Participants will receive educational handouts and complete research testing to evaluate their physical condition prior to beginning the resistance training and dietary supplementation. Adherence will be assured as described below.

Participants will receive educational handouts and complete research testing to evaluate their physical condition prior to beginning the resistance training and placebo. Adherence will be assured as described below.

Both groups of participants will receive educational handouts that explain the Physical Activity Guidelines for Americans at enrollment.

Educational handouts

Individuals in both groups will participate in an individually tailored progressive resistance training program 3 times/week for 24 weeks. During weeks 1-4 participants will be supervised twice a week tapering to once a week in weeks 5-12, every other week in weeks 13-20 and then once a month in weeks 21-24 by an American College of Sports Medicine (ACSM) Certified Exercise Specialist (trainer).

Adherence: To assure fidelity and safety of the resistance training component of the intervention, participants will initially be supervised more frequently They will complete an exercise log for each of their sessions. As the supervision level for exercise is tapered, participants may receive reminders to exercise and take their supplement/placebo via text, phone, or e-mail as needed.

Resistance training

A medical quality protein supplement powder will be mixed with water or a sugar free drink mix to be taken daily within 60 minutes of training on exercise days or mid-morning on non-exercise days.

Supplementation

A placebo that appears to be identical to the medical quality protein supplement powder will be mixed with water or a sugar free drink mix to be taken daily within 60 minutes of training on exercise days or mid-morning on non-exercise days.

Placebo

Kirsten K. Ness, PT, PhD

This study is being conducted because low lean muscle mass is prevalent among childhood cancer survivors. Lean muscle is the non-fatty muscle tissue that makes up part of the body's lean body mass. Low lean muscle mass is associated with loss of overall body strength, declining mobility and eventually, loss of independence. Among childhood cancer survivors, low lean muscle mass may contribute to reduced physical functioning and a sense of fatigue with exertion, limiting ability to participate in adequate physical activity. Loss of strength and a sense of fatigue with repeated movement make it difficult to participate in daily activities.

Although there have not been exercise intervention studies among childhood cancer survivors specifically designed to evaluate the effects of resistance training on muscle mass, studies among individuals with chronic disease, including survivors of adult onset cancers, indicate that resistance exercise improves muscle mass, muscle strength, mobility, vitality and physical activity levels. Resistance training (weight lifting) is a form of physical activity that is designed to improve muscular fitness by exercising a muscle or a muscle group against external resistance.

The purpose of the study is to evaluate the effects of resistance training combined with either a protein supplement or a sports drink on changes in lean muscle mass in young adults who were treated for childhood cancer. The sports drink, for this study, is considered a placebo.

This double-blind placebo controlled study will randomize adult survivors of childhood cancer who are 18 to 44 years of age, greater than ten years post first cancer diagnosis, and with low lean muscle mass to two groups: Resistance Training + Supplement (RT+S) or Resistance Training + Placebo (RT+P). Randomization will be stratified by sex and age (18-29 and 30-44 years) in a block size of 4. Three weekly resistance training sessions will occur over a 24 week period. The participants, investigator, trainer and individuals involved in testing will be blind to group assignment.

Participants will receive information about physical activity and its health benefits. They will be randomly assigned to one of two groups to receive individually tailored resistance training three times per week for 24 weeks. One group will receive a protein supplement, while the other group will receive a sports drink (placebo).

To assess outcomes, participants will have the following research tests:

* Blood will be drawn to assess heart health.
* Questionnaires will be completed to assess physical activity and health as well as food intake.
* Blood pressure measurement.
* Electrocardiogram to assess heart health.
* Height, weight, waist and hip measurements.
* Lean muscle mass will be measured by dual x-ray absorptiometry (DEXA scan).
* Muscle strength will be measured by handgrip, knee extension, and ankle dorsiflexion.
* Walking speed to determine usual walking speed.
* Six-minute walk test to determine endurance.
* Physical activity will be monitored by having the participant complete a survey and wear a small recording device (accelerometer) for seven days.

