Predictors of cardiopulmonary fitness in cancer-affected and -unaffected women with a pathogenic germline variant in the genes BRCA1/2 (LIBRE-1)

A Berling-Ernst, M Yahiaoui-Doktor, M Kiechle, C Engel, J Lammert, S Grill, R Dukatz, K Rhiem, F T Baumann, S C Bischoff, N Erickson, T Schmidt, U Niederberger, M Siniatchkin, M Halle, A Berling-Ernst, M Yahiaoui-Doktor, M Kiechle, C Engel, J Lammert, S Grill, R Dukatz, K Rhiem, F T Baumann, S C Bischoff, N Erickson, T Schmidt, U Niederberger, M Siniatchkin, M Halle

Abstract

Physical activity (PA) helps prevention and aftercare of sporadic breast cancer (BC), cardiopulmonary fitness (CPF) being an age-independent predictor of tumor-specific mortality. Therefore, we wanted to identify predictors of CPF (represented by peak oxygen uptake: VO2peak) in BRCA1/2 mutation carriers whose risk of developing BC is high. We used cross-sectional data from 68 BRCA1/2 germline mutation carrying women participating in the randomized, prospective, controlled clinical study LIBRE-1. Assessments included cardiopulmonary exercise testing, medical and lifestyle history plus socioeconomic status. Additionally, the participants completed a psychological questionnaire regarding their attitude, subjective norms, perceived behavior control and intention towards PA. A multivariate logistic regression model was used to identify predictors for participants reaching their age- and sex-adjusted VO2peak reference values. 22 participants (median age: 40 years, interquartile range (IQR) 33-46) were cancer-unaffected and 46 cancer-affected (median age: 44 years, IQR 35-50). The strongest predictor for reaching the reference VO2peak value was attitude towards PA (Odds Ratio 3.0; 95% Confidence Interval 1.3-8.4; p = 0.021). None of the other predictors showed a significant association. A positive attitude towards PA seems to be associated with VO2peak, which should be considered in developing therapeutic and preventive strategies.Trial registrations: NCT02087592; DRKS00005736.

Conflict of interest statement

The authors declare no competing interests.

© 2022. The Author(s).

Figures

Figure 1
Figure 1
Graphical abstract of the analysis. *LIBRE-1 Lifestyle Intervention study in women with hereditary BREast and ovarian Cancer, 1 = pilot; RCT randomized controlled trial; TPB theory of planned behavior, WSI Winkler-Stolzenberg-Index; *VO2peak reference values of the maximal oxygen uptake, OR odds ratio, CI confidence interval; y years. Pictures: miri019/shutterstock.com; leremy/shutterstock.com.

