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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 examine if these variables can influence changes in outcomes of interest in men with localised or locally advanced prostate cancer.A total of 83 prostate cancer patients (age: 68.2 ± 7.0 years, 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 x number of exercises x sets x repetitions x external load), compliance, tolerance, reductions and escalations were assessed. Outcomes assessed were body composition, physical function and muscle strength.Median resistance exercise attendance was 80.6%, with a median resistance exercise compliance of 88.5% (IQR: 61.1 to 107.1%) per participant. Median of 11 (IQR: 1 to 26) and 0 (IQR: 0 to 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 following 6 months of intervention (P0.05) regardless of resistance exercise compliance (Ptrend = 0.199 to 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).A higher resistance exercise compliance led to greater improvements in regional fat and lean mass, while physical function and muscle strength improvements were achieved with lower compliance. Additionally, patients experienced a high number of dose escalations during the intervention. These findings are important to improve the reproducibility/precision of exercise medicine prescription.

Contains fulltext : 293798.pdf (Publisher’s version ) (Open Access) INTRODUCTION: Older men with prostate cancer are commonly affected by reductions in lean mass and physical function following androgen deprivation therapy (ADT). Resistance-based exercise programs are critical to counteract the musculoskeletal toxicities derived from prostate cancer treatment and aging. However, there is significant variability in the effects of exercise interventions. Examining demographic and clinical moderators of exercise effects in this patient group can assist in identifying which subgroups of patients benefit most. Therefore, we examined the effects and moderators of resistance-based exercise programs on sarcopenia-related outcomes that included lean mass, skeletal muscle index, physical function, and muscle strength in older men with prostate cancer. MATERIALS AND METHODS: Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. For the present study, we included data from trials that examined the effects of supervised resistance-based exercise interventions on lean mass outcomes, muscle strength, and physical function in patients with prostate cancer previously or currently treated with ADT. Linear mixed models were undertaken to analyse the effects of resistance-based exercise programs considering the clustering of patients within studies. Effects were evaluated by regressing the study group on the post-intervention value of the outcome adjusted for the baseline value, while potential moderators were examined by adding the moderator and its interaction term into the regression model. RESULTS: A total of 560 patients with prostate cancer (age: 69.5 ± 7.8 yrs.; body mass index: 28.6 ± 4.0 kg.m(-2)) previously or currently treated with ADT were included. Resistance-based exercise programs resulted in significant effects on whole-body and appendicular lean mass and the skeletal muscle index (P

Background Identification of characteristics of individuals that are related to decreases in physical activity (PA) levels during lockdown is needed to develop targeted-interventions. This study aims to evaluate changes in domain-specific (i.e. leisure time, transportation, occupational, and household) and total PA due to the Dutch COVID-19 lockdown, which started on March 15 2020. Furthermore, we aim to identify demographic, health-related, and psychological correlates of these changes. Methods Individuals who participated in the Nijmegen Exercise Study during 2017-2019 were invited to this study, which was conducted between April 16 and May 12 2020. Participant characteristics (i.e. age, sex, body mass index (BMI), marital status, education, household composition, and occupation status), living environment (i.e. housing type and degree of urbanization), psychological characteristics (i.e. resilience, outcome expectations, vitality, and mental health), and medical history were collected via an online questionnaire. Short Questionnaire to Assess Health-enhancing physical activity was used to assess PA behavior before and during lockdown. Wilcoxon signed-rank test was used to compare PA levels, in metabolic equivalent of task (MET)-minutes per week (min/wk), before and during lockdown. Multivariable linear regression analyses were performed to examine correlates of PA changes. Results 4033 participants (57% male; 59 ± 13 years) were included. PA decreased significantly during lockdown with mean ± SD changes of 393 ± 2735 MET-min/wk for total, 133 ± 785 MET-min/wk for transportation, 137 ± 1469 MET-min/wk for occupation, and 136 ± 1942 MET-min/wk for leisure time PA. Household PA did not change significantly. Unemployment, COVID-19-related occupational changes, higher BMI, and living in an apartment or semi-detached/terraced house were significantly related to larger decreases in total and domain-specific PA. Higher vitality was related to smaller decreases in total and domain-specific PA. Higher age was significantly associated with a larger decrease in leisure time PA. Lower education was associated with smaller decreases in transportation and occupational PA compared to higher education. Conclusion PA levels significantly reduced during lockdown compared to before lockdown. Declines were observed during transportation and occupation, but were not compensated by an increase in leisure time PA. We identified subgroups that were more susceptible to reductions in domain-specific or total PA levels and should therefore be encouraged to increase their PA levels during lockdown.

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.

