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Lynch BM, van Roekel EH, Vallance JK. Physical activity and quality of life after colorectal cancer: overview of evidence and future directions. ACTA ACUST UNITED AC 2016. [DOI: 10.1080/23809000.2016.1129902] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Hubbard G, Adams R, Campbell A, Kidd L, Leslie SJ, Munro J, Watson A. Is referral of postsurgical colorectal cancer survivors to cardiac rehabilitation feasible and acceptable? A pragmatic pilot randomised controlled trial with embedded qualitative study. BMJ Open 2016; 6:e009284. [PMID: 26729381 PMCID: PMC4716214 DOI: 10.1136/bmjopen-2015-009284] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 08/28/2015] [Accepted: 10/19/2015] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES (1) Assess whether cardiac rehabilitation (CR) is a feasible and acceptable model of rehabilitation for postsurgical colorectal cancer (CRC) survivors, (2) evaluate trial procedures. This article reports the results of the first objective. DESIGN AND SETTING A pragmatic pilot randomised controlled trial with embedded qualitative study was conducted in 3 UK hospitals with CR facilities. Descriptive statistics were used to summarise trial parameters indicative of intervention feasibility and acceptability. Interviews and focus groups were conducted and data analysed thematically. PARTICIPANTS People with CRC were considered for inclusion in the trial if they were ≥ 18 years old, diagnosed with primary CRC and in the recovery period postsurgery (they could still be receiving adjuvant therapy). 31% (n=41) of all eligible CRC survivors consented to participate in the trial. 22 of these CRC survivors, and 8 people with cardiovascular disease (CVD), 5 CRC nurses and 6 CR clinicians participated in the qualitative study. INTERVENTION Referral of postsurgical CRC survivors to weekly CR exercise classes and information sessions. Classes included CRC survivors and people with CVD. CR nurses and physiotherapists were given training about cancer and exercise. RESULTS Barriers to CR were protracted recoveries from surgery, ongoing treatments and poor mobility. No adverse events were reported during the trial, suggesting that CR is safe. 62% of participants completed the intervention as per protocol and had high levels of attendance. 20 health professionals attended the cancer and exercise training course, rating it as excellent. Participants perceived that CR increased CRC survivors' confidence and motivation to exercise, and offered peer support. CR professionals were concerned about CR capacity to accommodate cancer survivors and their ability to provide psychosocial support to this group of patients. CONCLUSIONS CR is feasible and acceptable for postsurgical CRC survivors. A large-scale effectiveness trial of the intervention should be conducted. TRIAL REGISTRATION NUMBER ISRCTN63510637.
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Affiliation(s)
- Gill Hubbard
- School of Health Sciences, University of Stirling, Inverness, UK
| | - Richard Adams
- Institute of Cancer & Genetics, Cardiff University School of Medicine, Velindre Hospital, Cardiff, UK
| | - Anna Campbell
- Faculty of Life Science, Sport and Social Sciences, Edinburgh Napier University, Edinburgh, UK
| | - Lisa Kidd
- Faculty of Health and Social Care, Robert Gordon University Aberdeen, UK
| | | | - Julie Munro
- School of Health Sciences, University of Stirling, Inverness, UK
| | - Angus Watson
- NHS Highland, Colorectal Surgery, Raigmore Hospital, Inverness, UK
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103
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Gerritsen JKW, Vincent AJPE. Exercise improves quality of life in patients with cancer: a systematic review and meta-analysis of randomised controlled trials. Br J Sports Med 2015; 50:796-803. [PMID: 26719503 DOI: 10.1136/bjsports-2015-094787] [Citation(s) in RCA: 146] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2015] [Indexed: 01/10/2023]
Abstract
PURPOSE Exercise may be associated with increased health-related quality of life (QoL) in patients with cancer, but it is not prescribed as standard care during or after cancer treatment. We systematically reviewed the methodological quality of, and summarised the evidence from, randomised controlled trials (RCTs). A meta-analysis was performed to examine the effectiveness of exercise in improving the QoL in patients with cancer, during and after medical treatment. METHODS RCTs that met the PICO (Patient Intervention Control Outcome) format were included in this study. 16 RCTs were identified through a search of Embase, Medline (OvidSP) and the Cochrane Library. These trials were reviewed for substantive results and the methodological quality was assessed using the Delphi criteria list. RESULTS Exercise interventions differed widely in content, frequency, duration and intensity. Based on the meta-analysis, exercise improved QoL significantly in patients with cancer as compared to usual care (mean difference 5.55, 95% CI (3.19 to 7.90), p<0.001). Other outcomes closely related to QoL, such as fatigue and physical functioning, also improved. CONCLUSIONS Exercise has a direct positive impact on QoL in patients with cancer, during and following medical intervention. Exercise is a clinically relevant treatment and should be an adjunct to disease therapy in oncology.
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104
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Santa Mina D, Petrella A, Currie KL, Bietola K, Alibhai SMH, Trachtenberg J, Ritvo P, Matthew AG. Enablers and barriers in delivery of a cancer exercise program: the Canadian experience. ACTA ACUST UNITED AC 2015; 22:374-84. [PMID: 26715869 DOI: 10.3747/co.22.2650] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Exercise is an important therapy to improve well-being after a cancer diagnosis. Accordingly, cancer-exercise programs have been developed to enhance clinical care; however, few programs exist in Canada. Expansion of cancer-exercise programming depends on an understanding of the process of program implementation, as well as enablers and barriers to program success. Gaining knowledge from current professionals in cancer-exercise programs could serve to facilitate the necessary understanding. METHODS Key personnel from Canadian cancer-exercise programs (n = 14) participated in semistructured interviews about program development and delivery. RESULTS Content analysis revealed 13 categories and 15 subcategories, which were grouped by three organizing domains: Program Implementation, Program Enablers, and Program Barriers. ■ Program Implementation (5 categories, 8 subcategories) included Program Initiation (clinical care extension, research project expansion, program champion), Funding, Participant Intake (avenues of awareness, health and safety assessment), Active Programming (monitoring patient exercise progress, health care practitioner involvement, program composition), and Discharge and Follow-up Plan.■ Program Enablers (4 categories, 4 subcategories) included Patient Participation (personalized care, supportive network, personal control, awareness of benefits), Partnerships, Advocacy and Support, and Program Characteristics.■ Program Barriers (4 categories, 3 subcategories) included Lack of Funding, Lack of Physician Support, Deterrents to Participation (fear and shame, program location, competing interests), and Disease Progression and Treatment. CONCLUSIONS Interview results provided insight into the development and delivery of cancer-exercise programs in Canada and could be used to guide future program development and expansion in Canada.
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Affiliation(s)
- D Santa Mina
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Guelph-Humber, Toronto, ON; ; University of Toronto, Toronto, ON
| | - A Petrella
- Princess Margaret Cancer Centre, Toronto, ON
| | - K L Currie
- Princess Margaret Cancer Centre, Toronto, ON
| | - K Bietola
- University of Guelph-Humber, Toronto, ON
| | - S M H Alibhai
- University of Toronto, Toronto, ON; ; University Health Network, Toronto, ON
| | - J Trachtenberg
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Toronto, Toronto, ON
| | - P Ritvo
- School of Kinesiology and Health Science, York University, Toronto, ON; ; Cancer Care Ontario, Toronto, ON
| | - A G Matthew
- Princess Margaret Cancer Centre, Toronto, ON; ; University of Toronto, Toronto, ON
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105
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McNair AGK, Whistance RN, Forsythe RO, Rees J, Jones JE, Pullyblank AM, Avery KNL, Brookes ST, Thomas MG, Sylvester PA, Russell A, Oliver A, Morton D, Kennedy R, Jayne DG, Huxtable R, Hackett R, Dutton SJ, Coleman MG, Card M, Brown J, Blazeby JM. Synthesis and summary of patient-reported outcome measures to inform the development of a core outcome set in colorectal cancer surgery. Colorectal Dis 2015; 17:O217-29. [PMID: 26058878 PMCID: PMC4744711 DOI: 10.1111/codi.13021] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 05/05/2015] [Indexed: 12/14/2022]
Abstract
AIM Patient-reported outcome (PRO) measures (PROMs) are standard measures in the assessment of colorectal cancer (CRC) treatment, but the range and complexity of available PROMs may be hindering the synthesis of evidence. This systematic review aimed to: (i) summarize PROMs in studies of CRC surgery and (ii) categorize PRO content to inform the future development of an agreed minimum 'core' outcome set to be measured in all trials. METHOD All PROMs were identified from a systematic review of prospective CRC surgical studies. The type and frequency of PROMs in each study were summarized, and the number of items documented. All items were extracted and independently categorized by content by two researchers into 'health domains', and discrepancies were discussed with a patient and expert. Domain popularity and the distribution of items were summarized. RESULTS Fifty-eight different PROMs were identified from the 104 included studies. There were 23 generic, four cancer-specific, 11 disease-specific and 16 symptom-specific questionnaires, and three ad hoc measures. The most frequently used PROM was the EORTC QLQ-C30 (50 studies), and most PROMs (n = 40, 69%) were used in only one study. Detailed examination of the 50 available measures identified 917 items, which were categorized into 51 domains. The domains comprising the most items were 'anxiety' (n = 85, 9.2%), 'fatigue' (n = 67, 7.3%) and 'physical function' (n = 63, 6.9%). No domains were included in all PROMs. CONCLUSION There is major heterogeneity of PRO measurement and a wide variation in content assessed in the PROMs available for CRC. A core outcome set will improve PRO outcome measurement and reporting in CRC trials.
