Comprehensive Physiology Wiley Online Library

Cancer, Physical Activity, and Exercise

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Abstract

This review examines the relationship between physical activity and cancer along the cancer continuum, and serves as a synthesis of systematic and meta‐analytic reviews conducted to date. There exists a large body of epidemiologic evidence that conclude those who participate in higher levels of physical activity have a reduced likelihood of developing a variety of cancers compared to those who engage in lower levels of physical activity. Despite this observational evidence, the causal pathway underlying the association between participation in physical activity and cancer risk reduction remains unclear. Physical activity is also a useful adjunct to improve the deleterious sequelae experienced during cancer treatment. These deleterious sequelae may include fatigue, muscular weakness, deteriorated functional capacity, and many others. The benefits of physical activity during cancer treatment are similar to those experienced after treatment. Despite the growing volume of literature examining physical activity and cancer across the cancer continuum, a number of research gaps exist. There is little evidence on the safety of physical activity among all cancer survivors, as most trials have selectively recruited participants. The specific dose of exercise needed to optimize primary cancer prevention or symptom control during and after cancer treatment remains to be elucidated. © 2012 American Physiological Society. Compr Physiol 2:2775‐2809, 2012.

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Figure 1. Figure 1.

A paradigm of physical activity and cancer research.

Figure 2. Figure 2.

A conceptual model to guide and organize the role of physical activity across the cancer control continuum. Reproduced, with permission, from reference .

Figure 3. Figure 3.

Individual risk factor contributions to mortality from all cancers, worldwide. Data adapted, with permission, from reference .

Figure 4. Figure 4.

Relative risk and 95% confidence intervals (95% CI) comparing highest versus lowest levels of physical activity and cancer risk reduction.

Figure 5. Figure 5.

Candidate mechanistic pathways linking physical activity and breast cancer. Reproduced, with permission, from reference .

Figure 6. Figure 6.

Strength of evidence linking physical activity and hypothesized cancer prevention mechanistic pathways.

Figure 7. Figure 7.

Weight adjusted treatment effect ratio of exercise to control on sex hormone concentrations after 12 months. Data adapted, with permission, from reference .

Figure 8. Figure 8.

Adjusted insulin sensitivity according to frequency of participation in vigorous intensity physical activity. Data adapted, with permission, from reference .

Figure 9. Figure 9.

Adjusted fasting glucose according to frequency of participation in vigorous intensity physical activity. Data adapted, with permission, from reference .

Figure 10. Figure 10.

Exercise intensity and optimal states of infection risk and immunosurveillance. Figure adapted, with permission, from reference .

Figure 11. Figure 11.

Prevalence of upper limb dysfunction among breast cancer survivors. Data adapted, with permission, from reference .

Figure 12. Figure 12.

Prevalence of congestive heart failure at varying doses of anthracyline. Data adapted, with permission, from reference .

Figure 13. Figure 13.

Prevalence of any cardiac event at varying doses of anthracycline. Data adapted, with permission, from reference .

Figure 14. Figure 14.

New comorbidities acquired posttransplant at 37‐month follow‐up. Data adapted, with permission, from reference .

Figure 15. Figure 15.

Physiologic effects occurring as a result of exercise training during cancer treatment. Data adapted, with permission, from reference .

Figure 16. Figure 16.

Psychosocial effects occurring as a result of exercise training during cancer treatment. Data adapted, with permission, from reference .

Figure 17. Figure 17.

The intersection of cancer and aging. Reproduced, with permission, from reference . 1 Instrumental activities of daily living; 2 Activities of daily living.

Figure 18. Figure 18.

Breast cancer surveillance and rehabilitation model. Reproduced, with permission, from reference .



Figure 1.

A paradigm of physical activity and cancer research.



Figure 2.

A conceptual model to guide and organize the role of physical activity across the cancer control continuum. Reproduced, with permission, from reference .



Figure 3.

Individual risk factor contributions to mortality from all cancers, worldwide. Data adapted, with permission, from reference .



Figure 4.

Relative risk and 95% confidence intervals (95% CI) comparing highest versus lowest levels of physical activity and cancer risk reduction.



Figure 5.

Candidate mechanistic pathways linking physical activity and breast cancer. Reproduced, with permission, from reference .



Figure 6.

Strength of evidence linking physical activity and hypothesized cancer prevention mechanistic pathways.



Figure 7.

Weight adjusted treatment effect ratio of exercise to control on sex hormone concentrations after 12 months. Data adapted, with permission, from reference .



Figure 8.

Adjusted insulin sensitivity according to frequency of participation in vigorous intensity physical activity. Data adapted, with permission, from reference .



Figure 9.

Adjusted fasting glucose according to frequency of participation in vigorous intensity physical activity. Data adapted, with permission, from reference .



Figure 10.

Exercise intensity and optimal states of infection risk and immunosurveillance. Figure adapted, with permission, from reference .



Figure 11.

Prevalence of upper limb dysfunction among breast cancer survivors. Data adapted, with permission, from reference .



Figure 12.

Prevalence of congestive heart failure at varying doses of anthracyline. Data adapted, with permission, from reference .



Figure 13.

Prevalence of any cardiac event at varying doses of anthracycline. Data adapted, with permission, from reference .



Figure 14.

New comorbidities acquired posttransplant at 37‐month follow‐up. Data adapted, with permission, from reference .



Figure 15.

Physiologic effects occurring as a result of exercise training during cancer treatment. Data adapted, with permission, from reference .



Figure 16.

Psychosocial effects occurring as a result of exercise training during cancer treatment. Data adapted, with permission, from reference .



Figure 17.

The intersection of cancer and aging. Reproduced, with permission, from reference . 1 Instrumental activities of daily living; 2 Activities of daily living.



Figure 18.

Breast cancer surveillance and rehabilitation model. Reproduced, with permission, from reference .

