title: Effects of an exercise and hypocaloric healthy eating intervention on indices of psychological health status, hypothalamic-pituitary-adrenal axis regulation and immune function after early-stage breast cancer: a randomised controlled trial.
abstract: BACKGROUND
  Many women experience emotional distress, depression and anxiety after a diagnosis of breast cancer. Psychological stress and depression have been associated with hypothalamic-pituitary-adrenal (HPA) axis dysregulation that may adversely affect immune system functioning and impact upon survival. This study investigated the effects of a lifestyle intervention on indices of psychological health status, HPA axis regulation and immune function in overweight women recovering from early-stage breast cancer treatment.
  
  
  METHODS
  A total of 85 women treated for breast cancer 3 to 18 months previously were randomly allocated to a 6-month exercise and hypocaloric healthy eating program plus usual care or usual care alone (control group). Women in the intervention group received three supervised exercise sessions per week and individualized dietary advice, supplemented by weekly nutrition seminars. Depressive symptoms (Beck Depression Inventory version II: BDI-II), perceived stress (Perceived Stress Scale: PSS), salivary diurnal cortisol rhythms; inflammatory cytokines (IL-6 and Tumor necrosis factor-α), leukocyte phenotype counts, natural killer (NK) cell cytotoxicity and lymphocyte proliferation following mitogenic stimulation were assessed at baseline and 6-month follow up.
  
  
  RESULTS
  Compared with the control group, the intervention group exhibited a reduction in depressive symptoms (adjusted mean difference, 95% confidence intervals (95% CI): -3.12, -1.03 to -5.26; P = 0.004) at the 6-month follow-up but no significant decrease in PSS scores (-2.07, -4.96 to 0.82; P = 0.16). The lifestyle intervention also had a significant impact on diurnal salivary cortisol rhythm compared with usual care alone, as evidenced by an increase in morning salivary cortisol at the 6-month follow-up (P <0.04), indicating a change in HPA axis regulation. Women in the control group had higher total leukocyte, neutrophil and lymphocyte counts in comparison to the intervention group at the 6-month follow-up (P ≤0.05), whereas there was no difference in NK cell counts (P = 0.46), NK cell cytotoxicity (P = 0.85) or lymphocyte proliferation responses (P = 0.11) between the two groups.
  
  
  CONCLUSIONS
  Our results show that the lifestyle intervention resulted in a reduction in depressive symptoms and a normalisation of HPA axis regulation. Such changes could have important implications for long-term survival in women recovering from early-breast cancer treatment.
  