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Affiliation(s)
- A. G. K. McNair
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Severn School of SurgeryUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. N. Whistance
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - R. O. Forsythe
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Rees
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - J. E. Jones
- Colorectal Cancer Patient RepresentativeNorth Bristol NHS TrustBristolUK
| | | | - K. N. L. Avery
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - S. T. Brookes
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK
| | - M. G. Thomas
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - P. A. Sylvester
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - A. Russell
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - A. Oliver
- Colorectal Consumer Liaison GroupNational Cancer Research InstituteLondonUK
| | - D. Morton
- Academic Department of SurgeryUniversity of BirminghamBirminghamUK
| | - R. Kennedy
- Department of SurgerySt Mark's Hospital and Academic InstituteHarrowUK
| | - D. G. Jayne
- Academic Surgical UnitSt James' University Hospital NHS TrustLeedsUK
| | - R. Huxtable
- Centre for Ethics in MedicineUniversity of BristolBristolUK
| | - R. Hackett
- Colorectal Network Site Specific GroupAvon, Somerset and Wiltshire Cancer ServicesBristolUK
| | - S. J. Dutton
- Centre for Statistics in Medicine and Oxford Clinical Trials Research UnitNuffield Department of Orthopaedics, Rheumatology and Musculoskeletal SciencesUniversity of OxfordOxfordUK
| | - M. G. Coleman
- Department of Colorectal SurgeryPlymouth Hospitals NHS TrustPlymouthUK
| | - M. Card
- Colorectal Surgery UnitUniversity Hospitals Bristol NHS Foundation TrustBristolUK
| | - J. Brown
- Clinical Trials Research UnitUniversity of LeedsLeedsUK
| | - J. M. Blazeby
- Centre for Surgical ResearchSchool of Social and Community MedicineUniversity of BristolBristolUK,Division of Surgery Head and NeckUniversity Hospitals Bristol NHS Foundation TrustBristolUK
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106
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Møller T, Lillelund C, Andersen C, Bloomquist K, Christensen KB, Ejlertsen B, Nørgaard L, Wiedenbein L, Oturai P, Breitenstein U, Adamsen L. The challenge of preserving cardiorespiratory fitness in physically inactive patients with colon or breast cancer during adjuvant chemotherapy: a randomised feasibility study. BMJ Open Sport Exerc Med 2015; 1:e000021. [PMID: 27900123 PMCID: PMC5117008 DOI: 10.1136/bmjsem-2015-000021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 12/11/2022] Open
Abstract
Introduction Anti-neoplastic treatment is synonymous with an inactive daily life for a substantial number of patients. It remains unclear what is the optimal setting, dosage and combination of exercise and health promoting components that best facilitate patient adherence and symptom management in order to support cardio-respiratory fitness and lifestyle changes in an at-risk population of pre-illness physically inactive cancer patients. Methods Patients with breast or colon cancer referred to adjuvant chemotherapy and by the oncologists pre-screening verified as physically inactive were eligible to enter a randomised three-armed feasibility study comparing a 12-week supervised hospital-based moderate to high intensity exercise intervention or alternate an instructive home-based12-week pedometer intervention, with usual care. Results Using a recommendation based physical activity screening instrument in order to correspond with cardio-respiratory fitness (VO2 peak) proved to be an applicable method to identify pre-illness physically inactive breast and colon cancer patients. The study demonstrated convincing recruitment (67%), safety and intervention adherence among breast cancer patients; while the attendance rate for colon cancer patients was notably lower (33%). VO2-peak declined on average 12% across study groups from baseline to 12 weeks though indices towards sustaining watt performance and reduce fat mass favoured the hospital-based intervention. Pedometer use was well adapted in both breast and colon cancer patients. Conclusions Despite a fair adherence and safety, the current study calls into question whether aerobic exercise, regardless of intensity, is able to increase VO2-peak during texane-based chemotherapy in combination with Neulasta in physically inactive breast cancer patients. Trial Registration: ISRCTN24901641
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Affiliation(s)
- Tom Møller
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christian Lillelund
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Christina Andersen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Kira Bloomquist
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701 , Copenhagen , Denmark
| | - Karl Bang Christensen
- Faculty of Health and Medical Sciences, Section of Biostatistics , University of Copenhagen , Copenhagen , Denmark
| | - Bent Ejlertsen
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lone Nørgaard
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Liza Wiedenbein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Peter Oturai
- Department of Clinical Physiology, Nuclear Medicine and PET , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Ulla Breitenstein
- Department of Oncology 5073 , Copenhagen University Hospital Rigshospitalet , Copenhagen , Denmark
| | - Lis Adamsen
- The University Hospitals Centre for Health Care Research, UCSF Copenhagen University Hospital Rigshospitalet Department 9701, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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107
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The influence of high-intensity compared with moderate-intensity exercise training on cardiorespiratory fitness and body composition in colorectal cancer survivors: a randomised controlled trial. J Cancer Surviv 2015; 10:467-79. [PMID: 26482384 DOI: 10.1007/s11764-015-0490-7] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/05/2015] [Indexed: 12/22/2022]
Abstract
PURPOSE Following colorectal cancer diagnosis and anti-cancer therapy, declines in cardiorespiratory fitness and body composition lead to significant increases in morbidity and mortality. There is increasing interest within the field of exercise oncology surrounding potential strategies to remediate these adverse outcomes. This study compared 4 weeks of moderate-intensity exercise (MIE) and high-intensity exercise (HIE) training on peak oxygen consumption (V̇O2peak) and body composition in colorectal cancer survivors. METHODS Forty seven post-treatment colorectal cancer survivors (HIE = 27 months post-treatment; MIE = 38 months post-treatment) were randomised to either HIE [85-95 % peak heart rate (HRpeak)] or MIE (70 % HRpeak) in equivalence with current physical activity guidelines and completed 12 training sessions over 4 weeks. RESULTS HIE was superior to MIE in improving absolute (p = 0.016) and relative (p = 0.021) V̇O2peak. Absolute (+0.28 L.min(-1), p < 0.001) and relative (+3.5 ml.kg(-1).min(-1), p < 0.001) V̇O2 peak were increased in the HIE group but not the MIE group following training. HIE led to significant increases in lean mass (+0.72 kg, p = 0.002) and decreases in fat mass (-0.74 kg, p < 0.001) and fat percentage (-1.0 %, p < 0.001), whereas no changes were observed for the MIE group. There were no severe adverse events. CONCLUSIONS In response to short-term training, HIE is a safe, feasible and efficacious intervention that offers clinically meaningful improvements in cardiorespiratory fitness and body composition for colorectal cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS HIE appears to offer superior improvements in cardiorespiratory fitness and body composition in comparison to current physical activity recommendations for colorectal cancer survivors and therefore may be an effective clinical utility following treatment.
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108
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Rabin C, Pinto B, Fava J. Randomized Trial of a Physical Activity and Meditation Intervention for Young Adult Cancer Survivors. J Adolesc Young Adult Oncol 2015; 5:41-7. [PMID: 26812450 DOI: 10.1089/jayao.2015.0033] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Young adult cancer survivors have a number of increased health and psychosocial risks. To minimize these risks, they must address any modifiable risk factors, for example increase their physical activity (PA) and reduce stress. Unfortunately, more than half of young survivors remain sedentary, and few participate in a structured form of relaxation. This study evaluated the feasibility, acceptability, and effects of a theory-based PA and meditation intervention for young survivors. METHODS Young adult cancer survivors (age 18-39 years) were randomized to receive the 12-week "RElaxation aNd Exercise for Wellness" (RENEW) intervention right away (intervention group) or after a 12-week wait (control group). Participants were assessed at baseline, 12 weeks, and 24 weeks. RESULTS Thirty-five survivors were enrolled and randomized. Results indicate that 89% of intervention calls were delivered, and most participants felt that intervention goals and the number and duration of intervention calls were appropriate. Satisfaction ratings indicate that the intervention was acceptable, and 100% of participants would recommend it to others. Comparison of the intervention and control groups at the 12-week assessment (i.e., before controls received the intervention) revealed that the intervention group was performing more minutes of at least moderate intensity PA/week (p = 0.002; M = 113.8, SE = 23.5 vs. M = -8.7, SE = 27.1) and outperformed controls on a test of cardiovascular fitness (p = 0.008; M = -1.76, SE = 0.41 vs. M = -0.03, SE = 0.45). When data from the intervention and control groups were pooled, pre- to post-intervention analyses indicated a trend toward improved mood. CONCLUSION This theory-based intervention for young adult cancer survivors was feasible and acceptable, and may have helped survivors increase PA, improve fitness, and enhance mood.
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Affiliation(s)
- Carolyn Rabin
- 1 Clinical Psychology Department, William James College , Newton, Massachusetts
| | - Bernardine Pinto
- 2 College of Nursing, University of South Carolina , Columbia, South Carolina
| | - Joseph Fava
- 3 Centers for Behavioral and Preventive Medicine, The Miriam Hospital and Alpert Medical School of Brown University , Providence, Rhode Island
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109
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Becofsky K, Baruth M, Wilcox S. Physical activity mediates the relationship between program participation and improved mental health in older adults. Public Health 2015; 132:64-71. [PMID: 26318601 DOI: 10.1016/j.puhe.2015.07.040] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 06/12/2015] [Accepted: 07/16/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is an implicit assumption that increased physical activity (PA) levels are responsible for the mental health benefits resulting from participation in PA programs. Other factors associated with participation may in fact be responsible. The purpose of this study was to examine whether changes in PA mediated the effects of two PA programs (Active Choices [AC] and Active Living Every Day [ALED]) on mental health outcomes. STUDY DESIGN Secondary data analyses of quasi-experimental study. METHODS A sub-sample of older adults who participated in AC (n = 744) and ALED (n = 853) were included in the current analyses. MacKinnon's product of coefficients was used to test change in PA as a mediator of the relationship between program dose and change in mental health outcomes (depressive symptoms, stress, and number of days with poor mental health). RESULTS Change in PA explained 19% (AC) and 13% (ALED) of the absolute effects of program dose on depressive symptoms, 18% (AC) and 14% (ALED) of the effects on stress, and 37% (ALED) of the effects on days with poor mental health. CONCLUSIONS Mounting evidence from both epidemiological studies and controlled trials suggests that PA can improve mental health. This study adds that increasing PA levels may improve mental health in older adults in 'real-world' settings.
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Affiliation(s)
- K Becofsky
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA.
| | - M Baruth
- Department of Health Sciences, Saginaw Valley State University, 7400 Bay Road, University Center, MI 48710, USA
| | - S Wilcox
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA; Prevention Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29208, USA
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110
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Galdas P, Darwin Z, Fell J, Kidd L, Bower P, Blickem C, McPherson K, Hunt K, Gilbody S, Richardson G. A systematic review and metaethnography to identify how effective, cost-effective, accessible and acceptable self-management support interventions are for men with long-term conditions (SELF-MAN). HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundSelf-management support interventions can improve health outcomes, but their impact is limited by the numbers of patients able or willing to access them. Men’s attendance at, and engagement with, self-management support appears suboptimal despite their increased risk of developing serious and disabling long-term conditions (LTCs).ObjectivesTo assess the effectiveness, cost-effectiveness, accessibility and acceptability of self-management support interventions in men with LTCs.MethodsA quantitative systematic review with meta-analysis and a qualitative review using a metaethnography approach. The findings of the two reviews were integrated in parallel synthesis.Data sourcesIn the quantitative review, the Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by gender. In the qualitative review, the databases Cumulative Index to Nursing and Allied Health Literature, EMBASE, Medical Literature Analysis and Retrieval System Online, PsycINFO and Social Science Citation Index (July 2013) were searched from inception to July 2013.Review methodsIn the quantitative review, data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted independently by two reviewers using the Cochrane risk of bias tool. Meta-analysis was conducted to compare the effects of interventions in male, female and mixed-sex groups. In the metaethnography, study details, participant quotes (first-order constructs) and study authors’ themes/concepts (second-order constructs) were extracted. Quality appraisal was conducted independently by two reviewers using the Critical Appraisal Skills Programme tool. Data were synthesised according to a metaethnography approach. Third-order interpretations/constructs were derived from the extracted data and integrated to generate a ‘line-of-argument’ synthesis.ResultsForty RCTs of self-management support interventions in male-only samples, and 20 RCTs where an analysis by gender was reported, were included in the quantitative review. Meta-analysis suggested that interventions including physical activity, education and peer support have a positive impact on quality of life in men, and that men may derive more benefit than women from them, but there is currently insufficient evidence to draw definitive conclusions. Thirty-eight qualitative studies relevant to men’s experiences of, and perceptions of, self-management support were included in the qualitative review. The metaethnography identified four concepts: (1) need for purpose; (2) trusted environments; (3) value of peers; and (4) becoming an expert. Findings indicated that men may feel less comfortable engaging in support if it is perceived to be incongruous with valued aspects of masculine identities. Men may find support interventions more attractive when they have a clear purpose, are action-oriented and offer practical strategies that can be integrated into daily life. Support delivered in an environment that offers a sense of shared understanding can be particularly appealing to some men.ConclusionsHealth professionals and those involved in designing interventions may wish to consider whether or not certain components (e.g. physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this. Interventions are most likely to be accessible and acceptable to men when working with, not against, valued aspects of masculine identities.Study registrationThis study is registered as PROSPERO CRD42013005394.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Zoe Darwin
- School of Healthcare, Faculty of Medicine, University of Leeds, Leeds, UK
| | - Jennifer Fell
- Department of Health Sciences, University of York, York, UK
| | - Lisa Kidd
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Christian Blickem
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Kerri McPherson
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Kate Hunt
- Medical Research Council/Chief Scientist Office Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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111
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Comparison of the effects of a supervised exercise program and usual care in patients with colorectal cancer undergoing chemotherapy. Cancer Nurs 2015; 37:E21-9. [PMID: 23357886 DOI: 10.1097/ncc.0b013e3182791097] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although exercise has been addressed as a promising therapy for cancer adverse effects, few studies have evaluated the beneficial effects of exercise for colorectal cancer (CRC) patients during chemotherapy. OBJECTIVE The purpose of this study was to compare the effects of supervised-exercise intervention with those of usual care on cardiorespiratory fitness, muscle strength, fatigue, emotional distress, sleep quality, and quality of life (QoL) in patients with CRC undergoing chemotherapy. METHODS Patients with stage II or III CRC admitted for adjuvant chemotherapy were allocated to either a supervised-exercise group that received a combined aerobic and resistance exercise program or a "usual care" control group for 12 weeks. The outcomes, QoL, muscle strength, cardiorespiratory fitness, emotional distress, physical activity, fatigue, and sleep quality, were assessed at baseline and after intervention. RESULTS Significant interactions between intervention and time were observed for the role functioning and pain subscales of QoL and physical activity level. The time main effects were significant for the secondary outcomes: hand-grip strength, cardiorespiratory fitness, physical activity level, and physical functioning, role functioning, social functioning, fatigue, and pain subscales of QoL. CONCLUSION Compared with usual care, the supervised exercise demonstrated larger effects than usual care on physical activity level and role functioning and pain subscales of QoL. IMPLICATIONS FOR PRACTICE Supervised-exercise program is suggested to be incorporated as part of supportive care to promote the cardiorespiratory fitness, muscle strength, physical activity level, and QoL of patients with CRC undergoing chemotherapy.
