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Fernández Ortega JA, de Paz Fernández JA. Câncer de mama e exercício fisico: revisão. Hacia Promoc. Salud [Internet]. 1º de janeiro de 2012 [citado 21º de novembro de 2024];17(1):135-53. Disponível em: https://revistasojs.ucaldas.edu.co/index.php/hacialapromociondelasalud/article/view/2028
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A prescrição de atividade física para as sobreviventes ao câncer de mama depende da evidencia que se pode obter do impacto fisiológico, psicológico e biológico do exercício físico sobre a diminuição do risco recidiva. Objetivos: O propósito deste artigo é revisar os diferentes estudos publicados sobre o impacto do exercício em pacientes com câncer de mama, que finalizaram o tratamento de quimioterapia e/ou radioterapia com o fim de identificar a intensidade, frequência, tempo de intervenção, duração das sessões, tipo de trabalho realizado e as diferentes variáveis avaliadas. Método: se desenvolveu uma revisão dos estudos experimentais publicados sobre este tema desde 1995, incluíram se 27 estudos e se examinou com frequência, intensidade, duração das sessões, tempo de intervenção e efeitos da atividade física sobre as variáveis de controle utilizadas. Resultados: Sete estudos (58%) desenvolveram o programa de exercício durante um período de 24 semanas, seis (50%) estabeleceram, realizaram 3 sessões por semana, em cinco (41%) a duração das sessões eram de 30 minutos, três (25%) implementaram uma intensidade 50 80% da FC Max. Seis estudos (50%) avaliaram o IMC, a porcentagem de massa grassa e a qualidade de vida, cinco (41%) avaliaram o VO2 máx., e dois (16%) utilizaram marcadores tumorais. Conclusões: Não se pôde estabelecer qual é a intensidade, volumem frequência e tempo de duração que tem um melhor impacto fisiológico em pacientes sobreviventes ao câncer de mama. De igual forma, não se estabeleceu o impacto da atividade física sobre os biomarcadores.
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Referências
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Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
McTiernan A, Kooperberg C, White E, et al. Women’s health initiative cohort study. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 2003;290(10):1331-6.
Lee IM. Physical activity and cancer prevention – data from epidemiologic studies. Med Sci Sports Exerc 2003;35(11):1823-7.
Moore DB, Folsom AR, Mink PJ, Hong CP, Anderson KE, Kushi LH. Physical activity and incidence of postmenopausal breast cancer. Epidemiology 2000;11:292-6.
Bardia A, Hartmann LC, Vachon CM, et al. Recreational physical activity and risk of postmenopausal breast cancer based on hormone receptor status. Arch Intern Med 2006;166:2478-83.
Lahmann PH, Friedenreich C, Schuit AJ, Salvini S, Allen NE, Key TJ, et al. Physical activity and breast cancer risk the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2007;16(1):36-42.
Hoffman-Goetz L, Apter D, Demark-Wahnefried W, Goran MI, McTiernan A, Reichman ME. Possible mechanisms mediating an association between physical activity and breast cancer. Cancer 1998;83(Suppl 3):621-8.
McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175(1):34-41.
Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Effects of exercise on quality of life in women living with breast cancer: A systematic review. The Breast Journal 2009;15(1):45-51.
Schwartz AL. Physical activity. Semin Oncol Nurs 2008;24(3):164-70.
Markes M, Brockow T, Resch K. Ejercicio para mujeres que reciben tratamiento adyuvante para el cáncer de mama. Biblioteca Cochrane Plus 2007;4:1-33.
McTiernan A. Behavioral risk factor en breast cancer: can risk be modifie? Oncologist 2003;8(4):326-34.
Gammon MD, John EM, Britton JA. Recreational and occupational physical activities and risk of breast cancer. J Natl Cancer Inst 1998 Jan 21;90(2):100-17.
Margolis KL, Mucci L, Braaten T, Kumle M, Lagerros YT, Adami HO, et al. Physical activity in different periods of life and the risk of breast cancer: The Norwegian-Swedish women’s lifestyle and health cohort study. Cancer. Epidemiol Biomarkers Prev 2005;14(1):27-32.
Friedenre C, Cust A. Physical activity and breast cancer risk: Impact of timing, type and dose of activity and population sub-group effects review article. Br J Sports Med 2006;42:636-47.
Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and sitespecific. Med Sci Sports Exerc 2001;33(Suppl 6):S530-50
Adams SA, Matthews CE, Hebert JR,Moore CG .,Cunningham JE., Shu X_O., et al. Association of physical activity with hormone receptor status: the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev 2006;15:1170-8.
Monninkhof E, Elias S, Vlems F, Schuit A, Voskuil D, Van Leeuwen F. Physical activity and breast cancer: a systematic review. Epidemiology 2007;18(1):137-57.
Friedenreich CM, Cust AE. Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med 2008;42:636-47.
Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ 2007;334:517-24.
Friedenreich C. Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiology, Biomarkers & Prevention 2001;10:287-301.
Westby M, Clarke M, Hopewell S, Ram F. Masking reviewers at the study inclusion stage in a systematic review of health care interventions (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000019/pdf) [Acceso 2009 Feb 21].
Ghersi D, Dickersin K. Impact of shared scientific or ethical review of multicentre clinical research on the quality of clinical research and the clinical research process (Protocol for a Cochrane Review). The Cochrane Library, (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000017.pub2/pdf) [Acceso 2009 Feb 21].
Clarke M, Stewart L, Tierney J, Williamson P. Individual patient data meta-analyses compared with meta-analyses based on aggregate data (Protocol for a Cochrane Review). The Cochrane Library, (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000007/pdf) [Acceso 2009 Feb 21].
Vist GE, Hagen KB, Devereaux PJ, Dianne Jackowski, Oxman AD. Outcomes of patients who participate in randomized controlled trials versus those of similar patients who do not participate (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000009/pdf) [Acceso 2009 Feb 21].
Villanueva EV, Wasiak J. N-of-1 trials for making therapy decisions (Protocol for a Cochrane Review). The Cochrane Library, (http://www.update-software.com) [Acceso 2009 Feb 21].
Olsen KL, Hopewell S, Dickersin K, Clarke M, Oxman AD. Publication bias in clinical trials (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000006/pdf) [Acceso 2009 Feb 21].
McDonald S, Crumley E, Eisinga A, Villanueva E. Search strategies to identify reports of randomized trials in MEDLINE (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000018.pub2/pdf) [Acceso 2009 Feb 21].
Slattery ML, Edwards S, Murtaugh MA, Swenney C, Herrick J, Byers T, et al. Physical activity and breast cancer risk among women in the southwestern United States. Ann Epidemiol 2007;17:342-53.
Latka RN, Alvarez-Reeves M, Cadmus L, Irwin ML. Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: the Yale exercise and survivorship study. J Cancer Surviv 2009;3:148-57.
Hsieh CC, Sprod LK, Hydock DS, Carter SD, Hayward R, Schneider CM. Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncol Nurs Forum 2008;35(6):909-15.
Klika RJ, Callahan KE, Golik KS. Exercise Capacity of a Breast Cancer Survivor: A Case Study. Med Sci Sports Exerc 2008;40(10):1711-6.
Ligibel JA, Campbell N, Partridge A, Chen WY, Salinardi T, Chen H, et al. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol 2008;26:907-12.
Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs 2005;9:56-63.
Rabin C, Bernardine B, Dunsiger S, Nash J, Trask P. Exercise and relaxation intervention for breast cancer survivors: feasibility, acceptability and effects. Psychooncology 2008;18(3):258-66.
Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2008;108:279-88.
Mock V, Frangakis C, Davidson N, Ropka M, Pickectt M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. Psychooncology 2005;14:464-77.
Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH. Home-based physical activity intervention for breast cancer patients. Am J Clin Oncol 2005;23:3577-87.
Schmitz KH, Ahmed R, Hannan P, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev 2005;14:1672-80.
Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. J Clin Oncol 2003;21:1660-8.
Kaltsatou A, Mameletzi D, Douka S. Physical and psychological benefits of a 24-week traditional dance program in breast cancer survivors. J Bodyw Mov Ther 2011;15:(2):162-167.
Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast. Cancer. J Clin Oncol 2007;25:1713-21.
Zhang SM HS, Hunter DJ, Giovannucci EL, Colditz GA, Willett WC. Folate intake and risk of breast cancer characterized by hormone receptor status. Epidemiol Biomarkers Prev 2005;14:2004-8.
Potter JD, Cerhan JR, Sellers TA, et al. Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women’s Health Study: how many kinds of breast cancer are there? Cancer Epidemiol Biomarkers Prev 1995;4:319-26.
Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Research and Treatment 2005;90:105-112.
Mishchenco V, Monogarov V. Fisiología de Deportista: Bases científicas de la preparación, fatiga y recuperación de los sistemas funcionales del organismo de los deportistas de alto nivel. Barcelona, España: Paidotribo; 2000.
Saltin B, Blomqvist G, Mitchell J, Johnson RJ, Wildenthal K, Chapman C. Response to exercise after bed rest and after training. Circulation 1968;38(Suppl 5):1-78.
Astrand P-O, Rodhal K, Lacour J-R, Duizabo D. Précis de Physiologie de l´exercice musculaire. Paris: Masson; 1994.
Busso T, Benoit H, Bonnefoy R, Feasson L, Lacour J. Effects of training frequency on the dynamics of performance response to a single training bout. J Appl Physiol 2002;92(2):572-80.
Weineck J. Manuel D´entrainement. Paris: Vigot; 1990.
Timmer EC, De Creé C, Belgium Z. Effect of energy deficiency on estrogen metabolist in female athletes. Med Sci Sports Exerc 2007;39(7):1090-7.
McTiernan A, Ulrich C, Slate S, Potter J. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes and Control 1998;9:487-509.
McTiernan A, Kooperberg C, White E. Recreational physical activity and the risk of breast cancer in postmenopausal women: The women’s health initiative cohort study. JAMA 2003;290(10):1331-6.
Woolf-May K. Exercise Prescription: Physiological foundations. A guide for health, sport and exercise professionals. Boston: Masson; 2008.
Hoffman-Goetz L. Exercise, natural immunity, and tumor metastasis. Med Sci Sports Exerc 1994 Feb;26(2):157-63.
Parkin DM, Bray F, Ferlay J, Pisani P. Global cancer statistics, 2002. CA Cancer J Clin 2005;55:74-108.
McTiernan A, Kooperberg C, White E, et al. Women’s health initiative cohort study. Recreational physical activity and the risk of breast cancer in postmenopausal women: the Women’s Health Initiative Cohort Study. JAMA 2003;290(10):1331-6.
Lee IM. Physical activity and cancer prevention – data from epidemiologic studies. Med Sci Sports Exerc 2003;35(11):1823-7.
Moore DB, Folsom AR, Mink PJ, Hong CP, Anderson KE, Kushi LH. Physical activity and incidence of postmenopausal breast cancer. Epidemiology 2000;11:292-6.
Bardia A, Hartmann LC, Vachon CM, et al. Recreational physical activity and risk of postmenopausal breast cancer based on hormone receptor status. Arch Intern Med 2006;166:2478-83.
Lahmann PH, Friedenreich C, Schuit AJ, Salvini S, Allen NE, Key TJ, et al. Physical activity and breast cancer risk the European prospective investigation into cancer and nutrition. Cancer Epidemiol Biomarkers Prev 2007;16(1):36-42.
Hoffman-Goetz L, Apter D, Demark-Wahnefried W, Goran MI, McTiernan A, Reichman ME. Possible mechanisms mediating an association between physical activity and breast cancer. Cancer 1998;83(Suppl 3):621-8.
McNeely ML, Campbell KL, Rowe BH, Klassen TP, Mackey JR, Courneya KS. Effects of exercise on breast cancer patients and survivors: a systematic review and meta-analysis. CMAJ 2006;175(1):34-41.
Bicego D, Brown K, Ruddick M, Storey D, Wong C, Harris SR. Effects of exercise on quality of life in women living with breast cancer: A systematic review. The Breast Journal 2009;15(1):45-51.
Schwartz AL. Physical activity. Semin Oncol Nurs 2008;24(3):164-70.
Markes M, Brockow T, Resch K. Ejercicio para mujeres que reciben tratamiento adyuvante para el cáncer de mama. Biblioteca Cochrane Plus 2007;4:1-33.
McTiernan A. Behavioral risk factor en breast cancer: can risk be modifie? Oncologist 2003;8(4):326-34.
Gammon MD, John EM, Britton JA. Recreational and occupational physical activities and risk of breast cancer. J Natl Cancer Inst 1998 Jan 21;90(2):100-17.
Margolis KL, Mucci L, Braaten T, Kumle M, Lagerros YT, Adami HO, et al. Physical activity in different periods of life and the risk of breast cancer: The Norwegian-Swedish women’s lifestyle and health cohort study. Cancer. Epidemiol Biomarkers Prev 2005;14(1):27-32.
