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Ranes M, Wiestad TH, Thormodsen I, Arving C. Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study. PEC INNOVATION 2022; 1:100088. [PMID: 37213720 PMCID: PMC10194213 DOI: 10.1016/j.pecinn.2022.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 09/08/2022] [Accepted: 09/28/2022] [Indexed: 05/23/2023]
Abstract
Objective Despite verified knowledge that physical exercise plays an important part in recovery after cancer treatment, multiple studies have shown that maintaining a physically active lifestyle after cancer is challenging. There is a need for qualitative studies to increase understanding into patient experiences and perspectives, and facilitate the design of more sustainable exercise program. This qualitative descriptive feasibility study explores experiences from the implementation of a novel four-month community-based group exercise program for cancer survivors within municipality health service after completion of rehabilitation in the specialist health care service. Methods Fourteen cancer survivors participated in focus group interviews after completing Rehabilitation: Physical activity and Coping - feasibility study. Data were analyzed using the systematic text condensation method. Results We identified a main category, Determinants for exercise adherence and maintenance and four subcategories: peer-support, environment, structure and knowledge. Conclusion A social and supportive exercise environment promotes exercise adherence and maintenance among cancer survivors. This knowledge can be useful for further efforts to implement high quality community-based group exercise programs for cancer survivors. Innovation This study adds knowledge of survivors' experience of a novel community-based group exercise program in clinical practice and can promote the implementation of sustainable community-based exercise programs for cancer survivors.
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Affiliation(s)
- Maria Ranes
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Corresponding author at: Department of Oncology and Medical Physics, Haukeland University Hospital, Box 1400, 5021 Bergen, PO, Norway
| | - Tor Helge Wiestad
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Inger Thormodsen
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
| | - Cecilia Arving
- Department of Oncology and Medical Physics, Haukeland University Hospital, Bergen, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Usability, acceptability, and implementation strategies for the Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm: a Delphi study. Support Care Cancer 2022; 30:7407-7418. [PMID: 35614154 DOI: 10.1007/s00520-022-07164-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/19/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Oncology guidelines recommend participation in cancer rehabilitation or exercise services (CR/ES) to optimize survivorship. Yet, connecting the right survivor, with the right CR/ES, at the right time remains a challenge. The Exercise in Cancer Evaluation and Decision Support (EXCEEDS) algorithm was developed to enhance CR/ES clinical decision-making and facilitate access to CR/ES. We used Delphi methodology to evaluate usability, acceptability, and determine pragmatic implementation priorities. METHODS Participants completed three online questionnaires including (1) simulated case vignettes, (2) 4-item acceptability questionnaire (0-5 pts), and (3) series of items to rank algorithm implementation priorities (potential users, platforms, strategies). To evaluate usability, we used Chi-squared test to compare frequency of accurate pre-exercise medical clearance and CR/ES triage recommendations for case vignettes when using EXCEEDS vs. without. We calculated mean acceptability and inter-rater agreement overall and in 4 domains. We used the Eisenhower Prioritization Method to evaluate implementation priorities. RESULTS Participants (N = 133) mostly represented the fields of rehabilitation (69%), oncology (25%), or exercise science (17%). When using EXCEEDS (vs. without), their recommendations were more likely to be guideline concordant for medical clearance (83.4% vs. 66.5%, X2 = 26.61, p < .0001) and CR/ES triage (60.9% vs. 51.1%, X2 = 73.79, p < .0001). Mean acceptability was M = 3.90 ± 0.47; inter-rater agreement was high for 3 of 4 domains. Implementation priorities include 1 potential user group, 2 platform types, and 9 implementation strategies. CONCLUSION This study demonstrates the EXCEEDS algorithm can be a pragmatic and acceptable clinical decision support tool for CR/ES recommendations. Future research is needed to evaluate algorithm usability and acceptability in real-world clinical pathways.
