Physical activity programming and counseling preferences among cancer survivors: a systematic review

The Relationship Between Secondary Traumatic Stress and Compassion Satisfaction: A Systematic Literature Review

This systematic literature review examines the relationship between secondary traumatic stress (STS) and compassion satisfaction (CS) to identify the state of the science and directions for future research. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis framework was used to guide the identification and evaluation of studies. Eight academic databases were systematically searched between July and December of 2022 to identify articles and dissertations published in English or Hebrew between 2000 and 2022. Studies were considered for inclusion if they examined the relationship between STS and CS and met an established quality threshold. If studies used a mixed methods approach, only quantitative results were included in the review. The search strategy yielded 537 studies with 33 included in the final review. Findings of this review suggest experiences of high levels of STS can coexist with high levels of CS indicating that people can gain satisfaction from their work and experience STS. Most studies examined the relationship between STS and CS using bivariate analyses with variability found in the direction of the relationship. This variability was also found in multivariate studies included in this review. These findings suggest the need for interventions to address both STS and CS with attention paid to the potential negative impact of emotional contagion and the vulnerability of younger female practitioners. Future research should pay attention to the rigor of the analysis of STS and CS and the exploration of mediating or moderating mechanisms between these constructs.

Exploring Chemotherapy-Induced Peripheral Neuropathy Management Practice Patterns Among Oncology Clinicians

OBJECTIVES

Approximately 60% of cancer survivors receiving neurotoxic chemotherapy experience chemotherapy-induced peripheral neuropathy (CIPN) (eg, hand and foot numbness, tingling, or pain). There is only one recommended pharmacological treatment (duloxetine) and one modestly beneficial nonpharmacological treatment (exercise) for CIPN. However, data suggest national guideline recommendations are not routinely practiced. Further, less is known about nurses' CIPN management practices. The purpose of this convergent mixed methods study was to explore oncology clinicians' self-reported practices and perceptions regarding CIPN prevention and management.

METHODS

Oncology clinicians at three cancer centers completed a survey about their recommendations for CIPN prevention and management in practice. A subset of clinicians also participated in a semi-structured interview to explore their perspectives of and motivations for implementing CIPN assessment, prevention, and management in practice. Quantitative data were described (eg, frequency or median) and qualitative data were analyzed using inductive content analysis.

RESULTS

This study (N = 44 survey responses; n = 9 interviews) resulted in four themes: (1) clinicians primarily recommend gabapentin for CIPN management and often observe cryotherapy used for CIPN prevention, but these interventions are complicated by discomfort, intolerable side effects, and efficacy concerns; (2) clinicians perceive CIPN as troublesome and desire additional information and resources regarding CIPN prevention and management; (3) CIPN-related education provided by clinicians may be limited by patient retention of the amount of education received about cancer treatment and other factors; (4) clinicians use subjective CIPN assessment to screen at each visit for common CIPN symptoms (eg, numbness or tingling) and the impact of symptoms on day-to-day activities.

CONCLUSIONS

Discrepancies persist between evidence-based guidelines on CIPN management and current oncology clinician practices.

IMPLICATIONS FOR NURSING PRACTICE

Clinician involvement is needed when developing education and resources to help oncology clinicians provide the most evidence-based care to potentially prevent and manage their patients' CIPN.

Determinants of physical activity promotion in primary care from the patient perspective of people at risk of or living with chronic disease: a COM-B analysis

BACKGROUND

Chronic disease (CD) accounts for more than half of the overall global disease burden and physical activity (PA) is an established evidence-based strategy for the prevention and management of CD. Global policy emphasises the value of embedding PA into primary healthcare, highlighting the positive effects on PA behaviour. However, there is limited implementation of PA protocols in primary care, and research is needed to guide its integration into routine practice. The voice of the patient is underrepresented in the literature, resulting in the absence of critical insights into determinants of PA promotion in primary care. The purpose of the research was to identify the perspectives of people at risk of or living with CD on the determinants of PA promotion in primary care and to map these determinants across the six COM-B constructs.

METHODS

Semi-structured interviews (n = 22), guided by the COM-B model were conducted with people aged 35-60 years, at risk of or living with CD and not meeting the PA guidelines. A hybrid analytic approach of thematic inductive and deductive analysis was applied to the participant transcripts guided by a COM-B informed coding framework.

RESULTS

In total, 37 determinants across constructs related to capability, opportunity and motivation were prominent, examples include; physical capability constraints, the conflation of exercise with weight management, credibility of the health services in PA advice, communication styles in PA promotion, expectations of tailored support for PA, social support, accessibility, and integration of PA into routine habits.

CONCLUSION

Exploring the determinants of PA promotion through the lens of the COM-B model facilitated a systematic approach to understanding the primary care user perspective of the healthcare professional (HCP) broaching the topic of PA. Findings emphasise the value of HCPs being supported to broach the issue of PA in a therapeutic and patient-centred manner using diverse and flexible approaches, while highlighting the importance of tailored, accessible PA opportunities that build self-efficacy and foster social support. The research provides valuable learnings to support PA promotion and the development of strategies in primary care through encompassing the perspective of those living with or at risk of CD.

Creatine supplementation and resistance training to preserve muscle mass and attenuate cancer progression (CREATINE-52): a protocol for a double-blind randomized controlled trial

BACKGROUND

Muscle mass is important for metastatic prostate cancer survival and quality of life (QoL). The backbone of treatment for men with metastatic castration sensitive prostate cancer (mCSPC) is androgen deprivation therapy (ADT) with an androgen signaling inhibitor. ADT is an effective cancer treatment, but it facilitates significant declines in muscle mass and adverse health outcomes important to mCSPC survivors, such as fatigue, and reductions in physical function, independence, insulin sensitivity, and QoL. In non-metastatic CSPC survivors, resistance training (RT) preserves muscle mass and improves these related health outcomes, but the biggest barrier to RT in CSPC survivors of all stages is fatigue. Creatine monohydrate supplementation coupled with RT (Cr + RT) may address this barrier since creatine plays a critical role in energy metabolism. Cr + RT in cancer-free older adults and other clinical populations improves muscle mass and related health outcomes. Evidence also suggests that creatine supplementation can complement cancer treatment. Thus, Cr + RT is a strategy that addresses gaps in survivorship needs of people with mCSPC. The purpose of this parallel, double-blind randomized controlled trial is to test the effects of 52-weeks of Cr + RT compared with placebo (PLA) and RT (PLA + RT) on muscle mass, other related health outcomes, and markers of cancer progression.

METHODS

We will carry out this trial with our team's established, effective, home-based, telehealth RT program in 200 mCSPC survivors receiving ADT, and evaluate outcomes at baseline, 24-, and 52-weeks. RT will occur twice weekly with elastic resistance bands, and an established creatine supplementation protocol will be used for supplementation delivery. Our approach addresses a major facilitator to RT in mCSPC survivors, a home-based RT program, while utilizing a supervised model for safety.

DISCUSSION

Findings will improve delivery of comprehensive survivorship care by providing a multicomponent, patient-centered lifestyle strategy to preserve muscle mass, improve health outcomes, and complement cancer treatment (NCT06112990).

Virtually Supervised Exercise Programs for People With Cancer: A Scoping Review

BACKGROUND

Exercise has been shown to improve physical function and quality of life for individuals with cancer. However, low rates of exercise adoption and commonly reported barriers to accessing exercise programming have demonstrated a need for virtual exercise programming in lieu of traditional in-person formats.

OBJECTIVE

The aim of this study was to summarize the existing research on supervised exercise interventions delivered virtually for individuals living with and beyond cancer.

METHODS

We conducted a scoping review of randomized controlled trials, pilot studies, or feasibility studies investigating virtually supervised exercise interventions for adults either during or after treatment of cancer. The search included EMBASE, MEDLINE, CINAHL, SPORTDiscus, Cochrane Library, and conference abstracts.

RESULTS

Fifteen studies were included. The interventions were delivered mostly over Zoom in a group format, with various combinations of aerobic and resistance exercises. Attendance ranged from 78% to 100%, attrition ranged from 0% to 29%, and satisfaction ranged from 94% to 100%. No major adverse events were reported, and only 3 studies reported minor adverse events. Significant improvements were seen in upper and lower body strength, endurance, pain, fatigue, and emotional well-being.

CONCLUSION

Supervised exercise interventions delivered virtually are feasible and may improve physical function for individuals with cancer. The supervision included in these virtual programs promoted similar safety as seen with in-person programming. More randomized controlled trials with large cohorts are needed to validate these findings.

IMPLICATIONS FOR PRACTICE

Individuals living with and beyond cancer can be encouraged to join virtually supervised exercise programs because they are safe, well enjoyed, and may improve physical function and quality of life.

[Barriers and facilitators to physical activity in oncology in Seine-Saint-Denis: A qualitative study using the socio-ecological approach]

INTRODUCTION

Despite the undeniable benefits of physical activity during and beyond cancer treatments, patients do not always undertake and/or maintain it. The aim of the study is to identify, describe and understand the barriers and facilitators of physical activity practice among adults arriving at the end of treatment for solid cancer, in precarious situations, living in Seine-Saint-Denis.

