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PurposesPhysical activity is supposed to decrease mortality of colorectal cancer (CRC) and is suggested to reduce side-effects of the disease and its treatment. However, the knowledge about the influence of exercise interventions on patients suffering from CRC and metastasized CRC (mCRC) is still sparse. One frequently observed side effect in mCRC is chemotherapy-induced peripheral neuropathy (CIPN). This randomized controlled trial investigated the influence of a supervised exercise program on CIPN in mCRC.MethodsThirty patients (stage IV) undergoing outpatient palliative treatment including a median of 23.5 chemotherapy cycles of various regimens were randomly assigned to an intervention or control group (IG, n = 17; CG, n = 13). The IG participated in an eight-week supervised exercise program, including endurance, resistance and balance training (2×/week for 60 min) whereas the CG received written standard recommendations to obtain physical fitness. CIPN was assessed using the FACT/GOG-NTX questionnaire. Moreover, endurance capacity (6MWT), strength (h1RM) and balance (GGT-Reha) were evaluated before (t0) and after (t1) the intervention as well as after 4 weeks follow-up (t2).ResultsNeuropathic symptoms remained stable in the IG over time, while CIPN significantly worsened in the CG from t0 to t1 and t0 to t2. In contrast to the CG, the IG significantly improved in strength and balance function. Changes in CIPN correlated with changes in balance.ConclusionsThis is the first investigation showing positive effects of a multimodal exercise program on CIPN, balance and strength on mCRC patients in a palliative setting, thereby consequently increasing patients` quality of life. The results support earlier findings stating a positive influence of balance exercise on CIPN.

Due to therapeutic side effects and physical weakness, patients are not always able to carry out strenuous and lengthy exercises. Hence, this study investigated the effectiveness and feasibility of a short-term Whole-body electromyostimulation (WB-EMS) for oncological patients during and after anticancer treatment. The primary aim was to ensure the feasibility of WB-EMS training. Furthermore, the effects of WB-EMS training were investigated over a period of 2 weeks on parameters such as quality of life, body composition and physical performance. Thirteen cancer patients with different diagnosis, disease stages and treatment state were included. They participated in supervised WB-EMS sessions 4 times over a 2-week period. Physical functioning, body composition, depression, fatigue, and quality of life were measured before and after the intervention period. Moreover, a pre-post measurement of the patients' perceived body constitution was conducted in every exercise session. All included patients (n = 13) were able to complete the 4 WB-EMS sessions. At the end of the 2 weeks, a significant increase of the muscle strength could be observed. Additionally, patients improved their cardiovascular fitness. The body composition analyses showed significant reductions in body lean mass and extracellular water. Muscle mass remained unchanged. Furthermore, patients reported an improved perceived body constitution reduced pain and discomfort following all 4 WB-EMS sessions. This study suggests that WB-EMS is safe and feasible for cancer patients. Furthermore, it showed that even after 2 weeks, improvements concerning the physical performance and patient-reported outcomes can be achieved. This study indicates benefits of WB-EMS as short-term exercise methode in cancer patients, that could be utelised in fields such as cancer prehabilitation. This trial has been registered with the ISRCTN-Registry (ISRCTN68069634).

Background Increased levels of physical activity are associated with a reduction of breast cancer mortality, especially in postmenopausal women with positive hormone receptor status. So far, previous observational case–control and cohort studies have focused on associations between overall leisure time physical activity and survival of women with breast cancer in general. Methods In this multicenter prospective cohort study, conducted in Germany between 30th August 2012 to 29th December 2017, we investigated general physical activity in a homogenous sample of n  = 1440 postmenopausal women with advanced (inoperable locally advanced or metastatic), hormone receptor-positive breast cancer receiving the same therapy (everolimus and exemestane). Self-reported physical activity was assessed using the Godin Leisure Time Exercise Questionnaire (GLTEQ) before and every 3 months during treatment. Participants were then classified into “active” and “insufficiently active” to screen their activity behavior the week prior to medical treatment. In addition, changes in physical activity patterns were assessed. Adjusted Cox regression analyses were performed for the activity categories to determine hazard ratios (HR). Besides progression-free survival (PFS), adverse events (AEs), QoL, and fatigue were assessed every 3 months until study termination. Results Compared to “insufficiently active” patients, “active” individuals indicated a significantly longer PFS (HR: 0.84 [0.74; 0.984], p  = .0295). No significant differences were observed for changes of physical activity behavior. Patients who reported to be “active” at baseline revealed significantly fewer AEs compared to “insufficiently” active patients. In detail, both severe and non-severe AEs occurred less frequently in the “active” patients group. In line with that, QoL and fatigue were better in physical “active” patients compared to their insufficient active counterparts at the last post-baseline assessment. Participants who remained or become active indicated less AEs, a higher QoL, and reduced fatigue levels. Conclusions Physical activity behavior prior to medical treatment might have prognostic value in patients with advanced breast cancer in terms of extending the PFS. Moreover, physical activity before and during treatment may reduce treatment-related side effects and improve patients’ QoL and fatigue. Trial registration EUPAS9462. Registered 30th October 2012 “retrospectively registered.”