Study Objectives:

* To evaluate the effects of 24-week supervised RT+S compared to RT+P on changes in lean muscle mass, muscle strength, walking speed, self-reported exhaustion and physical activity levels among childhood cancer survivors.
* To evaluate the effects of 24-week supervised RT+S compared to RT+P on changes in blood pressure, high density lipoprotein, triglycerides, abdominal obesity, fasting glucose, fasting insulin, and C-reactive protein among childhood cancer survivors.

Impact of Resistance Training-Protein Supplementation on Lean Muscle Mass in Childhood Cancer Survivors

Dual x-ray absorptiometry (DEXA) will be used to determine lean muscle mass. Fat free mass will be measured in the total body scanning mode.

Handgrip strength will be evaluated with a hand held dynamometer.

Knee extension strength will be evaluated with the Biodex System IV dynamometer.

Ankle dorsiflexion strength will be evaluated with the Biodex System IV dynamometer.

Usual walking speed will be evaluated by having participants complete a timed 10 meter walk test.

Endurance will be evaluated by having participants complete the six minute walk test in a level of corridor as outlined by the American Thoracic Society.

Participants will complete the physical activity monitor (PAM) component of the most recent release of the National Health and Nutrition Examination Survey to measure activity levels. The PAM collects information on intensity and duration of common activities like walking and jogging for seven consecutive days. Participants will receive an accelerometer with written instructions, programmed to begin recording 12:01 a.m. on the day after the baseline assessment (the week before they begin training) and the day after their final training appointment.

Blood pressure will be evaluated with a sphygmomanometer.

High density lipoprotein will be evaluated from fasting blood samples as part of a standard lipid panel.

Triglycerides will be evaluated from fasting blood samples as part of a standard lipid panel.

Abdominal obesity will be evaluated by measuring waist circumference with a Gulick tape measure to the nearest mm.

Glucose level will be measured from fasting blood samples.

Insulin level will be measure from fasting blood samples.

Highly sensitive C-reactive protein will be measured from fasting blood samples.

Measured using the vitality subscale of the Medical Outcomes Survey Short Form-36 (SF-36), version 2.

ATC Fitness

American Institute for Cancer Research

St. Jude Children's Research Hospital

Neoplasms

All Conditions

Carcinoma

Neoplasms, Glandular and Epithelial

Neoplasms by Histologic Type

The patients submitted to periampullary cancer surgery will receive sugar pills in the preoperative and postoperative period.

The probiotics pills are given orally in the amount of two pills twice a day as early as two days before surgery until ten days after surgery.

Probiotics

Sugar pill

The purpose of this study is to evaluate the effect of the probiotic use in patients with periampullary cancers undergone curative or palliative treatment considering nutritional status, postoperative complications, infection rate, length of hospitalization and mortality.

Effect of Probiotics in Patients Undergoing Surgery for Periampullary Neoplasms

Effect of the Probiotics Use in Patients Undergoing Surgery for Periampullary Neoplasia - A Randomized Clinical Trial

Death will be considered as the primary outcome related to complications of surgical treatment in postoperative period

To assess postoperative infection rate in patients submitted to periampullary cancer surgery using probiotics.

Study title	NCT ID	Conditions	Interventions	Eligibility	Organization
Impact of Resistance Training-Protein Supplementation on Lean Muscle Mass in Childhood Cancer Survivors	NCT02501460	Cancer	Educational han... Resistance trai... Supplementation Placebo	18 Years - 44 Years	St. Jude Children's Research Hospital
Effect of Probiotics in Patients Undergoing Surgery for Periampullary Neoplasms	NCT01468779	Periampullary C...	Probiotics Sugar pill	18 Years -	Hospital de Clinicas de Porto Alegre
Effect of Probiotics in Patients Undergoing Surgery for Periampullary Neoplasms	NCT01468779	Periampullary C...	Probiotics Sugar pill	18 Years -	Hospital de Clinicas de Porto Alegre

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