References

    1. Kuchenbaecker KB, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA. 2017;317:2402–2416. doi: 10.1001/jama.2017.7112.
    1. Zhou S, et al. Effects of breast cancer genes 1 and 2 on cardiovascular diseases. Curr. Probl. Cardiol. 2021;46:100421. doi: 10.1016/j.cpcardiol.2019.04.001.
    1. Kodama S, et al. Cardiorespiratory fitness as a quantitative predictor of all-cause mortality and cardiovascular events in healthy men and women: A meta-analysis. JAMA. 2009;301:2024–2035. doi: 10.1001/jama.2009.681.
    1. Peel JB, et al. A prospective study of cardiorespiratory fitness and breast cancer mortality. Med. Sci. Sports Exerc. 2009;41:742–748. doi: 10.1249/MSS.0b013e31818edac7.
    1. Grill S, et al. Precursor fractions of neurotensin and enkephalin might point to molecular mechanisms of cancer risk modulation during a lifestyle-intervention in germline BRCA1/2 gene mutation carriers. Breast Cancer Res. Treat. 2021 doi: 10.1007/s10549-020-06070-x.
    1. Wirtz P, Baumann FT. Physical activity, exercise and breast cancer: What is the evidence for rehabilitation, aftercare, and survival? A review. Breast Care. 2018;13:93–101. doi: 10.1159/000488717.
    1. Jones LW, et al. Effect of exercise training on peak oxygen consumption in patients with cancer: A meta-analysis. Oncologist. 2011;16:112–120. doi: 10.1634/theoncologist.2010-0197.
    1. King MC, Marks JH, Mandell JB. Breast and ovarian cancer risks due to inherited mutations in BRCA1 and BRCA2. Science. 2003;302:643–646. doi: 10.1126/science.1088759.
    1. Grill S, et al. Smoking and physical inactivity increase cancer prevalence in BRCA-1 and BRCA-2 mutation carriers: Results from a retrospective observational analysis. Arch. Gynecol. Obstet. 2017;296:1135–1144. doi: 10.1007/s00404-017-4546-y.
    1. Lammert J, et al. Physical activity during adolescence and young adulthood and the risk of breast cancer in BRCA1 and BRCA2 mutation carriers. Breast Cancer Res. Treat. 2018;169:561–571. doi: 10.1007/s10549-018-4694-1.
    1. Pijpe A, Manders P, Brohet R, Margriet J, Verhoef S. Physical activity and the risk of breast cancer in BRCA1/2 mutation carriers. Breast Cancer Res. Treat. 2010;120:235–244. doi: 10.1007/s10549-009-0476-0.
    1. Vallance JK, Lavallee C, Culos-Reed NS, Trudeau MG. Predictors of physical activity among rural and small town breast cancer survivors: An application of the theory of planned behaviour. Psychol. Health Med. 2012;17:685–697. doi: 10.1080/13548506.2012.659745.
    1. Trinh L, Mutrie N, Campbell AM, Crawford JJ, Courneya KS. Effects of supervised exercise on motivational outcomes in breast cancer survivors at 5-year follow-up. Eur. J. Oncol. Nurs. 2014;18:557–563. doi: 10.1016/j.ejon.2014.07.004.
    1. Wood ME. Theoretical framework to study exercise motivation for breast cancer risk reduction. Oncol. Nurs. Forum. 2008;35:89–95. doi: 10.1188/08.onf.89-95.
    1. Kiechle M, et al. Lifestyle intervention in BRCA1/2 mutation carriers: Study protocol for a prospective, randomized, controlled clinical feasibility trial (LIBRE-1 study) Pilot Feasibility Stud. 2016;2:74. doi: 10.1186/s40814-016-0114-7.
    1. Borg GA. Psychophysical bases of perceived exertion. Med. Sci. Sports Exerc. 1982;14:377–381.
    1. Koch B, et al. Reference values for cardiopulmonary exercise testing in healthy volunteers: The SHIP study. Eur. Respir. J. 2009;33:389–397. doi: 10.1183/09031936.00074208.
    1. Fletcher GF, et al. Exercise standards for testing and training: A scientific statement from the American Heart Association. Circulation. 2013;128:873–934. doi: 10.1161/CIR.0b013e31829b5b44.
    1. Ajzen I. The theory of planned behavior. Organ. Behav. Hum. Decis. Process. 1991;50:179–211. doi: 10.1016/0749-5978(91)90020-T.
    1. Courneya KS, Friedenreich CM. Utility of the theory of planned behavior for understanding exercise during breast cancer treatment. Psychooncology. 1999;8:112–122. doi: 10.1002/(sici)1099-1611(199903/04)8:2<112::aid-pon341>;2-l.
    1. Courneya KS, Blanchard CM, Laing DM. Exercise adherence in breast cancer survivors training for a dragon boat race competition: A preliminary investigation. Psychooncology. 2001;10:444–452. doi: 10.1002/pon.524.
    1. Andrieu N, et al. Pregnancies, breast-feeding, and breast cancer risk in the International BRCA1/2 Carrier Cohort Study (IBCCS) J. Natl. Cancer Inst. 2006;98:535–544. doi: 10.1093/jnci/djj132.
    1. Winkler, J. & Stolzenberg, H. Adjusting the Social Status Index for Implementation in the Health Survey for Children and Adolescence (KiGGS) 2003/2006. (2009).
    1. Kiechle M, et al. Feasibility of structured endurance training and Mediterranean diet in BRCA1 and BRCA2 mutation carriers: An interventional randomized controlled multicenter trial (LIBRE-1) BMC Cancer. 2017;17:752. doi: 10.1186/s12885-017-3732-4.
    1. Hagger MS, Chatzisarantis NL, Biddle SJ. The influence of autonomous and controlling motives on physical activity intentions within the Theory of Planned Behaviour. Br. J. Health Psychol. 2002;7:283–297. doi: 10.1348/135910702760213689.
    1. Smith L, et al. Cancer survivors' attitudes towards and knowledge of physical activity, sources of information, and barriers and facilitators of engagement: A qualitative study. Eur. J. Cancer Care (Engl.) 2017 doi: 10.1111/ecc.12641.
    1. Bauman AE, et al. Correlates of physical activity: Why are some people physically active and others not? Lancet. 2012;380:258–271. doi: 10.1016/s0140-6736(12)60735-1.
    1. Ross R, et al. Importance of assessing cardiorespiratory fitness in clinical practice: A case for fitness as a clinical vital sign: A scientific statement from the American Heart Association. Circulation. 2016;134:e653–e699. doi: 10.1161/cir.0000000000000461.
    1. Scharhag-Rosenberger F, Schommer K. Die Spiroergometrie in der Sportmedizin. Dtsch Z Sportmed. 2013;64:362–366. doi: 10.5960/dzsm.2013.105.
    1. Klassen O, et al. Cardiorespiratory fitness in breast cancer patients undergoing adjuvant therapy. Acta Oncol. 2014;53:1356–1365. doi: 10.3109/0284186x.2014.899435.
    1. Jones LW, et al. Cardiopulmonary function and age-related decline across the breast cancer survivorship continuum. J. Clin. Oncol. 2012;30:2530–2537. doi: 10.1200/JCO.2011.39.9014.
    1. Jones LW, Eves ND, Haykowsky M, Joy AA, Douglas PS. Cardiorespiratory exercise testing in clinical oncology research: Systematic review and practice recommendations. Lancet Oncol. 2008;9:757–765. doi: 10.1016/s1470-2045(08)70195-5.
    1. Spector D. Lifestyle behaviors in women with a BRCA1 or BRCA2 genetic mutation: An exploratory study guided by concepts derived from the Health Belief Model. Cancer Nurs. 2007;30:E1–10. doi: 10.1097/00002820-200701000-00015.
    1. Digianni LM, Rue M, Emmons K, Garber JE. Complementary medicine use before and 1 year following genetic testing for BRCA1/2 mutations. Cancer Epidemiol. Biomark. Prev. 2006;15:70–75. doi: 10.1158/1055-9965.Epi-05-0646.
    1. Meisel SF, et al. Anticipated health behaviour changes and perceived control in response to disclosure of genetic risk of breast and ovarian cancer: A quantitative survey study among women in the UK. BMJ Open. 2017;7:e017675. doi: 10.1136/bmjopen-2017-017675.

Source: PubMed

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