Background Although quality-assured oncological exercise therapy (qOET) has proven effective for cancer patients at any stage of treatment and during aftercare, it is not yet incorporated into standard care in Germany and, to the best of our knowledge, in any other country. A collaboration involving eight German research institutions was initiated to investigate the barriers and facilitators to implementation and promote the wider dissemination of qOET for cancer patients across various settings in Germany. Methods The IMPLEMENT project is designed as an exploratory study with a quasi-experimental design and a mixed-methods approach, combining qualitative and quantitative data collection. Institutions involved in the treatment and/or aftercare of cancer patients will be approached to identify key barriers and facilitators of qOET. Based on these findings, a set of implementation strategies (IPS) will be developed, implemented, and evaluated to facilitate the delivery of qOET for cancer patients. We aim to develop a variety of IPS for different contexts: urban settings (e.g. qualifying local aftercare institutions to provide qOET); rural settings (e.g. a hybrid approach for areas with limited access to local qOET services); adult cancer patients (e.g. focussing on patient education); and children and young cancer patients (e.g. offering consultations with training therapy experts). Additionally, interface management, training concepts, digital support, and economic evaluation will be considered to further promote the wider dissemination of qOET. The impact of the IPS will primarily be measured by the reach of qOET, assessed by comparing the number of cancer patients receiving qOET before and after implementation. Discussion The aim of IMPLEMENT is to address key barriers and facilitators for the implementation of qOET in Germany, and to increase the number of cancer patients receiving qOET in the long term. Following the project, successful IPS will be disseminated for broader application. The IMPLEMENT consortium aims to make a significant contribution to the long-term integration of qOET into the standard care of cancer patients in Germany and prospectively for other countries as well. Trial registration Clin. Trials: NCT06496711. German Clinical Trial Register (Deutsches Register Klinischer Studien - DRKS): 00032292. Bavarian Cancer Research Center (Bayerisches Krebsforschungszentrum (BZKF bzw. ZKS): DZ-2024-2165-9

Introduction Breast cancer survivors are faced with several psychological issues. We report the influence on self-efficacy by a holistic orientated training schedule based on the “Kyusho Jitsu” martial art and explore the effects on self-efficacy, distress, fear, and depression. Methods Breast cancer survivors (N = 51) were randomly assigned to an intervention (n = 30) or control group (n = 21). The intervention group participated in a Kyusho Jitsu intervention twice a week over a period of 6 months, the control group received no intervention. Patients from both groups were measured at baseline, 3 and 6 months on level of self-efficacy (German General-Self-Efficacy Scale, SWE), stress (Perceived Stress Questionnaire, PSQ20), and fear and depression (Hospital Anxiety and Depression Scale, HADS). Results Analysis of the original data showed a significant difference between both groups regarding the subscale “joy” (P = .018). Several significant results within the intervention group were seen in self-efficacy (P = .014), fear (P = .009) and the overall score for fear and depression (P = .043). Both groups improved significantly within “worries” (intervention P = .006, control P = .019) and the PSQ20 overall score (both P = .005). The control group also significantly improved in the subscale for “demands” (P = .019). Conclusion To summarize, our pilot study showed that Kyusho Jitsu training is safe and feasible. Though, the intervention alone cannot be considered as being effective enough to help breast cancer survivors regarding relevant psychological issues, but might be an important supplement offer within follow-up care.

