5. DISCUSSIONE
Analizzando i risultati emersi dallo studio si evince come, l’attenzione al miglioramento dello stile di vita sia fondamentale per una ripresa ottimale in donne operate di tumore al seno.
Le pazienti dichiarano di aver ottenuto evidenti miglioramenti, sia a livello fisico, quindi diminuzione di massa grassa, sia funzionale, con aumento della forza e mobilità articolare.
Come già accennato in precedenza, la maggior parte delle pazienti praticavano attività fisica, quindi, è stato un aspetto che ne ha facilitato il recupero.
Nella maggior parte dei casi l’attività fisica praticata è stata di tipo non supervisionato, preferendo le semplici camminate, all’attività in palestra.
Questo aspetto, risulta in prima analisi, molto importante per strutturare programmi che non medicalizzino troppo, categorie di soggetti che sono già stati sottoposti a prolungati trattamenti chirurgici e farmacologici, con potenziale accumulo di fattori di rischio cardiovascolare.
Gli esercizi consigliati sono stati adeguati alle capacità dei soggetti, con semplici attività di mobilità articolare e contro resistenza.
Da questo studio, risulta evidente che il mantenimento nella norma del peso corporeo, una buona massa magra, un’alimentazione mediterranea adeguata alle necessità del soggetto ed una quotidiana attività fisica moderata, siano fattori indispensabili che devono entrare a far parte della vita di ognuno di noi, in particolar modo, per persone con neoplasia.
Questa osservazione ha trovato recentemente riscontro anche in letteratura, dove sono state evidenziate strette correlazioni tra la BMI e la mortalità per cancro alla mammella.
Sicuramente l’approccio multidisciplinare con l’intervento di personale specializzato nel settore, consente una più agevole gestione e personalizzazione del programma.
6. BIBLIOGRAFIA
1. Abdel-Malek AK, D. Mukherjee and A. F. Roche, (1985), A method of construction of an index of obesity, Human Biology Vol. 57, No.
3 pp. 415-430, Atlanta.
2. ACS, Guidelines for nutrition and physical activity, (2017), American Cancer society.
3. Antony MP, Surakutty B, Vasu TA, Chisthi M, (2018), Risk factors for breast cancer among Indian women: A case-control study, 21(4):436-442, India.
4. Ballinger TJ, Reddy A, Althouse SK, Nelson EM, Miller KD, Sledge JS, (2018), Impact of primary breast cancer therapy on energetic capacity and body composition, Breast cancer research and treatment.
5. Bedogni G, Battistini N, Fantuzzi AL, (2001), Atti del corso ANDID sulla valutazione antropometrica dello stato nutrizionale, ANDID.
6. Bedogni G, Borghi A, Battistini N, (2001), Manuale di valutazione antropometrica dello stato nutrizionale, (ed. Edra), Milano.
7. Bedogni G, Cecchetto G, (2009), Manuale ANDID di valutazione dello stato nutrizionale, (ed. Seu).
8. Benedetti M, Zona A, Beccaloni E, Carere M, Comba P, (2017), Incidence of Breast, Prostate, Testicular, and Thyroid Cancer in Italian Contaminated Sites with Presence of Substances with Endocrine Disrupting Properties Int. J. Environ. Res. Public Health 2017, 14(4), 355.
9. Berentzen TL, Gamborg M, Holst C, Sorensen T, Baker JL, (2014), Body mass index in childhood and adult risk of primary liver cancer, 60(2):325-30, Denmark.
10. Block G, (1982), A review of validations of dietary assessment methods, American Journal of Epidemiology, 115(4):492-505.
11. Bohlen J, McLaughlin SL, Hazard-Jenkins H, Infante AM, Montgomery C, Davis M, Pistilli EE, (2018), Dysregulation of metabolic-associated pathways in muscle of breast cancer patients:
preclinical evaluation of interleukin-15 targeting fatigue. 9(4):701- 714, West Virginia University School of Medicine.
12. Brown JC, Winters-Stone K, Lee A, Schmitz KH, (2012), Cancer, physical activity and exercise, 2(4):2775-809, University of Pennsylvania, USA.
13. Bruce J, Williamson E, Lait C, Richmond H, Betteley L, Lall R, Petrou S, Rees S, Withers EJ, Lamb SE, Thompson AM, PROSPER Study Group,(2018), Randomised controlled trial of exercise to prevent shoulder problems in women undergoing breast cancer treatment: study protocol for the prevention of shoulder problems trial (UK PROSPER), ;8(3):e019078.
14. Buell P, Dunn J, (2006), Cancer mortality among Japanese Isei and Nisei of California, American cancer society, pp. 656-664.