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112
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Effects of a multiple health behavior change intervention for colorectal cancer survivors on psychosocial outcomes and quality of life: a randomized controlled trial. Ann Behav Med 2015; 48:359-70. [PMID: 24722960 DOI: 10.1007/s12160-014-9610-2] [Citation(s) in RCA: 84] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Multiple health behavior change can ameliorate adverse effects of cancer. PURPOSE The purpose of this study was to determine the effects of a multiple health behavior change intervention (CanChange) for colorectal cancer survivors on psychosocial outcomes and quality of life. METHODS A total of 410 colorectal cancer survivors were randomized to a 6-month telephone-based health coaching intervention (11 sessions using acceptance and commitment therapy strategies focusing on physical activity, weight management, diet, alcohol, and smoking) or usual care. Posttraumatic growth, spirituality, acceptance, mindfulness, distress, and quality of life were assessed at baseline, 6 and 12 months. RESULTS Significant intervention effects were observed for posttraumatic growth at 6 (7.5, p < 0.001) and 12 months (4.1, p = 0.033), spirituality at 6 months (1.8, p = 0.011), acceptance at 6 months (0.2, p = 0.005), and quality of life at 6 (0.8, p = 0.049) and 12 months (0.9, p = 0.037). CONCLUSIONS The intervention improved psychosocial outcomes and quality of life (physical well-being) at 6 months with most effects still present at 12 months. ( TRIAL REGISTRATION NUMBER ACTRN12608000399392).
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113
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Elkins MR, Moseley AM. Intention-to-treat analysis. J Physiother 2015; 61:165-7. [PMID: 26096012 DOI: 10.1016/j.jphys.2015.05.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 05/11/2015] [Indexed: 11/25/2022] Open
Affiliation(s)
- Mark R Elkins
- Sydney Medical School, The University of Sydney, Australia
| | - Anne M Moseley
- The George Institute for Global Health and Sydney Medical School, The University of Sydney, Australia
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114
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Van Blarigan EL, Meyerhardt JA. Role of physical activity and diet after colorectal cancer diagnosis. J Clin Oncol 2015; 33:1825-34. [PMID: 25918293 PMCID: PMC4438267 DOI: 10.1200/jco.2014.59.7799] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
This review summarizes the evidence regarding physical activity and diet after colorectal cancer diagnosis in relation to quality of life, disease recurrence, and survival. There have been extensive reports on adiposity, inactivity, and certain diets, particularly those high in red and processed meats, and increased risk of colorectal cancer. Only in the past decade have data emerged on how such lifestyle factors are associated with outcomes in colorectal cancer survivors. Prospective observational studies have consistently reported that physical activity after colorectal cancer diagnosis reduces mortality. A meta-analysis estimated that each 15 metabolic equivalent task-hour per week increase in physical activity after colorectal cancer diagnosis was associated with a 38% lower risk of mortality. No randomized controlled trials have been completed to confirm that physical activity lowers risk of mortality among colorectal cancer survivors; however, trials have shown that physical activity, including structured exercise, is safe for colorectal cancer survivors (localized to metastatic stage, during and after treatment) and improves cardiorespiratory fitness and physical function. In addition, prospective observational studies have suggested that a Western dietary pattern, high carbohydrate intake, and consuming sugar-sweetened beverages after diagnosis may increase risk of colorectal cancer recurrence and mortality, but these data are limited to single analyses from one of two US cohorts. Additional data from prospective studies and randomized controlled trials are needed. Nonetheless, on the basis of the available evidence, it is reasonable to counsel colorectal cancer survivors to engage in regular physical activity and limit consumption of refined carbohydrates, red and processed meats, and sugar-sweetened beverages.
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Affiliation(s)
- Erin L Van Blarigan
- Erin L. Van Blarigan, University of California San Francisco, San Francisco, CA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA.
| | - Jeffrey A Meyerhardt
- Erin L. Van Blarigan, University of California San Francisco, San Francisco, CA; and Jeffrey A. Meyerhardt, Dana-Farber Cancer Institute, Boston, MA
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115
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Park JH, Lee J, Oh M, Park H, Chae J, Kim DI, Lee MK, Yoon YJ, Lee CW, Park S, Jones LW, Kim NK, Kim SI, Jeon JY. The effect of oncologists' exercise recommendations on the level of exercise and quality of life in survivors of breast and colorectal cancer: A randomized controlled trial. Cancer 2015; 121:2740-8. [PMID: 25965782 DOI: 10.1002/cncr.29400] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 02/24/2015] [Accepted: 02/24/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND The purpose of the current study was to examine the effect of an oncologist's exercise recommendation with and without an exercise motivation package on the amount of exercise participation and quality of life (QOL) in survivors of breast and colorectal cancer. METHODS A total of 162 survivors of early-stage breast and colorectal cancer who completed primary and adjuvant treatments were recruited for the current study. Participants were randomly assigned into 1 of 3 groups: 1) control (59 patients); 2) those receiving an oncologist's exercise recommendation (53 patients); and 3) those receiving an oncologist's exercise recommendation with an exercise motivation package (50 patients). At baseline and after 4 weeks, the level of exercise participation and QOL were assessed. RESULTS Of the 162 participants, 130 (80.2%) completed the trial. Intention-to-treat analysis indicated that participants who received an oncologist's exercise recommendation with an exercise motivation package significantly increased their level of exercise participation in terms of minutes (47.57 added minutes per week; 95% confidence interval, 9.62-85.52 minutes [P =.022] vs control) and in Metabolic Equivalent of Task (MET)-hours per week (4.14 additional MET-hours per week; 95% confidence interval, 1.70-6.58 MET-hours [P =.004] vs control) compared with the control group. Participants who received only their oncologist's exercise recommendation did not increase their exercise participation level. Further analysis demonstrated that role functioning was significantly improved among participants who received an oncologist's exercise recommendation with an exercise motivation package. CONCLUSIONS Providing an exercise motivation package in addition to the oncologist's exercise recommendation to increase the level of exercise among survivors of breast and colorectal cancer should be considered.
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Affiliation(s)
- Ji-Hye Park
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Minsuk Oh
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Hyuna Park
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Jisuk Chae
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Dong-Il Kim
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Mi Kyung Lee
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Yong Jin Yoon
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Chul Won Lee
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Seho Park
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Seung Il Kim
- Department of Surgery, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
| | - Justin Y Jeon
- Department of Sport and Leisure Studies, Yonsei University, Seoul, Korea.,Exercise Medicine Center for Diabetes and Cancer Patients, Yonsei University College of Medicine, Yonsei University, Seoul, Korea
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Williams GR, Nyrop KA, Deal AM, Muss HB, Sanoff HK. Self-directed physical activity intervention in older adults undergoing adjuvant chemotherapy for colorectal cancer: Design of a randomized controlled trial. Contemp Clin Trials 2015; 42:90-7. [DOI: 10.1016/j.cct.2015.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 03/19/2015] [Accepted: 03/21/2015] [Indexed: 02/08/2023]
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Pergolotti M, Deal AM, Lavery J, Reeve BB, Muss HB. The prevalence of potentially modifiable functional deficits and the subsequent use of occupational and physical therapy by older adults with cancer. J Geriatr Oncol 2015; 6:194-201. [PMID: 25614296 PMCID: PMC4459887 DOI: 10.1016/j.jgo.2015.01.004] [Citation(s) in RCA: 103] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 10/30/2014] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND Occupational and physical therapy (OT/PT) services seek to reduce morbidity, mortality, and improve the quality of life of individuals; however, little is known about the needs and use of OT/PT for older adults with cancer. The goal of this study was to describe the functional deficits and their associations with other factors, and to examine the use of OT/PT after a noted functional deficit. MATERIALS AND METHODS This study analyzed data from an institution-based registry that included geriatric assessments of older adults with cancer linked to billing claims data. Logistic regression was used to model predictors of functional deficits. Use of OT/PT was determined and validated with medical chart review. RESULTS 529 patients with cancer, a median age of 71, 78% were female, 87% Caucasian, 57% married, 53% post-secondary education, and 63% with breast cancer were included. In a multivariable model, the odds of having any functional deficits increased with age [5 year OR: 1.31, 95% CI: (1.10, 1.57)] were higher for those with a high school diploma versus those with advanced degrees [OR: 1.66, 95% CI: (1.00, 2.77)] and were higher for patients with comorbidities [OR: 1.15, 95% CI: (1.10, 1.21)]. Of patients with functional deficits only 9% (10/111) received OT/PT within 12 months of a noted deficit. DISCUSSION The odds of having any potentially modifiable functional deficit were higher in patients with increasing age, comorbid conditions, and with less than a college degree. Few were referred for OT/PT services suggesting major underutilization of these potentially beneficial services.
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Affiliation(s)
- Mackenzi Pergolotti
- Cancer Care Quality Training Program, Department of Health Policy and Management, 1102G McGavran-Greenberg Hall, CB# 7411, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
| | - Allison M Deal
- Biostatistics and Clinical Data Management Core, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 450 West Drive, CB#7295, Chapel Hill, NC 27599, USA.
| | - Jessica Lavery
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY 10032, USA.
| | - Bryce B Reeve
- Department of Health Policy and Management, 1101D McGavran-Greenberg Hall, Campus Box 7411, UNC Gillings School of Global Public Health, 135 Dauer Drive, Chapel Hill, NC 27599, USA.
| | - Hyman B Muss
- Department of Geriatric Oncology, University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, 170 Manning Drive, Chapel Hill, NC 27599, USA.
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Snowden MB, Steinman LE, Carlson WL, Mochan KN, Abraido-Lanza AF, Bryant LL, Duffy M, Knight BG, Jeste DV, Leith KH, Lenze EJ, Logsdon RG, Satariano WA, Zweiback DJ, Anderson LA. Effect of physical activity, social support, and skills training on late-life emotional health: a systematic literature review and implications for public health research. Front Public Health 2015; 2:213. [PMID: 25964921 PMCID: PMC4410348 DOI: 10.3389/fpubh.2014.00213] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/13/2014] [Indexed: 12/05/2022] Open
Abstract
PURPOSE Given that emotional health is a critical component of healthy aging, we undertook a systematic literature review to assess whether current interventions can positively affect older adults' emotional health. METHODS A national panel of health services and mental health researchers guided the review. Eligibility criteria included community-dwelling older adult (aged ≥ 50 years) samples, reproducible interventions, and emotional health outcomes, which included multiple domains and both positive (well-being) and illness-related (anxiety) dimensions. This review focused on three types of interventions - physical activity, social support, and skills training - given their public health significance and large number of studies identified. Panel members evaluated the strength of evidence (quality and effectiveness). RESULTS In all, 292 articles met inclusion criteria. These included 83 exercise/physical activity, 25 social support, and 40 skills training interventions. For evidence rating, these 148 interventions were categorized into 64 pairings by intervention type and emotional health outcome, e.g., strength training targeting loneliness or social support to address mood. 83% of these pairings were rated at least fair quality. Expert panelists found sufficient evidence of effectiveness only for skills training interventions with health outcomes of decreasing anxiety and improving quality of life and self-efficacy. Due to limitations in reviewed studies, many intervention-outcome pairings yielded insufficient evidence. CONCLUSION Skills training interventions improved several aspects of emotional health in community-dwelling older adults, while the effects for other outcomes and interventions lacked clear evidence. We discuss the implications and challenges in moving forward in this important area.
