**2.3 Phase 3: Recovery of quality of life**

The rehabilitation strategy is aimed at strengthening of the recovered **sensorimotor** capacity to allow the patient a gradual return to society, improving his/her quality of life Increasing the muscle strength needed for walking and for the orthostatic position, developing proprioception and requiring motor tasks more and more difficult and functional in daily life. In our rehabilitation method, we use instrumental or not instrumental techniques.

The aim of therapy is to:


#### Rehabilitation protocol

3 sessions per week for three months with a metabolic cost of 25-29 METs.

Physical Therapy:

Focused high intensity vibratory stimulation (VISS, VISSMAN, Rome, Italy). Position: supine in the absence of muscle contraction; frequency: 300Hz; duration: 30 min.

Global vibratory stimulation (PhysioPlate FIT, Globus Italy srl, Codognè (TV), Italy). Position: orthostatic; frequency: 50Hz; duration: 10 minMotor Rehabilitation:


Rehabilitation in Cancer Survivors: Interaction Between Lifestyle and Physical Activity 189

Carver, JR.; Shapiro, CL.; Ng A, Jacobs, L.; American Society of Clinical Oncology clinical

Cardiorespiratory Fitness,Not Smoking, and Normal Waist Girth on Morbidity and

Christine, M. F.; Orenstein, M.R.; Physical Activity and Cancer Prevention: Etiologic

Friedenreich, C.M.; Ladha, A.B.; Proulx, C.; Vallance, J.K.H.; Lane, K.; Yasui, Y.; McKenzie,

DerSimonian, R., Laird, N.; Meta-analysis in clinical trials. *Control Clin Trials. 1986;*7:177–88. Dessy, LA.; Monarca, C.; Grasso, F.; Saggini, A., Buccheri, EM.; Saggini, R.; Scuderi, N.; The

Egger,M.; Davey Smith, G.; Schneider, M.; Minder, C.; Bias in metaanalysis detected by a

Enger ,S.M.; Bernstein, L.; Exercise activity, body size and premenopausalbreast cancer

Escalante, C.P.; MD, FACP and Manzullo, E.F.; MD, FACP.; Cancer-Related Fatigue: The

Fairey, A.S.; Courneya, K.S.; Field, C.J.; Bell, G.J.; Jones, L.W.; Mackey, JR.; Effects of exercise

Fialka-Moser, V.; Crevenna, R.; Korpan, M.; Quittan, M.; Cancer rehabilitation: particularly with aspects on physical impairments. *J Rehabil Med.* 2003 Jul;35(4):153-62 Fossa, S. D.; Loge, J.H.; Dahl , A. A.; Long-term survivorship after cancer: how far have we

Frisch, R.E.; Wyshak, G.; Albright, N.L.; Albright, T.E.; Schiff, I.; Jones, K.P., *Witschi, J.,* 

Friedenreich, C.M.; Rohan, T.E.; A review of physical activity and breast cancer.

Friedenreich CM, Cust AE. Physical activity and breast cancer risk: impact of timing, type

subgroup effects timing, type and dose of activity and population. *Br. J. Sports Med.* 

*Shiang, E., Koff, E,, Marguglio, M. Lower prevalenceof breast cancer and cancers of the reproductive system among ormer college athletes compared to non-athletes. Br J* 

and dose of activity and population subgroup effects. *Br J Sports Med. 2008;*42:636–

Approach and Treatment *J Gen Intern Med* 24*(*Suppl 2):412–6-2009

come?; *Annals of Oncology 19* (Supplement 5): v25–v29, 2008

Friedenreich, C.M.; Cust, A.E.; Physical activity and breast cancer risk: impact of

Chong-Do Lee, EdD; Xuemei Sui, MD; Steven N. Blair; Combined Effects of

Mortality in Men *Arch Intern Med. 2009;*169(22):2096-2101

Courneya, K.S. ; Segal, R.J.; Mackey, J.R.; Gelmon, K.; Reid, R.D.;

simple, graphical test. *BMJ.1997*;315:629–34.

*for Nutritional Sciences.* 

*Surg*. 2008 Mar;32(2):339-45.

Castillo AL, Kwan

*2003*;12:721–7.

