Improving Exercise Capacity with a Tailored Physical Activity Intervention in Lymphoma Patients Undergoing Treatment

与接受具有潜在心脏毒性的基于蒽环类药物的化疗相关的心血管事件 (Anth-BC)，正在成为淋巴瘤幸存者发病率和死亡率的主要原因(第5期 北美最常见的癌症)。我们建议的目标是减少这种癌症治疗 通过开发、启用和测试体力活动干预措施 在接受Anth-BC的整个过程中继续服用，目的是减轻身体缺乏活动，保持锻炼 淋巴瘤患者的能力、简历和认知功能、力量和健康相关的生活质量(HRQOL)。 这项计划的需要和设计部分是基于淋巴瘤幸存者焦点的反馈 在我们NIH资助的综合癌症中心接受治疗的小组--初步试验数据(第3.C.1节)。 这项提议的几个新特点包括： 1)在接受癌症治疗期间的体力活动表现，这是运动不耐受的起因。 2)创建患者社区，使癌症患者能够在治疗期间相互支持。 3)在家庭中管理适合个人生活方式的有氧和力量活动 从4家附近的心脏康复机构提供指导，有锻炼经验 免疫受损的个人和那些由于癌症而先前存在的活动受限的人。 4)利用新开发的磁共振心肺运动跑步机测试方法 测量导致VO2峰值(A)的两个组成部分(心脏功能和外周因素) 最大运动量的量度)。这一新信息将提供机械性的洞察 体力活动有助于保持运动能力，减少疲劳。 5)评估认知功能、活动和运动能力之间的关系，从而帮助 了解癌症患者体力活动、HRQOL和认知功能之间的关系。 在这项应用中，我们建议在R21阶段对以下患者进行体力活动干预 参加为期6个月的干预。如果达到了适当的里程碑，我们将进行随机 R33期临床试验，以测试综合体力活动干预对维持高峰的有效性 V02，6分钟步行距离，心脏和认知功能，力量，活动，和HRQOL。 如果我们实现了我们的研究目标，这种拟议的干预可以降低心血管死亡率和与心力衰竭相关的 住院，通过延长心脏康复中心(通常是 靠近癌症中心)，提高与健康相关的生活质量，减少疲劳进行以下活动 日常生活，并减轻淋巴瘤幸存者的认知功能下降。这项研究的结果可能会对 在接受化疗期间改变现有的久坐行为模式，并最终导致 改善那些患有淋巴瘤和潜在其他形式癌症的人的长期结果。

Cardiovascular (CV) events related to the receipt of potentially cardiotoxic anthracycline-based chemotherapy (Anth-bC), are emerging as leading causes of morbidity and mortality for survivors of lymphoma (the 5th most common cancer in North America). The objective of our proposal is to reduce this cancer treatment related CV morbidity by developing, enabling, and testing a physical activity intervention that commences and continues throughout receipt of Anth-bC for the purpose of attenuating physical inactivity, preserving exercise capacity, CV & cognitive function, strength, and health-related quality of life (HRQOL) for those with lymphoma. The need for and the design of this program is based in part on feedback from lymphoma survivor focus groups treated in our NIH funded Comprehensive Cancer Center - preliminary pilot data (Section 3.C.1). Several novel features of this proposal include: 1) Performance of physical activity during receipt of cancer treatment where exercise intolerance originates. 2) Creation of patient communities that enable cancer patients to support one another during treatment. 3) Administration of aerobic & strength activities suited to one's individual lifestyle in the home guided by instruction provided from 4 close to home cardiac rehabilitation facilities experienced in exercising immunocompromised individuals and those with other pre-existing activity limitations due to cancer. 4) Utilization of newly developed magnetic resonance cardiopulmonary exercise treadmill testing methods to measure the two components (cardiac function and peripheral factors) that contribute to peak VO2 (a measure of maximal exercise capacity). This new information will provide mechanistic insight into how physical activity helps preserve exercise capacity and reduce fatigue. 5) Assessment of the relationships between cognitive function, activity, and exercise capacity thereby helping to unravel the association between physical activity, HRQOL and cognitive function in cancer patients. In this application, we propose to refine the physical activity intervention during the R21 Phase in patients who participate in the intervention for 6 months. If suitable milestones are achieved, we will conduct a randomized clinical trial in the R33 Phase to test the utility of the integrated physical activity intervention for sustaining peak V02, 6-min walk distance, cardiac and cognitive function, strength, activity, and HRQOL. If we achieve our study goals, this proposed intervention could reduce CV mortality and heart failure related hospital admissions, translate into clinical practice via extension through cardiac rehabilitation centers (often located close to cancer centers), increase health-related quality of life, reduce fatigue to perform activities of daily living, and attenuate cognitive function decline in lymphoma survivors. The results of this study could help to change existing sedentary behavior paradigms during receipt of chemotherapy and ultimately lead to improved long term outcomes for those with lymphoma and potentially other forms of cancer.