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Journal of Exercise Physiologyonline
August 2015
Volume 18 Number 4
Editor-in-Chief
Official Research Journal of
Tommy
the American
Boone, PhD,
Society
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Todd Astorino, PhD
Julien ISSN
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Official Research Journal
of the American Society of
Exercise Physiologists
ISSN 1097-9751
JEPonline
The Effects of Combined Training on Strength and
Aerobic Power in Patients with Cancer
Bruno P. Melo1, Francisco A. Manoel1, Ramon Cruz2, Sandro F. da
Silva3
1Postgraduation
student in Physical Education, Estadual University of
Maringá, Maringá/PR Brazil 2Postgraduation student in Physical
Education, Federal University of Juiz de Fora, Juiz de Fora/MG Brazil,
3Adjunct Professor at Federal University of Lavras, Lavras/MG Brazil
ABSTRACT
Melo BP, Manoel FA, Cruz R, da Silva SF. The Effects of Combined
Training on Strength and Aerobic Power in Patients with Cancer.
JEPonline 2015;18(4):10-16. Although exercise is considered an
effective strategy for mitigating problems caused by cancer, little is
known about the effects of combined training (CT) in cancer patients.
Six men (68.94 ± 11.79 yrs old, 66.68 ± 7.36 kg, 167 ± 8.02 cm) and 6
women (64.07 ± 11.46 yrs old, 74.70 ± 12.89 kg; 160 ± 10.01 cm) with
cancer were subjected to 20 wks of CT (3 d·wk-1). Each session
consisted of 40 min of aerobic exercise (60 to 70%) of maximum heart
rate and 3 sets of 12 to 15 repetitions at 50 to 60% of 1RM. The VO2
max was estimated by the 1 Mile Walk Test and strength was
estimated through 1RM prediction. The Student t-test was used to
identify differences between each assessment. Cohen’s D criterion was
used to calculate the effect size of the variables in the two moments,
adopting the significance level of P<0.05. The results indicated that
there was a significant increase (P<0.05) in strength in the following
exercises: chair abductor (58.40 ± 11.90 vs. 73.05 ± 15.00); shoulder
press (10.22 ± 5.30 vs. 17.63 ± 6.21); back lat pulldown (21.06 ± 4.99
vs. 27.36 ± 7.60); and peck-deck (32.91 ± 11.11 vs. 46.80 ± 14.58).
There was no statistically significant change in VO2 max. Therefore,
while the combined training resulted in an improvement in strength, it
did not improve the cancer patients’ aerobic capacity.
Key Words: Functional Capacity, Training, Exercise Physiology,
Special Populations
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INTRODUCTION
Understanding and having some control over malignant diseases requires scientific knowledge and
experiences that go from the awareness of complex intracellular molecular regulation mechanisms to
making individual lifestyle choices (6). Due to its prevalence and harmful effects, cancer represents a
major public health issue worldwide.
While radiotherapy and chemotherapy are commonly administered in several types of cancer (1), the
treatments often lead to significant side effects that result in diminished physical and psychological
capacities in the patients (13). Many of the effects are fatigue, depression, decreased strength, and
reduced quality of life after treatment begins and some adverse effects continue long term (2).
Hence, instead of dealing the side effects of undergoing radiotherapy and chemotherapy (18), regular
exercise has been demonstrated to have great health benefits for patients with cancer. This is the
case even though clients benefit from aerobic and resistance exercises at different intensities and
duration of effort (1,10). In fact, Fong and colleagues (9) and McClellan (15) demonstrated that
exercise programs for patients who had completed radiotherapy and chemotherapy treatments led to
the improvement in maximal oxygen uptake and distance covered in 6 min. Body weight, fatigue, and
depression were decreased.
Corroborating these findings, Keogh and MacLeod (11) observed that physical training throughout a
13-wk program improved aerobic endurance and the overall quality of life of the cancer patients. Lee
et al. (14) also demonstrated that patients who exercised regularly had lower rates of mortality that
were associated with cancer and cardiovascular diseases.
The purpose of this study was to: (a) identify the effects of the aerobic training combined with strength
training when performed under moderate intensity of cancer patients who underwent radiotherapy
and chemotherapy; and (b) determine whether the combined training leads to long term positive
effect in cancer patients.
