Primary care provider-led cancer survivorship care in the first 5 years following initial cancer treatment: a scoping review of the barriers and solutions to implementation

PURPOSE

To synthesize the barriers to primary care provider (PCP)-led cancer survivorship care (≤ 5 years after initial cancer treatment) experienced by healthcare systems around the world, and to explore potential solutions that would succeed within a developed country.

METHODS

A scoping review of peer-reviewed articles and grey literature was conducted. Four electronic databases (Medline, Embase, Web of Science Core Collection, and Google Scholar) were searched for articles prior to April 2021.

RESULTS

Ninety-seven articles published across the globe (USA, Canada, Australia, European Union, and UK) met the review inclusion/exclusion criteria. The four most frequently discussed barriers to PCP-led survivorship care in healthcare systems were as follows: (1) insufficient communication between PCPs and cancer specialists, (2) limited PCP knowledge, (3) time restrictions for PCPs to provide comprehensive survivorship care, and (4) a lack of resources (e.g., survivorship care guidelines). Potential solutions to combat these barriers were as follows: (1) improving interdisciplinary communication, (2) bolstering PCP education, and (3) providing survivorship resources.

CONCLUSIONS

This scoping review identified and summarized key barriers and solutions to the provision of PCP-led cancer survivorship care. Importantly, the findings from this review provide insight and direction to guide optimization of cancer care practice within BC's healthcare system.

IMPLICATIONS FOR CANCER SURVIVORS

Optimizing the PCP-led survivorship care model will be a valuable contribution to the field of cancer survivorship care and will hopefully lead to more widespread use of this model, ultimately lessening the growing demand for cancer-specific care by cancer specialists.

Exercise in the workplace: examining the receptivity of practical and time-efficient stair-climbing "exercise snacks"

In the workplace, people are often sedentary for prolonged time and do not regularly engage in physical activity-two factors independently linked to premature morbidity and mortality. This study aimed to determine the receptivity of incorporating practical stair-climbing "exercise snacks" (Snacks; three isolated bouts of ascending 53-60 stairs performed sporadically throughout the day) into workplace settings compared to more traditional high-intensity interval training (HIIT; performed as three bouts of 53-60 stairs within a structured HIIT workout) and to explore if these exercise strategies could influence sedentary and physical activity behaviour. Fourteen participants (12 women; Mage = 38.9 ± 10.2 years) completed two supervised exercise trials (Snacks and HIIT) followed by 1 week participating in either form of exercise in their workplace. Ratings of perceived exertion (RPE), affective valence, enjoyment, and self-efficacy were measured at the supervised exercise sessions. During the follow-up period, sedentary behaviour and physical activity were measured with an accelerometer. Affective valence was more positive (p = 0.03; η2 p = 0.21) and there was a lower rise in RPE (p = 0.01; η2 p = 0.29) during Snacks than HIIT. Post-exercise enjoyment of, and self-efficacy towards, Snacks and HIIT were high and similar (ps > 0.05). After the supervised trials, 10/14 of the participants preferred Snacks and 4/14 preferred HIIT (p = 0.18). On days when participants chose to perform either exercise modality, the average number of sit-to-stands in a 24 h period was increased (48.3 ± 8.7 to 52.8 ± 7.8; p = 0.03; Hedge's g = 0.73) and moderate-to-vigorous physical activity tended to increase (21.9 ± 18.2 to 38.1 ± 22.1 min; p = 0.06; Hedge's g = 0.60) compared to days when they chose not to exercise. Stair-climbing exercise snacks may be an attractive approach to implement in the workplace setting and has potential to positively impact sedentary behaviour and physical activity metrics.

Can In-Task Affect During Interval and Continuous Exercise Predict 12-Month Physical Activity Behavior? Findings from a Randomized Trial

BACKGROUND

In-task affective responses to moderate-intensity continuous exercise training (MICT) have been shown to predict future physical activity behavior. However, limited research has investigated whether this affect-behavior relationship is similar for high-intensity interval training (HIIT) and whether it holds true over the longer term. This study aims to determine (1) if in-task affect during 2 weeks of supervised MICT and HIIT predicted changes to unsupervised moderate-to-vigorous physical activity (MVPA) behavior 12 months post-intervention and (2) if this predictive relationship was moderated by exercise type (MICT vs. HIIT).