METHODS

The study was conducted using a descriptive qualitative phenomenological method involving semi-directed interviews with 23 participants during and beyond cancer.

RESULTS

Multiple-level factors (micro, meso, macro) are involved in active behavior of patients. Three main facilitators were identified: perceived benefit, social support, and urban planning. Three barriers are identified: (1) physical and psychological disorders whether or not related to cancer and its treatment, (2) precariousness, organizational constraints, unfavorable social environment, (3) lack of coordination, lack of accurate and appropriate information, lack of realistic referral to physical activity offers.

DISCUSSION

A diversity of representations, combinations of factors, and experiences are described. Getting people with cancer to engage in and maintain long-term physical activity is a complex task, requiring multidisciplinary action on all socio-ecological factors.

The Development of a Multi-Modal Cancer Rehabilitation (Including Prehabilitation) Service in Sheffield, UK: Designing the Active Together Service

Cancer patients undergoing major interventions face numerous challenges, including the adverse effects of cancer and the side effects of treatment. Cancer rehabilitation is vital in ensuring cancer patients have the support they need to maximise treatment outcomes and minimise treatment-related side effects and symptoms. The Active Together service is a multi-modal rehabilitation service designed to address critical support gaps for cancer patients. The service is located and provided in Sheffield, UK, an area with higher cancer incidence and mortality rates than the national average. The service aligns with local and regional cancer care objectives and aims to improve the clinical and quality-of-life outcomes of cancer patients by using lifestyle behaviour-change techniques to address their physical, nutritional, and psychological needs. This paper describes the design and initial implementation of the Active Together service, highlighting its potential to support and benefit cancer patients.

Feasibility of a novel exercise program for patients with breast cancer offering different modalities and based on patient preference

PURPOSE

Exercise improves quality of life and reduces the side effects of cancer therapies. Nevertheless, attendance to exercise programs remains a challenge for patients. This study explored the feasibility of an exercise program in which women with breast cancer may be allowed to choose among three exercise delivery modalities.

METHODS

Forty-seven patients with breast cancer (stage I-IV) participated in a 12-week combined aerobic and resistance training program. The exercise modality was chosen by patients according to their preferences and needs among three options: the personal training program, the home-based program, or the group-based program. Exercise prescription was similar between the three modalities. Whereas the primary endpoint was feasibility, assessed through recruitment rate, attendance, adherence, dropout rate, tolerability, and safety, secondary endpoints included health-related skills and quality of life.

RESULTS

Out of 47 recruited patients, 24 chose the home-based program, 19 the personal training program, and four the group-based program. Six dropouts (13%) were registered, and no severe adverse events were recorded. The median program attendance was 98% for personal training programs, 96% for home-based programs, and 100% for group-based programs, whereas compliance resulted in more than 90% in each modality. At postintervention, a significant increase in cardiorespiratory fitness, lower body flexibility, and body weight was observed. Different quality-of-life domains were improved following the intervention, including physical and social functioning, fatigue, and appetite loss. No significant changes in other parameters were detected.

CONCLUSIONS

An exercise prescription based on a patient-preferred delivery modality showed high feasibility in women with breast cancer.

The feasibility and acceptability of an app-based intervention with brief behavioural support (APPROACH) to promote brisk walking in people diagnosed with breast, prostate and colorectal cancer in the UK

INTRODUCTION

Increased moderate to vigorous physical activity (MVPA) can improve clinical and psychosocial outcomes for people living with and beyond cancer (LWBC). This study aimed to assess the feasibility and acceptability of trial procedures in a pilot randomised controlled trial (RCT) of a theory-driven app-based intervention with behavioural support focused on promoting brisk walking (a form of MVPA) in people LWBC (APPROACH).

METHODS

Participants diagnosed with breast, prostate or colorectal cancer were recruited from a single UK hospital site. Assessments at baseline and 3 months included online questionnaires, device-measured brisk walking (activPAL accelerometer) and self-reported weight and height. Participants were randomised to intervention or control (care as usual). The intervention comprised a non-cancer-specific app to promote brisk walking (National Health Service 'Active 10') augmented with print information about habit formation, a walking planner and two behavioural support telephone calls. Feasibility and acceptability of trial procedures were explored. Initial estimates for physical activity informed a power calculation for a phase III RCT. A preliminary health economics analysis was conducted.

RESULTS

Of those medically eligible, 369/577 (64%) were willing to answer further eligibility questions and 90/148 (61%) of those eligible were enrolled. Feasibility outcomes, including retention (97%), assessment completion rates (>86%) and app download rates in the intervention group (96%), suggest that the trial procedures are acceptable and that the intervention is feasible. The phase III RCT will require 472 participants to be randomised. As expected, the preliminary health economic analyses indicate a high level of uncertainty around the cost-effectiveness of the intervention.

CONCLUSIONS

This pilot study demonstrates that a large trial of the brisk walking intervention with behavioural support is both feasible and acceptable to people LWBC. The results support progression onto a confirmatory phase III trial to determine the efficacy and cost-effectiveness of the intervention.

The promoting physical activity in regional and remote cancer survivors (PPARCS) trial: Physical activity maintenance

INTRODUCTION

The study examined whether increased physical activity (PA) in nonmetropolitan cancer survivors was maintained 12 weeks following the PPARCS intervention.

METHODS

PA outcomes were assessed using an accelerometer at baseline, end of the intervention, and at 24 weeks. Linear mixed models were used to examine between-group changes in PA outcomes.

RESULTS

The increased moderate-to-vigorous PA (MVPA) following intervention was maintained with significantly higher MVPA in the intervention group at 24 weeks (vs. controls) compared to baseline nett change of 52.5 min/week (95% CI 11.0-94.0.4).

CONCLUSIONS

Distance-based interventions using wearables and health coaching may produce MVPA maintenance amongst nonmetropolitan cancer survivors.

Home-based exercise interventions' impact on breast cancer survivors' functional performance: a systematic review

INTRODUCTION

Home-based exercise (HBE) programs can be a feasible strategy to enhance functional performance and promote physical activity (PA) in breast cancer survivors. A deeper analysis of the effects of HBE interventions, structured by HBE program type and treatment phase, is needed. This systematic review aimed to synthesize the evidence on HBE interventions' impact on breast cancer survivors' functional performance, PA levels, and program adherence rates, according to HBE intervention type and treatment phase.

METHODS

A comprehensive search of peer-reviewed articles reporting HBE interventions' effects on the outcomes of interest was performed in Pubmed, Google Scholar, EBSCO, Web of Science, Science Direct, and B-ON until January 15th, 2024. Data were synthesized according to Denton's domains to classify HBE interventions (prescription: structured vs. unstructured; Delivery method: supervised vs. facilitated vs. unsupervised) and treatment phase. Methodological quality appraisal was performed using the Effective Public Health Practice Project tool.

RESULTS

Twenty-six studies were included. Most studies conducted structured/facilitated interventions and reported positive effects on functional performance (particularly aerobic capacity), increases in PA levels, and high adherence rates (> 70%) during and post-treatment.

CONCLUSION

HBE interventions may be feasible to improve functional performance and promote physical activity among breast cancer survivors. Further studies are needed to confirm which HBE intervention type is more appropriate for each treatment phase. More evidence applying HBE interventions with different designs is required to allow the drawing of more solid conclusions. Studies exploring the effects of HBE interventions on the pre-treatment phase are needed.

The effectiveness of E-health interventions promoting physical activity in cancer survivors: a systematic review and meta-analysis of randomized controlled trials

PURPOSE

This systematic review and meta-analysis aimed to identify whether E-health interventions effectively improve physical activity (PA) in cancer survivors.

METHODS

PubMed, Web of Science, and Cochrane Library databases were searched from inception to October 21, 2023. Randomized controlled trials reporting the effect of E-health interventions on PA among cancer survivors were included. Random-effect models were used to calculate standardized mean differences (SMD) and the 95% confidence interval (CI).

RESULTS

In total, 15 trials with 2,291 cancer survivors were included in this meta-analysis. The results showed that E-health interventions improved moderate to vigorous physical activity (MVPA) among cancer survivors (SMD = 0.26, 95% CI 0.08, 0.43, N = 8, p < 0.001, I2 = 37%), as well as moderate physical activity (MPA) (SMD = 0.22, 95% CI 0.05, 0.38, N = 9, p < 0.001, I2 = 28%) and vigorous physical activity (VPA) (SMD = 0.34, 95% CI 0.15, 0.54, N = 6, p < 0.001, I2 = 11%).

CONCLUSION

E-health interventions are effective at promoting PA among cancer survivors. As current research primarily focuses on immediate post-intervention measurements with limited follow-up data, further investigation is required to explore the long-term effects of E-health interventions on PA.