Background Chemotherapy-induced peripheral neuropathy (CIPN) is a common and clinically relevant side effect of chemotherapy. Approximately 50% of all leukemia, lymphoma, colorectal- and breast cancer patients are affected. CIPN is induced by neurotoxic chemotherapeutic agents and can manifest with sensory and/or motor deficits. It is associated with significant disability and poor recovery. Common symptoms include pain, altered sensation, reduced or absent reflexes, muscle weakness, reduced balance control and insecure gait. These symptoms not only affect activities of daily living, subsequently reducing patients’ quality of life, they have far more become a decisive limiting factor for medical therapy, causing treatment delays, dose reductions, or even discontinuation of therapy, which can affect the outcome and compromise survival. To date, CIPN cannot be prevented and its occurrence presents a diagnostic dilemma since approved and effective treatment options are lacking. Promising results have recently been achieved with exercise. We have revealed that sensorimotor training (SMT) or whole body vibration (WBV) can reduce the symptoms of CIPN and attenuate motor and sensory deficits. We furthermore detected a tendency that it may also have a preventive effect on the onset of CIPN. Methods We are therefore conducting a prospective, multicentre, controlled clinical trial involving 236 oncological patients receiving either oxaliplatin ( N  = 118) or vinca-alkaloid (N = 118) who are randomized to one of two interventions (SMT or WBV) or a treatment as usual (TAU) group. Primary endpoint is the time to incidence of neurologically confirmed CIPN. Secondary endpoints are pain, maintenance of the functionality of sensory as well as motor nerve fibres as well as the level of physical activity. The baseline assessment is performed prior to the first cycle of chemotherapy. Subsequent follow-up assessments are conducted at 12 weeks, after completion of chemotherapy, and at a 3-month follow-up. Patients who develop CIPN receive an additional assessment at this time point, as it represents the primary endpoint. Discussion We hypothesize that SMT and WBV prevent the onset or delay the progression of CIPN, decrease the likelihood of dose reductions or discontinuation of cancer treatment and improve patients’ quality of life. Trial registration Deutsche Register Klinischer Studien ( DRKS00006088 , registered 07.05.2014).

Purpose. Only one-third of patients with breast cancer reach the recommended activity level of 15 to 25 MET h/wk. The aim of this study was to determine the influence of personalized exercise recommendations during rehabilitation on patients’ physical activity level, fatigue, and self-perceived cognitive function as well as on side effect–associated biomarkers. Methods. Total metabolic rate, physical activity level, mean MET and steps, fatigue, self-perceived cognitive functioning , and biomarkers (C-reactive protein [CRP], interleukin 6, macrophage migration inhibiting factor [MIF], tumor necrosis factor [TNF]-α, brain-derived neurotrophic factor [BDNF], insulin-like growth factor 1 [IGF1]) were assessed in 60 patients with breast cancer in the aftercare phase before (t0) and 8 months after (t1) the intervention. The rehabilitation program consisted of an initial 3-week period and a 1-week stay after 4 months. Results. Paired t-test indicated a statistically significant increase in all activity outcomes from t0 to t1. Patients’ mean activity level significantly increased from 14.89 to 17.88 MET h/wk. Fatigue and self-perceived cognitive functioning significantly improved from t0 to t1. CRP levels significantly decreased, and BDNF as well as IGF1 levels significantly increased over time. Correlation analysis revealed statistically significant negative associations between fatigue, physical activity, and markers of inflammation (TNF-α and MIF). Furthermore, significant positive correlations between subjective cognitive functioning and all dimensions of fatigue were observed. Conclusions. The results support the importance of personalized exercise recommendations to increase physical activity levels in patients with breast cancer. Furthermore, the results highlighti an association between physical activity, fatigue, and inflammation.

