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Fosstveit SH, Berntsen S, Feron J, Joyce KE, Ivarsson A, Segaert K, Lucas SJE, Lohne-Seiler H. HIIT at Home: Enhancing Cardiorespiratory Fitness in Older Adults-A Randomized Controlled Trial. Scand J Med Sci Sports 2024; 34:e14694. [PMID: 38982665 DOI: 10.1111/sms.14694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Revised: 06/22/2024] [Accepted: 06/25/2024] [Indexed: 07/11/2024]
Abstract
BACKGROUND This study aimed to investigate the effectiveness of a 6-month home-based high-intensity interval training (HIIT) intervention to improve peak oxygen consumption (V̇O2peak) and lactate threshold (LT) in older adults. METHODS Two hundred thirty-three healthy older adults (60-84 years; 54% females) were randomly assigned to either 6-month, thrice-weekly home-based HIIT (once-weekly circuit training and twice-weekly interval training) or a passive control group. Exercise sessions were monitored using a Polar watch and a logbook for objective and subjective data, respectively, and guided by a personal coach. The outcomes were assessed using a modified Balke protocol combining V̇O2peak and LT measures. General linear regression models assessed between-group differences in change and within-group changes for each outcome. RESULTS There was a significant between-group difference in the pre-to-post change in V̇O2peak (difference: 1.8 [1.2; 2.3] mL/kg/min; exercise: +1.4 [1.0; 1.7] mL/kg/min [~5%]; control: -0.4 [-0.8; -0.0] mL/kg/min [approximately -1.5%]; effect size [ES]: 0.35). Compared with controls, the exercise group had lower blood lactate concentration (-0.7 [-0.9; -0.4] mmol/L, ES: 0.61), % of peak heart rate (-4.4 [-5.7; -3.0], ES: 0.64), and % of V̇O2peak (-4.5 [-6.1; -2.9], ES: 0.60) at the intensity corresponding to preintervention LT and achieved a higher treadmill stage (% incline) at LT (0.6 [0.3; 0.8]; ES: 0.47), following the intervention. CONCLUSION This study highlights the effectiveness of a home-based HIIT intervention as an accessible and equipment-minimal strategy to induce clinically meaningful improvements in cardiorespiratory fitness in older adults. Over 6 months, the exercise group showed larger improvements in all outcomes compared with the control group. Notably, the LT outcome exhibited a more pronounced magnitude of change than V̇O2peak.
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Affiliation(s)
- Sindre H Fosstveit
- Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
| | - Jack Feron
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Kelsey E Joyce
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
| | - Andreas Ivarsson
- Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Katrien Segaert
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Hilde Lohne-Seiler
- Department of Sport Science and Physical Education, Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway
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Campbell KL, Brown JC, Lee C, Weltzien E, Li J, Sternfeld B, Campbell N, Vaughan M, Fedric R, Meyerhardt JA, Caan BJ, Schmitz KH. Advances in Adherence Reporting of Resistance Training in a Clinical Trial during Adjuvant Chemotherapy for Colon Cancer. Med Sci Sports Exerc 2024; 56:1186-1195. [PMID: 38233992 PMCID: PMC11096063 DOI: 10.1249/mss.0000000000003395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
PURPOSE Detailed reporting of individually tailored exercise prescriptions (ExR x ) used in clinical trials is essential to describe feasibility, tolerability, and efficacy of the intervention and to inform translation to clinical care. This article outlines the methodology used to develop a resistance training (RT) ExR x for people with colon cancer receiving chemotherapy and reports adherence to the randomized controlled trial testing the impact of RT on relative dose intensity of chemotherapy and patient-reported toxicities. METHODS Participants randomized to the exercise arm ( n = 90) were included. To promote muscle hypertrophy, the ExR x was twice-weekly, moderate to heavy loads (65%-85% one-repetition maximum), high sets (3-5), and intermediate repetitions (6-10) of five large multijoint movements with adjustable dumbbells. Attendance (achieved frequency) and adherence (achieved volume) were calculated. Group-based trajectory modeling was used to identify clusters of individuals with similar adherence patterns and compared baseline characteristics across adherence groups. RESULTS The median attendance was 69.1%. Adherence was 60.6% but higher for those receiving 3 versus 6 months of chemotherapy (80.4 vs 47.4%; P < 0.05 ). Participants engaged in a median of 1.4 d of RT each week, lifting 62% of the one-repetition maximum load, for 3.0 sets and 7.5 repetitions per set. Three distinct adherence groups were identified: 13% "nonstarter," 37% "tapered off," and 50% "consistent exercisers." Females were more likely to be in the nonstarter and tapered-off groups. CONCLUSIONS This article outlines suggested methods for reporting ExR x of RT in oncology clinical trials and provides insight into the tolerance of ExR x of RT during chemotherapy treatment for colon cancer. These findings aim to foster constructive dialogue and offer a premise for designing future research to elucidate the benefits of exercise during chemotherapy.
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Affiliation(s)
| | | | | | | | - Jia Li
- Kaiser Permanente Northern California, Oakland, CA
| | | | | | | | - Regan Fedric
- Kaiser Permanente Northern California, Oakland, CA
| | | | - Bette J Caan
- Kaiser Permanente Northern California, Oakland, CA
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3
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Tao Z, Sun X, Sun J, Zhu E. Dose-response relationship between 15 weeks of running and aerobic fitness: a retrospective analysis based on the fun running program. BMC Public Health 2024; 24:1019. [PMID: 38609934 PMCID: PMC11010386 DOI: 10.1186/s12889-024-18484-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 03/28/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND Students' physical fitness, particularly aerobic fitness, has seriously declined during the COVID-19 epidemic. However, in the post-epidemic era, there are few studies on the methods of improving aerobic fitness. Understanding the dose-response relationship between physical activity and aerobic fitness is crucial for developing effective exercise prescriptions. METHOD This retrospective study reviewed the Fun Running program at Wannan Medical College in China. We conducted a pre-post study design to analyze the impact of 15 weeks of Fun Running training on aerobic fitness. Middle and long-distance running pace (MLDR-P) was used as the primary indicator of aerobic fitness. A paired sample T-test was used to analyze the differences between the two MLDR-Ps. Pearson's correlation was used to examine the correlation between variables. Multiple linear regression was used to determine the extent to which Fun Running components explain the variance in MLDR-P. RESULTS A total of 3244 college students participated in this study. 15 weeks of Fun Running training can significantly improve the MLDR-P in both females (P < 0.001, ES = 0.68) and males (P < 0.001, ES = 0.72). The MLDR-P was significantly correlated with Fun Running (R2 = 0.95, p < 0.05, for females; R2 = 0.96, p < 0.05, for males). The component that had the greatest impact on MLDR-P was pace (β = 1.39, for females; β = 1.09, for males), followed by distance (β = 0.49, for females; β = 0.15, for males), and last frequency (β = -0.03, for all). CONCLUSION This study fills the gap in research on the dose-response relationship between running and aerobic fitness among college students in the post-epidemic era. The results show that 15 weeks of Fun Running training can significantly improve aerobic fitness. Examination of the dose-response relationship between Fun Running and MLDR-P provides practitioners with valuable insights into prescribing aerobic fitness training, allowing them to develop more effective training programs. Future research should focus on how to implement a hierarchical Fun Running program effectively.
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Affiliation(s)
- Zhixuan Tao
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China
| | - Xugui Sun
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China
| | - Jun Sun
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China.
| | - Ergang Zhu
- Department of Public Foundation, Wannan Medical College, 241000, Wuhu, China.
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4
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Hu S, Guinan E, Mockler D, O'Neill L. Retention rates and reasons for non-retention in exercise oncology trials in the post-treatment phase-a systematic review. J Cancer Surviv 2024:10.1007/s11764-024-01569-4. [PMID: 38570403 DOI: 10.1007/s11764-024-01569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE Retention is a key marker of trial success. Poor retention can induce bias, reduce statistical power and minimise the validity of trials. This review examined retention rates in exercise trials in cancer survivors, reasons for non-retention and retention strategies utilised. METHODS A systematic review was conducted using a predefined search strategy in EMBASE RCTs, MEDLINE OVID, CINAHL, Web of Science-Core Collection and Cochrane Central Register of Controlled Trials (CENTRAL). The search was conducted on 27/03/2023. Title and abstract screening, full text review and data extraction were completed in duplicate. RESULTS Of 17,524 studies identified, 67 trials involving 6093 participants were included. The median overall retention rate immediately post-intervention was 89.85%, range (52.94-100%) and mean 87.36% (standard deviation 9.89%). Trials involving colorectal cancer survivors only had the highest median retention rate (94.61%), followed by breast (92.74%), prostate (86.00%) and haematological cancers (85.49%). Studies involving mixed cancer cohorts had the lowest retention rate (80.18%). The most common retention strategies were wait-list control groups, regular check-ins/reminders and free exercise equipment. Common reasons for non-retention were lost to follow-up, health problems, personal reasons including family/work commitments and travel burden, and disease progression. CONCLUSIONS Retention rates in exercise oncology trials are approximately 90% immediately post-interventions. Our previous work highlighted variable suboptimal recruitment rates of median 38% (range 0.52-100%). Recruitment rather than retention should be prioritised for methodology research in exercise oncology. IMPLICATIONS FOR CANCER SURVIVORS Optimising the quality of exercise oncology trials is critical to informing high quality survivorship care. PROSPERO registration number: CRD42023421359.
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Affiliation(s)
- S Hu
- School of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin, University of Dublin, Dublin 8, Ireland
| | - E Guinan
- Trinity St. James's Cancer Institute, Dublin, Ireland
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
| | - D Mockler
- John Stearne Library, Trinity Centre for Health Sciences, St. James's Hospital, Dublin, Ireland
| | - L O'Neill
- Trinity St. James's Cancer Institute, Dublin, Ireland.
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland.
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5
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Kearney N, Connolly D, Begic S, Mockler D, Guinan E. Feasibility metrics of exercise interventions during chemotherapy: A systematic review. Crit Rev Oncol Hematol 2024; 195:104272. [PMID: 38272152 DOI: 10.1016/j.critrevonc.2024.104272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/19/2024] [Accepted: 01/21/2024] [Indexed: 01/27/2024] Open
Abstract
BACKGROUND Exercise has been shown to play an important role in managing chemotherapy-related side effects, preserving skeletal muscle mass, and attenuating decline in cardiorespiratory fitness associated with chemotherapy treatment, however, the feasibility of how these exercise programs are being delivered has yet to be synthesized. The objective of this review was to measure the rates of recruitment, adherence, and retention to exercise programs delivered for cancer patients during chemotherapy. METHODS Relevant studies were identified through a search of MEDLINE, Cochrane, EMBASE and CINAHL databases from January 2002 to July 2022 using keywords relating to exercise interventions during chemotherapy. Title and abstract screening, full text review, data extraction, and quality assessment were all performed independently by two reviewers. RESULTS A total of 36 studies were included in the review. The mean recruitment rate for the included studies was 62.39% (SD = 19.40; range 25.7-95%). Travel was the most common reason for declining recruitment in these trials. Adherence rates ranged from 17-109%, however the definition of adherence varied greatly between studies. Mean retention rates for the exercise groups was 84.1% (SD = 12.7; range 50-100%), with chemotherapy side effects being the most common reason why participants dropped out of these trials. CONCLUSION Multiple challenges exist for cancer patients during chemotherapy and careful consideration needs to be given when designing an exercise program for this population. Future research should include public and patient involvement to ensure exercise programs are pragmatic and patient centred.
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Affiliation(s)
- Neil Kearney
- Department of Surgery, School of Medicine, Trinity College Dublin, Dublin, Ireland; Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland.
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland; Discipline of Occupational Therapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Sanela Begic
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland; Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Library, Trinity Centre for Health Sciences, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, St James's Hospital, Dublin, Ireland; Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
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Machado P, Pimenta S, Garcia AL, Nogueira T, Silva S, Dos Santos CL, Martins MV, Canha A, Oliveiros B, Martins RA, Cruz J. Effect of Preoperative Home-Based Exercise Training on Quality of Life After Lung Cancer Surgery: A Multicenter Randomized Controlled Trial. Ann Surg Oncol 2024; 31:847-859. [PMID: 37934383 PMCID: PMC10761542 DOI: 10.1245/s10434-023-14503-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/11/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Preoperative exercise training is recommended for improvement of clinical outcomes after lung cancer (LC) surgery. However, its effectiveness in preventing postoperative decline in quality of life (QoL) remains unknown. This study investigated the effect of preoperative home-based exercise training (PHET) on QoL after LC surgery. METHODS Patients awaiting LC resection were randomized to PHET or a control group (CG). The PHET program combined aerobic and resistance exercise, with weekly telephone supervision. Primary outcome was QoL-assessed with the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) at baseline, before surgery, and 1 month after surgery. The secondary outcomes were hospital length of stay and physical performance. The main analysis included a factorial repeated-measures analysis of variance. Additionally, the proportion of patients experiencing clinical deterioration from baseline to post-surgery was assessed. RESULTS The study included 41 patients (68.1 ± 9.3 years; 68.3% male) in the intention-to-treat analysis (20 PHET patients, 21 CG patients). A significant group × time interaction was observed for global QoL (p = 0.004). Between-group differences in global QoL were statistically and clinically significant before surgery (mean difference [MD], 13.5 points; 95% confidence interval [CI], 2.4-24.6; p = 0.019) and after surgery (MD, 12.4 points; 95% CI, 1.3-23.4; p = 0.029), favoring PHET. Clinical deterioration of global QoL was reported by 71.4% of the CG patients compared with 30 % of the PHET patients (p = 0.003). Between-group differences in favor of PHET were found in pain and appetite loss as well as in physical, emotional and role functions after surgery (p < 0.05). Compared with CG, PHET was superior in improving preoperative five-times sit-to-stand and postoperative exercise capacity (p < 0.05). No between-group differences in other secondary outcomes were observed. CONCLUSION The study showed that PHET can effectively prevent the decline in QoL after LC surgery.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal.
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal.
- Physioclem, Physical Therapy Clinics, Alcobaça, Portugal.
| | - Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal
| | - Ana Luís Garcia
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Tiago Nogueira
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, Coimbra, Portugal
| | - Sónia Silva
- Pulmonology Department, Leiria Hospital Center, Leiria, Portugal
| | | | - Maria Vitória Martins
- Pulmonology Department, District Hospital of Figueira da Foz, Figueira da Foz, Portugal
| | - André Canha
- Physical Medicine and Rehabilitation Department, District Hospital of Santarém, Santarém, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, Coimbra Institute for Clinical and Biomedical Research (iCBR), Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, Coimbra, Portugal
| | - Raul A Martins
- University of Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, Coimbra, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), Leiria, Portugal
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7
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H Fosstveit S, Lohne-Seiler H, Feron J, Lucas SJE, Ivarsson A, Berntsen S. The intensity paradox: A systematic review and meta-analysis of its impact on the cardiorespiratory fitness of older adults. Scand J Med Sci Sports 2024; 34:e14573. [PMID: 38389140 DOI: 10.1111/sms.14573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 01/15/2024] [Accepted: 01/21/2024] [Indexed: 02/24/2024]
Abstract
AIM The present systematic review and meta-analysis aimed to compare the effect of moderate- versus high-intensity aerobic exercise on cardiorespiratory fitness (CRF) in older adults, taking into account the volume of exercise completed. METHODS The databases MEDLINE (Ovid), EMBASE (Ovid), and CENTRAL (Cochrane Library) were searched to identify randomized controlled trials (RCTs). Two reviewers extracted data and assessed bias. Comprehensive Meta-Analysis software calculated overall effect size, intensity differences, and performed meta-regression analyses using pre-to-post intervention or change scores of peak oxygen uptake (V̇O2 peak). The review included 23 RCTs with 1332 older adults (intervention group: n = 932; control group: n = 400), divided into moderate-intensity (435 older adults) and high-intensity (476 older adults) groups. RESULTS Meta-regression analysis showed a moderate, but not significant, relationship between exercise intensity and improvements in V̇O2 peak after accounting for the completed exercise volume (β = 0.31, 95% CI = [-0.04; 0.67]). Additionally, studies comparing moderate- versus high-intensity revealed a small, but not significant, effect in favor of high-intensity (Hedges' g = 0.20, 95% CI = [-0.02; 0.41]). Finally, no significant differences in V̇O2 peak improvements were found across exercise groups employing various methods, modalities, and intensity monitoring strategies. CONCLUSION Findings challenge the notion that high-intensity exercise is inherently superior and indicate that regular aerobic exercise, irrespective of the specific approach and intensity, provides the primary benefits to CRF in older adults. Future RCTs should prioritize valid and reliable methodologies for monitoring and reporting exercise volume and adherence among older adults.