*Cancer.1985;52:885–91.* 

2008;42;636-647 (b)

47 (a)

*Epidemiology. 1995*;6:311–7.

25,28,1,2007

evidence review on the ongoing care of adult cancer survivors: cardiac and pulmonary late effects*. J Clin Oncol. 2007* Sep 1;25(25):3991-4008. Epub 2007 Jun 18.

Evidence and Biological Mechanisms 0022-3166/02 \$3.00 © 2002 *American Society* 

D.C. Effects of Aerobic and Resistance Exercise in Breast Cancer Patients Receiving Adjuvant Chemotherapy: A Multicenter Randomized Controlled Trial ; *J Clin Oncol* 

use of mechanical acoustic vibrations to improve abdominal contour. *Aesthetic Plast* 

survival. *Br J Cancer. 2004*;90: 2138–41.Sternfeld B, Weltzien E, Quesenberry CP Jr,

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.* 

month per each phase in 24 months from the end of the specific medical or surgical oncology treatment.

#### **3. Conclusions**

Cancer patients suffer from persistent emotional and social distress, because of functional deficits, all that results in a reduced quality of life (QOL). The QOL assessment should include at least four functional dimensions: physical, the emotional, the social and the cognitive function. These dimensions are positively influenced by a proper rehabilitation program which includes physical exercise. It is well known that phyisical activity is an important means to prevent and to fight the problems of inactivity and disuse, and to reduce fatigue.

The information about the role of physical activity in oncology has been increasing over the years, and now is possible to confirm that **" the physical activity decreases the risk of disease; in patients who suffer from cancer, it prolongs survival, reduces the occurrence of concomitant diseases and improves the life quality" in (U.S. Department of Health and Human Services, 2008).** 

#### **4. References**


Cancer patients suffer from persistent emotional and social distress, because of functional deficits, all that results in a reduced quality of life (QOL). The QOL assessment should include at least four functional dimensions: physical, the emotional, the social and the cognitive function. These dimensions are positively influenced by a proper rehabilitation program which includes physical exercise. It is well known that phyisical activity is an important means to prevent and to fight the problems of inactivity and disuse, and to

The information about the role of physical activity in oncology has been increasing over the years, and now is possible to confirm that **" the physical activity decreases the risk of disease; in patients who suffer from cancer, it prolongs survival, reduces the occurrence of concomitant diseases and improves the life quality" in (U.S. Department of Health and** 

Abrahamson, P.E.; Gammon, M.D.; Lund, M.J.; Britton, J.A.; Marshall, S.W.; Flagg, E.W.;

survival among young women with breast cancer. *Cancer. 2006*;107:1777–85. Baer*\**, H.J.; Tworoger,S.; Hankinson, S.; Willett W.; Body Fatness at Young Ages and Risk of Breast Cancer Throughout Life ; *American Journal of Epidemiology* Vol. 171, No. 11 Ballard-Barbash, R.; Hunsberger, S.; Alciati, M.H.; Blair, S.N.; Goodwin, P.J.; McTiernan, A.;

Barnett, G.C; Shah, M.; Redman, K.; Easton, D.F.; Ponder, B.A.J.; Pharoah, P.D. P. Risk

Belle, F.; Kampman, E.; McTiernan, A. et al. Dietary Fiber, Carbohydrates, Glycemic Index,

Boyes, A.; Girgis, A. Exercise and Nutrition Routine Improving Cancer Health (ENRICH):

Bianchini, F.; Kaaks, R.; Vainio, H,; Weight control and physicalactivity in cancer

Borugian, M.J.; Sheps, S.B.; Kim-Sing, C.; Van Patten, C.; Potter, J.D.; Dunn, B.; Gallagher,

Campbell, K.L.; McTiernan, A.; Exercise and Biomarkers for Cancer Prevention Studies; *J.* 

Porter, P.L.; Brinton, L.A.; Eley, J.W.; Coates, R.J.; Recreational physical activity and

Wing, R.; Schatzkin, A.; Physical Activity, Weight Control, and Breast Cancer Risk and Survival: Clinical Trial Rationale and Design Considerations; *J Natl Cancer Inst*

Factors for the Incidence of Breast Cancer: Do They Affect Survival From the

and Glycemic Load in Relation to Breast Cancer Prognosis in the HEAL Cohort;

The protocol for a randomized efficacy trial of a nutrition and physical activity program for adult cancer survivors and carers. *BMC Public Health* 2011, 11:236

R.P.; Hislop, T.G.; Insulin, macronutrient intake, and physical activity: are potential indicators of insulin resistance associated with mortality from breast cancer? *Cancer* 

oncology treatment.

