Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise
Abstract
:1. Introduction
2. Estrogen Receptors in Breast Cancer and Their Clinical Implications
3. The Role of Adipose Tissue
4. Physical Activity and Physical Exercise in Breast Cancer Prevention
- Primordial prevention—It consists in programs and campaigns, usually addressed to the younger population, aimed at promoting a healthy lifestyle and avoiding the incurrence of risk factors;
- Primary prevention—It consists in measures, addressed to a susceptible but healthy population, aimed at preventing a disease through specific activities that limit risk exposure or increase the immunity;
- Secondary prevention—It consists in procedures that increase the early disease detection, and its target is healthy-appearing individuals with subclinical forms of the disease, and often occurs in the form of screenings. The objective is the early identification of sick or high-risk subjects to achieve healing or prevent the onset and progression of the disease;
- Tertiary prevention—It targets both clinical and outcome stages of a disease, with the aim to reduce the severity of the disease as well as of any associated consequences, and to reduce the effects of the disease once established in an individual, through a tailored rehabilitation program;
- Quaternary prevention—It consist in practice able to protect patients from medical interventions that cause more harm than benefits, due to the over-treatment condition or final-stage of the disease.
5. Physical Activity and Exercise as Fundamental Approaches within ER-Positive Breast Cancer at Each Disease Prevention Level
5.1. Primary Prevention
5.2. Secondary and Tertiary Prevention
5.3. Quaternary Prevention
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Subtypes | Molecular Signatures | % Incidence |
---|---|---|
Luminal A | ER+, PR±, HER2−, Low Ki67 | ≈70% |
Luminal B | ER+, PR±, HER2±, High Ki67 | 10–20% |
Triple Negative | ER−, PR−, HER2− | 15–20% |
HER2 | ER−, PR−, HER+ | 5–15% |
REF. | GROUPS | EXERCISE CHARACTERISTICS | MAIN OUTCOMES |
---|---|---|---|
[128] | (n = 173) age 50 to 79 years BMI ≥ 25 kg/m2 (mean 30.4 ± 4.1) Groups: AG (n = 84) CG (n = 86) | 12 months AG: endurance exercise, 5 d/w progressively increase to 45 min at 60–75% HRmax; CG: no interventions | ↓Fat mass ↓ Testosterone and free testosterone = DHEA, DHEA-S =androstenedione |
[129] | (n = 169) age 50 to 75 years BMI ≥ 25 kg/m2 (mean 30.4 ± 4.1) Groups: AG (n = 84) CG (n = 85) | 12 months AG: endurance exercise, 5 d/w progressively increase to 45 min at 60–75% HRmax; CG: no interventions | ↓Fat mass ↓ Estrone ↓ Estradiol and free estradiol 🡹 SHBG |
[127] | (n = 189) age 50 to 69 years BMI 22–40 kg/m2 (mean 27.3 ± 3.6) Groups: AG (n = 96) CG (n = 93) | 12 months AG: 3 d/w of combined endurance + strength program (from 60–85% HRmax) (2.5 h/w) CG: no interventions | ↓Fat mass =estrogen levels =androgen levels =SHBG |
[116] | (n = 320) age 50–74 years BMI 22–40 kg/m2 (mean 29.1 ± 4.5) Groups: AG (n = 160) CG (n = 160) | 12 months AG: 225 min/w (average of 3.6 d/w for 178 min/w) at 70% to 80% HRR CG: no interventions | ↓ Estradiol and free estradiol 🡹 SHBG ↓ Body weight = estrone, androstenedione and testosterone |
[119] | (n = 439) age 50–75 years BMI ≥ 25 kg/m2 (mean 30.9) Groups: DG (n = 118) AG (n = 117) DAG (n = 117) CG (n = 87) | 12 months; DG: daily energy intake of 1200 to 2000 kcal/d based on baseline weight; AG: ≥45 min MVPA (70% to 85% heart rate max), 5 d/w; DAG: both interventions; CG: no interventions | ↓Fat mass in all groups vs. CG ↓ Insulin in DG and DAG ↓ hs-CRP in DG and DAG ↓ Leptin in all groups vs. CG 🡹 Adiponectin in DG and DAG ↓ Estron, estradiol, free estradiol, and free testosterone in all in all intervention groups vs. CG ↓ Total testosterone in DAG 🡹 SHBG in DG and DAG |
