This study examined the immune and inflammatory responses to resistance exercise in breast cancer survivors compared to healthy controls. Blood samples were taken before and after an acute bout of resistance exercise to measure leukocyte counts and cytokine levels. The results showed no significant differences between the groups in leukocyte counts, granulocytes, lymphocytes, monocytes, IL-6, IL-10, or TNF-α at any time point. Both groups did experience a significant increase in IL-6 two hours post and decrease in TNF-α 24 hours post exercise. However, the small sample size limits the ability to draw firm conclusions.

1. Background
Experimental Design & Methods
LEUKOCYTE, LEUKOCYTE SUBSETS, AND INFLAMMATORY CYTOKINE RESPONSE TO
RESISTANCE EXERCISE IN BREAST CANCER SURVIVORS
Robert C. Mills1,3
, Rachel Graff1,3,
Jacob Allen1,3
, Claudio L. Battaglini, FACSM1,2,3
,
Eric Ryan3
, A.C. Hackney, FACSM1,3,4
1
UNC EXERCISE ONCOLOGY RESEARCH LAB, 2
LINEBERGER COMPREHENSIVE CANCER CENTER,
3
DEPARTMENT OF EXERCISE AND SPORT SCIENCE, 4
NUTRITION, UNIVERSITY OF NORTH CAROLINA, CHAPEL HILL, NC
Purpose
Conclusions
=
Results
Physical Characteristics and Strength Breast Cancer Survivors
(mean ± SD)
Controls
(mean ± SD)
Age (yrs) 60 ± 12 56 ± 7
Height (cm) 168.6 ± 3.1 163.7 ± 6.8
Weight (kg) 75.6 ± 13.4 67.2 ± 6.3
Body Fat (%) 37.6 ± 10.3 37.6 ± 4.5
1-RM Leg Press (kg) 81.6 ± 20 79.5 ± 14.5
1-RM Lat Pull Down (kg) 33.2 ± 5.5 35.8 ± 6.8
1-RM Leg Extension (kg) 58.4 ± 15.1 60.3 ± 12.5
1-RM Seated Row (kg) 34.1 ± 5.3 38.8 ± 3.9
Abstract
Supported by UNC Lineberger Comprehensive Cancer Center and the Petro Kulynych Foundation
PURPOSE: The purpose of this pilot study was to examine the immune and inflammatory response to a single
bout of moderate-intensity resistance exercise (RE) in breast cancer survivors (BCS). METHODS: BCS (n=4) and
healthy controls (C) (n=8) completed an exercise session consisting of 3 sets of 10 repetitions at 70% of one
repetition-maximum on leg press, lateral pull down, leg extension, and seated row performed in a circuit fashion.
Blood samples were taken at baseline, immediately post (0h post), 2-hours post (2h post), and 24-hours post (24h
post) exercise and assessed for total leukocyte, granulocyte, lymphocyte, monocyte cell counts, and Interleukin 6
(IL-6), Interleukin 10 (IL-10), Tumor Necrosis Factor- α (TNF- α). Percent change (%Δ) scores from baseline-0h
post, baseline-2h post, and baseline-24h post were compared using mixed-model ANOVAs. RESULTS: There
were no significant differences between total leukocytes (p=0.560), granulocytes (p=0.239), lymphocytes
(p=0.257), or monocytes (p=0.721), nor differences between groups for each of the cytokines at each time point
after exercise. However, the RE did cause a significant up-regulation in IL-6 at 2-hours post (p=0.027) and a
significant down-regulation of TNF- α at 24-hours post in both groups (p=0.011). CONCLUSION: Findings suggest
that no difference exists in the immune or inflammatory response due to RE between BCS and C. However, an
anti-inflammatory response into recovery (i.e., decreased TNF- α at 24-hours post) was observed in both groups.
Large sample sizes are needed to support these findings.
•Acute, post-exercise inflammation is defined by intricate interactions between
cytokines, catabolic hormones, acute phase proteins and immune cells which
ultimately leads to variability in the internal endocrine and paracrine milieu (Pederson,
2000; Nieman, 2004).