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Haussmann A, Ungar N, Tsiouris A, Schmidt L, Wiskemann J, Steindorf K, Sieverding M. Better not resting: Carving out attitudes and their associations with physical activity in people with cancer. Eur J Cancer Care (Engl) 2022; 31:e13622. [DOI: 10.1111/ecc.13622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 04/04/2022] [Accepted: 05/11/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Alexander Haussmann
- Institute of Psychology Heidelberg University Heidelberg Germany
- Division of Physical Activity Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ) Heidelberg Germany
| | - Nadine Ungar
- Institute of Psychology Heidelberg University Heidelberg Germany
| | - Angeliki Tsiouris
- Division of Medical Oncology National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg Heidelberg Germany
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Mainz Johannes Gutenberg University Mainz Mainz Germany
| | - Laura Schmidt
- Institute of Psychology Heidelberg University Heidelberg Germany
| | - Joachim Wiskemann
- Division of Medical Oncology National Center for Tumor Diseases (NCT) Heidelberg and University Clinic Heidelberg Heidelberg Germany
| | - Karen Steindorf
- Division of Physical Activity Prevention and Cancer, National Center for Tumor Diseases (NCT) Heidelberg and German Cancer Research Center (DKFZ) Heidelberg Germany
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Watson G, Coyne Z, Houlihan E, Leonard G. Exercise oncology: an emerging discipline in the cancer care continuum. Postgrad Med 2021; 134:26-36. [PMID: 34854802 DOI: 10.1080/00325481.2021.2009683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Exercise is an essential component of healthy living and well-being. While there is a global acceptance of the benefits of exercise for the general population, there exists hesitancy and confusion among health-care professionals, particularly oncologists, as to whether these benefits translate to cancer patients. Patient referrals to accessible, structured exercise programs in this setting are often overlooked by physicians when formulating a cancer management plan. There is however increasing awareness and acceptance of cancer survivorship as a part of the cancer care continuum, identifying multiple factors that contribute to well-being beyond just cancer outcomes. Efforts to optimize cancer survivorship have stimulated further academic interest in the benefits of healthy living and particularly exercise oncology. There is now compelling evidence that exercise, which includes daily activities such as walking, as well as structured programs, improves multiple-cancer outcomes such as fatigue, quality of life and likely survival, and warrants consideration in the multidisciplinary care of cancer patients. International guidelines have been established that recommend counseling cancer patients with regard to healthy lifestyle changes including exercise. However, there still remains a reluctance from oncology physicians to prescribe exercise for these patients, largely due to uncertainty with regard to their patients' ability to tolerate such an intervention, coupled with insufficient understanding of the potential benefits of these programs. There also exist patient barriers and attitudes that must be overcome. Exercise strategies and bespoke programs that are tailored to the unique abilities and goals of the patients will enhance participation. To move the field forward and integrate exercise oncology into standard practice, it is imperative to raise awareness of the benefits of exercise to cancer patients and their health-care providers. This will facilitate the prescription of exercise as part of the multimodal treatment plan with the ultimate aim of promoting an active lifestyle to optimize patient care and well-being.
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Affiliation(s)
- Ga Watson
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - Zl Coyne
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
| | - E Houlihan
- Department of Physiotherapy, Cancer Care West, Galway, Ireland
| | - Gd Leonard
- Department of Medical Oncology, University Hospital Galway, Galway, Ireland
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5
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Wilkinson TJ, Clarke AL, Nixon DGD, Hull KL, Song Y, Burton JO, Yates T, Smith AC. Prevalence and correlates of physical activity across kidney disease stages: an observational multicentre study. Nephrol Dial Transplant 2021; 36:641-649. [PMID: 31725147 DOI: 10.1093/ndt/gfz235] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 10/14/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND People with chronic kidney disease (CKD) report high levels of physical inactivity, a major modifiable risk factor for morbidity and mortality. Understanding the biological, psychosocial and demographic causes of physical activity behaviour is essential for the development and improvement of potential health interventions and promotional initiatives. This study investigated the prevalence of physical inactivity and determined individual correlates of this behaviour in a large sample of patients across the spectrum of kidney disease. METHODS A total of 5656 people across all stages of CKD (1-2, 3, 4-5, haemodialysis, peritoneal dialysis and renal transplant recipients) were recruited from 17 sites in England from July 2012 to October 2018. Physical activity was evaluated using the General Practice Physical Activity Questionnaire. Self-reported cardiorespiratory fitness, self-efficacy and stage of change were also assessed. Binominal generalized linear mutually adjusted models were conducted to explore the associations between physical activity and correlate variables. This cross-sectional observational multi-centre study was registered retrospectively as ISRCTN87066351 (October 2015). RESULTS The prevalence of physical activity (6-34%) was low and worsened with disease progression. Being older, female and having a greater number of comorbidities were associated with greater odds of being physically inactive. Higher haemoglobin, cardiorespiratory fitness and self-efficacy levels were associated with increased odds of being active. Neither ethnicity nor smoking history had any effect on physical activity. CONCLUSIONS Levels of physical inactivity are high across all stages of CKD. The identification of stage-specific correlates of physical activity may help to prioritize factors in target groups of kidney patients and improve the development and improvement of public health interventions.