Flexibility and Strength Effects of Adapted Nordic Walking and Myofascial Exercises Practice in Breast Cancer Survivors and Analysis of Differences

Breast cancer treatments can elicit negative kinesiological side effects concerning both the posture and functional status of breast cancer survivors. As our body is functionally organized in myofascial meridians, physical exercise practice should favor a whole-body approach rather than a local one. The aim of the study was to investigate and compare the effects of two whole-body disciplines, i.e., adapted Nordic Walking and myofascial exercise, on the flexibility and strength performances in BCS. One hundred and sixty breast cancer survivors were trained three times per week for 12 weeks through adapted Nordic Walking or myofascial exercise. Handgrip, sit and reach, back scratch, and single leg back bridge tests and body composition were assessed at the beginning and completion of the training period. Linear mixed models showed no significant changes in body composition, whereas flexibility (p < 0.001), strength (p < 0.001), and muscle quality index (p = 0.003) changed independently from the treatment. When data modification has been analyzed according to sub-sample membership, no significant differences have been observed. Age, radiation therapy, and chemotherapy seem to have independent effects on several investigated variables. Twelve weeks of adapted myofascial exercise and Nordic Walking led to significant changes in flexibility, strength, and muscle quality in breast cancer survivors, with no apparent superiority of one approach over the other.

Designing viable, durable physical activity programs for cancer survivors: reflections from program participants and organizational leaders

PURPOSE

Despite recommendations for cancer survivors to participate in routine physical activity (PA), offering programs that fit both survivors' needs and sponsoring organizations' resources remains a challenge. The purpose of this study is to explore the perspectives of cancer survivors and organizational stakeholders with the intent of developing PA peer-led programs that organizations can implement into their programming.

METHODS

This study explored cancer survivors' (n = 11) and cancer care organizational stakeholders' (n = 27) perspectives on the design and feasibility of PA programs targeted for cancer survivors. Semi-structured interview guides were developed for survivors and stakeholders; interviews lasted approximately 30 min. Two analysts used a thematic analysis approach and independently conducted a line-by-line coding of each transcript. With guidance from a senior analyst, the codes were collapsed into themes and subthemes.

RESULTS

The qualitative analysis of the interview data resulted in seven major themes relating to PA program development and success. Survivor-related themes included the following: (1) developing PA programs based on cancer survivors' characteristics and experiences; (2) perceived value and importance of accessible, face-to-face instruction; (3) ensuring success based on physical abilities and limitations of the survivor; and (4) the value of physician recommendation for PA participation. Organization-related themes included the following: (1) incorporating participant and community input into program offerings; (2) program feasibility and sustainability; (3) incorporating organizational experience when adopting new program initiatives.

CONCLUSION

These findings highlight the challenges of developing viable PA programs for cancer survivors and may guide organizations in future program development and implementation.

The Role of Attachment, Insecurity, and Stress in Partner Maltreatment: A Meta-Analysis

Negative, destructive, and abusive behaviors in romantic relationships can vary from explicit kinds of abuse and aggression to more subtle and seemingly innocuous slights against or ways of treating a partner. However, regardless of the severity or explicit nature, these behaviors all, to one extent or another, reflect acts of invalidation, disrespect, aggression, or neglect toward a partner, and could be considered maltreatment of a partner. The current paper proposes the term partner maltreatment as a broad overarching concept, which was used to facilitate a meta-analytic synthesis of the literature to examine the associations between attachment insecurity (i.e., attachment anxiety, attachment avoidance) and perpetration of partner maltreatment. Additionally, this paper situated partner maltreatment within an attachment-based diathesis-stress perspective to explore the moderating role of stress. Five databases were systematically searched for published and unpublished studies that examined the direct association between perpetrator's adult attachment orientation and perpetration of partner maltreatment behaviors. We synthesized effect sizes from 139 studies (N = 38,472) and found the effect between attachment insecurity and acts of partner maltreatment varied between r = .11 to .21. Our findings provide meta-analytic evidence to suggest that attachment insecurity is a significant individual vulnerability factor (diathesis) associated with partner maltreatment; and that when individuals with an insecure attachment orientation experience stress, the tendency to perpetrate partner maltreatment is typically heightened. The findings of this meta-analysis provide empirical evidence for the importance of considering and addressing contextual factors, especially stress, for those individuals and couples seeking therapy for partner maltreatment.

Associations Between Health Behaviors, Gastrointestinal Symptoms, and Gut Microbiota in a Cross-Sectional Sample of Cancer Survivors: Secondary Analysis from the Chemo-Gut Study

BACKGROUND

Health behaviors, such as diet and exercise, are actions individuals take that can potentially impact gastrointestinal (GI) symptoms and the gut microbiota. Little is known about how health behaviors impact GI symptoms and the gut microbiota after anti-cancer therapies.

METHODS

This is a secondary analysis of a cross-sectional study that investigated relationships between GI symptoms, gut microbiota, and patient-reported outcomes in adult cancer survivors. Gut microbiota was assessed from stool samples using 16 S rRNA gene sequencing. GI symptoms and health behaviors were measured via self-report. Descriptive statistics, multiple regression, and correlation analyses are reported.

RESULTS

A total of 334 cancer survivors participated, and a subsample of 17 provided stool samples. Most survivors rated their diet as moderately healthy (55.7%) and reported engaging in low intensity exercise (53.9%) for ≤5 h/week (69.1%). Antibiotic use was associated with more belly pain, constipation, and diarrhea (P < .05). Survivors consuming a healthier diet had fewer symptoms of belly pain (P = .03), gas/bloating (P = .01), while higher protein consumption was associated with less belly pain (P = .03). Better diet health was positively correlated with Lachnospiraceae abundance, and negatively with Bacteroides abundance (P < .05). Greater exercise frequency positively correlated with abundance of Lachnospiraceae, Faecalibacterium, Bacteroides, Anaerostipes, Alistipes, and Subdoligranulum (P < .05).

CONCLUSION

Results provide evidence for associations between antibiotic use, probiotic use, dietary health behaviors, and GI symptoms. Diet and exercise behaviors are related to certain types of bacteria, but the direction of causality is unknown. Dietary-based interventions may be optimally suited to address survivors' GI symptoms by influencing the gut microbiota. Larger trials are needed.

Physical Activity, Alcohol, and Cigarette Use in Urological Cancer Patients over Time since Diagnosis

Urological cancers represent a substantial global public health concern, exerting far-reaching effects on both individuals and their families. There is an urgent need to comprehensively understand the transformations in patients' lifestyles and behaviors, given their critical role in the treatment process and overall well-being. This study, involving 128 urological cancer patients, aims to investigate changes in physical activity levels, problematic drinking behaviors assessed through the Alcohol Use Disorders Identification Test (AUDIT), and smoking habits assessed using the Fagerström Test for Nicotine Dependence (FTND) over four distinct time intervals over the subsequent three years from the time of diagnosis and among individuals diagnosed more than three years ago. The results reveal a significant decrease in physical activity levels between study intervals (p < 0.0001), declining from 69% to 45% between the first and second post-diagnosis assessments. Furthermore, the highest levels of problematic substance use, indicated by mean scores, were noted in the first year following diagnosis (AUDIT: 4.20, p = 0.01; FTND: 4.83, p = 0.08). Given the significant impact of physical activity on the prospects of recovery, it is imperative to delve more deeply into the factors contributing to this decline and devise targeted interventions for its improvement. In the context of substance use, it is essential to ascertain whether the initially high levels are a result of coping with the cancer diagnosis or represent a turning point at which patients modify their behaviors and cease their addiction. A more thorough understanding of this phenomenon would enhance the effectiveness of precisely focused interventions.

Effectiveness of Non-pharmacologic Interventions on Device-measured Physical Activity in Adults With Cancer, and Methodology Used for Assessment: A Systematic Review and Meta-analysis

OBJECTIVE

To investigate the effectiveness of different types of interventions aimed at enhancing device-measured physical activity (PA) and summarize the devices and methodologies used to measure PA in adults with cancer.

DATA SOURCES

A systematic review was prospectively registered on PROSPERO (CRD42020199466). The search was conducted in PubMed, The Cochrane Library, EMBASE (via Ovid), and PEDro from 2005 onward.

STUDY SELECTION

Prospective interventional studies (randomized controlled trials [RCTs], non-randomized controlled trials, and single-group trials), that included adults within 12 months from cancer diagnosis, and device-measured PA before and after commencement of an intervention were included. Studies were excluded if PA was measured at a single time point. Two independent reviewers screened 3033 records and 30 articles met the inclusion criteria.

DATA EXTRACTION

Two reviewers independently extracted the data. PEDro scale and GRADE approach were used to assess methodological quality of RCTs and overall quality of evidence, respectively. A meta-analysis of relevant RCTs was conducted.

DATA SYNTHESIS

Thirty studies were identified, mainly including adults with multiple cancer types. Interventions were behavior change interventions (n=15), exercise training (n=13), neuromuscular electrostimulation (n=1), or a nutritional program (n=1). The meta-analysis showed improvements on moderate-to-vigorous intensity PA (MVPA) in the experimental group (8 studies; standardized mean difference (SMD)=0.23; 95% CI 0.06-0.39); with subgroup analysis showing that findings were mainly driven by behavior change interventions (5 studies; SMD=0.23, 95% CI 0.05-0.41). An uncertain effect on sedentary behavior, daily steps, and light intensity PA was found. PA was measured with medical devices and commercial wearables, quality of the methodology was variable.

