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Purpose: To determine the effectiveness of interventions to increase physical activity (PA) in people with spinal cord injury (SCI)., Method: Online databases PubMed, Medline, AMED and CINAHL were searched from the earliest date available to July 2022. Randomised controlled trials (RCT) exploring the effect of interventions on physical activity in people with SCI were eligible. The search identified 1191 studies, after screening 16 reports of 15 RCT's were included. Data were extracted on participant characteristics, intervention characteristics and physical activity outcomes. Methodological quality was assessed using the PEDro Scale and certainty of evidence assessed using GRADE. Post intervention means and standard deviations were pooled in meta-analyses to calculate standardised mean differences or mean differences and 95% confidence intervals., Results: Fifteen trials with 693 participants (mean age 41-52) were included. There was moderate certainty evidence that exercise interventions had no effect on subjectively or objectively measured PA. There was moderate to high certainty evidence that behavioural interventions and combined behavioural and exercise interventions increased subjectively, but not objectively measured physical activity., Conclusion: Behaviour change techniques are an important intervention component for increasing PA in people with SCI.

Purpose: To determine if the effects of exercise-based cancer rehabilitation on physical functioning, activity (including physical activity) and participation (including quality of life) are maintained at 6 to 12 months., Methods: Electronic databases CINAHL, Embase, MEDLINE, PsycINFO and PubMed were searched from the earliest available time to August 2021. Randomised controlled trials examining the long-term effects (≥ 6 months post-intervention) of exercise-based rehabilitation were eligible for inclusion. Outcome data (e.g. fitness, physical activity, walking capacity, fatigue, depression, quality of life) were extracted and the methodological quality assessed using PEDro. Meta-analyses using standardised mean differences were used to synthesise data and Grades of Recommendation, Assessment, Development and Evaluation criteria were applied., Results: Nineteen randomised controlled trials including 2974 participants were included. Participants who underwent exercise-based rehabilitation had improved physical activity (SMD 0.30, 95% CI 0.09 to 0.51, I 2  = 0%), cardiorespiratory fitness (SMD 2.00 ml/kg/min, 95% CI 0.56 to 3.45, I 2  = 0%), walking capacity (SMD 0.62, 95% CI 0.33 to 0.92, I 2  = 0%), depression (SMD 0.71, 95% 0.05 to 1.37, I 2  = 90%), quality of life (physical functioning component SMD 0.56, 95% CI 0.11 to 1.01, I 2  = 62%) and sleep (MD 0.69 points, 95% 0.46 to 0.92, I 2  = 0%) at 6 to 12 months follow-up. There was no data available on cancer-related mortality or recurrence., Conclusion: Health outcomes of cancer survivors after exercise-based rehabilitation can be maintained after rehabilitation completion., Implications for Cancer Survivors: Cancer survivors can maintain health benefits achieved through exercise-based rehabilitation., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Question: What is the effect of multidisciplinary, exercise-based, group oncology rehabilitation programs on healthcare service outcomes and patient-level outcomes, including quality of life and physical and psychosocial function?, Design: Systematic review with meta-analysis of randomised controlled trials., Participants: Adults diagnosed with cancer., Intervention: Multidisciplinary, group-based rehabilitation that includes exercise for cancer survivors., Outcome Measures: Primary outcomes related to health service delivery, including costs, hospitalisations and healthcare service utilisation. Secondary outcomes were patient-level measures, including: the European Organisation for Research and Treatment of Cancer Quality-of-life Questionnaire, 30-second timed sit to stand and the Hospital Anxiety and Depression Scale. The evidence was evaluated using the PEDro Scale and the Grades of Research, Assessment, Development and Evaluation (GRADE) approach., Results: Seventeen trials (1,962 participants) were included. There was uncertainty about the effect of multidisciplinary, exercise-based rehabilitation on healthcare service outcomes, as only one trial reported length of stay and reported wide confidence intervals (MD 2.4 days, 95% CI -3.1 to 7.8). Multidisciplinary, exercise-based rehabilitation improved muscle strength (1RM chest press MD 3.6 kg, 95% CI 0.4 to 6.8; 1RM leg press MD 19.5 kg, 95% CI 12.3 to 26.8), functional strength (30-second sit to stand MD 6 repetitions, 95% CI 3 to 9) and reduced depression (MD -0.7 points, 95% CI -1.2 to -0.1) compared to usual care. There was uncertainty whether multidisciplinary rehabilitation programs are more effective when delivered early versus late or more effective than exercise alone. Adherence was typically high (mean weighted average 76% sessions attended) with no major and few minor adverse events reported., Conclusion: Multidisciplinary, exercise-based oncology rehabilitation programs improve some patient-level outcomes compared with usual care. Further evidence from randomised trials to determine their effect at a healthcare service level are required if these programs are to become part of standard care., Trial Registration: PROSPERO CRD42019130593., (Copyright © 2020. Published by Elsevier B.V.)