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Affiliation(s)
- Thomas J Wilkinson
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Amy L Clarke
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK
| | - Daniel G D Nixon
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Katherine L Hull
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,University Hospitals of Leicester NHS Trust, Infirmary Square, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Yan Song
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,School of Nursing, Nantong University Medical School, Nantong University, Nantong, PR China
| | - James O Burton
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Thomas Yates
- NIHR Leicester Biomedical Research Centre, Leicester, UK.,Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK
| | - Alice C Smith
- Department of Health Sciences, Leicester Kidney Lifestyle Team, University of Leicester, Leicester, UK.,NIHR Leicester Biomedical Research Centre, Leicester, UK
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6
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Elshahat S, Treanor C, Donnelly M. Factors influencing physical activity participation among people living with or beyond cancer: a systematic scoping review. Int J Behav Nutr Phys Act 2021; 18:50. [PMID: 33823832 PMCID: PMC8025326 DOI: 10.1186/s12966-021-01116-9] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 03/19/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND It has been posited that physical activity (PA) has the potential to improve health outcomes and the health-related quality of life of people living with or beyond cancer. Despite the well-documented health benefits of PA, there is a low level of PA among cancer patients. A systematic scoping review was conducted to investigate attitudes, perceptions, preferences and barriers vs. facilitators to cancer patients' PA participation. METHODS A systematic search was performed across four automated databases (PubMed, Embase, PsycINFO and Medline) in keeping with the PRISMA guideline. All cancer types were included, and any age/gender groups were eligible. Both qualitative and quantitative studies were included. The Health Belief Model provided a conceptual framework for the conduct of the scoping review as well as guiding thinking to inform evidence-based interventions. RESULTS Ninety-eight articles were included in this review. Nearly half of the studies focused on mixed cancer sites; breast cancer was the most commonly examined cancer type (19%). Post-treatment was the most commonly investigated stage (33%), followed by studies of mixed stages of the cancer trajectory (27%), the acute treatment stage (23%) and pre-treatment stage (1%). Patient treatment stage was not reported in 16% of studies. Cancer patients reported positive attitudes to PA and recognized its benefits for health and wellbeing. Cancer-related side effects (e.g. fatigue) were a leading physiological barrier to PA participation, whereas effective symptom management techniques/tools acted as a powerful facilitator. Psychosocial barriers included low motivation and kinesiophobia, and perceived health benefits and social support/guidance by healthcare providers were significant facilitators. Inaccessible fitness facilities hindered cancer patients' PA engagement though the availability of tailored amenities appeared to be a strong facilitator. PA preferences varied in terms of type, place, time, company and source of information and pointed to the need for individualized PA programs. CONCLUSIONS There is a need for further research to identify barriers and facilitators to PA that are faced by patients with particular cancer types. Recommended PA promoting-strategies involve including exercise science professionals in healthcare teams and ensuring that fitness facilities are accessible.
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Affiliation(s)
- Sarah Elshahat
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Charlene Treanor
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Sciences, Block B, Royal Victoria Hospital, Belfast, BT12 6BA, UK
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Zheng JY, Mixon AC, McLarney MD. Safety, Precautions, and Modalities in Cancer Rehabilitation: an Updated Review. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2021; 9:142-153. [PMID: 34178432 PMCID: PMC8214054 DOI: 10.1007/s40141-021-00312-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Providing rehabilitation to patients with cancer can be challenging due to the medical complexity associated with the illness and its treatments. This article provides the reader with a summary of frequently encountered medical conditions in the cancer population and associated safety considerations and precautions. An update on treatment modalities commonly used for symptom management is also presented. RECENT FINDINGS Cancer and cancer treatments can cause changes in multiple organ systems. Special considerations and precautions are necessary to provide safe and effective rehabilitation. Physical modalities can be used as monotherapy or adjunct to treatment for common cancer-related side effects with recent studies noting benefit with a variety of modalities. SUMMARY Detailed assessment of the cancer patient is necessary before implementing a rehabilitation program. Understanding cancer and side effects of treatments, including newer options, are necessary to provide safe care.