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Affiliation(s)
- Sindre H Fosstveit
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Hilde Lohne-Seiler
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Jack Feron
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Samuel J E Lucas
- School of Sport, Exercise and Rehabilitation Sciences and Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Andreas Ivarsson
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
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8
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Murphy K, Kehoe B, Denieffe S, Hacking D, Fairman CM, Harrison M. A comparison of aerobic- and resistance-emphasised exercise on cardiometabolic health and quality of life in men receiving androgen deprivation therapy for prostate cancer: Protocol for a feasibility trial. Contemp Clin Trials 2024; 136:107388. [PMID: 37972755 DOI: 10.1016/j.cct.2023.107388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/15/2023] [Accepted: 11/11/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Those with intermediate and high-risk prostate cancer typically receive androgen deprivation therapy (ADT) as part of their treatment. ADT often results in extensive side effects including increased risk of cardiometabolic disease. Many ADT side effects can be influenced by exercise, both resistance and aerobic training. Exercise regimes typically combine aerobic and resistance exercise but the appropriate emphasis for achieving the broadest range of therapeutic benefits has yet to be determined. We propose to determine the feasibility of undertaking a larger trial comparing a resistance- vs an aerobic-emphasised exercise intervention in men with prostate cancer undergoing ADT. The trial will also investigate preliminary evidence of difference between arms for cardiometabolic health and quality of life outcomes. METHODS This is a 6-month randomised two-armed feasibility trial. Prostate cancer patients undergoing ADT and radiotherapy will be recruited (n = 24) and randomised to either a resistance- or aerobic-emphasised group. Participants will attend twice-weekly supervised individual or small group sessions, with 75% of exercise time in the primary exercise modality. The primary outcome will be feasibility, determined via assessment of recruitment, retention, adherence, safety, and acceptability. Secondary outcomes will include quality of life, body composition, vascular indices, aerobic and muscular fitness and cardiometabolic health blood biomarkers. CONCLUSION It is envisaged that the trial will provide valuable information and preliminary difference data that will aid in the design of an efficacious larger trial that will adopt a major and minor emphasis approach to the scheduling of resistance and aerobic exercise.
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Affiliation(s)
- Kira Murphy
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland; UPMC Hillman Cancer Center, Whitfield Hospital, Waterford, Ireland
| | - Bróna Kehoe
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland
| | - Suzanne Denieffe
- School of Humanities, South East Technological University, Waterford, Ireland
| | - Dayle Hacking
- UPMC Hillman Cancer Center, Whitfield Hospital, Waterford, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Michael Harrison
- Department of Sport and Exercise Science, South East Technological University, Waterford, Ireland.
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Bøhn S, Oldervoll LM, Reinertsen KV, Seland M, Fosså A, Kiserud C, Skaali T, Nilsen TS, Blomhoff R, Henriksen HB, Lie HC, Berge T, Fjerstad E, Wisløff T, Slott M, Zajmovic I, Thorsen L. The feasibility of a multidimensional intervention in lymphoma survivors with chronic fatigue. Support Care Cancer 2023; 32:22. [PMID: 38095797 PMCID: PMC10721709 DOI: 10.1007/s00520-023-08204-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 11/21/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Chronic fatigue (CF) affects 25-30% of lymphoma survivors, but interventions designed to reduce fatigue are lacking. The main aim of this study was to test the feasibility of a multidimensional intervention study in lymphoma survivors with CF. Secondary aims were to describe individual changes in fatigue, quality of life (QoL) and physical performance from pre (T0) to post (T1) intervention. METHODS This feasibility study was as a one-armed intervention study performed in 2021. Hodgkin or aggressive non-Hodgkin lymphoma survivors received mailed study information and Chalder Fatigue Questionnaire and were asked to respond if they suffered from fatigue. The 12-week intervention included patient education, physical exercise, a cognitive behavioural therapy (CBT)-based group program and nutritional counselling. Feasibility data included patient recruitment, completion of assessments, adherence to the intervention and patient-reported experience measures. Participants responded to questionnaires and underwent physical tests at T0 and T1. RESULTS Seven lymphoma survivors with CF were included. Of all assessments, 91% and 83% were completed at T0 and T1, respectively. Adherence to the interventional components varied from 69% to 91%. At T1, all participants rated exercise as useful, of whom five rated the CBT-based program and five rated individual nutritional counselling as useful. Five participants reported improved fatigue, QoL and physical performance. CONCLUSION Lymphoma survivors with CF participating in a multidimensional intervention designed to reduce the level of fatigue showed high assessment completion rate and intervention adherence rate. Most of the participants evaluated the program as useful and improved their level of fatigue, QoL and physical performance after the intervention. TRIAL REGISTRATION ClinicalTrials.gov, identifier: NCT04931407. Registered 16. April 2021-Retrospectively registered. https://www. CLINICALTRIALS gov/ct2/show/NCT04931407.
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Affiliation(s)
- Skh Bøhn
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway.
| | - L M Oldervoll
- Centre for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - K V Reinertsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - M Seland
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - A Fosså
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - C Kiserud
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
| | - T Skaali
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - T S Nilsen
- Institute of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - R Blomhoff
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - H B Henriksen
- Department of Nutrition, Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - H C Lie
- Department of Behavioural Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - T Berge
- Diakonhjemmet Hospital, Oslo, Norway
| | | | - T Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - M Slott
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - I Zajmovic
- Department of Clinical Service, The Cancer Rehabilitation Center, Aker, Oslo University Hospital, Oslo, Norway
| | - L Thorsen
- National Advisory Unit for Late Effects After Cancer Treatment, Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway
- Department of Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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10
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Scott JM, Lee J, Herndon JE, Michalski MG, Lee CP, O’Brien KA, Sasso JP, Yu AF, Rowed KA, Bromberg JF, Traina TA, Gucalp A, Sanford RA, Gajria D, Modi S, Comen EA, D'Andrea G, Blinder VS, Eves ND, Peppercorn JM, Moskowitz CS, Dang CT, Jones LW. Timing of exercise therapy when initiating adjuvant chemotherapy for breast cancer: a randomized trial. Eur Heart J 2023; 44:4878-4889. [PMID: 36806405 PMCID: PMC10702461 DOI: 10.1093/eurheartj/ehad085] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/10/2023] [Accepted: 02/03/2023] [Indexed: 02/23/2023] Open
Abstract
AIMS The most appropriate timing of exercise therapy to improve cardiorespiratory fitness (CRF) among patients initiating chemotherapy is not known. The effects of exercise therapy administered during, following, or during and following chemotherapy were examined in patients with breast cancer. METHODS AND RESULTS Using a parallel-group randomized trial design, 158 inactive women with breast cancer initiating (neo)adjuvant chemotherapy were allocated to receive (1:1 ratio): usual care or one of three exercise regimens-concurrent (during chemotherapy only), sequential (after chemotherapy only), or concurrent and sequential (continuous) (n = 39/40 per group). Exercise consisted of treadmill walking three sessions/week, 20-50 min at 55%-100% of peak oxygen consumption (VO2peak) for ≈16 (concurrent, sequential) or ≈32 (continuous) consecutive weeks. VO2peak was evaluated at baseline (pre-treatment), immediately post-chemotherapy, and ≈16 weeks after chemotherapy. In intention-to-treat analysis, there was no difference in the primary endpoint of VO2peak change between concurrent exercise and usual care during chemotherapy vs. VO2peak change between sequential exercise and usual care after chemotherapy [overall difference, -0.88 mL O2·kg-1·min-1; 95% confidence interval (CI): -3.36, 1.59, P = 0.48]. In secondary analysis, continuous exercise, approximately equal to twice the length of the other regimens, was well-tolerated and the only strategy associated with significant improvements in VO2peak from baseline to post-intervention (1.74 mL O2·kg-1·min-1, P < 0.001). CONCLUSION There was no statistical difference in CRF improvement between concurrent vs. sequential exercise therapy relative to usual care in women with primary breast cancer. The promising tolerability and CRF benefit of ≈32 weeks of continuous exercise therapy warrant further evaluation in larger trials.
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Affiliation(s)
- Jessica M Scott
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Jasme Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - James E Herndon
- Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Road, 8020 Hock Plaza, Durham, NC 27705, USA
| | - Meghan G Michalski
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Catherine P Lee
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kelly A O’Brien
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - John P Sasso
- School of Health and Exercise Sciences, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
| | - Anthony F Yu
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Kylie A Rowed
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jacqueline F Bromberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Tiffany A Traina
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Ayca Gucalp
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Rachel A Sanford
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Devika Gajria
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Elisabeth A Comen
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Gabriella D'Andrea
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Victoria S Blinder
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Neil D Eves
- School of Health and Exercise Sciences, University of British Columbia, 1147 Research Road, Kelowna, BC V1V 1V7, Canada
| | - Jeffrey M Peppercorn
- Division of Hematology/Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA
| | - Chaya S Moskowitz
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Chau T Dang
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
| | - Lee W Jones
- Department of Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
- Department of Medicine, Weill Cornell Medical College, 418 E 71st St, New York, NY 10021, USA
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11
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Hart NH, Wallen MP, Farley MJ, Haywood D, Boytar AN, Secombe K, Joseph R, Chan RJ, Kenkhuis MF, Buffart LM, Skinner TL, Wardill HR. Exercise and the gut microbiome: implications for supportive care in cancer. Support Care Cancer 2023; 31:724. [PMID: 38012463 DOI: 10.1007/s00520-023-08183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 11/12/2023] [Indexed: 11/29/2023]
Abstract
PURPOSE Growing recognition of the gut microbiome as an influential modulator of cancer treatment efficacy and toxicity has led to the emergence of clinical interventions targeting the microbiome to enhance cancer and health outcomes. The highly modifiable nature of microbiota to endogenous, exogenous, and environmental inputs enables interventions to promote resilience of the gut microbiome that have rapid effects on host health, or response to cancer treatment. While diet, probiotics, and faecal microbiota transplant are primary avenues of therapy focused on restoring or protecting gut function in people undergoing cancer treatment, the role of physical activity and exercise has scarcely been examined in this population. METHODS A narrative review was conducted to explore the nexus between cancer care and the gut microbiome in the context of physical activity and exercise as a widely available and clinically effective supportive care strategy used by cancer survivors. RESULTS Exercise can facilitate a more diverse gut microbiome and functional metabolome in humans; however, most physical activity and exercise studies have been conducted in healthy or athletic populations, primarily using aerobic exercise modalities. A scarcity of exercise and microbiome studies in cancer exists. CONCLUSIONS Exercise remains an attractive avenue to promote microbiome health in cancer survivors. Future research should elucidate the various influences of exercise modalities, intensities, frequencies, durations, and volumes to explore dose-response relationships between exercise and the gut microbiome among cancer survivors, as well as multifaceted approaches (such as diet and probiotics), and examine the influences of exercise on the gut microbiome and associated symptom burden prior to, during, and following cancer treatment.
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Affiliation(s)
- Nicolas H Hart
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia.
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia.
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia.
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Matthew P Wallen
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Institute for Health and Wellbeing, Federation University, Ballarat, VIC, Australia
| | - Morgan J Farley
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Darren Haywood
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- Mental Health Division, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
- Department of Psychiatry, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Alexander N Boytar
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Kate Secombe
- The University of Queensland Diamantina Institute, Faculty of Medicine, The University of Queensland, St. Lucia, QLD, Australia
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Ria Joseph
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
- Cancer and Palliative Care Outcomes Centre, Faculty of Health, Queensland University of Technology (QUT), Brisbane, QLD, Australia
| | - Marlou-Floor Kenkhuis
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Laurien M Buffart
- Department of Medical BioSciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tina L Skinner
- Human Performance Research Centre, INSIGHT Research Institute, University of Technology Sydney (UTS), Moore Park, NSW, 2030, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, St. Lucia, QLD, Australia
| | - Hannah R Wardill
- School of Biomedicine, University of Adelaide, Adelaide, SA, Australia
- Supportive Oncology Research Group, Precision Cancer Medicine, South Australian Health and Medical Research Institute, Adelaide, SA, Australia
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12
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Brown M, O'Connor D, Turkington R, Eatock M, Vince R, Hulme C, Bowdery R, Robinson R, Wadsley J, Maraveyas A, Prue G. Feasibility of delivering supervised exercise training following surgical resection and during adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PRECISE): a case series. BMC Sports Sci Med Rehabil 2023; 15:116. [PMID: 37735664 PMCID: PMC10514993 DOI: 10.1186/s13102-023-00722-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/05/2023] [Indexed: 09/23/2023]
Abstract
INTRODUCTION Pancreatic ductal adenocarcinoma (PDAC) is an aggressive neoplasm, with surgical resection and adjuvant chemotherapy the only curative treatment. Treatment-related toxicities place a considerable burden on patients although exercise training has shown promise is helping to manage such adversities and facilitate rehabilitation. The feasibility and safety of exercise training as a supportive therapy during adjuvant chemotherapy remains unknown. METHODS Patients with PDAC were screened post-surgical resection and enrolled in a 16-week, progressive, concurrent exercise programme alongside their chemotherapy regimen. Feasibility was the primary objective detailing recruitment, retention and adherence rates throughout as well as the safety and fidelity of the intervention. Secondarily, the impact on functional fitness and patient-reported outcomes was captured at baseline, post-intervention and 3-month follow up. RESULTS Eight patients consented to participate in this trial, with five proceeding to enrol in exercise training. Concurrent exercise training is feasible and safe during adjuvant chemotherapy and prevented an expected decline in functional fitness and patient-reported outcomes during this time. DISCUSSION This case series provides preliminary evidence that concurrent exercise training during adjuvant therapy is safe, feasible and well tolerated, preventing an expected decline in functional fitness, muscular strength and health-related quality of life (HRQoL). Given the adverse effects of treatment, these findings are promising and provide further evidence for the inclusion of exercise training as a standard of care for surgical rehabilitation and managing treatment-related toxicities. Future research should explore the impact of exercise training during neoadjuvant chemotherapy, with prehabilitation now standard practice for borderline resectable disease. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04305067, prospectively registered 12/03/2020, https://classic. CLINICALTRIALS gov/ct2/show/NCT04305067 .
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Affiliation(s)
- Malcolm Brown
- School of Nursing and Midwifery, Queen's University Belfast Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK.
| | - Dominic O'Connor
- School of Health Sciences, The University of Nottingham, Nottingham, England, UK
| | - Richard Turkington
- The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
- The Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Martin Eatock
- The Patrick G. Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, Northern Ireland, UK
- The Northern Ireland Cancer Centre, Belfast Health and Social Care Trust, Belfast, Northern Ireland, UK
| | - Rebecca Vince
- School of Sport, Exercise and Rehabilitation Sciences, University of Hull, Hull, England, UK
| | - Claire Hulme
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, England, UK
| | - Roy Bowdery
- Pancreatic Cancer UK Research Involvement Network, London, England, UK
| | - Rebecca Robinson
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England, UK
| | - Jonathan Wadsley
- Department of Oncology and Metabolism, The Medical School, University of Sheffield, Sheffield, England, UK
| | | | - Gillian Prue
- School of Nursing and Midwifery, Queen's University Belfast Medical Biology Centre, 97 Lisburn Road, Belfast, BT9 7BL, UK
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13
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Midgley AW, Levy AR, Rogers SN, Brooker RC, Bryant V, Cherry MG, Lane S, Nugent MM, Price R, Schache AG, Young B, Patterson JM. ACTivity as medicine In Oncology for Head and Neck (ACTIOHN): Protocol for a feasibility study investigating a patient-centred approach to exercise for people with head and neck cancer. PLoS One 2023; 18:e0289911. [PMID: 37624789 PMCID: PMC10456155 DOI: 10.1371/journal.pone.0289911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 07/28/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND AND AIM Attempts at personalisation of exercise programmes in head and neck cancer (HaNC) have been limited. The main aim of the present study is to investigate the feasibility and acceptability of introducing a remotely delivered, fully personalised, collaborative, and flexible approach to prescribing and delivering exercise programmes into the HaNC usual care pathway. METHODS This is a single arm, feasibility study. Seventy patients diagnosed with HaNC will be recruited from two regional HaNC centres in the United Kingdom. Patients will undertake an 8-week exercise programme designed and delivered by cancer exercise specialists. The exercise programme will start any time between the time of diagnosis and up to 8 weeks after completing treatment, depending on patient preference. The content of the exercise programme will be primarily based on patient needs, preferences, and goals, but guided by current physical activity guidelines for people with cancer. The primary outcome measure is retention to the study. Secondary quantitative outcomes are uptake to the exercise programme, different measures of exercise adherence, pre- and post-intervention assessments of fatigue (Multidimensional Fatigue Symptom Inventory-Short Form), quality of life (SF-36), physical activity levels (International Physical Activity Questionnaire-Short Form), and various components of physical fitness. The outcomes of the nested qualitative study are acceptability and feasibility of the intervention evaluated via interviews with patients, health care professionals, and the cancer exercise specialists. Intervention and participant fidelity will be determined using checklists and scrutiny of each patient's logbook and the cancer exercise specialists' meeting notes. Analysis of quantitative data will be via standard summary statistics. Qualitative data will be analysed using thematic analysis. EXPECTED RESULTS This feasibility study will inform the design and conduct of a future randomised controlled trial. Success will be defined according to a traffic light system for identifying the appropriateness of progression to a randomised controlled trial. TRIAL REGISTRATION International Standard Randomised Controlled Trial Number registry (ISRCTN82505455).
