon cancer survivors. The pathways through which physical activity may alter disease outcomes are unknown, but may be mediated by changes in visceral adipose tissue. Methods: Thirty-nine stage I-III colon cancer survivors were randomised to one of three groups: usual-care control, 150 min wk À 1 of aerobic exercise (low dose) and 300 min wk À 1 of aerobic exercise (high dose) for 6 months. The prespecified key body composition outcome was visceral adipose tissue quantified using dual energy X-ray absorptiometry. Results: Exercise reduced visceral adipose tissue in dose-response fashion (P trend ¼ 0.008). Compared with the control group, the low-and high-dose exercise groups lost 9.5 cm 2 (95% CI:-22.4, 3.5) and 13.6 cm 2 (95% CI:-27.0,-0.1) in visceral adipose tissue, respectively. Each 60 min wk À 1 increase in exercise predicted a 2.7 cm 2 (95% CI:-5.4,-0.1) reduction in visceral adipose tissue. Conclusions: Aerobic exercise reduces visceral adipose tissue in dose-response fashion among patients with stage I-III colon cancer. Visceral adipose tissue may be a mechanism through which exercise reduces the risk of disease recurrence among colon cancer survivors.

BMC medicine, Jan 22, 2016

The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremit... more The Short Physical Performance Battery (SPPB) is a well-established tool to assess lower extremity physical performance status. Its predictive ability for all-cause mortality has been sparsely reported, but with conflicting results in different subsets of participants. The aim of this study was to perform a meta-analysis investigating the relationship between SPPB score and all-cause mortality. Articles were searched in MEDLINE, the Cochrane Library, Google Scholar, and BioMed Central between July and September 2015 and updated in January 2016. Inclusion criteria were observational studies; >50 participants; stratification of population according to SPPB value; data on all-cause mortality; English language publications. Twenty-four articles were selected from available evidence. Data of interest (i.e., clinical characteristics, information after stratification of the sample into four SPPB groups [0-3, 4-6, 7-9, 10-12]) were retrieved from the articles and/or obtained by the study...

Aging Clinical and Experimental Research, 2016

Background-It is unknown if physical activity and good diet quality modify the risk of poor outco... more Background-It is unknown if physical activity and good diet quality modify the risk of poor outcomes, such as mortality, among older adults with sarcopenia. Aim-To examine if physical activity and good diet quality modify the risk of poor outcomes, such as mortality, among older adults with sarcopenia Methods-A population-based cohort study among 1,618 older-adults with sarcopenia from the Third National Health and Nutrition Survey (NHANES III; 1988-1994). Sarcopenia was defined by the European Working Group on Sarcopenia in Older People. Physical activity was selfreported, and classified as sedentary (0 bouts per week), physically inactive (1-4 bouts per week), and physically active (≥5 bouts per week). Diet quality was assessed with the healthy eating index (a scale of 0-100 representing adherence to federal dietary recommendations), and classified as poor (<51), fair (51-80), and good (>80) diet quality. Results-Compared to participants who were sedentary, those who were physically inactive were 16% less likely to die [HR: 0.84 (95% CI: 0.64-1.09)], and those who were physically active were 25% less likely to die [HR: 0.75 (95% CI: 0.59-0.97); P trend =0.026]. Compared to participants with poor diet quality, those with fair diet quality were 37% less likely to die [HR: 0.63 (95% CI: 0.47-0.86)], and those with good diet quality were 45% less likely to die [HR: 0.55 (95% CI: 0.37-0.80); P trend =0.002]. Conclusions-Participation in physical activity and consumption of a healthy diet correspond with a lower risk of mortality among older adults with sarcopenia. Randomized trials are needed in this population.

Journal of geriatric oncology, Jan 18, 2016

This study aimed to characterize the relationship of patient-reported functional limitations, gai... more This study aimed to characterize the relationship of patient-reported functional limitations, gait speed, and mortality risk among cancer survivors. This study included cancer survivors from the Third National Health and Nutrition Survey. Patient-reported functional limitations were quantified by asking participants to assess their ability to complete five tasks: (1) walking 1/4mi, (2) walking up 10 steps, (3) stooping, crouching, or kneeling, (4) lifting or carrying an object of 10lb, and (5) standing up from an armless chair. Gait speed was quantified using a 2.4-meter walk. Vital status was obtained through the United States National Center for Health Statistics. The study sample included 428 cancer survivors who averaged 72.1years of age. The average number of patient-reported functional limitations was 1.8 (out of 5) and 66% of participants reported ≥1 functional limitation. Patient-reported functional limitations and gait speed were related, such that each functional limitatio...