CONCLUSIONS

Behavior change interventions increased device-derived MVPA in adult cancer patients who underwent the intervention within 12 months of the cancer diagnosis. Various devices and methodologies were used to assess PA, which limits comparisons across the studies.

Prevalence and Psychosocial Impacts of Stalking on Mental Health Professionals: A Systematic Review

Research examining the prevalence and impacts of stalking on mental health professionals (MHPs) has grown over the last two decades. Yet only one previous review has been undertaken examining impacts on staff and focusing on clients as stalkers, with prevalence estimated between 10% and 13%. This systematic review sought to assess prevalence of stalking, and associated impacts and methods of coping reported by MHPs, irrespective of perpetrator type. The search included all healthcare professional groups working in a mental health setting, reported in English or with available translation. Secondary searches were conducted through references cited in primary papers. Of the 7,060 papers identified in five databases, 11 peer-reviewed papers met rigorous inclusion criteria and were quality appraised. Reviewed studies reported prevalence rates between 10.2% and 50%, with higher quality papers reporting a narrower band, 13.9% and 14.3%. However, substantial variability in stalking definitions, and quality of methodology precluded precise prevalence estimation. Participants within the included studies disclosed significant adverse impacts on confidence and competence at work as a consequence of their experiences. Staff invoked substantial workplace and lifestyle changes to mitigate impacts of stalking. However, studies revealed staff disclosed stalking by perpetrators other than clients, notably colleagues and intimate partners, as often or more frequently than by clients. Limitations of the included research and future directions are discussed.

Effects of Food-Based Approaches on Vitamin A Status of Women and Children: A Systematic Review

Vitamin A deficiency (VAD) increases risk for morbidity and mortality. Food-based approaches offer one strategy to improve vitamin A status. This systematic review assessed evidence of the effects of food-based approaches on the vitamin A status of women and children under 5 y. VAD was defined as clinical ocular symptoms, such as loss of vision, and/or retinol plasma or serum concentration <0.70 μmol/L. Searches on food-based approaches to improve vitamin A status were conducted for the period 2011-2022 on PubMed, CINHAL, Web of Science, and Google Scholar using PRISMA guidelines. English-language publications were included. Case studies, unpublished dissertations, and non-peer-reviewed studies were excluded. This review comprises 24 of 27,322 identified studies; 23 included studies focused on provitamin A carotenoids. There were 17,214 participants across the 24 studies with sample sizes ranging from 8 to 3571 individuals. Intervention studies spanned from 3 wk to 2 y. Fifteen (63%) studies were randomized control trials, 7 were cross-sectional, and 2 were longitudinal studies. Most studies (N = 21) used biochemical measurements, for example, serum retinol, to assess vitamin A status; other studies used clinical symptoms (for example, xerophtalmia) or dietary intake. Thirteen (54%) studies reported a statistically significant effect of food-based interventions (N = 8) or an association of diet (N = 5) on vitamin A status. This systematic review indicated that some food-based interventions improved vitamin A status, thus offering a safe and effective delivery mechanism for vitamin A. There appeared to be significant association between vitamin A status and consumption of foods with high concentrations of preformed vitamin A and provitamin A carotenoids. Differences across studies in regard to the period of evaluation, food approaches used, and statistical power may explain the lack of effectiveness of food-based approaches on vitamin A status in some studies.

"It has to be more than exercise": exploring multiple perspectives to community-based exercise program design for persons with breast cancer

PURPOSE

Connecting persons with cancer to exercise resources and/or supports requires a diverse team of professionals. As such, there is merit to engaging multiple individuals or "partners" along the cancer pathway to explore the relevant features of community-based exercise program (CBEP) design. The purpose of this study was to explore multi-partner perspectives to CBEP design for persons diagnosed with breast cancer (PWBC) to inform the implementation of a CBEP in a local setting.

METHODS

PWBC, health care professionals and qualified exercise professionals participated in one of four 60-min focus group discussions. Rich dialogue about preferred program environments, program delivery teams, and core program practices was encouraged using a semi-structured discussion guide. Focus groups were audio recorded, transcribed verbatim, and analyzed using inductive thematic analysis.

RESULTS

Five main themes were identified based on focus group discussions, each pointing to an important feature of CBEP design for PWBC. Themes included the desire for CBEPs to incorporate elements designed to improve cancer literacy, provide opportunities to participate with peers, foster self-efficacy, prioritize program accessibility, and meaningfully integrate CBEPs within a network of supportive cancer care.

CONCLUSION

The collective effect of fostering such elements in CBEPs may serve to increase the uptake and maintenance of exercise among PWBC; ultimately enhancing their overall well-being and quality of life.

The relationship of exercise and cancer-related fatigue in patients with advanced liver cancer: a cross-sectional study

There is increasing interest in understanding exercise as a potential treatment for cancer-related fatigue (CRF); however, rarely research has been conducted on more aggressive cancers with short survival, such as liver cancer. The purpose of this study was to provide educational ideas for insufficient exercise and provide clues for the design of effective and safe exercise intervention programs with high compliance in patients of advanced liver cancer in the future. Participants were recruited from a tertiary cancer hospital using convenience sampling. All participants were asked to complete self-report questionnaires that assessed their medical and demographic variables, exercise habits and CRF during their hospitalization in the interventional department. Spearman's correlation analysis and Nonparametric test was used to explore correlations between exercise subgroups and CRF. The Baron and Kenny's Approach was used to investigate the mediating effect of exercise index between P-EX and CRF. 207 out of 255 participants were enrolled in this study, with an average age of 55.4 years. The CRF score was 33 (28, 36), and 93.2% had insufficient exercise. Exercise frequency (≥ 3 Times/week) (Z = 4.34, p = 0.037) and maintaining exercise trend (Z = 15.85, p = 0.001) had a positive effect on CRF. P-EX had a great impact on exercise index and affecting CRF directly. Participants in the study showed serious fatigue and insufficient exercise. Exercise education can be initiated earlier, particularly those without regular exercise experience. Sustained light exercise, compliant with exercise habits and interests, three times a week may be a practical way to reduce the risk of CRF in advanced liver cancer.

Telemedicine-based inspiratory muscle training and walking promotion with lung cancer survivors following curative intent therapy: a parallel-group pilot randomized trial

PURPOSE

Following curative-intent therapy of lung cancer, many survivors experience dyspnea and physical inactivity. We investigated the feasibility, acceptability, safety, and potential efficacy of inspiratory muscle training (IMT) and walking promotion to disrupt a postulated "dyspnea-inactivity" spiral.

METHODS

Between January and December 2022, we recruited lung cancer survivors from Kaiser Permanente Colorado who completed curative-intent therapy within 1-6 months into a phase-IIb, parallel-group, pilot randomized trial (1:1 allocation). The 12-week intervention, delivered via telemedicine, consisted of exercise training (IMT + walking), education, and behavior change support. Control participants received educational materials on general exercise. We determined feasibility a priori: enrollment of ≥ 20% eligible patients, ≥ 75% retention, study measure completion, and adherence. We assessed acceptability using the Telemedicine-Satisfaction-and-Usefulness-Questionnaire and safety events that included emergency department visits or hospitalizations. Patient-centered outcome measures (PCOMs) included dyspnea (University-of-California-San-Diego-Shortness-of-Breath-Questionnaire), physical activity (activPAL™ steps/day), functional exercise capacity (mobile-based-six-minute-walk-test), and health-related quality of life (HRQL, St.-George's-Respiratory-Questionnaire). We used linear mixed-effects models to assess potential efficacy.

RESULTS

We screened 751 patients, identified 124 eligible, and consented 31 (25%) participants. Among 28 participants randomized (14/group), 22 (11/group) completed the study (79% retention). Intervention participants returned > 90% of self-reported activity logs, completed > 90% of PCOMs, and attended > 90% of tele-visits; 75% of participants performed IMT at the recommended dose. Participants had high satisfaction with tele-visits and found the intervention useful. There was no statistically significant difference in safety events between groups. Compared to control participants from baseline to follow-up, intervention participants had statistically significant and clinically meaningful improved HRQL (SGRQ total, symptom, and impact scores) (standardized effect size: -1.03 to -1.30).

CONCLUSIONS

Among lung cancer survivors following curative-intent therapy, telemedicine-based IMT + walking was feasible, acceptable, safe, and had potential to disrupt the "dyspnea-inactivity" spiral. Future efficacy/effectiveness trials are warranted and should incorporate IMT and walking promotion to improve HRQL.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05059132.

Effect of the Fit2Thrive Intervention on Patient-reported Outcomes in Breast Cancer Survivors: A Randomized Full Factorial Trial

BACKGROUND

Moderate to vigorous physical activity (MVPA) interventions improve patient-reported outcomes (PROs) of physical and psychological health among breast cancer survivors (BCS); however, the effects of specific intervention components on PROs are unknown.