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Affiliation(s)
- Adrian W. Midgley
- Department of Sport and Physical Activity, Edge Hill University, Ormskirk, United Kingdom
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
| | - Andrew R. Levy
- Health Research Institute, Edge Hill University, Ormskirk, Lancashire, United Kingdom
- Department of Psychology, Edge Hill University, Ormskirk, United Kingdom
| | - Simon N. Rogers
- Arrowe Park Hospital, Wirral University Teaching Hospital NHS Foundation Trust, Liverpool, United Kingdom
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, United Kingdom
| | - Rachel C. Brooker
- The Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, United Kingdom
| | - Valerie Bryant
- Cancer of Head and Neck Group Experience (CHANGE) Patient and Public Involvement Group, Sunderland Royal Hospital, Sunderland, United Kingdom
| | - Mary Gemma Cherry
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Steven Lane
- Institute of Infection, Veterinary, and Ecological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Michael M. Nugent
- Oral and Maxillofacial Surgery, Sunderland Royal Hospital, South Tyneside and Sunderland NHS Foundation Trust, Sunderland, United Kingdom
| | - Ruth Price
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
| | - Andrew G. Schache
- Liverpool Head and Neck Centre, Liverpool University Hospitals NHS Foundation Trust, Liverpool, United Kingdom
- Department of Molecular and Clinical Cancer Medicine, Liverpool Head and Neck Centre, University of Liverpool, Liverpool, United Kingdom
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Joanne M. Patterson
- Liverpool Head and Neck Centre, School of Health Science, University of Liverpool, Liverpool, United Kingdom
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14
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Crosby BJ, Newton RU, Galvão DA, Taaffe DR, Lopez P, Meniawy TM, Khattak MA, Lam WS, Gray ES, Singh F. Feasibility of supervised telehealth exercise for patients with advanced melanoma receiving checkpoint inhibitor therapy. Cancer Med 2023. [PMID: 37184115 DOI: 10.1002/cam4.6091] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/16/2023] Open
Abstract
PURPOSE To determine the feasibility, safety and preliminary efficacy of a telehealth supervised exercise programme in patients with advanced melanoma receiving checkpoint inhibitor therapy. METHODS A 8-week non-randomised feasibility pilot trial utilising a telehealth delivered multimodal exercise programme undertaken thrice weekly with assessments at baseline and post-intervention. The study was considered feasible if there were no severe or life-threatening adverse events as a result of exercise, and three or more of the following criteria were met: the recruitment rate was >50%, completion rate was >80%, median programme attendance was >75%, median exercise compliance >75%, and average tolerance was >70%. Preliminary efficacy was assessed for objective measures of physical function (2-min step test, repeated chair stand test, 30-s push-up test, and a modified static balance test) and quality of life (QoL), fatigue and other patient-reported outcomes were assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire Core 30. RESULTS Eleven patients (32-80 years) were included in the study (6 female, 5 male). The recruitment rate was 48%, completion rate 91%, programme attendance 88%, median exercise compliance 82.1% and 84.9% for resistance and aerobic exercise, respectively, and tolerance 88%, with no severe or life-threatening adverse events as a result of exercise. In terms of preliminary efficacy, physical function significantly improved while QoL was maintained following the intervention. CONCLUSION An 8-week telehealth exercise intervention is feasible and safe for patients with advanced melanoma and appears to improve physical function while preserving QoL during checkpoint inhibitor therapy.
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Affiliation(s)
- Brendan J Crosby
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Human Movement and Nutrition Sciences, University of Queensland, Saint Lucia, Queensland, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Pedro Lopez
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Pleural Medicine Unit, Institute for Respiratory Health, Perth, Western Australia, Australia
| | - Tarek M Meniawy
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Muhammad A Khattak
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
- School of Medicine, University of Western Australia, Crawley, Western Australia, Australia
| | - Wei-Sen Lam
- Department of Medical Oncology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Elin S Gray
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
- Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Favil Singh
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
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15
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Thomsen SN, Lahart IM, Thomsen LM, Fridh MK, Larsen A, Mau-Sørensen M, Bolam KA, Fairman CM, Christensen JF, Simonsen C. Harms of exercise training in patients with cancer undergoing systemic treatment: a systematic review and meta-analysis of published and unpublished controlled trials. EClinicalMedicine 2023; 59:101937. [PMID: 37096190 PMCID: PMC10121410 DOI: 10.1016/j.eclinm.2023.101937] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 04/26/2023] Open
Abstract
Background Exercise is recommended for people with cancer. The aim of this study was to evaluate the harms of exercise in patients with cancer undergoing systemic treatment. Methods This systematic review and meta-analysis included published and unpublished controlled trials comparing exercise interventions versus controls in adults with cancer scheduled to undergo systemic treatment. The primary outcomes were adverse events, health-care utilization, and treatment tolerability and response. Eleven electronic databases and trial registries were systematically searched with no date or language restrictions. The latest searches were performed on April 26, 2022. The risk of bias was judged using RoB2 and ROBINS-I, and the certainty of evidence for primary outcomes was assessed using GRADE. Data were statistically synthesised using pre-specified random-effect meta-analyses. The protocol for this study was registered in the PROESPERO database (ID: CRD42021266882). Findings 129 controlled trials including 12,044 participants were eligible. Primary meta-analyses revealed evidence of a higher risk of some harms, including serious adverse events (risk ratio [95% CI]: 1.87 [1.47-2.39], I2 = 0%, n = 1722, k = 10), thromboses (risk ratio [95% CI]: 1.67 [1.11-2.51], I2 = 0%, n = 934, k = 6), and fractures (risk ratio [95% CI]: 3.07 [3.03-3.11], I2 = 0%, n = 203, k = 2) in intervention versus control. In contrast, we found evidence of a lower risk of fever (risk ratio [95% CI]: 0.69 [0.55-0.87], I2 = 0% n = 1109, k = 7) and a higher relative dose intensity of systemic treatment (difference in means [95% CI]: 1.50% [0.14-2.85], I2 = 0% n = 1110, k = 13) in intervention versus control. For all outcomes, we downgraded the certainty of evidence due to imprecision, risk of bias, and indirectness, resulting in very low certainty of evidence. Interpretation The harms of exercise in patients with cancer undergoing systemic treatment are uncertain, and there is currently insufficient data on harms to make evidence-based risk-benefits assessments of the application of structured exercise in this population. Funding There was no funding for this study.
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Affiliation(s)
- Simon N. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Ian M. Lahart
- Faculty of Health, Education, and Wellbeing, School of Sport, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Laura M. Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
| | - Martin K. Fridh
- Department of Pediatrics and Adolescent Medicine, The Juliane Marie Center, University Hospital of Copenhagen – Rigshospitalet, Juliane Maries Vej 9, 2100, Copenhagen OE, Denmark
| | - Anders Larsen
- University Hospitals Centre for Health Research, Copenhagen University Hospital - Rigshospitalet, Ryesgade 27, 2200, Copenhagen N, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Centre for Cancer and Organ Diseases, University Hospital of Copenhagen - Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen OE, Denmark
| | - Kate A. Bolam
- Department of Physical Activity and Health, The Swedish School of Sport and Health Sciences, Lidingovagen, 5626, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Alfred Nobels Alle 23, 141 35, Stockholm, Sweden
| | - Ciaran M. Fairman
- Department of Exercise Science, University of South Carolina, Columbia, SC, USA
| | - Jesper F. Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
- Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
- Digestive Disease Center, Bispebjerg Hospital, Nielsine Nielsens Vej 11, 2400, Copenhagen, Denmark
| | - Casper Simonsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen OE, Denmark
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16
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Machado P, Pimenta S, Garcia AL, Nogueira T, Silva S, Oliveiros B, Martins RA, Cruz J. Home-Based Preoperative Exercise Training for Lung Cancer Patients Undergoing Surgery: A Feasibility Trial. J Clin Med 2023; 12:jcm12082971. [PMID: 37109307 PMCID: PMC10146369 DOI: 10.3390/jcm12082971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 03/16/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Clinical guidelines recommend prehabilitation with exercise training to optimize recovery after lung cancer surgery. However, the lack of access to facility-based exercise programs is a major barrier to routine participation. This study aimed to assess the feasibility of a home-based exercise intervention before lung cancer resection. METHODS We conducted a prospective, two-site feasibility study, including patients scheduled for lung cancer surgery. Exercise prescription involved aerobic and resistance training with telephone-based supervision. The primary endpoint was overall feasibility (recruitment rate, retention rate, intervention adherence and acceptability). Secondary endpoints included safety and effects on health-related quality of life (HRQOL) and physical performance, evaluated at baseline, after the exercise intervention and 4-5 weeks after surgery. RESULTS Over three months, 15 patients were eligible, and all agreed to participate (recruitment rate: 100%). A total of 14 patients completed the exercise intervention, and 12 patients were evaluated postoperatively (retention rate: 80%). The median length of the exercise intervention was 3 weeks. Patients performed an aerobic and resistance training volume higher than prescribed (median adherence rates of 104% and 111%, respectively). A total of nine adverse events occurred during the intervention (Grade 1, n = 8; Grade 2, n = 1), the most common being shoulder pain. After the exercise intervention, significant improvements were observed in the HRQOL summary score (mean difference, 2.9; 95% confidence interval [CI], from 0.9 to 4.8; p = 0.049) and the five-times sit-to-stand test score (median difference, -1.5; 95% CI, from -2.1 to -0.9; p = 0.001). After surgery, no significant effects on HRQOL and physical performance were observed. CONCLUSION A short-term preoperative home-based exercise intervention is feasible before lung cancer resection and may enhance accessibility to prehabilitation. Clinical effectiveness should be investigated in future studies.
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Affiliation(s)
- Pedro Machado
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
- Univ Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
- Physioclem, Physical Therapy Clinics, 2460-042 Alcobaça, Portugal
| | - Sara Pimenta
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
| | - Ana Luís Garcia
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, 3000-075 Coimbra, Portugal
| | - Tiago Nogueira
- Thoracic Surgery Unit, Portuguese Oncology Institute of Coimbra, 3000-075 Coimbra, Portugal
| | - Sónia Silva
- Pulmonology Department, Leiria Hospital Center, 2410-197 Leiria, Portugal
| | - Bárbara Oliveiros
- Laboratory of Biostatistics and Medical Informatics (LBIM), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-548 Coimbra, Portugal
- Institute for Biomedical Imaging and Translational Research (CIBIT), University of Coimbra, 3000-548 Coimbra, Portugal
| | - Raul A Martins
- Univ Coimbra, Research Unit for Sport and Physical Activity (CIDAF, UID/PTD/04213/2019), Faculty of Sport Sciences and Physical Education, 3040-248 Coimbra, Portugal
| | - Joana Cruz
- Center for Innovative Care and Health Technology (ciTechCare), School of Health Sciences of the Polytechnic of Leiria (ESSLei), 2411-901 Leiria, Portugal
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Nilsen TS, Sæter M, Sarvari SI, Reinertsen KV, Johansen SH, Edvardsen ER, Hallén J, Edvardsen E, Grydeland M, Kiserud CE, Lie HC, Solberg PA, Wisløff T, Sharples AP, Raastad T, Haugaa KH, Thorsen L. Effects of Aerobic Exercise on Cardiorespiratory Fitness, Cardiovascular Risk Factors, and Patient-Reported Outcomes in Long-Term Breast Cancer Survivors: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e45244. [PMID: 36920460 PMCID: PMC10131898 DOI: 10.2196/45244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/31/2023] [Accepted: 01/31/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Anthracycline-based chemotherapy has been mainstay of adjuvant breast cancer therapy for decades. Although effective, anthracyclines place long-term breast cancer survivors at risk of late effects, such as reduced cardiorespiratory fitness and increased risk of cardiovascular disease. Previous research has shown beneficial effects of exercise training on cardiorespiratory fitness, but the effects of exercise on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes in long-term survivors are less clear. Whether previous exposure to breast cancer therapy modulates the effects of exercise is also unknown. OBJECTIVE The primary aim of the CAUSE (Cardiovascular Survivors Exercise) trial is to examine the effect of aerobic exercise on cardiorespiratory fitness in anthracycline-treated long-term breast cancer survivors. Secondary aims are to examine effects of exercise training on limiting factors for cardiorespiratory fitness, cardiovascular risk factors, and patient-reported outcomes, and to compare baseline values and effects of exercise training between similar-aged women with and those without prior breast cancer. A third aim is to examine the 24-month postintervention effects of aerobic exercise on primary and secondary outcomes. METHODS The CAUSE trial is a 2-armed randomized controlled trial, where 140 long-term breast cancer survivors, 8-12 years post diagnosis, are assigned to a 5-month nonlinear aerobic exercise program with 3 weekly sessions or to standard care. Seventy similar-aged women with no history of cancer will undergo the same exercise program. Cardiorespiratory fitness measured as peak oxygen consumption (VO2peak), limiting factors for VO2peak (eg, cardiac function, pulmonary function, hemoglobin mass, blood volume, and skeletal muscle characteristics), cardiovascular risk factors (eg, hypertension, diabetes, dyslipidemia, obesity, physical activity level, and smoking status), and patient-reported outcomes (eg, body image, fatigue, mental health, and health-related quality of life) will be assessed at baseline, post intervention, and 24 months post intervention. RESULTS A total of 209 patients were included from October 2020 to August 2022, and postintervention assessments were completed in January 2023. The 24-month follow-up will be completed in February 2025. CONCLUSIONS The findings from the CAUSE trial will provide novel scientific understanding of the potential benefits of exercise training in long-term breast cancer survivors. TRIAL REGISTRATION ClinicalTrials.gov NCT04307407; https://clinicaltrials.gov/ct2/show/NCT04307407. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/45244.
