The purpose of this study was to examine the effect of a 12-week walking exercise program on body composition and immune cell count in patients with breast cancer who are undergoing chemotherapy.
Twenty patients (age, 47.8 ± 3.12) participated in the study. Body composition (weight, body mass index, muscle weight, body fat mass, and percent body fat) and the cell counts for immune cells (white blood corpuscles, lymphocytes, helper T cells, cytotoxic T cells, natural killer cells, and natural killer T cells) were measured before and after the 12-week walking exercise program. SPSS 17.0 statistical software was used. The two-way repeated ANOVA with post hoc was used to determine the difference between time and interaction.
There were significant reductions in the weight (
These results indicated that the 12-week walking exercise program had an effect on the balances among weight, BMI and percent body fat in patients with breast cancer.
Based on the 2012 National Statistics of the Korean Ministry of Health and Welfare, malignant neoplasms ranked first among all causes of mortality, with 32.1% of all deaths resulting from cancer [
In addition to the negative effects of breast cancer and breast cancer treatment on physical status and body composition, impairment and damage to the immune defense mechanisms are also common outcomes of radiotherapy and chemotherapy [
Epidemiological studies have provided evidence of a preventative effect of exercise against certain cancers, as well as on ameliorating the outcomes of cancer therapy by reducing cancer-related side effects, such as loss of appetite, general fatigue, and lethargy, and improving therapeutic effects of drugs and, ultimately, survival rate [
Unlike for other cancers, inconsistent results regarding the benefits of exercise on outcomes have been reported in patients with breast cancer. Holick
Although various studies have reported positive effects of exercise for increasing the quality of life of breast cancer patients undergoing rehabilitation following surgery through improvements in body functions, cardiovascular endurance, stamina, and depression [
The participants were 20 breast cancer patients (mean age, 47.8 ± 6.77 years) who received radiotherapy and/or chemotherapy. The patients with histologically confirmed stage I to III breast cancer along with radiotherapy and/or chemotherapy were eligible for inclusion in this study. Participants were excluded if they had cardiac disease, uncontrolled hypertension, thyroid disease, lymphatic complications, diabetes mellitus, or mental illness. Breast cancer stage was TNM classified as follows [
The participants provided written consent after being informed about the purpose of the experiment and experimental procedures as well as possible discomfort, positive effects, and adverse effects of the study. All data were collected before and after the 12-week walking exercise program.
Weight, fat free mass, and percentage fat were measured using the In body 3.0 system (Biospace, Seoul, Korea). Body mass index (BMI) was calculated by dividing the weight by the square of the height (kg/m2). Participants were not permitted to consume food and to exercise for 6 h before the measurement of body composition parameters.
Blood samples were collected after a 6-h water and food fast with participants in the seated position. Blood samples were collected into ethylenediaminetetraacetic acid (EDTA)-treated vacutainers on ice at Y hospital. Immunocyte (white blood cell [WBC], lymphocyte, helper T cell, cytotoxic T cell, natural killer cell, and natural killer T cell) counts were analyzed using flow cytometry (FACScan, Becton Dickinson, CA, USA). Two separate fluorescence immunocytochemistry analyses were performed with 2 different isotopic control reagents. Non-specific reaction markers of immunocytes were < 5%, and the cell count was determined.
The walking exercise program was performed 5 consecutive days per week for 12 weeks. An exercise intensity of 4–60% heart rate reserve (HRR) was recommended [
Data were analyzed using SPSS version 17.0 for windows (SPSS Inc., Chicago, IL, USA), and they are presented as mean ± standard deviation. A two-way repeated ANOVA with post-hoc test was used for group comparisons after walking exercise. The statistical significance level was set at
The changes in body composition parameters after the 12-week walking exercise program are shown in
Loss of appetite is a common side effect of cancer treatments, such as surgery, chemotherapy and radiotherapy, which generally results in loss of weight in cancer patients after diagnosis. However, cancer of the female reproductive system has been strongly correlated to an increase in fat retention due to the effects of cancer on hormone regulation [
In our study, weight, BMI, and fat mass were significantly reduced after a 12-week program of walking exercise. When we consider previous reports of either low weight loss [
Physiological indicators of immune function in cancer patients include neutrophil count, NK cell number, T-lymphocyte count, and cytokines regulator [
There has been increasing interest in exercise intervention to improve immune function in breast cancer patients [
We do propose that the absence of significant effects of exercise on the immune system may be due to the small size of our study group, with few patients in each stage of cancer. Therefore, further studies that compare the difference in the immune function by stages of breast cancer, using a larger sample size, are needed.
The authors declare no potential conflicts of interest.