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Affiliation(s)
- Jasmine Y. Zheng
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
| | - Alyssa C. Mixon
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
| | - Mitra D. McLarney
- Department of Physical Medicine and Rehabilitation, University of Pennsylvania, 1800 Lombard St, 1st Floor, Philadelphia, PA 19146 USA
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Suderman K, Dolgoy N, Yurick J, Sellar C, Nishimura K, Culos-Reed SN, Joy AA, McNeely ML. A Practical Approach to Using Integrated Knowledge Translation to Inform a Community-Based Exercise Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113911. [PMID: 32492824 PMCID: PMC7312668 DOI: 10.3390/ijerph17113911] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/19/2020] [Accepted: 05/28/2020] [Indexed: 12/17/2022]
Abstract
Background: Our aim was to understand cancer survivor needs prior to, and following the Alberta Cancer Exercise (ACE) pilot randomized trial as a means to inform implementation of a province-wide cancer-specific, community-based exercise program. Methods: Questionnaires and semi-structured stakeholder engagement sessions were conducted with cancer survivors to explore preferences, barriers and facilitators/benefits at two timepoints: (1) pre-ACE: prior to initiation of the ACE pilot trial (n = 13 survivors and n = 5 caregivers); and (2) post-ACE: following participation in the ACE pilot trial (n = 20 survivors). Descriptive statistics were used to summarize quantitative data from questionnaires. Stakeholder engagement data were analyzed using a framework analysis approach. Emergent themes were then mapped to actionable outcomes. Results: Pre-ACE, survivors indicated a preference for exercise programs that were (1) supervised by exercise specialists knowledgeable about cancer, (2) included support from other health care providers, (3) were held in community locations that were easily accessible. Post-ACE, participants identified (1) a lack of exercise counseling from health care providers, (2) the need for earlier introduction of exercise in the care pathway, and (3) supported referral to exercise programming. Conclusions: An integrated knowledge translation approach identified actionable outcomes to address survivor needs related to exercise in clinical cancer and community-based contexts.
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Affiliation(s)
- Kirsten Suderman
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Naomi Dolgoy
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Janice Yurick
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
| | - Christopher Sellar
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
| | - Kathryn Nishimura
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - S. Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, AB T2N 1N4, Canada;
| | - Anil A. Joy
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
| | - Margaret L. McNeely
- Department of Physical Therapy, University of Alberta, 2-50 Corbett Hall, Edmonton, AB T6G 2G4, Canada; (K.S.); (N.D.); (C.S.); (K.N.)
- Cross Cancer Institute, Alberta Health Services, 11560 University Avenue, Edmonton, AB T6G 1Z2, Canada; (J.Y.); (A.A.J.)
- Correspondence: ; Tel.: +1-780-248-1531
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Jesus TS, Gianola S, Castellini G, Colquhoun H, Brooks D. Evolving Trends in Physiotherapy Research Publications between 1995 and 2015. Physiother Can 2020; 72:122-131. [PMID: 32494096 DOI: 10.3138/ptc-2018-0065] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose: The aim of this study was to comparatively analyze evolving trends in physiotherapy (PT) research publications (excluding case reports and epidemiological and qualitative studies) between 1995 and 2015, inclusively in terms of research design, funding support, age groups, and health conditions. Method: This was an observational study using PubMed-indexed data. Combinations of medical subject headings identified yearly research publications for PT and comparator fields: human-based health and physical rehabilitation. Yearly publications data were extracted, relative percentages were computed, and linear or