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Affiliation(s)
- Mark B. Snowden
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Lesley E. Steinman
- Health Promotion Research Center, University of Washington, Seattle, WA, USA
| | - Whitney L. Carlson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Kara N. Mochan
- University of Washington School of Nursing with Environmental Health Focus, Seattle, WA, USA
- Adolescent Medicine, Seattle Children’s, Seattle, WA, USA
| | - Ana F. Abraido-Lanza
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, USA
| | - Lucinda L. Bryant
- Department of Community and Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - Michael Duffy
- Department of Educational Psychology, Counseling Psychology Program, Texas A&M University, College Station, TX, USA
| | - Bob G. Knight
- Davis School of Gerontology and Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Dilip V. Jeste
- Sam and Rose Stein Institute for Research on Aging and Department of Psychiatry, University of California San Diego, San Diego, CA, USA
| | | | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
| | - Rebecca G. Logsdon
- Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle, WA, USA
| | | | - Damita J. Zweiback
- Division of Chronic Disease and Injury Prevention, Michigan Department of Community Health, Lansing, MI, USA
- Healthy Aging Council and Health Equity Council, National Association of Chronic Disease Directors, Atlanta, GA, USA
| | - Lynda A. Anderson
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
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Hubbard G, Campbell A, Davies Z, Munro J, Ireland AV, Leslie S, Watson AJ, Treweek S. Experiences of recruiting to a pilot trial of Cardiac Rehabilitation In patients with Bowel cancer (CRIB) with an embedded process evaluation: lessons learned to improve recruitment. Pilot Feasibility Stud 2015; 1:15. [PMID: 27965794 PMCID: PMC5154094 DOI: 10.1186/s40814-015-0009-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 03/24/2015] [Indexed: 11/10/2022] Open
Abstract
Background Recruitment to randomised controlled trials (RCTs) is a perennial problem. Calls have been made for trialists to make recruitment performance publicly available. This article presents our experience of recruiting to a pilot RCT of cardiac rehabilitation for patients with bowel cancer with an embedded process evaluation. Methods Recruitment took place at three UK hospitals. Recruitment figures were based on the following: i) estimated number of patient admissions, ii) number of patients likely to meet inclusion criteria from clinician input and iii) recruitment rates in previous studies. The following recruitment procedure was used:Nurse assessed patients for eligibility. Patients signed a screening form indicating interest in and agreement to be approached by a researcher about the study. An appointment was made at which the patient signed a consent form and was randomised to the intervention or control group.
Information about all patients considered for the study and subsequently included or excluded at each stage of the recruitment process and reasons given were recorded. Results There were variations in the time taken to award Research Management approval to run the study at the three sites (45–359 days). Sixty-two percent of the original recruitment estimate was reached. The main reason for under-recruitment was due to over-estimation of the number of patient admissions; other reasons were i) not assessing all patients for eligibility, ii) not completing a screening form for eligible patients and iii) patients who signed a screening form being lost to the study before consenting and randomisation. Conclusions Pilot trials should not simply aim to improve recruitment estimates but should also identify factors likely to influence recruitment performance in a future trial and inform the development of that trial’s recruitment strategies. Pilot trials are a crucial part of RCT design. Nevertheless, pilot trials are likely to be small scale, involving only a small number of sites, and contextual differences between sites are likely to impact recruitment performance in any future trial. This means that ongoing monitoring and evaluation in trials are likely to be required. Trial registration ISRCTN63510637; UKCRN id 14092.
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Affiliation(s)
- Gill Hubbard
- Cancer Care Research Centre, School of Health Sciences, University of Stirling, Highland Campus, Old Perth Road, Inverness, IV2 3JH UK
| | - Anna Campbell
- Faculty of Life Science, Sport and Social Sciences, Edinburgh Napier University, Sighthill Campus, Edinburgh, EH11 4BN UK
| | - Zoe Davies
- Cancer Trials Unit, Tower Block 2, Room 20, UHW, Heath Park, Cardiff, CF14 4XW UK
| | - Julie Munro
- Cancer Care Research Centre, School of Health Sciences, University of Stirling, Highland Campus, Old Perth Road, Inverness, IV2 3JH UK
| | - Aileen V Ireland
- Cancer Care Research Centre, School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Stephen Leslie
- Cardiac Unit, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ UK
| | - Angus Jm Watson
- NHS Highland, Inverness, IV2 3BW UK ; Colorectal Surgery, Raigmore Hospital, Old Perth Road, Inverness, IV2 3UJ UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, 3rd Floor, Health Sciences Building, Foresterhill, Aberdeen, AB25 2ZD UK
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Steins Bisschop CN, Courneya KS, Velthuis MJ, Monninkhof EM, Jones LW, Friedenreich C, van der Wall E, Peeters PHM, May AM. Control group design, contamination and drop-out in exercise oncology trials: a systematic review. PLoS One 2015; 10:e0120996. [PMID: 25815479 PMCID: PMC4376879 DOI: 10.1371/journal.pone.0120996] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 02/09/2015] [Indexed: 11/19/2022] Open
Abstract
Purpose Important considerations for exercise trials in cancer patients are contamination and differential drop-out among the control group members that might jeopardize the internal validity. This systematic review provides an overview of different control groups design characteristics of exercise-oncology trials and explores the association with contamination and drop-out rates. Methods Randomized controlled exercise-oncology trials from two Cochrane reviews were included. Additionally, a computer-aided search using Medline (Pubmed), Embase and CINAHL was conducted after completion date of the Cochrane reviews. Eligible studies were classified according to three control group design characteristics: the exercise instruction given to controls before start of the study (exercise allowed or not); and the intervention the control group was offered during (any (e.g., education sessions or telephone contacts) or none) or after (any (e.g., cross-over or exercise instruction) or none) the intervention period. Contamination (yes or no) and excess drop-out rates (i.e., drop-out rate of the control group minus the drop-out rate exercise group) were described according to the three design characteristics of the control group and according to the combinations of these three characteristics; so we additionally made subgroups based on combinations of type and timing of instructions received. Results 40 exercise-oncology trials were included based on pre-specified eligibility criteria. The lowest contamination (7.1% of studies) and low drop-out rates (excess drop-out rate -4.7±9.2) were found in control groups offered an intervention after the intervention period. When control groups were offered an intervention both during and after the intervention period, contamination (0%) and excess drop-out rates (-10.0±12.8%) were even lower. Conclusions Control groups receiving an intervention during and after the study intervention period have lower contamination and drop-out rates. The present findings can be considered when designing future exercise-oncology trials.
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Affiliation(s)
| | - Kerry S. Courneya
- Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada
| | - Miranda J. Velthuis
- Comprehensive Cancer Center the Netherlands (IKNL), Utrecht, the Netherlands
| | - Evelyn M. Monninkhof
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Lee W. Jones
- Memorial Sloan-Kettering Cancer Center, New York, New York, United States of America
| | - Christine Friedenreich
- Department of Population Health Research, Cancer Control Alberta, Alberta Health Services, Calgary, Canada
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Canada
- Department of Oncology, Faculty of Medicine, University of Calgary, Calgary, Canada
| | | | - Petra H. M. Peeters
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
| | - Anne M. May
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, the Netherlands
- * E-mail:
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Galdas P, Fell J, Bower P, Kidd L, Blickem C, McPherson K, Hunt K, Gilbody S, Richardson G. The effectiveness of self-management support interventions for men with long-term conditions: a systematic review and meta-analysis. BMJ Open 2015; 5:e006620. [PMID: 25795688 PMCID: PMC4368927 DOI: 10.1136/bmjopen-2014-006620] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To assess the effectiveness of self-management support interventions in men with long-term conditions. METHODS A quantitative systematic review with meta-analysis. DATA SOURCES The Cochrane Database of Systematic Reviews was searched to identify published reviews of self-management support interventions. Relevant reviews were screened to identify randomised controlled trials (RCTs) of self-management support interventions conducted in men alone, or which analysed the effects of interventions by sex. REVIEW METHODS Data on relevant outcomes, patient populations, intervention type and study quality were extracted. Quality appraisal was conducted using the Cochrane Risk of Bias Tool. Meta-analysis was conducted to compare the effects of interventions in men, women, and mixed-sex sub-groups. RESULTS 40 RCTs of self-management support interventions in men, and 20 eligible RCTs where an analysis by sex was reported, were included in the review. Meta-analysis suggested that physical activity, education, and peer support-based interventions have a positive impact on quality of life in men. However, there is currently insufficient evidence to make strong statements about whether self-management support interventions show larger, similar or smaller effects in men compared with women and mixed-sex groups. CONCLUSIONS Clinicians may wish to consider whether certain types of self-management support (eg, physical activity, education, peer support) are particularly effective in men, although more research is needed to fully determine and explore this.
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Affiliation(s)
- Paul Galdas
- Department of Health Sciences, University of York, York, UK
| | - Jennifer Fell
- Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Lisa Kidd
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Christian Blickem
- NIHR Collaboration for Leadership in Applied Health Research and Care (CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Kerri McPherson
- School of Health and Life Sciences/Institute for Applied Health Research, Glasgow Caledonian University, Glasgow, UK
| | - Kate Hunt
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Simon Gilbody
- Department of Health Sciences, University of York, York, UK
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Telephone, print, and Web-based interventions for physical activity, diet, and weight control among cancer survivors: a systematic review. J Cancer Surviv 2015; 9:660-82. [PMID: 25757733 DOI: 10.1007/s11764-015-0442-2] [Citation(s) in RCA: 125] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 02/17/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Broad-reach (non-face-to-face) modalities offer an accessible and cost-effective means to provide behavior change programs in diverse and growing cancer survivor populations. The purpose of this systematic review is to evaluate the efficacy of physical activity, dietary, and/or weight control interventions for cancer survivors in which telephone, short-message service, print, and/or Web is the primary method of delivery. METHODS A structured search of PubMed, Embase, Web of Science, CINAHL, and CENTRAL (May 2013) was conducted. Included studies focused and reported on physical activity (PA) and dietary change and/or weight control in adult cancer survivors, delivered at least 50% of intervention contacts by broad-reach modality and included a control group. Study design, intervention features, and behavioral/weight outcomes were extracted, tabulated, and summarized. RESULTS Twenty-seven studies were included; 22 telephone, three Web, and two print. Sixteen studies targeted PA, two diet, and nine targeted multiple behaviors. Most studies (18/27) targeted a single survivor group, namely breast cancer (n = 12). Nineteen of 27 studies found evidence for initiation of behavior change, with only eight reporting on maintenance and one on cost-effectiveness. CONCLUSIONS This review provides support for broad-reach modalities, particularly the telephone, in the delivery of lifestyle interventions to cancer survivors. Future research should evaluate (1) newer technologies (i.e., SMS and mobile phone applications), (2) interventions for diverse cancer survivors and those targeting multiple behaviors, (3) long-term outcomes, and 4) cost-effectiveness. IMPLICATIONS FOR CANCER SURVIVORS Broad-reach lifestyle interventions are effective, with further research needed to evaluate their generalizability and integration into cancer care.
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Lee J, Lee M, Hong S, Kim JY, Park H, Oh M, Yang HI, Kang DW, Park J, Kim DI, Chu S, Lee J, Hur H, Kim NK, Jeon JY. Association between physical fitness, quality of life, and depression in stage II-III colorectal cancer survivors. Support Care Cancer 2015; 23:2569-77. [PMID: 25688034 DOI: 10.1007/s00520-015-2615-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Accepted: 01/13/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE The impact of cancer on quality of life and depression is an important issue. The purpose of this study was to identify the impact of physical fitness on quality of life and depression in stage II-III colorectal cancer survivors. METHODS Participants in the current study included 122 stage II-III colorectal cancer survivors (57 females; 56.67 ± 9.16 years of age and 55 males; 54.69 ± 9.78 years of age). Fitness was assessed using the 6-min walk test, chair stand test, and push-up test. Quality of life and depression were measured using the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) scale and a 9-item patient health questionnaire interview, respectively. RESULTS There was a significant association between physical fitness and quality of life and depression in colorectal cancer survivors. The 6-min walk test results were associated with FACT-C total (r = 0.298, p < 0.05), physical well-being (r = 0.230, p < 0.05), functional well-being (r = 0.234, p < 0.05), colorectal cancer concern (r = 0.229, p < 0.05), and depression (r = -0.228, p < 0.05), and the chair stand test results were associated with functional well-being (r = 0.231, p < 0.05), colorectal cancer concern (r = 0.242, p < 0.05), and depression (r = -0.227, p < 0.05) even after controlling for all potentially confounding variables. A multiple regression analysis indicated that the 6-min walk was a significant predictor of health-related quality of life, and participants in the lowest tertile of the 6-min walk test results had lower quality of life and greater depression than those in the highest tertile. CONCLUSION Improving and maintaining physical fitness are important for quality of life and depression in stage II-III colorectal cancer survivors.
