Physiologic, psychologic, and oxidative stress responses to multimodal exercise in an endometrial cancer survivor undergoing high-dose chemotherapy: a case study

Exercise training, as a rehabilitative strategy, may be a vital factor in combatting the noxious toxicities related to cancer treatment. Research employing mixed modality exercise consistently demonstrates health benefits ranging from enhanced aerobic capacity and muscular strength to attenuated psychological distress. The primary aim of this case study was to examine the effects of exercise training on physiological and psychological parameters in an endometrial cancer survivor undergoing high-dose chemotherapy. Secondly, believed to play a role in toxicity development and progression, oxidative stress has yet to be studied in cancer survivors. The second aim of this case study was to determine the effects of exercise on a selection of blood parameters including reactive carbonyl derivatives, a marker of protein degradation. The case study subject was a 60-yr-old female, diagnosed with stage IIIC1 endometrial cancer, undergoing chemotherapy (paclitaxel and carboplatin, [PC]). Assessments (e.g., body composition, VO2peak, 1-RM, pulmonary spirometry, fatigue and quality of life [QoL] indexes) were performed 1 day prior to the first PC cycle and again at 3- and 6-months. Exercise was performed 3 days/week (Tues, Thurs, and Sat) of each week for 21 weeks. Each 1 hour session consisted of treadmill walking and total body strength exercises. Blood pressure (BP), heart rate (HR), and ratings of perceived exertion (RPE) were recorded during training sessions. Over 141 calendar days, the case study completed 63 exercise sessions (~45%). Physical characteristics remained relatively stable. VO2peak improved approx. 16% over the 6-month period (23.0 to 27.3 mL·kg-1·min-1). Decrements in lung function were evidenced by spirometry parameters, FVC (-10%) and FEV1 (-9%). Changes in global fatigue were not significant (p=.17) but affective and sensory subscales increased significantly between baseline and 3-months (p=.05). Subject-reported RPE scores during Phase I Nadir training were significantly lower than the prescribed range (p=.008). Also, Phase II Nadir scores were significantly lower than those reported in phase I (p=.003), suggesting the capacity to maintain exercise participation. Comparison of mean arterial pressure (MAP) between Phases I and II were not significantly different for Nadir (p=.74) or standard (p=.12) training. MAP was significantly reduced for Nadir compared to standard training (p=.005). ELISA results of oxidative stress markers illustrated a significant reduction of protein carbonyl concentration with programmed exercise (p=.03). Reduced protein oxidation may explicate the observed gains in muscular strength. Furthermore, results of complete hematology panels (e.g., WBC, RBC, HGB, and PLT) depicted a collective attenuation of treatment-related damage as per the recurring escalation toward initial (e.g., baseline) cellular concentrations. Multimodal exercise, as a remedial approach, appears to be well tolerated and appropriate for the preservation of physical and psychological capacities in an endometrial cancer survivor undergoing treatment