Please select the eligibility criteria that correspond to the clinical trial below.
Title: Can Exercise Improve Cancer Associated Cognitive Dysfunction?
Brief Summary: Following chemotherapy, some breast cancer survivors report alterations in their ability to remember, concentrate, or think, which can have significant emotional, psychological, and economic impact on their lives. Survivors have also reported feeling frustrated by the response of the medical community, who either may not acknowledge their symptoms or have no treatment options to suggest. Exercise may be a promising treatment, as improvements in cognitive function with exercise have been demonstrated in older adults and other clinical populations.

The investigators will recruit women who have completed chemotherapy for breast cancer (within the past 2 years) and report cognitive changes. Women will be randomly assigned to either a 24-week aerobic exercise intervention or delayed exercise control (offered the same exercise program following the study). At the start and end of the study the investigators will measure: i) performance on four standard neuropsychological tests that measure working memory, learning, and problem solving; ii) a questionnaire on cognitive function and its impact on quality of life; iii) functional magnetic resonance imaging (fMRI) during two of the standard neuropsychological tests which provides information on how the brain is working during the tests.

To knowledge of the investigators this is the first study to examine the effect of an exercise intervention on cognitive function in breast cancer survivors. In addition, the use of fMRI imaging is a new way to approach this research question, and may be more sensitive to change than traditional measures of cognitive function.


Options:
A: Inclusion Criteria:

* Women
* Completed chemotherapy within past 2 years

  * completed for at least 3 months
* Self report cognitive dysfunction following chemotherapy
* Stage I-IIIA breast cancer
* Physically able to undertake moderate to vigorous physical activity program

Exclusion Criteria:

* Self report \> 90min/week of moderate physical activity (last 6 months)
* Mini-mental status exam score \< 23
* Co-morbid conditions that may alter cognitive testing results (i.e., a clinically diagnosed major depression, anxiety disorder, or other psychiatric condition, meeting DSM IV criteria)
* History of substance abuse
* Other neurological disorder (i.e., head injury, epilepsy, tumour, neurodegenerative disease)
* Ruled ineligible for MRI scanning (i.e., metal implants)
B: Inclusion Criteria:

1. Women aged 20 years and older
2. Histologically confirmed stage 0 to III breast cancer who received curative breast cancer surgery within 12 months since completion of primary cancer treatment and 2 years since diagnosis
3. Serum platelet ≥ 100,000/mm3
4. Serum hemoglobin ≥ 10g/dl
5. Not met one or more behavior goals: i) energy expenditure of aerobic exercise ≥ 12.5 kcal/kg/week; ii) intake of vegetables except kimchi ≥ 5 serv/day and intake of fruit 1-2 serv/day; iii) maintenance of healthy weight (18.5 kg/m2 ≤ BMI \< 23 kg/m2)
6. Ability to use internet, and being accessible internet at home
7. Mobile phone user
8. Consent form to participate in the study

Exclusion Criteria:

1. Currently receiving any cancer treatment
2. Conditions that could limit adherence to an unsupervised exercise program such as uncontrolled congestive heart failure or angina, recent myocardial infarction, or breathing difficulties requiring oxygen use or hospitalization; walker or wheelchair use; or plans to have hip or knee replacement
3. Conditions that could interfere with a high vegetable and fruit diet, such as kidney failure or chronic warfarin use
4. Progressive malignant disease or additional primary cancers
5. Infectious condition (body temperature ≥ 37.2℃ or WBC ≥ 11,000mm3)
6. Inability to use computer or internet
7. Visual and motor dysfunction
C: Inclusion Criteria:

1. Legal age (\>18 years old)
2. An interval of at least 6 weeks between prior radical prostatectomy and study enrollment
3. Karnofsky performance status of at least 70% at study entry
4. Estimated life expectancy of ≥6 months
5. Ability to read and understand English
6. Attending urologist approval
7. Signed informed consent
8. Willingness to be randomized; and
9. No contraindications to exercise as recommended by the American Thoracic Society

Exclusion Criteria:

1. Acute myocardial infarction (6 weeks)
2. Unstable angina
3. Uncontrolled arrhythmias causing symptoms or hemodynamic compromise
4. Syncope
5. Acute endocarditis
6. Acute myocarditis or pericarditis
7. Uncontrolled heart failure
8. Acute pulmonary embolus or pulmonary infarction
9. Thrombosis of lower extremities
10. Suspected dissecting aneurysm
11. Uncontrolled asthma
12. Pulmonary edema
13. Room air desaturation at rest ≤85%
14. Respiratory failure
15. Acute noncardiopulmonary disorder that may affect exercise performance or be aggravated by exercise; and
16. Mental impairment leading to inability to cooperate
D: Inclusion Criteria:

* Women without lymphedema must be 1-5 years post breast cancer diagnosis
* Women with lymphedema must be 1-15 years post breast cancer diagnosis
* Women with lymphedema must have stable lymphedema. ONE of the following:

  * 0-40\>10% girth volume difference between the affected and non- affected limb for a non-dominant arm
  * 6-40% girth volume difference between the affected and non- affected limb for a dominant arm inter-limb discrepancy in volume or circumference at the point of greatest visible difference OR swelling or obscuration of anatomic architecture upon close inspection OR pitting edema.

    * 2 cm circumference difference
  * A prior clinical diagnosis of lymphedema and having had any prior intensive lymphedema therapy on the affected arm

As well as ALL of the following four conditions:

* Women with Lymphedema must have ALL of the following:

  * No recorded arm girth change of 15% or greater within the three months.
  * No more than one lymphedema related infection requiring antibiotics within the past 3 months.
  * Participation in all Activities of Daily Living (ADLs) without lymphedema exacerbation for the past 3 months.

Exclusion Criteria:

* For ALL participants (with and without lymphedema)

  * No medical conditions or medications that would prohibit participation in an exercise program or would negatively impact our ability to test our primary aims
  * Not morbidly obese (body mass index \>50 kg/m2)
  * No plans for additional (e.g. reconstructive) surgery during the study period
  * No bilateral breast cancers (because this prohibits our ability to assess the primary outcome of interest)
  * No strength training or other upper body resistive exercise within the past year
  * Not planning to move away from the area over the next year
  * Not pregnant or lactating or planning to become pregnant during the study
  * Among women who have given birth: at least 6 months post pregnancy and at least 3 months post lactation

Answer: A