Cachexia in Gynecological Cancer and the Preventive Role of Weight Training

Study Overview
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Brief Summary
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The study aim was to compare the effectiveness of combined training (CT; aerobic + resistance exercises) and high-intensity interval body weight training (HIITBW) on body composition, metabolic and inflammatory profile, physical function and quality of life in older women with gynecological and breast cancer and their pair-matched controls (older women with no cancer). The hypothesis of the present clinical trial is that HIITBW is effective as well as CT for improvements on body composition, metabolic and inflammatory profile, physical function and quality of life in older women with gynecological and breast cancer.

Detailed Description
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Physical training has been recommended to prevent or attenuation cachexia and sarcopenia in older people with or without cancer. The American College of Sports Medicine recommends 150 min of moderate intensity exercise combining aerobic exercise with resistance exercises, termed as combined training (CT). However, it has been reported that very low proportion (<10%) of older adults meet the physical activity recommendation. Lack of time has been reported as a common reason to people not to do exercise. Thus, identifying effective physical training dosages and modalities which may be feasible are necessary for this population. Repeated brief bouts of fast and intense exercise interspersed with low intensity exercise termed as high intensity interval training (HIIT) has shown to be a time-effective strategy to improve cardiorespiratory fitness in young and older. Moreover, HIIT has shown to improve glycemic control in patients at high risk for TDM2, muscle mass, body fat and physical function. However, there were many pending issues involving the HIIT for sarcopenia and cachexia in older people. For instance, the lack of access to physical activity facilities, such as the need for specific equipment (i.e. fitness equipment: treadmill, bike or resistance exercise equipment) and the need for high motor skill levels to performance the high-intensity exercise (i.e. run at high speed) have been reported as another reason to older people not to do HIIT. Different HIIT programs performed outside of laboratory has been proposed, especially with body-weight exercises. The high-intensity interval body weight training (HIBWT) is performed without equipment and with low motor skill levels. HIBWT has been shown to improve fat mass, muscle mass, cardiorespiratory capacity and physical performance in young adults with or without overweight. Despite this, no previous studies have evaluated HIBWT efficacy and safe in older people with sarcopenia and cachexia. The study aim was to compare the effectiveness of CT and HIITBW on body composition, metabolic and inflammatory profile, physical function and quality of life in older women with gynecological and breast cancer and their pair-matched controls (older women with no cancer). The hypothesis of the present clinical trial is that HIITBW is effective as well as CT for improvements on body composition, metabolic and inflammatory profile, physical function and quality of life in older women with gynecological and breast cancer.

Official Title
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Comparison of High Intensity Interval Body Weight Training Versus Combined Training on Body Composition, Physical Function, Metabolic Risk and Inflammation in Postmenopausal Women With and Without Gynecological Cancer

Conditions
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Breast Cancer Female, Gynecologic Cancer, Menopause, Physical Activity

Intervention / Treatment
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* Other: Combined training
* Other: High intensity interval training with body weight


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Postemenopausal women without cancer Postemenopausal women with breast cancer Postemenopausal women with gynecological cancer Exclusion Criteria: • No several physical limitations (wheelchair, canes or any similar device)