Contains fulltext : 251716.pdf (Publisher’s version ) (Open Access) OBJECTIVE: This study examined experiences, adherence and satisfaction with a combined exercise and dietary intervention in patients with ovarian cancer and their healthcare professionals (HCPs) as part of the randomized PADOVA trial. METHODS: A mixed-methods approach was used in 24 patients with ovarian cancer receiving first-line chemotherapy who were randomly allocated to a combined exercise and dietary intervention or usual care with counseling sessions post-treatment. Qualitative data on intervention experiences, adherence and satisfaction was collected using semi-structured interviews with patients and their HCPs (n = 18 physical therapists; n = 5 dietitians). Quantitative data on adherence and satisfaction was collected to provide context to qualitative data. RESULTS: Exercise relative dose intensity ranged from 36 to 100% (median 72%) and patients attended 33-133% (median 100%) of the prescribed dietary counseling sessions. Patients appreciated guidance on exercise and nutrition and perceived benefits including improved physical fitness, quality of life, peer support and recovery after surgery and/or chemotherapy cycles. Both patients and HCPs were satisfied with the intervention and perceived that participation exceeded prior expectations. Median patient satisfaction score with the intervention was 8.5 out of 10. Suggestions for improving the intervention included further personalization of the number, content and scheduling of the sessions to preferences of patients and HCPs. Patients in the usual care group reported counseling sessions post-chemotherapy to be too little too late. CONCLUSIONS: Patients with ovarian cancer adhered well to the intervention. Numerous perceived benefits of the intervention were reported by patients and HCPs. Good adherence and positive experiences support successful implementation in clinical practice. 01 juni 2022

Objective: Only between 25% and 50% of patients invited to participate in clinical trial-based physical exercise programs during cancer treatment agree to do so. The purpose of this study was to identify factors associated significantly with the decision (not) to participate in a randomized controlled trial of physical exercise during adjuvant chemotherapy for breast cancer. Methods: Based on questionnaire data, we compared trial participants and non-participants on a range of sociodemographic, clinical health-related, practical, behavioral, and attitudinal variables. Results: Two hundred thirty of 524 patients agreed to participate in the trial (44%). The 294 (56%) non-participants indicated that they wanted to exercise on their own or that they did not wish to exercise in the context of a trial. Those who preferred to exercise on their own were relatively similar to trial participants but were more likely to be in the maintenance exercise stage. Those non-participants who did not wish to exercise had a significantly lower level of education, were less likely to be working, reported more fatigue and lower health-related quality of life, had lower sense of self-efficacy, more negative attitudes towards exercise, less social support, and perceived fewer benefits and more barriers to exercising during treatment than trial participants. Conclusion: Minimizing practical barriers to participation, providing educational materials on the potential benefits of exercise, and giving adequate professional and social network encouragement may increase the number of patients willing to exercise during treatment and to participate in such studies.

Objective Mediating mechanisms of a 12-week group-based exercise intervention on cancer survivors' quality of life (QoL) were examined to inform future exercise intervention development. Methods Two hundred nine cancer survivors ≥3 months posttreatment (57% breast cancer) aged 49.5 (±10.4) years were assigned to physical exercise (n = 147) or wait-list control (n = 62). QoL, fatigue, emotional distress, physical activity, general self-efficacy and mastery were assessed at baseline and post-intervention using questionnaires. Path analysis was conducted using Mplus to explore whether improved physical activity, general self-efficacy and mastery mediated the effects of exercise on fatigue and distress and consequently QoL. Results The intervention was associated with increased physical activity (β = 0.46, 95% confidence interval (CI) = 0.14;0.59), general self-efficacy (β = 2.41, 95%CI = 0.35;4.73), and mastery (β = 1.75, 95%CI = 0.36;2.78). Further, the intervention had both a direct effect on fatigue (β = -1.09, 95%CI = -2.12;0.01), and an indirect effect (β = -0.54, 95%CI = -1.00;-0.21) via physical activity (β = -0.29, 95%CI = -0.64;-0.07) and general self-efficacy (β = -0.25, 95%CI = -0.61;-0.05). The intervention had a borderline significant direct effect on reduced distress (β =-1.32, 95%CI =-2.68;0.11), and a significant indirect effect via increased general self-efficacy and mastery (β =-1.06, 95%CI =-1.89;-0.38). Reductions in fatigue (β =-1.33, 95%CI =-1.85;-0.83) and distress (β =-0.86, 95%CI =-1.25;-0.52) were associated with improved QoL. Further, increased physical activity was directly associated with improved QoL (β = 3.37, 95%CI = 1.01;5.54). Conclusion The beneficial effect of group-based physical exercise on QoL was mediated by increased physical activity, general self-efficacy and mastery, and subsequent reductions in fatigue and distress. In addition to physical activity, future interventions should target self-efficacy and mastery. This may lead to reduced distress and fatigue, and consequently improved QoL of cancer survivors. Copyright © 2013 John Wiley & Sons, Ltd.