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Affiliation(s)
- Junga Lee
- Department of Sport and Leisure Studies, Yonsei University, 134 Seodaemun-Gu, Shinchon-Dong, Seoul, Korea, 120-749
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Chen HM, Tsai CM, Wu YC, Lin KC, Lin CC. Randomised controlled trial on the effectiveness of home-based walking exercise on anxiety, depression and cancer-related symptoms in patients with lung cancer. Br J Cancer 2015; 112:438-45. [PMID: 25490525 PMCID: PMC4453645 DOI: 10.1038/bjc.2014.612] [Citation(s) in RCA: 127] [Impact Index Per Article: 14.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Revised: 10/27/2014] [Accepted: 11/13/2014] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Although exercise has been addressed as an adjuvant treatment for anxiety, depression and cancer-related symptoms, limited studies have evaluated the effectiveness of exercise in patients with lung cancer. METHODS We recruited 116 patients from a medical centre in northern Taiwan, and randomly assigned them to either a walking-exercise group (n=58) or a usual-care group (n=58). We conducted a 12-week exercise programme that comprised home-based, moderate-intensity walking for 40 min per day, 3 days per week, and weekly exercise counselling. The outcome measures included the Hospital Anxiety and Depression Scale and the Taiwanese version of the MD Anderson Symptom Inventory. RESULTS We analysed the effects of the exercise programme on anxiety, depression and cancer-related symptoms by using a generalised estimating equation method. The exercise group patients exhibited significant improvements in their anxiety levels over time (P=0.009 and 0.006 in the third and sixth months, respectively) and depression (P=0.00006 and 0.004 in the third and sixth months, respectively) than did the usual-care group patients. CONCLUSIONS The home-based walking exercise programme is a feasible and effective intervention method for managing anxiety and depression in lung cancer survivors and can be considered as an essential component of lung cancer rehabilitation.
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Affiliation(s)
- H-M Chen
- Graduate Institute of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan
- School of Nursing, College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - C-M Tsai
- Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y-C Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - K-C Lin
- Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - C-C Lin
- School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei 11031, Taiwan
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Gracey JH, Watson M, Payne C, Rankin J, Dunwoody L. Translation research: 'Back on Track', a multiprofessional rehabilitation service for cancer-related fatigue. BMJ Support Palliat Care 2014; 6:94-6. [PMID: 25526904 PMCID: PMC4789756 DOI: 10.1136/bmjspcare-2014-000692] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 11/29/2014] [Indexed: 11/07/2022]
Abstract
Objectives To assess the effectiveness and acceptability of an individually tailored rehabilitation intervention for patients with cancer-related fatigue (CRF). Methods Eighteen individuals, (16 female, two male, aged 40–83 years), who self-reported CRF (above four on a 10-point Likert scale) took part in an 8 week physical activity intervention weekly review and optional gym-based support. Fifteen participants had a primary diagnosis of breast cancer and along with the other participants had multiple myeloma, colorectal or prostate cancer. All participants took part in a goal-oriented walking and muscle strengthening programme with dietary advice and psychological support based on the Transtheoretical Model (TTM) of behaviour change. Effectiveness was assessed by physical and psychological outcomes. Focus groups with participants and individual interviews with the professionals delivering the intervention explored the feasibility and acceptability of the intervention. Results Statistically significant improvements were seen in the primary outcome of fatigue and on the secondary outcomes of physical function, depression and in triceps skin fold thickness reduction. Participants endorsed the intervention as being highly acceptable, holistic and as important as medical treatments for cancer. The importance of team working was highlighted as key to service delivery and success. Conclusions A multidisciplinary home-based tailored intervention with optional weekly gym attendance is acceptable to people with CRF, improving physical and psychosocial outcomes. Study limitations and suggestions for further research are discussed.
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Affiliation(s)
- J H Gracey
- Institute of Nursing and Health Research, University of Ulster, Newtownabbey, UK
| | - M Watson
- Department of Education and Research, Northern Ireland Hospice, Whiteabbey, UK
| | - C Payne
- Institute of Nursing and Health Research, University of Ulster, Newtownabbey, UK
| | - J Rankin
- Physiotherapy Department, Cancer Centre, Belfast City Hospital, Belfast, UK
| | - L Dunwoody
- Psychology Research Institute, University of Ulster, Coleraine, UK
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Abstract
UNLABELLED There has been an increase in the cancer survivor population in the United States over the past several decades primarily due to improvements in early detection of first malignancies and effective treatment modalities. A wealth of evidence has demonstrated that regular physical activity is associated with a lower risk of death, all-cause mortality, cancer recurrence, and several chronic diseases, including type 2 diabetes and cardiovascular disease, common comorbid conditions in people who have survived cancer. Physical activity also is a central component of weight management. METHODS This review summarizes the current physical activity recommendations and the evidence linking physical activity to improvements in weight management, physiological effects, and psychological health outcomes for cancer survivors. RESULTS The available literature suggests physical activity is safe and is positively associated with weight management, cardiorespiratory fitness, muscular strength and endurance, quality of life, fatigue, and other psychosocial factors in cancer survivors. Yet relationships related to specific cancer diagnoses, treatments, and underlying cardiometabolic mechanisms associated with survival have not been thoroughly examined in randomized controlled trials. Furthermore, factors that influence adherence to physical activity behaviors must be identified to develop effective exercise programs. The use of objective measures of physical activity and the standardization of reporting outcome measures within intervention trials are needed to complement this effort. CONCLUSIONS Healthcare providers should consider individual differences among cancer survivors and tailor physical activity programs to meet the individual needs of the patient to assist in the adoption and maintenance of a physically active lifestyle.
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Affiliation(s)
- David O Garcia
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
| | - Cynthia A Thomson
- Canyon Ranch Center for Prevention and Health Promotion, Mel & Enid Zuckerman College of Public Health, Division of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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Mishra SI, Scherer RW, Snyder C, Geigle P, Gotay C. Are exercise programs effective for improving health-related quality of life among cancer survivors? A systematic review and meta-analysis. Oncol Nurs Forum 2014; 41:E326-42. [PMID: 25355029 PMCID: PMC4332787 DOI: 10.1188/14.onf.e326-e342] [Citation(s) in RCA: 103] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE/OBJECTIVES To evaluate the effectiveness of exercise interventions on overall health-related quality of life (HRQOL) and its domains among cancer survivors who have completed primary treatment. DATA SOURCES 11 electronic databases were searched from inception (dates varied) to October 2011. The authors also identified eligible trials through a search of additional sources. DATA SYNTHESIS 40 trials with 3,694 participants met the inclusion criteria. At 12 weeks, cancer survivors exposed to exercise interventions had greater positive improvement in overall HRQOL (standardized mean difference [SMD] 0.48; 95% confidence interval [CI] [0.16, 0.81]), emotional well-being (SMD 0.33; 95% CI [0.05, 0.61]), and social functioning (SMD 0.45; 95% CI [0.02, 0.87]); and had a significant reduction in anxiety (SMD -0.26; 95% CI [-0.44, -0.07]) and fatigue (SMD -0.82; 95% CI [-1.5, -0.14]). CONCLUSIONS Exercise programs have a beneficial effect on HRQOL and most of its domains and can be integrated into the management plans for cancer survivors who have completed treatment. Future research is needed to help understand specific attributes of exercise programs that are beneficial for improving HRQOL within and across cancer types. IMPLICATIONS FOR NURSING Evidence presented in this review supports the inclusion of exercise programs in clinical guidelines for the management of cancer survivors who have completed treatment, such as the Oncology Nursing Society's Putting Evidence Into Practice resource.
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Affiliation(s)
- Shiraz I. Mishra
- Professor in the Departments of Pediatrics and Family and Community Medicine in the School of Medicine at the University of New Mexico in Albuquerque
| | - Roberta W. Scherer
- Associate scientist at the Center for Clinical Trials in the Department of Epidemiology at Johns Hopkins Bloomberg School of Public Health
| | - Claire Snyder
- Associate professor of medicine in the Division of General Internal Medicine at Johns Hopkins University School of Medicine
| | - Paula Geigle
- Research physical therapist in the Department of Neurology at the University of Maryland School of Medicine, all in Baltimore
| | - Carolyn Gotay
- Professor in the School of Population and Public Health at the University of British Columbia in Vancouver, Canada
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Otto SJ, Korfage IJ, Polinder S, van der Heide A, de Vries E, Rietjens JAC, Soerjomataram I. Association of change in physical activity and body weight with quality of life and mortality in colorectal cancer: a systematic review and meta-analysis. Support Care Cancer 2014; 23:1237-50. [PMID: 25318696 DOI: 10.1007/s00520-014-2480-0] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Accepted: 10/06/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE A systematic review and a meta-analysis were performed to assess the associations between change over time in physical activity and weight and quality of life and mortality in colorectal cancer patients. METHODS The PubMed, Embase, and Cochrane Central Register of Controlled Trials databases were searched for English language articles published between January 1, 1990 and October 7, 2013. These articles reported results for changes in physical activity and body weight, assessed at pre- to post-diagnosis or at post-diagnosis only. A random effects model was used to analyze pooled quality of life and mortality estimates. RESULTS Seven eligible studies were identified and analyzed. Increased physical activity was associated with higher overall quality of life scores (N = 3 studies; standardized mean difference (SMD) = 0.74, 95 % confidence interval (CI) = 0.66-0.82), reduced disease-specific mortality risk (hazard ratio (HRpooled) = 0.70, 95 % CI = 0.55-0.85), and reduced overall mortality (HRpooled = 0.75, CI = 0.62-0.87) (N = 2 studies). Weight gain was not associated with disease-specific (HRpooled = 1.02, CI = 0.84-1.20) or overall (HRpooled = 1.03, CI = 0.86-1.19) mortality (N = 3 studies). CONCLUSIONS Increased physical activity was associated with improved quality of life, a reduced risk of colorectal cancer, and overall mortality rate. Given the paucity of the literature published on this topic, this finding should be interpreted with caution.
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Affiliation(s)
- S J Otto
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, Netherlands,
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129
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Thomas AA, Gallagher P, O'Céilleachair A, Pearce A, Sharp L, Molcho M. Distance from treating hospital and colorectal cancer survivors' quality of life: a gendered analysis. Support Care Cancer 2014; 23:741-51. [PMID: 25179691 DOI: 10.1007/s00520-014-2407-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 08/18/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE Distance from residence to hospital has been associated with clinical outcomes for colorectal cancer patients. However, little is known about the association of remoteness with quality of life (QoL) for colorectal cancer survivors. We examined the relationship between distance from hospital and colorectal cancer survivors' QoL, with a specific focus on gender. METHODS Colorectal cancer survivors in Ireland who were more than 6-months postdiagnosis completed the European Organization for Research and Treatment of Cancer QLQ-C30, measuring global health status (GHS) and physical, role, cognitive, social, and emotional functioning. Bootstrap linear regression was used to evaluate the association between remoteness and QoL scales, controlling for demographic and clinical variables. Separate models were generated for the full sample, for women, and for men. RESULTS The final analytical sample was 496 colorectal cancer survivors; 186 women and 310 men. Living remote from the treating hospital was associated with lower physical functioning (coefficient -4.38 [95 % confidence interval -8.13, -0.91]) and role functioning (coeff. -7.78 [-12.64, -2.66]) among all colorectal cancer survivors. In the separate gender models, remoteness was significantly associated with lower physical (coeff. -7.00 [-13.47, -1.49]) and role functioning (coeff. -11.50 [-19.66, -2.65]) for women, but not for men. Remoteness had a significant negative relationship to GHS (coeff. -4.31 [-8.46, -0.27]) for men. CONCLUSIONS Aspects of QoL are lower among colorectal cancer survivors who live far from their treating hospital. There are gender differences in how remoteness is related to QoL domains. The results of this study suggest that policy makers, service providers, and health care professionals should consider the specific QoL needs of remote colorectal cancer survivors, and be attuned to and prepared to address the differing needs of men and women.