15. Busin S, Nicosia N, Suardi C, Zambelli S, Hatfield F, (2007), Fitness la guida complete, International Science Association, (ed. Sporting club Leonardo da Vinci), Milano.
16. Cartabellotta A, Ciuro A, Salvioli S, Da roit M, Lazzari S, Crainich U, Inclimona F, Serafini F, (2016), Efficacia dell’esercizio fisico nei pazienti con patologie croniche, Evidence 8(9).
17. Castello A, Martin M, Ruiz A, Casas AM, Baena-Canada JM, Lope V, Antolín S, Sánchez P, Ramos M, Antón A, Muñoz M, Bermejo B, De Juan-Ferré A, Jara C, Chacón JI, Jimeno MA, Rosado P, Díaz E, Guillem V, Lluch A, Carrasco E, Pérez-Gómez B, Vioque J, Pollán M; EpiGEICAM Researchers, (2015), Lower breast cancer risk among women following the world cancer research fund and American Institute for cancer research lifestyle recommendations:
EPIGEICAM case-control study, 10(5):e0126096, Spain.
18. Catt S, Sheward J, Sheward E, Harder H, (2018), Cancer survivors' experiences of a community-based cancer-specific exercise programme: results of an exploratory survey. Volume 26, Issue 9, pp 3209–3216.
19. Chindapasirt J, (2015), Sarcopenia in cancer patients, Asian Pacific Journal of Cancer Prevention 16 (18), 8075-8077, Khon Kaen University, Tahiland.
20. Collins J, Noble S, Chester J, Coles B, Byrne A, (2014), The assessment and impact of sarcopenia in lung cancer: a systematic literature review, 4:e003697, United Kingdom.
21. Delrieu L, Pérol O, Fervers B, Friedenreich C, Vallance J, Febvey- Combes O, Pérol D, Canada B, Roitmann E, Dufresne A, Bachelot T, Heudel PE, Trédan O, Touillaud M, Pialoux V, (2018), A Personalized Physical Activity Program With Activity Trackers and a Mobile Phone App for Patients With Metastatic Breast Cancer:
Protocol for a Single-Arm Feasibility Trial, France.
22. Dittus KL, Harvey JR, Bunn JY, Kokinda ND, Wilson KM, Priest J, Pratley RE, (2018), Impact of a behaviorally-based weight loss intervention on parameters of insulin resistance in breast cancer survivors, 18(1):351, Burlington.
23. El Asmar M, Bechnak A, Fares J, Al Oweini D, Alrazim A, El Achkar A, Tamim H, (2018), Knowledge, attitudes and practices regarding breast cancer amongst lebanese females in Beirut, 19(3):625-631, American University of Beirut.
24. Farnè R, Regi ML, Arnold J, (2002), Educazione motoria, sport e curricolo, (ed.Guerini), Milano.
25. Fiatarone Singh MA, Gates N, Salgal N, Wilson GC, Brodaty H, Wen W, Baune BT, (2014), The study of mental and resistance training, study resistance training and/or cognitive training in mild cognitive impairment: a randomized, double blind, double sham controlled trial, 15(12):873-80, Australia.
26. Fong AJ, Faulkner G, Jones JM, Sabiston CM, (2018), A qualitative analysis of oncology clinicians' perceptions and barriers for physical activity counseling in breast cancer survivors, 3117-3126, Canada.
27. Garcia DO, Thomson CA, (2014), Physical activity and cancer survivorship, 768-779, Arizona.
28. Guillamo E, Travier N, Oviedo GR, Fonseca-Nunes A, Alamo JM, Cos F, Roca A, Nino O, Agudo A, Javierre C, (2018), A physical test to estimate suitable workloads for an exercise program in breast cancer survivors, Spain.
29. Guo W, Key TJ, Reeves GH, (2018), The sity and breast cancer risk in postmenopausal women: results from the UK Biobank prospective cohort, 143(5):1037-1046, University of Oxford.
30. Hamer J, Warner E, (2017), Lifestyle modification for patients with breast cancer to improve prognosis and optimize overall health.
31. Hangstrom A, Denham J, (2018), The effect of resistance training on telomere length in women recovering from breast cancer, 3(1), 9, J.
Funct. Morphol. Kinesiol.
32. Huang DD, Wang SL, Zhuang CL, Zhen BS, Luj X, Chen FF, Zhow CJ, Shen X, Yu Z, (2015), Sarcopenia as defined by low muscle mass, strength and physical performance, predicts complications after surgery for colorectal cancer, National Natural Science Foundation of China.
33. Han X, Stevens J, Truesdale KP, (2014), Body mass index at early adulthood, subsequent weight change and cancer incidence and mortality, 135(12): 2900–2909, Int J Cancer.