References
 1. Abbas S, Seitz M. Systematic review and meta‐analysis of the used surgical techniques to reduce leg lymphedema following radical inguinal nodes dissection. Surg Oncol 20(2): 88‐96, 2011.
 2. Ainsworth BE, Haskell WL, Whitt MC, Irwin ML, Swartz AM, Strath SJ, O'Brien WL, Bassett DR, Jr, Schmitz KH, Emplaincourt PO, Jacobs DR, Jr, Leon AS. Compendium of physical activities: An update of activity codes and MET intensities. Med Sci Sports Exerc 32(9 Suppl): S498‐S504, 2000.
 3. American College of Sports Medicine. American College of Sports Medicine Position Stand. Exercise and physical activity for older adults. Med Sci Sports Exerc 30(6): 992‐1008, 1998.
 4. American College of Surgeons. Cancer program standards 2012: Ensuring patient‐centered care [online]. www.facs.org/cancer/clp/cpstandards.pdf.
 5. Amir E, Seruga B, Niraula S, Carlsson L, Ocana A. Toxicity of adjuvant endocrine therapy in postmenopausal breast cancer patients: A systematic review and meta‐analysis. J Natl Cancer Inst 103(17): 1299‐1309, 2011.
 6. Argiles JM, Busquets S, Garcia‐Martinez C, Lopez‐Soriano FJ. Mediators involved in the cancer anorexia‐cachexia syndrome: Past, present, and future. Nutrition 21(9): 977‐985, 2005.
 7. Arimidex, Tamoxifen, Alone or in Combination (ATAC) Trialists' Group, Forbes JF, Cuzick J, Buzdar A, Howell A, Tobias JS, Baum M. Effect of anastrozole and tamoxifen as adjuvant treatment for early‐stage breast cancer: 100‐month analysis of the ATAC trial. Lancet Oncol 9(1): 45‐53, 2008.
 8. Bird BR, Swain SM. Cardiac toxicity in breast cancer survivors: Review of potential cardiac problems. Clin Cancer Res 14(1): 14‐24, 2008.
 9. Blackburn H. Ancel Keys Lecture. The three beauties. Bench, clinical, and population research. Circulation 86(4): 1323‐1331, 1992.
 10. Blaney J, Lowe‐Strong A, Rankin J, Campbell A, Allen J, Gracey J. The cancer rehabilitation journey: Barriers to and facilitators of exercise among patients With cancer‐related fatigue. Phys Ther 90: 1135‐1147, 2010.
 11. Bobbio A, Chetta A, Ampollini L, Primomo GL, Internullo E, Carbognani P, Rusca M, Olivieri D. Preoperative pulmonary rehabilitation in patients undergoing lung resection for non‐small cell lung cancer. Eur J Cardiothorac Surg 33(1): 95‐98, 2008.
 12. Bonnet F, Lewden C, May T, Heripret L, Jougla E, Bevilacqua S, Costagliola D, Salmon D, Chene G, Morlat P. Malignancy‐related causes of death in human immunodeficiency virus‐infected patients in the era of highly active antiretroviral therapy. Cancer 101(2): 317‐324, 2004.
 13. Booth M, Beral V, Smith P. Risk factors for ovarian cancer: A case‐control study. Br J Cancer 60(4): 592‐598, 1989.
 14. Bossola M, Pacelli F, Tortorelli A, Doglietto GB. Cancer cachexia: It's time for more clinical trials. Ann Surg Oncol 14(2): 276‐285, 2007.
 15. Bower JE, Ganz PA, Tao ML, Hu W, Belin TR, Sepah S, Cole S, Aziz N. Inflammatory biomarkers and fatigue during radiation therapy for breast and prostate cancer. Clin Cancer Res 15(17): 5534‐5540, 2009.
 16. Bria E, Cuppone F, Fornier M, Nistico C, Carlini P, Milella M, Sperduti I, Terzoli E, Cognetti F, Giannarelli D. Cardiotoxicity and incidence of brain metastases after adjuvant trastuzumab for early breast cancer: The dark side of the moon? A meta‐analysis of the randomized trials. Breast Cancer Res Treat 109(2): 231‐239, 2008.
 17. Brinton LA, Berman ML, Mortel R, Twiggs LB, Barrett RJ, Wilbanks GD, Lannom L, Hoover RN. Reproductive, menstrual, and medical risk factors for endometrial cancer: Results from a case‐control study. Am J Obstet Gynecol 167(5): 1317‐1325, 1992.
 18. Burstein R, Polychronakos C, Toews CJ, MacDougall JD, Guyda HJ, Posner BI. Acute reversal of the enhanced insulin action in trained athletes. Association with insulin receptor changes. Diabetes 34(8): 756‐760, 1985.
 19. Calle EE, Rodriguez C, Walker‐Thurmond K, Thun MJ. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med 348(17): 1625‐1638, 2003.
 20. Campbell KL, McTiernan A. Exercise and biomarkers for cancer prevention studies. J Nutr 137(1 Suppl): 161S‐169S, 2007.
 21. Cao Y, Tan A, Gao F, Liu L, Liao C, Mo Z. A meta‐analysis of randomized controlled trials comparing chemotherapy plus bevacizumab with chemotherapy alone in metastatic colorectal cancer. Int J Colorectal Dis 24(6): 677‐685, 2009.
 22. Carver JR, Shapiro CL, Ng A, Jacobs L, Schwartz C, Virgo KS, Hagerty KL, Somerfield MR, Vaughn DJ, ASCO Cancer Survivorship Expert Panel. American Society of Clinical Oncology clinical evidence review on the ongoing care of adult cancer survivors: Cardiac and pulmonary late effects. J Clin Oncol 25(25): 3991‐4008, 2007.
 23. Caspersen CJ, Powell KE, Christenson GM. Physical activity, exercise, and physical fitness: Definitions and distinctions for health‐related research. Public Health Rep 100(2): 126‐131, 1985.
 24. Cesario A, Ferri L, Galetta D, Cardaci V, Biscione G, Pasqua F, Piraino A, Bonassi S, Russo P, Sterzi S, Margaritora S, Granone P. Pre‐operative pulmonary rehabilitation and surgery for lung cancer. Lung Cancer 57(1): 118‐119, 2007.
 25.ClinicalTrials.gov. Exercise programs in healthy young women at increased risk of developing breast cancer [online]. http://clinicaltrials.gov/ct2/show/NCT00892515?term=wiser+sister&rank=2.
