Ongoing studies

The effect of combined aerobic and muscle strengthening exercises on structural and functional cardiovascular adaptations in endometrial cancer survivors. (NCT06534008)

This work was supported by Grant IRG-21-141-46-IRG from the American Cancer Society, administered through the Holden Comprehensive Cancer Center at The University of Iowa (PI: Gorzelitz).

Background: Endometrial cancer survivors (ECS) are more likely to die from cardiovascular disease (CVD) than any other cause, and exercise is an established intervention to lower the burden of CVD. The development of endometrial cancer is associated with obesity, physical inactivity and cardiometabolic dysfunction which will often persist without significant intervention. We have an established exercise protocol for improving strength, aerobic fitness in ECS but the mechanism by which exercise can mitigate secondary and latent effects of cancer treatment, which if controlled could lower longer-term risk of CVD or CVD-associated mortality. Understanding the mechanistic adaption for exercise as a cancer control strategy is essential as ECS have a disproportionately high burden of CVD risk factors, metabolic dysfunction, obesity, and effects of treatment.

In our first year of ACS IRG funding, we successfully completed our two aims which included a qualitative analysis of inactive endometrial cancer patients (on treatment) to understand their perceptions, knowledge, and preferences for exercise. We found that this group overwhelmingly wanted tailored, home-based exercise programs. In our second aims, we successfully completed our aerobic, muscle strengthening exercise protocol in ten ECS who had large improvements in strength and aerobic fitness, with high exercise adherence and satisfaction with the intervention. Our primary objective is to measure changes biomarkers of vascular structure and function following our combined aerobic and muscle strengthening exercise in endometrial cancer survivors. We hypothesize that there will be clinically meaningful improvements in structural and functional vascular biomarkers, and improved composite risk scores. Specifically, our two aims are to (1) Quantify the changes in vascular structure (pulse wave velocity) and function (flow mediated dilation) following a distance-based exercise program; and (2) Determine the magnitude of changes in ASCVD risk profiles following a distance-based exercise program.

More information to follow!

If interested in more information, please contact Dr. Gorzelitz at jessica-gorzelitz@uiowa.edu 

Post diagnosis aerobic and resistance exercise on mortality in cancer survivors in the Cancer Prevention II Cohort Study 

Background. For cancer survivors, participation in exercise can help improve physical health and function and reduce mortality. Aerobic activity is particularly beneficial for improving cardiorespiratory fitness and quality of life, while resistance exercise promotes increases in muscle mass, strength, and bone mineral density. Despite the benefits, only 50% of cancer survivors report participating in enough aerobic exercise to meet guidelines, and only 15% report sufficient resistance exercise to meet guidelines. Aerobic exercise has been well studied in cancer survivors, yet resistance exercise and its benefits remain understudied.

Study Overview. Using data from the American Cancer Society’s Cancer Prevention Study II (CPS II) cohort, this study aims to explore the independent and joint associations between aerobic and resistance exercise and all-cause, cardiovascular disease, and cancer-specific mortality. The analysis will include differences by cancer and treatment type.

Led by Caleb Brandner, supported by researchers at the American Cancer Society: Drs. Erika Rees-Punia and Lauren Bates-Fraser.

Analysis ongoing.

Instrument development, testing and refinement for exercise needs in Iowan cancer survivors

Funded from the Holden Comprehensive Cancer Center Population Science Research Program at The University of Iowa (PI Dr. Jess Gorzelitz)

Study overview. Aerobic and muscle strengthening exercise is recommended for cancer survivors to reap maximal health benefits. Despite these recommendations, participation rates in these exercise behaviors are low. Unique barriers persist for exercise that can include individual level (knowledge, attitudes, beliefs), interpersonal (partner, family), clinical (oncologist, provider) policy (insurance, cost) and environmental (access to facilities, locations for recreation). Understanding the multiple areas of influence and the specific exercise needs of cancer survivors is necessary for building interventions and programs that are accessible to all cancer survivors. Understanding the exercise needs for cancer survivors requires stakeholder engagement to understand the specific needs of the population through a developed, tested, and refined survey instrument targeted towards breast, colorectal, prostate, and lung cancer survivors as these are the most prevalent sites. 

Our specific aims are:

 (1) Establish a construct specification for an initial item pool on which the instrument will be built using key informant interviews with content experts, and implementation science literature; 

(2) Engage with motivated groups of cancer survivors to conduct focus groups to assess the instrument’s content validity; 

(3) Pilot test the instrument with a highly engaged population of cancer survivors to assess its initial reliability; 

(4) Finalize the revised instrument through a second expert review of its content validity.

More information to follow!

Post-diagnosis weightlifting, aerobic exercise and mortality risk in cancer survivors  in the PLCO cohort

Secondary analysis of the Prostate, Lung, Colorectal and Ovarian (PLCO) cohort (Project ID: PLCO-1032)

Study overview. The epidemiologic evidence base for weightlifting and cancer is very scant, including very limited evidence on the characteristics of those who participate in weightlifting behaviors. This is even more limited when restricting to adults with a previous cancer diagnosis, known as cancer survivors. 

Aims

1. Identify and describe the demographic and behavioral characteristics associated with cancer survivors (restricted by primary site) who report weightlifting activity.

2. Determine if weightlifting is associated with reduced mortality (all-cause, cancer-specific and cardiovascular-disease specific); these analyses will be restricted by primary tumor site.

Led by: Alexis Hosch, BBIP trainee

Analysis ongoing.

Post-diagnosis aerobic, muscle strengthening exercise associations with mortality in cancer survivors from the NIH-AARP cohort

Secondary analysis of the NIH-AARP cohort data (Proposal ID: 202201-0013)

Study overview. The epidemiologic evidence base for weightlifting and cancer is very scant, including very limited evidence on the characteristics of those who participate in weightlifting behaviors. This is even more limited when restricting to adults with a previous cancer diagnosis, known as cancer survivors. This analysis builds on our previous work and uses a different, potentially comparable, exposure of muscle strengthening activity (MSA).

Objectives:

1.     Determine if moderate-vigorous intensity physical activity (MVPA) and muscle strengthening activity (MSA) are associated with all-cause, cancer-specific and cardiovascular-disease mortality in adults with a cancer history

2.     Determine if physical activity (MVPA and MSA)-mortality associations vary by first cancer anatomic site 

3.     Explore if these associations are modified by age, BMI, grade and histologic subtype

Led by: Dr. Gorzelitz

Analysis ongoing.

Completed studies

Feasibility, interests and attitudes surrounding home-based comprehensive exercise programs in endometrial cancer survivors 

This work was supported by Grant IRG - 18-164-43 from the American Cancer Society, administered through the Holden Comprehensive Cancer Center at The University of Iowa (PI: Gorzelitz).

Study overview. Endometrial cancer is an increasingly common diagnosis, with health and quality of life concerns persisting after the active cancer treatment period. Exercise in cancer survivors has the potential to reduce the risk of death by improving cardiovascular fitness, quality of life, strength, longevity, and independence. Understanding the needs and preference of the patient population to inform exercise programs is essential to making these programs possible, accessible, and sustainable for those who are transitioning from cancer patient to cancer survivor. We aim to (1) conduct semi-structured interviews of  examine knowledge, attitudes, barriers, preferences of comprehensive (aerobic and muscle strengthening) exercise programs in a sample of endometrial cancer survivors to inform an intervention to (2) test the feasibly and acceptability of a stakeholder-informed home-based comprehensive exercise program. 

Study update: Recruitment and analysis complete. Manuscript writing is in press: Attitudes, beliefs and preferences surrounding home-based exercise programs in endometrial cancer patients receiving treatment