34. Kalantari N, Keshavarz Mohammadi N, Izadi P, Gholamalizadeh M, Doaei S, Eini-Zinab H, Salonurmi T, Rafieifar S, Janipoor R, Azizi Tabesh G, (2018), A complete linkage disequilibrium in a haplotype of three SNPs in Fat Mass and Obesity associated (FTO) gene was strongly associated with anthropometric indices after controlling for calorie intake and physical activity, 19(1):146, Iran.
35. Kenzik KM, Demark W, Ganz PA, Colditz G, Rock CL, Rogers LQ, (2018), Changes in body mass index and physical activity predict changes in vitality during a weight loss trial in breast cancer survivors, Annals of behaviourals Medicine.
36. Lee J, (2018), A Meta-analysis of the Association Between Physical Activity and Breast Cancer Mortality, Korea.
37. Lewis-Smith H, Diedrichs PC, Rumsey N, Harcourt D, (2018), Efficacy of psychosocial and physical activity-based interventions to improve body image among women treated for breast cancer: A systematic review, United Kingdom.
38. Lippincott, Williams, Wilkins, (2013), ACSM’s guidelines for exercise testing and prescription, American College of Sports Medicine.
39. Lozano-Lozano M, Galiano-Castillo N, Martín-Martín L, Pace- Bedetti N, Fernández-Lao C, Arroyo-Morales M, Cantarero- Villanueva I, (2018), Monitoring energy balance in breast cancer survivors using a mobile app: reliability study, 6(3):e67, Granada.
40. Le Boulch J, (2000), L’educazione del corpo nella scuola del domani, (ed. Magi), Roma.
41. Mascherini G, (2010), Prescrizione dell’esercizio fisico: approccio multidisciplinare, Dip. Scienze Fisiologiche, Università degli studi di Firenze.
42. McArdle W, Katch F, Katch V, (2009), Fisiologia applicata allo sport, aspetti energetici, nutrizionali e performance, (ed.Ambrosiana).
43. Miller AB, Choi NW, Howe GR, Mattews V, Morgan RW, Munan L, Burch JD, Feather J, Jain M, Kelly A, (1978), An epidemiologic study of breast cancer, American journal of epidemiology, vol 107, pp. 510- 521.
44. Mirandola D, Monaci M, Miccinesi G, Ventura L, Muraca ML, Casini E, Sgambati E, Manetti M, Marini M, (2017), Long-term benefits of adapted physical activity on upper limb performance and quality of life in breast cancer survivors, 2(4), 38, J. Funct. Morphol.
Kinesiol.
45. Murtezani A, Ibraimi Z, Bakalli A, Krasniqi S, Disha ED, Kurtishi I, (2014), The effect of aerobic exercise on quality of life among breast cancer survivors: a randomized controlled trial, 3:658-64, Journal of cancer research and therapeutics.
46. Mutschler NS, Scholz C, Friedl TWP, Zwingers T, Fashing PA, Beckmann MV, Fehm T, (2018), Prognostic impact of weight change during adjuvant chemotherapy in patients with high-risk early breast cancer: results from the ADEBAR Study, 2:175-183, Germany.
47. Park SW, Lee I, Kim JI, Park H, Lee JD, Uhm KE, Hwang JH, Lee ES, Jung SY, Park YH, Lee JY, (2018), Factors associated with physical activity of breast cancer patients participating in exercise intervention, South Korea.
48. Pasanisi P, Andreoli C, Angiolucci G, Bortul M, Branchini L, Ceccherini R, Costanzo MP, D’Amuri A, D’Angelo I, Friedman D, (2016), Epidemiologia del carcinoma mammario, Collegio Italiano dei Senologi.
49. Pearsons JJ, Hussain SR, (2015), A review on the mechanisms of blood-flow restriction resistance training-induced muscle hypertrophy, 45(2):187-200, Manchester.
50. Persson G, Brosson A, Ekvall H, (2013), Physical activity on prescription from the general practitioner’s prospective – a qualitative study, 14:128, Sweden.
51. Pizzi A, Incardona P, Nifosì MA, (2016), Attività motoria, benessere e salute. Attività motoria preventiva, compensativa adattata e fitness, Pisa University Press.
52. Prado EM, Lieffers JR, Bowthorpe L, Baracos VE, Mourtzakis M, McCargar LJ, (2013), Sarcopenia and physical function in overweight patients with advanced cancer, Canadian Journal of dietetic practice and research.
53. Psutka SP, Carrasco A, Schmit GD, Moynayh MR, Boorjan SA, Frank I, Stewart SB, Thapa P, Tarrel RF, Cheville JC, Tollefson MK, (2014), Sarcopenia in patients with bladder cancer undergoing radical cystectomy: impact on cancer- specific and all- cause mortality, 120(18):2910-8, Department of Urology, Minnesota.