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Affiliation(s)
- Tormod Skogstad Nilsen
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Mali Sæter
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Sebastian Imre Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Kristin Valborg Reinertsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Sara Hassing Johansen
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Jostein Hallén
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
- Department of Pulmonary Medicine, Oslo University Hospital, Oslo, Norway
| | - May Grydeland
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Cecilie Essholt Kiserud
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Hanne Cathrine Lie
- Department of Behavioural Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Paul André Solberg
- Norwegian Olympic and Paralympic Committee and Confederation of Sports, Oslo, Norway
| | - Torbjørn Wisløff
- Health Services Research Unit, Akershus University Hospital, Lørenskog, Norway
| | - Adam Philip Sharples
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Truls Raastad
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, Norway
| | - Kristina Hermann Haugaa
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, Oslo, Norway
- Department for Clinical Service, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
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Shannon S, Shevlin M, Brick N, Breslin G. Frequency, intensity and duration of muscle strengthening activity and associations with mental health. J Affect Disord 2023; 325:41-47. [PMID: 36587908 DOI: 10.1016/j.jad.2022.12.063] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 12/05/2022] [Accepted: 12/17/2022] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Despite growing emphasis on the benefits of physical activity for promoting mental health, inclusion of muscle-strengthening (MS) (e.g., body-weight exercises, resistance machines) activities is limited. Notably, few studies collectively assess MS behavioural frequency, duration, and intensity. To address the gap, the current study examined associations between frequency (days), intensity (rating of perceived exertion in relation to repetitions in reserve [RPE/RIR]), and duration (minutes per typical session) of MS activities on anxiety, depression, and mental well-being. METHOD A cross-sectional study of 601 participants (Mean age = 30.92 years [SD = 12.70]; 57.7 % female) across Ireland was conducted. Participants completed a self-report questionnaire containing MS instruments previously used, or adapted from valid and reliable measures (i.e., International Physical Activity Questionnaire IPAQ, RPE/RIR), alongside, the Generalized Anxiety Disorder-7 (GAD-7), Patient Health Questionnaire-8 (PHQ-8) and the Mental Health Continuum- Short Form (MHC-SF). A multivariate regression model was tested in MPLUS, using dummy coding for MS frequency in relation to no activity (i.e., 0-days) non-adherence (i.e., 1-day), adherence (i.e., 2-days) and enhanced adherence (i.e., ≥3 days) to the MS public health guidelines, with the mental health variables representing the dependent variables. Intensity and duration were specified in the model as continuous variables; gender and age were included as statistical controls. RESULTS Three or more days engaged in MS activities was associated with fewer anxiety (β = -0.12, p < .05) and depression (β = -0.14, p < .01) symptoms. Increased intensity had a negative association with anxiety (β = -0.10, p < .05) and depression (β = -0.15, p < .001). Unexpectedly, adherence to the MS guidelines (2-days) did not predict any of the mental health outcomes, whereas 1-day of MS activity was associated with fewer depression symptoms (β = -0.11). No effects were observed for mental well-being, and MS duration exerted a null effect across all mental health outcomes. CONCLUSION Higher frequency and intensity of MS activities may protect against anxiety and depression symptoms. Doing some MS activities (at least 1-day) is likely more beneficial than none for depression. Evidence-based, MS interventions may help curb mental illness rates, and future longitudinal, intervention-based research could consider inclusion of MS frequency, intensity and duration variables to enhance efforts to identify at-risk groups and trends within physical activity and mental illness surveillance.
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Affiliation(s)
- Stephen Shannon
- Sport and Exercise Sciences Research Institute, Ulster University Jordanstown Campus, Shore Road, Newtownabbey, Northern Ireland BT370QB, UK; Bamford Centre for Mental Health and Wellbeing, Ulster University Jordanstown Campus, Shore Road, Newtownabbey, Northern Ireland BT370QB, UK.
| | - Mark Shevlin
- School of Psychology, Ulster University Coleraine Campus, Cromore Road, Coleraine, Northern Ireland BT521SA, UK
| | - Noel Brick
- School of Psychology, Ulster University Coleraine Campus, Cromore Road, Coleraine, Northern Ireland BT521SA, UK
| | - Gavin Breslin
- Bamford Centre for Mental Health and Wellbeing, Ulster University Jordanstown Campus, Shore Road, Newtownabbey, Northern Ireland BT370QB, UK; School of Psychology, Ulster University Coleraine Campus, Cromore Road, Coleraine, Northern Ireland BT521SA, UK
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Lopez P, Taaffe DR, Newton RU, Spry N, Joseph D, Tang C, Buffart LM, Galvão DA. Reporting Attendance and Resistance Exercise Compliance in Men with Localized Prostate Cancer. Med Sci Sports Exerc 2023; 55:354-364. [PMID: 36374564 DOI: 10.1249/mss.0000000000003069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Resistance exercise is a well-established intervention to counteract musculoskeletal and metabolic toxicities from prostate cancer treatment. In this study, we reported resistance exercise attendance and compliance, and examined if these variables can influence changes in outcomes of interest in men with localized or locally advanced prostate cancer. METHODS A total of 83 prostate cancer patients (age, 68.2 ± 7.0 yr; body mass index, 27.7 ± 3.8 kg·m -2 ) who had undergone 6 months of resistance-based exercise and had data available on exercise training from logbook records were examined. Attendance outcomes such as missed sessions, interruptions and permanent discontinuation, and metrics such as dosage completed (sessions × number of exercises × sets × repetitions × external load), compliance, tolerance, reductions, and escalations were assessed. Outcomes assessed were body composition, physical function, and muscle strength. RESULTS Median resistance exercise attendance was 80.6%, with a median resistance exercise compliance of 88.5% (interquartile range [IQR], 61.1%-107.1%) per participant. A median of 11 (IQR, 1-26) and 0 (IQR, 0-2) sessions were escalated or reduced, respectively. Significant improvements were observed in whole-body lean mass, 400-m walk, repeated chair rise, leg press, and chest press strength after 6 months of intervention ( P < 0.05) regardless of resistance exercise compliance ( Ptrend = 0.199-0.950). Participants with higher levels of resistance exercise compliance presented greater improvements in trunk fat mass ( Ptrend = 0.026) and appendicular lean mass ( Ptrend = 0.047). CONCLUSIONS A higher resistance exercise compliance led to greater improvements in regional fat and lean mass, whereas physical function and muscle strength improvements were achieved with lower compliance. In addition, patients experienced a high number of dose escalations during the intervention. These findings are important to improve the reproducibility/precision of exercise medicine prescription.
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Affiliation(s)
| | | | | | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, AUSTRALIA
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20
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Luo H, Galvão DA, Newton RU, Tang CI, Hart NH, Singh F, Dean A, Jasas K, Johansson M, Yusoff I, Spry N, Taaffe DR. Evaluation of a Clinic-Based Exercise Program in Patients with Pancreatic Cancer Undergoing Nonsurgical Treatment. Med Sci Sports Exerc 2023; 55:9-19. [PMID: 35941522 DOI: 10.1249/mss.0000000000003019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Evidence regarding the role of exercise in pancreatic cancer (PanCa) is limited and is derived exclusively under tightly controlled research conditions. This study aimed to quantify adherence, adverse events, and changes in physical and psychological outcomes in any patients with PanCa referred to undertake exercise during nonsurgical treatment. METHODS The study involved 22 patients with localized or metastatic PanCa undertaking a clinic-based exercise program during chemotherapy or chemoradiotherapy. The program included supervised aerobic and resistance exercise undertaken twice weekly for 12 wk and a 12-wk follow-up with supervised exercise optional dependent on patient preference and condition. Patients were monitored for adherence and adverse events. Objective and patient-reported outcomes were assessed at baseline, 12 wk, and 24 wk. RESULTS A total of 251 sessions were attended by 19 patients over the first 12 wk (attendance rate, 55%). Complete case analyses indicated significant ( P < 0.05) improvements in functional ability (5.2%-17.2%), muscle strength (16.9%-25.1%), and static balance (6.8%). There were no significant changes in body composition or patient-reported outcomes except for sleep quality, which deteriorated; however, at an individual level, several patients had clinically relevant improvements in cancer-related fatigue and quality of life. Patients who continued with supervised exercise to week 24 largely preserved improvements in functional ability, muscle strength, and static balance. No serious adverse events resulted from the exercise program. CONCLUSIONS Individualized, supervised aerobic and resistance exercise in a clinic-based setting appears to be safe and may improve or maintain physical and psychological health in patients with PanCa undergoing nonsurgical treatment.
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Affiliation(s)
| | | | | | | | | | | | - Andrew Dean
- Department of Oncology, St John of God Subiaco Hospital, Subiaco, WA, AUSTRALIA
| | - Kevin Jasas
- Department of Medical Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, AUSTRALIA
| | - Mikael Johansson
- Department of General Surgery, Sir Charles Gairdner Hospital, Nedlands, WA, AUSTRALIA
| | - Ian Yusoff
- Department of Gastroenterology, Sir Charles Gairdner Hospital, Nedlands, WA, AUSTRALIA
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21
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Iyengar NM. Inclusion of Exercise in Cancer Treatment Planning. JACC: CARDIOONCOLOGY 2022; 4:504-506. [PMID: 36444234 PMCID: PMC9700249 DOI: 10.1016/j.jaccao.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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22
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Bigaran A, Howden EJ, Foulkes S, Janssens K, Beaudry RI, Haykowsky MJ, La Gerche A, Fraser SF, Selig SE. Prescribing Exercise in Early-Stage Breast Cancer During Chemotherapy: A Simple Periodized Approach to Align With the Cyclic Phases of Chemotherapy. J Strength Cond Res 2022; 36:2934-2941. [PMID: 36135037 DOI: 10.1519/jsc.0000000000003990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Bigaran, A, Howden, EJ, Foulkes, S, Janssens, K, Beaudry, R, Haykowsky, MJ, La Gerche, A, Fraser, SF, and Selig, SE. Prescribing exercise in early-stage breast cancer during chemotherapy: a simple periodized approach to align with the cyclic phases of chemotherapy. J Strength Cond Res 36(10): 2934-2941, 2022-To evaluate whether a periodized aerobic and resistance training plan aligned to the anthracycline chemotherapy (AC) cycles would be well tolerated, feasible, and attenuate the decline in peak oxygen uptake (V̇o2peak) in breast cancer (BC) patients. Twenty-eight women with early-stage BC treated with AC self-selected to undertake exercise training (EX 47 ± 9 years, n = 14) or usual care (53 ± 9 years, n = 14) for 12 weeks as part of a nonrandomized controlled trial. The periodized EX was aligned to the cyclic phases of AC, including AC taper and nontaper weeks. Outcome measures included cardiopulmonary exercise testing. Attendance and adherence variables (relative dose intensity [RDI] and volume load) were calculated to quantify the dose of EX completed relative to the amount of EX prescribed. The mean session attendance was 76% (range 46-88%). The mean ± SD prescribed and completed dose of aerobic training was 332.3 ± 48.7 MET h·wk-1 and 380.6 ± 53.2 MET h·wk-1 (p = 0.02), equating to a mean RDI of 89 ± 17%. For resistance training, the prescribed and completed cumulative dose was 128,264 ± 54,578 and 77,487 ± 26,108 kg (p < 0.001), equating to an RDI of 60 ± 11%. Adherence to the AC taper week RDI (52 ± 14%) for resistance training was significantly lower than the non-AC taper week (72 ± 8%, p = 0.02). The most frequent cause for EX interruption was hospitalization (35%), whereas AC-related illness was the most common cause for missed (57%) or modified EX sessions (64%). This periodized approach was mostly well tolerated for patients with BC. We speculate that a periodized approach may be both more palatable and useful, although this requires further investigation in a randomized controlled trial.
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Affiliation(s)
- Ashley Bigaran
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, VIC, Australia
| | - Erin J Howden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Steve Foulkes
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
| | - Kristel Janssens
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Rhys I Beaudry
- Integrated Cardiovascular Exercise Physiology and Rehabilitation Laboratory, College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, Texas
| | - Mark J Haykowsky
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada ; and
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- Cardiology Department, St Vincent's Hospital Melbourne, Melbourne, VIC, Australia
| | - Steve F Fraser
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
- Institute for Physical Activity and Nutrition, Deakin University, Burwood, VIC, Australia
| | - Steve E Selig
- School of Exercise and Nutrition Sciences, Deakin University, Burwood, VIC, Australia
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Schlüter K, Schneider J, Rosenberger F, Wiskemann J. Feasibility of High-Intensity Resistance Training Sessions in Cancer Survivors. J Strength Cond Res 2022; 36:2643-2652. [PMID: 35900790 DOI: 10.1519/jsc.0000000000004279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/20/2023]
Abstract
ABSTRACT Schlüter, K, Schneider, J, Rosenberger, F, and Wiskemann, J. Feasibility of high-intensity resistance training sessions in cancer survivors. J Strength Cond Res 36(9): 2643-2652, 2022-Moderate-intensity resistance training (MIRT) is regarded as safe in cancer survivors (CS), but for high-intensity resistance training (HIRT), evidence is lacking. Hence, in the current exploratory analyses, single sessions of HIRT are compared with MIRT regarding safety and feasibility. Twenty-three of 24 included CS (14 breast and 10 prostate CS, 61.6 ± 9.5 years, body mass index 27.0 ± 4.3 kg·m -2 , 6-52 weeks after end of primary therapy) started a 12-week resistance training (RT) with a daily undulating periodization model including HIRT (90% of 1 repetition maximum [1RM]) and MIRT (67% 1RM) sessions. Parameters of safety (adverse events [AEs] and training-related pain), feasibility (physical and mental exhaustion, sensation of effort, enjoyment, and dropout rate), and adherence were assessed. An alpha level of 0.05 was applied for analyses. Nineteen of 23 training starters (83%) completed all sessions. Fourteen minor AEs occurred. A significantly higher increase for physical exhaustion appeared in HIRT ( p < 0.001). For 18% (HIRT) and 19% (MIRT) of the sessions, training-related pain was reported with no significant difference between intensities. In total, 34% of HIRT and 35% of MIRT sessions were perceived as overstraining or partly overstraining with no significant difference between intensities, but enjoyment (median and quartiles on a 1-7 scale) was high for both (HIRT = 5 [5;6] and MIRT = 5 [4,6]). Our analysis indicates that HIRT sessions do not differ from MIRT sessions concerning safety or feasibility, but training-related pain should be monitored. RT protocols incorporating high-intensity training loads can be applied safely in breast and prostate CS.
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Affiliation(s)
- Kathrin Schlüter
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany ; and
| | - Justine Schneider
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany ; and
| | - Friederike Rosenberger
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
- German University of Applied Sciences for Prevention and Health Management, Saarbrücken, Germany
| | - Joachim Wiskemann
- Department of Medical Oncology, National Center for Tumor Diseases (NCT), Heidelberg University Hospital, Heidelberg, Germany
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Bjørke ACH, Buffart LM, Raastad T, Demmelmaier I, Stenling A, Nordin K, Berntsen S. Exploring Moderators of the Effect of High vs. Low-to-Moderate Intensity Exercise on Cardiorespiratory Fitness During Breast Cancer Treatment – Analyses of a Subsample From the Phys-Can RCT. Front Sports Act Living 2022; 4:902124. [PMID: 35903402 PMCID: PMC9314879 DOI: 10.3389/fspor.2022.902124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/06/2022] [Indexed: 12/24/2022] Open
Abstract
IntroductionThe results from the physical training and cancer randomized controlled trial (Phys-Can RCT) indicate that high intensity (HI) strength and endurance training during (neo-)adjuvant cancer treatment is more beneficial for cardiorespiratory fitness (CRF, measured as peak oxygen uptake [VO2peak]) than low-to-moderate intensity (LMI) exercise. Adherence to the exercise intervention and demographic or clinical characteristics of patients with breast cancer undergoing adjuvant treatment may moderate the exercise intervention effect on VO2peak. In this study, the objective was to investigate whether baseline values of VO2peak, body mass index (BMI), time spent in moderate- to vigorous-intensity physical activity (MVPA), physical fatigue, age, chemotherapy treatment, and the adherence to the endurance training moderated the effect of HI vs. LMI exercise on VO2peak.Materials and MethodsWe used data collected from a subsample from the Phys-Can RCT; women who were diagnosed with breast cancer and had a valid baseline and post-intervention VO2peak test were included (n = 255). The exercise interventions from the RCT included strength and endurance training at either LMI, which was continuous endurance training at 40–50% of heart rate reserve (HRR), or at HI, which was interval training at 80–90% of HRR, with similar exercise volume in the two groups. Linear regression analyses were used to investigate moderating effects using a significance level of p < 0.10. Statistically significant interactions were examined further using the Johnson–Neyman (J-N) technique and regions of significance (for continuous variables) or box plots with adjusted means of post-intervention VO2peak (for binary variables).ResultsAge, as a continuous variable, and adherence, dichotomized into < or > 58% based on median, moderated the effect of HI vs. LMI on CRF (B = −0.08, 95% CI [−0.16, 0.01], pinteraction = 0.06, and B = 1.63, 95% CI [−0.12, 3.38], pinteraction = 0.07, respectively). The J-N technique and regions of significance indicated that the intervention effect (HI vs. LMI) was positive and statistically significant in participants aged 61 years or older. Baseline measurement of CRF, MVPA, BMI, physical fatigue, and chemotherapy treatment did not significantly moderate the intervention effect on CRF.ConclusionWomen with breast cancer who are older and who have higher adherence to the exercise regimen may have larger effects of HI exercise during (neo-)adjuvant cancer treatment on CRF.