exponential regressions examined the yearly growth in the proportion of research publications over these 2 decades. Results: As a percentage of human-based health research publications, PT research publications grew exponentially: from 0.54% in 1995 to 2.37% in 2015 (r² = 0.97; p < 0.01). As a percentage of physical rehabilitation research publications, PT research grew from 38.2% in 1995 to 58.7% in 2015 (r² = 0.89; p < 0.01). Randomized controlled trials (RCTs) resulted in the majority of PT research publications (from 45.1% in 1995 to 59.4% in 2015; r² = 0.79; p < 0.01). Rates of declared funding increased (from 29.7% in 1995 to 57% in 2015; r² = 0.83; p < 0.01), but the comparator fields had similar growth. The percentage of PT research publications remained stable for most health conditions and age groups, decreased for those aged 0-18 years (p = 0.012) and for cardiovascular and pulmonary conditions (both p < 0.01), and increased for neoplasms (p < 0.01). Conclusions: PT research publications have become more prevalent among health and physical rehabilitation research publications; the majority of publications report on RCTs.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon, Lisbon, Portugal
| | - Silvia Gianola
- Center of Biostatistics for Clinical Epidemiology, School of Medicine and Surgery, University of Milano-Bicocca.,Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi
| | - Greta Castellini
- Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Heather Colquhoun
- Department of Occupational Science and Occupational Therapy.,Rehabilitation Sciences Institute
| | - Dina Brooks
- Rehabilitation Sciences Institute.,Department of Physical Therapy, University of Toronto, Toronto.,School of Rehabilitation Science, McMaster University, Hamilton, Ont
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10
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Schmitz KH, Campbell AM, Stuiver MM, Pinto BM, Schwartz AL, Morris GS, Ligibel JA, Cheville A, Galvão DA, Alfano CM, Patel AV, Hue T, Gerber LH, Sallis R, Gusani NJ, Stout NL, Chan L, Flowers F, Doyle C, Helmrich S, Bain W, Sokolof J, Winters-Stone KM, Campbell KL, Matthews CE. Exercise is medicine in oncology: Engaging clinicians to help patients move through cancer. CA Cancer J Clin 2019; 69:468-484. [PMID: 31617590 PMCID: PMC7896280 DOI: 10.3322/caac.21579] [Citation(s) in RCA: 374] [Impact Index Per Article: 74.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 07/18/2019] [Accepted: 07/23/2019] [Indexed: 02/03/2023] Open
Abstract
Multiple organizations around the world have issued evidence-based exercise guidance for patients with cancer and cancer survivors. Recently, the American College of Sports Medicine has updated its exercise guidance for cancer prevention as well as for the prevention and treatment of a variety of cancer health-related outcomes (eg, fatigue, anxiety, depression, function, and quality of life). Despite these guidelines, the majority of people living with and beyond cancer are not regularly physically active. Among the reasons for this is a lack of clarity on the part of those who work in oncology clinical settings of their role in assessing, advising, and referring patients to exercise. The authors propose using the American College of Sports Medicine's Exercise Is Medicine initiative to address this practice gap. The simple proposal is for clinicians to assess, advise, and refer patients to either home-based or community-based exercise or for further evaluation and intervention in outpatient rehabilitation. To do this will require care coordination with appropriate professionals as well as change in the behaviors of clinicians, patients, and those who deliver the rehabilitation and exercise programming. Behavior change is one of many challenges to enacting the proposed practice changes. Other implementation challenges include capacity for triage and referral, the need for a program registry, costs and compensation, and workforce development. In conclusion, there is a call to action for key stakeholders to create the infrastructure and cultural adaptations needed so that all people living with and beyond cancer can be as active as is possible for them.