METHOD

Ninety-nine adults (69.7% female; 50.9 ± 9.4 years) who were low active and overweight were randomized to 2 weeks of exercise training of MICT (n = 52) or HIIT (n = 47), followed by 12 months of accelerometry-assessed free-living MVPA.

RESULTS

The pooled moderation model was not significant, F(3, 94) = 2.54, p = .07 (R2 = 0.085), with a non-significant group by affect interaction (p = .06). The conditional effect for MICT was significant (B = 17.27, t = 2.17, p = .03), suggesting that 12-month change in MVPA increased by 17.27 min/week for every one-point increase in in-task affect. The conditional effect for HIIT was not significant (p = .85), suggesting that in-task affect was not predictive of 12-month change in MVPA.

CONCLUSION

The current findings raise important questions about whether the affect-behavior relationship may vary depending on exercise type. For HIIT-based exercise in particular, additional psychological constructs beyond in-task affect should be considered when attempting to predict future physical activity behavior.

The Acute Physiological and Perceptual Responses Between Bodyweight and Treadmill Running High-Intensity Interval Exercises

Objective

The purpose of this study was to compare the acute physiological, perceptual, and enjoyment responses between bodyweight high-intensity interval exercise (BW-HIIE) and treadmill running high-intensity interval exercise HIIE (RUN-HIIE).

Methods

Twelve adults [age: 29.5 ± 5.3 years; weight: 70.9 ± 15.0 kg; height: 167.9 ± 8.9 cm; peak oxygen consumption (VO2 peak): 48.7 ± 6.5 ml min−1·kg−1] performed both RUN-HIIE and BW-HIIE. RUN-HIIE consisted of two sets of 5, 60-s (s) run intervals at 100% of the speed achieved during VO2 peak testing followed by 60s of walking at 4.02 km/h. BW-HIIE consisted of two sets of 5, 60s ‘all-out’ effort calisthenic exercises followed by 60s of marching in place at 100 steps per minute. Oxygen consumption (VO2), blood lactate (Blac), heart rate (HR), and rating of perceived exertion (RPE) were measured during exercise. Physical activity enjoyment (PACES) was assessed post-exercise. Creatine Kinase (CK) was measured before exercise and 48-h post-exercise. Muscle soreness was assessed before exercise, post-exercise, and 48-h post-exercise.

Results

Oxygen consumption relative to VO2 peak was higher (p < 0.001) during RUN-HIIE (88 ± 3%) compared to BW-HIIE (77 ± 4%). HR relative to HRpeak was higher (p = 0.002) for RUN-HIIE (93 ± 1%) compared to BW-HIIE (88 ± 2%). Blac was higher (p < 0.001) after BW-HIIE (11.2 ± 3.2 mmol/l) compared to RUN-HIIE (6.9 ± 2.0 mmol/l). Average RPE achieved was higher (p = 0.003) during BW-HIIE (16 ± 2) than RUN-HIIE (14 ± 2). PACES was similar for RUN-HIIE and BW-HIIE (p > 0.05). No differences (p > 0.05) in CK were observed between RUN-HIIE and BW-HIIE.

Conclusion

Our results indicate ‘all-out’ calisthenic exercise can elicit vigorous cardiorespiratory, Blac, and RPE responses. Implementing this style of exercise into training requires minimal space, no equipment, and may elicit cardiometabolic adaptations seen with traditional forms of high-intensity exercise.

Affecting Effects on Affect: The Impact of Protocol Permutations on Affective Responses to Sprint Interval Exercise; A Systematic Review and Meta-Analysis of Pooled Individual Participant Data