 26.Committee on Cancer Survivorship: Institute of Medicine and national Research Board, editor. From Cancer Patient to Cancer Survivor: Lost in Transition, Washington, DC: The National Academic Press, 2006.
 27. Concato J. Observational versus experimental studies: What's the evidence for a hierarchy? NeuroRx 1(3): 341‐347, 2004.
 28. Cormier JN, Askew RL, Mungovan KS, Xing Y, Ross MI, Armer JM. Lymphedema beyond breast cancer: A systematic review and meta‐analysis of cancer‐related secondary lymphedema. Cancer 116(22): 5138‐5149, 2010.
 29. Corpet DE, Jacquinet C, Peiffer G, Tache S. Insulin injections promote the growth of aberrant crypt foci in the colon of rats. Nutr Cancer 27(3): 316‐320, 1997.
 30. Courneya KS. Exercise in cancer survivors: An overview of research. Med Sci Sports Exerc 35(11): 1846‐1852, 2003.
 31. Courneya KS, Friedenreich CM. Relationship between exercise during treatment and current quality of life among survivors of breast cancer. J Psychosoc Oncol 15(3‐4): 35‐57, 1997.
 32. Courneya KS, Friedenreich CM. Framework PEACE: An organizational model for examining physical exercise across the cancer experience. Ann Behav Med 23(4): 263‐272, 2001.
 33. Courneya KS, Segal RJ, Mackey JR, Gelmon K, Reid RD, Friedenreich CM, Ladha AB, Proulx C, Vallance JK, Lane K, Yasui Y, McKenzie DC. Effects of aerobic and resistance exercise in breast cancer patients receiving adjuvant chemotherapy: A multicenter randomized controlled trial. 25(28): 4396‐4404, 2007.
 34. Craft L, Vaniterson EH, Helenowski IB, Rademaker A, Courneya KS. Exercise effects on depressive symptoms in cancer survivors: A systematic review and meta‐analysis. Cancer Epidemiol Biomarkers Prev 21 3‐19, 2011.
 35. Cust AE. Physical activity and gynecologic cancer prevention. Recent Results Cancer Res 186: 159‐185, 2011.
 36. Cuzick J, Sestak I, Cella D, Fallowfield L, ATAC Trialists' Group. Treatment‐emergent endocrine symptoms and the risk of breast cancer recurrence: A retrospective analysis of the ATAC trial. Lancet Oncol 9(12): 1143‐1148, 2008.
 37. D'Addario G, Pintilie M, Leighl NB, Feld R, Cerny T, Shepherd FA. Platinum‐based versus non‐platinum‐based chemotherapy in advanced non‐small‐cell lung cancer: A meta‐analysis of the published literature. J Clin Oncol 23(13): 2926‐2936, 2005.
 38. Danaei G, Vander Hoorn S, Lopez AD, Murray CJ, Ezzati M, Comparative Risk Assessment collaborating group (Cancers). Causes of cancer in the world: Comparative risk assessment of nine behavioural and environmental risk factors. Lancet 366(9499): 1784‐1793, 2005.
 39. De Laurentiis M, Cancello G, D'Agostino D, Giuliano M, Giordano A, Montagna E, Lauria R, Forestieri V, Esposito A, Silvestro L, Pennacchio R, Criscitiello C, Montanino A, Limite G, Bianco AR, De Placido S. Taxane‐based combinations as adjuvant chemotherapy of early breast cancer: A meta‐analysis of randomized trials. J Clin Oncol 26(1): 44‐53, 2008.
 40. Dimeo FC, Stieglitz RD, Novelli‐Fischer U, Fetscher S, Keul J. Effects of physical activity on the fatigue and psychologic status of cancer patients during chemotherapy. Cancer 85(10): 2273‐2277, 1999.
 41. Din OS, Dodwell D, Wakefield RJ, Coleman RE. Aromatase inhibitor‐induced arthralgia in early breast cancer: What do we know and how can we find out more? Breast Cancer Res Treat 120(3): 525‐538, 2010.
 42. Dodd MJ, Cho MH, Miaskowski C, Painter PL, Paul SM, Cooper BA, Duda J, Krasnoff J, Bank KA. A randomized controlled trial of home‐based exercise for cancer‐related fatigue in women during and after chemotherapy with or without radiation therapy. Cancer Nurs 33(4): 245‐257, 2010.
 43. Donnelly JE, Blair SN, Jakicic JM, Manore MM, Rankin JW, Smith BK, American College of Sports Medicine. American College of Sports Medicine Position Stand. Appropriate physical activity intervention strategies for weight loss and prevention of weight regain for adults. Med Sci Sports Exerc 41(2): 459‐471, 2009.
 44. Dupont WD, Page DL. Risk factors for breast cancer in women with proliferative breast disease. N Engl J Med 312(3): 146‐151, 1985.
 45. Emaus A, Thune I. Physical activity and lung cancer prevention. Recent Results Cancer Res 186: 101‐133, 2011.
 46. Esposito K, Pontillo A, Di Palo C, Giugliano G, Masella M, Marfella R, Giugliano D. Effect of weight loss and lifestyle changes on vascular inflammatory markers in obese women: A randomized trial. JAMA 289(14): 1799‐1804, 2003.
 47. Fairey AS, Courneya KS, Field CJ, Bell GJ, Jones LW, Mackey JR. Effects of exercise training on fasting insulin, insulin resistance, insulin‐like growth factors, and insulin‐like growth factor binding proteins in postmenopausal breast cancer survivors: A randomized controlled trial. Cancer Epidemiol Biomarkers Prev 12(8): 721‐727, 2003.
 48. Fletcher GF, Balady G, Froelicher VF, Hartley LH, Haskell WL, Pollock ML. Exercise standards. A statement for healthcare professionals from the American Heart Association. Writing Group. Circulation 91(2): 580‐615, 1995.
 49. Frank LL, Sorensen BE, Yasui Y, Tworoger SS, Schwartz RS, Ulrich CM, Irwin ML, Rudolph RE, Rajan KB, Stanczyk F, Bowen D, Weigle DS, Potter JD, McTiernan A. Effects of exercise on metabolic risk variables in overweight postmenopausal women: A randomized clinical trial. Obes Res 13(3): 615‐625, 2005.
 50. Friedenreich CM. The role of physical activity in breast cancer etiology. Semin Oncol 37(3): 297‐302, 2010.