[126] | (n = 439) aged 50–75 years BMI ≥ 25 kg/m2 (mean 30.9) Groups: DG (n = 118) AG (n = 117) DAG (n = 117) CG (n = 87) | 12 months; DG: daily energy intake of 1200–2000 kcal/d based on baseline weight; AG: ≥45 min of MVPA (70–85% heart rate max), 5 d/w (225 min/w). DAG: both interventions (diet + exercise) CG: no interventions | ↓Fat mass in all intervention groups vs. CG; ↓ Waist circumference in all intervention groups vs. CG; |
[117] | (n = 382) age 50–74 years BMI 22–40 kg/m2 (mean 29.4 ± 4.4) Groups: COG (n = 193) MVG (n = 189) | 12 months of endurance activity (5 d/w, 3 supervised, 2 unsupervised); COG: 60 min/session, 60–80% HRR MVG: 30 min/session, 60–80% HRR | ↓Fat mass depending on exercise volume (high or moderate); =sex hormone levels between groups |
[120] | (n = 243) age 50–69 years BMI 25–35 kg/m2 (mean 29.5 ± 2.6) Groups: DG (n = 97) COG (n = 98) CG (n = 48) | 16 weeks; DG: caloric deficit of 3500 kcal/w with habitual physical activity level; COG: 4 h/w of combined endurance (from 60% to 90% HRR) and strength program with an average energy expenditure of 2530 kcal/week; CG: habitual physical activity level + standardized diet | ↓Fat mass in DG and COG ↓ hs-CRP in DG and COG; =IL6 in all groups; ↓ Adiponectin in COG; ↓ Leptin in DG and COG |
[121] | (n = 41) age 50–74 years BMI 23.8–32.9 kg/m2 (mean 28.2 ± 3.4) Groups: AG (n = 22) CG (n = 19) | 6 months; AG: 3 d/w progressively increase to 50 min at 70–80% HRmax; CG: no interventions | =Leptin =Resistin =Fat mass 🡹 Aerobic Fitness level ↓ BMI |
[122] | (n = 306) age 50–74 years BMI 22–40 kg/m2 (mean 29.0) Groups: AG (n = 153) CG (n = 154) | 12 months; AG: 45 min/d, 5 d/w (70% to 80% HRR); CG: no interventions | ↓ Total estradiol =estrogen metabolites and metabolic pathways |
[123] | (n = 439) age 50–75 years BMI ≥ 25 kg/m2 (mean 30.0 ± 3.7) Groups: DG (n = 118) AG (n = 117) DAG (n = 117) CG (n = 87) | 12 months + 18 months follow-up (FU); DG: daily energy intake of 1200–2000 kcal/d based on baseline weight; AG: ≥45 min of MVPA (70–85% heart rate max), 5 d/w (225 min/w); DAG: both interventions (diet + exercise); CG: no interventions | 🡹SHBG in DAG; =SHBG in DG and AG; Participants who reported weight loss had statistically greater decreases in free estradiol, free testosterone, and increases in SHBG |
[118] | (n = 333) age 50–74 years BMI 22–40 kg/m2 (mean 28.9 ± 4.4) Groups: COG (n = 168) MVG (n = 165) | 12 months of endurance activity (5 d/w, 3 supervised, 2 unsupervised) + 12 months follow-up (FU); COG: 60 min/session, 65% to 75% HRR; MVG: 30 min/session, 65% to 75% HRR | ↓Fat mass depending on exercise volume (high or moderate); ↓ hs-CRP, insulin, glucose, HOMA-IR, estrone, estradiol, free estradiol at 12 months; SHBG at 12 months; ↓ Glucose, insulin, HOMA-IR, estrone at FU; 🡹 hs-CRP, free estradiol, estradiol at FU; ↓ SHBG at FU =biomarker changes over the time between groups. |
[124] | (n = 35) age 50–65 years BMI ≥ 25 kg/m2 (mean 33.2 ± 1.4) Groups: AG (n = 10) COG (n = 13) CG (n = 12) | 12 weeks, 3 d/w; AG: 60 min/session of endurance exercise, 55–75% of HRR; COG: 40 mn resistance (6 exercises, 3 sets of 8–12 repetition at 65% of 1RM) + 20 min endurance exercise; CG: no interventions | ↓Fat mass in AG and COG; ↓ Lean body mass in the COG; ↓ DHEA-S (−13%), total (−40%) and free testosterone (−41%) in AG; ↓ Total (25%) and free testosterone (21%) in COG; =estrogen levels in both groups. The decrease in fat mass and DHEA-S correlates with an increase in circulating SHBG. |