•A well functioning immune system plays an integral role in maintaining overall
health and optimal physiological function. However, cancer and its treatments are
associated with higher inflammatory state and immunodeficiency, which often lasts
well beyond the completion of treatments and have been postulated to increase risk
of secondary infection as well as a risk of cancer recurrence (Fairey et al., 2005; Hutnick et
al., 2005).
•As a population that often experience chronic inflammation and
immunosuppression, cancer survivors are in need of interventions that promote less
inflammation and boost the immune system as a preventative strategy to improve
overall health and reduce chances of poorer long term prognosis.
•To date, few studies have examined the acute effects of exercise on the
inflammatory and immune system responses in breast cancer patients (Peters et al.,
1994; Nieman et al., 1995; Fairey et al. 2005). Furthermore, most of these studies have looked
at chronic aerobic exercise with no studies to date examining the effects of
resistance training. Examining markers of immunity and the inflammatory response
to an acute exercise bout may serve as an important initial step for the development
of more precise exercise prescriptions aimed to alleviate inflammation and improve
immune function in breast cancer survivors.
The purpose of this pilot study was to examine the immune and inflammatory
response to a single bout of moderate-intensity resistance exercise in breast cancer
survivors and to compare these responses to a group of age, fitness level, matched
apparently healthy women.
Breast Cancer Survivors (n = 4) Controls (n = 8)
Diagnosed with Stage I-III invasive breast cancer
Received chemotherapy
Completed surgery, chemotherapy, and radiation
therapy within 3-6 months prior to enrollment
No history of cancer diagnosis or treatment
Women, ages 40-70 years
Physically inactive for ≥ 1 year
Post-menopausal for ≥ 1 year
Not regular users of anti-inflammatory medications
Baseline Physiological Assessments
Parameter Assessment Method
Height Stadiometer (Perspective Enterprises, Portage, MI)
Body Mass Mechanical Scale (Detecto, Webb City, MO)
Resting Electrocardiogram GE Case Cardiosoft V. 6.6 ECG Diagnositic System
(General Electric, Palatine, IL)
Percent Body Fat Dual Energy X-ray Absorption (DEXA) scanner
(Hologic, Inc., Bedford, MA)
Muscular Strength 1-RM
Acute Resistance Exercise Bout and Blood Sampling
•3x10 repetitions at 70% of 1-RM of each exercise (leg press, lateral pull down, leg extension, and
seated row, respectively) with 30 to 45 seconds of rest between sets, and 1:30 seconds to 2
minutes of rest between subsequent circuits.
•Whole blood samples taken pre-exercise, immediately post-exercise, 2 hours post-exercise, and
24 hours post-exercise using a 22 gage Protectiv Plus catheter. The fourth sample was done
using standard venipuncture techniques.
Parameter Measurement Method
Total Leukocyte, Granulocyte,
Lymphocyte, and Monocyte Counts
COULTER® Ac•T diff™ Hematology Analyzer (Beckman Coulter, Inc.,
Brea, CA)
IL-6, IL-10 and TNF-α Enzyme linked immunosorbent assays (ELISA) Biolegend (San Diego,
USA)
Statistical Analysis
2x4 mixed model ANOVA, Bonferonni post-hoc, and independent samples t-tests
• There were no significant differences found between breast cancer survivors
and healthy controls for total leukocytes, granulocytes, lymphocytes, or
monocytes based on percent change (%Δ) scores.
• There were no significant differences observed between groups for IL-6, IL-10,
or TNF- α at each time point after exercise.
• The results of this study suggest that breast cancer survivors and healthy age-
matched controls exhibit similar immune and inflammatory responses to an
acute bout of resistance training.
• However, due to the small sample size and the preliminary nature of this study,
more research is needed to confirm or refute these findings.No significant differences were found between the BCS and Control groups for any physical characteristics and strength at baseline
*Denotes statistical significance (p ≤ 0.05) when compared to baseline.
†Denotes statistical significance (p ≤ 0.05) between BCS and control groups.
No significant differences were found between the breast cancer survivor group and the
control group using % Δ scores (baseline to all post-exercise time points) for any of the
dependent variables.
*References available upon request