 51. Friedenreich CM. Physical activity and breast cancer: Review of the epidemiologic evidence and biologic mechanisms. Recent Results Cancer Res 188: 125‐139, 2011.
 52. Friedenreich CM, Woolcott CG, McTiernan A, Ballard‐Barbash R, Brant RF, Stanczyk FZ, Terry T, Boyd NF, Yaffe MJ, Irwin ML, Jones CA, Yasui Y, Campbell KL, McNeely ML, Karvinen KH, Wang Q, Courneya KS. Alberta physical activity and breast cancer prevention trial: Sex hormone changes in a year‐long exercise intervention among postmenopausal women. J Clin Oncol 28(9): 1458‐1466, 2010.
 53. Galvao DA, Nosaka K, Taaffe DR, Peake J, Spry N, Suzuki K, Yamaya K, McGuigan MR, Kristjanson LJ, Newton RU. Endocrine and immune responses to resistance training in prostate cancer patients. Prostate Cancer Prostatic Dis 11(2): 160‐165, 2008.
 54. Galvao DA, Nosaka K, Taaffe DR, Spry N, Kristjanson LJ, McGuigan MR, Suzuki K, Yamaya K, Newton RU. Resistance training and reduction of treatment side effects in prostate cancer patients. Med Sci Sports Exerc 38(12): 2045‐2052, 2006.
 55. Galvao DA, Taaffe DR, Spry N, Joseph D, Newton RU. Combined resistance and aerobic exercise program reverses muscle loss in men undergoing androgen suppression therapy for prostate cancer without bone metastases: A randomized controlled trial. J Clin Oncol 28(2): 340‐347, 2010.
 56. Ganz PA, Hahn EE. Implementing a survivorship care plan for patients with breast cancer. J Clin Oncol 26(5): 759‐767, 2008.
 57. Giordano SH, Kuo YF, Freeman JL, Buchholz TA, Hortobagyi GN, Goodwin JS. Risk of cardiac death after adjuvant radiotherapy for breast cancer. J Natl Cancer Inst 97(6): 419‐424, 2005.
 58. Giovannucci E. Modifiable risk factors for colon cancer. Gastroenterol Clin North Am 31(4): 925‐943, 2002.
 59. Gondos A, Bray F, Brewster DH, Coebergh JW, Hakulinen T, Janssen‐Heijnen ML, Kurtinaitis J, Brenner H, EUNICE Survival Working Group. Recent trends in cancer survival across Europe between 2000 and 2004: A model‐based period analysis from 12 cancer registries. Eur J Cancer 44(10): 1463‐1475, 2008.
 60. Hariharan D, Saied A, Kocher HM. Analysis of mortality rates for pancreatic cancer across the world. HPB (Oxford) 10(1): 58‐62, 2008.
 61. Harriss DJ, Atkinson G, Batterham A, George K, Cable NT, Reilly T, Haboubi N, Renehan AG, Colorectal Cancer, Lifestyle, Exercise And Research Group. Lifestyle factors and colorectal cancer risk (2): A systematic review and meta‐analysis of associations with leisure‐time physical activity. Colorectal Dis 11(7): 689‐701, 2009.
 62. Haslam DW, James WP. Obesity. Lancet 366(9492): 1197‐1209, 2005.
 63. Hayes S, Johansson K, Alfano C, Schmitz K. Exercise for breast cancer survivors: Bridging the gap between evidence and practice. Trans Behav Med 4: 539‐544, 2011.
 64. Haykowsky MJ, Liang Y, Pechter D, Jones LW, McAlister FA, Clark AM. A meta‐analysis of the effect of exercise training on left ventricular remodeling in heart failure patients: The benefit depends on the type of training performed. J Am Coll Cardiol 49(24): 2329‐2336, 2007.
 65. Herida M, Mary‐Krause M, Kaphan R, Cadranel J, Poizot‐Martin I, Rabaud C, Plaisance N, Tissot‐Dupont H, Boue F, Lang JM, Costagliola D. Incidence of non‐AIDS‐defining cancers before and during the highly active antiretroviral therapy era in a cohort of human immunodeficiency virus‐infected patients. J Clin Oncol 21(18): 3447‐3453, 2003.
 66. Herrera JE, Stubblefield MD. Rotator cuff tendonitis in lymphedema: A retrospective case series. Arch Phys Med Rehabil 85(12): 1939‐1942, 2004.
 67. Hursting SD, Berger NA. Energy balance, host‐related factors, and cancer progression. J Clin Oncol 28(26): 4058‐4065, 2010.
 68. Ibrahim EM, Al‐Homaidh A. Physical activity and survival after breast cancer diagnosis: Meta‐analysis of published studies. Med Oncol 28(3): 753‐765, 2011.
 69. Il'yasova D, Colbert LH, Harris TB, Newman AB, Bauer DC, Satterfield S, Kritchevsky SB. Circulating levels of inflammatory markers and cancer risk in the health aging and body composition cohort. Cancer Epidemiol Biomarkers Prev 14(10): 2413‐2418, 2005.
 70. Ingram C, Courneya KS, Kingston D. The effects of exercise on body weight and composition in breast cancer survivors: An integrative systematic review. Oncol Nurs Forum 33(5): 937‐47; quiz 948‐50, 2006.
 71. International Agency for Research on Cancer. Weight control and physical activity [online]. http://www.iarc.fr/en/publications/pdfs‐online/prev/handbook6/index.php.
 72. Irwin ML, Alvarez‐Reeves M, Cadmus L, Mierzejewski E, Mayne ST, Yu H, Chung GG, Jones B, Knobf MT, DiPietro L. Exercise improves body fat, lean mass, and bone mass in breast cancer survivors. Obesity (Silver Spring) 17(8): 1534‐1541, 2009.
 73. Irwin ML, Crumley D, McTiernan A, Bernstein L, Baumgartner R, Gilliland FD, Kriska A, Ballard‐Barbash R. Physical activity levels before and after a diagnosis of breast carcinoma: The Health, Eating, Activity, and Lifestyle (HEAL) study. Cancer 97(7): 1746‐1757, 2003.
 74. Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D. Global cancer statistics. CA Cancer J Clin 61(2): 69‐90, 2011.
 75. Jemal A, Siegel R, Ward E, Hao Y, Xu J, Thun MJ. Cancer statistics, 2009. CA Cancer J Clin 59(4): 225‐249, 2009.
