Table Of ContentEnergy Balance and Cancer
Series Editor:
Nathan A. Berger
Case Western Reserve University
Cleveland, OH, USA
For further volumes:
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Cornelia M. Ulrich (cid:129) Karen Steindorf
Nathan A. Berger
Editors
Exercise, Energy Balance,
and Cancer
Editors
Cornelia M. Ulrich Karen Steindorf
National Center for Tumor Diseases German Cancer Research Center
Heidelberg, Germany Heidelberg, Germany
Nathan A. Berger
Center for Science, Health & Society
Case Western Reserve University
School of Medicine
Cleveland , OH , USA
ISBN 978-1-4614-4492-3 ISBN 978-1-4614-4493-0 (eBook)
DOI 10.1007/978-1-4614-4493-0
Springer New York Heidelberg Dordrecht London
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Contents
1 Exercise, Energy Balance and Cancer .................................................. 1
Cornelia M. Ulrich , Karen Steindorf , and Nathan A. Berger
2 Impact of Exercise, Reactive Oxygen and Reactive
Nitrogen Species on Tumor Growth ...................................................... 7
Andreas N. Kavazis and Scott K. Powers
3 Exercise Associated Regulation of Tumor Promoters,
Hormones and Cytokines in Cancer Control ....................................... 21
Nora L. Nock and Nathan A. Berger
4 Exercise Impact on Immune Regulation of Cancer ............................. 37
Huicui Meng and Connie J. Rogers
5 Biological Pathways Impacting Cancer Survival:
Exercise as a Countermeasure for the Development
and Progression of Cachexia .................................................................. 59
James A. Carson and Melissa J. Puppa
6 Physical Activity and Primary Cancer Prevention .............................. 83
Karen Steindorf , Michael F. Leitzmann , and Christine M. Friedenreich
7 Bene fi ts and Rationale for Exercise During Cancer Therapy ............ 107
Morten Quist and Lee W. Jones
8 Exercise During Stem Cell Transplantation ......................................... 119
Joachim Wiskemann and Cornelia M. Ulrich
9 Physical Exercise in Advanced Malignant Diseases ............................. 143
Winfried Banzer , Ezster Füzeki , Markus Bernhörster , and Elke Jäger
10 Exercise in Pediatric Cancer Patients ................................................... 159
Luisa Soares-Miranda , Carmen Fiuza-Luces , and Alejandro Lucia
11 Exercise in Elderly Cancer Survivors ................................................... 181
Anna L. Schwartz and Kerri Winters-Stone
v
vi Contents
12 Bene fi ts of Aerobic and Resistance Exercise
for Cancer Survivors ............................................................................... 199
Melinda L. Irwin
13 Exercise Behavior, Motivation, and Maintenance
Among Cancer Survivors ....................................................................... 215
Jeff Vallance , Lauren Spark , and Elizabeth Eakin
Index ................................................................................................................. 233
Chapter 1
Exercise, Energy Balance and Cancer
Cornelia M. Ulrich , Karen Steindorf , and Nathan A. Berger
Energy balance in living organisms is a complex process in which energy input,
determined by quantity and quality of caloric intake, is balanced by energy expenditure,
which includes physical activity, exercise, and thermogenesis. These processes are
exquisitely regulated by environmental, physiologic and genetic in fl uences, as well
as by biobehavioral in fl uences including appetite, satiety and sleep, to facilitate
normal growth, development and function. Abnormalities in any aspect of these
processes may result in underweight and malnutrition or overweight and obesity
and a variety of comorbid conditions. Obesity can be associated with multiple
comorbidities including diabetes, cardiovascular diseases and a variety of malig-
nancies. In contrast, physical activity and exercise have been associated with pre-
vention of these disorders and with bene fi cial effects in their therapy and outcomes.
More speci fi cally, physical activity and exercise are associated with reduced risk of
some malignancies, with evidence considered convincing for colon cancer, probable
for endometrial and post-menopausal breast cancer and limited for lung, and pan-
creatic cancers [1 ] . Carefully designed programs of moderate to aggressive physical
activity and exercise in patients with cancer can lead to improved quality of life,
reduced cancer related fatigue, improved cardiovascular fi tness, reduced visceral fat
C. M. Ulrich , Ph.D. (*)
Preventive Oncology, DKFZ , National Center for Tumor Diseases (NCT) ,
Im Neuenheimer Feld 460 , 69120 Heidelberg , Germany
e-mail: [email protected]
K. Steindorf , Ph.D.
Unit of Physical Activity and Cancer, Preventive Oncology and Environmental Epidemiology ,
German Cancer Research Center (DKFZ) , Im Neuenheimer Feld 280 , 69120
Heidelberg , Germany
e-mail: [email protected]
N. A. Berger , M.D.
Hanna-Payne Professor of Experimental Medicine, Center for Science, Health and Society ,
Case Western Reserve University , 10900 Euclid Avenue , Cleveland , OH 44106-4971 , USA
e-mail: [email protected]
C.M. Ulrich et al. (eds.), Exercise, Energy Balance, and Cancer, Energy Balance and Cancer 6, 1
DOI 10.1007/978-1-4614-4493-0_1, © Springer Science+Business Media New York 2013
2 C.M. Ulrich et al.
mass and improved bone mineral density [ 2, 3 ] . Moreover, exercise has more
recently been shown to improve both overall and, in some cases, cancer-speci fi c
survival [ 4 ] . Yet concern exists that exhaustive exercise may cause suf fi cient increase
in oxidative stress to increase in fl ammation, impair immune function and allow for
increased tumor growth [5 , 6 ] . Thus, careful examination of the risks and bene fi ts
associated with exercise interventions and their potential mechanisms of action is a
central theme in considerations of energy balance and cancer.
