A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology

Abstract

To date, the prevailing evidence in the field of exercise oncology supports the safety and efficacy of resistance training to attenuate many oncology treatment-related adverse effects, such as risk for cardiovascular disease, increased fatigue, and diminished physical functioning and quality of life. Moreover, findings in the extant literature supporting the benefits of exercise for survivors of and patients with cancer have resulted in the release of exercise guidelines from several international agencies. However, despite research progression and international recognition, current exercise oncology-based exercise prescriptions remain relatively basic and underdeveloped, particularly in regards to resistance training. Recent publications have called for a more precise manipulation of training variables such as volume, intensity, and frequency (i.e., periodization), given the large heterogeneity of a cancer population, to truly optimize clinically relevant patient-reported outcomes. Indeed, increased attention to integrating fundamental principles of exercise physiology into the exercise prescription process could optimize the safety and efficacy of resistance training during cancer care. The purpose of this article is to give an overview of the current state of resistance training prescription and discuss novel methods that can contribute to improving approaches to exercise prescription. We hope this article may facilitate further evaluation of best practice regarding resistance training prescription, monitoring, and modification to ultimately optimize the efficacy of integrating resistance training as a supportive care intervention for survivors or and patients with cancer.

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References

  1. 1.

    Sasso JP, Eves ND, Christensen JF, et al. A framework for prescription in exercise-oncology research. J Cachexia Sarcopenia Muscle. 2015;6(2):115–24. doi:10.1002/jcsm.12042.

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Hardee JP, Porter RR, Sui X, et al. The effect of resistance exercise on all-cause mortality in cancer survivors. Mayo Clin Proc. 2014;89(8):1108–15. doi:10.1016/j.mayocp.2014.03.018.

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Schmitz KH, Courneya KS, Matthews C, et al. American College of Sports Medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc. 2010;42(7):1409–26. doi:10.1249/MSS.0b013e3181e0c112.

    Article  PubMed  Google Scholar 

  4. 4.

    Campbell A, Stevinson C, Crank H. The BASES Expert Statement on exercise and cancer survivorship. J Sports Sci. 2012;30(9):949–52. doi:10.1080/02640414.2012.671953.

    Article  PubMed  Google Scholar 

  5. 5.

    Hayes SC, Spence RR, Galvão DA, et al. Australian Association for Exercise and Sport Science position stand: optimising cancer outcomes through exercise. J Sci Med Sport. 2009;12:428–34. doi:10.1016/j.jsams.2009.03.002.

    Article  PubMed  Google Scholar 

  6. 6.

    Fleck SJ. Non-linear periodization for general fitness and athletes. J Hum Kinet. 2011;29A:41–5. doi:10.2478/v10078-011-0057-2.

    Article  PubMed  PubMed Central  Google Scholar 

  7. 7.

    McNamara JM, Stearne DJ. Effect of concurrent training, flexible nonlinear periodization, and maximal-effort cycling on strength and power. J Strength Cond Res. 2013;27(6):1463–70. doi:10.1519/JSC.0b013e318274f343.

    Article  PubMed  Google Scholar 

  8. 8.

    Ratamess NA, Alvar BA, Evetoch TK, et al. American College of Sports Medicine position stand. Progression models in resistance training for healthy adults. Med Sci Sports Exerc. 2009;41(3):687–708. doi:10.1249/MSS.0b013e3181915670.

    Article  Google Scholar 

  9. 9.

    Courneya KS, Segal RJ, Mackey JR, et al. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: a multicenter randomized controlled trial. J Clin Oncol. 2007;25(28):4396–404. doi:10.1200/JCO.2006.08.2024.

    Article  PubMed  Google Scholar 

  10. 10.

    Dolan LB, Gelmon K, Courneya KS, et al. Hemoglobin and aerobic fitness changes with supervised exercise training in breast cancer patients receiving chemotherapy. Cancer Epidemiol Biomark Prev. 2010;19(11):2826–32. doi:10.1158/1055-9965.EPI-10-0521.

    CAS  Article  Google Scholar 

  11. 11.

    Segal RJ, Reid RD, Courneya KS, et al. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. J Clin Oncol. 2009;27(3):344–51. doi:10.1200/JCO.2007.15.4963.

    Article  PubMed  Google Scholar 

  12. 12.

    Steindorf K, Schmidt ME, Klassen O, et al. Randomized, controlled trial of resistance training in breast cancer patients receiving adjuvant radiotherapy: results on cancer-related fatigue and quality of life. Ann Oncol. 2014;25(11):2237–43. doi:10.1093/annonc/mdu374.