REF. | GROUPS | EXERCISE CHARACTERISTICS | MAIN OUTCOMES |
[152] |
(n = 85) age 52–62 years IRG (n = 42) DRG (n = 42) | 6 months (after treatment) 2 d/w IRG and DRG: 3 set 12 repetition (13 w supervised + 13 w no-supervised) | ↓ Body fat and IGF-II in IRG 🡹 IGFBP-3 in IRG |
[153] | (n = 66) age 46–58 years HAG (n = 22) HRG (n = 21) CG (n = 23) | 6 months (before and during adjuvant CH) 4 d/w HAG: 15–30 min HRG: 2 sets 10 repetitions CG: no intervention | 🡹 Aerobic capacity (25%) in HAG and (4%) in HRG ↓ BMD (6.2%) in CG, (4.9%) in HRG and (0.7%) in HAG ↓ Aerobic capacity (10%) in CG |
[154] | (n = 101) Age HARG (n = 51) CG (n = 50) | 16 weeks (after CH, RT, during HT) 2 d/w HARG: 50-min supervised strength + 90 min unsupervised aerobic CG: no intervention | ↓ Fast insulin and hip circumference in HARG = insulin resistance, fasting glucose and BMI |
[155] | (n = 90) age 41–48 years DG (n = 29) DHARG (n = 29) DHARG + FVLF (32) | 6 months 5 d/w DG: Calcium reach Diet DHARG: Calcium Diet + 150 min of MVPA AT + RT DHARG + FVLF: Calcium Diet + exercise + FVLF | ↓ Waist circumference and % body fat in DHARG + FVLF = insulin, proinsulin, IGF-1, CRP, cholesterol, SHBG, IL-1B, and TNFR2 in all groups 🡹 In QoL in all groups |
[156] | (n = 75) age 55–64 years AG + HAG (n = 37) CG (n = 38) | 6 months (after CH) 5 d/w AG + HAG: 3 d/w 150 min/week of supervised gym- and 2 d/w home-based moderate-intensity aerobic exercise CG: no intervention | ↓ FAT in AG + HAG 🡹 LM in AG + HAG ↓ FAT, LM and BMD in CG |
[157] | (n = 26) Age 40–60 years AG (n = 16) CG (n = 10) | 8 weeks AG: moderate intensity CG: no intervention | ↓ Waist circumference in AG 🡹 PA level = blood pressure, HDL, insulin resistance and CRP |
[158] | (n = 90) age 55–65 years DARG (n = 47) CG (n = 43) | 6 months (duirng and after CH) 3 d/w DARG: 30 min 65–80% predicted HRmax + 10–15 min resistance band exercise + total daily caloric intake 600 kcal below their requirements CG: no intervenation | ↓ Central adiposity, WHR, total cholesterol and leptin in DARG 🡹 Predicted VO2max in DARG |
[159] | (n = 28) age 56–66 years ARG (n = 15) CG (n = 13) | 12 weeks, supervised 6 wks, unsupervised 6 wks ARG:, 150 min/wk aerobic moderate intensity + resistance exercise, 2 d/wk CG: no intervention | 🡹 IL6 and predicted O2 in ARG ↓ IL-10, adiponectin, fatigue and sleep disturbance in ARG |
[160] | (n = 46) age 30–70 years ARG (n = 22) CG (n = 24) | 12 weeks 5 d/w ARG: 160 min/wk at 48–52% of heart rate reserve +resistance exercise CG: no intervention | ↓ %BF, IL10, anxiety, sleep dysfunction, exercise social support in ARG 🡹 VO2max in ARG |
[161] | (n = 242) age ≥ 18 years AG (n = 78) RG (n = 82) CG (n = 82) | 3 d/w during CH AG: 45 min at 80% VO2max RG: two sets of 8–12 at 60–70% of estimated 1-RM GC: no intervention | 🡹DFS and RFI in AG and RG |
[162] | (n = 165) DG (n = 83) DRG (n = 82) | 12 months (after CH, during antiestrogenic treatment) 7 d/w DG: food naturally high in proteins, calcium, probiotics and prebiotics DRG: diet + 4 reps of 1 isometric exercise | ↓ Weight and fat in DG and DRG ↓ Visceral fat in DRG |
[163] |
(n = 36) age 63–75 years ARG (n = 18) CG (n = 18) | 9 months (during AI) 3 d/w ARG: 30 min at 75/80% HRmax + 3 sets 8–10 reps at 75% 1RM CG: no intervention | 🡹 Osteocalcin in ARG ↓ Total mass, total fat and HDL in ARG |