  
  BACKGROUND
  Current Controlled Trials: ISRCTN08045231.
authors.forename: John M
authors.initials: JM
authors.lastname: Saxton
authors.forename: Emma J
authors.initials: EJ
authors.lastname: Scott
authors.forename: Amanda J
authors.initials: AJ
authors.lastname: Daley
authors.forename: M
authors.initials: M
authors.lastname: Woodroofe
authors.forename: Nanette
authors.initials: N
authors.lastname: Mutrie
authors.forename: Helen
authors.initials: H
authors.lastname: Crank
authors.forename: Hilary J
authors.initials: HJ
authors.lastname: Powers
authors.forename: Robert E
authors.initials: RE
authors.lastname: Coleman
mesh_terms: D000368:Aged; D001943:Breast Neoplasms / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D031204:Caloric Restriction; D003863:Depression / Q000523:psychology / Q000628:therapy; D015444:Exercise / Q000502:physiology*; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D007030:Hypothalamo-Hypophyseal System / Q000502:physiology*; D007107:Immune System / Q000473:pathology / Q000503:physiopathology*; D008603:Mental Health / Q000592:standards; D008875:Middle Aged; D009367:Neoplasm Staging; D050177:Overweight / Q000503:physiopathology / Q000523:psychology / Q000628:therapy; D010913:Pituitary-Adrenal System / Q000502:physiology*; D012463:Saliva / Q000737:chemistry; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D006854:Hydrocortisone
references.citation: Behav Med. 1991 Summer;17(2):67-75
references.pmid: 1878611
references.citation: Cochrane Database Syst Rev. 2012 Jul 11;(7):CD004366
references.pmid: 22786489
references.citation: Psychooncology. 2012 Jun;21(6):588-93
references.pmid: 22438289
references.citation: J Clin Oncol. 2007 May 1;25(13):1713-21
references.pmid: 17470863
references.citation: Asian Pac J Cancer Prev. 2013;14(4):2649-56
references.pmid: 23725190
references.citation: Clin Breast Cancer. 2008 Feb;8(1):70-9
references.pmid: 18501061
references.citation: J Psychosom Res. 2005 Apr;58(4):335-42
references.pmid: 15992569
references.citation: Int J Sport Nutr. 1998 Sep;8(3):213-22
references.pmid: 9738131
references.citation: Breast Cancer Res. 2013 Oct 01;15(5):R92
references.pmid: 24286369
references.citation: Br J Cancer. 1995 Jun;71(6):1292-6
references.pmid: 7779726
references.citation: Soc Work Health Care. 2008;47(1):73-91
references.pmid: 18956514
references.citation: Cancer Epidemiol Biomarkers Prev. 2012 Jan;21(1):3-19
references.pmid: 22068286
references.citation: Integr Cancer Ther. 2009 Mar;8(1):37-46
references.pmid: 19190034
references.citation: Science. 1982 Oct 29;218(4571):474-5
references.pmid: 7123245
references.citation: Psychosom Med. 2003 Sep-Oct;65(5):842-8
references.pmid: 14508030
references.citation: Complement Ther Clin Pract. 2011 May;17(2):65-70
references.pmid: 21457893
references.citation: Psychoneuroendocrinology. 2005 Jan;30(1):92-100
references.pmid: 15358446
references.citation: J Health Soc Behav. 1983 Dec;24(4):385-96
references.pmid: 6668417
references.citation: Cancer Immunol Immunother. 2008 Oct;57(10):1471-81
references.pmid: 18327581
references.citation: Integr Cancer Ther. 2005 Mar;4(1):14-20
references.pmid: 15695473
references.citation: J Clin Oncol. 2002 Feb 15;20(4):1017-25
references.pmid: 11844825
references.citation: PLoS One. 2012;7(1):e30955
references.pmid: 22303474
references.citation: Prog Neuropsychopharmacol Biol Psychiatry. 2007 Aug 15;31(6):1242-7
references.pmid: 17587477
references.citation: Int J Behav Med. 2011 Dec;18(4):333-41
references.pmid: 21336679
references.citation: Spine J. 2007 Sep-Oct;7(5):541-6
references.pmid: 17448732
references.citation: Psychooncology. 2006 Jun;15(6):453-62
references.pmid: 16173111
references.citation: Integr Cancer Ther. 2007 Sep;6(3):242-50
references.pmid: 17761637
references.citation: Clin Breast Cancer. 2011 Dec;11(6):364-8
references.pmid: 21831722
references.citation: Int J Behav Nutr Phys Act. 2011 Oct 25;8:118
references.pmid: 22026966
references.citation: J Am Board Fam Med. 2011 Jan-Feb;24(1):75-85
references.pmid: 21209347
references.citation: BMJ. 2005 Mar 26;330(7493):702
references.pmid: 15695497
references.citation: Psychoneuroendocrinology. 2013 Mar;38(3):356-66
references.pmid: 22818228
references.citation: Lancet Oncol. 2004 Oct;5(10):617-25
references.pmid: 15465465
references.citation: J Clin Oncol. 2005 Jul 1;23(19):4298-311
references.pmid: 15994143
references.citation: Endocrinology. 1997 May;138(5):2207-10
references.pmid: 9112422
references.citation: Breast Cancer Res Treat. 2007 Jan;101(2):225-32
references.pmid: 17028988
references.citation: Oncol Nurs Forum. 2011 Mar;38(2):E97-106
references.pmid: 21356647
references.citation: Br J Cancer. 1987 Jan;55(1):75-6
references.pmid: 3814479
references.citation: Exp Aging Res. 2012;38(3):295-314
references.pmid: 22540384
references.citation: Cytometry. 2000 Dec 1;41(4):289-97
references.pmid: 11084614
references.citation: Med Hypotheses. 2012 Jun;78(6):752-6
references.pmid: 22445460
references.citation: Cancer Causes Control. 2013 Jan;24(1):181-91
references.pmid: 23184120