PURPOSE

To use the Multiphase Optimization Strategy (MOST) to examine overall effects of the Fit2Thrive MVPA promotion intervention on PROs in BCS and explore whether there are intervention component-specific effects on PROs.

METHODS

Physically inactive BCS [n = 269; Mage = 52.5 (SD = 9.9)] received a core intervention (Fitbit + Fit2Thrive smartphone app) and were randomly assigned to one of 32 conditions in a full factorial experiment of five components ("on" vs. "off"): (i) support calls, (ii) deluxe app, (iii) text messages, (iv) online gym, and (v) buddy. Patient-Reported Outcomes Measurement Information System (PROMIS) questionnaires assessed anxiety, depression, fatigue, physical functioning, sleep disturbance and sleep-related impairment at baseline, post-intervention (12-week), and 24-week follow-up. Main effects for all components at each time point were examined using an intention to treat mixed-effects model.

RESULTS

All PROMIS measures except sleep disturbance significantly improved (p's < .008 for all) from baseline to 12-weeks. Effects were maintained at 24-weeks. The "on" level of each component did not result in significantly greater improvements on any PROMIS measure compared to the "off" level.

CONCLUSIONS

Participation in Fit2Thrive was associated with improved PROs in BCS, but improvements did not differ for "on" vs. "off" levels for any component tested. The low-resource Fit2Thrive core intervention is a potential strategy to improve PROs among BCS. Future studies should test the core in an RCT and examine various intervention component effects in BCS with clinically elevated PROs.

Effectiveness of home-based exercise in breast cancer survivors: a randomized clinical trial

BACKGROUND

Breast cancer patients are recommended to engage in regular exercise. In developing countries, where there is a lack of facilities to offer specialized, supervised exercise for this population, regularly exercising might be a challenge. We aimed to evaluate the effectiveness of a home-based intervention in this population.

METHODS

Breast cancer survivors were randomly assigned to either the home-based exercise program or the usual care group. Exercise intervention included walking, balance, and stretch exercises, along with weekly follow-up telephone calls. Quality of life (QOL) was evaluated using EORTC QLQ-C30 and EORTC QLQ-BR23 questionnaires and the predicted VO2 peak was measured using the Ebbeling submaximal treadmill test.

RESULTS

Eighty-nine patients were enrolled in the study. Reported minutes of exercise gradually increased from 40.7 min per week in week 1 to 116.9 min per week in week 12. This intervention improved global QOL (P = 0.001), social functioning (P = 0.04), and the predicted VO2 peak (P = 0.01).

CONCLUSION

This home-based exercise regime effectively increased quality of life and physical activity levels.

TRIAL REGISTRY

Iranian Registry of Clinical Trials identifier: IRCT20140810018746N1, prospectively registered 08/01/2018, https://en.irct.ir/trial/27959 .

Sedentary Behavior and Physical Activity of Community-Dwelling Korean Breast Cancer Survivors: A Nationwide Study

This study aimed to investigate the contemporary characteristics of sedentary behavior and physical activity levels in breast cancer survivors. The cross-sectional data of 10,073 community-dwelling Korean women aged ≥50 years in the Korea National Health and Nutrition Examination Survey were analyzed. The differences in sedentary behavior, walking activity, and moderate-to-vigorous physical activity (MVPA) levels between breast cancer survivors, other cancer survivors, and women with no history of cancer were compared by complex-sample general linear models. Breast cancer survivors spent significantly less mean time in sedentary behavior than other cancer survivors and women with no history of cancer; however, among them, 48.34% spent a long sedentary time of ≥420 min/day. Breast cancer survivors had a significantly higher level of walking activity and similar total MVPA levels compared to women with no history of cancer. When comparing domain-specific MVPA levels, breast cancer survivors showed significantly lower work-related MVPA levels than women with no history of cancer. In recent years, community-dwelling Korean breast cancer survivors were less sedentary, walked more, and had equivalent MVPA levels compared with women with no history of cancer. Considering the growing emphasis on healthy lifestyles, our results may reflect more contemporary behavior trends of breast cancer survivors.

Benefits of nature-based walking for breast cancer survivors

INTRODUCTION

Physical activity (PA) promotes significant physical and psychosocial benefits for breast cancer survivors. While evidence exists regarding recommendations for the frequency, duration and intensity of exercise that optimise PA benefits for cancer survivors, the role of the environment in achieving optimal outcomes has yet to be determined. This paper presents a protocol for a clinical trial to evaluate the feasibility of a 3-month nature-based walking programme for breast cancer survivors. Secondary outcomes assessed include the impact of the intervention on fitness, quality of life outcomes, and biomarkers of ageing and inflammation.

METHODS AND ANALYSIS

The trial is a 12-week single-arm pilot study. Twenty female breast cancer survivors will engage in a supervised moderate intensity walking intervention in small groups in a nature reserve for 50 minutes three times per week. Data will be collected at baseline and end of study, and include assessment of inflammatory cytokines and anti-inflammatory myokines (TNF-α, IL-1ß, IL-6, CRP, TGF-ß, IL-10, IL-13), as well as ageing (DNA methylation, ageing genes) biomarkers; surveys (Patient-Reported Outcomes Measurement Information System-29, Functional Assessment of Cancer Therapy-General, Post-Traumatic Growth Inventory); and fitness assessments (6 min Walk Test, Grip-Strength, One Repetition-Maximum Leg Press). Participants will also complete weekly surveys assessing social support and participate in an exit interview. This is an important first step for future research on the influence of exercise environment on cancer survivor PA outcomes.

ETHICS AND DISSEMINATION

This study was approved by the Cedars Sinai Medical Center Institutional Review Board (IIT2020-20). Findings will be disseminated through academic manuscripts, conferences, and community presentations.

TRIAL REGISTRATION NUMBER

NCT04896580.

Preferences and engagement with physical activity resources among cancer survivors during the COVID-19 pandemic

PURPOSE

The COVID-19 pandemic has imposed additional barriers to physical activity (PA) in cancer survivors. Adaptations to PA programmes are needed during the pandemic. Therefore, the purpose of this study was to evaluate (1) the PA preferences of cancer survivors prior to and during the pandemic and (2) the available resources to engage in PA during the pandemic.

METHODS

Using a cross-sectional study design, cancer survivors were recruited globally to participate in a self-administered survey assessing their PA preferences and available PA resources during the pandemic. Descriptive statistics were used to determine trends in PA preferences and resources. A sub-group analysis was conducted for age, gender, education, and PA levels.

RESULTS

Cancer survivors (N = 493) were mainly women (70.4%) diagnosed with breast cancer (29.0%), with a mean age of 48.7 ± 15.8 years, and 87.1 ± 81.9 months since diagnosis. Since the start of the pandemic, cancer survivors were primarily walking (82.6%), and performing PA alone (62.7%) and at home (46.6%). Sub-group analysis revealed education level, PA levels, and age to be associated with significant differences in PA preferences. The most common equipment available to survivors in their homes were exercise mats (40.6%) and free weights (39.8%). Few survivors were made aware of at-home PA resources (19.1%), and approximately half indicated wanting to receive these resources (49.6%).

CONCLUSIONS

Understanding cancer survivors' preferences and resources for PA during the pandemic is critical to designing effective home-based interventions. Interventions and recommendations should be tailored based on the level of education and PA participation, as well as age.

The effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning among older cancer survivors: a meta-analysis of randomized controlled trials

PURPOSE

To evaluate the effect of exercise with or without dietary advice on muscle mass, muscle strength and physical functioning (including perceived physical functioning and physical performance) in old cancer survivors.

METHODS

A systematic literature search was undertaken in May 2022 by searching multiple databases. Randomized controlled trials (RCTs) that compared exercise with or without dietary advice to control group among old cancer survivors were screened. Meta-analyses were conducted to evaluate the effects of exercise with or without dietary advice on muscle mass, muscle strength, and physical functioning.

RESULTS

Data from 21 trials were included in this study, including 16 exercise trials and 5 exercise + dietary advice studies. Regarding exercise, evidence supported its significant benefits on muscle strength among old cancer survivors, while no effect was seen on physical functioning and muscle mass. Concerning exercise combined with dietary advice, meta-analysis showed overall benefits on physical functioning, while limited study examined muscle mass and strength. As for safety and feasibility of interventions, low recruitment rate, moderate compliance, and few adverse events were reported.

CONCLUSIONS

Exercise combined with dietary advice is a more effective approach for old cancer survivors in improving physical functioning compared with exercise alone. Future study is needed to explore the effects of exercise combined with dietary advice on combating sarcopenia. As recruitment and compliance among old cancer survivors were challenging, strategies to stimulate their motivation and promote habitual healthy behaviour are warranted.

IMPLICATIONS FOR CANCER SURVIVORS

It is necessary for old cancer survivors to receive exercise and dietary support to improve physical functioning.

