Jeremy Park, Vera Mcllvain, Jared Rosenberg, Lorin Donovan, Priya Desai, Joon Young Kim. KJSM 2022;40:67-85. https://doi.org/10.5763/kjsm.2022.40.2.67

PURPOSE: Effective methods to improve body composition and metabolic/hormonal dysregulation are central to breast cancer care. We hypothesized that a nutrition regimen focused on food quality and an observed exercise regimen using high-load resistance training during or after cancer treatment would improve body composition and functional capacity. METHODS: Forty-four women with breast cancer, including survivors on therapy and in surveillance, excluding chemotherapy, underwent a continuously monitored dose-escalated exercise regimen utilizing heavy weights and linear progression in an exercise oncology facility along with a diet focused on food quality and adequate protein intake. Dietary strategy was discussed during each exercise session and twice monthly meetings. Pre- and post-workout assessment of body composition, functional mobility, balance, activity levels, and quality of life were compared via paired T -test and Wilcoxon signed-rank test. RESULTS: Forty-four women completed the protocol, with a median age of 54 years and BMI of 30.3. Most participants reported cancer-related symptoms (79.5%). Across compound exercises, composite load lifted increased by 36.5% ( P < .001) and bilateral Y-balance scores increased 18% ( P < .001). A 6.6% reduction in body fat was observed (1.8 kg; P < .001) alongside a 1.4% increase in muscle mass (0.5 kg; P = .003). Resting metabolic rate increased by 0.8% ( P = .018). Significant improvements were uniformly demonstrated across quality-of-life scores (European Quality of Life 5-Dimension Score, Patient Health Questionnaire 9 Depression Scale, and Generalized Anxiety Disorder 7 questionnaires). CONCLUSION: A 3-month regimen of nutrition counseling and high-intensity resistance training promoted significant muscle mass gain and adipose tissue loss, alongside significant improvements across body composition, strength, mobility, and functional status, and patient-reported quality of life.

Objectives: Resistance training can improve body composition and physical function during and after breast cancer treatment and improve quality of life. It is unclear whether these changes persist once a person is no longer actively enrolled in a structured exercise regimen. Thus, we analyzed participants from the EXERT-BC protocol, assessing an intense exercise regimen in women with breast cancer at one year. Methods: All the participants were asked to undergo reassessment at one year. Current exercise habits, injuries, changes in medical history, body composition, handgrip strength, functional mobility and balance, and patient-reported quality of life were assessed. Pairwise comparison was performed via the paired t test. Results: Out of 40 initial participants, 33 returned for reevaluation, with 6 lost to follow-up and 1 with unrelated hospitalization. The median age was 57.8 years, and stage at diagnosis was 1. Weekly exercise was reported by 16 participants (48.5%), with 14 of the 16 following structured resistance training. Between completion of the EXERT-BC and one year follow-up, five women (15.2%) experienced musculoskeletal injuries, which inhibited their ability to exercise. Three women (9%), who were no longer exercising experienced orthopedic injuries requiring medical intervention. The significant reduction in percent body fat, total body fat, excess fat, and increases in muscle mass, resting metabolic rate, and whole-body phase angle dissipated at 1 year. Activity levels and quality of life were no longer significantly improved. However, strength, mobility, and balance remained significantly improved versus pre-exercise measurements, whether a participant was still engaged in exercise or not. Conclusions: After a 3-month dose-escalated resistance training regimen, exercise compliance was poor at one year. The anthropomorphic benefits of the regimen regressed by one year; however, the improvements in strength, balance, and mobility persisted.

Background/Objectives: Higher percent body fat (BF) is associated with worse outcomes after treatment for breast cancer (BC). While ultrasound (US) imaging is a reliable method for analyzing body composition, it requires trained individuals for utilization. As such, bioelectrical impedance analysis (BIA) has been suggested as an alternative. Therefore, the goal of this study was to compare BIA with US. Methods: Women from three prospective exercise BC studies were analyzed with US and BIA before an exercise intervention. Spearman’s correlation was used as a nonparametric measure to examine bivariate relationships between percent body fat measured by BIA and US. Results: In total, 106 women with BC had their body composition measured using both US and BIA. Despite a strong correlation between the two methods (r = 0.8, p < 0.01), US reported lower mean percent BF vs. BIA (34.6 ± 0.7% vs. 38.0 ± 0.8%, p < 0.01). In a subgroup analysis, concordance was seen in women with a body mass index below (BMI) ≤ 26 kg/m². BIA overreported percent BF compared to US in women with a BMI > 26 kg/m². Conclusions: In women with BC and BMI ≤ 26, US and BIA are in concordance when measuring BF. In women with a BMI > 26, BIA reports a higher BF than US. Overall, there was a strong correlation between modalities, while BMI can be used to guide the utilization of BIA as an alternative to US for assessing body composition.

Although the function movement screen (FMS) has been widely used in the general population, no study to date has used the FMS as a preparticipation screen for individuals with breast cancer (BC) engaging in an exercise regimen. Even though individuals with BC are anthropometrically similar to individuals without cancer, the lack of studies assessing the FMS in individuals with BC may potentially hinder exercise prescription. Therefore, we aim to examine the relationships of the FMS score to anthropometric biomarkers in individuals with BC before undergoing an exercise regimen. One-hundred and twelve women with BC underwent a thrice-weekly three-month dose-escalated exercise regimen utilizing multi-joint compound movements and linear progression balanced with resistance training volume to elicit hypertrophy. FMS score and anthropometric markers were assessed pre- and post-intervention. With significance set at p≤0.05, baseline FMS scores correlated significantly with all anthropometric markers, and was similar to previous studies published in non-cancer populations. However, baseline FMS scores were not associated with changes in anthropometric markers, from pre- to post-intervention. While the baseline FMS score was not associated with changes in anthropometric markers, the similar correlation found in our study compared to previous studies suggest that the FMS can be used as a preparticipation in individuals with BC to help guide the exercise regimen. Future studies designed to elicit weight loss in individuals with BC should assess whether the baseline FMS score is predictive of anthropometric changes.