Chapter 1-Introduction Background and Significance Cancer Survivorship Cancer is a major public h... more Chapter 1-Introduction Background and Significance Cancer Survivorship Cancer is a major public health problem. In 2009 there were an estimated 11 million cancer survivors in the United States. Cancer is the leading cause of death among women 40 to 79 yr and men 60 to 79 yr. The most common forms of cancer among men are prostate, lung, and colorectal cancer with rates of 158.2, 87.3, and 61.2 diagnoses per 100,000 persons, respectively. The cancer incidence rate among White non-Hispanic men is 551 diagnoses per 100,000 people compared to African American men with 652 diagnoses per 100,000 people. The most common forms of cancer among women are breast, lung, and colorectal with rates of 123.6, 55.4, and 44.8 diagnoses per 100,000 persons, respectively. White non-Hispanic women are at higher risk for developing cancer with 423 diagnoses per 100,000 people compared to African American women with 398 diagnoses per 100,000 people. Cancers of the breast, prostate, lung, and colon accounted for an estimated 751,061 new diagnoses (~50% of all cancer diagnoses) and 276,000 deaths (~49% of all cancer related deaths) in 2009 in the United States. The lifetime probability of developing cancer for men is 50% (1 in 2) and for women 38% (~1 in 3) (1). Despite high incidence rates among the general population, advances in screening, surgical procedures, and pharmacological interventions have increased the 5 yr survival rate among all cancers survivors from 50% in 1974 to 66% in 2009 (1). This 16% increase equates to ~1.7 million people living with cancer for ≥5 yr after diagnosis in 2004 that if diagnosed in 1969 may have not been alive in 1974 (1). 2 While living longer after diagnosis, cancer survivors frequently report physical and psychological symptoms associated with cancer or cancer treatment(s) including loss of appetite, nausea, difficulty concentrating, fatigue, and depression (2). Nearly all cancer survivors report one or more symptoms affecting their sense of well-being that negatively affects physical and social quality of life (QOL) (3). Management of symptoms associated with cancer or cancer treatment may have limited or no treatment so that clinicians are often left with the option of advising their patients that cancer related symptoms are something they have to learn to live with (3). However, there is a variety of established interventions to aid in modulating symptom severity. These interventions include individual and family counseling, coping skill development, and communication skill development. These above-mentioned interventions broadly focus on improving psychological components of cancer survivor well-being rather than physical well-being (4, 5). However, in the past two decades, literature has accumulated that indicates exercise after cancer diagnosis reduces the incidence and severity of a variety physiologic and psychosocial symptoms' frequently reported by cancer survivors. However, the magnitude of symptom improvement among exercise interventions in cancer survivors is highly variable among individual exercise interventions. These variations in symptom improvement may due to differences among exercise interventions including the type of cancer targeted, stage and type of treatment, type of exercise performed, and the primary health outcomes examined (2, 6). Exercise Interventions The accumulation of literature addressing the effect of exercise on symptom management among cancer survivors has spurred various professional organizations to develop exercise recommendations tailored for cancer survivors. These organizations 3 include the American Cancer Society (7), National Comprehensive Cancer Network (3), and American College of Sports Medicine (ACSM) (2, 8). The two sets of ACSM exercise guidelines were developed differently; one in the form of guidelines based on limited literature-based evidence (8), and the other, an expert panel consensus (2). A noteworthy comment, each exercise recommendation from the American Cancer Society, National Comprehensive Cancer Network and the ACSM suggest different "Exercise Prescription's (Ex R x)" elicit favorable outcomes among cancer survivors. For example, the American Cancer Society and National Comprehensive Cancer Society make no recommendation of resistance training among cancer survivors, whereas the ACSM suggests resistance training performed two days per week to achieve the healthbenefits associated with exercise. The current professional exercise recommendations for cancer survivors (2, 3, 7, 8) are generic, in that one set of recommendations is used for all cancer survivors. However, due to the variety of cancers, their varying pathophysiology, and varying treatment regimes, Ex R x 's may need tailoring specific to the health outcome of interest (i.e., reducing depression) for the most efficacious benefits of exercise to be achieved (8). The components of any Ex R x are frequency (F), intensity (I), time (T), and type (T) of exercise performed, labeled the FITT principle of Ex R x (8). Frequency refers to how often the exercise sessions take place (i.e., 2 d•wk-1). Intensity refers to how hard or the level of physical exertion is (i.e., low, moderate, or vigorous). Intensity of exercise can be quantified using metabolic equivalent units (METs). One MET is equal to 3.5 ml•kg-1 •min-1 , representing oxygen consumption (ml) per kg of body weight per minute while sitting quietly. METs are categorized into light intensity (<3 METs), moderate intensity (3 to 6 METs), or vigorous intensity (>6 METs). Time refers to how long each exercise session is (i.e., 30 min•d-1). Type refers to the modality or kind of activity completed (i.e., 4 cycling, walking, weight training). ACSM's Guidelines for Exercise Testing and Prescription, eighth edition (8) provide the most detailed FITT recommendations for cancer survivors. These recommendations focus on a balanced health-fitness program consisting of cardiovascular fitness, muscular strength, muscular endurance, and flexibility activities (8). These guidelines suggest moderate-intensity aerobic and resistance exercise, complimented with flexibility exercise (Table 1) are appropriate for the general physical and mental health of cancer survivors. However, this FITT Ex R x is not symptom specific and thus, may not be the most effective FITT when attempting to maximize the modulation of specific symptoms and health outcomes of cancer survivors.