Participation in adequate physical activity improves the health status of cancer survivors, enhances their survival, and reduces their risk of cancer recurrence. However, cancer survivors engage in low levels of physical activity and have limited access to rehabilitation services that could increase their participation. No optimal framework has been developed that supports physical activity participation among cancer survivors. Given the growth in numbers of cancer survivors, development of a framework may provide a pathway to facilitate timely and appropriate care. This perspective paper describes the development of the Cancer Rehabilitation to Recreation (CaReR) Framework and its practical implications. The CaReR Framework uses a tailored, stepped approach to guide health services and clinicians on the design and implementation of interventions to promote physical activity among cancer survivors. Implementation of the CaReR Framework will improve continuity and quality of care for cancer survivors and promote physical activity with the ultimate aim of improving health outcomes., (© The Author(s) 2020. Published by Oxford University Press on behalf of the American Physical Therapy Association. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Purpose: Exercise-based rehabilitation is not routinely offered to patients. We explored the experience of cancer survivors completing an exercise-based cancer rehabilitation program with and without motivational interviewing., Method: A qualitative study using semi-structured interviews and thematic analysis was completed with a purposive sample of 26 cancer survivors (n = 17 female, n = 18 post-treatment) participating in cancer rehabilitation at a tertiary hospital. Interviews were recorded and transcribed verbatim. Coding was completed by two reviewers independently and confirmed by a third reviewer., Results: The main theme that emerged was exercise-based rehabilitation facilitated a return to normality after diagnosis which included positive changes in physical activity behaviour. Sub-themes were that rehabilitation is person-centred, challenges expectations, empowering and facilitated by expert staff. Common themes emerged whether participants received additional motivational interviewing or not. However, participants who received motivational interviewing were more likely to report feeling accountable for their physical activity levels. Transition to ongoing independent physical activity remained a challenge for some people who did not feel empowered or socially supported., Conclusion: Exercise-based cancer rehabilitation is important in facilitating 'return to normal' including increased participation in physical activity. To challenge expectations and to empower cancer survivors, rehabilitation programs should be person-centred and led by expert staff.

Aim: Oncology rehabilitation improves outcomes for cancer survivors but little is known about program availability in Australia. The aims of this study were: to describe oncology rehabilitation programs in Australia: determine whether the exercise component of programs is consistent with guidelines: and to explore barriers and facilitators to program implementation., Methods: A sequential, explanatory mixed-methods study was completed in two phases: (1) a survey of Australian oncology rehabilitation programs; and (2) purposively sampled follow-up semistructured interviews with senior clinicians working in oncology rehabilitation who were involved with exercise prescription., Results: Hospitals and/or cancer centers from 42 public hospital health networks (representing 163 hospitals) and 39 private hospitals were contacted to identify 31 oncology rehabilitation programs. All 31 surveys were returned (100% response rate). Programs were typically multidisciplinary, ran twice weekly, provided education and exercise and included self-management strategies. Exercise prescription and progression was patient centered and included a combination of resistance and aerobic training supplemented by balance, pelvic floor, and core stability exercises. Challenges to implementation included a lack of awareness of programs in the community and organizational barriers such as funding. Strong links with oncologists facilitated program referrals., Conclusion: Despite evidence to support oncology rehabilitation, there are few programs in Australia and there are challenges that limit it becoming part of standard practice. Programs that exist are multidisciplinary with a focus on exercise with the majority of programs following a cardiac rehabilitation model of care., (© 2016 John Wiley & Sons Australia, Ltd.)