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Affiliation(s)
- Audrey Alforque Thomas
- Health Promotion Research Centre, National University of Ireland, Aras na Coiribe, Galway, Ireland,
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130
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C. Mills R, Nascimento MGB, Melo GFD, Hackney AC, Battaglini CL. Exercise training improves mean arterial pressure in breast cancer survivors. MOTRIZ: REVISTA DE EDUCACAO FISICA 2014. [DOI: 10.1590/s1980-65742014000300012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Currently, many breast cancer survivors worldwide live with treatment-related side effects, including cardiovascular health problems. This study examined effects of a 5-month exercise intervention on non-invasive markers of cardiovascular health in breast cancer survivors. Relationships between these markers and commonly used markers of overall health were also explored. Fifty-two survivors completed the exercise training at a rehabilitation center at the University of North Carolina at Chapel Hill between 2008-2011. A combined aerobic and resistance exercise intervention (3 times/week for 1h) at intensities progressing from low (40%) to moderate (65-70% of VO2max) for aerobic and 8-12 repetitions max for the resistance exercise were implemented. Significant reduction in mean arterial pressure (MAP) was observed from baseline to final assessment. A significant correlation was found between MAP and Body Mass Index (BMI). In conclusion, 5-months combined aerobic and resistance exercise intervention positively improved MAP which was, in part, attributed to changes in BMI.
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131
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Repka CP, Peterson BM, Brown JM, Lalonde TL, Schneider CM, Hayward R. Cancer Type Does Not Affect Exercise-Mediated Improvements in Cardiorespiratory Function and Fatigue. Integr Cancer Ther 2014; 13:473-81. [DOI: 10.1177/1534735414547108] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Purpose. Despite mounting evidence indicating that exercise training has a positive effect on cancer recovery, the influence of cancer type on the response to exercise training remains uncharacterized. Therefore, the adaptations to exercise training were compared between groups composed of 7 different forms of cancer. Methods. A total of 319 cancer survivors completed fatigue inventories and participated in assessments of cardiorespiratory function, which encompassed aerobic capacity (VO2peak), pulmonary function (forced vital capacity [FVC] and forced expiratory volume in 1 second [FEV1]), and resting blood pressure and heart rate. Participants were divided into 7 groups based on cancer type, including breast cancer (BC, n = 170), prostate cancer and other male urogenital neoplasia (PC, n = 38), hematological malignancies (HM, n = 34), colorectal cancer (CC, n = 25), gynecological cancers (GC, n = 20), glandular and epithelial neoplasms (GEN, n = 20), and lung cancer (LC, n = 12). All participants completed an individualized, multimodal exercise intervention consisting of cardiorespiratory, flexibility, balance, and muscular strength training 3 days per week for 3 months. Following the intervention, all subjects were reassessed. Generalized Estimating Equations with exchangeable working correlation structure was used to model each response; the group by time interaction effect represented the effect of cancer type on exercise-associated improvements. Results. No significant ( P > .05) group by time interaction effects were observed between different types of cancer for any parameter. Pre- to postexercise contrasts revealed significant improvements in VO2peak in BC, PC, HM, and GEN at the Bonferroni adjusted significance level (.00714). Heart rate was significantly lowered in the BC and CC groups. Mean fatigue indices decreased by at least 17% in all groups, but these changes were only significant in the BC, HM, CC, and GC groups. Systolic blood pressure decreased significantly in BC and GC, and diastolic blood pressure decreased significantly only in the BC group while pulmonary function remained unchanged in all cancer types. Conclusion. Although trends toward improved cardiorespiratory and fatigue parameters only reached significance in some groups, there were no significant differences between cancer types. This suggests that cardiorespiratory and fatigue improvements following rehabilitative exercise are not dependent on cancer type. Further research investigating alternative physiological parameters are needed to confirm the relationship between cancer type and exercise-mediated rehabilitation.
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Affiliation(s)
- Chris P. Repka
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
| | - Brent M. Peterson
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
| | - Jessica M. Brown
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
| | - Trent L. Lalonde
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
| | - Carole M. Schneider
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
| | - Reid Hayward
- University of Northern Colorado and the Rocky Mountain Cancer Rehabilitation Institute, Greeley, CO, USA
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Predictors of physical activity in colorectal cancer survivors after participation in a telephone-delivered multiple health behavior change intervention. J Cancer Surviv 2014; 9:40-9. [PMID: 25103607 DOI: 10.1007/s11764-014-0389-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 07/20/2014] [Indexed: 10/24/2022]
Abstract
PURPOSE Physical activity improves the health outcomes of colorectal cancer (CRC) survivors, yet few are exercising at levels known to yield health benefits. Baseline demographic, clinical, behavioral, and psychosocial predictors of physical activity at 12 months were investigated in CRC survivors. METHODS Participants were CRC survivors (n = 410) who completed a 12-month multiple health behavior change intervention trial (CanChange). The outcome variable was 12 month sufficient physical activity (≥150 min of moderate-vigorous physical activity/week). Baseline predictors included demographics and clinical variables, health behaviors, and psychosocial variables. RESULTS Multivariate linear regression revealed that baseline sufficient physical activity (p < 0.001), unemployment (p = 0.004), private health insurance (p = 0.040), higher cancer-specific quality of life (p = 0.031) and higher post-traumatic growth (p = 0.008) were independent predictors of sufficient physical activity at 12 months. The model explained 28.6% of the variance. CONCLUSIONS Assessment of demographics, health behaviors, and psychosocial functioning following a diagnosis of CRC may help to develop effective physical activity programs. IMPLICATIONS FOR CANCER SURVIVORS Understanding the demographic, behavioral and psychosocial determinants of physical activity may facilitate the development and delivery of effective public health interventions designed to promote long term behavior change. TRIAL REGISTRATION ACTRN12608000399392.
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134
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Lynch BM, Courneya KS, Sethi P, Patrao TA, Hawkes AL. A randomized controlled trial of a multiple health behavior change intervention delivered to colorectal cancer survivors: Effects on sedentary behavior. Cancer 2014; 120:2665-72. [DOI: 10.1002/cncr.28773] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 03/24/2014] [Accepted: 04/07/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Brigid M. Lynch
- Physical Activity Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
- Melbourne School of Population and Global Health; The University of Melbourne; Melbourne Victoria Australia
| | - Kerry S. Courneya
- Department of Physical Education and Recreation; University of Alberta; Edmonton Alberta Canada
| | - Parneet Sethi
- Physical Activity Laboratory; Baker IDI Heart and Diabetes Institute; Melbourne Victoria Australia
| | - Tania A. Patrao
- Menzies School of Health Research; Brisbane Queensland Australia
| | - Anna L. Hawkes
- School of Public Health and Social Work, Queensland University of Technology; Brisbane Queensland Australia
- School of Public Health, Tropical Medicine and Rehabilitation Sciences; James Cook University; Townsville Queensland Australia
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135
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Short CE, James EL, Vandelanotte C, Courneya KS, Duncan MJ, Rebar A, Plotnikoff RC. Correlates of resistance training in post-treatment breast cancer survivors. Support Care Cancer 2014; 22:2757-66. [PMID: 24805910 DOI: 10.1007/s00520-014-2273-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/28/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To explore demographic, health, social-cognitive and behavioural correlates of resistance training among post-treatment breast cancer survivors. METHODS A sample of 330 post-treatment breast cancer survivors recruited from across Australia completed a mailed questionnaire. A multivariate logistical regression model was used to test associations between independent variables and meeting the resistance training guidelines. RESULTS Less than a quarter of the participants were meeting the resistance training guidelines of at least two sessions of resistance training per week. Higher task self-efficacy for resistance training (p < 0.01) and greater goal-setting behaviour (p < 0.05) were identified as significant predictors of meeting the resistance training guidelines, with a one unit increase in task self-efficacy and goal setting, increasing the odds of meeting the resistance training guidelines by a factor of approximately 1.2 (odds ratio (OR) task self-efficacy = 1.23, 95 % confidence interval (CI) = 1.05-1.43; goal-setting OR = 1.20, 95 % CI = 1.04-1.38). No other variables significantly predicted meeting the resistance training guidelines in the multivariate analysis. CONCLUSIONS Strategies targeting task self-efficacy and goal-setting behaviours are likely to be important intervention components in resistance training interventions for breast cancer survivors. IMPLICATIONS FOR CANCER SURVIVORS The findings of this study will be useful for informing the development of evidence-based interventions aiming to promote resistance training among this group.
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Affiliation(s)
- Camille E Short
- Centre for Physical Activity Studies, School of Human Health and Social Sciences, Central Queensland University, Rockhampton, Australia,
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van Roekel EH, Bours MJ, de Brouwer CP, Ten Napel H, Sanduleanu S, Beets GL, Kant IJ, Weijenberg MP. The Applicability of the International Classification of Functioning, Disability, and Health to Study Lifestyle and Quality of Life of Colorectal Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2014; 23:1394-405. [DOI: 10.1158/1055-9965.epi-13-1144] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Physical activity in relation to quality of life in newly diagnosed colon cancer patients: a 24-month follow-up. Qual Life Res 2014; 23:2235-46. [PMID: 24706291 DOI: 10.1007/s11136-014-0679-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Self-reported health status in cancer patients is an independent predictor of medical outcomes. This study investigated the association between changes in recreational physical activity in colon cancer survivors and quality of life (QoL) across a 24-month follow-up beginning at diagnosis. METHODS Patients (n = 453) diagnosed with stage II colon cancer were recruited from the North Carolina Central Cancer Registry from 2009 to 2011. Patients were interviewed annually about health behaviors (e.g., dietary intake, physical activity, alcohol and tobacco use), socioeconomic variables, and treatment. To index QoL, the Functional Assessment of Cancer Therapy-Colorectal (FACT-C) and Short Form-12 (SF-12) were utilized. RESULTS Baseline vigorous exercise showed a positive correlation with the Functional Assessment of Cancer Therapy-General (FACT-G) Colorectal Cancer Scale (CCS) (β = 0.15, 95% CI 0.07-0.23), FACT-C (β = 0.39, 95% CI 0.06-0.72), and Trial Outcome Index (TOI) (β = 0.28, 95% CI 0.01-0.55). Race modified the association between vigorous activity and the FACT-G (P interaction = 0.010), FACT-C (P interaction = 0.020), TOI (P interaction < 0.010), and the PCS (P interaction < 0.010). As compared to no change, increasing physical activity over a 24-month period following diagnosis significantly improved scores from the FACT-G (β = 3.13, 95% CI 0.48-5.77, P trend = 0.054), FACT-C (β = 3.51, 95% CI 0.35-6.68, P trend = 0.08) TOI (β = 2.46, 95% CI 0.16-4.75, P trend = 0.04), and PCS of the SF-12 (β = 3.28, 95% CI 0.93-5.63, P trend < 0.01). CONCLUSION Vigorous exercise is a significant predictor of higher QoL in stage II colon cancer patients. Patients with increased recreational physical activity have significantly improved QoL over 24 months following diagnosis.
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Walker GJ, Caperchione CM, Mummery WK, Chau S. Examining the role of acculturation in the leisure-time physical activity of South Asians living in Canada. J Sci Med Sport 2014; 18:156-60. [PMID: 24690445 DOI: 10.1016/j.jsams.2014.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 01/15/2014] [Accepted: 02/20/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The purpose of this study was to examine the leisure-time physical activity of South Asians living in Canada using a four-mode, bidimensional acculturation framework. DESIGN Cross-sectional, descriptive study. METHODS A random sample (N=204) of South Asian adults living in Calgary, Canada completed a telephone interview that assessed their leisure-time physical activity and acculturation. Interviews were conducted in either English or Punjabi, depending on participant preference. RESULTS Cluster analysis identified four acculturation clusters: Low-Separated and High-Separated (with separation signifying different preference levels for maintaining one's heritage culture while distancing oneself from the mainstream culture); and Integrated-Heritage and Integrated-Mainstream (with integration indicating a preference for maintaining one's heritage culture and being involved in the mainstream culture-albeit with the former cluster emphasizing heritage more whereas the latter cluster emphasized the mainstream more). A MANOVA performed on light, moderate, and vigorous leisure-time physical activity using the four clusters was significant (p<.05). Moderate leisure-time physical activity was greater for the two separated clusters than the two integrated clusters (p<.05), with the Separated-Low cluster being greater than both the Integrated-Mainstream (p<.05) and the Integrated-Heritage (p<.01) clusters. Vigorous leisure-time physical activity was greater for the two integrated clusters than the two separated clusters (p<.01), with the Integrated-Mainstream cluster being greater than both the Separated-Low (p<.05) and Separated-High (p<.01) clusters. CONCLUSIONS An integrative, four-mode bidimensional approach should be employed when developing messages and designing programs to promote and encourage leisure-time physical activity in South Asian communities.
