Enhancing cognitive function in breast cancer survivors through community-based aerobic exercise training

通过社区有氧运动训练增强乳腺癌幸存者的认知功能

基本信息

批准号：
10393679
负责人：
Diane Kristen Ehlers
金额：
$ 19万
依托单位：
UNIVERSITY OF NEBRASKA MEDICAL CENTER
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-05-01 至 2022-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10393679
关键词：
Address Adjuvant Therapy Adoption Aerobic Exercise Affect Aftercare Age-associated memory impairment Aging Area Brain Breast Cancer survivor Cancer Survivorship Characteristics Clinical Clinical Trials Clinical effectiveness Cognition Cognitive Cognitive deficits Communities Consensus Data Dissemination and Implementation Distress Education Effectiveness Effectiveness of Interventions Elderly Evidence based program Exercise Exercise Test Exhibits Fatigue Fitness Centers Funding Goals Gold Health Health education Hybrids Impaired cognition Individual Institutionalization Intervention Literature Maintenance Malignant Neoplasms Measurement Measures Mediator of activation protein Mind Neuropsychology Obesity Outcome Participant Pathogenesis Pathway interactions Patient Self-Report Performance Physical activity Population Postmenopause Protocols documentation Randomized Reach Effectiveness Adoption Implementation and Maintenance Recommendation Reporting Research Research Personnel Research Support Rest Scientist Short-Term Memory Site Stress Structure Survivors Testing Translations Treatment Protocols United States United States National Institutes of Health Woman Work aged arm attentional control base brain health brain morphology brain volume breast cancer diagnosis cancer therapy cancer-related cognitive impairment cardiorespiratory fitness care delivery chemotherapy clinically significant cognitive benefits cognitive change cognitive enhancement cognitive function cognitive performance cognitive task effectiveness implementation design effectiveness testing executive function exercise intervention exercise program exercise training experience follow-up implementation outcomes improved information gathering intervention delivery neuroimaging normal aging novel optimal treatments post intervention primary outcome secondary outcome standard care success white matter

项目摘要

Project Summary Women aged 50+ years comprise 77% of breast cancer diagnoses and 93% of all breast cancer survivors (BCS). Unfortunately, the interaction between cancer treatment and normal aging often results in a number of health sequelae. Up to 75% of BCS suffer cognitive changes during treatment, and over 45% experience clinically significant cognitive decline pre- to post-treatment. An optimum treatment for cancer-related cognitive impairment (CRCI) is likely one integrating interventions known to improve cognition in similar populations, such as older adults. Our previous research supports the efficacy of moderate-intensity aerobic exercise training for improving cognitive function in older adults without cancer. This work suggests that cardiorespiratory fitness (i.e., peak VO2) and brain structural and functional integrity (e.g., white matter microstructure, resting state functional connectivity) may underlie exercise-induced changes in cognitive function. We recently applied an aging framework to gain preliminary information on the effects of physical activity on cognitive function in BCS. Our work in this area suggests that aerobic exercise training may similarly ameliorate cognitive decline due to cancer and that cancer-related fatigue may also represent a mechanism of exercise’s cognitive benefits in the context of cancer. Our preliminary data in aging and cancer, along with the well-documented benefits of exercise relative to proposed CRCI mechanisms (e.g., cardiorespiratory fitness, fatigue), provide a compelling argument in support of aerobic exercise training for improving cognitive function in BCS. While evidence toward efficacy in this area is growing, few large trials have been conducted and none, to our knowledge, with consideration of dissemination and implementation a priori. We propose a clinical trial in which post-menopausal BCS (3-24 months post primary adjuvant therapy) will be randomized to a community-based aerobic exercise program or attentional control. This study utilizes a Hybrid Type I effectiveness-implementation design to investigate clinical effectiveness while gathering information on implementation success associated with our novel, community- based approach. Our exercise protocol is based upon our previous studies with demonstrated efficacy in older adults, and our community-based approach is based upon our previous studies with demonstrated implementation success in BCS and post-menopausal women without cancer. The specific aims are: 1) Examine the effectiveness of a 6-month, community-based aerobic exercise program, compared to control, on indicators of cognitive function (i.e., cognitive performance, neuroimaging metrics of brain health, self-reported cognitive impairment) in post-menopausal BCS; and 2) Gather information on the intervention’s potential for scalability as defined by the RE-AIM framework (i.e., reach, effectiveness, adoption, implementation, maintenance). We will also explore intervention interactions with clinical variables (e.g., moderators: chemotherapy treatment regimen, obesity status) and potential pathways by which aerobic exercise, compared to control, influences cognitive function (i.e., mediators: neuroimaging outcomes, cardiorespiratory fitness, fatigue).

项目摘要 50岁以上的妇女占乳腺癌诊断的77％和所有乳腺癌存活（BCS）的93％。不幸的是，癌症治疗与正常衰老之间的相互作用通常会导致许多健康后遗症。在治疗期间，多达75％的BC遭受认知变化，超过45％的经验治疗前的认知能力大幅下降。与癌症相关认知的最佳治疗损害（CRCI）可能是一种综合干预措施，已知可以改善类似人群的认知，例如作为老年人。我们以前的研究支持现代强度有氧运动训练的效率改善没有癌症的老年人的认知功能。这项工作表明心肺健康（即峰值VO2）以及大脑结构和功能完整性（例如，白质微观结构，静止状态功能连通性）可能是运动引起的认知功能变化的基础。我们最近应用了衰老框架以获取有关体育活动对BCS认知功能影响的初步信息。我们的在这一领域的工作表明，有氧运动训练可能会因取消而改善认知能力下降与癌症相关的疲劳也可能代表了运动在上下文中的认知益处的机制癌症。我们在衰老和癌症方面的初步数据，以及据文化的锻炼相对的好处提出的CRCI机制（例如心肺适应性，疲劳）在支持有氧运动训练以改善BCS的认知功能。同时证明放松该领域正在增长，据我们所知，很少进行大型试验，而没有考虑先验传播和实施。我们提出了一项临床试验，其中绝经后BCS（3-24 初级调整疗法后的月份）将被随机分为社区的有氧运动计划或注意控制。这项研究利用I型I型有效性 - 实现设计来研究临床有效性，同时收集有关与我们的小说社区相关的实施成功的信息 - 基于方法。我们的运动方案是基于我们以前的研究，并证明了在较旧的情况下的效率成人和我们基于社区的方法基于我们以前的研究在卑诗省和没有癌症的绝经后妇女实施成功。具体目的是：1）检查与对照相比，一个6个月的基于社区的有氧运动计划的有效性，指标认知功能（即认知表现，神经影像学指标，大脑健康，自我报告的认知损害）在绝经后BC中； 2）收集有关干预潜力可伸缩性的信息由RE-AIM框架定义（即覆盖范围，有效性，采用，实施，维护）。我们将还探索与临床变量的干预相互作用（例如，主持人：化学疗法治疗方案，肥胖状态）和有氧运动与对照相比的潜在途径会影响认知功能（即介体：神经影像学结局，心肺适应性，疲劳）。