Walking exercise program
Stage | Exercise | Intensity | Duration | Frequency | |
---|---|---|---|---|---|
Warm-up | Stand Stretch | 5~10min | 5d/week | ||
Main Exercise | Walking | 1–6 wks | 40~50% HRR | 30min | |
7–12 wks | 50~60% HRR | 40min | |||
Cool-down | Stand Stretch | 5~10min |
Changes of body composition in breast cancer
Values | Pre (n = 20) | Post (n = 20) | Δ% | |
---|---|---|---|---|
Weight (kg) | 57.02 ± 6.12 | 56.34 ± 5.63 | −1.20 | 0.023 |
BMI (kg/m2) | 22.84 ± 2.42 | 22.48 ± 2.26 | −1.58 | 0.002** |
Fat mass (kg) | 16.50 ± 4.18 | 15.76 ± 3.72 | −4.49 | 0.011 |
%Fat (%) | 28.61 ± 4.64 | 27.73 ± 4.12 | −3.08 | 0.047 |
Muscle (kg) | 32.00 ± 7.80 | 32.42 ± 7.08 | 1.32 | 0.137 |
Changes of immunocyte in breast cancer
Values | Pre (n = 20) | Post (n = 20) | Δ% | |
---|---|---|---|---|
WBC (103 μl) | 4.89 ± 2.23 | 5.00 ± 1.64 | 2.25 | 0.805 |
Lymphocyte (103 μl) | 1.31 ± 0.57 | 1.18 ± 0.41 | −9.93 | 0.349 |
Helper T cell (%) | 36.76 ± 13.90 | 40.36 ± 17.03 | 9.8 | 0.160 |
Cytotoxic T cell (%) | 19.22 ± 8.27 | 22.22 ± 6.60 | 15.61 | 0.149 |
Natural Killer cell (%) | 16.48 ± 8.23 | 15.82 ± 9.36 | −4.01 | 0.729 |
Natural Killer T cell (%) | 10.40 ± 6.03 | 8.21 ± 5.19 | −21.06 | 0.118 |
Changes of body composition in breast cancer stage (mean ± SD)
Variables | Group | Pre | Post | F-values | ||
---|---|---|---|---|---|---|
| ||||||
G | T | G × T | ||||
Weight (kg) | stage 1 (n = 6) | 55.17 ± 3.46 | 53.83 ± 2.18 | |||
stage 2 (n = 7) | 57.83 ± 6.93 | 57.60 ± 6.47 | .590 | 5.556 | 1.747 | |
stage 3 (n = 7) | 57.79 ± 7.47 | 57.49 ± 6.76 | ||||
BMI (kg/m2) | stage 1 (n = 6) | 22.74 ± 1.30 | 22.12 ± 1.05 | |||
stage 2 (n = 7) | 23.24 ± 2.86 | 23.09 ± 2.73 | .214 | 13.118 | 2.263 | |
stage 3 (n = 7) | 22.52 ± 2.93 | 22.29 ± 2.70 | ||||
Fat mass (kg) | stage 1 (n = 6) | 15.57 ± 2.82 | 14.72 ± 1.77 | |||
stage 2 (n = 7) | 16.41 ± 4.70 | 15.50 ± 4.79 | .311 | 7.663 | .004 | |
stage 3 (n = 7) | 17.36 ± 4.99 | 16.50 ± 4.29 | ||||
%Fat (%) | stage 1 (n = 6) | 28.12 ± 4.25 | 27.27 ± 2.81 | |||
stage 2 (n = 7) | 28.06 ± 5.40 | 27.67 ± 6.34 | .163 | 1.473 | .128 | |
stage 3 (n = 7) | 29.59 ± 4.72 | 28.40 ± 4.00 | ||||
Muscle (kg) | stage 1 (n = 6) | 34.02 ± 6.64 | 33.28 ± 5.37 | |||
stage 2 (n = 7) | 29.40 ± 9.32 | 28.94 ± 9.77 | .674 | .552 | 2.955 | |
stage 3 (n = 7) | 32.86 ± 7.51 | 33.50 ± 6.83 |
G, group; T, time; G*T, group*time;
F-values in two-way repeated ANOVA, No marking means no significance.
Changes of immunocyte in breast cancer stage (mean ± SD)
Variables | Group | Pre | Post | F-values | ||
---|---|---|---|---|---|---|
| ||||||
Groups (G) | Times (T) | G × T | ||||
WBC (103 μl) | stage 1 (n = 6) | 5.25 ± 1.56 | 5.93 ± 1.43 | |||
stage 2 (n = 7) | 4.53 ± 2.12 | 4.91 ± 2.01 | .644 | .093 | .861 | |
stage 3 (n = 7) | 4.91 ± 2.97 | 4.24 ± 1.09 | ||||
Lymphocyte (103 μl) | stage 1 (n = 6) | 1.23 ± 0.42 | 1.08 ± 0.64 | |||
stage 2 (n = 7) | 1.39 ± 0.31 | 1.36 ± 0.29 | .611 | .628 | .092 | |
stage 3 (n = 7) | 1.26 ± 0.85 | 1.10 ± 0.22 | ||||
Helper T cell (%) | stage 1 (n = 6) | 35.82 ± 17.76 | 43.45 ± 16.99 | |||
stage 2 (n = 7) | 35.83 ± 16.45 | 37.86 ± 20.79 | .060 | 2.281 | .552 | |
stage 3 (n = 7) | 38.07 ± 8.20 | 39.81 ± 15.31 | ||||
Cytotoxic T cell (%) | stage 1 (n = 6) | 18.85 ± 8.35 | 24.35 ± 9.44 | |||
stage 2 (n = 7) | 17.53 ± 9.74 | 19.99 ± 6.11 | .483 | 2.175 | .355 | |
stage 3 (n = 7) | 20.96 ± 7.75 | 22.20 ± 3.35 | ||||
Natural Killer cell (%) | stage 1 (n = 6) | 19.28 ± 9.46 | 20.95 ± 9.84 | |||
stage 2 (n = 7) | 16.54 ± 9.85 | 18.23 ± 8.49 | .825 | .042 | .164 | |
stage 3 (n = 7) | 13.86 ± 5.37 | 13.54 ± 8.59 | ||||
Natural Killer T cell (%) | stage 1 (n = 6) | 13.27 ± 8.40 | 8.87 ± 5.85 | |||
stage 2 (n = 7) | 9.41 ± 4.42 | 9.50 ± 6.49 | .912 | 3.366 | .981 | |
stage 3 (n = 7) | 9.03 ± 4.90 | 5.94 ± 2.82 |
F-values in two-way repeated ANOVA, No marking means no significance.