Responses to sprint interval exercise (SIE) are hypothesized to be perceived as unpleasant, but SIE protocols are diverse, and moderating effects of various SIE protocol parameters on affective responses are unknown. We performed a systematic search to identify studies (up to 01/05/2021) measuring affective valence using the Feeling Scale during acute SIE in healthy adults. Thirteen studies involving 18 unique trials and 316 unique participant (142 women and 174 men) affective responses to SIE were eligible for inclusion. We received individual participant data for all participants from all studies. All available end-of-sprint affect scores from each trial were combined in a linear mixed model with sprint duration, mode, intensity, recovery duration, familiarization and baseline affect included as covariates. Affective valence decreased significantly and proportionally with each additional sprint repetition, but this effect was modified by sprint duration: affect decreased more during 30 s (0.84 units/sprint; 95% CI: 0.74–0.93) and 15–20 s sprints (1.02 units/sprint; 95% CI: 0.93–1.10) compared with 5–6 s sprints (0.20 units/sprint; 95% CI: 0.18–0.22) (both p < 0.0001). Although the difference between 15–20 s and 30 s sprints was also significant (p = 0.02), the effect size was trivial (d = −0.12). We observed significant but trivial effects of mode, sprint intensity and pre-trial familiarization, whilst there was no significant effect of recovery duration. We conclude that affective valence declines during SIE, but the magnitude of the decrease for an overall SIE session strongly depends on the number and duration of sprints. This information can be applied by researchers to design SIE protocols that are less likely to be perceived as unpleasant in studies of real-world effectiveness.

Psychological responses to HIIT and MICT over a 2-week progressive randomized trial among individuals at risk of type 2 diabetes

The purpose of this secondary analysis study was to examine the affective and social cognitive responses to low-volume high-intensity interval training (HIIT) and moderate-intensity continuous training (MICT) over a progressive two-week supervised intervention for individuals at risk of type 2 diabetes. Ninety-nine adults that were low-active and overweight were randomized into one of two exercise conditions and had affective and social cognitive measures assessed before, during, and after intervention. Increases over time in post-exercise enjoyment, attitudes towards exercise, and intentions to exercise were noted for both HIIT and MICT conditions (ps <.05). The patterns of change in acute affective responses over the two-week intervention were consistent for both conditions, with participants in MICT reporting more positive in-task affect and affective attitudes throughout (ps <.001). Positive correlational relationships between affective and social cognitive responses were revealed throughout the intervention (ps <.05), highlighting the relationship between reflexive responses and reflective cognitions. Research is warranted to determine whether findings are a consequence of familiarization with exercise, whether such findings are translatable to real-world environments and non-progressive exercise protocols, and whether these reflexive responses and reflective cognitions are predictive of future exercise behaviour for individuals at risk of type 2 diabetes.

Affective responses to high-intensity interval training with continuous and respite music

Music has been shown to enhance affective responses to continuous exercise, but the most effective application of music during interval exercise is poorly understood. This study examined two contrasting applications of music designed to assuage the decline in pleasure often experienced during high-intensity interval training (HIIT). In a repeated measures crossover design, 18 recreationally active participants (10 men and 8 women; M _age = 25.1 ± 5.1 years; M _BMI = 23.08 ± 2.01 kg/m 2; M VO_2max = 38.82 ± 10.73 ml/kg/min) completed three HIIT sessions (10 x 60 s efforts at 100% Wmax, separated by 75 s recovery) on a cycle ergometer. Participants completed two experimental conditions: respite music (applied only during the recovery periods), continuous music (applied throughout the entire HIIT session); and a no-music control condition. Results indicated that music did not influence affective valence during the work bouts or recovery periods of the HIIT sessions (ps >.05), but that listening to music continuously elicited greater post-task enjoyment (p =.032, d = 0.66) and remembered pleasure (p =.044, d = 0.5). This study is the first to investigate the application of music during a practical HIIT protocol and to compare the effects of respite versus continuous music during interval exercise.

A scoping review of the psychological responses to interval exercise: is interval exercise a viable alternative to traditional exercise?

While considerable evidence suggests that interval exercise confers numerous physiological adaptations linked to improved health, its psychological consequences and behavioural implications are less clear and the subject of intense debate. The purpose of this scoping review was to catalogue studies investigating the psychological responses to interval exercise in order to identify what psychological outcomes have been assessed, the research methods used, and the results. A secondary objective was to identify research issues and gaps. Forty-two published articles met the review inclusion/exclusion criteria. These studies involved 1258 participants drawn from various active/inactive and healthy/unhealthy populations, and 55 interval exercise protocols (69% high-intensity interval training [HIIT], 27% sprint interval training [SIT], and 4% body-weight interval training [BWIT]). Affect and enjoyment were the most frequently studied psychological outcomes. Post-exercise assessments indicate that overall, enjoyment of, and preferences for interval exercise are equal or greater than for continuous exercise, and participants can hold relatively positive social cognitions regarding interval exercise. Although several methodological issues (e.g., inconsistent use of terminology, measures and protocols) and gaps (e.g., data on adherence and real-world protocols) require attention, from a psychological perspective, the emerging data support the viability of interval exercise as an alternative to continuous exercise.