**3. Conclusions** 

reduce fatigue.

**4. References** 

**Human Services, 2008).** 

2009;101: 630 – 643

Disease? *J Clin Oncol* 26,20,10,2008

doi:10.1186/1471-2458-11-236

*Nutr.* 137: 161S–169S, 2007.

prevention. *Obes Rev. 2002*;3:5–8.

*Epidemiol Biomarkers Prev. 2004*;13:1163–72.

*Cancer Epidemiol Biomarkers Prev* 2011;20:890-899.

month per each phase in 24 months from the end of the specific medical or surgical


Rehabilitation in Cancer Survivors: Interaction Between Lifestyle and Physical Activity 191

Knols, R.; Aaronson, N. K.; Uebelhart, D.; Fransen, J.; Aufdemkampe, G.; Physical Exercise

Laky,B.; Janda, M.; Cleghorn, G.; Obermair A.; Comparison of different nutritional

LaPorte, R.E.; Montoye, H.J.; Caspersen, C.J.; Assessment of physical activity in

LaStayo, P.C.; Larsen, S.; Smith, S.; Dibble, L.; Marcus, R.; The Feasibility And Efficacy Of

Lau, J.; Ioannidis, J.P.; Schmid, C.H., Quantitative synthesis in systematic reviews. *Ann* 

Ligibel, J.A.; Campbell, N.; Partridge, A.; Chen, W.Y.; Salinardi, T.; Chen, H.;Adloff, K.;

Lyman, G.H.; Kuderer, N.M.; The strengths and limitations of metaanalysesbased on

Mathur N.; Pedersen B.K.; Exercise as a Mean to Control Low-Grade Systemic Inflammation

McNeely, M.L.; Campbell, K.L.; Rowe, B.H.; Klassen, T.P.; Mackey, J.R.; Courneya K.S.

McTiernan, A.; Rajan, K.B.; Tworoger, S.; Irwin, M.; Bernstein, L.; Baumgartner, R.; Gilliland,

McTiernan, A.; Tworoger, S.S.; Ulrich, C.M.; Yasui, Y.; Irwin, M.L.; Rajan, K.B.; Sorensen, B.;

McTiernan, A.; Irwin, M.; VonGruenigenWeight, V.;Physical Activity, Diet, and Prognosis in

McTiernan, A.; Irwin, M.; VonGruenigen, V.; Weight, Physical Activity, Diet, and Prognosis

Meyerhardt, J.A.; Giovannucci, E.L.; Holmes, M.D.; Chan, A.T.; Chan, J. A.; Colditz, G. A.,

Breast and Gynecologic Cancers.*J Clin Oncol 28.© 2010 (a)* 

in Breast and Gynecologic Cancers; *J Clin Oncol* 28,26,10,2010 (b)

aggregate data. *BMC Med Res Methodol.2005*;5:14.

meta-analysis; *CMAJ* • July 4, 2006 • 175(1) | 34

Lee, IM.; Physical activity in women: how much is good enough? *JAMA. 2003;*290:1377–9. Ligibel, J.A.; Campbell, N.; Partridge, A.; Chen, W.Y.; Salinardi, T.; Chen, H.; Adloff, K.;

gynecologic cancer patients1–3. *Am J Clin Nutr 2008;*87:1678–85.

Med Oncol

*26,.6, 2008* (a)

(b)

*Phys Ther. 2010* ; 33(3): 135–140

*Intern Med. 1997*;127:820–6.

doi:10.1155/2008/109502

(May 15), 2003: pp 1961-1966

trial. *Cancer Res. 2004;*64:2923–8.