 76. Jones LW, Eves ND, Kraus WE, Potti A, Crawford J, Blumenthal JA, Peterson BL, Douglas PS. The lung cancer exercise training study: A randomized trial of aerobic training, resistance training, or both in postsurgical lung cancer patients: Rationale and design. BMC Cancer 10: 155, 2010.
 77. Jones LW, Liang Y, Pituskin EN, Battaglini CL, Scott JM, Hornsby WE, Haykowsky M. Effect of exercise training on peak oxygen consumption in patients with cancer: A meta‐analysis. Oncologist 16(1): 112‐120, 2011.
 78. Jones LW, Peddle CJ, Eves ND, Haykowsky MJ, Courneya KS, Mackey JR, Joy AA, Kumar V, Winton TW, Reiman T. Effects of presurgical exercise training on cardiorespiratory fitness among patients undergoing thoracic surgery for malignant lung lesions. Cancer 110(3): 590‐598, 2007.
 79. Kaaks R. Nutrition, hormones, and breast cancer: Is insulin the missing link? Cancer Causes Control 7(6): 605‐625, 1996.
 80. Kaaks R, Lukanova A. Energy balance and cancer: The role of insulin and insulin‐like growth factor‐I. Proc Nutr Soc 60(1): 91‐106, 2001.
 81. Karim‐Kos HE, de Vries E, Soerjomataram I, Lemmens V, Siesling S, Coebergh JW. Recent trends of cancer in Europe: A combined approach of incidence, survival and mortality for 17 cancer sites since the 1990s. Eur J Cancer 44(10): 1345‐1389, 2008.
 82. Keating NL, O'Malley AJ, Smith MR. Diabetes and cardiovascular disease during androgen deprivation therapy for prostate cancer. J Clin Oncol 24(27): 4448‐4456, 2006.
 83. Key T, Appleby P, Barnes I, Reeves G, Endogenous Hormones and Breast Cancer Collaborative Group. Endogenous sex hormones and breast cancer in postmenopausal women: Reanalysis of nine prospective studies. J Natl Cancer Inst 94(8): 606‐616, 2002.
 84. Khandwala HM, McCutcheon IE, Flyvbjerg A, Friend KE. The effects of insulin‐like growth factors on tumorigenesis and neoplastic growth. Endocr Rev 21(3): 215‐244, 2000.
 85. Khera N, Storer B, Flowers ME, Carpenter PA, Inamoto Y, Sandmaier BM, Martin PJ, Lee SJ. Nonmalignant late effects and compromised functional status in survivors of hematopoietic cell transplantation. J Clin Oncol 30: 71‐77, 2012.
 86. Kim CJ, Kang DH, Park JW. A meta‐analysis of aerobic exercise interventions for women with breast cancer. West J Nurs Res 31(4): 437‐461, 2009.
 87. Kossman DA, Williams NI, Domchek SM, Kurzer MS, Stopfer JE, Schmitz KH. Exercise lowers estrogen and progesterone levels in premenopausal women at high risk of breast cancer. J Appl Physiol 111(6): 1687‐1693, 2011.
 88. Lee I, editor. Epidemiologic Methods in Physical Activity Studies. New York: Oxford University Press, Inc., 2008.
 89. Leitzmann MF. Physical activity and genitourinary cancer prevention. Recent Results Cancer Res 186: 43‐71, 2011.
 90. Limburg PJ, Stolzenberg‐Solomon RZ, Vierkant RA, Roberts K, Sellers TA, Taylor PR, Virtamo J, Cerhan JR, Albanes D. Insulin, glucose, insulin resistance, and incident colorectal cancer in male smokers. Clin Gastroenterol Hepatol 4(12): 1514‐1521, 2006.
 91. Liu Y, Hu F, Li D, Wang F, Zhu L, Chen W, Ge J, An R, Zhao Y. Does physical activity reduce the risk of prostate cancer? A systematic review and meta‐analysis. Eur Urol 60(5): 1029‐1044, 2011.
 92. Lowenfels AB, Maisonneuve P. Risk factors for pancreatic cancer. J Cell Biochem 95(4): 649‐656, 2005.
 93. Lukanova A, Lundin E, Toniolo P, Micheli A, Akhmedkhanov A, Rinaldi S, Muti P, Lenner P, Biessy C, Krogh V, Zeleniuch‐Jacquotte A, Berrino F, Hallmans G, Riboli E, Kaaks R. Circulating levels of insulin‐like growth factor‐I and risk of ovarian cancer. Int J Cancer 101(6): 549‐554, 2002.
 94. Lynch BM, Dunstan DW, Healy GN, Winkler E, Eakin E, Owen N. Objectively measured physical activity and sedentary time of breast cancer survivors, and associations with adiposity: Findings from NHANES (2003‐2006). Cancer Causes Control 21(2): 283‐288, 2010.
 95. Lynch BM, Dunstan DW, Winkler E, Healy GN, Eakin E, Owen N. Objectively assessed physical activity, sedentary time and waist circumference among prostate cancer survivors: Findings from the National Health and Nutrition Examination Survey (2003‐2006). Eur J Cancer Care (Engl) 20(4): 514‐519, 2011.
 96. Lynch BM, Neilson HK, Friedenreich CM. Physical activity and breast cancer prevention. Recent Results Cancer Res 186: 13‐42, 2011.
 97. MacDonald RS, Thornton WH, Jr, Bean TL. Insulin and IGE‐1 receptors in a human intestinal adenocarcinoma cell line (CACO‐2): Regulation of Na+ glucose transport across the brush border. J Recept Res 13(7): 1093‐1113, 1993.
 98. MacMahon B. Risk factors for endometrial cancer. Gynecol Oncol 2(2‐3): 122‐129, 1974.
 99. Mann CJ. Observational research methods. Research design II: Cohort, cross sectional, and case‐control studies. Emerg Med J 20(1): 54‐60, 2003.
 100. Mao JJ, Stricker C, Bruner D, Xie S, Bowman MA, Farrar JT, Greene BT, DeMichele A. Patterns and risk factors associated with aromatase inhibitor‐related arthralgia among breast cancer survivors. Cancer 115(16): 3631‐3639, 2009.
 101. Mayer‐Davis EJ, D'Agostino R, Jr, Karter AJ, Haffner SM, Rewers MJ, Saad M, Bergman RN. Intensity and amount of physical activity in relation to insulin sensitivity: The Insulin Resistance Atherosclerosis Study. JAMA 279(9): 669‐674, 1998.
 102. McGowan L, Norris HJ, Hartge P, Hoover R, Lesher L. Risk factors in ovarian cancer. Eur J Gynaecol Oncol 9(3): 195‐199, 1988.
