# Exercise as it relates to Disease/Can physical function and mental health of brain cancer survivors be improved by exercise?

This Wikipedia page is a critical analysis of the paper: Exercise Improves Physical Function and Mental Health of Brain Cancer Survivors: Two Exploratory Case Studies.

## What is the background to this research?

Brain cancer can be classified into two different type of tumours. Benign tumour meaning unlikely to spread and malignant tumour meaning likely to spread to other regions of the brain and spinal cord. Malignant brain cancer can be challenging due to its poor prognosis and unpredictability. The treatment is intensive through surgery, radiation therapy and chemotherapy . Treatment is associated with physical impairment, cognitive dysfunctions e.g. decreased memory and also compromised psychological well-being Research into interventions is important as it can help to improve quality of life and reduce the negative effects of treatment.
The study assessed exercise as an intervention to improve the physical function and mental health of brain cancer survivors. Physiological and psychological measures were taken to provide clinical outcomes. This study is one of very few that aims to assess exercise and brain cancer survivors, as earlier studies have assessed current patients. The measure/procedure of this study are also highly thorough compared to others, as it assesses both aerobic and resistance exercise and psychosocial measures.

## Where is the research from?

The study was published by in 2014 by Integrative Cancer Therapies. It was written and researched by GT Levin, KM Greenwood, F Singh and D Tsio. The research of this study was conducted by:
* University of Calgary, AB, Canada
* Edith Cowan University, Perth, WA, Australia
* Capital Medical University, Beijing, PRC
* St John of God Hospital, Subiaco, WA, Australia
* Cumming School of Medicine
GT. Levin has performed other research on the topics of mental health, cancer and exercise.His is experience in this area of research is extensive and significant. By including multiple researchers and institutions, it can be assumed the procedure and processes of the study are of high quality and the results are valid.

## What kind of research was this?

This is an exploratory case study on two female participants and both are brain cancer survivors. The participants were diagnosed with different types of brain cancer and were at different stages of their recovery and care. With an exercise program as the intervention, the study explores if exercise can improve the physical function and mental health of the participants. The participants also met the other inclusion criteria of the study.

## What did the research involve?

* Two female participants took part in an exercise program. 2 x 20 minutes of aerobic training and 2 x 40 minutes of resistance training with a qualified exercise physiologist per week.Also additional self-managed aerobic session per week.
* Physiological and psychosocial measures recorded at baseline, 6 and 12 weeks.
* Aerobic measures: oxygen consumption (VO2 ml/kg/min) and heart rate (BPM).
* Resistance measures: 1 repetition maximum (RM) for a chest press and leg press (kg).
* Total body lean and fat mass: dual energy X-ray absorptiometry (DEXA) scan (% body fat).
* Psychosocial measures: questionnaires measured quality of life, depression, anxiety, satisfaction with life, etc.
Limitations of the research:
* This study was small, consisting of two people and were both females. This study did not include people of different ages, genders, socioeconomical backgrounds.
* Included self-reported aerobic session and psychosocial questionnaires therefore there may be bias.
* This study is a short-term exercise program. A long-term study following the participants over multiple months or years may determine permanent adherence to the program and further clinical outcomes.
* It is difficult to compare the participants exercise outcomes as they had different diagnosis and at different stages of their treatment and care.
* Study lacked a controlled variable. Both participants were at different activity levels before baseline testing, the additional session was self-managed therefore bias may be involved and they also had different diagnosis of brain cancer.

## What were the basic results?

* Improvement in cardiovascular efficiency shown by lower heart and reduction in 400-metre walk time.
* Upper body maximal strength increased by 17% and lower body strength increased by 48%.
* Reduction in mental health questionnaires scores showing reduced feelings of depression, anxiety and total distress.
The results table below shows the key tests performed and the differences when comparing baseline to measures after 12-weeks of exercise training.
↑: Increase from baseline testing to 12 weeks testing ↓: Decrease from baseline testing to 12-week testing
Participant Physiological and Psychosocial Differences :
| Test Conducted | Participant A | Participant B |
| VO2 (ml/kg/min) at rest | ↑ 1.54ml/kg/min | ↓ 0.02ml/kg/min |
| Heart rate at rest (beats per minute) | ↓ 7bpm | ↓ 9bpm |
| Heart rate during exercise (BPM) | ↓ 8bpm | ↓ 7bpm |
| 400 metre walk time (seconds) | ↓ 9.9 seconds | ↓ 19.2 seconds |
| Chest press 1RM (kilograms) | ↑ 12.5kg | ↑ 7.5kg |
| Leg press 1RM (kilograms) | ↑ 13.5kg | ↑ 22.5kg |
| Body fat percentage (%) | ↑ 2.1% | ↓ 3.1% |
| Hospital Anxiety and Depression Scale 0-7= normal 8-10 = borderline abnormal 11-21+ = abnormal | Pre exercise program: 23 Post exercise program: 14 | Pre exercise program: 24 Post exercise program: 13 |

