Differences in physical performance between men and women with and without lymphoma

The feasibility and acceptability of neuromuscular electrical stimulation to improve exercise performance in patients with advanced cancer: a pilot study

Background

To determine the feasibility and acceptability of lower limb neuromuscular electrical stimulation (NMES) as a home-based exercise therapy in patients with cancer who could not attend hospital-based exercise training.

Methods

A single-arm prospective pilot study of NMES, applied daily to both quadriceps muscles for six weeks. Participants were recruited from patients referred to a hospital-based multi-disciplinary supportive care team specializing in treatment of patients with nutritional depletion and functional decline.

Results

Of the 15 participants who underwent baseline testing, 10 (67%) completed the study and only one (7%) withdrew because of discomfort due to NMES treatment. 7/10 (70%) of participants used NMES at least three times a week for the duration of the study. Use of NMES did not lead to significant improvements in physical performance tests.

Conclusions

NMES is a feasible and acceptable intervention for home use in patients with cancer, poor performance status and metastatic disease. However, whether NMES is an effective strategy to stabilize or improve physical performance in such patients is not proven.

Cancer-related fatigue: central or peripheral?

To evaluate cancer-related fatigue (CRF) by objective measurements to determine if CRF is a more centrally or peripherally mediated disorder, cancer patients and matched noncancer controls completed a Brief Fatigue Inventory (BFI) and underwent neuromuscular testing. Cancer patients had fatigue measured by the BFI, were off chemotherapy and radiation (for more than four weeks), had a hemoglobin level higher than 10 g/dL, and were neither receiving antidepressants nor were depressed on a screening question. The controls were screened for depression and matched by age, gender, and body mass index. Neuromuscular testing involved a sustained submaximal elbow flexion contraction (SC) at 30% maximal level (30% maximum elbow flexion force). Endurance time (ET) was measured from the beginning of the SC to the time when participants could not maintain the SC. Evoked twitch force (TF), a measure of muscle fatigue, and compound action potential (M-wave), an assessment of neuromuscular-junction transmission were performed during the SC. Compared with controls, the CRF group had a higher BFI score (P<0.001), a shorter ET (P<0.001), and a greater TF with the SC (CRF>controls, P<0.05). This indicated less muscle fatigue. There was a greater TF (P<0.05) at the end of the SC, indicating greater central fatigue, in the CRF group, which failed to recruit muscle (to continue the SC), as well as the controls. M-Wave amplitude was lower in the CRF group than in the controls (P<0.01), indicating impaired neuromuscular junction conduction with CRF unrelated to central fatigue (M-wave amplitude did not change with SC). These data demonstrate that CRF patients exhibited greater central fatigue, indicated by shorter ET and less voluntary muscle recruitment during an SC relative to controls.

A framework for assessment in oncology rehabilitation

Although the incidence of cancer in the United States is high, improvements in early diagnosis and treatment have significantly increased survival rates in recent years. Many survivors of cancer experience lasting, adverse effects caused by either their disease or its treatment. Physical therapy interventions, both established and new, often can reverse or ameliorate the impairments (body function and structure) found in these patients, improving their ability to carry out daily tasks and actions (activity) and to participate in life situations (participation). Measuring the efficacy of physical therapy interventions in each of these dimensions is challenging but essential for developing and delivering optimal care for these patients. This article describes the acute and long-term effects of cancer and its treatment and the use of the World Health Organization's International Classification of Functioning, Disability and Health (ICF) as a basis for selection of assessment or outcome tools and diagnostic or screening tools in this population.

Assessing walking speed in clinical research: a systematic review

OBJECTIVE

To provide a systematic review and describe how assessments of walking speed are reported in the health care literature.

METHODS

MEDLINE electronic database and bibliographies of select articles were searched for terms describing walking speed and distances walked. The search was limited to English language journals from 1996 to 2006. The initial title search yielded 793 articles. A review of the abstracts reduced the number to 154 articles. Of these, 108 provided sufficient information for inclusion in the current review.

RESULTS

Of the 108 studies included in the review 61 were descriptive, 39 intervention and 8 randomized controlled trials. Neurological (n=55) and geriatric (n=27) were the two most frequent participant groups in the studies reviewed. Instruction to walk at a usual or normal speed was reported in 55 of the studies, while 31 studies did not describe speed instructions. A static (standing) start was slightly more common than a dynamic (rolling) start (30 vs 26 studies); however, half of the studies did not describe the starting protocol. Walking 10, 6 and 4 m was the most common distances used, and reported in 37, 20 and 11 studies respectively. Only four studies included information on whether verbal encouragement was given during the walking task.