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Affiliation(s)
- Kathryn H Schmitz
- Department of Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania
| | - Anna M Campbell
- School of Applied Sciences, Edinburgh Napier University, Edinburgh, United Kingdom
| | - Martijn M Stuiver
- Center for Quality of Life, Netherlands Cancer Institute, Amsterdam, The Netherlands
- ACHIEVE, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bernardine M Pinto
- College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Anna L Schwartz
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - G Stephen Morris
- Department of Physical Therapy, Wingate University, Wingate, North Carolina
| | - Jennifer A Ligibel
- Division of Women's Cancers, Dana Farber Cancer Institute, Boston, Massachusetts
| | - Andrea Cheville
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | | | - Alpa V Patel
- Behavioral and Epidemiology Research, American Cancer Society, Atlanta, Georgia
| | - Trisha Hue
- Data and Information Management, University of California at San Francisco, San Francisco, California
| | - Lynn H Gerber
- Health Administration and Policy, George Mason University, Fairfax, Virginia
| | - Robert Sallis
- Family Medicine, Kaiser Permanente Southern California, Pasadena, California
| | - Niraj J Gusani
- Department of Surgery, Penn State Cancer Institute, Hershey, Pennsylvania
| | - Nicole L Stout
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Fiona Flowers
- Community Settings, Macmillan Cancer Support, London, United Kingdom
| | - Colleen Doyle
- Department of Cancer Control, American Cancer Society, Atlanta, Georgia
| | | | | | - Jonas Sokolof
- Physical Medicine and Rehabilitation, New York University Langone Medical Center, New York, New York
| | - Kerri M Winters-Stone
- Knight Cancer Institute, School of Nursing, Oregon Health and Science University, Portland, Oregon
| | - Kristin L Campbell
- Department of Physical Therapy, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles E Matthews
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, Maryland
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11
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Faller H, Hass HG, Engehausen D, Reuss-Borst M, Wöckel A. Supportive care needs and quality of life in patients with breast and gynecological cancer attending inpatient rehabilitation. A prospective study. Acta Oncol 2019; 58:417-424. [PMID: 30632891 DOI: 10.1080/0284186x.2018.1543947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Among patients with breast or gynecological cancer, supportive care needs are both highly prevalent and enduring. However, little is known about whether meeting patients' needs is accompanied by increased quality of life (QoL). We aimed to explore patients' supportive care needs reported at the beginning of inpatient rehabilitation and examined whether meeting these needs resulted in improved QoL. MATERIAL AND METHODS In a multicenter, prospective cohort study with 2 measurement occasions (beginning and end of inpatient rehabilitation), 292 patients with breast and gynecological cancer (mean age 55 years; 71% breast cancer) were enrolled. In 73%, time since diagnosis was longer than 6 months. We obtained self-reports of supportive care needs in 12 domains and measured QoL using the EORTC QLQ-C30 functioning subscales. RESULTS At the beginning of inpatient rehabilitation, top-ranking severe supportive care needs concerned coordination of care (48%), medical information (45%), alleviation of physical symptoms (42%) and support with improving health behaviors (36%). At the end of inpatient rehabilitation, all needs assessed declined significantly, although many patients still expressed strong needs in some domains. However, meeting patients' needs was accompanied by improvements in all functioning subscales. CONCLUSIONS This is the first study to show that meeting breast and gynecological cancer patients' supportive care needs during inpatient rehabilitation resulted in improved QoL. Given the considerable proportions of patients still reporting unmet needs at the end of their stay, stronger and continuing efforts seem warranted to meet these needs and thus further increase QoL.
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Affiliation(s)
- Hermann Faller
- Department of Medical Psychology and Psychotherapy, Medical Sociology and Rehabilitation Sciences, and Comprehensive Cancer Center Mainfranken, University of Würzburg, Würzburg, Germany
| | | | - Dirk Engehausen
- Sinntal Clinic Bad Brückenau, German Statutory Pension Insurance of Northern Bavaria, Bad Brückenau, Germany
| | - Monika Reuss-Borst
- Center for Rehabilitation and Prevention Bad Bocklet, Bad Bocklet, Germany
| | - Achim Wöckel
- Department of Gynecology and Obstetrics, University Hospital Würzburg, Würzburg, Germany
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Romero SAD, Brown JC, Bauml JM, Hay JL, Li QS, Cohen RB, Mao JJ. Barriers to physical activity: a study of academic and community cancer survivors with pain. J Cancer Surviv 2018; 12:744-752. [PMID: 30182150 DOI: 10.1007/s11764-018-0711-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 08/20/2018] [Indexed: 11/24/2022]
Abstract
PURPOSE Despite the numerous benefits of physical activity (PA) for patients with cancer, many cancer survivors report challenges to participating in PA. The objectives of this study were (1) to assess barriers to PA and (2) to examine participant characteristics associated with modifiable barriers to PA among cancer survivors with pain. METHODS We conducted a cross-sectional survey study at one academic medical center and 11 community hospitals. Participants completed the 12-item Physical Activity Barriers After Cancer (PABAC) instrument (Cronbach's alpha = 0.75). Multivariable regression models examined participant characteristics associated with PABAC scores with a higher score indicating more barriers to PA. RESULTS Among 662 survivors, 67% had moderate or severe pain (rating 4 or greater on a scale of 0 to 10). Seventy-five percent of survivors did not meet the American Cancer Society PA recommendations on average, and these individuals had higher mean PABAC scores (beta coefficient (β) = 2.02, 95% confidence interval (CI) 0.96-3.09, p < 0.001). In adjusted analyses, cancer survivors who were non-white (β = 1.55, 0.28-2.82, p = 0.02), treated at a community hospital (β = 1.07, 0.09-2.05, p = 0.03), had surgery (β = 1.69, 0.69-2.69, p = 0.001), or within 12 months of diagnosis (β = 1.15, 0.20-2.10, p = 0.02) reported greater barriers to PA. CONCLUSIONS The majority of cancer survivors with pain are not adequately participating in PA. Key demographic and clinical characteristics are associated with survivors' barriers. IMPLICATIONS FOR CANCER SURVIVORS Efforts to overcome specific barriers are needed to promote PA after a cancer diagnosis.
