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Table of Contents
Year : 2020  |  Volume : 3  |  Issue : 4  |  Page : 841-844

Role of exercise in mitigating breast cancer-related cognitive impairment in women

Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy

Date of Submission09-Oct-2020
Date of Decision29-Oct-2020
Date of Acceptance30-Oct-2020
Date of Web Publication25-Dec-2020

Correspondence Address:
Chidiebere Emmanuel Okechukwu
Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/crst.crst_314_20

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How to cite this article:
Okechukwu CE. Role of exercise in mitigating breast cancer-related cognitive impairment in women. Cancer Res Stat Treat 2020;3:841-4

How to cite this URL:
Okechukwu CE. Role of exercise in mitigating breast cancer-related cognitive impairment in women. Cancer Res Stat Treat [serial online] 2020 [cited 2021 Sep 22];3:841-4. Available from: https://www.crstonline.com/text.asp?2020/3/4/841/304985

According to a recent study conducted by Wagner et al.,[1] several women with breast cancer experience cognitive impairment (CI) that compromises their mental well-being, judgment, skill to perform daily tasks, and commitment to cancer treatment. DNA methylation plays an important role in cognition, and exercise has been shown to influence DNA methylation. Hence, exercise can be an effective means to mitigate cancer-related CI in women with breast cancer, as it can improve the cognitive function by modulating the epigenome.[1] Breast cancer survivors who participated in a 30-min bout of moderate-intensity treadmill walking gained improvements in the domains of cognitive functioning.[2] Similarly, participating in an 8-week Qigong program resulted in an improvement in cognition among breast cancer survivors.[3]

High-intensity interval training has been shown to improve the executive functioning, episodic memory, working memory, and cerebral blood flow among breast cancer survivors, proving the effectiveness of high-intensity aerobic exercise in mitigating cancer-treatment-related CI. However, introducing a supervised high-intensity exercise program during chemotherapy can be an effective approach to improve the health-related quality of life and reduce cancer-related fatigue and CI among breast cancer survivors.[4]

An integrated, tailored, and supervised exercise intervention comprising aerobic and resistance training and mind-body exercises should be added to the treatment plan for patients with breast cancer undergoing chemotherapy and breast cancer survivors to mitigate cancer-related CI [Table 1]. The exercise regimen should be tailored to patients' tolerance, functional capacity, health status, and preferences.[9] For aging adults who are functionally limited or have chronic diseases that affect their ability to exercise, the physicians should prescribe a low-intensity physical activity, such as light walking or light calisthenics, with an intensity of 1.1–3.0 metabolic equivalents or 35%–50% heart rate reserve (HRR) or 1–3 rating of perceived exertion, at the beginning of the exercise routine, for 30 min, for 5 days/week. Advancing further to a moderate-intensity exercise routine depends on the tolerance and functional capacity of the individuals [Table 2].[10]
Table 1: Effectiveness of physical activity in mitigating cancer-related cognitive impairment among breast cancer survivors

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Table 2: Physical activity based on intensity using metabolic equivalents level, heart rate reserve, and rating of perceived exertion

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Aerobic exercise has been found to be effective in mitigating the side effects of chemotherapy on cardiovascular health, by improving endothelial function and cardiorespiratory fitness in patients with cancer.[11] The beneficial effects of exercise on the cardiovascular health and cognitive function of patients with cancer is associated with improvement in the quality of life. Moreover, exercise can be combined with other effective non-pharmacological interventions such as cognitive rehabilitation, cognitive behavioral therapy, and cognitive training to rapidly achieve therapeutic goals in the management of cancer-related CI.[12]

In conclusion, an oncologist in cooperation with a physiotherapist and an accredited exercise physiologist should continue to prescribe both supervised and home-based individualized exercise regimens to breast cancer survivors. Moreover, they should be encouraged often to maintain and adhere to their exercise routine so as to improve their mental health and cognitive performance. However, further studies are needed to investigate the underlying mechanisms for exercise-mediated improvement in cognitive performance among patients with breast cancer undergoing treatment and breast cancer survivors.

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  References Top

Wagner MA, Erickson KI, Bender CM, Conley YP. The influence of physical activity and epigenomics on cognitive function and brain health in breast cancer. Front Aging Neurosci 2020;12:123.  Back to cited text no. 1
Salerno EA, Rowland K, Kramer AF, McAuley E. Acute aerobic exercise effects on cognitive function in breast cancer survivors: A randomized crossover trial. BMC Cancer 2019;19:371.  Back to cited text no. 2
Myers JS, Mitchell M, Krigel S, Steinhoff A, Boyce-White A, Van Goethem K, et al. Qigong intervention for breast cancer survivors with complaints of decreased cognitive function. Support Care Cancer 2019;27:1395-403.  Back to cited text no. 3
Mijwel S, Jervaeus A, Bolam KA, Norrbom J, Bergh J, Rundqvist H, et al. High-intensity exercise during chemotherapy induces beneficial effects 12 months into breast cancer survivorship. J Cancer Surviv 2019;13:244-56.  Back to cited text no. 4
Bedillion MF, Ansell EB, Thomas GA. Cancer treatment effects on cognition and depression: The moderating role of physical activity. Breast 2019;44:73-80.  Back to cited text no. 5
Ehlers DK, Fanning J, Salerno EA, Aguiñaga S, Cosman J, Severson J, et al. Replacing sedentary time with physical activity or sleep: Effects on cancer-related cognitive impairment in breast cancer survivors. BMC Cancer 2018;18:685.  Back to cited text no. 6
Ehlers DK, Aguiñaga S, Cosman J, Severson J, Kramer AF, McAuley E. The effects of physical activity and fatigue on cognitive performance in breast cancer survivors. Breast Cancer Res Treat 2017;165:699-707.  Back to cited text no. 7
Hartman SJ, Weiner LS, Nelson SH, Natarajan L, Patterson RE, Palmer BW, et al. Mediators of a physical activity intervention on cognition in breast cancer survivors: Evidence from a randomized controlled trial. JMIR Cancer 2019;5:e13150.  Back to cited text no. 8
Deb AA, Okechukwu CE, Emara S, Sami AA. Physical activity and prostate cancer: A systematic review. Urol Nephrol Open Access J 2019;7:117-29.  Back to cited text no. 9
Okechukwu CE, Deb AA, Emara S, Abbas SA. Physical activity as preventive therapy for older adults: A narrative review. Niger J Exp Clin Biosci 2019;7:82-92.  Back to cited text no. 10
  [Full text]  
Okechukwu CE. Role of aerobic exercise in mitigating cancer treatment-induced cardiovascular toxicity. Cancer Res Stat Treat 2020;3:636-8.  Back to cited text no. 11
  [Full text]  
Zeng Y, Dong J, Huang M, hang JE, Zhang X, Xie M, et al. Nonpharmacological interventions for cancer-related cognitive impairment in adult cancer patients: A network meta-analysis. Int J Nurs Stud 2020;104:103514.  Back to cited text no. 12


  [Table 1], [Table 2]


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