METHODS
Subjects
Six men with prostate cancer and six women with breast cancer participated in this study. All subjects
signed the Free and Informed Consent Form that was approved by the Ethics Committee of the
University of Itaúna under protocol n. 017/10. The sample characteristics are presented in Table 1.
Table 1. Descriptive Data of the Subjects.
Age
Body Mass
Height
%G
N
(yrs)
(Kg)
(cm)
Radiotherapy
Chemotherapy
n (treatment)
6
68.94 ± 11.79
66.68 ± 7.36
167.0 ± 8.2
23.95 ± 1.67
6 (2010-2011)
Women 6
64.07 ± 11.46
74.70 ± 12.89
160.9 ± 9.1
24.07 ± 2.13
6 (2010-2011)
Men
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Procedures
All the subjects underwent diagnostic evaluation of anamnesis, anthropometric evaluation, muscle
strength, and aerobic capacity. The subjects underwent an afternoon of physical training that
combined aerobic and strength activities performed 3 times·wk-1 on alternate days, with mean
duration of 90 min for 20 wks (60 training sessions). Training intensity was individually prescribed
according to outcomes obtained during the diagnostic evaluation. The exercise room at the Human
Movement Studies Laboratory was specifically designed for research and extension projects. Aerobic
power and muscle strength evaluations were performed before and after the 20 wks program of
combined training.
Maximal strength of the upper (SUL) and lower limbs (SLL) was evaluated by means of resistance
machines and free weights used to perform the following exercises: (a) SUL = peck-deck (fly),
shoulder press (shoulder), barbell curls (biceps), and triceps pushdown; and (b) SLL = leg curl
machine, knee extension chair, chair adductor, and chair abductor.
Strength training emphasized exercises for different muscle groups that consisted of performing 3
sets of 12 to 15 repetitions with an intensity of 50 to 60% of 1RM. At the end of each set, the Rating
of Perceived Exertion (RPE) was determined for each subject following the 0 to 10 point scale of
exercise resistance (16) during the entire training period. For estimating maximal strength in each
exercise, the subject performed about 8 to 12 repetitions. Subsequently, the equation by Brzycki (5)
was used to estimate 1RM. Subjects were evaluated every 15 training sessions in order to adjust the
training load and to monitor the intensity of the exercises.
The prediction of maximum oxygen consumption (VO 2 max) was performed by the 1 Mile Walk Test
(12), during which the subjects walked 1609 m as fast as possible without trotting or running. The
evaluation was performed on a running track. Each 100 m of the route was marked for HR collection,
which was done by means of a Polar® (RS800cx) heart rate monitor and the RPE was done for each
subject.
Aerobic training was conducted on a treadmill and on a running track. Intensity was controlled by
heart rate and RPE (4), given the intensity of 60 to 70% of maximum heart rate (HR max) and RPE
between 12 to 15 points. Each training session lasted 40 min.
Statistical Analyses
Descriptive statistics with comparison of the mean and standard deviation was used. For the sample
distribution, Shapiro-Wilk W-test was applied followed by the Student t-test to identify differences
between each assessment. Cohen’s D criterion was used to calculate the effect size of the variables
in the two moments. The SPSS 20.0 statistic software was used. Statistical significance was set at an
alpha level of P<0.05.
RESULTS
After the subjects participated in the combined training, it was possible to observe that the exercises
for the lower limbs showed improvement in strength compared to the diagnostic evaluations. The
exercise performed in the chair abductor showed significant difference (P = 0.02) in increasing 1RM
strength after completing the training (Table 2).
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Table 2. Strength in the Lower Limbs Related to 1RM in Kg.
1RM (kg)
Before
After
P
Effects Size
Horizontal leg curl machine
14.59 ± 7.64
21.53 ± 9.17
0.06
0.82
Chair abductor
58.40 ± 11.90
73.05 ± 15.00
0.02*
1.08
Knee extension chair
59.37 ± 14.99
74.94 ± 21.43
0.06
0.84
Chair adductor
61.72 ± 12.46
73.96 ± 14.74
0.33
0.89
*Significant difference (P<0.05).
