# Exercise as it relates to Disease/Effects of chemotherapy on oxidative stress and exercise tolerance
## What is the background to this research?

Cancer, over time, has continued to rank as one of the largest leading causes of death in the world. In 2019, the World Health Organisation estimated that cancer was the largest leading cause of death in 112 countries before the age of 70. Progressing from this, cancer is said to have a significant association with cardiopulmonary disease and affected oxidative stress. As the disease stands such dominant physiological effects, chemotherapy is used as a form of treatment, but with this and the accompanying effects of the disease, individual health is seriously compensated.
Authors Chia-Jui Yeng and her accompanying cohort, investigated, the overseeing concept that exercise could potentially be recognised and validated as a rehabilitation tool for oxidative stress within head and neck cancer patients following chemotherapy. This study consoles to previous studies that test cardiopulmonary function, oxidative stress, cognitive dysfunction, and general fitness standards following cancer and chemotherapy. All produced similar constructs, in that, exercise benefits multiple physiological and psychological components affected by cancer and chemotherapy, but acknowledges limitations and the need for further research.

## Where is the research from?

The study was conducted by the National Cheng Kung University and National Cheng Kung University Hospital located in Taiwan. Within the process of authorisation, the study was approved by the ethical committee of the National Cheng Kung University Hospital Institutional Review Board, as well as registered in the Thai Clinical Trials Registry. The cohort stemmed from the local community within Taiwan, which is important due to Taiwan’s growing cancer trends. But, this potentially allows for variance as the suggested data may be mistranslated to the wider, international community.
Complementing this, the authors of the research all specialise in the fields of molecular science, molecular biology, and a variety of other sciences, as well as working under the department of the Taiwan Head and Neck Society. All with extensive knowledge and expertise in the relevant field, the cohort is just to run the study within this field. The study was funded and conducted within the National Cheng Kung University and National Cheng Kung University Hospital. Meaning bias or skewed results shouldn’t be an affecting variable due to the integrity, ethical and moral obligations of the referred institutions.

## What kind of research was this?

The study conducted was constructed using a Cohort study method, where the particular cohort being investigated was head and neck cancer patients following chemotherapy and were prescribed and observed throughout exercise.
As the studies conducted revolving around Cancer and its effects on health are so broad, studies consider different outcome measures within their data. So, while outcome measures may differ depending on access to resources or preference, the generalised concept of improved health and/or fitness is constant.

## What did the research involve?

All patients involved stemmed from rehabilitation within the Cheng Kung institution and consented to join the study once the procedures were fully explained. The patients participated in an 8-week exercise intervention involving both aerobic and resistance training. Aerobic blocks lasted no longer than 30 minutes, and resistance training was conducted using TheraBand at an intensity of “heavy” to “somewhat heavy” at three sets, and 10-12 reps.
The methodology allowed enough time for physiological adaptations to occur and followed appropriate risk management. Considering the health status of the population, moderate exercise was prescribed and maintained between 60-70% of maximum heart rate. Primary outcome measures for cardiopulmonary development were blood pressure, heart rate, SpO2, and RPE. For measurement of oxidative stress, total antioxidant capacity, 8-hydroxy-2′-deoxyguanosine, and carbonyl levels were taken from plasma. Considering the primary and secondary outcome measures, the authors utilised a non-invasive, consistent structure to track data and progress.
Limitations:
For future studies, greater variance in types of exercise could be included to investigate wider forms of exercise for differing circumstances. Also, consideration for longer periods of exercise intervention will allow for more concise data as only acute affects are measured. Regarding population recruitment, the study only sampled 30 participants (23 male, 7 female), allowing discrepancies. The recruitment process could be improved to convey a more representative data set for a broader population.

## What were the basic results?

Within the study, results were clearly and concisely explained with an indication of significant and no significant outcomes depending on the exercise. Succeeding the study, the participants were seen to repress heart rate (85.2 ± 12.1, 76.4 ± 10.2; p < 0.05) and blood pressure (SBP 111 ± 18.7, 106.8 ± 12.1; DBP 69.6 ± 12.6, SBP 64 ± 10.6) at rest and improve recovery following exercise. While during exercise, no significant results were seen in the mentioned cardiopulmonary measures.
Through secondary outcomes of oxidate stress measures, antioxidant capacity increased significantly (221.7 ± 62.2, 443.7 ± 72.1) and plasma levels of carbonyl content and 8-OHdG decreased after exercise training (carbonyl content 10.1 ± 2.6, carbonyl content 5.5 ± 1.8; 8-OHdG 1031.3 ± 43.8, 8-OHdG 761.3 ± 66.3). With no significant developments in MDA and oxygen saturation.