*Oncol* 24,22,1,2006 (a)

in Cancer Patients During and After Medical Treatment: A Systematic Review of Randomized and Controlled Clinical Trials. *Journal of Clinical oncology vol 23,16,2005*

assessments and bodycomposition measurements in detecting malnutrition among

epidemiologic research: problems and prospects. *Public Health Rep. 1985*;100:131–46.

Eccentric Exercise With Older Cancer Survivors: A Preliminary Study ; *J Geriatr* 

Keshaviah, A.; Winer, E.P. Impact of a Mixed Strength and Endurance ExerciseIntervention on Insulin Levels in Breast Cancer Survivors; *J Clin Oncol* 

Keshaviah, A.; Winer E.P. Impact of a Mixed Strength and Endurance Exercise Intervention on Insulin Levels in Breast Cancer Survivors; *J Clin Oncol* 26,6,20,2008

; *Mediators of Inflammation* Volume 2008, Article ID 109502, 6 pages

Effects of exercise on breast cancer patients and survivors: a systematic review and

F.; Stanczyk, F.; Yasui, Y.; Ballard-Barbash R. Adiposity and Sex Hormones in Postmenopausal Breast Cancer Survivors ; *Journal of Clinical Oncology,* Vol 21, No 10

Rudolph, R.E.; Bowen, D.; Stanczyk, F.Z.; otter JD, Schwartz, R,S.; Effect of exercise on serum estrogens inpostmenopausal women:a 12-month randomized clinical

Fuchs, C.S.; Physical Activity and Survival After Colorectal Cancer Diagnosis; *J Clin* 


Giovannucci, E.; Insulin, Insulin-Like Growth Factors and Colon Cancer: A Review of the

Goodwin, P.J.; Boyd, N.F.; Body size and breast cancer prognosis: a critical review of the

Harvie, MN.; Howell, A.; Thatcher, N.; Baildam, A.; Campbell, I. Energy balance in patients

Hoffman-Goetz, L.; Apter, D.; Demark-Wahnefried, W.; Goran, MI,; McTiernan, A.;

Holick, C.N.; Newcomb, P.A.; Trentham-Dietz, A.; Titus-Ernstoff, L.; Bersch, A.J., Stampfer,

Holmes, M.D.; Chen, W.Y.; Feskanich, D.; Kroenke, C.H.; Colditz, G.A.; Physical activity and survival after breast cancer diagnosis. *JAMA. 2005*;293:2479–86. Med Oncol. (a) Holmes, M.D.; Chen, W.Y.; Feskanich, D.; et al. Physical Activity and Survival After Breast

Holmes, M.; MD, DrPH Wendy Chen, Y.; MD Feskanich, D.; ScD Candyce Kroenke, H.; ScD

Iodice, P.; Bellomo RG.; Gialluca, G.; Fanò, G.; Saggini, R.; Acute and cumulative effects of

Irwin, M.L.; Crumley, D.; McTiernan, A.; Bernstein, L., Baumgartner, R.; Gilliland, F.D.;

Irwin, M.L.; Smith, A,W.; McTiernan, A.; Ballard-Barbash, R.; Cronin, K.; Gilliland, F.D.;

Irwin, M.L.; Physical activity interventions for cancer survivors; *Br. J. Sports Med.* 2009;43;32-

Jernstrom, H.; Barrett-Connor, E.; Obesity, weight change, fasting insulin, proinsulin, c-

Kaaks, R.; Nutrition, hormones, and breast cancer: is insulin the missing link? *Cancer Causes* 

Karvinen, K.H.;. Courneya, K.S.; North, S.; et al. Associations between Exercise and Quality

eating, activity, and lifestyle study. *J Clin Oncol. 2008*;26:3958–64.

James, E.L.; Stacey, F.; Chapman, K.; Lubans, D.R.; Asprey, G.; Sundquist, K.;

with advanced NSCLC, metastatic melanoma and metastatic breast cancer receiving chemotherapy – a longitudinal study; *British Journal of Cancer (2005)* 92,

Reichman, ME.; Possible mechanisms mediating an association between physical

M.; Baron J.A.; Egan, K.M.; Willett, W.C.; Physical activity and survival after diagnosis of invasive breastcancer. *Cancer Epidemiol Biomarkers Prev. 2008*;17:379–86.