Question: Is there a dose-response effect of exercise on inflammation, fatigue and activity in cancer survivors?, Design: Systematic review with meta-regression analysis of randomised trials., Participants: Adults diagnosed with cancer, regardless of specific diagnosis or treatment., Intervention: Exercise interventions including aerobic and/or resistance as a key component., Outcome Measures: The primary outcome measures were markers of inflammation (including C-reactive protein and interleukins) and various measures of fatigue. The secondary outcomes were: measures of activity, as defined by the World Health Organization's International Classification of Functioning, Disability and Health, including activities of daily living and measures of functional mobility (eg, 6-minute walk test, timed sit-to-stand and stair-climb tests). Risk of bias was evaluated using the PEDro scale, and overall quality of evidence was assessed using the Grades of Research, Assessment, Development and Evaluation (GRADE) approach., Results: Forty-two trials involving 3816 participants were included. There was very low-quality to moderate-quality evidence that exercise results in significant reductions in fatigue (SMD 0.32, 95% CI 0.13 to 0.52) and increased walking endurance (SMD 0.77, 95% CI 0.26 to 1.28). A significant negative association was found between aerobic exercise intensity and fatigue reduction. A peak effect was found for moderate-intensity aerobic exercise for improving walking endurance. No dose-response relationship was found between exercise and markers of inflammation or exercise duration and outcomes. Rates of adherence were typically high and few adverse events were reported., Conclusions: Exercise is safe, reduces fatigue and increases endurance in cancer survivors. The results support the recommendation of prescribing moderate-intensity aerobic exercise to reduce fatigue and improve activity in people with cancer., Review Registration: PROSPERO CRD42015019164., (Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.)

Purpose: To establish the feasibility of embedding a flexible, exercise-based rehabilitation program into a cancer treatment unit to allow cancer survivors early exercise support. Method: A pre-post study was conducted using Bowen's Framework to describe key domains of feasibility: demand (referrals), acceptability (uptake, attendance, satisfaction), implementation (resources), practicality (adverse events, costs) and limited-efficacy (function, quality of life, self-efficacy). Participants were medically stable, adult cancer survivors receiving curative or palliative treatment for cancer at the health service. Participants completed an 8-week home or hospital-based exercise program. Data were analysed descriptively. Standardised mean differences (Hedge's g) and mean differences were calculated to determine effect size and clinical significance. Results: The exercise-based rehabilitation service received 155 referrals over 6 months. Of those eligible, 73/119 (61%) commenced. Participants opting for twice-weekly, hospital-based exercise attended 9/16 (56%) sessions. Participants reported high satisfaction and there were no major adverse events. The program utilised existing resources, with the predominant cost being staff. The average health service cost per participant was AUD $1,104. Participants made clinically significant gains in function (6-min walk distance; + 73 m, 95% confidence interval 49 to 96) and quality of life (EORTC QLQ-C30 Global quality of life; + 8 units, 95% confidence interval 3 to 13). Conclusion: Implementation of exercise-based rehabilitation in a co-located cancer unit was safe and feasible. Access, patient and staff education and establishing funding streams are important implementation considerations. Implications for cancer survivors Access to exercise in a cancer unit provides opportunity for early intervention to optimise function during treatment. [ABSTRACT FROM AUTHOR]

Background: Metabolic syndrome has been associated with poorer outcomes in the immediate postoperative period following joint replacement surgery for osteoarthritis. The aim of this study was to determine whether a multidisciplinary, preoperative intervention would minimize postoperative differences between people with and without metabolic syndrome who underwent joint replacement surgery for osteoarthritis. Method: A retrospective cohort study of older adults with multiple comorbidities (n = 230) attending a preoperative intervention service before lower limb joint replacement surgery. The intervention aimed to optimize the patient's health and functional reserve before surgery through weight loss, physical activity and medical management. Patient outcomes were adverse events, discharge destination and function. Health service outcomes were length of stay, hospital readmissions and emergency department presentations over a 2-year follow-up. Results: Two-thirds of participants (n = 151) had metabolic syndrome. There were no significant differences between those with and without metabolic syndrome in terms of discharge destination or adverse events during the acute hospital admission. There were no differences in function during rehabilitation but people with metabolic syndrome had significantly more adverse events (P = 0.037) during rehabilitation. In the 2 years following surgery, there were no differences in hospital readmission rates but people with metabolic syndrome had a higher observed frequency of potentially avoidable emergency department presentations (P = 0.066). Conclusions: Providing a preoperative intervention may help minimize differences between people with and without metabolic syndrome in the immediate postoperative period. However, having a diagnosis of metabolic syndrome may still adversely affect some long-term health service outcomes following joint replacement surgery. [ABSTRACT FROM AUTHOR]