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Affiliation(s)
- Ann Christin Helgesen Bjørke
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- *Correspondence: Ann Christin Helgesen Bjørke
| | - Laurien M. Buffart
- Department of Physiology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, Netherlands
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - Truls Raastad
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Ingrid Demmelmaier
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Andreas Stenling
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Psychology, Umeå University, Umeå, Sweden
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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Nerz C, Kramer-Gmeiner F, Jansen CP, Labudek S, Klenk J, Becker C, Schwenk M. Group-Based and Individually Delivered LiFE: Content Evaluation and Predictors of Training Response – A Dose-Response Analysis. Clin Interv Aging 2022; 17:637-652. [PMID: 35509348 PMCID: PMC9057901 DOI: 10.2147/cia.s359150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/12/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Material and Methods Results Discussion and Conclusion Trial Registration
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Affiliation(s)
- Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Correspondence: Corinna Nerz, Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, Stuttgart, 70376, Germany, Tel +49 711-81010 6070, Fax +49 711 8101 3194, Email
| | | | - Carl-Philipp Jansen
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Sports and Sports Sciences, Heidelberg University, Heidelberg, Germany
| | - Sarah Labudek
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Jochen Klenk
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Institute of Epidemiology and Medical Biometry, Ulm University, Ulm, Germany
- IB University of Health and Social Sciences, Study Centre Stuttgart, Stuttgart, Germany
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
- Unit Digitale Geriatrie, Medical Faculty of the University Heidelberg, Heidelberg, Germany
| | - Michael Schwenk
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
- Human Performance Research Centre, Department of Sport Science, University of Konstanz, Konstanz, Germany
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26
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Scott JM, Thomas SM, Herndon JE, Douglas PS, Yu AF, Rusch V, Huang J, Capaci C, Harrison JN, Stoeckel KJ, Nilsen T, Edvardsen E, Michalski MG, Eves ND, Jones LW. Effects and tolerability of exercise therapy modality on cardiorespiratory fitness in lung cancer: a randomized controlled trial. J Cachexia Sarcopenia Muscle 2021; 12:1456-1465. [PMID: 34658160 PMCID: PMC8718021 DOI: 10.1002/jcsm.12828] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 09/01/2021] [Accepted: 09/11/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Poor cardiorespiratory fitness (CRF) is a cardinal feature of post-treatment primary lung cancer. The most effective exercise therapy regimen to improve CRF has not been determined. METHODS In this parallel-group factorial randomized controlled trial, lung cancer survivors with poor CRF (below age-sex sedentary values) were randomly allocated to receive 48 consecutive supervised sessions thrice weekly of (i) aerobic training (AT)-cycle ergometry at 55% to >95% of peak oxygen consumption (VO2 peak); (ii) resistance training (RT)-lower and upper extremity exercises at 50-85% of maximal strength; (iii) combination training (CT)-AT plus RT; or (iv) stretching attention control (AC) for 16 weeks. The primary endpoint was change in CRF (VO2 peak, mL O2 ·kg-1 ·min-1 ). Secondary endpoints were body composition, muscle strength, patient-reported outcomes, tolerability (relative dose intensity of exercise), and safety. Analysis of covariance determined change in primary and secondary endpoints from baseline to post-intervention (Week 17) with adjustment for baseline values of the endpoint and other relevant clinical covariates. RESULTS Ninety patients (65 ± 9 years; 66% female) were randomized (AT, n = 24; RT, n = 23; CT, n = 20; and AC, n = 23) of the planned n = 160. No serious adverse events were observed. For the overall cohort, the lost-to-follow-up rate was 10%. Mean attendance was ≥75% in all groups. In intention-to-treat analysis, VO2 peak increased 1.1 mL O2 ·kg-1 ·min-1 [95% confidence interval (CI): 0.0, 2.2, P = 0.04] and 1.4 mL O2 ·kg-1 ·min-1 (95% CI: 0.2, 2.5, P = 0.02) in AT and CT, respectively, compared with AC. There was no difference in VO2 peak change between RT and AC (-0.1 mL O2 ·kg-1 ·min-1 , 95% CI: -1.2, 1.0, P = 0.88). Favourable improvements in maximal strength and body composition were observed in RT and CT groups compared with AT and AC groups (Ps < 0.05). No between-group changes were observed for any patient-reported outcomes. Relative dose intensity of exercise was lower in RT and CT compared with AT (Ps < 0.05). CONCLUSIONS In the context of a smaller than planned sample size, AT and CT significantly improved VO2 peak in lung cancer survivors; however, the tolerability-to-benefit ratio was superior for AT and hence may be the preferred modality to target impaired CRF in post-treatment lung cancer survivors.
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Affiliation(s)
- Jessica M Scott
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Anthony F Yu
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - Valerie Rusch
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | - James Huang
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
| | | | | | | | - Tormod Nilsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Elisabeth Edvardsen
- Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | | | - Neil D Eves
- University of British Columbia, Kelowna, BC, Canada
| | - Lee W Jones
- Memorial Sloan-Kettering Cancer Center, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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27
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Attention to principles of exercise training: an updated systematic review of randomized controlled trials in cancers other than breast and prostate. BMC Cancer 2021; 21:1179. [PMID: 34740332 PMCID: PMC8569988 DOI: 10.1186/s12885-021-08701-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 08/16/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The primary objective of this systematic review was to update our previous review on randomized controlled trials (RCTs) of exercise in cancers other than breast or prostate, evaluating: 1) the application of principles of exercise training within the exercise prescription; 2) reporting of the exercise prescription components (i.e., frequency, intensity, time, and type (FITT)); and 3) reporting of participant adherence to FITT. A secondary objective was to examine whether reporting of these interventions had improved over time. METHODS MEDLINE, EMBASE, CINAHL and SPORTDiscus databases were searched from 2012 to 2020. Eligible studies were RCTs of at least 4 weeks of aerobic and/or resistance exercise that reported on physiological outcomes relating to exercise (e.g., aerobic capacity, muscular strength) in people with cancer other than breast or prostate. RESULTS Eighty-six new studies were identified in the updated search, for a total of 107 studies included in this review. The principle of specificity was applied by 91%, progression by 32%, overload by 46%, initial values by 72%, reversibility by 7% and diminishing returns by 5%. A significant increase in the percentage of studies that appropriately reported initial values (46 to 80%, p < 0.001) and progression (15 to 37%, p = 0.039) was found for studies published after 2011 compared to older studies. All four FITT prescription components were fully reported in the methods in 58% of all studies, which was higher than the proportion that fully reported adherence to the FITT prescription components in the results (7% of studies). Reporting of the FITT exercise prescription components and FITT adherence did not improve in studies published after 2011 compared to older studies. CONCLUSION Full reporting of exercise prescription and adherence still needs improvement within exercise oncology RCTs. Some aspects of exercise intervention reporting have improved since 2011, including the reporting of the principles of progression and initial values. Enhancing the reporting of exercise prescriptions, particularly FITT adherence, may provide better context for interpreting study results and improve research to practice translation.
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28
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Müller J, Weiler M, Schneeweiss A, Haag GM, Steindorf K, Wick W, Wiskemann J. Preventive effect of sensorimotor exercise and resistance training on chemotherapy-induced peripheral neuropathy: a randomised-controlled trial. Br J Cancer 2021; 125:955-965. [PMID: 34226683 PMCID: PMC8476560 DOI: 10.1038/s41416-021-01471-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/25/2021] [Accepted: 06/17/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Chemotherapy-induced peripheral neuropathy (CIPN) is a common, unpleasant and usually long-lasting side effect of neurotoxic chemotherapeutic agents. This study aimed to investigate the preventive potential of sensorimotor- (SMT) and resistance training (RT) on CIPN. METHODS Patients (N = 170) were randomised to SMT, RT or usual care (UC). Both exercise groups trained 3×/week for a total of 105 min/week during neurotoxic chemotherapy (mean length: 20 weeks). Before and 3 weeks after neurotoxic chemotherapy, CIPN signs/symptoms were assessed via Total Neuropathy Score (TNSr; primary endpoint) and EORTC QLQ-CIPN15 questionnaire. In addition, balance (centre of pressure), muscle strength (isokinetic), quality of life (QoL, EORTC QLQ-C30) and relative chemotherapy dose intensity (RDI) were investigated. The follow-up period covered 6 months after the end of chemotherapy. RESULTS Intention-to-treat analyses (N = 159) revealed no differences regarding CIPN signs/symptoms. Exploratory per-protocol analyses (minimum training attendance rate 67%; N = 89) indicated that subjectively perceived sensory symptoms in the feet increased less during chemotherapy in the adherent exercisers (pooled group: SMT+RT) than in the UC group (-8.3 points (-16.1 to -0.4); P = 0.039, ES = 1.27). Furthermore, adherent exercisers received a higher RDI (96.6 ± 4.8 vs. 92.2 ± 9.4; P = 0.045), showed a better course of muscular strength (+20.8 Nm (11.2-30.4); P < 0.001, ES = 0.57) and QoL (+12.9 points (3.9-21.8); P = 0.005, ES = 0.64). During follow-up, CIPN signs/symptoms persisted in all groups. CONCLUSIONS This study demonstrates that SMT and/or RT alleviate subjectively perceived sensory CIPN symptoms in the feet and other clinically relevant cancer therapy-related outcomes, if an appropriate training stimulus is achieved. CLINICAL TRIAL REGISTRATION NCT02871284.
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Affiliation(s)
- Jana Müller
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany ,grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.7700.00000 0001 2190 4373Institute of Sports and Sport Science, Heidelberg University, Heidelberg, Germany
| | - Markus Weiler
- grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Andreas Schneeweiss
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Division of Gynecological Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Georg Martin Haag
- grid.5253.10000 0001 0328 4908Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
| | - Karen Steindorf
- grid.7497.d0000 0004 0492 0584Division of Physical Activity, Prevention and Cancer, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg, Germany
| | - Wolfgang Wick
- grid.7497.d0000 0004 0492 0584German Cancer Research Center (DKFZ), Heidelberg, Germany ,grid.5253.10000 0001 0328 4908Department of Neurology, Heidelberg University Hospital, Heidelberg, Germany
| | - Joachim Wiskemann
- grid.5253.10000 0001 0328 4908Working Group Exercise Oncology, Division of Medical Oncology, National Center for Tumor Diseases (NCT) and Heidelberg University Hospital, Heidelberg, Germany
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29
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Carter SJ, Baranauskas MN, Ballinger TJ, Rogers LQ, Miller KD, Nabhan DC. Exercise load monitoring: integrated approaches to advance the individualisation of exercise oncology. BMJ Open Sport Exerc Med 2021; 7:e001134. [PMID: 34540269 PMCID: PMC8407211 DOI: 10.1136/bmjsem-2021-001134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Whether slowing disease progression or combatting the ills of advancing age, the extensive utility of exercise training has contributed to the outright declaration by the American College of Sports Medicine that 'exercise is medicine'. Consistent with general framework of adaptation, the advantages of exercise training are indiscriminate-benefitting even the most susceptible clinical populations. Still, the benefit of exercise training presupposes healthy adaptation wherein progressive overload matches sufficient recovery. Indeed, a difference exists between healthy adaptation and non-functional over-reaching (ie, when internal/external load exceeds recovery capacity)-a difference that may be blurred by cancer treatment and/or comorbidity. Recent advances in smartwatches make them ideally suited to non-invasively monitor the physiological stresses to exercise training. Resolving whether individuals are successfully adapting to exercise training via load monitoring bears clinical and practical relevance. While behaviour-change research aims to identify positive constructs of exercise adherence, further attention is needed to uncover how to optimise exercise prescription among cancer populations. Herein, we briefly discuss the constituents of exercise load monitoring, present examples of internal and external load and consider how such practices can be applied to cancer populations.
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Affiliation(s)
- Stephen J Carter
- Department of Kinesiology, Indiana University Bloomington, Bloomington, Indiana, USA.,Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Marissa N Baranauskas
- Department of Kinesiology, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Tarah J Ballinger
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Laura Q Rogers
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA.,Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Dustin C Nabhan
- United States Olympic & Paralympic Committee, Colorado Springs, Colorado, USA.,Norwegian School of Sport Sciences, Oslo, Norway
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30
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Thomsen SN, Mørup ST, Mau-Sørensen M, Sillesen M, Lahart I, Christensen JF. Perioperative exercise training for patients with gastrointestinal cancer undergoing surgery: A systematic review and meta-analysis. Eur J Surg Oncol 2021; 47:3028-3039. [PMID: 34294466 DOI: 10.1016/j.ejso.2021.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 06/16/2021] [Accepted: 07/10/2021] [Indexed: 10/20/2022] Open
Abstract
Exercise training is emerging as a supportive treatment strategy in surgical oncology, but its effects remain uncertain in patients with gastrointestinal cancer. The primary objective of this systematic review and meta-analysis was to evaluate the effects of perioperative exercise training on gastrointestinal cancer-specific mortality, recurrence, and surgical outcomes (postoperative complications, hospitalization, surgical stress) in patients with gastrointestinal cancer. Randomized or quasi-randomized controlled trials evaluating the effects of perioperative exercise training versus control in patients with GI cancer were eligible. MEDLINE, EMBASE, CENTRAL, CINAHL, PEDro, and SPORTDiscus were systematically searched on June 20, 2020. Data were synthesized using random-effects meta-analyses. Risk of bias was assessed using the Cochrane risk of bias tool 2, and the certainty of evidence was assessed using GRADE. Study selection, data extraction, risk of bias, and GRADE assessments were performed independently by two authors. Ten randomized controlled trials comprising 448 participants with gastrointestinal cancer were eligible. Meta-analyses indicated no statistical effects of exercise on postoperative complications (risk ratio: 1.11, 95% CI: 0.84; 1.47), readmissions (risk ratio: 2.76; 95% CI: 0.00, 9394.76), or postoperative length of stay (difference in means: -0.47, 95% CI: -17.2; 16.2 days). None of the eligible studies assessed gastrointestinal cancer-specific mortality or recurrence. Overall risk of bias was high or of some concerns in all studies, and the certainty of evidence was very low. The effects of perioperative exercise on cancer-specific and surgical outcomes are unknown in patients with gastrointestinal cancer due to lack of studies and very low certainty of evidence.
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Affiliation(s)
- Simon Nørskov Thomsen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Stine Truel Mørup
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Morten Mau-Sørensen
- Department of Oncology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martin Sillesen
- Department of Surgical Gastroenterology and Transplantation, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Center for Surgical Translational and Artificial Intelligence Research (CSTAR), Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian Lahart
- Faculty of Health, Education, and Wellbeing, Institute of Human Sciences, University of Wolverhampton, Walsall Campus, Walsall, WS1 3BD, UK
| | - Jesper Frank Christensen
- Centre for Physical Activity Research, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Sports Science and Clinical Biomechanics, Faculty of Health Sciences, University of Southern Denmark, Denmark
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31
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Smyth E, O'Connor L, Mockler D, Reynolds JV, Hussey J, Guinan E. Preoperative high intensity interval training for oncological resections: A systematic review and meta-analysis. Surg Oncol 2021; 38:101620. [PMID: 34161894 DOI: 10.1016/j.suronc.2021.101620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 05/13/2021] [Accepted: 06/06/2021] [Indexed: 12/25/2022]
Abstract
Exercise prehabilitation prior to major surgery targets a reduction in postoperative complications through improved conditioning and respiratory function. However its effectiveness in cancer surgery is unclear. The objective of this review was to determine if preoperative high-intensity interval training (HIIT) improves preoperative fitness in patients scheduled for oncologic resection, and whether postoperative complications are impacted. METHODS: CINAHL, AMED, PEDro, EMBASE, The Cochrane Library and PubMed/MEDLINE were searched until April 2021 using predefined search strategy and accompanied by manual forward and backwards citation review. Screening of titles, abstracts, full-texts, data extraction, risk of bias assessment and methodologic quality was performed independently by two reviewers. Mean difference (MD) with 95% confidence intervals (CI) was compared and heterogeneity assessed using Chi Squared Test and I2 statistic. Six randomised controlled trials (RCTs) were included in the systematic review. Interventions prescribed bouts of high-intensity exercise [80-115% peak work rate (WRp)] interspaced with low-intensity (rest-50% WRp) exercise. The meta-analysis included five RCTs reporting peak oxygen consumption (VO2peak). Preoperative HIIT did not result in significantly higher VO2peak in comparison to usual care or moderate intensity exercise (MD 0.83, 95%CI-0.51-2.17) kg/ml/min, p = 0.12). Studies were insufficiently powered with respect to postoperative complications, but there is no evidence of significant impact. No adverse events occurred and high adherence rates were reported. Results of this systematic review and meta-analysis demonstrate there is insufficient evidence to support HIIT as a method of improving preoperative fitness prior to oncologic resection. Further work is needed to determine if specific HIIT parameters can be adapted to improve efficacy over short time-frames.