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Ahmed RL, Thomas W, Yee D, et al. Randomized controlled trial of weight training and lymphedema in breast cancer survivors. J Clin Oncol. 2006;24(18):2765–72. doi:10.1200/JCO.2005.03.6749.

    Article  PubMed  Google Scholar 

  14. 14.

    Schmitz KH, Ahmed RL, Troxel AB, et al. Weight lifting for women at risk for breast cancer-related lymphedema: a randomized trial. JAMA. 2010;304(24):2699–705. doi:10.1001/jama.2010.1837.

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Winters-Stone KM, Laudermilk M, Woo K, et al. Influence of weight training on skeletal health of breast cancer survivors with or at risk for breast cancer-related lymphedema. J Cancer Surviv. 2014;8(2):260–8. doi:10.1007/s11764-013-0337-z.

    Article  PubMed  PubMed Central  Google Scholar 

  16. 16.

    Campbell KL, Neil SE, Winters-Stone KM. Review of exercise studies in breast cancer survivors: attention to principles of exercise training. Br J Sports Med. 2012;46(13):909–16. doi:10.1136/bjsports-2010-082719.

    Article  PubMed  Google Scholar 

  17. 17.

    Bompa TO. Annual training plan. In: Bompa TO, Haff GG, editors. Periodization: theory and methodology of training. 5th ed. Champaign: Human Kinetics; 2009. p. 126–77.

    Google Scholar 

  18. 18.

    Milanez VF, Ramos SP, Okuno NM, et al. Evidence of a non-linear dose-response relationship between training load and stress markers in elite female futsal players. J Sports Sci Med. 2014;13(1):22–9.

    PubMed  PubMed Central  Google Scholar 

  19. 19.

    Smith DJ. A framework for understanding the training process leading to elite performance. Sports Med. 2003;33(15):1103–26.

    Article  PubMed  Google Scholar 

  20. 20.

    Kiely J. Periodization paradigms in the 21st century: evidence-led or tradition-driven? Int J Sports Physiol Perform. 2012;7(3):242–50.

    Article  PubMed  Google Scholar 

  21. 21.

    Kraemer WJ, Ratamess N, Fry AC, et al. Influence of resistance training volume and periodization on physiological and performance adaptations in collegiate women tennis players. Am J Sports Med. 2000;28(5):626–33.

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Marx JO, Ratamess NA, Nindl BC, et al. Low-volume circuit versus high-volume periodized resistance training in women. Med Sci Sports Exerc. 2001;33(4):635–43.

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Rhea MR, Alderman BL. A meta-analysis of periodized versus nonperiodized strength and power training programs. Res Q Exerc Sport. 2004;75(4):413–22. doi:10.1080/02701367.2004.10609174.

    Article  PubMed  Google Scholar 

  24. 24.

    Prestes J, De Lima C, Frollini AB, et al. Comparison of linear and reverse linear periodization effects on maximal strength and body composition. J Strength Cond Res. 2009;23(1):266–74. doi:10.1519/JSC.0b013e3181874bf3.

    Article  PubMed  Google Scholar 

  25. 25.

    Harries SK, Lubans DR, Callister R. Systematic review and meta-analysis of linear and undulating periodized resistance training programs on muscular strength. J Strength Cond Res. 2015;29(4):1113–25. doi:10.1519/JSC.0000000000000712.

    Article  PubMed  Google Scholar 

  26. 26.

    Schwartz AL. Daily fatigue patterns and effect of exercise in women with breast cancer. Cancer Pract. 2000;8(1):16–24.

    CAS  Article  PubMed  Google Scholar 

  27. 27.

    Jim HSL, Small B, Faul LA, et al. Fatigue, depression, sleep, and activity during chemotherapy: daily and intraday variation and relationships among symptom changes. Ann Behav Med. 2011;42(3):321–33. doi:10.1007/s12160-011-9294-9.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Richardson A, Ream E, Wilson-Barnett J. Fatigue in patients receiving chemotherapy: patterns of change. Cancer Nurs. 1998;21(1):17–30.

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Jones LW, Alfano CM. Exercise-oncology research: past, present, and future. Acta Oncol. 2013;52(2):195–215. doi:10.3109/0284186X.2012.742564.

    Article  PubMed  Google Scholar 

  30. 30.

    Savard J, Liu L, Natarajan L, et al. Breast cancer patients have progressively impaired sleep-wake activity rhythms during chemotherapy. Sleep. 2009;32(9):1155–60.

    Article  PubMed  PubMed Central  Google Scholar 

  31. 31.

    Liu L, Fiorentino L, Natarajan L, et al. Pre-treatment symptom cluster in breast cancer patients is associated with worse sleep, fatigue and depression during chemotherapy. Psychooncology. 2009;18(2):187–94. doi:10.1002/pon.1412.

    Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Berger AM, Higginbotham P. Correlates of fatigue during and following adjuvant breast cancer chemotherapy: a pilot study. Oncol Nurs Forum. 2000;27(9):1443–8.

    CAS  PubMed  Google Scholar 

  33. 33.

    De Jong N, Kester ADM, Schouten HC, Abu-Saad HH, Courtens AM. Course of fatigue between two cycles of adjuvant chemotherapy in breast cancer patients. Cancer Nurs. 2006;29(6):467–77.

    Article  PubMed  Google Scholar 

  34. 34.

    Cohen L, de Moor CA, Eisenberg P, et al. Chemotherapy-induced nausea and vomiting: incidence and impact on patient quality of life at community oncology settings. Support Care Cancer. 2007;15(5):497–503. doi:10.1007/s00520-006-0173-z.

    Article  PubMed  Google Scholar 

  35. 35.

    Bergkvist K, Wengström Y. Symptom experiences during chemotherapy treatment–with focus on nausea and vomiting. Eur J Oncol Nurs. 2006;10(1):21–9. doi:10.1016/j.ejon.2005.03.007.

    Article  PubMed  Google Scholar 

  36. 36.

    Salihah N, Mazlan N, Lua PL. Chemotherapy-induced nausea and vomiting: exploring patients’ subjective experience. J Multidiscip Healthc. 2016;9:145–51. doi:10.2147/JMDH.S97695.

    PubMed  PubMed Central  Google Scholar 

  37. 37.

    Cheung AS, Zajac JD, Grossmann M. Muscle and bone effects of androgen deprivation therapy: current and emerging therapies. Endocr Relat Cancer. 2014;21(5):R371–94. doi:10.1530/ERC-14-0172.

    CAS  Article  PubMed  Google Scholar 

  38. 38.

    Taillibert S, Le Rhun E, Chamberlain MC. Chemotherapy-related neurotoxicity. Curr Neurol Neurosci Rep. 2016;16(9):81. doi:10.1007/s11910-016-0686-x.

    Article  PubMed  Google Scholar 

  39. 39.

    Kolb NA, Smith AG, Singleton JR, et al. The association of chemotherapy-induced peripheral neuropathy symptoms and the risk of falling. JAMA Neurol. 2016;73(7):860–6. doi:10.1001/jamaneurol.2016.0383.

    Article  PubMed  Google Scholar 

  40. 40.

    Win T, Groves AM, Ritchie AJ, et al. The effect of lung resection on pulmonary function and exercise capacity in lung cancer patients. Respir Care. 2007;52(6):720–6.

    PubMed  Google Scholar 

  41. 41.

    Borst GR, De Jaeger K, Belderbos JSA, et al. Pulmonary function changes after radiotherapy in non-small-cell lung cancer patients with long-term disease-free survival. Int J Radiat Oncol Biol Phys. 2005;62(3):639–44. doi:10.1016/j.ijrobp.2004.11.029.

    Article  PubMed  Google Scholar 

  42. 42.

    Mann JB, Thyfault JP, Ivey PA, et al. The effect of autoregulatory progressive resistance exercise vs. linear periodization on strength improvement in college athletes. J Strength Cond Res. 2010;24(7):1718–23. doi:10.1519/JSC.0b013e3181def4a6.

    Article  PubMed  Google Scholar 

  43. 43.

    Monteiro AG, Aoki MS, Evangelista AL, et al. Nonlinear periodization maximizes strength gains in split resistance training routines. J Strength Cond Res. 2009;23(4):1321–6. doi:10.1519/JSC.0b013e3181a00f96.

    Article  PubMed  Google Scholar 

  44. 44.

    Simão R, Spineti J, de Salles BF, et al. Comparison between nonlinear and linear periodized resistance training: hypertrophic and strength effects. J Strength Cond Res. 2012;26(5):1389–95. doi:10.1519/JSC.0b013e318231a659.

    Article  PubMed  Google Scholar 

  45. 45.

    Zourdos MC, Jo E, Khamoui AV, et al. Modified daily undulating periodization model produces greater performance than a traditional configuration in powerlifters. J Strength Cond Res. 2016;30(3):784–91. doi:10.1519/JSC.0000000000001165.

    Article  PubMed  Google Scholar 

  46. 46.

    Klemp A, Dolan C, Quiles JM, et al. Volume-equated high- and low-repetition daily undulating programming strategies produce similar hypertrophy and strength adaptations. Appl Physiol Nutr Metab. 2016;41(7):699–705. doi:10.1139/apnm-2015-0707.

    Article  PubMed  Google Scholar 

  47. 47.