Table 3 shows the subjects’ means ± SD of muscle strength related to 1RM for the upper limb
exercise. There were significant increases in shoulder press, back lat pulldown, and peck-deck (fly)
exercises. The subjects’ before and after responses during the 1 Mile Walk Test are presented in
Table 4.
Table 3. Strength in the Upper Limbs Related to 1RM.
1RM (kg)
Before
After
Barbell curls
P
Effects Size
6.92 ± 1.09
8.85 ± 1.98
0.07
1.20
Shoulder press
10.22 ± 5.30
17.63 ± 6.21
0.05*
1.28
Back lat pulldown
21.06 ± 4.99
27.36 ± 7.60
0.02*
0.98
Triceps pushdown
24.99 ± 9.65
30.41 ± 11.08
0.21
0.52
Peck-deck (fly)
32.91 ± 11.11
46.80 ± 14.58
0.02*
1.07
*Significant difference (P<0.05).
Table 4. The Subjects’Responses during the Before and After the 1 Mile Walk Test.
Before
After
P
Effects Size
Time (min:seg)
18:40 ± 3:28
17:26 ± 2:59
0.87
0.38
HR - average (beats·min-1)
121.9 ± 17.50
122.5 ± 14.20
0.91
0.04
HR - peak (beats·min-1)
131.7 ± 17.2
132.6 ± 11.7
0.89
0.06
RPE
13.21 ± 1.07
12.97 ± 1.00
0.85
0.23
Average speed (km·h-1)
5.21 (0.90)
5.61 (0.82)
0.78
0.47
VO2 max (mL.kg-1·min-1)
29.8 ± 13.1
32.91 ± 10.6
0.41
0.80
*Significant difference (P<0.05).
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DISCUSSION
Cancer patients frequently experience loss of physical capacity and well-being when treated for their
disease. Strength training combined with aerobic exercise training is believed to be an important
intervention for cancer patients who undergo radiotherapy and chemotherapy. Prescribed resistance
training at an intensity of 50 to 60% of 1RM is well accepted by patients who report no muscle
discomfort when performing physical activities.
Except for the non-significant difference in VO2 max after training, the increase in the cancer patients’
muscle strength is in agreement with the work of Adamsen and colleagues (1) and Battaglini et al. (3).
The results suggest that emphasis on resistance training should be used to combat fatigue and
increase lean muscle mass and strength in cancer patients.
The statistically different strength differences were found predominately in the upper limb muscles.
Part of the explanation may be in the exercises that were used in this study. The fact that the patients
adapted to the exercises is important, since motor coordination and quality of movement are vital to
the success of this intervention in cancer survivors.
Maximum oxygen consumption and strength are important predictive factors for chronic prognosis in
cancer patients. Evidences obtained from epidemiological studies indicate that there is an inverse
relationship between cancer mortality and lifestyle, which includes aerobic activities in the daily life of
patients (6-8,18). Interestingly, after 20 wks of participation in the combined training program, there
was no statistically significant improvement in the cancer patients’ performance of the 1 Mile Walk
Test. Also, there were no significant differences in HR-average, HR-peak, RPE, average speed, and
VO2 max. With regards to the aerobic power, the finding is in disagreement with the study by Vincent
et al. (17) who found an improvement of VO2 max of 2.21 mL.kg-1·min-1 with aerobic exercise at 50 to
60% of HR max for 12 wks in women with breast cancer treated with chemotherapy.
CONCLUSIONS
The findings in the present study indicate that combined training did not produce the expected
strength and aerobic power benefits to cancer patients who had undergone radiotherapy and
chemotherapy. However, aside from the non-significant change in VO2 max in particular, the increase
in primarily upper limb muscle strength should lead help minimize the hemodynamic response to daily
activities. This factor alone should be viewed as a positive outcome when it comes to increasing the
patients’ longevity and quality of life by decreasing fatigue, muscle wasting, and energy loss in cancer
survivors.
ACKNOWLEDGMENTS
Financial Support – CAPES – Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
– Scientific Initiation Scholarship.
Address for correspondence: Sandro Fernandes da Silva, PhD, NEMOH - Nucleus of Studies
of Human Movement - Department of Physical Education - University of Lavras - University Campus,
PO Box 3037, ZIP Code 37200-000. Lavras/MG. Brasil. 00 55 (35) 3829-5132- sandrofs@def.ufla.br
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