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Affiliation(s)
- Emily Smyth
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - David Mockler
- John Stearne Medical Library, Trinity College Dublin, Trinity Centre for Health Sciences, Dublin, Ireland
| | - John V Reynolds
- Trinity Translational Medicine Institute, Department of Surgery, Trinity College Dublin and St. James's Hospital, Dublin 8, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Emer Guinan
- School of Medicine, Trinity College Dublin, Dublin, Ireland.
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González-Santos Á, Postigo-Martin P, Gallart-Aragón T, Esteban-Cornejo I, Lopez-Garzon M, Galiano-Castillo N, Arroyo-Morales M, Illescas-Montes R, Artacho-Cordón F, Martín-Martín L, Forneiro-Pérez R, Lozano-Lozano M, Fernández-Lao C, Ruiz-Vozmediano J, Sánchez-Salgado C, Cantarero-Villanueva I. Neurotoxicity prevention with a multimodal program (ATENTO) prior to cancer treatment versus throughout cancer treatment in women newly diagnosed for breast cancer: Protocol for a randomized clinical trial. Res Nurs Health 2021; 44:598-607. [PMID: 33963594 DOI: 10.1002/nur.22136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 01/22/2023]
Abstract
A current challenge in breast cancer (BC) patients is how to reduce the side effects of cancer and cancer treatments and prevent a decrease in quality of life (QoL). Neurotoxic side effects, especially from chemotherapy, are present in up to 75% of women with BC, which implies a large impact on QoL. There is a special interest in the preventive possibilities of therapeutic exercise (TE) for these neurological sequelae, and the benefits of TE could be improved when it is combined with vagal activation techniques (VATs). This superiority randomized controlled trial aims to examine the feasibility and efficacy of an 8-week multimodal intervention (ATENTO) based on moderate-vigorous intensity and individualized TE (aerobic and strength exercises) and VAT (myofascial and breathing exercises), on neurotoxicity prevention in women with BC before starting adjuvant chemotherapy (ATENTO-B) versus throughout adjuvant chemotherapy (ATENTO-T). A sample of 56 women newly diagnosed with BC, as calculated with a power of 85%, will be randomly allocated into these two groups. This study could provide an impetus for the introduction of early multimodal intervention methods to prevent neurotoxicity and consequently avoid the QoL deterioration that BC patients presently suffer throughout their treatments.
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Affiliation(s)
- Ángela González-Santos
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Paula Postigo-Martin
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | | | - Irene Esteban-Cornejo
- Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Department of Physical and Sport Education, Faculty of Sports Sciences, University of Granada, Granada, Spain.,PROFITH "PROmoting FITness and Health through physical activity" Research Group, Granada, Spain
| | - Maria Lopez-Garzon
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain
| | - Noelia Galiano-Castillo
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Manuel Arroyo-Morales
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Rebeca Illescas-Montes
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Nursing, Biomedical Group (BIO277), Faculty of Health Sciences, University of Granada, Granada, Spain
| | - Francisco Artacho-Cordón
- Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Mario Lozano-Lozano
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | | | - Irene Cantarero-Villanueva
- Department of Physiotherapy, Faculty of Health Sciences, University of Granada, Granada, Spain.,"CUIDATE" Support Unit for Oncology Patients (UAPO), University of Granada, Granada, Spain.,Sport and Health University Research Institute (iMUDS), University of Granada, Granada, Spain.,Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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O'Neill L, Guinan E, Brennan L, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2021; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Louise Brennan
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Suzanne L. Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M. Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V. Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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Betschart M, Rezek S, Unger I, Beyer S, Gisi D, Shannon H, Sieber C. Feasibility of an Outpatient Training Program after COVID-19. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3978. [PMID: 33918887 PMCID: PMC8069591 DOI: 10.3390/ijerph18083978] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/25/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023]
Abstract
Long-term physical consequences of coronavirus disease 2019 (COVID-19) are currently being reported. As a result, the focus is turning towards interventions that support recovery after hospitalization. To date, the feasibility of an outpatient program for people recovering from COVID-19 has not been investigated. This study presents data for a physiotherapy-led, comprehensive outpatient pulmonary rehabilitation (PR) program. Patients were recruited after hospital discharge. Training consisted of twice weekly, interval-based aerobic cycle endurance (ACE) training, followed by resistance training (RT); 60-90 min per session at intensities of 50% peak work rate; education and physical activity coaching were also provided. Feasibility outcomes included: recruitment and dropout rates, number of training sessions undertaken, and tolerability for dose and training mode. Of the 65 patients discharged home during the study period, 12 were successfully enrolled onto the program. Three dropouts (25%) were reported after 11-19 sessions. Tolerability of interval-based training was 83% and 100% for exercise duration of ACE and RT, respectively; 92% for training intensity, 83% progressive increase of intensity, and 83% mode in ACE. We tentatively suggest from these preliminary findings that the PR protocol used may be both feasible, and confer benefits to a small subgroup of patients recovering from COVID-19.
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Affiliation(s)
- Martina Betschart
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Spencer Rezek
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Ines Unger
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Swantje Beyer
- Department of Medicine, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.B.); (C.S.)
| | - David Gisi
- Institute of Therapies and Rehabilitation, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.R.); (I.U.); (D.G.)
| | - Harriet Shannon
- Department of Physiotherapy, University College London, London WC1N 1EH, UK;
| | - Cornel Sieber
- Department of Medicine, Kantonsspital Winterthur, 8400 Winterthur, Switzerland; (S.B.); (C.S.)
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35
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Argudo N, Rodó-Pin A, Martínez-Llorens J, Marco E, Visa L, Messaggi-Sartor M, Balañá-Corberó A, Ramón JM, Rodríguez-Chiaradía DA, Grande L, Pera M. Feasibility, tolerability, and effects of exercise-based prehabilitation after neoadjuvant therapy in esophagogastric cancer patients undergoing surgery: an interventional pilot study. Dis Esophagus 2021; 34:5906903. [PMID: 32940327 DOI: 10.1093/dote/doaa086] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 12/11/2022]
Abstract
Patients requiring surgery for locally advanced esophagogastric cancer often require neoadjuvant therapy (NAT), which may have a detrimental impact on cardiorespiratory reserve. The aims of this study were to investigate the feasibility and tolerability of a 5-week preoperative high-intensity interval training program after NAT, and to assess the potential effects of the training protocol on exercise capacity, muscle function, and health-related quality of life (HRQL). We prospectively studied consecutive patients with resectable locally advanced esophageal and gastric cancer in whom NAT was planned (chemo- or chemoradiotherapy). Feasibility was assessed with the TELOS (Technological, Economics, Legal, Operational, and Scheduling) components, and data on exercise tolerability (attendance and occurrence of adverse or unexpected events). Exercise capacity was assessed with peak oxygen uptake (VO2peak) in a cardiopulmonary exercise test at baseline, post-NAT, and following completion of a high-intensity interval exercise training (25 sessions). Changes in muscle strength and HRQL were also assessed. Of 33 recruited subjects (mean age 65 years), 17 received chemoradiotherapy and 16 chemotherapy. All the TELOS components were addressed before starting the intervention; from a total of 17 questions considered as relevant for a successful implementation, seven required specific actions to prevent potential concerns. Patients attended a mean of 19.4 (6.4) exercise sessions. The predefined level of attendance (≥15 sessions of scheduled sessions) was achieved in 27 out of 33 (81.8%) patients. Workload progression was adequate in 24 patients (72.7%). No major adverse events occurred. VO2peak decreased significantly between baseline and post-NAT (19.3 vs. 15.5 mL/Kg/min, P < 0.05). Exercise led to a significant improvement of VO2peak (15.5 vs. 19.6 mL/kg/min, P < 0.05). Exercise training was associated with clinically relevant improvements in some domains of HRQL, with the social and role function increasing by 10.5 and 11.6 points, respectively, and appetite loss and fatigue declining by 16 and 10.5, respectively. We conclude that a structured exercise training intervention is feasible and safe following NAT in patients with esophagogastric cancer, and it has positive effects to restore exercise capacity to baseline levels within 5 weeks with some improvements in HRQL.
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Affiliation(s)
- Núria Argudo
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Rodó-Pin
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Juana Martínez-Llorens
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Ester Marco
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Visa
- Department of Medical Oncology. Hospital del Mar, Barcelona, Spain
| | - Monique Messaggi-Sartor
- Department of Physical Medicine and Rehabilitation. Parc de Salut Mar (Hospital del Mar-Hospital de l'Esperança). Rehabilitation Research Group, Hospital del Mar Medical Research Institute (IMIM). Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anna Balañá-Corberó
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - José M Ramón
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Diego A Rodríguez-Chiaradía
- Department of Pulmonary Medicine. Hospital del Mar, Hospital del Mar Medical Research Institute (IMIM), Universitat Pompeu Fabra (UPF), CIBERES, (ISCIII), Barcelona, Barcelona, Spain
| | - Luis Grande
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Manuel Pera
- Section of Gastrointestinal Surgery. Hospital del Mar. Hospital del Mar Medical Research Institute (IMIM), Universitat Autònoma de Barcelona, Barcelona, Spain
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Postigo-Martin P, Peñafiel-Burkhardt R, Gallart-Aragón T, Alcaide-Lucena M, Artacho-Cordón F, Galiano-Castillo N, Fernández-Lao C, Martín-Martín L, Lozano-Lozano M, Ruíz-Vozmediano J, Moreno-Gutiérrez S, Illescas-Montes R, Arroyo-Morales M, Cantarero-Villanueva I. Attenuating Treatment-Related Cardiotoxicity in Women Recently Diagnosed With Breast Cancer via a Tailored Therapeutic Exercise Program: Protocol of the ATOPE Trial. Phys Ther 2021; 101:6124131. [PMID: 33528004 DOI: 10.1093/ptj/pzab014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/09/2020] [Accepted: 12/01/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Therapeutic exercise is already used to ameliorate some of the side effects of cancer treatment. Recent studies examined its preventive potential regarding treatment-related toxicity, which can increase the risk of functional decline and lead to disease recurrence and death. This trial will examine whether the Tailored Therapeutic Exercise and Recovery Strategies (ATOPE) program, performed before treatment, can mitigate the onset and extent of cardiotoxicity beyond that achieved when the program is followed during treatment in recently diagnosed breast cancer patients. METHODS The intervention has a preparatory phase plus 12 to 18 sessions of tailored, high-intensity exercise, and post-exercise recovery strategies. A total of 120 women recently diagnosed with breast cancer, at risk of cardiotoxicity due to anticancer treatment awaiting surgery followed by chemotherapy and/or radiotherapy, will be randomized to either group. In a feasibility study, measurements related to recruitment rate, satisfaction with the program, adherence to them, the retention of participants, safety, and adverse effects will be explored. In the main trial, the efficacy of these interventions will be examined. The major outcome will be cardiotoxicity, assessed echocardiographically via the left ventricular ejection fraction. Other clinical, physical, and anthropometric outcomes and biological and hormonal variables will also be assessed after diagnosis, after treatment, 1 year after treatment ends, and 3 years after treatment ends. CONCLUSION Given its potential effect on patient survival, the mitigation of cardiotoxicity is a priority, and physical therapists have an important role in this mitigation. If the ATOPE intervention performed before treatment returns better cardioprotection results, it may be recommendable that patients recently diagnosed follow this program. IMPACT The ATOPE program will highlight the need for a physical therapist intervention from the moment of diagnosis, in the prevention or mitigation of cardiotoxicity, in women with breast cancer. It could help physical therapists to establish an adequate therapeutic exercise dose adapted to breast cancer patients and to propose correct therapeutic exercise prescription according to the assimilation of the sessions.
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Affiliation(s)
- Paula Postigo-Martin
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain
| | | | | | | | - Francisco Artacho-Cordón
- Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Department of Radiology and Physical Medicine, University of Granada, Granada, Spain
| | - Noelia Galiano-Castillo
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Carolina Fernández-Lao
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Lydia Martín-Martín
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Mario Lozano-Lozano
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | | | - Salvador Moreno-Gutiérrez
- Department of Computer Architecture and Technology, Information and Communication Technologies Research Center (CITIC), University of Granada, Spain
| | | | - Manuel Arroyo-Morales
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
| | - Irene Cantarero-Villanueva
- Health Sciences Faculty, University of Granada, Spain.,Sport and Health Research Center (IMUDs), Granada, Spain.,Institute for Biomedical Research (ibs.GRANADA), University Hospital Complex of Granada, University of Granada, Granada, Spain.,Unit of Excellence on Exercise and Health (UCEES), University of Granada, Granada, Spain
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37
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Demmelmaier I, Brooke HL, Henriksson A, Mazzoni AS, Bjørke ACH, Igelström H, Ax AK, Sjövall K, Hellbom M, Pingel R, Lindman H, Johansson S, Velikova G, Raastad T, Buffart LM, Åsenlöf P, Aaronson NK, Glimelius B, Nygren P, Johansson B, Börjeson S, Berntsen S, Nordin K. Does exercise intensity matter for fatigue during (neo-)adjuvant cancer treatment? The Phys-Can randomized clinical trial. Scand J Med Sci Sports 2021; 31:1144-1159. [PMID: 33527488 DOI: 10.1111/sms.13930] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/13/2021] [Accepted: 01/26/2021] [Indexed: 12/11/2022]
Abstract
Exercise during cancer treatment improves cancer-related fatigue (CRF), but the importance of exercise intensity for CRF is unclear. We compared the effects of high- vs low-to-moderate-intensity exercise with or without additional behavior change support (BCS) on CRF in patients undergoing (neo-)adjuvant cancer treatment. This was a multicenter, 2x2 factorial design randomized controlled trial (Clinical Trials NCT02473003) in Sweden. Participants recently diagnosed with breast (n = 457), prostate (n = 97) or colorectal (n = 23) cancer undergoing (neo-)adjuvant treatment were randomized to high intensity (n = 144), low-to-moderate intensity (n = 144), high intensity with BCS (n = 144) or low-to-moderate intensity with BCS (n = 145). The 6-month exercise intervention included supervised resistance training and home-based endurance training. CRF was assessed by Multidimensional Fatigue Inventory (MFI, five subscales score range 4-20), and Functional Assessment of Chronic Illness Therapy-Fatigue scale (FACIT-F, score range 0-52). Multiple linear regression for main factorial effects was performed according to intention-to-treat, with post-intervention CRF as primary endpoint. Overall, 577 participants (mean age 58.7 years) were randomized. Participants randomized to high- vs low-to-moderate-intensity exercise had lower physical fatigue (MFI Physical Fatigue subscale; mean difference -1.05 [95% CI: -1.85, -0.25]), but the difference was not clinically important (ie <2). We found no differences in other CRF dimensions and no effect of additional BCS. There were few minor adverse events. For CRF, patients undergoing (neo-)adjuvant treatment for breast, prostate or colorectal cancer can safely exercise at high- or low-to-moderate intensity, according to their own preferences. Additional BCS does not provide extra benefit for CRF in supervised, well-controlled exercise interventions.
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Affiliation(s)
- Ingrid Demmelmaier
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Hannah L Brooke
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anna Henriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Anne-Sophie Mazzoni
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | | | | | - Anna-Karin Ax
- Department of Oncology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Katarina Sjövall
- Department of Oncology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Maria Hellbom
- Stockholm Health Care Services, Centre for Cancer Rehabilitation, Stockholm, Sweden
| | - Ronnie Pingel
- Department of Statistics, Uppsala University, Uppsala, Sweden
| | - Henrik Lindman
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Silvia Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Galina Velikova
- Leeds Cancer Centre, Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Truls Raastad
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway.,Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | | | | | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Peter Nygren
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sussanne Börjeson
- Department of Oncology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sveinung Berntsen
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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38
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Taylor JL, Holland DJ, Keating SE, Bonikowske AR, Coombes JS. Adherence to High-Intensity Interval Training in Cardiac Rehabilitation: A REVIEW AND RECOMMENDATIONS. J Cardiopulm Rehabil Prev 2021; 41:61-77. [PMID: 33647920 DOI: 10.1097/hcr.0000000000000565] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
PURPOSE High-intensity interval training (HIIT) is gaining popularity as a training approach for patients attending cardiac rehabilitation (CR). While the literature has focused on the efficacy of HIIT for improving cardiorespiratory fitness (CRF), particularly when compared with moderate intensity exercise, less emphasis has been placed on adherence to HIIT. The aim of this review was to summarize the current literature regarding adherence to HIIT in CR patients with coronary artery disease. REVIEW METHODS A review identified 36 studies investigating HIIT in CR patients with coronary artery disease. Methods and data were extracted for exercise or training adherence (to attendance, intensity, and duration), feasibility of protocols, and CRF. The review summarizes reporting of adherence; adherence to HIIT and comparator/s; the influence of adherence on changes in CRF; and feasibility of HIIT. SUMMARY Adherence to the attendance of HIIT sessions was high and comparable with moderate-intensity exercise. However, adherence to the intensity and duration of HIIT was variable and underreported, which has implications for determining the treatment effect of the exercise interventions being compared. Furthermore, additional research is needed to investigate the utility of home-based HIIT and long-term adherence to HIIT following supervised programs. This review provides recommendations for researchers in the measurement and reporting of adherence to HIIT and other exercise interventions to facilitate a sufficient and consistent approach for future studies. This article also highlights strategies for clinicians to improve adherence, feasibility, and enjoyment of HIIT for their patients.