54. Reis AD, Pereira PTVT, Diniz RR, DeCastro JL, Dos Santos AM, (2018), Effect of exercise on pain and functional capacity in breast cancer patients, 16(1):58, Brazil.
55. Romaguera D, Vergnaud AC, Vangils CH, Peeters PH, Chan DS, Ferrari P, Fagherazzi G, Olsen A, Lagiov P, Tumino R, Sieri S, Panico S, Riboli E, Norat T, (2012), Is concordance with World Cancer Research Fund / American Institute for Cancer Research guidelines for cancer prevention related to subsequent risk of cancer? Results from the EPIC study.
56. Scott JM, Iyengar NM, Nilsen TS, Michalski M, Thomas SM, (2018), Feasibility, safety, and efficacy of aerobic training in pretreated patients with metastatic breast cancer: A randomized controlled trial, 124(12):2552-2560, American Cancer Society.
57. Sheng JY, Sharma D, Jerome G, Santa-Maria CA, (2018), Obese Breast Cancer Patients and Survivors: Management Considerations, New York.
58. Shepard RJ, MC Graw Hill, (1998), Attività fisica, invecchiamento e salute, Milano.
59. Short CE, James EL, Vandelanotte C, Courneya KS, Duncan MJ, Rebar A, (2014), Correlates of resistance training in post treatment breast cancer survivors, 22(10):2757-66, Supportive Care Cancer.
60. Stefani L, Galanti G, Mazzoni F, Lunghi A, Costanzo FD, (2016), Percorso di recupero dello stile di vita attraverso la prescrizione dell’esercizio fisico nelle neoplasie, Università degli studi di Firenze.
61. Stefani L, Mascherini G, Galanti G, Il monitoraggio della attività fisica,http://www.aditechsrl.com/media/610819-
Innovazione_tecnologia_applicata_allo_sport.pdf
62. Stefani L, Palmerini D, Corezzi M, Mascherini G, Petri C, Riggs J Klika, Galanti G, (2017), Total Body Water Distribution in Breast Cancer Survivors Following Cancer Rehabilitation, 2(2) - 12, J. Funct.
Morphol. Kinesiol.
63. Stefani L, Petri C, Mascherini G, Galanti G, (2016), Lifestyle intervention in surviving cancer patients, Sports Medicine Center, Clinical and Experimental Department, School of Sports Medicine University of Florence.
64. Stefani L, Rotelli M, Frulli A, Amoroso L, Belloni L, Galanti G, (2016), Mental health and quality of life perception of surviving cancer patients: a pilot study, 1(3), 322-327, J. Funct. Morphol.
Kinesiol.
65. Turati F, Carioli G, Bravi F, Ferraroni M, Serraino D, Montella M, Giacosa A, Toffolutti F, Negri E, Levi F, La Vecchia C, (2018), Mediterranean Diet and Breast Cancer Risk, 10(3), 326, Nutrients 2018.
66. Vecellio V,(2014), Attivi contro il cancro. Attività motoria e home training per rinvigorire mente e corpo ( ed. Athesia).
67. Zhang P, Sui X, Hand GA, Hebert SR, Blair SN, (2014), Association of changes in fitness and body composition with cancer mortality in men, 46(7):1366-74, Medicine and Science in sports and exercise.
68. Zhao R, Zhao M, Xu Z, (2015), The effects of differing resistance training modes on the preservation of bone mineral density in postmenopausal women: a meta-analysis, 26(5):1605-18, College of Physical Education and Health Sciences, China.
69. Wang S, Huang Y, Mu X, Qi T, Qiao S, Lu Z, Li H, (2018), DNA methylation is related to the occurrence of breast cancer and is not affected by culture conditions, 7365-7371, China.
70. White E, Pivarnik J, Pfeiffer K, (2014), Resistance training during pregnancy and perinatal outcomes, 11(6):1141-8, Journal of physical activity and health.
71. WHO, (1995), Physical status: the use and interpretation of antropometry.
72. WHO, (1998), Obesity: preventing and managing the global epidemic.
73. WHO, (2013), Cancer prevention, guidelines for screening and treatment of precancerous lesions for cervical cancer prevention.
74. Wilmore J, Costill L, (2005), Fisiologia dell’esercizio fisico e dello sport, (ed. Calzetti Mariucci).
75. www.fondazioneveronesi.it 76. www.salute.gov.it
77. www.muoversiti.it
78. www.mypersonaltrainer.it 79. www.airc.it
80. www.registri-tumori.it 81. www.osteosalute.org