Various aspects of the relations between exercise and cancer have been considered
in earlier volumes of Energy Balance and Cancer including Volume 1, Cancer and
Energy Balance, Epidemiology and Overview; Volume 2, Insulin Resistance and
Cancer: Epidemiology, Cellular and Molecular Mechanisms and Clinical Implications;
Volume 3, Physical Activity, Dietary Calorie Restriction, and Cancer; Volume 4,
Energy Balance and Hematologic Malignancies; and Volume 5, Energy Balance and
Gastrointestinal Malignancies. This sixth volume now focuses entirely on a transla-
tional and transdisciplinary examination of the role of exercise in the relation between
energy balance and cancer, its risks and bene fi ts across the age spectrum, potential
mechanisms of action, and strategies for implementation and sustainability.
The stimulus for this volume derives from a National Center for Tumor Diseases
(NCT) Conference on Exercise, Energy Balance and Cancer: De fi ning the Role and
Potential of Exercise and Body Weight Maintenance in Cancer Prevention, Treatment
and Outcomes, convened in November 2010 in Heidelberg, Germany by Professor,
Cornelia M. Ulrich, Director, National Center for Tumor Diseases, and Head,
Division of Preventive Oncology, German Cancer Research Center (DKFZ),
Professor Karen Steindorf, Head, Physical Activity and Cancer Research Group
(DKFZ and NCT), Dr. Joachim Wiskemann, Ph.D., Scienti fi c Coordinator, Physical
Activity and Cancer, Division of Preventive Oncology, (DKFZ and NCT) and
Professor Dirk Jäger MD, Head Medical Oncology and Director, NCT. The confer-
ence featured an international, transdisciplinary series of experts in the fi eld of
energy balance and cancer, who discussed their research and clinical experience in
multiple areas including the role of physical activity and exercise across the spec-
trum from cancer prevention to cancer survivorship; potential mechanisms linking
physical activity and exercise to cancer risk and survival; effects of exercise at all
stages of anticancer therapy; application of exercise interventions in different clini-
cal settings and challenges of sustaining exercise in cancer survivors.
The importance of implementing a transdisciplinary approach to better under-
stand the role of exercise in cancer risk reduction and to most effectively incorporate
exercise into cancer prevention and control strategies was emphasized by Dr. Linda
Nebeling, Chief, Health Promotion Research Branch, Behavioral Research Program,
Division of Cancer Control and Population Sciences (DCCPS), National Cancer
Institute (NCI), and by Dr. Robert Croyle, Director, DCCPS, NCI, who provided an
expert overview of the science and organization in the USA focused on exercise,
and, more broadly, on energy balance and cancer. These two have provided leader-
ship and guidance for the development and ongoing coordination of the innovative
US NCI sponsored program on Transdisciplinary Research on Energetics and
Cancer (TREC) [7 , 8 ] .
1 Exercise, Energy Balance and Cancer 3
The conference emphasized the important conceptual and practical challenges
that occurred in recent years in the application of physical activity and exercise for
cancer patients and during cancer therapy. Historically, it was noted that doctors
admonished their patients to refrain from strenuous exercise during cancer treat-
ment. The standard motto was “no sports or physical activities for cancer patients,
they need to save their energy and get plenty of rest and relaxation.” In the 1980s
and 1990s patients were still given this admonition in spite of the fact that epidemio-
logic studies indicated that the right amount of physical effort had a protective effect
that was likely to both reduce the incidence of cancer and bene fi t clinical outcomes
in cancer patients. Further research has shown that exercise clearly reduces the risk
of certain cancers including colon, breast and probably endometrial, has a salutary
bene fi t in patients undergoing cancer therapy, promotes improved quality of life and
prolongs survival in cancer patients.
A striking contrast at the conference, was the observation that, while clinicians
and scientist in the United States were interested in investigating the role of exercise
in prevention and therapy of cancer, the Europeans had already signi fi cantly incor-
porated exercise into their therapeutic regimens. Commenting on the change in atti-
tude in Europe towards incorporation of exercise programs into the approach to
cancer patients, one of the presenters, Professor Fernando Dimeo, Charité Campus
Benjamin Franklin, Medicine, Berlin, Germany, noted that cancer patients at his
institution now question why they are being neglected, if the exercise team does not
visit them within a few days of their hospitalization for cancer. Rapid incorporation
of exercise into the overall approach to cancer patients in Europe compared to its
rather sluggish uptake in the United States was attributed, in part, to the cultural
orientation to regular participation in physical activity and sports in Europe versus
a more spectator approach to sports in the US.
The Heidelberg Conference and this volume address many of the same important
questions, including, but not limited to, the following: Is exercise possible and
bene fi cial for all types of cancer, across the age spectrum and at every stage of the
disease? Which type of physical training is the most effective for cancer prevention
and prognosis? What type, how much and at what frequency? What are the biologic
mechanisms by which exercise contributes to the well-being of healthy individuals
and what are the bene fi ts and the mechanisms by which exercise improves the well-
being and survival of cancer patients? What kind of physiological, psychological
and social changes can be obtained with exercise programs for cancer patients?
What are the best ways to maintain a high level of physical activity over long peri-
ods of time in cancer survivors? Answers to these questions, provided in this vol-
ume, should contribute to better understanding of the risks and bene fi ts associated
with exercise in cancer patients and help to optimize the use of exercise in cancer
prevention and control.
In preparing this volume we have been fortunate to engage many of the experts
and pioneers who participated in the 2010 Heidelberg Conference and to attract
other top investigators to share their expertise. In Chap. 2 , Andreas N. Kavazis,
University of Mississippi and Scott K. Powers, University of Florida, U.S.A.,
discuss the impact of free radicals generated by exercise on tumor growth and the