A. Colditz, G.; MD, DrPH. Physical Activity and Survival After Breast Cancer

focused high-frequency vibrations on the endocrine system and muscle strength.

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.* 

Baumgartner, R.N.; Baumgartner, K.B.; Bernstein, L.; Influence of pre- and postdiagnosis physical activity on mortality in breast cancer survivors: the health,

peptide, and insulin-like growth factor-1levels in women with and without breast cancer: the rancho bernardo study. *J Womens Health Gend Based Med. 1999;*8:1265–72.

of Life in Bladder Cancer Survivors: A Population-Based Study; *Cancer Epidemiol* 

Evidence*; J. Nutr.* 131: 3109S–3120S, 2001.

673 – 680

*2003;*97:1746–57

*Control. 1996*;7:605–25.

*Biomarkers Prev* 2007;16:984-990.

38;

evidence. *Breast Cancer Res Treat. 1990*;16:205–14.

activity and breast cancer. *Cancer.1998*;83:621–8.

Cancer Diagnosis *JAMA*. 2005;293(20):2479-2486 (b)

*Eur J Appl Physiol*. 2011 Jun;111(6):897-904.

Diagnosis ; *JAMA, May 25, 2005*—Vol 293, No. 20 2479 (c) Hutchison NA. *Cancer rehabilitation*. Minn Med. 2010 Oct;93(10):50-2


Rehabilitation in Cancer Survivors: Interaction Between Lifestyle and Physical Activity 193

Protani, M.; Coory, M.; Martin, J.H. Effect of obesity on survival of women with breast

Robinson-Cohen, C.; MS; Katz, R.; Phil, D.; Mozaffarian, D.; MD, DrPH; Dalrymple, L.S.;

Saggini, R.; Scuderi, N.; Bellomo, R.G.; Dessy, R.A.; Cancelli, F.; Iodice, P.; (2006) Selective

Sandhu, M.S.; Dunger, D. B.; Giovannucci, E.L.; Insulin, Insulin-Like Growth Factor-I (IGF-

Schmitz, K. H. 1; Holtzman J. 3,4,; Courneya K.S. 5; Masse, L.C. 6; CA Controlled Physical

Schmitz, K. H.; Holtzman, J.; Courneya, K.S.; Maˆsse, L.C.; Duval, S.; Kane, R.; Controlled

Segal, R.; Evans, W.; Johnson, D.; Smith, J.; Colletta, S.; Gayton, J.; Woodard, S.; Wells, G.;

Slattery, M.L.; Caan, B.J.; Physical activity and risk of recurrenceand mortality in breast

Stacey, A.; Kenfield,, Meir J;. Stampfer Giovannucci, E.; Chan, J.M.; Physical Activity and

Stoll, B.A.; Diet and exercise regimens to improve breast carcinoma prognosis. *Cancer.* 

Thune, I.; Furberg, A.S.; Physical activity and cancer risk: dose responseand cancer, all sites and site-specific. *Med Sci Sports Exerc. 2001*;33:S530–50. discussion S609-510. Torjesen, P.A.; Birkeland, K.I.; Anderssen, S.A.; Hjermann, I.; Holme, I.; Urdal, P.; Lifestyle

Trinh, L.; Plotnikoff, R.C.; Rhodes, R.E. et al. Associations Between Physical Activity and

and exercise study: a randomized trial. *Diabetes Care. 1997*;20:26–31. Trinh, L. 1; Plotnikoff R. C. 1,2,5; Rhodes R.E. 4; Scott North 3, and Courneya K. S.;

*of the National Cancer Institute*, Vol. 94, No. 13, July 3, 2002

analysis. *Cancer Epidemiol Biomarkers Prev* 2005;14:1588-1595.

635

*2009;169(22):2116-2123*

*J Clin 2003*;53;268-291

19:657-665. 2001

*2009*;18:87–95.

*1996*;78:2465–70.