## What conclusions can we take from this research?

This study provides evidence supporting other research that using exercise as an intervention reduces negative consequences of brain cancer and its treatment. Other supporting exercise intervention research includes by Cormie and colleagues: The Potential Role of Exercise in Neuro-Oncology and additionally The Brain Cancer Fact Guide provided by the Cancer Council. This study shows specifically aerobic training coupled with resistance training should be considered to become a part of the standard care of brain cancer survivors as the participants showed positive links between exercise and improved physical function. Significant improvements occurred to the participants mental health seen through the The Hospital Anxiety and Depression Scale. Other current research reinforce this studies findings as they have shown exercise to improve mental health of brain cancer patients.
Additionally, a longer term and a larger cohort with different genders, ages, socioeconomical backgrounds may also increase the validity of the outcomes of this type of study.

## Practical advice

With respect to the limitations of this study, brain cancer survivors are recommended to perform 80-100 minutes of aerobic exercise and additionally 2-3 resistance sessions (80 minutes) per week to benefit from improved physical function and mental health.. The exercise mode and intensity should be prescribed as dose response to ensure safety.
Longer-term studies and further evidence, in comparison to this case study, may find exercise programs used as apart of the standard supportive care for brain cancer survivors to reduce the negative cognitive, physical and emotional effects and improve survivor outcomes.

## Further information/resources

* Cure Brain Cancer Foundation: https://www.curebraincancer.org.au/page/7/about-brain-cancer
* Cancer Council – Understanding Brain Tumours: https://www.cancer.org.au/assets/pdf/understanding-brain-tumour-booklet
* Australian Government Cancer Australia: https://www.canceraustralia.gov.au/affected-cancer/cancer-types/brain-cancer/statistics
* Brain Foundation Australia: https://brainfoundation.org.au/brain-tumour-cancer/
* The Potential Role of Exercise in Nero-Oncology: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389372/
* Role of physical exercise in reducing depression and improving mental health in cancer survivors: https://ro.ecu.edu.au/cgi/viewcontent.cgi?article=2415&context=theses

## References

* 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 Levin, GT; Greenwood, KM; Singh, F; Tsio, D. Exercise Improves Physical Function and Mental Health of Brain Cancer Survivors. [Internet Journal Article]. August 2015. [Cited 1st September 2020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5736053
* 1 2 3 Cancer Council. Brain Cancer. Cancer Council Australia. [Internet website]. 2020. [Cited 1st September 2020]. Available from: https://www.cancer.org.au/cancer-information/types-of-cancer/brain-cancer
* ↑ Cure Brain Cancer Foundation. Brain Cancer Treatment [Internet Website]. 2020. [Cited 10th September 2020]. Available from: https://www.curebraincancer.org.au/page/9/treatment
* ↑ Capozzi, LC; Boldt, KR; Easaw, J; Bultz, B. Culos-Reed,NS. Evaluating a 12-Week Exercise Program for Brain Cancer Patients. [Internet Journal Article]. May 2015. [Cited 2st September 2020]. Available from: https://onlinelibrary.wiley.com/doi/epdf/10.1002/pon.3842
* 1 2 3 Gehring, K; Stuiver, MM; Visser, E; Kloek, C; Bent, MVD; Hanse, M. A pilot randomized controlled trial of exercise to improve cognitive performance in patients with stable glioma: a proof of concept [Internet Journal Article]. 2020. [Cited 5th September 2020]. Available from: https://academic.oup.com/neuro-oncology/article/22/1/103/5637916
* ↑ Liu, R; Page, M; Solheim, K; Fox, S; Chang, SM. Quality of life in adults with brain tumors: Current knowledge and future directions [Internet Journal Article]. June 2009. [Cited 8th September 2020]. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2718978/
* ↑ Snaith, RP. The Hospital Anxiety and Depression Scale. [Internet Journal Article]. August 2003. [Cited 3rd September 2020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC183845/
* 1 2 3 4 Cormie, P; Nowak, AK; Chambers, SK; Galvao, DA; Newton, RU. The Potential Role of Exercise in Neuro-Oncology. [Internet Journal Article]. April 2015. [Cited 3rd September 2020. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4389372/
* 1 2 Cancer Council. Understanding Brain Tumors. Cancer Council Australia. [Internet Website]. May 2020. [Cited 7th September 2020. Available from: https://www.cancer.org.au/assets/pdf/understanding-brain-tumour-booklet