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Exercise and serum biomarkers after cancer treatment: An area for further discovery

While the historical advice to cancer patients was mainly to rest and avoid exercise, there is now compelling evidence showing that physical activity is not only safe for cancer survivors, but improves quality of life whilst reducing anxiety, fatigue, and depression. As well as the benefits to our cardiovascular systems and mental health, physical activity can actually impact the body’s cellular processes. The ReStOre (Rehabilitation Strategies following Oesophagogastric Cancer) study provides an opportunity to assess serum biomarkers in survivors of oesophagogastric cancer (cancer of the food pipe and stomach).

Oesophagogastric cancer can have a devastating effect on health and well-being. Before diagnosis, patients may experience eating difficulties and dysphagia (difficulty swallowing food) which can cause severe weight loss and fatigue. In addition, cancer treatment (chemotherapy, radiation and surgery) often has a detrimental effect on health-related quality of life, and patients frequently struggle with loss of appetite, difficulty eating, sarcopenia (loss of muscle mass), fatigue, and post-operative weight loss. Cardiorespiratory fitness, an important indicator of overall health and all-cause mortality, remains poor in those who survive oesophagogastric cancer. Exercise rehabilitation strategies in oesophagogastric cancer need to prevent excess weight loss in these patients. There is also a strong rationale to provide rehabilitation programmes for oesophagogastric cancer patients.

The multidisciplinary ReStOre programme was developed by researchers from the Trinity St James Cancer Institute. This novel programme aims to incorporate exercise rehabilitation with 1:1 dietary counselling and patient education sessions for patients with oesophagogastric cancer. The group recently published the results of a 12-week intervention study in the esteemed Journal, Frontiers in Oncology. One of the programme’s lead researchers, Professor Juliette Hussey described the study:

The ReStOre study was devised to determine if fitness could be improved with a multidisciplinary programme of rehabilitation including exercise for patients after oesophageal cancer surgery. The study was powered to examine the impact on fitness but also provided the opportunity to explore the impact of the intervention on a range of circulating serum proteins. Significant changes were found in a number of biomarkers involved in inflammation and metastasis. This pilot work is important in informing our follow-on study ReStOre II which includes establishing a UGI cancer survivorship biobank for further collaborative translational biomarker studies.”

The group previously showed that a combination of aerobic and resistance training improved physical, mental and social well-being. The current study showed that the exercise-based intervention improved some of the measured blood biomarkers which are involved in inflammation and cancer metastasis. Professor Hussey explained the study’s impact:

This initial work has been crucial in exploring changes in biomarkers in the blood as a result of a rehabilitation intervention where the main focus was on increasing fitness. The exercise intervention which included aerobic and resistance components lasted for 12 weeks, and it is possible that a longer time may be needed to lead to a more significant change in inflammation.

This initial work will provide a strong background for future studies focused on examining how interventions with exercise can change the inflammatory blood profiles in patients with these types of cancer.”

The study, which was funded by the Health Research Board, was a collaborative effort, including Professor Jacintha O’Sullivan, Dr Emer Guinan, Professor John Reynolds, Dr Susan Kennedy and Dr Stephanie Annett.

The study text can be accessed here: https://www.frontiersin.org/articles/10.3389/fonc.2021.669078/full