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

与接受潜在心脏毒性的蒽环类化疗相关的心血管（CV）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届 北美最常见的癌症）。我们提案的目的是减少这种癌症治疗 通过开发、启用和测试一种体力活动干预措施， 在整个Anth-bC接收过程中持续，以减少身体活动，保持锻炼 能力，CV和认知功能，强度，以及淋巴瘤患者的健康相关生活质量（HRQOL）。 该计划的需要和设计是基于部分从淋巴瘤幸存者焦点的反馈 在我们的NIH资助的综合癌症中心接受治疗的组-初步试验数据（第3.C.1节）。 该提案的若干新特点包括： 1)在接受癌症治疗期间进行身体活动，其中运动不耐受起源。 2)创建患者社区，使癌症患者在治疗期间相互支持。 3)管理有氧和力量活动适合一个人的个人生活方式在家里的指导下 从4家有锻炼经验的家庭心脏康复机构提供指导 免疫受损个体和由于癌症而具有其他预先存在的活动限制的那些。 4)利用新开发的磁共振心肺运动平板试验方法， 测量导致峰值VO 2（a）的两个分量（心功能和外周因素 最大运动能力（maximum exercise capacity）这一新信息将提供机械的洞察力， 体力活动有助于保持运动能力和减少疲劳。 5)评估认知功能、活动和运动能力之间的关系，从而帮助 阐明癌症患者体力活动、HRQOL和认知功能之间的关联。 在本申请中，我们建议在R21阶段对以下患者进行身体活动干预： 参与干预6个月。如果达到合适的里程碑，我们将进行随机化 R33阶段的临床试验，旨在测试综合体力活动干预对维持峰值的效用 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，这种拟议的干预措施可以降低CV死亡率和心力衰竭相关性。 住院，通过心脏康复中心（通常 位于癌症中心附近），提高健康相关的生活质量，减少疲劳，以执行活动， 日常生活，并减弱淋巴瘤幸存者的认知功能下降。这项研究的结果可能有助于 在接受化疗期间改变现有的久坐行为模式，并最终导致 改善淋巴瘤和其他潜在癌症患者的长期预后。

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.