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Affiliation(s)
- Gordon J Walker
- University of Alberta, Faculty of Physical Education and Recreation, Canada.
| | | | - W Kerry Mummery
- University of Alberta, Faculty of Physical Education and Recreation, Canada.
| | - Shirley Chau
- University of British Columbia, School of Social Work, Canada.
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Munro J, Adams R, Campbell A, Campbell S, Donaldson C, Godwin J, Haw S, Kidd L, Lane C, Leslie SJ, Mason H, Mutrie N, O'Carroll R, Taylor C, Treweek S, Watson A, Hubbard G. CRIB--the use of cardiac rehabilitation services to aid the recovery of patients with bowel cancer: a pilot randomised controlled trial (RCT) with embedded feasibility study. BMJ Open 2014; 4:e004684. [PMID: 24549168 PMCID: PMC3931997 DOI: 10.1136/bmjopen-2013-004684] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/23/2014] [Accepted: 01/24/2014] [Indexed: 01/03/2023] Open
Abstract
INTRODUCTION Patients with colorectal cancer report ongoing physical and psychological impairments and a high proportion of these patients are overweight, insufficiently active and high-risk drinkers, putting them at risk of poor recovery and risk of recurrence and comorbidities. A challenge is implementing sustainable and effective rehabilitation as part of routine care for this group. METHODS AND ANALYSIS A two-arm pilot randomised controlled trial (RCT) with embedded feasibility study undertaken as a phased programme of work. The intervention involves an existing cardiac rehabilitation programme for cardiac patients accepting colorectal cancer patient referrals. The intervention consists of supervised exercise sessions run by a cardiac physiotherapist and information sessions. Phase 1 will involve one research site enrolling 12 patients to assess intervention and study design processes. Semistructured interviews with patients with colorectal cancer and cardiac patients and clinicians will be used to gather data on acceptability of the intervention and study procedures. Phase 2 will involve three sites enrolling 66 patients with colorectal cancer randomised to control or intervention groups. Outcome measures will be taken preintervention and postintervention, for phases 1 and 2. The primary outcome is accelerometer measured physical activity; secondary outcomes are self-report physical activity, quality of life, anxiety, depression, symptoms including fatigue. The following variables will also be examined to determine if these factors influence adherence and outcomes: self-efficacy, risk perception and treatments. ETHICS AND DISSEMINATION Full ethical approval was granted by NRES Committees-North of Scotland (13/NS/0004; IRAS project ID: 121757) on 22 February 2013. The proposed work is novel in that it aims to test the feasibility and acceptability of using an evidence-based and theory driven existing cardiac rehabilitation service with patients with colorectal cancer. Should this model of rehabilitation prove to be clinically and cost effective we aim to conduct a randomised controlled trial of this intervention to measure effectiveness. TRIAL REGISTRATION REFERENCE ISRCTN63510637; UKCRN id 14092.
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Affiliation(s)
- Julie Munro
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Richard Adams
- Cardiff University, School of Medicine, Velindre Hospital, Cardiff, UK
| | - Anna Campbell
- Institute of Sport and Exercise, University of Dundee, UK
| | | | - Cam Donaldson
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jon Godwin
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Sally Haw
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
| | - Lisa Kidd
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | | | | | - Helen Mason
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Nanette Mutrie
- Moray House School of Education, The University of Edinburgh, Edinburgh, UK
| | - Ronan O'Carroll
- School of Natural Sciences, University of Stirling, Stirling, UK
| | - Cara Taylor
- NHS Tayside, Level 10, Ninewells Hospital, Dundee, UK
| | - Shaun Treweek
- Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen, UK
| | | | - Gill Hubbard
- School of Nursing, Midwifery and Health, University of Stirling, Stirling, UK
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140
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Exercise training in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy: a pilot study. Support Care Cancer 2014; 22:1797-806. [PMID: 24531742 DOI: 10.1007/s00520-014-2139-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Accepted: 01/20/2014] [Indexed: 11/12/2022]
Abstract
PURPOSE This pilot study aimed to investigate the feasibility of two different training programs in patients with advanced gastrointestinal cancer undergoing palliative chemotherapy. Potential effects of training programs on the patients' quality of life, physical performance, physical activity in daily living, and biological parameters were exploratorily evaluated. METHODS Patients were randomly assigned to a resistance (RET) and aerobic exercise training group (AET). Both underwent supervised training sessions twice a week for 12 weeks. RET was performed at 60-80% of the one-repetition maximum and consisted of 2-3 sets of 15-25 repetitions. The AET group performed endurance training at 60-80% of their predetermined pulse rate (for 10 to 30 min). RESULTS A total of 26 gastrointestinal cancer patients could be randomized. Twenty-one patients completed the 12 weeks of intervention. The median adherence rate to exercise training of all 26 patients was 65%, while in patients who were able to complete 12 weeks, adherence was 75%. The fatigue score of all patients decreased from 66 to 43 post-intervention. Sleeping duration increased in both groups and muscular strength increased in the RET group. A higher number of steps in daily living was associated with higher levels of physical and social functioning as well as lower scores for pain and fatigue. CONCLUSION RET and AET are feasible in gastrointestinal cancer patients undergoing palliative chemotherapy. Both training programs seem to improve cancer-related symptoms as well as the patient's physical activities of daily living.
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141
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Kim HJ, Chu SH, Yoo JS, Kim NK. Nutritional Risk and Physical Activity on Quality of Life in Patients with Colorectal Cancer. ASIAN ONCOLOGY NURSING 2014. [DOI: 10.5388/aon.2014.14.2.66] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hee Jung Kim
- Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Sang Hui Chu
- Yonsei University College of Nursing, Seoul, Korea
| | - Ji Soo Yoo
- Yonsei University College of Nursing, Seoul, Korea
| | - Nam Kyu Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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Santa Mina D, Guglietti CL, Alibhai SMH, Matthew AG, Kalnin R, Ahmad N, Lindner U, Trachtenberg J. The effect of meeting physical activity guidelines for cancer survivors on quality of life following radical prostatectomy for prostate cancer. J Cancer Surviv 2013; 8:190-8. [PMID: 24317972 DOI: 10.1007/s11764-013-0329-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 11/12/2013] [Indexed: 01/09/2023]
Affiliation(s)
- Daniel Santa Mina
- Kinesiology Program, The University of Guelph-Humber, Room GH-308-G, 207 Humber College Boulevard, Toronto, ON, Canada, M9W 5L7,
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143
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Sellar CM, Bell GJ, Haennel RG, Au HJ, Chua N, Courneya KS. Feasibility and efficacy of a 12-week supervised exercise intervention for colorectal cancer survivors. Appl Physiol Nutr Metab 2013; 39:715-23. [PMID: 24869975 DOI: 10.1139/apnm-2013-0367] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Exercise training improves health-related physical fitness and patient-reported outcomes in cancer survivors, but few interventions have targeted colorectal cancer (CRC) survivors. This investigation aimed to determine the feasibility and efficacy of a 12-week supervised exercise training program for CRC survivors. Feasibility was assessed by tracking participant recruitment, loss to follow-up, assessment completion rates, participant evaluation, and adherence to the intervention. Efficacy was determined by changes in health-related physical fitness. Over a 1-year period, 72 of 351 (21%) CRC survivors screened were eligible for the study and 29 of the 72 (40%) were enrolled. Two participants were lost to follow-up (7%) and the completion rate for all study assessments was ≥93%. Mean adherence to the exercise intervention was 91% (standard deviation = ±18%), with a median of 98%. Participants rated the intervention positively (all items ≥ 6.6/7) and burden of testing low (all tests ≤ 2.4/7). Compared with baseline, CRC survivors showed improvements in peak oxygen uptake (mean change (MC) = +0.24 L·min(-1), p < 0.001), upper (MC = +7.0 kg, p < 0.001) and lower (MC = +26.5 kg, p < 0.001) body strength, waist circumference (MC = -2.1 cm, p = 0.005), sum of skinfolds (MC = -7.9 mm, p = 0.006), and trunk forward flexion (MC = +2.5 cm, p = 0.019). Exercise training was found to be feasible and improved many aspects of health-related physical fitness in CRC survivors that may be associated with improved quality of life and survival in these individuals.
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Affiliation(s)
- Christopher M Sellar
- a Faculty of Physical Education and Recreation, E459 Van Vliet Center, University of Alberta, Edmonton, AB T6G 2H9, Canada
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144
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"EXHALE": exercise as a strategy for rehabilitation in advanced stage lung cancer patients: a randomized clinical trial comparing the effects of 12 weeks supervised exercise intervention versus usual care for advanced stage lung cancer patients. BMC Cancer 2013; 13:477. [PMID: 24124893 PMCID: PMC3816603 DOI: 10.1186/1471-2407-13-477] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2013] [Accepted: 10/03/2013] [Indexed: 12/30/2022] Open
Abstract
Background Lung cancer is the leading cause of cancer death in North America and Western Europe. Patients with lung cancer in general have reduced physical capacity, functional capacity, poor quality of life and increased levels of anxiety and depression. Intervention studies indicate that physical training can address these issues. However, there is a lack of decisive evidence regarding the effect of physical exercise in patients with advanced lung cancer. The aim of this study is to evaluate the effects of a twelve weeks, twice weekly program consisting of: supervised, structured training in a group of advanced lung cancer patients (cardiovascular and strength training, relaxation). Methods/Design A randomized controlled trial will test the effects of the exercise intervention in 216 patients with advanced lung cancer (non-small cell lung cancer (NSCLC) stage IIIb - IV and small cell lung cancer (SCLC) extensive disease (ED)). Primary outcome is maximal oxygen uptake (VO2peak). Secondary outcomes are muscle strength (1RM), functional capacity (6MWD), lung capacity (Fev1) and patient reported outcome (including anxiety, depression (HADS) and quality of life (HRQOL)). Discussion The present randomized controlled study will provide data on the effectiveness of a supervised exercise intervention in patients receiving systemic therapy for advanced lung cancer. It is hoped that the intervention can improve physical capacity and functional level, during rehabilitation of cancer patients with complex symptom burden and help them to maintain independent function for as long as possible. Trial registration http://ClinicalTrials.gov, NCT01881906
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145
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Bourke L, Homer KE, Thaha MA, Steed L, Rosario DJ, Robb KA, Saxton JM, Taylor SJC. Interventions for promoting habitual exercise in people living with and beyond cancer. Cochrane Database Syst Rev 2013:CD010192. [PMID: 24065550 DOI: 10.1002/14651858.cd010192.pub2] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND The beneficial effects of regular exercise for people living with or beyond cancer are becoming apparent. However, how to promote exercise behaviour in sedentary cancer cohorts is not as well understood. A large majority of people living with or recovering from cancer do not meet exercise recommendations. Hence, reviewing the evidence on how to promote and sustain exercise behaviour is important. OBJECTIVES To assess the effects of interventions to promote exercise behaviour in sedentary people living with and beyond cancer and to address the following questions: Which interventions are most effective in improving aerobic fitness and skeletal muscle strength and endurance? What adverse effects are attributed to different exercise interventions? Which interventions are most effective in improving exercise behaviour amongst patients with different cancers? Which interventions are most likely to promote long-term (12 months or longer) exercise behaviour? What frequency of contact with exercise professionals is associated with increased exercise behaviour? What theoretical basis is most often associated with increased exercise behaviour? What behaviour change techniques are most often associated with increased exercise behaviour? SEARCH METHODS We searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 8, 2012), MEDLINE, EMBASE, AMED, CINAHL, PsycLIT/PsycINFO, SportDiscus and PEDro from inception to August 2012. We also searched the grey literature, wrote to leading experts in the field, wrote to charities and searched reference lists of other recent systematic reviews. SELECTION CRITERIA We included only randomised controlled trials (RCTs) that compared an exercise intervention with a usual care approach in sedentary people over the age of 18 with a homogenous primary cancer diagnosis. DATA COLLECTION AND ANALYSIS Two review authors working independently (LB and KH) screened all titles and abstracts to identify studies that might meet the inclusion criteria, or that cannot be safely excluded without assessment of the full text (e.g. when no abstract is available). All eligible papers were formally abstracted by at least two members of the review author team working independently (LB and KH) and using the data collection form. When possible, and if appropriate, we performed a fixed-effect meta-analysis of study outcomes. For continuous outcomes (e.g. cardiorespiratory fitness), we extracted the final value, the standard deviation of the outcome of interest and the number of participants assessed at follow-up in each treatment arm, to estimate standardised mean difference (SMD) between treatment arms. SMD was used, as investigators used heterogeneous methods to assess individual outcomes. If a meta-analysis was not possible or was not appropriate, we synthesised studies as a narrative. MAIN RESULTS Fourteen trials were included in this review, involving a total of 648 participants. Only studies involving breast, prostate or colorectal cancer were identified as eligible. Just six trials incorporated a target level of exercise that could meet current recommendations. Only three trials were identified that attempted to objectively validate independent exercise behaviour with accelerometers or heart rate monitoring. Adherence to exercise interventions, which is crucial for understanding treatment dose, is often poorly reported. It is important to note that the fundamental metrics of exercise behaviour (i.e. frequency, intensity and duration, repetitions, sets and intensity of resistance training), although easy to devise and report, are seldom included in published clinical trials.None of the included trials reported that 75% or greater adherence (the stated primary outcome for this review) of the intervention group met current aerobic exercise recommendations at any given follow-up. Just two trials reported six weeks of resistance exercise behaviour that would meet the guideline recommendations. However, three trials reported adherence of 75% or greater to an aerobic exercise goal that was less than the current guideline recommendation of 150 minutes per week. All three incorporated both supervised and independent exercise components as part of the intervention, and none placed restrictions on the control group in terms of exercise behaviour. These three trials shared programme set goals and the following behaviour change techniques: generalisation of a target behaviour; prompting of self-monitoring of behaviour; and prompting of practise. Despite the uncertainty surrounding adherence in many of the included trials, interventions caused improvements in aerobic exercise tolerance at 8 to 12 weeks (from 7 studies, SMD 0.73, 95% confidence interval (CI) 0.51 to 0.95) in intervention participants compared with controls. At six months, aerobic exercise tolerance was also improved (from 5 studies, SMD 0.70, 95% CI 0.45 to 0.94), but it should be noted that four of the five trials used in this analysis had a high risk of bias, hence caution is warranted in interpretation of results. Attrition over the course of these interventions is typically low (median 6%). AUTHORS' CONCLUSIONS Interventions to promote exercise in cancer survivors who report better levels of adherence share some common behaviour change techniques. These involve setting programme goals, prompting practise and self-monitoring and encouraging participants to attempt to generalise behaviours learned in supervised exercise environments to other, non-supervised contexts. However, expecting most sedentary survivors to achieve current guideline recommendations of at least 150 minutes per week of aerobic exercise is likely to be unrealistic. As with all well-designed exercise programmes in any context, prescriptions should be designed around individual capabilities, and frequency, duration and intensity or sets, repetitions, intensity or resistance training should be generated on this basis.