Ages Eligible for Study
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Minimum Age: 50 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Physical training, CT<br>Combined Trained with no cancer (CT): Post menopausal women with no cancer submitted to 12 weeks of combined training (i.e. aerobic training plus resistance training) | Other: Combined training<br>* The CT and CTc protocol (total length time  60 min) were performed three times a week for 12 weeks, in nonconsecutive days, and were composed by 30-min walk at 70% of maximum heart rate or Borg Scale at 5-6 following resistance exercises (RE: 45-degree half squat, bench press, leg curl, rowing machine and unilateral leg extension) at 70% of one repetition maximum (1RM) with three sets of 8-12 repetitions and 1.5 min rest interval between sets and exercises. If the volunteer exceeded or did not reach the walk intensity, the volunteer was stimulated by to decrease or increase the walk speed, respectively. Regarding the resistance exercises, the load was adjusted in the 6th week with the 1RM test to ensure the 70% of 1RM between 8-12 repetitions.<br>|
| Active Comparator: Physical training, HIITBW<br>High intensity interval training with body weight with no cancer (HIITBW): Post menopausal women with no cancer submitted to 12 weeks of high intensity interval training with body weight (i.e. step climbing plus squats) | Other: High intensity interval training with body weight<br>* The HIITBW and HIITBWc protocol (total length time  28 min) were performed three times a week for 12 weeks, in nonconsecutive days, and were composed by ten sets of 60 s of high (vigorous) intensity exercises at 80-95% of HRmax or Borg Scale at 8-9 (i.e. 30s of stepping up and down on a step and 30s of squatting up and down as fast as possible) interspersed with a recovery of 60 s of light walk (<60% of HRmax or Borg Scale at <5). To ensure vigorous zone of all sets, if the volunteer exceeded or did not reach the vigorous zone the volunteer was stimulated by the fitness professionals to decrease or increase the number of steps and squats, respectively.<br>|
| Experimental: Physical training, CTc<br>Combined Trained with gynecological and/or breast cancer (CTc): Post menopausal women with with gynecological and/or breast cancer submitted to 12 weeks of combined training (i.e. aerobic training plus resistance training) | Other: Combined training<br>* The CT and CTc protocol (total length time  60 min) were performed three times a week for 12 weeks, in nonconsecutive days, and were composed by 30-min walk at 70% of maximum heart rate or Borg Scale at 5-6 following resistance exercises (RE: 45-degree half squat, bench press, leg curl, rowing machine and unilateral leg extension) at 70% of one repetition maximum (1RM) with three sets of 8-12 repetitions and 1.5 min rest interval between sets and exercises. If the volunteer exceeded or did not reach the walk intensity, the volunteer was stimulated by to decrease or increase the walk speed, respectively. Regarding the resistance exercises, the load was adjusted in the 6th week with the 1RM test to ensure the 70% of 1RM between 8-12 repetitions.<br>|
| Experimental: Physical training, HIITBWc<br>High intensity interval training with body weight with gynecological and/or breast cancer (HIITBWc): Post menopausal women with gynecological and/or breast cancer submitted to 12 weeks of high intensity interval training with body weight (i.e. step climbing plus squats) | Other: High intensity interval training with body weight<br>* The HIITBW and HIITBWc protocol (total length time  28 min) were performed three times a week for 12 weeks, in nonconsecutive days, and were composed by ten sets of 60 s of high (vigorous) intensity exercises at 80-95% of HRmax or Borg Scale at 8-9 (i.e. 30s of stepping up and down on a step and 30s of squatting up and down as fast as possible) interspersed with a recovery of 60 s of light walk (<60% of HRmax or Borg Scale at <5). To ensure vigorous zone of all sets, if the volunteer exceeded or did not reach the vigorous zone the volunteer was stimulated by the fitness professionals to decrease or increase the number of steps and squats, respectively.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Body composition | Soft-tissue (fat mass, kg and lean mass, kg) of whole body and regional composition were assessed via dual-energy x-ray absorptiometry scanning (iDXA; GE Healthcare-Luna, Madison, WI; software Encore version 14.10) | pre intervention and post intervention (i.e. 12 weeks) | 
| Muscle strength | It was measured by the one repetition maximum (1RM) test in the leg extension equipment. | pre intervention and post intervention (i.e. 12 weeks) | 
| Rate of force development (a critical component of muscle power) | It was measured by a rapid maximum isometric voluntary contraction of the one-sidedly knee extension force pulses (Metrolog SD20-LVDT, São Carlos/SP, Brazil) of both legs. | pre intervention and post intervention (i.e. 12 weeks) | 
| Cardiorespiratory fitness | The six-minute walk test and the one mile walk test was performed indoor, on a flat floor in a sports court. | pre intervention and post intervention (i.e. 12 weeks) | 
| Short physical performance battery (SPPB) | The SPPB consisted of three tests performed in the following order: balance test, four-meter walk test, and five-time-sit-to-stand test. Each test score varied to zero to four points, and the SPPB total score varied to zero to 12 points (sum of the scores of the three tests). | pre intervention and post intervention (i.e. 12 weeks) | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Citokines | Blood samples (16 ml) were collected between 7:30 AM and 9:00 AM after an overnight fast (10-12 hours). The blood samples (venous) were collected by a dry tube with gel separator or EDTA (vacuum-sealed system; Vacutainer, England). The sample was centrifuged for 10 minutes (3.000 rpm) and samples were separated and stocked (-80 C) for futures analysis. The blood indicators were measured as follows: IL-10, IL-6, IL-1ra, TNF-α, ICAM-1, MCP-1, Leptin and Total Adiponectin (enzyme-linked immunosorbent assay method) with Readwell Touch equipment (Robonik, India) and R&D kits (USA). | pre intervention and post intervention (i.e. 12 weeks) | 
| Quality of life | Quality of life - The 36-Item Short Form Health Survey (SF-36) was used to measure the overall quality of life aspects, separated in the following domains: functional capacity, physical limitations, pain, overall health, vitality, social aspects, emotional limitations and mental health. | pre intervention and post intervention (i.e. 12 weeks) | 
| Hormones | Blood samples (16 ml) were collected between 7:30 AM and 9:00 AM after an overnight fast (10-12 hours). The blood samples (venous) were collected by a dry tube with gel separator or EDTA (vacuum-sealed system; Vacutainer, England). The sample was centrifuged for 10 minutes (3.000 rpm) and samples were separated and stocked (-80 C) for futures analysis. The blood indicators were measured as follows: Testosterone, LH, TSH, T4, insulin, DHEA-S, E2 and FSH (electrochemoluminescence method). | pre intervention and post intervention (i.e. 12 weeks) | 
| Metabolic markers | Blood samples (16 ml) were collected between 7:30 AM and 9:00 AM after an overnight fast (10-12 hours). The blood samples (venous) were collected by a dry tube with gel separator or EDTA (vacuum-sealed system; Vacutainer, England). The sample was centrifuged for 10 minutes (3.000 rpm) and samples were separated and stocked (-80 C) for futures analysis. The blood indicators were measured as follows: Glucose, C-reactive protein, Hb1Ac (automated colorimetric method), total cholesterol, ALT and AST (kinetic method) with Cobas 6000 equipment and Roche kit (USA). | pre intervention and post intervention (i.e. 12 weeks) | 
| Electromyography | Quadriceps electromyography | pre intervention and post intervention (i.e. 12 weeks) | 
| Physical activity level | The International Physical Activity Questionnaire (IPAQ) was used to measure the level (time spent) of physical activities of light, moderate and high intensities during the day. Also, the sitting time (minutes) per day was measured. | pre intervention and post intervention (i.e. 12 weeks) | 
| Nutrition habits | A three-day food record (two days in the middle of week and one on the weekend) was used to determine the energy and macronutrients (carbohydrates, proteins and fats). | pre intervention and post intervention (i.e. 12 weeks) | 
| Functional capacity | The activities of daily living was assessed by Lawnton and Katz scale. | pre intervention and post intervention (i.e. 12 weeks) | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Breast Cancer Female, Gynecologic Cancer, Menopause, Physical Activity