This study aimed to describe participation and health-related quality of life (HRQoL) in adolescents and young adults with myelomeningocele and to explore their relationships with lifestyle-related factors. Fifty-one individuals with a mean age of 21 years 1 month (SD 4y 6mo) years participated (26 males, 25 females; 82% hydrocephalus, 55% wheelchair-dependent). Participation was assessed using the Life Habits Questionnaire, and HRQoL was assessed using the Medical Outcomes Study 36-item Short-form Health Survey. Physical activity was measured using an accelerometry-based activity monitor, fitness (peak oxygen uptake) was measured during a maximal exercise test, and the sum of four skin-folds was assessed to indicate body fat. Relationships were studied using logistic regression analyses. Of the participants, 63% had difficulties in daily activities and 59% in social roles. Participants perceived lower physical HRQoL than a Dutch reference population. Participants with higher levels of physical activity and fitness had fewer difficulties in participating in daily activities (odds ratio [OR]=8.8, p=0.02 and OR=29.7, p=0.02 respectively) and a higher physical HRQoL (OR=4.8, p=0.02 and OR=30.2, p=0.006 respectively), but not mental HRQoL. Body fat was not related to participation or HRQoL. In conclusion, a large proportion of individuals with myelomeningocele had difficulties in participation and perceived low physical HRQoL. Higher levels of physical activity and fitness were related to fewer difficulties in participation and higher physical HRQoL

Contains fulltext : 293832.pdf (Publisher’s version ) (Open Access) Radboud University, 04 juli 2023 Promotores : Hopman, M.T.E., Vliet, J.J. van der Co-promotores : Buffart, L.M., Stuiver, M.M. 209 p.

The general aim of this thesis was to investigate whether a patient’s physical function could be estimated more accurately with objective measurements of physical activity and fitness. More specifically, the first aim was to investigate whether measurements of physical activity and fitness in patients with cancer could be improved. Furthermore, the second aim was to identify patients at risk for physical inactivity and low levels of physical fitness. And the third and last aim was to identify predictors for early trial discontinuation in early phase oncology trials and whether smartphone measurements of physical activity and fitness might improve the selection of eligible patients for these trials. Herewith, this thesis provided knowledge on the added value of measuring physical activity and fitness objectively to estimate a patient’s physical function. Chapter 2 presents the results of the analysis of the association between patient-reported outcomes of physical function and objective measurements of physical activity and fitness. Chapter 3 evaluates the agreement between a physical activity questionnaire and accelerometer assessed physical activity. Chapter 4 presents the feasibility, validity and reliability of objective smartphone measurements of physical activity and fitness in patients with cancer. Chapter 5 identifies demographic, clinical and lifestyle-related correlates of low levels of physical activity, fitness and function in newly-diagnosed patients with head and neck cancer. Chapter 6 investigates predictors of early trial discontinuation in patients with cancer participating in phase I clinical trials. Chapter 7 explores whether smartphone measurements of physical activity and fitness are predictive for early trial discontinuation in patients with cancer participating in phase I and II clinical trials. Finally, Chapter 8 summarizes the main findings of this thesis, discusses the methodological considerations and provides clinical implications and directions for future research.

Hematopoietic stem cell transplantation (HSCT) is currently the treatment of choice for many hematologic malignancies. The aim of HSCT is usually to cure, or in some malignancies, to improve survival. Two frequently applied types of HSCT can be distinguished: autologous stem cell transplantation (auto-SCT), which uses the patient’s own stem cells, and allogeneic stem cell transplantation (allo-SCT), which uses the stem cells of a donor. Unfortunately, both auto- and allo-SCT are aggressive treatment options which are associated with short- and long-term medical complications. HSCT survivors may also report physical and psychological symptoms and deficits in quality of life. This thesis focuses on the rehabilitation of patients recently treated with HSCT, and in particular on the effectiveness of exercise interventions. The five specific aims are: 1) to quantify health-related physical fitness in patients recently treated with auto-SCT, and to determine its demographic and clinical correlates; 2) to systematically review the literature on the effectiveness of exercise interventions in comparison to usual care with respect to physical fitness, fatigue and health-related quality of life in patients treated with HSCT; 3) to determine the effectiveness of a high intensity exercise program on physical fitness and fatigue in patients recently treated with auto-SCT (EXIST study); 4) to evaluate the actual implementation of this exercise program; and 5) to explore the experiences with return to work among HSCT survivors.