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Affiliation(s)
- Jenna L Taylor
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota (Drs Taylor and Bonikowske); Centre for Research on Exercise, Physical activity, and Health, School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Australia (Drs Taylor, Holland, Keating, and Coombes); and Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Australia (Dr Holland)
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Luo H, Galvão DA, Newton RU, Lopez P, Tang C, Fairman CM, Spry N, Taaffe DR. Exercise Medicine in the Management of Pancreatic Cancer: A Systematic Review. Pancreas 2021; 50:280-292. [PMID: 33835957 PMCID: PMC8041568 DOI: 10.1097/mpa.0000000000001753] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 01/14/2021] [Indexed: 12/25/2022]
Abstract
ABSTRACT The aim of this study was to examine the health-related effects of exercise in patients with pancreatic cancer (PanCa) through a systematic review of current evidence. Studies were obtained through searching PubMed, Web of Science, PsycINFO, Embase, CINAHL Plus, and Cochrane Library databases with additional hand searches. All intervention-based studies were included if it involved (1) adult patients with PanCa, (2) exercise training, and (3) findings in quality of life, cancer-related fatigue, psychological distress, and physical function. The review protocol was registered in PROSPERO: CRD42020154684. Seven trials described in 9 publications were included consisting of 201 patients with early-stage and advanced PanCa. Participants were required to perform supervised and/or home-based, low- to moderate-intensity resistance and/or aerobic exercise for 12 to 35 weeks or duration of neoadjuvant therapy. There were no exercise-related adverse events with a reported retention rate of 71% to 90% and exercise attendance of 64% to 96%. The programs were consistently associated with improvements in cancer-related fatigue, psychological distress, and physical function, with mixed effects on quality of life. Exercise training seems to be safe and feasible and may have a beneficial effect on various physical and psychological outcomes in patients with PanCa. Further work with rigorous study designs is required to consolidate and advance current findings.
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Affiliation(s)
- Hao Luo
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
| | - Daniel A. Galvão
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
| | - Robert U. Newton
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane
| | - Pedro Lopez
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
| | - Colin Tang
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
- Department of Radiation Oncology, Sir Charles Gairdner Hospital
| | - Ciaran M. Fairman
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
| | - Nigel Spry
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
- Department of Radiation Oncology, GenesisCare, Perth, Australia
| | - Dennis R. Taaffe
- From the Exercise Medicine Research Institute
- School of Medical and Health Sciences, Edith Cowan University, Joondalup
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40
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Spinal Stabilization Exercises for Cancer Patients with Spinal Metastases of High Fracture Risk: Feasibility of the DISPO-II Training Program. Cancers (Basel) 2021; 13:cancers13020201. [PMID: 33429892 PMCID: PMC7827062 DOI: 10.3390/cancers13020201] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/27/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Previous research indicates that the outcomes of irradiation of spinal metastases can be improved through exercise. After this was demonstrated for metastases of low fracture risk, we conducted the first study in patients with spinal metastases of high fracture risk to investigate exercise feasibility. An exercise group performed four spinal stabilization exercises daily over two weeks of radiotherapy, while a control group received relaxation. Patients in the exercise group attended 90% of training sessions, compared to 80% in the control group. No injuries occurred. However, about half of the patients could not perform two out of the four exercises due to pain, weakness or immobility. Nevertheless, they increased exercise time and training-specific strength. Altogether, exercise is well accepted and enhances muscle strength in these patients, but frequent individual adaptations of the training program are needed. This knowledge is a prerequisite for larger studies addressing exercise effects on health. Abstract Exercise concomitant to radiotherapy for stable spinal metastases was demonstrated to increase bone density and reduce pain. In the DISPO-II study, the feasibility of exercise concomitant to radiotherapy for unstable spinal metastases was investigated. Here, a detailed analysis of the training program is presented. Cancer patients with spinal metastases (Taneichi score ≥ D) were randomly assigned to an intervention group (INT, n = 27, 62 ± 9 years) or control group (CON, n = 29, 61 ± 9 years). INT performed spinal stabilization exercises (“all fours”/“plank”/“swimmer”/“band exercise”), and CON received relaxation, daily concomitant to radiotherapy. Exercise attendance rate was 90% in INT and 80% in CON (p = 0.126). Within INT, exercise dose increased significantly (p < 0.001). 54% of patients could not perform “swimmer” in some or all sessions. 42% could not perform “plank” in some or all sessions. 13 and 25% could not perform “all fours” and “band exercise” in some sessions. “Plank” holding time increased in INT and remained unchanged in CON with different development between groups (p = 0.022). Handgrip strength did not develop differently between groups (p = 0.397). The exercise intervention demonstrated high acceptability but required frequent modifications due to pain, weakness and immobility to be feasible for the majority of participants. It enhanced specific muscle strength. Larger trials should now investigate exercise effects on health.
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Sheill G, Guinan E, O'Neill L, Smyth E, Normand C, L. Doyle S, Moore S, Newell J, McDermott G, Ryan R, V. Reynolds J, Hussey J. Prehabilitation during a pandemic: preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus, the PRE-HIIT trial: an updated study protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13198.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Pre-operative fitness is an established predictor of postoperative outcome; accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation for patients with cancer of the lung or oesophagus is challenging to implement due to the short opportunity for intervention between diagnosis and surgery. In addition, there are now additional challenges to providing prehabilitation during the coronavirus disease 2019 (COVID-19) pandemic due to concerns about social distancing and minimising patient contact. The PRE-HIIT project will examine the influence of virtually delivered exercise prehabilitation on physiological outcomes and postoperative recovery. Methods: The PRE-HIIT randomised controlled trial (RCT) will compare a 2-week high intensity interval training programme to standard preoperative care in a cohort of patients with thoracic and oesophageal cancers. A protocol for this study has been published previously. As a result of the COVID-19 pandemic, changes to the study assessment battery and the mode of intervention delivery have been made. The PRE-HIIT programme will now be a home-based intervention. Both the exercise intervention and standard care will be delivered via telehealth. The recruitment target for the study remains 78 participants. There is no change to the primary outcome of the study; cardiorespiratory fitness. Secondary outcomes include measures of pulmonary and physical function, quality of life and post-operative morbidity. Outcomes will be measured at baseline and post-intervention. The impact of PRE-HIIT on well-being will be examined qualitatively with interviews post-intervention (T1). This revised protocol will also explore participant’s satisfaction with delivery of prehabilitation via telehealth. The healthcare costs associated with the PRE-HITT programme will also be examined. Discussion: The overall aim of this RCT is to examine the effect of tailored, individually prescribed high intensity interval training on pre-operative fitness and postoperative recovery for patients undergoing complex surgical resections. Trial registration: ClinicalTrials.Gov NCT03978325 07/06/2019
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Henriksson A, Johansson B, Radu C, Berntsen S, Igelström H, Nordin K. Is it safe to exercise during oncological treatment? A study of adverse events during endurance and resistance training - data from the Phys-Can study. Acta Oncol 2021; 60:96-105. [PMID: 33339484 DOI: 10.1080/0284186x.2020.1851046] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Few studies have systematically evaluated the risk of adverse events (AEs) among persons exercising during oncological treatment. We aimed to describe incidence and types of AEs during exercise for persons undergoing oncological treatment, and associations to exercise intensity, exercise adherence, chemotherapy treatment, initial aerobic fitness. A second aim was to compare incidence of lymphedema, periphery inserted central catheter (PICC) complications, and other new medical conditions (any illness or injury occurred during the exercise trial) between high-intensity vs low-to-moderate exercise and usual care (UC). METHODS This descriptive, comparative study was based on data from an observational study including patients in an UC setting (n = 90) and a randomized exercise trial (n = 577) in which participants exercised at high-intensity (HI) or low-moderate intensity (LMI). Persons with breast, prostate, or colorectal cancer undergoing neo/adjuvant treatment were included. AEs were reported by exercise coaches, participants, and identified in medical records, as were lymphedema, PICC-complications, and new medical conditions. RESULTS Coaches reported AEs for 20% of the participants, while 28% of participants self-reported AEs. The most common coach- and participant reported AEs were musculoskeletal and the majority (97%) were considered minor. HI had higher likelihood of AEs than LMI, according to both coaches (OR: 1.9 [95%CI 1.16-3.21], p=.011) and participants (OR: 3.36 [95%CI 2.00-5.62], ≤.001). Lymphedema rates were low (4-9%) and PICC complications ranged from 15% in LMI to 23% in UC and there were no statistically significant differences between HI, LMI, and UC. There were no statistically significant differences between HI and LMI regarding new medical conditions. CONCLUSIONS Exercise during treatment is safe for these patient groups in this setting, even HI exercise can be recommended if no medical contraindications are present. Similar to healthy populations, a higher risk of having minor AEs when exercising at HI in comparison to LMI may exist.
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Affiliation(s)
- Anna Henriksson
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Calin Radu
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Sveinung Berntsen
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Department of Sport Science and Physical Education, University of Agder, Kristiansand, Norway
| | | | - Karin Nordin
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
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O'Neill L, Guinan E, Doyle SL, O'Connor L, Sheill G, Smyth E, Fairman CM, Segurado R, Connolly D, O'Sullivan J, Reynolds JV, Hussey J. ReStOre@Home: Feasibility study of a virtually delivered 12-week multidisciplinary rehabilitation programme for survivors of upper gastrointestinal (UGI) cancer - study protocol. HRB Open Res 2020; 3:86. [PMID: 34046552 PMCID: PMC8127012 DOI: 10.12688/hrbopenres.13185.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 04/03/2024] Open
Abstract
Background: Exercise rehabilitation programmes, traditionally involving supervised exercise sessions, have had to rapidly adapt to virtual delivery in response to the coronavirus disease 2019 (COVID-19) pandemic to minimise patient contacts. In the absence of an effective vaccine, the pandemic is likely to persist in the medium term and during this time it is important that the feasibility and effectiveness of remote solutions is considered. We have previously established the feasibility of the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) intervention - a face to face multidisciplinary rehabilitation programme for upper gastrointestinal (UGI) cancer survivors. This study will examine the feasibility of a virtually delivered 12-week multi-component ReStOre@Home programme. Methods: This single arm feasibility study will recruit 12 patients who have completed curative treatment for oesophago-gastric cancer. Participants will complete the 12-week ReStOre@Home programme consisting of exercise (aerobic and resistance training), 1:1 dietary counselling and group education sessions through virtual delivery. Underpinned by the Medical Research Council (MRC) Framework, feasibility will be determined by recruitment rates, adherence, retention, incidents, and acceptability. Acceptability will be assessed qualitatively through post-intervention interview and the Telehealth Usability Questionnaire. Secondary outcomes will be assessed pre and post-intervention and will include measures of physical performance (cardiopulmonary exercise test, short physical performance battery, hand grip strength, Godin Leisure Time Questionnaire, and body composition), health related quality of life (European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC-QLQ-C30) and oesophago-gastric cancer specific subscale (EORTC-QLQ-OG25), fatigue (Multidimensional Fatigue Inventory (MFI-20), and venous blood samples will be collected for the UGI Cancer Survivorship Biobank. Discussion: The ReStOre@Home feasibility study will provide important data regarding the amenability of a multidisciplinary programme designed for UGI cancer survivors to virtual delivery. Trial registration: ClinicalTrials.gov NCT04603339 (26/10/2020).
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emer Guinan
- Trinity St James's Cancer Institute, Dublin, Ireland
- School of Medicine, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Louise O'Connor
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Emily Smyth
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
| | - Ciaran M Fairman
- Department of Exercise Science, Arnold School of Public Health, University of South Carolina, Columbia, USA
| | - Ricardo Segurado
- School of Public Health, Physiotherapy and Sports Sciences,, University College Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Trinity St James's Cancer Institute, Dublin, Ireland
- Discipline of Occupational Therapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - John V Reynolds
- Trinity St James's Cancer Institute, Dublin, Ireland
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College Dublin, the University of Dublin and St James's Hospital Dublin, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, Trinity College Dublin, the University of Dublin, Dublin, Ireland
- Trinity St James's Cancer Institute, Dublin, Ireland
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Arietaleanizbeaskoa MS, Sancho A, Olazabal I, Moreno C, Gil E, Garcia-Alvarez A, Mendizabal N, de la Fuente I, Dominguez S, Pablo S, Grandes G. Effectiveness of physical exercise for people with chronic diseases: the EFIKRONIK study protocol for a hybrid, clinical and implementation randomized trial. BMC FAMILY PRACTICE 2020; 21:227. [PMID: 33158422 PMCID: PMC7648284 DOI: 10.1186/s12875-020-01298-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/25/2020] [Indexed: 12/24/2022]
Abstract
Background Chronic illnesses are the leading cause of morbidity and mortality and threaten the sustainability of healthcare systems worldwide. There is limited evidence in terms of the best modality and intensity of physical activity for improving cardiorespiratory capacity and quality of life in patients with chronic conditions. The objective of the EfiKroniK study is to estimate the common effect of innovative, individualized and supervised physical exercise, on cardiorespiratory functional capacity and quality of life across people with different chronic conditions. Methods/design This is a multicentre clinical trial with a type I hybrid effectiveness-implementation design, including 370 patients each with one of four different chronic illnesses: solid cancer, blood cancer, chronic obstructive pulmonary disease or schizophrenia. Patients will be randomly divided into two parallel groups, stratified by illness type. Patients in both groups will receive a standard healthy life prescription (PVS, from the Spanish “Prescribe Vida Saludable”) and additionally, the EfiKroniK group will be prescribed a physical exercise programme tailored to each patient in terms of intensity in each session. The primary outcome variables will be cardiorespiratory functional capacity and quality of life. The secondary outcome variables will be signs and symptoms, psychological and social factors and specific laboratory parameters. We will also analyse the dose-response effect of the physical exercise programme. Qualitative variables will describe patients’ perception of the utility and suitability of the EfiKroniK programme, as well as their expectations and satisfaction, identifying barriers to and facilitators of the EfiKroniK implementation process through discussion groups. The study will be carried out on an intention-to-treat basis, comparing changes throughout the 1-year follow-up between groups, adjusting for baseline, by performing mixed-effect analysis of covariance. We will estimate the effect of time on repeated measures in each subject and changes in the EfiKroniK and PVS groups over time. Discussion The study will provide the data necessary to allow us to prescribe physical exercise in a similar way to a drug and as a key part of the treatment of chronic illnesses within our healthcare system. Trial registration NCT03810755. Date and version identifier: October 9, 2020. Version2.0.
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Affiliation(s)
- María Soledad Arietaleanizbeaskoa
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain.
| | - Aintzane Sancho
- Medical Oncology Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Iñigo Olazabal
- Medical Hematology Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Concepcion Moreno
- Medical Mental Health Group, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Erreka Gil
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Arturo Garcia-Alvarez
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Nere Mendizabal
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Ibon de la Fuente
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Silvia Dominguez
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Susana Pablo
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
| | - Gonzalo Grandes
- Primary Care Group on Health, Prevention and Chronic Diseases, Biocruces Bizkaia Health Research Institute, Plaza de Cruces 12, 48903, Barakaldo, Bizkaia, Spain
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Boniface G, Gandhi V, Norris M, Williamson E, Kirtley S, O’Connell NE. A systematic review exploring the evidence reported to underpin exercise dose in clinical trials of rheumatoid arthritis. Rheumatology (Oxford) 2020; 59:3147-3157. [PMID: 32780816 PMCID: PMC7590408 DOI: 10.1093/rheumatology/keaa150] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 02/06/2020] [Accepted: 03/09/2020] [Indexed: 02/07/2023] Open
Abstract
We aimed to evaluate the evidence reported to underpin exercise dose in randomised controlled trials (RCTs) using strengthening exercise in RA. We searched six different databases between 1 January 2000 and 3 April 2019. We included RCTs, where a main component of the intervention and/or control used strengthening exercise. Evidence sources cited to underpin dose were judged for their quality, consistency and applicability. Thirty-two RCTs were reviewed. Four (12.5%) piloted the intervention without using dose-escalation designs to determine optimal dose-response. Twenty (62.5%) reported no evidence underpinning dose. Where reported, quality, consistency and applicability of the underpinning evidence was a cause for methodological concern. The majority of RCTs did not report the evidence underpinning dose. When reported, the evidence was often not applicable to the clinical population. Frequently, the dose used differed to the dose reported/recommended by the underpinning evidence. Our findings illustrate exercise dose may not be optimised for use with clinical populations prior to evaluation by RCT.