868 (a)

Study. *J Clin Oncol 28. © 2011* 

*Epidemiol Biomarkers Prev* 2011;20:859-868.(b)

*2006*;42(suppl.1 to No.3) pag. 69-75

cancer: systematic review and meta-analysis; *Breast Cancer Res Treat* (210) 123:627–

MD, MPH; Ian de Boer, MD, MS; Sarnak, M.; MD, MS; Mike Shlipak, MD, MPH;David Siscovick, MD, MPH; Bryan Kestenbaum, MD, MS Physical Activity and Rapid Decline in Kidney Function Among Older Adults *Arch Intern Med.* 

development of muscular force in the rehabilitative context. *Eur Med Phys* 

I), IGF Binding Proteins, Their Biologic Interactions, and Colorectal Cancer; *Journal* 

Activity Trials in Cancer Survivors: A Systematic Review and Meta-analysis*. Cancer* 

Physical Activity Trials in Cancer Survivors: A Systematic Review and Meta-

Reid, R.;Structured Exercise Improves Physical Functioning in Women With Stages I and II Breast Cancer: Results of a Randomized Controlled Trial; *J Clin Oncol* 

cancer survivors: findings from the lace study. *Cancer Epidemiol Biomarkers Prev.* 

Survival After Prostate Cancer Diagnosis in the Health Professionals Follow-Up

changes may reverse development of the insulin resistance syndrome. The oslo diet

Associations Between Physical Activity and Quality of Life in a Population-Based Sample of Kidney Cancer Survivors, *Cancer Epidemiol Biomarkers Prev;* 2011;20:859-

Quality of Life in a Population-Based Sample of Kidney Cancer Survivors ; *Cancer* 


Meyerhardt, J.A.; Heseltine, D.; Niedzwiecki, D.; Hollis, D.; Saltz, L.B. Robert; Mayer, J.;

Colon Cancer: Findings From CALGB 89803; *J Clin Oncol 24,22,, 2006* (b) Meyerhardt, J. A.; Niedzwiecki, D.; Hollis, D.; Saltz, L. B;. Mayer, R. J.; Nelson,H.; Whittom,

Meyerhardt, J. A.; MD, MPH; Giovannucci, E. L.; MD, ScD; Ogino, S.; MD, PhD; Kirkner; G.

Mikkelsen, T.; Sondergaard, J.; Sokolowski, I.; Jensen, A.; Olesen, F.; *Cancer survivors'* 

Monninkhof, E.M., Elias, S.G.; Vlems, F.A.;, van der Tweel, I.; Schuit, A.J.; Voskuil, D.W.;

Mustian, K.M. Ph.D., M.P.H., A.C.S.M, F.S.B.M., Sprod, L.K. Ph.D.; Palesh, O.G.; Ph.D.;

Neilson, H. K.; Friedenreich, C.M.; Brockton, N.T.; Millikan R.C. Physical Activity and

Neilson, H.; Friedenreich, C.; Brockton, N.T.; et al. Physical Activity and Postmenopausal

Noble, M.; Caryl, R.; Kraemer L.; Sharratt, M.; UW WELL-FIT: the impact of supervised

Pietrangelo, T.; Mancinelli, R.; Toniolo, L.; Cancellara, L.; Paoli, A.; Puglielli, C.; Iodice, P.;

treatment for cancer; *Support Care Cancer* DOI 10.1007/s00520-011 1175-z Parmar , M.K.; Torri, V.; Stewart, L., Extracting summary statistics to perform meta-analyses of the published literature for survival endpoints. S*tat Med. 1998;*17:2815–34. Pierce, J.P.; Stefanick, M.L.; Flatt, S.W.; Natarajan, L.; Sternfeld, B., Madlensky, L.; Al-

Cancer Survivors. *Curr Sports Med Rep. 2009* ; 8(6): 325–330.

*Epidemiol Biomarkers Prev* 2009;18:11-27. (b)

Future Research; *Cancer Epidemiol Biomarkers Prev 2009*;18(1). (a)

*Clinical oncology vol 28,25,2008*

*Epidemiology. 2007;*18:137–57.

*2108* 

Epub 2009 Mar 5.

25:2345–51.

Oct;24(4):503-12.