Journal of Cachexia, Sarcopenia and Muscle, 2015

Background Sarcopenia is a risk-factor for all-cause mortality among older adults, but it is unkn... more Background Sarcopenia is a risk-factor for all-cause mortality among older adults, but it is unknown if sarcopenia predisposes older adults to specific causes of death. Further, it is unknown if the prognostic role of sarcopenia differs between males and females, and obese and non-obese individuals. Methods A population-based cohort study among 4425 older adults from the Third National Health and Nutrition Survey (1988-1994). Muscle mass was quantified using bioimpedance analysis, and muscle function was quantified using gait speed. Multivariable-adjusted Cox regression analysis examined the relationship between sarcopenia and mortality outcomes. Results The mean age of study participants was 70.1 years. The prevalence of sarcopenia was 36.5%. Sarcopenia associated with an increased risk of all-cause mortality [hazard ratio (HR): 1.29 (95% confidence interval (95% CI): 1.13-1.47); P < 0.001] among males and females. Sarcopenia associated with an increased risk of cardiovascular-specific mortality among females [HR: 1.61 (95% CI: 1.22-2.12); P = 0.001], but not among males [HR: 1.07 (95% CI: 0.81-1.40; P = .643); P interaction = 0.079]. Sarcopenia was not associated with cancer-specific mortality among males and females [HR: 1.07 (95% CI: 0.78-1.89); P = 0.672]. Sarcopenia associated with an increased risk of mortality from other causes (i.e. non-cardiovascular and non-cancer) among males and females [HR: 1.32 (95% CI: 1.07-1.62); P = 0.008]. Obesity, defined using body mass index (P interaction = 0.817) or waist circumference (P interaction = 0.219) did not modify the relationship between sarcopenia and all-cause mortality. Conclusions Sarcopenia is a prevalent syndrome that is associated with premature mortality among community-dwelling older adults. The prognostic value of sarcopenia may vary by cause-specific mortality and differ between males and females.

Journal of clinical oncology : official journal of the American Society of Clinical Oncology, Jan 11, 2015

Survivors of breast cancer may experience deterioration of physical function. This is important b... more Survivors of breast cancer may experience deterioration of physical function. This is important because poor physical function may be associated with premature mortality, injurious falls, bone fracture, and disability. We conducted a post hoc analysis to explore the potential efficacy of slowly progressive weight lifting to reduce the incidence of physical function deterioration among survivors of breast cancer. Between October 2005 and August 2008, we conducted a single-blind, 12-month, randomized controlled trial of twice-per-week slowly progressive weight lifting or standard care among 295 survivors of nonmetastatic breast cancer. In this post hoc analysis of data from the Physical Activity and Lymphedema Trial, we examined incident deterioration of physical function after 12 months, defined as a ≥ 10-point decrease in the physical function subscale of the Medical Outcomes Short-Form 36-item questionnaire. The proportion of participants who experienced incident physical function ...

Canadian journal of diabetes, 2014

To examine the associations between body mass index (BMI) and physical activity with body image, ... more To examine the associations between body mass index (BMI) and physical activity with body image, self-esteem and social support in adolescents with type 1 diabetes compared to adolescents without health conditions. We studied 46 adolescents with type 1 diabetes and 27 comparison adolescents who provided self-reports of height and weight, which were used to calculate BMI z-scores. Participants also completed validated questionnaires that assessed physical activity, body image, self-esteem and social support. No significant group differences were found between adolescents with type 1 diabetes and comparison adolescents in terms of BMI and physical activity. Examination of group and gender revealed that higher BMI was significantly associated with a less positive body image in girls with diabetes only. Higher BMI was associated with poorer self-esteem and lower levels of social support in adolescents with diabetes, particularly girls. Higher levels of physical activity were not associa...

