Combined Aerobic And Strength Exercise Maintains Circulating Fgf-21 In Asian Breast Cancer Patients

PURPOSE: Combined aerobic and resistance training improves systemic inflammation and muscle mass in breast cancer survivors. However, whether combined exercise modulates novel metabolic hormones and alarmins is unknown. FGF-21 was reported to modulate glucose metabolism in physically active adults, while IL-33, a recently discovered alarmin, is prognostic for breast cancer outcomes. This study aimed to determine the effects of 3 months of combined aerobic and strength exercise on systemic FGF-21, FGF-23, IL-33 and cytokines in Asian breast cancer patients. METHODS: Patients with early stage (I-II) breast cancer underwent curative breast surgery and were randomized into a combined aerobic and strength exercise group (Age: 55.3 ± 9.2 years; BMI: 26.7 ± 3.8; N = 23) or observation group (Age: 49.3 ± 8.7 years ; BMI: 24.7 ± 4.6; N = 20) that spanned 3 months. Antecubital blood was collected at baseline, 3 months and 6 months. Serum concentration of cytokines (IL-10, IL-12, IL-33, IFN-γ, TNF-α) and myokines (FGF-21, FGF-23) were quantified using a customized magnetic bead panel (Milliplex®) and read with a Luminx 200™ instrument. Biomarker data were assessed by a 2-way [group (exercise vs. observation) by time (baseline, 3 months, 6 months)] analysis of variance (ANOVA). Data are reported as means ± SD, with significance set at P < 0.05. RESULTS: A significant main effect of intervention was observed for FGF-21 (P < 0.01), with patients in the exercise group presenting with higher FGF-21 at 3 months (73.16 ± 54.05 pg/mL vs. 46.47 ± 25.33 pg/mL) and 6 months (66.67 ± 50.03 pg/mL vs. 41.79 ±33.81 pg/mL), compared with the observation group. A significant main effect of exercise on IFN-γ (P < 0.05) was observed, with lower serum IFN-γ in the exercise group at 3 months (3.85 ± 4.34 pg/mL vs. 5.43 ± 7.28 pg/mL and 6 months (3.89 ± 4.58 pg/mL vs. 5.32 ± 8.1 pg/mL), compared with controls. No significant differences were observed between groups in other outcome measures. CONCLUSIONS: A 3-month aerobic and strength exercise program preserves serum FGF-21, possibly associated with better glucose control in breast cancer patients. Lower serum IFN-γ after exercise training may suggest an attenuated pro-inflammatory response, which may be linked to better immune outcomes.