Effect of exercise on biomarkers, fatigue, sleep disturbances, and depressive symptoms in older women with breast cancer receiving hormonal therapy.

School of Nursing, Duke University Medical Center, Durham, NC, USA. payne031@mc.duke.edu

PURPOSE/OBJECTIVES: To compare the effectiveness of a prescribed home-based walking exercise intervention with usual care in older women receiving hormonal treatment for breast cancer, and to examine relationships among levels of the cortisol, serotonin, interleukin-6, and bilirubin biomarkers and fatigue, sleep disturbances, and depressive symptoms. DESIGN: Longitudinal randomized clinical trial. SETTING: A National Cancer Institute-designated cancer center in the southeastern United States. SAMPLE: 20 women (aged 55 years or older) with breast cancer receiving hormonal treatment. METHODS: Participants were randomized to a walking exercise intervention or usual care. Laboratory samples and the Pittsburgh Sleep Quality Index (PSQI), the Piper Revised Fatigue Scale, and the Center for Epidemiological Studies-Depression Scale were collected at the initial clinic visit and at 12 weeks from the groups. Questionnaires also were collected at weeks 2 and 14. MAIN RESEARCH VARIABLES: Fatigue, sleep disturbances, depressive symptoms, biomarkers, and exercise. FINDINGS: Effect of the exercise intervention on sleep scores was highly significant between groups. Exercise group scores on the PSQI decreased significantly over time (indicating improved sleep quality), although scores did not change significantly within the control group. Sleep actigraphy also showed significantly shorter actual wake time and less movement in the exercise group. Serotonin levels also were significantly affected by the intervention. CONCLUSIONS: Data suggest that a walking exercise intervention improves sleep in older women receiving hormonal treatment for their breast cancer. Serotonin levels may be a useful biomarker when assessing sleep disturbances in this group. IMPLICATIONS FOR NURSING: Clinicians need to be aware that older women receiving hormonal treatment for their breast cancer may experience fatigue, sleep disturbances, and depressive symptoms. Homebased walking activity may reduce symptom severity in this group.

PMID: 18591167 [PubMed - in process]

One Key to Dieting: The No Choice Technique by Judith S. Beck, Ph.D.

One reason dieting is painful is that dieters often struggle with themselves over whether or not to eat something they know they shouldn’t. For example, you’re at someone’s house and even before you see them, you can smell the scent of fresh baked cookies. You begin to go back and forth in your mind about eating or not eating them.

Sabotaging Voice: Those cookies smell so good!
Logical Voice: You know you’re not supposed to have them.
Sabotaging Voice: But other people are eating them.
Logical Voice: It doesn’t matter. You’re dieting.
Sabotaging Voice: I don’t know if I can resist them!
Logical Voice: You’ll be sorry later.
Sabotaging Voice: Oh, I just don’t care. I’m going to have one anyway.

This internal struggle is unpleasant. Many times dieters end the struggle by giving in and eating. They get momentary pleasure, but then feel terrible afterwards.

One of the many techniques in The Beck Diet Solution to handle situations like this is learning how to say, “NO CHOICE.” If you think about it, you probably have put many things in your NO CHOICE category. When you walk through the mall, don’t you see dozens of things you wish you had? Why isn’t it a struggle to keep yourself from buying them? Because you don’t give yourself a choice.

Imagine how difficult it would be if you struggled over every item you wanted! “Oh, that big screen television looks great! I wish I could have it. I know I don’t have the money for it but I really want it. I know I have to pay for essentials first, but I don’t know if I can stand not having it!” Imagine if you struggled not only over this television, but also over items of clothing, electronics, DVDs, appliances, watches, furniture…It would be torture.

Fortunately, you don’t struggle over every item that calls your name. You don’t fight with yourself. Whether you’re aware of it or not, you’ve put these items in your “NO CHOICE” category. You need to do the same with food that you haven’t planned in advance to eat. Did your coworker offer you a brownie-but you brought low-fat yogurt for a snack? NO CHOICE. Is lasagne on the dinner menu at the restaurant-but you planned to have a salad topped with chicken? NO CHOICE.

Dieting will become so much easier when you do two things: When you accept the fact that you can eat whatever you want OR you can be thinner, but you can’t do both. And when you become proficient at saying, “NO CHOICE” to any food you hadn’t planned in advance to eat.

Judith S. Beck, Ph.D. is the Director of the Beck Institute for Cognitive Therapy and Research and a Clinical Associate Professor of Psychology in Psychiatry, University of Pennsylvania. Listen to her interview on Healthful Living’s Reality Sandwich Radio where she speaks in detail about The Beck Diet Solution.