Introduction Urinary incontinence, erectile dysfunction, fatigue as well as fears and depression rank among the most common complaints in patients with prostate cancer, resulting in a reduced participation in daily life and social isolation. Consequently, the quality of life of prostate cancer patients is strongly affected in a negative way. Numerous studies focusing on physical exercise interventions in prostate cancers patients demonstrate positive physiological and psychological effects. Our objective was to evaluate the evidence of randomized controlled studies which examined exercise during medical treatment and in the aftercare of a prostate cancer disease. Methods Twenty-five randomized controlled trials regarding physical activities in patients with prostate cancer were obtained by systematic literature research (Medpilot). Twenty-one studies examined clinical exercise interventions during the phase of medical treatment (irradiation, pre- and/or post-op, androgen deprivation therapy) and four studies during the aftercare. In order to evaluate the evidence of the included studies, the evaluation system of the Oxford Centre for Evidence-Based Medicine was used. Within this systematic review, we differentiated between “supervised clinical exercise” and “non-supervised clinical exercise.” Results and discussion Current data suggest that incontinence, fitness, fatigue, body constitution, and also quality of life can be improved by clinical exercise in patients during and after prostate cancer. Studies were mostly ranked evidence level “2b.” Only four studies, all conducted during medical treatment, reached the level “1b.” It seems to be that “supervised exercise” is more effective than “non-supervised exercise.” For future research, further randomized controlled trials with high methodological quality need to be conducted in order to establish evidence-based recommendations particularly for prostate cancer patients.

Introduction Peripheral neuropathies (PNPs) encompass a large group of disorders of heterogeneous origin which can manifest themselves with sensory and/or motor deficits depending on the predominantly affected nerve fiber modality. It represents a highly prevalent disease group which can be associated with significant disability and poor recovery. Exercise has the potential to improve side effects of PNP. Objective Our objective in this systematic review was to analyze exercise interventions for neuropathic patients in order to evaluate the possible benefits of exercise. Methods Three independent reviewers used PubMed, MEDPILOT ® (MEDLINE), Cochrane, and relevant reference lists to obtain the data. Relevant studies were graded according to the Oxford Levels of Evidence. Results Eighteen studies (ten randomized controlled trials and eight controlled clinical trials) met all inclusion criteria. Three (diabetic) studies were ranked very high quality [1b (A)], nine high quality (four diabetes, one cancer, four others) [2b (B)], while six (four diabetes, two others) showed low quality (4/C). Current data suggests that exercise is a feasible, safe, and promising supportive measure for neuropathic patients. This is best documented for patients with diabetic peripheral neuropathy (DPN), suggesting that endurance training has the potential to prevent the onset of and reduce the progression of DPN. In general, balance exercises showed the highest effect on the motor as well as sensory symptoms in all types of PNP. Conclusion Overall, balance training appears to be the most effective exercise intervention. Studies focusing exclusively on strength, or a combination of endurance and strength, appear to have a lower impact. For metabolically-induced neuropathies, endurance training also plays an important role. Further research with high methodological quality needs to be conducted in order to establish evidence-based clinical recommendations for neuropathic patients.

Purpose Multiple myeloma (MM) is a severe hemato-oncological disease with high mortality and increasing incidence rate. Since evidence on exercise therapy in MM patients remains limited, this study examines feasibility, adherence, and efficacy based on real-life data from an oncologic care structure. Methods A data evaluation of MM patients who participated in the oncologic exercise and movement therapy (OTT) at the Cologne University Hospital between 2012 and 2019 was conducted. The patient flow was incrementally reduced to four cohorts, intention-to-treat cohort (ITTC), safety cohort (SC), adherence cohort (AC), and efficacy cohort (EC). Cohorts were evaluated descriptively and by means of correlation analysis as well as group and time comparisons. Results Thirty patients registered at the OTT between 2012 and 2019 (ITTC). The SC ( N  = 26) attended exercise therapy on average about one session per week over a period of 8 months. One-third dropped out within 3 months. In the AC ( N  = 15), BMI at baseline exhibited a strong and very significant negative correlation with exercise adherence. In the EC ( N  = 8), a significant improvement in physical functioning and a tendency towards significance in fatigue reduction between two measurement points was observed. No adverse events were documented. Conclusions The present observatory study reveals safety and feasibility while indicating adherence and efficacy of exercising MM patients under real-life therapy circumstances. Found obstacles to exercising as well as improvements in questionnaire scale scores need to be further examined in confirmatory study designs.