Type, intensity and duration of daily physical activities performed by adults with spinal cord injury

STUDY DESIGN

Secondary analysis of cross-sectional data.

OBJECTIVES

To describe and compare (1) self-reported intensities and durations of specific types of daily physical activities and (2) minutes per day spent on daily physical activities across key demographic groups.

SETTING

Community (Ontario, Canada).

METHODS

Participants were 695 adults with spinal cord injury (SCI; 76% male, M_age=46.81±13.41 years, M_{years post injury}=15.19±11.10 years). Daily activities were assessed over the telephone using the Physical Activity Recall Assessment for People with SCI. Multivariate analyses of variance (MANOVA) were computed to test for differences in intensities and durations of different daily activities (objective 1) and between-group differences in minutes per day of daily activities (objective 2).

RESULTS

Overall, participants reported 127.92±142.79 min per day of daily physical activities with significantly more time spent in mild intensity (78.93±104.62 min per day) than moderate- (40.23±68.71 min per day) or heavy-intensity activities (8.75±24.53 min per day). Four patterns emerged with respect to type, duration and intensity, with some activities being typically performed at lighter or heavier intensities than others. There were significant differences in minutes per day of activity intensity and duration between groups based on education, injury severity and mode of mobility (P<0.05).

CONCLUSION

Given that some groups were more likely to engage in moderate-heavy-intensity activities, and some activities were more likely to be performed at moderate-heavy intensities, interventions that target key groups to increase certain daily activities may be one strategy to enhance overall physical activity participation among people with SCI.

A systematic review of behavioural interventions to increase maternal calcium intake

Pregnancy and lactation are a time when adequate calcium consumption is essential for the development of the fetus and to ensure the health of the mother. Over 50% of Canadian women of childbearing and rearing age fail to meet the recommended daily intake of calcium. Identification of effective behavioural intervention strategies for increasing calcium intake is needed within this specific population. This paper brings together all published behavioural interventions designed to increase calcium consumption in pregnant, lactating or post-partum mothers in a systematic review. Relevant studies were obtained through searches of MEDLINE, EMBASE, PsycINFO, CINAHL and the Cochrane Library with no date restrictions. Studies were evaluated using previously published criteria for evaluating calcium behaviour change interventions. This systematic literature review identified five behavioural calcium interventions conducted within this population. Three interventions aimed to improve overall dietary behaviours, the fourth aimed to promote breastfeeding (including increasing calcium consumption) and the fifth aimed to increase daily servings of yoghurt. Only one of the five interventions yielded large effect sizes, with a mean change of 954 mg of calcium per day post-intervention. The number of behavioural change techniques did not appear to be related to intervention efficacy. Only one study used a theoretical framework to guide the intervention. This review highlights the lack of research examining behaviour change interventions aimed at increasing calcium consumption in pregnant, lactating and post-partum women and provides practical suggestions for researchers wishing to intervene with this population in the future.

Using self-reported and objective measures of self-control to predict exercise and academic behaviors among first-year university students

Thirty students (mean age = 18 ± 0.5 years) completed self-report (Self-Control Scale) and objective (isometric handgrip squeeze performance) measures of self-control, provided their exercise and academic (study/schoolwork) plans for the next month, and then logged these behaviors over the subsequent 4-week period. Trait self-control predicted exercise and academic behavior. Handgrip squeeze performance predicted academic behavior and adherence to academic plans. Further, regression analysis revealed that trait self-control and handgrip performance explained significant variance in academic behavior. These findings provide a new understanding of how different self-control measures can be used to predict first-year students’ participation in, and adherence to, exercise and academic behaviors concurrently.