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Affiliation(s)
- Graham Boniface
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Varsha Gandhi
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Meriel Norris
- Department of Clinical Sciences, Brunel University London, Uxbridge, UK
| | - Esther Williamson
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Shona Kirtley
- Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences (NDORMS), Centre for Rehabilitation Research in Oxford (RRIO), University of Oxford, Oxford
| | - Neil E O’Connell
- Department of Clinical Sciences, Brunel University London, Uxbridge, UK
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Bye A, Sandmael JA, Stene GB, Thorsen L, Balstad TR, Solheim TS, Pripp AH, Oldervoll LM. Exercise and Nutrition Interventions in Patients with Head and Neck Cancer during Curative Treatment: A Systematic Review and Meta-Analysis. Nutrients 2020; 12:E3233. [PMID: 33105699 PMCID: PMC7690392 DOI: 10.3390/nu12113233] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 10/14/2020] [Accepted: 10/20/2020] [Indexed: 12/19/2022] Open
Abstract
The aim of this meta-analysis was to examine the effects of nutritional and physical exercise interventions and interventions combining these interventions during radiotherapy treatment for patients with head and neck cancer on body composition, objectively measured physical function and nutritional status. Systematic electronic searches were conducted in MEDLINE (PubMed interface), EMBASE (Ovid interface), CINAHL (EBSCO interface) and Cochrane Library (Wiley interface). We identified 13 randomized controlled trials (RCTs) that included 858 patients. For body composition, using only nutrition as intervention, a significant difference between treatment and control group were observed (SMD 0.42 (95CI 0.23-0.62), p < 0.001). Only pilot RCTs investigated combination treatment and no significant difference between the treatment and control groups were found (SMD 0.21 (95CI -0.16-0.58), p = 0.259). For physical function, a significant difference between treatment and control group with a better outcome for the treatment group were observed (SMD 0.78 (95CI 0.51-1.04), p < 0.001). No effects on nutritional status were found. This meta-analysis found significantly positive effects of nutrition and physical exercise interventions alone in favor of the treatment groups. No effects in studies with combined interventions were observed. Future full-scaled RCTs combining nutrition and physical exercise is warranted.
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Affiliation(s)
- Asta Bye
- Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
- Regional Advisory Unit for Palliative Care, Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway
| | | | - Guro B. Stene
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (G.B.S.); (T.R.B.); (T.S.S.)
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Lene Thorsen
- National Advisory Unit on Late Effects after Cancer Treatment, Department of Oncology, Oslo University Hospital, 0424 Oslo, Norway;
- Department for Clinical Service, Division of Cancer Medicine, Oslo University Hospital, 0424 Oslo, Norway
| | - Trude R. Balstad
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (G.B.S.); (T.R.B.); (T.S.S.)
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Tora S. Solheim
- Department of Cancer Research and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway; (G.B.S.); (T.R.B.); (T.S.S.)
- Cancer Clinic, St. Olavs Hospital, Trondheim University Hospital, 7006 Trondheim, Norway
| | - Are Hugo Pripp
- Faculty of Health Sciences, OsloMet—Oslo Metropolitan University, 0130 Oslo, Norway;
- Oslo Centre of Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, 0424 Oslo, Norway
| | - Line M. Oldervoll
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, 5020 Bergen, Norway;
- Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, The Norwegian University of Science and Technology (NTNU), 7491 Trondheim, Norway
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Fairman CM, Nilsen TS, Newton RU, Taaffe DR, Spry N, Joseph D, Chambers SK, Robinson ZP, Hart NH, Zourdos MC, Focht BC, Peddle-McIntyre CJ, Galvão DA. Reporting of Resistance Training Dose, Adherence, and Tolerance in Exercise Oncology. Med Sci Sports Exerc 2020; 52:315-322. [PMID: 31436734 DOI: 10.1249/mss.0000000000002127] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE While general guidelines (such as CONSORT or Consensus on Exercise Reporting Template) exist to enhance the reporting of exercise interventions in the field of exercise science, there is inadequate detail facilitating the standardized reporting of resistance training adherence in the oncology setting. The purpose of this study was to apply a novel method to report resistance training dose, adherence, and tolerance in patients with cancer. METHODS A total of 47 prostate cancer patients (70.1 ± 8.9 yr, body mass index, 28.6 ± 4.0) with bone metastatic disease completed an exercise program for 12 wk. We assessed traditional metrics of adherence (attendance and loss to follow-up), in addition to novel proposed metrics (exercise-relative dose intensity, dose modification, and exercise interruption). Total training volume in kilograms (repetitions × sets × training load (weight)) was calculated for each patient. RESULTS Attendance assessed from traditional metrics was 79.5% ± 17.0% and four patients (9%) were lost to follow-up. The prescribed and actual cumulative total dose of resistance training was 139,886 ± 69,150 kg and 112,835 ± 83,499 kg, respectively, with a mean exercise-relative dose intensity of 77.4% ± 16.6% (range: 19.4% -99.4%). Resistance training was missed (1-2 consecutive sessions) or interrupted (missed ≥3 consecutive sessions) in 41 (87%) and 24 (51%) participants, respectively. Training dose was modified (reduction in sets, repetitions, or weight) in 40 (85%) of patients. Importantly, using attendance as a traditional metric of adherence, these sessions would have all counted as adherence to the protocol. CONCLUSIONS Traditional reporting metrics of resistance training in exercise oncology may overestimate exercise adherence. Our proposed metrics to capture resistance training dose, adherence, and tolerance may have important applications for future studies and clinical practice.
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Affiliation(s)
| | - Tormod S Nilsen
- Department of Physical Performance, The Norwegian School of Sport Sciences, Oslo, NORWAY
| | | | | | | | | | | | - Zac P Robinson
- Exercise and Behavioural Medicine Laboratory, The Ohio State University, Columbus, OH
| | | | - Michael C Zourdos
- Department of Exercise Science and Health Promotion, Muscle Physiology Laboratory, Florida Atlantic University, Boca Raton, FL
| | - Brian C Focht
- Exercise and Behavioural Medicine Laboratory, The Ohio State University, Columbus, OH
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Twomey R, Yeung ST, Wrightson JG, Millet GY, Culos-Reed SN. Post-exertional Malaise in People With Chronic Cancer-Related Fatigue. J Pain Symptom Manage 2020; 60:407-416. [PMID: 32105793 DOI: 10.1016/j.jpainsymman.2020.02.012] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Cancer-related fatigue (CRF) is a distressing and persistent sense of tiredness or exhaustion that interferes with usual functioning. Chronic CRF continues for months after curative cancer treatment is complete. Post-exertional malaise (PEM) is a worsening of symptoms after physical or mental activity, with limited investigations in people with chronic CRF. OBJECTIVES The purpose of this study was to identify and describe self-reported incidences of PEM in people with chronic CRF. METHODS Participants (n = 18) were eligible if they scored ≤34 on the Functional Assessment of Chronic Illness Therapy-Fatigue scale and had a cancer-related onset of fatigue. Participants completed a brief questionnaire to assess PEM during a six-month time frame (the DePaul Symptom Questionnaire-PEM). In addition, a maximal exercise test was used to investigate self-reported symptom exacerbation (via an open-ended questionnaire) after strenuous physical exertion. RESULTS On the DePaul Symptom Questionnaire-PEM, three participants met previously defined scoring criteria, which included experiencing moderate to very severe symptoms at least half of the time, worsening of fatigue after minimal effort, plus a recovery duration of >24 hours. Content analysis of responses to open-ended questionnaires identified five people who experienced a delayed recovery and symptoms of PEM after maximal exercise. CONCLUSION A subset of people with chronic CRF (up to 33% in this sample) may experience PEM. Exercise specialists and health care professionals working with people with chronic CRF must be aware that PEM may be an issue. Symptom exacerbation after exercise should be monitored, and exercise should be tailored and adapted to limit the potential for harm.
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Affiliation(s)
- Rosie Twomey
- Faculty of Kinesiology, University of Calgary, Calgary, Canada.
| | - Samuel T Yeung
- Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - James G Wrightson
- Department of Clinical Neurosciences, University of Calgary, Calgary, Canada
| | - Guillaume Y Millet
- Faculty of Kinesiology, University of Calgary, Calgary, Canada; UJM Saint-Etienne, Inter-university Laboratory of Human Movement Biology, University of Lyon, Saint-Etienne, France
| | - S Nicole Culos-Reed
- Faculty of Kinesiology, University of Calgary, Calgary, Canada; Department of Oncology, Cumming School of Medicine, Calgary, Canada; Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta Health Services, Calgary, Canada
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O'Neill L, Guinan E, Doyle S, Connolly D, O'Sullivan J, Bennett A, Sheill G, Segurado R, Knapp P, Fairman C, Normand C, Geoghegan J, Conlon K, Reynolds JV, Hussey J. Rehabilitation strategies following oesophagogastric and Hepatopancreaticobiliary cancer (ReStOre II): a protocol for a randomized controlled trial. BMC Cancer 2020; 20:415. [PMID: 32404096 PMCID: PMC7222585 DOI: 10.1186/s12885-020-06889-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 04/22/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Curative treatment for upper gastrointestinal (UGI) and hepatopancreaticobiliary (HPB) cancers, involves complex surgical resection often in combination with neoadjuvant/adjuvant chemo/chemoradiotherapy. With advancing survival rates, there is an emergent cohort of UGI and HPB cancer survivors with physical and nutritional deficits, resultant from both the cancer and its treatments. Therefore, rehabilitation to counteract these impairments is required to maximise health related quality of life (HRQOL) in survivorship. The initial feasibility of a multidisciplinary rehabilitation programme for UGI survivors was established in the Rehabilitation Strategies following Oesophago-gastric Cancer (ReStOre) feasibility study and pilot randomised controlled trial (RCT). ReStOre II will now further investigate the efficacy of that programme as it applies to a wider cohort of UGI and HPB cancer survivors, namely survivors of cancer of the oesophagus, stomach, pancreas, and liver. METHODS The ReStOre II RCT will compare a 12-week multidisciplinary rehabilitation programme of supervised and self-managed exercise, dietary counselling, and education to standard survivorship care in a cohort of UGI and HPB cancer survivors who are > 3-months post-oesophagectomy/ gastrectomy/ pancreaticoduodenectomy, or major liver resection. One hundred twenty participants (60 per study arm) will be recruited to establish a mean increase in the primary outcome (cardiorespiratory fitness) of 3.5 ml/min/kg with 90% power, 5% significance allowing for 20% drop out. Study outcomes of physical function, body composition, nutritional status, HRQOL, and fatigue will be measured at baseline (T0), post-intervention (T1), and 3-months follow-up (T2). At 1-year follow-up (T3), HRQOL alone will be measured. The impact of ReStOre II on well-being will be examined qualitatively with focus groups/interviews (T1, T2). Bio-samples will be collected from T0-T2 to establish a national UGI and HPB cancer survivorship biobank. The cost effectiveness of ReStOre II will also be analysed. DISCUSSION This RCT will investigate the efficacy of a 12-week multidisciplinary rehabilitation programme for survivors of UGI and HPB cancer compared to standard survivorship care. If effective, ReStOre II will provide an exemplar model of rehabilitation for UGI and HPB cancer survivors. TRIAL REGISTRATION The study is registered with ClinicalTrials.gov, registration number: NCT03958019, date registered: 21/05/2019.
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Affiliation(s)
- Linda O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland.
| | - Emer Guinan
- School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Suzanne Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Deirdre Connolly
- Discipline of Occupational Therapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Jacintha O'Sullivan
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College, the University of Dublin and St. James's Hospital, Dublin, Ireland
| | - Annemarie Bennett
- Department of Clinical Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Grainne Sheill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Ricardo Segurado
- Centre for Support and Training in Analysis and Research, and School of Public Health, Physiotherapy and Sports Sciences, University College Dublin, Dublin, Ireland
| | - Peter Knapp
- Department of Health Sciences and the Hull York Medical School, University of York, York, UK
| | - Ciaran Fairman
- Exercise Medicine Research Institute, School of Medical and Health Sciences, Edith Cowan University, Joondalup, Australia
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Justin Geoghegan
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
| | - Kevin Conlon
- Department of Surgery, St Vincent's University Hospital, Dublin, Ireland
- Department of Surgery, Tallaght University Hospital, Dublin, Ireland
- Department of Surgery, Trinity College, the University of Dublin, Dublin, Ireland
| | - John V Reynolds
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College, the University of Dublin and St. James's Hospital, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
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Sheill G, Guinan E, O'Neill L, Normand C, Doyle SL, Moore S, Newell J, McDermott G, Ryan R, Reynolds JV, Hussey J. Preoperative exercise to improve fitness in patients undergoing complex surgery for cancer of the lung or oesophagus (PRE-HIIT): protocol for a randomized controlled trial. BMC Cancer 2020; 20:321. [PMID: 32293334 PMCID: PMC7160913 DOI: 10.1186/s12885-020-06795-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 03/27/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Patients with cancer of the lung or oesophagus, undergoing curative treatment, usually require a thoracotomy and a complex oncological resection. These surgeries carry a risk of major morbidity and mortality, and risk assessment, preoperative optimisation, and enhanced recovery after surgery (ERAS) pathways are modern approaches to optimise outcomes. Pre-operative fitness is an established predictor of postoperative outcome, accordingly, targeting pre-operative fitness through exercise prehabilitation has logical appeal. Exercise prehabilitation is challenging to implement however due to the short opportunity for intervention between diagnosis and surgery. Therefore, individually prescribed, intensive exercise training protocols which convey clinically meaningful improvements in cardiopulmonary fitness over a short period need to be investigated. This project will examine the influence of exercise prehabilitation on physiological outcomes and postoperative recovery and, through evaluation of health economics, the impact of the programme on hospital costs. METHODS The PRE-HIIT Randomised Controlled Trial (RCT) will compare a 2-week high intensity interval training (HIIT) programme to standard preoperative care in a cohort of thoracic and oesophageal patients who are > 2-weeks pre-surgery. A total of 78 participants will be recruited (39 per study arm). The primary outcome is cardiorespiratory fitness. Secondary outcomes include, measures of pulmonary and physical and quality of life. Outcomes will be measured at baseline (T0), and post-intervention (T1). Post-operative morbidity will also be captured. The impact of PRE-HIIT on well-being will be examined qualitatively with focus groups/interviews post-intervention (T1). Participant's experience of preparation for surgery on the PRE-HIIT trial will also be explored. The healthcare costs associated with the PRE-HITT programme, in particular acute hospital costs, will also be examined. DISCUSSION The overall aim of this RCT is to examine the effect of tailored, individually prescribed high intensity interval training aerobic exercise on pre-operative fitness and postoperative recovery for patients undergoing complex surgical resections, and the impact on use of health services. TRIAL REGISTRATION The study is registered with Clinical Trials.Gov (NCT03978325). Registered on 7th June 2019.
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Affiliation(s)
- Gráinne Sheill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland.
| | - Emer Guinan
- School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Linda O'Neill
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
| | - Charles Normand
- Centre for Health Policy and Management, Trinity College, the University of Dublin, Dublin, Ireland
| | - Suzanne L Doyle
- School of Biological and Health Sciences, Technological University Dublin, Dublin, Ireland
| | - Sarah Moore
- Physiotherapy Department, St James's Hospital, Dublin 8, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Grainne McDermott
- Department of Anaesthesia and Intensive Care, St. James's Hospital, Dublin, Ireland
| | - Ronan Ryan
- Department of Surgery, Trinity Translational Medicine Institute, Trinity College, The University of Dublin and St. James's Hospital, Dublin, Ireland
| | - John V Reynolds
- Department of Surgery, St. James's Hospital, Dublin, Ireland
| | - Juliette Hussey
- Discipline of Physiotherapy, School of Medicine, Trinity College, the University of Dublin, Dublin, Ireland
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