Thomas, J.; Nelson, H.; Whittom,, R.; Hantel, A.; Schilsky, R. L.; Fuchs, C.S. Impact of Physical Activity on Cancer Recurrence and Survival in Patients With Stage III

R.; Hantel, A.; Thomas, J.; Fuchs, S.C,; Impact of Body Mass Index and Weight Change After Treatment on Cancer Recurrence and Survival in Patients With Stage III Colon Cancer: Findings From Cancer and Leukemia Group B 89803. *Journal of* 

J.;Chan, A. T. ; MD, MPH; Willett, W.; MD, DrPH; Fuchs, C. S.; MD, MPH Physical Activity and Male Colorectal Cancer Survival. *Arch Intern Med. 2009;169(22):2102-*

*rehabilitation needs in a primary health care context*. Fam Pract. 2009 Jun;26(3):221-30.

van Leeuwen, F.E.; Physical activity and breastcancer: a systematic review.

Luke, M.P.H. ; Peppone, J. Ph.D.; Janelsins, M.C. Ph.D.; Mohile, S.G.; M.D., Carroll, J. M.D.; Exercise for the Management of Side Effects and Quality of Life among

Postmenopausal Breast Cancer: Proposed Biologic Mechanisms and Areas for

Breast Cancer:Proposed Biologic Mechanisms and Areas for Future Research *Cancer* 

exercise programs on physical capacity and quality of life in individuals receiving

Delaimy, W.K., Thomson, C.A.; Kealey, S.; Hajek, R.; Parker, B.A.; Newman, V.A.; Caan, B.; Rock, C.L.; Greater survival after breast cancer in physically active women with high vegetable- fruit intake regardless of obesity. *J Clin Oncol.2007;* 

Doria, C.; Bosco, G.; D'Amelio, L.; di Tano, G.; Fulle, S.; Saggini, R.; Fanò, G.; Reggiani, C.; Effects of local vibrations on skeletal muscle trophism in elderly people: mechanical, cellular, and molecular events. *Int J Mol Med.* 2009


**13** 

**Fertility Preservation for Pre-Pubertal** 

R. Gerritse1,2, L. Bastings1,3, C.C.M. Beerendonk1, J.R. Westphal1, D.D.M. Braat1 and R. Peek1,4 *1Radboud University Nijmegen Medical Centre, Department Obstetrics and Gynaecology Nijmegen,* 

*2Koningin Beatrix Ziekenhuis Winterswijk, The Netherlands,* 

*3Jeroen Bosch Hospital 's Hertogenbosch,* 

*The Netherlands* 

**Girls and Young Female Cancer Patients** 

New protocols in the early diagnosis and treatment of cancer have led to major improvements in the long-term survival of patients. However, aggressive chemotherapy or radiotherapy of the pelvic region, often lead to infertility, due to the damage of the follicles and/or oocytes that are present in the ovaries. In women the probability of sterilization due to cancer therapy varies with age, the type of treatment, and the follicular reserve in the ovary. Safeguarding their reproductive potential is a very important issue for women that have not yet started or completed their family, and even more so in pre-pubertal girls. Several options, some of which are still in the experimental phase, can now be offered to

In this review, we will, after briefly describing the anatomy and physiology of an ovary, discuss the detrimental effects of chemotherapy and radiation on ovarian function. Subsequently, the various options that are currently available or are still in an experimental phase, for preserving fertility in women and pre-pubertal girls, will be discussed. These options (with the exception of option (i)), deal with cryopreserving either oocytes, embryos

i. Minimizing the effects of radiation of the inner pelvic region by transposing the ovaries

ii. Standard IVF procedures can be offered to women who are awaiting chemotherapy and radiotherapy for neoplastic disease. This procedure results in the generation of embryos that can be transferred after recovery of the disease. This option has its limitations, since it not only requires the presence of a male partner, but also delays cancer treatment during ovarian stimulation. In addition, the number of embryos that can be produced is restricted, and the chance of achieving a pregnancy after transfer of a cryo-preserved embryo is only 8-30%. Furthermore, the presence of estrogen-sensitive tumors is a contra-indication for this type of treatment, as high estradiol levels are induced during a normal IVF procedure, although alternative stimulation protocols with aromataseinhibitors are nowadays available for these specific patients. Most importantly, this

**1. Introduction** 

these women to (partially) preserve their fertility.

or ovarian tissue until the patient has been cured.

from the radiation area.