 103. McNeely ML, Courneya KS. Exercise programs for cancer‐related fatigue: Evidence and clinical guidelines. J Natl Compr Canc Netw 8(8): 945‐953, 2010.
 104. McTiernan A. Mechanisms linking physical activity with cancer. Nat Rev Cancer 8(3): 205‐211, 2008.
 105. McTiernan A, Tworoger SS, Rajan KB, Yasui Y, Sorenson B, Ulrich CM, Chubak J, Stanczyk FZ, Bowen D, Irwin ML, Rudolph RE, Potter JD, Schwartz RS. Effect of exercise on serum androgens in postmenopausal women: A 12‐month randomized clinical trial. Cancer Epidemiol Biomarkers Prev 13(7): 1099‐1105, 2004.
 106. McTiernan A, Tworoger SS, Ulrich CM, Yasui Y, Irwin ML, Rajan KB, Sorensen B, Rudolph RE, Bowen D, Stanczyk FZ, Potter JD, Schwartz RS. Effect of exercise on serum estrogens in postmenopausal women: A 12‐month randomized clinical trial. Cancer Res 64(8): 2923‐2928, 2004.
 107. Menu E, van Valckenborgh E, van Camp B, Vanderkerken K. The role of the insulin‐like growth factor 1 receptor axis in multiple myeloma. Arch Physiol Biochem 115(2): 49‐57, 2009.
 108. Miller AH, Ancoli‐Israel S, Bower JE, Capuron L, Irwin MR. Neuroendocrine‐immune mechanisms of behavioral comorbidities in patients with cancer. J Clin Oncol 26(6): 971‐982, 2008.
 109. Monsuez JJ, Charniot JC, Vignat N, Artigou JY. Cardiac side‐effects of cancer chemotherapy. Int J Cardiol 144(1): 3‐15, 2010.
 110. Muscaritoli M, Bossola M, Aversa Z, Bellantone R, Rossi Fanelli F. Prevention and treatment of cancer cachexia: New insights into an old problem. Eur J Cancer 42(1): 31‐41, 2006.
 111. Mustian KM, Palesh OG, Flecksteiner SA. Tai Chi Chuan for breast cancer survivors. Med Sport Sci 52: 209‐217, 2008.
 112.National Cancer Institute: Division of Applied Research. Walking & bicycling related items from physical activity questionnaires [online]. http://appliedresearch.cancer.gov/tools/paq/reflist.html.
 113. Neilson HK, Friedenreich CM, Brockton NT, Millikan RC. Physical activity and postmenopausal breast cancer: Proposed biologic mechanisms and areas for future research. Cancer Epidemiol Biomarkers Prev 18(1): 11‐27, 2009.
 114. Nieman DC. Upper respiratory tract infections and exercise. Thorax 50(12): 1229‐1231, 1995.
 115. Nindl BC, Pierce JR. Insulin‐like growth factor I as a biomarker of health, fitness, and training status. Med Sci Sports Exerc 42(1): 39‐49, 2010.
 116. Olsen CM, Bain CJ, Jordan SJ, Nagle CM, Green AC, Whiteman DC, Webb PM, Australian Ovarian Cancer Study Group. Recreational physical activity and epithelial ovarian cancer: A case‐control study, systematic review, and meta‐analysis. Cancer Epidemiol Biomarkers Prev 16(11): 2321‐2330, 2007.
 117. O'Rorke MA, Cantwell MM, Cardwell CR, Mulholland HG, Murray LJ. Can physical activity modulate pancreatic cancer risk? A systematic review and meta‐analysis. Int J Cancer 126(12): 2957‐2968, 2010.
 118. Oshima M, Taketo MM. COX selectivity and animal models for colon cancer. Curr Pharm Des 8(12): 1021‐1034, 2002.
 119. Pan SY, DesMeules M. Energy intake, physical activity, energy balance, and cancer: Epidemiologic evidence. Methods Mol Biol 472: 191‐215, 2009.
 120. Pan SY, Morrison H. Physical activity and hematologic cancer prevention. Recent Results Cancer Res 186: 135‐158, 2011.
 121. Patnaik JL, Byers T, DiGuiseppi C, Dabelea D, Denberg TD. Cardiovascular disease competes with breast cancer as the leading cause of death for older females diagnosed with breast cancer: A retrospective cohort study. Breast Cancer Res 13(3): R64, 2011.
 122. Patt DA, Goodwin JS, Kuo YF, Freeman JL, Zhang DD, Buchholz TA, Hortobagyi GN, Giordano SH. Cardiac morbidity of adjuvant radiotherapy for breast cancer. J Clin Oncol 23(30): 7475‐7482, 2005.
 123. Pekmezi DW, Demark‐Wahnefried W. Updated evidence in support of diet and exercise interventions in cancer survivors. Acta Oncol 50(2): 167‐178, 2011.
 124. Pienta KJ, Esper PS. Risk factors for prostate cancer. Ann Intern Med 118(10): 793‐803, 1993.
 125. Pilepich MV, Winter K, John MJ, Mesic JB, Sause W, Rubin P, Lawton C, Machtay M, Grignon D. Phase III radiation therapy oncology group (RTOG) trial 86‐10 of androgen deprivation adjuvant to definitive radiotherapy in locally advanced carcinoma of the prostate. Int J Radiat Oncol Biol Phys 50(5): 1243‐1252, 2001.
 126. Pollock RE, Doroshow JH, Khayat D, Nakao A, O'Sullivan B, editors. UICC Manual of Clinical Oncology. Hoboken, NJ: Wiley‐Liss, 2003, p. 917.
 127. Ranpura V, Pulipati B, Chu D, Zhu X, Wu S. Increased risk of high‐grade hypertension with bevacizumab in cancer patients: A meta‐analysis. Am J Hypertens 23(5): 460‐468, 2010.
 128. Rundle A. Molecular epidemiology of physical activity and cancer. Cancer Epidemiol Biomarkers Prev 14(1): 227‐236, 2005.
 129. Saarto T, Sievanen H, Kellokumpu‐Lehtinen P, Nikander R, Vehmanen L, Huovinen R, Kautiainen H, Jarvenpaa S, Penttinen HM, Utriainen M, Jaaskelainen AS, Elme A, Ruohola J, Palva T, Vertio H, Rautalahti M, Fogelholm M, Luoto R, Blomqvist C. Effect of supervised and home exercise training on bone mineral density among breast cancer patients. A 12‐month randomised controlled trial. Osteoporos Int 23: 1601‐1612, 2011.
 130. Santen RJ. Clinical review: Effect of endocrine therapies on bone in breast cancer patients. J Clin Endocrinol Metab 96(2): 308‐319, 2011.
