The high rate of recurrent disease is a critical barrier to promote the health and longevity of colon cancer (CC) survivors. An approach to reduce this barrier is to develop interventions to minimize recurrence that CC survivors can accomplish autonomously, such as lifestyle and behavioral modification. Epidemiologic evidence suggests that increasing levels of post-diagnosis physical activity is associated with a 42% improvement in disease-free survival, 40% reduction in recurrence, and 45-71% reduction in CC-specific mortality. However, the underlying molecular mechanisms of this association remain unidentified. Characterizing biomarkers that promote existing tumor growth and dissemination of circulating tumor cells (CTCs) may advance knowledge of CC recurrence and progression. Cell-adhesion molecules play a pivotal role in the development and progression of CC recurrence. Cell-adhesion molecules, such as soluble intercellular adhesion molecule-1 (sICAM-1), and soluble vascular adhesion molecule-1 (sVCAM-1), promote the growth and progression of existing micro-metastases, and promote the formation of additional metastatic foci by enabling CTC invasion of the extracellular matrix, infiltration and dissemination throughout the blood stream, and extravasation into distant organs. This pilot study will randomize 39 CC survivors to three equal-sized groups: low dose (150 min?wk-1) moderate-intensity aerobic exercise, high-dose (300 min?wk-1) moderate-intensity aerobic exercise, or a control group, for 26-weeks. Participants will be provided with in-home treadmills to support the achievement of these exercise goals. Our research team has demonstrated success in prescribing these volumes of aerobic exercise. The primary aims of this trial are to quantify and describe the feasibility, incidence of healthcare events requiring dose-reduction or cessation of exercise and to gather preliminary evidence regarding the biologic efficacy of two distinct doses of aerobic exercise on two cell-adhesion biomarkers associated with CC recurrence and metastasis (sICAM-1 and sVCAM-1). We will then explore the relationship between cell-adhesion molecules and CTCs. This line of investigation aligns with the current mission of the National Cancer Institute PAR-12-229, and provocative question PQA-5, which aim to elucidate the optimal exercise prescription to improve molecular pathways hypothesized to underlie the association between physical activity and cancer prognosis.

Public Health Relevance

Despite the success of surgery and chemotherapy among people with colon cancer (CC), 30-50% of patients develop recurrent disease. Physical activity has emerged as a potential lifestyle intervention to reduce cancer recurrence and improve survival among people with CC. This pilot study aims to identify the dose-response effects of exercise on molecular and cellular pathways associated with physical activity and CC outcomes.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Exploratory/Developmental Grants (R21)
Project #
5R21CA182767-02
Application #
8867184
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Perna, Frank
Project Start
2014-06-10
Project End
2016-05-31
Budget Start
2015-06-01
Budget End
2016-05-31
Support Year
2
Fiscal Year
2015
Total Cost
Indirect Cost
Name
University of Pennsylvania
Department
Biostatistics & Other Math Sci
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Brown, Justin C; Rickels, Michael R; Troxel, Andrea B et al. (2018) Dose-response effects of exercise on insulin among colon cancer survivors. Endocr Relat Cancer 25:11-19
Brown, Justin C; Damjanov, Nevena; Courneya, Kerry S et al. (2018) A randomized dose-response trial of aerobic exercise and health-related quality of life in colon cancer survivors. Psychooncology 27:1221-1228
Igwebuike, Lotachukwu T; Zhang, Xiaochen; Brown, Justin C et al. (2018) Applying pre-participation exercise screening to breast cancer survivors: a cross-sectional study. Support Care Cancer 26:1825-1831
Brown, Justin C; Troxel, Andrea B; Ky, Bonnie et al. (2018) Dose-response Effects of Aerobic Exercise Among Colon Cancer Survivors: A Randomized Phase II Trial. Clin Colorectal Cancer 17:32-40
Brown, Justin C; Harhay, Michael O; Harhay, Meera N (2018) Anthropometrically predicted visceral adipose tissue and blood-based biomarkers: a cross-sectional analysis. Eur J Nutr 57:191-198
Brown, Justin C; Zemel, Babette S; Troxel, Andrea B et al. (2017) Dose-response effects of aerobic exercise on body composition among colon cancer survivors: a randomised controlled trial. Br J Cancer 117:1614-1620
Brown, Justin C; Schmitz, Kathryn H (2017) The dose-response effects of aerobic exercise on musculoskeletal injury: a post hoc analysis of a randomized trial. Res Sports Med 25:277-289
Brown, Justin C; Harhay, Michael O; Harhay, Meera N (2017) Anthropometrically-predicted visceral adipose tissue and mortality among men and women in the third national health and nutrition examination survey (NHANES III). Am J Hum Biol 29:
Brown, Justin C; Harhay, Michael O; Harhay, Meera N (2017) Nonalcoholic fatty liver disease and mortality among cancer survivors. Cancer Epidemiol 48:104-109
Rogers, Benjamin H; Brown, Justin C; Gater, David R et al. (2017) Association Between Maximal Bench Press Strength and Isometric Handgrip Strength Among Breast Cancer Survivors. Arch Phys Med Rehabil 98:264-269

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