The Streaming Web-Based Exercise at Home Study for Breast and Prostate Cancer Survivors: A Feasibility Study Protocol

BACKGROUND

Despite the known benefits of physical activity in cancer survivors, adherence to exercise guidelines remains low. Known barriers to adhering to guidelines include a lack of time and an unwillingness to return to treatment facilities. Virtual exercise programming could assist in mitigating these barriers. This protocol presents a single arm pilot study exploring the feasibility of personalized Zoom-delivered exercise training for breast and prostate cancer survivors. A secondary objective is to determine the preliminary efficacy of participation on body composition, estimated VO_2max, hand grip, one repetition maximum leg press, resting heart rate, resting blood pressure, exercise self-efficacy, and intentions to remain active.

METHODS

Breast (n = 10) and prostate (n = 10) cancer survivors will participate in a 24-week feasibility study, including (1) 12 weeks of one-on-one virtual personal training with an exercise physiologist (EP) via Zoom, and (2) individual exercise for a 12-week follow-up period using recordings of Zoom sessions for guidance. Physical assessments and surveys will be implemented at baseline, 12 weeks, and at the end of the study (24 weeks from baseline).

CONCLUSIONS

While virtual exercise programming became popularized during the pandemic, evidence is still required to understand whether it can successfully address barriers and promote participation.

Enhancing the utilization of healthy living interventions among cancer survivors in historically underserved populations and communities

PURPOSE

This study aimed to describe the clinical characteristics and wellness programming preferences of cancer survivors from Acres Homes, a historically Black neighborhood in Houston, Texas, with areas of persistent poverty. The goal of this study was to identify opportunities to increase cancer survivor utilization of healthy eating and active living interventions aligned to cancer center community outreach and engagement efforts.

METHODS

This multiple methods study included a retrospective review of electronic health record data (n = 413) and qualitative interviews with cancer survivors (n = 31) immediately preceding initiation of healthy eating, active living programming in Acres Homes.

RESULTS

This study found Acres Homes survivors have high rates of co-occurrent cardiometabolic disease including obesity (45.0%), diabetes (30.8%), and other related risk factors as well as treatment-related symptoms. Four major concepts emerged from interviews: (1) Factors that influence survivors' ability to eat well and exercise, (2) Current usage of community resources, (3) Interest in relevant programming, and (4) Specific programming preferences. Opportunities for current and future health promotion programming for cancer survivors were explored.

CONCLUSION

Strategically tailoring community resources for cancer survivors can provide a more robust network of support to promote healthy eating and active living in this population. This work informed community implementation of evidence-based health interventions in Acres Homes and may support future projects aiming to enhance community-led cancer prevention efforts in historically underserved communities.

Correlates and participation in community-based exercise programming for cancer patients before and during COVID-19

PURPOSE

COVID-19 pandemic restrictions ceased the opportunity for face-to-face group exercise classes with at risk populations, such as cancer patients, forcing an adaptation to online exercise programming. The purpose of this study was to compare the attendance rates and correlates of face-to-face exercise programming pre-COVID-19 to online programming delivered during the first year of pandemic restrictions.

METHOD

The sample was comprised from 1189 patient records between 2018 and 2021. Data analysis was based around the three primary research questions: (i) whether the volume of attendance in online exercise programming differed from the previous face-to-face programming; (ii) whether there were any differences in attendee demographics between online and face-to-face classes; and (iii) whether there were specific correlates of online attendance that can inform future exercise programming.

RESULTS

Class attendance increased significantly when online exercise classes were introduced during the first year of the pandemic when compared to face-to-face attendance the prior years (p < .01). Multiple demographic findings were also observed including age, gender, and geographic differences.

CONCLUSION

While COVID-19 has effected the ability to deliver face-to-face exercise programs for cancer patients, online programming has proved a promising delivery model with greater geographical reach. The approach, however, has gender and age differences in program attendance so targeted programming to reach specific cancer patient demographics may need attention. These results add to the continuing research in the area of online exercise and online programming strategies offering an effective option for cancer patients to achieve targeted exercise prescription.

Breast cancer survivors' exercise preferences change during an exercise intervention are associated with post-intervention physical activity

PURPOSE

Exercise program preferences are important for designing physical activity (PA) interventions; yet may change following an intervention. Further, the relationship between preferences and PA behavior change is unclear. This study evaluated exercise program preferences among breast cancer survivors (BCS) before and after a behavioral intervention and associations between program preferences and PA change.

METHODS

BCS were randomized to the BEAT Cancer intervention (n = 110) or written materials (n = 112). Questionnaires assessed exercise program preferences. Minutes per week of moderate-to-vigorous PA (MVPA) were accelerometer-measured and self-reported at baseline (M0), post-intervention (M3), and 3-month follow-up (M6).

RESULTS

At M0, the majority of intervention group participants preferred exercising with others (62%) yet shifted to preferring exercising alone (59%) at M3 (p < 0.001). Furthermore, preferring exercising with others at M0 was associated with greater increases in self-reported MVPA between M0 and M6 (124.2 ± 152 vs. 53.1 ± 113.8, p = 0.014). BCS preferring facility-based exercise decreased after the BEAT Cancer intervention (14% vs. 7%, p = 0.039) and preferring exercising at home/had no preference at M0 had greater improvements in accelerometer-measured MVPA from M0 to M3 (74.3 ± 118.8 vs. -2.3 ± 78.4, p = 0.033) and M0 to M6 (44.9 ± 112.8 vs. 9.3 ± 30.4, p = 0.021). Exercise program preferences regarding mode of counseling, training supervision, and type of exercise changed from M0 to M3 but were not associated with changes in MVPA.

CONCLUSION

Findings suggest BCS exercise program preferences may change after an intervention and be associated with changes in MVPA. Understanding the role of PA preferences will better inform the design and success of PA behavior change interventions. ClinicTrials.gov, ClinicalTrials.gov number: NCT00929617.

Implementing Physical Activity Recommendations in Clinical Practice: A Survey of Oncology Nurses' Perspectives

PROBLEM STATEMENT

Better understanding of oncology nurses' perspectives about how interventions should be designed can promote physical activity (PA) in clinical settings.

DESIGN

75 oncology nurses completed online surveys.

DATA SOURCES

A published survey, guided by the Consolidated Framework for Implementation Research, was used to assess multilevel factors that influence implementation of evidence-based interventions.

ANALYSIS

Descriptive statistics were applied to quantitative data; directed content analyses were applied to qualitative data.

FINDINGS

Participants believed it was important to discuss PA with patients; however, they had limited self-efficacy and resources to provide PA counseling. Barriers to providing counseling included competing clinical demands and a lack of education about PA for cancer survivors and resources.

IMPLICATIONS FOR PRACTICE

Findings inform how interventions can be designed for implementation and sustained practice change in clinical settings. Integration of PA education in routine clinical practice will lead to increased PA and, ultimately, improved quality of life among cancer survivors.

The 24-Hour Movement Paradigm: An integrated approach to the measurement and promotion of daily activity in cancer clinical trials

Increased physical activity (PA), improved sleep, and decreased sedentary behavior (SB) are essential components of supportive care for cancer survivors. However, researchers and health care professionals have achieved limited success in improving these behaviors among cancer survivors. One potential reasoning is that, over the past two decades, guidelines for promoting and measuring PA, sleep, and SB have been largely siloed. With greater understanding of these three behaviors, health behavior researchers have recently developed a new paradigm: the 24-Hour movement approach. This approach considers PA, SB, and sleep as movement behaviors along a continuum that represent low through vigorous intensity activity. Together these three behaviors form the sum of an individual's movement across a 24-hour day. While this paradigm has been studied in the general population, its usage is still limited in cancer populations. Here, we seek to highlight (a) the potential benefits of this new paradigm for clinical trial design in oncology; (b) how this approach can allow for greater integration of wearable technology as a means of assessing and monitoring patient health outside the clinical setting, improving patient autonomy through self-monitoring of movement behavior. Ultimately, implementation of the 24-Hour movement paradigm will allow health behavior research in oncology to better promote and assess critical health behaviors to support the long-term well-being for cancer patients and survivors.

Factors associated with physical activity promotion efforts in individuals with chronic diseases: A systematic review from the perspective of patients

OBJECTIVES

To determine factors associated with healthcare provider physical activity (PA) promotion in individuals with chronic diseases from the perspective of patients.

METHODS

A systematic review of literature was conducted between March and April 2022 by searching five databases. Studies were included if they used survey data, published in English or Chinese, and investigated factors influencing healthcare provider PA promotion in chronic diseases from the perspective of adult patients. Retrieved factors were extracted and mapped to Anderson's Behavioral Model of Health Services Use. Quality of each study was assessed using the NIH Quality Assessment Tool.

RESULTS

Thirteen articles were included for final analysis. The quality of the included studies ranged from fair to good. A series of factors were positively related to healthcare provider PA promotion (e.g., having emotional support or public programs for PA). Conflicting results were found for other factors (e.g., age and gender).

CONCLUSIONS

A series of factors may impact the incorporation of PA promotion into clinical care. More studies with well-designed surveys using primary data collection are suggested to confirm these findings.

PRACTICE IMPLICATIONS

Factors identified from this review provide insights for developing of strategies related to healthcare provider PA promotion for individuals with chronic diseases.

Dutch prostate cancer patients' views about exercise and experience with exercise advice: a national survey

PURPOSE

To support the development and implementation of exercise programming for people with prostate cancer (PC), we investigated their views on exercise.