Friedenre C, Cust A. Physical activity and breast cancer risk: Impact of timing, type and dose of activity and population sub-group effects review article. Br J Sports Med 2006;42:636-47.
Thune I, Furberg AS. Physical activity and cancer risk: dose-response and cancer, all sites and sitespecific. Med Sci Sports Exerc 2001;33(Suppl 6):S530-50
Adams SA, Matthews CE, Hebert JR,Moore CG .,Cunningham JE., Shu X_O., et al. Association of physical activity with hormone receptor status: the Shanghai Breast Cancer Study. Cancer Epidemiol Biomarkers Prev 2006;15:1170-8.
Monninkhof E, Elias S, Vlems F, Schuit A, Voskuil D, Van Leeuwen F. Physical activity and breast cancer: a systematic review. Epidemiology 2007;18(1):137-57.
Friedenreich CM, Cust AE. Physical activity and breast cancer risk: impact of timing, type and dose of activity and population subgroup effects. Br J Sports Med 2008;42:636-47.
Mutrie N, Campbell AM, Whyte F, McConnachie A, Emslie C, Lee L, et al. Benefits of supervised group exercise programme for women being treated for early stage breast cancer: Pragmatic randomised controlled trial. BMJ 2007;334:517-24.
Friedenreich C. Physical activity and cancer prevention: from observational to intervention research. Cancer Epidemiology, Biomarkers & Prevention 2001;10:287-301.
Westby M, Clarke M, Hopewell S, Ram F. Masking reviewers at the study inclusion stage in a systematic review of health care interventions (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000019/pdf) [Acceso 2009 Feb 21].
Ghersi D, Dickersin K. Impact of shared scientific or ethical review of multicentre clinical research on the quality of clinical research and the clinical research process (Protocol for a Cochrane Review). The Cochrane Library, (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000017.pub2/pdf) [Acceso 2009 Feb 21].
Clarke M, Stewart L, Tierney J, Williamson P. Individual patient data meta-analyses compared with meta-analyses based on aggregate data (Protocol for a Cochrane Review). The Cochrane Library, (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000007/pdf) [Acceso 2009 Feb 21].
Vist GE, Hagen KB, Devereaux PJ, Dianne Jackowski, Oxman AD. Outcomes of patients who participate in randomized controlled trials versus those of similar patients who do not participate (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000009/pdf) [Acceso 2009 Feb 21].
Villanueva EV, Wasiak J. N-of-1 trials for making therapy decisions (Protocol for a Cochrane Review). The Cochrane Library, (http://www.update-software.com) [Acceso 2009 Feb 21].
Olsen KL, Hopewell S, Dickersin K, Clarke M, Oxman AD. Publication bias in clinical trials (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000006/pdf) [Acceso 2009 Feb 21].
McDonald S, Crumley E, Eisinga A, Villanueva E. Search strategies to identify reports of randomized trials in MEDLINE (Protocol for a Cochrane Review). The Cochrane Library (http://onlinelibrary.wiley.com/doi/10.1002/14651858.MR000018.pub2/pdf) [Acceso 2009 Feb 21].
Slattery ML, Edwards S, Murtaugh MA, Swenney C, Herrick J, Byers T, et al. Physical activity and breast cancer risk among women in the southwestern United States. Ann Epidemiol 2007;17:342-53.
Latka RN, Alvarez-Reeves M, Cadmus L, Irwin ML. Adherence to a randomized controlled trial of aerobic exercise in breast cancer survivors: the Yale exercise and survivorship study. J Cancer Surviv 2009;3:148-57.
Hsieh CC, Sprod LK, Hydock DS, Carter SD, Hayward R, Schneider CM. Effects of a supervised exercise intervention on recovery from treatment regimens in breast cancer survivors. Oncol Nurs Forum 2008;35(6):909-15.
Klika RJ, Callahan KE, Golik KS. Exercise Capacity of a Breast Cancer Survivor: A Case Study. Med Sci Sports Exerc 2008;40(10):1711-6.
Ligibel JA, Campbell N, Partridge A, Chen WY, Salinardi T, Chen H, et al. Impact of a mixed strength and endurance exercise intervention on insulin levels in breast cancer survivors. J Clin Oncol 2008;26:907-12.