 131. Schatzkin A, Gail M. The promise and peril of surrogate end points in cancer research. Nat Rev Cancer 2(1): 19‐27, 2002.
 132. Schmitz K. Physical activity and breast cancer survivorship. Recent Results Cancer Res 186: 189‐215, 2011.
 133. Schmitz KH. Exercise for secondary prevention of breast cancer: Moving from evidence to changing clinical practice. Cancer Prev Res (Phila) 4(4): 476‐480, 2011.
 134. Schmitz KH. Balancing lymphedema risk: Exercise versus deconditioning for breast cancer survivors. Exerc Sport Sci Rev 38(1): 17‐24, 2010.
 135. Schmitz KH, Cappola AR, Stricker CT, Sweeney C, Norman SA. The intersection of cancer and aging: Establishing the need for breast cancer rehabilitation. Cancer Epidemiol Biomarkers Prev 16(5): 866‐872, 2007.
 136. Schmitz KH, Courneya KS, Matthews C, Demark‐Wahnefried W, Galvao DA, Pinto BM, Irwin ML, Wolin KY, Segal RJ, Lucia A, Schneider CM, VON Gruenigen VE, Schwartz AL. American college of sports medicine roundtable on exercise guidelines for cancer survivors. Med Sci Sports Exerc 42(7): 1409‐1426, 2010.
 137. Schmitz KH, Prosnitz RG, Schwartz AL, Carver JR. Prospective surveillance and management of cardiac toxicity and health in breast cancer survivors. Cancer 118(S8): 2270‐2276, 2012.
 138. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Effects of supervised exercise training on cardiopulmonary function and fatigue in breast cancer survivors during and after treatment. Cancer 110(4): 918‐925, 2007.
 139. Schneider CM, Hsieh CC, Sprod LK, Carter SD, Hayward R. Exercise training manages cardiopulmonary function and fatigue during and following cancer treatment in male cancer survivors. Integr Cancer Ther 6(3): 235‐241, 2007.
 140. Schoen RE, Tangen CM, Kuller LH, Burke GL, Cushman M, Tracy RP, Dobs A, Savage PJ. Increased blood glucose and insulin, body size, and incident colorectal cancer. J Natl Cancer Inst 91(13): 1147‐1154, 1999.
 141. Schwartz AL. Physical activity after a cancer diagnosis: Psychosocial outcomes. Cancer Invest 22(1): 82‐92, 2004.
 142. Schwartz AL, Winters‐Stone K. Effects of a 12‐month randomized controlled trial of aerobic or resistance exercise during and following cancer treatment in women. Phys Sportsmed 37(3): 62‐67, 2009.
 143. Scott JM, Khakoo A, Mackey JR, Haykowsky MJ, Douglas PS, Jones LW. Modulation of anthracycline‐induced cardiotoxicity by aerobic exercise in breast cancer: Current evidence and underlying mechanisms. Circulation 124(5): 642‐650, 2011.
 144. Segal RJ, Reid RD, Courneya KS, Malone SC, Parliament MB, Scott CG, Venner PM, Quinney HA, Jones LW, D'Angelo ME, Wells GA. Resistance exercise in men receiving androgen deprivation therapy for prostate cancer. J Clin Oncol 21(9): 1653‐1659, 2003.
 145. Segal RJ, Reid RD, Courneya KS, Sigal RJ, Kenny GP, Prud'Homme DG, Malone SC, Wells GA, Scott CG, Slovinec D'Angelo ME. Randomized controlled trial of resistance or aerobic exercise in men receiving radiation therapy for prostate cancer. 27(3): 344‐351, 2009.
 146. Shah JP, Danoff JV, Desai MJ, Parikh S, Nakamura LY, Phillips TM, Gerber LH. Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 89(1): 16‐23, 2008.
 147. Shapiro CL, Recht A. Side effects of adjuvant treatment of breast cancer. N Engl J Med 344(26): 1997‐2008, 2001.
 148. Sharifi N, Gulley JL, Dahut WL. Androgen deprivation therapy for prostate cancer. JAMA 294(2): 238‐244, 2005.
 149. Shephard RJ, Shek PN. Effects of exercise and training on natural killer cell counts and cytolytic activity: A meta‐analysis. Sports Med 28(3): 177‐195, 1999.
 150. Silverman DT, Schiffman M, Everhart J, Goldstein A, Lillemoe KD, Swanson GM, Schwartz AG, Brown LM, Greenberg RS, Schoenberg JB, Pottern LM, Hoover RN, Fraumeni JF, Jr. Diabetes mellitus, other medical conditions and familial history of cancer as risk factors for pancreatic cancer. Br J Cancer 80(11): 1830‐1837, 1999.
 151. Smith LA, Cornelius VR, Plummer CJ, Levitt G, Verrill M, Canney P, Jones A. Cardiotoxicity of anthracycline agents for the treatment of cancer: Systematic review and meta‐analysis of randomised controlled trials. BMC Cancer 10: 337, 2010.
 152. Speck RM, Courneya KS, Masse LC, Duval S, Schmitz KH. An update of controlled physical activity trials in cancer survivors: A systematic review and meta‐analysis. J Cancer Surviv 4(2): 87‐100, 2010.
 153. Sporn MB. The war on cancer. Lancet 347(9012): 1377‐1381, 1996.
 154. Stortecky S, Suter TM. Insights into cardiovascular side‐effects of modern anticancer therapeutics. Curr Opin Oncol 22(4): 312‐317, 2010.
 155. Stubblefield MD. Cancer rehabilitation. Semin Oncol 38(3): 386‐393, 2011.
 156. Stubblefield MD. Radiation fibrosis syndrome: Neuromuscular and musculoskeletal complications in cancer survivors. PM R 3(11): 1041‐1054, 2011.
 157. Stubblefield MD, Custodio CM. Upper‐extremity pain disorders in breast cancer. Arch Phys Med Rehabil 87(3 Suppl 1): S96‐S99; quiz S100‐1, 2006.
 158. Stubblefield MD, O'Dell MW, editors. Cancer Rehabilitation: Principles and Practice. New York: Demos Medical Publishing, LLC., 2009, p. 1093.
 159. Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin: A retrospective analysis of three trials. Cancer 97(11): 2869‐2879, 2003.
 160. Syrjala KL, Langer SL, Abrams JR, Storer BE, Martin PJ. Late effects of hematopoietic cell transplantation among 10‐year adult survivors compared with case‐matched controls. J Clin Oncol 23(27): 6596‐6606, 2005.