[164] | (n = 240) age 52–64 years ARG-HIIT (n = 79) AG-HIIT (n = 80) CG (n = 81) | 16 weeks 2 d/w + 12 months FU (during and after CH) ARG-HIIT: 3 sets 10 rep at 70–80% 1RM + 3 × 3-min bouts on cycle ergometer, 1 min of recovery AG-HIIT: from 20 min MACT to aerobic part of ARG-HIIT CG: no intervention | 🡹 Role functioning in RG-HIIT and AG-HIIT ↓ Total cancer-related fatigue in RG-HIIT and AG-HIIT 🡹 Pain in CG |
[69] | (n = 23) age 51–63 years ARG-HIIT (n = 8) AG-HIIT (n = 9) CG (n = 13) | 16 weeks 2 d/w + 12 months FU (during and after CH) ARG-HIIT: 3 sets 10 rep at 70–80% 1RM + 3 × 3-min bouts on cycle ergometer, 1 min of recovery AG-HIIT: from 20 min MACT to aerobic part of ARG-HIIT CG: no intervention | 🡹 Muscle fiber CSA and SC count per fiber in ARG-HIIT ↓ Symptoms and displayed gains in lower limb in ARG-HIIT and AG-HIIT 🡹 Number of capillaries per fiber in AG-HIIT ↓ MHC isoform type I and protein levels of PINK1 in CG 🡹 SOD2 level in CG |
REF. | GROUPS | EXERCISE CHARACTERISTICS | MAIN OUTCOMES |
---|---|---|---|
[170] |
(n = 13) Life expectancy ≥ 6 months age 44–75 years YG (n = 13) | YG: 8 weekly group session (during CH) | ↓ Pain, fatigue distress 🡹 Relaxation, invigoration |
[171] | (n = 101) Life expectancy ≥ 12 months age 59–59 years AG (n = 48) CG (n = 53) | 16 weeks (during CH) AG: 150 min MVPA per week CG: no intervention | =min/w exercise and physical functioning in AG |
[172] | (n = 65) age 62–72 years AG (n = 33) CG (n = 32) | 12 weeks 3 d/w (during CH) AG: 55–80 % VO2peak on treadmill CG: no intervention | 🡹VO2peak and functional capacity in AG. Attendance rate 63%, permanent discontinuation 27%, dose modification 49%, acceptable tolerability 42% in AG. |
[173] | (n = 14) Life expectancy at least 4 months age ≥ 18 years HARG (n = 8) CG (n = 6) | 8 weeks 2 d/w (during CH and HT) HARG: supervised RT 2 sets of 12 repetitions 1 min recovery, intensity 6–7 Adult OMNI Scale + unsupervised 10–15 min walking CG: no intervention | 🡹FACIT-F score, VO2max and six-minute walking test in HARG. Adherence 100% in RT and 25% in walking. |
[174] | (n = 48) Life expectancy ≥ 9 months age 56–67 years YG (n = 30) CG (n = 18) | 8 week 5–6 d/w (undergoing treatments) YG: meditation, gentle postures, breathing techniques, presentations on yogic principles for optimal coping. 15–30 min/d CG: Discussion about several topic related to the disease concerns | ↓ Pain levels in YG and CG Dose–response relationship between YG, duration and daily pain. |
[175] | (n = 49) age 55–65 years HPA (n = 49) | 6 months (during CH, RT, HT, TT) HPA: reach 10,000 steps per day. | 🡹HPA increases 6-MWT, quadriceps strength ↓ BMI =muscle CSA, skeletal muscle radiodensity, LM. |
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Dimauro, I.; Grazioli, E.; Antinozzi, C.; Duranti, G.; Arminio, A.; Mancini, A.; Greco, E.A.; Caporossi, D.; Parisi, A.; Di Luigi, L. Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise. Int. J. Environ. Res. Public Health 2021, 18, 9834. https://doi.org/10.3390/ijerph18189834
Dimauro I, Grazioli E, Antinozzi C, Duranti G, Arminio A, Mancini A, Greco EA, Caporossi D, Parisi A, Di Luigi L. Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise. International Journal of Environmental Research and Public Health. 2021; 18(18):9834. https://doi.org/10.3390/ijerph18189834
Chicago/Turabian StyleDimauro, Ivan, Elisa Grazioli, Cristina Antinozzi, Guglielmo Duranti, Alessia Arminio, Annamaria Mancini, Emanuela A. Greco, Daniela Caporossi, Attilio Parisi, and Luigi Di Luigi. 2021. "Estrogen-Receptor-Positive Breast Cancer in Postmenopausal Women: The Role of Body Composition and Physical Exercise" International Journal of Environmental Research and Public Health 18, no. 18: 9834. https://doi.org/10.3390/ijerph18189834