Background: One quarter of the world's adults have metabolic syndrome. Lifestyle modification is the first line of intervention as improvements in diet and exercise can have positive effects on the individual components of metabolic syndrome. The primary aim of this research was to evaluate the effect of an 8-week lifestyle intervention program for people with metabolic syndrome on emergency department presentations, hospital admissions, and metabolic parameters. Methods: A retrospective case-control study of adults ( n = 58, mean age 60 ± 7 years) with metabolic syndrome referred to a group lifestyle self-management intervention program between 2013 and 2015. The intervention program consisted of 8 weekly sessions of group exercise and education delivered in a community healthcare setting. The intervention group ( n = 29) was compared with a group of people who declined to attend the program ( n = 29). Data were collected from the time a participant was referred to the program, and all participants were followed for a minimum of 100 days. Results: Participants who attended the lifestyle intervention program had significantly fewer emergency department presentations [risk ratio (RR) 0.31, 95% confidence interval (CI) 0.11 to 0.83] and potentially avoidable emergency department presentations (RR 0.06, 95% CI 0.004 to 0.097) over the follow-up period (mean 495 ± 224 days per participant). There were no differences between the groups in hospital admissions and there were insufficient data to determine changes in metabolic parameters. Lifestyle group participants increased their exercise capacity [6-min walk test mean difference (MD) 41 m, 95% CI 20 to 62, P < 0.001] and had a mild decrease in weight (MD −0.8 kg, 95% CI −1.5 to −0.2, P = 0.018) and waist circumference (MD −1.3 cm, 95% CI −2.1 to −0.6, P = 0.002) after 8 weeks. Conclusions: Implementation of a group lifestyle intervention program to improve activity and self-management skills may assist in decreasing emergency department presentations. [ABSTRACT FROM AUTHOR]

Aim Oncology rehabilitation improves outcomes for cancer survivors but little is known about program availability in Australia. The aims of this study were: to describe oncology rehabilitation programs in Australia: determine whether the exercise component of programs is consistent with guidelines: and to explore barriers and facilitators to program implementation. Methods A sequential, explanatory mixed-methods study was completed in two phases: (1) a survey of Australian oncology rehabilitation programs; and (2) purposively sampled follow-up semistructured interviews with senior clinicians working in oncology rehabilitation who were involved with exercise prescription. Results Hospitals and/or cancer centers from 42 public hospital health networks (representing 163 hospitals) and 39 private hospitals were contacted to identify 31 oncology rehabilitation programs. All 31 surveys were returned (100% response rate). Programs were typically multidisciplinary, ran twice weekly, provided education and exercise and included self-management strategies. Exercise prescription and progression was patient centered and included a combination of resistance and aerobic training supplemented by balance, pelvic floor, and core stability exercises. Challenges to implementation included a lack of awareness of programs in the community and organizational barriers such as funding. Strong links with oncologists facilitated program referrals. Conclusion Despite evidence to support oncology rehabilitation, there are few programs in Australia and there are challenges that limit it becoming part of standard practice. Programs that exist are multidisciplinary with a focus on exercise with the majority of programs following a cardiac rehabilitation model of care. [ABSTRACT FROM AUTHOR]

Question: Are ambulant patients who are admitted for inpatient rehabilitation for a lower limb orthopaedic condition active enough to meet current physical activity guidelines? Design: Prospective observational study. Participants: Adults admitted for inpatient rehabilitation for a lower limb orthopaedic condition who were cognitively alert and able to walk independently or with assistance. Outcome measures: Participants wore an activity monitor for three full days. Daily time spent in moderate intensity physical activity was used to determine whether the levels of physical activity recommended in clinical guidelines were achieved. Results: Fifty-four participants with a mean age of 74 years (SD 11) took a median of 398 (IQR 140 to 993) steps per day and spent a median of 8 (IQR 3 to 16) minutes walking per day. No participant completed a 10-minute bout of moderate intensity physical activity during the monitoring period. One participant accumulated 30 minutes of moderate intensity physical activity and nine participants accumulated 15 minutes of moderate intensity physical activity in a day. Physical activity was associated with shorter length of stay (r=−0.43) and higher functional status on discharge (r=0.39). Conclusions: Adults with lower limb orthopaedic conditions in inpatient rehabilitation are relatively inactive and do not meet current physical activity guidelines for older adults. Results of this study indicate that strategies to increase physical activity are required. [ABSTRACT FROM AUTHOR]