 161. Tardon A, Lee WJ, Delgado‐Rodriguez M, Dosemeci M, Albanes D, Hoover R, Blair A. Leisure‐time physical activity and lung cancer: A meta‐analysis. Cancer Causes Control 16(4): 389‐397, 2005.
 162. Thompson HJ, Jiang W, Zhu Z. Candidate mechanisms accounting for effects of physical activity on breast carcinogenesis. IUBMB Life 61(9): 895‐901, 2009.
 163. Thompson WR, Gordon NF, Pescatello LS, ed. ACSM's Guidelines for Exercise Testing and Prescription. Philadelphia, PA: Lippincott, Williams & Wilkins, 2010.
 164. Thun MJ, Namboodiri MM, Heath CW, Jr. Aspirin use and reduced risk of fatal colon cancer. N Engl J Med 325(23): 1593‐1596, 1991.
 165. Thune I, Furberg AS. Physical activity and cancer risk: Dose‐response and cancer, all sites and site‐specific. Med Sci Sports Exerc 33(6 Suppl): S530‐S550; discussion S609‐10, 2001.
 166. Tsai RJ, Dennis LK, Lynch CF, Snetselaar LG, Zamba GK, Scott‐Conner C. The risk of developing arm lymphedema among breast cancer survivors: A meta‐analysis of treatment factors. Ann Surg Oncol 16(7): 1959‐1972, 2009.
 167. Twiss JJ, Waltman NL, Berg K, Ott CD, Gross GJ, Lindsey AM. An exercise intervention for breast cancer survivors with bone loss. J Nurs Scholarsh 41(1): 20‐27, 2009.
 168. van't Spijker A, Trijsburg RW, Duivenvoorden HJ. Psychological sequelae of cancer diagnosis: A meta‐analytical review of 58 studies after 1980. Psychosom Med 59(3): 280‐293, 1997.
 169. Velthuis MJ, Agasi‐Idenburg SC, Aufdemkampe G, Wittink HM. The effect of physical exercise on cancer‐related fatigue during cancer treatment: A meta‐analysis of randomised controlled Trials. Clin Oncol (R Coll Radiol) 22(3): 208‐221, 2010.
 170. Viani GA, Afonso SL, Stefano EJ, De Fendi LI, Soares FV. Adjuvant trastuzumab in the treatment of her‐2‐positive early breast cancer: A meta‐analysis of published randomized trials. BMC Cancer 7: 153, 2007.
 171. Voskuil DW, Monninkhof EM, Elias SG, Vlems FA, van Leeuwen FE, Task Force Physical Activity and Cancer. Physical activity and endometrial cancer risk, a systematic review of current evidence. Cancer Epidemiol Biomarkers Prev 16(4): 639‐648, 2007.
 172. Vrieling A, Kampman E. The role of body mass index, physical activity, and diet in colorectal cancer recurrence and survival: A review of the literature. Am J Clin Nutr 92(3): 471‐490, 2010.
 173. Wei EK, Ma J, Pollak MN, Rifai N, Fuchs CS, Hankinson SE, Giovannucci E. C‐peptide, insulin‐like growth factor binding protein‐1, glycosylated hemoglobin, and the risk of distal colorectal adenoma in women. Cancer Epidemiol Biomarkers Prev 15(4): 750‐755, 2006.
 174. Weiderpass E. Lifestyle and cancer risk. J Prev Med Public Health 43(6): 459‐471, 2010.
 175. Weiss EP, Holloszy JO. Improvements in body composition, glucose tolerance, and insulin action induced by increasing energy expenditure or decreasing energy intake. J Nutr 137(4): 1087‐1090, 2007.
 176. Weiss EP, Racette SB, Villareal DT, Fontana L, Steger‐May K, Schechtman KB, Klein S, Holloszy JO, Washington University School of Medicine CALERIE Group. Improvements in glucose tolerance and insulin action induced by increasing energy expenditure or decreasing energy intake: A randomized controlled trial. Am J Clin Nutr 84(5): 1033‐1042, 2006.
 177. Winters‐Stone KM, Schwartz A, Nail LM. A review of exercise interventions to improve bone health in adult cancer survivors. J Cancer Surviv 4(3): 187‐201, 2010.
 178. Wolfson L, Judge J, Whipple R, King M. Strength is a major factor in balance, gait, and the occurrence of falls. J Gerontol A Biol Sci Med Sci 50: 64‐67, 1995.
 179. Wolin KY, Tuchman H. Physical activity and gastrointestinal cancer prevention. Recent Results Cancer Res 186: 73‐100, 2011.
 180. Wolin KY, Yan Y, Colditz GA, Lee IM. Physical activity and colon cancer prevention: A meta‐analysis. Br J Cancer 100(4): 611‐616, 2009.
 181. Wonders KY, Reigle BS. Trastuzumab and doxorubicin‐related cardiotoxicity and the cardioprotective role of exercise. Integr Cancer Ther 8(1): 17‐21, 2009.
 182. Yahalom J, Portlock CS. Long‐term cardiac and pulmonary complications of cancer therapy. Hematol Oncol Clin North Am 22(2): 305‐18, vii, 2008.
 183. Yang EJ, Park WB, Seo KS, Kim SW, Heo CY, Lim JY. Longitudinal change of treatment‐related upper limb dysfunction and its impact on late dysfunction in breast cancer survivors: A prospective cohort study. J Surg Oncol 101(1): 84‐91, 2010.
 184. Yeh ET, Bickford CL. Cardiovascular complications of cancer therapy: Incidence, pathogenesis, diagnosis, and management. J Am Coll Cardiol 53(24): 2231‐2247, 2009.
 185. Zakikhani M, Blouin MJ, Piura E, Pollak MN. Metformin and rapamycin have distinct effects on the AKT pathway and proliferation in breast cancer cells. Breast Cancer Res Treat 123(1): 271‐279, 2010.
 186. Zhu Z, Jiang W, Sells JL, Neil ES, McGinley JN, Thompson HJ. Effect of nonmotorized wheel running on mammary carcinogenesis: Circulating biomarkers, cellular processes, and molecular mechanisms in rats. Cancer Epidemiol Biomarkers Prev 17(8): 1920‐1929, 2008.

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Justin C. Brown, Kerri Winters‐Stone, Augustine Lee, Kathryn H. Schmitz. Cancer, Physical Activity, and Exercise. Compr Physiol 2012, 2: 2775-2809. doi: 10.1002/cphy.c120005