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Affiliation(s)
- Sally A D Romero
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
| | | | - Joshua M Bauml
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA
| | - Jennifer L Hay
- Department of Psychiatry and Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Q Susan Li
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Roger B Cohen
- Department of Medicine, Perelman School of Medicine, University of Pennsylvania, PA, Philadelphia, USA
| | - Jun J Mao
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Memorial Sloan Kettering Cancer Center, Bendheim Integrative Medicine Center, 1429 First Avenue, New York, NY, 10021, USA.
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An Exploration of Sensation Seeking in Persons With Disabilities in Rehabilitation. Rehabil Nurs 2018; 44:230-235. [PMID: 29794570 DOI: 10.1097/rnj.0000000000000146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study reports the findings of a study about sensation-seeking or high-risk/challenging sports in persons who have disabilities. DESIGN Exploratory, cross-sectional, and descriptive. METHODS Two hundred and twenty-three recruitment e-mails were sent to potential participants. Data were collected through Qualtrics. FINDINGS Mean score for Contextual Sensation Seeking Questionnaire for Skiing and Snowboarding (M = 30.21, SD = 8.18) was significantly lower than a sample of able-bodied skiers and snowboarders, t(239) = 2.75, p = .006. Mean for impulsive sensation seeking was lower than the same sample of able-bodied athletes cited in a previous study, t(240) = 4.56, p = .001. Means for the Zuckerman Kuhlman Personality Questionnaire subscales were impulsivity (M = 1.98, SD = 4.05) and sensation seeking (M = 6.75, SD = 2.68). CONCLUSIONS This group scored lower in sensation seeking compared to able-bodied high-risk/challenging sports activities participants. Sensation seeking is not a motivating factor in this sample. CLINICAL RELEVANCE Nurses could encourage rehabilitation patients to engage in challenging activities for personal and group mastery.
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Catt S, Sheward J, Sheward E, Harder H. Cancer survivors’ experiences of a community-based cancer-specific exercise programme: results of an exploratory survey. Support Care Cancer 2018; 26:3209-3216. [DOI: 10.1007/s00520-018-4179-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/23/2018] [Indexed: 11/30/2022]
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Lyons KD, Newman R, Adachi-Mejia AM, Whipple J, Hegel MT. Content Analysis of a Participant-Directed Intervention to Optimize Activity Engagement of Older Adult Cancer Survivors. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 38:38-45. [PMID: 28929925 DOI: 10.1177/1539449217730356] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many older adult cancer survivors reduce their activity level during and after cancer treatment. Occupational therapy interventions need to flexibly address various obstacles to occupational engagement that survivors may face. The aim of this analysis was to describe the content of a participant-directed occupational therapy intervention for older adults with cancer. Content analysis was used to describe the treatment session data from the experimental arm of a pilot randomized controlled trial in terms of activities addressed, obstacles reported, and treatment strategies utilized. Participants predominantly used the intervention to increase exercise engagement or address instrumental activities of daily living. The most common obstacles to occupational engagement included fatigue, finding time, weather, and pain. Regarding treatment strategies, 77% of participants chose to practice the activity with the occupational therapist, 42% requested a piece of equipment, and 11% modified the environment to increase activity engagement. Overall, the participant-directed intervention appears flexible enough to address various activities and obstacles to occupational engagement.
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Affiliation(s)
- Kathleen Doyle Lyons
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,2 Dartmouth College, Hanover, NH, USA
| | | | | | | | - Mark T Hegel
- 1 Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.,2 Dartmouth College, Hanover, NH, USA
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