PM & R : the journal of injury, function, and rehabilitation, 2015

The health benefits of exercise increase in dose-response fashion among cancer survivors. However... more The health benefits of exercise increase in dose-response fashion among cancer survivors. However, it is unclear how to identify cancer survivors who may require a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate- to vigorous-intensity exercise. To clarify how to identify cancer survivors who should undergo a pre-exercise evaluation before they progress from the common recommendation of walking to unsupervised moderate- to vigorous-intensity exercise. Electronic survey. Forty-seven (n = 47) experts in the field of exercise physiology, rehabilitation medicine, and cancer survivorship. Not applicable. We synthesized peer-reviewed guidelines for exercise and cancer survivorship and identified 82 health factors that may warrant a pre-exercise evaluation before a survivor engages in unsupervised moderate- to vigorous-intensity exercise. The 82 health factors were classified into 3 domains: (1) clinical health factors; (2) com...

Comprehensive Physiology, 2012

This review examines the relationship between physical activity and cancer along the cancer conti... more This review examines the relationship between physical activity and cancer along the cancer continuum, and serves as a synthesis of systematic and meta-analytic reviews conducted to date. There exists a large body of epidemiologic evidence that conclude those who participate in higher levels of physical activity have a reduced likelihood of developing a variety of cancers compared to those who engage in lower levels of physical activity. Despite this observational evidence, the causal pathway underling the association between participation in physical activity and cancer risk reduction remains unclear. Physical activity is also a useful adjunct to improve the deleterious sequelae experienced during cancer treatment. These deleterious sequelae may include fatigue, muscular weakness, deteriorated functional capacity, including many others. The benefits of physical activity during cancer treatment are similar to those experienced after treatment. Despite the growing volume of literature examining physical activity and cancer across the cancer continuum, a number of research gaps exist. There is little evidence on the safety of physical activity among all cancer survivors, as most trials have selectively recruited participants. It is also unclear the specific dose of exercise needed that is optimal for primary cancer prevention or symptom control during and after cancer treatment.

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2014

We sought to quantify the proportion of uterine cancer survivors who self-report poor physical fu... more We sought to quantify the proportion of uterine cancer survivors who self-report poor physical function. We then sought to quantify the association of poor physical function with physical activity (PA), walking, and lower limb lymphedema (LLL), among women with a history of uterine cancer. Physical function was quantified using the Medical Outcomes Study 12-Item Short-Form Health Survey (SF-12) questionnaire. PA, walking, and LLL were measured using self-report questionnaire. PA was calculated using metabolic equivalent hours per week (MET-h week(-1)), and walking was calculated using blocks per day (blocks day(-1)). Logistic regression estimated odds ratios (OR) and 95 % confidence intervals (95 % CI). Among the 213 uterine cancer survivors in our survey (43 % response rate), 35 % self-reported poor physical function. Compared to participants who reported <3.0 MET-h week(-1) of PA, participants who reported ≥18.0 MET-h week(-1) of PA were less likely to have poor physical functi...

PLoS ONE, 2010

Background: Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge worldwid... more Background: Pandemic influenza A (H1N1) 2009 has posed a serious public health challenge worldwide. In absence of reliable information on severity of the disease, the nations are unable to decide on the appropriate response against this disease. Methods: Based on the results of laboratory investigations, attendance in outpatient department, hospital admissions and mortality from the cases of influenza like illness from 1 August to 31 October 2009 in Pune urban agglomeration, risk of hospitalization and case fatality ratio were assessed to determine the severity of pandemic H1N1 and seasonal influenza-A infections. Results: Prevalence of pandemic H1N1 as well as seasonal-A cases were high in Pune urban agglomeration during the study period. The cases positive for pandemic H1N1 virus had significantly higher risk of hospitalization than those positive for seasonal influenza-A viruses (OR: 1.7). Of 93 influenza related deaths, 57 and 8 deaths from Pune (urban) and 27 and 1 death from Pune (rural) were from pandemic H1N1 positive and seasonal-A positive cases respectively. The case fatality ratio 0.86% for pandemic H1N1 was significantly higher than that of seasonal-A (0.13%) and it was in category 3 of the pandemic severity index of CDC, USA. The data on the cumulative fatality of rural and urban Pune revealed that with time the epidemic is spreading to rural areas. Conclusions: The severity of the H1N1 influenza pandemic is less than that reported for 'Spanish flu 1918' but higher than other pandemics of the 20 th century. Thus, pandemic influenza should be considered as serious health threat and unprecedented global response seems justified.