## What conclusions can we take from this research?

As the results indicate, through exercise intervention, components of health and oxidative stress have been improved within the desired population. Patients were deemed to improve outcome measures at rest and their ability to recover had improved significantly. While not all measures improved, the desired oxidative and cardiorespiratory components showed promising outcomes.
The findings complement similar studies in that exercise proved a consistently effective resource for improving some aspects of health. As mentioned, outcomes are only seen in particular measures and varying methodologies, such as; pharmaceutical implementation or greater exercise interaction to sustain more operational data should be explored.

## Practical advice

When applying these findings practically within everyday life, individuality is an important variable to consider. Differing populations and varying types of cancers allow for unpredictable predicaments on health and can change depending on the individual. The mentioned studies all produced a positive association between exercise and progression of health during exposure to chemotherapy and cancer. Therefore, meaning moderate physical exercise in a sort of moderation is valued under the supervision of a health professional.
Exercise is always recommended with no regard to health status. For those under treatment or recovering from an illness, exercise is an important interface to have access to. Monitoring intensity, anywhere from 30-60 minutes of moderate aerobic or resistance training is ideal and has been proven to have an affirming correlation with health outcomes provided by the Exercise Guidelines for Cancer Patients.
Continuing from this research, whether it be within a clinical setting, or years following recovery, the implication of exercise inherits significant value for health. Whether it be a walk day-to-day, or cycling to work, incorporating these simple moderate intensity tasks can manifest momentous health progresses.

## Further information/resources

Cancer Support and Guidelines:
Cancer Council Australia
NSQHS Standards User Guide for Medication Management in Cancer Care
Exercise Guidelines for Cancer Patients
Further Research Articles
Effects of exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment
Blood oxidative stress biomarkers: influence of sex, exercise training status, and dietary intake
Impact of exercise on chemotherapy completion rate: A systematic review

## References

* Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
* Schneider, C. M., Hsieh, C. C., Sprod, L. K., Carter, S. D., & Hayward, R. (2007). Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer: Interdisciplinary International Journal of the American Cancer Society, 110(4), 918-925.
* Cauli, O. (2021). Oxidative stress and cognitive alterations induced by cancer chemotherapy drugs: A scoping review. Antioxidants, 10(7), 1116.
* Yen, C. J., Hung, C. H., Tsai, W. M., Cheng, H. C., Yang, H. L., Lu, Y. J., & Tsai, K. L. (2020). Effect of exercise training on exercise tolerance and level of oxidative stress for head and neck cancer patients following chemotherapy. Frontiers in Oncology, 10, 1536.
* Chiang, C. J., Chen, Y. C., Chen, C. J., You, S. L., & Lai, M. S. (2010). Cancer trends in Taiwan. Japanese journal of clinical oncology, 40(10), 897-904.
* Bland, K. A., Zadravec, K., Landry, T., Weller, S., Meyers, L., & Campbell, K. L. (2019). Impact of exercise on chemotherapy completion rate: a systematic review of the evidence and recommendations for future exercise oncology research. Critical reviews in oncology/hematology, 136, 79-85.
* 1 2 Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: a cancer journal for clinicians, 71(3), 209-249.
* 1 2 3 Schneider, C. M., Hsieh, C. C., Sprod, L. K., Carter, S. D., & Hayward, R. (2007). Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer: Interdisciplinary International Journal of the American Cancer Society, 110(4), 918-925.
* 1 2 3 Cauli, O. (2021). Oxidative stress and cognitive alterations induced by cancer chemotherapy drugs: A scoping review. Antioxidants, 10(7), 1116.
* 1 2 3 4 5 6 7 8 9 10 11 12 Yen, C. J., Hung, C. H., Tsai, W. M., Cheng, H. C., Yang, H. L., Lu, Y. J., & Tsai, K. L. (2020). Effect of exercise training on exercise tolerance and level of oxidative stress for head and neck cancer patients following chemotherapy. Frontiers in Oncology, 10, 1536.
* ↑ Chiang, C. J., Chen, Y. C., Chen, C. J., You, S. L., & Lai, M. S. (2010). Cancer trends in Taiwan. Japanese journal of clinical oncology, 40(10), 897-904.
* ↑ Bland, K. A., Zadravec, K., Landry, T., Weller, S., Meyers, L., & Campbell, K. L. (2019). Impact of exercise on chemotherapy completion rate: a systematic review of the evidence and recommendations for future exercise oncology research. Critical reviews in oncology/hematology, 136, 79-85.