Campbell A, Mutrie N, White F, McGuire F, Kearney N. A pilot study of a supervised group exercise programme as a rehabilitation treatment for women with breast cancer receiving adjuvant treatment. Eur J Oncol Nurs 2005;9:56-63.
Rabin C, Bernardine B, Dunsiger S, Nash J, Trask P. Exercise and relaxation intervention for breast cancer survivors: feasibility, acceptability and effects. Psychooncology 2008;18(3):258-66.
Milne HM, Wallman KE, Gordon S, Courneya KS. Effects of a combined aerobic and resistance exercise program in breast cancer survivors: a randomized controlled trial. Breast Cancer Res Treat 2008;108:279-88.
Mock V, Frangakis C, Davidson N, Ropka M, Pickectt M, Poniatowski B, et al. Exercise manages fatigue during breast cancer treatment: A randomized controlled trial. Psychooncology 2005;14:464-77.
Pinto BM, Frierson GM, Rabin C, Trunzo JJ, Marcus BH. Home-based physical activity intervention for breast cancer patients. Am J Clin Oncol 2005;23:3577-87.
Schmitz KH, Ahmed R, Hannan P, Yee D. Safety and efficacy of weight training in recent breast cancer survivors to alter body composition, insulin, and insulin-like growth factor axis proteins. Cancer Epidemiol Biomarkers Prev 2005;14:1672-80.
Courneya KS, Mackey JR, Bell GJ, Jones LW, Field CJ, Fairey AS. Randomized controlled trial of exercise training in postmenopausal breast cancer survivors: Cardiopulmonary and quality of life outcomes. J Clin Oncol 2003;21:1660-8.
Kaltsatou A, Mameletzi D, Douka S. Physical and psychological benefits of a 24-week traditional dance program in breast cancer survivors. J Bodyw Mov Ther 2011;15:(2):162-167.
Daley AJ, Crank H, Saxton JM, Mutrie N, Coleman R, Roalfe A. Randomized trial of exercise therapy in women treated for breast. Cancer. J Clin Oncol 2007;25:1713-21.
Zhang SM HS, Hunter DJ, Giovannucci EL, Colditz GA, Willett WC. Folate intake and risk of breast cancer characterized by hormone receptor status. Epidemiol Biomarkers Prev 2005;14:2004-8.
Potter JD, Cerhan JR, Sellers TA, et al. Progesterone and estrogen receptors and mammary neoplasia in the Iowa Women’s Health Study: how many kinds of breast cancer are there? Cancer Epidemiol Biomarkers Prev 1995;4:319-26.
Isasi CR, Moadel RM, Blaufox MD. A meta-analysis of FDG-PET for the evaluation of breast cancer recurrence and metastases. Breast Cancer Research and Treatment 2005;90:105-112.
Mishchenco V, Monogarov V. Fisiología de Deportista: Bases científicas de la preparación, fatiga y recuperación de los sistemas funcionales del organismo de los deportistas de alto nivel. Barcelona, España: Paidotribo; 2000.
Saltin B, Blomqvist G, Mitchell J, Johnson RJ, Wildenthal K, Chapman C. Response to exercise after bed rest and after training. Circulation 1968;38(Suppl 5):1-78.
Astrand P-O, Rodhal K, Lacour J-R, Duizabo D. Précis de Physiologie de l´exercice musculaire. Paris: Masson; 1994.
Busso T, Benoit H, Bonnefoy R, Feasson L, Lacour J. Effects of training frequency on the dynamics of performance response to a single training bout. J Appl Physiol 2002;92(2):572-80.
Weineck J. Manuel D´entrainement. Paris: Vigot; 1990.
Timmer EC, De Creé C, Belgium Z. Effect of energy deficiency on estrogen metabolist in female athletes. Med Sci Sports Exerc 2007;39(7):1090-7.
McTiernan A, Ulrich C, Slate S, Potter J. Physical activity and cancer etiology: associations and mechanisms. Cancer Causes and Control 1998;9:487-509.
McTiernan A, Kooperberg C, White E. Recreational physical activity and the risk of breast cancer in postmenopausal women: The women’s health initiative cohort study. JAMA 2003;290(10):1331-6.
Woolf-May K. Exercise Prescription: Physiological foundations. A guide for health, sport and exercise professionals. Boston: Masson; 2008.
Hoffman-Goetz L. Exercise, natural immunity, and tumor metastasis. Med Sci Sports Exerc 1994 Feb;26(2):157-63.