    Rhea MR, Phillips WT, Burkett LN, et al. A comparison of linear and daily undulating periodized programs with equated volume and intensity for local muscular endurance. J Strength Cond Res. 2003;17(1):82–7.

    PubMed  Google Scholar 

  48. 48.

    Miranda F, Simão R, Rhea M, et al. Effects of linear vs. daily undulatory periodized resistance training on maximal and submaximal strength gains. J Strength Cond Res. 2011;25(7):1824–30. doi:10.1519/JSC.0b013e3181e7ff75.

    Article  PubMed  Google Scholar 

  49. 49.

    Prestes J, Frollini AB, De Lima C, et al. Comparison between linear and daily undulating periodized resistance training to increase strength. J Strength Cond Res. 2009;23(9):2437–42. doi:10.1519/JSC.0b013e3181c03548.

    Article  PubMed  Google Scholar 

  50. 50.

    Peterson MD, Dodd DJ, Alvar BA, et al. Undulation training for development of hierarchical fitness and improved firefighter job performance. J Strength Cond Res. 2008;22(5):1683–95. doi:10.1519/JSC.0b013e31818215f4.

    Article  PubMed  Google Scholar 

  51. 51.

    Buford TW, Rossi SJ, Smith DB, et al. A comparison of periodization models during nine weeks with equated volume and intensity for strength. J Strength Cond Res. 2007;21(4):1245–50. doi:10.1519/R-20446.1.

    PubMed  Google Scholar 

  52. 52.

    Zourdos MC, Klemp A, Dolan C, et al. Novel resistance training-specific rating of perceived exertion scale measuring repetitions in reserve. J Strength Cond Res. 2016;30(1):267–75. doi:10.1519/JSC.0000000000001049.

    Article  PubMed  Google Scholar 

  53. 53.

    McNamara JM, Stearne DJ. Flexible nonlinear periodization in a beginner college weight training class. J Strength Cond Res. 2010;24(8):2012–7. doi:10.1519/JSC.0b013e3181b1b15d.

    Article  PubMed  Google Scholar 

  54. 54.

    Timmons JA. Variability in training-induced skeletal muscle adaptation. J Appl Physiol. 2011;110(3):846–53. doi:10.1152/japplphysiol.00934.2010.

    Article  PubMed  Google Scholar 

  55. 55.

    Mazzetti SA, Kraemer WJ, Volek JS, et al. The influence of direct supervision of resistance training on strength performance. Med Sci Sports Exerc. 2000;32(6):1175–84.

    CAS  Article  PubMed  Google Scholar 

  56. 56.

    Rhea MR, Ball SD, Phillips WT, et al. A comparison of linear and daily undulating periodized programs with equated volume and intensity for strength. J Strength Cond Res. 2002;16(2):250–5.

    PubMed  Google Scholar 

  57. 57.

    Colquhoun RJ. Comparison of powerlifting performance in trained males using traditional and flexible daily undulating periodization. Dissertation, University of South Florida; 2015.

  58. 58.

    Meyerhardt JA, Heseltine D, Niedzwiecki D, et al. Impact of physical activity on cancer recurrence and survival in patients with stage III colon cancer: findings from CALGB 89803. J Clin Oncol. 2006;24(22):3535–41. doi:10.1200/JCO.2006.06.0863.

    Article  PubMed  Google Scholar 

  59. 59.

    Sternfeld B, Weltzien E, Quesenberry CP, et al. Physical activity and risk of recurrence and mortality in breast cancer survivors: findings from the LACE study. Cancer Epide0miol Biomark Prev. 2009;18(1):87–95. doi:10.1158/1055-9965.EPI-08-0595.

    Article  Google Scholar 

  60. 60.

    Chen X, Lu W, Zheng W, et al. Exercise after diagnosis of breast cancer in association with survival. Cancer Prev Res (Phila). 2011;4(9):1409–18. doi:10.1158/1940-6207.CAPR-10-0355.

    Article  Google Scholar 

  61. 61.

    Laurent CM, Green JM, Bishop PA, et al. A practical approach to monitoring recovery: development of a perceived recovery status scale. J Strength Cond Res. 2011;25(3):620–8.

    Article  PubMed  Google Scholar 

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Correspondence to Ciaran M. Fairman.

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Ciaran Fairman, Michael Zourdos, Eric Helms, and Brian Focht have no conflicts of interest relevant to the content of this article.

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Fairman, C.M., Zourdos, M.C., Helms, E.R. et al. A Scientific Rationale to Improve Resistance Training Prescription in Exercise Oncology. Sports Med 47, 1457–1465 (2017). https://doi.org/10.1007/s40279-017-0673-7

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Keywords

  • Resistance Training
  • Cancer Population
  • Exercise Prescription
  • Training Load
  • Training Adaptation