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Does inflammation markers or treatment type moderate exercise intensity effects on changes in muscle strength in cancer survivors participating in a 6-month combined resistance and endurance exercise program? Results from the Phys-Can trial
Henriksson A, Strandberg E, Stenling A, Mazzoni A-S, Sjovall K, Borjeson S, Raastad T, Demmelmaier I, Berntsen S, Nordin K
BMC Sports Science, Medicine and Rehabilitation 2023 Jan 19;15(8):Epub
clinical trial
4/10 [Eligibility criteria: No; Random allocation: Yes; Concealed allocation: No; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: No; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

BACKGROUND: Resistance exercise has a beneficial impact on physical function for patients receiving oncological treatment. However, there is an inter-individual variation in the response to exercise and the tolerability to high-intensity exercise. Identifying potential moderating factors, such as inflammation and treatment type, for changes in muscle strength is important to improve the effectiveness of exercise programs. Therefore, we aimed to investigate if inflammation and type of oncological treatment moderate the effects of exercise intensity (high versus low-moderate) on muscular strength changes in patients with breast (BRCA) or prostate cancer (PRCA). METHODS: Participants with BRCA (n = 286) and PRCA (n = 65) from the Physical training and Cancer study (Phys-Can) were included in the present study. Participants performed a combined resistance- and endurance exercise program during six months, at either high or low-moderate intensity. Separate regression models were estimated for each cancer type, with and without interaction terms. Moderators included in the models were treatment type (ie, neo/adjuvant chemotherapy-yes/no for BRCA, adjuvant androgen deprivation therapy (ADT) yes/no for PRCA)), and inflammation (interleukin 6 (IL6) and tumor necrosis factor-alpha (TNFalpha)) at follow-up. RESULTS: For BRCA, neither IL6 (b = 2.469, 95% CI -7.614 to 12.552) nor TNFalpha (b = 0.036, 95% CI -6.345 to 6.418) levels moderated the effect of exercise intensity on muscle strength change. The same was observed for chemotherapy treatment (b = 4.893, 95% CI -2.938 to 12.724). Similarly, for PRCA, the effect of exercise intensity on muscle strength change was not moderated by IL6 (b = -1.423, 95% CI -17.894 to 15.048) and TNFalpha (b = -1.905, 95% CI -8.542 to 4.732) levels, nor by ADT (b = -0.180, 95% CI -11.201 to 10.841). CONCLUSIONS: The effect of exercise intensity on muscle strength is not moderated by TNFalpha, IL6, neo/adjuvant chemotherapy, or ADT, and therefore cannot explain any intra-variation of training response regarding exercise intensity (eg, strength gain) for BRCA or PRCA in this setting. TRIAL REGISTRATION: ClinicalTrials.gov NCT02473003.

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