METHODS

Online survey with open recruitment. We collected data on clinical and sociodemographic variables, experiences with exercise advice, outcome expectations, and preferences. We explored determinants of (1) having been counselled about exercise and (2) preferring supervised exercise.

RESULTS

The survey was completed by 171 patients (mean age = 70 years, SD = 6.5) from all PC treatment pathways. Sixty-three percent of the respondents reported never having been informed about the potential benefits of exercise. Forty-nine percent preferred exercise to be supervised. Respondents generally reported a positive attitude towards exercise. Seventy-four percent indicated barriers to exercising, including fatigue and lack of access to specific programmes. Outcome expectations were generally positive but moderately strong. Receiving hormonal therapy and younger age were significantly associated with having received exercise advice. Being insured and having higher fatigue levels contributed significantly to the preference for supervised exercise.

CONCLUSION

Dutch people with PC report receiving insufficient effective exercise counselling. Yet, they are open to exercise and expect exercise to improve their health, although they experience various barriers that limit their ability to exercise.

IMPLICATIONS FOR CANCER SURVIVORS

The moderate outcome expectations for exercise of people with PC and their limited recall of exercise counselling highlight the need for better integration of exercise in clinical pathways. The lack of access to specific programming limits the use of evidence-based exercise programmes for people with PC.

Relationships between Obesity, Exercise Preferences, and Related Social Cognitive Theory Variables among Breast Cancer Survivors

Breast cancer survivors with obesity have an increased risk of cancer recurrence, second malignancy, and comorbidities. Though physical activity (PA) interventions are needed, investigation of the relationships between obesity and factors influencing PA program aspects among cancer survivors remain understudied. Thus, we conducted a cross-sectional study examining associations amongst baseline body mass index (BMI), PA program preferences, PA, cardiorespiratory fitness, and related social cognitive theory variables (self-efficacy, exercise barriers interference, social support, positive and negative outcome expectations) from a randomized controlled PA trial with 320 post-treatment breast cancer survivors. BMI was significantly correlated with exercise barriers interference (r = 0.131, p = 0.019). Higher BMI was significantly associated with preference to exercise at a facility (p = 0.038), lower cardiorespiratory fitness (p < 0.001), lower walking self-efficacy (p < 0.001), and higher negative outcome expectations (p = 0.024), independent of covariates (comorbidity score, Western Ontario and McMaster Universities osteoarthritis index score, income, race, education). Those with class I/II obesity reported a higher negative outcome expectations score compared with class III. Location, walking self-efficacy, barriers, negative outcome expectations, and fitness should be considered when designing future PA programs among breast cancer survivors with obesity.

Cancer-related Fatigue in Lung Cancer: A Research Agenda: An Official American Thoracic Society Research Statement

Background: Fatigue is the most common symptom among cancer survivors. Cancer-related fatigue (CRF) may occur at any point in the cancer care continuum. Multiple factors contribute to CRF development and severity, including cancer type, treatments, presence of other symptoms, comorbidities, and medication side effects. Clinically, increasing physical activity, enhancing sleep quality, and recognizing sleep disorders are integral to managing CRF. Unfortunately, CRF is infrequently recognized, evaluated, or treated in lung cancer survivors despite more frequent and severe symptoms than in other cancers. Therefore, increased awareness and understanding of CRF are needed to improve health-related quality of life in lung cancer survivors. Objectives: 1) To identify and prioritize knowledge and research gaps and 2) to develop and prioritize research questions to evaluate mechanistic, diagnostic, and therapeutic approaches to CRF among lung cancer survivors. Methods: We convened a multidisciplinary panel to review the available literature on CRF, focusing on the impacts of physical activity, rehabilitation, and sleep disturbances in lung cancer. We used a three-round modified Delphi process to prioritize research questions. Results: This statement identifies knowledge gaps in the 1) detection and diagnostic evaluation of CRF in lung cancer survivors; 2) timing, goals, and implementation of physical activity and rehabilitation; and 3) evaluation and treatment of sleep disturbances and disorders to reduce CRF. Finally, we present the panel's initial 32 research questions and seven final prioritized questions. Conclusions: This statement offers a prioritized research agenda to 1) advance clinical and research efforts and 2) increase awareness of CRF in lung cancer survivors.

Walking activity and emotional distress among breast cancer survivors: the parallel mediating effects of posttraumatic growth and body image

PURPOSE

Although the antidepressant effects of physical activity have been well established, the underlying psychological mechanisms are understudied among cancer survivors. The present study aims to examine the parallel mediating effects of posttraumatic growth and body image on the association between walking activity and emotional distress (anxiety and depression) among Chinese breast cancer survivors.

METHODS

Chinese breast cancer survivors (n = 235) completed a cross-sectional questionnaire that assessed walking activity, anxiety, depression, posttraumatic growth, and body image over the past week. Path analysis was conducted to test the hypothesized mediation model.

RESULTS

The hypothesized model was supported: walking activity was positively associated with posttraumatic growth and body image satisfaction, which were then negatively associated with anxiety and depression. After controlling for the mediators, the direct effect of physical activity on depression was still significant, whereas the direct effect of physical activity on anxiety was no longer significant.

CONCLUSION

Our findings suggest that posttraumatic growth and body image may be essential psychological pathways underlying the association between walking activity and emotional distress among Chinese breast cancer survivors. Researchers and health practitioners should consider supplementing physical activity interventions with mental health services that facilitate psychological growth and a positive body image to enhance the potential psychological benefits of physical activity.

Beliefs and interests in physical activity programs of cancer survivors and their romantic partners

PURPOSE

Physical activity is associated with improved health outcomes for cancer survivors and their romantic partners, yet it is unclear if joint exercise programs for survivor-partner dyads are acceptable. This study examined demographic, relationship, exercise, and cancer history correlates of survivors' and their romantic partners' couples-based exercise beliefs and their preferences for program designs.

METHODS

All participants (survivors n=209, partners n=155, couples n=143) completed an online survey. Correlations and linear regression analyses were used to examine correlates of participants' importance of and interest in couples-based exercise and their likelihood of joining a couples-based exercise program. Intraclass correlations estimated shared variance at the couple level.

RESULTS

Most participants believed that couples-based exercise was highly important (51.8%) and were interested in a couples-based exercise program (61.5%), but fewer survivors believed their partner would be interested or would likely join a couples-based program. Across all outcomes, partner support for exercise was most strongly associated with participants' couples-based exercise beliefs (r = 0.19-0.54, p<.05), and couples were significantly aligned in their beliefs (ρ=0.20-0.31, p<.01). Participants were interested in exercise programs involving exercising together (67.3%) as well as exercising separately while sharing activity data on an app or website (48.0%).

CONCLUSIONS

This novel understanding of couples-based exercise beliefs provides a strong foundation upon which future exercise programs may be designed for survivors and their romantic partners.

IMPACT FOR CANCER SURVIVORS

Survivors' adoption and maintenance of exercise may be enhanced by the inclusion of romantic partners in exercise programs, and partners' inclusion is appealing to couples.

Outcomes of a Multi-Modal Hospital-Associated Home-Based Cancer Prehabilitation Program

OBJECTIVE

To assess the impact of a "one-stop", multi-modal, hospital-associated-home-based prehabilitation model, helmed by a small core team, on newly diagnosed gastrointestinal and urological cancer patients planned for surgery.

METHODS

This is a retrospective study in a tertiary public hospital, involving all newly diagnosed gastrointestinal and urological cancer patients planned for surgery. The primary outcome measure was the 6-minute walk test (6MWT). Other outcomes included physical, psychological and quality-of-life measures, and patient satisfaction surveys, taken at baseline, pre-operatively (post-prehabilitation), and at 3 months post-operatively.

RESULTS

When comparing the baseline to pre-operatively (post-prehabilitation), there was a statistically significant improvement in the 6MWT (21.52 m, p<0.001), 30-Second Sit to Stand test (STS) (1.08 repetitions, p<0.001), Timed Up and Go test (TUG) (0.83 seconds, p=0.014) and Hospital Anxiety and Depression Scale (HADS) (total score 1.77, p<0.001). These were sustained (6MWT: 0.22, p=0.964; STS: 0.08 repetitions, p=0.863; TUG: 0.04 seconds, p=0.939) or further improved (HADS total score 2.06, p=0.003) at 3 months post-operatively. There was also a statistically significant improvement in the EuroQol-5 dimension health score (health-related quality-of-life measure) from baseline to 3 months post-operatively (7.04 points, p=0.001), with more than 90% overall patient satisfaction reported.

CONCLUSION

Prehabilitation applied via our model resulted in significant improvements in functional capacity, psychological and quality-of-life outcomes, sustained at 3 months post-operatively, and is a feasible and effective approach that is well-received by our patients.

Designing home-based physical activity programs for rural cancer survivors: A survey of technology access and preferences

Background

While technology advances have increased the popularity of remote interventions in underserved and rural cancer communities, less is understood about technology access and preferences for home-based physical activity programs in this cancer survivor population.

