PALMA Stefano

High-intensity interval training as a Supportive Care and Side Effect Management in Breast Cancer Survivors

Aim of this project is to conduct a high-intensity interval intervention with breast cancer survivors (BCS).

Cancer as well as other severe diseases are associated with physical deconditioning and detrimental changes in body composition which in turn promote the development of secondary diseases and increased morbidity and mortality. Particularly when considering improved treatment modalities and hence increased survival rates and times, the focus needs to be on the multimodal rehabilitation of the survivors. On the one hand, it is important to target the detrimental changes of body composition and physical performance to counteract the development of cardiovascular and metabolic secondary diseases. Moreover, measures that prevent patients from falling below a physical performance level that would ultimately lead to dependency on care are medically sensible and important. On the other hand, additional to the physiologic parameters, the psychosocial components of the patients ought not to be neglected. Self-dependence, workability, social inclusion, as well as sexual health are meaningful for the patients’ quality of life and will be a substantial part of this project.
The theory behind this project is that improving physical performance levels by utilizing different exercise intervention programs will positively affect all of the respective outcomes. It is well established, that exercise is a potent modality for improving body composition, particularly increasing lean body mass while decreasing body fat percentage in healthy people and in a number of patient populations. Moreover, there is a considerable number of publications that show a connection between improved physical performance and a better ability to sufficiently conduct activities of daily living. What is still unknown to date is which exercise methodology works best in different patient populations. This is going to be a large part of this project.
Although literature is sparse in this perspective, there are several publications that show promising results of various exercise interventions on psychosocial parameters in different patient populations. This is going to be another focus of this project.
Depending on the development of cooperation projects between the Department of Physical Medicine, Rehabilitation and Occupational Medicine and hence the availability of specific patient populations, the exact populations and interventions are still to be decided.
However, the plan stipulates that the candidate will focus on one specific patient population and will consecutively publish one meta-analysis, one cross-sectional study and one randomized controlled exercise intervention trial. The meta-analyses will show what’s currently known about exercise in the respective patient environments and will identify the research gaps. The cross-sectional studies are supposed to analyse the living conditions of the respective patient populations in Austria and will focus on the criteria that influence the patients’ willingness to participate in exercise intervention programs. The randomized controlled exercise intervention study will include the results collected in the preceding meta-analyses and cross-sectional studies in the study protocol design. This will enable us to conduct a study design targeted specifically on the life situation of the respective patient populations in Austria. Moreover, we expect that throughout this project we will meet some interesting patients whose individual situation we will publish as case reports, respectively case series.
The possible assessments will include the whole range of what is available and possible to assess at the Department of Physical Medicine, Rehabilitation and Occupational Medicine including isokinetic dynamometry, exercise testing, gait analysis, bioimpedance analysis, and heart rate variability. Moreover, disease specific questionnaires as well as analyses of population specific blood parameters are planned as well.
The question of which exercise interventions are going to be investigated, either as a single intervention or in specific combinations, will be subject to change regarding the results of the meta-analyses and the cross-sectional studies that will be performed as part of the preparation for the intervention trials. Most likely, resistance and endurance exercises of different intensities and methodologies as well as other standard exercise methods will be implemented and investigated in different patient populations in the context of this project.

Methods and Skills:

clinical studies; functional asssessment of physical performance; lymphedema assessment; exercise intervention

Publications:

Hasenoehrl T, Palma S, Ramazanova D, Kölbl H, Dorner TE, Keilani M, Crevenna R: Resistance exercise and breast cancer-related lymphedema-a systematic review update and meta-analysis [published online ahead of print, 2020 May 15]. Support Care Cancer. 2020;10.1007/s00520-020-05521-x. doi:10.1007/s00520-020-05521-x

Palma S, Keilani M, Hasenoehrl T, Crevenna R. Impact of supportive therapy modalities on heart rate variability in cancer patients - a systematic review. Disabil Rehabil. 42: 36‐43, 2020; doi:10.1080/09638288.2018.1514664

Keilani M, Kainberger F, Pataraia A, Hasenöhrl T, Wagner B, Palma S, Cenik F, Crevenna R: Typical aspects in the rehabilitation of cancer patients suffering from metastatic bone disease or multiple myeloma. Wien Klin Wochenschr. 131:567‐575, 2019; doi:10.1007/s00508-019-1524-3