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

• 批准号: 10212058
• 负责人: Diane Kristen Ehlers
• 金额: $ 60.33万
• 依托单位: UNIVERSITY OF NEBRASKA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-05-01 至 2026-04-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10212058
• 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; neuroimaging; normal aging; novel; optimal treatments; post intervention; primary outcome; secondary outcome; standard care; success; white matter

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).

项目概要 50 岁以上的女性占乳腺癌诊断的 77%，占所有乳腺癌幸存者 (BCS) 的 93%。 不幸的是，癌症治疗和正常衰老之间的相互作用往往会导致许多健康问题 后遗症。高达 75% 的 BCS 在治疗期间出现认知变化，超过 45% 的患者出现临床症状 治疗前至治疗后认知能力显着下降。癌症相关认知的最佳治疗方法 认知障碍（CRCI）可能是一种已知可以改善类似人群认知的综合干预措施，例如 作为老年人。我们之前的研究支持中等强度有氧运动训练的功效 改善未患癌症的老年人的认知功能。这项工作表明心肺健康（即 峰值摄氧量）和大脑结构和功能完整性（例如，白质微观结构、静息状态功能） 连接性）可能是运动引起的认知功能变化的基础。我们最近应用了老化 框架以获得有关体力活动对 BCS 认知功能影响的初步信息。我们的 该领域的工作表明，有氧运动训练可能同样可以改善癌症引起的认知能力下降 与癌症相关的疲劳也可能代表了运动对认知有益的机制 癌症。我们在衰老和癌症方面的初步数据，以及运动相关的有据可查的好处 针对拟议的 CRCI 机制（例如心肺健康、疲劳），提供令人信服的论据 支持有氧运动训练以改善 BCS 的认知功能。虽然有证据证明其功效 这一领域正在不断发展，但据我们所知，几乎没有进行过大型试验，而且没有考虑到 先验的传播和实施。我们建议进行一项临床试验，其中绝经后 BCS（3-24 主要辅助治疗后几个月）将被随机分配到基于社区的有氧运动计划或 注意力控制。本研究利用混合 I 型有效性实施设计来研究临床 有效性，同时收集与我们新颖的社区相关的实施成功信息 基于的方法。我们的锻炼方案基于我们之前的研究，已证明对老年人有效 成年人，我们基于社区的方法是基于我们之前的研究，并已证明 在 BCS 和没有癌症的绝经后妇女中成功实施。具体目标是： 1）检查 与对照相比，为期 6 个月的社区有氧运动计划在指标上的有效性 认知功能（即认知表现、大脑健康的神经影像指标、自我报告的认知 绝经后BCS中的损伤）； 2) 收集有关干预措施可扩展潜力的信息： 由 RE-AIM 框架定义（即范围、有效性、采用、实施、维护）。我们将 还探索干预措施与临床变量的相互作用（例如调节因素：化疗治疗方案、 肥胖状态）以及有氧运动与对照相比影响认知的潜在途径 功能（即调节因素：神经影像学结果、心肺健康、疲劳）。