Purpose

To determine access, preferences, and needs, for a home-based physical activity program in rural cancer survivors.

Methods

A Qualtrics Research Panel was recruited to survey adults with cancer across the United States. Participants self-reported demographics, cancer characteristics, technology access and usage, and preferences for a home-based physical activity program. The Godin Leisure Time Exercise Questionnaire (GLTEQ) assessed current levels of physical activity. Descriptive statistics included means and standard deviations for continuous variables, and frequencies for categorical variables. Independent samples t-tests explored differences between rural and non-rural participants.

Results

Participants (N=298; mean age=55.2 ± 16.5) had a history of cancer (mean age at diagnosis=46.5), with the most commonly reported cancer type being breast (25.5%), followed by prostate (16.1%). 74.2% resided in rural hometowns. 95% of participants reported accessing the internet daily. On a scale of 0-100, computer/laptop (M=63.4) and mobile phone (M=54.6) were the most preferred delivery modes for a home-based physical activity intervention, and most participants preferred balance/flexibility (72.2%) and aerobic (53.9%) exercises. Desired intervention elements included a frequency of 2-3 times a week (53.5%) for at least 20 minutes (75.7%). While there were notable rural disparities present (e.g., older age at diagnosis, lower levels of education; ps<.001), no differences emerged for technology access or environmental barriers (ps>.08). However, bias due to electronic delivery of the survey should not be discounted.

Conclusion

These findings provide insights into the preferred physical activity intervention (e.g., computer delivery, balance/flexibility exercises) in rural cancer survivors, while highlighting the need for personalization. Future efforts should consider these preferences when designing and delivering home-based interventions in this population.

Associations between snoring and dental sleep conditions: A systematic review

BACKGROUND

It is important for dentists to know if the presence of snoring is associated with the presence of other dental sleep conditions (e.g. obstructive sleep apnea [OSA], sleep bruxism [SB], gastroesophageal reflux disease [GERD], xerostomia and oro-facial pain). If so, dentists could play a significant role in the early recognition and management of these conditions.

OBJECTIVES

This systematic review aimed to: (i) investigate the associations between the presence of snoring and the presence of other dental sleep conditions; and (ii) determine if it is clinically relevant that dentists assess snoring in their population.

METHODS

The literature search was performed in PubMed and Embase.com in collaboration with a medical librarian. Studies were eligible if they employed regression models to assess whether snoring was associated with other dental sleep conditions, and/or investigated the incidence of snoring in patients with other dental sleep conditions and vice versa.

RESULTS

Of the 5299 retrieved references, 36 eligible studies were included. The available evidence indicates that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Due to limited evidence and conflicting findings, the currently available articles are not indicative of associations between the presence of snoring and the presence of SB and oral dryness.

CONCLUSION

Within the limitations of this study, it can be concluded that the presence of snoring is associated with higher probabilities of OSA, GERD and headache. Therefore, it is clinically relevant that dentists assess snoring in their patient population.

Breast Cancer Survivors' Exercise Preferences Change During an Exercise Intervention and are associated with Post-Intervention Physical Activity

Purpose Exercise program preferences are important for designing physical activity (PA) interventions; yet may change following an intervention. Further, the relationship between preferences and PA behavior change is unclear. This study evaluated exercise program preferences among breast cancer survivors (BCS) before and after a behavioral intervention and associations between program preferences and PA change. Methods BCS were randomized to the BEAT Cancer intervention (n = 110) or written materials (n = 112). Questionnaires assessed exercise program preferences. Minutes per week of moderate-to-vigorous PA (MVPA) were accelerometer-measured and self-reported at baseline (M0), post-intervention (M3), and 3-month follow-up (M6). Results At M0, the majority of intervention group participants preferred exercising with others (62%) yet shifted to preferring exercising alone (59%) at M3 ( p  < 0.001). Furthermore, preferring exercising with others at M0 was associated with greater increases in self-reported MVPA between M0 and M6 (124.2 ± 152 vs. 53.1 ± 113.8, p = 0.014). BCS preferring facility-based exercise decreased after the BEAT Cancer intervention (14% vs. 7%, p  = 0.039) and preferring exercising at home/had no preference at M0 had greater improvements in accelerometer-measured MVPA from M0 to M3 (74.3 ± 118.8 vs. -2.3 ± 78.4, p = 0.033) and M0 to M6 (44.9 ± 112.8 vs. 9.3 ± 30.4, p = 0.021). Exercise program preferences regarding mode of counseling, training supervision, and type of exercise changed from M0 to M3 but were not associated with changes in MVPA. Conclusion Findings suggest BCS exercise program preferences may change after an intervention and be associated with changes in MVPA. Understanding the role of PA preferences will better inform the design and success of PA behavior change interventions. ClinicTrials.gov, ClinicalTrials.gov number: NCT00929617.

Telehealth multicomponent exercise and health education in breast cancer patients undergoing primary treatment: rationale and methodological protocol for a randomized clinical trial (ABRACE: Telehealth)

BACKGROUND

Current guidelines emphasize cancer patients should increase their physical activity levels, encouraging physical exercise practice as a complementary therapy to mitigate adverse effects during treatment. Telehealth can be a feasible method to improve adherence and interventional support for breast cancer patients, of which most do not meet sufficient physical activity levels after diagnosis. The Adaptations to Breast Cancer and Exercise Using Telehealth (ABRACE: Telehealth) study aims to investigate the effects of a 12-week telehealth multicomponent training program plus a health education program (MTHE), compared to a health education program alone (HE), on physical and psychological outcomes in breast cancer patients undergoing treatment.

METHODS

This study is a randomized controlled trial. Women undergoing primary treatment (during or after chemotherapy) for breast cancer (stages I-III) will be randomly assigned to MTHE (twice a week) or HE (once a week). MTHE components are mobility, aerobic, balance, resistance, and flexibility home-based exercises, supervised by video call. The primary study outcome is cancer-related fatigue. The secondary outcomes are quality of life, symptoms of depression and anxiety, physical activity level, cancer-related cognitive impairment, and functional capacity. Other outcomes are adherence to interventions and a follow-up questionnaire evaluating the individual perception in motivation, lifestyle changes, and main barriers to participation. All outcomes will be remotely assessed before and after intervention. Our analysis will follow the intention-to-treat approach and per-protocol criteria, with additional sub-group analysis.

DISCUSSION

To our knowledge, this is the first randomized clinical trial in breast cancer patients using a face-to-face videoconference strategy to supervise physical exercise. Our hypothesis is of superiority for the effects of MTHE on primary and secondary outcomes compared to the effects of only the health education intervention.

TRIAL REGISTRATION

Adaptations to Breast Cancer and Exercise Using Telehealth (ABRACE: Telehealth), NCT04641377. Registered on 23 November 2021, https://clinicaltrials.gov/ct2/show/NCT04641377.

Determinants of exercise adherence and maintenance for cancer survivors: Implementation of a community-based group exercise program. A qualitative feasibility study

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.

The impact of assistive devices on community-dwelling older adults and their informal caregivers: a systematic review

OBJECTIVE

The purpose of this systematic review is to assess the impact of assistive devices on the life satisfaction of (Research Question 1), and informal caregiving hours received by (Research Question 2), community-dwelling older adults (≥ 65 years).

METHODS

We searched CINAHL, MEDLINE, and Scopus from database inception to March 2022. For each question, two reviewers independently screened citations, extracted and narratively synthesized the data, and assessed article quality and strength of evidence.

RESULTS

Of the 1391 citations screened, we found two articles pertaining to each question, for a total of four articles. In general, assistive device use was not associated with life satisfaction, while it was positively associated with informal caregiving hours. However, the risk of bias was serious across the two studies for Research Question 1, and the overall quality of evidence was "very low". The risk of bias was not serious across the two studies included in Research Question 2 and the overall quality of evidence was "low".

CONCLUSION

Due to the scarcity of studies, the limitations of existing studies (i.e., risk of bias), and the evidence being low or very low quality, we could not draw firm conclusions about the associations of interest. Additional research will produce a better understanding of the two relationships and provide further evidence to inform policy decisions regarding the provision and funding of assistive devices for community-dwelling older adults.

TRIAL REGISTRATION

This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database of systematic reviews (identification number: CRD42021248929 ).

Challenges in launching a community-based group walking program for adults affected by cancer

Walking is one form of physical activity (PA) individuals affected by cancer have indicated strong preference for and interest in, regardless of disease or treatment status. We developed a community-based, outdoor, peer-led walking program for adults affected by cancer called Walk it Out (WIO). Over the span of six months, we were unable to meet targets for peer-leaders (to lead the walking groups; n = 5 self-identified) or participants (n = 0 self-identified; n = 3 recruited via peer-leaders). This inability to recruit meant that we were not able to offer the WIO program. In this paper, we reflect upon the lack of coherence between what has been shown in the literature regarding preferences for walking and the lack of interest in the present program. We describe challenges at both the interpersonal and individual level. Adults affected by cancer can benefit immensely from PA, and desire outdoor walking programs, but the question remains: how do we best launch and promote this type of physical activity program?