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Affiliation(s)
- Liam Bourke
- Queen Mary University of London, Barts & The London School of Medicine and Dentistry, Centre for Primary Care and Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London, UK, E1 2AB
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146
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Cramer H, Lauche R, Klose P, Dobos G, Langhorst J. A systematic review and meta-analysis of exercise interventions for colorectal cancer patients. Eur J Cancer Care (Engl) 2013; 23:3-14. [DOI: 10.1111/ecc.12093] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
- H. Cramer
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine; University of Duisburg-Essen; Essen Germany
| | - R. Lauche
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine; University of Duisburg-Essen; Essen Germany
| | - P. Klose
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine; University of Duisburg-Essen; Essen Germany
| | - G. Dobos
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine; University of Duisburg-Essen; Essen Germany
| | - J. Langhorst
- Department of Internal and Integrative Medicine, Kliniken Essen-Mitte, Faculty of Medicine; University of Duisburg-Essen; Essen Germany
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147
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Hawkes AL, Chambers SK, Pakenham KI, Patrao TA, Baade PD, Lynch BM, Aitken JF, Meng X, Courneya KS. Effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes in survivors of colorectal cancer: a randomized controlled trial. J Clin Oncol 2013; 31:2313-21. [PMID: 23690410 DOI: 10.1200/jco.2012.45.5873] [Citation(s) in RCA: 167] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Colorectal cancer survivors are at risk for poor health outcomes because of unhealthy lifestyles, but few studies have developed translatable health behavior change interventions. This study aimed to determine the effects of a telephone-delivered multiple health behavior change intervention (CanChange) on health and behavioral outcomes among colorectal cancer survivors. METHODS In this two-group randomized controlled trial, 410 colorectal cancer survivors were randomly assigned to the health coaching intervention (11 theory-based telephone-delivered health coaching sessions delivered over 6 months focusing on physical activity, weight management, dietary habits, alcohol, and smoking) or usual care. Assessment of primary (ie, physical activity [Godin Leisure Time Index], health-related quality of life [HRQoL; Short Form-36], and cancer-related fatigue [Functional Assessment of Chronic Illness Therapy Fatigue Scale]) and secondary outcomes (ie, body mass index [kg/m(2)], diet and alcohol intake [Food Frequency Questionnaire], and smoking) were conducted at baseline and 6 and 12 months. RESULTS At 12 months, significant intervention effects were observed for moderate physical activity (28.5 minutes; P = .003), body mass index (-0.9 kg/m(2); P = .001), energy from total fat (-7.0%; P = .006), and energy from saturated fat (-2.8%; P = .016). A significant intervention effect was reported for vegetable intake (0.4 servings per day; P = .001) at 6 months. No significant group differences were found at 6 or 12 months for HRQoL, cancer-related fatigue, fruit, fiber, or alcohol intake, or smoking. CONCLUSION The CanChange intervention was effective for improving physical activity, dietary habits, and body mass index in colorectal cancer survivors. The intervention is translatable through existing telephone cancer support and information services in Australia and other countries.
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Affiliation(s)
- Anna L Hawkes
- Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Brisbane, Queensland, Australia.
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148
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Wenzel JA, Griffith KA, Shang J, Thompson CB, Hedlin H, Stewart KJ, DeWeese T, Mock V. Impact of a home-based walking intervention on outcomes of sleep quality, emotional distress, and fatigue in patients undergoing treatment for solid tumors. Oncologist 2013; 18:476-84. [PMID: 23568000 PMCID: PMC3639536 DOI: 10.1634/theoncologist.2012-0278] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 01/07/2013] [Indexed: 11/17/2022] Open
Abstract
Exercise use among patients with cancer has been shown to have many benefits and few notable risks. The purpose of this study was to evaluate the impact of a home-based walking intervention during cancer treatment on sleep quality, emotional distress, and fatigue. Methods. A total of 138 patients with prostate (55.6%), breast (32.5%), and other solid tumors (11.9%) were randomized to a home-based walking intervention or usual care. Exercise dose was assessed using a five-item subscale of the Cooper Aerobics Center Longitudinal Study Physical Activity Questionnaire. Primary outcomes of sleep quality, distress, and fatigue were compared between the two study arms. Results. The exercise group (n = 68) reported more vigor (p = .03) than control group participants (n = 58). In dose response models, greater participation in aerobic exercise was associated with 11% less fatigue (p < .001), 7.5% more vigor (p = .001), and 3% less emotional distress (p = .03), after controlling for intervention group assignment, age, and baseline exercise and fatigue levels. Conclusion. Patients who exercised during cancer treatment experienced less emotional distress than those who were less active. Increasing exercise was also associated with less fatigue and more vigor. Home-based walking is a simple, sustainable strategy that may be helpful in improving a number of symptoms encountered by patients undergoing active treatment for cancer.
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Affiliation(s)
- Jennifer A Wenzel
- School of Nursing, Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205-2110, USA.
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149
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Thraen-Borowski KM, Trentham-Dietz A, Edwards DF, Koltyn KF, Colbert LH. Dose-response relationships between physical activity, social participation, and health-related quality of life in colorectal cancer survivors. J Cancer Surviv 2013; 7:369-78. [PMID: 23546822 DOI: 10.1007/s11764-013-0277-7] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 03/04/2013] [Indexed: 12/14/2022]
Abstract
PURPOSE The purpose of this study was to examine the relationships between physical activity (PA), social participation, and health-related quality of life (HQOL) in older, long-term colorectal cancer survivors. METHODS Male and female colorectal cancer survivors (n = 1,768), aged ≥65 and ≥5 years post-diagnosis, completed surveys on their current PA, social participation, HQOL, health history, and relevant covariates. Analysis of covariance was used to evaluate the cross-sectional relationship between PA and social participation with the SF-36 subscales, as well as the physical component summary score (PCS) and mental health component summary score (MCS). RESULTS The final analytic sample (n = 832) was 81.5 ± 5.8 years and 8.2 ± 1.7 years post-diagnosis (mean ± SD). Meeting the current recommendation of 150 min/week of PA was associated with higher PCS (p < 0.001) but not MCS (p = 0.30). Engaging in any social participation, vs. none, was associated with MCS (p = 0.003), but not PCS (p = 0.13). There was a dose-response relationship between moderate-vigorous-intensity PA and PCS (p trend<0.001). Light-intensity PA was not associated with either summary score after adjustment for moderate-vigorous PA (p > 0.05), but in survivors performing no higher-intensity PA, it was associated with both (p < 0.01, p = 0.02, respectively). Participants reporting greater amounts of both planned exercise and non-exercise PA had significantly higher PCS (p trend<0.01, p trend < 0.01, respectively). Individuals participating in greater weekly hours of social participation had higher PCS and MCS (p trend<0.05) than those participating in less. CONCLUSIONS Among older, long-term colorectal cancer survivors, PA is related to their physical health, while social participation is predominantly related to their mental health. IMPLICATIONS FOR CANCER SURVIVORS Older colorectal cancer survivors who participate socially and are engaged in PA, even non-exercise and light-intensity activities, have higher levels of physical and mental health.
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Affiliation(s)
- Keith M Thraen-Borowski
- Department of Kinesiology, University of Wisconsin-Madison, 2000 Observatory Drive, Madison, WI 53706, USA
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150
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Singh F, Newton RU, Galvão DA, Spry N, Baker MK. A systematic review of pre-surgical exercise intervention studies with cancer patients. Surg Oncol 2013; 22:92-104. [PMID: 23434347 DOI: 10.1016/j.suronc.2013.01.004] [Citation(s) in RCA: 130] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2012] [Revised: 01/22/2013] [Accepted: 01/28/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Recent reviews suggest that enhancing fitness and functional capacity prior to surgery can accelerate post-surgery recovery and reduce mortality. However, the effect of pre-surgical exercise interventions in cancer patients is not fully explained. The aim of this paper is to systematically review the available literature regarding pre-surgery exercise training interventions in cancer patients and examine their effects on physiological outcomes as well as quality of life (QOL) and length of hospital stay. METHODS Relevant studies were identified through a search on MEDLINE, PreMEDLINE, AMED, MEDLINE Daily Update, CINAHL and SPORTDiscus. All randomized controlled trials (RCTs) and non-RCTs that had some form of physical exercise undertaken prior to surgery were included. Descriptive characteristics such as participant characteristics, study design, types of cancer, length of study, and primary outcomes were extracted. Methodological rigour was assessed using a modified Delphi List. Due to the heterogeneity and the dearth of pre-surgical studies, we were limited to a systematic review rather than a meta-analysis. RESULTS Eighteen studies were included consisting of a total of 966 participants. Lung cancer studies were the predominant group represented. Most of the studies prescribed an aerobic intervention programs done prior to surgery. Mode, frequency, duration, and intensity of exercise intervention varied across the different cancer groups. The majority of studies showed preliminary positive change in clinical outcomes with significant improvements in the rate of incontinence, functional walking capacity and cardiorespiratory fitness. CONCLUSION Pre-surgical exercise may benefit cancer patients through positive effects on function and physical capacity. Surgical oncologists may consider pre-surgical exercise interventions as a potential adjuvant therapy to improve patients' outcomes.
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Affiliation(s)
- Favil Singh
- Edith Cowan University Health and Wellness Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Perth, Western Australia 6027, Australia.
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