CONCLUSIONS

Tests of walking speed have been used in a wide range of populations. However, methodologies and descriptions of walking tests vary widely from study to study, which makes comparison difficult. There is a need to find consensus for a standardized walking test methodology.

Mechanisms of cancer-related fatigue

Cancer-related fatigue (CRF) is one of the most prevalent symptoms patients with cancer experience, both during and after treatment. CRF is pervasive and affects patients' quality of life considerably. It is important, therefore, to understand the underlying pathophysiology of CRF in order to develop useful strategies for prevention and treatment. At present, the etiology of CRF is poorly understood and the relative contributions of the neoplastic disease, various forms of cancer therapy, and comorbid conditions (e.g., anemia, cachexia, sleep disorders, depression) remain unclear. In any individual, the etiology of CRF probably involves the dysregulation of several physiological and biochemical systems. Mechanisms proposed as underlying CRF include 5-HT neurotransmitter dysregulation, vagal afferent activation, alterations in muscle and ATP metabolism, hypothalamic-pituitary-adrenal axis dysfunction, circadian rhythm disruption, and cytokine dysregulation. Currently, these hypotheses are largely based on evidence from other conditions in which fatigue is a characteristic, in particular chronic fatigue syndrome and exercise-induced fatigue. The mechanisms that lead to fatigue in these conditions provide a theoretical basis for future research into the complex etiology of this distressing and debilitating symptom. An understanding of relevant mechanisms may offer potential routes for its prevention and treatment in patients with cancer.Disclosure of potential conflicts of interest is found at the end of this article.

Physiological Basis of Fatigue

This work summarizes our knowledge of the physiological basis of fatigue and the effects of exercise and pharmacological interventions on fatigue. Fatigue may be defined as physical and/or mental weariness resulting from exertion, that is, an inability to continue exercise at the same intensity with a resultant deterioration in performance. The concept of deconditioning in patients is discussed as well as the implications for their rehabilitation and exercise. Because fatigue may result from a number of causes, including loss of muscle mass, deconditioning, nutritional deficiencies, oxygen delivery, and anemia, it should be treated comprehensively. Antifatigue therapy should be the standard of care for most chronic conditions associated with fatigue.

The effect of a physical exercise program in palliative care: A phase II study

The purpose of this pilot study was to assess the effects of a physical exercise program on physical performance and quality of life (QOL) in a population with incurable cancer and a short life expectancy. Thirty-four patients participated in a 50-minute group exercise program twice a week for 6 weeks. Physical performance was measured by three tests: "6-minute walk test," "timed repeated sit to stand," and "functional reach." Fatigue was measured by the Fatigue Questionnaire. QOL was assessed by the European Organization for Research and Treatment of Cancer Core Quality of Life Questionnaire. The outcome variables were assessed before and after the intervention. The walk length increased and the "timed repeated sit to stand" was reduced (P < 0.05). Emotional functioning improved and physical fatigue was reduced (P < 0.05). Physical exercise seems to be a feasible way to improve well-being among patients with incurable cancer. Future randomized trials are needed to confirm the results.

Differences in quality of life between non-Hodgkin's lymphoma survivors meeting and not meeting public health exercise guidelines

The primary purpose of this study was to examine differences in quality of life (QoL) between non-Hodgkin's lymphoma (NHL) survivors meeting and not meeting public health exercise guidelines. A secondary purpose was to examine exercise behavior changes across three distinct cancer-related time periods (i.e. prediagnosis, on treatment and off treatment). Using a retrospective survey design, 438 NHL survivors residing in Alberta, Canada completed a mailed questionnaire that assessed self-reported exercise prediagnosis, on treatment and off treatment, and current QoL. Descriptive analyses indicated that 33.8, 6.5 and 23.7% of NHL survivors met public health exercise guidelines during prediagnosis, on treatment, and off treatment time periods, respectively. Multivariate analyses of variance indicated that NHL survivors meeting public health exercise guidelines during postdiagnosis time periods had higher current QoL scores than NHL survivors not meeting guidelines. QoL difference scores between the two groups met proposed standards for clinically important differences. Multivariate analyses also indicated significant differences in exercise behavior across the three cancer-related time periods (all p's<0.01). These analyses were unchanged after statistically controlling for important medical and demographic variables. The results of this study provide evidence that NHL survivors meeting public health exercise guidelines on and off treatment reported higher current QoL than those survivors not meeting guidelines. These findings corroborate research examining exercise behavior in other cancer survivor groups and provide preliminary data to support a randomized controlled trial on exercise and QoL in this population.